Enterovirus Infections

Abstract

The human enteroviruses (EV) comprise one group of the picornavirus family. The best known members are the polioviruses (PV), coxsackieviruses, and echoviruses. They replicate in the oropharynx and gastrointestinal (GI) tract and are primarily spread by fecal-hand-oral contamination. With systemic invasion nonspecific febrile illness occurs as well as specific syndromes (rashes, hand-footand-mouth disease, herpangina, pleurodynia, myocarditis/pericarditis, and conjunctivitis). With systemic replication a high level viremia may result in central nervous system (CNS) invasion. EV activity can be endemic in warm climates or epidemic in temperate climates. In temperate climates, because of improved hygiene, newborns were not exposed to EV until they were older, resulting in large epidemics of poliomyelitis, which were finally curtailed with the killed PV vaccines in the 1950s and the live oral PV vaccines in the 1960s. Today, "aseptic" meningitis is the most common neurologic syndrome caused by EV. EV are also the most common cause of viral meningitis. Other EV neurologic syndromes include encephalitis, rhombencephalitis, paralytic disease, persistent infections, and the severe group B coxsackievirus fatal systemic infections of neonates. Diagnostic clues can come from epidemics, systemic manifestations, household infections, the cerebrospinal picture, and the neurologic syndrome. However, definite diagnosis depends on laboratory methods, primarily nucleic acid amplification. Treatment of acute infections is supportive. Preventative methods include good hygiene and aggressive polio vaccination programs.

Varicella-zoster virus transverse myelitis in an immunocompetent patient

“…It is known to occur against a background of viral diseases, vaccinations, systemic lupus erythematosus, vasculitis, multiple sclerosis, heroin abuse and trauma. 5 Approximately 25%-40% cases of transverse myelitis are caused by viral infections with herpes viruses and poliovirus. Varicella zoster infection is not a common cause of transverse myelitis in immunocompetent patients.…”

A Case of Neuro-Behçet’s Disease Mimicking Meningitis

“…Nörolojik tutulum, tüm BH tanısı konulmuş olguların ortalama %20'sinde görülmektedir. Genellikle aseptik menenjit, ensefalit, kraniyal sinir paralizileri ve ataksi gibi fokal defisitler ile seyretmektedir (9). Santral tutulumu olanların yaklaşık %12'si bulgu vermemektedir (10).…”

“…Meninkslerde, perivasküler boşluklarda, bazal gangliyonlarda, serebellumda inflamatuar reaksiyon, gangliyon hücrele-rinde dejeneratif değişiklikler yapar. Hastalarda konvülziyon, mental konfüzyon, afazi ve hemiparezi izlenebilir (9). Baş ağ-rısı NBH'de en sık görülen nörolojik yakınmayı oluşturur (13).…”

“…Lenfosit ya da nötrofil hakimiyeti olabilir. Orta derecede protein artışı, fakat normal glikoz değerleri görülür (9). Buradaki olguda klinik bulgularının yanı sıra oldukça yüksek ESR ve hafif düzeyde anemi saptanmıştır.…”