Echo virus eruption is an eruptive disease caused by Echo virus.


Causes

Echo virus eruption is caused by enteric cytopathogenic human orphan virus (Echo virus), a small, 20 to 30nm in diameter, RNA virus, with 38 serotypes, often parasitic in human intestine and transmitted through feces and oral secretions.

Echo viruses that can cause eruption include type 1, 2, 4, 5, 8, 9, 14, 16, 18, 23, 30, and 32. Echo virus type 4, 9, and 16 can cause pleomorphic eruption.


Signs and Symptoms

Echo virus infection in children presents with various manifestations clinically, usually characterized by syndromes such as meningitis, encephalitis and spastic diseases, myocarditis, pericarditis, herpangina, eruptive fever, gastroenteritis, and respiratory infection. The incubation period is 4 days. Patients have upper respiratory symptoms such as moderate fever, sore throat, runny nose, and cough, and gastrointestinal symptoms such as anorexia, nausea, vomiting, and diarrhea at onset. Eruption occurs mostly during fever, usually at onset or 1 to 2 days after onset. Eruption can also occur after reduction of fever. Similar to exanthema subitum, eruption is pleomorphic, various sized, rubella-like red maculopapular rash, without pruritus, without pigmentation after regression, often in the face, neck, limbs, torso, occasionally in the soles and palms.

Echo virus 2 eruptions are red rubella-like papules while fevering, initially in the abdomen and waist, spreading to the trunk and neck, with or without pharyngitis, rhinitis, and cervical lymphadenopathy.

Echo virus 4 eruptions are orange red or purplish red spots or ecchymosis in the cheeks, torso, palms, and soles during fever or at the second peak of biphasic fever. Some patients may develop rubella-like eruption, and few patients may develop blisters, often with meningitis and intestinal symptoms.

Echo virus 5 eruptions are light red papules occurring 2 - 3 days after onset, densely in the buttocks and limbs, sparsely in the face and torso, sometimes with enteritis.

Echo virus 7 eruptions are maculopapular rashes and ecchymoses in the trunk while fevering, often accompanied by aseptic meningitis.

Echo virus 9 is often pandemic, with sudden onset, and can cause headache, sore throat, abdominal pain, nausea, generally without diarrhea. Light red maculopapular rash, rubella-like or measles-like eruptions occur in the face, neck, torso, extensor surfaces of extremities, palms, and soles in sequence 1 to 2 days after onset, sometimes with spots or ecchymosis. White or light gray spots may occur in the buccal mucosa opposite molar teeth, and blisters or small ulcers may also occur in the tongue. The body temperature rises while erupting, and eruptions can occur repeatedly, with enlargement of lymphnodes, often with meningitis, sometimes with temporary mild muscle weakness.

Echo virus 11 eruptions are systemic maculopapular rash, blisters, or erythema multiforme, without fever, often complicated by occipital lymphadenopathy, mild respiratory symptoms, sometimes with diarrhea.

Echo virus 16 eruption is also known as Boston exanthem disease. The incubation period is 3 - 8 days. Fever, headache, sore throat, muscle soreness, and ocular burning sensation occur initially. The systemic symptoms in adults are more severe than those in children. The body temperature drops 1 to 2 days after onset, light red spots or maculopapular rashes occur, they are mostly scattered, but they can also merge with each other. In severe cases, measles-like rashes and even vesicular rashes may occur. Eruption mainly occurs in the face, chest, and back, extending to the limbs, palms, soles, and even the whole body. 50% of patients may have scattered red spots or yellow white erosions in the throat, gums, or buccal mucosa. Conjunctivitis, mild lymphadenopathy, and aseptic meningitis may be concomitant. The count of white blood cells is normal. During the recovery period, neutralizing antibodies or complement-binding antibodies are present in serum, and they can persist for many years. Eruption spontaneously subsides in 2 to 3 weeks.

Echo virus 18 eruptions are systemic maculopapular rashes.

Echo virus 19 eruption is maculopapular rash occurring in the face, neck, and upper trunk 2 to 3 days after onset. Sometimes they can merge with each other, and they regress in about 5 days.

Echovirus 25 eruptions are maculopapular rashes or blisters occurring in the face, limbs, and even the whole body during or after fever, with or without herpangina, aseptic meningitis, or respiratory symptoms.

Echo virus 11, 19 can cause a purpuric rash.

Echo virus 6, 11, 25 can cause maculopapular rash.

Echo virus 23, 32 can cause telangiectatic lesions.


Diagnosis

Echo virus eruption has various manifestations and is easily misdiagnosed.

Definitive diagnosis should be based on typical clinical manifestations and Echo virus repeatedly isolated from throat swabs and feces.


Treatment

There is no special treatment. Symptomatic treatment can be applied to skin lesions. Gamma globulin can be administered to susceptible infants and young children.