Sections

Enteroviruses

Sections Enteroviruses
Overview
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- Physical
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Treatment
Medication
Follow-up
Questions & Answers
References

Treatment

Medical Care

Polio management is supportive in nature, as follows:

Abortive polio: Treatment with bed rest and minimal exertion may be done at home. Supportive treatment with analgesics and sedatives may be used.
Nonparalytic polio: Management is similar to that of abortive polio. Combine analgesic therapy with hot packs for pain relief.
Paralytic polio: In contrast to abortive and nonparalytic polio, which can be managed at home, patients with paralytic polio require hospitalization.
Bed rest is required during the early stages of the disease because exertion may worsen the paralysis.
Applying hot packs to affected muscles may alleviate pain.
Align the body in a neutral position to minimize deformity. Patients should start physical therapy soon after the resolution of pain. Physical therapy should include both active and passive exercises.
Mechanical ventilation may be required if respiratory muscles are affected.
Postural drainage and suction should be implemented in mild bulbar polio.
Patients with weakness or paralysis of the bladder may be treated with cholinergic agents, the sound of running water, or catheterization.

Pleurodynia

Treatment is symptomatic, using analgesics and heat application for pain relief. Severe pain may require opiate analgesics.

Aseptic meningitis

Treatment is symptomatic, with analgesics for headache relief. Headache is often severe and prolonged in adults; potent analgesics should be administered, when necessary.

Myopericarditis

Treatment is mainly supportive in nature and involves management of pericardial pain, pericardial effusion, arrhythmias, and heart failure.

Bed rest is important since exercise can increase the degree of myocardial necrosis.

Intravenous immunoglobulin (IVIG) therapy has shown some benefit in small case-control studies. Nevertheless, most reports lack statistical significance, and randomized trials are needed.^{[70, 71]}

Capsid-binding inhibitors belong to a class of drugs that have shown benefit in some immunosuppressed patients with myocarditis. However, these drugs are not available for use in the United States.^[72]

Corticosteroids yield little or no benefit, and immunosuppressive therapy is contraindicated during the acute phase of viral myocarditis because they have been shown to cause clinical deterioration.^[73]

Acute hemorrhagic conjunctivitis

Treatment is primarily symptomatic in nature.

Antimicrobial agents are not indicated unless bacterial superinfection occurs. Corticosteroids are contraindicated.

Cold compresses may be used, along with antihistamine/decongestant eye drops.

Herpangina and hand-foot-and-mouth disease

Symptomatic treatment for sore throat is the mainstay of treatment, including analgesics, topical anesthetics, mouth wash, and saline rinses.

Viscous lidocaine (2% solution) may be helpful.

Surgical Care

Cardiac transplantation may be required in severe cases of dilated cardiomyopathy due to enteroviral infection.

Consultations

Consultation with a physiatrist is helpful to plan specific exercise programs, to direct physical therapy, and to provide adaptive equipment for patients with paralytic polio.

Consultation with a cardiologist may be requested in myopericarditis for management of arrhythmias.

Consultation with a cardiovascular surgeon may be required for the management of complicated pericardial effusions and in some cases for cardiac transplantation.

Consultation with an ophthalmologist is appropriate for AHC.

Consultation with a neurologist is recommended in cases of paralytic polio.

Physical and occupational therapists help patients with polio to establish a safe exercise program, to adapt the home environment, and to use mechanical aids (eg, grab bars).

Consultation with an infectious disease specialist may be useful in cases of unexplained aseptic meningitis or myopericarditis.

Diet

Patients with paralytic polio should be encouraged to maintain a high fluid intake.

The application of hot packs leads to sweating, meaning that fluids need to be replenished.

High fluid intake protects against nephrocalcinosis and urinary tract infections due to prolonged immobilization.

A diet rich in L-carnitine is under research as a treatment for postpolio syndrome.

Patients with herpangina should consume soft bland foods and fluids and avoid pain-inducing salty foods and citrus fruits.

Activity

Bed rest is required for patients in the early stages of paralytic polio. Physical therapy should begin as soon as possible after the resolution of pain. Isometric exercises for select muscle groups can help increase muscle strength. Muscle capacity can also be increased with bracing and orthotics.

Medication

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Smeeta Sinha, MD Resident Physician, Department of Dermatology, Rutgers New Jersey Medical School

Smeeta Sinha, MD is a member of the following medical societies: Alpha Omega Alpha, Phi Beta Kappa, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Alexander Velazquez, MD Fellow, Department of Infectious Diseases, Orlando Regional Medical Center

Alexander Velazquez, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Pratibha Dua, MD, MBBS Staff Physician, Internal Medicine, United Medical Park

Pratibha Dua, MD, MBBS is a member of the following medical societies: American Medical Association

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.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Mark R Wallace, MD, FACP, FIDSA Infectious Disease Physician, Skagit Valley Hospital, Skagit Regional Health

Disclosure: Nothing to disclose.

Mary D Nettleman, MD, MS, MACP Professor and Chair, Department of Medicine, Michigan State University College of Human Medicine

Mary D Nettleman, MD, MS, MACP is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical and Translational Research, Infectious Diseases Society of America, Society of General Internal Medicine

Disclosure: Nothing to disclose.

Rajendra Kapila, MD, MBBS † Professor, Department of Medicine, Rutgers New Jersey Medical School

Rajendra Kapila, MD, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, Infectious Diseases Society of New Jersey

Disclosure: Nothing to disclose.