Enteric Viruses

Question 1

Classify Picornaviruses, Noroviruses, and Rotaviruses

Answer 1

Small, naked, icosahedral RNA viruses

Question 2

Enteroviruses are a subset of what virus family?

Answer 2

Picornaviruses

Question 3

What system do the enteroviruses infect?

Answer 3

GI

Question 4

Geographically speaking where do you see infection from Picornaviruses, Noroviruses, and Rotaviruses?

Answer 4

Worldwide

Question 5

In the first world, what factors have attenuated disease risk of these enteric viruses?

Answer 5

Hygiene and vaccination

Question 6

Which of the enteric viruses are environmentally rugged?

Answer 6

All three: Picornaviruses, Noroviruses, and Rotaviruses

Question 7

Why are the enteric viruses able to be spread by fecal-oral transmission?

Answer 7

Because they are environmentally rugged

Question 8

Picornaviruses, Noroviruses, and Rotaviruses all cause what syptoms?

Answer 8

A self-limited GI illness

Question 9

Are there usually complications from infection with Picornaviruses, Noroviruses, and Rotaviruses?

Answer 9

Symptoms usually resolve without medical intervention or complicaions

Question 10

What’s the most common complication of rotovirus and what should you look for to spot it?

Answer 10

Dehydration- look for pediatric anorexia + lethargy

Question 11

What’s the most common complication of infection with enteroviruses?

Answer 11

CNS infection

Question 12

Where do enteroviruses mainly replicate?

Answer 12

In the gut

Question 13

How do enteroviruses cause viremia?

Answer 13

Through replication in the regional lymph nodes that then spreads

Question 14

Can enteroviruses penetrate the CNS?

Answer 14

Yes (though it doesn’t happen often)

Question 15

Is infection with an enterovirus mild or severe?

Answer 15

Usually mild, but occasionally devastating

Question 16

In what patient population do we see the most problematic enterovirus infections?

Answer 16

Pediatric patients- the younger the worse

Question 17

What are the symptoms of Coxsackie A infection?

Answer 17

Hand Foot and Mouth Disease, Herpangina, Acute Hemorrhagic Conjunctivitis

Question 18

What are the symptoms of Coxsackie B infection?

Answer 18

Myocarditis, Pleurodynia, Meningitis

Question 19

Is there overlap between symptoms of Coxsackie A and B infections?

Answer 19

There can be

Question 20

What kind of labs should you run to keep track of these enteroviruses in your patients?

Answer 20

Lumbar puncture to check for known bad enteroviruses (like polio or anything causing aseptic meningitis)
Take samples (swabs, blood) to PCR to differentiate any usually harmless enteroviruses (HFMD, herpangina) that are causing concern

Question 21

What treatment should you be keeping an eye on the literature for new approvals/contraindications?

Answer 21

Pleconaril (potentioal to treat aseptic meningitis and viral myocarditis)