Pleconaril, a Novel Antipicornaviral Agent

Naomi R. Florea, Pharm.D., Dana Maglio, Pharm.D., David P. Nicolau, Pharm.D., FCCP


Pharmacotherapy. 2003;23(3) 

In This Article


Enteroviruses have more than 65 serotypes. They are classified into five groups: polioviruses, group A coxsackieviruses, group B coxsackieviruses, echoviruses, and numbered enteroviruses. Although polio infections are contained in most countries, nonpolio enteroviruses continue to cause disease. Most patients are young infants, but adults can be affected as well. The enterovirus groups share a similar pathogenic process of disease but differ in the target organ affected after blood-borne dissemination. Enteroviral infection results from fecal-oral contamination and to a lesser degree respiratory inhalation. Viral replication can occur in the nasopharynx, but the principal site of viral entry is the gastrointestinal tract.

Enteroviruses are responsible for a wide spectrum of infections involving almost every organ system ranging from nonfocal febrile illness to encephalitis, myocarditis, and fulminant neonatal sepsis.[23] Infection of the CNS ranges from meningitis, which generally is associated with an excellent prognosis, to encephalitis, which can be associated with profound acute disease and long-term sequelae or even death. Enteroviral infection also commonly causes nonspecific febrile illness that affects 10-15 million people in the United States annually.[1] The infection may also present as a vesicular disease affecting the skin as in hand-foot-mouth disease and herpangina. In addition, patients can present with myocarditis, hemorrhagic conjunctivitis, and pleurodynia.

Most infections are characterized by a mild disease and positive prognosis; however, serious complications can occur and not all patients have a benign disease course. A report of enteroviral infection in infants described progression to fulminant, nearly fatal cardiopulmonary disease.[24] Some strains caused acute fatal epidemics in at least five areas of the world.[25] In addition, infections are associated with several chronic illnesses including juvenile-onset diabetes mellitus, chronic fatigue syndrome, dermatomyositis, polymyositis, congenital hydrocephalus, and amyotrophic lateral sclerosis (ALS).[21]