From the Guidelines
Echovirus infections are typically managed with supportive care, as there are no specific antiviral medications approved, and treatment focuses on relieving symptoms and preventing complications. The management of echovirus infections, particularly in the context of neurological involvement, is crucial for preventing severe outcomes. According to the guidelines for the management of encephalitis by the Infectious Diseases Society of America 1, the approach to echovirus infections, which are part of the enterovirus family, involves supportive care. This includes rest, adequate hydration, and the use of over-the-counter pain relievers such as acetaminophen or ibuprofen to manage symptoms like fever and discomfort.
Key considerations in the management of echovirus infections include:
- The recognition of severe symptoms that may indicate complications such as meningitis, including severe headache, neck stiffness, persistent high fever, or unusual drowsiness.
- The importance of practicing good hand hygiene and avoiding close contact with others while symptomatic to prevent transmission, given that echovirus spreads through the fecal-oral route and respiratory droplets.
- The potential for the virus to remain contagious for several weeks after symptoms resolve, emphasizing the need for continued hygiene practices.
In specific cases, such as agammaglobulinemia, where patients are more susceptible to severe enteroviral infections, including echovirus, treatment with high doses of intravenous immunoglobulin (IVIG) containing measurable antibody to the infecting virus is recommended 1. This approach is particularly relevant for managing chronic enteroviral meningoencephalitis, which can be caused by echoviruses in these immunocompromised patients.
For diagnostic purposes, sampling should be performed according to clinical manifestations, and as soon as possible after symptom onset, including the collection of specimens such as stool, CSF, and blood for EV testing 1. This comprehensive approach to diagnosis and management is critical for optimizing outcomes in patients with echovirus infections, particularly those at higher risk of severe disease.
From the Research
Positive Echovirus Infection
- Echovirus infections can pose a serious threat to patients with humoral deficiencies and may be lethal 2
- The efficacy of proposed treatment options such as corticosteroids, intravenous immunoglobulins, and fluoxetine remains debated 2
Antiviral Treatment Options
- Fluoxetine has been shown to be effective in treating echovirus 13 meningoencephalitis/myofasciitis, with viral clearance obtained after 167 days of oral fluoxetine 2
- Amantadine and ribavirin have been found to have antiviral activity against the Korean ECV 18 isolate, with IC50 values of 4.97 ± 0.77 μg/mL and 7.63 ± 0.87 μg/mL, respectively 3
- Itraconazole, an antifungal drug, has been found to exhibit antiviral activity against echovirus 30, with concentration-dependent activity 4
Mechanism of Action of Antiviral Drugs
- Antiviral drugs can increase the cell's resistance to a virus, suppress the virus adsorption in the cell or its diffusion into the cell, and inhibit nucleic acid synthesis 5
- The action mechanism of antiviral drugs consists of its transformation to triphosphate, following the viral DNA synthesis inhibition 5
Approved Antiviral Drugs
- Over the past 50 years, 90 antiviral drugs have been formally approved for the treatment of various human infectious diseases, including HIV, hepatitis B and C, herpesvirus, influenza, and human cytomegalovirus infections 6