Abstract
Enteroviruses are a major source of human disease, particularly in neonates and young children where infections can range from acute, self-limited febrile illness to meningitis, endocarditis, hepatitis, and acute flaccid myelitis. The enterovirus genus includes poliovirus, coxsackieviruses, echoviruses, enterovirus 71, and enterovirus D68. Enteroviruses primarily infect by the fecal–oral route and target the gastrointestinal epithelium early during their life cycles. In addition, spread via the respiratory tract is possible and some enteroviruses such as enterovirus D68 are preferentially spread via this route. Once internalized, enteroviruses are detected by intracellular proteins that recognize common viral features and trigger antiviral innate immune signaling. However, co-evolution of enteroviruses with humans has allowed them to develop strategies to evade detection or disrupt signaling. In this review, we will discuss how enteroviruses infect the gastrointestinal tract, the mechanisms by which cells detect enterovirus infections, and the strategies enteroviruses use to escape this detection.
Highlights
EnterovirusesAccording to the Centers for Disease Control and Prevention, enteroviruses cause at least
According to the Centers for Disease Control and Prevention, enteroviruses cause at least10–15 million symptomatic infections in the United States each year [1]
Previous studies have shown that echovirus 11 (E11), enterovirus 71 (EV71), and coxsackievirus B (CVB) induce a robust innate immune response in intestinal epithelial cell lines and primary cells [73,74,75]
Summary
According to the Centers for Disease Control and Prevention, enteroviruses cause at least. EV-D68 outbreaks typically impact neonates and children and have caused many cases of acute flaccid myelitis (AFM) in the United States, including 120 confirmed cases across 34 states in 2014 [13,14]. These severe outcomes are the focus of many studies, most individuals infected with enteroviruses are asymptomatic. Neutralizing antibodies to PV arise from vaccination-induced long-lived memory B cells and neutralizing antibodies that are protective against infection [17,18] This suggests that neutralizing antibodies are important for protection from re-exposure and may explain why children and neonates are most likely to experience severe infection since they likely lack these antibodies [15]. The concerted actions of the innate and adaptive immune response allow for the clearance of enteroviruses
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