eMedicine Specialties > Infectious Diseases > Viral Infections

Enteroviruses: Treatment & Medication

Author: Alexander Velazquez, MD, Fellow, Department of Infectious Diseases, Orlando Regional Medical Center
Coauthor(s): Mark R Wallace, MD, FACP, FIDSA, Clinical Professor of Medicine, Florida State University College of Medicine; Infectious Disease Fellowship Director, Orlando Regional Medical Center; Smeeta Sinha, MD, Staff Physician, Department of Dermatology, UMDNJ-New Jersey Medical School; Rajendra Kapila, MD, MBBS, Professor of Medicine, Department of Medicine, UMDNJ, New Jersey Medical School; Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School; Pratibha Dua, MD, MBBS, Staff Physician, Department of Internal Medicine, The Brooklyn Hospital Center
Contributor Information and Disclosures

Updated: Nov 10, 2009

Treatment

Medical Care

  • Polio management is supportive in nature.
    • Abortive polio: Treatment with bed rest and minimal exertion may be done at home. Supportive treatment with analgesics and sedatives may be used.
    • Nonparalytic polio: Management is similar to that of abortive polio. Combine analgesic therapy with hot packs for pain relief.
    • Paralytic polio: In contrast to abortive and nonparalytic polio, which can be managed at home, patients with paralytic polio require hospitalization.
    • Bed rest is required during the early stages of the disease because exertion may worsen the paralysis.
    • Applying hot packs to affected muscles may alleviate pain.
    • Align the body in a neutral position to minimize deformity. Patients should start physical therapy soon after the resolution of pain. Physical therapy should include both active and passive exercises.
    • Mechanical ventilation may be required if respiratory muscles are affected.
    • Postural drainage and suction should be implemented in mild bulbar polio.
    • Patients with weakness or paralysis of the bladder may be treated with cholinergic agents, the sound of running water, or catheterization.
  • Pleurodynia: Treatment is symptomatic, using analgesics and heat application for pain relief. Severe pain may require opiate analgesics.
  • Aseptic meningitis: Treatment is symptomatic, with analgesics for headache relief. Headache is often severe and prolonged in adults; potent analgesics should be administered, when necessary.
  • Myopericarditis
    • Treatment is mainly supportive in nature and involves management of pericardial pain, pericardial effusion, arrhythmias, and heart failure.
    • Bed rest is important since exercise can increase the degree of myocardial necrosis.
    • Intravenous immunoglobulin (IVIG) therapy has shown some benefit in small case-control studies. Nevertheless, most reports lack statistical significance, and randomized trials are needed.53,54
    • Capsid-binding inhibitors belong to a class of drugs that have shown benefit in some immunosuppressed patients with myocarditis. However, these drugs are not available for use in the United States.55
    • Corticosteroids yield little or no benefit, and immunosuppressive therapy is contraindicated during the acute phase of viral myocarditis because they have been shown to cause clinical deterioration.56
  • Acute hemorrhagic conjunctivitis
    • Treatment is primarily symptomatic in nature.
    • Antimicrobial agents are not indicated unless bacterial superinfection occurs. Corticosteroids are contraindicated.
    • Cold compresses may be used, along with antihistamine/decongestant eye drops.
  • Herpangina and hand-foot-and-mouth disease
    • Symptomatic treatment for sore throat is the mainstay of treatment, including analgesics, topical anesthetics, mouth wash, and saline rinses.
    • Viscous lidocaine (2% solution) may be helpful.

Surgical Care

  • Cardiac transplantation may be required in severe cases of dilated cardiomyopathy due to enteroviral infection.

Consultations

  • Consultation with a physiatrist is helpful to plan specific exercise programs, to direct physical therapy, and to provide adaptive equipment for patients with paralytic polio.
  • Consultation with a cardiologist may be requested in myopericarditis for management of arrhythmias.
  • Consultation with a cardiovascular surgeon may be required for the management of complicated pericardial effusions and in some cases for cardiac transplantation.
  • Consultation with an ophthalmologist is appropriate for AHC.
  • Consultation with a neurologist is recommended in cases of paralytic polio.
  • Physical and occupational therapists help patients with polio to establish a safe exercise program, to adapt the home environment, and to use mechanical aids (eg, grab bars).
  • Consultation with an infectious disease specialist may be useful in cases of unexplained aseptic meningitis or myopericarditis.

Diet

  • Patients with paralytic polio should be encouraged to maintain a high fluid intake.
    • The application of hot packs leads to sweating, meaning that fluids need to be replenished.
    • High fluid intake protects against nephrocalcinosis and urinary tract infections due to prolonged immobilization.
    • A diet rich in L-carnitine is under research as a treatment for postpolio syndrome.
    • Patients with herpangina should consume soft bland foods and fluids and avoid pain-inducing salty foods and citrus fruits.

Activity

  • Bed rest is required for patients in the early stages of paralytic polio. Physical therapy should begin as soon as possible after the resolution of pain. Isometric exercises for select muscle groups can help increase muscle strength. Muscle capacity can also be increased with bracing and orthotics.

Medication

Management is supportive and addresses symptoms. No antiviral medications are currently approved for the treatment of enterovirus infections.

More on Enteroviruses

Overview: Enteroviruses
Differential Diagnoses & Workup: Enteroviruses
Treatment & Medication: Enteroviruses
Follow-up: Enteroviruses
References
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Further Reading

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Keywords

Enterovirus, enteroviral infections, Bornholm disease, Bornholm's disease, epidemic myalgia, Sylvest's disease, Sylvest disease, devil's grip, polio, poliovirus, coxsackievirus group A, coxsackievirus group B, echovirus, aseptic meningitis, poliomyelitis, viral heart disease, hand foot and mouth disease, hand-foot-and-mouth disease, HFM disease, hemorrhagic conjunctivitis, herpangina, pleurodynia, myocarditis, pericarditis, meningoencephalitis, common cold, aseptic meningitis, acute hemorrhagic conjunctivitis, AHC, viremia, myopericarditis, abortive polio, nonparalytic polio, paralytic polio

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Contributor Information and Disclosures

Author

Alexander Velazquez, MD, Fellow, Department of Infectious Diseases, Orlando Regional Medical Center
Alexander Velazquez, 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)

Mark R Wallace, MD, FACP, FIDSA, Clinical Professor of Medicine, Florida State University College of Medicine; Infectious Disease Fellowship Director, Orlando Regional Medical Center
Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Smeeta Sinha, MD, Staff Physician, Department of Dermatology, UMDNJ-New Jersey Medical School
Smeeta Sinha, MD is a member of the following medical societies: Alpha Omega Alpha, Phi Beta Kappa, and Sigma Xi
Disclosure: Nothing to disclose.

Rajendra Kapila, MD, MBBS, Professor of Medicine, Department of Medicine, UMDNJ, New Jersey Medical School
Rajendra Kapila, MD, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, and Infectious Diseases Society of New Jersey
Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Pratibha Dua, MD, MBBS, Staff Physician, Department of Internal Medicine, The Brooklyn Hospital Center
Pratibha Dua, MD, MBBS is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Mary Nettleman, MD, MS, Chair, Department of Medicine, Michigan State University
Mary Nettleman, MD, MS is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical Research, Infectious Diseases Society of America, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

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Disclosure: eMedicine Salary Employment

Managing Editor

Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine
Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist  Speaking and teaching

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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