Prevention of infection caused by coxsackie viruses. Coxsackie virus: prevention is easier than treatment. Symptoms, causes, how to avoid getting sick Coxsackie virus in children, prevention and treatment

Every summer, vacationers at popular resorts fear becoming infected with the Coxsackie virus. What kind of disease is this? Is she dangerous or not? There are many questions. There is only one answer: everyone can know and be able to reduce the risk of infection.

Diseases caused by Coxsackie viruses belong to the group of enteroviral infections that are widespread in most countries, including the Russian Federation.

The Coxsackie virus received its name because it was first discovered in the city of Coxsackie, located south of Albany in New York.

Indeed, the incidence of enteroviral infections increases in the summer.

How does infection occur?

The source of spread of infection is only a person (patient, carrier), who releases the pathogen into the environment with feces. Infection occurs through consumption of contaminated water, food, and through household items.

Airborne transmission of infection is possible - the virus is released from the upper respiratory tract. The patient secretes the virus most actively in the first days of the illness, however, the virus can continue to be secreted for a longer time - for several months.

The infectious agent can remain in water, on the surface of objects, and on food for a long time.

Who is at risk for contracting the Coxsackie virus?

• Vacationers in places where cases of the disease have been recorded.

• Children attending organized children's groups: kindergartens, preschool institutions, schools and other educational institutions can spread the infection among their peers.

• Newborns, due to insufficiently developed immunity, are extremely vulnerable.

• Elderly people with a physiologically weakened immune system.

• Persons with immunodeficiency conditions (cancer patients, HIV-infected).

How does the disease progress?

Coxsackievirus can cause a wide variety of symptoms. About half of those infected are asymptomatic. Others suddenly develop fever, headaches, muscle aches, sore throat, nausea, and abdominal pain. A person who has an infection caused by Coxsackie viruses may have no symptoms other than fever.

There are two serotypes of Coxsackievirus that cause most clinically recognized syndromes, usually in infants and children.

Coxsackie A (type 23) causes herpangina, a febrile disease.

The well-known name for the “hand-foot-mouth” infection is caused by the Coxsackie A16 virus with symptoms localized according to the name: painful blisters in the mouth, throat, arms and legs.

Coxsackie B (6 types) – causes inflammation of the heart muscle, liver , which is accompanied by headaches, abdominal pain, fever, which can last up to 20 days.

Complications:

In some cases, serious complications may occur that require hospitalization of the patient and serious treatment:

viral meningitis - infection of the meninges (the membranes surrounding the brain and spinal cord)

Encephalitis - infection of the brain

Myocarditis is an infection of the heart muscle.

Unfortunately, due to such complications, the disease can be fatal.

The cause of the development of complications (meningitis, myocarditis and pericarditis) can be both Coxsackie A viruses and Coxsackie B viruses.

Previous Coxsackie infection in pregnant women can cause

congenital malformations of the cardiovascular, genitourinary and digestive systems in a newborn. Enteroviruses can cause severe infection of the central nervous system in newborns, which can result in death.

When should you see a doctor?

• temperature above 38°C in children under 6 months, and above 38.8°C in older children

• lack of appetite

• vomit

• diarrhea

• labored breathing

• convulsions

• unusual drowsiness

• the child complains of chest or abdominal pain

• numerous rashes on the skin or mouth

• severe sore throat

• severe headache, especially accompanied by headache, confusion, or unusual drowsiness

• stiff neck (difficulty bending your head forward)

• redness, inflammation of the eyes.

If you have one or more of these symptoms, you should consult a doctor as soon as possible.

Can infection be prevented?

Specific prevention of infection caused by the Coxsackie virus has not been developed.

Compliance with the rules of personal and public hygiene will minimize the risk of infection:

• regular hand washing with soap

• Thoroughly wash vegetables and fruits before eating

• purchasing food products only in authorized places

• heat treatment of products

• Swimming only in approved areas (do not swallow water)

• no contact with infected people, especially those with a rash

• drink only bottled water

Scaring tourists is the privilege of ancient castles: each one has a creepy ghost or at least a legend about it. But seaside resorts don’t need horror stories. But a few years ago, a terrible legend about the Coxsackie virus went for a walk in Turkey. Among the rumors and speculation, it was difficult to find the truth - but it turned out to be not so terrible.

Firstly, this enemy of holidaymakers is not a new scourge, and doctors have long known how to treat it. Secondly, the body itself successfully fights the virus, and it only needs competent support. Kidpassage has collected truthful information about the Coxsackie virus: symptoms in children, treatment and prevention. Find out how to bypass the soreness and relax peacefully.

Coxsackievirus in children: a familiar stranger

Among the many viruses that humans come into contact with are enteroviruses. They successfully survive and multiply in the gastrointestinal tract, but also affect other organs.

Some enteroviruses (such as poliovirus, which causes polio) are very dangerous, and the best way to prevent the disease is to get vaccinated.

But doctors do not consider Coxsackie, a type of enterovirus around which there is so much fuss every summer, to be dangerous. But since children most often get sick with Coxsackie, you need to be fully prepared in case you encounter this infection.

Doctors know of 29 types of Coxsackievirus, grouped into groups A and B. Group A viruses affect the skin and mucous membranes, including the eyes and oral cavity. Group B viruses infect the pleural region, heart, liver, pancreas and often cause severe consequences.

The virus has another name, which is very eloquent: “hand-foot-mouth disease”, or HFMD (Hand-foot-and-mouth disease). This is due to the fact that with Coxsackie disease, a characteristic rash appears on the arms and legs, as well as ulcers in the mouth.

A person of any age can get Coxsackie, but children under 10 years of age are most often affected. There are two reasons for this.

1. Until the age of 5, children’s immunity is not yet fully formed. The older the child, the less chance of getting sick. After an illness, immunity to the type of virus that the child has already encountered is developed. If you encounter another species, repeated illnesses are possible.
2. One of the ways of transmitting Coxsackie is through dirty hands. Until a child's hygiene skills are developed, he may become infected.

Coxsackie virus: symptoms

In the first few days after infection, a person looks quite healthy: the incubation period of the Coxsackie virus is up to 10 days. Occasionally, the first symptoms appear after 2-4 days.

The onset of the disease may resemble ARVI:
. general health worsens;
. weakness appears;
. loss of appetite;
. the temperature rises, sometimes up to 39° and above;
. nausea and vomiting occurs;
. Sore throat, difficulty swallowing.

Most often, symptoms do not appear simultaneously and may be mild or completely absent. Sometimes diarrhea is added to the typical symptoms, and in children, on the contrary, constipation may occur.

The most specific symptom is Coxsackie rash, or enteroviral exanthema. Flat, red sores in the mouth usually appear first, followed by a rash on the palms and soles of the feet. Sometimes the rash covers the knees, elbows, buttocks and groin area.

Mouth ulcers most often occur on the cheeks and gums. But in some cases, ulcers appear on the palate and throat: then they talk about herpetic sore throat, or herpangina. It is relatively easy to recognize the Coxsackie virus in children: the photo shows the characteristic location of the rash. In adults, the disease may be asymptomatic.

It should be added that the “hand-foot-mouth” syndrome is characteristic of many enteroviruses. Regardless of what virus the child encounters, the treatment will be the same.

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Only a doctor can clearly distinguish infection with the Coxsackie virus from other similar diseases - chickenpox, rubella, scarlet fever.

The diagnosis is made after examination and questioning about the course of the disease: the doctor only needs to see the clinical picture in order to prescribe treatment for Coxsackie or another identified infection. Only in severe cases are virological tests prescribed.

And yet there are several landmarks that allow you to distinguish enterovirus from other diseases.

The main difference between chickenpox and Coxsackie is the location of the rash. Chickenpox usually does not affect the palms and feet, but in the case of Coxsackie, it is these parts of the body that become covered in the rash.

Chickenpox is characterized by a wave-like appearance of the rash. This means that on one area of ​​the skin there will be fresh spots, blisters, and crusts in place of the opened blisters.

The photo of a rash with the Coxsackie virus looks different: first there are flat red spots everywhere, then there are blisters everywhere. In addition, chickenpox can be immediately ruled out if the child has already suffered from this disease.

Another case when you can make a diagnosis yourself is the prevalence of the disease. When the Coxsackie virus in Turkey ruined the holidays of hundreds of tourists, there was no doubt about the origin of the rash.

At other resorts, where there are fewer cases of illness, sometimes you have to rely on the experience of the doctor. For example, vacationers in Bulgaria encounter the Coxsackie virus every summer, but so far these have been isolated cases. If your child's symptoms seem unusual, medical attention will be needed to rule out other conditions.

But now the diagnosis has been made: Coxsackie in all its glory. How to treat a virus in a child? It turns out that there are no innovations, and you will find everything you need in your travel first aid kit.

Virus manifestation

The disease caused by Coxsackie viruses can occur in different ways. The typical picture looks like this: a high temperature rises, which lasts for 3-4 days, and as soon as the fever passes and the child revives, a rash appears on the arms, legs and mouth.

It is this rash that is called sudden exanthema - one of the manifestations of Coxsackievirus. Sudden exanthema does not require treatment and goes away on its own in 4-7 days.

The Coxsackie rash may itch, but should not fester. If you notice pus in the blisters, you should immediately consult a doctor: this may indicate a secondary infection.

Herpangina causes more trouble. In this case, the rash in the mouth affects not so much the gums and cheeks, but the soft palate, uvula and tonsils. The child complains of a sore throat and has difficulty swallowing.

In addition, herpangina is usually accompanied by high fever. The parents' task is to reduce the temperature if necessary and give the child water as often as possible. The child's condition improves after 8-10 days.

Be sure to see a doctor if the mouth ulcers are so painful that your child refuses to eat or drink.

Let us clarify that herpangina, despite the name, is not caused by the herpes virus. In addition, this condition is easy to distinguish from ordinary tonsillitis (acute tonsillitis), in which the tonsils become inflamed.

Another symptom that is often present with Coxsackie infection is hemorrhagic conjunctivitis. The eyes begin to water and hurt, the eyelids swell, hemorrhages appear on the mucous membrane, and purulent discharge appears.

As a rule, one eye suffers first, then the disease spreads to the other. The temperature may be normal or slightly elevated.

How to treat Coxsackie

When information about the “Turkish Coxsackie virus” first appeared, the symptoms were described as more terrible than the other. Fortunately, most of the horror stories turned out to be myths.

Doctors have long known what the Coxsackie virus is, its effect on the body has been studied, treatment protocols have been developed, and the vast majority of patients recover completely.

You need to fight enterovirus in the same way as with all familiar ARVIs: lower the temperature if necessary, provide plenty of fluids and do not force-feed the child. More about this.

1. There is no specific antiviral therapy for Coxsackie virus. The body is able to overcome the disease on its own. Care must be taken to relieve symptoms and avoid dehydration.
2. An elevated temperature can only be reduced with medications containing ibuprofen or paracetamol. Do not give your child aspirin under any circumstances: this can aggravate the course of the disease and cause complications.
3. Ibuprofen and paracetamol also help reduce the pain of mouth ulcers. Your doctor may recommend local pain relievers, such as lidocaine gel.
4. The drinking regimen remains normal unless the child has a significant increase in temperature and/or vomiting. If there is a loss of fluid, you need to replenish it: use special solutions for oral rehydration or prepare such a solution yourself (add 1 tablespoon of sugar and 0.5 teaspoon of table salt per 1 liter of water). If dehydration is severe, intravenous rehydration will be necessary.

   Sometimes children refuse to eat or drink because of mouth ulcers and pain when swallowing. Drinking at room temperature or lower helps relieve discomfort; you can even add ice to drinks. It is advisable not to give carbonated drinks and citrus juice because this increases the pain.
   To relieve pain, you can offer little ones to drink from a spoon or cup instead of a bottle.

5. A special diet is not needed, but for as long as the main signs of the virus persist, exclude spicy, salty, and sour foods from the child’s menu. It is best if the food is at room temperature or lukewarm. While your child is sick, offer him vegetable and fruit purees, yogurt, cottage cheese puddings, smoothies and other soft foods. As soon as the appetite is restored, the child can be given any usual food.

With a mild course of the disease, children recover within 3-5 days. Most often, complete recovery occurs after 7-10 days: the child becomes cheerful, cheerful, eats for three and is eager to go for a walk.

If there is no longer a rash on the body and in the mouth, feel free to return to a normal lifestyle (read more about the ways of transmission of the Coxsackie virus in the “Prevention” section).

Consequences of the disease

The human body is accustomed to contact with enteroviruses and tolerates most encounters with them easily. However, Coxsackie infection in children rarely leads to serious consequences. Viruses that infect the heart, liver and brain are especially dangerous.

1. Disorders of the heart, including infectious myocarditis, that is, inflammation of the heart muscle. Only a doctor can install it, and if signs of myocarditis are detected, you will most likely be asked to go to the hospital. After anti-inflammatory therapy, you will need to limit physical activity; complete recovery will take several weeks.
2. Liver inflammation not caused by hepatitis viruses. A doctor must make a diagnosis and prescribe treatment.
3. Pleurisy, or inflammation of the pleural cavity. This complication can be suspected when pain occurs during breathing and coughing without a previous runny nose. Pleurisy requires hospitalization and treatment under medical supervision.
4. Serous meningitis, or inflammation of the lining of the brain/spinal cord. The most dangerous complication, the success of treatment of which depends on timely medical care. You should see a doctor immediately if your child has a very high fever, repeated vomiting, and a severe headache.

Although complications after encountering the Coxsackie virus rarely occur, we recommend that you carefully monitor the child’s condition and consult a doctor at the first alarming signs.

Before traveling abroad, be sure to take out medical insurance and have a representative from the insurance company explain to you in detail what to do if someone in your family gets sick while on vacation.

Prevention

It's good to know how to deal with the Turkish flu, but it's even better not to encounter it at all. We do not suggest giving up trips to resorts: you can meet Coxsackie in a kindergarten, in a store, and in any place where there are a lot of people. It is enough just to know where the causative agent of the disease settles and what is destructive for it.

The Coxsackie virus is found in saliva, sputum, nasal mucus, blisters, and stool. Accordingly, the virus is transmitted from a sick person through:
. use of common things, including towels and dishes;
. feces (parents can become infected by changing a sick child's diaper);
. close bodily contact;
. cough and sneezing.

It is the latter method of transmission of infection that is the reason that you can get sick even in a prosperous country, at a respectable resort.

Coxsackie viruses survive well in the environment; at room temperature they can live up to several days outside the human body, but quickly die under the influence of ultraviolet radiation - that is, in the sun.

Chlorine-containing preparations and boiling are used as disinfectants. Items used by the patient should be boiled for at least 20 minutes.

But animals are not carriers of the Coxsackie virus. This, of course, does not mean that you need to get to know all the nearby cats and dogs: you can catch other diseases from them.

So, no matter in which country the Coxsackie virus appears, the disease can be avoided. And even if one of your relatives gets sick, there is a way to protect the rest of the family from the virus. Prevention measures are largely obvious:

• wash your hands thoroughly with soap before eating, after using the toilet, and after changing your child’s diaper;
• do not touch your face, eyes, nose, mouth with dirty hands;
• wash vegetables and fruits;
• use bottled water.

Prevention of the virus in children includes several more points. If you know about people who are sick at the resort, try not to go to crowded places.

You should prefer walking outdoors to playing indoors. It is also undesirable for children to swim in hotel pools: for infection the water needs to get into the mouth, and it is difficult to protect children from this.

The news of an outbreak of infection with this virus shook up the ranks of vacationers in hot countries and their compatriots spending the summer at Russian resorts. Citizens frightened by the “epidemic” are hastily looking for a panacea, and those who have a vacation ahead of them, in a panic, decide to completely abandon the tours to the coast purchased in advance. And if you cool down and calmly figure out what kind of virus this is with the mysterious name Coxsackie and what disease does it cause?

Who is Coxsackie?

These enteroviruses were discovered by chance in 1949, when American scientist Gilbert Dalldroff was testing the feces of polio patients to create a cure or vaccine. The attempt to create a cure for polio failed, but Dalldroff went down in history as the discoverer of enteroviruses, to which he gave the name Coxsackie - after the small town on the Hudson River, from where the scientist received the first samples of material for research.

Despite the rather exotic sounding name, Coxsackie viruses do not represent anything extraordinary. These are common enteroviruses that thrive in the human gastrointestinal tract. They are distributed throughout the world, their activity depends on the season and climate.

Enterovirus infections are common in summer and early autumn in countries with temperate climates, and in semi-tropics and tropics throughout the year. Moreover, the number of cases each year is approximately the same. So the rumors about an epidemic reaping an unprecedented harvest this year, to put it mildly, are not true. Just as the stories about the danger of diseases associated with the Coxsackie virus do not correspond to it.

Hand-foot-mouth

This is not an empty set of nouns describing parts of the body - it is the name of a disease that develops as a result of infection with enteroviruses, including the Coxsackie virus. It most often affects infants and children under 5 years of age, but it can also occur in school-age children and adults.

It all starts like the flu: with a sharp rise in temperature, decreased appetite and weakness. But unlike the flu, after 1-2 days small red rashes appear in the mouth, which turn into ulcers - this condition is called herpangina. Of course, it has nothing to do with the herpes virus - it just looks like herpetic lesions.

At the same time, the palms of the hands and soles of the feet “color” with pink spots (sometimes with blisters, as with chicken pox), justifying the funny name of the disease. The rash may also appear on the knees, elbows, buttocks, and genital area. Sometimes (but not always) nails are affected: they can peel, crack, and then completely peel off. Fortunately, this process is usually painless, and the nails grow back safely.

With a good immune response, especially in children, an asymptomatic course of the disease is possible, while the person, without knowing it, is the source of infection. Viruses are found in secretions from the patient's nose and throat, fluid released from ulcerative lesions, and feces.

Infection occurs through personal contact, with particles of saliva when coughing or sneezing, as well as by touching contaminated surfaces (door handles, household items, etc.). Patients can be contagious until they fully recover, although the maximum chance of “giving the virus to a friend” remains during the first week from the day the fever begins.

Will we treat him or let him live?

With the question “who is to blame?” we figured it out, there remains the no less pressing and traditional “what to do?” And there’s nothing special to do. Enterovirus infection, like most diseases associated with viruses, cannot be treated. No antiviral drugs, interferons or homeopathic pills can change the course of the disease.

Recovery occurs “automatically”, on average after 7 days, when the enteroviruses die ingloriously. In the meantime, while the disease is in full swing, one simple but important rule should be followed - to compensate for fluid losses in order to avoid dehydration. Regular drinking water, compotes or special rehydration mixtures will help, preferably cold ones to reduce the sensitivity of pain receptors and reduce sore throat.

For high fever or pain, antipyretic and analgesics are indicated, for example Paracetamol (Panadol). The patient should not go outside or to crowded places until he recovers, as he is a source of infection. To reduce the likelihood of infection of relatives, it would be good to strengthen sanitary vigilance: ventilate the premises, carry out regular cleaning, provide the patient with individual utensils and hygiene items. If the infection "finds" you while on vacation, focus on washing your hands frequently with hot water and soap.

Complications: rare, but accurate

In the vast majority of cases, hand-foot-mouth syndrome is well tolerated and goes away without leaving a trace. However, occasionally the disease can cause a rather serious complication - serous meningitis. Therefore, if you experience symptoms such as headache, neck stiffness and back pain, you should immediately call a doctor. All other problems associated with the Coxsackie virus are solved almost on their own. The main healer of this disease is time, and quite a short one. And, of course, Coxsackie is not the reason why you should deprive yourself of a long-awaited vacation at the resort.

Marina Pozdeeva

Photo istockphoto.com

Not long ago, information appeared in the media about a real epidemic of eteroviral infections, including Coxsackie, in Turkish resorts, because of which many vacationers were allegedly forced to interrupt their vacation early. This does not correspond to reality: the Ministry of Health did not report a worsening of the epidemiological situation regarding the Coxsackie virus in Turkey, however, Rospotrebnadzor is closely monitoring the situation and tracking every case of the disease. It is important for everyone to know about measures to prevent it, because an untimely diagnosed infection poses a serious health hazard. How to prevent the Coxsackie virus in children and adults: let’s try to figure it out.

Coxsackie is an enterovirus pathogenic for the human body. It consists of a single strand of RNA and is relatively small in size. Depending on the serotype, of which there are several dozen, it can manifest itself in different ways: from a slight increase in temperature and mild weakness to severe meningitis. Most often it causes Coxsackie pharyngitis (proceeds like herpangina) and hand-foot-mouth syndrome - a profuse rash with red spots and blisters.

The virus is widespread. It “feels” most comfortable in a hot, humid climate, so outbreaks of infection are usually recorded in the Mediterranean countries, southern Russia, and Southeast Asia. Each of them claims several lives.

How can you become infected with the Coxsackie virus?

The peculiarity of this dangerous enterovirus infection is that it is predominantly transmitted through the two most “lethal” routes:

• airborne - when sneezing and coughing, with droplets of saliva;
• fecal-oral – through poorly washed food, dishes, dirty hands.

That is why in most cases the infection may manifest itself during or after a holiday on the coast. This is due to large crowds of people at seaside resorts, eating in canteens and cafes, and accidentally swallowing water in the pool. In addition, the virus spreads easily in kindergartens, schools and other organizations where children are in close contact with each other for a long time. In regions with temperate climates, the peak incidence occurs in July, August and the first days of autumn.

Most often, children aged 3-10 years become victims of enterovirus infection. Although it occurs with severe intoxication syndrome and fever, there is usually no reason to panic. With timely treatment, the virus can be defeated in 3-5 days. The infection is especially dangerous for newborns and babies up to one year old: due to their unformed immunity, the disease is often complicated by meningitis, endocarditis, sepsis, etc.

The Coxsackie virus develops less frequently in adults. However, its symptoms are not pronounced, and the disease often imitates a common ARVI. However, frail, elderly, and immunocompromised patients may face serious consequences from the infection.

Symptoms

The incubation period of the disease is short: it does not exceed 5-6 days. The Coxsackie virus always begins suddenly with severe signs of intoxication. The infection manifests itself:

• a sharp increase in temperature to 39-40 ° C;
• chills – often, against the background of fever, the child’s limbs remain cold;
• weakness, lack of appetite;
• drowsiness;
• sometimes - headache;
• nausea, diarrhea;
• rash: usually occurs in childhood, located on the oral mucosa and extremities.

Features of treatment

Currently, no specific treatment for Coxsackie virus has been developed. Therefore, neither antiviral nor antibacterial drugs are prescribed to fight the infection. Even if the disease is not treated, the immune system usually copes with it on its own, and recovery occurs after 3-7 days.

To alleviate the patient’s condition, we can recommend to him:

• drink more warm liquids: teas, fruit drinks, milk (not only soften the throat, but also accelerate the removal of toxins from the body);
• rest and stay in bed more;
• take symptomatic medications:
  • antipyretics (Paracetamol, Ibuprofen) – to normalize temperature;
  • sorbents (Polysorb, Smecta) - to cleanse the intestines of viral toxins;
  • antihistamines (Zodak, Suprastin) - to reduce itching and other manifestations of allergies;
  • antiseptics (Chlorhexidine, Furacilin) ​​- for treating skin and mucous membranes for rashes.

A method based on the treatment of the Coxsackie virus with immunoglobulins (IVIG) and interferons obtained from blood serum containing antibodies is currently undergoing clinical trials.

As a rule, therapy is carried out on an outpatient basis. It is possible to open a hospital at home. Hospitalization may be required if complications develop (arthritis, meningitis) or severe dehydration.

Prevention measures

Like any infection, Coxsackie is better prevented than treated. Prevention of the virus is the simplest and most reliable way to reduce the incidence of the disease. Unfortunately, specific measures (vaccines or vaccinations) have not been developed to date, so expert recommendations include:

• Thorough washing of vegetables and fruits before consumption;
• washing hands before eating and after walking outside;
• if possible, avoid visiting children's pools (swimming is recommended only in the sea);
• wearing a mask when coughing or sneezing;
• timely and correct disposal of diapers and fecal waste of the child;
• disinfection of contaminated surfaces (the simplest disinfectant is 1 tablespoon of bleach per liter of water);
• regular wet cleaning of the premises;
• playing in the children's club only in socks; in case of a large crowd of children, refusal to attend;
• strengthening the immunity of the child and all family members:
  • balanced and varied diet;
  • eating enough vegetables and fruits;
  • daily walks in the fresh air;
  • physical activity;
  • hardening.

It should be remembered that the disease is extremely contagious, so the patient should remain at home until complete recovery. If one person is sick, he should allocate his own dishes and hygiene products. The premises must be wet cleaned daily. In addition, it is important to minimize contact with other family members, especially children.

In general, the prognosis for Coxsackie virus is favorable. Most patients recover completely within 5-7 days. With the development of myopyocarditis, heart failure may develop in a third of cases. Infection in newborns can be fatal.

Despite all the concerns, the Coxsackie virus usually occurs without complications and can be successfully treated. However, the infection has pronounced symptoms and causes great discomfort to the baby. It is especially unpleasant to become infected with it at a resort. Timely prevention of the disease allows you to maintain health and enjoy a sea holiday.

And they are the main causative agents of enterovirus infection (EVI). In recent years, there has been a tendency towards activation of Coxsackie viruses and an increase in infectious diseases caused by enteroviruses. The incidence rates of EVI in the CIS countries vary between 11.5-16.2/100 thousand population. The majority of cases are children (90%). The specificity of EVI is the polymorphism of clinical manifestations, which is due to their ability to affect various tissues/organs (kidneys, heart, central nervous system, lungs, liver and others), long-term virus carriage, the presence and wide distribution of asymptomatic forms, the absence of a clear pronounced dependence of nosological forms on the serological type of the pathogen , as well as the lack of specific methods of prevention, which makes enterovirus infections practically uncontrollable.

Diseases more often occur in the form of sporadic morbidity, but every 3-4 years epidemic outbreaks caused by different serotypes of Coxsackie viruses are recorded around the world. Every year, the proportion of certain infecting serotypes of the virus changes significantly, which many authors explain by the accumulation of a “critical mass” of susceptible children, which is necessary to maintain the epidemic process. It is also important that one serotype of the Coxsackie virus in adults and children can cause clinically completely different diseases (even at the same time in the same family), while at the same time different serotypes of the virus can cause diseases whose symptoms are very similar, which complicates the diagnosis and treatment of patients .

Enterovirus infection Coxsackie in the everyday lexicon is called “Turkish flu” due to partial similarity with the symptoms of classic flu and the introduction of the Coxsackie virus into the CIS countries by people vacationing at resorts in Turkey.

Pathogenesis

For Coxsackievirus A and B, the entry gates are the mucous membranes of the oral cavity, upper respiratory tract and intestines. Enteroviruses freely overcome the “gastric barrier” and penetrate the cells of the small intestinal mucosa. Subsequently, the process of virus replication occurs in the cells of the intestinal epithelium, lymphoid tissue and mesenteric lymph nodes. The virus then enters the bloodstream and causes primary viremia. The Coxsackie virus exhibits the greatest tropism for cells of the central nervous system/muscle tissue, but a variety of organs are also involved in the pathological process.

Dissemination of the pathogen occurs in the heart, liver, lungs, kidneys, eye vessels, pancreas, where it multiplies and accumulates. Clinical symptoms, severity and outcome of the disease are determined by a number of factors - the biological properties of the virus serotypes, their tropism, the state of the humoral/cellular immunity of the human body. Swelling, inflammation and areas of necrosis develop in the affected organs. The stages of pathogenesis are shown schematically in the figure.

In people who have recovered from the disease, a long-lasting (over several years) type-specific pattern is formed.

Classification

There is no unified classification of enteroviruses due to the wide polymorphism of clinical symptoms. In the Russian Federation, a classification according to the type of disease has been adopted.

• Typical forms of enterovirus infection: herpangina , enteroviral fever , acute respiratory diseases, epidemic myalgia , aseptic serous meningitis , encephalomyocarditis , hepatitis , myocarditis , gastroenteric form , hemorrhagic conjunctivitis , vesicular.
• Atypical forms of enterovirus infection: erased, inapparent.

By current: light, medium-heavy. heavy.

Causes

Coxsackie viruses of group A (serotypes 1-22, 24) and group B (serotypes 1-6) are the etiological factor of a number of enteroviral infections.

Morphology and biological properties

Coxsackie enterovirus is a small RNA virion (28 nm) with cube-shaped symmetry and the ability to form crystals inside affected cells. Virion capsid without envelope. The appearance of the Coxsackie virus is shown in the figure below (Wikipedia).

Based on their antigenic structure, Coxsackie viruses are divided into two large groups: A-26 and B-6 serological types. The virus is highly resistant in environments and on environmental objects. But they are quickly inactivated at temperatures exceeding 50 degrees, they can persist for 2 months at a temperature of 37°C, survive for a long time in river/tap water, but especially for a long time in waste water.

Stable in acidic environments (pH 3-5). The activity of enteroviruses remains for several years even when frozen, and when stored in a refrigerator at a temperature of +4-6°C - for several weeks. At the same time, repeated freezing and subsequent thawing does not lead to a decrease in their activity. They quickly die when dried, under ultraviolet irradiation and when exposed to solutions. formaldehyde even in small concentrations. They are destroyed by boiling (at 100°C - instantly, 60°C in 6-8 minutes).

Epidemiology

Coxsackie viruses are ubiquitous: their reservoir in nature is water, soil, and food. In the human population - the human body. The main epidemiological feature is the widespread ability to form healthy virus carriers in the human body with a long period of virus release into the external environment (up to 3-6 weeks). Virus carriage in healthy individuals varies between 17-40%. Among children, the percentage of virus excretors reaches 20.0%, and at the age of under 1 year it is even higher - 32.6%. This feature contributes to the survival of the virus even in conditions of high levels of immunity in the population.

The level of natural immunity increases with age, reaching 90% already at the age of 5-10 years. Among the adult population, antibodies to the most common Coxsackie serotypes are found in 30-80% of the population. At the same time, the seropositivity of the human population is much higher in regions/countries/cities with a low social and hygienic standard of living. Some authors even consider these data as an indicator of the standard of living of the population and even the effectiveness of anti-epidemic protection.

The source of infection is a sick person, a convalescent person or a virus carrier. Infection with Coxsackie viruses occurs throughout the year, but in the northern hemisphere the peak incidence of EVI occurs in the summer-autumn season. In warm regions and the tropics, the incidence does not have a pronounced seasonality. EVI affects people of all age groups, but incidence rates are inversely proportional to age. About 75% of EVI cases occur in children under 15 years of age, and children under 1 year of age get sick several times more often than older children and adults. Males get sick more often.

The leading mechanism of transmission is fecal-oral. Its implementation is carried out by water, food and household contact. Airborne and transplacental (from mother to fetus) routes are possible. The main condition for the implementation of the infection transmission mechanism is poor sanitary living conditions. The infection rate of children living in unfavorable sanitary conditions can reach 50%.

The most important way for Coxsackie viruses to spread is through contact with another person's contaminated hands and objects, followed by inoculation of the virus through the nose, mouth or eyes, and through contaminated food and water. Those infected are most contagious during the first week of illness.

Symptoms of the Coxsackie virus

The incubation period of the Coxsackie virus varies for different nosological forms and can range from 2 to 35 days. The average incubation period is 7-10 days. The clinical symptoms of the Coxsackie virus in adults, as well as the symptoms of the Coxsackie virus in children, are extremely varied. Among the main clinical syndromes caused by the Coxsackie virus of various serotypes are:

• Coxsackie A viruses - herpangina , serous meningitis , acute pharyngitis , paralysis, exanthema , pneumonia of newborns , exanthema of the mouth and limbs, contagious runny nose , hepatitis , newborns/young children, acute hemorrhagic conjunctivitis .
• Coxsackie B viruses - serous meningitis , pleurodynia , severe systemic infection of newborns, pneumonia and upper respiratory tract disease, myocarditis And meningoencephalitis , fever , hepatitis , rash.

Let us briefly consider the clinical manifestations of the most common nosological forms of enteroviral infections in adults caused by the Coxsackie virus.

• Enteroviral fever : the most common form of enterovirus infection in recent years. It is characterized by an acute onset with short-term fever for up to 2-4 days, less often up to 1-1.5 weeks. It occurs with mild general infectious symptoms - moderate headache, minor catarrhal symptoms, muscle pain, and less often occurs with an enlarged liver and spleen. Often not diagnosed or diagnosed in the presence of a local epidemic outbreak in a community.
• Epidemic exanthema : increase in body temperature, during a decline/at a height of temperature, the appearance of a small maculopapular, less often hemorrhagic rash, which is localized mainly on the torso, face and arms. The rash persists for several hours or 1-2 days, after which it disappears without a trace. On the oral mucosa - . A more common variant of enteroviral exanthema in children is damage to the skin of the hands and feet, as well as the mucous membrane of the oral cavity - the so-called “hand-foot-mouth syndrome” (see photo below), caused by serovars 5,10,16 of the Coxsackie A virus. Against the background moderate general intoxication on the skin of the hands, feet, cheeks and mucous membrane of the tongue, rashes appear in the form of vesicles with a diameter of 1-3 mm with hyperemia around them.
• Herpangina : sore throat, increased body temperature. On the palatine arches and mucous membrane of the soft palate there are papules, which quickly transform into vesicles and after 1-2 days ulcerate and become covered with a white coating. Hyperthermia persists for 2-3 days and gradually decreases. Changes in the pharynx persist for 6-7 days. With the addition of bacterial flora, general infectious symptoms increase. Often combined with other forms of EVI.
• Gastroenteric form: begins with an increase in body temperature to a subfebrile level, weakness, decreased appetite, hyperemia of the pharynx mucosa, and after 1-2 days a watery diarrhea , abdominal pain, bloating, an admixture of mucus appears in the stool, stool frequency up to 10 times, sometimes vomiting. The duration of the disease is 1-2 weeks.
• Serous meningitis : headache, fever up to 39-40 C, anxiety, vomiting, sometimes convulsions. At the height of the fever, meningeal signs appear - stiff neck and specific symptoms. Abdominal pain, abdominal reflexes are reduced. During a spinal puncture, there is an increase in cerebrospinal fluid pressure. Sometimes undulating fever. After meningitis, asthenic syndrome persists for a long time; in some cases, intracranial hypertension .
• Enteroviral encephalitis : headache, high body temperature, /excitement, impaired consciousness, convulsions, vomiting. Subsequently, symptoms develop depending on the area of ​​brain damage (hemispheric, brain stem, cerebellar). Sometimes the pathological process in the brain is combined with damage to the spinal cord, which is manifested by flaccid paresis/paralysis of the muscles of the limbs and torso, and autonomic disorders. During development meningoencephalitis meningeal symptoms appear. The course of the disease is severe, with a high probability of death.
• Epidemic myalgia : pain in the muscles of the chest, diaphragm and abdomen. Often the pain is localized in the epigastric/iliac region or migrates, sometimes combined with pain in the extremities, fever to febrile levels, difficulty breathing, especially inhalation, headache. Muscle pain is paroxysmal, lasting 10-30 minutes. The duration of symptoms is 3-10 days.
• Mesadenitis : symptoms of general intoxication, abdominal muscle tension, frequent vomiting, pain and bloating.
• Paralytic form: weakness in the legs/arms, muscle tone and tendon reflexes are reduced on the affected side, increased body temperature, gait disturbance. Paresis and paralysis quickly disappear, atrophy does not develop.
• Mesadenitis : inflammation of the mesenteric lymph nodes. Increased body temperature, abdominal pain, vomiting, bloating, abdominal muscle tension.
• Enteroviral myocarditis : weakness, fatigue, discomfort/pain in the heart area, the boundaries of the heart are expanded, tachycardia , muffled heart sounds, ECG shows focal/diffuse changes in the myocardium.
• Enteroviral hemorrhagic conjunctivitis: redness, lacrimation, pain in the eyeballs, swelling of the eyelids, photophobia, hemorrhage in the conjunctiva of the eyes/sclera. Increased body temperature, over time, many patients develop epithelial small focal keratitis or uveitis. In severe cases - iris dystrophy, uveal cataract, corneal opacification, atrophy of the eyeball.
• Enteroviral hepatitis: clinical symptoms resemble the anicteric form of viral hepatitis A . Abdominal pain, increased body temperature, myalgia, enlarged liver. Deviations in liver function tests are insignificant.

Photo of Coxsackie virus in children (hand-foot-mouth syndrome)

Modern studies convincingly prove the role of EVI in the occurrence of isolated encephalitis, glomerulonephritis and hemorrhagic cystitis.

Tests and diagnostics

The diagnosis of a specific nosological form of EVI is made on the basis of complaints, clinical manifestations, data from laboratory and instrumental examinations.

Laboratory tests include: CBC, OAM, analysis for Coxsackie virus (nasopharyngeal swab, vesicle contents, cerebrospinal fluid for enteroviruses using PCR), blood for CSC/PHA.

Additional diagnostic examinations: ECG, biochemical blood test (bilirubin, creatinine, AlAt, AsAt, urea), comprehensive ultrasound, MRI.

Treatment of Coxsackie virus

Treatment of Coxsackie virus in adults is aimed at relieving symptoms of intoxication and clinical recovery, normalizing biochemical parameters of blood/cerebrospinal fluid and preventing complications. Hospitalization of patients is carried out according to clinical indications (symptoms of central nervous system damage, peripheral paralysis, the presence of meningeal syndrome, encephalomyocarditis, intense muscle pain that requires relief, severe symptoms of intoxication, severe background pathology, secondary infection, and others). For outpatient treatment, if necessary, bed rest. Since medications for etiotropic therapy have not yet been developed, treatment of patients is reduced to pathogenetic therapy and relief of symptoms of the disease in accordance with the clinical manifestations, form and severity of the disease.

For severe pain syndrome - NSAIDs, non-opioid analgesics (,), for hyperthermic syndrome (over 39.5 C) - antipyretic drugs ( Acetaminophen , ). In case of severe intoxication, detoxification therapy is carried out by infusion of solutions, Glucose (5-10%), (0.9%). If necessary (meningitis and meningoencephalitis), dehydration therapy (,). For desensitizing therapy - . For the paralytic form, EVI is prescribed. For myalgia: , . For encephalitis and convulsions -, Diazepam . In severe cases with cerebral edema, oxygen therapy .

As for antibiotics, their prescription is justified only in cases of the addition of bacterial flora and the development of bacterial complications. For this purpose, beta-lactam antibiotics are also prescribed (, Ticarcillin/clavulanate and others).

How to treat EVI in children?

There are no fundamental differences, but children have a number of characteristics. Treatment of Coxsackie virus in children includes drugs that have antiviral and immunomodulatory effects - human recombinant interferon α-2b. Immunoglobulins (, Sandoglobulin ), recombinant interferons (,). In newborn children of patients and children with myocarditis, immunoglobulin preparations can be prescribed to prevent complications. With the most common forms of EVI in children ( herpangina , “hand-foot-mouth” syndrome), according to a number of authors (Komarovsky), specific treatment is not required and bed rest, symptomatic treatment and plenty of fluids are quite sufficient.

Indicators of the effectiveness of treatment are the absence of symptoms of intoxication and fever, the disappearance of the rash, the absence of motor disorders, pain, normalization of blood and CSF parameters.

Medicines

• Azithromycin .
• Human immunoglobulin (IgG+IgA+IgM).
• Interferon alpha 2b .

Procedures and operations

Not carried out.

Coxsackievirus in children

Despite the commonality of the manifestations of the Coxsackie virus in the body of adults and children, there are a number of features. First of all, in most children, Coxsackie infection is asymptomatic. According to Dr. Komarovsky, the most common symptoms of the Coxsackie virus in children are herpangina and hand-foot-mouth syndrome, which affect almost all children. In his opinion, no special treatment is required for such children; symptomatic therapy and plenty of fluid intake are sufficient. Diseases disappear quickly.

Sometimes parents are interested in whether the child is contagious and how contagious he is. A child is a source of the EVI pathogen with the possibility of transmitting it to others throughout the disease, and in many cases even after the disease for 1-2 weeks. Therefore, a sick child should be isolated as soon as possible.

Newborns and young children are a special risk group. In most cases, EVI manifests itself in the form of a relatively benign fever, in some with a rash on the body. At the same time, Coxsackie viruses are the most common cause encephalomyocarditis . A child becomes infected mainly from relatives in the family, sometimes intrauterinely. Characterized by lethargy, vomiting, increased body temperature, symptoms of heart damage: acrocyanosis , heart rhythm disturbances, expansion of the boundaries of the heart. With encephalitis - focal symptoms. The course is severe and death is possible.

Another extremely serious disease is sepsis-like disease, the etiological agent of which is Coxsackie viruses. Very often, the infectious disease is extremely severe, lightning fast with liver necrosis and damage to the heart, lungs, pancreas and brain and ends in death. The severity of the disease is determined by the level of maternal antibodies, the state of health of the child and the virulence of the infectious agent.

Diet

A balanced dairy-vegetable diet with plenty of fluids. When treating enteroviral exanthems, foods that irritate the oral mucosa (fried foods, spices, pickles, citrus fruits, hot foods/drinks) are excluded from the diet.

Prevention of Coxsackie virus

There is still no specific prevention, which is due to the large number of serotypes of the virus. Nonspecific prevention includes:

• compliance with personal hygiene rules (thorough hand washing with disinfectant solution after visiting the toilet/before eating);
• Thorough washing of fruits and vegetables before consumption and rinsing with boiling water;
• using bottled water for drinking;
• swim only in permitted places; do not swallow water while swimming;
• avoiding contact with persons with clinical manifestations of EVI.

When a focus of EVI is identified, in order to localize it, the following is carried out:

• Active identification of patients with EVI and persons in contact with patients and establishment of monitoring of them.
• Isolation and hospitalization of patients (if necessary).
• Disinfection measures - disinfection (final and current).
• Strengthening sanitary supervision over catering, the water supply system, maintenance of the territory, compliance with the regime of organized children's groups and health care facilities.
• In case of an unfavorable epidemiological situation, it is recommended to administer 0.3 ml/kg of gamma globulin to all persons in the foci of infection.

Consequences and complications

EVI, which occurs in mild forms, ends in the vast majority of cases with complete recovery. However, when encephalomyocarditis And meningoencephalitis In newborns, complications such as cerebral edema, hemi/monoparesis, epileptoid seizures, and decreased muscle tone are common. Severe EVI can contribute to acute respiratory failure and the development of pneumonia, and in case of eye damage -.

Forecast

For most nosological forms of EVI, which occur in a mild form, the prognosis is favorable. However, severe forms ( meningoencephalitis , myopericarditis ), especially in newborns and children under one year old, can cause serious complications that can be fatal.

List of sources

• Bondarenko, V. I. Enteroviruses in river water Text. / V. I. Bondarenko, V. I. Zadorozhnaya, K. V. Yashchenko // Hygienic aspects of biological pollution* of the environment: materials of the X All-Union Conference. -M., 1988. Part: 2. - P. 79.
• Kozhevnikova, N.V. Increasing role of enteroviruses in modern infectious pathology Text. / N.V. Kozhevnikova, T.N. Karavyanskaya, E.B. Golubeva // Far Eastern Journal of Infectious Pathology. 2007. -No. 10. - P. 52-53. - Bibliographer: p. 53.
• Kokoreva S.P. Modern complex therapy of viral neuroinfections in children / S.P. Kokoreva, N.P. Kuprina, O.A. Panina // Children's infections, 2007. – T. 6, No. 4. – P. 47-53.
• Resolution of the Chief State Sanitary Doctor of the Russian Federation dated July 27, 2011 N 106 SP 3.1.2950-11 “Prevention of enterovirus infection.”
• Sabitova A.M., Alexandrova T.A. Modern clinical and epidemiological features of enterovirus various clinical forms of infection // Collection of materials of the X Russian conference “Pediatrics and pediatric surgery in the Volga Federal District”, Kazan, November 26-28, 2013. - P. 60.