Picornavirus-Overview Clinical Presentation

  • Author: Larry I Lutwick, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 11, 2012
 

History

The following summary intends to cover general clinical symptomatology for major members of the Picornaviridae family.

  • Enteroviral infection symptoms[28]
    • Poliovirus: Manifestations of infection range from inapparent illness to severe paralysis and death.
    • Abortive poliomyelitis virus infection is characterized by 2-3 days of fever, headache, sore throat, listlessness, anorexia, vomiting, and abdominal pain. Findings of neurologic examination are normal.
    • Nonparalytic poliomyelitis differs is similar to the abortive form but produces meningeal irritation.
    • Spinal paralytic poliomyelitis has a biphasic course. The minor illness coinciding with viremia corresponds to the symptoms of abortive polio and lasts 1-3 days. The patient then appears to be recovering and remains symptom-free for 2-5 days before the abrupt onset of the major illness. Meningitis is the preparalytic symptom of the major illness. Meningismus and accompanying muscle pain are generally present for 1-2 days before frank weakness and paralysis ensue. The paralysis is flaccid, asymmetric in distribution. Proximal muscles of the extremities tend to be more involved than distal muscles; the legs are more commonly involved than the arms.
    • Bulbar paralytic poliomyelitis consists of paralysis of muscle groups innervated by cranial nerves, especially those of the soft palate and pharynx, resulting in dysphagia, nasal speech, and some dyspnea.
    • Polioencephalitis is characterized by disturbances of consciousness, occurring predominantly in infants. This condition is the only type of poliomyelitis in which seizures are common.
  • Systemic infections caused by enteroviruses other than polioviruses[26]
    • CNS: Enterovirus 71 is a prominent cause of CNS infections, including encephalitis.[29]
    • Heart: Coxsackievirus B in particular causes acute myocarditis and pericarditis.
    • Skeletal muscles: Pleurodynia (Bornholm disease) is also usually caused by coxsackievirus B and is characterized by fever and severe pain in the chest. If the diaphragm is involved, severe pain develops in the abdomen. Symptoms last for a few days to 2 weeks and resolve without ill effects. Individuals who develop myalgic encephalomyelitis (ME), another syndrome, have few, if any, physical signs, but many symptoms develop. The most prominent symptoms include fatigue, following even minor physical activity, and depressive psychological illness.
    • Skin and mucous membranes: Enteroviral infections of these tissues are caused almost entirely by coxsackievirus A. Rashes may accompany infections of other systems. Herpangina is a painful infection of the pharynx with herpeslike features (eg, vesicles of the soft palate, fauces, uvula, posterior wall of the pharynx). The infection resolves spontaneously in a few days. In hand-foot-and-mouth disease (HFMD) unrelated to the FMD of cattle, vesicles and ulcers develop in the anterior part of the mouth, followed by a vesicular rash on the hands and feet.
    • Conjunctiva: Infection is characterized by subconjunctival hemorrhage, severe pain in the eyes, photophobia, and occasional keratitis. Coxsackievirus A24 and echovirus 70 are the main causes of this infection.
  • Rhinoviruses[13, 30, 31]
    • Rhinoviruses produce the common cold, which usually lasts no more than 7 days.
    • In most cases, rhinorrhea and nasal obstruction are the most prominent complaints.
    • The throat is frequently sore or scratchy. Cough and hoarseness occur in 33% of all cases.
  • Hepatitis A[23]
    • HAV has an incubation period of 2-6 weeks, with an average of 28 days. Many infections are silent, particularly in small children.
    • Clinical illness usually starts in a few days, with symptoms of malaise, anorexia, vague abdominal discomfort, and fever. Later, the urine becomes dark and the feces appear pale.
    • Soon afterwards, jaundice appears, first in the sclera and then in the skin; if severe, itching may accompany these symptoms. The patient starts to feel better within the next week or so, and the jaundice disappears within a month.
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Physical

Physical examination findings depend on the infection, and a given virus and strain can produce variable symptoms in different patients.[23, 13, 28, 26]

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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)

Robert L Holmes, DO  Major, Medical Corps, US Air Force, Medical Director of Infectious Diseases, Chair, Infection Control Review Function, Associate Program Director, Internal Medicine Residency Training Program, Keesler Medical Center

Robert L Holmes, DO is a member of the following medical societies: American College of Physician Executives, American Osteopathic Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Yana Bron, MD  Consulting Staff, Department of Pediatrics, Linden Children Services Inc

Yana Bron, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Informatics Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

John M Leedom, MD  Professor Emeritus of Medicine, Keck School of Medicine of the University of Southern California

John M Leedom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Charles V Sanders, MD  Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Nothing to disclose.

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.

References

  1. Melnick JL. Portraits of viruses: the picornaviruses. Intervirology. 1983;20(2-3):61-100. [Medline].

  2. Atmar RL, Piedra PA, Patel SM, Greenberg SB, Couch RB, Glezen WP. Picornavirus - the Most Common Respiratory Virus Infection among Patients of All Ages Hospitalized with Acute Respiratory Illness. J Clin Microbiol. Nov 23 2011;[Medline].

  3. Racaniello VR. Picornaviridae: the viruses and their replication. In: Knipe DM, Howley PM, Griffin DE. Fields Virology. Vol 1. 5th ed. Lippincott Williams & Wilkins; 2006:795-838.

  4. Melnick JL. Properties and classification of hepatitis A virus. Vaccine. 1992;10 Suppl 1:S24-6. [Medline].

  5. Papadopoulos NG, Sanderson G, Hunter J. Rhinoviruses replicate effectively at lower airway temperatures. J Med Virol. May 1999;58(1):100-4. [Medline].

  6. Drexler JF, Luna LK, Stöcker A, Almeida PS, Ribeiro TC, Petersen N. Circulation of 3 lineages of a novel Saffold cardiovirus in humans. Emerg Infect Dis. Sep 2008;14(9):1398-405. [Medline].

  7. Abraham G, Colonno RJ. Many rhinovirus serotypes share the same cellular receptor. J Virol. Aug 1984;51(2):340-5. [Medline].

  8. Holland J. Enterovirus entrance into specific host cells and subsequent alterations of cell protein and nucleic acid synthesis. Bacteriol Rev. 1964;28:3-13.

  9. Lonberg-Holm K, Korant BD. Early interaction of rhinoviruses with host cells. J Virol. Jan 1972;9(1):29-40. [Medline].

  10. Ogram SA, Flanegan JB. Non-Templated Functions of Viral RNA in Picornavirus Replication. Curr Opin Virol. Nov 1 2011;1(5):339-346. [Medline]. [Full Text].

  11. Alexander HE, Koch G, Mountain IM, Sprunt K, Van Damme O. Infectivity of ribonucleic acid of poliovirus on HeLa cell mono-layers. Virology. Feb 1958;5(1):172-3. [Medline].

  12. Trip HF, Schonenberg D, Starreveld JS, Versteegh FG. An enterovirus epidemic in infants in the summer and fall of 2006. Eur J Clin Microbiol Infect Dis. Nov 7 2008;[Medline].

  13. Gwaltney JM Jr. Rhinovirus. In: Mandell GL, Bennet JE, Dolin R. Principles and Practice of Infectious Diseases. Vol 2. 6th 3d. Philadelphia: Churchill Livingstone; 2005:2185-94.

  14. Abed Y, Boivin G. New Saffold cardioviruses in 3 children, Canada. Emerg Infect Dis. May 2008;14(5):834-6. [Medline].

  15. D'Errico MM, Barbadoro P, Bacelli S, Esposto E, Moroni V, Scaccia F. Surveillance of acute flaccid paralysis in the Marches region (Italy): 1997-2007. BMC Infect Dis. 2008;8:135. [Medline].

  16. Dos Santos GP, Skraba I, Oliveira D, Lima AA, de Melo MM, Kmetzsch CI, et al. Enterovirus meningitis in Brazil, 1998-2003. J Med Virol. Jan 2006;78(1):98-104. [Medline].

  17. Global Polio Eradication Initiative (partnership between World Health Organization, US Centers for Disease Control and Prevention, Rotary International, and United Nations Children's Fund). Wild Poliovirus 2000-2008. Global Polio Eradication Initiative. Available at http://www.polioeradication.org/content/general/casecount.pdf. Accessed 21 November, 2008.

  18. Qiu J. Enterovirus 71 infection: a new threat to global public health?. Lancet Neurol. Oct 2008;7(10):868-9. [Medline].

  19. Tu PV, Thao NT, Perera D, Huu TK, Tien NT, Thuong TC. Epidemiologic and virologic investigation of hand, foot, and mouth disease, southern Vietnam, 2005. Emerg Infect Dis. Nov 2007;13(11):1733-41. [Medline].

  20. Zhao YN, Jiang QW, Jiang RJ, Chen L, Perlin DS. Echovirus 30, Jiangsu Province, China. Emerg Infect Dis. Apr 2005;11(4):562-7. [Medline].

  21. Legay F, Lévêque N, Gacouin A, Tattevin P, Bouet J, Thomas R. Fatal coxsackievirus A-16 pneumonitis in adult. Emerg Infect Dis. Jul 2007;13(7):1084-6. [Medline].

  22. Abed Y, Boivin G. Human parechovirus types 1, 2 and 3 infections in Canada. Emerg Infect Dis. Jun 2006;12(6):969-75. [Medline].

  23. Bell BP, Anderson DA, Feinstone SM. Hepatitis A virus. In: Mandell GL, Bennet JE, Dolin R. Principles and Practice of Infectious Diseases. Vol 2. 6th ed. Philadelphia: Churchill Livingstone; 2005:2162-85.

  24. Verboon-Maciolek MA, Groenendaal F, Hahn CD, Hellmann J, van Loon AM, Boivin G, et al. Human parechovirus causes encephalitis with white matter injury in neonates. Ann Neurol. Sep 2008;64(3):266-73. [Medline].

  25. Chen JH, Chiu NC, Chang JH. A neonatal echovirus 11 outbreak in an obstetric clinic. J Microbiol Immunol Infect. 2005;38:332-37. [Medline].

  26. Modlin JF. Coxsackieviruses, echoviruses, and newer enteroviruses. In: Mandell GL, Bennet JE, Dolin R. Principles and Practice of Infectious Diseases. Vol 2. 6th ed. Philadelphia: Churchill Livingstone; 2005:2148-61.

  27. Makela MJ, Puhakka T, Ruuskanen O. Viruses and bacteria in the etiology of the common cold. J Clin Microbiol. Feb 1998;36(2):539-42. [Medline].

  28. Modlin JF. Poliovirus. In: Mandell GL, Bennet JE, Dolin R. Principles and Practice of Infectious Diseases. Vol 2. 6th ed. Philadelphia: Churchill Livingstone; 2005:2141-8.

  29. Fowlkes AL, Honarmand S, Glaser C, Yagi S, Schnurr D, Oberste MS. Enterovirus-associated encephalitis in the california encephalitis project, 1998-2005. J Infect Dis. Dec 1 2008;198(11):1685-91. [Medline].

  30. Peltola V, Waris M, Osterback R, Susi P, Hyypiä T, Ruuskanen O. Clinical effects of rhinovirus infections. J Clin Virol. Dec 2008;43(4):411-4. [Medline].

  31. Xiang Z, Gonzalez R, Xie Z, Xiao Y, Chen L, Li Y, et al. Human rhinovirus group C infection in children with lower respiratory tract infection. Emerg Infect Dis. Oct 2008;14(10):1665-7. [Medline].

  32. Andreoletti L, Blassel-Damman N, Dewilde A. Comparison of use of cerebrospinal fluid, serum, and throat swab specimens in diagnosis of enteroviral acute neurological infection by a rapid RNA detection PCR assay. J Clin Microbiol. Feb 1998;36(2):589-91. [Medline].

  33. Watanabe K,Oie M, Higuchi M, Nishikawa M, Fujii M. Isolation and characterizationof novel human parechovirusfrom clinical samples. Emerg Infect Dis. 2007;13(6):889-895. [Medline].

  34. Andeweg AC, Bestebroer TM, Huybreghs M. Improved detection of rhinoviruses in clinical samples by using a newly developed nested reverse transcription-PCR assay. J Clin Microbiol. Mar 1999;37(3):524-30. [Medline].

  35. Jaïdane H, Hober D. Role of coxsackievirus B4 in the pathogenesis of type 1 diabetes. Diabetes Metab. Oct 16 2008;[Medline].

  36. Liang Z, Kumar AS, Jones MS, Knowles NJ, Lipton HL. Phylogenetic analysis of the species Theilovirus: emerging murine and human pathogens. J Virol. Dec 2008;82(23):11545-54. [Medline].

  37. Tee KK, Takebe Y, Kamarulzaman A. Emerging and re-emerging viruses in Malaysia, 1997-2007. Int J Infect Dis. Nov 13 2008;[Medline].

 
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