Enterovirus infection in children is a whole group of pathogenic microorganisms that can cause sore throat, conjunctivitis, dermatosis, damage to the heart and other internal organs of the baby. The variety of forms of the disease is due to the large number of microbes related to enterovirus infection; doctors count more than 70 types of them.
Clinical signs differ depending on the strain of the intestinal virus; the illnesses are dangerous to the baby’s health and cause many complications. A timely visit to a doctor and proper treatment will help you avoid negative consequences. The lack of qualified assistance leads to damage to the nervous system, heart, internal organs and systems of the child.
Causes and routes of infection with enterovirus infection
Enterovirus (translated from Greek means “guts”) is one of a number of viruses localized in the gastrointestinal tract. It is here that the microorganism settles down, begins active life, and disrupts the baby’s normal digestive process. The main danger of pathogenic microorganisms of this group is that they can affect the child’s nervous system, tissues, and internal organs.
The most dangerous enteroviruses include: Coxsackie A, Coxsackie B, polio, echoviruses, enteroviruses type 68-71. Enteroviruses are very tenacious microorganisms; they can exist on the surface of the Earth for up to two months. In the refrigerator, their lifespan increases even more; when frozen, viruses are stored for more than two years. Microorganisms are resistant to acidic environments, so they don’t care about gastric juice. Enteroviruses are not always killed by products containing alcohol.
What kills pathogens? Enterovirus dies at temperatures above 50 degrees Celsius, disinfection, drying, and exposure to ultraviolet radiation. Only these methods can cope with pathogenic microorganisms.
Enterovirus can live in the nasopharynx, intestines, mucous membranes of the eyes and mouth. The virus is particularly contagious, so enterovirus infection is usually epidemiological in nature. This is especially true for children's institutions (kindergartens, schools). Children aged three to ten years are most susceptible to the disease. Breastfed babies have maternal immunity; after switching to independent feeding, the weak protection quickly disappears.
The incubation period varies and depends on the baby’s immunity, the type of virus, and other unforeseen factors; it can range from several days to one month. Infection often occurs in summer or autumn. Enteroviruses are able to survive in food, water, soil, and virus carriers for a very long time, so the infection is ubiquitous and often occurs in children.
Doctors identify several main routes of transmission of enteroviruses:
- from a sick person to a healthy one. It is interesting that the virus is transmitted not only through the nose, mouth, eyes, but also through the hands. If one family member is infected, the likelihood of other members becoming infected increases many times;
- contaminated food. Often a child catches the virus after eating poorly washed vegetables and fruits;
- contact-household. Pathogenic microorganisms thrive in the environment; contact of a baby with contaminated objects (toys, towels, plates) risks infection.
Often, children are carriers of enterovirus infection; this category of the population gets sick more often than others, their immunity is weak, and they rarely observe the rules of personal hygiene. As mentioned above, children under 10 years old get sick; if a baby is infected, this can signal serious health problems; complications in this case are very common. It is important for young parents to find out the reason for the baby’s poor health and be sure to consult a doctor.
Clinical picture
How to determine the course of enterovirus infection in a child? The question is quite complex, even for experienced doctors. The clinical picture for this disease is blurry. The virus is capable of infecting the child’s internal organs and the central nervous system, so the symptoms can be specific and nonspecific. Signs of infection by enterovirus may be similar to the course of acute respiratory viral infection, acute intestinal infection, and other diseases. A baby's blood test will help confirm or refute the diagnosis. Treatment is prescribed only on its basis.
Enterovirus infection in children is manifested by the following symptoms:
- characteristic rash. Doctors call skin rashes enteroviral exanthema. Any formations on the baby’s skin appear 2-3 days after the body temperature rises. Typical localization area: arms, back, neck, face, chest, legs. The rashes are small red dots that resemble formations associated with measles and other viral infections. Sometimes bubbles form in the throat, lips, mouth, palms, feet;
- elevated body temperature. This symptom is characteristic of the course of ARVI in children. At the beginning of the disease, the fever appears rapidly, then subsides a little, and appears again. Attacks of high temperature have a wave-like character. The fever lasts no more than three days, the child becomes noticeably weaker and feels slightly unwell;
- Often a young patient experiences vomiting and diarrhea. These symptoms are caused by damage to the gastrointestinal tract. Signs appear suddenly and disappear without a trace. Diarrhea is accompanied by bloating and dehydration. It is important to replenish fluid loss in a timely manner by using home rehydration therapy methods;
- in the initial stage, symptoms similar to the course of colds are noted: cough, runny nose, sore throat, pain in the child to swallow. This aspect makes correct diagnosis difficult; parents begin to treat the baby with the wrong methods;
- pain in the muscles. Often the baby feels discomfort in the chest, back, and much less often in the arms and legs. Muscle spasms are paroxysmal in nature, lasting from several minutes to half an hour. Lack of necessary treatment leads to temporary pain becoming chronic.
Additionally, doctors identify several symptoms that are less common than others:
- swelling of the limbs;
- increased tearing, noticeable redness of the eyes;
- headaches, dizziness;
- there is a decrease in appetite, severe abdominal pain;
- enlarged lymph nodes that are located in the groin area, under the chin.
Methods and rules of treatment
The doctor determines how to treat enterovirus infection in a child. Simple cases can be treated at home. Damage to the nervous system, fever (it is not possible to bring down the fever for a long time), problems with the heart, kidneys - indications for hospitalization of a small patient. There are no specific drugs for enterovirus infection, treatment is aimed at eliminating nonspecific symptoms; compliance with special rules speeds up the healing process.
- keep bed rest. Rest and sleep are the best “medicines” in the fight against illness;
- in most cases, the disease is accompanied by elevated body temperature. Children are given antipyretic drugs, it is allowed to use rectal suppositories (if there is no severe diarrhea), drugs in the form of a suspension. For such purposes, Paracetamol, Ibufen and others are used;
- restoration of water-salt balance is necessary to normalize the condition of a small patient. Diarrhea and frequent vomiting can lead to dehydration. Treatment for this situation consists of drinking plenty of fluids, using Regidron, and it is allowed to give the baby compotes and fruit drinks;
- to increase the baby’s immunity, interferons are prescribed (non-specific medications, they prevent the proliferation of pathogens and strengthen the child’s body’s defenses);
- Antibiotics are prescribed in cases where a bacterial infection occurs in a chronic form. The doctor chooses the specific drug; it is strictly forbidden to give the baby strong medications on your own;
- special diet. Includes an abundance of protein foods (lean meat), dairy products are allowed in small quantities. It is forbidden to give fresh fruits and vegetables to the baby; boiled vegetables and baked apples are suitable. It is strictly forbidden to feed your baby fried, smoked foods, soda, and sweets. The diet must be followed until complete recovery, preferably for a few more days after its onset;
- It is important to isolate the child from all family members during treatment. Provide your baby with separate bedding and dishes. When in contact with the baby, wear a gauze bandage, then wash your hands thoroughly and change clothes.
Important! Multivitamins and immunostimulating medications are prescribed by the doctor. It is prohibited to give your child various folk remedies on your own. Any therapeutic actions must be agreed with the attending physician.
Possible complications
Negative consequences after infection are rarely observed. Complications occur in isolated cases; often the disease goes away on the seventh day after the onset of the disease. The lethal outcome of the pathology is extremely rare. The appearance of negative effects is observed in children with HIV infection under one year old, children with a weak immune system, and diseases of the cardiovascular system.
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Preventive measures
Avoiding infection with enterovirus infection is quite difficult, especially for children. Their immune system has not yet strengthened; there are many carriers of the virus around.
- Teach your child the rules of personal hygiene. Before each meal, you must wash your hands with soap for at least 20 seconds;
- buy filtered water, liquid from the tap is strictly prohibited for drinking;
- Wash fruits and vegetables thoroughly before eating;
- buy food only from trusted places that have quality certificates;
- Swimming in open reservoirs should only be in specially designated areas. Where the water is stagnant, the risk of infection increases many times;
- Specific vaccinations against polio are permitted. This method will protect the baby only from this strain of the virus.
Enterovirus is dangerous due to complications and requires mandatory medical care. Self-medication is unacceptable especially in relation to children. Call a doctor at home in a timely manner, be sure to follow his recommendations.
Contents:
The second thing you should do is to ensure that the sick person drinks plenty of fluids throughout the entire period of illness. This is especially important if your child is sick and has diarrhea and vomiting. Below in the answers to questions regarding treatment, you will find additional recommendations on this matter.
No other special treatment is necessary. Currently, there are no drugs that could prevent the multiplication of enteroviruses and prevent the development of complications of this infection.
What symptoms and signs can enterovirus infection manifest in children and adults?
In different people, enterovirus infection develops differently and manifests itself with different symptoms: for some it can proceed almost unnoticeably or cause only symptoms similar to a common cold, while for others it can develop very severely.
Below we describe the main symptoms that can be observed with enterovirus infection.
The first and only symptoms of enterovirus infection may be:
- temperature from 38.5 to 40 C, which persists for several days
- severe weakness and chills;
- pain in muscles and joints;
a little later (but not necessarily) the following may appear:
- sore throat (sore throat).
- nausea and vomiting;
- stomach ache;
- diarrhea.
Can an enterovirus infection cause sores (stomatitis) in the mouth or throat?
In some people (especially children from 3 to 10 years old), enterovirus infection (especially its varieties Coxsackie virus A and enterovirus 71) often, along with fever and sore throat, causes the appearance of numerous bubbles.
These blisters quickly burst and turn into small whitish ulcers that heal within 5-10 days.
Such cases of illness in medicine are called Gerpangina.
In some children, enterovirus infection causes another form of the disease, which is medically called Hand-foot-mouth syndrome .
In this form of the disease, simultaneously with the appearance of fever
- in the child’s mouth (on the tongue, on the inner surface of the lips and cheeks, on the gums, on the palate) many very painful white ulcers with a diameter of 2 to 8 mm appear.
- Several or many small (up to 5 mm) grayish blisters may appear on the skin of the arms and legs (on the fingers, palms and soles), surrounded by a red rim of inflamed skin.
- The child's condition can be very serious. The painful sores may cause him to refuse to eat or drink.
Can an enterovirus infection cause a skin rash?
In addition to the rash described above in the form of grayish blisters on the arms and legs, enterovirus infection can provoke the appearance of a more or less profuse rash in the form of red spots, which can be very similar to the rash with or when .
Can enterovirus infection cause eye inflammation?
Yes it is possible. In some people, enterovirus infection causes the development of so-called Acute hemorrhagic conjunctivitis , in which severe inflammation and redness of the eyes occurs, accompanied by severe burning in the eyes.
Usually, the condition of the eyes improves on the second or third day and the disease completely disappears after 7-10 days.
Can enterovirus infection cause inflammation of the testicles?
In some rare cases, enterovirus infection can cause inflammation of the testicles (orchitis) in boys and men, which is manifested by swelling and pain in the scrotum. Such cases of illness may be similar to another infection called parotitis(piggy).
What treatment is necessary for enterovirus infection in children and adults?
As mentioned above, at the moment there are no drugs that could stop the multiplication of enterovirus infection.
For this reason, doctors prescribe so-called symptomatic treatment to all adults and children who become infected with this disease (that is, treatment that helps a person tolerate the symptoms of the disease more easily until his body copes with the infection on its own).
If you or your child's illness is accompanied by severe diarrhea, vomiting or fever, review our recommendations in the articles.
In this article:
Enterovirus infection in children is a very pressing problem. This is one of the most common infectious diseases transmitted at this age. That is why every parent needs to know what it is, how to recognize it and what methods of control, and most importantly, prevention can be taken. This article will clearly describe the symptoms and treatment of enterovirus in children.
Reasons for development
The infection is caused by several groups of intestinal viruses that can cause the development of certain symptoms.
They all have common structural features. It is based on a nucleus, which is represented by a nucleic acid molecule: in some cases it is DNA, and in others RNA. The internal structure is surrounded on the outside by a capsule, which has certain characteristics depending on what pathogen we are dealing with. Depending on the configuration and composition of the capsule elements, viruses are divided into various subtypes, which determines their “love” for certain organs and tissues.
Thus, the group of intestinal viruses that are pathogenic for the human body includes:
- Coxsackie (enterovirus infection in children is most often caused): divided into A (23 types) and B (6 types);
- ECHO (divided into 32 serovars according to their antigenic composition);
- Polioviruses (type 1-3);
- Enteroviruses 68-71 types.
The division of each individual pathogen into types is important not only for microbiologists from a scientific point of view, but also for clinicians. After doctors successfully treat enterovirus in children, there is still a high chance of reinfection.
The fact is that the body develops immunity to a certain version of the infectious agent, and it will be ineffective against another. For example, having become infected with the Coxsackie A20 virus, there will be no re-infection with it, but the child will be absolutely defenseless against Coxsackie A21. It is precisely because of this feature that it is impossible to create a vaccine.
Epidemiology
The most dangerous periods in terms of the appearance of signs of enterovirus infection in children are summer and autumn.
The pathogen is stable in the external environment and retains its viability for a long time outside a living organism: in soil and water. It is not at all afraid of low temperatures and can be stored frozen for a long time. It is quite tolerant of disinfectants and acidic environments. The only thing that destroys the virus well and quickly is high temperature, so boiling brings absolute results in the fight against transmission of the disease.
Infection leading to certain symptoms of enterovirus infection in children can occur from a sick person or from a virus carrier who release the pathogen into the external environment with feces and other biological secretions, for example, saliva. Virus carriers are individuals who have a pathogen, but do not show any signs of illness. This phenomenon can be observed either in those who have recently recovered from the disease, or in those whose immunity was unable to destroy the agent, but was able to prevent the development of the disease. The duration of this condition can reach many years.
One of the most relevant routes of transmission that causes signs of enterovirus in children is airborne. The pathogen is released in saliva in the form of a fine suspension during sneezing, coughing and even talking. An equally important method of infection is fecal-oral. It is especially important to remember about it in children's groups, for which the disease of “dirty hands” is most typical. After all, children do not understand the importance of hygiene measures after using the toilet, so they do not wash their hands without adult supervision. And then they put them in their mouths, touch the toys, exchange them with other children, thereby spreading the disease. And finally, the last method of transmission: when drinking unboiled water from reservoirs, wells, or a home tap.
Enterovirus infection in infants presents a separate discussion. The transmission routes typical for older children usually do not apply to them. In addition, during breastfeeding, antibodies accumulated over her life are transferred along with milk. This is why newborns rarely suffer from infectious diseases.
Clinical picture
The virus penetrates through mucous membranes. The specific location depends on how the pathogen enters the child’s body. That is, when airborne droplets are carried out, the first sign will be manifestations from the respiratory tract. Accordingly, if there is a fecal-oral mechanism, then the symptoms of enterovirus in children will appear from the intestines.
After active reproduction on the mucous membrane of the corresponding area, the virus enters the lymph nodes of this region, where it continues its vital activity. This stage is especially important, because if the child’s immune system fails to destroy the pathogen here, it will begin to spread throughout the body. The further cycle depends on the specific pathogen. The fact is that everyone has certain general symptoms, but a specific type is characterized by effects on certain organs and tissues.
When an infectious agent enters the body, it does not immediately provide external signs of the disease. The period before the first symptoms is called incubation. For enteroviruses, its value ranges from two to ten days, with an average of five.
The onset of infection is always characterized by fever, reaching 39 degrees. Such numbers can last up to five days, and then they normalize. It happens that the temperature curve has a wave-like character: periods of normal values are replaced by elevated ones. This entire period is accompanied by lethargy, drowsiness, patients complain of headache, nausea and vomiting. At this stage, parents may already suspect the need for treatment of enterovirus in children. In addition, when the pathogen enters through the respiratory system, enlarged lymph nodes in the neck can be detected.
With widespread damage to the body, the following organs and tissues may be involved in the process:
- nervous system (both central and peripheral);
- upper respiratory tract (nasopharynx and oropharynx);
- eyeballs;
- muscle;
- heart;
- intestines;
- liver;
- testicles.
If the virus infects the oropharynx, the disease develops as a sore throat. Body temperature rises, signs of intoxication such as headache, lethargy, pain in muscles and joints are noted. In this case, the rash due to enterovirus infection in children covers the arches, the tonsils themselves, and adjacent areas of the mucosa. It consists of blisters that subsequently burst open, and in their place small ulcers with a whitish coating appear, after healing of which no scars remain.
A characteristic manifestation is conjunctivitis with all its characteristic symptoms such as lacrimation, redness of the eyes, and photophobia. In addition, there is some swelling of the eyelids and vascular injection.
Myositis also occurs when muscles are involved in the process. Their pain is related to the intensity of intoxication: the greater it is, the more the muscle tissue hurts.
Especially often the primary affect is intestinal damage. A characteristic symptom is enteroviral diarrhea in children with unchanged stool color and without impurities, as well as abdominal pain.
In relation to the heart, we can talk about the development of myocarditis, and inflammation spreads to the valves with the inner membrane when endocarditis develops. If the entire organ is affected, then we are talking about pancarditis. All this entails serious consequences of enterovirus infection in children with arrhythmias and even valve defects in the future with poor quality treatment.
Dangerous situations occur when the virus reaches nerve tissue. In this case, encephalitis, meningitis and other neurological diseases develop. In addition, convulsive syndrome, paresis of the limbs, and loss of consciousness may occur. On the part of the liver, hepatitis may develop. The testicles are also affected in the form of their inflammation, when they are painful and enlarged. And don’t forget about the rash that often appears on the body with this disease. All this determines the importance of treatment of enterovirus infection in children.
Treatment
There is no specific treatment aimed at combating a specific virus. Most often, hospitalization is not necessary if the disease is not complicated. In such situations, therapy is carried out at home, when bed rest is prescribed.
The diet for enterovirus in children does not have any special features: food should be light, not plentiful, and not be given to the child by force. It is also worth drinking plenty of fluids in order to reduce intoxication.
The basis of therapy is a symptomatic approach. If your throat hurts, we treat it with sprays; if you have diarrhea, don’t forget to replace the lost volume of water. In addition, antipyretic drugs are used.
But we must remember that only treatment under the supervision of a doctor guarantees the absence of complications of enterovirus infection in children in the form of serious damage to internal organs.
Prevention
No specific measures in the form of a vaccine have been developed, the reason for which was indicated above. Therefore, the most important point that will help protect a child from infection is isolating patients. A significant point is strict adherence to hygiene rules.
Parents should teach their child to wash their hands in any situation, as if to develop a reflex in him. Only if these measures are followed will the prevention of enterovirus infection in children be effective.
Every parent is faced with many diseases that their child manages to catch. Intestinal infections are among the most common of these. But at the same time, it is important to understand that self-indulgence in relation to health can lead to serious consequences, especially when it comes to your own child. Therefore, before treating enterovirus in children, you should consult your pediatrician.
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What is Enterovirus infection
Enterovirus infection is a group of acute infectious diseases caused by intestinal viruses (enteroviruses), characterized by fever and polymorphism of clinical symptoms caused by damage to the central nervous system, cardiovascular system, gastrointestinal tract, muscular system, lungs, liver, kidneys and other organs.In recent years, there has been a clear trend of intensification of enterovirus infection in the world, as evidenced by the epidemiological rises in incidence and outbreaks constantly recorded in different countries. The geography of enterovirus infections is extremely wide and covers all countries of the world, including the post-Soviet space. Thus, the scientific literature describes outbreaks of enteroviral (aseptic) meningitis in France (2002, 559 cases, ECHO 13, 20, 6 viruses), in Japan (2000, several hundred people fell ill, there were deaths, enterovirus 71- type), USA (2001, more than 100 sick, ECHO 13 virus), Spain (2000, 135 cases, ECHO 13 virus), Germany (2001, 70 sick, Coxsackie B5 virus), Turkey. The largest of the described outbreaks were observed in Taiwan (1998, 2000, about 3 thousand people fell ill, the ECHO 13, 30 viruses, enterovirus type 71 predominated) and in Singapore (2000, 1 thousand cases, 4 deaths, outbreak caused by enterovirus type 71), Tunisia (2003, 86 people, represented by ECHO 6, 13 viruses). In the post-Soviet space, the largest outbreaks in recent years have been observed in Russia, in the Primorsky Territory (Khabarovsk, 1997, dominated by Coxsackie viruses B3, 4, 5, ECHO 6, 17, enterovirus type 70) and in Kalmykia (2002). , 507 cases, ECHO 30 virus), as well as in Ukraine (1998, 294 people fell ill, Coxsackie B4 virus).
One of the main features of these infections is healthy virus carriage, which constantly causes the occurrence of sporadic forms and mass diseases, which, like the incidence, is observed not only among young and older children, but also among adults. It has been established that the duration of stay of enteroviruses in the intestines does not exceed 5 months.
However, two factors appear to be of primary importance in maintaining the circulation of enteroviruses among the population: the presence of susceptible populations and the significant duration of virus carriage. The latter feature allows the virus, after infecting non-immune individuals, creating a highly immune layer, to wait for new susceptible populations.
What causes enterovirus infection
The modern classification of enteroviruses was developed in 2000 based on the data accumulated by that time on the genetic structure and phylogenetic relationships of different representatives of the Enterovirus genus. This genus includes the family Picornoviridae, which, in turn, includes 5 species of non-polio enteroviruses, namely Enterovirus A, B, C, D, E. Polioviruses, according to this classification, constitute a separate species within the genus Enterovirus. Type A includes Coxsackie viruses A2–8, 10, 12, 14, 16 and enterovirus 71.
The Enterovirus B species is the most numerous and includes all Coxsackie B and ECHO viruses, with the exception of ECHO 1, as well as Coxsackie A9 virus and enteroviruses 69, 73, 77, 78 types. The Enterovirus C species unites the remaining representatives of Coxsackie A viruses, including types 1, 11, 13, 15, 17–22, and 24. Species Enterovirus D and E are relatively few in number and include 2 (Enterovirus68 and 70) and 1 (A2 plaque virus) representatives, respectively. In addition, the genus includes a significant number of unclassified enteroviruses. Thus, the genus Enterovirus includes more than 100 viruses dangerous to humans. They are widespread and highly resistant to physical and chemical factors.
Pathogenesis (what happens?) during Enterovirus infection
Enterovirus infections belong to the group of anthroponoses. The existence of entroviruses in nature is due to the presence of two main reservoirs - humans, in whom the virus multiplies and accumulates, and the external environment (water, soil, food), in which they are able to survive due to their high resistance. The risk of outbreaks increases significantly when massive enterovirus contamination is “introduced” into the human population, which can most often be realized through water and food transmission.
The vertical route of transmission of enteroviral infections is described. The high risk of congenital enteroviral infection, as a rule, is determined not by an acute enteroviral disease suffered by the mother during pregnancy, but by the presence of a persistent form of enteroviral infection in the woman. Sudden infant death syndrome is associated with congenital enterovirus infection.
Source of infection- a sick person or a virus carrier. The transmission mechanism is airborne or fecal-oral. Children and young people get sick more often. Summer-autumn seasonality is typical. Immunity after an illness is quite long-lasting (up to several years).
Entrance gates of infection– mucous membranes of the upper respiratory tract or digestive tract, where the virus multiplies, accumulates and causes a local inflammatory reaction, which is manifested by symptoms of herpetic sore throat, acute respiratory infections, pharyngitis or intestinal dysfunction. As a result of subsequent viremia, viruses spread hematogenously throughout the body and settle in various organs and tissues.
The tropism of enteroviruses for nervous tissue, muscles, and epithelial cells determines the variety of clinical forms of infection. When the virus penetrates the central nervous system, it may be damaged with the development of aseptic meningitis, meningoencephalitis or paralytic poliomyelitis-like forms.
ECHO viruses usually do not disseminate from the sites of primary penetration; only sometimes they are hematogenously introduced into other organs.
Symptoms of Enterovirus infection
The wide pantropic nature of enteroviruses underlies the wide variety of clinical forms of infection they cause, affecting almost all organs and tissues of the human body: nervous, cardiovascular systems, gastrointestinal, respiratory tract, as well as kidneys, eyes, skin muscles, oral mucosa, liver, endocrine organs. Enterovirus infections are particularly dangerous in immunocompromised individuals.
Most cases of enterovirus infections are asymptomatic. Most of the clinically noticeable manifestations are cold-like diseases, and enteroviruses are considered the second most common causative agent of acute respiratory viral infections.
Conventionally, two groups of diseases caused by enteroviruses can be distinguished:
I. Potentially severe:
- serous meningitis;
- encephalitis;
- acute paralysis;
- neonatal septic-like diseases;
- myo-(peri-)carditis;
- hepatitis;
- chronic infections of immunodeficient persons.
II. Less dangerous:
- three-day fever with or without rash;
- herpangina;
- pleurodynia;
- vesicular pharyngitis;
- conjunctivitis;
- uveitis;
- gastroenteritis.
1. Herpangina. On the first day of the disease, red papules appear, which are located on the moderately hyperemic mucosa of the palatine arches, uvula, soft and hard palate, and quickly turn into vesicles 1–2 mm in size, numbering from 3–5 to 15–18, not merging with each other. After 1–2 days, the blisters open with the formation of erosions or disappear without a trace by 3–6 days of illness. Pain when swallowing is absent or insignificant, sometimes drooling appears. The enlargement of the cervical and submandibular lymph nodes is slight, but their palpation is painful.
2. Epidemic myalgia(Bornholm's disease, "devil's dance", pleurodynia). It is characterized by acute pain localized in the muscles of the anterior abdominal wall, lower chest, back, and limbs. The pain is paroxysmal in nature, lasting from 30–40 seconds to 15–20 minutes, repeated over several days, and can be recurrent, but with less intensity and duration.
3. Meningeal syndrome lasts from 2-3 days to 7-10 days, sanitation of the cerebrospinal fluid occurs in the 2nd - 3rd week. Residual effects in the form of asthenic and hypertension syndromes are possible.
Other neurological symptoms of meningitis of enteroviral etiology may include disturbances of consciousness, increased tendon reflexes, absence of abdominal reflexes, nystagmus, foot clonus, and short-term oculomotor disorders.
4. Paralytic forms of enterovirus infection differ in polymorphism: spinal, bulbospinal, pontine, polyradiculoneuric forms can develop. The most common form is the spinal form, which is characterized by the development of acute flaccid paralysis of one or both legs, less often of the arms with severe muscle pain. The course of these forms is mild and does not leave persistent paresis or paralysis.
5. Enteroviral fever(minor illness, 3-day fever). This is the most common form of enterovirus infection, but difficult to diagnose in sporadic cases. It is characterized by short-term fever without pronounced symptoms of local lesions. It occurs with moderate general infectious symptoms, the state of health is slightly disturbed, there is no toxicosis, the temperature persists for 2–4 days. Clinically it can be diagnosed in the presence of an outbreak in a community, when other forms of enterovirus infection also occur.
6. Enteroviral exanthema("Boston fever") It is characterized by the appearance of pink, maculopapular or maculopapular rashes on the face, torso, and limbs from the 1st to 2nd day of illness; sometimes there may be hemorrhagic elements. The rash lasts 1–2 days, less often longer, and disappears without a trace.
7. Intestinal (gastroenteric) form. It occurs with watery diarrhea up to 5–10 times a day, abdominal pain, flatulence, and infrequent vomiting. Symptoms of intoxication are moderate. In children under 2 years of age, intestinal syndrome is often combined with catarrhal symptoms of the nasopharynx. The duration of the disease in young children is 1–2 weeks, in older children 1–3 days.
8. Respiratory (catarrhal) form manifests itself with mild catarrhal symptoms in the form of nasal congestion, rhinitis, and a dry, rare cough. On examination, hyperemia of the mucous membrane of the oropharynx, soft palate and posterior pharyngeal wall is revealed. Mild dyspeptic disorders may occur. Recovery occurs in 1–1.5 weeks.
9. Myocarditis, encephalomyocarditis of newborns, hepatitis, kidney damage, eye damage (uveitis)– these forms of enterovirus infection in children are rare. Clinical diagnosis is possible only in the presence of manifest forms of enterovirus infection or epidemic outbreaks of the disease. More often they are diagnosed during virological and serological studies.
The high tropism of enteroviruses for the nervous system is characterized by a variety of clinical forms of the most common lesions of the nervous system: serous meningitis, encephalitis, polyradiculoneuritis, neuritis of the facial nerve.
The leading place among childhood neuroinfections is still occupied by meningitis, which accounts for 70–80% of the total number of infectious lesions of the central nervous system. Every year there is an increase in the incidence of enteroviral meningitis in the summer-autumn period. Mostly children of preschool and school age are affected. Clinically, aseptic serous meningitis caused by different types of polioviruses, ECHO viruses, Coxsackie viruses A and B is almost impossible to distinguish. Cerebrospinal fluid changes are also indistinguishable. To date, the most common clinical form of enteroviral meningitis has been well described.
According to WHO, enterovirus infections of the heart are a regularly recorded pathology around the world. Depending on the pathogen, enterovirus infections of the heart have a very definite share in the structure of general infectious morbidity, amounting to about 4% of the total number of registered viral diseases. The largest number of enteroviral infections of the heart are caused by Coxsackie B viruses, the second place among the causative agents of enteroviral heart infections (by proportion in infectious pathology) is occupied by Coxsackie A viruses, followed by ECHO viruses and polioviruses.
The following clinical forms of virus-induced heart diseases are distinguished: myo-, peri-, endocarditis, cardiomyopathies, congenital and acquired heart defects.
Clinical manifestations of enterovirus infections of the heart depend on the degree of involvement of the myocardium in the pathological process and can be accompanied by either an almost complete absence of disturbances in the functional activity of the myocardium, or severe damage to cardiac activity, accompanied by dilatation of all chambers of the heart with significant impairment of systolic function. Enteroviruses have a high tropism for heart tissue, in which alternative destructive processes first develop due to the direct cytopathic effect of the virus, and subsequently virus-induced inflammation occurs with the formation of myo-, endo- and epicarditis, diffuse cardiosclerosis, leading to the development of dilated cardiomyopathy.
Of interest are reports of vascular lesions during Coxsackie infections identified in patients with entroviral myocarditis.
Enterovirus 70 has caused numerous outbreaks of acute epidemic hemorrhagic conjunctivitis in recent years, which is prone to spread. Some patients developed paralysis and paresis of varying severity and localization after a period of time from the onset of the disease. There are uveitis caused by ECHO 11, 19.
Enteroviral infections pose the greatest danger to immunosuppressed individuals: patients with malignant blood diseases, newborns, persons after bone marrow transplantation, HIV-infected patients.
Infection caused by the Coxsackie A9 virus is associated with the development of autoimmune diseases. The role of enteroviruses in the development of type 1 diabetes has been proven.
The literature discusses the role of enteroviral infections, in particular Coxsackievirus, in the etiology of spontaneous miscarriages.
Damage to the genital area is manifested by the clinical picture of parenchymal orchitis and epididymitis, most often caused by the Coxsackie viruses B1–5, ECHO 6, 9, 11. Enteroviruses as the cause of infectious orchitis occupy second place after the mumps virus. The peculiarity of this disease is that at the first stage a clinical picture of another symptom complex characteristic of enterovirus infection (herpangina, meningitis, etc.) develops, and after 2–3 weeks signs of orchitis and epididymitis appear. The disease occurs in children of puberty and is relatively benign, but can also result in the development of azospermia.
Diagnosis of Enterovirus infection
Diagnosis of enterovirus infection includes 4 main methods:
1) serological;
2) immunohistochemical;
3) molecular biological;
4) cultural.
Serological methods aimed at identifying markers of enteroviral infections in the blood serum of patients. Early markers of infection include IgM and IgA. When identifying serological markers of enterovirus infections, the most representative is the IgM titer, which indicates a recent infection. Therefore, virus-specific IgM are convenient markers of a “fresh” antigenic stimulus, while IgG can persist and circulate in the blood of a recovered person for several years or even the rest of his life. To indicate IgM, immunofluorescence and enzyme immunoassay methods are used. In patients with acute symptoms of the disease, EV-specific IgM is detected 1–7 days after the onset of infection. After 6 months, IgM usually disappears.
Among the oldest but most relevant serological methods is the detection of virus-neutralizing antiviral antibodies in a neutralization reaction; a 4-fold or more increase in titer is considered diagnostically significant.
Virological methods Research is aimed at isolating enteroviruses from clinical material (blood, feces, cerebrospinal fluid) using cultures of sensitive cells.
The main goal of immunohistochemical methods is the in situ detection of enteroviral antigens. The most accessible methods of immunohistochemistry include immunofluorescence and immunoperoxidase assays.
Molecular biological methods Research is aimed at identifying the genetic material of enteroviruses.
To diagnose enterovirus infections, a polymerase chain reaction with a reverse transcription stage is used, which has a number of advantages over the above methods: high specificity, sensitivity and speed of execution.
Treatment of Enterovirus infection
Interferons are used to prevent viral infections. This group of compounds belonging to low molecular weight glycoproteins, including antipicornoviral activity, is produced by the cells of the body when they are exposed to viruses. An increase in the level of endogenous interferon in the cerebrospinal fluid in children with acute epidemic enteroviral meningitis has been shown, which plays an important role in getting rid of the infection. Interferons are formed at the very beginning of a viral infection. They increase the resistance of cells to damage by viruses. Interferons are characterized by a wide antiviral spectrum (they do not have specificity of action against individual viruses). Viruses do not develop resistance to interferons.
Currently, alpha-interferon preparations (alpha-2a, alpha-2b), both natural and recombinant, are mainly used as antiviral agents. Interferons are used topically and parenterally.
The second group of drugs used to treat enteroviral infections are immunoglobulins. Their clinical effectiveness has been shown in patients with enteroviral infection against the background of an immunodeficiency state (congenital or acquired), as well as in neonatal practice in newborns with enteroviral infections who did not have antibodies to enteroviral infections (with neonatal sepsis due to congenital enteroviral infection). The most effective was intravenous administration of the drug, which is widely used in the treatment of immunodeficient patients with acute and chronic meningoencephalitis caused by enteroviruses. However, the experience of using immunoglobulins in this situation has not been sufficiently studied. There is evidence of successful treatment of meningoencephalitis with intraventricular administration of gamma globulin.
The third group is capsidinhibiting drugs. The most effective of this group is pleconaril. This is the most widely used etiotropic drug that has undergone clinical trials. Pleconaril has demonstrated a wide spectrum of antiviral activity against both rhinovirus and enterovirus infections, and is characterized by high bioavailability (70%) when taken enterally.
This drug can be and is used in newborns with enteroviral meningitis at a dose of 5 mg/kg enterally 3 times a day for 7 days. There is a high level of pleconaril in the central nervous system and nasopharyngeal epithelium. No side effects were observed when using pleconaril in different age groups. This drug is widely used for the treatment of meningitis, encephalitis, and respiratory infections caused by enteroviruses. When using pleconaril in the treatment of meningitis in children, a reduction in meningeal symptoms by 2 days was reliably noted. INR days are held in Russia 14.10.2019
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Enteroviruses can cause specific skin manifestations in babies. The rash caused by enterovirus infection has its own specific characteristics. This article will help parents recognize this condition in their child and distinguish it from other diseases that are also accompanied by the development of rashes.
What does it look like?
A child can get an enterovirus infection very easily. Viruses spread rapidly through airborne droplets from a sick baby to a healthy one. After the end of the incubation period, the infected child begins to show specific symptoms of this infection.
Doctors may also call such eruptive elements enteroviral exanthema. This condition develops in all babies who become ill with this infection. The severity of symptoms in this pathological condition varies. It largely depends on the age of the child, as well as the initial state of his health and the presence of concomitant diseases of the internal organs.
In most cases, this clinical sign occurs 1-3 days after body temperature normalizes. The localization of skin rashes varies greatly. Rashes appear on the baby’s neck, back, face, arms and legs. Rashes such as: bright red spots. The size of these formations is usually 2-4 mm.
It is important to note that characteristic enterovirus rashes can also appear on the mucous membranes. They usually cover the tongue, the inner surfaces of the cheeks, and the upper palate. If the course of the disease is more severe, then such rashes may also spread to the oropharynx and pharynx.
Parents can notice these rashes on their own at home. To do this, they should carefully examine the throat of the sick child using a regular teaspoon. If parents have discovered that the baby has some kind of rash on the mucous membranes, then he should definitely be shown to the attending physician. This cannot be delayed, because The development of the disease is usually rapid.
Some clinical types of enteroviral exanthema are accompanied by the development of multiple small bubbles or blisters on the body. Inside such rashes there is a serous or bloody fluid. It can flow out of the blisters when they are injured. Any mechanical impact can lead to this condition. After the fluid leaks out, a bleeding ulcer appears in the place of the former blister.
Sufficient time is required for the skin to heal from the rash and for the epithelization of mucous membranes damaged by enterovirus infection. They usually recover completely in 7-10 days.
For the fastest healing of damaged mucous membranes in the oral cavity, it is very important to follow a gentle diet. This diet completely excludes any solid food that can cause additional damage to the child.
Associated symptoms
Specific rashes are not the only clinical sign that develops with enterovirus infection. This infectious disease is accompanied by the appearance in the sick child of a whole complex of unfavorable symptoms, which significantly worsen his general well-being. These manifestations increase rapidly, within several days from the end of the incubation period. It should be noted that Infants suffer enterovirus infection somewhat more severely than older children.
Once they enter the child’s body and begin their active reproduction, enteroviruses lead to the development of a severe inflammatory process. It is manifested by the appearance of intoxication syndrome in the child. A sick baby's body temperature rapidly increases. Its values can be different and depend on the severity of the disease. Severe forms of the disease may even be accompanied by an increase in body temperature to 38-39 degrees.
The general well-being of a sick child is significantly impaired. His anxiety, drowsiness increases, his appetite decreases, and he has difficulty falling asleep. Infants may refuse to breastfeed. Severe intoxication syndrome is accompanied by the development of headache and severe weakness. A sick baby tries to spend more time in his crib, and playing with his favorite toys does not give him any pleasure or joy at this time.
Loose stools are also a fairly common symptom of this infection. Severe disease is accompanied by frequent trips to the toilet. This leads to increased dehydration. Your baby may also experience tummy tenderness that is independent of meals. The severity of the pain syndrome can be very intense.
A sick baby often develops vomiting. It can occur not only after eating, but also against the background of a headache. The use of antipyretics significantly improves the child’s overall well-being and reduces the feeling of constant nausea that develops in a sick baby.
Muscle pain can develop in a child as early as 2-3 days after the onset of the disease. The primary localization of this pain syndrome is the baby’s arms and legs, back and upper half of the body.
Quite often, muscle soreness is paroxysmal in nature. The duration of such an attack can last from a couple of minutes to several hours.
Differences from other diseases
To establish the correct diagnosis, doctors must conduct additional examinations. They are necessary to exclude all diseases that occur with the development of similar symptoms. Various laboratory tests help doctors carry out differential diagnosis. They also make it possible to identify the severity of functional disorders that have arisen in the child’s body as a result of this disease.
Enterovirus infection Quite often it resembles the flu. Sick babies also feel “broken,” muscle pain, and their body temperature rises. An important difference between influenza and enterovirus infection is its seasonal nature and widespread spread.
For accurate differential diagnosis, it is necessary to conduct special serological tests that will accurately identify the causative agents of the disease.
Herpetic infection - also one of the pathologies that can occur with the development of specific skin rashes on the child’s skin. Herpes viruses are quite selective. Their “favorite” location is the mucous membranes. It should be noted that they can also cause damage to the skin. But this is quite rare in children.
The course of herpetic infection is usually long-term. This disease is accompanied by alternating periods of complete well-being and exacerbations, when specific rashes appear on the mucous membranes and skin. It should be noted that remission can be quite long. A pronounced decrease in immunity leads to the development of rashes.
Mass outbreaks of herpes infections, as a rule, do not occur. Enteroviral infections, on the contrary, develop more often in children in crowded groups. Enteroviruses cause more pronounced symptoms than herpes viruses. This determines the main difference between these pathologies. Enterovirus infection is accompanied by a more rapid onset of adverse symptoms.
Chickenpox can be distinguished from enterovirus infection mainly by the combination of symptoms. Chicken pox rarely manifests itself in a child by the appearance of pain in his tummy. Abnormal bowel movements are also not typical for chickenpox. Rashes with chickenpox are usually more intense on the body. They can cover almost all skin.
Measles rubella can also occur with the appearance of various rashes on the child’s clean skin. It can be easily confused with a skin rash caused by an enterovirus infection. Taking an anamnesis helps establish the correct diagnosis. If a preschool child does not have measles vaccinations, and the skin rashes are generalized (widespread), then this most likely indicates that he has measles.
Differential diagnosis of enterovirus infection is also carried out with various allergies. Allergic diseases, accompanied by the appearance of various rashes on the baby’s skin, develop only when allergens enter the child’s body. Such pathologies occur in children who have hypersensitivity to certain substances or foods.
If a child has only rashes, but no high fever or other symptoms of intoxication, this indicates that he has developed a certain allergic pathology, and not an enterovirus infection.
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