Enteroviral infection (enterovirus). Intestinal diseases in children: enterovirus infection Enterovirus infection as

Enteroviral infections in children- acute infectious diseases, the causative agents of which are intestinal viruses (enteroviruses) from the family of picornaviruses. Clinical manifestations of enterovirus infection in children are polymorphic; the disease can occur in the following forms: catarrhal, gastroenteric, enterovirus fever, enterovirus exanthema, herpangina, serous meningitis, myocarditis, neonatal encephalomyocarditis, conjunctivitis, uveitis, etc. PCR, ELISA, and RPHA methods are used to detect viruses in biological fluids. Etiopathogenetic treatment of enterovirus infection in children is carried out with interferons, immunoglobulins and other drugs.

General information

In addition to the general symptoms, the clinic of various forms of enterovirus infection in children has its own specific manifestations.

Enteroviral fever in children (minor illness, summer flu, three-day fever) is caused by different serotypes of Coxsackie and ECHO viruses. The infection is characterized by an acute manifestation with fever, myalgia, moderate catarrhal phenomena. The child has common signs of enterovirus infection: injection of sclera vessels, facial hyperemia, swollen lymph nodes, etc.; enlargement of the liver and spleen may be noted. This form of enterovirus infection in children is mild, usually no more than 2-4 days. In rare cases, enteroviral fever lasts 1-1.5 weeks or has an undulating course.

Intestinal (gastroenteric) form enterovirus infection is more common in children under 3 years of age. The disease proceeds with minor catarrhal symptoms (rhinitis, nasal congestion, hyperemia of the mucous membranes of the oropharynx, cough) and dyspeptic syndrome (diarrhea, vomiting, flatulence). Severe intoxication, dehydration and colitis are not typical. The duration of the intestinal form of enterovirus infection in children is 1-2 weeks.

Catarrhal (respiratory) form enterovirus infection in children proceeds according to the type of acute respiratory infections. There is a short-term fever, nasopharyngitis, laryngitis. Perhaps the development of false croup syndrome.

Enteroviral exanthema, associated with ECHO and Coxsackieviruses, is characterized by the appearance of a skin rash at the height of the fever. The rash may be similar in character to that of scarlet fever, measles, or rubella; elements are located mainly on the skin of the face and trunk. Less common are vesicular rashes in the oral cavity, resembling herpes (pemphigus of the oral cavity). The course of enterovirus infection in children is favorable; rash and fever disappear within 1-2 days.

Treatment of enterovirus infection in children

Treatment of mild isolated forms of enterovirus infection in children is carried out on an outpatient basis; hospitalization is required for serous meningitis, encephalitis, myocarditis, severe combined lesions. In the febrile period, rest, bed rest, sufficient drinking regimen are shown.

Etiopathogenetic therapy of enterovirus infection in children includes the use of recombinant interferons (alpha interferon), interferonogens (oxodihydroacridinyl acetate, meglumine acridone acetate), polyspecific immunoglobulins (in severe cases).

With myocarditis, meningitis, and other forms, the appointment of glucocorticosteroids is indicated. At the same time, symptomatic treatment is carried out (taking antipyretics, detoxification therapy, irrigation of the nasal cavity, rinsing of the throat, etc.).

Forecast and prevention of enterovirus infection in children

In most cases, enterovirus infection in children ends with convalescence. The most serious in terms of prognosis are enteroviral encephalitis, neonatal encephalomyocarditis, meningitis, generalized infection, and bacterial complications.

Children with enterovirus infection are subject to isolation; contact persons are quarantined for 2 weeks. Disinfection measures are being taken in the epidemiological focus. Due to the wide variety of enteroviruses, a specific vaccine against the infection has not been developed. Nonspecific prophylaxis includes endonasal instillation of leukocyte interferon to children and adults who have been in contact with a patient with an enterovirus infection.

The gastrointestinal tract of a child has some differences from the gastrointestinal tract of an adult. He is more receptive to new food ingredients. In children, intestinal immunity is not yet fully formed, so the body is extremely sensitive to various viruses.

At a tender age, one can encounter two variations of diseases of an infectious nature that affect the intestines and the gastrointestinal tract. These are rotavirus and enterovirus infections. The latter in children is much more common, and without proper treatment can cause irreparable harm to a fragile body. The peak incidence usually occurs in the spring-autumn period. What is the difference between enterovirus in children? Symptoms, photos of small patients, as well as a detailed treatment regimen are presented in the materials of this article.

What is an enterovirus infection?

This concept combines several diseases, the sources of which are enteroviruses. Otherwise they are called intestinal. Currently, more than 60 species of these pathogens have been studied. Depending on the serotype, they are all divided into 4 ECHO, Coxsackie, polioviruses and enteroviruses.

A child can get sick with one of the serotypes only once in a lifetime. After treatment, he develops strong immunity. On the other hand, he can become infected with another enterovirus. Such a variety of pathogens does not allow scientists to create a single effective vaccine.

Why is enterovirus dangerous in children? The whole seriousness of the infection lies in the fact that its pathogens are highly resistant to aggressive factors from the outside. They can exist for a long time in moist soil and water, then enter the human body through contaminated products.

In early 2008, a large-scale epidemic among children was recorded in China. Her appearance was provoked by the EV71 virus. It enters the human body through the respiratory tract, as well as the mucous membrane of the digestive tract. After it spreads throughout the body by the circulatory system, affecting the lungs and brain. The infection was detected in 15 thousand children, and 20 of them died. This once again indicates that enterovirus in children and adults requires timely and comprehensive treatment.

Causes of infection

The infection develops against the background of the activation of groups that are the cause of certain symptoms. All of them share a number of common characteristics. At the heart of each virus is a core, represented by a nucleic acid molecule. In some cases it is DNA, in others it is RNA. Outside, the internal structure is surrounded by a capsule, which has some features. Depending on the configuration of the shell elements, viruses are divided into different subtypes.

Enterovirus enters the body by inhalation of air or through the mouth while eating. After that, the pathogen migrates to the lymph nodes, where it settles and begins to multiply. Its further development, as well as the severity of the infectious process, depend on several factors:

virulence of the virus (the ability to resist the body's immunity);
tropism (the ability of an infectious agent to infect internal organs);
the state of the immune system itself.

How long is the incubation period? Enterovirus in children may not show external symptoms from 1 to 12 days. Typically, the incubation period is five days. The clinical picture of a particular disease depends directly on the serotype of the pathogen. Enterovirus is usually activated in spring and autumn. At other times of the year, the incidence is much lower.

Ways of transmission of infection

Enterovirus can be transmitted from a sick person to a healthy person in several ways: airborne, fecal-oral, contact. The mechanism of spread of diseases is characterized by great diversity. Enterovirus in children is transmitted mainly through raw water or toys. The causative agents of the disease for a long time can be in a viable state in feces, soil, and also water. Even the freezing process is not fatal for them. The pathogen dies under the action of disinfectants only if the processing time is strictly observed.

Enterovirus in children under one year old has similar causes. However, breastfed babies have innate immunity to most serotypes. On the other hand, a child can pick up an infection immediately after the end of the use of mother's milk.

Clinical picture

The incubation stage usually does not show any symptoms. At this time, the viruses settle on the mucous membranes and enter the lymphatic system, where they begin to actively multiply.

Then follows the stage of the disease itself. Signs of enterovirus in children begin to appear with a sharp increase in temperature, which reaches a critical point and persists for five days. The child moves little and sleeps a lot. The first days after infection may also be accompanied by severe vomiting and headaches. As soon as the temperature returns to normal, all accompanying symptoms disappear.

Sometimes children have an increase in lymph nodes, mainly submandibular and cervical. Another symptom of the disease is exanthema. Eruptions appear simultaneously on the head, chest and arms. They look like red spots. After their disappearance, small pigment marks remain on the body, which disappear on their own after a few days.

The intensity of the clinical picture directly depends on the state of the child's immunity, the received "portion" of the virus and some features of its type.

Common forms of enterovirus infection

Knowledge of the full classification is usually not required. Parents should be able to recognize the most common forms of enterovirus infection in order to timely determine the pathology and consult a doctor.

Herpetic angina. This is a catarrhal manifestation of an enterovirus. Herpetic sore throat usually occurs in children between three and ten years of age. Its main manifestations are high fever, sore throat and vesicles on the back of the throat. The bubbles burst and form sores. The main pathogens are Coxsackie A and B viruses.
Exanthema. This is one of the most common examples of how an enterovirus can manifest itself. In children, the rash has two pronounced types: red-eared and roseolous. Exanthema may appear on the first or second day after infection. Rashes appear on the face, body and look like small red spots. Sometimes they merge together. Against the background of red rashes, hemorrhagic elements may also appear. Enteroviral exanthema is more susceptible to children under six years of age.
flu-like syndrome. This form of enterovirus infection is characterized by symptoms of a typical flu or SARS. In children, there are (runny nose, swelling, nasal congestion), fever, weakness, muscle pain. Of the symptoms typical of the syndrome, which distinguish it from the usual flu, stool upset and vomiting can be distinguished.
intestinal form. This is one of the most dangerous variants of enterovirus infection. It is accompanied by a moderate rise in temperature, watery diarrhea, bloating and flatulence. The main danger of the intestinal form is considered to be a high probability of dehydration, which complicates the condition of a small patient. Such a disorder requires constant monitoring by doctors and emergency care.

All types of infection can proceed according to a typical / atypical clinical picture. Depending on the type of pathology, the doctor chooses how to treat enterovirus in children.

Rare forms of infection

In some cases, enterovirus infection is characterized by a complicated course. It is also classified as typical, but at the same time it is combined. Small patients require complex and more complex treatment.

Hemorrhagic conjunctivitis. This is a fairly common form of enterovirus infection. Its manifestations begin with severe pain in the eye, partial loss of vision and increased lacrimation. Sometimes retinal hemorrhages are observed.
Myocarditis/pericarditis. With this pathology, certain structures of the heart are primarily affected. Against the background of myocardial damage, the contractile function of the main muscle of the body is disturbed. Involvement in the pathological process of the pericardium is characterized by a change in the process of blood filling.
Meningitis and encephalitis. These are the most severe and at the same time dangerous forms of enterovirus infection. They begin with an increase in temperature to the mark of 40 degrees. The next day there is an intolerable headache, severe vomiting, which is not associated with eating. Common symptoms are abdominal pain, cramps,

Atypical variants of the infection are characterized by an asymptomatic and latent course. Clinical diagnosis becomes possible only in the event of visible complications.

Enteroviral infection in children is characterized by a diverse course. Therefore, it is important to consult a doctor in time to undergo a diagnostic examination. It allows you to differentiate the infection from common respiratory diseases, poisoning and dermatological problems.

medical examination

Signs of enterovirus infection in young patients are usually manifested by serous meningitis and herpetic sore throat. Group outbreaks of the epidemic are often recorded in preschool institutions during the warm season. The main one is fecal-oral.

Above, we have already told what symptoms enterovirus is characterized by. Photos (in children) of various forms of its manifestation can be viewed in specialized sources. They help to notice the disease and consult a doctor. Currently, there are four main methods for identifying the causative agent of infection:

Serological (detection of the virus in the blood serum). Early markers of pathology include IgA and IgM. A 4-fold increase in titer is also considered significant for diagnosis.
Virological (determination of the causative agent of infection in the cerebrospinal fluid, feces, blood). Excrements are examined for two weeks.
Immunohistochemical (detection of antigens to enteroviruses in the blood).
Molecular biological methods (study of RNA fragments of enteroviruses).

Doctors pay special attention to differential diagnosis. Enterovirus in children in its various manifestations is important to distinguish from herpes, SARS, and allergic reactions. In addition, it is necessary to test the sensitivity to the action of antibacterial drugs. Thanks to the achievements of modern microbiology, high-quality diagnostics does not pose any difficulties. With timely identification of the source of the disease, a child of any age can be cured relatively quickly.

Medical therapy

How to treat enterovirus in children? This is the question that many parents ask when they hear a diagnosis. With a mild course of the disease, a small patient can stay at home. The following conditions are considered indications for immediate hospitalization: damage to the central nervous system, heart, high fever.

Modern medicine cannot provide a single universal remedy for infection. In the acute period, small patients are advised to adhere to bed rest, a fortified diet and drink plenty of water. How to treat enterovirus in children?

If the disease is accompanied by fever, headaches and muscle pain, it is advisable to take analgesics and antipyretics (Nurofen, Paracetamol). With diarrhea, drugs are prescribed to normalize the water-salt balance ("Regidron"). Antibiotics are used only in case of bacterial infections.

To help the body cope with the enterovirus, children are prescribed interferons (Viferon, Cycloferon, Neovir). They belong to the category of non-specific antiviral agents that inhibit and activate the immune system.

Treatment should be prescribed by a doctor after a comprehensive examination of a small patient. Only a specialist can correctly recognize the symptoms and suspect an enterovirus. Infection in children is often accompanied by damage to the central nervous system, eyes and kidneys. In this case, the child, in addition to drug therapy, is shown to be monitored by a doctor for several months. Sometimes it may take several years.

Diet for enterovirus in children plays an important role, since the digestive tract is disrupted. First of all, it means drinking plenty of water. The use of ordinary non-carbonated water in large quantities helps to eliminate toxins from the body, is the prevention of dehydration.

Pediatricians recommend excluding fried and smoked foods, all sweets and pastries from the diet. It is important to limit the consumption of products from whole milk, butter, eggs. The ban also includes meat broth, nuts, legumes and bread. Food should be steamed or baked in the oven.

What can you eat? The diet should consist of fresh vegetables and fruits that have undergone heat treatment. Sour-milk products (biokefir, low-fat cottage cheese) are allowed. You can eat lean meat, fish. They are best served to the child in a crushed or even wiped form. In general, food should be fractional. It is recommended to eat often, but in small portions. If a child refuses to eat, he should not be forced or force-fed.

What to do when acute diarrhea is accompanied by an enterovirus? Treatment in children of school age in this case implies the observance of the so-called hungry pause. It is good to skip one or two meals. Hungry pauses in infants are unacceptable. Then a strict diet is prescribed for small patients.

On the first day, you can eat cereals on the water and baked apples. As the general condition of the child improves, fermented milk products, vegetable puree soups should be introduced into the diet. Last but not least, meat and fish dishes are allowed.

Complications of enterovirus infection

Enterovirus in children, the symptoms and treatment of which were described earlier, can penetrate into all organs and tissues. This explains a large number of its manifestations. In most cases, the child manages to survive the disease without serious health complications. Due to weakened immunity or the presence of concomitant diseases, negative consequences can still occur. As a rule, doctors diagnose meningitis and encephalitis.

These diseases affect the brain of a small patient, which can lead to epilepsy, paralysis, or death. There are also known cases of secondary infection, which requires additional therapy. Deaths are usually due to acute heart or lung failure. If a comprehensive examination confirms an enterovirus, treatment in children should be prescribed by a pediatrician. It is strictly forbidden to try to overcome the disease on your own. Parents can cause irreparable harm to the health of the baby.

Prevention methods

Specific prevention of enterovirus in children has not been developed. However, vaccinations against meningococcemia and poliomyelitis show good results. Many European countries now use vaccination against the most common pathogens of enterovirus infection. However, such prevention does not give an absolute guarantee due to the variety of viruses. Research and clinical trials on this issue are ongoing.

To prevent infection in the family of an infected child, it should be isolated. It is necessary to ventilate the premises more often, carry out daily wet cleaning with disinfectants. implies observance of elementary rules of personal hygiene, the use of interferons ("Laferon", "Nazoferon", "Viferon").

Now you know how enterovirus differs in children. Symptoms and treatment of diseases, the source of which is this pathogen, require a competent approach from specialists. If you do not postpone a visit to the doctor, you can prevent the occurrence of life-threatening complications. Be healthy!

Enteroviral infections are a group of diseases caused by several types of viruses. The disease is caused by Coxsackieviruses, polioviruses and ECHO (ECHO). These viruses have in their structure a capsule and a nucleus containing RNA (a type of DNA). The structure of the capsule can be very different, so the so-called serotypes (varieties) are isolated. There are 3 serological types of polioviruses. Viruses of the Coxsackie group are divided into Coxsackie A and Coxsackie B. In Coxsackie A viruses, 24 serological varieties are distinguished, in Coxsackie B - 6. In ECHO viruses, 34 serological types are distinguished. 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 an enterovirus infection several times in his life. Also, this feature does not allow the development of a vaccine to protect our children from this disease. The disease has a seasonality: outbreaks of the disease are most often observed in the summer-autumn period.

Causes of infection with enterovirus infection

Infection occurs in several ways. Viruses can enter the environment from a sick child or from a child who is a carrier of the virus. Virus carriers do not have any manifestations of the disease, however, the viruses are in the intestines and are excreted into the environment with feces. This condition can be observed in children who have been ill after a clinical recovery, or in children in whom the virus has entered the body, but could not cause the disease due to the strong immunity of the child. The virus carrier 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; heated to 45º C die in 45-60 seconds). Viruses tolerate changes in the pH of the environment well and feel great in an environment with a pH of 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 an enteroviral infection transmitted?

The mechanism of transmission 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 is not followed. Most often, infection occurs through water, when drinking raw (not boiled) water. It is also possible to infect children through toys if children take them in their mouths. Most often, children aged 3 to 10 years are ill. In children who are breastfed, there is immunity in the body received from the mother through breast milk, however, this immunity is not stable and quickly disappears after the cessation of breastfeeding.

Symptoms of an 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 protective properties of the body), tropism (the tendency to infect individual tissues and organs) of the virus, and the state of the child's immunity.

Enteroviral infections have both similar manifestations and different ones, depending on the species 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 stays for 2-3 days, after which it decreases and stays at normal levels for 2-3 days, then rises again for 1-2 days and finally returns to normal. When the temperature rises, the child feels weakness, drowsiness, headache, nausea, and vomiting may occur. With a decrease in body temperature, all these symptoms disappear, but with a repeated increase, they may return. The cervical and submandibular lymph nodes also increase, as viruses multiply in them.

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

When the mucous membrane of the oropharynx is affected, the development enteroviral tonsillitis. 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 fluid-filled vesicles on the mucous membrane of the oropharynx and tonsils. These bubbles burst, and sores filled with white bloom form from the place. After recovery, no traces remain at the site of the sores.

When the eye is damaged, it develops conjunctivitis. It can be one- and two-sided. It 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- pain in the muscles. Pain appears on the background of an increase in temperature. Soreness is observed in the chest, arms and legs. The appearance of pain in the muscles, as well as temperature, can be undulating. When the body temperature decreases, the pain decreases or disappears completely.

In lesions of the intestinal mucosa, there is liquid stool. Stools of normal color (yellow or brown), liquid, without pathological (mucus, blood) impurities. The appearance of loose stools can be both against the background of an increase in temperature, and isolated (without an increase in body temperature).

Enteroviral infections can affect various parts of the heart. So with damage to the muscle layer develops myocarditis, with damage to the inner layer with the capture of heart valves, develops endocarditis, with damage to the outer shell of the heart - pericarditis. The child may experience: increased fatigue, weakness, palpitations, drop in blood pressure, rhythm disturbances (blockade, extrasystoles), pain behind the sternum.

Damage to the nervous system can develop encephalitis, meningitis. The child has: severe headache, nausea, vomiting, fever, convulsions, paresis and paralysis, loss of consciousness.

When the liver is damaged, it develops acute hepatitis. It is characterized by an increase in the liver, a feeling of heaviness in the right hypochondrium, pain in this place. Perhaps the appearance of nausea, heartburn, weakness, fever.

Skin lesions may cause exanthems- hyperemia (red coloration) of the skin, most often on the upper half of the body (head, chest, arms), does not rise above the level of the skin, appears simultaneously. In my practice, an enterovirus infection was observed with a skin manifestation in the form of a vesicular rash on the palms and feet. After 5-6 days, the bubbles were blown away without opening, and in their place a pigmentation area (brown dot) formed, which disappeared after 4-5 days.

Boys may have 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 (tonsillitis, loose stools, and others). The disease passes quite quickly and does not bear any consequences, however, in rare cases, the development of aspermia (lack of sperm) in adulthood is possible.

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

Diagnosis of enterovirus infection

To make an accurate diagnosis, swabs are taken from the nose, pharynx or priests of the child, depending on the symptoms of the disease. Washouts are seeded on cell cultures, and after incubation for 4 days, a polymerase chain reaction (PCR) is performed. Since it takes quite a long time, the diagnosis is made on the basis of 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 when using antipyretics. The child is shown bed rest for the entire period of fever.

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

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

Children are isolated for the entire period of the disease. In the children's team may be after the disappearance of all symptoms of the disease.

Prevention of enterovirus infection

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

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.

Pediatrician Litashov M.V.

Enterovirus infection belongs to the group of acute infectious diseases that develop when different strains of the intestinal virus enter the body. Depending on the type of microorganism, the disease can occur with different symptoms, in most cases there are lesions of the digestive tract, respiratory disorders.

In severe cases, muscles, the heart, and the central nervous system are involved in the pathological process. Enteroviral infection often develops in young children.

Types of disease

Enterovirus infections that develop in children, depending on the main manifestations of the disease, are divided into typical and atypical. Typical lesions include:

herpetic sore throat;
catarrh of the upper respiratory tract;
enteroviral fever;
epidemic myalgia;
gastroenteritis;
hepatitis.

The nervous system is less often affected - meningitis, encephalitis develop. The defeat of the heart by the virus leads to pericarditis and myocarditis. The penetration of the virus into the genitourinary system causes nephritis, cystitis, orchitis in boys. With eye damage, conjunctivitis occurs more often, less often uevitis.

Atypical manifestations of infection in children include cases of asymptomatic or erased course of the disease.

According to the severity of symptoms, enterovirus infection is divided into mild, moderate and severe forms. The disease can be uncomplicated and complicated.

The reasons

Enteroviral infections develop under the influence of various pathogens. Most often these are Coxsackie viruses, enteroviruses, ECHO. Dangerous microorganisms are isolated by infected people or virus carriers. Infection occurs in several ways, the main route of transmission of infection is fecal-oral - viruses can be found on food products, in water.

Less commonly, infection occurs by airborne droplets and contact. Infection among children often spreads when using some toys, towels, dishes.

Enteroviruses perfectly retain their viability in soil, water, tolerate freezing well and are resistant even to some disinfectants. For a group of these microorganisms, the acidic environment of the stomach does not pose any danger, therefore they do not die in it, but multiply, develop and affect the organs of the gastrointestinal tract.

Viruses enter the body through the respiratory tract or through the mouth. Initially, they are localized on the mucous membranes, but then they are transferred to the lymph nodes, where they multiply.

The symptoms of an enterovirus infection in a child will depend on the strain of the microorganism, its ability to infect certain organs and tissues, and on the amount that has entered the lymph nodes of the pathogen. Immunity plays an important role in the development of infection, with the excellent functioning of the immune system, the child gets sick in a mild form.

Clinical manifestations of the disease

Enteroviral infections are manifested by a number of common symptoms.

The manifestations of the disease also depend on which organ or system of the body is affected by viruses.

Common manifestations of the disease include:

The presence of an incubation period, on average, it lasts from 2 to 10 days.
Acute onset of the disease. Fever appears sharply - the temperature rises to 39-40 degrees, chills, headache are observed. The child is lethargic, naughty, refuses to eat, there may be vomiting.
Hyperemia of the skin of the upper half of the body, face. You can notice redness of the sclera and conjunctiva.

Different types of enterovirus infection are often manifested by the appearance of a rash on the body, an increase in the cervical lymph nodes, when examining the throat, redness of the tonsils and pharynx is noted.

Specific symptoms of infection depend on the form of the disease:

Respiratory or catarrhal form infection proceeds almost the same way as ARVI. The child may have a short-term fever, sore throat. The development of laryngitis can cause laryngospasm.
Enteroviral fever or summer flu is manifested by febrile syndrome, muscle pain, headache. Catarrhal changes are detected in the throat, redness of the face and sclera is noted, in some cases the spleen and liver are enlarged. This form of the disease is usually mild and lasts no more than 4 days, although in some children the infection has an undulating course. That is, changes in well-being can stop or worsen again within 7-10 days.
Gastroenteric form predominantly occurs in preschool children. The child develops catarrhal phenomena, develops rhinitis with nasal congestion, cough appears. Against the background of these symptoms, nausea, vomiting, abdominal cramps and pain, bloating and diarrhea occur. Usually there are no severe signs of intoxication and dehydration, the body recovers in one to two weeks.
Enteroviral infection manifested by a skin rash that appears on the body at a high temperature. Rashes cover the trunk and face, less often found on the oral mucosa. All changes take two to three days.
epidemic myalgia characterized by severe muscle pain and high fever. Children may complain of pain in the chest, back, abdomen. With movements, the pain intensifies and causes profuse sweating, pallor of the skin, and respiratory failure.
Hemorrhagic conjunctivitis manifested by photophobia, redness of the sclera, pain in the eyes and lacrimation.

Severe enterovirus infections include myocarditis, paralysis, meningitis, and hepatitis. Damage to the meninges is manifested by a severe headache, vomiting, high fever, convulsions and loss of consciousness are possible. Boys may develop inflammation of the testicles, the lack of treatment of orchitis can cause infertility.

Enterovirus infection is dangerous for infants and children under two years of age. It is at this age that the heart, central nervous system, and muscles are more often affected. All symptoms increase rapidly and severe intoxication develops.

Principles of treatment

Specific medicines for the treatment of enterovirus infection have not yet been developed, so medicines are selected depending on the symptoms of the disease.

The general principles of treatment of the disease include:

Compliance with bed rest until the temperature normalizes. Compliance with this condition reduces the likelihood of severe complications.
Plentiful drink. Sufficient fluid intake in the body helps relieve symptoms of intoxication and prevents dehydration in the intestinal form of infection.
Isolation of the child during illness in order to prevent infection of other family members.
Providing the patient with separate dishes, towels.
Dieting. Dishes should be easy to digest and fortified; in case of damage to the digestive organs, sparing food is chosen. It is better to eat in small portions.

Drug treatment is selected by the doctor based on the examination of the child. With an increase in body temperature, antipyretics are used, with catarrhal phenomena in the upper respiratory tract, local antiseptics are used, rinsing is recommended. The doctor may prescribe antiviral drugs.

With enterocolitis, the water-salt balance should be restored. The child is prescribed rehydration solutions that fix medications, parents should ensure that he drinks after each visit to the toilet.

Antibiotics are prescribed if there is an assumption about the addition of a bacterial infection or complications may develop. With severe forms of damage to the central nervous system, heart, respiratory failure and with a temperature that is difficult to reduce, the child is hospitalized in the infectious diseases department. Some children may need intensive care in the intensive care unit.

Prevention

There is no specific prevention of enterovirus infection.

In order to reduce the risk of infection in their child, parents should teach him to comply with hygiene standards. That is, the baby should always wash his hands after going to the toilet, drink only boiled water or bottled water, use his own towel to wipe his face and hands in the kindergarten.

Swimming in natural reservoirs, especially with stagnant water, is also dangerous. A good state of the immune system is also a guarantee of the absence of the disease, or at least its mild course.

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All information is presented for educational purposes. Do not self-medicate, it is dangerous! An accurate diagnosis can only be made by a doctor.

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

This term in medicine refers to a separate group of anthroponotic diseases caused by ECHO and picornaviruses. Getting into the human body mainly by the fecal-oral route, pathogens are localized in the intestinal mucosa and oropharynx. In the case of distribution with blood flow throughout the body, they affect the nervous system, muscle tissue, skin and mucous membranes.

The enterovirus infection code according to ICD 10 depends on the form of the disease:

B34.1 - for unspecified forms of the infectious process;
A85.0 - for enteroviral encephalitis and encephalomyelitis;
A87.0 - for meningitis;
B08.5 - for vesicular pharyngitis and herpetic tonsillitis, etc.

According to clinical manifestations, typical forms are distinguished:

aseptic serous meningitis
herpangina
exanthema
epidemic myalgia

And atypical ones, which include "summer flu", acute catarrh of the upper respiratory tract, encephalomyocarditis in newborns, epidemic hemorrhagic conjunctivitis, uveitis, pancreatitis, cystitis, nephritis, as well as encephalitic, poliomyelitis-like, gastrointestinal and innaparant (asymptomatic) forms.

Etiology

Microorganisms that cause enterovirus infection belong to the family of RNA-containing picornaviruses. Characteristic features: small size (diameter does not exceed 30 nm) and the absence of a capsid - the outer shell. The genus Enterovirus includes:

polioviruses - the cause;
two groups (A and B) of the Coxsackie virus;
ECHO (abbreviation of the English name enteric cytopathogenic human orphan);
five unclassified human viruses.

All intestinal viruses are characterized by increased resistance to such adverse external factors as low and high temperatures, exposure to ethanol and lysol solutions. In sewage, they remain viable for about 2 months, in feces - up to six months.

Enteroviruses are susceptible to a significant increase in temperature (they die instantly when boiled), drying, exposure to ultraviolet, radiation, and ultrasound. They are rapidly destroyed when treated with substances such as formaldehyde, hydrogen peroxide, potassium permanganate, heterocyclic dyes, free residual chlorine.

Epidemiology of enterovirus infection

Enterovirus infection in adults and children is transmitted from person to person. The sources are patients with clinical signs of the disease, as well as those who have recovered, but continue to isolate convalescent viruses and carriers without signs of the disease. Children are most susceptible to enteroviruses, especially in the first year of life. Immunity after enterovirus infection is formed resistant, type-specific. Cross-immunity to several strains of enterovirus infection may also develop.

Viruses are ubiquitous, a seasonal surge in incidence in the temperate climate zone occurs at the end of summer and autumn, in hot countries the epidemiological situation is unfavorable all year round. The factors contributing to infection are drinking non-disinfected water, non-compliance with hygiene standards, crowding of people (the latter is typical for children's groups).

How is an enterovirus transmitted?

Usually, the virus enters the body through the fecal-oral route, mainly through contaminated water, food, dirty hands and toys. Additional transmission mechanisms are airborne (due to reproduction in the nasopharynx, the pathogen can be released into the environment even before the end of the incubation period) and transplacental - from a pregnant woman to a fetus.

Pathogenesis

Enterovirus infection in children and adults is a consequence of the pathogen entering the mucous membranes of the intestine and oropharynx. There, the reproduction and primary accumulation of viruses take place, after which they spread to the lymphoid intestinal formations and the nearest lymph nodes, and if they enter the bloodstream, they spread throughout the body. Enteroviruses are characterized by a special affinity for nervous and muscle tissues, which explains the development of encephalitis, meningitis, myositis, etc.

At the same time, in 20-40% of patients, the multiplication of viruses in the intestine is asymptomatic (healthy carriage of viruses).

Symptoms and treatment of enterovirus infection in adults and children

The variety of signs of the disease does not always allow a reliable diagnosis at the initial stage of the disease without laboratory diagnostic methods. Reproduction and accumulation of viruses in the oropharynx causes symptoms typical of respiratory diseases, and in the intestine - for acute gastroenteritis.

Common characteristic reactions of the body to enterovirus are fever, intoxication symptoms, dyspepsia, headaches and muscle pains, hyperemia of the posterior pharyngeal wall, swollen lymph nodes (cervical and submandibular).

The incubation period for enterovirus infection ranges from 2 to 10 days, on average - from 3 to 4 days. Each form of the disease has its own clinical signs.

Serous meningitis

It is the most severe and common manifestation of enterovirus infection. It is caused by the neurotropic genotype of enterovirus infections.

It can occur both in the form of isolated cases and in the form of outbreaks. It always begins acutely, with a significant increase in body temperature (up to 39 ° C) and signs of intoxication. Symptoms of enterovirus infection in adults and children with serous meningitis appear as a meningeal syndrome, including:

intense and persistent headaches of a bursting nature;
skin hyperesthesia, light and noise fear;
recurring vomiting fountain;
profuse white coating on the tongue;
lethargy or pronounced psychomotor agitation;
the appearance of rigidity of the occipital muscles;
increased blood pressure due to cerebral edema;
decrease in heart rate;
sometimes there are convulsions, flatulence, catarrhal phenomena.

In laboratory diagnostics, changes in the cerebrospinal fluid typical of serous meningitis are revealed.

Epidemic exanthema

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

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

epidemic myalgia

It is distinguished by a sudden acute onset with a sharp rise in temperature up to 40 ° C and chills. At the same time, weakness, nausea, headache, pain in the chest, muscles of the back and limbs, epigastric pain are noted. When coughing, movement, pain in the muscles intensifies. There is also profuse sweating, vomiting, nausea, loss of appetite.

Tachycardia, enlargement of the liver and spleen, enlargement of the cervical lymph nodes, granularity and hyperemia of the posterior pharyngeal wall, and not intense catarrhal symptoms are often recorded.

The disease lasts from 3 to 7 days. With a wave-like course of the infectious process, it is possible to lengthen the febrile period up to two weeks.

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

Gerpangina

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

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

Pain is moderate, erosion heals in less than a week.

Atypical forms

For them, according to the totality of clinical symptoms, the following types of manifestations of infection are characteristic:

Gastrointestinal (enteroviral diarrhea, enteroviral gastroenteritis) - there are feverish and intoxication symptoms, headaches, a sharp decrease in appetite, moderate abdominal pain, bloating, diarrhea and repeated vomiting, enlarged liver and spleen. Sometimes catarrhal symptoms are recorded (cough, runny nose, hyperemia of the mucous membrane of the posterior pharyngeal wall).
Respiratory catarrh - short-term fever in combination with inflammation of the oropharyngeal mucosa.
Enteroviral (aka three-day) fever or "minor" illness combines intoxication, fever, swollen lymph nodes, muscle and joint pain, catarrhal symptoms, abdominal pain.
Neonatal encephalomyocarditis is the most dangerous enterovirus infection in children, where drowsiness, vomiting, diarrhea, anorexia, and dyspepsia are noted against the background of hyperthermia. Other characteristic symptoms are tachycardia, heart murmurs, and a gray or bluish tint to the skin.
The poliomyelitis-like or spinal form is characterized by a mild course with the onset of acute paresis. Usually the legs are affected and "morning lameness" occurs with a characteristic change in gait. After recovery, all symptoms disappear, but rare severe cases can lead to death.
Encephalitis and meningoencephalitis - symptoms of this form are vomiting, fever, intense headache, sometimes impaired consciousness and convulsions, the appearance of nystagmus, cranial nerve palsies.
Myocarditis and pericarditis are the most common complications after a respiratory enterovirus. Symptoms are moderate fever and pain in the heart against the background of progressive general weakness. The appearance of pericardial friction noise, deafness of heart tones, expansion of cardiac boundaries is also noted.
Hemorrhagic conjunctivitis is subjectively felt as a foreign body in one eye, photophobia and lacrimation appear. The eyelid swells, multiple hemorrhages appear in the conjunctiva, purulent or serous discharge is observed. The second eye is not always affected, recovery occurs within one and a half to two weeks.

In general, the treatment of various manifestations of enterovirus infection is reduced to hospitalization of the patient in severe cases, the appointment of antiviral drugs such as symptomatic and detoxification therapy.

Diagnostics

Diagnosis in the presence of typical clinical signs of enterovirus infection (exanthema, meningeal syndrome, myalgia, and others) does not cause difficulties, especially if an epidemic outbreak has been recorded. Difficulties can arise if the disease takes an atypical form or proceeds easily. Laboratory confirmation is mandatory in any case.

For serological analysis for enterovirus infection, blood, cerebrospinal fluid, nasopharyngeal mucus and feces are taken. In this case, the increase in antibody titer should be at least fourfold. The most informative method of research is the polymerase chain reaction. Instrumental methods can be used as additional confirmation: ECG, echocardiogram, MRI and others.

Treatment of enterovirus infection in children

A child with a mild form of the disease is treated on an outpatient basis, and moderate and severe require hospitalization.

The volume of drug therapy depends on the form of the disease and the severity of the patient's condition.

In a hospital, detoxification treatment is carried out, cardioprotectors, diuretics or blood circulation improvers, immunomodulators, multivitamins, anticonvulsant therapy, etc. are prescribed.

If the child is at home, then he is shown: strict bed rest for the entire period of fever, diet, since proper nutrition for enterovirus infection in children contributes to recovery, symptomatic and pathogenetic drug therapy. The latter consists in taking such groups of drugs as:

antipyretics to reduce temperature during acute fever;
analgesics and anti-inflammatory drugs - relief of pain attacks, especially with myalgia;
antihistamines - in order to reduce the toxic-allergic reaction;
antiviral drugs for enterovirus infection are ineffective, so they are replaced with immunomodulators or immunostimulants;
enterosorbents will help reduce general intoxication;
probiotics to activate the intestinal microflora in enteritis;
vasoconstrictor in the nose to facilitate breathing and general condition with a strong ;

It is important to remember that antibiotics are not effective for viral infections.

However, the attending physician may prescribe these drugs in the event of a secondary infection of bacterial etiology.

Diet for enterovirus infection in children

For babies during treatment, the "menu" remains the same, since mother's milk will help the body cope with the virus faster. The diet of older children during the period of illness and recovery should be light to minimize the burden on the digestive tract, but nutritious. It is necessary to exclude raw fruits and vegetables, fried, smoked, pickled dishes, confectionery. The best food option is lean soups, boiled meat and vegetables, cereals, biscuits, teas, fruit drinks and compotes.

Treatment of enterovirus infection in adults

With age, the human body becomes less susceptible to enteroviruses. Therefore, adults get sick much less often than children, transferring the infection easily or asymptomatically. Hospitalization for this age group is indicated only for severe forms, all others require treatment at home. Therapy for enterovirus infection, both outpatient and inpatient, consists of the same items as in children.

Predictions and consequences

The outcome of the disease depends on the form in which the infection manifests itself, and the severity of the course of the disease. The most unfavorable forecasts are given for serous meningitis, encephalomyocarditis, severe spinal form. The rest of the varieties are easily cured and pass without consequences. For example, an enterovirus infection in children with a rash is easy, and the exanthema itself does not even require special treatment, disappearing without a trace in a maximum of four days.

Prevention

A vaccine that protects the body from enteroviruses has not been developed.

A healthy fortified and balanced diet and lifestyle, regular moderate exercise, and the absence of bad habits will help strengthen the latter. Spend more time walking outdoors.

Preventive measures in the outbreak include its regular ongoing disinfection, isolation of the sick person until complete recovery, and compliance with sanitary and hygienic requirements. For preschool institutions, quarantine for enterovirus infection for a period of two weeks is recommended.