title: Tissue tropism, pathology and pathogenesis of enterovirus infection.
abstract: Enteroviruses are very common and cause infections with a diverse array of clinical features. Enteroviruses are most frequently considered by practising pathologists in cases of aseptic meningitis, encephalitis, myocarditis and disseminated infections in neonates and infants. Congenital infections have been reported and transplacental transmission is thought to occur. Although skin biopsies during hand, foot and mouth disease are infrequently obtained, characteristic dermatopathological findings can be seen. Enteroviruses have been implicated in lower respiratory tract infections. This review highlights histopathological features of enterovirus infection and discusses diagnostic modalities for formalin-fixed paraffin-embedded tissues and their associated pitfalls. Immunohistochemistry can detect enterovirus antigen within cells of affected tissues; however, assays can be non-specific and detect other viruses. Molecular methods are increasingly relied upon but, due to the high frequency of asymptomatic enteroviral infections, clinical-pathological correlation is needed to determine significance. Of note, diagnostic assays on central nervous system or cardiac tissues from immunocompetent patients with prolonged disease courses are most often negative. Histopathological, immunohistochemical and molecular studies performed on clinical specimens also provide insight into enteroviral tissue tropism and pathogenesis.
authors.affiliation: Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Atis
authors.initials: A
authors.lastname: Muehlenbachs
authors.forename: Julu
authors.initials: J
authors.lastname: Bhatnagar
authors.forename: Sherif R
authors.initials: SR
authors.lastname: Zaki
mesh_terms: D000818:Animals; D001706:Biopsy; D004770:Enterovirus / Q000235:genetics / Q000276:immunology / Q000472:pathogenicity*; D004769:Enterovirus Infections / Q000453:epidemiology / Q000276:immunology / Q000473:pathology* / Q000821:virology*; D005838:Genotype; D054884:Host-Pathogen Interactions; D006801:Humans; D057089:Pathology, Molecular / Q000379:methods; D011237:Predictive Value of Tests; D012307:Risk Factors; D056189:Viral Tropism; D014773:Virology / Q000379:methods; D014774:Virulence
keywords: PCR; autopsy; enterovirus; immunohistochemistry; meningoencephalitis; neonatal and congenital infections