The enteroviruses are a large group of viruses that infect and cause illness in tens of millions of people every year, mostly in the summer and fall.
Infection with enterovirus typically causes a cold or upper respiratory tract infection that may be mistaken for the flu.
In 2014, however, some children who were infected with a particular strain enterovirus D68 (EV-D68) developed more serious symptoms, including wheezing and difficulty breathing.
A few also developed neurological symptoms, including muscle weakness and paralysis. However, it has not been proven that EV-D68 was the cause of those symptoms.
By late October, the Centers for Disease Control and Prevention (CDC) had confirmed more than 900 cases of EV-D68 infection, including seven people who died.
EV-D68 is one of more than 100 non-polio enteroviruses. (Poliovirus, which causes polio, is also an enterovirus).
EV-D68 was first identified in California in 1962, and small numbers of cases have been reported regularly to the CDC since 1987.
In the past ten years, incidence of the virus has been increasing. Clusters of EV-D68 have been reported in Southeast Asia, Europe, and Africa, as well as in North America.
Beginning in August 2014 and continuing through October, the United States experienced an outbreak of serious respiratory illness that was caused mainly by EV-D68.
The outbreak ultimately spread to more than 45 states and affected more than 900 people who became ill, including seven who died, the CDC reports.
The illness mainly affected children, and many of those children had asthma or a history of wheezing.
In most cases the illness resembled a bad cold or flu, but some children developed trouble breathing, and some had neurological symptoms such as facial drooping, muscle weakness, and paralysis.
Doctors were surprised to see EV-D68 associated with these symptoms, because it had not been previously.
Viruses mutate constantly, and experts believe its possible that a new strain of EV-D68 has developed that causes more severe illness and is more easily transmitted from one person to another.
Genetic tests being conducted by the CDC were expected to show whether and how the EV-D68 circulating in 2014 differed from previous years.
EV-D68 is not the only enterovirus thats becoming more common.
In the past 15 years, large outbreaks of enterovirus A71 (EV-A71) have been reported in the Asia-Pacific region.
Normally, EV-A71 causes relatively minor illness, mostly in children.
But the virus appears to be rapidly evolving, and some of the new variants called genogroups and subgenogroups have been associated with high rates of illness and fatal cases of encephalitis (inflammation of the brain).
In 2012, four cases of illness caused by the EV-A71 C4 strain were identified in infants in France, according to the CDC. Previously, this strain had circulated extensively in China, but rarely in Europe.
The researchers who studied the medical records of the four French infants called for increased monitoring of EV-A71 infections in Europe, including monitoring for the possible introduction and circulation of new EV-A71 genogroups and subgenogroups.
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Enterovirus infections often have no symptoms, especially in adults. In people who do have symptoms, they are usually mild, resembling the common cold. Some people experience an illness more like the flu.
Symptoms of an enterovirus infection may include:
While most cases of enterovirus get better with rest and normal at-home care, in some people the illness can become very serious and require immediate medical attention.
You should especially watch out for severe illness in infants and people with weak immune systems. Precautions should be taken for children with asthma or other lung problems, too, because they are more likely than others to develop serious breathing problems.
More severe symptoms may include:
Serious but less common complications can include the central nervous system and heart. Its possible for the virus to infect the brain (causing encephalitis) or inflame the membranes that envelop the spinal cord and brain (causing meningitis), which may have a broad range of neurological symptoms.
The virus can also inflame the sac around the heart (causing pericarditis), or even infect the heart muscle (causing myocarditis). Symptoms may include fatigue, rapid heartbeat, chest pain, shortness of breath, or swelling in the feet, ankles, or legs.
Symptoms of enterovirus infection tend to be more severe in children than in adults, but most children can still be treated with supportive care at home. However, parents should seek immediate medical attention for children who develop any of the following respiratory symptoms:
Enterovirus D68 (EV-D68), which caused a nationwide outbreak of severe respiratory illness in 2014, was notable for causing these symptoms in some children, particularly those with asthma or other lung conditions.
Its also important to seek medical help for anyone who develops neurological symptoms, such as:
In the 2014 outbreak, a small number of children who tested positive for EV-D68 developed these symptoms, although it was not absolutely certain they were caused by the virus.
When doctors dont know the diagnosis of a patient who has severe enterovirus-like symptoms, they might do a test to identify the disease and find out how to treat it. The test may entail taking a nasal or throat swab, collecting a stool sample, or doing a spinal tap.
There are antiviral medications that can be used to help treat severe cases of many types of enterovirus infections.
However, they were not effective against the EV-D68 enterovirus that caused the 2014 outbreak. Instead, diagnostic tests of nasal and throat swabs were used mainly to help public health officials track the spread of the virus.
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There is no medication that specifically treats enteroviral infections.
Most cases of enterovirus get better on their own with common at-home supportive measures, such as rest, fluids, and the use of nonprescription drugs to help with symptoms, such as ibuprofen (Advil) or acetaminophen (Tylenol) for pain.
Antibiotics should not be used because they are useless against any viral infection, including enterovirus.
Medical attention should be sought, however, if the illness becomes serious. Most of the severe cases are in infants, adults with weak immune systems, or children who already have lung problems, such as asthma.
Those experiencing severe respiratory problems may need to be hospitalized.
While there are antiviral drugs that may be used against viruses including enterovirus, none of them have been proven useful against enterovirus D68 (EV-D68) the strain of enterovirus responsible for the 2014 outbreak according to the Centers for Disease Control and Prevention (CDC).
Enteroviruses are most likely passed from one person to another when an infected person coughs, sneezes, or touches a surface that is then touched by others.
An enteroviral infection starts when material contaminated with the virus is swallowed. The virus reproduces in the digestive tract then if it is not killed by the immune system enters the bloodstream and begins to cause symptoms.
It only takes the tiniest bit of infected material a drop of saliva too small to see with the naked eye, for example to transmit a virus to a new host.
The same hygienic routines are recommended to prevent the spread of enteroviruses as those used to prevent the spread of colds and flu:
There is no vaccine for enteroviral infection. The flu vaccine is important to protect against the influenza viruses that cause the flu, but it will not protect against enteroviruses.
People who have asthma a condition in which certain triggers cause the airways to become inflamed and narrowed are more vulnerable to respiratory illnesses generally.
The 2014 outbreak of EV-D68 caused particularly severe respiratory illness in children with asthma.
The CDC had special advice for parents of children with asthma to prepare for the possibility of EV-D68 infection. The advice is important even in years with less severe enterovirus outbreaks as well:
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Source: http://www.everydayhealth.com
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