Picornavirus-Overview Treatment & Management

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

Medical Care

  • Poliomyelitis[28]
    • 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[26]
    • 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[23]
    • 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[13]
    • 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

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

  • 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 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.

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