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Picornavirus-Overview Treatment & Management

  • Author: Larry I Lutwick, MD; Chief Editor: Mark R Wallace, MD, FACP, FIDSA  more...
 
Updated: Dec 17, 2014
 

Medical Care

See the list below:

  • Poliomyelitis[29]
    • No specific antiviral agents for the treatment of poliomyelitis are available; therefore, management is supportive and symptomatic.
    • Patients in the acute phase of paralytic poliomyelitis may require hospitalization.
      • Paralysis of the respiratory muscles necessitates mechanical ventilation before severe hypoventilation develops.
      • Severe bulbar paralysis necessitates tracheal intubation.
      • Weakness or paralysis of the bladder necessitates catheterization.
    • Applying moist hot packs to muscles can help relieve pain and muscle spasm.
    • Bed rest prevents the augmentation or extension of paralysis. Animal model data suggest that exercise early during infection can heighten the paresis.
  • Other systemic enteroviral infections[27, 38]
    • Because of the lack of specific antiviral therapy, clinicians manage most enteroviral illnesses symptomatically.
    • Patients with agammaglobulinemia and echoviral meningoencephalitis have benefited from immunoglobulin therapy.
  • Hepatitis A[24]
    • At present, no specific therapy is available for HAV infection, and management is supportive in nature.
    • Explain dietary recommendations to the patient, including the avoidance of other potentially hepatotoxic substances (eg, medications, ethanol).
    • Hospitalize and offer supportive treatment to any patient with fulminant hepatitis. Consider liver transplantation in patients who have a poor prognosis with medical management alone.
  • Rhinovirus[14]
    • Symptomatically care for fever and rhinitis.
    • Rest, hydration, nasal decongestants, and cough suppressants may be appropriate.
      • Start treatment as early as symptoms are recognized, and continue for 4-5 days.
      • Consider petrolatum-based ointment to nares to prevent painful maceration.
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Surgical Care

See the list below:

  • Tracheotomy or tracheostomy may be required for acute paralysis that involves the respiratory muscles.
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Consultations

See the list below:

  • Polio survivors may require consultations with a physical, occupational, or speech therapist.
  • Gastric or other feeding tubes may be needed if ventilation or cranial nerve disability is prolonged.
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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, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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

Disclosure: Received royalty from Baxter International for other.

Chief Editor

Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Clinical Professor of Medicine, University of Central Florida College of Medicine

Mark R Wallace, MD, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, Florida Infectious Diseases Society

Disclosure: Nothing to disclose.

Additional Contributors

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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.

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