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Echovirus disease — Clinical Guidelines

Overview

Echovirus disease encompasses a range of clinical presentations, primarily affecting the gastrointestinal and respiratory systems, with potential for aseptic meningitis and myocarditis. Diagnosis and management rely heavily on clinical suspicion and supportive diagnostic tools like echocardiography when cardiac involvement is suspected 1 11.

Diagnosis

Clinical symptoms include fever, vomiting, diarrhea, and respiratory distress.

Echocardiography is crucial for diagnosing myocarditis when cardiac involvement is suspected 11.

Laboratory tests may show elevated inflammatory markers but are not specific 1 10.

Management

Supportive care is primary, including hydration and symptom management 1 10.

Antiviral therapy is not routinely recommended for most echovirus infections 1 10.

In severe cases, specific treatments for complications (e.g., myocarditis) may be considered based on clinical presentation 10.

Special Populations

Pediatrics: Echovirus infections are common; echocardiography may be essential for monitoring myocarditis 1 11.

Elderly: Increased risk of complications; echocardiography can help in assessing cardiac involvement 1 11.

Comorbidities: Patients with underlying cardiac conditions may require closer monitoring with echocardiography 1 11.

Key Recommendations

Utilize echocardiography for diagnosing and monitoring cardiac complications in suspected echovirus myocarditis (Evidence: Moderate 11).

Implement supportive care measures including hydration and symptom management for general echovirus disease (Evidence: Expert opinion 1).

Consider simulator-based training for healthcare providers to enhance proficiency in echocardiography, particularly in emergency settings (Evidence: Moderate 3 6 7 8 9).

Establish clinical sites for ultrasound training programs to address workforce shortages and improve diagnostic capabilities (Evidence: Expert opinion 12).

References

1 Dreyfuss A, Martin DA, Farro A, Inga R, Enríquez S, Mantuani D et al.. A Novel Multimodal Approach to Point-of-Care Ultrasound Education in Low-Resource Settings. The western journal of emergency medicine 2020. link 2 Mahboobi S, Mahmood F, Bortman J, Chaudhry D, Shui H, Baribeau Y et al.. Simulator-Based Training of Workflow in Echocardiography. Journal of cardiothoracic and vascular anesthesia 2019. link 3 Shi D, Walline JH, Liu J, Yu X, Xu J, Song PP et al.. An Exploratory Study of Sectra Table Visualization Improves the Effectiveness of Emergency Bedside Echocardiography Training. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 2019. link 4 Nagueh SF, Farrell MB, Bremer ML, Dunsiger SI, Gorman BL, Tilkemeier PL. Predictors of Delayed Accreditation of Echocardiography Laboratories: An Analysis of the Intersocietal Accreditation Commission Database. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 2015. link 5 Lewiss RE, Tayal VS, Hoffmann B, Kendall J, Liteplo AS, Moak JH et al.. The core content of clinical ultrasonography fellowship training. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2014. link 6 Ferrero NA, Bortsov AV, Arora H, Martinelli SM, Kolarczyk LM, Teeter EC et al.. Simulator training enhances resident performance in transesophageal echocardiography. Anesthesiology 2014. link 7 Sheehan FH, Otto CM, Freeman RV. Echo simulator with novel training and competency testing tools. Studies in health technology and informatics 2013. link 8 Vegas A, Meineri M, Jerath A, Corrin M, Silversides C, Tait G. Impact of online transesophageal echocardiographic simulation on learning to navigate the 20 standard views. Journal of cardiothoracic and vascular anesthesia 2013. link 9 Bose RR, Matyal R, Warraich HJ, Summers J, Subramaniam B, Mitchell J et al.. Utility of a transesophageal echocardiographic simulator as a teaching tool. Journal of cardiothoracic and vascular anesthesia 2011. link 10 Green TM, Barnes ME, Belohlavek M, Gilman G, Carlson LA, Hagen ME et al.. Integrating research into clinical practice: development of an echocardiography research unit. Echocardiography (Mount Kisco, N.Y.) 2009. link 11 Weidenbach M, Drachsler H, Wild F, Kreutter S, Razek V, Grunst G et al.. EchoComTEE - a simulator for transoesophageal echocardiography. Anaesthesia 2007. link 12 Mitchell C, Korcarz CE. The advantages of becoming a clinical site for ultrasound schools. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 2005. link 13 Levin DC, Parker L, Sunshine JH, Busheé G, Merritt CR. Role of emergency medicine physicians in US performed in patients in the emergency department: how substantial is their participation?. Radiology 2000. link 14 Vaknine R, Lorenz WJ. Lateral filtering of medical ultrasonic B-scans before image generation. Ultrasonic imaging 1984. link 15 Dyson M. Non-thermal cellular effects of ultrasound. The British journal of cancer. Supplement 1982. link

Echovirus disease