Among the enteroviruses include coxsackie A1-A21, A24 and B1 – 6 echo virus (enteric cytopathic human orphan viruses *) 1-7, 9, 11-21, 24-27 and 29-33 // * “Orphan” is originally for non-pathogenic viruses. The historical name has been retained, although the viruses mentioned now humanpothegene significance could be demonstrated. Enteroviruses 68-71, 73-91 and 100-101 poliovirus types 1-3 are enteroviruses, as well as the rhinoviruses (flu), and human Parechoviren, picornaviruses (The nomenclature of these RNA viruses was due to their small size: pico = small) , Humane Parechoviren types 1 and 2 were previously referred to as echovirus 22 and 23, but have now reclassified. All enteroviruses are antigenically heterogeneous and geographically widespread. Enteroviruses are excreted through respiratory secretions and stool and sometimes in the blood and cerebrospinal fluid of infected patients present. The infection can generally take place through direct contact with respiratory secretions or stool, but can also be transmitted through contaminated environmental sources (eg., Water). In the US and Europe diseases and epidemics occur by enteroviruses in summer and autumn. Infections that are transmitted from the mother during birth can cause severe disseminated infection of the newborn, possibly including hepatitis, liver necrosis, meningoencephalitis, myocarditis or a combination. An intact humoral immunity and B-cell function are for the control of enteroviral diseases of paramount importance. Severe enteroviral infections (often manifested as slowly progressive encephalitis) occur in patients with agammaglobulinemia, but usually not in those suffering from other immune. caused by enteroviruses Enteroviruses diseases can cause various syndromes (see table: enteroviruses caused Syndrome). Which are almost exclusively caused by enteroviruses: Epidemic Pleurodynia hand, foot and mouth disease Herpangina poliomyelitis Other conditions (eg, aseptic meningitis, myopericarditis.) Can be caused both by enteroviruses or by other pathogens. Enteroviruses caused Syndrome Syndrome serotypes that are most involved aseptic meningitis Coxsackie A2, 4, 7, 9 and others and B2-5 poliovirus types 1-3, ECHO viruses 4, 6, 7, 9, 11, 30 and other human Parechoviren 1-4 Aseptic meningitis rash with coxsackievirus A9 B4 and ECHO viruses 4 and 16 enterovirus 71 conjunctivitis (haemorrhagic) enterovirus 70 coxsackie A24 Bornholm disease (Bornholm disease) Coxsackievirus B1-6 hand, foot and mouth disease Coxsackieviruses A6, 16 and other Coxsackieviruses B2-5 Enterovirus 71 Coxsackie A2 Herpangina, 4-6, 8 and 10 probably coxsackie B3 and other myopericarditis Coxsackie A4 and 16 and B1-5 and human echoviruses 9 Parechovirus 1 flaccid paralysis polioviruses 1-3 Cox sackieviren A7 and other echoviruses 4, 6, 9 and other enterovirus 71 rash Coxsackieviruses A9 and B1, 3, 4 and 5 (also involved: A4-6 and 16) ECHO viruses 9 and 16 (also involved: 2, 4 , 11, 14, 19 and 25) airway disorders echoviruses 4, 8, 9, 11, 20 and other Coxsackievirus A21 and 24, and B1 and 3-5 enterovirus D68 Aseptic meningitis Aseptic meningitis is most common in infants and children. In infants and young children, the cause is often one of the following: Coxsackievirus Group A or B An echo virus Human parechovirus In older children and adults, other enteroviruses as well as other viruses can cause of aseptic meningitis. The course is usually benign. In an enteroviral aseptic meningitis an accompanying rash may occur. Rarely there is a potentially serious encephalitis. Enterovirus D68 D68 enterovirus (EV-D68) causes a respiratory illness, especially in children; The symptoms are similar in general to those of a common cold (eg. as cold, cough, malaise, fever in some children). Some children, especially those with asthma have severe symptoms that affect the lower respiratory tract (eg. As wheezing, shortness of breath). Healthy adults can be infected, but they usually have few or no symptoms. Immunocompromised adults can cause serious respiratory problems. Every year, respiratory infections, which are caused by EV-D68, has been identified in some children. However, in 2014 more than 1,000 cases have been confirmed in a large outbreak in the US in late summer and autumn. Severe respiratory distress developed in a substantial number of children and EV-D68 has been detected in samples of some of the children who died. In addition, developed a few children after respiratory disease, focal limb weakness or paralysis with spinal cord injuries (in MRI to see); EV-D68 was identified in respiratory samples in about half of cases. It is unclear whether the EV-D68 infection represented the main cause of death or paralysis or whether the virus was present at random in children who had other diseases. Investigations to determine the cause of death and the neurological symptoms are not yet complete. Hemorrhagic conjunctivitis predominantly hemorrhagic Kunjunktivitis in Asia, Africa and Europe enters this disease as an epidemic. Cases in Germany are often imported from outside Europe. The eyelids swell rapidly. A hemorrhagic conjunctivitis often results, as opposed to a simple conjunctivitis to subconjunctival hemorrhages or keratitis, which causes pain, increased lacrimation, and photophobia. A systemic disease is rare. However, a transient lumbosacral radiculitis, that is, a poliomyelitis disease was isolated, in cases where a hemorrhagic conjunctivitis caused by enterovirus 70, the described (with paralysis). Usually it comes within 1-2 weeks after disease onset to a complete remission. Coxsackievirus A24 also causes hemorrhagic conjunctivitis, subconjunctival hemorrhage occurs here but less frequent and neurological complications were not described. Most patients recover within 1-2 weeks. Myopericarditis Cardiac infection can occur at any age, but the peak incidence is in the 20-39-year-olds. In the patients chest pain, cardiac arrhythmias, heart failure or sudden death may occur. The remission is usually complete, but some patients develop dilated cardiomyopathy. The diagnosis can by reverse transcriptase (RT) PCR are secured to the heart muscle. Myocarditis neonatorum (cardiac infection at birth) is of coxsackie virus group B, causing some echo virus and human Parechoviren. The disease is accompanied by fever and often with associated heart failure and has a high mortality rate. Most neonatal infections developed the newborn a few days after the birth of a syndrome that resembles a sepsis, fever, lethargy, disseminated intravascular coagulation, bleeding and multiple (including heart) organ failure. At the same time it can cause central nervous system, hepatic, myocardial, pancreatic or adrenal lesions come. It may come within a few weeks of recovery, but also to deaths due to circulatory collapse or, at a liver involvement, due to liver failure. Certain rashes coxsackie viruses, ECHO viruses viruses and human Parechoviren cause rashes, often during epidemics. Rashes usually do not go with itching associated not scale and occur on the face, neck, chest and extremities area. They are occasionally maculopapular or morbilliform, sometimes hemorrhagic, petechial or vesicular. Also fever is common. Simultaneous an aseptic meningitis may develop. The course is usually benign. Respiratory infections These infections can be caused by enteroviruses. The symptoms include fever, runny nose, pharyngitis and, in some infants and children, vomiting and diarrhea. In children and adults, there are occasional bronchitis and interstitial pneumonia. The course is usually mild. Diagnosis Clinical Investigation Sometimes culture or reverse transcriptase-PCR (RT-PCR) The diagnosis of enterovirus-related diseases is made clinically. The laboratory diagnosis is not generally required, but can often be made by cultivating the virus detection of viral RNA by RT-PCR Less commonly, shows seroconversion enteroviruses, which cause an aseptic meningitis, can in a sample from the throat, stool, blood or Liquor be detected by RT-PCR tests of blood and CSF However, human Parechoviren not be identified by means of the most standard RT-PCR assays for enteroviruses; there are specific RT-PCR assays for Parechoviren required. Therapy Supportive Treatment of enterovirus-caused disease is supportive. Patients with agammaglobulinemia be with i.v. Immunoglobulins treated with varying degrees of success.


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