Overview
Enteroviral encephalomyelitis encompasses severe neurological manifestations caused by enteroviruses, including meningitis, encephalitis, and myocarditis, often presenting acutely but potentially persisting or recurring 13.Diagnosis
Clinical Presentation: Meningitis, encephalitis, myocarditis, pleurodynia, and systemic febrile illness 34.
Laboratory Tests:
- Culture-Negative Cases: Utilize seminested PCR for detecting enterovirus RNA, even in culture-negative samples 1.
- Serology: Monitor antibody titers for evidence of recent infection, especially in paired sera showing significant increases 4.
Imaging and Other Tests: Not specifically detailed in abstracts provided.Management
Supportive Care: Focus on symptom management including neurological support, cardiac monitoring, and fluid/electrolyte balance 13.
Antiviral Therapy: No specific antiviral treatments mentioned in the abstracts; management remains largely supportive 13.
Monitoring: Regular clinical and laboratory monitoring to assess disease progression and response to supportive care 13.Special Populations
Pediatrics: Enteroviral infections in early infancy can be severe, often manifesting as meningitis or systemic disease, with Coxsackie B and echoviruses being predominant 3.
Immunocompromised: Susceptibility to chronic and persistent infections noted, highlighting the importance of sensitive diagnostic tools like PCR 1.
Pregnancy: Potential vertical transmission leading to severe neonatal outcomes, such as myocarditis, is documented 4.Key Recommendations
Utilize seminested PCR for diagnosing enteroviral infections, especially in culture-negative cases to confirm persistent or chronic infections (Evidence: Strong 1).
Monitor antibody titers in paired sera to detect recent enteroviral infections, particularly useful in confirming disease causality [Evidence: Moderate 4].
Employ supportive care measures tailored to the clinical presentation, including neurological and cardiac support, given the severity of enteroviral encephalomyelitis (Evidence: Expert opinion).References
1 Leparc I, Aymard M, Fuchs F. Acute, chronic and persistent enterovirus and poliovirus infections: detection of viral genome by seminested PCR amplification in culture-negative samples. Molecular and cellular probes 1994. link
2 Beck MA, Tracy SM. Evidence for a group-specific enteroviral antigen(s) recognized by human T cells. Journal of clinical microbiology 1990. link
3 Morens DM. Enteroviral disease in early infancy. The Journal of pediatrics 1978. link80422-3)
4 McLean DM, Coleman MA, Larke RP, McNaughton GA. Viral infections of Toronto children during 1965. I. Enteroviral disease. Canadian Medical Association journal 1966. link