eMedicine Specialties > Infectious Diseases > Viral Infections

Echoviruses: Treatment & Medication

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

Treatment

Medical Care

Antivirals to treat echoviral infections are not available commercially; medical treatment is supportive and symptomatic. Pleconaril, an experimental agent with good in vitro activity against most enteroviruses, is being evaluated in clinical trials and can be obtained for myocarditis, neonatal sepsis, meningoencephalitis, and vaccine-associated polio on a compassionate use basis (call ViroPharma at 610-651-0200). Physicians also use intravenous, intrathecal, and intraventricular gamma globulin with high type-specific antibodies for chronic meningoencephalitis caused by echovirus, but the results are not uniformly effective.

  • Chronic meningoencephalitis in hosts who are agammaglobulinemic and other hosts who are immunocompromised
    • Intravenous gamma globulin therapy has now replaced immune serum globulin for routine replacement therapy for patients with B-cell immunodeficiency and has been used to treat this disease. This therapy may prove more effective because a much higher serum immunoglobulin G (IgG) concentration can be maintained.
    • Use of intravenous immunoglobulin (IGIV) in the treatment of chronic enteroviral meningitis generally has been ineffective, even when using IGIV lots with relatively high concentrations of type-specific antibody. Intrathecal and intraventricular administration of high-titer type-specific antibody preparations have been used, but relapse of infection has occurred even after long-term therapy.

Medication

As noted earlier, no approved drugs for enteroviral infections exist. Pleconaril can be obtained through the manufacturer on a compassionate basis for neonatal sepsis, chronic meningoencephalitis, myocarditis, and enteroviral complications of marrow transplantation and vaccine-associated polio. Call ViroPharma at 610-651-0200 for information/eligibility for this experimental agent.

More on Echoviruses

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

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  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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