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== Acute enterovirus infections == Enteroviruses can infect a wide array of organs in the body, and thus a given enterovirus serotype may cause a variety of different acute infections, and its symptoms in one person can be quite different to the symptoms it creates in the next person. During the acute phase of infection, enteroviruses may produce one or more of the following symptoms and illnesses:<ref>{{Cite web | url = https://www.youtube.com/watch?v=IWxqftHYvqU&t=1m24s | title = Enteroviruses and Myalgic Encephalomyelitis / Chronic Fatigue Syndrome: An Update on Pathogenesis. Presentation at the Invest in ME International ME Conference, London 2015. |at=1:24 | last = Chia | first = John | date = 2015 | website = |archive-url=|archive-date=|url-status=|access-date=|quote= | authorlink = }}</ref><ref>{{Cite web | url = https://www.enterovirusfoundation.org/the-symptoms/ | title = Symptoms and Signs of an Enterovirus Infection. | last = | first = | date = |website=Enterovirus Foundation|archive-url=|archive-date=|url-status=|access-date=}}</ref><ref>{{Cite web | url = https://www.cdc.gov/non-polio-enterovirus/about/symptoms.html | title = Non-Polio Enterovirus: Symptoms. | last = | first = | date = |website=CDC Website|archive-url=|archive-date=|url-status=|access-date=}}</ref> * '''Respiratory''' â [[Sinusitis|rhinosinusitis]], [[sore throat|pharyngitis]], bronchitis, bronchiolitis, pleurisy, pneumonia. * '''Gastrointestinal''' â [[vomiting]], [[diarrhea]], gastritis, terminal ileitis, colitis, hepatitis, pancreatitis, [[GERD]], [[dyspepsia|functional dyspepsia]]. * '''Immune manifestations''' â prolonged [[Fever]]s (102 to 104°F, or 39 to 40°C) lasting 3 weeks, leukopenia, lymphopenia, bone marrow failure. * '''Central nervous system''' â meningitis, [[encephalitis]], myelitis, [[Guillain-BarrĂ© syndrome]], epidemic [[vertigo]] and deafness. * '''Cardiovascular''' â myocarditis, pericarditis, myopericarditis, endocarditis. * '''Musculoskeletal''' â acute myositis, rhabdomyolysis, [[arthralgia]] and [[arthritis]], pleurodynia (Bornholm disease). * '''Genito-urinary tract''' â epididymitis, orchitis, salpingitis (fallopian tube inflammation), prostatitis. * '''Skin''' â vesicles, [[skin rash#maculopapular|maculopapular rash]], petechiae, [[urticaria]], vasculitis. * '''Oral''' â enanthem (rash on the mucous membranes), herpangina, tongue and mouth [[ulcer]]s. * '''Other illnesses''' â hand, foot, and mouth disease, hemorrhagic conjunctivitis, [[poliomyelitis]], [[acute flaccid paralysis|Acute Flaccid Paralysis]] (AFM), inflammatory muscle disease. Note that enterovirus is able to mimic a [[chickenpox]] rash: if a patient previously had chickenpox, and then develops a [[flu-like illness]] with a chickenpox-like [[rash]], that is likely due to enterovirus. But an enterovirus rash can also look like measles, German measles (rubella) and can look like [[hives]].<ref>{{Cite web | url = https://www.youtube.com/watch?v=WAZ4HiSC_sM&t=7m29s | title = Enterovirus Infection in ME/CFS. Presentation at the Invest in ME International ME Conference, London 2010. | last = Chia | first = John | date = 2010 | website = |archive-url=|archive-date=|url-status=|access-date=|quote=Enterovirus is the greatest mimicker of chickenpox. If the patient already had chickenpox before and they then develop flu-like illness with chickenpox-like rashes that's enterovirus until proven otherwise. But the rash could look like measles, German measles, it could look like hives. | authorlink = }}</ref> Enteroviruses are the only group of viruses able to routinely infect the [[muscle]]s, [[heart]] and [[central nervous system]]. Other viruses can infect one or two of these organs, but not all three.<ref>{{Cite web | url = https://www.youtube.com/watch?v=XBUfUEwyEIA&t=8m08s | title = Clinical and Research Experience of Enteroviral Involvement in ME/CFS. Presentation at the Invest in ME International ME Conference, London 2011. | last = Chia | first = John | date = 2011 | website = |archive-url=|archive-date=|url-status=|access-date=|quote=Only one group of viruses that routinely will go to the muscles heart and the brain, and that's enteroviruses. | authorlink = }}</ref><ref>{{Cite web | url = https://www.youtube.com/watch?v=IWxqftHYvqU&t=2m15s | title = Enteroviruses and Myalgic Encephalomyelitis / Chronic Fatigue Syndrome: An Update on Pathogenesis. Presentation at the Invest in ME International ME Conference, London 2015. | last = Chia | first = John | date = 2015 | website = |archive-url=|archive-date=|url-status=|access-date=|quote=These viruses can then spread to the central nervous system, the heart, and also muscles. As a group these are viruses are actually the only virus that can actually to go to all three sites, OK. The other viruses can go to one or two and others. | authorlink = }}</ref> The incubation period (time between catching the virus and the appearance of its first acute symptoms) for coxsackie viruses is three to five days,<ref>{{Cite web | url = https://www.msdsonline.com/resources/msds-resources/free-safety-data-sheet-index/coxsackievirus/ | title = Coxsackievirus â Material Safety Data Sheet - Infectious Substances | last = | first = | date = |website=|archive-url=|archive-date=|url-status=|access-date=}}</ref> and the incubation period for echovirus is two to 14 days.<ref>{{Cite web | url = https://www.canada.ca/en/public-health/services/laboratory-biosafety-biosecurity/pathogen-safety-data-sheets-risk-assessment/echovirus-pathogen-safety-data-sheet.html | title = Pathogen Safety Data Sheets: Infectious Substances â Echovirus | last = | first = | date = |website=|archive-url=|archive-date=|url-status=|access-date=}}</ref> Coxsackievirus B (serotypes B2 to B5) and echoviruses account for more than 90% of causes of viral (aseptic) [[meningitis]].<ref>{{Cite web | url = https://emedicine.medscape.com/article/215241-clinical#b5 | title = Coxsackieviruses Clinical Presentation (Medscape article) | last = Muller | first = Martha L | date = | website = Medscape |archive-url=|archive-date=|url-status=|access-date=|quote=Coxsackievirus B (serotypes 2-5) and echoviruses account for more than 90% of viral causes of aseptic meningitis.}}</ref> Evidence of enteroviral infection in the myocardium or endocardium tissues of the heart is detected in 40% of those who died suddenly of a heart attack, though it is not clear whether enterovirus causes these heart attacks.<ref>{{Cite journal | last = AndrĂ©oletti | first = Laurent | last2 = VentĂ©o | first2 = Lydie | last3 = Douche-Aourik | first3 = Fatima | last4 = Canas | first4 = FrĂ©dĂ©ric | last5 = Lorin de la Grandmaison | first5 = Geoffroy | last6 = Jacques | first6 = JĂ©rĂŽme | last7 = Moret | first7 = HĂ©lĂšne | last8 = Jovenin | first8 = Nicolas | last9 = Mosnier | first9 = Jean-François | date = 2007-12-04 | title = Active Coxsackieviral B infection is associated with disruption of dystrophin in endomyocardial tissue of patients who died suddenly of acute myocardial infarction | url =https://www.ncbi.nlm.nih.gov/pubmed/18061067|journal=Journal of the American College of Cardiology|volume=50|issue=23 | pages = 2207â2214|doi=10.1016/j.jacc.2007.07.080|issn=1558-3597|pmid=18061067}}</ref> Another study found 26% of heart attack patients had serological evidence of a very recent coxsackievirus B infection.<ref>{{Cite journal | last = Nicholls | first = A.C. | last2 = Thomas | first2 = M. | date = 1977-04-23 | title = Coxsackie virus infection in acute myocardial infarction | url =https://www.ncbi.nlm.nih.gov/pubmed/67289|journal=Lancet (London, England)|volume=1|issue=8017 | pages = 883â884|issn=0140-6736|pmid=67289}}</ref>
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