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Advice for doctors from Dr. John Chia to aid in the diagnosis of both acute and chronic enteroviral infections:

  • Most of the acute enteroviral infections, even in the case of poliovirus infections, are asymptomatic (no sickness.)
  • The diagnosis of acute symptomatic infection is usually suspected and empirically diagnosed based on the physician's assessment of the patient along with outbreaks of other cases in the community, known exposure risks, geographic locations (next to a river and lake) and age groups.
  • Ulcerations of the mouth (stomatitis), especially over the lining of the cheeks, tongue ulcers, blisters of the soft palate or the roof of the mouth (herpangina) are helpful signs of acute enteroviral infection.
  • Pediatricians can often diagnose enteroviral infections in young children since they are trained to recognize these infections.
  • All "flu-like illnesses" are not the same, and can be caused by a number of infectious agents. With effective influenza vaccination, the numbers of influenza cases have decreased dramatically. Most of the respiratory infections in the winter or summer are not due to influenza but other respiratory viruses or mycoplasma. Whereas acute influenza symptoms rarely last more than one week, acute enteroviral infections often last much longer than one or two weeks.
  • Acute enteroviral infection can present with respiratory and/or gastrointestinal symptoms or just flu-like symptoms (fevers, body ache, headache etc.). Few viral infections present with respiratory and GI symptoms. An enteroviral infection should be suspected if the same symptoms recur every month.
  • Diagnostic testing plays a role in enteroviral infections. As newer methods have demonstrated increased sensitivities, determining viral etiologies of aseptic meningitis and neonatal sepsis has resulted in improved patient care.
  • Cell culture (growth of the actual virus), serology (antibody testing of the blood), and polymerase chain reaction (PCR, a special viral gene test) can confirm acute enteroviral infections. Enteroviruses are found in the stool, the pharynx, blood, and the cerebrospinal fluid.
  • In the past, the standard of virus isolation has been cell cultures, but cultures take approximately 3-8 days to grow the enterovirus, and the identification of the particular type of enterovirus is usually not done for a long time afterwards.
  • Virus isolation from blood is not very helpful because the viral levels may be undetectable by the time symptoms have appeared. Pharyngeal viral levels remain present from 2 days to 2 weeks after the infection. Stool isolation of enteroviruses is not specific to acute infections because viral stool shedding persists for as long as 3 months after the infection.
  • Another method, serologic testing, uses two blood samples to identify a rise of antibody levels over a 2- to 4-week period. A single level of enteroviral antibodies can be present in a healthy patient; therefore, monitoring the serology to identify a 4-fold increase in levels is needed. We can only identify 11 of the 70+ Human enteroviruses by this method. Furthermore, waiting for periods of 2-4 weeks for tissue results is not useful in improving patient care.
  • In contrast, the reverse transcriptase PCR testing is designed to detect a common genetic area of most of the enteroviruses. The results could be available in 24 hours, making detection more sensitive (95%), more specific (97%), and more time efficient. FDA has approved this test for diagnosing enterovirus meningitis. For other body fluids (stool, respiratory secretions and blood), the yield is less certain.
  • Measure cardiac and muscle enzymes in a patient with heart and muscle symptoms. Enteroviruses are the usual pathogen of the heart and skeletal muscles. Other viruses can affect the heart.