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Epidemiology and clinical characteristics of severe non-polio enteroviruses infections: the pediatric experience of the National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, a 5 year survey


Currently, an increase in the enteroviruses associated diseases is reported in many countries of the world. Understanding the trend of severe non-polio enteroviruses infections, in the pediatric population, becomes an important public health issue.


We analyzed the clinical manifestations of patients aged 1 month to 14 years, with serology-confirmed non-polio enteroviral infections, who were hospitalized for at least 4 days in the National Institute for Infectious Diseases “Prof. Dr. Matei Balş”, between January 2009 and September 2013.


There were 63 laboratory-confirmed enteroviruses severe infections during this period. In our cohort 67% of the patients were males and the median age was 4.2±2.2 years of age. The average days from onset to deterioration were 4.3 days (range 1–10 days). Interestingly, more than half did not have oral ulcers, and/or characteristic skin rashes, thus making earlier diagnosis more difficult. The vast majority (92% of the patients) associated gastrointestinal manifestations.

A total of 23 patients were diagnosed with severe non-polio enterovirus aseptic meningitis, with the highest prevalence of the cases in the summer of 2012, when 18 children developed acute flaccid paralysis, 13 manifested non-specific febrile skin rashes and 9 presented with viral hepatitis.

The average time of hospitalization was 6.4 days (range 4-31 days) and all patients required interdisciplinary consults, 12 required kineto-therapy after discharge but neither one of our patients had a fatal outcome.


Even in the absence of typical oral ulcers, skin rashes and/or gastrointestinal symptoms, clinicians should be alert about any flaccid paralysis episode and other neurological signs.

Author information

Correspondence to Monica Luminos.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Hepatitis
  • Meningitis
  • Viral Hepatitis
  • Gastrointestinal Symptom
  • Skin Rash