title: Enteroviruses in the early 21st century: new manifestations and challenges.
abstract: OBJECTIVE
  Enteroviruses cause a wide variety of diseases with neurologic, respiratory, skin, and gastrointestinal findings. The purpose of this review is to clarify changes in the classification of enteroviruses, provide information about recent disease outbreaks, and to summarize progress toward the treatment and prevention of these infections.
  
  
  RESULTS
  Enteroviruses are now classified into four distinct species. New variants of coxsackievirus B1, enterovirus-A71, and enterovirus-D68 (EV-D68) have emerged as causes of recent outbreaks in the United States and other countries, including more severe disease manifestations than previously described. EV-D68 now commonly circulates in the United States, and has been linked to severe respiratory disease and associated with acute flaccid myelitis (AFM). Overcoming enormous political and logistical challenges, fewer than 100 cases of polio have been reported in 2015, and the initiation of 'endgame' strategies appears imminent. Unfortunately, treatment for enterovirus infections remains supportive, although the recently completed pleconaril trial in newborns suggests that antiviral therapy may reduce mortality in neonatal disease.
  
  
  CONCLUSIONS
  Clinicians should be aware of the respiratory and neurological manifestations associated with EV-D68 and the potential for severe disease seen with other recently described enterovirus variants. Healthcare professionals should recognize the utility of rapid diagnostic methods and progress toward prevention and treatment of enterovirus infections.
authors.affiliation: aDepartment of Pediatrics bMolecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA.
authors.forename: Debra
authors.initials: D
authors.lastname: Lugo
authors.forename: Paul
authors.initials: P
authors.lastname: Krogstad
mesh_terms: D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000628:therapy; D003384:Coxsackievirus Infections / Q000453:epidemiology / Q000628:therapy; D004196:Disease Outbreaks; D029822:Enterovirus B, Human; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000628:therapy*; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D009187:Myelitis / Q000453:epidemiology / Q000821:virology; D009205:Myocarditis / Q000453:epidemiology / Q000628:therapy; D011051:Poliomyelitis / Q000453:epidemiology / Q000517:prevention & control; D014765:Viral Vaccines
chemical_list: D014765:Viral Vaccines