FX Excursions

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Enterovirus Infection

by Mary Gallagher, RN, MSN, CCRN

Jul 1, 2018
Health

ENTEROVIRUSES ARE VIRUSES that enter the body through the gastrointestinal tract and live there, often moving on to attack the nervous system. These viruses are small, made up of ribonucleic acid and protein. The polioviruses are enteroviruses. In addition to the three different polio viruses, there are non-polio enteroviruses that can cause disease in humans, including coxsackieviruses and echoviruses.

Enterovirus infections are common in the United States during summer and fall. Non-polio enteroviruses are common, causing 10–15 million infections and tens of thousands of hospitalizations each year. Most infected people do not get sick or have mild illness, like the common cold. But some people experience serious complications, especially infants and people with weakened immune systems.

Infants, children and teenagers are more likely than adults to get infected and become sick because they do not yet have immunity from previous exposure to the viruses. Adults can get infected, too, but are less likely to have symptoms, or their symptoms may be milder. Symptoms of mild illness include fever, runny nose, sneezing, cough, skin rash, mouth blisters and body and muscle aches.

Some non-polio enterovirus infections can cause viral conjunctivitis; hand, foot and mouth disease; viral meningitis (infection of the covering of the spinal cord or brain); viral encephalitis (infection of the brain); myocarditis (infection of the heart); pericarditis (infection of the sac around the heart); acute flaccid paralysis (a sudden onset of weakness in one or more arms or legs); and inflammatory muscle disease (slow, progressive muscle weakness). Infants and people with weakened immune systems have a greater chance of experiencing these complications.

People who develop myocarditis may have heart failure and require long-term care. Some people who develop encephalitis or paralysis may not fully recover. Newborns infected with a nonpolio enterovirus may develop sepsis (the body’s overwhelming response to infection, which can lead to tissue damage, organ failure and death), but this is rare. Non-polio enterovirus infections may play a role in the development of type 1 diabetes in children.

Non-polio enteroviruses can be found in an infected person’s feces; eye, nose and mouth secretions such as saliva, nasal mucus or sputum; and blister fluid. You may be exposed to the virus through close contact — such as touching or shaking hands — with an infected person; touching objects containing the virus then touching your eyes, nose or mouth before washing your hands; changing diapers of an infected person; and drinking water contaminated with the virus.

Pregnant women infected with a non-polio enterovirus shortly before delivery can pass the virus to their babies. Mothers who are breastfeeding should talk with their doctor if they are sick or think they have an infection.

If you become infected, you can shed the virus in your stool for several weeks or longer. You can shed the virus from your respiratory tract, such as through coughing or sneezing, for one to three weeks or less. Many people infected with non-polio enteroviruses do not have symptoms but can still spread the virus to other people. The best way to protect yourself and others is to wash your hands often with soap and water, especially after using the toilet and changing diapers; avoid close contact such as touching people who are sick; and cleaning and disinfecting frequently touched surfaces.

The Centers for Disease Control and Prevention recommend the following hand-washing method: Wet your hands with clean, running water (warm or cold), turn off the tap and apply soap. Lather your hands by rubbing them together with the soap, including the backs of your hands, between your fingers and under your nails. Scrub your hands for at least 20 seconds (hum the “Happy Birthday” song twice). Rinse your hands well under clean, running water. Dry your hands using a clean towel or air-dry them.

If soap and water are not available, use hand sanitizer containing at least 60 percent alcohol. Alcohol-based sanitizers can quickly reduce the number of germs on hands in some situations but do not eliminate all types of germs and might not remove harmful chemicals. Hand sanitizers are not as effective when hands are visibly dirty or greasy. Apply the product to the palm of one hand (read the label for the correct amount), rub your hands together and rub the product over all surfaces of your hands and fingers until your hands are dry.

There is no vaccine to protect you from nonpolio enterovirus infection, nor is there specific treatment. People with mild illness caused by non-polio enterovirus infection typically only need supportive treatment for symptoms. Drink enough water to stay hydrated and take over-thecounter cold medications as needed. Most people recover completely. However, some illnesses caused by non-polio enteroviruses are severe enough to require hospitalization.

If you are concerned about your symptoms, contact your health care provider, who will assess your condition. You will be asked about your recent health history and symptoms. Non-polio enteroviruses can be detected in stool or rectal swabs and respiratory specimens. Depending on symptoms, other specimen types such as cerebrospinal fluid, blister fluid and blood can be tested. A positive laboratory test for non-polio enteroviruses from certain specimens, such as rectal or respiratory swab, does not necessarily mean the virus is the cause of infection, as the viruses can be shed for an extended time after symptoms resolve.

The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition

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