Medical Care
No specific antiviral medication or treatment is yet available for an enteroviral infection. The best care is provided through supportive measures and through ruling out bacterial infection and rationalizing antimicrobial use. Fluid hydration and analgesia are the mainstays of care for a viral syndrome.
In patients with severe illness, if a bacterial infection is suspected, antibiotics are administered at the physician’s discretion or according to local guidelines. Test results, such as polymerase chain reaction (PCR) test results from cerebrospinal fluid (CSF) samples, require 24 hours to return, and a positive result does not necessarily eliminate a bacterial infection. Thus, the use of cultures is important.
Corticosteroids have been proposed to have a beneficial effect on myocarditis, but no significant improvement has been demonstrated. Furthermore, because of deleterious side effects, steroids are not recommended for treatment.
Pleconaril is a capsid-binding antiviral agent with activity against most strains of enterovirus. One small randomized, controlled trial of pleconaril in newborns with suspected enterovirus has shown some efficacy, although further data are needed. [33] At present, it is not being manufactured. Many potential targets for anti-enteroviral treatments have been identified; however, a very small number have been pursued in clinical trials. [33] EV-71 specific immunoglobulin has been investigated in mice; however, clinical trials in humans are awaited. [34]
Vaccines are also in development against EV-71 and have been subject to clinical trials in China with promising results. [35, 36] The vaccines appeared safe and reduced the burden of associated hand-foot-and-mouth disease and herpangina. Further data are needed to assess the vaccines’ impact on neurologic disease caused by EV-71.
The best medical care involves continued efforts for worldwide poliovirus vaccination.
Consultations
If poliomyelitis is suspected, consultation with a neurologist and a physical medicine specialist is helpful. Furthermore, CDC notification is required because they are responsible for virus surveillance. The CDC investigates cases of suspected polio and helps to identify the etiology of the case.
For nonpoliovirus enteroviruses, no consultations are specifically required, but the physician should address individual clinical situations.
Diet and Activity
Diet
Patients can continue with a normal diet. Soft foods and liquids are appeasing to children with herpangina.
Activity
As with any illness, children should avoid vigorous activity that may contribute to fluid losses and exhaustion.
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Erosions on the base of the tongue.
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A red halo surrounds several vesicles on the finger flexures and palms.
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Small linear vesicle on the thumb.
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Vesicle on the dorsal hand of a young adult.
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Calf blisters from coxsackievirus A6 as seen in atypical hand-foot-mouth disease. Courtesy of Elsevier (Feder HM Jr, Bennett N, Modlin JF. Atypical hand, foot, and mouth disease: a vesiculobullous eruption caused by Coxsackie virus A6. Lancet Infect Dis. Jan 2014;14(1):83-6).
