Enterovirus and rotavirus infection in children. Viral diarrhea (rotavirus, norovirus, enterovirus). How is enterovirus infection transmitted?

Enterovirus, unlike rotavirus, affects not only the gastrointestinal tract. The disease takes longer, is more severe, and has a longer incubation period. When the company viral infection the condition stabilizes after 2-3 days.

Young children are most susceptible to various infectious diseases. And it is rare to meet a child who has never caught the so-called intestinal flu. This popular name was given to rotavirus and enterovirus - it is thanks to them that children suddenly begin to diarrhea, have a fever and complain of bad feeling. And taking into account the fact that both viruses are highly virulent, some of the people who come into contact with a sick child, mainly children 3–4 years old, become ill. At an older age, the body can already cope with the infection, so cases of the disease are extremely rare.

The situation is aggravated by the fact that microorganisms have good resistance and survivability even in unfavorable conditions. environment– simply washing your hands with soap does not always help. Well, we don’t have to talk about using the same toys, dishes or educational materials. In addition, these viruses can be transmitted not only through household contact, but also through airborne droplets.

Periodic outbreaks of rotavirus or enterovirus infection are not uncommon in any locality, where available kindergarten or other establishment that is visited a large number of little children.

All unpleasant symptoms can be caused by both microorganisms; in both cases, the onset of the disease can easily be confused with ARVI, acute respiratory infections or another disease that can be caused by adenoviruses. And only after intestinal disorders appear can we confidently talk about “ stomach flu" How does one microorganism differ from another?

Rotaviruses

They account for about half of the cases of diarrhea that require hospitalization. This is explained by the fact that the child begins to diarrhea frequently and profusely. Naturally, this leads to severe dehydration of the body, and this condition requires urgent hospitalization.

Typical complaints of rotavirus infection:

nausea from the first day, possible vomiting;
profuse diarrhea up to 20 times a day from the 2nd day of illness;
acute onset;
temperature rise to 38-40 degrees;
general deterioration of condition: weakness, drowsiness, headache;
white coating on the tongue, “geographic tongue”.

Rotavirus infection affects only the gastrointestinal tract of a child, this is also its difference from enterovirus.

Incubation period rotavirus is from 1 to 4 days. The high temperature does not last long, about 2 days, then begins to decrease. However, diarrhea continues even after the temperature normalizes; on average, this period lasts 5 or 6 days.

Enteroviruses

The incubation period for infection with this microorganism may vary longer. It ranges from 1 to 10 days. Another significant difference: the virus affects not only the gastrointestinal tract, but also other organs. The eyes, heart, liver, and nervous system suffer, which naturally affects the child’s well-being and determines the typical symptoms of the disease.

Characteristic manifestations of enterovirus infection:

acute onset;
high fever that lasts from 3 to 5 days;
deterioration of health;
diarrhea is not as frequent as with rotavirus;
nausea, vomiting;
symptoms disappear simultaneously with normalization of temperature;
swelling;
redness of the eyes and soft palate;
rash on the body;
muscle pain;
abdominal pain;
enlarged lymph nodes;
cold sweat.

Thus, a feature of an infection caused by enteroviruses is the presence of not only symptoms of digestive disorders, but also manifestations that indicate damage to other organs and systems.

Treatment

There is a difference in the symptoms of the two viral pathologies, but in all cases the treatment is the same. Its basis is drinking plenty of fluids - it is necessary to restore water balance in organism. It is dehydration, and not the disease itself, that leads to most of the complications, in some cases even to placement in intensive care.

The best option for replenishing lost fluid are special solutions, for example, Ringer's. They can be soldered little by little, but often, every 15 minutes. As mentioned above, in half of the cases with rotavirus, hospitalization is required, since it is simply drink plenty of fluids not enough, necessary intravenous administration glucose-saline solution.

The second basis of treatment is hunger. For the first three days, the patient is on a starvation diet. This is due to the fact that enteroviruses and rotaviruses multiply when nutrient medium in the intestines, and since food does not enter the body, this environment does not exist. To be fair, it is worth saying that during the first days the patient does not experience hunger, completely losing his appetite.

Concerning drug treatment, then there are no specific drugs against infections.

In addition to drinking plenty of fluids, patients are prescribed probiotics - preparations containing bifidobacteria and lactobacilli to normalize the intestinal microflora. They begin taking them after the relative stabilization of the condition and the appearance of appetite.

IN mandatory Enterosorbents are immediately prescribed: Activated carbon, Enterosgel, Smecta, Polysorb or others. They are necessary for the rapid removal of the virus and decay products from the body.

If there is a digestive disorder, which happens often, enzymes may be prescribed: Mezim, Pancreatin.

As for lowering the temperature, viruses are inactivated just at temperatures above 38 degrees. And when there is no significant deterioration in well-being, the temperature should not be lowered if it is slightly above 38. Naturally, this does not apply to children under one year old - infants are always prescribed Panadol or Nurofen.

Prevention

High virulence, the possibility of infection by airborne droplets or household contact, and the persistence of viruses in the environment - all this makes prevention difficult. During an outbreak of infection, specific vaccines are recommended - this is the only effective method preventing infection.

As for non-specific methods, they are standard: compliance with personal hygiene rules, food processing. In children's institutions, it is necessary to regularly disinfect toys, furniture, household items, and dishes.

Briefly about enteroviruses

IN Lately The Coxsackie virus (a group of enteroviruses) has literally forced many lovers of travel and vacations in exotic countries to choose whether it is worth risking their health if there is a threat of contracting the disease, or all the talk has nothing to do with reality. Indeed, the fear of such a plan was not born out of nowhere; Turkey, a country visited annually by millions of tourists from all over the world, especially distinguished itself in this regard. countries of the world, and where outbreaks of enterovirus infections have been reported.

Viral epidemics are an extremely unpleasant phenomenon in their manifestations, and the consequences with which they are “rich” can affect the entire future life. By the way, Coxsackie, as a virus, is not the only representative of the class of enteroviruses, there is great amount other varieties of these microorganisms, and some of them are truly very dangerous due to their effects and consequences on the human body.

What it is?

The set of infectious diseases in an acute form of manifestation that arise against the background of intestinal viruses is enterovirus infection. The disease is characterized by a number of associated symptoms: fever, damage to the gastrointestinal tract, central nervous system, muscle and cardiovascular systems, kidneys, liver.

Enteroviral microorganisms are representatives of the group of anthroponoses, the existence of which involves two main development factors:

Human body.
External environment suitable for their existence (moisture, food, soil).

How is rotavirus different from enterovirus?

To protect yourself from contracting the virus from a person who got sick earlier, experts advise organizing a quarantine for the patient for 10 days, after which it is enough to follow the rules of individual hygiene.

Types of enteroviruses

Enteroviruses ( intestinal viruses) for ease of diagnosis are divided into 4 main types, detailed classification was last carried out by doctors in 2000, but after that this list was replenished with several more representatives of these microorganisms:

Coxsackie A type 23. Coxsackie B 6 types.
ECHO 32 serovars.
Enteroviruses type 71, approximate figure.
Polioviruses types I, II, III.

Being in RNA viruses, microorganisms can be stored under favorable conditions for up to a month, but in a hostile environment (heat treatment) they die almost instantly.

Enteroviral symptoms

The high affinity of intestinal viruses for many organs and tissues of the body makes the symptoms of diseases very diverse. IN healthy body The infection may not manifest itself in any way. Serious harm from its effects is felt by people with cancer, HIV-infected people and infants, that is, a category of patients with a poorly developed immune system.

General signs

Diagnosing diseases by external signs and sensations, enterovirus infection manifests itself in the following characteristic manifestations:

Nausea, vomiting .
My head hurts and my muscles feel achy.
High temperature (up to 39 0 C).

Characteristic symptoms of diseases

Depending on the development of the disease, secondary symptoms may change, appearing in different formats:

Respiratory form (catarrhal). There is a runny nose, congestion in the nasal canals, a dry and infrequent cough, and occasionally simple disorders of the gastrointestinal tract.
Gastroenteritis. Complaints about painful sensations in the stomach area and abdominal cavity varying intensity, diarrhea, occasionally vomiting.
Fever. It manifests itself in a sharp increase in temperature, which lasts 2-3 days.
Exanthema. Damage to areas of the face and hands with characteristic rashes in the form of pink spots. The rash lasts no more than two days.
Other skin lesions in the form of mucous rash.

Features of manifestation in children and adults

A feature of an enterovirus attack on a child’s body is:

In newborns, infection can cause myocarditis, kidney damage, and encephalomyocarditis.
Meningitis. Children who have virus attacks affect the central nervous system, enterovirus often causes the development of polyradiculoneuritis, neuritis facial nerve, encephalitis.

Otherwise, the symptoms associated with infection with enterovirus infection manifest themselves in the same way in adults and children:

Swelling of facial tissues, muscle pain.
Changes in the size of some organs.
Lymph node entrainment.
The presence of plaque on the tongue and palate (white).
Increased heart rate.
Fever accompanied by high temperature.
Rash on various parts of the body.
Vomiting, nausea, headache.

At mild form course of diseases (up to 80% of all cases) most of manifestations disappear up to 5 days from the onset of damage to the body by enterovirus infection.

Diagnostic procedures in a hospital setting

To determine the type of infection that has “settled” in the body, there are 5 main types of diagnosis:

PCR (polymerase chain reaction) with a reverse transcription step.
Immunohistochemistry.
Indication of the pathogen by collecting biomaterial (smear, mucus).
Molecular biological diagnostics.
Serological studies of enterovirus infection.

In some cases, specialists may prescribe additional tests in the form of blood and urine tests, followed by examination of body organs using ultrasound.

Possible complications

Although enterovirus infection proceeds practically without residual effects, this does not prevent us from noting the seriousness of the manifestations in the form possible complications. Most often this can affect children's body, since the child’s immunity is much weaker than that of adult, and this is how serious it all looks:

Respiratory form of infection. Pneumonia, respiratory tract pathology (chronic form).
Gastroenteritis type of infection. Liver and heart failure, diabetes, mental disorders, cerebral edema, orchitis.

The main risk group is children from 2 to 5 years old; at this age, children put everything in their mouths: dirty hands, food, toys, things, and it is on these objects that the infection most often settles.

Treatment of enterovirus infection

When treating diseases caused by enterovirus infection, a complex of drugs is used that suppress symptoms and prevent the development of complications. There are no special medicinal substances in medicine; the doctor independently determines on the spot how and what to use as medicine.

If you detect symptoms characteristic of infection with an enterovirus infection, the first thing you need to do is contact a therapist (pediatrician). With the help of diagnostic measures (taking tests), a course of treatment for the symptoms of the disease is prescribed, subject to the creation of a barrier, the task of which is to inhibit the development of harmful microorganisms, completely destroy them and remove them along with toxic substances from the body.

During treatment infectious diseases Several specialists can participate simultaneously: ENT doctor, gastroenterologist, nephrologist, neurologist, ophthalmologist. Sometimes cardiologists are also involved as consultants.

Drugs and therapies

Allocation of a separate room to prevent infection of other family members (quarantine).
Compliance with bed rest for treatment.
Increasing the daily volume of fluid you drink.
Wet cleaning and ventilation of premises (at least 2 times a day).
Maintain high humidity in the room where the patient is located.
Dietary food for the entire period of treatment.

Preventive measures

Due to the lack of specific methods that can 100% prevent infection with enterovirus infection, until reliable vaccines are found, experts advise adhering to the following measures to prevent viral diseases:

Compliance with personal hygiene rules.
Use of food products that have not expired, provided they are stored correctly.
Healthy lifestyle (hardening, active recreation).
Prohibition of contact with potentially infected individuals.
Balanced necessary vitamins food.
Compliance sanitary standards in areas where food is prepared and eaten.
Timely treatment using a wet method, including wiping off dust using non-toxic antiseptics.
Ventilation of premises.

The name of the disease, rotavirus enteritis, was given by a type of acute chronic inflammatory process that occurs in the small intestine and leads to persistent functional disorders With severe dehydration With characteristic features general intoxication, in severe cases leading to necrosis of the mucous membrane.

Difference between enteritis and rotavirus enteritis– the latter is characterized by a viral nature.

Enteritis is provoked by many unfavorable factors (pathological microorganisms, autoimmune and allergic reactions, bad habits, exposure to toxins on the intestinal mucosa, unhealthy diet, etc.).

Rotavirus and enterovirus have the following differences:

Etiology (causes) of the disease

Rotavirus enteritis develops inside the gastrointestinal tract due to external infection with viral agents, collectively called “rotaviruses.”

Massive cell death causes intestinal dysfunction and acute diarrhea, leading to dehydration due to decreased water absorption by the intestinal villi epithelium.

Prevention

Since 1998, vaccination has been an effective preventive measure, practiced in more than a hundred countries around the world.

Rotavirus and enterovirus infections are not dangerous if you follow the rules of personal hygiene.

Treatment if infection occurs

Since it is a sign of this disease severe dehydration and poisoning of the body with toxic waste products of the virus, leading to cardiovascular dysfunction and inflammation urinary system, effective treatment is to restore water-salt balance and ridding the body of toxins.

In severe cases, patients are given intravenous fluid, orally exposed to toxin-absorbing substances (charcoal, polysorb, etc.).

There is no effective drug for this infection.

Rotavirus and enterovirus, like any enterovirus infection, are more successfully treated in combination with a diet that does not allow the consumption of dairy products, due to the deficiency of the lactase enzyme caused by the disease.

The main routes of transmission of this disease are nutritional and contact. That is, you can become infected with rotavirus by drinking contaminated water or food, as well as by contacting a sick person, using his dishes, playing with his toys, touching the door handle after him, etc.

What happens in the body after infection with rotavirus?

Once in the small intestine, the pathogen actively attacks its epithelial cells, causing their death. The resulting defects are filled with immature and functionally defective epithelial cells, which leads to the development of enzymatic deficiency. In this case, the breakdown and absorption in digestive tract carbohydrates (especially lactose, which is found in milk). Undigested substances enter colon, causing fluid accumulation there (it is released in excess from the tissues) and subsequent diarrhea. These processes lead to dehydration and loss chemical substances body.

Rotavirus has the ability to attach only to mature epithelial cells of the villi small intestine, therefore, until all cells are replaced with new ones, the disease will progress. After the acute process subsides, the body needs time to restore the intestines and digestive functions.

Quite often, the course of rotavirus gastroenteritis is aggravated by the addition of bacterial flora, which requires prescription special treatment. Appearance inflammatory processes in the upper respiratory tract, doctors also explain it as a secondary viral infection, although the presence of rotaviruses in the saliva of patients with gastroenteritis has been confirmed, but this phenomenon has not yet been fully studied.

Symptoms of rotavirus infection

From infection with the virus to the manifestation of the disease, an average of 1-3 days passes - this is the incubation period. After it, the patient develops the main signs of rotavirus infection:

elevated temperature;
repeated vomiting (in young children this symptom should not be confused with excessive regurgitation after feedings);
diarrhea (up to 10 or more times a day);
flatulence, cramps and abdominal pain, strong rumbling;
intoxication – weakness, pallor, lack of appetite;
catarrhal phenomena - runny nose, redness of the throat, coughing, conjunctivitis.

Stool with rotavirus infection first has a mushy character, later it becomes watery, gray-yellow, and has a sharp and unpleasant smell. Impurities of mucus and blood may be noticeable in the stool (this occurs when bacterial flora is attached). If the disease is severe, with profuse vomiting and repeated diarrhea, the patient may develop signs of life-threatening dehydration, accompanied by the following symptoms:

dry mouth, dry lips;
dry skin and decreased elasticity;
lack of tears when crying in children;
no urination long time(6-8 hours);
"sunken eyes;
weight loss (especially in infants).

How long rotavirus gastroenteritis lasts is influenced by the patient’s age, the condition of his body and the presence of concomitant pathology. Severe forms illnesses and complications develop in newborns and children under 1 year of age, the elderly, people suffering from kidney and heart diseases, chronic diseases intestines.

With an uncomplicated course of rotavirus gastroenteritis, the acute period lasts 5-7 days, the recovery process is about 5 more days. Wherein Negative consequences for human health do not occur often. In rare cases, the development of chronic digestive disorders, dysbacteriosis, and chronic enterocolitis is possible.

Rotavirus infection in children

Almost every child under 5 years of age contracts rotavirus disease. Moreover, for the first time this most often occurs between the ages of six months and 12 months, when the baby “runs out” of maternal antibodies and begins to form its own immune defense. Children, as a rule, become infected again in kindergartens.

Features of the course of rotavirus gastroenteritis in children under 1 year of age are the very rapid development of dehydration and severe intoxication, so the appearance of vomiting and even minor intestinal disorders at this age requires immediate consultation with a doctor. As is typical for children, the disease can have two phases: respiratory and intestinal. In this case, gastroenteritis develops after the extinction of catarrhal symptoms.

Rotavirus infection in adults

Rotavirus disease in adults quite often occurs without fever, severe diarrhea, concomitant nausea and vomiting, as mild intestinal disorder, which disappears in a few days. Some patients do not even notice that they have the disease. This is explained by the higher acidity of the stomach, which has a detrimental effect on rotaviruses, and the maturity of the immune system in adults. However, in elderly and weakened people, the course of rotavirus disease can be severe.

During pregnancy, the occurrence of acute rotavirus gastroenteritis is quite dangerous, since dehydration can negatively affect the fetus, and intestinal spasms and severe flatulence can cause reflex contractions of the uterus and the threat of miscarriage or premature birth.

Diagnostics

Very often, the diagnosis is made based on the patient’s symptoms and complaints. At the same time, the most reliable method Diagnosis of rotavirus infection is specific analysis stool (immunochromatography). Other studies are not indicative of a quick diagnosis.

Many parents of sick children, and even sick adults, are interested in the question of how to distinguish rotavirus from poisoning, since the symptoms of these conditions are similar. The main difference lies in the presence of catarrhal symptoms in rotavirus disease, as well as the characteristic seasonality (autumn-winter), which for food poisoning not typical. However, you shouldn’t make a diagnosis yourself, and in any case, you need to consult a doctor, especially if your child is sick.

How and with what to treat rotavirus infection: basic principles

There is no specific treatment for rotavirus disease, antiviral drugs at this disease are not used, and the main efforts are directed towards replenishing fluid losses in the body and combating intoxication. For this purpose, rehydration and detoxification therapy is carried out.

Second important point in the treatment of rotavirus gastroenteritis is a dairy-free, gentle diet. In addition, the patient is prescribed enzyme preparations(for example, Mezim, Festal, Pancreatin), probiotics ( medicines containing bifidobacteria, coli, lactobacilli, etc.).

Treatment of rotavirus infection in children with symptoms of dehydration is usually carried out in a hospital, since in such situations intravenous administration of solutions is required, especially if the baby is vomiting. If the course of the disease is mild, the child can stay at home, while parents should give him an adequate amount of fluid, which compensates for the body’s losses, and follow all doctor’s orders. If the temperature rises (above 38 °C), the baby can be given an antipyretic medicine based on paracetamol or ibuprofen.

Treatment of rotavirus infection in adults, if symptoms are not pronounced, is not carried out or is limited to diet and symptomatic therapy(for example, antidiarrheal drugs).

Rehydration and detoxification

To eliminate the symptoms of intoxication, patients are prescribed sorbents. This could be Enterosgel, Smecta and similar products. IN severe cases administered intravenously colloidal solutions and glucose.

To replenish fluid losses, rehydration is carried out. To do this, at home you can use Regidron (according to the instructions), Glyukosil. In case of severe dehydration, hospitalization of the patient and infusion therapy solutions Trisol, Quartasol, Ringer, etc.

In what cases are antibiotics prescribed?

Since viruses are not sensitive to antibiotics, prescribing anti bacterial preparations for uncomplicated rotavirus gastroenteritis it is not advisable. If the patient has a bacterial intestinal infection(this is determined by changes in the nature of feces and the results laboratory tests, temperature fluctuations) to warn persistent diarrhea Enterofuril, Furazolidone and other similar antibacterial drugs are used.

Diet

Following a rotavirus diet is critical to reducing symptoms of gastroenteritis and preventing subsequent dehydration. Since the main trigger for the development of diarrhea is temporary lactose intolerance, it is necessary to completely exclude any dairy products from the patient’s diet. It is also important not to force your child to eat, even if he completely refuses food.

Nutrition should be moderate and gentle (boiled and steamed dishes are preferred), and fluid intake should be in the foreground. It can be consumed in the form of decoctions of dried fruits, rice, carrots or a special solution for rehydration (for example, Regidron), as well as ordinary drinking water.

Patients with rotavirus gastroenteritis can eat jelly, liquid rice porridge on water, boiled carrots and potatoes, light meat broths, lean meat and fish, baked apples. And vice versa, you can’t: carbonated drinks, fresh vegetables and fruits, sweets, legumes, baked goods.

The diet for rotavirus infection in children under one year of age has its own characteristics. If the baby is artificial, he should be given special lactose-free mixtures and dairy-free porridges, boiled vegetables. In this case, portions should be smaller than usual so as not to provoke vomiting.

Mothers of sick babies who are breastfed are especially interested in the question of what to feed their child. IN acute period It is necessary to try to reduce the amount of breast milk consumed by the baby by half. Between feedings, the baby should be given special teas for infants or plain boiled water. Doctors do not recommend stopping breastfeeding completely.

Recovery after rotavirus infection

It takes time to normalize enzymatic processes and restore the mucous membrane of the gastrointestinal tract, so you should not immediately return to your normal diet. A low-lactose diet after rotavirus infection can last from several weeks to 6 months, depending on how severe the disease is. At this time, in addition to restrictions on dairy products, you should avoid fatty foods, fried foods, sweets, concentrated fruit juices, strong tea and coffee. It is advisable to eat small meals, this will help digestion to cope with food more easily.

What to feed a child after rotavirus infection? For children under one year of age, it is also important to follow a lactose-free diet until the doctor allows otherwise. In addition, it is worth waiting at least a month before introducing the next complementary foods, since for a weakened digestive system the new food will be too heavy. After vomiting and diarrhea stop, infants can resume full feeding. IN recovery period great importance, especially for young children, has the use of bacterial preparations (probiotics), which should be prescribed by a pediatrician.

Is it possible to get sick again?

It can happen more than once, which is often the case among children. With age gastrointestinal tract becomes more resistant to bacteria and viruses, and the immune system– stronger, so adults suffer from rotavirus gastroenteritis less often, although it all depends on the person’s health status and individual digestive characteristics.

Prevention of rotavirus infection

The only one effective means protection against this disease is vaccination against rotavirus infection, which must be done before the child is six months old, since later this preventative measure will no longer be relevant. However, the vaccine used is registered only in some countries. European countries and the USA, so in Russia it is quite problematic to protect children from rotavirus.

How not to get infected?

Basic rules: wash your hands more often, teach children to comply with mandatory hygiene; drink boiled water; treat baby dishes and pacifiers with boiling water, and periodically wash toys with soap. If someone in the family is sick, do a thorough wet cleaning, treat door handles, surfaces with disinfectants (you can medical alcohol), it is imperative to isolate patients from healthy surroundings.

Enterovirus infection in children. Symptoms and treatment

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

Causes of enterovirus infection

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

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

How is enterovirus infection transmitted?

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

Symptoms of enterovirus infection

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

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

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

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

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

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

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

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

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

In case of defeat nervous system may develop encephalitis, meningitis. The child experiences: severe headache, nausea, vomiting, increased body temperature, convulsions, paresis and paralysis, loss of consciousness.

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

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

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

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

Diagnosis of enterovirus infection

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

Treatment of enterovirus infection

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

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

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

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

Prevention of enterovirus infection

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

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

What happens in the body after infection with rotavirus?

Once in the small intestine, the pathogen actively attacks its epithelial cells, causing their death. The resulting defects are filled with immature and functionally defective epithelial cells, which leads to the development of enzymatic deficiency. This disrupts the breakdown and absorption of carbohydrates in the digestive tract (especially lactose, which is found in milk). Undigested substances enter the large intestine, causing fluid accumulation there (it is released in excess from the tissues) and subsequent diarrhea. These processes lead to dehydration and loss of chemicals from the body.

Rotavirus has the ability to attach only to mature epithelial cells of the villi of the small intestine, so until all cells are replaced by new ones, the disease will progress. After the acute process subsides, the body needs time to restore the intestines and digestive functions.

Quite often, the course of rotavirus gastroenteritis is aggravated by the addition of bacterial flora, which requires special treatment. Doctors also explain the appearance of inflammatory processes in the upper respiratory tract by the addition of a secondary viral infection, although the presence of rotaviruses in the saliva of patients with gastroenteritis has been confirmed, but this phenomenon has not yet been fully studied.

Symptoms of rotavirus infection

From infection with the virus to the manifestation of the disease, an average of 1-3 days passes - this is the incubation period. After it, the patient develops the main signs of rotavirus infection:

elevated temperature;
repeated vomiting (in young children this symptom should not be confused with excessive regurgitation after feedings);
diarrhea (up to 10 or more times a day);
flatulence, cramps and abdominal pain, strong rumbling;
intoxication – weakness, pallor, lack of appetite;
catarrhal phenomena - runny nose, redness of the throat, coughing, conjunctivitis.

Stool with rotavirus infection first has a mushy character, later it becomes watery, gray-yellow, and has a sharp and unpleasant smell. Impurities of mucus and blood may be noticeable in the stool (this occurs when bacterial flora is attached). If the illness is severe, with profuse vomiting and repeated diarrhea, the patient may develop signs of life-threatening dehydration, accompanied by the following symptoms:

dry mouth, dry lips;
dry skin and decreased elasticity;
lack of tears when crying in children;
absence of urination for a long time (6-8 hours);
"sunken eyes;
weight loss (especially in infants).

How long rotavirus gastroenteritis lasts is influenced by the patient’s age, the condition of his body and the presence of concomitant pathology. Severe forms of the disease and complications develop in newborns and children under 1 year of age, the elderly, people suffering from kidney and heart diseases, and chronic intestinal diseases.

With an uncomplicated course of rotavirus gastroenteritis, the acute period lasts 5-7 days, the recovery process is about 5 more days. However, negative consequences for human health do not occur often. In rare cases, the development of chronic digestive disorders, dysbacteriosis, and chronic enterocolitis is possible.

Rotavirus infection in children

Almost every child under 5 years of age contracts rotavirus disease. Moreover, for the first time this most often occurs between the ages of six months and 12 months, when the baby “runs out” of maternal antibodies and its own immune defense begins to form. Children, as a rule, become infected again in kindergartens.

Rotavirus infection in adults

Rotavirus disease in adults quite often occurs without fever, severe diarrhea, and accompanying nausea and vomiting, like a minor intestinal disorder that disappears within a few days. Some patients do not even notice that they have the disease. This is explained by the higher acidity of the stomach, which has a detrimental effect on rotaviruses, and the maturity of the immune system in adults. However, in elderly and weakened people, the course of rotavirus disease can be severe.

During pregnancy, the occurrence of acute rotavirus gastroenteritis is quite dangerous, since dehydration can negatively affect the fetus, and intestinal spasms and severe flatulence can cause reflex contractions of the uterus and the threat of miscarriage or premature birth.

Diagnostics

Very often, the diagnosis is made based on the patient’s symptoms and complaints. At the same time, the most reliable method for diagnosing rotavirus infection is a specific stool analysis (immunochromatography). Other studies are not indicative of a quick diagnosis.

Many parents of sick children, and even sick adults, are interested in the question of how to distinguish rotavirus from poisoning, since the symptoms of these conditions are similar. The main difference is the presence of catarrhal symptoms in rotavirus disease, as well as the characteristic seasonality (autumn-winter), which is not typical for food poisoning. However, you shouldn’t make a diagnosis yourself, and in any case, you need to consult a doctor, especially if your child is sick.

How and with what to treat rotavirus infection: basic principles

There is no specific treatment for rotavirus disease; antiviral drugs are not used for this disease, and the main efforts are directed toward replenishing fluid losses in the body and combating intoxication. For this purpose, rehydration and detoxification therapy is carried out.

The second important point in the treatment of rotavirus gastroenteritis is a dairy-free, gentle diet. In addition, the patient is prescribed enzyme preparations (for example, Mezim, Festal, Pancreatin), probiotics (medicines containing bifidobacteria, E. coli, lactobacilli, etc.).

Treatment of rotavirus infection in adults, if symptoms are not severe, is not carried out or is limited to diet and symptomatic therapy (for example, antidiarrheal drugs).

Rehydration and detoxification

To eliminate the symptoms of intoxication, patients are prescribed sorbents. This could be Enterosgel, Smecta and similar products. In severe cases, colloidal solutions and glucose are administered intravenously.

In what cases are antibiotics prescribed?

Since viruses are not sensitive to antibiotics, the prescription of antibacterial drugs for uncomplicated rotavirus gastroenteritis is inappropriate. If the patient has a bacterial intestinal infection (this is determined by changes in the nature of feces and laboratory test results, temperature fluctuations), Enterofuril, Furazolidone and other similar antibacterial drugs are used to prevent prolonged diarrhea.

Diet

Patients with rotavirus gastroenteritis can eat jelly, liquid rice porridge with water, boiled carrots and potatoes, light meat broths, lean meat and fish, and baked apples. And vice versa, you can’t: carbonated drinks, fresh vegetables and fruits, sweets, legumes, baked goods.

Mothers of sick babies who are breastfed are especially interested in the question of what to feed their child. In the acute period, it is necessary to try to reduce the amount of breast milk consumed by the baby by half. Between feedings, the baby should be given special teas for infants or plain boiled water. Doctors do not recommend stopping breastfeeding completely.

Recovery after rotavirus infection

What to feed a child after rotavirus infection? For children under one year of age, it is also important to follow a lactose-free diet until the doctor allows otherwise. In addition, you should wait at least a month before introducing the next complementary foods, since for a weakened digestive system the new food will be too heavy. After vomiting and diarrhea stop, infants can resume full feeding. During the recovery period, taking bacterial preparations (probiotics), which should be prescribed by a pediatrician, is of great importance, especially for young children.

Is it possible to get sick again?

It can happen more than once, which is often the case among children. With age, the gastrointestinal tract becomes more resistant to bacteria and viruses, and the immune system becomes stronger, so adults suffer from rotavirus gastroenteritis less often, although it all depends on the person’s health status and individual digestive characteristics.

Prevention of rotavirus infection

The only effective means of protection against this disease is vaccination against rotavirus infection, which should be done before the child is six months old, since later this preventive measure will no longer be relevant. However, the vaccine used in this case is registered only in some European countries and the USA, so in Russia it is quite problematic to protect children from rotavirus.

How not to get infected?

Basic rules: wash your hands more often, teach children to comply with mandatory hygiene; drink boiled water; treat baby dishes and pacifiers with boiling water, and periodically wash toys with soap. If someone in the family is sick, perform a thorough wet cleaning, treat door handles and surfaces with disinfectants (medicinal alcohol can be used), and be sure to isolate the sick from healthy surroundings.

Enterovirus infection in children. Symptoms and treatment

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

Causes of enterovirus infection

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

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

How is enterovirus infection transmitted?

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

Symptoms of enterovirus infection

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

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

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

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

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

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

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

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

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

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

Diagnosis of enterovirus infection

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

Treatment of enterovirus infection

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

Meals should be light, rich in proteins. A sufficient amount of liquid is required: boiled water, mineral water without gases, compotes, juices, fruit drinks.

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