2. Enteroviruses
A genus of the picornavirus family
Naked ssRNA virus
Are stable in acidic pH
Enter the body mainly via ingestion
Primary site of replication is lymphoid
tissue in the gut.
Spread to blood and into lumen of gut to
be excreted in feces
4. At least 71 serotypes are known:
divided into 5 groups
Polioviruses
Coxsackie A viruses
Coxsackie B viruses
Echoviruses
Enteroviruses
Enteroviruses
5.
6. Poliovirus
First identified in 1909
First grown in cell culture in 1949 which
became the basis for vaccines.
3 serotypes of poliovirus (1, 2, and 3)
but no common antigen.
Humans are the only susceptible hosts.
Polioviruses are distributed globally.
Immunization has eradicated poliovirus
in most regions of the world except in
the Indian Subcontinent and Africa.
7. Pathogenesis
Incubation period : 7 - 14 days.
After ingestion, the virus multiplies
in the tonsils and Peyer's patches of
the ileum
Transient viraemia occurs
In few cases, involves the CNS
Spreads along axons of peripheral
nerves to involve anterior horn cells
of spinal cord, intermediate grey
ganglia and even posterior horn cells
9. Clinical Manifestations
Subclinical infection (90 - 95%)
A minor influenza-like illness
Recovers within a few days
May be accompanied by aseptic meningitis
Major illness (1 - 2%)
Signs of aseptic meningitis.
Infection of anterior horn cells: flaccid paralysis.
Infection of medulla: respiratory paralysis and death.
10. Laboratory Diagnosis
Virus Isolation
Mainstay of diagnosis
Can be readily isolated in cell culture
from throat swabs, feces, rectal swabs
& CSF.
Serology
Very rarely used
12. Prevention
No specific antiviral therapy is available.
Intramuscular Poliovirus Vaccine (IPV)
Formalin inactivated virus of all 3 serotypes.
Oral Poliovirus Vaccine (OPV)
Consists of live attenuated virus of all 3 serotypes.
Produces local immunity through the induction of
an IgA response as well as systemic immunity.
13. Prevention
The normal response rate to OPV is
close to 100%.
OPV is used for the WHO poliovirus
eradication campaign.
Poliovirus was targeted for eradication
by the WHO by the end of year 2005
Eradicated from most regions of the
world except the Indian subcontinent
and sub-Saharan Africa.
17. Coxsackieviruses
Coxsackieviruses are distinguished from other
enteroviruses by their pathogenicity for suckling rather
than adult mice.
Two groups on the basis of the lesions in suckling mice.
Group A: diffuse myositis with acute inflammation
and necrosis of fibers of voluntary muscles. Has 23
serotypes
Group B: focal areas of degeneration in the brain,
necrosis in the skeletal muscles, and inflammatory
changes in the dorsal fat pads, the pancreas and
occasionally the myocardium. Have 6 serotypes
18. Echoviruses
Were accidentally discovered in human
feces, unassociated with human disease
during epidemiological studies of
polioviruses. The viruses were named
echoviruses (enteric, cytopathic, human,
orphan viruses).
Altogether, There are 32 echoviruses
(types 1-9, 11-27, 29-34
19. New Enteroviruses
Newly identified picornaviruses that are not
polioviruses, coxsackie, and echovirus : 5
types (68 - 72).
Enterovirus 70 causes acute haemorrhagic
conjunctivitis
Enterovirus 71 has been associated with
epidemics of aseptic meningitis, encephalitis,
paralytic poliomyelitis-like disease and
hand-foot-mouth disease.
21. Laboratory Diagnosis
Virus Isolation
Mainstay of diagnosis of enterovirus infection
Coxsackie B and Echoviruses can be readily grown in cell culture from
throat swabs, feces, and rectal swabs. They can also be isolated from the
CSF
Coxsackie A viruses cannot be easily isolated in cell culture. Can be
isolated readily in suckling mice. Molecular techniques may provide a
better alternative.
Serology
Very rarely used for diagnosis since cell culture is efficient.
Neutralization tests or EIAs
23. Management and Prevention
No specific antiviral therapy available
IVIG in the treatment of neonatal
infections or severe infections in
immunocompromised individuals.
HNIG to prevent outbreaks of
neonatal infection with good results.
No vaccine available