Pediatric Enteroviral Infections Medication

  • Author: Nicholas John Bennett, MB, BCh, PhD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Mar 29, 2012
 

Medication Summary

Antiviral therapy is not currently a component in the standard of care for enteroviral infection. Studies with investigational antiviral agents are currently ongoing. Current treatment remains purely supportive.

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Antipyretic and analgesic agents

Class Summary

These agents are used to treat fever, myalgia, and headache associated with enterovirus.

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Acetaminophen (Tylenol, FeverAll)

 

Reduces fever by directly acting on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating.

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Ibuprofen (Motrin, Advil)

 

One of the few NSAIDs indicated for reduction of fever.

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Immunoglobulins

Class Summary

This agent is a purified preparation of gamma globulin derived from large pools of human plasma and is composed of 4 subclasses of antibodies, approximating the distribution of human serum.

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Immune globulin, intravenous (Carimune NF, Gammagard, Polygam S/D)

 

Neutralizes circulating myelin antibodies through anti-idiotypic antibodies. Down-regulates proinflammatory cytokines, including INF-gamma. Blocks Fc receptors on macrophages. Suppresses inducer T and B cells and augments suppressor T cells. Blocks complement cascade and promotes remyelination. May increase CSF IgG (10%).

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Antiviral agents

Class Summary

One antiviral medication (pleconaril) has shown promise in treating enteroviral infections, but its use has so far been largely restricted to experimental protocols. Its release has been repeatedly delayed, and it is still not yet licensed in the United States.

Pleconaril (Picovir)

 

Investigational in the United States. Low-molecular weight capsid-inhibitor fits into the hydrophobic pocket of the VP1 capsid protein and interferes with viral attachment and uncoating. Has shown efficacy against enterovirus species.

Several clinical trials in adults have shown good drug tolerability with low adverse effects. Drug distribution shows good penetration into the liver, CNS, and nasal mucosa. Efficacy demonstrated in terms of symptom scores, nasal mucus production, and length of illness in studies in which administration of the drug precedes or coincides with experimental enterococcus inoculation. Bioavailability increases more than 2-fold when administered with a fatty meal compared with administration in a fasting state. Treatment of subjects presenting with a "common cold" reduced the disease duration by about 1 d.

Several case reports document successful treatment of severe or life-threatening infections. Data in children is extremely limited. Studies are underway. Contact Schering-Plough for information regarding experimental protocols or compassionate need.

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Contributor Information and Disclosures
Author

Nicholas John Bennett, MB, BCh, PhD,  Assistant Professor in Pediatrics, Division of Infectious Diseases, Connecticut Children's Medical Center

Nicholas John Bennett, MB, BCh, PhD, is a member of the following medical societies: Alpha Omega Alpha and American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

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.

Mobeen H Rathore, MD, CPE, FAAP, FIDSA  Chief of Division of Pediatric Infectious Diseases/Immunology, Associate Chairman of Department of Pediatrics, University of Florida College of Medicine at Jacksonville; Hospital Epidemiologist and Section Chief of Infectious Disease and Immunology, Wolfson Children's Hospital; Director of University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES)

Mobeen H Rathore, MD, CPE, FAAP, FIDSA is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, European Society for Paediatric Infectious Diseases, Florida Medical Association, Florida Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Healthcare Epidemiology of America, Society for Pediatric Research, Southern Medical Association, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Leonard R Krilov, MD  Chief of Pediatric Infectious Diseases and International Adoption, 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

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD  American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

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: Novartis 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: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Michelle Mowad, MD, to the original writing and development of this article.

References

  1. Pichichero ME, McLinn S, Rotbart HA, et al. Clinical and economic impact of enterovirus illness in private pediatric practice. Pediatrics. Nov 1998;102(5):1126-34. [Medline]. [Full Text].

  2. Picornaviridae Study Group. New and Re-classified TypesGenus Parechovirus, species Human parechovirus. Available at http://www.picornastudygroup.com/types/parechovirus/hpev.htm. Accessed 3/14/09.

  3. Tra My PV, Rabaa MA, Vinh H, Holmes EC, Hoang NV, Vinh NT, et al. The emergence of rotavirus G12 and the prevalence of enteric viruses in hospitalized pediatric diarrheal patients in southern Vietnam. Am J Trop Med Hyg. Oct 2011;85(4):768-75. [Medline]. [Full Text].

  4. Ikeda T, Mizuta K, Abiko C, Aoki Y, Itagaki T, Katsushima F, et al. Acute respiratory infections due to enterovirus 68 in Yamagata, Japan between 2005 and 2010. Microbiol Immunol. Feb 2012;56(2):139-43. [Medline].

  5. Puenpa J, Theamboonlers A, Korkong S, Linsuwanon P, Thongmee C, Chatproedprai S, et al. Molecular characterization and complete genome analysis of human enterovirus 71 and coxsackievirus A16 from children with hand, foot and mouth disease in Thailand during 2008-2011. Arch Virol. Nov 2011;156(11):2007-13. [Medline].

  6. Poliovirus. Pediatrics. Oct 2011;128(4):805-8. [Medline].

  7. CDC. Enterovirus surveillance--United States, 1997-1999. MMWR Morb Mortal Wkly Rep. Oct 13 2000;49(40):913-6. [Medline].

  8. Global Polio Eradication Initiative. Wild Poliovirus Weekly Update. Global Polio Eradication. Available at http://www.polioeradication.org/casecount.asp. Accessed 3/14/09.

  9. Ooi MH, Wong SC, Mohan A, Podin Y, Perera D, Clear D, et al. Identification and validation of clinical predictors for the risk of neurological involvement in children with hand, foot, and mouth disease in Sarawak. BMC Infect Dis. Jan 19 2009;9:3. [Medline].

  10. Chonmaitree T, Menegus MA, Powell KR. The clinical relevance of 'CSF viral culture'. A two-year experience with aseptic meningitis in Rochester, NY. JAMA. Apr 2 1982;247(13):1843-7. [Medline].

  11. Singer JI, Maur PR, Riley JP, Smith PB. Management of central nervous system infections during an epidemic of enteroviral aseptic meningitis. J Pediatr. Mar 1980;96(3 Pt 2):559-63. [Medline].

  12. Ahmed A, Brito F, Goto C, et al. Clinical utility of the polymerase chain reaction for diagnosis of enteroviral meningitis in infancy. J Pediatr. Sep 1997;131(3):393-7. [Medline].

  13. Wood DL. Increasing immunization coverage. American Academy of Pediatrics Committee on Community Health Services. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine. Pediatrics. Oct 2003;112(4):993-6. [Medline]. [Full Text].

  14. Hyoty H, Hiltunen M, Knip M, et al. A prospective study of the role of coxsackie B and other enterovirus infections in the pathogenesis of IDDM. Childhood Diabetes in Finland (DiMe) Study Group. Diabetes. Jun 1995;44(6):652-7. [Medline].

  15. Abzug MJ, Keyserling HL, Lee ML, et al. Neonatal enterovirus infection: virology, serology, and effects of intravenous immune globulin. Clin Infect Dis. May 1995;20(5):1201-6. [Medline].

  16. Abzug MJ, Levin MJ, Rotbart HA. Profile of enterovirus disease in the first two weeks of life. Pediatr Infect Dis J. Oct 1993;12(10):820-4. [Medline].

  17. Andrus JK, Strebel PM, de Quadros CA, Olive JM. Risk of vaccine-associated paralytic poliomyelitis in Latin America, 1989-91. Bull World Health Organ. 1995;73(1):33-40. [Medline].

  18. Ballow M. Mechanisms of action of intravenous immune serum globulin in autoimmune and inflammatory diseases. J Allergy Clin Immunol. Aug 1997;100(2):151-7. [Medline].

  19. Gaspar BG, Kinnon C. Humoral Immunodeficiency: X-linked agammaglobulinemia. Immunol Allergy Clin North Am. 2001;21(1).

  20. Huang CC, Liu CC, Chang YC, et al. Neurologic complications in children with enterovirus 71 infection. N Engl J Med. Sep 23 1999;341(13):936-42. [Medline].

  21. Jiang P, Faase JA, Toyoda H, et al. Evidence for emergence of diverse polioviruses from C-cluster coxsackie A viruses and implications for global poliovirus eradication. Proc Natl Acad Sci U S A. May 29 2007;104(22):9457-62. [Medline]. [Full Text].

  22. Kohler KA, Banerjee K, Gary Hlady W, Andrus JK, Sutter RW. Vaccine-associated paralytic poliomyelitis in India during 1999: decreased risk despite massive use of oral polio vaccine. Bull World Health Organ. 2002;80(3):210-6. [Medline].

  23. Morag A, Ogra P. Enteroviruses. In: Nelson Textbook of Pediatrics. 16th ed. Philadelphia, Pa: WB Saunders Co; 2000.

  24. Norris CM, Danis PG, Gardner TD. Aseptic meningitis in the newborn and young infant. Am Fam Physician. May 15 1999;59(10):2761-70. [Medline].

  25. Prager P, Nolan M, Andrews IP, Williams GD. Neurogenic pulmonary edema in enterovirus 71 encephalitis is not uniformly fatal but causes severe morbidity in survivors. Pediatr Crit Care Med. Jul 2003;4(3):377-81. [Medline].

  26. Prevots DR, Burr RK, Sutter RW, Murphy TV,. Poliomyelitis prevention in the United States. Updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. May 9 2000;49(RR-5):1-22; quiz CE1-7. [Medline]. [Full Text].

  27. Roivainen M. Enteroviruses and myocardial infarction. Am Heart J. Nov 1999;138(5 Pt 2):S479-83. [Medline].

  28. Rotbart HA, Sawyer MH, Fast S, Lewinski C, Murphy N, Keyser EF, et al. Diagnosis of enteroviral meningitis by using PCR with a colorimetric microwell detection assay. J Clin Microbiol. Oct 1994;32(10):2590-2. [Medline]. [Full Text].

  29. Shechet RJ, Tanenbaum B. Preventing unnecessary hypospadias repair. Am Fam Physician. Nov 1 1999;60(7):1933. [Medline].

  30. WHO. Progress towards interruption of wild poliovirus transmission in 2005. Wkly Epidemiol Rec. Apr 28 2006;81(17):165-72. [Medline]. [Full Text].

  31. Wilfert CM, Lehrman SN, Katz SL. Enteroviruses and meningitis. Pediatr Infect Dis. Jul-Aug 1983;2(4):333-41. [Medline].

  32. Yang TT, Huang LM, Lu CY, et al. Clinical features and factors of unfavorable outcomes for non-polio enterovirus infection of the central nervous system in northern Taiwan, 1994-2003. J Microbiol Immunol Infect. Dec 2005;38(6):417-24. [Medline].

  33. Zaoutis T, Klein JD. Enterovirus infections. Pediatr Rev. Jun 1998;19(6):183-91. [Medline].

 
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Erosions on the base of the tongue.
A red halo surrounds several vesicles on the finger flexures and palms.
Small linear vesicle on the thumb.
Vesicle on the dorsal hand of a young adult.
 
 
 
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