Medical Care

No antiviral therapy has been available except IVIG therapy, which reportedly has some success in patients who are immunocompromised and have persistent enterovirus infections. The role of IVIG therapy for acute infections is unproven. A study evaluating its use in enteroviral infection in neonates failed to demonstrate a clear benefit. Another study evaluating the use of IVIG in 21 patients with myocarditis showed improved left ventricular function and survival when compared with 25 control patients. However, additional studies are needed.

Corticosteroid use to treat viral myopericarditis remains controversial at best. Several antiviral agents have in vitro activity against a broad range of enterovirus types, and several clinical trials have been conducted on their use.

The first of these agents to be studied was pleconaril, a drug that interferes with the binding of enterovirus to the cell membrane and the uncoating of virions by attaching to the virus protein capsid.^{[19, 20]}Several clinical trials have demonstrated a benefit in children and adults with enterovirus meningitis.^[21]Pleconaril apparently may be on the verge of becoming readily available for clinical use as a new therapy option for echovirus (EV) and other enteroviral infections.

Pleconaril at concentrations of 0.1 mg/mL has activity against more than 90% of the most common circulating enteroviruses. The drug has good bioavailability and a prolonged half-life, allowing oral administration 3 times a day. Adequate levels can be achieved in serum and CSF.

Pleconaril has been studied in enteroviral meningitis, in respiratory tract infections, and in a limited number of patients who are immunocompromised and have viral myocarditis.

Phase III clinical trials are underway, and initial results are promising. In the first placebo-controlled double-blind study, 221 children (aged 4-14 years) with signs and symptoms of viral meningitis, most confirmed as enterovirus with EV-PCR, received 2.5 or 5 mg/kg of pleconaril or placebo 3 times a day for 7 days.^[21]Initial findings showed a 38-50% improvement among treated patients when compared with patients receiving a placebo. Improvement was seen as early as 24 hours after therapy initiation. Similar results have been obtained in studies of adolescents and adults with enteroviral meningitis. Pleconaril is currently under investigation in a multicenter collaborative study of therapy for neonatal enteroviral sepsis sponsored by the National Institutes of Health.

Schering-Plough lists pleconaril nasal spray as having completed phase II trials for preventing asthma exacerbation and common cold symptoms in asthmatic patients exposed to picornavirus.^[20]

Pleconaril has not been approved by the US Food and Drug Administration (FDA).

Follow-up care

The specific type of infection caused by EV should dictate follow-up care.

Morosky S, Wells AI, Lemon K, et al. The neonatal Fc receptor is a pan-echovirus receptor. Proc Natl Acad Sci U S A. 2019 Feb 26. 116 (9):3758-63. [Medline].
Farcy C, Mirand A, Marque Juillet S, Henquell C, Neulier C, Foucaud P, et al. [Enterovirus nosocomial infections in a neonatal care unit: from diagnosis to evidence, from a clinical observation of a central nervous system infection]. Arch Pediatr. 2012 Sep. 19(9):921-6. [Medline].
Abedi GR, Watson JT, Nix WA, Oberste MS, Gerber SI. Enterovirus and parechovirus surveillance - United States, 2014-2016. MMWR Morb Mortal Wkly Rep. 2018 May 11. 67 (18):515-8. [Medline]. [Full Text].
Hauri AM, Schimmelpfennig M, Walter-Domes M, et al. An outbreak of viral meningitis associated with a public swimming pond. Epidemiol Infect. 2005. 133:291-8. [Medline].
Narkeviciute I, Vaiciuniene D. Outbreak of echovirus 13 infection among Lithuanian children. Clin Microbiol Infect. 2004. 10:1023-5. [Medline].
Somekh E, Cesar K, Handsher R, et al. An outbreak of echovirus 13 meningitis in Central Israel. Epidemiol Infect. 2003. 130:257-62. [Medline].
Chen JH, Chiu NC, Chang JC, et al. A neonatal echovirus 11 outbreak in an obstetric clinic. J Microbiol Immunol Infect. 2005. 38:332-7. [Medline].
Baek K, Yeo S, Lee B, Park K, Song J, Yu J, et al. Epidemics of enterovirus infection in Chungnam Korea, 2008 and 2009. Virol J. 2011 Jun 13. 8:297. [Medline]. [Full Text].
Tryfonos C, Richter J, Koptides D, Yiangou M, Christodoulou CG. Molecular typing and epidemiology of enteroviruses in Cyprus, 2003-2007. J Med Microbiol. 2011 Oct. 60:1433-40. [Medline].
Ke GM, Lin KH, Lu PL, Tung YC, Wang CF, Ke LY, et al. Molecular epidemiology of Echovirus 30 in Taiwan, 1988-2008. Virus Genes. 2011 Apr. 42(2):178-88. [Medline].
Savolainen-Kopra C, Paananen A, Blomqvist S, Klemola P, Simonen ML, Lappalainen M, et al. A large Finnish echovirus 30 outbreak was preceded by silent circulation of the same genotype. Virus Genes. 2011 Feb. 42(1):28-36. [Medline].
Mantadakis E, Pogka V, Voulgari-Kokota A, Tsouvala E, Emmanouil M, Kremastinou J, et al. Echovirus 30 outbreak associated with a high meningitis attack rate in Thrace, Greece. Pediatr Infect Dis J. 2013 Aug. 32(8):914-6. [Medline].
Chen J, Han Z, Wu H, Xu W, Yu D, Zhang Y. A large-scale outbreak of echovirus 30 in Gansu Province of China in 2015 and its phylodynamic characterization. Front Microbiol. 2020. 11:1137. [Medline].
Rodà D, Pérez-Martínez E, Cabrerizo M, Trallero G, Martínez-Planas A, Luaces C, et al. Clinical characteristics and molecular epidemiology of Enterovirus infection in infants <3 months in a referral paediatric hospital of Barcelona. Eur J Pediatr. 2015 Nov. 174 (11):1549-53. [Medline].
Hamilton MS, Jackson MA, Abel D. Clinical utility of polymerase chain reaction testing for enteroviral meningitis. Pediatr Infect Dis J. 1999 Jun. 18(6):533-7. [Medline].
Sawyer MH, Holland D, Aintablian N, et al. Diagnosis of enteroviral central nervous system infection by polymerase chain reaction during a large community outbreak. Pediatr Infect Dis J. 1994 Mar. 13(3):177-82. [Medline].
Schlesinger Y, Sawyer MH, Storch GA. Enteroviral meningitis in infancy: potential role for polymerase chain reaction in patient management. Pediatrics. 1994 Aug. 94(2 Pt 1):157-62. [Medline].
Chiang PS, Huang ML, Luo ST, Lin TY, Tsao KC, Lee MS. Comparing molecular methods for early detection and serotyping of enteroviruses in throat swabs of pediatric patients. PLoS One. 2012. 7(10):e48269. [Medline]. [Full Text].
Pevear DC, Tull TM, Seipel ME, Groarke JM. Activity of pleconaril against enteroviruses. Antimicrob Agents Chemother. 1999 Sep. 43(9):2109-15. [Medline]. [Full Text].
National Institutes of Health. Effects of Pleconaril Nasal Spray on Common Cold Symptoms and Asthma Exacerbations Following Rhinovirus Exposure (Study P04295AM2). Clinical Trials.gov. Available at http://www.clinicaltrials.gov/ct/gui/show/NCT00394914. Accessed: May 9, 2008.
Abzug MJ, Cloud G, Bradley J, et al. Double blind placebo-controlled trial of pleconaril in infants with enterovirus meningitis. Pediatr Infect Dis J. 2003. 22:335-41. [Medline].
Abzug MJ. Presentation, diagnosis, and management of enterovirus infections in neonates. Paediatr Drugs. 2004. 6:1-10. [Medline].
Abzug MJ, Levin MJ, Rotbart HA. Profile of enterovirus disease in the first two weeks of life. Pediatr Infect Dis J. 1993 Oct. 12(10):820-4. [Medline].
Cherry J. Enteroviruses. Remington J, Klein J, eds. Infectious Diseases of the Fetus and Newborn Infant. 4th ed. Philadelphia, Pa: WB Saunders Co; 1995: 404-46.
Cherry J. Enteroviruses: Coxsackieviruses, Echoviruses and Polioviruses. Feigin R, Cherry J, eds. Textbook of Pediatric Infectious Diseases. 4th ed. Philadelphia, PA: WB Saunders Co; 1998. 1787-839.
Dagan R. Nonpolio enteroviruses and the febrile young infant: epidemiologic, clinical and diagnostic aspects. Pediatr Infect Dis J. 1996 Jan. 15(1):67-71. [Medline].
Estrada B. Enteroviral Meningitis: Time for PCR?. Infect Med. 1999. 16:493.
Frisk G, Tuvemo T. Enterovirus infection with beta-cell tropic strains are frequent in siblings of children diagnosed with type 1 diabetes children and in association with elevated levels of GAD65 antibodies. J Med Virol. 2004. 73:450-9. [Medline].
Joki-Korpela P, Hyypia T. Diagnosis and epidemiology of echovirus 22 infections. Clin Infect Dis. 1998 Jul. 27(1):129-36. [Medline].
Krajden S, Middleton P. Enterovirus Infections in the Neonate. Clin Pediatr. 1982. 22:87-92.
Modlin J. Coxsackieviruses, echoviruses and newer enteroviruses. Mandell G, Bennett J, Dolin R. Douglas and Bennett's Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone; 1995. 1620-36.
Modlin J. Enteroviruses: Coxsackieviruses, echoviruses, and newer enterovirus. Long S, Pickering L, Prober C, eds. Principles and Practice of Pediatric. 1st ed. 1997.
Modlin JF. Perinatal echovirus infection: insights from a literature review of 61 cases of serious infection and 16 outbreaks in nurseries. Rev Infect Dis. 1986 Nov-Dec. 8(6):918-26. [Medline].
Modlin JF. Update on enterovirus infections in infants and children. Adv Pediatr Infect Dis. 1996. 12:155-80. [Medline].
Onishi N, Hosoya M, Sato K, et al. First report of an outbreak of aseptic meningitis caused by echovirus type 13 in Japan. Pediatr Int. 2003 Aug. 45(4):494-6. [Medline].
Paananen A, Ylipaasto P, Rieder E, et al. Molecular and biological analysis of echovirus 9 strain isolated from a diabetic child. J Med Virol. 2003. 69:529-37. [Medline].
Pichichero ME, McLinn S, Rotbart HA, et al. Clinical and economic impact of enterovirus illness in private pediatric practice. Pediatrics. 1998 Nov. 102(5):1126-34. [Medline].
Rabkin CS, Telzak EE, Ho MS, et al. Outbreak of echovirus 11 infection in hospitalized neonates. Pediatr Infect Dis J. 1988 Mar. 7(3):186-90. [Medline].
Rotbart HA. Enteroviral infections of the central nervous system. Clin Infect Dis. 1995 Apr. 20(4):971-81. [Medline].
Sawyer MH. Enterovirus infections: diagnosis and treatment. Pediatr Infect Dis J. 1999 Dec. 18(12):1033-9; quiz 1040. [Medline].
Shah SS, Gallagher PG. Neonatal sepsis due to echovirus 18 infection. J Perinat Med. 1997. 25(4):381-4. [Medline].
Verboon-Maciolek MA, Swanink CM, Krediet TG, et al. Severe neonatal echovirus 20 infection characterized by hepatic failure. Pediatr Infect Dis J. 1997 May. 16(5):524-7. [Medline].

Media Gallery

of 0

Author

Jorge M Quinonez, MD Senior Vice President and Chief Medical Officer, Family Health Centers of Southwest Florida, Inc

Jorge M Quinonez, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America

Disclosure: Received consulting fee from Glaxo Smith Kline for speaking and teaching.

Specialty Editor Board

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.

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, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics, Novavax, Regeneron, Diassess, Actelion<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Leonard R Krilov, MD Chief of Pediatric Infectious Diseases and International Adoption, Vice Chair, Department of Pediatrics, Winthrop University Hospital; Professor of Pediatrics, Stony Brook University School of Medicine

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, Society for Pediatric Research

Disclosure: Nothing to disclose.

Pediatric Echovirus Treatment & Management

Medical Care

Follow-up care

About

Membership

Apps

WebMD Network

Editions

Pediatric Echovirus Treatment & Management

Medical Care

Follow-up care

References

Tables

Contributor Information and Disclosures

What would you like to print?

Find Us On

About

Membership

Apps

WebMD Network

Editions