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Overview of Enterovirus Infections

By

Brenda L. Tesini

, MD, University of Rochester School of Medicine and Dentistry

Last full review/revision Jul 2021| Content last modified Jul 2021
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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 many different viruses.

  • Symptoms of enterovirus infections include fever, headache, respiratory illness, 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 is aimed at relieving 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.

Transmission

Enteroviruses are spread (transmitted) in various ways. These viruses are spread by

  • Swallowing food or water contaminated with stool from an infected person

  • Touching a contaminated surface, then touching the mouth

  • Inhaling contaminated airborne droplets

Surfaces can become contaminated by saliva from an infected person or droplets expelled when an infected person sneezes or coughs.

Symptoms of Enterovirus Infections

Sometimes enteroviruses survive immune defenses and spread 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.

Diagnosis of Enterovirus Infections

  • A doctor's evaluation

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.

Treatment of Enterovirus Infections

  • Symptom relief

There is no cure for enterovirus infections. Treatment of enterovirus infections is directed at relieving symptoms.

Enteroviral infections usually resolve completely, but infections of the heart or central nervous system are occasionally fatal.

Diseases Caused by Enteroviruses

The following diseases are caused almost exclusively by enteroviruses:

Aseptic meningitis

Meningitis is inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid space). Aseptic meningitis Viral Meningitis Viral meningitis is inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid space) when it is caused... read more refers to meningitis that is caused by anything other than the bacteria that typically cause 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 also develop a viral brain infection (encephalitis Encephalitis Encephalitis is inflammation of the brain that occurs when a virus directly infects the brain or when a virus, vaccine, or something else triggers inflammation. The spinal cord may also be involved... read more ).

Encephalitis

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, typically with only a slight fever if any. Some children, particularly those who have asthma Asthma in Children Asthma is a recurring inflammatory lung disorder in which certain stimuli (triggers) inflame the airways and cause them to temporarily narrow, resulting in difficulty breathing. Asthma triggers... read more Asthma in Children , have more serious symptoms such as wheezing and difficulty breathing. Adults can be infected, but they tend to have few or no symptoms.

There was an increase in severe illnesses caused by enterovirus D68 in 2014 and 2018. Some of the infected children had severe respiratory distress. In addition, in some children the spinal cord was affected, causing weakness or paralysis of one of their arms or legs, and several children died. Doctors are not sure whether the enterovirus infection was the main cause of these complications or whether the virus merely happened to be present in children who also had other disorders.

Epidemic pleurodynia (Bornholm disease)

Epidemic pleurodynia 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 return within a few days and continue or return for several weeks.

Hemorrhagic conjunctivitis

Hemorrhagic conjunctivitis Infectious Conjunctivitis Infectious conjunctivitis is inflammation of the conjunctiva usually caused by viruses or bacteria. Bacteria and viruses can infect the conjunctiva. Redness and tearing or discharge are common... read more Infectious Conjunctivitis involves inflammation of the eyes. The eyelids swell rapidly. This disease may lead to bleeding (hemorrhage Subconjunctival Hemorrhage Subconjunctival hemorrhages are small accumulations of blood beneath the conjunctiva (the membrane that lines the eyelid and covers the front of the eye). Sometimes the whole eye appears red... read more Subconjunctival 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.

Herpangina

Herpangina 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. Despite the name, this enteroviral disease has nothing to do with herpesvirus infection or the heart problem called angina.

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 similar to sepsis Sepsis in Newborns Sepsis is a serious bodywide reaction to infection spread through the blood. Newborns with sepsis appear generally ill—they are listless, do not feed well, often have a gray color, and may have... read more . They have fever, are very sleepy, and have bleeding, and the virus can damage parts of many organs and tissues, causing multiple organ failure (including heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more Heart Failure (HF) ).

Newborns may recover within a few weeks, but death may occur, particularly if heart failure or other severe organ damage is present.

Myopericarditis

Myopericarditis is inflammation of the heart muscle (myocardium) and/or the sac that covers the heart (pericardium).

Newborns who are affected at birth (myocarditis neonatorum) have fever and heart failure. Heart failure causes difficulty breathing and poor feeding. Many infants die.

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