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Chapter 8 : Enteroviruses
Category: Clinical Microbiology
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The genus Enterovirus is currently comprised of 68 distinct serotypes within the family Picornaviridae. Enterovirus (EV) infections occur worldwide, although rates of infections may vary noticeably by location and are seasonal in nature. Clinical syndromes associated with EV infection in immunocompromised hosts such as primary B-cell-associated immunodeficiencies, transplant recipients and malignancy have been provided in this chapter. Among hereditary B-cell-associated immunodeficiency syndromes, X-linked agammaglobulinemia (XLA), common variable and severe combined immunodeficiency syndromes, and X-linked hyper-immunoglobulin M (XHIM) syndrome have been associated with persistent progressive EV infection. Of one cardiac transplant and seven stem cell transplant recipients with radiographic evidence of lower respiratory tract disease due to EV, five developed acute respiratory distress syndrome (ARDS), three required mechanical ventilation, and three died. Viral pneumonia is a frequent complication in patients undergoing intensive chemotherapy for treatment of hematologic malignancies. Available laboratory diagnostic techniques to identify EV infection include nucleic acid detection, culture, serology, and antigen detection. Nucleic acid amplification methods, such as reverse transcription-polymerase chain reaction (RT-PCR) and nucleic acid sequence-based amplification, have replaced culture-based techniques as the gold standard for detection of EV, given the significant increase in sensitivity and the rapid turnaround time. The recent availability of real-time PCR methods has further facilitated the rapid and sensitive detection of EV in the cerebrospinal fluid (CSF) and other types of specimens.
Classification of the genus Enterovirus
Clinical syndromes associated with EV infection in immunocompromised hosts and reported EV serotypes
Performance characteristics of selected real-time PCR assays for detection of EV RNA