Diseases due to enteroviruses Flashcards
What are the different viruses in the Genera of Picornaviruses?
Enterovirus:
Polio,Coxsackie A and B, Echo,Other enteroviruses
Rhinovirus
Cardiovirus
Hepatovirus
Aphthovirus
Others
What are the main enteroviruses?
- Polio
- Echoviruses
- Coxachie
What type of viruses are Enteroviruses?
RNA Viruses
What are some clinical manifestations of Enterovirus infections?
Aseptic meningitis
Nonspecific febrile illness
Colds
Pharyngitis
Herpangina
Exanthems
Encephalitis
Paralytic polio
Vomiting
Diarrhea
Pericarditis
Myocarditis
Hand-foot-mouth syndrome
How are enteroviruses transmitted?
Person to person
fecal-oral
respiratory
What is the incubation period for enteroviruses?
3-6 days
What is the pathogenesis of an enterovirus infection?
URI Infection
Regional lymph nodes involvement
Low-Grade viremia (Heart, Skin, Pericardium, Lungs)
Clinical illness & Major viremia
Antibody appearance on 7th day
GI Replication
What does the polio virus affect?
Motor neurons, brain, meninges
What does the Coxakie virus affect?
meninges, brain, skin, muscle, pleura, adrenal glands, pancreas, liver
What does the echovirus affect?
meninges, skin, muscle, liver
What is the incubation period for poliovirus infections?
3-7 to 35 days
What are the different forms of poliovirus infections?
non-paralytic form and paralytic form
what are the three types of non-paralytic forms of poliovirus?
- asymptomatic infection (95%)
- abortive form
- aseptic meningitis
What can be seen in the abortive form of poliovirus infection?
Fever, Headache, Malaise, Anorexia, Nausea, Vomiting, Pharyngitis, Abdominal pain
What can be seen in aseptic meningitis caused by poliovirus?
Sudden onset
Fever, headache, nausea, vomiting
Two febrile waves
After the second febrile wave, nuchal rigidity, Kernig and Brudzinski’s sign occurs
LP – at the beginning of the disease, predominance of segmented neutrophils can occur and after that lymphocytes count are elevated. Proteins are normal or low elevated
Sometimes protein-cell dissociation can be seen
What are the four types of paralytic polio? (in accordance with the localization of the inflammatory process)
Spinal form
Bulbar form
Pontine form
Mixed form
What are the 4 stages in the clinical course of the paralytic form of poliovirus infection?
Pre-paralytic stage
Paralytic stage
Recovery stage
Residual stage
What are the stages of the spinal form of polio?
pre-paralytic stage
paralytic stage
recovery stage
residual stage
What is involved in the pre-paralytic stage of the spinal form of polio?
Sudden onset
Fever
Muscular (motor) weakness
Hyporeflexes
Tremor
Weak innervation disturbances
Facies poliomyelitica
Pains in the back, neck, sweating
What is involved in the paralytic stage?
Paralyses occur after 2-3 days of apirexia
Typical sluggish paralyses:
Proximal muscles are involved – m. deltoideus, m. quadriceps femoris, adductores femoris,
mm. fibularis longus et brevis, m. obliquus abdominis
Asymetric paralyses
Muscle hypo- or atonia
Hypo- or areflexia
The duration of the paralyses is about two weeks
What is involved in the recovery stage of spinal form of polio?
Its duration is up to 2-3 years
Reflexes go better, after that muscle tonus and muscle trophy last
In the most cases muscle atrophy occurs and the limb lags of its growth
What is involved in the residual stage of teh spinal form of polio?
Deformation of the limbs
Disability
What is bulbar polio?
Sudden onset with fever, vomiting, severe intoxication
9 and 10 CFN involvement often:
Palatal & Pharyngeal weakness (nasal voice)
Pooling of saliva
Poor cough
Nasal regurgitation of saliva
Deviation of palate,uvula,tongue
Hoarseness , Aphonia
Tachycardia, bradycardia, changes in the blood pressure
What is involved in the pontine form of spinal polio?
Peripheral paresis of n. facialis
There is no intoxication in the most cases
There are no taste changes in the first 2/3 part of the tongue, oozing, hypoacusis
What is involved in the mixed form of polio?
Ascending paralyses
Death is due to acute respiratory and cardiac failure
How do people who have been vaccinated get poliomyelitis?
Immunizing at the time of enteral infection
Interference with other
Disrupted immunity due to other causes
Irregular intake of the vaccine
Poor quality vaccine
What is VAPP?
Post-vaccinal paralytic poliomyelitis
Sluggish paralysis due to vaccinal viruses = Vaccine-derived poliovirus (VDPV)
( since 2000 - Sabin type 1 OPV )
How is polio diagnosed?
- History and epidemiological data
- Clinical data
- Biochemical indicators - ДКК, liver enzymes, liquor
- Virusological diagnosis
Smears from nose and throat
Feces
Blood
Liquor - Serological diagnosis - 2 samples every 14 days
What are some differential diagnosis of polio?
Guillain-Barre syndrom
Other viral encephalomyelitis
Tick paralysis
CNS Tumor
Trauma
Vaccine associated paralytic polio
What is the treatment of polio?
- Isolation 21 days in poliomyelitis
Pathogenically – fighting the brain edema, vitamins, protection from other infections
Symptomatically
Rehabilitation in the town of Momin prohod
Treatment of the other syndromes
Etiologically -
PLECONARYL – inhibits viral replication
GAMMA - GLOBULIN
What is the prognosis of polio?
Determined during 1 month after infection
Some degree of permanent damage
Bulbar paralysis generally recover completely
What causes herpangina?
Coxakie A virus
What are the symptoms of herpangina?
Fever, sore throat, weakness
Oral ulcers and vesicles which cause salivation and pain
This clinical form can be in combination with aseptic meningitis
What are the symptoms of herpangina?
Fever, sore throat, weakness
Oral ulcers and vesicles which cause salivation and pain
This clinical form can be in combination with aseptic meningitis
What is pleurodynia?
Sudden onset, fever, severe muscle pain with different localization – thorax, abdominal muscles, back muscles, limb muscles
When chest muscle are involved, the patient feels severe pain in breathing, and the last one is superficially, with cyanosis
When abdominal muscles are involved, severe abdominal pain occurs and it has to be differentiate from acute app.
What are some non-polio enteroviral infections?
Gasterointestinal manifestation:
Vomiting, Non bloody diarrhea, Abdominal pain, Pseudoappendicitis
Respiratory form:
Cosackie A21 is the agent
Fever, headache, muscle pain, tracheitis, bronchitis, laryngitis
Pericarditis&Myocarditis:
High mortality especially in neonate
What causes hand-foot-mouth disease?
Hand-foot-mouth syndrome:
Coxackie infection
Small intraoral ulcers
Macular or vesicular lesion on hands and feet&buttock
What are some other nonpolio-enteroviral infections?
Aseptic meningitis syndrome:
Rash,Sore throat, Muscle pain, Sign of meningeal irritation
CSF (PMN pleocytosis,High protein,Normal glucose)
Seasonal Encephalitis:
Fever, headache, vomiting, nuchal rigidity, paralyses of CFN, seizures, psychosis
Spring and summer seasonality
Paralysis like polio:
Agents: Coxackie and ECHO
Fever, muscle paralyses without lasting changes in the limbs
Bulbar form can leads to death
Neonatal myocarditis:
Fever,Tachycardia, Cardiomegaly, ECG changes, Transient systolic murmur, Shock, Respiratory distress
Fulminant encephalomyocarditis
How do you diagnose nonpolio enteroviral infections?
Age, Season, Location, Exposure
Clinical manifestation
PCR
Culture from sterile sites biopsy
How do you treat nonpolio enteroviral infections?
Supportive therapy
Pleconaril in immunocompetent
No Steroids
