Coxsackie virus is a viral infection that belongs to the family of herpes viruses that live and multiply in the human digestive tract. They enter the environment with feces, therefore, outbreaks of this viral disease are often found in the summer-autumn period, when there is frequent contamination of soil and water with feces. Flies and cockroaches carry the virus, so outbreaks can occur in areas with low living standards and in underdeveloped countries. Mostly children under 10 years old suffer from this pathology.
It is important to remember that the virus is easily transmitted from a sick child to a healthy one, therefore, outbreaks of this disease may occur in kindergartens and other preschool institutions.
There are two varieties of this virus - A and B. The type can be determined only after passing certain tests, while the symptoms of the disease are not too pronounced, and sometimes the disease is completely asymptomatic.
Coxsackie virus type A causes damage to the mucous membranes of the oral cavity, conjunctiva of the eyes, diseases of the upper respiratory tract. With type B, herpes, Bornholm's disease (pleurodynia) can often occur.
Infection routes
As mentioned above, the virus is extremely contagious, so it is quite easy to catch it in childhood, because children do not pay too much attention to hygiene, and if the parents do not keep track of the child, he can easily stick his dirty hands in his mouth, which will cause the development of viral pathology.
Both sick children and the surrounding objects that these children touched can be contagious. In addition, the infection can be found on unwashed fruits and vegetables, water, sand in which children play, etc. Therefore, the ways of infection with the virus can be as follows:
- airborne;
- contact and household;
- food.
Sometimes the Coxsackie virus develops in adults, and pregnant women can deal with it. By itself, it is not too scary for the expectant mother, since in adults the symptoms of the virus are even less pronounced than in children, but in this case, it can be transmitted through the placenta to a child who is born with symptoms of viral pathology. In this case, the route of transmission of the virus is intrauterine.
You can get the virus through drinking water and pool water, as well as through contaminated food. Therefore, doctors strongly recommend to all parents to give their children to drink only purchased filtered water, and to wash fruits and vegetables thoroughly before use. This will be the prevention of infection with the Coxsackie virus.
Symptoms
Most often, the Coxsackie virus in children manifests itself in the form of rashes on the mucous membranes and skin. These rashes have a specific character - these are small bubbles surrounded by a red halo, which can appear on the palms and feet of the baby, as well as in the genital area and in the mouth of the child (on the tonsils, palate).
The incubation period from the moment of infection until the first symptoms appear in the form of rashes is about 10 days. Other symptoms also appear, such as:
- a sharp increase in body temperature up to 38 degrees and above;
- overlapping of the tongue;
- general weakness;
- sore throat;
- eating disorder;
- enlargement of the cervical lymph nodes.
Symptoms of the disease can be either severe or insignificant, which makes diagnosis difficult. Parents usually begin to treat the disease in cases where the child's condition is significantly impaired. If the baby feels normal and his temperature rises slightly, many parents mistake the symptoms of the virus for symptoms of a common cold (and sometimes).
Since the Coxsackie virus can cause other pathologies, such as meningitis, myocarditis, etc., you should know the possible symptoms of such disorders.
In particular, with myocarditis of viral origin, which usually occurs in infants, all signs of acute develop. In addition, symptoms such as diarrhea, fever, and enlarged liver appear. Treatment of this disease must be timely, since this condition threatens the life of the child.
If the Coxsackie virus has caused meningitis in a child, then he may have a stiff neck muscles, headaches and a violation of the general condition. The body temperature also rises to febrile levels.
A common disease caused by the virus is pleurodynia. This is a pathology in which there is induration and soreness in the intercostal muscles, headaches, and fever.
As mentioned above, the symptoms of diseases caused by the virus in children are not too pronounced, therefore, the pathologies themselves proceed without serious consequences and sometimes, even without treatment, the process ends with the recovery of young patients. Nevertheless, timely diagnosis and treatment can shorten the course of the disease and prevent possible complications in severe forms of pathology.
Treatment
How to treat a child if he contracted the Coxsackie virus? Treatment depends on the disease caused by it. With a viral baby, special treatment is not required - it is important to follow a diet, provide the child with a sufficient amount of warm drink and bring down the temperature, if any. Since the virus can provoke illnesses in adults, they also need to stay in bed for several days and limit contact with other people to avoid infection.
For more severe pathologies caused by this pathogen, treatment can be carried out with antiviral drugs, as well as drugs such as:
- immunoglobulins;
- leukocyte interferon;
- interferonogens.
Also, in children and adults, treatment consists of symptomatic therapy:
- taking antipyretic drugs;
- the use of dehydration agents (with meningitis);
- taking vitamins.
If life-threatening conditions occur, treatment with glucocorticoids is indicated. And when an infection joins, antibiotics are prescribed.
Treatment of viral pathology in adults is similar. The prognosis of the course of the disease in both adults and children is often favorable.
Prevention is essential. Although it is impossible to protect yourself from infection, you can reduce the likelihood level if you are careful about your health, your baby's health and hygiene. Early isolation of sick children and adults is also a kind of prevention of the spread of a viral infection.
Coxsackie virus in children - a virus of the enterovirus genus from the picornavirus family, contains a single-stranded RNA that encodes a polyprotein, and is one of the main causes of aseptic meningitis. The human gastrointestinal tract serves as a favorable environment for the multiplication of the virus, however, with the blood flow, the infectious agent penetrates into other organs and tissues, causing inflammation in them. There are 30 known serological types of Coxsackie virus, all of them are divided into two groups that have a common complement-binding antigen, as well as differences in type-specific antigens involved in the neutralization reaction.
Skin rash with Coxsackie virus in children
Most often, diseases caused by the Coxsackie virus are recorded in children under ten years old, older children usually carry a viral infection in a mild form. Children under 3 months of age do not become infected with this virus, which is due to the fact that maternal antibodies that protect against viral infection circulate in the child's blood during this period.
After a disease, the patient develops a tense type-specific immunity. Virus-neutralizing antibodies in the blood of a person who has had the Coxsackie virus have been present for several years, complement-binding antibodies usually disappear a few months after the illness.
Diseases that arise when a child is infected with the Coxsackie virus most often proceed easily and do not have any serious complications.
Causes and risk factors
The source of infection is a sick person or a virus carrier. The Coxsackie virus enters the external environment through airborne droplets, as well as with the feces of an infected person. It is quite stable and can persist in the external environment for two and a half years; it collapses when dried, boiled, or exposed to disinfectants. Most often (up to 97% of cases), infection occurs through contaminated food, water, household items, less often - in water bodies and swimming pools. It can be carried by insects (flies, cockroaches). The fecal-oral route is predominant in children in the first years of life. The virus can also be transmitted through the placenta from an infected mother to a fetus during fetal development. The peak incidence of infection caused by the Coxsackie virus occurs in the summer-autumn period.
Forms of the disease
There are two main groups:
- Coxsackie virus type A (group A)- consists of 24 serotypes, causes the development of a pathological process in the mucous membranes of the oral cavity (erosive vesicular stomatitis), upper respiratory tract (herpangina), conjunctiva (acute hemorrhagic conjunctivitis), dura mater (aseptic meningitis), however, most often it manifests itself as a rash on skin. The disease caused by it usually proceeds without complications, in some cases the infection is asymptomatic (virus carrier).
- Coxsackie virus type B (group B)- includes 6 serological types and usually affects the heart (myocarditis, pericarditis), pleura (pleurodynia, or Broncholm disease), liver (hepatitis).
For both groups, multiple organ tropism is characteristic. Determining which of the groups the causative agent of a particular disease belongs to is possible only in a laboratory way.
An infectious disease caused by the Coxsackie virus can take a typical or atypical form. Typical forms include:
- isolated lesions (enteroviral sore throat, hepatitis, myalgia, gastroenteritis);
- lesions of the nervous system (meningitis, encephalitis, paralysis);
- lesions of the urogenital tract (epididymitis, cystitis);
- eye damage (conjunctivitis);
- heart damage (myocarditis, pericarditis).
For atypical forms, an erased course is characteristic.
The consequences of the Coxsackie virus in a child, especially in the first year of life, include angina, as well as inflammation of the heart muscle (myocarditis), which usually occurs in newborns.
Depending on the severity of the course, the disease can be mild, moderate and severe, as well as complicated and uncomplicated.
Symptoms of the disease caused by the Coxsackie virus in children
The incubation period for infection with the Coxsackie virus lasts from several days to one and a half weeks. The first clinical manifestations of the disease are usually an increase in body temperature up to 39-40 ˚С, repeated vomiting and / or diarrhea. Patients have headache, increasing weakness, loss of appetite, sleep disturbances, sore throat, cough, and sometimes heart rhythm disturbances. With the course of the pathological process, the patient develops hyperemia of the mucous membrane of the oral cavity and / or pharynx, a yellowish coating on the tongue, an increase in the cervical lymph nodes. With damage to the mucous membrane of the pharynx, food intake is difficult. In some cases, there is an increase in the size of the liver and spleen. These symptoms of the Coxsackie virus in children precede the appearance of rashes on the skin of the upper and lower extremities (including the soles of the feet and palms), chest and face. The rash may spread to the genital area. The elements of the rash have a diameter of 1-2 mm, are filled with serous contents and are surrounded by a hyperemic halo, they can open with subsequent ulceration. The appearance of a rash can be accompanied by itching, a feeling of discomfort in the affected areas. The late symptoms of the Coxsackie virus in children include a change in the nail plates.
The described manifestations can be both pronounced and slightly expressed. They usually last 1-2 weeks and then fade away.
In the case of aseptic meningitis, the child develops meningeal symptoms: a sharp headache, photophobia, hypersensitivity to sounds, persistent nausea and vomiting, stiff neck muscles, positive Kernig and Brudzinsky symptoms. Body temperature rises to febrile values (38 ° C and above).
With the development of pleurodynia, compaction is observed in the intercostal muscles, which is accompanied by pain, as well as headache and fever.
In some cases, against the background of a child's infection with the Coxsackie virus, paralysis develops, which can manifest itself both at the peak of the temperature and when acute symptoms subside. Manifestations range from weakness in the upper and lower extremities to gait disturbance. Persistent severe paralysis is not caused by the Coxsackie virus.
With the development of pericarditis or myocarditis in children, fever, shortness of breath, chest pain, cyanosis of the nasolabial triangle, edema of the lower extremities, deterioration of the general condition appear.
Herpetic sore throat, provoked by the Coxsackie virus, is characteristic of children 3-10 years old. The main signs of the disease are intense sore throat, aggravated by swallowing, the appearance of ulceration on the mucous membrane of the mouth and pharynx, a significant increase in body temperature, headache and a decrease in general well-being. Because of a sore throat, children usually refuse to eat.
Pleurodynia is characterized by sudden intense pains of a spastic nature in the chest and upper abdomen.
Hemorrhagic conjunctivitis is manifested by puffiness and severe pain in the eyes (the child often refuses to open his eyes, cries when trying to open his eyes), sensation of a foreign body in the eyes, hemorrhage in the sclera and conjunctiva, lacrimation and photophobia.
Diagnostics
Diagnostics of the Coxsackie virus in children is based, first of all, on the data obtained during the collection of anamnesis and patient complaints, an objective examination of the patient, and the epidemic situation. The causative agent is established as a result of a number of laboratory tests.
Children under 3 months of age do not become infected with the Coxsackie virus, which is due to the fact that maternal antibodies that protect against viral infection circulate in the child's blood during this period.
In order to isolate the pathogen, the patient's blood, pathological discharge from the nasopharynx, feces, cerebrospinal fluid (with the development of meningitis) are examined by polymerase chain reaction, complement binding reaction, enzyme immunoassay, hemagglutination inhibition reaction.
Depending on the form of the lesion, you may need to consult an ophthalmologist, otorhinolaryngologist, cardiologist, pulmonologist, neurologist, rheumatologist.
Differential diagnosis is carried out with acute respiratory viral infections, intestinal and skin infections of a different etiology, childhood diseases, which are characterized by skin rashes (measles, scarlet fever, rubella), scabies, streptoderma, etc.
Treatment of diseases caused by the Coxsackie virus in children
When a child develops symptoms that are characteristic of a viral infection, especially in a complicated epidemic situation in the region, in order to prevent the further spread of the virus, you should call a doctor at home, and not bring the child to a hospital. With a standard uncomplicated course, the treatment of the Coxsackie virus in children is carried out at home, and only in the case of a severe form of the disease (meningitis, pericarditis, etc.) or with the development of complications, hospitalization is indicated in the children's department of an infectious hospital.
An etiotropic treatment for the Coxsackie virus has not yet been developed. The main therapeutic measures are aimed at detoxification and elimination of the symptoms of the disease. The child needs to drink plenty of fluids. When the body temperature rises to high numbers, antipyretic drugs based on ibuprofen or paracetamol are indicated. The same funds are used to relieve pain. With pronounced signs of intoxication, enterosorbents can be prescribed (drugs of this group should be taken separately from all others, observing the time intervals).
For the treatment of ulcerations on the skin and / or mucous membranes, antiseptic preparations are used in the form of ointments, gels, sprays, rinsing solutions. With severe itching on the affected areas of the skin and / or mucous membranes, antihistamines are prescribed, which makes it possible to avoid scratching and the addition of a secondary bacterial infection. If bacterial infection could not be avoided, local antibacterial drugs are prescribed.
With a severe course of the disease and the development of complications, the use of corticosteroids may be required, as well as intensive care measures.
Possible complications and consequences of the Coxsackie virus in a child
Diseases that arise when a child is infected with the Coxsackie virus most often proceed easily and do not have any serious complications. The consequences of the Coxsackie virus in a child, especially in the first year of life, include angina, as well as inflammation of the heart muscle (myocarditis), which usually occurs in newborns. Severe forms of viral infection can be complicated by the development of heart failure, cerebral edema, encephalitis.
Forecast
In most cases, the prognosis is good. With the development of complications, especially with myocarditis in a newborn or serous meningitis, the prognosis worsens, severe complications can cause death.
Prevention of Coxsackie virus in children
The specific prophylaxis of the Coxsackie virus in children has not been developed.
Measures to reduce the risk of viral infection include:
- early isolation of the sick from the children's team;
- avoiding visiting crowded places during the epidemic (for the Coxsackie virus - summer-autumn) period;
- avoiding eating foods that have not been properly processed;
- compliance with the rules of personal hygiene;
- avoiding sunstroke and heatstroke;
- sufficient ventilation of the room in which the child is during the day;
- restorative measures.
YouTube video related to the article:
1. Can you meet only at resorts or in Russia too?
At the resorts, the chance to meet is higher, but in Russia there are isolated cases.
In the past month (July), I personally saw 5 patients with this infection, not related to recreation outside the city.
In St. Petersburg, there will be no widespread morbidity, but in the southern regions the situation is no better than seaside and ocean resorts.
2. How can you not get infected?
No way!
If you are in the same room with the patient, or in the room where he visited, then you will definitely get infected!
Will you get sick or not is another question))
Adults are less common than children.
Healthy less often than patients with chronic diseases.
Fans of personal hygiene are less likely than those who use soap and water only once a day.
3. What are the main manifestations?
Leading signs
1.Skin rash
Appears along with the rise in temperature
- drips with repeated increases
- rarely, but it happens that it appears only after the normalization of the state
- bubbles and pimples
- on the palms, soles and around the mouth is especially characteristic
- on the feet, legs, around the knees and on the buttocks less often
--on the hands, forearms and around the elbows too
--may itch, especially in allergy sufferers and atopics
- never under the hair on the head
2. stomatitis
- pain in the mouth
- a bunch of drool
- inability to eat and swallow cold
- bubbles and spots on the mucous membrane of the mouth and throat
3.fever
- no characteristic features
- does not disturb behavior and well-being in normal conditions
- strongly interferes with hot, stuffy and little drink
Possible Signs
-headache
-vomit
-stomach ache
-diarrhea
-...
4. How can you help with fever?
Yes, all the same:
-drink every hour
-air conditioner
-Cool air
- wipes wet
- "Nurofen for children" in a dose per child's weight no more than 1 time in 8 hours
- paracetamol drug for the child's weight no more than 1 time in 6 hours
5. How to help with pain in the mouth and throat?
Cold food
-cold drinks
-ice cream
-cold watermelon (it is also drink)
- "Nurofen for children" in the above mode
-gel for the oral cavity as prescribed by the doctor
6. How to smear the rash on the skin?
- "Kalamin" or "Tsindol" as often as the child worries
- for very severe itching "Fenistil" gel additionally
- when combing and opening the bubbles "Povidone iodine" 1-2 times a day
- in case of suppuration "Bactroban" ointment every 6 hours before examination by a doctor
7. Do you need antiviral drugs?
No.
And no.
Also no.
And these are also not needed.
8. How long will you have to be sick?
No complications 7-10 days
With complications - depending on the type of complication
9. What is the threat of the disease?
Recovery)))
Sometimes there can be complications and very (very, very rarely) serious
In this regard, the disease is similar to chickenpox.
If there are symptoms other than the three leading ones, you should see a doctor within 12 hours.
If the three leading symptoms persist without improvement on the 4th day of illness, consult a doctor within 24 hours.
10. Can you lead a normal life?
Yes, after improvement in the condition and if the child's well-being and behavior is not disturbed.
And walk.
And swim.
And sunbathe.
And communicate with everyone who is not afraid (you need to take into account the risk of infection of other children), because the child is contagious for at least a week from the first symptoms.
And this is also possible)
Alarming information appeared in the media that the Turkish resorts were allegedly covered by an epidemic of an infectious disease caused by the Coxsackie virus. “The disease has laid siege to all the seaside resorts of the country,” REN TV reported, announcing the early return of dozens of Russian tourists from vacations. However, the Turkish authorities categorically deny such reports.
How dangerous the Coxsackie virus is, about its symptoms, treatment and possible routes of infection, read our material.
(Total 8 photos + 1 video)
What is Coxsackie virus
Coxsackie virus refers to enteroviruses that multiply in the gastrointestinal tract. It causes a viral infectious process - enteroviral stomatitis with exanthema. This infection was first discovered in the small town of Coxsackie in the United States. About 30 varieties of the Coxsackie virus are known.
The large group of viral particles is divided into two classes: A-type and B-type. The difference lies in what complications appear after the transfer of infections initiated by one of the two types of the Coxsackie virus.
- Most of the known species (24) are type A. After infection with the type A virus, meningitis and throat diseases can develop.
- B-type is more dangerous and threatens with serious changes in the brain (mental and degenerative disorders), heart and skeletal muscles.
Who is at risk of contracting the Coxsackie virus
These viruses are considered "childhood", since children from 3 to 10 years old are most likely to get sick. In adults, the disease is extremely rare. After suffering a disease caused by the Coxsackie virus, a person develops a strong immunity to infection and re-infection is excluded.
It is believed that children under 3 months of age are protected from this enterovirus, and after 10-12 years, almost everyone already has an experience of infection behind them, after which a stable immunity is developed. Thus, children older than 3 months and up to 12 years old fall into the risk group of infection with the Coxsackie virus, but the peak of the disease falls on the period from 3 to 10 years. It is believed that it is impossible to raise a child and never face an enterovirus infection.
How is Coxsackie virus infection
Any enterovirus infections are considered diseases of dirty hands, and the Coxsackie virus is no exception. You can become infected with the Coxsackie virus from a person who is a carrier, both sick and in the absence of signs of the disease. The virus spreads by the oral-fecal route - that is, it is introduced into the mouth with dirty hands. Enteroviruses, including the Coxsackie virus, getting on the mucous membrane of the mouth, are absorbed into the bloodstream and end up in the intestines through the bloodstream, where the virus multiplies and exits with feces.
The Coxsackie virus can remain viable in the external environment for a long time, it is possible to get infected by airborne droplets, through contaminated products that have not been heat treated, and even water.
Symptoms and signs of Coxsackie virus infection
The incubation period lasts from 2 to 10 days, most often the disease manifests itself on the 3-4th day.
The first symptom of the Coxsackie virus in a baby may be the appearance of sores and watery pimples. As a rule, they become the result of a developing infection. The place of their localization is usually the legs and arms of the child, however, doctors find them in the oral cavity. Over time and the development of the virus, ulcers can appear all over the body, but they will mostly be located around the mouth. Hand-foot-mouth syndrome is also often observed - a rash appears simultaneously on the mucous membrane of the mouth, palms and feet.
The second symptom of the Coxsackie virus can be a child's unwell. He will sleep and eat poorly. So, because of abscesses in the oral cavity, it will be extremely difficult for parents to feed the baby, since any contact with the affected areas can cause pain. In addition, the baby will be inactive and his interest in games and any other usual activity for him will drop sharply.
The third sign of the Coxsackie virus in a child may be a fever. It rises in just a few hours and may not go down for about three days. Since this virus is an infectious disease that is not directly related to this indicator, antipyretic medications will be powerless in the fight against high fever.
Treatment and prevention of Coxsackie virus
To date, a vaccine against the Coxsackie virus, however, as well as from other enteroviruses, has not been obtained. The only prevention is personal hygiene. But since one of the ways of transmission of the virus is airborne droplets, then this method is not a panacea. It is desirable that the child was less in crowded places, especially during the epidemic period. Do not swallow pool water, it is recommended to drink only special drinking water from clean dishes.
Treatment for children includes:
- bed rest for the entire period of intoxication,
- a diet with sufficient amounts of fluids and vitamins,
- plentiful drink
- in case of severe diarrhea and vomiting - taking rehydration solutions.
A number of medicines are also used - topical antiseptics, antihistamines, and anti-inflammatories to reduce headaches and fever. The rash on the skin is treated with fucorcin or brilliant green solution (brilliant green). Antiviral agents are used only for severe infections.
In most cases, the disease gradually disappears within 7-10 days with symptomatic treatment. In rare cases, complications such as dehydration, meningitis, or encephalitis (inflammation of the brain) can develop.
Video: signs of the Coxsackie virus and other enteroviruses - Dr. Komarovsky
Coxsackie virus or eh interovirus infection,- a group of acute infectious diseases caused by intestinal viruses (enteroviruses). The disease most often occurs in children, especially in the spring-summer and autumn period. Sometimes, due to the unclear etiology, this infection is called Summer flu.
Manifestations Coxsackie virus differ in polymorphism, are often associated with damage to the central nervous system, muscles, myocardium of the heart and skin. In different regions of the Russian Federation and countries of the near and far abroad, epidemic outbreaks and / or increases in morbidity are recorded.
The circulation of enteroviruses among the population is associated with the presence of susceptible individuals in the population and long-term carrier of viruses. One of the features of these infections is a healthy carrier of viruses, as a result of which the emergence of sporadic forms and mass diseases among children of younger and older ages.
The history of the discovery of the Coxsackie virus
In 1948. Dalldorf and G. Sickles first isolated the Coxsackie A virus from the feces of a paralyzed child in the American town of Coxsackie. The virus was discovered by infecting mice with material obtained from this patient.
In 1949, Dr. J. Melnik for the first time isolated the Coxsackie B virus when newborn mice were infected with material obtained from children with serous meningitis. In subsequent years, other serotypes of Coxsackie A and B viruses were isolated.
Coxsackie virus epidemics
The geography of enterovirus infections is very wide and covers almost all countries of the world. Outbreaks of enteroviral (aseptic) meningitis have been described in France (2002), Japan (2001), Spain (2000), Germany (2001), Turkey (2017). The largest of the described outbreaks were observed in 1998 and 2000. in Taiwan, in 2000 in Singapore, in 2003 in Tunisia.
In Russia, the largest outbreaks of Coxsackie virus were observed in Primorsky Territory (Khabarovsk, 1997, Coxsackie viruses B 3, 4, 5; ECHO 6, 17, enterovirus type 70) and Kalmykia (2002, 507 cases, virus ECHO 30).
Coxsackie causative agents
Coxsackie viruses are members of the picornavirus family, a genus of enteroviruses. There are 23 serotypes of Coxsackie A virus; 6 serotypes of Coxsackie B; 32 serotypes of viruses ECHO (Enteric Cytopathogenic Human Orphan - orphan intestinal cytopathogenic viruses of a person); 5 human enteroviruses (enteroviruses 68-72 types).
According to the international classification, the Enterovirus genus includes 70 viruses dangerous to humans. It is known that they all have some similarities: resistant to alcohol, ether and freezing; widespread and highly resistant to the effects of physical and chemical factors.
Enteroviruses can be inactivated by drying, ultraviolet irradiation, high temperatures, as well as during treatment with formalin solution and chlorine-containing solutions. It has been established that the duration of stay of enteroviruses in the intestine does not exceed 5 months.
Coxsackie virus in children
The virus mainly affects children under the age of 10, and serious complications usually develop in children under 2 years of age. The susceptibility of children to enteroviruses is high; children aged 1 to 10 years are most susceptible to the disease.
Older children and adults are less likely to get sick, due to the immunity that can be formed as a result of asymptomatic infection.
All clinical forms of enterovirus infection in children can be divided into typical and atypical(erased, asymptomatic).
A child who has entered the body with enterovirus can become a carrier or suffer a mild disease. So, according to the Arkhangelsk SES, with an outbreak of an acute disease, about 85% of cases were almost asymptomatic, in 12-14% mild and moderate forms of the disease were determined, and only 1-3% of children were severe. These infections are especially dangerous for people with immunodeficiency.
TO typical manifestations include: herpangina, epidemic myalgia with severe muscle pain, serous meningitis, encephalitis, paralytic form, encephalomyocarditis of newborns, as well as enteroviral fever, enteroviral exanthema, gastroenteritis, mesenteric adenitis, myocarditis, hepatitis, pericarditis.
Coxsackie in newborns and infants
It should be noted that children of the first months of life constitute a risk group for enteroviral meningitis... At the same time, children may experience a progressive development of systemic disorders in the form of liver necrosis, myocarditis, necrotizing enterocolitis, and disseminated intravascular coagulation syndrome.
There are two groups of diseases caused by enteroviruses:
- potentially severe: meningitis, encephalitis, acute paralysis, neonatal septic-like conditions, myocarditis, pericarditis, hepatitis, chronic infections in persons with immunodeficiencies;
- less dangerous forms: three-day fever with / without rash, herpangina, pleurodynia, vesicular pharyngitis, conjunctivitis, uveitis, gastroenteritis.
When mild course of meningitis in children, the disease ends within 7-10 days with complete recovery without residual effects. Meningeal symptoms can be wavy in nature, and the condition tends to worsen by the 3rd week of the disease.
There are also known cases transverse myelitis in the form of severe damage to the spinal cord, which manifests itself in the form of spastic paresis and paralysis (more often of the lower) extremities with dysfunction of the pelvic organs.
It was revealed that the development of poliomyelitis-like forms is associated with Coxsackie A7 enteroviruses and type 71 enteroviruses, while the clinical picture has common features with poliomyelitis and can manifest itself in the form of spinal, bulbar, pontine and meningeal forms.
Deaths are not associated with damage to the central nervous system, but with the development liver failure(ECHO viruses) and myocarditis(Coxsackie viruses).
Symptoms of the Coxsackie virus in children
Infections caused by Coxsackie enteroviruses and ECHO, are characterized by a variety of clinical forms: from virus carriers and mild febrile states to manifest manifestations in the form of enteroviral exanthema, serous meningitis, myalgias, etc.
Due to the fact that these viruses are capable of affecting various organs and systems, the development of several clinical forms of the disease is possible, that is, there is a pronounced polymorphism.
In this case, damage to the nervous, cardiovascular, digestive, respiratory, excretory systems, as well as muscles, the organ of vision, the mucous membrane of the mouth, and endocrine organs can be observed. One of the most severe manifestations of CNS damage is serous meningitis with severe headache, febrile fever, occipital pain, photophobia, vomiting.
However, most cases of enterovirus infection are asymptomatic, clinically manifested episodes are in the form of colds, often with intestinal syndrome.
Clinical manifestations of the Coxsackie virus
This infection is characterized by fever against the background of polymorphism of clinical manifestations, manifested by damage to the central nervous (CNS) and cardiovascular systems, gastrointestinal tract, muscles and other organs.
The disease usually begins acutely with intoxication syndrome, characterized by headache, nausea, vomiting, sometimes chills, fever up to 39-40 ° C.
When examining a patient, sometimes you can notice flushing of the face and neck, signs of scleritis. In the pharynx, hyperemia of the palatine arches, the soft palate, granularity of the posterior pharyngeal wall is observed. The tongue may be somewhat thickened and coated with a white coating.
On palpation - enlarged lymph nodes in the cervical and axillary groups. Sometimes there is an increase in the size of the liver and spleen from 1-3 days of illness. There are frequent cases of tachycardia, heart rhythm disturbances.
Several organs and systems are often affected at the same time. It has been proven that one and the same enterovirus serotype is capable of causing various clinical forms of the disease.
If symptoms of the disease occur, the patient should be isolated for at least 10 days. Each case of the disease is subject to registration and registration at the place of detection.
Ways of transmission of the Coxsackie virus
The main route of transmission of viruses is fecal-oral (dirty hands disease). However, the airborne transmission of the disease is also observed, when the virus penetrates the mucous membranes of the respiratory tract, causing the manifestations of the disease in the form of respiratory disorders.
There are also water and contact-household transmission routes. The transmission factors are water, as well as vegetables contaminated with enteroviruses when using wastewater for irrigation. Viruses can be spread through dirty hands, toys, and other objects.
The entrance gates for this disease are the mucous membranes of the nasal cavity, oropharynx, and small intestine. After the virus has entered the body, it multiplies in lymphoid tissue, epithelial cells, lymph nodes, then enters the bloodstream - primary viremia develops (on the 3rd day of illness). It should be noted that enteroviruses are the most tropic to cells of the central nervous system and muscle tissue.
Some researchers call this disease "intestinal flu", which is not entirely correct from the point of view of the etiology of the disease. There is a way of transmission of viruses - from mother to fetus.
The reservoir and source of the virus is a sick person, or a virus carrier. Healthy carriers play an essential role in the transmission of the virus (up to 46%).
The most intense isolation of the pathogen occurs in the first days of the disease (the contagiousness of these viruses increases). The incubation period can last from 2 to 20 days, on average 2-4.
Replication of enteroviruses occurs in epithelial cells and lymphoid formations of the upper respiratory tract and intestines. In the future, viruses by the hematogenous route (through the blood), according to the laws of tropism, reach various target organs.
Diagnostics of the Coxsackie virus
Diagnosis of enterovirus infection is possible using laboratory methods, such as the detection of antigens of enteroviruses in the epithelial cells of nasopharyngeal lavages and in epithelial cells of urine by the method of indirect immunofluorescence reaction (RNIF).
In specialized virological laboratories, enteroviruses are isolated from feces, nasopharyngeal secretions, less often cerebrospinal fluid and blood, infecting cell cultures or mice. The typing of viruses is performed in the reaction of neutralizing their infectivity with a set of polyvalent antisera.
There is a serological method that detects an increase in antibody titer in various immunological reactions (RTGA, RSK, RN, ELISA).
Recently, molecular typing of enteroviruses and the method polymerase chain reaction(PCR) to identify a common nucleotide sequence for all enteroviruses.
Treatment of the Coxsackie virus in children
Currently, the therapy of viral infections is difficult due to the lack of etiotropic drugs, especially in cases of nonspecific multiple organ symptoms caused by the possible reproduction of various viruses, as well as untimely diagnosis of the disease.
To date, no standard treatment regimens for the Coxsackie virus have been developed. At the first signs of the disease, it is necessary to seek medical help, in no case to self-medicate, since deaths from meningitis and other severe forms of the disease are possible, especially in young children.
Antibodies that neutralize the virus appear in the early stages of infection almost simultaneously with the first symptoms of the disease. They are usually type-specific and can persist in the body for many years, and possibly throughout life.
Examples of Coxsackie treatment in children
As examples, we present extracts from the case histories of children with enterovirus infection, which were diagnosed after a thorough laboratory examination.
Example # 1
Boy M., 13 years old. He fell ill acutely. Complaints of sore throat and mouth, temperature rise to 37.8 ° C, decreased appetite, lethargy. Sick the second day, when there was a low-grade fever, nasal congestion, sore throat, unstable stool. From the anamnesis it is known that another 1 child from the class fell ill with similar symptoms.
On examination: on the skin of the hands in the region of the distal phalanges of the fingers, there are single elements of exanthema in the form of bubbles with white contents on a hyperemic background of the skin (limited area), painless on palpation, having no tendency to merge.
In the pharynx, hyperemia of the palatine arches and the posterior pharyngeal wall is noted, single vesicles with white content are found on the mucous membranes of the oral cavity (inner surfaces of the cheeks, gums, lateral and lower surfaces of the tongue). Some elements are located in groups, with single erosion.
Peripheral lymph nodes on palpation are slightly enlarged in the paratonsillar and posterior cervical groups, painless. Examination of urine by fluorescence revealed antigen A of enteroviruses. In the blood test, leukocytes are 9.5x109 / l, without changes in the blood formula, ESR is 25 mm / h. The rest of the indicators are within the reference intervals.
The skin and mucous membranes of the oral cavity were treated with an antiseptic Octenisept after each meal, appointed Cycloferon in the age dosage according to the scheme, Metronidazole, Loratadine... Ointment Acyclovir on the elements of the rash.
After 2 days, the condition improved, pain in the throat and in the oral cavity did not bother. After 1 week from the onset of the disease, the exanthema disappeared, the mouth cleared. No fresh elements were observed.
However, after another 1 week, the condition worsened somewhat due to the associated diarrhea, while the frequency of bowel movements reached 5-6 times a day. Within 2 days, the character of the stool became watery, an admixture of greenery, mucus appeared. The patient noted a rumbling in the abdomen, but no pain was observed.
In the analysis of feces in the study: a large amount of mucus, single leukocytes, yeast cells, a moderate amount of neutral fat.
Within three days, the condition improved, the stool returned to normal. The state of health is good. On examination after 10 days, there were no complaints. The child is practically healthy. However, taking into account the data on the epidemiological characteristics of enteroviruses, an additional laboratory examination in dynamics was recommended three times with an interval of 2-3 weeks.
Example No. 2
Boy K., 2 years old. He fell ill acutely with a rise in temperature to subfebrile numbers. Complaints of nasal congestion and mucous discharge in small quantities.
From the anamnesis it is known that his sister S., 5 years old, three days ago addressed with similar complaints, and on the 3rd day of illness she developed single elements of a rash (vesicles) on the fingers and knee joints.
On the third day of the disease, the boy developed exanthema on the skin of the hands (fingers, the back of the hands) and in the area of the knee joints. The elements of the rash were single, had the appearance of small vesicles with light content on an unchanged skin background, did not tend to merge; later complaints of sore throat, soreness when chewing joined.
On examination: peripheral lymph nodes are not enlarged, from the side of internal organs - no pathology. In the oral cavity on the mucous membrane, elements of pustules with whitish contents are visible, located on the arches, soft palate, lateral surface of the tongue, cheeks, under the tongue. After opening, some elements had an erosive surface.
During examination, antibodies to chickenpox virus, herpes simplex, Yersinia, Salmonella, pseudotuberculosis were not found in the blood. The RNIF method detected Coxsackie A antigen in urine. PCR did not detect cytomegalovirus infection (CMV), Epstein-Barr virus (EBV), herpes types 1, 2, 6.
Herpangina was treated with antiseptic solutions for treating the oral cavity up to 8 times a day (Octenisept), ointment Acyclovir on the elements of the rash.
On the second day from the start of treatment, the state of health improved, the appetite returned to normal. No fresh rashes were observed. The number of elements in the oral cavity has decreased. On the skin of the lower extremities, the rash persisted for up to 5 days. A control urine test after 1 month was recommended.
Example No. 3
Girl F., 7 years old. She complained of periodic rises in temperature to febrile numbers. According to the mother, she has been sick for the third week.
From the anamnesis it is known that she fell ill acutely, when the temperature rose to febrile numbers, there was weakness, decreased appetite. The fever lasted up to 5 days, then the temperature returned to normal.
The girl felt practically healthy, however, after 5 days, the temperature rose again, which remained for 3 days and then dropped to normal values without treatment. A few days later, subfebrile condition was observed again, and within three days the body temperature returned to normal on its own.
On examination, pronounced asthenovegetative syndrome, the skin and mucous membranes are clean, from the side of the internal organs without pathology. In the general analysis of blood: hemoglobin - up to 114 g / l, ESR - 50 mm / h. Leukocytosis was not observed, but microscopy of a blood smear showed the presence of toxicogenic granularity of neutrophils. Antibodies to Yersinia, pseudotuberculosis, salmonella, parvovirus B19 were not detected in the blood serum. The PCR method did not detect CMV, herpes and EBV viruses. Coxsackie A antigen was detected in urine by the RNIF method.
Received treatment: drinking plenty of fluids, antiviral drug.
Against the background of treatment, the condition stabilized, during the observation period (14 days) there were no temperature rises, the indicators of the general blood test returned to normal.
As can be seen from the above examples, the diseases caused by Coxsackie viruses are characterized by pronounced polymorphism: from the complete absence of clinical symptoms with high fever (repeated rises in temperature) to diseases with lesions of the skin, mucous membranes of the oral cavity (tongue, soft palate).
In the clinical analysis of blood, polymorphism is also possible - from a normal content of leukocytes and a significantly increased ESR (up to 50 mm / h) to leukocytosis with a moderate increase in ESR. In this regard, clinical diagnosis is sometimes very difficult. To make a diagnosis, it is necessary to use laboratory diagnostic methods: detection of viral antigen in urine or epithelial cells of nasopharyngeal swabs by the RNIF method.
Prevention of infection with the Coxsackie virus
Preventive measures are aimed at preventing enterovirus contamination of environmental objects, using only boiled water for food.
It is required to wash your hands after using the toilet, strictly observe the rules of personal hygiene, thoroughly wash vegetables and fruits before eating; swim only in designated areas.
Measures of specific prophylaxis (vaccination) have not yet been developed. Possibly, one of the methods of combating enterovirus infections is vaccination against poliomyelitis, since the vaccine strain used can have an inhibitory effect on enterovirus.
Loading ...