Dermatologic Manifestations of Enteroviral Infections Treatment & Management

Updated: May 21, 2018
  • Author: Mercè Alsina-Gibert, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

Enteroviral infections in immunocompetent individuals heal spontaneously within 7-10 days; therefore, the main goal of treatment is symptomatic relief.

Neonates show a wide spectrum of signs and symptoms, which range from a nonspecific febrile illness to potentially fatal multisystem disease. [2]

Fever

Adequate hydration and antipyretics, such as acetaminophen, are helpful.

Oral lesions

Mouth rinses with topical anesthetics (eg, lidocaine 2%) or antihistamines (eg, diphenhydramine hydrochloride) may relieve oral pain. [60]

Acyclovir was used in an open clinical trial involving 13 patients with hand-foot-and-mouth disease (HFMD). Involution of oral lesions occurred within 24 hours of the start of therapy. The mechanism of action was unknown; to the authors’ knowledge, no other series results have been published.

Allopurinol mouthwashes (3 mg/mL) are reported to accelerate the resolution of oral lesions.

Immunoglobulin

Some anecdotal evidence suggests that prophylactic immunoglobulin can mitigate disease severity in some exposed neonates. Immunoglobulin has also been used for the treatment of symptomatic infants with enterovirus infection. [2]

Pleconaril

This antiviral drug has demonstrated efficacy against enteroviruses. It is a broad-spectrum antiviral drug that blocks enteroviral attachment to cellular receptors. [61, 62, 63] Pleconaril therapy is prescribed for the treatment of severe neonatal enteroviral sepsis. [64] A randomized controlled trial conducted in neonates with enteroviral sepsis showed a shorter time to negativity and a greater survival at 2 months in the pleconaril group. [65]

Pyridyl imidazolidinone

A novel class of capsid binder, pyridyl imidazolidinone can inhibit enterovirus 71 (EV71) replication. [1]

Other treatments

Direct-acting antivirals targeting capsid entry, RNA polymerase, ATPase, cyclophilins, and assembly inhibitors and protease inhibitors are being evaluated. [66] However, to date there is no adequate treatment.

Pirodavir, pocapavir and vapendavir are capsid inhibitors that have shown effectiveness in phase 2 clinical trials. [67]

Some other repurposed drugs seem to be effective in animals, such as ribavirin and itraconazole. [67, 68] Idarubicin has also been shown to be an enterovirus replication inhibitor. [69]

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Prevention

Adequate hand hygiene of contacts prevents the spread of disease. Alcohol-based solutions may not completely eradicate viral particles. 

Vaccination

Development of an inactivated enterovirus vaccine [70] and an inactivated whole virus–based bivalent vaccine for both enterovirus 71 (EV71) and coxsackie A virus (CVA) 16 is in progress. [71] A vaccination program for enterovirus E71 in China seems to be cost-effective in preventing morbidity and mortality. [72] In a 2017 review of all available vaccines for E71, the highest effectivity was of 80% in severe cases of hand-foot-mouth disease (HFMD). It should be taken into account that HFMD may be caused by several enteroviruses. [73] Therefore, a monovalent vaccine would only protect against other serotypes if cross-reactions immunogenicity were present.

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