Are we under siege?

Following on from the paper ‘Orofacial Viral Infections – an Update for Clinicians’ by RG Nair et al in the July/August issue (Dent Update 2014; 41: 518–524), an interesting overview, for completeness it is important to point out that some of these infections can be more serious than mentioned and that others, unmentioned, are increasingly encountered.

For example, the enteroviruses which, in addition to Coxsackieviruses, can cause hand-foot and mouth disease (HFMD) can be dangerous. Human enterovirus species A (HEV-A) consists of at least 16 members of different serotypes that are known to be the causative agents of HFMD and herpangina, but also other diseases, such as respiratory disease and polio-like flaccid paralysis. Enterovirus 71 (EV71) and Coxsackievirus A16 (CVA16) are Picornaviridae, genus Enterovirus, species A and are the major causative agents of HFMD. Infections involving EV71, but not CVA16, can progress to severe neurological disease, including aseptic meningitis, encephalitis, acute flaccid paralysis and neurogenic pulmonary oedema. EV71 is thus considered to be a neuropathogenic virus and EV71 outbreaks have become a major public health concern. Not only can EV71 HFMD on occasions rapidly progress to cardiopulmonary failure, but so can cases associated with adenoviruses.1