Dermatologic Manifestations of Enteroviral Infections Follow-up

  • Author: Susanna Nogués-Siuraneta, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 12, 2010
 

Complications

Enteroviruses occasionally cause severe complications, especially cardiac and neurologic complications. These include the following:

  • Myocarditis
  • Aseptic meningitis: Nonpolio human enteroviruses are the leading recognizable causes of aseptic meningitis, accounting for 80-92% of all cases in which a pathogen is identified. Certain enteroviruses (eg, coxsackie B virus 5; echoviruses 6, 9, and 30) are more likely to cause meningitis outbreaks, while others (coxsackie A virus 9, coxsackie B viruses 3 and 4) are the cause of endemic aseptic meningitis.[27]
  • Meningoencephalitis
  • Sepsis[28]
  • Hepatitis
  • Disseminated intravascular coagulation
  • Paralysis

Coxsackievirus infections in pregnancy have been associated in several studies with increased rates of type 1 diabetes mellitus in the offspring. Additionally, maternal coxsackie B virus infection during pregnancy may increase the rate of cardiac anomalies.[29] Enteroviral infection acquired during the first trimester of pregnancy may result in spontaneous abortion

Next

Prognosis

In general, the systemic and cutaneous manifestations of enteroviruses in immunocompetent individuals are self-limited. Cutaneous lesions heal without scarring. Mortality rates ranging between 0-42% in the neonatal period. Risk factors for severe infection are as follows:

  • Prematurity
  • Maternal viral symptoms at delivery
  • Symptoms in the first week of life
  • No specific antibodies (acquired by placental transfer) of the infecting serotype in the neonate[2]

A few cases of prolonged or recurrent hand-foot-and-mouth disease (HFMD) have been reported. In 1964, Evans and Waddington[30] reviewed a large outbreak in South Wales. They described a relapsing course occurring over 2 years in one patient.

Previous
 
Contributor Information and Disclosures
Author

Susanna Nogués-Siuraneta, MD  Resident, Department of Dermatology, Hospital Clinic de Barcelona

Disclosure: Nothing to disclose.

Coauthor(s)

Mercè Alsina-Gibert, MD  Consultant, Department of Dermatology, Hospital Clinic, Spain

Disclosure: Nothing to disclose.

Steven Brett Sloan, MD  Assistant Professor, Department of Dermatology, University of Connecticut School of Medicine; Director of Nail Disease Clinic and Chief of Dermatology, Newington Veterans Affairs Medical Center

Steven Brett Sloan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Connecticut State Medical Society, New England Dermatological Society, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michelle Pelle, MD  Clinical Assistant Professor, Division of Dermatology, Department of Medicine, University of California at San Diego

Michelle Pelle, MD is a member of the following medical societies: American Academy of Dermatology, California Medical Association, Medical Dermatology Society, and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Trallero G, Avellon A, Otero A, et al. Enteroviruses in Spain over the decade 1998-2007: virological and epidemiological studies. J Clin Virol. Feb 2010;47(2):170-6. [Medline].

  2. Tebruegge M, Curtis N. Enterovirus infections in neonates. Semin Fetal Neonatal Med. Aug 2009;14(4):222-7. [Medline].

  3. Oberste M, Schnurr D, Maher K, al-Busaidy S, Pallansch M. Molecular identification of new picornaviruses and characterization of a proposed enterovirus 73 serotype. J Gen Virol. Feb 2001;82:409-16. [Medline].

  4. Oberste MS, Michele SM, Maher K, et al. Molecular identification and characterization of two proposed new enterovirus serotypes, EV74 and EV75. J Gen Virol. Nov 2004;85:3205-12. [Medline].

  5. Norder H, Bjerregaard L, Magnius L, Lina B, Aymard M, Chomel JJ. Sequencing of 'untypable' enteroviruses reveals two new types, EV-77 and EV-78, within human enterovirus type B and substitutions in the BC loop of the VP1 protein for known types. J Gen Virol. Apr 2003;84:827-36. [Medline].

  6. Chia JK. The role of enterovirus in chronic fatigue syndrome. J Clin Pathol. Nov 2005;58(11):1126-32. [Medline]. [Full Text].

  7. Bowles NE, Dubowitz V, Sewry CA, Archard LC. Dermatomyositis, polymyositis, and Coxsackie-B-virus infection. Lancet. May 2 1987;1(8540):1004-7. [Medline].

  8. Robinson CR, Doane FW, Rhodes AJ. Report of an outbreak of febrile illness with pharyngeal lesions and exanthem: Toronto, summer 1957; isolation of group A Coxsackie virus. Can Med Assoc J. Oct 15 1958;79(8):615-21. [Medline]. [Full Text].

  9. Alsop J, Flewett TH, Foster JR. "Hand-foot-and-mouth disease" in Birmingham in 1959. Br Med J. Dec 10 1960;2(5214):1708-11. [Medline]. [Full Text].

  10. Enterovirus surveillance--United States, 1997-1999. MMWR Morb Mortal Wkly Rep. Oct 13 2000;49(40):913-6. [Medline].

  11. Prose NS, Tope W, Miller SE, Kamino H. Eruptive pseudoangiomatosis: a unique childhood exanthem?. J Am Acad Dermatol. Nov 1993;29(5 Pt 2):857-9. [Medline].

  12. Mirkovic RR, Kono R, Yin-Murphy M, Sohier R, Schmidt NJ, Melnick JL. Enterovirus type 70: the etiologic agent of pandemic acute haemorrhagic conjunctivitis. Bull World Health Organ. 1973;49(4):341-6. [Medline]. [Full Text].

  13. Mirkovic RR, Schmidt NJ, Yin-Murphy M, Melnick JL. Enterovirus etiology of the 1970 Singapore epidemic of acute conjunctivitis. Intervirology. 1974;4(2):119-27. [Medline].

  14. Yaffee HS. Erythema multiforme caused by Coxsackie B5. A possible association with epidemic pustular stomatitis of children. Arch Dermatol. Nov 1960;82:737-9. [Medline].

  15. Jaidane H, Sane F, Gharbi J, Aouni M, Romond MB, Hober D. Coxsackievirus B4 and type 1 diabetes pathogenesis: contribution of animal models. Diabetes Metab Res Rev. Oct 2009;25(7):591-603. [Medline].

  16. Richer MJ, Horwitz MS. Coxsackievirus infection as an environmental factor in the etiology of type 1 diabetes. Autoimmun Rev. Jun 2009;8(7):611-5. [Medline].

  17. Ooi MH, Solomon T, Podin Y, et al. Evaluation of different clinical sample types in diagnosis of human enterovirus 71-associated hand-foot-and-mouth disease. J Clin Microbiol. Jun 2007;45(6):1858-66. [Medline]. [Full Text].

  18. Michos AG, Syriopoulou VP, Hadjichristodoulou C, et al. Aseptic meningitis in children: analysis of 506 cases. PLoS One. Aug 1 2007;2(7):e674. [Medline].

  19. Piqueur et al. Improvement of a real-time RT-PCR asay for the detection of enterovirus RNA. Virology Journal. 2009;6:95.

  20. Haneke E. Electron microscopic demonstration of virus particles in hand, foot and mouth disease. Dermatologica. 1985;171(5):321-6. [Medline].

  21. Parra CA. Hand, foot and mouth disease. Light and electron microscopic observations. Arch Dermatol Forsch. 1972;245(2):147-53. [Medline].

  22. Parra CA. Hand, foot and mouth disease. Light and electron microscopic observations. Arch Dermatol Forsch. 1972;245(2):147-53. [Medline].

  23. Goodfellow IG, Evans DJ, Blom AM, et al. Inhibition of coxsackie B virus infection by soluble forms of its receptors: binding affinities, altered particle formation, and competition with cellular receptors. J Virol. Sep 2005;79(18):12016-24. [Medline]. [Full Text].

  24. Werk D, Schubert S, Lindig V, et al. Developing an effective RNA interference strategy against a plus-strand RNA virus: silencing of coxsackievirus B3 and its cognate coxsackievirus-adenovirus receptor. Biol Chem. Sep 2005;386(9):857-63. [Medline].

  25. Rotbart HA, Webster AD. Treatment of potentially life-threatening enterovirus infections with pleconaril. Clin Infect Dis. Jan 15 2001;32(2):228-35. [Medline].

  26. Waldfahrer F, Iro H. Successful treatment of herpangina with allopurinol mouthwashes. Laryngoscope. Dec 1995;105(12 Pt 1):1405. [Medline].

  27. Lee BE, Davies HD. Aseptic meningitis. Curr Opin Infect Dis. Jun 2007;20(3):272-7. [Medline].

  28. Nathan M, Walsh R, Hardin JT, et al. Enteroviral sepsis and ischemic cardiomyopathy in a neonate: case report and review of literature. ASAIO J. Sep-Oct 2008;54(5):554-5. [Medline].

  29. Ornoy A, Tenenbaum A. Pregnancy outcome following infections by coxsackie, echo, measles, mumps, hepatitis, polio and encephalitis viruses. Reprod Toxicol. May 2006;21(4):446-57. [Medline].

  30. Evans AD, Waddington E. Hand, foot and mouth disease in south Wales, 1964. Br J Dermatol. Jun 1967;79(6):309-17. [Medline].

  31. Haley JC, Hood AF. Hand-foot-and-mouth disease. In: Fitzpatrick's Dermatology in General Medicine. Vol 2. New York, NY: McGraw-Hill; 1999:2403-7.

  32. Pallansch MA. Acute hemorrhagic conjunctivitis. In: Strickland GT, ed. Hunter's Tropical Medicine. Philadelphia, Pa: WB Saunders; 2000:226-7.

  33. Pallansch MA, Roos RP. Enteroviruses: polioviruses, coxsackieviruses, echoviruses, and newer enteroviruses. In: Knipe DM, Howley PM, Griffin DE, Lamb RA, Martin MA, Roizman B, Straus SE, eds. Fields' Virology. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001:723-75.

  34. Pindborg JJ. Atlas of Diseases of the Oral Mucosa. 4th ed. Copenhagen, Denmark: WB Saunders; 1985:36-8.

  35. Raskin CA, Parrot RH. Herpangina. In: Fitzpatrick's Dermatology in General Medicine. Vol 2. New York, NY: McGraw-Hill; 1999:2407-9.

  36. Sterling JG, Kurtz JB. Viral infections. In: Rook/Wilkinson/Ebling Textbook of Dermatology. Vol 2. London, England: Blackwell Science; 1998:995-1096.

 
Previous
Next
 
Erosions on the base of the tongue.
A red halo surrounds several vesicles on the finger flexures and palms.
Small linear vesicle on the thumb.
Vesicle on the dorsal hand of a young adult.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.