eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Echovirus: Differential Diagnoses & Workup

Author: Jorge M Quinonez, MD, Medical Director of Pediatrics, Chief Medical Officer, Family Health Centers of South West Florida, Inc
Contributor Information and Disclosures

Updated: Jul 29, 2008

Differential Diagnoses

Neonatal Sepsis

Other Problems to Be Considered

Bacterial sepsis
Bacterial meningitis
Neonatal herpes simplex infection
Herpes simplex virus encephalitis
Arbovirus encephalitis
Fever without localizing signs
Viral exanthems
Pharyngoconjunctival fever

Workup

Laboratory Studies

Until recently, the criterion standard laboratory procedure to diagnose echovirus (EV) and other enterovirus infections was to isolate the virus in cell culture. An etiologic diagnosis is confirmed when virus is isolated from blood, CSF, tissue, or pericardial fluid. EV can also be isolated from stool or oropharynx, although these findings are less indicative of disease because asymptomatic shedding from these sites can occur for several weeks after acute infection.

  • Enteroviruses grow rapidly in cell culture, yet viral recovery occurs too slowly to provide data for decisions about treatment. Virus detection in cell culture typically takes 3-8 days, requires multiple cell lines for optimal recovery, is labor intensive and costly, and is not readily available in all clinical facilities. Antiviral therapy for enterovirus requires a faster and more efficient mechanism for diagnosis.
  • Enterovirus polymerase chain reaction (EV-PCR), based on amplification of conserved genetic sequences, has been thoroughly studied and is superior to viral culture for revealing many enteroviral infections, particularly enteroviral meningitis.5,6,7
    • EV-PCR can be used in samples other than CSF, although experience is not as extensive. EV-PCR has been successfully used in urine and serum to document neonatal infection and on throat swabs to document common outpatient illnesses.
    • Quality control from laboratory to laboratory is necessary because no commercial kit is available. Because of its extreme sensitivity, EV-PCR is subject to false-positive results from contamination within the laboratory. The greatest benefit of EV-PCR is that the test can provide results in 5-24 hours, which can expedite patient management decisions (eg, decrease length of hospitalization, antibiotic use, overall costs).
  • Serologic tests for enteroviral infection diagnosis have limited value because they are slow, require acute and convalescent titers, and are not type-specific.

More on Echovirus

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

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Further Reading

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Keywords

echovirus, ECHO virus, ECHOvirus, EV, enteric cytopathic human orphan virus, aseptic meningitis, coxsackievirus, rhinovirus, viremia, disseminated encephalitis, liver failure, myocarditis, neonatal sepsis, bacterial sepsis, echoviral meningitis, herpes simplex encephalitis, poliomyelitis, pleurodynia, pleural inflammation, pneumonia, pleural effusion, appendicitis, peritonitis, upper respiratory infection, pericardial friction rub, congestive heart failure, CHF, respiratory distress, hepatic necrosis, disseminated intravascular coagulation, bronchitis, bronchiolitis

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Contributor Information and Disclosures

Author

Jorge M Quinonez, MD, Medical Director of Pediatrics, Chief Medical Officer, Family Health Centers of South West Florida, Inc
Jorge M Quinonez, MD is a member of the following medical societies: American Academy of Pediatrics and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Leonard R Krilov, MD, Chief of Pediatric Infectious Diseases, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital
Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Medimmune Grant/research funds Cliinical trials; Medimmune Honoraria Speaking and teaching; Medimmune Consulting fee Consulting

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University
Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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