Enterovirus and Parechovirus Neurologic Infections in Children: Clinical Presentations and Neuropathogenesis

Enteroviruses (EVs) and parechoviruses (PeVs) are common pathogens of childhood. Enteroviral infections cause a range of clinical syndromes from mild illness to neurologic manifestations of meningitis, encephalitis, and acute flaccid myelitis. Disease manifestations are driven by a combination of viral replication and host immune response. Despite ubiquitousness and clinical importance, there are no approved targeted therapies for these viruses and most are without an available vaccine. Studies of EV neuropathogenesis began with poliovirus and are ongoing for other nonpolio EVs and PeVs. Many unanswered questions remain with regard to cellular tropism, mechanisms of dissemination, receptor usage, immunologic control, and cellular death. This review describes what is known about epidemiology, clinical presentations, and neuropathogenesis of these important pathogens.