eMedicine Specialties > Infectious Diseases > Viral Infections

Echoviruses: Follow-up

Author: Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Coauthor(s): Syed Hussain, Department of Surgery, Nassau University Medical Center
Contributor Information and Disclosures

Updated: Jun 29, 2006

Follow-up

Deterrence/Prevention:

  • The ubiquitous nature of echoviruses, and of enteroviruses in general, and the ease of person-to-person transmission make prevention of echoviral infections difficult. As in other enteroviral infections, good overall public health, including adequate clean and potable water, sanitation, and clean living conditions can act as deterrents.
  • No vaccines are available for echovirus infections.

Complications:

  • Acute aseptic meningitis
    • Complications (eg, febrile seizures, complex seizures, lethargy, coma, movement disorders) occur early in the course of aseptic meningitis in 5-10% of patients.
    • Adults may experience a more prolonged period of fever and headache than infants and children; some adult patients may require weeks to return to normal activity.
  • Paralysis and other neurologic complications
    • Sporadic cases of flaccid motor paralysis are associated with echoviruses 6 and 9. Serotypes implicated less frequently include echoviruses 1-4, 7, 11, 14, 16-18, and 30.
    • Paralytic disease caused by nonpolio enteroviruses characteristically is less severe than poliovirus-associated paralysis. In fact, muscle weakness is more common than flaccid paralysis, and the paresis usually is not permanent.
    • Cranial nerve involvement occasionally has resulted in complete unilateral oculomotor palsy. Cases of fatal bulbar involvement occur rarely.
    • Guillain-Barré syndrome is reported in a small number of patients in association with echovirus serotypes 6 and 22. In a few cases, the implicated virus was isolated from CSF or the brain stem.
    • Specialists report transverse myelitis in one patient whose CSF contained echovirus 5.

Prognosis:

  • Chronic meningoencephalitis in hosts who are agammaglobulinemic and other hosts who are immunocompromised may end in death.

Patient Education:

  • Inform patients that, even if person-to-person transmission of an echovirus occurs, any complication that occurs in one person and is related to the particular type will not necessarily occur in other people.

Miscellaneous

Medicolegal Pitfalls

  • Neurologic disease can be confused with the flaccid asymmetrical paralysis caused by poliovirus. The presentation of such a case should always bring up the specter of polio; public health officials must be alerted promptly to initiate investigation.
  • Meningoencephalitides caused by echoviruses are summertime diseases, and they may occur in areas where the newly implanted West Nile virus is found (ie, middle Atlantic area of the United States). The differentiation can be suspected clinically and may only be made with certainty in the laboratory.
  • In the setting of epidemic pleurodynia, approaching every case with close scrutiny so those individuals with myocardial infarction or pulmonary embolus are not missed is important.
 


More on Echoviruses

Overview: Echoviruses
Differential Diagnoses & Workup: Echoviruses
Treatment & Medication: Echoviruses
Follow-up: Echoviruses
References
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References

  1. Bell EJ, Grist NR. ECHO viruses, carditis, and acute pleurodynia. Am Heart J. Jul 1971;82(1):133-5. [Medline].

  2. Bultmann BD, Eggers HJ, Galle J. Age dependence of paralysis induced by echovirus type 9 in infant mice. J Infect Dis. Jun 1983;147(6):999-1005. [Medline].

  3. CDC. Outbreak of aseptic meningitis associated with multiple enterovirus serotypes--Romania, 1999. MMWR Morb Mortal Wkly Rep. Jul 28 2000;49(29):669-71. [Medline].

  4. Committee on the ECHO Viruses. Enteric cytopathogenic human orphan (ECHO) viruses. Science. 1955;122:1187-8.

  5. Crennan JM, Van Scoy RE, McKenna CH. Echovirus polymyositis in patients with hypogammaglobulinemia. Failure of high-dose intravenous gammaglobulin therapy and review of the literature. Am J Med. Jul 1986;81(1):35-42. [Medline].

  6. Hadfield MG, Seidlin M, Houff SA. Echovirus meningomyeloencephalitis with administration of intrathecal immunoglobulin. J Neuropathol Exp Neurol. Sep 1985;44(5):520-9. [Medline].

  7. Hall CB, Cherry JD, Hatch MH. The return of Boston exanthem. Echovirus 16 infections in 1974. Am J Dis Child. Mar 1977;131(3):323-6. [Medline].

  8. Haynes RE, Cramblett HG, Kronfol HJ. Echovirus 9 meningoencephalitis in infants and children. JAMA. Jun 2 1969;208(9):1657-60. [Medline].

  9. Kaplan GJ, Clark PS, Bender TR. Echovirus type 30 meningitis and related febrile illness: epidemiologic study of an outbreak in an Eskimo community. Am J Epidemiol. Oct 1970;92(4):257-65. [Medline].

  10. Malcom BS, Eiden JJ, Hendley JO. ECHO virus type 9 meningitis simulating tuberculous meningitis. Pediatrics. Apr 1980;65(4):725-6. [Medline].

  11. Modlin JF, Polk BF, Horton P. Perinatal echovirus infection: risk of transmission during a community outbreak. N Engl J Med. Aug 13 1981;305(7):368-71. [Medline].

  12. Spencer FJ. The devil and William Dabney. An epidemiological postscript. JAMA. Feb 21 1966;195(8):645-8. [Medline].

  13. Wilfert CM, Buckley RH, Mohanakumar T. Persistent and fatal central-nervous-system ECHOvirus infections in patients with agammaglobulinemia. N Engl J Med. Jun 30 1977;296(26):1485-9. [Medline].

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Further Reading

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Keywords

echoviruses, enteroviruses, Enterovirus, Picornaviridae, echovirus viremia, acute aseptic meningitis, encephalitis, viremia rash virus-induced rash, viral respiratory illness, herpangina, epidemic pleurodynia, myopericarditis, meningoencephalitis, viral paralysis, viral paresis, echovirus, echo virus

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Contributor Information and Disclosures

Author

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Syed Hussain, Department of Surgery, Nassau University Medical Center
Syed Hussain is a member of the following medical societies: American Medical Student Association/Foundation, Phi Beta Kappa, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Mark Raymond Wallace, MD, Chief, Clinical Professor, Department of Internal Medicine, Division of Infectious Disease, Naval Medical Center at San Diego
Mark Raymond Wallace, MD is a member of the following medical societies: Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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