Enterovirus infection in children: forms, symptoms, treatment, possible complications. How is enterovirus infection transmitted? Symptoms of enterovirus infection

Enteroviruses are a fairly large group of viruses that consist of ribonucleic acid (RNA) and protein. The best known are the polioviruses - which cause the disease paralytic poliomyelitis (commonly known as poliomyelitis). Less known, but more common, are the non-polio enteroviruses - Echoviruses and Coxsackieviruses.

Paralytic polio is believed to have been completely eradicated through vaccination. The cause of a huge number of diseases caused by enteroviruses are Echoviruses and Coxsackie viruses; today there are about 64 different strains (species) of enterovirus that cause diseases in humans; more than 70% of infections are caused by only 10 strains. Anyone can be infected with enterovirus infection, which is the causative agent of more than a billion diseases worldwide. It is believed that 90% of enterovirus infections are asymptomatic or result in mild illness, but the number of people affected by serious illness is high.

Children and adolescents are more susceptible to diseases caused by Enteroviruses than younger age, the more dangerous the disease can progress.

The alarming fact about enteroviruses is that they are able to spread to various organs and can persist in the human body for many years - which can lead to long-term illness after the initial infection.

Causes of enterovirus infection

Enteroviruses- so named because after an infection occurs, they reproduce initially in gastrointestinal tract. Despite this, they usually do not cause intestinal symptoms, most often they actively spread and cause symptoms and diseases of such organs as: heart, skin, lungs, brain and spinal cord, etc.

Viruses are generally divided into those that use DNA (deoxyribonucleic acid) or RNA as their genetic material - all enteroviruses are RNA viruses. Enteroviruses are part of a large group of viruses known as picornaviruses. This word comes from a combination of "pico" (from Spanish - meaning "a little"), and RNA (ribonucleic acid, important component genetic material).

Polioviruses (3 strains)
Echoviruses (28 strains)
Coxsackie viruses (Coxsackie A – 23 strains, Coxsackie B – 6 strains)
Enteroviruses - not included in any of the groups (4 strains)

Enteroviruses are found throughout the world, but infection most often occurs in areas with poor hygiene and high overcrowding. The virus is most often transmitted through the fecal-oral route or through contaminated food or water. The entry of some strains of the virus into the body by airborne droplets can lead to respiratory diseases. The possibility of infection of the fetus through the placenta has also been documented. Breast milk contains antibodies that can protect newborns. Incubation period for most enteroviruses it ranges from 2 to 14 days. In areas with temperate climates, infections occur mainly in summer and autumn.

Enterovirus most often enters the human body through the gastrointestinal tract (GIT) or respiratory tract. Once in the gastrointestinal tract, viruses stop in local lymph nodes where they begin the first stage of reproduction. Around the third day after infection, viruses enter the bloodstream and begin to circulate throughout the body. On the 3-7th day, viruses with blood can enter organ systems where the second stage of reproduction can begin and, as a result, cause various diseases. The production of antibodies to the virus occurs during the first 7-10 days.

It is known that the virus Coxsackie, most often begins to actively multiply and causes diseases by getting into such tissues and organs as: pharynx (sore throat), skin (viral pemphigus of the oral cavity and extremities), myocardium (myocarditis) and meninges (aseptic meningitis). The adrenal glands, pancreas, liver, pleura and lungs may also be affected.

Echovirus- actively multiplies and causes diseases by getting into tissues and organs such as: liver (liver necrosis), myocardium, skin ( viral exanthems), meninges (aseptic meningitis), lungs and adrenal glands.

Symptoms and signs of enterovirus infection

Non-polio Enteroviruses cause a huge number of infections per year. More than 90% of these cases are either asymptomatic or cause a nonspecific febrile illness. Usually the range of symptoms is very wide, but in most cases it almost always includes: fever (increase in body temperature to 39-40°C), general weakness, headache, muscle pain and gastrointestinal symptoms.
Enteroviruses entering the human body can cause several symptoms in various combinations.

Possible symptoms are described below:

Runny nose and congestion in the nose and sinuses, sore nose, sore throat, ear pain, difficulty swallowing, loss of smell or taste.
Nausea, upset stomach, reflux, bloating, top and lower pain in the abdomen, cramps, constipation, alternating with diarrhea.
Rapid weight loss due to poor digestion and decreased calorie intake or weight gain due to inactivity.
Numbness in the limbs, muscle twitching and spasms. Facial tingling and numbness may occur.
Different types of headaches(sharp, aching, pulsating).
Pain in bones, muscles and joints. Leg pain is quite common.
Chest pain and tightness, palpitations.
Cough, shortness of breath, wheezing .
Violation heart rate(arrhythmias) or tachycardia (rapid heartbeat)
Intermittent fever- characterized by a rapid, significant increase in temperature (38-40°C), which lasts for several hours, and then is replaced by a rapid drop to normal values), chills and severe night sweats.
Reproductive dysfunction as well as pain in the testicular area. Pain in the pelvic area.
Blurred vision, decreased visual acuity.
Blisters or ulcerations in oral cavity, pharynx and in women in the vagina/cervix.
Psychological problems – anxiety states or depression.
Problems concentrating. Cognitive problems, short-term memory problems.
Sleep disturbance.
Convulsions Rarely occur, but they do happen.
Increase lymph nodes in the neck area and armpits
Rash
Enterovirus infections should be suspected if the same symptoms recur every month.

You can't talk about any specific symptoms characteristic of the entire group of enteroviruses in addition to those listed above, but the symptoms that appear during complications of enterovirus infection can be grouped:

Enteroviral fever(summer flu) - the most common form of enterovirus infection, begins with sudden increase temperatures, the temperature usually stays between 38.5-40 °C. Clinical indicators include a flu-like syndrome consisting of general weakness, muscle pain, sore throat, headaches, inflammation of the mucous membrane of the eyes (conjunctivitis), nausea, vomiting and diarrhea. Genitourinary manifestations such as orchitis (inflammation of testicular tissue) and epididymitis (inflammation of the epididymis) are possible. Symptoms usually last 3-7 days and can usually be caused by all enterovirus subtypes.

Herpangina - In such patients, painful blisters filled with light liquid appear on the back of the throat and tonsils, the blisters are usually surrounded by a red border. These injuries are accompanied by fever, sore throat, and pain when swallowing (odynophagia). Mothers may notice that their children are reluctant to eat due to painful ulcers. The causative agent is most often the Coxsackie virus group A and, sometimes, the Coxsackie virus group B. Sore throat is a self-limiting disease, and its symptoms last 3-7 days.

Viral pemphigus of the mouth and extremities- manifests itself as a vesicular rash (small blisters filled with fluid that rise above the surface of the skin) in the oropharynx, on the palms, soles and area between fingers in babies and children school age. Blisters in the mouth are usually not painful. Patients often have a fever for 1-2 days and small red spots on the skin of the arms and legs (a characteristic viral exanthema). The lesions most often occur on the surface of the skin on the lower arms and legs. The most common pathogen is the Coxsackievirus group A.
Viral exanthemas - Common cause emergency room visits are viral exanthems similar to rubella or roseola rashes; occur during the summer months. These exanthemas occur in children under 5 years of age and resolve favorably within 3-5 days. The causative agents are, as a rule, Echoviruses.
Pleurodynia(Bornholm disease, devil's flu) - Causes severe muscle pain in the chest and abdomen. These sharp pains worsen when breathing or coughing and are associated with profuse sweating. Cramping muscle pain lasts 15-30 minutes in children and adolescents. The condition can mimic serious surgical symptoms and may cause periodic episodes of difficulty breathing. These symptoms are accompanied by fever, headache, sharp decline weight, nausea and vomiting. Symptoms last for 2 days. Coxsackievirus B3 and B5 infect the intercostal muscles, causing these frightening but rare outbreaks.

Myocarditis and/or pericarditis - includes infections of the heart muscle (myocardium) and the lining around the heart (pericardium). Babies and children preschool age are the most susceptible to this disease, and for some reason, more than two-thirds of cases occur in males. The disease usually begins as an upper respiratory tract infection with cough, shortness of breath and fever. Chest pain, severe shortness of breath, abnormal heart rhythms, and heart failure may develop.

Acute hemorrhagic conjunctivitis– implies viral infection the conjunctiva of the eye, which is the covering around the eyes. Symptoms include pain, blurred vision, decreased visual acuity, photophobia, and eye discharge. Headache and fever occur in only one in five patients. The disease lasts 10 days.
Aseptic meningoencephalitis– is a well-known syndrome caused by Enteroviruses. In fact, enteroviruses are responsible for approximately 90% of cases of aseptic meningitis, and most often affect children and adolescents. It is characterized by headache, fever, light refusal and eye pain. Symptoms may include drowsiness, sore throat, cough, muscle pain and rash. Sometimes not only the meninges become infected, but also the brain tissue itself, causing encephalitis. The illness resolves in about a week, and permanent damage is uncommon. Enteroviruses can also cause Guillain-Barré syndrome, which involves weakness and paralysis of the limbs and, less commonly, the respiratory muscles.

Diagnosis of enterovirus infection

In most cases, the diagnosis is made based on the characteristic symptoms caused by the virus, medical history, and physical examination. Specific studies are necessary to determine the causative agent of the infection, since this will greatly influence the approach to treatment (if the causative agent of the disease is a virus, then antibiotic therapy will not be required), as well as in the event of complications developing.

Laboratory research:

Serology - a serological blood test can reveal an increase in the number of antibodies produced by the body to fight enterovirus during acute and convalescent (recovery) periods of the disease. This diagnostic test can only detect Coxsackievirus B 1-6 and Echoviruses 6, 7, 9, 11, and 30. Other known enteroviruses cannot be identified with this test. A negative serological test may not necessarily mean the absence of enteroviruses.

Polymerase chain reaction (PCR) - This test is highly sensitive and specific for the detection of enteroviral RNA in cerebrospinal fluid samples, with a sensitivity of 100% and a specificity of 97% for identifying the causative agent of the disease. PCR gives quick results. PCR blood testing can detect the virus in only 30% of patients with the syndrome chronic fatigue(myalgic encephalomyelitis).

Cardiac enzymes and troponin I – a blood test that is aimed at determining the level of specific cardiac enzymes and troponin 1, which, when present in the blood at high levels, indicate damage to the heart muscles. The normal level of troponin I in serum is 0-0.5 ng/ml. Carried out at

Cerebrospinal fluid analysis – carried out when symptoms of damage to the brain and spinal cord and their membranes appear. Using a puncture, a small amount of fluid is removed from the patient's spinal canal under sterile conditions. In patients with aseptic meningitis, it shows a moderate increase in leukocyte levels. Glucose levels are normal or slightly low, while protein levels are normal or slightly elevated.

Polymerase chain reaction with reverse transcriptase (RT-PCR) - This test is designed to detect common genetic regions of RNA among most enteroviruses. Results can be available within 24 hours, making detection more sensitive (95%), more specific (97%) and effective. This test is approved for the diagnosis of enteroviral meningitis. The best results are obtained when using cerebrospinal fluid for research. When using other body fluids, such as feces, sputum and mucus from the respiratory tract and blood, this method does not show as good results.

Instrumental studies

Chest X-ray- In patients with myopericarditis, chest x-ray may reveal cardiomegaly (enlargement of the heart) following pericarditis or cardiac enlargement. In pleurodynia, chest x-ray findings are normal.

Electroencephalography- This test can be used to assess the extent and severity of the disease in patients with encephalitis.

Echocardiography- prescribed to patients with suspected myocarditis, the study may show disturbances in the movement of the walls of the heart chambers. IN severe cases This method can detect acute ventricular dilatation and decreased ejection fraction.

Ophthalmic examination using a slit lamp– In patients with acute hemorrhagic conjunctivitis, corneal erosions can be detected using a fluorescent spot. Enterovirus 70 and Coxsackievirus A24 can be isolated from conjunctival swabs within the first 3 days after infection.

Treatment of enterovirus infection

In most cases Enterovirus infection proceeds without complications and does not require any specific treatment. The basis is symptomatic and supportive treatment. Bed rest, drinking plenty of fluids, vitamins, in case high temperature antipyretic. No specific diet for this moment does not exist for patients with enterovirus infection. There is no specific antiviral treatment, such as vaccination, for the treatment and prevention of non-polio enterovirus infection.

In the table you can see a number of drugs that can help you cope with one or another symptom of a mild form of enterovirus infection. But do not forget that even if the slightest and insignificant symptoms appear, you should immediately consult a doctor, especially if the symptoms appear in a child!
Antipyretic and painkillers– these drugs are used to treat fever, muscle pain and headaches caused by enterovirus infection.

Active substance	Drug name	Description	Directions for use and dosage
Acetaminophen	Paracetamol Tylenol Efferalgan Panadol	The drug belongs to the group of non-steroidal anti-inflammatory drugs. It has antipyretic, analgesic and anti-inflammatory properties. Release forms for children: Tablets – 80 mg, 160 mg; Chewable tablets– 80 mg.; Syrup – 160 mg/5 ml; 240 mg/7.5 ml; 320 mg/10 ml. Release form for adults: Tablets – 325 mg, 500 mg; Capsules – 500 mg; Chewable tablets – 80 mg, 160 mg; Suspensions – 160 mg/5 ml.	For children: Under 12 years old– 10-15 mg/kg, time between doses is 6-8 hours, but not more than 2.6 g per day. Over 12 years old– 40-60 mg/kg/day (divided into 6 doses). No more than 3.7 g per day. 6 years– 200 mg/kg. For adults: 500 mg. 3-4 times a day, but not more than 4 g per day.
Ibuprofen	Advil Ibupron MIG 200/400 Nurofen Profen Motrin Ibusan Yprene	The drug belongs to the group of non-steroidal anti-inflammatory drugs. It has analgesic, anti-inflammatory and antipyretic properties. Release form for children and adults: Tablets – 100 mg, 200 mg, 400 mg, 600 mg, 800 mg; Chewable tablets – 50 mg, 100 mg; Suspensions – 100 mg/5 ml, 40 mg/ml.	For children: From 6 months to 12 years Body temperature below 39°C - 5-10 mg/kg/dose every 6-8 hours, but not more than 40 mg/kg/day. Body temperature above 39°C - 10 mg/kg/dose every 6-8 hours, but not more than 40 mg/kg/day. For muscle pain and/or headache - 4-10 mg/kg/dose every 6-8 hours, but not more than 40 mg/kg/day. Potentially dangerous dose for children younger 6 years– 200 mg/kg. Take with meals. For adults: At elevated temperature– 400 mg every 4-6 hours, maximum dose not more than 3.2 g per day. For muscle pain and/or headache - 200 - 400 mg every 4-6 hours, maximum dose no more than 1.2 g per day.

Immunoglobulins– drugs that stimulate the immune system. Immunoglobulins are a purified preparation of gamma globulin obtained from human blood plasma. Immunoglobulin preparations are administered intravenously or intramuscularly. Intravenous immunoglobulins are often used in the treatment of enteroviral infections. The dose is prescribed strictly individually, depending on the severity of the disease, age and tolerability of the drug by the patient.

Specific antiviral therapy at this stage of development of medicine has not shown any effective results, and is currently not included in standard treatment regimens for enterovirus infection. Existing drugs can have any effect only when taken very early stage the development of enterovirus infection in the first 5-10 hours, but it is not possible to determine the presence of infection during this period of time at home.

As a maintenance therapy, it is worth taking vitamins, the most important being vitamin D, as it is involved in the production of a peptide that is important for immune cells. It is also worth using supplements containing microelements such as zinc, selenium, potassium, calcium and magnesium - they play an important role in the fight against viral infections.

Pharmaceuticals to Avoid

Some drug treatments may do more harm than good. The following treatments should be avoided: antibiotic therapy - does not give any results in the treatment of enteroviral infections, since antibiotics only act on bacteria. However, in patients with severe disease where it is unclear whether the cause is a viral or bacterial infection, such as in the case of meningitis, antibiotics can be used as long as the bacterial culture results are unknown. If the cause is determined to be viral, antibiotics should be discontinued.

Should be avoided corticosteroids as a treatment for acute enterovirus infection, if possible. Although these medications are often prescribed for acute enterovirus infections to treat acute asthmatic bronchitis and severe localized muscle pain (neck, chest, back), they should be avoided because they suppress the immune response and allow viruses to survive in the body. It should be noted that the use of steroids for myocarditis is harmful. If the use of steroids is considered medically necessary in a situation, life threatening(for example, in severe asthma or acute respiratory distress syndrome), steroid treatment should be delayed if possible until the sick person's body has developed antibodies against the enterovirus.

Prevention

Currently, no vaccine is effective against non-polio enteroviruses. General hygiene and frequent hand washing are effective in reducing the spread of these viruses. If soap and clean water are not available, use an alcohol-based “hand sanitizer.”

It is important to note that breast milk contains antibodies that may protect newborns.

Enterovirus infection is a group of acute diseases of the digestive tract that are caused by RNA-containing pathogens of the Enterovirus genus.

Nowadays, outbreaks of enterovirus infection are increasingly observed in many countries around the world. The danger of this group of diseases is that clinical symptoms can be very diverse. In most cases, there is a mild course, characterized by minor discomfort, but there may be serious complications, including severe damage to the respiratory system and central nervous system, as well as the kidneys and digestive tract.

Pathogens and routes of their transmission

The vast majority of RNA-containing enteroviruses are pathogenic for humans.

To date, over 100 types of pathogens have been identified, including:

ECHO viruses;
Coxsackie viruses (types A and B);
pathogens (polioviruses);
unclassified enteroviruses.

The pathogens are ubiquitous. They are characterized high degree sustainability in external environment, tolerate freezing, as well as treatment with antiseptics such as 70% ethanol, Lysol and ether. Enteroviruses die quickly when heat treatment(cannot tolerate heating up to 50°C), drying and exposure to formaldehyde or chlorine-containing disinfectants.

Natural reservoirs for pathogens are water bodies, soil, some food products, and the human body.

note: In feces, enteroviruses remain viable for up to six months.

In most cases, the source of the pathogen is a sick person or a virus carrier, who may completely lack clinical signs of enterovirus infection. According to medical statistics, among the population of some countries, up to 46% of people can be carriers of pathogens.

Main routes of transmission:

fecal-oral (with a low level of hygiene);
contact-household (through contaminated objects);
airborne (if the virus is present in the respiratory system);
vertical transmission (from an infected pregnant woman to a child);
water (when swimming in polluted waters and watering plants with wastewater).

note: cases of infection with enteroviruses have been recorded even through water in coolers.

This group of acute diseases is characterized by seasonal outbreaks in the warm season (summer-autumn). Human susceptibility to enteroviruses is very high, but after an infection it is quite for a long time(up to several years) type-specific immunity is maintained.

Symptoms of enterovirus infection

Enterovirus infection in adults and children can cause a number of pathologies characterized by varying degrees of severity of the inflammatory process.

The most severe pathologies include:

inflammation of the myocardium (heart muscle);
pericarditis (inflammation of the pericardial sac);
hepatitis (anicteric);
serous (lesion soft shells brain);
acute paralysis;
kidney damage;
newborns.

Less dangerous manifestations:

three-day fever (including with skin rashes);
gastroenteritis (inflammation of the digestive tract);
herpetic sore throat;
lymphadenopathy;
polyradiculoneuropathy;
inflammation of the conjunctiva;
inflammation choroid eyes;
damage to the optic nerve;
vesicular pharyngitis.

note: When enterovirus D68 enters the body, bronchopulmonary obstruction often develops. A characteristic symptom is a severe cough.

Severe complications rarely develop in adult patients with good immunity. They are typical for people with reduced body resistance - children (especially - early age) and persons suffering from serious diseases (, malignant tumors).

note: variety clinical manifestations due to a certain affinity of enteroviruses for many tissues of the human body.

The most characteristic clinical signs of enterovirus infection in children and adults:

The duration of the incubation period for enteroviral infections in most cases ranges from 2 days to 1 week.

Most often, when infectious agents of this type enter the body, a person develops ARVI.

Symptoms catarrhal form enterovirus infection:

runny nose;
cough (dry and rare);
increased temperature (usually within subfebrile range);
hyperemia of the mucous membrane of the throat;
digestive disorders (usually not very significant).

As a rule, a person recovers within a week from the onset of the disease.

Symptoms of enteroviral fever:

febrile reaction within 3 days from the onset of the disease;
moderate signs of general intoxication;
skin rashes (not always);
deterioration general well-being(weak or moderate).

note: Enteroviral fever is also called “minor illness” because the symptoms do not last long and their severity is low. This form of pathology is relatively rarely diagnosed, since most patients do not even seek medical help.

With this form of enterovirus infection, children may experience symptoms of damage to the upper respiratory tract (catarrhal manifestations). In young children, the disease can last up to 2 weeks or more.

A sign of herpangina against the background of an enterovirus infection is the formation of red papules on the mucous membranes. They are localized in the area of the hard palate, uvula and arches. These small rashes quickly transform into vesicles, which after 2-3 open with the formation of erosions or gradually resolve. Herpangina is also characterized by enlargement and tenderness of the submandibular and cervical lymph nodes, as well as hypersalivation (salivation).

The main clinical manifestation of enteroviral exanthema is the appearance on skin patients with a rash in the form of spots and (or) small bubbles Pink colour. In most cases, the skin elements disappear after 2-3 days; At the site of their resolution, peeling of the skin is observed, and the upper layers come off in large fragments.

Important: exanthema can be diagnosed in parallel with meningeal symptoms.

Symptoms of serous meningitis against the background of enterovirus infection:

photophobia (photophobia);
increased sensitivity to sounds;
severe headache when bringing the chin to the chest;
lethargy;
apathy;
psycho-emotional arousal (not always);
high body temperature;
convulsions.

Oculomotor disorders, disturbances of consciousness, muscle pain and increased tendon reflexes are also possible.

Meningeal symptoms last from 2 days to one and a half weeks. The virus can be detected in the cerebrospinal fluid for 2-3 weeks.

Symptoms of enteroviral conjunctivitis:

pain (stinging) in the eyes;
tearfulness;
photophobia;
redness of the conjunctiva;
swelling of the eyelids;
copious discharge (serous or purulent).

note: with enteroviral conjunctivitis, one eye is initially affected, but soon inflammatory process extends to the second one as well.

Signs of enterovirus infection in children

It is typical for children (especially children under 3 years of age) acute onset diseases.

The most common clinical manifestations of enterovirus infection are:

sleep disorders;
fever;
chills;
diarrhea;
catarrhal symptoms;
myalgia;
dizziness;
weakness;
exanthema and (or) sore throat (not always).

Currently, the causative agent of enterovirus infection can be identified in one of four ways:

Changes in general analysis blood:

slight leukocytosis;
hyperleukocytosis (rare);
neutrophilia (early stage);
eosinophytosis and lymphocytosis (as the disease progresses).

Important:establishing the presence of a virus in the body is not indisputable evidence that it was this pathogen that provoked the disease. Happens quite often asymptomatic carrier. Diagnostic criterion is an increase in the number of antibodies (in particular, immunoglobulins A and M) by 4 or more times!

Differential diagnosis

Herpes sore throat, which is caused by the Coxsackie virus, should be differentiated from herpes simplex and oral candidiasis (fungal). Serous meningitis caused by infection with enteroviruses should be distinguished from damage to the meninges of meningococcal etiology.

If symptoms of the gastroenteric form occur, other intestinal infections should be excluded. It is important to differentiate exanthema from rashes caused by rubella and hypersensitivity reactions (allergic).

Etiotropic (i.e., specific) treatment methods have not been developed to date.

Treatment of enterovirus infection in adults involves detoxification and symptomatic therapy. Therapeutic tactics determined individually for each patient depending on the nature, location and severity of the course pathological process. According to indications, patients are given antiemetics, painkillers and antispasmodics.

When treating enterovirus infection in children, rehydration therapy often comes to the fore, i.e. eliminating dehydration and restoring electrolyte balance. To this end saline solutions and 5% glucose is either given orally or administered through intravenous infusion. Children are also given detoxification therapy and, if necessary, given antipyretics (antipyretics).

To combat viruses, intranasal administration of a solution of leukocyte interferon is indicated.

If complications occur due to the addition of a secondary bacterial infection, the patient is prescribed a course of antibiotic therapy. Defeats nervous system often require the use hormone therapy with the use of corticosteroids.

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 persistent lifelong immunity to this disease, however, 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 makes it very difficult to develop medicines and vaccines, does not make it possible to completely deal with the infection.

Enterovirus infection is transmitted in three main ways - contact, fecal-oral or airborne. At the same time, not only a person who already has a strong infection can act as a source of infection. severe symptoms 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;
efficiency protective functions organisms, their ability long time resist the aggressive effects of the virus;
tropism or the ability of pathogenic microorganisms to provide negative action to internal organs.

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

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, the 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, rinse the patient in the shower. Otherwise, it is better to refrain from swimming until full recovery. But you need to wash your hands mandatory, 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 limbs, 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

Defeat the enterovirus infection that has affected small child, not easy, however A complex approach and strict adherence to all the 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 recovery 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 becomes complicated negative impact 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 an infection is to take 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, frightened by individual symptoms of infection, begin to give their 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.

The patient can be treated 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 are perfect for this; they are not too strong. green tea, jelly, compotes and fruit drinks.

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.

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.

Enteroviral infections are a group of diseases that are caused by several types of viruses. The disease is caused by Coxsackie viruses, polioviruses and ECHO (ECHO). These viruses have a capsule and a core containing RNA (a type of DNA). The structure of the capsule can vary greatly, so so-called serotypes (varieties) are distinguished. Polioviruses have 3 serological types. Viruses of the Coxsackie group are divided into Coxsackie A and Coxsackie B. Coxsackie A viruses have 24 serological types, Coxsackie B viruses have 6. ECHO viruses have 34 serological types. After an enterovirus infection, persistent lifelong immunity is formed, however, it is serospecific. This means that immunity is formed only to the serological type of virus that the child has had and does not protect him from other varieties of these viruses. Therefore, a child can get sick with enterovirus infection several times during his life. Also, this feature does not allow us to develop a vaccine to protect our children from of this disease. The disease is seasonal: outbreaks of the disease are most often observed in the summer-autumn period.

Causes of enterovirus infection

Infection occurs in several ways. Viruses can enter the environment from a sick child or from a child who is a virus carrier. Virus carriers do not have any manifestations of disease, but the viruses are in the intestines and are released into the environment with feces. This condition can be observed in children who have been ill after clinical recovery, or in children in whom the virus entered the body, but was unable to cause the disease due to strong immunity child. Virus carriage can persist for 5 months.

Once in the environment, viruses can persist for quite a long time, as they tolerate adverse effects well. Viruses are well preserved in water and soil; when frozen they can survive for several years; they are resistant to disinfectants (when exposed to solutions high concentration phenol, chlorine, formaldehyde, viruses begin to die only after three hours), however, they are susceptible to high temperatures (when heated to 45º C they die in 45-60 seconds). Viruses tolerate changes in environmental pH well and thrive in an environment with a pH from 2.3 to 9.4, therefore acidic environment the stomach does not have any effect on them and the acid does not perform its protective function.

How is enterovirus infection transmitted?

The transmission mechanism can be airborne (when sneezing and coughing with droplets of saliva from a sick child to a healthy one) and fecal-oral if personal hygiene rules are not observed. Most often, infection occurs through water, when drinking raw (not boiled) water. It is also possible to infect children through toys if children put them in their mouths. Children aged 3 to 10 years are most often affected. Breastfed children have immunity in their bodies, received from the mother through breast milk, however, this immunity is not stable and quickly disappears after stopping breastfeeding.

Symptoms of enterovirus infection

Viruses enter the body through the mouth or upper respiratory tract. Once in the child’s body, the viruses migrate to the lymph nodes, where they settle and begin to multiply. The further development of the disease is associated with many factors, such as virulence (the ability of the virus to resist the body’s protective properties), tropism (the tendency to infect individual tissues and organs) of the virus and the state of the child’s immunity.

Enterovirus infections have both similar and different manifestations, depending on the type and serotype. Incubation period (the period from the virus entering the child’s body to the appearance of the first clinical signs) is the same for all enterovirus infections - from 2 to 10 days (usually 2-5 days).

The disease begins acutely - with an increase in body temperature to 38-39º C. The temperature most often lasts 3-5 days, after which it drops to normal numbers. Very often the temperature has a wave-like course: the temperature lasts for 2-3 days, after which it decreases and stays at a low temperature for 2-3 days. normal numbers, then rises again for 1-2 days and returns to normal again completely. When the temperature rises, the child feels weak, drowsy, and may experience headache, nausea, and vomiting. When the body temperature decreases, all these symptoms disappear, but when the body temperature rises again, they may return. The cervical and submandibular lymph nodes, since viruses multiply in them.

Depending on which organs are most affected, several forms of enterovirus infection are distinguished. Enteroviruses can affect: the central and peripheral nervous systems, the mucous membrane of the oropharynx, the mucous membrane of the eyes, skin, muscles, heart, intestinal mucosa, liver; in boys, testicular damage is possible.

When the mucous membrane of the oropharynx is damaged, the development occurs enteroviral sore throat. It is manifested by an increase in body temperature, general intoxication (weakness, headache, drowsiness) and the presence of a vesicular rash in the form of bubbles filled with liquid on the mucous membrane of the oropharynx and tonsils. These bubbles burst, and ulcers filled with white plaque form in their place. After recovery, no traces remain at the site of the ulcers.

When the eyes are affected, it develops conjunctivitis. It can be one- or two-sided. Manifests itself in the form of photophobia, lacrimation, redness and swelling of the eyes. There may be hemorrhages in the conjunctiva of the eye.

When muscles are damaged, it develops myositis– muscle pain. Pain appears against the background of rising temperature. Soreness is observed in chest, arms and legs. The appearance of muscle pain, like fever, can be wave-like. As the body temperature decreases, the pain decreases or disappears completely.

When the intestinal mucosa is damaged, the presence of loose stool. The stool is of normal color (yellow or brown), liquid, without pathological (mucus, blood) impurities. The appearance of loose stools can be either against the background of an increase in temperature or isolated (without an increase in body temperature).

Enteroviral infections can affect various areas hearts. So, when the muscle layer is damaged, it develops myocarditis, when the inner layer is damaged with the capture of the heart valves, it develops endocarditis, with damage to the outer lining of the heart - pericarditis. The child may experience: increased fatigue, weakness, rapid heartbeat, falling blood pressure, rhythm disturbances (blockades, extrasystoles), chest pain.

When the nervous system is damaged, they can develop encephalitis, meningitis. The child experiences: severe headache, nausea, vomiting, increased body temperature, convulsions, paresis and paralysis, loss of consciousness.

When the liver is damaged, it develops acute hepatitis. It is characterized by an enlarged liver, a feeling of heaviness in the right hypochondrium, and pain in this place. Nausea, heartburn, weakness, and increased body temperature may occur.

If the skin is damaged, it may appear exanthema– hyperemia (red coloring) of the skin, most often on the upper half of the body (head, chest, arms), does not rise above the skin level, appears simultaneously. In my practice, enterovirus infection was observed with cutaneous manifestation in the form of a vesicular rash on the palms and soles. After 5-6 days, the bubbles deflated without opening, and in their place an area of pigmentation (brown dot) formed, which disappeared after 4-5 days.

In boys, there may be inflammation in the testicles with the development orchitis. Most often, this condition develops 2-3 weeks after the onset of the disease with other manifestations (angina, loose stool and others). The disease goes away quite quickly and does not have any consequences, however, in rare cases, aspermia (lack of sperm) may develop in adulthood.

There are also congenital forms of enterovirus infection, when viruses enter the child’s body through the placenta from the mother. Typically, this condition has a benign course and is cured on its own, however, in some cases, an enterovirus infection can cause termination of pregnancy (miscarriage) and the development of the syndrome in the child sudden death(the death of a child occurs against the background of full health).
Very rarely, damage to the kidneys, pancreas, and lungs is possible. Defeat various organs and systems can be observed both isolated and combined.

Diagnosis of enterovirus infection

For staging accurate diagnosis swabs are taken from the child’s nose, throat or bottom, depending on the symptoms of the disease. The washings are sown on cell cultures, and after incubation for 4 days, a polymerase test is carried out chain reaction(PCR). Since this takes quite a long time, the diagnosis is made based on clinical manifestations (symptoms), and PCR serves only to confirm the diagnosis and does not affect the treatment.

Treatment of enterovirus infection

There is no specific treatment for enterovirus infection. Treatment is carried out at home, hospitalization is indicated in the presence of damage to the nervous system, heart, high temperature, which cannot be reduced for a long time with the use of antipyretics. The child is prescribed bed rest for the entire period of increased body temperature.

Meals should be light, rich in proteins. Necessary sufficient quantity liquids: boiled water, mineral water without gases, compotes, juices, fruit drinks.

Treatment is carried out symptomatically depending on the manifestations of the infection - sore throat, conjunctivitis, myositis, loose stools, heart damage, encephalitis, meningitis, hepatitis, exanthema, orchitis. In some cases (sore throat, diarrhea, conjunctivitis...) prevention of bacterial complications is carried out.

Children are isolated for the entire period of illness. They can stay in the children's group after all symptoms of the disease disappear.

Prevention of enterovirus infection

For prevention, it is necessary to observe the rules of personal hygiene: wash your hands after using the toilet, walking outside, drink only boiled water or water from a factory bottle, it is unacceptable to use water from an open source (river, lake) for a child to drink.

There is no specific vaccine against enterovirus infection, since environment present a large number of serotypes of these viruses. However, in Europe, vaccines containing the most common enterovirus infections (Coxsackie A-9, B-1, ECHO -6) are often used. The use of such vaccines reduces the risk of enterovirus infections in children.

Pediatrician Litashov M.V.

The end of summer and autumn is a period of increasing incidence of enteroviral infections. These diseases have many clinical manifestations similar to respiratory ones, intestinal infections, allergic reactions. Mostly children are infected; in most cases the disease is asymptomatic or mild form. However, viremia (spread of the pathogen throughout the body) leads to severe complications.

Epidemic exanthema

Boston or enteroviral exanthema is one of the mildest forms of infection and is caused mainly by serotypes of the ECHO virus. The onset of the disease is always acute, with febrile symptoms that can last from two to 8 days. An increase in temperature is accompanied by headaches, myalgia, and sore throat. The body, face and limbs are covered with a rash due to enterovirus infection in this form. It is usually rubella-like and lasts from 2 to 4 days, but can be petechial, bullous, or maculopapular.

The acute period of the disease is often accompanied by conjunctivitis and pharyngitis, symptoms of meningism, and can also be combined with serous meningitis. There are cases when enteroviral exanthema causes a vesicular rash exclusively on the hands and feet, and single aphthae (“hand-foot-mouth”) appear in the oral cavity. The temperature rises slightly, and intoxication of the body is moderate. It is often observed in a mild form and is called enteroviral pemphigus in children.

Epidemic myalgia

It is characterized by a sudden acute onset with a sharp rise in temperature up to 40°C and chills. At the same time, weakness, nausea, headache, pain in the chest, back muscles and limbs, and epigastric pain are noted. When coughing or moving, the pain in the muscles intensifies. Profuse sweating, vomiting, nausea, and decreased appetite are also noted.

Tachycardia, enlarged liver and spleen, enlarged cervical lymph nodes, granularity and hyperemia are often recorded back wall pharynx, not intense catarrhal symptoms.

The illness lasts from 3 to 7 days. With wavy flow infectious process the febrile period may be extended to two weeks.

After the third or fourth day of illness, the intensity of febrile symptoms decreases.

Herpangina

Signs of enterovirus infection in adults and children in this form: acute onset with a temperature of 39.0–40.5 ° C (fever goes away after 3-5 days), general state the patient is satisfactory. The pharynx is hyperemic, during the first two days vesicles appear on its mucous membrane, which open within a day, forming erosions covered with a grayish coating.

Vesicles cover the mucous membrane of the tonsils, soft palate, tonsil arches, posterior pharyngeal wall.

The pain is moderate, erosions heal in less than a week.