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Enterovirus Infections in Children

By Mary T. Caserta, MD, Professor of Pediatrics, Division of Infectious Diseases; Attending Physician, University of Rochester School of Medicine and Dentistry; Golisano Children’s Hospital at Strong, University of Rochester Medical Center

Enterovirus infections affect many parts of the body and may be caused by any of several different strains of enterovirus.

  • Enterovirus infections are caused by viruses.

  • Symptoms of enterovirus infections include fever, headache, and sore throat and sometimes mouth sores or a rash.

  • Doctors base the diagnosis on symptoms and on examination of the skin and mouth.

  • Treatment of enterovirus infections aims to relieve symptoms.

The enteroviruses include numerous strains of coxsackievirus, echovirus, enterovirus, and poliovirus. These viruses are responsible for illness in 10 to 30 million people each year in the United States, primarily in the summer and fall. Infections are highly contagious and typically affect many people in a community, sometimes reaching epidemic proportions. Enteroviral infections are most common among children.

The infection begins when material contaminated with the virus is swallowed. The virus then reproduces in the digestive tract. The body's immune defenses stop many infections at this stage, and the result is few or no symptoms. Colds and upper respiratory infections are common outcomes of infection with enteroviruses. Sometimes, the virus survives and spreads into the bloodstream, resulting in fever, headache, sore throat, and, at times, vomiting and diarrhea. People often refer to such illnesses as the "summer flu," although they are not influenza.

Some strains of enterovirus also cause a generalized, nonitchy rash on the skin or sores inside the mouth. This type of illness is by far the most common enteroviral infection. Rarely, an enterovirus progresses from this stage to attack a particular organ. The virus can attack many different organs, and the symptoms and severity of disease depend on the specific organ infected.

To diagnose enterovirus infections, doctors examine any rashes or sores. Doctors may do blood tests or send samples of material taken from the throat, stool, or cerebrospinal fluid to a laboratory for culture and testing.

Enteroviral infections usually resolve completely, but infections of the heart or central nervous system are occasionally fatal. There is no cure. Treatment of enterovirus infections is directed at relieving symptoms.

Diseases Caused by Enteroviruses

Epidemic pleurodynia, hand-foot-and-mouth disease, herpangina, and poliomyelitis are caused almost exclusively by enteroviruses. Other diseases, such as aseptic meningitis, myopericarditis, and hemorrhagic conjunctivitis, may be caused by enteroviruses or other organisms.

Enterovirus D68

Enterovirus D68 causes a respiratory illness in children that usually resembles a cold. Children have a runny nose, cough, and generally feel ill, but only about 20% develop fever. Some children, particularly those who have asthma, have more serious symptoms such as wheezing and difficulty breathing. Adults can be infected, but they tend to have few or no symptoms.

Although every year some children develop infections caused by enterovirus D68, in the late summer and fall of 2014 there were over 1,000 cases identified in the United States. Some of the infected children had severe respiratory distress. In addition, some children developed weakness or paralysis of one of their arms or legs. Also, enterovirus D68 was detected in specimens from 14 children who died of severe respiratory illnesses. Doctors are not sure whether the enterovirus infection was the main cause of the reported deaths or the cases of paralysis or whether the virus merely happened to be present in children who also had other disorders.

Hand-foot-and-mouth disease

This disease can be caused by many different enteroviruses and is most common among young children. A common symptom of hand-foot-and-mouth disease is fever. This disease affects the skin and mucous membranes, causing painful sores to appear inside the mouth, on the hands and feet, and occasionally on the buttocks or genitals. Children have a sore throat or mouth pain and may refuse to eat. The sores usually heal quickly.

Depending on which virus causes this disease, children may also develop nervous system infections such as meningitis or encephalitis.


This disease most commonly affects infants and children. Children suddenly develop fever with a sore throat, headache, loss of appetite, and frequently neck pain. Infants may vomit. Within 2 days of the start of the disease, grayish bumps develop inside the mouth and throat. The bumps become painful sores, which heal in 1 to 7 days.

Aseptic meningitis

Aseptic meningitis refers to meningitis that is caused by anything other than the bacteria that typically cause meningitis (see also Viral Meningitis). This disease is most common among infants and children. Aseptic meningitis that is caused by an enterovirus rarely causes a rash. Aseptic meningitis causes fever, severe headache, vomiting, a stiff neck, and sensitivity to light. Children may rarely develop encephalitis.


This disease is inflammation of the brain (see also Encephalitis), causing fever, vomiting, headache, confusion, weakness, seizures, and coma.

Paralytic poliomyelitis ( polio )

This disease affects the nervous system. Common symptoms of polio include deep muscle pain, pins-and-needles sensations, and weakness of various muscles.


This disease is inflammation of the heart muscle (myocardium) and/or the sac that covers the heart (pericardium). Newborns who are affected at birth have fever and heart failure. Heart failure causes difficulty breathing and poor feeding. Many infants die.

Epidemic pleurodynia (Bornholm disease)

This disease is most common among children. Epidemic pleurodynia affects the muscles of the chest, causing severe pain, often on one side of the lower chest or upper abdomen making breathing uncomfortable. Other common symptoms of epidemic pleurodynia include fever and often headache and a sore throat. Symptoms usually lessen in 2 to 4 days but may recur within a few days and continue or recur for several weeks.

Hemorrhagic conjunctivitis

This disease involves inflammation of the eyes. The eyelids swell rapidly. This disease may lead to bleeding (hemorrhage) under the clear membrane that covers the white part of the eye (conjunctiva), causing the eye to become red. The infection may also affect the clear, curved layer in front of the pupil (the cornea), causing eye pain, tearing, and pain with exposure to bright light. Depending on which enterovirus causes the disease, people rarely develop a brief period of weakness or paralysis of their legs. People usually recover in 1 to 2 weeks.

Infection in the newborn

Sometimes mothers pass on enteroviruses to their newborn during delivery. Usually, several days after birth, infected newborns suddenly develop a severe, generalized illness (sepsis). They have fever, are very sleepy, have bleeding, and develop multiple organ (including heart) failure. Parts of organs and tissues may become damaged. Newborns may recover within a few weeks, but death may occur.