What are the other Names for this Condition? (Also known as/Synonyms)

• Bornholm Virus Disease
• Coxsackie A9 Virus Infection
• Coxsackie B Virus Infection

What is Echo Virus Infection? (Definition/Background Information)

• Echo Virus Infection is an infection caused by echo viruses, which are group of viruses (belonging to the species enterovirus) that infect the gastrointestinal tract and also cause skin rashes. The term ECHO virus denotes “Enteric Cytopathic Human Orphan” virus
• Echo viruses are common human pathogens that can cause a wide variety of illnesses, which may be mild, severe, or even fatal. They cause both epidemic and endemic types of infection in individuals of all ages
• In the temperate climate, infections occur very commonly during summer and fall; in the tropical climates, it seems to occur throughout the year. The infection rate varies depending upon the following factors:
  • Season
  • Geography
  • Age
  • Socio-economic status
• Overcrowded living conditions and poor hygiene are the main reasons for infection among lower socio-economic groups
• Common complications associated with Echo Virus Infection that affect the heart and brain are myocarditis, pericarditis, meningitis, encephalitis, coma, and death
• There is no specific treatment to cure Echo Virus Infection; most often, the infection clears spontaneously on its own. When the severity of the illness is mild, a complete recovery without any treatment is possible. But when infections affect other organs, such as the heart and lungs, the disease can become very severe and fatal

Who gets Echo Virus Infection? (Age and Sex Distribution)

• Individuals of all ages are vulnerable to Echo Virus Infections. Echo viruses are found worldwide, and they affect people of all races, ethnicities, and cultures
• Below the age of 20 years, males are affected more than females
• According to the World Health Organization, children under the age of 15 years are more susceptible to Echo Virus Infections

What are the Risk Factors for Echo Virus Infection? (Predisposing Factors)

The risk factors for Echo Virus Infection include:

• Males: A male predominance was reported among patients who were younger than 20 years of age, but not among patients who were older
• Pregnancy: Pregnant women may not have any serious risks, but newborn babies can face adverse effects if they are born during the time their mothers were infected by the echo virus
• Seasons: In countries and regions with temperate climates, the infection is likely to peak during the summer and fall

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Echo Virus Infection? (Etiology)

Echo Virus Infections are caused by echo viruses that affect the gastrointestinal (GI) tract. Echo viruses are RNA viruses that belong to the species Enterovirus B and family Picornaviridae.

An individual can become infected by the virus:

• When he/she comes in contact with stools (fecal matter) contaminated by the virus
• By breathing in air particles from an infected individual
• By touching contaminated surfaces
• Coming in contact with respiratory secretions such as saliva or mucus from the nose
• Coming in direct contact with the infected individual

What are the Signs and Symptoms of Echo Virus Infection?

90% of Echo Virus Infections are asymptomatic. The presence of signs and symptoms depend upon the following factors:

• Age and gender of the individual
• The individual’s immune status
• Serotype (the species variety)
• Enteroviral strain

The signs and symptoms of Echo Virus Infection may include:

• Croup: A respiratory condition which is caused by an acute viral infection of the upper airway, characterized by a loud cough and breathing difficulty
• Meningitis: Inflammation of the protective membrane covering the brain and spinal cord with symptoms that include:
  • Fever
  • Chills
  • Nausea
  • Vomiting
  • Sensitivity to light
  • Headache
  • Stiff neck
• Herpangina or mouth sores (painful mouth infection)
• Pneumonia (inflammation of the lungs)
• Skin rashes
• Upper respiratory infection
• Sore throat
• Bornholm disease or epidemic pleurodynia (uncommon viral infection of the intercostal muscles that causes the ribs to join together)

How is Echo Virus Infection Diagnosed?

There are no specific tests or examinations for diagnosing an Echo Virus Infection. However, generally, the following tests are conducted to confirm the infection and these may include:

• Complete evaluation of medical history along with a thorough physical exam
• Rectal culture: A laboratory test to identify the virus in the rectum causing gastrointestinal infections
• Spinal fluid culture: A laboratory test to detect the virus in the cerebrospinal fluid (CSF) that can cause bacterial meningitis
• Stool culture: To find organisms in the stool causing intestinal illnesses
• Throat culture: A lab test that is performed to identify the virus present in the throat
• Viral isolation through cell culture: The virus is isolated in the blood, CSF, tissue, or pericardial fluid
• Reverse transcriptase polymerase chain reaction test (RT-PCR): It is a rapid and sensitive method of detecting echoviral RNA in the CSF, throat swabs, serum, and stool samples
• Serology blood test: It is performed to detect and measure the level of antibodies, as a result of exposure to a particular bacteria or virus
• Radiography: It is a type of imaging study done with the use of x-rays to view the internal organs
• Echocardiography: A painless test that uses sound waves to create a moving picture of the heart
• Electrocardiography: A test performed to measure the electrical activity of the heart

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Echo Virus Infection?

Complications due to Echo Virus Infection will depend on:

• The site of infection
• The type of infection

Some of the serious complications caused by Echo Virus Infection may include:

• Myocarditis (inflammation of the heart muscle)
• Pericarditis (an inflammation of the pericardium, which is a sac surrounding the heart)
• Encephalitis (inflammation of the brain tissue)
• Meningitis that is characterized by
  • Febrile seizures
  • Complex seizures
  • Lethargy
  • Movement disorders
  • Adults suffer from prolonged fever and headaches
  • Coma
• Paralysis and other neurological complications:
  • Cranial nerve involvement is seen leading to complete unilateral oculomotor palsy, resulting in ptosis (drooping eyelid) and pupillary dilation (narrowing of the eye pupil)
  • Guillain-Barre syndrome: A rare, but serious condition of the peripheral nervous system
  • Transverse myelitis: A neurological disorder, caused due to inflammation of the spinal cord, is also occasionally observed
• Complication during pregnancy: There is a serious risk to the neonate (and not to the pregnant woman), who can face adverse effects after birth if the expectant mother had been infected by echo virus. The illness may be mild or, in rare cases, it can affect the baby’s organs and be fatal. Such a severe infection occurs mostly during the first two weeks of birth

How is Echo Virus Infection Treated?

There is no specific treatment for curing Echo Virus Infections; most often the infection clears on its own, spontaneously.

• In a majority of the cases, the treatment is both supportive and symptomatic
• Immune system treatment, called IVIG (intravenous immunoglobulin), is often recommended for patients suffering from severe Echo Virus Infections, accompanied by a weakened immune system

How can Echo Virus Infection be Prevented?

Currently, there are no definitive preventative methods available for Echo Virus Infection. However, the following measures may be helpful:

• Frequent hand washing may be useful, especially after coming in contact with individuals who are ill
• Cleaning and disinfecting surfaces (floors, walls, etc.), especially in places like childcare centers, hospitals, and other institutional settings, is important  for effective prevention of any infection
• Healthcare providers must ensure that pregnant woman adhere strictly to personal hygiene practices during childbirth, so that the newborns are well protected from transmission of the disease
• Maintaining good practices and ensuring overall public health and sanitation can help in preventing Echo Virus Infection transmission and spread. Such practices may include:
  • Providing clean and potable water
  • Ensuring good hygiene and sanitation
  • Providing clean living conditions

What is the Prognosis of Echo Virus Infection? (Outcomes/Resolutions)

• When Echo Virus Infections are mild, a complete recovery without the need for any treatment is possible
• When infections affect certain major organs, such as the heart, lungs, and brain, the disease can be severe and even lead to death
• Occurrence of meningoencephalitis (an inflammation of the brain and brain coverings) in immunocompromised individuals is often fatal

Additional and Relevant Useful Information for Echo Virus Infection:

• Enteroviuses stand second in the list of common viruses that attack human beings; next only to rhinoviruses, which causes the common cold
• Pleconaril, an experimental agent with in vitro activity against most enteroviruses was tried, but it is still to be approved by the FDA (U.S. Food and Drug Administration) to be used as an antiviral agent
• In the United States, children under a year old are predominantly affected more than older children and adults; the infection rate under the age of 1 year stands at 44.2%
• The CDC (Centers for Disease Control and Prevention) reports that approximately 10-15 million symptomatic enterovirus infections occur every year in the United States