Enteroviruses, including coxsackieviruses and echoviruses, are important viral pathogens in humans, causing a variety of diseases. The most common symptomatic manifestation is a nonspecific febrile illness, with or without a rash, often accompanied by upper respiratory tract symptoms. Enteroviruses can cause aseptic meningitis; hand, foot, and mouth syndrome; encephalitis; poliomyelitis; myocarditis; hemorrhagic conjunctivitis; pleurodynia and severe neonatal disease. Immunocompromised patients may develop chronic enteroviral infection. Late-onset muscle atrophy and pain have been reported in persons who had paralytic poliomyelitis 20 to 40 years previously. Rotbart describes antiviral therapies for enteroviral infection, including immune serum globulin and pleconaril, an antipicornaviral agent.
Immune serum globulin has been used prophylactically and therapeutically against enteroviruses in neonates and immunocompromised patients. Neonates may develop a sepsis-like disease following peripartum infection with enterovirus. Maternal serum or plasma, or commercially available immune serum globulin, has been reported to be useful in treating this syndrome. Prophylactic immune serum globulin has decreased the frequency of progressive enteroviral meningoencephalitis in patients with immunoglobulin deficiency. Further study is needed to evaluate the treatment role of this agent in patients with active enteroviral meningoencephalitis.
Pleconaril inhibits viral replication, has broad-spectrum effects and exhibits potent antienterovirus and antirhinovirus activity. It can be administered orally and has few side effects. Studies have demonstrated a benefit in symptom scores and a marked decrease in peak viral titers among patients treated with 200 mg of pleconaril twice daily for six days following inoculation with the virus. Clinical improvement with compassionate-release treatment has been demonstrated among antibody-deficient patients with chronic enteroviral meningoencephalitis, as well as patients with severe neonatal enteroviral disease, and a few patients with vaccine-associated or wild-type poliomyelitis. Placebo-controlled studies in pediatric patients with enteroviral meningitis show a reduction in total morbidity and disease symptoms.
The author concludes that immune serum globulin and pleconaril appear to show promise in the prevention and treatment of enteroviral infections. Further studies of pleconaril in other enteroviral diseases, including viral respiratory infection, will clarify the extent of the drug's efficacy.