Enteroviruses in Humans


Enteroviruses are significant ribonucleic acid (RNA) viral pathogens of humans with a worldwide distribution. Humans are the only known hosts for the enteroviruses. Their major route of infection is that of the faecal–oral route. In temperate climates enteroviral infection occurs primarily in the summer and early fall. Infants represent the majority of cases. Enteroviral infection results in viremia and prolonged gastrointestinal shedding of the virus. Enteroviral syndromes involve almost every organ system. Although the majority of infections are asymptomatic or result in a self‐limited infection, fatalities do occur. Especially in neonates or individuals with B‐cell immunodeficiencies. Advances in technology are providing improved understanding of their taxonomy, epidemiology and means of detection.

Key Concepts:

  • Enteroviruses have RNA genomes. The 5′NTR of the enteroviruses contain areas of conserved nucleotide identity.

  • Originally five species were described within the genus: polioviruses, the group A and B coxsackievirus, the echoviruses and the numbered enteroviruses. Using modern molecular virologic methods the species have been redefined and novel members of the genus have been identified.

  • Enteroviruses have a worldwide distribution and exhibit strong seasonality. The coding sequence of VP1 is used for the detailed analysis of enteroviruses.

  • Humans are the sole reservoir for the enteroviruses. Infections by enteroviruses are significantly higher in infants.

  • Faecal–oral transmission is the major mode of transmission of the enteroviruses. Infection results in prolonged shedding of the enteroviruses.

  • Understanding the pathophysiology of the enteroviruses is based on the study of prototypic members of the genus: the polioviruses.

  • The major determinant of susceptibility to the enteroviruses is the presence of the receptor required for viral attachment.

  • Reverse transcription‐polymerase chain reaction (RT‐PCR) has replaced tissue culture and mouse inoculation for detection of the enteroviruses. RT‐PCR is more sensitive and faster for the detection of the enteroviruses than tissue culture or mouse inoculation.

  • RT‐PCR diagnosis of enteroviral infections can significantly impact on patient care.

  • Management of enteroviral infections is supportive in nature.

Keywords: enteroviruses; epidemiology; diagnosis; treatment; pleconaril


Abzug MA (2004) Presentation, diagnosis, and management of enterovirus infections in neonates. Pediatric Drugs 6: 1–10.

Barnard DL (2006) Current status of anti‐picornavirus therapies. Current Pharmaceutical Design 12: 1379–1390.

Begier EM, Oberste MS, Landry ML et al. (2008) An outbreak of concurrent echovirus 30 and coxsackievirus A1 infections associated with sea swimming among a group of travelers to Mexico. Clinical Infectious Diseases 47: 616–623.

Caggana M, Chan P and Ramsingh A (1993) Identification of a single amino acid residue in the capsid protein VP1 of coxsackievirus B4 that determines the virulent phenotype. Journal of Virology 67: 4797–4803.

Chu PY, Ke GM, Chen YS et al. (2010) Molecular epidemiology of Coxsackievirus B3. Infection, Genetics and Evolution 10: 777–784.

Committee on the ECHO viruses – National Foundation for Infantile Paralysis (1955) Enteric Cytopathic Human Orphan (ECHO) viruses. Science 122: 1187–1188.

Dalldorf G and Sickles GM (1948) An unidentified, filterable, agent isolated from the feces of children with paralysis. Science 108: 61–62.

Desmond RA, Accortt NA, Talley L et al. (2006) Enterovirus meningitis: natural history and outcome of pleconaril therapy. Antimicrobial Agents Chemotherapy 50: 2409–2417.

Dunn JJ, Bradrick SS, Chapman NM et al. (2003) The stem loop II within the 5′ nontranslated region of clinical Coxsackievirus B3 genomes determines cardiovirulence phenotype in a murine model. Journal of Infectious Diseases 187: 1552–1561.

Fowles AL, Honarmand S, Glaser C et al. (2008) Enterovirus‐associated encephalitis in the California encephalitis project, 1998–2005. Journal of Infectious Diseases 198: 1685–1691.

Grist NR, Bell EJ and Assaas F (1978) Enteroviruses in human disease. Progress in Medical Virology 24: 114–157.

Hauri AM, Schimmelpfennig M, Walter‐Domes M et al. (2005) An outbreak of viral meningitis associated with a public swimming pond. Epidemiology & Infection 133: 291–298.

Hyypia T, Horsnell C, Maaronen M et al. (1992) A distinct picornavirus group identified by sequence analysis. Proceedings of the National Academy of Sciences of the USA 89: 8847–8851.

Kee F, McElroy G, Stewart D et al. (1994) A community outbreak of echovirus infection associated with an outdoor swimming pool. Journal of Public Health Medicine 16: 145–148.

Khetsuriani N, LaMonte‐Folwkes A, Oberste MS and Pallansch M (2006b) Neonatal enterovirus infections reported to the National Surveillance System in the United States, 1983–2003. Pediatric Infectious Diseases Journal 25: 889–893.

Khetsuriani N, LaMonte‐Folwkes A, Oberste MS et al. (2006a) Enterovirus Surveillance – United States, 1970–2005. Morbidity and Mortality Weekly Report 55(SS‐8): 1–24.

Knowles N (2011). Picornaviridae: Enterovirus. http://www.picornaviridae.com/enterovirus/enterovirus.htm

Knowles NJ, Hove T, King AMQ and Stanway G (2010) Overview of taxonomy. In: Ehrenfeld E, Domingo E and Roos RP (eds) The Picornaviruses, pp. 19–32. Washington, DC: American Society of Microbiology.

Melnick JL, Shaw EW and Curnen EC (1949) A virus isolated from patients diagnosed as non‐paralytic poliomyelitis or aseptic meningitis. Proceeding of the Society of Experimental Biology and Medicine 71: 344–349.

Mirkovic RR, Kono R, Yin‐Murphy M et al. (1973) Enterovirus type 70: the etiologic agent of pandemic acute haemorrhagic conjuctivitis. Bulletin of the World Health Organization 49: 341–346.

Morens DM and Pallansch MA (1995) Epidemiology. In: Rotbart HA (ed.) Human Enterovirus Infections, pp. 3–23. Washington, DC: American Society for Microbiology.

Oberste MS, Maher K and Pallansch MA (1998) Complete sequence of echovirus 23 and its relationship to echovirus 22 and other human enteroviruses. Virus Research 56: 217–223.

Oberste MS, Maher K, Kennett ML et al. (1999a) Molecular epidemiology and genetic diversity of echovirus type 30 (E30): genotypes correlate with temporal dynamics of E30 isolation. Journal of Clinical Microbiology 37: 3928–3933.

Oberste MS, Maher K, Kennett ML et al. (1999d) Molecular epidemiology and genetic diversity of echovirus type 30 (E30): genotypes correlate with temporal dynamics of E30 isolation. Journal of Clinical Microbiology 37: 3928–3933.

Oberste MS, Maher K, Kilpatrick DR and Pallansch MA (1999c) Molecular evolution of the human enteroviruses: correlation of serotype with VP1 sequence and application to picornavirus classification. Journal of Virology 73: 1941–1948.

Oberste MS, Maher K, Kilpatrick DR et al. (1999b) Typing of human enteroviruses by partial sequencing of VP1. Journal of Clinical Microbiology 37: 1288–1293.

Oberste MS, Nix WA, Kilpatrick DR et al. (2003) Molecular epidemiology and type‐specific detection of echovirus 11 isolates from the Americas, Europe, Africa, Australia, southern Asia and the Middle East. Virus Research 91: 241–248.

Papa A, Skoura L, Dumaidi K et al. (2009) Molecular epidemiology of Echovirus 6 in Greece. European Journal of Clinical Microbiology and Infectious Diseases 28: 683–687.

Powell RM, Ward T, Goodfellow I, Almond JW and Evans DJ (1999) Mapping the binding domains on decay accelerating factor (DAF) for haemagglutinating enteroviruses; implications for the evolution of a DAF‐binding phenotype. Journal of General Virology 80: 3145–3152.

Racaniello VR (2007) Picornaviridae: the viruses and their replication. In: Fields BN, Knipe DM and Howley PM et al. (eds) Fields Virology, 5th edn, pp. 795–838. Philadelphia: Lippincott Williams & Wilkins.

Ramers C, Billman G, Hartin M et al. (2000) Impact of a diagnostic cerebrospinal fluid enterovirus polymerase chain reaction test on patient management. Journal of the American Medical Association 283: 2680–2685.

Rico‐Hesse R, Pallansch MA, Nottay BK and Kew OM (1987) Geographic distribution of wild poliovirus type 1 genotypes. Virology 160: 311–322.

Rogers JM, Diana GD and McKinlay MA (1999) Pleconaril. A broad spectrum antipicornaviral agent. Advances in Experimental Medicine and Biology 458: 69–76.

Romero JR (1999) Reverse‐transcription polymerase chain reaction detection of the enteroviruses. Archives of Pathology and Laboratory Medicine 123: 1161–1169.

Romero JR (2001) Pleconaril: a novel antipicornaviral drug. Expert Opinion in Investigational Drugs 10: 369–379.

Romero JR (2009) Enteroviruses. In Richman DD, Whitley RJ and Hayden FG (eds) Clinical Virology, 3rd edn, pp. 1031–1062. Washington, DC: American Society for Microbiology Press.

Rotbart HA, Webster AD and Pleconaril Treatment Registry Group (2001) Treatment of potentially life‐threatening enterovirus infections with pleconaril. Clinical Infectious Diseases 32: 228–235.

van der Sanden S, Koopmans M, Uslu G et al. (2009) Epidemiology of enterovirus 71 in the Netherlands, 1963 to 2008. Journal of Clinical Microbiology 47: 2826–2833.

Stanway G and Hyypia T (1999) Parechoviruses. Journal of Virology 73: 5249–5254.

Stellrecht KA, Lamson DA and Romero JR (2011) Entroviruses and parechoviruses. In: Murray PR, Baron EJ, Jorgensen JH, Landry ML and Pfaller MA (eds) Manual of Clinical Microbiology, 10th edn, pp. 1388–1399. Washington, DC: American Society for Microbiology.

Yeung WC, Rawlinson WD and Craig ME (2011) Enterovirus infection and type 1 diabetes mellitus: systematic review and meta‐analysis of observational molecular studies. British Medical Journal 342: 1–9.

Further Reading

Cherry JD and Krogstad P (2009) Enteroviruses and Parechoviruses. In: Feigin RD, Cherry JD, Demmler‐Harrison GJ and Kaplan SL (eds) Textbook of Pediatric Infectious Diseases, 5th edn, pp. 2110–2170. Philadelphia: WB Saunders.

Coller BA, Chapman NM, Beck MA et al. (1990) Echovirus 22 is an atypical enterovirus. Journal of Virology 64: 2692–2701.

Rotbart HA (ed.) (1995) Human Enterovirus Infections. Washington, DC: ASM Press.

Rotbart HA, Romero JR, Modlin JF and Sawyer MH (1999) Clinical and pharmacologic considerations for viral meningitis. Infections in Medicine 16(suppl. D): 1–32.

Contact Editor close
Submit a note to the editor about this article by filling in the form below.

* Required Field

How to Cite close
Romero, José R(Jan 2012) Enteroviruses in Humans. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0002230.pub2]