Enteroviral tonsillitis in children: symptoms and treatment. Enterovirus infections in children: treatment, symptoms, signs; rash and diet for enterovirus infection

Enterovirus infection in children is one of the most common, but many parents perceive it as something mild and harmless. Because of this, the first symptoms are attributed to mild poisoning, and minor rashes are treated with children's ointments. Such events often actually lead to complete recovery, but, alas, this is far from always the case. Quite often, enterovirus in children provokes much more severe consequences, which are very, very difficult to treat. Therefore, we strongly recommend that you immediately contact your pediatrician at the first clinical manifestations.

Enterovirus infection in a child can be caused by any of the many viruses of the Picornavirales family, so a correct diagnosis can be made and adequate treatment can be prescribed only after a comprehensive examination. But since the disease is often mild and the symptoms are vague, not all parents turn to the pediatrician.

Previously, it was believed that the genus of enteroviruses includes 71 species of pathogenic microorganisms belonging to one of 5 groups:

• poliomyelitis (Poliovirus): 3 types;
• Coxsackievirus, type A: 23 types;
• Coxsackievirus, type B: 6 types;
• echoviruses (ECHO, Enteric Cytopathic Human Orphan): 31 types;
• Enteroviruses: 4 types.

The modern classification adopted by the International Committee on Taxonomy, as of May 2016, includes 12 types of enteroviruses:

• enteroviruses A, B, C, D, E, F, G, H, J;
• rhinoviruses A, B, C.

Some of them can be called conditionally safe, since they cause “mild” symptoms. Others, on the contrary, can provoke extremely serious complications. Consequently, in some cases, a special dietary table will be able to help the child, while in others he will need full treatment in a hospital.

Transfer methods

Enteroviruses are extremely contagious. They can enter the body in several ways, therefore the widespread opinion even among doctors that the main routes of transmission are airborne and fecal-oral can be considered unfounded. The only possible way to prevent infection is strict quarantine. But given that the incubation period can last from 2-3 days to 1 month, its widespread use is not possible.

Routes of infection:

• Airborne (aerogenic). The most common, but by no means the only, route of infection. The risk increases significantly when a virus carrier and a healthy child stay for a long time in a closed and poorly ventilated area (nurseries, kindergartens, schools).
• Fecal-oral (nutritional). If a child is not taught to observe the rules of personal hygiene, his body becomes defenseless against any pathogenic microorganisms. But often the blame for the spread of enterovirus infection lies with the employees of children's institutions. After all, it’s much “easier” to discuss food prices or a new fashionable hairdresser than to regularly clean the premises...
• Contact and household. In this case, the source of infection may be toys, furniture or cutlery. The risk increases significantly with weakened immunity and other negative factors (see the first two points).
• Vertical (transplacental). If a woman follows all the recommendations of the obstetrician-gynecologist and basic precautions, the likelihood of the baby becoming infected is extremely low. But if the newborn is not protected by maternal immunity, he can become infected.
• Water. In medical practice, cases of infection have been reported during bathing, when watering flowers with sewage, and even after using a shared cooler. The risk in this case is extremely small, but it should not be completely ignored.

Special Notes:

• Enterovirus infection in children is characterized by seasonal outbreaks. The most dangerous time is the end of spring, summer and beginning of autumn.
• After recovery, the child develops a pronounced immunity, but it lasts only a few years and protects only against a specific type of virus.
• The most dangerous age is up to 10 years, and in infants the disease is much more severe and lasts longer.
• Enterovirus infection is considered a “children’s” infection, but the possibility of infection in adults cannot be completely excluded, especially if they have reduced immunity.
• Many people are hidden carriers of one of the enteroviruses (according to various estimates - from 17 to 46%).
• Standard disinfectant formulations are practically unable to cope with enteroviruses. Therefore, reliable treatment of the premises requires the use of special preparations.

Symptoms

Signs of enterovirus infection in children can be very different. All of them are not specific, therefore it is impossible to make an accurate diagnosis based on clinical manifestations alone. Let us especially remind you that in many cases the symptoms of the disease are blurred, which is why parents attribute them to the general malaise of their children. But if the child has a weakened immune system (for example, as a result of chemotherapy or the acute phase of a chronic disease), the consequences can be very dire.

We also note that a rash due to enterovirus infection in children does not appear in all cases, therefore it cannot be considered a reliable diagnostic criterion. Moreover, the main symptoms depend entirely on the form of the disease.

Respiratory (catarrhal)

• severe nasal congestion and severe runny nose;
• rare cough (most often dry);
• minor digestive upset.

Special Notes:

• the described clinical manifestations persist for no longer than a week and a half and most often disappear completely without any health consequences.

Intestinal (gastroenteric)

• abdominal pain of varying intensity;
• bloating;
• flatulence;
• severe diarrhea (up to 10-15 visits to the toilet “in a big way” per day);
• vomit;
• severe general weakness;
• decreased appetite;
• slight increase in temperature (maximum - up to 38 degrees).

Special Notes:

• in an infant, the intestinal form can be combined with catarrhal;
• the duration of the disease depends on age (small children - 1-2 weeks, over 3 years - no more than a few days).

Enteroviral fever

• the elevated temperature lasts from 2 to 4 days, and there are no pronounced ENT symptoms;
• moderate signs of intoxication;
• deterioration in general health (rare).

Enteroviral exanthema (Boston fever)

• the appearance of pinkish rashes over the entire surface of the skin (sometimes with a hemorrhagic component).

Special Notes:

• obvious symptoms most often completely disappear after 1-2 days.

Attention! No matter how long the pronounced clinical manifestations last and no matter how harmless they may seem, the child should be shown to a doctor!

General symptoms

Some clinical manifestations are to some extent “standard”. Let us be especially clear: a rash due to enterovirus infection in children (exanthema) can be classified as such with great reservations. Moreover, the symptoms of this disease are often vague and cannot in themselves serve as a basis for making a diagnosis.

Diseases that often accompany enterovirus infection:

• herpetic sore throat;
• vesicular pharyngitis;
• conjunctivitis;
• uveitis;
• meningitis;
• neuritis of the facial nerve;
• encephalomyocarditis of newborns;
• encephalitis;
• polyradiculoneuritis;
• myocarditis;
• various kidney lesions.

Diagnostics

It is quite difficult to identify an enterovirus infection, given the total number of viruses that can cause it. Therefore, we will allow ourselves to repeat ourselves once again and remind you that if your child begins to rash, you should contact your pediatrician as soon as possible. Another problem that arises during diagnosis concerns the laboratory tests themselves. Carrying them out requires a lot of time, complex, high-precision equipment and special reagents, so there is no need to talk about mass production in this case.

Basic methods for detecting enterovirus infection:

• Serological. Allows the detection and identification of pathogens in blood serum. Early markers that conditionally confirm the diagnosis are IgA, IgM and IgG. The first two are detected in the acute phase of enterovirus infection, and the latter can be detected even after complete recovery, as it sometimes remains in the body for life. A reliable diagnostic criterion is a 4-fold increase in titer.
• Virological. They detect pathogenic microorganisms in feces, blood, cerebrospinal fluid and nasopharyngeal mucosa. In the first day or two, analysis of nasopharyngeal swabs is considered the most effective, and stool is examined for 14 days from the onset of the disease.
• Immunohistochemical. They make it possible to detect not the virus itself, but antigens to it. Immunofluorescence and immunoperoxidase tests are considered the most effective, but, alas, they cannot be called cheap.
• Molecular biological. Enterovirus RNA fragments are detected in the test sample.
• General clinical. First of all, this is a clinical blood test. The test is not 100% accurate, but it is very cheap. Signs of enterovirus infection may include a slight increase in erythrocyte sedimentation rate (ESR) and leukocytes. Much less common are hyperleukocytosis and neutrophilia, which quickly transform into lymphocytosis and eosinophilia.

Differential diagnosis

Treatment of enterovirus infection in children will be effective only if the doctor can make the correct diagnosis. This is extremely important, since the disease can successfully disguise itself as many other ailments: both relatively harmless and deadly.
Diseases that may be similar to enterovirus infection (its main possible manifestation is given in parentheses):

• herpes simplex, fungal stomatitis (herpangina);
• pneumonia, acute appendicitis, pneumonia, cholecystitis (epidemic myalgia);
• various meningitis: meningococcal, tuberculous (serous meningitis);
• influenza, ARVI of unknown etiology (enteroviral fever);
• scarlet fever, rubella, measles, allergic rash reaction (enteroviral exanthema);
• poliomyelitis, diphtheria polyradiculoneuritis (paralytic form of enterovirus infection);
• various intestinal infections, salmonellosis, dysentery (intestinal form of enterovirus infection).

Treatment

There are no specific therapeutic measures that would guarantee getting rid of enterovirus infection. But this does not mean at all that it is in principle incurable. Rather, on the contrary: the problem can most often be dealt with using conventional home treatment, and if you follow all the pediatrician’s recommendations, the risk of developing side effects will be extremely low. The need for inpatient observation may arise only in the case of a complicated course of the disease, when the child has a high risk of damage to the cardiovascular system, brain or other vital organs.

Attention! The absolute reasons for urgent hospitalization are severe dehydration and high fever, which cannot be brought down with standard medications for several days.

We especially note: no matter how long the treatment lasts, for the entire duration of the treatment the child needs strict bed rest and isolation from other family members. At home, it is quite difficult to achieve compliance with the last point, but it is still worth a try. Below we will talk about the main therapeutic measures, each of which is of considerable importance for a successful (and, note, speedy) recovery.

Preventing dehydration

Black tea, homemade decoctions (raisins, rice) or even ordinary, slightly salted, boiled water are perfect for this. If such methods turn out to be ineffective, it is worth switching to more powerful means.

Minimum volume of liquid depending on age (give every 10 minutes):

• up to one year: 1 teaspoon;
• from 1 to 3 years: 2 teaspoons;
• over 3 years: 1 dessert spoon.

Give your child food as often as possible, but in small portions, otherwise you may provoke severe vomiting. The approximate volume of liquid should be at least 100 ml per 1 kg of body weight.

Medications:

• "Glucosan";
• "Oralit";
• "Regidron";
• "Humana electrolyte".

Diet

One of the most important (if not the most important) conditions for recovery. The main principle of special nutrition is the rejection of heavy foods in favor of light, protein foods.

What to eat:

• lean meat: veal, chicken, turkey;
• “water” porridges: rice, oatmeal, buckwheat;
• boiled vegetables: carrots, potatoes, onions;
• drinks: dried fruit compotes, kefir;
• biscuits.

Prohibited products:

• fast food in any form;
• raw fruits and vegetables;
• rich meat broths;
• dairy products;
• any sweets and flour products;
• fruit juices;
• fat meat;
• pickles;
• any fatty and spicy foods.

• you can: low-fat, baked, boiled, steamed;
• not allowed: smoked, fried.

We especially note: the diet for enterovirus infection in children should be followed for some time even after complete recovery. How long can this regime last? This depends entirely on the severity of the case and the general condition of the child.

Detoxification

Its main task is to normalize the functioning of the gastrointestinal tract (combat vomiting, nausea and stool upset) and get rid of headaches.

Medications:

• "Atoxil";
• "Lactofiltrum";
• "Smecta";
• "Enterosgel".

High temperature with enterovirus infection does not always occur. Moreover, pediatricians do not recommend fighting it if the thermometer fluctuates around 37-37.5 degrees. But if the fever does not subside for several days, you need to take measures, and tablets, pills or capsules will be less effective than rectal suppositories.

Medications:

• "Efferalgan";
• "Panadol";
• "Nurofen".

Fighting an infectious agent

Only a pediatrician should prescribe the appropriate medications, so give up the idea of ​​discussing this with the pharmacist at the pharmacy. You won’t be able to cope with enterovirus infection with hot raspberry tea in any case, but these old, proven methods will significantly speed up recovery.

Medications:

• "Viferon";
• "Cycloferon";
• "Nazoferon";
• "Reaferon";
• "Leukocyte interferon."

Restoration of normal microflora

If you do not want your child to become a regular client of a gastroenterologist, you need to restore the number of lacto- and bifidobacteria.

Medications:

• "Bifiform";
• "Linex";
• "Lactomune".

Antibiotics

They are very fond of being prescribed with or without reason in our clinics and on thematic forums. But the authors of these recommendations “forget” that antibiotics have practically no effect on any (!) viral infections, but can easily kill normal microflora. They can and should be used if, against the background of a weakened immune system, the child has developed a secondary infection or an acute inflammatory process, but in all other cases there is absolutely no point in this. We also note that the appropriate medications should only be prescribed by a doctor.

Prevention

Specific methods that would reliably prevent enterovirus infection have not yet been developed. Therefore, its prevention comes down to general recommendations.

Factors that will reduce the likelihood of infection:

• personal hygiene (both of the child himself and the adults who surround him);
• clean drinking water;
• swimming only in specially designated places;
• preventive vaccination against polio (as one of the most dangerous complications of enterovirus infection);
• good quality, guaranteed fresh products without chemicals (we especially note: before cooking they must be subjected to appropriate culinary processing).

Enteroviral infection in children is not a death sentence, so there is no point in “panic” and stuffing the child with a lot of medications. But if you want to avoid serious complications, at the first signs of illness you need to show the little patient to a pediatrician. Health to you and your children!

The baby's gastrointestinal tract is very susceptible to new foods. Unlike adults, children are more likely to become infected with intestinal infections due to the fact that their immunity is not sufficiently developed.

At an early age, children are often exposed to two types of pathogens that affect the gastrointestinal tract: rotavirus and enterovirus. In the latter case, the infection rate is significantly higher. As a rule, the increase in the number of cases occurs in the spring and autumn. Enterovirus infection in children can lead to serious consequences.

Enteroviruses: what are they and what diseases do they cause?

Enterovirus infection is caused by several subtypes of pathogens, which, when entering the body, provoke various disorders. These viruses include:

• Coxsackie viruses are divided according to their antigenic structure into groups A and B. Their distinctive feature is the number of serotypes.
• ECHO viruses. Today there are 34 types of pathogens.
• Polioviruses. Divided into three types: 1, 2 and 3. The first is more widespread, often causing epidemics.

About 100 types of pathogens pose a danger to humans. They can remain viable in the environment for a long time, and viruses live in the human body for up to 5 months.

Viruses infect various human systems and organs, this directly depends on the pathogen of enterovirus infection that has entered the body. If infected, the following may be affected:

general characteristics

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Enteroviruses can inhabit the intestines of a healthy person for a long time without making themselves known. At this time, the carrier of the virus is infectious to others. However, any malfunction of the immune system can become an impetus for the development of the disease.

During illness, antibodies are formed that form lasting immunity to a specific serotype. Having been ill once, the patient may soon become infected with enterovirus infection again. In this case, the causative agent will be another type of virus, to which the body has not yet developed antibodies.

Enteroviruses are poorly susceptible to external factors. They can withstand freezing, and their viability at sub-zero temperatures can persist for several years.

When treated with chemicals (chlorine, formaldehyde, etc.), their death occurs only after a few hours.

The acidic environment of the stomach is not able to somehow protect the body from the penetration of pathogens of enterovirus infection - they safely bypass this part of the digestive system and then enter the intestines. Only high temperatures can kill the virus. To do this, you need to heat them to a temperature of 45–50 degrees Celsius.

This group of diseases is seasonal. The peak incidence occurs in the summer and autumn months. Children and adolescents are more susceptible to infection. Scientists note that every year the number of people who have contracted this infection is increasing, and the geographic coverage is expanding. Often the disease leads to the death of the patient. Since the beginning of the 21st century, deaths have been recorded in the Russian Federation, Western Europe, Japan, the USA, Turkey and other countries.

How does enterovirus enter the body and is it possible to prevent the disease?

The main habitats of enterovirus are the natural environment and the human intestine. The entry points for infection are the mouth and nose. Most often, the virus enters the human body through contaminated water and food. Infection from person to person occurs:

How long it takes from the moment of infection to the appearance of the first signs of viral enteritis depends on the individual characteristics of the body and the state of the immune system. On average, the incubation period lasts 1–10 days, usually the first symptoms of the disease appear on the 5th day. The causative agent of enterovirus infection, entering the gastrointestinal tract or the mucous membranes of the upper respiratory tract, leads to the development of diseases such as:

• herpetic sore throat;
• pharyngitis;
• intestinal dysfunction, etc.

In the affected area, the virus actively multiplies. Having penetrated the bloodstream, it spreads throughout the body, creating new foci of inflammation.

The risk group includes children aged 3-10 years. Breastfed babies receive antibodies to infectious agents through their mother's milk.

Innate immunity to the disease disappears almost immediately after the baby stops breastfeeding.

General signs of enterovirus infection

Most specialists cannot immediately determine the cause of the malaise. The clinical picture of the disease is usually blurry. Enterovirus infection in children can affect any organs and systems. In each individual case, the symptoms will be different. Sometimes enterovirus infection manifests itself as ARVI, in other cases the disease occurs with severe intestinal disorders (we recommend reading:). A doctor can make an accurate diagnosis only after receiving test results. As soon as the type of pathogen is identified, the baby is prescribed appropriate treatment.

Infected children may experience the following symptoms:

Also signs of enterovirus infection in children are:

• lacrimation;
• headache, dizziness;
• loss of appetite;
• inflammation of the lymph nodes;
• swelling in the lower and upper extremities.

Treatment of diseases caused by enterovirus

There are no specific treatments for enterovirus infection.

Therapy is aimed only at relieving the main symptoms. If the severity of the disease is mild, the child can be treated at home.

The baby will need hospitalization if he has the following conditions:

• the functioning of the heart and central nervous system is impaired;
• high body temperature;
• dehydration.

Treatment of enterovirus infection in children with orchitis, diarrhea, exanthema, myositis, hepatitis, cardiovascular lesions, encephalitis, meningitis and other conditions involves not only taking medications, but also following a special diet. The child needs complete rest. Until the body temperature has dropped to normal values, it is recommended to remain in bed. The child should be treated until all symptoms of the disease disappear.

The treatment regimen is drawn up by the attending physician. He assesses the severity of the patient’s general condition and determines the nature of complications. Drug therapy may include taking the following medications:

Features of nutrition of a sick child

With the intestinal form of the disease, a properly formulated diet will help speed up recovery. A diet for enterovirus infection in children will help improve the functioning of the child’s digestive system (we recommend reading:). Parents must follow basic nutritional recommendations for their young patient. His diet should include:

• drinking plenty of water;
• thermally processed fruits and vegetables;
• warm steamed or oven-cooked food;
• low-fat cottage cheese or biokefir.

The baby’s menu should not contain fried, smoked, spicy, salty foods, sweets, eggs, milk, butter or vegetable oils. Also, in the acute period, you should not feed him meat broth, nuts, legumes and baked goods. Children are strictly prohibited from drinking carbonated drinks. There should be at least 5-6 nutritious meals during the day, but you should not overfeed your child when he is sick. It is better to divide your meals into small portions.

With frequent vomiting and diarrhea, it is important to ensure that the baby receives a sufficient amount of fluid. The diet for enterovirus infection allows you to drink mineral water, compotes, herbal decoctions, green tea, and jelly.

What will Dr. Komarovsky say?

The well-known TV presenter of the program “Doctor Komarovsky’s School” is well acquainted with all manifestations of enterovirus infection. The doctor claims that up to 90% of babies suffer from this disease. According to Komarovsky, viral enteritis is rarely diagnosed, because it is often disguised as symptoms of other diseases, from a sore throat to meningitis.

At the slightest suspicion of an enterovirus infection, parents should immediately show their child to a doctor. The disease is difficult to recognize in the early stages. If a one-year-old child has loose stools, fever and a skin rash, then it is likely that these are all signs of viral enteritis.

Dehydration will be indicated by a decrease in the amount of urine produced and the frequency of urination. You should immediately call an ambulance if the baby has not peed for more than 3 hours in a row. While the team is on the way to the call, it is necessary to replenish the fluid supply by giving the baby something to drink. The disease is extremely dangerous for the health of infants; any delay can lead to serious consequences and even death.

The pediatrician is convinced that antibiotic treatment in the case of viral enteritis can do more harm than good (see the video below for more details). There is no point in giving your baby antimicrobial drugs, because the causative agent is a virus.

As soon as the child’s body defeats the virus, the child will develop lifelong immunity to this pathogen. This infection will no longer threaten the baby’s health. To avoid getting infected again, you should follow simple prevention rules: wash your hands before eating, use a separate towel, etc.

Possible complications

In many cases, the disease proceeds without complications, recovery occurs 5–7 days from the moment the first symptoms appear. Complications, as a rule, arise against the background of a severe course of the disease, as well as when choosing the wrong method of treatment. Enterovirus infection can cause the development of the following pathologies:

• swelling of brain tissue due to damage to the central nervous system;
• breathing problems (false croup develops due to narrowing of the airways);
• secondary infection (bacterial pneumonia, meningitis, etc. (more details in the article: ).);
• sudden infant death syndrome if the infection occurred in utero (we recommend reading:);
• viral orchitis leading to infertility.

Enterovirus infection includes a whole group of acute infectious pathologies. Infection occurs through penetration of a virus of the Enterovirus type into the intestine. The main danger of infection is the different forms of clinical manifestation, including disturbances in parts of the central nervous system.

Classification of enteroviral infections

Enterovirus infection is classified into: kinds:

• 3 strains belong to polioviruses;
• 28 strains – echoviruses;
• 23 strains – to Coxsackie A;
• 6 strains – to Coxsackie B;
• 4 strains are simply enteroviruses that are not included in any species.

Incubation period

Enterovirus of any type, after penetrating the gastrointestinal tract, penetrates into the lymph nodes, where the 1st stage of virus reproduction begins. For this, 3 days are enough, after which the viruses penetrate the bloodstream, circulating along with the blood fluid throughout the body.

After a maximum of a week, the internal organ system becomes infected, where the second stage of reproduction occurs, leading to the development of enteroviral pathologies. In this case, antibodies are formed on days 7-10. Consequently, the incubation period can range from 3 days to 10.

Causes

IN risk group includes the following people:

• children and elderly people;
• workers in child care institutions;
• with reduced immunity and high susceptibility to enterovirus, which is 80% of the population;
• having chronic diseases.

Methods of infection

• Contact and household. In this case, you can become infected by using shared household items, toys, dishes, towels, etc. The virus is also transmitted through a handshake.
• Air and drip. Enterovirus spreads when sneezing, talking and coughing.
• Water. Infection occurs when swimming in contaminated waters. And when vegetable and fruit crops come into contact with infected liquid (during watering, washing).
• Fecal-oral. The virus spreads through the soil through bowel movements, as well as through kissing, etc.
• Vertical(transplacental), that is, infection occurs from the mother to the fetus inside the womb.

Enterovirus infection most often occurs in summer and autumn. Feature - a person has a high degree of susceptibility. Because of this, after one illness, a type-specific type of immunity can persist for up to several years.

Symptoms, depending on location

Other symptoms of enterovirus infection are neuritis in the optic nerves, anicteric hepatitis, encephalitis, lymphadenitis, polyradiculoneuritis, encephalomyocarditis and pericarditis.

Possible complications and consequences

• After meningitis and similar diseases, epilepsy, swelling of the brain, and mental disorders may develop. As well as hypertension, hemiparesis, that is, partial paralysis of the body.
• After a severe course - acute respiratory failure.
• Other consequences: frequent headaches, intracranial pressure, decreased hearing or vision.

Rash due to enterovirus infection in adults and children

• Spots appear on the skin in the form of papules of a pink or red hue and small in size (no larger than the head of a pin).
• Rashes on the mucous membranes of the oral cavity of the vesicular type. Small ulcers look like bubbles that are filled with liquid.

Diagnostics

1. In laboratory conditions the following is carried out:

• serological test - blood collection, which detects the virus;
• polymerase chain reaction detects the presence of enterovirus from the cerebrospinal fluid;
• blood test for troponin 1 and cardiac enzymes;
• additional analysis of cerebrospinal fluid to determine the extent of damage to the brain and spinal cord;
• Reverse transcriptase PCR detects common genetic regions of RNA between viruses.

• X-rays are taken on the chest to reveal deviations in the size of the heart;
• echocardiography examines the condition of the heart;
• electroencephalography is prescribed for encephalitis;
• The slit lamp reveals abnormalities in the visual apparatus.

In each specific case, a specific examination technique is prescribed, which makes it possible to identify not only the virus, but also the degree of damage to the body.

Treatment with traditional methods

In severe cases, hospitalization is prescribed. The patient must remain in bed. The dosage and type of drug are selected only by the attending physician. Products need to be purchased based on age, as there are drugs for children and adults.

Diet

• By following a diet, you can significantly improve your immunity. To do this, you need to eat foods rich in vitamins C, B and A. You can take vitamin premixes purchased at the pharmacy.
• It is important to reduce intoxication by drinking plenty of fluids. Preference should be given to freshly prepared juices and fruit drinks, for example, from rosehip, rowan, black currant and always lemon.
• It is necessary to exclude fatty and fried foods, smoked foods and sweets, pickled and canned foods.
• You need to eat exclusively food that is healthy for the stomach microflora.
• Food should not be consumed cold or hot, only warm.

Etiotropic and pathogenetic treatment

• Etiotropic treatment consists of drugs against viruses. Preparations based on interferon - Grippferon drops, Viferon suppositories, etc. This group not only neutralizes enterovirus, but also significantly strengthens the immune system. Interferon inducers can be prescribed: Levomax, Amiksin, Anaferon, Cycloferon, Aflubin.
• Pathogenetic treatment is aimed at strengthening the body's own defenses. Detoxification drugs, dehydration agents, and cardioprotectors may be prescribed. These methods are mainly used for pathologies of the brain and heart. This therapy is prescribed only during hospitalization.

Symptomatic method of treatment

• Means for lowering body temperature: Coldrex, Theraflu, Efferalgan, Fervex; for children: Panadol or Nurofen.
• Analgesics with anti-inflammatory effects: Paracetamol, Ibuprofen or Ketorol.
• Antihistamine medications are used to eliminate intoxication and allergies: Suprastin, Diazolin, Zodak, Claritin or Zyrtec.
• Adsorbent preparations are needed to remove toxins and death products of enteroviruses: “Activated black carbon”, “Enterosgel”, “Activated white carbon”, “Polifepam” or “Smecta”.
• To eliminate rhinitis, nasal drops are prescribed: “Nazivin”, “Nazol”, “Tizin”, “Aquamaris”.
• If a secondary bacterium attaches, which happens quite often, then antibiotics are prescribed. The choice of drug is based on the type of new infection.
• If disturbances are detected in the gastrointestinal tract, probiotics are prescribed. This could be “Bifidum forte”, “Yogulact”, “Bifiform”. "Bifistim" or other similar products.
• If necessary, the doctor prescribes immunostimulants.

Folk remedies

You can do the following:

• Buy viburnum berries in an amount of 250 grams. Fill them with 1 liter of water and boil for 8-10 minutes. Add 2-3 tbsp. l. natural honey and drink 1/3 cup three times a day.
• Radish is very useful for viruses. Wash the root vegetable, cut off the top and lightly cut out the inside. Thus, you will get a kind of depression into which you need to pour honey. Cover the resulting container with a radish “lid” and leave to steep for 4-5 hours. Drink the resulting liquid three times a day, 1 tsp.

Enterovirus infection in children is symptoms of numerous types of disease. There are infections that children are more susceptible to than adults. In particular, such an infection is enterovirus.

What is the essence of the disease?

Enterovirus infection is a group that combines several infectious diseases with the same pathogen and the same mechanism of infection. These diseases are characterized by polymorphism of clinical manifestations.

The causative agent is viruses belonging to the Enterovirus genus. The place of localization of viruses is the intestine. Among the viruses, several groups are distinguished: polioviruses, Coxsackie viruses A and B, ECHO viruses and enteroviruses of types 68-72.

• Each type of pathogen affects a specific organ.
• The viral particle is small in size - 15-35 nm.
• The genetic material is contained in RNA.
• The viral particle is surrounded by protein molecules along the periphery.

The virus is highly resistant – it is able to retain its properties at low temperatures and exposure to 70% ethyl alcohol. The following have a detrimental effect on it: high temperature and boiling, formaldehyde, oxidizing agents and chlorine, ultraviolet irradiation.

Who can get sick?

The only source of enterovirus infection in children (photo) is an infected person.

In young children, only virus carriage is often observed, without any clinical manifestations.

Children aged 3 to 10 years are most susceptible to the disease.

Babies under 3 months cannot get sick, since they are protected by maternal antibodies.

The virus is transmitted by water and food routes; contact through contaminated hands is possible.

Transmission of the virus through the placenta and infection of the fetus has been noted.

How the disease develops

The virus can remain dormant in a child’s body for a long time. When the body's resistance decreases for any reason, the virus is activated and symptoms of enterovirus infection appear.

The virus spreads to the lymph nodes, where it multiplies. After its release into the blood, damage to various organs is observed.

Each type of virus has a tropism for certain tissues, which contributes to the polymorphism of the disease.

Features of the clinical picture

Incubation for all viruses is the same and lasts about 5 days. First, nonspecific symptoms are observed, common to all types of the disease.

There is an acute onset with a sharp rise in temperature to 40*C. Phenomena of general intoxication are observed:

• headache;
• decreased appetite;
• body aches and malaise;
• Some children may develop nausea and vomiting.

All types of the disease are accompanied by redness of the skin of the face and upper half of the body.

4 forms of the disease

Enterovirus infection in children - Komarovsky, a pediatrician, identifies 4 typical forms of the disease.

① Serous meningitis

Caused by viruses of the Coxsackie and ECHO groups. The headache comes to the fore here, which gradually increases. The temperature rises to 40*C, and repeated vomiting is observed.

The child is excited and cannot find a place for himself. The face is clearly hyperemic, the sclera is injected. Moreover, the symptoms are very similar to the classic one.

In most cases, meningeal symptoms begin to appear. However, sometimes they may not be present, making diagnosis difficult.

Lesions of the nervous system also include the paralytic form of enterovirus infection. It is characterized by the appearance of rapidly passing flaccid paralysis. It is more common in children under one year of age.

② Herpetic sore throat

A type of enterovirus infection, also caused by the Coxsackie and ECHO viruses. After 1-2 years from the onset of the disease, pronounced changes in the pharynx can be detected. The mucous membrane of the oropharynx is clearly hyperemic.

Against this background, rashes appear - at first they are small red papules that transform into blisters. Their number may vary. Bubbles are always located separately and are not prone to merging.

After the bubbles open, erosions form in their place. Rash due to enterovirus infection in children, photo in the mouth, shows that they go away after treatment.

The child will complain of a sore throat and difficulty swallowing. Palpation reveals enlargement of the cervical lymph nodes and their soreness.

③ Epidemic myalgia

Caused by viruses of the Coxsackie group. The main symptom is severe pain in the muscles.

It always appears and disappears suddenly; the occurrence of an attack cannot be predicted in advance. Accompanied by the following manifestations:

• pale and moist skin;
• increased heart rate and breathing;
• tension in the abdominal muscles.

The pain occurs in paroxysms and intensifies with movement. Duration is 1-2 minutes.

④ Heart damage

Enteroviral myocarditis in most cases is a congenital form of infection, after intrauterine infection. The child is lethargic and does not eat well.

Signs of heart failure gradually appear:

• skin cyanosis;
• severe shortness of breath;
• cardiopalmus;
• arrhythmia and appearance;
• the boundaries of the heart expand.

The child's condition is serious and requires immediate treatment, otherwise death is possible..

Symptoms of atypical forms

Enterovirus infection in children, including adults, can be atypical. There are 5 types of atypical forms, which are characterized by certain symptoms:

⑤ Intestinal damage

ECHO viruses predominate here. Three days after the onset of the disease, the child will complain of abdominal pain and flatulence. Loose, infrequent stools mixed with mucus appear.

Nausea and vomiting may occur. The abdomen is painless on palpation and rumbles slightly. There is no protective tension in the abdominal wall muscles.

⑥ Skin damage

Enteroviral exanthema - two days after the onset of the disease, a rash appears on the skin.

Localization of the rash is the face and torso, much less often the limbs.

Enterovirus infection in children - the rash resembles that of or.

Disappears quickly, sometimes even on the day it appears. It leaves no traces behind. However, it requires attention from parents and should be a reason to consult a doctor.

⑦ Liver damage

Another type of disease can be acute enteroviral hepatitis. The child's skin becomes yellow and severe itching appears. The liver and sometimes the spleen enlarge. All this is accompanied by symptoms of general intoxication.

⑧ Eye damage

Enterovirus type 70 often causes. The disease is acute– sudden sharp pain occurs in the eyeballs, accompanied by lacrimation and photophobia.

Externally the following symptoms are observed:

• eyelids are swollen, hyperemic;
• small hemorrhages on the conjunctiva;
• sclera injected;
• there is copious discharge from the eyes,
• when bacterial flora joins, it becomes purulent in nature.

⑨ Enteroviral fever

It is caused by viruses of the Coxsackie and ECHO group. Fever is usually short-lived and lasts no more than 4 days.

In addition to the rise in temperature, the following symptoms will be observed:

• headache;
• nausea and vomiting;
• muscle pain and malaise;
• redness of the skin of the face and body;
• scleritis and hyperemia of the pharynx;
• enlargement of all groups of lymph nodes;
• enlarged liver and spleen.

Who will help with enterovirus infection?

To diagnose enterovirus infection in children, symptoms and treatment, you need to consult an infectious disease specialist.

Treatment can be carried out on an outpatient basis, but there are certain indications that require hospitalization in a hospital.

• children under one year old with any form of the disease;
• damage to the heart and nervous system;
• intestinal form with dehydration of degree 2 or higher;
• children from socially disadvantaged families.

Enterovirus infection - treatment may require consultation with related specialists:

• surgeon;
• neurologist;
• cardiologist;
• ophthalmologist

Diagnosis of the disease

To make a diagnosis, epidemiological history data and clinical examination data are taken into account.

Laboratory methods include serological reactions to detect antibodies or polymerase chain reaction to detect viral RNA.

The materials for the study are nasal mucus, blood, feces, and cerebrospinal fluid..

Instrumental research methods are prescribed for meningeal and cardiac forms of the disease.

How to cure a child?

There is no specific etiotropic treatment for enterovirus infection in children. t, therefore only symptomatic and pathogenetic treatment is carried out.

In the meningeal form:

• dehydration using osmodiuretics – Mannitol;
• hormone therapy – Dexamethasone;
• means for improving microcirculation - Pentoxifylline, Trental;
• means for improving cerebral circulation - Cavinton, Vinpocetine.

The myalgic form is treated only symptomatically with the use of analgesics - Ketorol, Nimesulide.

For treatment use:

• – Zyrtec, Zodak;
• antiviral eye drops – Oftalmoferon, Poludan;
• When purulent discharge appears, antibiotics are added - Tobrex, Uniflox.

For myocarditis, detoxification therapy using saline solutions and cardiac support with sympathomimetics are prescribed.

The cutaneous form usually goes away on its own and does not require treatment.

For the intestinal form, sorbents are prescribed - Smecta, Enterosgel and rehydration therapy - Regidron Bio.

Enterovirus infection occurs in children much more often than in adults. All children's age groups are susceptible, but in children under 1 year of age it is more severe. The disease is polymorphic - characterized by many clinical symptoms; various organs and systems are affected. Antiviral therapy is not prescribed; treatment is syndromic, depending on which systems are involved in the pathological process. The outcome is favorable.

The causative agent of infection

Enterovirus infection is a disease with one pathogen and a similar pathogenesis (mechanism of development), but with different clinical manifestations.

The causative agent of the disease is viruses of the Enterovirus family. These include RNA containing viruses:

Polioviruses;

Unclassified viruses.

Distributed everywhere. Highly resistant in the external environment, they remain viable in feces for up to 6 months, characterized by seasonality - summer - autumn. The source is a sick person or a virus carrier. Globally, up to 46% of the population are asymptomatic carriers.

Transmission mechanism

The routes of transmission of infection are varied:

Fecal - oral;

Domestic;

Air-drip;

Vertical (from mother to fetus during childbirth);

Water (when swimming in dirty ponds and watering plants with contaminated water).

Cases of transmission of the virus through water in coolers have been described.

Susceptibility to viruses is very high, but after an infection, immunity remains for several years.

Course and forms of the disease

The entrance gate is the mucous membrane of the respiratory tract and gastrointestinal tract. Viruses actively multiply and spread throughout the body through the blood, causing a polymorphism of symptoms.

The hidden period is from 3 days to a week. With enterovirus infection in children, symptoms begin with the manifestation of intoxication, acute onset, high fever up to 400 C, then several forms of the disease develop, occurring in isolation or in combination:

Meningitis;

Epidemic myalgia;

Heart lesions.

Atypical forms:

Abdominal - intestinal damage;

Skin lesions - polymorphic exanthema;

Liver damage;

Eye pathology.

Clinical manifestations

Intoxication is manifested by enterovirus infection in children with symptoms of severe weakness, lethargy, painful headaches, dizziness, and insomnia. Accompanies all forms of the disease.

Gastroenteric form and liver damage

Abdominal syndrome: diarrhea up to 10 times a day of a watery nature of a normal color without pathological impurities, flatulence, abdominal pain, most often in the right half of the abdomen, decreased appetite or lack thereof, nausea, vomiting. The appearance of loose stools may be accompanied by an elevated temperature, but it can also occur at normal temperatures.

At an early age, acute gastroenteritis is combined with catarrhal syndrome: runny nose, dry and rare cough, hyperemia of the throat.

In young children, the duration of the disease is up to 2 weeks.

Liver lesions are manifested by signs of enteroviral hepatitis: the child’s skin and mucous membranes of the oral cavity and conjunctiva turn yellow, severe itching of the skin appears, urine becomes dark, feces become discolored. Palpation of the abdomen reveals an enlarged liver, and sometimes an enlarged spleen.

In many cases, with enterovirus infection in children, the symptoms of catarrhal phenomena come to the fore. Then the disease resembles ARVI, but subfebrile or moderate febrile (380 C) temperature with a runny nose, cough, manifestations of intoxication in the form of headaches, weakness, sleep disturbances is accompanied by gastroenteric syndrome with abdominal pain, repeated watery diarrhea, nausea, and repeated vomiting.

Angina

Against the background of enterovirus infection in children, the symptoms of herpangina are the main manifestation of the disease. When examined, papules are clearly visible on the hyperemic mucous membrane of the pharynx, which transform into vesicles. After 2 - 3 days, erosions form at the site of the opened vesicles. The rash is accompanied by severe pain when swallowing, enlargement and tenderness of nearby lymph nodes, and increased salivation.

Skin lesions

In any clinical form of enterovirus infection in children, the symptoms of the disease are accompanied by a rash in the form of red spots and small bubbles (vesicles) up to 1 - 3 mm in diameter, pink. Changes in the skin go away on their own after 2-3 days, leaving peeling of the skin. The localization of the rash is the torso and face, less often - the limbs.

Meningeal form

Exanthema accompanies another form of enterovirus infection - meningeal. It occurs in parallel with the symptoms of meningitis. Enteroviral serous meningitis is manifested by the following symptoms:

Photophobia;

Increased sensitivity to sounds;

Positive meningeal signs (Lassegue's symptom: painful headaches when bringing the chin to the chest, Kernig's symptom: due to increased tone of the flexor muscles, it is difficult to straighten the child's bent leg, Brudzinski's symptom: spontaneous flexion of the legs when the chin touches the chest);

Severe weakness;

Apathy;

Temperature up to 400 C;

Cramps.

Subsequently, visual disturbances and consciousness develop, muscle pain and increased tendon reflexes appear.

Eye pathology

Another form of pathology is eye damage:

Conjunctival hyperemia;

Pain or stinging in the eyes;

lacrimation;

Photophobia;

Swelling of the eyelids;

Serous or purulent discharge;

In severe cases, hemorrhage into the conjunctiva of the eye is observed.

A characteristic sign of eye damage is the one-sidedness of the process, after 2 - 3 days the second eye is involved.

Heart pathology

With infection caused by enteroviruses, congenital myocarditis develops - this occurs during intrauterine (vertical) infection. The child eats poorly, is lethargic, and adynamic. As heart failure increases, clinical manifestations increase:

Cyanosis of the lips and skin;

Tachycardia or other rhythm disturbances;

Severe shortness of breath;

Heart murmurs.

The child’s condition is serious; immediate treatment is necessary; without timely treatment, death is possible.

Myalgia

Epimyalgia is caused mainly by Coxsackie viruses and is characterized by severe muscle pain. It occurs in paroxysms, the duration of the attack varies: from 30 seconds to 20 minutes, the pain appears and disappears suddenly, intensifies with movement, it is impossible to predict the occurrence of an attack. Myalgia is accompanied by:

Rapid heartbeat and breathing,

Tension and pain in the anterior abdominal wall;

Paleness and dampness of the skin.

Treatment

For enterovirus infection in children, treatment is pathogenetic and symptomatic. Specific antiviral therapy is not carried out in children.

The scope of therapeutic measures depends on the form and severity of the disease. For liver damage and intestinal enterovirus infection in children, treatment consists of:

Dehydration and detoxification (inside - Regidron, various saline solutions, just saline solution or saline solution prepared at home),

In the use of sorbents (Smecta, Enterosgel, Polysorb, etc.), hepatoprotectors, antispasmodics (No - spa).

For the meningeal form of enterovirus infection in children, treatment is complex and includes:

Dehydration using Mannitol;

Hormone therapy - in severe cases (Dexazone, etc.);

Measures to improve microcirculation (pentoxifylline /Trental/);

Improving cerebral circulation (vinpocetine /Cavinton/).

For myalgia, symptomatic treatment is carried out - painkillers are used (NSAIDs - Ketorol, Nimesulide, etc.).

Eye damage - conjunctivitis - is treated by using:

Antiviral drugs (eye drops - Oftalmoferon, Poludan, etc.);

When a bacterial infection occurs and purulent discharge appears, antibiotics are used (Tobrex, Uniflox, etc.);

Desensitization therapy (Zodac, Zyrtec).

Treatment of endocarditis, myocarditis, pericarditis is aimed at detoxification and restoration of cardiac activity.

The cutaneous form generally does not require special treatment; over time, all manifestations regress on their own.

For microbial complications, antibacterial therapy is used.

For any form of enterovirus infection in children, treatment is prescribed exclusively by a doctor - self-medication is dangerous due to the severity of the disease. In severe cases, the child is hospitalized. For the entire period of treatment, bed rest and a strict diet are prescribed. Prevention is personal hygiene.