Enteroviral infection as. Enterovirus infection in children: forms, symptoms, treatment, possible complications

Wikipedia gives the following definition of enterovirus infections: “This is a group of infectious diseases caused by various serotypes of enteroviruses from the picornavirus family. The name enteroviruses is associated with their reproduction in the intestines, but they rarely cause clinical enteritis.” This natural feature gave rise to the name “enterovirus” for the entire large group of viruses. Infection caused by these viruses has varied and numerous clinical manifestations.

Picornaviruses also include a virus that causes the corresponding disease, but active immunization helps prevent this infection. IN last years There has been a significant increase in diseases caused by non-polimyelitis enteroviruses. The relevance of identifying and treating this type of infection lies in the fact that they are uncontrollable due to significant variability and polymorphism, a high frequency of asymptomatic forms, prolonged viral carriage and lack of specific prevention. The same pathogen can cause several clinical manifestations, and one syndrome can be caused by several types of enteroviruses. The same type of enterovirus can cause mild and extremely severe forms of infection nervous system. One type of virus can cause isolated diseases and large epidemics.

The incidence is recorded throughout the year, but spring-summer seasonality is more typical. Enteroviruses have been proven to be highly contagious and children aged 3 to 10 years are susceptible to their effects. About 85% of cases of infection are asymptomatic, and in 3% of cases a severe course is observed - this applies to young children and people with immunodeficiency conditions. Every 4 years, there are outbreaks of the disease caused by different serotypes of viruses. The serotypes dangerous to humans change every year.

Pathogenesis

The entry gate for viruses is the mucous membrane of the nasopharynx and intestines. Enteroviruses, which do not have a protein shell, easily pass the “gastric barrier” and concentrate on the cells of the intestinal mucosa. Their reproduction occurs in the lymphatic system of the intestines or nasopharynx (if the oral mucosa served as the entrance gate), and then the viruses enter the blood (viremia stage) and are spread throughout the body.

Possessing a high degree of tropism for many tissues (especially nervous and muscle tissue, including the myocardium), viruses cause characteristic clinical manifestations. At the same time, the process also involves various organs: heart, eye vessels, liver, lungs, kidneys, intestines, which further expands the clinic of infectious diseases. By fixing on various tissues and organs, viruses cause swelling, inflammatory dystrophic and necrotic changes - that is, a secondary infection of target organs occurs. Clinically, this is manifested by a rash, isolated respiratory tract infection (ARVI), liver necrosis , And so on. The process of inflammation (systemic or organ) is triggered by products of free radical oxidation and proinflammatory cytokines .

Thus, three stages can be distinguished in pathogenesis:

• Impact of the virus on lymphatic system nasopharynx and intestines, which is manifested in the clinic nasopharyngitis , And .
• Viremia, which is accompanied by fever and intoxication.
• Damage to various organs.

In response to exposure to viruses, immune restructuring occurs - immune reactions ( leukocytosis , increased number of monocytes and neutrophils active in phagocytosis).

Classification

By type of disease.

Typical forms:

• damage to the nervous system;
• herpangina ;
• enteroviral fever;
• myalgia ;
• enterovirus;
• heart damage;
• respiratory form;
• hepatitis ;
• eye lesions;
• gastroenteric;
• hemorrhagic cystitis , orchitis , epidymitis ;
• vesicular stomatitis .

Atypical forms:

• erased;
• asymptomatic (the virus is in the intestines and does not penetrate the blood).

Mixed forms:

• combination and myalgia ;
• meningitis and herpangina ;
• exanthema And herpangina .

According to severity:

• light form;
• moderate severity;
• heavy.

According to the presence of complications:

• uncomplicated form;
• complicated.

Causes

As we found out, the cause of the infection is infection with enteroviruses, which are widespread everywhere. Microbiology defines enteroviruses as RNA-containing, small in size, heat-stable and resistant to acidic environments, bile and digestive juices. At a temperature of 37 C they remain viable for up to 65 days. When frozen, their activity remains for many years and is not lost during repeated freezing and thawing.

Overall genus Enterovirus includes more than 100 viruses dangerous to humans, including the virus and non-polimyelitis enteroviruses ( Coxsackie A And IN , ECHO, enteroviruses A , IN , WITH , D ), which cause infections with a polymorphic clinical picture. It could be ARVI, diarrhea , conjunctivitis , enteroviral exanthema , herpangina , damage to the nervous system ( meningitis , ), transverse myelitis . Factors that contribute to the disease are a decrease in local (local mucosal immunity) and general defense of the body.

Epidemiology

Of greatest epidemiological significance are enterovirus Coxsackie A , IN And ECHO . The source of infection is a sick or asymptomatic carrier of the virus. Among children, the percentage of virus shedding is 7-20%, and in those under 1 year of age - 32.6%. It is healthy virus carriage that causes the constant occurrence of sporadic and widespread forms of diseases. The following factors are of great importance in the constant circulation of viruses: long-term virus carriage and the presence of susceptible populations. The risk of outbreaks increases when significant enteroviral contamination is “released” into the population.

Pathogens are released into the external environment from intestinal tract the patient (their main habitat and reservoir) and the nasopharynx (for coughing and sneezing). The virus is found in wastewater, water bodies, soil, and on products. Due to its high resistance to many factors, the pathogen persists for a long time in water and other environmental objects. Overcoming the water treatment barrier at stations, it enters the water supply network. It spreads quickly in the body, withstanding the action of gastric juice.

How is enterovirus infection transmitted? The main mechanism is fecal-oral, which is realized in various ways:

• Contact-household - infection through dishes used by the patient or through toys.
• Aquatic - when swimming in ponds or pools and ingesting water infected with a virus. Water transmission plays a leading role in the emergence of seasonal outbreaks, and this is facilitated by the asymptomatic carriage of enteroviruses by a wide range of people, their constant release in the environment and their almost constant circulation.
• Food - consumption of virus-contaminated foods or raw water. The factor of “dirty hands” is also important, as the main one in the transmission of pathogens among children. The virus thus enters the body through the mouth, nose or eyes.
• It is transmitted less frequently by airborne droplets (by sneezing and coughing with droplets of saliva).
• Separately, one can distinguish transplacental, when the enterovirus is transmitted from a pregnant woman to the fetus. Moreover, a woman does not necessarily have to experience the infection during pregnancy - it is enough to have it in a persistent form. Sudden infant death has been associated with congenital infection.

Direct contact with feces occurs when changing babies and diapers, making infants the most common transmitters of the virus. Indirect transmission occurs through contaminated water, food and household items when sanitary standards are not met. There are cases of infection from swimming in seawater contaminated by sewage.

The incubation period varies depending on the condition immune system person and characteristics of the virus species. On average, its duration ranges from 2 to 10 days.

How long is a person contagious?

The most intensive release of the virus occurs in the first days of the disease. These days the pathogen is released in the highest concentrations. Considering that the virus is detected in the sick person several days before the onset of symptoms and the virus is excreted in the feces for another 3 weeks, it turns out that the person poses a danger for at least 3-4 weeks. It has been established that the duration of residence of viruses in the intestines is no more than 5 months. However, it is difficult to definitively establish how many days a sick person remains dangerous, since in immunodeficient individuals the virus can be excreted for several years, which means this contingent poses a danger in terms of infecting others.

Symptoms of enterovirus infection

How does enterovirus infection manifest? It depends on the pathogen and signs of enterovirus can manifest as lesions:

• Respiratory tract ( acute respiratory infections , herpangina , pneumonia ). Caused by viruses Coxsackie A And B , enterovirus type 71, certain viruses ECHO. Lesions are characterized by either catarrhal symptoms of the upper respiratory tract, or interstitial pneumonia, or conjunctivitis.
• Nervous system (enteroviral meningitis , encephalitis ,transverse myelitis ). The causative agents of meningitis in the last 10-20 years are viruses ECHO 30 And ECHO 11. The most common recorded form of enterovirus infection was serous meningitis (66.1%). Poliomyelitis-like diseases are caused by Coxsackie A7 and enterovirus type 71.
• Muscular system - viruses Coxsackie B3 And B5 have myotropism (that is, they affect muscles).
• Cardiovascular system with development myocartitis , paricarditis , endocaditis .
• Skin - enteroviral exanthema or disease " hand, foot and mouth disease» (rash on arms, legs, in and around the mouth). The most common pathogens are Coxsackie A5 , 11 , 16 , 10 , B3 And enterovirus 71 (EV71 infection).
• Gastrointestinal tract - enteroviral diarrhea , called Coxsackie A (18, 20, 21, 22, 24) and three types ECHO (11, 14, 18).
• Eye - causes enterovirus type 70 .

The most common forms that occur without damage to the nervous system include respiratory diseases, herpangina , meningitis-like form, epidemic myalgia .

Enteroviruses are a common cause (in second place) of respiratory diseases affecting the upper respiratory tract. These respiratory diseases have a short incubation period (no more than 1-3 days) and are relatively mild. Pneumonia with this infection is rare.

Young people are more likely to get herpangina. It proceeds benignly, recovery occurs within a few days, only in rare cases in children it can be complicated by meningitis.

After identifying tropism Coxsackie viruses to muscle tissue, enteroviruses began to be attached great importance in inflammatory muscle diseases. Myalgia (pleurodynia) occurs in outbreaks or sporadic cases. Muscle inflammation can be acute or chronic, but in chronic processes enteroviruses are rarely isolated. Most likely, enteroviruses trigger autoimmune inflammatory processes in the muscles, but then disappear.

Symptoms of enterovirus in adults

Enterovirus most often causes catarrhal form and has the following clinical manifestations:

• acute onset;
• fever (up to 37.5-38 C);
• weakness;
• hyperemia of the pharynx of the face, neck;
• sore throat and sore throat;
• nausea,
• scleral vascular injection.

Enteroviral fever (minor disease)

This is another common form of infection in adults. It is a mild manifestation and is often not diagnosed because it is not severe and lasts no more than 3 days. Three-day fever is not accompanied by any local symptoms (only sometimes there is pharyngitis with regional lymphadenitis), general health is practically not affected, intoxication is moderate, so the patient does not seek medical help.

Acute hemorrhagic conjunctivitis

It also occurs among the adult population and mainly among young adults (20-35 years old) and adolescents. Patients report that there were people with conjunctivitis at home and after that they developed the disease. This infection is extremely contagious. It begins acutely and affects one eye first. The patient complains of a feeling of a foreign body or “sand” in the eyes, fear of bright light and lacrimation. In some cases, the second eye is affected after 2 days.

Upon examination, hemorrhages under the conjunctiva (small petechiae and even large spots), swelling of the eyelids, enlarged parotid lymph nodes and the presence of scanty serous discharge are revealed. The disease is benign, and the patient recovers for 2 weeks without visual impairment. In some cases it occurs or uveitis . Some patients with conjunctivitis develop neurological complications in the form of acute radiculomyelitis who required hospital treatment.

Pericarditis and myocarditis

The course of the disease with heart damage occurs in young people (from 20 to 40 years old). Moreover, it is mostly men who get sick. It manifests itself as pain in the heart, weakness and moderate shortness of breath, which occur after an enterovirus infection caused by Coxsackie B. In general, it has a benign course, but in some patients acute inflammation of the heart muscle turns into a chronic process, progressing over time to dilated cardiomyopathy . In this case, the heart increases in size and its function suffers significantly.

Rash due to enterovirus infection is less common in adults than in children. It may accompany other forms of enterovirus infection (three-day fever) or be isolated. Externally, it resembles a measles rash (pink maculopapular), spreads throughout the body, involving the feet and face. Enterovirus rash disappears without a trace after 2-3 days.

Symptoms of enterovirus infection in children

If we consider the symptoms of enterovirus in children, we can say that their infection occurs in varying degrees severity: from mild localized forms ( vesicular pharyngitis , herpangina ) to heavy ( serous meningitis And meningoencephalitis ).

According to statistics, children come to the fore serous meningitis , and then follows herpangina , epidemic myalgia And meningitis-like form . In infants and early age the intestinal form is predominantly observed and enteroviral uveitis .

In all cases, the disease begins acutely: the temperature reaches 38-39 C, weakness, nausea, headache, vomiting, and enlarged lymph nodes (cervical and submandibular, as viruses multiply in them) appear. The temperature lasts 3-5 days and returns to normal, and after a few days the second wave of fever passes. When the temperature normalizes, the child's condition improves.

The further development of the disease depends on many factors - the virulence of the virus, its tendency to damage certain tissues and the state of the child’s immunity.

Herpangina

Most often detected in preschool children and junior schoolchildren(up to 10 years). The onset of the disease is flu-like: fever, headache, and the child’s appetite also decreases. Pain may appear in the muscles of the legs, back and abdomen. Against this background, inflammation of the oral mucosa develops, accompanied by pain, which intensifies when talking and swallowing, excessive salivation, cough, and runny nose.

Against the background of the red mucous membrane, small papules (dense, rising above the mucous membrane) appear on the palatine arches, tonsils, palate, tongue and uvula. Gradually, the papules transform into vesicles - vesicles with serous contents. Subsequently, they open with the formation of grayish-white ulcers with a crown of redness. Larger ulcers may merge. Erosion of the mucous membrane is very painful, so the child refuses to eat and drink. Herpetic tonsillitis is accompanied by enlarged lymph nodes on both sides (parotid, cervical and submandibular). The duration of the disease is up to 10 days.

Signs of serous meningitis and encephalitis

This is a severe form of infection that occurs with inflammation of the membranes of the brain. The child's temperature rises significantly (up to 40.5°C or more), he is bothered by a severe headache and repeated vomiting, which does not bring relief. Meningeal symptoms appear: photophobia, sensitivity to loud sounds, increased headache when the chin is forcibly brought to the chest. Children become lethargic, apathetic, sometimes there is agitation and convulsions while maintaining consciousness. It often occurs, and when examining the abdomen, rumbling is detected. All these symptoms can last up to 10 days or more.

Often, against the background of a meningeal symptom complex, catarrhal syndrome, rash and diarrhea can be detected (it is characteristic only for ECHO-meningitis ), but they are of a secondary nature. This flow is called dissociated. For Coxsackie B-meningeal form, only a complete meningeal symptom complex is characteristic, and for ECHO meningitis - a dissociated meningeal symptom complex.

The clinical picture of meningitis depends on age: in younger children, meningeal symptoms disappear faster, and in children over seven years of age, the leading symptoms persist longer. In preschool children in the acute period, antiviral protection occurs due to innate immunity (active monocytes and neutrophils), so recovery occurs faster. After meningitis, residual effects may persist: increased, asthenic syndrome , oculomotor disorders, increased tendon reflexes and disorders of consciousness.

Encephalitis is inflammation of the brain. This is a dangerous disease with a high mortality rate. Children may experience cerebellar ataxia, motor seizures, and severe disease leads to coma . Based on localization, several varieties are distinguished: stem, cerebellar, hemispheric. In the cerebellar form, which is considered the most favorable, complete recovery is observed.

Epidemic myalgia

There is a second name for this infection - pleurodynia . Myalgia is characterized by severe pain in the abdominal muscles, back, arms and legs, and chest. Pain occurs when the temperature rises and its appearance is wave-like. When the temperature drops, muscle pain may disappear completely. The pain occurs in attacks, lasting from a few seconds to 20-25 minutes, and bothers the child for several days in a row. They intensify with movement, coughing and are accompanied by sweating.

In this case, the child experiences hyperemia of the pharynx, granularity of the mucous membrane, as well as cervical lymphadenitis. In some cases, an enlargement of the liver and spleen is detected. Average duration illness from 3 to 7 days. If the disease takes on a wave-like course, the duration of the disease may increase by 2 weeks (3 exacerbations with breaks of 4 days).

Enteroviral uveitis

It is observed in children under one year of age. The main manifestations are rapid swelling and redness of the iris, disruption of its pigment, and deformation of the pupil due to damage to the muscles of the pupil. The disease often progresses and leads to the development of early and late complications in the form and with partial or complete loss of vision.

Enteroviral diarrhea

The gastroenteric form is also common in children and is manifested by watery, loose stools (up to 10 times a day without pathological impurities), lack of appetite, bloating, vomiting (first days), abdominal pain (more in the right iliac region). At the same time, signs of intoxication (fever, weakness, loss of appetite) are moderate. In young children, this form is accompanied by catarrhal manifestations. The febrile period in babies can last a whole week, and full recovery lasts up to 2 weeks. But even with the duration of the disease, significant dehydration does not occur in them. Sometimes the liver and spleen become enlarged. Older children recover by 3-4 days.

Pericarditis and myocarditis

It is believed that in 1.5% of cases, enterovirus infection occurs with heart damage, which most often develops in older children 1.5–2 weeks after the respiratory form. Often myocarditis complications occur and residual effects, having a benign course and a favorable prognosis. In some cases it is severe and leads to death.

The child has a slight increase in temperature, weakness, fatigue and pain in the heart area. On examination, a moderate expansion of the borders of the heart is revealed, muffled heart sounds are heard in case of myocarditis and a pericardial friction noise in case of pericarditis. Myocarditis is found at autopsies of children who died from fulminant infection caused by Coxsackie virus .

Enteroviral exanthema

This form occurs in children from 6 months to 3 years. It occurs in the form of an exanthema (rash), which appears on the skin on the 2-3rd day of illness, when the temperature drops. A rubella-like or maculopapular rash is localized on the trunk, arms, legs (less commonly) and face. The infection sometimes has a two-phase course.

The first phase is characterized by fever, skin rashes, and vomiting. The second phase is neurological complications that occur 3-5 days after the first manifestations of the disease and are regarded as a severe course of the disease. Neurological manifestations include aseptic meningitis , paralysis , rhombencephalitis . In mild cases, the disease passes through only one phase and the rash disappears without a trace in 2-3 days. Enteroviral exanthema can manifest itself as an independent clinical form, or accompany other forms of viral infections (serous meningitis, herpetic sore throat, gastroenteric form).

Enteroviral vesicular stomatitis

The second name is “arm, leg, mouth” syndrome, in which, against the background of a febrile reaction, a rash appears on the extremities and in the oral cavity on the 2-3rd day of illness. The onset of the disease is acute - with a rise in temperature to 40 C, which is accompanied by nausea, headache, vomiting and lasts up to 5 days.

Photos of enterovirus rash in children various localizations

Abdominal pain may also occur, loose stool, catarrhal symptoms, runny nose and cough. From the second day from the onset of the disease, a spotted red-pink or vesicular (vesicular) rash appears on the arms, legs, around the mouth, on the lips and always in the oral cavity (vesicular stomatitis). Changes in the mucous membrane may be observed, as in herpangina . Vesicular stomatitis is characterized by the fact that blisters on the mucous membrane quickly turn into erosions; the child is bothered by pain, itching in the mouth and lip area. Skin rashes usually disappear after two to three days, leaving no traces, but manifestations of stomatitis can bother the child for up to 7-10 days.

Orchitis

In boys, inflammation of the testicles is possible. This disease appears 2 weeks after an infection that has other manifestations (respiratory variant, herpangina or diarrhea). The disease passes quickly and usually does not result in complications such as aspermia (lack of sperm) in adulthood. However, isolated cases of such a complication have been described.

The disease develops as a result of infection carried through the bloodstream into the testicle. Sharp pain appears, the scrotum on the affected side is noticeably enlarged, the skin of the scrotum is tense. The child's temperature rises and there are signs of intoxication. Touching the testicle is painful.

Poliomyelitis-like form

Children are predominantly affected. With this form, symptoms similar to polio occur, but they are caused not by the polio virus, but by enteroviruses 68–71 , Coxsackie And echoviruses . Acute paralysis develops in severe forms of the disease with damage to the central nervous system. As with, they lead to serious consequences.

Tests and diagnostics

Diagnosis of infection is established on the basis of epidemiological, clinical data and laboratory confirmation. Used:

• PCR study. Detection of RNA viruses PCR method in different biological materials is more reliable, has greater sensitivity and this is the most quick method research. Stool samples, discharged vesicles or nasopharyngeal washings for PCR are collected in the first 3 days from the onset of the disease, and cerebrospinal fluid- in the first week of illness.
• The virological method is a direct method of identifying the pathogen - isolating it in cell culture. Isolation of enterovirus is carried out from sterile and non-sterile materials taken from the patient: cerebrospinal fluid, conjunctival and vesicular discharge, blood, oropharyngeal smear, fecal samples, smear of herpangina discharge. Isolation of the virus takes longer, and some viruses may not reproduce in cell culture.
• Serological. Blood is examined at the very beginning of the disease and after 2 weeks. This is the oldest but most relevant serological test for enterovirus, which detects specific antiviral antibodies in the neutralization reaction. It is carried out dynamically and determines the increase in antibody titer. Two samples of the patient's serum are examined using RTGA and RSC, taken with an interval of 14 days. A 4-fold increase in antibody titer is diagnostically significant. An accelerated modified m-RSC method has also been developed, which allows for rapid identification of enteroviruses.
• The ELISA method detects anti-enteroviral antibodies in the blood - markers of enteroviral infections. Early markers include IgM And IgA. Titer IgM indicates a recent infection and is detected 1–7 days after the onset of the disease. In 6 months IgM disappear while IgG persist and circulate in the blood for several years. However, the individual detection of anti-enteroviral IgM in blood serum is not a diagnostically significant indicator.
• The immunochromatographic method determines the presence or absence of antigen in feces or other test material. A negative antigen indicates that no traces of antigens were found, which means that the pathogen is absent.
• In the case of meningitis, the cerebrospinal fluid is examined, in which it is more often found neutrophilic pleocytosis (increase in cell number) or lymphocytic . During recovery, the indicators improve (the cerebrospinal fluid is sanitized), but this process is quite long. Thus, only on the 16-23rd day of illness does cerebrospinal fluid reorganization occur, and faster in young children than in school-age children. Sanitation of the cerebrospinal fluid indicates that the blood-CSF barrier has been restored. Its recovery is lagging behind clinical symptoms.

Treatment of enterovirus infection

Enterovirus infection in adults in mild form is treated on an outpatient basis. Mild forms include conjunctivitis , herpangina , three-day fever (with and without rash), vesicular pharyngitis , gastroenteritis , pleurodynia , uveitis . In healthy adults with strong immune systems, the infection does not develop to severe forms. Enterovirus in adults most often affects the respiratory tract (cold-like form) or occurs in the form of a three-day fever without catarrhal symptoms.

The characteristic symptoms were discussed above. Now let's look at the treatment and answer the questions: how to treat enterovirus and how to treat it?

• Bed rest is prescribed for the entire period of fever.
• A dairy-vegetable diet, drinking plenty of fluids (2.5 liters per day) and a balanced diet.
• The patient is given separate dishes and a towel, which are treated with boiling water.
• Toilets and sinks are treated with detergents and disinfectants to household use(“Sanita”, “Nika-Sanit”, “Domestos”). The exposure time of the drugs is doubled.

There is no etiotropic treatment. In mild cases, symptomatic therapy is carried out aimed at lowering the temperature, eliminating muscle and throat pain, and in severe cases, antiviral (interferons, ribonuclease, immunoglobulin), immunomodulating and anti-inflammatory hormonal therapy is carried out in a hospital setting.

Treatment of enterovirus infection in adults

Relief of hyperthermic syndrome

At temperatures above 38.5 C, antipyretic drugs from the group of non-steroidal anti-inflammatory drugs are prescribed: Acetaminophen , . At the same time, desensitizing drugs are prescribed for 5-6 days.

For epidemic myalgia

• within 5 days.
• Non-steroidal anti-inflammatory drugs.

In case of bacterial complications

Antibiotics are added to treatment -,.

Antiviral and immunomodulatory therapy

• Interferons, which have a wide antiviral spectrum. Natural and recombinant alpha-interferon preparations are prescribed. They are used topically and parenterally. Viruses do not develop resistance to interferons.
• Human immunoglobulin is normal - the solution is administered intramuscularly. Treatment of enterovirus in adults, which has caused severe damage to the nervous system, is carried out only in a hospital setting.

For meningitis and meningoencephalitis

• Dehydration therapy aimed at reducing cerebral edema and intracranial pressure. Intravenous drip administration is carried out for 3-5 days, with a transition to taking diuretics orally (,) in combination with potassium preparations.
• Prescribed for anti-inflammatory and desensitizing purposes hormonal drugs according to the scheme ( , ) during the week.
• In case of seizures, treatment includes intramuscular/intravenous injections or.
• For the purpose of immunocorrection they carry out intravenous administration in three days.

In paralytic form

• within 5 days.
• Subcutaneous administration in a monthly course. After a break of 14 days, a solution is prescribed intramuscularly.

An antiviral drug is considered an effective remedy Pleconaril , acting on picornaviruses and rhinoviruses. This etiotropic drug has passed clinical trials abroad, however, the drug is not registered in the countries of the former CIS, and therefore is not available to Russian citizens.

The drug is characterized by high bioavailability when taken orally (5 mg per kg of body weight 3 times a day, course 7 days). A high concentration of the drug is observed in the central nervous system and nasopharyngeal mucosa. Pleconaril can be used to treat enteroviral meningitis, encephalitis and respiratory lesions.

Treatment of enterovirus infection in children

How to treat enterovirus in children? As in adults, in mild forms treatment is carried out at home. To prevent the spread of infection, the child is provided with personal utensils and hygiene products, the room must be frequently ventilated and it must be wet cleaned daily.

Catarrhal and eczematous forms, herpangina

Komarovsky believes that for these forms of enteroviral diseases, it is enough to carry out symptomatic treatment, since it is impossible to “kill” the virus with any drugs. The main treatment is drinking plenty of fluids, antipyretic and proper care for the child. For example, with herpangina, it is painful for a child to swallow, so he refuses to even drink. Warm and hot drinks increase sore throats, so you can give your child cool drinks and those that he prefers - the main thing is to prevent dehydration. After 10 days, the symptoms of herpangina or vesicular stomatitis in the “arm, leg, mouth” syndrome disappear - you just need to wait time. Catarrhal and eczematous forms usually do not cause much suffering to the child.

Gastroenteric form of infection

Concerning diarrhea in case of enterovirus infection, the doctor recommends, first of all, drinking large amounts of fluid with electrolytes (rehydration therapy - Humana Regidron Bio , Humana-electrolyte , Oralit , Glucosolan ), as well as cytomucoprotectors (these drugs protect the intestinal mucosa and restore it), for example,. If vomiting is present, drinks are given very often (15-20 minutes) and in small portions (1-2 sips). Children are recommended vegetarian puree soups, pureed or well-cooked porridge (rice, buckwheat, oatmeal) in water, mashed potatoes without milk, boiled lean meat minced through a meat grinder, crackers and dryers.

Often, with moderate and severe diarrhea syndrome, children are prescribed (active ingredient -). The drug is active against pathogenic bacterial flora that can cause diarrhea: streptococcus, staphylococcus, salmonella, shigella, klebsiella, campylobacter and others. On the one hand, there is no need to prescribe it for diarrhea of ​​viral etiology. On the other hand, this drug is still prescribed because it prevents the occurrence of bacterial superinfection. Its purpose is indicated for young children with a burdened premorbid background. Nifuroxazide is almost not absorbed from the gastrointestinal tract, exerting its effect in the intestinal lumen, does not affect the saprophytic flora and does not disrupt the normal intestinal flora. Excreted through the gastrointestinal tract. It has a convenient release form: suspension (for children from 1 month) and capsules (from 7 years).

In case of moderate and severe diarrhea, immunopreparations (IPPs, ), which are prescribed for 5 days, and always probiotics ( , ) for a course of up to 14 days, are added to the treatment.

Indications for urgent hospitalization of children are:

• convulsions;
• peripheral paralysis;
• myocarditis ;
• lethargy ;
• headache with impaired consciousness;
• severe symptoms of intoxication;
• layering of secondary infection;
• severe background pathology;
• children under 5 years of age with vomiting after every meal, infants who refuse to drink or latch on to the breast, a history of convulsions, impaired consciousness.

An important point in the treatment of children in hospital conditions with symptoms of dehydration is reregistration (use water-salt solutions and glucose) and detoxification . Antiemetics are also used antihistamines, antispasmodics. In the presence of bacterial infection- . In severe forms with damage to the nervous system, corticosteroids are indicated steroid drugs.

Therapy of enteroviral meningitis

• Dehydration is carried out - Mannitol , Diakarb , . Lumbar puncture brings relief.
• In severe cases, administration is indicated (intravenously for up to 3 days).
• A complex is assigned B vitamins .
• In the acute period of the disease, immunomodulatory therapy is carried out. Any of the drugs is prescribed: (for a course of 6 tablets), (for a course of 5 injections), (intramuscularly, for a course of 5 injections), (rectal suppositories for 10 days). Inclusion during meningitis in children leads to a reduction in the period of meningeal symptoms and allows for faster sanitization of the cerebrospinal fluid. Against the background of the prescription, the febrile period was shortened and the condition of the cerebrospinal fluid quickly improved. Usage Polyoxidonium leads to a shortening of the duration of fever, headache and meningeal symptoms. The drug also increases antibody formation and stops the inflammatory process. Clinical effect Cycloferon consists in reducing the duration of meningeal symptoms, the sanitation of the cerebrospinal fluid goes well. On the background Viferona sanitation of the cerebrospinal fluid is observed in 87% of children. According to clinical observations, the use of Viferona , Polyoxidonium , Anaferona , and for children over 7 years old - Anaferona , Amiksina, Polyoxidonium . Viferon is especially indicated for cytosis in the cerebrospinal fluid of more than 300 cells/µl. Also, observations have shown that a low level of initial pleocytosis of the cerebrospinal fluid (up to 50x106/l) is an indicator of a protracted process of sanitation of the cerebrospinal fluid and there is a basis for the prescription of immunomodulators.
• In immunocompromised children, intravenous administration of gamma globulin has been successfully used.
• If used by children Pleconaril , the symptoms of meningitis disappeared 2 days earlier than in patients who did not receive this drug.
• With developed paralysis and polyneuritis , Consequently myelitis , encephalitis , drugs are prescribed that improve neuromuscular conduction and increase muscle contractility (,).
• If respiratory function is impaired, artificial respiration is performed.

The doctors

Medicines

• Antipyretic drugs and NSAIDs: Paracetamol , Nice , Movalis .
• Desensitizing (anti-allergic): , Cytherizine .
• Hormonal agents: , .
• Interferons. Natural: Egiferon , Feron . Recombinant: Reaferon , Viferon , Realdiron , Roferon , Berofor , Inrek , .
• Immunoglobulins: Human immunoglobulin normal for IM administration
• Combined drugs (immunoglobulin plus interferon).
• Diuretics: Furosemide , .
• Anticonvulsants: , Phenobarbital .
• Infusion solutions: , Glucose 0.9% , .
• Antibiotics (for bacterial complications): Azivok , .
• M-anticholinergics (for lesions of the nervous system and spinal cord with paresis): , .

Procedures and operations

For bronchiolitis or severe pneumonia, meningitis and other conditions, life-threatening, artificial ventilation and other resuscitation measures may be necessary. In case of cerebral edema it is carried out oxygen therapy . Surgeries for this infection are not indicated.

Prevention of enterovirus infection

Prevention of enteroviruses is ensured by compliance with sanitary and epidemiological requirements at the national level:

• Providing the population with quality water supply. This is possible by carrying out planned laboratory research water (not only drinking water, but also waste water and in open reservoirs) to detect contamination by microbes and viruses. Hygienic requirements for drinking water have been developed - GSanPiN. According to them, the unit of measurement is the presence of enteroviruses in 10 dm3. Tap water from wells and packaged water should be free of enteroviruses. If necessary, hyperchlorination is carried out drinking water, in institutions (hospitals, kindergartens) a regime with mandatory boiling of water is established.
• Improvement of water supply sources and open reservoirs that are used for domestic and drinking water use.
• Maintenance of the territory treatment facilities in proper order and control over the quality functioning of treatment facilities.
• Providing high-quality and safe food products.
• Control of public catering establishments.
• Disinfection of sewage and control of enteroviruses in the environment to determine the preconditions for epidemic troubles.
• Organization and implementation of anti-epidemic measures in treatment and prevention, preschool and other institutions. Taking into account the high contagiousness (possibility of infection) of the infection, sanitary and epidemiological rules and regulations (SanPiN dated May 18, 2010 No. 58) have been developed for institutions engaged in medical activities. This is especially true for hospitals providing obstetric care(perinatal centers, maternity and departments). The rules include mandatory periodic disinfection of premises, furniture, and linen. Special requirements are imposed on catering units, storage conditions for products (separately dry, raw, meat and fish) and their processing.
• A person, observing basic hygiene rules, can prevent contracting this infection. This applies to frequent hand washing (necessarily before eating and after using the toilet), drinking high-quality bottled or boiled water, thoroughly washing vegetables and fruits that are consumed raw, treating dishes with boiling water, keeping kitchen utensils clean and frequently changing (processing) kitchen sponges or cotton rags (napkins).
• A memo on the prevention of enterovirus infection for parents includes the same accessible and feasible measures for observing normal personal hygiene rules as for adults, but they must be carried out especially carefully.
• Mandatory hand washing with soap after visiting the toilet, before eating and throughout the day, since the “dirty hands” factor is the main factor in the transmission of pathogens in childhood.
• Treat with soapy water and hot water children's toys and other objects with which the child comes into contact.
• In outdoor conditions, on the street or in public places, wipe the child’s hands with antiseptic sanitary napkins.
• Eat only well-washed and processed (if possible) raw fruits, vegetables and berries. To treat vegetables and herbs, you can use the Aquatabs disinfectant.
• For drinking, offer your child boiled water or high-quality bottled water.
• In summer, swim in permitted bodies of water, the water in which meets sanitary safety standards.
• Make sure that your child does not swallow water while bathing. After bathing, if possible, take a shower; if not, wash the child and wash your hands with clean bottled water.

Prevention of enterovirus infection in kindergarten also involves strict compliance with the rules of personal hygiene for children. In addition, a very important aspect is early detection by daily medical examinations during the morning reception of children, cases of illness and isolation of the sick.

• Isolate patients with mild forms for at least 10 days. Recovered mild form admitted to the children's team without a virological examination.
• A restriction (or prohibition) on holding festive events is introduced in the team.
• If a kindergarten has a swimming pool or children regularly attend a city swimming pool, swimming is prohibited if a virus is detected in the water.
• Children's institutions are closed for quarantine and disinfection measures are carried out using drugs that have virucidal activity. They destroy the virus in the environment (wall and floor surfaces, dishes, toilets, pots, hard furniture, toys). In the outbreaks, “Nika-Chlor”, “Nika Neodez” (no need to wash off), “Zhavilar Plus” are used.
• Disinfectants are available in tablets that dissolve in water in different proportions. The items to be treated are either wiped with the prepared solution or soaked for a certain time.

Specific vaccines have not been developed due to the variety of virus serotypes. It is impossible to predict which serotype will circulate in a given region and at a given time. Nevertheless, effective prevention in children 1 to 14 years of age during outbreaks serous meningitis , poly-like form or uveitis , is possible by using a live polio vaccine containing attenuated strains (Sabin), which have an antagonistic effect on the enterovirus.

Vaccination is carried out once when the incidence rate rises. Within 2-3 days after vaccination, the intestines are populated by the vaccine poliovirus and pathogens are displaced serous meningitis . Prophylactic vaccination with live poliovirus vaccine significantly limits the scope of outbreaks.

After infection, those who have recovered from the infection develop lifelong immunity, but it is serospecific - only to the serotype of the virus that caused the disease. This immunity cannot protect a person from other types of enteroviruses, so the infectious disease can be transmitted many more times.

Enterovirus infection in children

Due to decreased immunity, children, especially infants, are more susceptible to the virus and their infection rate can reach up to 50%. With age, the level of immunity increases. The clinical picture of enteroviral infections in a child is diverse - from benign enteroviral fever to severe multiple organ lesions, which often lead to death as a result of liver or heart failure. In infancy, the most characteristic are catarrhal symptoms of the nasopharynx and intestines. In severe cases, the infection manifests itself meningoencephalitis , pneumonia , myocarditis , hepatitis .

Some enteroviruses (eg. ECHO 11) cause severe generalized diseases in newborns. Generalized infections cause myocarditis or fulminant hepatitis which are accompanied by encephalopathy. Most often in newborns, symptoms of the disease appear on the 3rd-5th day of life. Boys and premature newborns have a more serious prognosis. The first symptoms are nonspecific: lethargy, lethargy, poor appetite. Hyperthermia is not observed in all babies.

In the case of myocarditis, heart failure develops rapidly with respiratory distress, an increase in heart size, and occurs. Mortality from myocarditis at this age reaches 50%. Death occurs within 7 days from the onset of the disease. Myocarditis is often accompanied meningoencephalitis , while appearing characteristic symptoms: drowsiness or constant sleep, convulsions, protrusion of the fontanelle, and when examining the cerebrospinal fluid, it is detected pleocytosis . Infection with enteroviruses immediately after birth or up to one year of age causes a lightning-fast infection in an infant, which is called “viral sepsis,” which quickly leads to death.

Fortunately, in recent years, minor enteroviral disease has been detected more often. It occurs quickly, without pronounced symptoms and damage to the central nervous system or internal organs. This clinical form ranks first in frequency among other forms caused by enteroviruses. The disease begins acutely without a period of prodrome (predecessors). The temperature rises sharply , nausea, redness of the pharynx and conjunctiva often appears. The temperature lasts three days, after which all symptoms disappear. Parents should be aware of this form and, despite its relatively mild course, take all measures to prevent possible complications.

There is no specific treatment. Mild forms can be treated at home, but hospitalization is necessary for damage to the nervous system, heart, or high temperature that cannot be reduced for a long time. The child must remain in bed during the entire period of elevated temperature.

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If there is loose stool, drugs are given that restore the water-salt balance: Regidron Optim , Regidron Bio (additionally restores the balance of microflora), Humana-electrolyte , Oralit , Glucosalan . At home, you can prepare a solution: dilute 1 tsp in 1 liter of water. salt, 8 tsp. sugar and juice of one lemon (citric acid on the tip of a spoon). Enterosorbents can be added to treatment -, Filtrum , . All these drugs have a high sorption capacity and remove viruses from the intestines. Typically, these actions significantly reduce the frequency and severity of stools.

Taking into account the viral etiology of diarrhea, a complex immunoglobulin preparation (CIP) can be used. It is used in children from one month of age in the presence of dysbacteriosis and immunodeficiency conditions. One bottle contains 300 mg of immunoglobulins ( IgG, IgA, IgM). After opening, add 5 ml of boiled water to the bottle and dissolve the powder. TPI is given to the child 1 dose once a day for 5 days, 30 minutes before meals.

The diet should be light, but rich in proteins (cottage cheese, fermented milk products, boiled meat). For diarrhea, food should be as gentle as possible - pureed meat and cereals, omelettes. It is necessary to give the child plenty of fluids. Recommends boiled water or mineral water, devoid of gas, dried fruit compotes, juices.

Komarovsky believes that there is no point in using antiviral drugs for this infection. First of all, because there are no drugs with proven effectiveness against enteroviruses. Antiviral drug Pleconaril , used for etiotropic treatment of this infection abroad, is not registered in Russia and Ukraine.

In case of severe infection (heart damage, encephalitis , meningitis , hepatitis ) in stationary conditions recombinant interferons are used ( Realdiron , Roferon , Viferon , Reaferon ) and immunoglobulins. These groups of drugs have shown their effectiveness in infections against the background of an immunodeficiency state and in newborns in the absence of antibodies to enteroviruses.

Of particular importance is the spread of infection in a kindergarten or school, where up to 50% of children can be infected. In order to timely identify and isolate patients in groups, it is necessary to examine the skin, pharynx and measure body temperature. Parents should monitor the child and in this matter they will be helped by a memo that indicates all the characteristic symptoms of infection and what to do if the child becomes ill. The first thing to do is to isolate the child, report the disease to a child care facility, where a quarantine is imposed for a period of 10-15 days.

Disinfection measures are carried out in the outbreak. All these actions will help localize the infection and prevent its spread. The important thing in the memo is measures to prevent the disease: teach the child to wash his hands after using the toilet and walking, drink boiled or bottled water, and it is unacceptable to use unwashed fruits and water from a lake or river. Children under 3 years of age who have had contact with the patient are given interferon drops into their nose for a week for prevention.

Enterovirus during pregnancy

During pregnancy, in addition to the usual manifestations of infection, a symptom complex with acute pain lower abdomen and elevated temperature caused by acute viral mesadenitis . In practice, this is often interpreted as acute appendicitis or premature placental abruption, which leads to incorrect treatment tactics for the pregnant woman. Persistent enterovirus infection causes miscarriage and placental insufficiency. Intrauterine infection of the fetus is also possible. Transferred during pregnancy coxsackie infection causes congenital heart defects ( tetralogy of Fallot , tricuspid valve defects), digestive and genitourinary systems in a child.

A newborn can become infected in utero (hematogenously during the period of viremia) or during childbirth (ingestion of infected water). Intrauterine infection of the fetus is rare, and the outcome depends on the virulence of the circulating virus and the presence of maternally transmitted antibodies. The most dangerous are : lightning-fast infection (“viral sepsis”) and generalized infection with damage to the myocardium, central nervous system and lungs.

Diet for enterovirus infection

The patient's diet should be predominantly dairy-vegetable and organized within. It is important to maintain a drinking regime to reduce intoxication. In the case of diarrheal symptoms, it is advisable for the child to use a diet characterized by maximum sparing of the gastrointestinal tract.

Consequences and complications

The severity of manifestations and outcome of the disease depend on the ability of the immune system to respond to the pathogen. Timely comprehensive treatment, taking into account the patient’s form and immunity, ensures positive results and complete recovery. Among the consequences of meningitis, note long-lasting asthenic syndrome (weakness, headaches, fatigue), increased intracranial pressure, oculomotor disorders, increased tendon reflexes and disorders of consciousness.

Complications of enterovirus infection are most often associated with damage to the nervous system. In severe cases, the following may occur:

• cerebral edema ;
• dislocation syndrome (brain herniation, accompanied by cardiac and pulmonary arrest);
• encephalitis ;
• convulsive syndrome;
• hemiparesis (paralysis of one half of the body);
• development ;
• deterioration of hearing and vision.

Among other complications, it should be noted pneumonia , respiratory distress syndrome , acute kidney and liver damage.

Forecast

In most cases, the prognosis for infection is favorable. It is quite serious in myelitis and encephalitis, and very unfavorable in newborns with encephalomyocarditis . Loss of ability to work and hospital treatment for serous meningitis lasts up to 3 weeks.

Patients with damage to the nervous system are discharged from the hospital only after the composition of the cerebrospinal fluid has normalized, which lags behind the normalization of the clinical symptoms of the disease. Patients with damage to internal organs and the nervous system should be observed by appropriate specialists and undergo rehabilitation. After the disappearance of residual effects, the patient is removed from the dispensary register.

List of sources

• Nikonov O. S., Chernykh E. S., Garber M. B., Nikonova E. Yu. Enteroviruses: classification, diseases caused and directions of development antiviral agents// Advances in biological chemistry, vol. 57, 2017, p. 119–152.
• Protasenya I.I. Enterovirus (Coxsackie and ECHO) infection in children /I.I. Protasenya, V.P. Molochny, V.I. Reznik //Far Eastern Journal of Infectious Pathology, 2003. - No. 2. - P. 51-54.
• Sutherland S. Enteroviruses. Congenital, perinatal and neonatal infections / Ed. A. Greenough, J. Osborne, S. Sutherland. - M.: Medicine, 2000. - P. 74-82.
• Heydarova N.F. Aggravating influence of enterovirus infection on the course and outcome of pregnancy / N.F. Heydarova // Ukrainian Journal of Clinical and Laboratory Medicine. – 2011. – No. 4, T. 6. – P. 70-74.
• Clinical and immunological features of enteroviral meningitis in children / V. V. Fomin, A. U. Sabitov, Yu. B. Khamanova, O. A. Chesnakova, JI. G. Besedina, Ya. B. Beikin // Bulletin of the Ural Medical Academic Science. - 2008. - No. 2 (20). - pp. 144-147.

In summer and winter, adults and children, low-income and frankly rich - enterovirus infections spare no one. The symptoms of diseases associated with this pathogen have a wide range. The geography of viruses and their diversity is amazing. Let's try to understand the etiology, sources, routes of infection, methods of treatment and clinical guidelines with enterovirus infection.

Relevance of the topic

Data on epidemiological outbreaks recorded in different countries, demonstrate the intensification of enteroviral infections in the world. The geography of distribution of this group of pathogens is ubiquitous, clinical manifestations are varied.

The peculiarity of infections of this kind is associated with the concept of virus carriage. This means that the virus can be in the human body, but manifests itself in special cases - when natural immunity is weakened. In addition, virus carriage contributes to the formation of spores, leading to mass diseases and infection of a large number of non-immune recipients.

Pathogenicity and manifestation

This is a group of infections that are mostly asymptomatic or do not cause too much harm to a person. But there are exceptions to every rule. It is enterovirus infections that are in second place in the frequency of cold-like diseases.

The infection can be extremely dangerous and affect all systems and organs, muscles, and mucous membranes. This anthroponosis has two reservoirs:

• humans, where the pathogen multiplies and accumulates;
• environment (water, air, food), where virions are able to maintain virulence for a long time.

The main route of transmission of enteroviral infections is airborne - the fastest and most unpredictable. No less effective is the route of infection entering the human body through food tract and oral-fecal. There is also a vertical route of infection - from the carrier mother to the newborn. And it is with this phenomenon that many pediatricians associate sudden infant death syndrome.

What kind of animal is this?

Microbiology of enteroviruses

The group of human pathogens includes representatives of the picornovirus family (Picornaviridae). This family includes more than 60 pathogens from the genus Enterovirus, Rhinovirus, Cardiovirus, and Aphtovirus.

The genus of enteroviruses includes polio viruses (3 forms or serotypes), Coxsackie viruses of group A (24 serotypes) and B (6 serotypes), ECHO (Enteric Cytopathogenic Human Orphans - intestinal cytopathogenic human orphans, 34 serological types), hepatitis A virus and many unclassified enteroviruses. They all have a number of similar structural features:

• These are small viruses (from pico - “small”), measuring within 28 nanometers.
• They have a cubic type of capsid, built from 4 types of proteins.
• They have a common complement-fixing antigen for the entire genus; serotypes differ in type-specific protein antigens.
• The genetic material is single-stranded linear RNA.
• The outer supercapsid shell, carbohydrates and lipids are absent.
• They are highly stable in the external environment. That is why they are not killed by stomach acid.

Pathogenicity and resistance

Representatives of this genus are ubiquitous and infect plants, animals, and bacteria. Enteroviruses enter the body in various ways, mainly through the digestive tract, reproduce in the mucous membrane and lymph nodes, penetrate the blood and spread throughout the body. Damage to one or another organ depends on the type of pathogen and the immune status of the recipient.

Enteroviruses are common on all continents of the planet. They remain contagious (infectious) in the environment for up to a month, and in feces for up to six months. They are resistant to freezing, but die when heated to 50 °C. They remain pathogenic in acidic environments (they are not afraid of gastric juice), are resistant to 70% alcohols, but are destroyed by exposure to ultraviolet radiation and ultrasound.

When disinfecting premises and objects, oxidizing agents (hydrogen peroxide and potassium permanganate), chlorine-containing agents, and formaldehyde are used, which inactivate the pathogen.

Diagnosis of enteroviral infections

The specificity of diagnosing pathogens of this group of diseases is based on identifying all pathogens present in the body. The material for research is feces and urine, washings from the affected areas of the mucous membranes, blood and cerebrospinal fluid. For the diagnosis of enteroviral infections are used following methods:

1. Virological research. This technique uses cell cultures and laboratory animals. For example, to determine all serotypes of the polio virus, clinical material is used using continuous cultures of the renal epithelium of monkeys. The polymerase chain reaction reaction is also used.
2. Serological tests. The method of paired sera and color samples is used. The method is based on the ability of viruses to suppress metabolism in a cell, change the pH of the environment and, accordingly, the color of the test sample.
3. Express method. Quite complex and not widespread. Cardiac analysis (changes in the nuclei of affected cells) is used for diagnosis.

Many pathogens - many manifestations

Forms of enteroviral infections in accordance with modern classification:

• Intestinal, or gastroenteric. The disease lasts from one to two weeks. Clinical manifestations: rhinitis, swelling of the mucous membranes of the oropharynx, cough, flatulence, diarrhea and vomiting.
• Enteroviral fever. Symptoms: fever up to 40 °C, weakness, muscle pain, redness of the sclera of the eyeball, nausea and vomiting, and in rare cases, diarrhea. The disease lasts 3-7 days. Pathogens are enteroviruses of all subtypes.
• Catarrhal or respiratory (herpangina). The disease lasts up to a week and proceeds as an acute respiratory disease. Caused by Coxsackie viruses A and B. Symptoms: short-term fever with a slight increase in temperature, sore throat, ulcers on the walls of the pharynx and tonsils, loss of appetite.
• Intestinal infection. The duration of the disease in young children is up to 2 weeks, in older and adults - 1-3 days. Only the intestinal mucosa is affected. Clinic: abdominal pain, frequent and loose stools, diarrhea, possibly a slight increase in body temperature.
• Myocarditis. Disorders of the heart due to damage to its different layers. Symptoms include increased heart rate, fatigue, weakness, decreased blood pressure and chest pain. The causative agents are Coxsackie B5 and ECHO.
• Exanthema. Within 3-5 days, a rubella-type rash appears on the face and body.
• Conjunctivitis. Symptoms: pain in the eye, blurred vision, lacrimation and hemorrhages, enlarged lymph nodes may be observed. The illness lasts up to two weeks. Pathogens: enterovirus serotype 70, Coxsackie 24.
• Meningitis and encephalitis. The most severe form of enterovirus infection. Clinical manifestations: severe pain, heat, vomiting, delirium, convulsions. The course of the disease occurs in periodic outbreaks, which can last up to 2 months. The causative agents of this form are the Coxsackie B and ECHO viruses.
• Paralytic form. Accompanied by unilateral or bilateral paralysis of the limbs, decreased muscle tone. Symptoms may persist for up to 8 weeks, with severe development Possible death due to disorders of the respiratory center.
• Epidemic myalgia. A rather rare disease that manifests itself in paroxysmal pain in the muscles, chest and abdomen. Accompanied by fever and increased sweating. Duration of the course is up to 10 days. The causative agents are Coxsackie B3 and B5.
• Encephalomyocarditis of newborns leads to death in 60-80% of cases. Pathogens are Coxsackie viruses of group B. Symptoms: lethargy, convulsions, heart failure, breast refusal.

The incubation period in all cases lasts from 2 to 15 days. The onset of the disease is always acute. There may be mixed forms of infection.

Pathogen entry gate

Before asking the question of how to treat enterovirus infection in children, let’s figure out how it enters the body. The entry gates in this case are the mucous membranes of the respiratory tract and digestive tract, where viruses enter through the fecal-oral or airborne routes.

When a pathogen enters the mucous membranes, a local inflammatory reaction begins. This will end the infection if the immune system is strong enough. But if the immune status is weakened, and the virulence of the virus is high and its quantity is quite large, then generalization of the infection occurs. It penetrates the bloodstream and spreads throughout the body in accordance with the tropic characteristics of the pathogen.

Depending on the affected organ or tissue, the clinical picture and symptoms of the disease can be very diverse.

General symptoms and course of the disease

The severity and duration of enterovirus infection depends on many factors. These include:

1. Virulence of the pathogen (the ability to resist the body’s defense mechanisms).
2. Features of tropism - the direction of the virus to damage certain organs and tissues.
3. Immune status of the infected person. The higher it is, the more likely the body’s victory over the pathogen.

As is already clear, viruses of this group can infect various systems and organs of our body. But regardless of the source of infection, the common symptoms of such infections are the following:

• The temperature during enterovirus infection rises from 38 ºС to 40 ºС.
• Swelling of the submandibular and other lymph nodes.
• Weakness and drowsiness.
• In some cases, rash.
• Nausea, vomiting and diarrhea.

Preventive measures

Special methods of prevention in in this case does not exist. To avoid infection, you must first of all follow the rules of personal hygiene: wash your hands and food, drink boiled and purified water. During a disease outbreak, avoid visiting crowded places. But, perhaps, the main thing is to monitor the condition of the body and increase immunity. Healthy image life, proper nutrition and physical activity will minimize the possibility of a viral attack.

If there is an infected family member, all contacts should be more careful about preventive measures. Separate utensils and personal hygiene items for the patient and increased attention to the personal hygiene of all family members should be a priority.

In children's institutions, in case of outbreaks of enterovirus infections, quarantine is established for 14 days from the date of last contact, and anti-epidemic measures (disinfection) are carried out. IN maternity hospitals quarantine is also introduced, and all employees who had contact with patients are sent on vacation for two weeks.

How to treat enterovirus infection in children?

Children, due to their immune status, are more susceptible to such diseases. If you suspect an enterovirus infection in a child, you must contact your pediatrician and receive a referral to conduct research necessary in a particular case. Sometimes it may be necessary to consult doctors of narrow specialties - a cardiologist, otolaryngologist or ophthalmologist.

Treatment of mild forms of the disease is carried out on an outpatient basis and only if meningitis, myocarditis and other combined lesions are suspected, the child can be hospitalized. There are no special drugs for enterovirus infection. Treatment boils down to reducing negative symptoms, preventing dehydration and promptly identifying side effects.

As a rule, the body copes with the infection on its own within a week, and no significant consequences of enterovirus infections are observed. To maintain the body, drugs of a symptomatic (for example, antipyretic) and pathogenetic nature (sorbents and antiseptic ointments). There are no restrictions on the diet, but it is worth remembering that nutrition for enterovirus infection must be balanced and take into account the nature of the disease. So, if the oropharynx is infected, food should not be hot or cold, which will ease the pain when swallowing it.

Antibiotics are prescribed for secondary infections and complications of enterovirus infection, such as pneumonia, otitis, myocarditis. For some forms of disease, hormonal drugs are prescribed. But all these appointments should be made by a doctor after carefully studying the research results and taking into account the patient’s condition.

The most typical enteroviral diseases

It is impossible not to list the most common and considered typical infections that are caused by enteroviruses. These include:

• Summer flu. The most common infection occurs when swimming in rivers and the sea. Overheating and hypothermia contribute to the development of infection. The symptoms combine flu-like symptoms and intestinal disorder. The disease lasts from 3 to 7 days, accompanied by fever, diarrhea, sore throat, and sometimes conjunctivitis.
• Herpangina. Herpes-like rashes in the back of the throat and on the tonsils. The disease goes away in 3-5 days.
• Viral pemphigus. The appearance of bubbles filled with liquid on the palms, between the fingers, on the soles. Fever accompanies infection in the first 1-2 days; symptoms disappear within a week.
• Viral exanthema. It is caused by echoviruses and is accompanied by a rash all over the body, similar to rubella. It is not so common, symptoms disappear within ten days.

In conclusion, I would like to note that this group of diseases is characterized by the phenomenon of virus carriage. Often adults do not get sick, but are virus carriers. But children, with their immune system not yet stable, become easily infected. Therefore, observing the rules of personal hygiene is mandatory for both adults and children. And remember - the key to the body’s victory over viruses that constantly attack it is strong natural immunity. Be healthy and take care of yourself and your children!

Enterovirus infection, originating and very actively multiplying in the gastrointestinal tract, can cause a sensitive blow to several internal organs at once. It can affect the nervous system, kidneys, liver, and cardiovascular system. The disease can occur with a large number of varied symptoms, which significantly complicate its diagnosis.

Enterovirus most often affects young children. After complete recovery, the child acquires stable lifelong immunity to this disease, but you should know that it is serospecific. That is, it ensures the body’s resistance only to the virus that turns out to be the causative agent of the disease. This feature greatly complicates the development of drugs and vaccines and does not make it possible to completely deal with the infection.

Enterovirus in children

Enterovirus infection is transmitted in three main ways - contact, fecal-oral or airborne. In this case, the source of infection can be not only a person who already has pronounced symptoms of the disease, but also a completely healthy carrier of one of the viruses that causes the development of the disease.

The disease begins with the penetration of the pathogen into the body, its migration through internal organs and settling in the lymph nodes. In the vast majority of cases, this entire process takes only a couple of days, but sometimes the incubation period can reach 10 days. Its duration depends on several important factors:

• the health status of the small patient at the time the infection entered the body;
• the effectiveness of the body’s protective functions, their ability to resist the aggressive effects of the virus for a long time;
• tropism or the ability of pathogenic microorganisms to have a negative effect on internal organs.

It is very important to identify enterovirus infection at an early stage of its development, as this will minimize harm to the child’s internal organs.

This is not as difficult to do as it might seem. As we said earlier, the disease is characterized by numerous symptoms that simply cannot go unnoticed.

Temperature during enterovirus infection in children

We have already mentioned above that when an enterovirus infection occurs, a child’s body temperature rises sharply. How many days can it stay at 38-39 degrees? In most cases, this depends on the general condition of the body, as well as on the activity of its protective functions.

Fever is not only a sign of so-called enteroviral fever, it can also accompany a number of other symptoms - rash, diarrhea or vomiting, sore throat and swollen lymph nodes.

Enterovirus infection in infants

In children under one year of age, enterovirus infection is characterized by almost the same symptoms as we described above. At this age, the disease can develop according to one of the following scenarios:

• herpetic sore throat, which is the appearance of a rash in the throat and mouth;
• conjunctivitis or uveitis caused by exposure to enteroviruses. In this case, the organs of vision suffer;
• cutaneous or rash form, characterized by profuse rashes throughout the body;
• enteroviral meningitis. It affects the brain and is accompanied by severe pain. A very dangerous form of the disease that cannot be completely cured;
• an infection that affects the cardiovascular system. In children under the age of 1 year it can develop rapidly and in the vast majority of cases leads to death.

In any of these forms, the disease is extremely dangerous for a newborn baby, so it is very important to identify it promptly and begin treatment.

How long does enterovirus infection last in children?

The answer to this question depends on two main factors:

• the state of the protective functions of the child’s body;
• the correctness of the treatment prescribed by the doctor, the parents’ compliance with all the recommendations of the treating doctor.

No matter how many days the illness lasts, the child remains contagious while exposed to the virus. Therefore, it is necessary to isolate him and provide all conditions for treatment at home.

Is it possible to bathe a child with an enterovirus infection?

The answer to this question depends on his body temperature. If it stays below 38 degrees, you can limit yourself to short water procedures and rinse the patient in the shower. Otherwise, it is better to refrain from swimming until complete recovery. But it is imperative to wash your hands, and it is advisable to do this as often as possible.

Symptoms of enterovirus infection in children

When diagnosing enterovirus infection, the main task of parents and doctors is not to confuse it with other diseases. For this purpose, immediately after identifying at least one of the symptoms described below, you must go to the clinic and undergo all the necessary tests:

• The rash caused by enterovirus is called exanthema and can affect the skin almost all over the body. It may also appear in the oral cavity, taking the form of small bubbles filled with liquid. Exanthema often frightens inexperienced parents who confuse the infection with measles;
• pain in muscle tissue. This symptom It appears mainly in the abdomen or chest, but can also spread to the limbs and back. The pain intensifies even with the slightest muscle tension and becomes chronic if the need to begin urgent treatment is ignored;
• changes in body temperature or so-called enteroviral fever. Sometimes accompanied by severe diarrhea, nausea and vomiting. May last about three days. First, the temperature suddenly jumps to values ​​above 38 degrees, after which it drops for a couple of hours and rises again. If enteroviral fever is detected, you should immediately call a doctor;
• diarrhea already mentioned above, which is not accompanied by an increase in body temperature. At this stage of the development of the disease, it is very important to maintain the water-salt balance in the body in order to completely eliminate the risk of dehydration;
• vomiting and bloating;
• cough, runny nose, sore throat and pain in the throat when swallowing. These signs confuse parents who begin to suspect ARVI.

In addition, enterovirus infection can cause symptoms such as conjunctivitis, swelling of the lower and upper extremities, weakness in the body, fatigue and drowsiness. The child stops eating normally due to loss of appetite and constantly complains of a deterioration in his general condition. Enlarged lymph nodes are also a sign that you need to visit a doctor.

At the same time, we should not forget that each disease has its own incubation period, which is characterized by certain symptoms, enterovirus infections are no exception. From the moment the infection enters the body until its first signs appear, it can take from 1 to 10 days. More often this happens within a period of 2-5 days. In frequent cases, the disease begins with a sharp increase in temperature to 38-39º C. This temperature can last up to 3-5 days inclusive.

Also, this condition can have a wave-like character. Outbreaks of temperature and accompanying symptoms may decrease or increase throughout the entire period of the disease.

Rash due to enterovirus infection in children

The appearance of enterovirus exanthema on the skin of the feet and hands, and on the mucous membrane of the oral cavity usually indicates that the causative agent of the disease is the Coxsackie A virus. Rashes can also appear on the back or abdomen. The rash is usually accompanied by fever and mild intoxication of the body.

After the appearance of small bubbles with liquid that appear on the tongue, rather painful ulcers gradually form in their place, causing discomfort to the child. The cutaneous form of exanthema looks like small red dots abundantly covering the affected areas. If such rashes are detected, treatment should be started immediately to avoid serious complications.

Treatment of enterovirus infection in children

It is not easy to defeat an enterovirus infection that affects a small child, but an integrated approach and strict adherence to all doctor’s recommendations will allow you to cope with the disease, eliminating any complications.

The set of measures aimed at combating the virus most often includes:

• mandatory bed rest, which is prescribed to all patients, regardless of age;
• taking medications that make it possible to bring down a high temperature;
• rehydration or restoration of water-salt balance. The child should drink as much as possible. If the disease manifests itself with vomiting and diarrhea, it is also advisable to use special medications that restore electrolyte levels;
• antibiotic treatment. This group of medications is necessary if the infection is complicated by the negative effects of pathogenic bacteria;
• when the throat is affected, skin rash If problems with the kidneys or liver occur, these organs must be treated separately with medical supervision for several months.

Antiviral drugs for enteroviral infection for children

A mandatory measure to effectively treat the infection is taking antiviral drugs. In the vast majority of cases, drugs from the group of interferons are used, which include Enterofuril and Acyclovir, Isoprinosine and Viferon, Polisorb and Augmentin, Enterosgel and Arbidol. The dosage and frequency of taking medications is determined by the attending physician depending on the condition of the individual patient.

Many parents are scared individual symptoms infections, they start giving the child antibiotics. Let us say right away that this is a common mistake, since the causative agent of the disease is a virus, not pathogenic microorganisms. It is possible to treat a patient with antibacterial drugs only in cases of concomitant infections.

Diet for enterovirus infection in children

The main goal of treating enterovirus infection is to destroy the causative agents of the disease. A properly selected diet makes it possible to solve this problem. It is very important to completely eliminate spicy and sour, salty and fatty foods, and give your child as little sweets and fried foods as possible. All this negatively affects the immune system and can become one of the reasons for the development of the disease, even with effective treatment.

In addition, it is important to strictly follow the recommendations below:

• fruits and vegetables should not be eaten raw. It is best to use them for preparing compotes, jelly, and other dishes;
• under no circumstances should a child be forced to eat;
• It is best to cook crushed foods;
• the diet should contain only baked or boiled dishes prepared without the use of oils and fats;
• You need to feed your baby in small portions up to 6 times a day.

To restore fluid balance, the patient needs to drink as much fluid as possible. Chamomile decoctions, not too strong green tea, jelly, compotes and fruit drinks are perfect for this.

Child after enterovirus infection

A child’s recovery from an enterovirus infection can take from several weeks to several months, depending on the effectiveness of treatment and the condition of the body. It is necessary to start taking antiviral and other drugs as early as possible, immediately after detecting the first symptoms and conducting research. Otherwise, the consequences may be most unpredictable.

The main complications of enterovirus infection are further damage to the affected internal organs and the transition of a number of diseases to chronic form. But with proper and effective treatment, such cases are quite rare.

Prevention of enterovirus infection in children

To ensure that your child is never affected by an enterovirus infection, you just need to follow basic hygiene rules. Teach your child to wash his hands before eating, and never give him dirty vegetables and fruits or tap water.

Any products for cooking for a child should be purchased in places specifically designed for this purpose. If the seller complies sanitary standards, the risk of disease is reduced to zero. It is also very important to prevent children from swimming in polluted water bodies, which create almost ideal conditions for the development of pathogenic microflora.

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Compliance with hygiene rules will help protect the child not only from enterovirus infection, but also from a number of other diseases caused by the negative effects of pathogens.

Enterovirus infection in children is usually called not a specific condition, but a whole group of infectious diseases caused by any pathogen from the enterovirus family. Because the modern medicine identifies several species of representatives of this family; entervirus infection in children can appear more than once. This same feature makes it impossible to develop a vaccine that would provide the desired protection to the child’s body.

It is worth noting that infants are not susceptible to this disease, since they are protected by maternal immunity. Most often, this infection affects children aged three to ten years.

If you are wondering how to treat enterovirus infection in children, contact the CELT multidisciplinary clinic! We have experienced pediatricians who will help your baby cope with the disease and eliminate any complications. The main symptoms and treatment of enterovirus infection in children will be discussed below in this article. Do not forget: this information is provided for informational purposes - treatment should be prescribed by a specialist who will select it individually after diagnosis!

How does infection occur?

Enterovirus infection is seasonal. Its peak usually occurs in summer and autumn. The source is a patient or a carrier of the virus. Children who are carriers of enterovirus infection have no symptoms of infection, but, nevertheless, viruses are present in the intestines, and they are excreted together with feces. Carriers are children who have clinically recovered or have not become ill at all, despite infection with enterovirus. This is possible if the child's body has strong immunity. The virus can live in the intestines for up to five months.

Enteroviruses can live for a long time in soil and water. Moreover: they can survive for several years in a frozen state, are not afraid of the effects of disinfectants, but die when exposed to high temperatures, from +45°C.

The mechanism of transmission of enteroviral infections in children can be:

• airborne: with drops of saliva when sneezing or coughing;
• nutritional: with a low level of personal hygiene;
• aqueous: when consuming raw water;
• household: through toys, cutlery, door handles.

Symptoms

The symptoms of enterovirus infection in children are diverse, which is explained by damage to the mucous membranes of various locations (upper respiratory tract, digestive tract, central nervous system).

A frequent manifestation of enterovirus infection (taking into account the entry gate of the pathogen) is the mucous membrane of the upper respiratory tract.

• Viral sore throat - characterized by inflammatory lesions of the oropharynx, severe pain in the throat, rashes on the back wall of the pharynx, which in turn have stages of changes: small red granular elements - round vesicles (bubbles) with liquid contents - defects of the mucous membrane like “ulcers” » – polymorphic islands of whitish deposits.

Almost always, enterovirus infection occurs with a high fever.

• Fever is characterized by high temperatures (up to 40° C), resistance to the action of antipyretic drugs (the effect does not occur immediately, lasts less than 6 hours), duration of the course (up to 5-6 days).

One of the typical manifestations of enterovirus infection is skin rash syndrome.

• Exanthema - characterized by the appearance of maculopapular elements on the skin of the face, torso, and limbs. Noteworthy is the rash affecting the skin of the palms and soles of the feet - this is a distinctive sign only of an enterovirus rash!

Virus infection of the mucous membrane of the digestive tract triggers various symptoms of intestinal dysfunction.

• Gastrointestinal form - characterized by impaired digestion and absorption of food components, resulting in nausea, vomiting, excessive gas formation, bloating, impaired stool consistency, and increased bowel movements (diarrhea syndrome). Symptoms deserve no less attention, as they can cause dehydration.

There are a number of other manifestations of enterovirus infection. They are less common than those listed and may be due to age (newborns) or certain features of the body’s immune response (various forms of immunodeficiency). Severe manifestations include meningitis, encephalitis, and myocarditis. With these forms of enterovirus infection, headaches, uncontrollable vomiting, drowsiness, or motor excitability, increased irritability, convulsive symptoms, and various forms of impaired consciousness appear. Any of the listed symptoms is a reason for mandatory hospitalization!

Also, do not forget that the enterovirus family includes the pathogens of polio. This relationship between viruses led to the existence

• polio-like form of enterovirus infection. The symptoms resemble a formidable disease: paralysis, paresis of the limbs. However, the changes are reversible, and recovery occurs without consequences.

Among the symptoms that may accompany the course of an enterovirus infection, but do not always occur, it is worth noting conjunctivitis (often one-sided at the onset of the disease), myalgia (wavy attacks of muscle pain), lymphoproliferative syndrome (enlarged, painful lymph nodes).

Diagnostics

Before prescribing treatment for enterovirus infection in children, it is necessary to diagnose it correctly. As a rule, this does not cause difficulties, since outbreaks occur in children's groups in the summer and autumn. To confirm the diagnosis, one of the methods is used to identify the causative agent of the infection:

• serological;
• virological;
• immunohistochemical;
• molecular biology.

In addition, CELT pediatricians pay attention differential diagnosis, which allows you to distinguish enterovirus infection from:

• allergies;
• other types of viral infections;
• bacterial infections.

Treatment

Treatment of enterovirus infection is usually carried out at home. Hospitalization is resorted to only in extreme cases: when it is not possible to reduce the high temperature for a long time, there are symptoms of dehydration, signs of damage to the nervous system or heart. During the entire acute period, the small patient must remain in bed. The food recommended is light, but rich in protein. It is important to provide your child with plenty of fluids in the form of boiled water, mineral water without gas, fruit drinks or compotes.

There is no single universal remedy against enteroviruses. Treatment depends on how the infection manifests itself:

• for fever, antipyretics are prescribed;
• for diarrhea, medications are prescribed to help stop diarrhea and restore water and electrolyte balance;
• a number of local symptomatic care products (sprays, gargles, nasal rinsing solutions, eye drops, etc.);
• if there are bacterial complications, antimicrobial drugs are prescribed.

If your baby is sick, contact CELT! We have experienced pediatricians who will identify the cause of the disease and help eliminate the existing symptoms!

If you think that people are most vulnerable to the effects of the influenza virus, then you are mistaken. There is a group of viruses that infect hundreds of millions of people every year. They are called enteroviruses. However, in most cases, enterovirus infection does not pose a threat to life and health. However, there are no rules without exceptions; in certain cases it poses a threat.

Description of viruses

Enteroviruses are a whole group of viruses belonging to the picornavirus family. All such viruses are RNA-containing. This means that their genetic information is contained in an RNA molecule, and not in a DNA molecule, like the vast majority of other living beings, including viruses.

There are several varieties of enteroviruses, of which echoviruses and Coxsackie viruses should be distinguished. In addition, polioviruses, which cause poliomyelitis, belong to the enterovirus genus. However, we will not consider polio due to the specificity of this disease.

There are also viruses that do not belong to any group. There are approximately 70 strains of Enterovirus viruses, but 70% of diseases are caused by just 10 strains.

Coxsackie viruses

Coxsackie viruses are several serotypes of viruses belonging to three types of the Enterovirus genus: A, B and C. Coxsackie viruses type A cause severe enteroviral diseases such as herpetic tonsillitis, hemorrhagic conjunctivitis, and aseptic meningitis. Coxsackievirus type B is even more dangerous, as it can cause myocarditis, pericarditis and hepatitis.

Echoviruses

Echoviruses represent great danger for newborns, as they can cause myocarditis, meningitis and hepatitis, which often leads to the death of babies. In older children and adults, when infected with echoviruses, the disease proceeds without complications. Interestingly, when the echovirus was first discovered, scientists gave it the name “orphan virus” (Orphan Virus or Enteric Cytopathic Human Orphan Virus, hence the abbreviation ECHO), since it was not believed to be responsible for any disease.

Virus resistance to external influences

All types of viruses that cause enteroviral infections are quite resistant to external influences and can exist for a long time in the environment. They can withstand freezing. In addition, they thrive in acidic environments.

It is this circumstance that determines the fact that viruses feel good in the gastrointestinal tract - after all, the hydrochloric acid contained in the stomach does not kill them. Thus, they can be classified as intestinal viruses, but the symptoms they cause are not always limited to gastrointestinal disorders.

Viruses, however, also have weaknesses. They are quite sensitive to heat. At a temperature of +50ºС they lose their pathogenic properties, and at a temperature of +70ºС they die. Effectively kills viruses and ultraviolet irradiation. Viruses are also sensitive to the effects of certain disinfectants (chlorine compounds, hydrogen peroxide, potassium permanganate, formaldehyde). However ethanol has an extremely weak effect on viruses. Antibiotics are also ineffective against viruses.

Spread of enterovirus infection

There are two main reservoirs in which viruses live: natural environment, in particular, bodies of water and land, and the human body. Thus, the source of infection for a person can be either another person or surrounding objects, water and food.

Enteroviruses are transmitted in various ways. The most common ones are:

• airborne (from sneezing, coughing, talking),
• household (through objects that are used by several people at once),
• oral-fecal (through unwashed hands, contaminated food and water).

A proven fact is the possibility of a mother infecting her child in the womb.

A peculiarity of enterovirus infections is that they most often occur in the summer and autumn months, and not in winter or spring, when the main outbreaks of diseases occur.

Mechanism of action of viruses

Viruses almost always enter the body through the oral cavity. After this has happened, the pathogens invade the tissues of the body and begin to reproduce. A peculiarity of viruses of the genus Enterovirus is that they can use almost any cells for this purpose. However, most often viruses infect the tissues of the intestinal mucosa, the epithelium of the oral cavity, and lymphoid tissue. It is for this reason that symptoms associated with the gastrointestinal tract and upper respiratory tract are usually observed during the disease. However, nervous tissue, blood vessels, and muscles are also often affected. Viruses spread throughout the body hematogenously - through the bloodstream.

After an infection, the body develops immunity to the type of virus that caused the enteroviral disease. Immunity is not developed to other types of Enterovirus. In addition, immunity is not lifelong, but only lasts for a few years. People who have had an enterovirus infection can be virus carriers for approximately 5 months.

Enterovirus in children

Approximately 80-90% of patients with enteroviral infections are children. Half of them are preschool children. The disease is most dangerous for children under 3 years of age. Infants do not often get sick, as they are usually protected by antibodies obtained from mother's milk. But if infection does occur, then enteroviral disease in an infant will not be easy to cure.

Enterovirus infection in children can take various forms - from intestinal and respiratory to damage to the nervous system and heart. In particular, diseases such as herpetic sore throat, viral meningitis, oral pemphigus, many cases of conjunctivitis, cystitis, encephalitis, myocarditis and pericarditis are caused by enteroviruses. In addition, enterovirus infection increases the likelihood of developing type 1 diabetes in children.

Enterovirus in children, symptoms

In 9 out of 10 cases, the disease occurs without any symptoms or manifests itself only as mild discomfort. However, this is typical only for adults who have a fairly strong immune system. In children (especially those who lack immunity to viruses), the infection can take serious and sometimes severe forms.

The incubation period of enterovirus infection ranges from 2 to 14 days.

The main organs that viruses infect:

• intestinal tract,
• respiratory tract and lungs,
• liver,
• skin,
• muscles,
• nerve tissue.

Less commonly, viruses infect the pancreas, adrenal glands, and pleura. Coxsackie viruses most often attack the skin, respiratory tract, meninges, and myocardium. The main targets of echoviruses are the liver, skin, meninges, and myocardium.

A common clinical sign of enterovirus infection is high fever. A symptom such as an increase in temperature during a viral infection can have varying intensity - from severe hyperthermia (up to +40ºС) to low-grade fever. An increase in temperature often has an intermittent nature, that is, a rise in temperature to high values ​​may be followed by sharp drops. Characteristic symptoms of general intoxication of the body may also be observed - weakness, lethargy, nausea, headache.

Enteroviral disease in children often occurs with a predominance of respiratory symptoms. In this case, you may experience:

• runny nose, nasal congestion;
• pain in the throat, nose and ears;
• cough;
• dyspnea;
• wheezing.

With enterovirus infection of the gastrointestinal variety, the following symptoms are common:

• bloating,
• nausea,
• epigastric pain,
• pain in the lower abdomen,

Possible general symptoms include:

• arrhythmias (tachycardia or bradycardia);
• weight loss;
• numbness in the limbs, muscle spasms;
• pain in bones, muscles, joints, chest, pelvic area and genitals;
• visual impairment;
• enlarged lymph nodes.

Also, symptoms may include herpes-type rashes, in the form of a rash or small blisters on the skin or mucous membranes (in the mouth, pharynx, and in women - in the vagina).

Neurological and psychological abnormalities also occur:

• anxiety states,
• depression,
• memory impairment,
• sleep disorders.

Types of enterovirus infection in children

There are several varieties of Enterovirus, and the diseases that these viruses cause differ in their symptoms. Enteroviral fever in children is perhaps the most common type of disease, but other types of disease are also quite dangerous for the child’s health.

Enteroviral fever

Enteroviral fever is also often called “summer flu” due to the fact that it is most often observed in the summer or autumn, in contrast to the real flu, which is more typical for the cold season. The “summer flu” has a characteristic acute onset. Manifestations of this disease include a complex of flu-like symptoms (body temperature up to +40ºС, sore throat and muscles, headaches, conjunctivitis). The disease is accompanied by a number of acute intestinal disorders(nausea, vomiting). Typically, fever lasts 3-7 days, which is why it is also called three-day fever.

Herpangina

Herpangina occurs more often in children and is caused by the Coxsackie virus. The disease is accompanied by a herpetic type rash located on the mucous membrane of the surface of the pharynx and tonsils. This disease also goes away within 3-7 days.

Viral pemphigus

Viral pemphigus can occur in children of both preschool and primary school age. It appears as small fluid-filled blisters located in the throat, on the palms of the hands, soles of the feet, and between the fingers. Fever with this form of the disease lasts 1-2 days. Typically, the disease is caused by the Coxsackievirus type A.

Viral exanthema

Enteroviral exanthema is usually caused by echoviruses or Coxsackie viruses. With this form of infection, a characteristic rash similar to rubella is observed. It consists of bright red spots with a diameter of up to 4 mm, located on the face, neck, limbs and torso. Enteroviral exanthema usually affects children under 5 years of age.

Pleurodynia

Caused by Coxsackie viruses. With pleurodynia, severe muscle pain may occur in the lower and upper abdomen. The disease can easily be confused with some kind of surgical pathology. Both preschool children and adolescents are susceptible to it.

Serous meningitis

Enterovirus infection in children often causes complications in the form of serous meningitis. This type of meningitis is an inflammation of the meninges, accompanied by the production of serous exudate. In 70-80% of cases, this disease is caused by Coxsackie viruses and echoviruses. Manifestations of meningitis include headache, high fever, increased and painful sensitivity to various irritants (skin touch, bright light and loud sounds). Delirium and seizures may occur.

Diagnosis of enteroviral infections

Due to the characteristics of viruses of the genus Enterovirus, clinical diagnosis the disease has its own characteristics. To date, there is no specific therapy for enteroviral infections in children, so the goal of diagnosis is to separate them from infections that have a similar therapy - viral (influenza, herpes) and bacterial. Diagnostics also has a certain research value. However, in most cases, diseases caused by viruses are fleeting and the patient manages to recover even before the test results are ready.

There are several diagnostic techniques– serological analysis, analysis for CNR and some others.

Treatment of enterovirus infection in children

In most cases, enteroviral infections are treated with symptomatic means. For example, for a disease that manifests itself in the form of an intestinal infection, treatment includes taking enterosorbents that absorb viruses and toxins in the gastrointestinal tract. Also, with persistent diarrhea accompanying enterovirus infection, it is necessary to ensure that the body is not subject to dehydration. That is, the patient should drink as much fluid as possible or take rehydration solutions. In addition, drinking plenty of fluids can reduce signs of intoxication in the body.

In the presence of elevated temperature, signs of inflammation, severe pain, anti-inflammatory drugs are taken to treat these symptoms. As a rule, these are non-steroidal drugs (ibuprofen). Also, in some cases (for myocarditis, meningitis), the doctor may prescribe steroid medications. In addition, in case of severe enterovirus infection and weakened immunity, the doctor may prescribe immunomodulators or drugs with interferon. Treatment of serious complications such as myocarditis, encephalitis and meningitis is carried out in a hospital.

Prevention of enteroviral infections

There is no specific prophylaxis effective specifically against Enterovirus viruses. It is necessary to observe preventive measures common to all types of infectious diseases. This is, first of all, compliance with the rules of personal hygiene - regular washing of hands, fruits and vegetables, heat treatment of meat and fish, regular wet cleaning of the premises. You should also avoid swimming in polluted waters.

Despite the fact that mainly children are susceptible to severe forms of enterovirus infections, adults can also become infected with viruses. Without getting sick themselves, they can pose a danger as asymptomatic carriers of pathogens. Therefore, compliance with preventive rules to avoid infection with enteroviruses is mandatory for both children and adults.