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Abzug MJ Presentation, diagnosis, and management of enterovirus infections in neonates Paediatr Drugs 2004;6(1):1 10 [PMID: 14969566] Chia JK The role of enterovirus in chronic fatigue syndrome J Clin Pathol 2005 Nov;58(11):1126 32 [PMID: 16254097] Desmond RA et al Enteroviral meningitis: natural history and outcome of pleconaril therapy Antimicrob Agents Chemother 2006 Jul;50(7):2409 14 [PMID: 16801419] Mullins JA et al Emergence of echovirus type 13 as a prominent enterovirus Clin Infect Dis 2004 Jan 1;38(1):70 7 [PMID: 14679450]

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A virus identified in 2000 is a picornavirus first seen in association with respiratory and gastrointestinal illness in young children However, it has been found to be responsible for neonatal sepsis, flaccid paralysis, and encephalitis It is referred to as a parechovirus It has three known serotypes (with severe disease most often found with the third serotype) and cases are reported from Europe and North America Rare cases are reported from immunosuppressed adults Treatment at this stage is largely supportive

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Abed Y et al Human parechovirus types 1, 2 and 3 infections in Canada Emerg Infect Dis 2006 Jun;12(6):969 75 [PMID: 16707054] Benschop KS et al Human parechovirus infections in Dutch children and the association between serotype and disease severity Clin Infect Dis 2006 Jan 15;42(2):204 10 [PMID: 16355330]

3 Enteroviruses 70 & 71

Several clinical syndromes are being described in association with newer enteroviruses The most common of these are enterovirus 70, associated with acute hemorrhagic conjunctivitis, a ubiquitous agent first identified in 1969 and responsible for abrupt bilateral eye discharge and occasional systemic symptoms, but in most cases subconjunctival hemorrhage, and enterovirus 71, associated with hand, foot, and mouth disease as well as a form of epidemic encephalitis (genogroups B and C in the Western Pacific region) associated on occasion with pulmonary edema, and acute flaccid paralysis Hand, foot, and mouth disease tends to infect the very young (under age 5) in nonendemic areas because of lower herd immunity Sequelae include central hypoventilation, dysphagia, and limb weakness, all of which are minimized by stage-based treatment, dividing the illness into four classical stages (HFMD/herpangina, CNS disease, cardiopulmonary failure, and convalescence) Diagnosis of both entities is facilitated by the clinical and epidemiologic findings with the isolation of the suspect agent from either conjunctival scraping for enterovirus 70 or vesicle swabs, body secretions, or cerebrospinal fluid for enterovirus 71 An IgM capture ELISA is being developed for the latter agent Treatment of both entities remains largely symptomatic, though there are increasing reports of the successful use of pleconaril, an agent available in some countries but not the United States The major complication associated with enterovirus 70 is the development in a small percentage of cases of an acute neurologic illness with motor paralysis akin to poliomyelitis Household contacts, especially children under 6 months of age, are at particular risk for enterovirus 71 acquisition A commercial disinfectant, Virkon S, at 1 2% application, appears to reduce infectivity titers Enterovirus 72 is another term for hepatitis A virus (see 15)

Chang LY et al Transmission and clinical features of enterovirus 71 infections in household contacts in Taiwan JAMA 2004 Jan 14;291(2):222 7 [PMID: 14722149]

In 3, we introduced you to the intrinsic types built into the C# language Those simple types allow you to hold and manipulate numeric values and strings The true power of C#, however, lies in its capacity to let the programmer define new types to suit particular problems That ability to create new types is what characterizes an object-oriented language You specify new types in C# by declaring and defining classes Particular instances of a class are called objects The difference between a class and an object is the same as the difference between the concept of a Dog and the particular dog who is sitting at your feet as you read this You can t play fetch with the definition of a Dog, only with an instance A Dog class describes what dogs are like; they have weight, height, eye color, hair color, disposition, and so forth.

Prodrome of headache, then chills and fever Severe, intractable headaches, prostration, persisting high fever Macular rash appearing on the fourth to seventh days on the trunk and in the axillae, spreading to the rest of the body but sparing the face, palms, and soles Diagnosis confirmed by specific antibodies using complement fixation, microagglutination, or immunofluorescence

Epidemic louse-borne typhus is due to infection with Rickettsia prowazekii, a parasite of the body louse (Table 32 3) Transmission is favored by crowded, unsanitary living conditions, famine, war, or any circumstances that predispose to heavy infestation with lice When the louse sucks the blood

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