Enterovirus Infection in Children: Symptoms, Treatment, and Diagnostic Approach

Clinical Presentation

Enterovirus infections in children typically begin with fever, accompanied by respiratory symptoms, gastrointestinal symptoms, and rash in approximately 37% of cases, presenting as small pink macules evolving to vesicular lesions characteristic of hand, foot, and mouth disease, according to the American Academy of Pediatrics 1
The American Academy of Pediatrics recommends that peak incidence occurs in late summer and early fall, which is a critical period for increased vigilance 1

Aseptic meningitis is more common than encephalitis in enterovirus infections, but severe neurological complications can occur and require urgent recognition, as stated by the Centers for Disease Control and Prevention 1
The American Academy of Neurology notes that meningoencephalitis presents with disturbances in consciousness and seizures 1
Enterovirus 71 rhombencephalitis manifests with myoclonus, tremors, ataxia, and cranial nerve defects, according to the World Health Organization 1
Acute flaccid myelitis (AFM) causes rapid limb weakness with low muscle tone, particularly associated with Enterovirus-D68 and Enterovirus-71, as reported by the Centers for Disease Control and Prevention 1

The Infectious Diseases Society of America recommends that no specific antiviral treatment is recommended for enterovirus encephalitis in most cases; supportive care remains the mainstay of treatment, though pleconaril or intravenous immunoglobulin may be considered in patients with severe disease 2
Supportive care is the primary treatment for most enterovirus infections, according to the American Academy of Pediatrics 2
Patients with falling level of consciousness require urgent assessment by pediatric Intensive Care Unit staff for airway protection, ventilatory support, management of raised intracranial pressure, and correction of electrolyte imbalances, as stated by the Society of Critical Care Medicine 2

The Centers for Disease Control and Prevention recommends that all patients with suspected encephalitis should have CSF PCR testing for HSV (1 and 2), VZV, and enteroviruses, as this will identify 90% of known viral cases 4
Throat and rectal swabs for enterovirus investigations should be considered in all patients with suspected viral encephalitis, according to the Infectious Diseases Society of America 4
Diagnosis of enterovirus radiculoneuropathy relies on CSF PCR for enterovirus detection, not serum antibody testing, with results available within 24-48 hours, as reported by the American Academy of Neurology 3