Enterovirus infection Is a group caused by RNA viruses acute diseases, manifested by catarrhal, hyperthermic and intestinal syndromes. Entero pathogens viral infection there are (according to differing data from different sources) from 70 to 140: Coxsackie viruses (23 types from group A, 6 types from group B), three types of poliomyelitis viruses, several types of enteroviruses, 32 strains of ECHO viruses, more than thirty subspecies of echoviruses and others ...
The variety of pathogens is one of the reasons that enterovirus infection has a variable course, different duration and severity of symptoms. However, there are a number of signs characteristic of the entire group: seasonality (summer-autumn), age factor (the disease is inherent in children and young people), tropism of enteroviruses to the intestinal epithelial integument, in which the pathogen multiplies.
Enteroviruses are able to survive for a long time in food, aquatic environment, soil, as well as in the human body-virus carrier, as a result of which enterovirus infection is ubiquitous.
Causes of enterovirus infection
Unlike the so-called colds, enterovirus infection can enter the body not only through the integument of the upper respiratory tract, but also through the mucous membranes of the digestive tract, which significantly expands the possibilities of infection. It is not necessary to be in contact with an already ill person, it is enough to bring enteroviruses with food, drinks or through dirty hands, since pathogens are very common infectious agents. Possessing long-term resistance in the external environment, enteroviruses can spread even with dust particles.
Summer outbreaks of the disease are often associated with places of public recreation and entertainment, especially for children, near reservoirs, the beaches of which are not equipped with sources of drinking water and comfortable toilets, showers and washstands. On hot days, water contaminated with human waste turns into a broth of all kinds of pathogens, including enteroviruses.
Nevertheless, most often enterovirus infection spreads in collectives, especially children, the source is either a sick person or a virus carrier, in whose body enteroviruses live for many months. Due to the presence of such different routes of infection, there are two natural reservoirs of habitat and accumulation of enteroviruses. The first is external objects, including water, surface layers of the soil, food products and other elements of the human environment that carry viral contamination. The second reservoir is actually a person who can become a carrier of infection for a long time without any of its manifestations. Enterovirus infection does not have obvious symptomatic differences when infected with pathogens from the first or second reservoir, much more important for its development and course is the state of immunity and the general habit of a person.
Despite the long survival in both reservoirs, enteroviruses lose their pathogenic properties at temperatures above 50 ° C and quickly die at temperatures above 70 ° C, which allows them to be eliminated from food without boiling. However, all pathogens of enterovirus infection are immune to an acidic environment, which explains their tropism (affinity) for the mucous membranes of the digestive system - these viruses are not afraid of hydrochloric acid of gastric contents. The specific name of pathogens is associated with the same factor - the prefix Entero- denotes a connection with the intestine, the ability to inhabit it.
Unlike most other pathogens, enteroviruses are most active in the summer and autumn. In this regard, enterovirus infection is characterized by just such a seasonality and rarely occurs in the winter-spring months. Given the modes of transmission, it is easy to guess that children are more likely to be infected with enteroviruses, as the most communicative and least protected age group by unformed immunity.
The incubation period of enterovirus infection varies from one to three days, which is associated not only with individual sensitivity to the pathogen, but also with a wide variety of enteroviruses.
Symptoms and signs of enterovirus infection
It will not even be possible to describe a single symptomatic complex that characterizes an enterovirus infection, because the manifestations are very different. The most common variants of the disease are perceived by an infected person as a mild malaise, while there will be no local signs. This course is usually for adults, although they also have more severe and even complicated cases.
But in general, enterovirus infection develops along the chain: "gateway" - "local reaction" - "general toxic viral effect" - "formation of immune defense" - "recovery". The entry gate for enteroviruses can be the epithelial membranes of the respiratory tract and the digestive tract, therefore, even at the stage of primary manifestations, there may be differences in the patient's complaints. Someone will experience discomfort in the throat area, a burning sensation in the throat, while others infected with an enterovirus infection will begin with aching abdominal pains. Such differences are explained by the fact that enterovirus can penetrate, multiply, accumulate both in the nasopharynx and in the intestinal mucosa. Moreover, this group of pathogens is able to actively reproduce in other tissues, in particular, in the vascular endothelium, meninges and nerves, the substance of the brain, myocardium. Depending on the degree of damage to certain tissues, forms of enterovirus infection are distinguished, although such a distinction is very conditional, more often the symptoms are layered or alternated.
• Respiratory, or catarrhal form of enterovirus infection will proceed as familiar to everyone: stuffy nose, runny nose (from the mildest to profuse rhinorrhea), cough, often rare and dry. With a more severe course, the epithelial membranes of the pharynx and larynx are involved, inflammation develops in these sections as well, the cough becomes moist, becomes frequent, sometimes harsh. An increase in temperature is not an obligatory companion of this form of the disease, but hyperthermia can reach high numbers and be accompanied by a headache. Symptoms usually last no more than a week, only mild swelling of the nasal mucosa may remain for another one to two weeks.
• Intestinal, or gastroenteric form of enterovirus infection is manifested by abdominal pain, which can be barely perceptible, aching. Sometimes the pain syndrome is more pronounced, up to intense, cramping, simulating a picture of an acute abdomen. But this does not mean that the patient develops enteritis, such manifestations are a consequence of reactive hyperplasia of the lymphoid tissue of the intestine itself or the lymph nodes of the mesentery, which gives pain to one degree or another. An enterovirus infection in this form can manifest itself as swelling of the intestines, which will aggravate the pain syndrome, and dyspeptic symptoms are also possible (frequent loose stools, nausea, rarely vomiting). Body temperature usually does not exceed subfebrile numbers. The symptoms of the intestinal form lasts up to two weeks in babies, but the older the patient, the easier the infection proceeds and the faster it passes, sometimes the manifestations disappear on the third day.
• Enteroviral hyperthermia (fever) is a very common form of the disease in which there are no local lesions either in the respiratory tract or in the intestines, the only sign of enterovirus infection is an increase in temperature to 38.5 ° C. Due to individual characteristics, some patients feel mild signs of intoxication, but in general, the condition is not noticeably disturbed. Of course, it is usually not possible to diagnose enteroviral fever as a single (not associated with an epidemic) case, since infected people rarely go to a doctor with similar symptoms, and besides, the malaise lasts only two to three days.
• Enterovirus, or Boston exanthema, is so named for its geographical location where it was first identified and described. A rash with enterovirus infection is a rather rare phenomenon associated with the accumulation of pathogens in the endothelium of small vessels. Violation of the integrity of the walls of the capillaries leads to the development of extravasates - small hemorrhages in the subcutaneous tissue and dermis, which is manifested by an erythematous or papular pink rash. The skin elements are not accompanied by any sensations such as itching or burning, which is different from purely allergic reactions, the rash disappears by the end of the second day, leaving no traces on the skin. In rare cases, such rashes develop on the mucous membranes of the larynx and pharynx, as well as on the skin of the eyelids.
• Enterovirus infection with neurological manifestations is predominantly a children's variant of the course, in which the development of meningitis, encephalitis, neuritis of different localization is possible. Damage to nerve tissues can be the result of exposure to viral toxins brought in with the bloodstream, but the direct introduction of the pathogen is also possible - enteroviruses can penetrate into the sheaths of nerve fibers, meninges, brain tissue and multiply there.
• Enterovirus infection with myocardial damage, a rare form described in newborns, usually associated with involvement of the brain and kidneys.
All of the listed forms of enterovirus infection are rarely found in isolated form, much more often the patient shows signs of two or more forms, which can be supplemented by individual differences from the described symptoms.
Enterovirus infection in children
The incubation period of enterovirus infection in children usually does not exceed two days, which sometimes makes it possible to retrospectively understand where the child became infected, although it is often not possible to confidently determine the source of the pathogen, with the exception of massive cases of infection in the children's collective.
The symptoms of enterovirus infection in children are very diverse, but in general they fit into the picture of a common cold, with the difference that colds are diseases of the cold season, while enterovirus infection is of a summer-autumn nature. The second significant difference between symptomatology and the majority respiratory infections - these are intestinal manifestations in almost all infected. The rest of the symptoms of the disease are nonspecific, variable, do not have an obvious difference with those in ARVI.
In children, it is even more difficult than in adults to distinguish between a certain form of infection, usually a combination of respiratory and intestinal forms is found, often in combination with enteroviral exanthema and neurological manifestations. There is a clear dependence of the symptomatology on the patient's age - the smaller it is, the more pronounced the signs of enterovirus infection in children and the longer the recovery. In babies, manifestations of viral intoxication often occur, hyperthermia can reach high numbers, there are signs of capillary damage, including a rash with enterovirus infection. Cutaneous manifestations are explained by the toxic effect of viruses on the endothelium of small vessels with an increase in the permeability of the walls. Excessive release of only plasma elements into the tissues adjacent to the capillary leads to a papular rash, the addition of blood cells to the plasma, including erythrocytes, will manifest itself as a reddish or pink rash.
The most difficult variants of the course are enterovirus infection in newborns, in which lesions of the meninges (), brain tissue (encephalitis), and polyneuritis often develop. Also, in the smallest patients, the involvement of the heart muscle in the inflammatory process is possible, while all layers of the myocardium are affected with the development of pancarditis. The addition of renal pathology due to viral damage to the glomerular capillaries aggravates the condition and poses a significant threat to the life of the newborn. Infection in such cases is usually intrauterine, since enteroviruses are able to cross the placental barrier.
But in the overwhelming majority of cases, the symptoms of enterovirus infection in children are moderately expressed, the child's condition often remains within the normal range or suffers slightly, without interfering with the usual children's entertainment, without reducing the baby's appetite and activity. And the prevailing opinion that the signs of enterovirus infection in children are of high intensity is erroneous, since it reflects only severe forms of the disease, while the bulk of cases of infection are not diagnosed, parents are taken for fatigue from prolonged play or swimming in a pond, overheating in the sun, overeating or other short-term ailments.
Enterovirus infection in adults
A distinctive feature of enterovirus infection in adults is the frequent asymptomatic virus carriage, which can last up to five months. An infected person does not experience the slightest discomfort, he does not have any manifestations of the disease, while the virus carrier is dangerous to others as a source of infection. The ability of enteroviruses to survive for a long time in the human body and retain disease-causing properties when infecting other people is one of the main reasons for the widespread spread of this type of infection.
If an enterovirus infection in an adult leads to the development of certain symptoms, then most often there is a mixed variant of the course, including intestinal and catarrhal forms. Usually, nasal discharge and discomfort in the throat begins with mild aching pain throughout the abdomen, sometimes accompanied. These symptoms are caused by the irritating effect of viruses on the secretory epithelium of the digestive tract, in response to which mucus is intensively produced, peristalsis is accelerated, which leads to frequent bowel movements. Bloating is not a permanent symptom, but if it develops, it leads to a pronounced, audible rumbling in the abdomen, sometimes accompanied by increased pain, cuts. At the same time, enteritis in infected adults rarely develops, much more often the lymphoid tissue of both the intestine itself and the mesenteric lymph nodes reacts to the viral invasion, which becomes the cause pain in the abdominal cavity. Body temperature usually does not exceed subfebrile, but sometimes in the first two days it can reach 39 ° C, accompanied by aches, headaches, severe weakness. As a rule, an enterovirus infection in adults lasts no more than three days, but symptoms of mild dyspepsia and nasal congestion may remain for several days. There were no long-term consequences of infection in adults.
Enterovirus infection in severe form (with damage to the nervous system, myocardium, kidneys, persistent hyperthermia) is extremely rare in adults and always against the background of a significantly weakened immune defense. Chronic diseases, including HIV infection, oncological pathology, and others, can contribute to this aggravation of symptoms.
Diagnosis of enterovirus infection
Enterovirus infection in sporadic (isolated) cases of the disease is usually not diagnosed, being regarded as a cold. In general, this does not contradict the etiological principles, since the lion's share of colds infections are caused by enteroviruses. And only massive outbreaks, which allow accumulating data on the symptoms and characteristics of the course of the disease, in combination with laboratory virological diagnostics, make it possible to identify the pathogen.
The detection of enteroviruses in biological media (blood, nasal discharge, laryngeal washes, feces) is possible in many ways, but the practical use of virological diagnostics is most often inappropriate for several reasons at once. First, this kind of research is carried out for a long time, by the time the result is obtained, the patient usually recovers. Secondly, due to the lack of specific drugs for the treatment of enterovirus infection, the definition of the type of pathogen is not significant for the doctor and patient. Thirdly, the probability of a false-positive result is high due to frequent cases of virus carriers, while the disease could be caused by a completely different infectious agent.
Thus, in terms of virological identification, enterovirus infection is more of a scientific than a practical interest. But if necessary, the enteroviral nature of the disease can be confirmed by serological or immunohistochemical methods.
Serological studies include enzyme immunoassay, immunofluorescence, immunochromatographic analysis, and immunoelectrophoresis. Each of these methods is based on the "antigen-antibody" reaction, that is, with the help of specific markers, antibodies of a certain type are detected in human biological media, which confirms contact with a specific type of pathogen.
Immunohistochemical methods aim at detecting viral antigen, usually using labeled antibodies, fluorescent dyes or enzymes.
Treatment of enterovirus infection in children
Since specific (etiotropic) medications for the treatment of enterovirus infection have not been developed, then the course of therapy is aimed at reducing the intensity of certain symptoms developing in a particular patient. In children, this infection often proceeds with an increase in body temperature, muscle and headaches; to eliminate such manifestations, Ibuprofen, Brufen, Paracetamol, Tylenol are used, more often in the form of a suspension, which is easier to dose in accordance with the instructions. The child needs bed rest in the presence of any of the listed symptoms, especially if the general condition suffers, weakness or drowsiness develops, as well as a diet for enterovirus infection.
Enterovirus infection is often accompanied by intestinal syndrome with signs of dyspepsia, which can cause dehydration, so it is advisable for the child to give a lot of liquid in the form of fruit drinks, jelly, compotes. During development, it is necessary to maintain not only water, but also salt balance, in such cases the doctor will prescribe Rehydron, Enterol, Bactisuptil or another drug that restores the ionic balance of the body and prevents excessive excretion of fluid.
The appearance in a child of the slightest signs of neurological disorders (lethargy, convulsions, muscle tension in the occiput), as well as severe pallor, requires immediate referral to a specialist. Involvement of the nervous system in the process requires intensive treatment with the use of corticosteroid, diuretic, anticonvulsant drugs. As a rule, this requires correction of the vascular tone and rheological factors of the blood; for this, Cavinton, Solcoseryl, Trental are prescribed.
In general, you need to consult a doctor immediately after detecting signs of ill health in the baby, otherwise you can provoke an unfavorable course of infection, which will significantly slow down recovery.
The diet for enterovirus infection should eliminate from the diet all foods that can increase intestinal motility. Sweet and carbonated drinks, baked goods, fatty, smoked and fried foods are contraindicated, fresh fruits should not be abused. Until dyspeptic manifestations stop, it is better to refrain from dairy (including fermented milk) products. It is necessary to feed the child often, but in small portions, this will noticeably reduce the load on the disturbed intestinal tract and reduce pain.
Treatment of enterovirus infection in adults
Since enterovirus infection in adults does not last long and proceeds mainly in a mild form, in the vast majority of cases it does not even require symptomatic treatment. A gentle regimen is recommended, but always at home in order to avoid infecting other people. In the presence of minor dyspeptic disorders, there is no threat of dehydration, but an abundant drink rich in vitamins is still desirable. For the duration of the illness, it is necessary to completely eliminate foods containing a significant amount of fiber (fresh vegetables and fruits) from the diet, which increase intestinal motility and aggravate bloating, undesirable sweets, milk, which also enhance the fermentation processes. Until the symptoms of enterovirus infection disappear, it is good to switch to light broths, cereals, rice has especially proven itself in such cases.
If the enterovirus infection proceeds with a low temperature, then it is better to refuse antipyretics - they will interfere with the development of the body's natural defenses and slow down recovery. However, an excess of subfebrile numbers indicates an increase in toxic viral exposure and requires correction. It is better to choose drugs for this that not only lower body temperature, but also have an anti-inflammatory effect - Paracetamol, Brufen, Ibuprofen. The same drugs have an analgesic effect, therefore, they will reduce the feeling of discomfort (spasms, pain) in the abdominal cavity.
In cases where dyspeptic disorders are manifested not only by frequent loose stools, but also by nausea, vomiting, headache, a specialist examination and, possibly, hospitalization are needed. Usually, such complicated forms occur in patients with reduced immunity, therefore, it is imperative to see a doctor.
There are no specific medications for the treatment of enterovirus infection, therefore, a complex of symptomatic therapy must be used in combination with a rational diet and a regimen that restricts the patient's physical activity and physical activity.
In general, enterovirus infection in adults proceeds in mild benign forms with recovery after a few days without any residual effects.
Prevention of enterovirus infection
Enterovirus are very common infectious agents found in almost all environments of the human environment (water, soil, air), transmitted by contact with infected people and surfaces contaminated with viruses. Considering that enterovirus infection in adults usually has an erased course and is not diagnosed at all, as well as the fact that there are virus carriers among people, it becomes clear: it is quite difficult to protect yourself from infection, it is almost impossible to prevent contact with pathogens. Therefore, the most reliable type of prophylaxis is to build up the body's protective capabilities in combination with adherence to general hygiene standards.
The prevention of enterovirus infection in children who are in contact with pathogens more often due to unformed personal hygiene settings is interpreted somewhat differently. Babies can become infected through ordinary everyday objects, on which enteroviruses survive for a long time. It is enough to know that this type of pathogen is unstable to temperature influences; to destroy it, it is enough to wash the child's toys and dishes with hot water. This simple but regular treatment will reduce the risk of infection. Enteroviruses quickly die under the influence of ultraviolet radiation, which is why it is so important to frequently ventilate the home with open windows, because enterovirus infection is more common in the summer.
An important direction of prevention is the sanitary control of drinking water sources in places of mass recreation, especially for children, and the arrangement of reservoirs for bathing. Summer outbreaks of mass diseases are closely associated with beaches, where there is a lack of well-equipped toilets, there are no washstands, and there are no conditions for taking food with the necessary hygiene standards. Very often, a trip with children to the lake or the sea ends in failure - the child falls ill due to infection through water contaminated with human waste, and parents wonder where the diarrhea comes from if they were fed only homemade and fresh food. And the baby just drank water while frolicking in shallow water, and he developed an enterovirus infection.
For greater awareness and alertness of parents, educational work with the involvement of the widest possible possibilities of the media is necessary.
Enterovirus infection - which doctor will help? If you have or suspect an enterovirus infection, you should seek the advice of a doctor such as an infectious disease specialist.
Enterovirus infection in children is much more common than in adults. The susceptibility is the same in all age groups; in newborns and infants, a more severe course of the disease is observed. The clinical picture of enterovirus infection is characterized by significant polymorphism. Treatment of most forms includes syndrome therapy, rarely used. The outcome of the disease is favorable.
Causes of the disease
The causes (pathogens) of this infectious disease are a whole group of viral microbial agents that are combined in accordance with general structural features. Enteroviruses include RNA viruses from the following subgroups:
- Coxsackie A;
- Coxsackie B (the name of the virus is derived from the name of the town in the state of New York, where this virus was first isolated);
- ECHO (from the English abbreviation enteric, cytopathogenic, human, orphan virus).
All enteroviruses are quite small in size, resistance to action low temperatures and classic disinfectants (lysol, ether, alcohol), which must be taken into account when disinfecting premises and surfaces in children's groups. They persist for a long time in biological fluids (vomit, feces), which must also be taken into account when disinfecting.
The source of infection for a child of any age is another person with obvious signs of illness or a carrier of the virus. Carriage is most often observed in preschool children. The source of infection can shed the virus for weeks or even months.
Any enterovirus can be transmitted in the following ways:
- contact, that is, with direct contact with a sick person or a virus carrier, as well as with the general use of household items (dishes, toys, towels);
- airborne, when viral particles enter the air with saliva and mucus from the nasopharynx;
- food - when eating untreated boiling water and poorly washed fruits and vegetables;
- water - when using (drinking, brushing teeth) contaminated water from wells, cisterns, any other reservoirs in which water is stored for a long time;
- vertical - from the mother to the fetus during the prenatal period or during childbirth (relevant only for infants and newborns).
After any form of enterovirus infection has been transferred, specific immunity remains, that is, the child will not get sick and will not suffer from the action of the same type of virus, but can become infected with any of its other variants.
The greatest likelihood of developing enterovirus infection is observed in preschool children, since a child at this age does not yet have household immunization against these infectious agents and the level of immunological reactivity is generally quite low.
For enterovirus infection, so-called outbreaks are characteristic, that is, a one-stage massive illness of a large group of children. Such episodes of enterovirus infection develop:- in kindergartens and nurseries;
- in children's health summer camps;
- in school collectives at the beginning of the school year.
The highest incidence of this infectious disease is in summer and early autumn.
Forms of the disease and their features
Modern infectious disease doctors adhere to the clinical classification of enterovirus infection. The following forms stand out:
- typical:
- ;
- serous;
- epidemic myalgia;
- sudden exanthema;
- atypical:
- minor illness (it is also called summer disease);
- respiratory form;
- encephalitis;
- poliomyelitis-like form;
- , uveitis;
- nephritis;
With any form of enterovirus infection, there are general symptoms, namely:
- an increase in temperature in the form of several waves, that is, the temperature rises and falls several times;
- general weakness and malaise;
- catarrhal symptoms (eg, sore throat, sneezing);
- intestinal symptoms (nausea, liquid bowel movements without blood and mucus);
- various sizes and colors of skin rashes.
More specific signs, on the basis of which the diagnosis of a specific clinical form of the disease is established, do not depend on the age of the child, that is, they develop in both the preschooler and the adolescent.
Herpangina
This clinical form of the disease develops suddenly in the midst of complete health. The child complains of a moderate sore throat, refuses to eat. This clinical form of enterovirus infection is distinguished by:
- on the mucosa in oral cavity, tonsils, tongue, bubbles with a clear liquid form;
- they are easily transformed into erosion, while the pain increases, the child hardly drinks even plain water;
- erosion heals within a week, if pathogenic (purulent) bacterial flora does not join.
Serous meningitis
The most severe form of the disease, but its outcome in most cases is favorable. The development of serous enteroviral meningitis should be thought about in the presence of such signs in a child of any age:
- spilled character, the intensity of which is increasing every hour;
- vomiting without nausea, after which the child does not feel relief;
- increased pain and repeated episodes of vomiting can be triggered by bright lights or loud sounds;
- the child may be inhibited or, conversely, extremely agitated;
- in severe cases, all muscle groups develop;
- the final diagnosis of meningitis can only be made by a doctor after a lumbar puncture and a study of laboratory parameters of the obtained cerebrospinal fluid.
Epidemic myalgia
The very name of the clinical form of enterovirus infection describes its symptoms. The child complains of fairly severe pain in all muscle groups - back, abdomen, arms and legs. Sometimes the pain is so severe that a child (especially a very small child) can hardly breathe. Within 2-4 days, muscle pain disappears without a trace.
Sudden exanthema
Any rash that occurs on the skin is called exanthema. With an enterovirus infection, the rash occurs really suddenly, simultaneously with an increase in temperature and catarrhal symptoms. An enterovirus rash is somewhat different from that in childhood drip infections:
- located on unchanged skin color;
- does not itch, does not transform into ulcers and erosion;
- represented only by spots and papules (spot with compaction);
- occurs immediately throughout the body (limbs, including hands and feet, trunk, face);
- rarely can occur on mucous membranes.
After 1-3 days, all elements of the rash completely disappear, pigmentation and peeling are not observed.
Atypical clinical forms
They are rare; specific diagnostics are required to confirm their enteroviral nature.
Specific clinical signs that distinguish, for example, enteroviral uveitis from inflammatory process there is no other etiology.
Can be observed in a child of any age. For older age (schoolchildren and adolescents), mild forms are typical: minor illness and respiratory form.
Typical for a baby:
- encephalitis;
- encephalomyocarditis of newborns;
- conjunctivitis, uveitis;
- nephritis;
- pancreatitis.
The most severe variant is neonatal encephalomyocarditis. It is characterized by severe disorders of the blood supply system and the brain. With late hospitalization and improper treatment, the death of the child is possible.
Another unfavorable option is the poliomyelitis-like form. It is characterized by:
- a combination of intestinal and catarrhal symptoms;
- after 1-3 days of illness, the child complains of severe pain throughout the body, especially along the spine, which intensifies with the slightest movement;
- flaccid paresis and paralysis develop, while the sensitivity of the limbs is preserved;
- in contrast to the classic, motor functions are restored.
Complications of the disease
Complications of enterovirus infection are rare in children of any age. With the development of severe forms of this infectious disease (meningitis, meningoencephalitis, encephalomyocarditis), there may be:
- swelling of the brain;
- seizures;
- pneumonia;
- acute respiratory failure.
The consequences of enterovirus infection are even less common than complications. That is, it is rather an exception than a rule. As a result of the transferred inflammatory process in the substance of the brain, changes in the child's psyche can be observed in the form of unmotivated excitement or delay in psycho-emotional development.
Diagnostics and necessary examination
An infectious disease doctor deals with the treatment and diagnosis of enterovirus infection (all its forms). Comprehensive diagnostics of almost all forms of enterovirus infection includes:
- (leukopenia, lymphocytosis are detected) and urine (no changes);
- examination of all laboratory parameters of the obtained cerebrospinal fluid (to confirm the enteroviral variant of serous meningitis);
- serological method (detection of a certain diagnostic antibody titer), which is especially important for the diagnosis of mild forms of the disease;
- polymerase chain reaction, which detects enterovirus in any biological fluid (saliva, cerebrospinal fluid, blood), even in small concentrations.
In most cases, the diagnosis is made based on a set of clinical and epidemiological data. Instrumental research methods for this disease are not informative and not appropriate.
General directions of treatment
Treatment of severe forms (meningitis, encephalitis) of enterovirus infection is performed in a hospital. Clinical forms of mild to moderate severity can be treated on an outpatient basis.
For any form of enterovirus infection in complex therapy, the following are used:
- plentiful drink (tea, mineral water, compote - any drink that the child drinks willingly);
- lactic acid diet, including high-calorie, but easily digestible foods;
- antipyretic (in a child of any age, paracetamol is effective and safe, only the age dosage changes).
Antiviral agents (interferon) and immunomodulators (groprinosin, amiksin, polyoxidonium) should be used in severe forms of enterovirus infection.
The complex of treatment for meningitis and / or encephalitis includes:
- strict bed rest until all laboratory parameters of cerebrospinal fluid are normalized;
- solutions to reduce cerebral edema (mannitol, uregit);
- solutions to reduce intoxication (glucose, rheopolyglucin);
- drugs that improve cerebral blood flow (cerebrolysin, trental, piracetam);
- multivitamin complexes.
How to cure a particular child with one or another clinical form of enterovirus infection is decided only by the attending doctor. Traditional methods of treatment in this case can only harm. The appointment of antibiotics is justified only when bacterial complications are attached.
In most cases, special rehabilitation measures are not required. Rehabilitation is advisable and necessary after the transferred enteroviral meningitis, meningoencephalitis.
The complex of activities includes:
- general massage and physiotherapy exercises to restore muscle strength;
- enhanced high-calorie nutrition to replenish energy costs;
- sparing mode of work and rest;
- the child can visit the team only after full recovery, physical education lessons are not attended for six months;
- vaccination is not recommended for a period of 6 months;
- long (at least 3 months) course of multivitamins.
Preventive actions
Prevention of enterovirus infection is only in the general principles of sanitary and hygienic standards and personal hygiene. If a child with any form of enterovirus infection is identified in the children's team, all rooms are disinfected, new children are not allowed into this team.
No specific prophylaxis (vaccine) has been developed.
The gastrointestinal tract of a child has some differences from the gastrointestinal tract of an adult. He is more susceptible to new food ingredients. In children, intestinal immunity has not yet been fully formed, so the body is extremely sensitive to various viruses.
At a tender age, you can encounter two variations of diseases of an infectious nature that affect the intestines and the gastrointestinal system. This is rotavirus and the latter is much more common in children, and without proper treatment it can cause irreparable harm to an immature body. The peak incidence usually occurs in the spring-autumn period. What is the difference between enterovirus in children? Symptoms, photos of young patients, as well as a detailed treatment regimen are presented in the materials of this article.
What is an enterovirus infection?
This concept combines several diseases, the sources of which are enteroviruses. Otherwise, they are called intestinal. Currently, more than 60 types of these pathogens have been studied. Depending on the serotype, they are all divided into 4 ECHOs, Coxsackie, poliovirus and enterovirus.
A child can get sick with one of the serotypes only once in a lifetime. After treatment, he develops strong immunity. On the other hand, he can become infected with another enterovirus. Such a variety of pathogens prevents scientists from creating a single effective vaccine.
Why is enterovirus dangerous in children? The whole seriousness of the infection lies in the fact that its pathogens are highly resistant to aggressive factors from the outside. They can exist for a long time in moist soil and water, then penetrate the human body through contaminated products.
In early 2008, a large-scale epidemic among children was recorded in China. Its appearance was provoked by the EV71 virus. It enters the human body through the respiratory tract, as well as the mucous membrane of the digestive tract. Then it spreads throughout the body by the circulatory system, affecting the lungs and brain. The infection was detected in 15 thousand children, and 20 of them died. This once again indicates that enterovirus in children and adults requires timely and comprehensive treatment.
Reasons for infection
The infection develops against the background of activation of groups that are the cause of certain symptoms. They all differ side by side general characteristics... Each virus is based on a nucleus, represented by a nucleic acid molecule. In some cases, DNA plays its role, in others - RNA. Outside, the inner structure is surrounded by a capsule, which has some peculiarities. Depending on the configuration of the shell elements, viruses are classified into different subtypes.
Enterovirus enters the body by inhaling air or through the mouth while eating. After that, the causative agent of the disease migrates to the lymph nodes, where it settles and begins to multiply. Its further development, as well as the severity of the infectious process, depend on several factors:
- virulence of the virus (the ability to resist the body's immunity);
- tropism (the possibility of the causative agent of infection infecting internal organs);
- the state of the immune system itself.
How long is the incubation period? Enterovirus in children may not show external symptoms from 1 to 12 days. Typically, the incubation period is five days. The clinical picture of a particular disease depends directly on the serotype of the pathogen. Enterovirus usually activates in spring and autumn. At other times of the year, the incidence is much lower. 
Ways of transmission
Enterovirus can be transmitted from a sick person to a healthy person in several ways: airborne, fecal-oral, contact. The disease spreading mechanism is characterized by great variety. Enterovirus in children is transmitted primarily through raw water or toys. The causative agents of the disease for a long time can be in a viable state in feces, soil, and also water. Even the freezing process is not detrimental to them. The pathogen dies under the action of disinfectants only if the processing time is strictly observed.
Enterovirus in children under one year old has similar causes. However, babies who are on breastfeeding, most serotypes have innate immunity. On the other hand, a baby can pick up an infection immediately after he stops drinking breast milk.
Clinical picture
The incubation stage usually does not show any symptoms. At this time, viruses settle on the mucous membranes and enter the lymphatic system, where they begin to actively multiply.
Then the stage of the disease itself follows. Signs of enterovirus in children begin to appear with sharp rise temperature, which reaches a critical point and lasts for five days. The child moves little and sleeps a lot. The first days after infection can also be accompanied by severe vomiting and headaches. As soon as the temperature returns to normal, all accompanying symptoms disappear.
Sometimes children have an increase in lymph nodes, mainly submandibular and cervical. Another symptom of the disease is exanthema. The rash appears simultaneously on the head, chest and arms. They look like red spots. After their disappearance, small pigmented marks remain on the body, which disappear on their own after a few days.
The intensity of the clinical picture directly depends on the state of the child's immunity, the received "portion" of the virus and some features of its type. 
Frequent forms of enterovirus infection
Knowledge of the complete classification is usually not required. Parents should be able to recognize the most common forms of enterovirus infection in order to timely determine the pathology and consult a doctor.
- Herpetic sore throat. This is a catarrhal manifestation of enterovirus. Herpetic sore throat usually occurs in children between three and ten years of age. Its main manifestations are heat, sore throat and vesicles on back wall pharynx. The bubbles burst and form ulcers. The main pathogens are Coxsackie A and B viruses.
- Exanthema. This is one of the most common examples of how enterovirus can manifest itself. In children, the rash has two distinct types: red-eared and roseolous. The exanthema may appear on the first or second day after infection. The rash occurs on the face, body and looks like small red spots. Sometimes they merge together. Against the background of red rashes, hemorrhagic elements may also appear. Enterovirus exanthema is more susceptible to children under six years of age.
- Flu-like syndrome. This form of enterovirus infection is characterized by symptoms of a typical flu or ARVI. Children have (runny nose, swelling, nasal congestion), fever, weakness, muscle pain. Of the typical symptoms of the syndrome that distinguish it from the usual flu, stool disorder and vomiting can be distinguished.
- Intestinal form. This is one of the most dangerous types of enterovirus infection. It is accompanied by a moderate rise in temperature, watery diarrhea, bloating, and flatulence. The main danger of the intestinal form is the high probability of dehydration, which complicates the condition of the little patient. Such a disorder requires constant monitoring by doctors and emergency care.
All types of infection can occur in a typical / atypical clinical picture. Depending on the type of pathology, the doctor chooses how to treat enterovirus in children. 
Rare forms of infection
In some cases, enterovirus infection is characterized by a complicated course. It is also classified as typical, but at the same time it is combined. Small patients require complex and more complex treatment.
- Hemorrhagic conjunctivitis. This is a fairly common form of enterovirus infection. Its manifestations begin with severe pain in the eye, partial loss of vision and increased lacrimation. Retinal hemorrhages are sometimes observed.
- Myocarditis / pericarditis. With this pathology, certain structures of the heart are primarily affected. Against the background of myocardial damage, the contractile function of the main muscle of the body is disrupted. Involvement in the pathological process of the pericardium is characterized by a change in the process of blood filling.
- Meningitis and encephalitis. These are the most severe and at the same time dangerous forms of enterovirus infection. They start with a rise in temperature to around 40 degrees. The next day the unbearable appears headache, severe vomiting that is not associated with food intake. Common symptoms are abdominal pain, cramps,
Atypical variants of infection are characterized by an asymptomatic and latent course. Clinical diagnosis becomes possible only in the event of visible complications.
Enterovirus infection in children has a varied course. Therefore, it is important to consult a doctor in time to undergo a diagnostic examination. It allows you to differentiate infection from common respiratory diseases, poisoning and dermatological problems.
Medical examination
In young patients, they usually present with serous meningitis and herpetic sore throat. Group outbreaks of the epidemic are often recorded in preschool institutions during the warm season. The main mechanism of transmission is fecal-oral.
Above, we have already described what symptoms enterovirus is characterized by. Photos (in children) of various forms of its manifestation can be viewed in specialized sources. They help to notice the ailment and see a doctor. Currently, there are four main methods for identifying the causative agent of the infection:
- Serological (detection of the virus in the blood serum). Early markers of pathology include IgA and IgM. An increase in the titer of a 4-fold value is also considered significant for diagnosis.
- Virological (determination of the causative agent of infection in cerebrospinal fluid, feces, blood). The stools are examined for two weeks.
- Immunohistochemical (detection of antigens to enteroviruses in the blood).
- Molecular biological methods (study of RNA fragments of enteroviruses).
Doctors pay special attention to differential diagnosis... Enterovirus in children in its various manifestations is important to distinguish from herpes, SARS, allergic reactions. In addition, action sensitivity needs to be tested antibacterial drugs... Thanks to the achievements of modern microbiology, high-quality diagnostics does not pose any difficulties. With the timely identification of the source of the disease, you can relatively quickly cure a child of any age. 
Drug therapy
How to treat enterovirus in children? This is the question that many parents ask themselves when they hear the diagnosis. When easy course disease, the little patient can stay at home. The indications for immediate hospitalization are the following conditions: damage to the central nervous system, heart, high fever.
Modern medicine cannot provide a single universal remedy for infection. In the acute period, young patients are recommended to adhere to bed rest, a fortified diet and drink plenty of fluids. How to treat enterovirus in children?
If the ailment is accompanied by fever, headaches and muscle pains, the use of analgesics and antipyretics (Nurofen, Paracetamol) is considered appropriate. With diarrhea, drugs are prescribed to normalize the water-salt balance ("Regidron"). Antibiotics are used only in case of bacterial infections.
To help the body cope with enterovirus, children are prescribed interferons ("Viferon", "Cycloferon", "Neovir"). They are classified as non-specific antiviral agentsthat inhibit and activate the immune system.
Treatment should be prescribed by a doctor after a comprehensive examination of a small patient. Only a specialist can correctly recognize the symptoms and suspect enterovirus. Infection in children is often accompanied by damage to the central nervous system, eyes and kidneys. In this case, in addition to drug therapy, the child is shown observation by a doctor for several months. Sometimes it can take several years. 
The diet for enterovirus in children plays an important role, since the digestive tract is disrupted. First of all, it means drinking plenty of fluids. Drinking regular non-carbonated water in large quantities helps to eliminate toxins from the body, is the prevention of dehydration.
Pediatricians recommend excluding fried and smoked foods, all sweets and pastries from the diet. It is important to limit the consumption of foods made from whole milk, butter, eggs. Meat broth, nuts, legumes and bread are also banned. Food should be steamed or baked in the oven.
What can you eat? The diet should consist of fresh vegetables and fruits that have undergone heat treatment. Fermented milk products (biokefir, low-fat cottage cheese) are allowed. You can eat lean meat, fish. It is better to serve them to the child crushed or even mashed. In general, food should be fractional. It is recommended to eat often, but in small portions. If a child refuses to eat, he should not be forced or force-fed.
What to do when acute diarrhea is accompanied by enterovirus? Treatment in schoolchildren in this case involves the so-called hunger pause. It is helpful to skip a meal or two. Hungry pauses in infants are unacceptable. Then a strict diet is prescribed to young patients.
On the first day, you can eat porridge in the water and baked apples. As the general condition of the child improves, fermented milk products, vegetable puree soups should be introduced into the diet. Last but not least, meat and fish dishes are allowed. 
Complications of enterovirus infection
Enterovirus in children, the symptoms and treatment of which have been described earlier, can penetrate into all organs and tissues. This explains the large number of its manifestations. In most cases, the child manages to survive the illness without serious health complications. Due to weakened immunity or the presence of concomitant diseases, negative consequences can still occur. Typically, doctors diagnose meningitis and encephalitis.
These diseases affect the brain of a small patient, which can lead to epilepsy, paralysis or death. There are also known cases of secondary infection, which requires additional therapy. Deaths are usually due to acute heart or pulmonary failure. If a comprehensive examination confirms enterovirus, a pediatrician should prescribe treatment in children. It is strictly forbidden to try to overcome the disease on your own. Parents can cause irreparable harm to the baby's health.
Prevention methods
Specific prevention of enterovirus in children has not been developed. However, vaccinations against meningococcemia and poliomyelitis show good results. In many European countries, vaccination is now used against the most common pathogens of enterovirus infection. However, such prevention does not give an absolute guarantee due to the variety of viruses. Research and clinical trials on this issue are ongoing.
To prevent infection of the family of an infected child, he should be isolated. It is necessary to ventilate the premises more often, to carry out wet cleaning with disinfectants every day. Non-specific prophylaxis implies the observance of basic rules of personal hygiene, the use of interferons (Laferon, Nazoferon, Viferon).
Now you know how enterovirus differs in children. Symptoms and treatment of diseases caused by this pathogen require a competent approach from specialists. If you do not delay your visit to the doctor, you can prevent the occurrence of life-threatening complications. Be healthy!
Enterovirus infection is a multiple group of acute infectious diseasesthat can affect children and adults when infected with viruses of the Enterovirus genus. In recent years, these enteric viruses have begun to cause outbreaks of massive diseases around the world.
The insidiousness of the causative agents of enterovirus infection is that they can cause various forms of clinical manifestations, from mild malaise to serious damage to the central nervous system.
With the development of an enterovirus infection, the symptoms are characterized by a febrile state and a wide variety of other signs due to the defeat respiratory system, gastrointestinal tract, kidneys, central nervous system and other organs.
What is an enterovirus infection?
Most RNA containing enteroviruses are pathogenic for humans:
- these include 32 serovars of ECHO viruses
- 23 types of Coxsackie A viruses and 6 types of Coxsackie B
- enterroviruses D 68 by 71 type
- 1 to 3 polioviruses.
In addition, the genus includes a significant number of unclassified enteroviruses. The genus Enterovirus contains over 100 dangerous viruses for humans, which are ubiquitous, have small sizes and high resistance to physical and chemical factors, for example, they are resistant to freezing and to disinfectants - 70% alcohol, ether, lysol, and in feces they are able to maintain their viability for more than 6 months.
However, upon drying, the action of ultraviolet radiation, when heated to 50C, when treated with chlorine-containing agents and formaldehyde solution, these viruses die without leading to the development of enterovirus infection. In nature, enteroviruses exist in 2 reservoirs - in the external environment, where they persist for a long time - food, water, soil, and in the human body, where they accumulate and multiply. The source of enterovirus infection for a person is most often a virus carrier or a sick person, the peak of the pathogen release is considered in the first days of the onset of symptoms. In various countries, healthy carriage of enteroviruses among the population ranges from 17 to 46%.
- The main route of transmission of enterovirus infection is considered fecal-oral, contact-household, through household items, contaminated hands, with non-compliance with personal hygiene.
- Airborne, if the pathogen multiplies in the respiratory tract, when you cough, sneeze
- Waterway - contamination can occur when vegetables and fruits are watered with contaminated wastewater, as well as when swimming in open contaminated water bodies; according to some reports, even water in coolers is a source of enterovirus infection.
- If a pregnant woman is infected with an enterovirus infection, a vertical route of transmission of the pathogen to the child is also possible.
Enterovirus infection is characterized by summer-autumn seasonality, a person has a very high natural susceptibility, and after a disease, type-specific immunity remains for several years.
Signs, symptoms of enterovirus infection
All diseases that can cause enetroviruses according to the severity of the inflammatory process can be conditionally divided into 2 groups:
Severe illness
These include acute paralysis, hepatitis, and adults, pericarditis, neonatal septic-like diseases, any chronic infections in HIV infected ().
Less severe illnesses
Conjunctivitis, three-day fever without or with rash, herpangina, vesicular pharyngitis, pleurodynia, uveitis, gastroenteritis. Enterovirus D68 can occur with severe cough and bronchopulmonary obstruction.
It is clear that all these diseases have a clinical picture, symptomatology is very diverse, therefore it is rather difficult to differentiate the occurrence of various pathologies. The most common symptoms of enterovirus infection are fever, signs of general intoxication of the body, polymorphic exanthema, and abdominal and catarrhal symptoms. The incubation period for any enterovirus infection is no more than 2-7 days.
Since intestinal viruses have some affinity (high tropism) for most organs and tissues of the human body, therefore, the symptoms and clinical forms are very diverse. Moreover, in healthy adults with strong immunity, enterovirus infection cannot develop to severe pathological processes, but most often it is generally asymptomatic, which cannot be said about young children, especially newborns and adults, weakened by other diseases, such as HIV infection, oncological diseases, tuberculosis.
Catarrhal form
The most significant part of all enteroviral manifestations is occupied by ARVI caused by enteroviruses, which proceed as a respiratory catarrhal form with rhinitis, a rare dry cough, nasal congestion, a slight reddening of the throat and not severe digestive disorders. Such an enterovirus infection, the symptoms of which are cold-like, last no more than a week and are not accompanied by complications.
Herpangina
On the first day of the disease, red papules appear on the hard palate, uvula and palatine arches, while the mucous membrane is moderately hyperemic, these papules quickly turn into small 1-2 mm vesicles that do not merge with each other, which open after a couple of days, forming erosions or to 3-5 days without leaving a trace. For such an enterovirus infection, the symptoms are complemented by salivation, a slight but painful increase in the cervical and submandibular lymph nodes, either insignificant or absent.
Gastroenteric form
This is also a fairly common form of enetroviral infection, the symptoms of which are expressed by watery diarrhea up to 10 r / day, vomiting, abdominal pain, most often in the right iliac region, bloating, while the signs of general intoxication are moderate - subfebrile temperature, weakness, decreased appetite. In children early age this form of infection is usually accompanied by catarrhal manifestations, and older children recover by 3 days, and in babies the disease can be delayed up to 2 weeks.
Serous meningitis
It is a widespread and often severe form of enterovirus infection, the symptoms of which are primarily characterized by positive meningeal signs:
- photophobia
- sound sensitivity
- inability to press the chin to the chest without a headache
- increased pain when raising the unbent leg in the supine position.
Kernig's symptom - in the supine position, the patient's leg bent at a right angle does not want to unbend due to the increased tone of the flexors.
Brudzinsky's symptoms - involuntary flexion of the legs when trying to bring the chin to the chest, flexion of the legs in the hip joint and knee when pressing on the pubis, flexion of the leg, if the other is checked for Kernig's symptom.
Children are usually very sensitive to bright light and loud sounds, lethargic, apathetic, possibly psycho-emotional agitation, convulsions, consciousness is preserved, the temperature is high ().
Both the symptoms of meningitis and the increased body temperature last no more than 2-10 days, only by 2-3 weeks the cerebrospinal fluid is sanitized. Sometimes persist residual effectssuch as hypertensive and asthenic syndrome.
Sometimes there are other neurological symptoms with enteroviral meningitis - the absence of abdominal reflexes, short-term oculomotor disorders, disorders of consciousness, nystagmus, increased tendon reflexes, clonus of the feet.
Epidemic myalgia - "fucking dance", Bornholm's disease, pleurodynia
Myalgia is characterized by severe acute pain in the muscles of the anterior abdominal wall, back, extremities, lower part chest... Paroxysmal pains last from 30 seconds to 20 minutes, the duration of which is several days, sometimes there are relapses of the disease with a shorter duration and intensity.
Enteroviral fever or minor illness
This form of manifestation is also considered a mass disease, but it is diagnosed very rarely, since the duration and severity of the disease are not great, few people apply for medical care and thorough diagnostics. Signs of enterovirus infection in this case are characterized by a three-day fever, that is, an increase in body temperature for 2-3 days, not accompanied by local symptoms, moderate intoxication, general well-being is also not greatly disturbed, hence its second name - minor illness. Very rarely, clinical cases of enteroviral fever are diagnosed during an outbreak of infection in collectives, when other types of manifestations, symptoms of enterovirus infection are found.
Enterovirus exanthema or Boston fever
From day 2, sometimes from the first day of the disease, a pink rash of a maculopapular nature appears on the face, limbs, body of an infected person, it also happens with a hemorrhagic component. Usually, after 2 days, the rash disappears without leaving a trace. Enterovirus exanthema often accompanies other forms of enterovirus infection, for example, herpangina or serous meningitis. Enterovirus exanthema, after its resolution, gives large-lamellar peeling and the skin peels off in large areas.
Hemorrhagic conjunctivitis
With enteroviral conjunctivitis, the onset of the disease is very acute, photophobia, pain in the eyes, and tearing suddenly appear. On examination by an ophthalmologist, multiple hemorrhages are found, the conjunctiva is hyperemic, the eyelids are swollen, profuse purulent, serous discharge. First, only one eye is affected, then the second is attached.
In addition to the listed manifestations of enetroviral infection, the symptoms of the disease can manifest themselves as anicteric hepatitis, encephalitis, myocarditis, eneroviruses are capable of affecting the lymph nodes, causing lymphadenitis of various groups of lymph nodes, cardiac sac - pericarditis, polyradiculoneuritis, and rarely encephalomyocarditis of the kidneys.
Diagnostic signs of enterovirus infection in children
- Signs of enterovirus infection in children are most often manifested by the gastrointestinal form, herpangine, less often serous meningitis, and paralytic forms.
- Group outbreaks are not uncommon in preschool institutions and schools, in children 3-10 years old, mainly with a fecal-oral transmission mechanism during warm periods of the year - spring, summer, autumn.
- Usually, in children, enterovirus infection develops acutely, violently - chills, fever, headache, sleep disturbance, dizziness.
- Also, children are characterized by polymorphism of clinical symptoms - muscle pain, herpangina, catarrhal manifestations, diarrhea, enteroviral exanthema.
Diagnostics of the enetroviral infection
Today there are 4 main methods for identifying the causative agent of the disease:
- Serological methods - determination of the pathogen in blood serum. The early markers of enerovirus infection include IgA and IgM, they determine a fresh antigenic stimulus, and IgG remains in the blood of a person who has been ill for several years or all their life. For the diagnosis of enterovirus infection, an increase in titer over a 4-fold value is considered significant.
- Virological methods - detection of the virus in feces, cerebrospinal fluid, blood, nasopharyngeal mucosa on cultures of sensitive cells. Stool is examined for 2 weeks, in the first days of the disease, nasopharyngeal washings, according to the CSF indications.
- Immunohistochemical methods - detection of antigens to enteroviruses in the patient's blood. The most accessible methods of immunohistochemistry are immunoperoxidase and immunofluorescence analyzes.
- Molecular biological methods - determination of RNA fragments of enteroviruses.
- General blood analysis - usually ESR and the number of leukocytes are normal or slightly increased, rarely hyperleukocytosis, neutrophilia, which is subsequently replaced by lymphocytosis.
However, many diagnostic methods are not of a mass nature due to the duration, complexity of the analysis and low diagnostic value, since due to the high number of asymptomatic carriers of enteroviruses, the detection of the virus in the analysis is not 100% proof of its involvement in the disease.
The main important diagnostic method is a 4-fold increase in antibody titer in paired sera, which are determined using RTGA and RSK. And also PCR with the stage of reverse transcription is a fast analysis with high specificity and sensitivity.
Enterovirus infections should be differentiated from other diseases:
- herpangina from fungal diseases (), from a simple
- epidemic myalgia - from pancreatitis, etc.
Treatment of enterovirus infection and prevention
Treatment of an enterovirus infection is aimed at relieving the symptoms of the disease and at killing the virus. Since the etiotropic treatment of enteroviral infections has not been developed, symptomatic and detoxification therapy is performed, depending on the severity and localization of the inflammatory process. In children, an important point in treatment is regitration (water-salt solutions and glucose orally or intravenously) and detoxification.
In severe forms of infection, when the nervous system is affected, corticosteroid drugs are prescribed, and diuretics are prescribed to correct the acid-base and water-electrolyte balance. If life-threatening conditions develop, resuscitation and intensive care are required.
To prevent the spread of a viral infection, a sick person should use personal utensils, a towel, wash their hands often, the room with a sick person should be often ventilated and daily wet cleaning should be performed. Compliance with the rules of personal hygiene, proper thorough processing of food, when swimming in open water, avoiding water entering the nasopharynx is best prevention enterovirus infection. Small children (up to 3 years old) in contact with the patient are usually prescribed immunoglobulin and interferon intranasally for prophylaxis for a week.
Enterovirus infection occurs in children much more often than in adults. All children's age groups are affected, but in children under 1 year of age, the course is more severe. The disease is polymorphic - characterized by a variety of clinical symptoms, various organs and systems are affected. Antiviral therapy is not prescribed, treatment is syndromic, depending on which systems are involved in the pathological process. The outcome is favorable.
Causative agent of infection
Enterovirus infection is a disease with one pathogen and a similar pathogenesis (development mechanism), but with different clinical manifestations.
The causative agent of the disease is viruses of the Enterovirus family. These include RNA - containing viruses:
Polioviruses;
Unclassified viruses.
Distributed everywhere. Highly resistant in the external environment, in feces they remain viable for up to 6 months, seasonality is characteristic - summer - autumn. The source is a sick person or a virus carrier. Globally, up to 46% of the population are asymptomatic carriers.
Transmission mechanism
The transmission routes of infection are varied:
Fecal - oral;
Domestic;
Airborne;
Vertical (from mother to fetus during childbirth);
Water (when swimming in dirty reservoirs and watering plants with contaminated water).
Cases of transmission of the virus through water in coolers are described.
Susceptibility to viruses is very high, but after an infection, immunity remains for several years.
The course and forms of the disease
The entrance gate is the mucous membrane of the respiratory tract and the gastrointestinal tract. Viruses actively multiply and spread through the blood throughout the body, causing polymorphism of symptoms.
The latent period is from 3 days to a week. With enterovirus infection in children, the symptoms begin with the manifestation of intoxication, acute onset, high fever up to 400 C, then several forms of the disease develop, proceeding in isolation or in combination:
Meningitis;
Epidemic myalgia;
Heart affections.
Atypical forms:
Abdominal - intestinal damage;
Skin lesions - polymorphic exanthema;
Liver damage;
Eye pathology.
Clinical manifestations
Intoxication manifests itself with enterovirus infection in children with symptoms of severe weakness, lethargy, excruciating headaches, dizziness, and insomnia. Accompanies all forms of the disease.
Gastroenteric form and liver damage
Abdominal syndrome: diarrhea up to 10 times a day of a watery nature of normal color without pathological impurities, flatulence, abdominal pain, most often in the right abdomen, decreased appetite or lack thereof, nausea, vomiting. The appearance of loose stools may be accompanied by elevated temperature, but it can be at normal temperatures.
At an early age, acute gastroenteritis is combined with catarrhal syndrome: runny nose, dry and rare cough, flushing of the throat.
In young children, the duration of the disease is up to 2 weeks.
Liver lesions are manifested by signs of enteroviral hepatitis: the child's skin and mucous membranes of the mouth, conjunctiva turn yellow, there is severe itching of the skin, urine becomes dark, feces become discolored. On palpation of the abdomen, an enlargement of the liver is determined, and sometimes the spleen.
In many cases, with enterovirus infection in children, the symptoms of catarrhal phenomena come to the fore. Then the disease resembles ARVI, but to a subfebrile or moderate febrile (380 C) temperature with a runny nose, cough, manifestations of intoxication in the form of headaches, weakness, sleep disturbances, gastroenteric syndrome with abdominal pain, repeated watery diarrhea, nausea, repeated vomiting joins.
Angina
Against the background of enterovirus infection in children, the symptoms of herpangina are the main manifestation of the disease. When viewed on the hyperemic mucous membrane of the pharynx, papules are clearly visible, which are converted into vesicles. After 2 - 3 days, erosion forms at the site of the opened vesicles. Rash accompanied severe pain when swallowing, enlargement and soreness of the nearest lymph nodes, increased salivation.
Skin lesions
With any clinical forms of enterovirus infection in children, the symptoms of the disease are accompanied by a rash in the form of red spots and small vesicles (vesicles) up to 1 - 3 mm in diameter, pink. Changes in the skin go away on their own after 2 - 3 days, leaving skin peeling. The localization of the rash is the trunk and face, less often the limbs.
Meningeal form
Exanthema accompanies another form of enterovirus infection - meningeal. It runs in parallel with the symptoms of meningitis. Enteroviral serous meningitis is manifested by the following symptoms:
Photophobia;
Increased sensitivity to sounds;
Positive meningeal signs (Lassegh's symptom: excruciating headaches when bringing the chin to the chest, Kernig's symptom: due to increased muscle tone - flexors, it is difficult to straighten the child's bent leg, Brudzinsky's symptom: spontaneous bending of the legs when the chin touches the chest);
Sharp weakness;
Apathy;
Temperatures up to 400 C;
Convulsions.
In the future, disorders of vision, consciousness join, muscle pains, increased tendon reflexes appear.
Eye pathology
Another form of pathology is eye damage:
Conjunctival hyperemia;
Pain or soreness in the eyes;
Lachrymation;
Photophobia;
Swelling of the eyelids;
Serous or purulent discharge;
In severe cases, there is hemorrhage in the conjunctiva of the eye.
A characteristic sign of eye damage is the one-sidedness of the process, after 2 - 3 days the second eye is involved.
Heart pathology
With an infection caused by enteroviruses, congenital myocarditis develops - this happens with intrauterine (vertical) infection. The child does not eat well, is lethargic, adynamic. As heart failure increases, clinical manifestations increase:
Cyanosis of the lips and skin;
Tachycardia or other rhythm disturbances;
Severe shortness of breath;
Heart murmurs.
At the same time, the child's condition is serious, immediate treatment is necessary, without timely therapy, a fatal outcome is possible.
Myalgia
Epidmyalgia is caused mainly by Coxsackie viruses, characterized by severe muscle pain. It proceeds in a paroxysmal manner, the duration of the attack is different: from 30 seconds to 20 minutes, pains arise and disappear suddenly, intensify with movements, it is impossible to predict the occurrence of an attack. Myalgias are accompanied by:
Rapid heartbeat and breathing
Tension and pain in the anterior abdominal wall;
Pallor and moisture of the skin.
Treatment
With enterovirus infection in children, treatment is pathogenetic and symptomatic. Specific antiviral therapy is not performed in children.
The scope of therapeutic measures depends on the form and severity of the disease. With liver damage and the intestinal form of enterovirus infection in children, treatment consists of:
Dehydration and detoxification (inside - Regidron, various saline solutions, just saline or saline solutioncooked at home),
In the use of sorbents (Smecta, Enterosgel, Polysorb, etc.), hepatoprotectors, antispasmodics (No-shpa).
With the meningeal form of enterovirus infection in children, complex treatment is carried out:
Dehydration with Mannitol;
Hormone therapy - in severe cases (Dexazon and others);
Measures to improve microcirculation (pentoxifylline / Trental /);
Improvement of cerebral circulation (vinpocetine / Cavinton /).
With myalgias, symptomatic treatment is carried out - pain relievers are used (NSAIDs - Ketorol, Nimesulide, etc.).
Eye damage - conjunctivitis - is treated with:
Antiviral drugs (eye drops - Oftalmoferon, Poludan, etc.);
When a bacterial infection is attached, when a purulent discharge appears, antibiotics are used (Tobrex, Uniflox, etc.);
Desensitizing therapy (Zodak, Zirtek).
Treatment of endocarditis, myocarditis, pericarditis is aimed at detoxification and restoration of cardiac activity.
The cutaneous form, in general, does not require special treatment; over time, all manifestations regress on their own.
For microbial complications, antibiotic therapy is used.
For any form of enterovirus infection in children, treatment is prescribed exclusively by a doctor - self-medication is dangerous due to the severity of the disease. In severe cases, the child is hospitalized. For the entire period of treatment, bed rest and a strict diet are prescribed. Prevention is personal hygiene.