Feature Poliovirus Echovirus Coxsackie A & B
Site of Replication Oropharynx and small Oropharynx and small Oropharynx, small intestine;
intestine → lymphoid tissue intestinal mucosa spreads to multiple organs
(Peyer’s patches)
Pathogenesis Primary replication in gut → Primary replication in gut → Viremia → tissue tropism
viremia → may invade viremia → systemic flu-like varies: Coxsackie A
anterior horn cells causing illness or aseptic meningitis (skin/mucosa), Coxsackie B
paralysis (muscle, heart, pancreas)
Organs Involved Intestine, CNS (anterior horn Intestine, meninges Intestine, skin, oral mucosa,
cells) heart, pancreas, CNS
Clinical Features Asymptomatic or mild illness; Fever, rash, aseptic Coxsackie A: herpangina,
can cause paralytic meningitis; mild GI hand-foot-mouth disease.
poliomyelitis (flaccid symptoms Coxsackie B: myocarditis,
paralysis) pericarditis, pleurodynia
Duration Acute phase 3–7 days; Self-limiting, 3–7 days Self-limiting 3–7 days;
paralysis may persist myocarditis may persist
Transmission Fecal–oral; respiratory Fecal–oral; contaminated Fecal–oral; respiratory
droplets water droplets; fomites
Unique Features Only enterovirus causing Common cause of aseptic Coxsackie A: vesicular
paralysis; strong CNS meningitis outbreaks rashes. Coxsackie B:
tropism myocarditis (‘devil’s grip’
chest pain)