Non-Polio enterovirus infections differential diagnosis

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Overview

The differential diagnoses of non-polio enterovirus infections spans diseases affecting the respiratory, gastrointestinal and central nervous systems:

• Influenza
• Upper respiratory tract infections (pharyngitis, sinusitis)
• Allergic rhinitis
• Meningitis
• Gastroenteritis

Differential diagnoses

Differential diagnoses for rhinovirus

Disease	Clinical Findings	Para-clinical findings	Gold standard	Additional findings
Influenza	Cough, fever, sore throat, headache, myalgia, runny nose, congested eyes	Chest X-ray may show signs of concomitant bacterial pneumonia	Immunofluorescent direct and indirect antibody staining for detection of viral antigen, real-time PCR test, cell culture of upper or lower respiratory tract specimens	Frontal or retro-orbital headache, photophobia, ocular pain, shortness of breath, tachycardia, hypotension and need for ventilation in severe cases
Adenovirus infection	Fever, pharyngitis, coryza, watery eyes	Cervical adenopathy, pharyngoconjunctivitis, tonsillitis	Viral culture, PCR, viral antigen assay, serology	Dyspnea, gross bloody urine
Bacterial pharyngitis, sinusitis	Purulent nasal discharge, maxillary tooth or facial pain, worsening after initial improvement (fever, headache, increase in nasal discharge)	Unilateral maxillary sinus tenderness, pharyngeal erythema and swelling, tonsillar exudates, edematous uvula, palatine petechiae, anterior cervical lymphadenopathy	Nasal endoscopy or antral puncture and culture of secretions, Centor criteria	Ear pain/pressure/fullness, sore throat, halitosis, cough, fatigue, rheumatic fever, peritonsillar abscess, post-streptococcal glomerulonephritis and scarlet fever
Allergic rhinitis	Sneezing, rhinorrhoea, watery eyes, postnasal drip, chronic nasal congestion and obstruction, triggers like pollen, animal dander, flooring/upholstery, molds, humidity, perfumes and/or tobacco smoke	Mouth breathing, frequent sniffling/throat clearing, transverse supra-tip nasal crease and dark circles under the eyes. Swelling of the nasal mucosa and thin,clear secretions on anterior rhinoscopy	Serum testing for allergen-specific IgE or allergy skin testing	Bluish hue of inferior turbinates, cobblestoning of the nasal mucosa, nasal polyps, eustachian tube dysfunction, allergic dermatitis, aspirin sensitivity, tender sinuses

Differential diagnoses of non-rhinovirus non-polio enterovirus infections

Disease	Clinical findings	Para-clinical findings	Gold standard	Additional findings
Meningitis	Fever, neck pain, stiffness, photophobia, altered mental status, neurological deficits, seizures, Brudzinski and Kernig signs of meningeal irritation,	Cerebrospinal fluid analysis reveals elevated opening pressures, increased White cell count and protein.Glucose is typically normal in viral and fungal meningitis. CT head for signs of raised intracranial pressure and/or brain herniation before lumbar puncture	Analysis of cerebrospinal fluid (CSF) including cultures, serology and microscopy	Headache, dizziness, confusion, delirium, irritability, nausea/vomiting, petechiae/purpura in meningococcal meningitis, cranial nerve abnormalities; hypothermia, decreased oral intake, irritability and bulging fontanelle in infants
Gastroenteritis	Malaise, anorexia, abdominal pain and cramping, watery diarrhea, nausea and vomiting, low-grade fever, signs of dehydration (dry mucous membranes, tachycardia, orthostatic blood pressure,	Sorbitol McConkey agar for E.coli O157:H7	Mostly clinical diagnosis; stool for ova, parasites and cultures, fecal leukocytes and occult blood, toxin assays	Colitis, bloody diarrhea, tenesmus, hemolytic uremic syndrome, reactive arthritis, Guillain-Barre syndrome

References

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