Enteroviruses

Enteroviruses are a group of viruses that commonly infect the gastrointestinal tract but can affect various parts of the body, including the nervous system, respiratory system, and skin. These viruses are highly contagious and are especially prevalent among children. While many enteroviral infections are mild or even asymptomatic, some can lead to serious health conditions such as meningitis, encephalitis, and myocarditis.

With over 100 identified types, enteroviruses are among the most common viral pathogens worldwide. Outbreaks are particularly frequent during the summer and autumn months. Although the majority of cases resolve on their own, recognising the signs and seeking timely medical care can help prevent complications.

Enteroviruses belong to the Picornaviridae family and are non-enveloped RNA viruses. They spread mainly through the faecal-oral route, but can also be transmitted via respiratory secretions. Common illnesses caused by enteroviruses include hand, foot and mouth disease (HFMD), herpangina, viral meningitis, and poliomyelitis.

Because enteroviruses can affect multiple organs, symptoms can vary widely, ranging from a simple cold to neurological or cardiac involvement. These infections are more common in infants and children due to underdeveloped immunity.

Worldwide Prevalence

Enteroviral infections are found across the globe, with millions of cases reported each year. According to the World Health Organization (WHO), enteroviruses cause an estimated 10 to 15 million symptomatic infections annually. Outbreaks of hand, foot and mouth disease and viral meningitis are common in Asia, Europe, and North America.

Poliovirus, a well-known member of the enterovirus group, has been largely eradicated in most countries thanks to widespread vaccination, though isolated cases still occur in some regions.

Prevalence in India

In India, enteroviral infections are common, particularly among children under five. Outbreaks of hand, foot and mouth disease have been reported in various states including Kerala, Maharashtra, and Tamil Nadu. India remains polio-free since 2014, but surveillance continues for non-polio enteroviruses (NPEVs), which still cause cases of viral meningitis and other complications.

There are over 100 types of enteroviruses, but they are commonly grouped into the following categories:

1. Polioviruses (Types 1, 2, and 3)
   
   • Cause poliomyelitis
   • Now largely controlled through vaccination
2. Coxsackieviruses (A and B)
   
   • Coxsackie A: HFMD, herpangina
   • Coxsackie B: Pericarditis, myocarditis, meningitis
3. Echoviruses
   
   • Commonly cause viral meningitis, rash illnesses
4. Enteroviruses 68 to 71 and others
   
   • EV-D68: Respiratory illnesses, neurological complications
   • EV-A71: Associated with severe HFMD and encephalitis

Enteroviruses are caused by infection with viruses from the Picornaviridae family. Transmission typically occurs through:

• Faecal-oral route: Ingestion of virus-contaminated food or water
• Respiratory droplets: Coughing, sneezing, or close contact
• Direct contact: With infected surfaces or bodily fluids

Poor hygiene, inadequate sanitation, and crowded living conditions increase the risk of spread. The virus multiplies in the gut and can then spread to other parts of the body.

The symptoms of enterovirus infections vary depending on the specific virus and the organ systems affected.

General Symptoms:

• Fever
• Fatigue
• Sore throat
• Headache
• Muscle aches
• Vomiting or diarrhoea

Disease-Specific Symptoms:

• Hand, Foot and Mouth Disease (HFMD): Blister-like rash on hands, feet, and mouth
• Herpangina: Painful ulcers in the mouth
• Viral Meningitis: Stiff neck, light sensitivity, confusion
• Myocarditis/Pericarditis: Chest pain, shortness of breath
• Poliomyelitis: Paralysis, muscle weakness

In some cases, especially in infants and people with weak immune systems, symptoms can become severe and life-threatening.

Diagnosis is based on a combination of clinical evaluation and laboratory testing.

Diagnostic Methods:

• Throat swab or stool sample: Virus isolation and culture
• PCR test: Detects enteroviral RNA in blood, cerebrospinal fluid, or other tissues
• Serology: Checks for antibodies against specific enteroviruses
• Lumbar puncture: In suspected meningitis cases to analyse cerebrospinal fluid

Timely diagnosis helps guide treatment and control outbreaks.

There is no specific antiviral treatment for most enterovirus infections. Management is generally supportive and focuses on relieving symptoms.

Standard Treatments:

• Rest and hydration
• Paracetamol or ibuprofen: For fever and pain relief. (Brutex 200mg Tablet)
• Antiemetics: To control vomiting.(Ondem 4mg Tablet)
• Antibiotics: Only used if there is a secondary bacterial infection

Hospitalisation:

Required in cases of severe complications like encephalitis, myocarditis, or severe dehydration. Intravenous fluids, respiratory support, and monitoring may be needed.

Alternative therapies cannot replace medical treatment but may provide additional symptom relief.

• Herbal teas and warm fluids: May soothe sore throat and aid hydration
• Probiotics: Can help restore gut health, particularly in gastrointestinal infections
• Nutritional supplements: Zinc and vitamin C to support immune function

These should be used under the guidance of a healthcare provider.

The following factors increase the risk of contracting enterovirus infections:

• Age (infants and young children are most susceptible)
• Poor hygiene and sanitation
• Crowded environments (schools, daycare centres)
• Immunocompromised state (e.g., HIV, cancer therapy)
• Lack of prior exposure or immunity
• Travel to areas with active outbreaks

Though many enterovirus infections are mild, serious complications can occur:

• Meningitis
• Encephalitis
• Myocarditis and pericarditis
• Acute flaccid paralysis (AFP)
• Neonatal sepsis-like illness
• Chronic fatigue syndrome (in some viral persistence cases)

These complications often require intensive care and prolonged recovery.

Most people recover quickly from enterovirus infections, but in cases of complications, longer-term care is needed.

• Follow your doctor’s treatment plan closely
• Stay well-hydrated and rest adequately
• Maintain personal hygiene to prevent spreading the infection
• Monitor for warning signs of worsening symptoms
• Keep children home from school or daycare until they recover

Supportive care and healthy habits can ease recovery and reduce recurrence risk.

1. "Enteroviruses only affect the intestines."
   
   
   • False. They can impact the brain, heart, lungs, and skin.
      
2. "Only children get infected."
   
   
   • While more common in children, adults can also be infected.
      
3. "Antibiotics can treat enteroviruses."
   
   
   • Antibiotics do not work on viruses.
      
4. "Once infected, you are immune to all enteroviruses."
   
   
   • Immunity is type-specific. One infection does not protect against others.
      
5. "Enteroviruses are always severe."
   
   
   • Many cases are mild or asymptomatic.

Consult a healthcare provider if you or your child experience:

• High fever that doesn’t subside
• Severe headache, stiff neck, or confusion
• Difficulty breathing or chest pain
• Vomiting and diarrhoea lasting more than 2 days
• Signs of dehydration (dry mouth, low urine output)

Early medical attention helps reduce complications.

• What type of enterovirus might I have?
• Are there any tests needed to confirm the diagnosis?
• How long will the symptoms last?
• What are the risks of complications?
• Is hospitalisation necessary?
• How can I prevent spreading it to others?

Support during recovery can make a big difference:

• Offer emotional reassurance, especially to children
• Ensure proper rest and hydration
• Help manage symptoms with medications and comfort measures
• Keep them isolated to prevent spread
• Monitor closely for worsening symptoms

In severe cases, help them access follow-up care and specialist support.

Enteroviruses are a widespread group of viruses that typically cause mild illness but can lead to serious complications in certain cases. Understanding the symptoms, transmission routes, and prevention methods can help reduce the spread and impact of these infections. While there is no specific antiviral treatment, most people recover with supportive care.

Public health efforts, good hygiene, and timely medical care are essential for managing enteroviral infections. Staying informed and cautious, especially during seasonal outbreaks—can go a long way in protecting yourself and your loved ones.