Coxsackievirus symptoms and treatment quarantine. Coxsackie virus: incubation period, symptoms, treatment, consequences

A young mother contacted the DELFI Reporter with a request to help figure it out. “The fact is that now viruses have spread in kindergartens, and many people are suffering from the Coxsackie virus. Is the kindergarten obliged to introduce quarantine in this case?” - the woman is interested.

“The fact is that now in many kindergartens children suffer from the Coxsackie virus, which is accompanied by diarrhea, rashes around the mouth, on the skin, and fever. However, parents are simply presented with a fact – there is a virus in the kindergarten,” writes Alena. “In this regard, I have a question - is there still such a thing as quarantine? Who sets it and who controls the situation? Because every morning you take your baby to kindergarten as if to Calvary, and then you sit all day at work and are nervous about whether he will get infected or not. Moreover "No one tells you whether there will be any kind of disinfection or quarantine. I think that after that incident, the topic of health control in kindergartens is still relevant for many parents."

For clarification, DELFI The reporter contacted the Ministry of Health. Cabinet Regulation No. 890 (“Hygiene Requirements in Preschool Educational Institutions”) states that kindergarten does not accept children with symptoms of infectious diseases(diarrhea, vomiting, rashes, elevated (more than 37.5°C) temperature, changes in the child’s behavior - drowsiness, refusal to eat, rapid heartbeat and breathing) except in cases where supervision is provided for one child or children from the same family, or it is possible to ensure the isolation of a sick child by placing him in a separate room and providing medical supervision. It has also been established that it is prohibited to accept children with head lice.

“If a child develops symptoms of an infectious disease, employees of an educational institution are obliged to promptly inform parents that children cannot attend kindergarten. In turn, in such preschool educational institutions, where children spend 24 hours a day, there must be rooms for short-term isolation children in case of infection,” says Ministry of Health spokesman Oscar Schneiders.

Kindergartens should have developed internal rules order in which it is indicated how the kindergarten and parents act if a child is found to have infection. Parents must be familiar with these rules.

According to Article 36.1 of the Law on Epidemiological Safety, if in educational institution If an infectious disease is detected that is not considered dangerous, the decision on quarantine is made by the head of this institution. Epidemiologists at the Center for Disease Prevention and Control establish quarantine only if we are talking about registered dangerous infectious diseases. Diseases caused by the Coxsackie virus (with the exception of meningitis and encephalitis) are not included in this list, so the decision on quarantine is made by the head of the kindergarten.

The list of diseases caused by the Coxsackie virus can be found on the home page of the Center for Disease Prevention and Control at this link: https://www.spkc.gov.lv/lv/tavai-veselibai/infekcijas-slimibas/apraksti/enterovirusu-meningits

Coxsackie viruses belong to a large group of enteroviruses, and can cause various, mainly mild, clinical manifestations. You can most often become infected through contact with the secretions of an infected person, for example, saliva, mucus, or feces. You can also become infected by coming into contact with the contents of a rash on the patient’s skin. Patients usually pose a threat to others in the first week of illness, in turn, the virus can be released for two weeks.

There is no specific treatment, only symptomatic. As a preventive measure, it is recommended to thoroughly wash your hands with soap, especially after contact with the patient or surfaces that he touched. It is advisable not to touch your eyes, nose and mouth with dirty hands, and also to avoid close contact (kissing, hugging and eating from the same utensil) with an infected person. Objects (children's toys, door handles) and surfaces that are frequently used must be disinfected.

Good evening!!! We have a situation like this. Starting September 1, I take my granddaughter to kindergarten. The daughter-in-law is expecting her second child. Quite by accident, I learned from my parents that half of the group had contracted the Coxsackie virus. That is, the diseases began a month ago and are gaining momentum. From that day on, my granddaughter was not taken to the garden. But she still got sick. Pregnant daughter-in-law and me too. In response to my indignation at why the teachers did not report the disease after the first children fell ill, I was told that the teachers were not obliged to inform the parents. Please explain to me, is this so?! I do not understand anything. If the teachers don't remain silent, we could avoid the disease. The pregnancy is short, it is unknown how it will affect the baby. Thank you in advance!

Answer: from your information we can conclude that there are many violations of sanitary rules in preschool educational institutions (“SP 3.1.2950-11. Prevention of enterovirus (non-polio) infection”, “MU 3.1.1.2969-11. 3.1.1. Prevention of infectious diseases. Intestinal infections” etc.). In particular, clause 6.3-6.9 SP 3.1.2950-11 states:

- the obligation to prepare a plan of anti-epidemic and preventive measures, which includes: the introduction of restrictions (primarily in children's organized groups), the suspension of classes in primary school in case of deterioration of the epidemiological situation, etc.;

- active identification of patients by questioning and examination during the morning admission of children to the team (for organized children), as well as during door-to-door (door-to-door) rounds;

- medical observation of contacts daily with the entry of examination results into the appropriate medical documents(observation sheets);

— after isolating a patient with EVI (or a person suspected of having this disease) in a children’s organized group, carrying out restrictive measures, including: prohibiting the participation of the quarantine group in general cultural events of the children’s organization; organizing walks for the quarantine group in compliance with the principle of group isolation at the site and upon returning to the group; compliance with the principle of isolation of children in the quarantine group when organizing meals; etc.

That is, when the first case of an enterovirus infection (EVI) with the causative agent of the Coxsackie virus is detected in a child from a preschool group, a set of measures should be carried out in the preschool in accordance with the above documents, including a survey of parents during the morning reception of children at the preschool. In this regard, Rospotrebnadzor should be immediately notified if this sanitary and epidemiological authority has not been informed earlier.

If you prove that the cause of your granddaughter’s illness was infection in the preschool and failure to carry out mandatory sanitary measures in the preschool (including a morning survey of parents), then you can recover damages from the preschool for the harmful consequences of such a disease. Grounds for full financial liability for harmful effects from illness that occurred due to the fault of preschool employees, and compensation for moral damage are regulated in the provisions of Art. 151, 1068, 1101, etc. of the Civil Code of the Russian Federation, as well as clause 15. Part 3 of Art. 28, clauses 8 and 9, part 1, clause 4, part 4, art. 41 and part 1 of Art. 68 Federal Law dated December 29, 2012 N 273-FZ “On education in the Russian Federation.”

Vladimir Korzhov, lawyer.

What it is? The Coxsackie virus is a group of 30 active enteroviruses that multiply in the gastrointestinal tract of a child. Epidemics caused by a virus spread as intestinal diseases among children younger age. The disease was first diagnosed in the small US town of Coxsackie, and due to its high level of infectiousness, it quickly spread around the globe.

These viruses are considered “childhood” viruses, since they mainly affect children from 3 to 10 years old. An outbreak of Coxsackievirus is characterized by a significant number of people in close contact, with an undulating course. clinical symptoms lasting up to 21 days. In the article we will consider: what kind of virus this is, the causes and symptoms of the disease, what treatment is effective for the Coxsackie virus, as well as the main methods of prevention in children.

What is the Coxsackie virus?

Coxsackie virus is a viral infection belonging to the family of herpes viruses that live and multiply in the human digestive tract. Coxsackie often presents with hand-foot-mouth syndrome. The syndrome gets its name from the typical rashes that cover these parts of the body. Its symptoms resemble the well-known stomatitis, stomach flu, sometimes the disease is misdiagnosed as acute polio.

contagious by 98% - if we are talking about close contact with the patient or his things.

The main category of risk for the development of a disease provoked by the Coxsackie virus or the development of virus carriage are children from 3 to 10 years old, while in newborn children, as well as infants Breast-fed infants develop stable immune defense mechanisms in the body that prevent the development of the disease.

In adolescents and the adult population, the Coxsackie virus, after entering the body, does not provoke the development of active clinical symptoms and has a latent course with the subsequent formation of immunity.

Routes of transmission and main causes of the disease

Coxsackie is a disease dirty hands. 97% of infections occur through the food route - through hands, dishes, unwashed fruits, tap water. That is why the virus mainly affects young children who have not yet developed strong hygienic skills (washing hands, not drinking raw, untreated water). The most susceptible category to the disease is children of preschool and primary school age.

A person can become infected from another sick person, and often from a virus carrier. People often catch the infection in hotels in Turkey, Cyprus or other holiday destinations.

In the first few days of the disease, the Coxsackie virus is maximally concentrated in the nasopharyngeal mucus, while its active reproduction occurs in the lumen of the human intestine, which creates conditions for transmission of the virus through the fecal-oral route. Direct infection of the microorganism occurs when contaminated food and water are consumed.

The time between the introduction of the virus and its activation is called the incubation period. For the Coxsackie virus it ranges from 2 to 10 days. After the incubation period, an acute form of the disease occurs. Appear visible symptoms- fever, indigestion, rash on the palms and soles of the feet, rashes inside the mouth.

How can you get infected?

You can become infected with the virus through drinking water and water in swimming pools, as well as through contaminated food. Enteroviruses spread quickly if personal hygiene rules are not observed. It is enough for a sick person to visit the toilet, not wash his hands and use household items to spread the infection throughout the house.

You can protect your child from infection and carry out prevention from the beginning. Therefore, doctors strongly recommend that all parents allow their children to drink only purchased filtered water, and wash fruits and vegetables thoroughly before consumption. This will be the prevention of infection with the Coxsackie virus.

Important! The patient should be isolated from healthy children and adults. It is advisable that the isolation lasts about 1-1.5 weeks.

The outcome of the infection is determined by the type of virus and the personal characteristics of the patient’s body:

1. The person recovers completely (all viral particles are destroyed).
2. The process becomes chronic (neurons and internal organs retain the virus indefinitely).
3. The patient becomes a virus carrier.

How does the infection progress?

Main features of enteroviral infections:

• almost always this is an acute onset;
• the infection usually proceeds violently, the patient is put to bed;
• manifestations of enteroviruses can be very diverse;
• recovery occurs relatively quickly;
• Complications develop quite rarely;
• The most dangerous virus is group B Coxsackievirus.

Measures specific prevention(vaccination) against the Coxsackie virus have not been developed to date.

In addition to these types of diseases, there are different forms and variants of the course of enteroviral diseases.

Coxsackie viruses are divided into two large groups:

• type A virus (causes meningitis and throat infections);
• type B virus (causes inflammatory and degenerative changes in the brain, muscles and heart).

Course options: mild, moderate and severe.

The severity of the disease primarily depends on the degree of damage to vital organs (the brain and its membranes, heart, liver), as well as the severity of intoxication.

In addition, the course of enteroviral infections can be:

• smooth – recovery occurs within 10-20 days;
• wavy;
• recurrent;
• with complications.

Forms of the disease:

• isolated – in the presence of only one syndrome;
• combined – when the virus affects several organs and systems.

Symptoms of the Coxsackie virus and photos

The incubation period from the moment of infection until the first signs appear in the form of rashes is about 10 days. Other symptoms also appear, such as:

• A sharp increase in body temperature to 38 degrees or higher;
• coated tongue;
• general weakness;
• a sore throat;
• eating disorders;
• enlarged cervical lymph nodes.

In the photo below, characteristic features Coxsackie virus:

Depending on the prevalence of any symptom, several clinical forms of this disease are distinguished:

• Herpangina or enterovirus vesicular. This is an infection that causes ulcers to develop on the tonsils, soft palate and back of the throat.
• Epidemic myalgia— the leading symptom is the development of pain in all muscle groups.
• Pathology nervous system – damage to the membranes of the brain (serous meningitis). A more severe form of infection with the development of severe headache and severe intoxication. Some serotypes of the Coxsackie virus can lead to the development of temporary paralysis of the leg muscles (reminiscent).
• Enteroviral fever– characterized by the absence of specific symptoms, only a rise in body temperature and poor general health of the child are noted.
• Enteroviral exanthema– The main manifestation of infection is the appearance of a rash on the skin.

Complete healing of red blisters is observed after 6-7 days, and the rash - after 10-12. The occurrence of complications depends on the quality of treatment and timely consultation with a doctor. It is better to ask your doctor how to treat Coxsackie virus. Doctors advise relieving fever and pain with Paracetamol or Ibuprofen.

Coxsackie virus in children

The disease can easily be confused with chickenpox or allergies. The virus has several symptoms and can also be found in different countries. Incubation period, or the time from infection to the first symptoms of the disease, with the Coxsackie virus is usually 3-6 days, less often from 2 to 10 days. Already in this period the child may have poor appetite, become lethargic and drowsy, capricious.

Symptoms of the Coxsackie virus in children:

• fever;
• headache varying degrees intensity;
• severe weakness;
• chills;
• nausea;
• vomit;
• catarrhal phenomena - runny nose, pain or soreness in the oropharynx;
• decreased appetite;
• muscle pain (myalgia);
• fast fatiguability;
• heartbeat;
• the youngest age group- false croup.

Very often, the Coxsackie virus is confused with a rash with allergies (including to antibiotics), or chickenpox, since the clinical manifestations of these diseases are similar.

The Coxsackie virus in children in the photo with herpangina looks like a specific plaque on the arches of the palatine tonsils, uvula, and posterior wall of the pharynx.

The disease caused by the Coxsackie virus in children can occur in two forms:

• typical;
• atypical.

Typical forms of the disease manifest themselves in the form of lesions:

• isolated ( enteroviral sore throat, exanthema or fever, hepatitis, myalgia and gastroenteritis);
• nervous system (serous meningitis, encephalitis, paralysis and encephalomyocarditis of newborns);
• heart (endocarditis, pericarditis and myocarditis);
• genitourinary system (orchitis, epididymitis, cystitis);
• eye (uveitis - inflammation of the choroid, conjunctivitis).

Due to initial signs have a lot of similarities with acute respiratory viral infections, the diagnosis sometimes ends with this process, and then incorrect treatment decisions are made. This makes it worse big picture. But after 1-2 days, other phenomena appear on the palms and soles - a rash in adults and children (vesicles have a diameter of 3 mm).

Hand-foot-mouth syndrome is also often observed - a rash appears simultaneously on the mucous membrane of the mouth, palms and feet.

An urgent call to a pediatrician is necessary if a child is found to have:

• Pallor of the skin;
• Appearance of blue discoloration on the body, near the ears, between the fingers;
• Signs of dehydration appear: lethargy, dry lips, decreased urination, increased sleepiness, delirium, dizziness;
• Severe headache;
• Refusal to eat;
• Long fever.

If the infection develops severely, urgent hospitalization is necessary.

Treatment for children includes:

• bed rest for the entire period of intoxication,
• diet with sufficient quantity liquids and vitamins,
• drinking plenty of water,
• in case of severe diarrhea and vomiting, take rehydration solutions.

Sick children are quarantined for 2 weeks. The prognosis for treatment is favorable in most cases. After the disease, persistent specific immunity develops.

Your doctor may need to recheck for the presence of Coxsackie viruses in your body. This rarely occurs, but sometimes in children the disease becomes additionally inflamed. Signs of a contagious infection are dehydration in which the child refuses to swallow due to a sore throat. If your newborn refuses food or water, moisten the nipples more than usual and call the doctor.

For prevention Special attention should be addressed to:

• Drinking water (and also in the pool, where a child can take a sip while swimming);
• Food (extreme heat is not conducive to long-term storage of food);
• Protect children from sun and heatstroke.

Coxsackievirus in adults

Coxsackievirus is rare in adults medical case. The older a person is, the less likely he is to contract such an infection. The routes of entry of the virus are the same for patients of any age.

If an infection with Coxsackievirus type A occurs, and everything is in order with the immune system, the infection is often asymptomatic. Sometimes the following symptoms are observed:

• redness of some skin areas;
• small papular rash of pinkish color;
• short-term fever.

With type B virus in adults, the following symptoms are possible:

• the appearance of redness, rash;
• loss of appetite;
• heat;
• a sore throat;
• cough;
• runny nose;
• diarrhea.

For general health For an adult, the disease does not carry any dangerous phenomena or consequences. With the right approach, the rash on the body will go away quickly, leaving no consequences for the general internal health.

Possible complications

The Coxsackie virus usually passes quickly and leaves no consequences. But in rare cases complications develop:

• dehydration of the body;
• pulmonary edema;
• Iron-deficiency anemia;
• diabetes;
• severe forms and myocarditis.

Diagnostics

Which doctor should I contact when the first symptoms appear? If you have or suspect the development of the Coxsackie virus in a person, you should immediately seek help from doctors such as an infectious disease specialist or epidemiologist.

Enterovirus infection is diagnosed based on:

• examination of the child;
• blood test to detect pathogen RNA and antibodies to it;
• analysis of stool, washing from the nasal mucosa, scraping from the skin or conjunctiva (depending on the location of the lesion).

How to treat Coxsackie virus

If the disease proceeds without complications, then it is treated in the same way as ordinary acute respiratory viral infections. In general, it is enough to undergo treatment at home. Pathogenetic and symptomatic therapy:

1. If a child has a strong fever, then antipyretics should be taken: Ibuprofen, Paracetamol, Ibufen.
2. To increase immunity, the use of immunomodulators is indicated: interferons or immunoglobulins.
3. Antipyretics - given when poor tolerance temperature (ibuprofen, paracetamol). With normal tolerance, the temperature is not reduced (temperature rise - defensive reaction body, which helps control and limit the replication of the virus).
4. Antiseptics: soda and soda are used to treat the mouth. salt rinses, for treating leather - fucorcin, brilliant green. To reduce itching - baths with soda. They can also prescribe: Tantum-Verde, Hexoral.
5. Antihistamines, topical or general action to reduce itching - Vitaon Baby, Fenistil gel, Suprastin, Zyrtec.
6. Antibiotics: application antibacterial drugs for the Coxsackie virus, it is allowed only with the addition of a bacterial component with the preferred use of agents with wide range antimicrobial activity.
7. For support immune system It is necessary to ensure a sufficient supply of vitamins and microelements, which are sold in pharmacies as over-the-counter supplements. Positive influence Echinacea, shiitake mushrooms and goji berries also have an effect on the immune system.

Treatment skin rashes is also not carried out. It is recommended to protect the elements of the rash from scratching, and also not to take a bath until complete recovery. Local therapy for cutaneous forms illness is not prescribed.

If a child or adult experiences dehydration, it is worth paying attention to taking the amount of water that the body needs to maintain normal functioning.

Nutrition

• Feed in small portions, but often (5-6 times a day).
• Avoid salty, spicy and sour foods.
• Prepare dishes by steaming, baking or boiling.
• Include foods rich in vitamins (fruits, vegetables) in your diet.

You can treat the disease with folk remedies:

1. Rinse your mouth with chamomile decoction.
2. Drink tea with cinnamon and honey. It soothes a sore throat.
3. Eat more garlic, which resists viral infection.

Prevention of Coxsackie virus in children and adults

Prevention of the Coxsackie virus will help you avoid the disease:

• You should wash your hands with soap after walking and visiting the toilet.
• Drink only purified drinking water.
• Food products must be treated with boiling water.
• You should not use shared cutlery: let each family member have their own cup, spoon, and fork.

If someone in the family does become infected with the Coxsackie virus, be sure to provide them with separate personal hygiene items, which will reduce the chance of transmitting the infection to healthy people. Don't forget to carefully maintain cleanliness in the house. Personal hygiene products such as pads, diapers, wipes, etc. must be disposed of immediately after use.

Prevention of any disease depends on the degree of protective mechanisms. It is necessary to harden the child, to visit more often fresh air and eat right to keep your immune system normal.

Thank you

Coxsackie virus very common throughout the world, and has many manifestations. It was identified back in 1950 in the USA, in the small town of Coxsackie, hence its name. But, despite its widespread prevalence, this virus is still rarely diagnosed, in many cases the diagnosis sounds like “fever unknown origin", "allergic dermatitis", "chicken pox", "flu" or "ARVI". All due to the fact that Coxsackie has many faces, and it is not always possible to identify specific specific symptoms. And tests for viruses In our country, unfortunately, it is not customary to carry out this procedure in all cases of acute viral infections; it is expensive. Coxsackie may be asymptomatic, in the form of a three-day fever, typical manifestations of the virus, serous meningitis or severe infectious process with damage to vital organs.

Interesting facts about the Coxsackie virus

• More than 95% of people in the world are infected with the Coxsackie virus sooner or later; this mainly occurs in childhood.
• Enteroviral infections most cases affect children early age(up to 5 years). In adults, this infection is detected quite rarely, which is due to the fact that by adulthood a person has already suffered this virus and has specific antibodies to it. Coxsackie does not affect children under 3 months of age, unless congenital infection transmitted from the mother during pregnancy or childbirth.
• Mother's milk protects the baby from Coxsackie and its severe course throughout the entire period of breastfeeding - it's all about maternal immunoglobulins.
• It is very easy to become infected with the Coxsackie virus; up to 85-90% of those in contact with infectious patients become infected. Therefore, outbreaks and epidemics of this infection are very often recorded, especially in preschool children's groups. Children's institutions may be quarantined.
• Coxsackie often presents with hand-foot-mouth syndrome. The syndrome gets its name from the typical rashes that cover these parts of the body.
• Coxsackie often manifests itself as "summer flu" intestinal virus", "herpetic sore throat". This is due to the peculiarity and diversity of its clinical picture.
• Like many viruses, the Coxsackie virus negatively affects immunity, reducing protective forces to other viruses and bacteria.
• The Coxsackie virus is especially dangerous for children under two years of age, pregnant women, HIV-positive people and people with various immunodeficiencies.
• Coxsackie is not herpetic infection, as many people think, even these viral pathologies often very similar in clinical manifestations.

Coxsackie epidemics in the resorts of Turkey, Cyprus and Sochi

Interesting! Coxsackie epidemics are found everywhere, and do not depend at all on the level economic development countries. If other intestinal infections lead to epidemics mainly in “poor” countries, then Coxsackie epidemics periodically occur in European countries, the USA and Japan. This is explained by the fact that the virus is transmitted not only by the fecal-oral route, but also by airborne droplets.

The causative agent of infection

The Coxsackie virus is the largest group of the enterovirus genus, but not the only one.

Other representatives of enteroviruses:

• ECHO - echoviruses, are very similar to the Coxsackie virus in their characteristics and the clinical manifestations of the disease they cause, they are often combined into one group;
• Virus polio - especially dangerous infection, affecting the nervous system and leading to paralysis and disability;
• Rhinoviruses– viruses that cause ARVI primarily affect the mucous membrane of the upper respiratory tract, especially the nose and paranasal sinuses;
• Human enteroviruses, including hepatitis A virus.

Characteristics of Coxsackie and ECHO viruses

* All serotypes of the Coxsackie and ECHO viruses can cause diseases that are absolutely identical in symptoms and severity. Coxsackie A virus is much more common and has a milder course. Also, these serotypes of group A are characterized by an asymptomatic or typical course of the disease. The most common variant of Coxsackie A is hand-foot-mouth syndrome and herpangina. Coxsackie B virus often has a severe and atypical course of the infectious process, can be accompanied by various complications, and is more dangerous for pregnant women than virus A.

How is Coxsackie virus infection transmitted?

Source of infection:

• a sick man;
• virus carrier.

1. Contact and fecal-oral route from a patient or a virus carrier - viruses that are released in the feces and saliva of a patient can end up on various household items, in bodies of water, including swimming pools, in drinking water or on food (if personal hygiene rules are not followed). When swallowed, the virus ends up in the intestines, then in Peyer's patches (intestinal The lymph nodes), where it reproduces.

2. Airborne path from a sick person - viruses from a sick person enter the air during coughing, sneezing and loud conversation, where they remain suspended for some time. When such air is inhaled, the virus enters the nasopharynx, where it multiplies.

3. Transplacental route– from mother to child (rare).

Coxsackie pathogenesis: what happens in the body?

What organs and tissues can the Coxsackie virus infect?

• Mucous membranes of the nasopharynx, oral cavity and tonsils;
• lymph nodes of all groups, especially the intestines (Peyer's patches);
• muscle tissue, including myocardium;
• less often – mucous membranes of the intestines, eyes, liver cells;
• embryos and fetus during pregnancy.

Who is a virus carrier?

Isolation of the virus is always observed in patients after acute Coxsackie virus infection. The patient seems to have recovered, but the virus still lives and multiplies in his intestines. Isolation of the virus can persist for a long time, up to 2 months, on average 10-21 days. It all depends on the characteristics of both the virus and the human body.

But virus carriage can also be determined in people who did not have symptoms of the disease, that is, in clinically healthy people, and these account for up to 40% of all coxsackie virus isolates. This suggests that the person suffered from Coxsackie asymptomatically. Asymptomatic viral shedding is also typical for other enteroviral infections.

The virus is shed by patients with a chronic course of Coxsackie infection; they can be infectious for a year or more.

Virus carriage is probably the factor that favors the development of outbreaks and epidemics of Coxsackie.

Incubation period

Symptoms and signs of the Coxsackie virus, photo

Interesting that the typical form of the Coxsackie virus is less common than its atypical course. All this is due to the asymptomatic manifestation of the virus, enteroviral fever and catarrhal phenomena of the upper respiratory tract.

Syndromes of a typical enterovirus infection associated with the Coxsackie virus:

• herpangina (herpetic sore throat);
• Boston (enteroviral) exanthema and hand-foot-mouth syndrome;
• epidemic myalgia;
• aseptic meningitis.

• asymptomatic (non-hardware) course of the disease;
• enteroviral fever, which is often also called " minor illness"or summer flu;
• respiratory form or catarrh of the upper respiratory tract;
• enteroviral encephalitis and meningoencephalitis;
• hemorrhagic conjunctivitis and uveitis;
• spinal or polio-like form of enteroviral infection;
• neonatal encephalomyocarditis;
• acute mesadenitis;
• enterovirus infection with damage to the digestive organs: acute hepatitis, pancreatitis, gastroenteritis, gastroenterocolitis;
• acute nephritis and other syndromes associated with damage to internal organs by the virus.

1. Flow options:

• lung;
• average;
• heavy.

In addition, the course of enteroviral infections can be:

• smooth – recovery occurs within 10-20 days;
• wavy;
• recurrent;
• with complications.

• isolated – in the presence of only one syndrome;
• combined – when the virus affects several organs and systems.

Minor illness or summer flu (enteroviral fever)

Summer flu can be caused by all serotypes of the Coxsackie and ECHO viruses.

This form is characterized only by intoxication syndrome. That is, the Coxsackie virus does not affect vital organs, and usually does not lead to a complicated course of infection.

Symptoms of intoxication with the Coxsackie virus:

• acute onset;
• increased body temperature above 39 o C;
• headache;
• weakness, lethargy;
• body aches;
• loss of appetite, even to the point of refusing to eat;
• redness of the pharynx and palatine arches, slight granularity back wall pharynx;
• a feeling of heat, which may be followed by bouts of chills;
• redness of the eyes may occur;
• infrequently in the background high temperature vomiting and stool disorders develop;
• In many children, the peripheral lymph nodes become enlarged; they are small, painless, and elastic when palpated;
• In some children, the liver and spleen become enlarged.

In some cases, a wave-like course may be observed, that is, after relief, a repeated febrile period begins, which ends just as quickly, and recovery occurs.

Herpangina (herpangina)

Herpetic sore throat always has an acute onset, occurs with severe intoxication and with the appearance of specific changes in the mouth.

Interestingly, with catarrhal and other forms of tonsillitis, tonsils enlarge, and with herpetic tonsillitis, changes appear on the mucous membrane covering the tonsils, but they do not increase. The main part of the rashes is observed on the soft palate, palatine arches and uvula - this is what distinguishes herpangina. Herpetic stomatitis differs from herpangina in that a herpetic rash appears on the mucous membrane throughout the oral cavity, most often in the area of ​​the mucous membranes of the cheeks, lips, gums, and hard palate.


Photo: healthy pharynx The structure of the soft palate.

Symptoms of intoxication are the same as for minor illness; fever usually persists for up to 5 days.

Symptoms in the oral cavity with herpetic sore throat:

• 1st day – redness of the tonsils, arches and uvula;
• 1-2 days - whitish papules (or nodules) up to 4 mm in size appear on the soft palate, tonsils and arches;
• 2-3 days - papules become vesicles with red outlines;
• 3-4 days - the blisters burst, erosions (ulcers) form with redness around;
• After the 4-5th day, healing of the ulcers and restoration of the mucous membranes occurs.

These changes are accompanied by itching and soreness in the throat, aggravated by swallowing and eating. In young children, this symptom may manifest itself as crying and complete refusal to eat.

With herpetic sore throat, the rashes are multiple or single, sometimes only one element of the rash is detected.

Complete recovery from herpetic sore throat occurs in 5-7 days.

Enteroviral exanthema and hand-foot-mouth syndrome

This syndrome is more common for group A Coxsackie viruses, less often for group B, as well as for the ECHO virus.

Exanthema, like other manifestations of enterovirus infection, begins acutely, with an increase in body temperature. Unlike the summer flu, the body temperature may not be as high, but other symptoms of intoxication are also expressed. There may be redness of the throat and eyes. The fever is usually not long-lasting; after 1-2 days the body temperature normalizes or decreases to lower numbers. But as the intoxication subsides, a rash appears on the skin and mucous membranes of the mouth.

Localization of the rash:

• face, most often in the area around the mouth, sometimes a rash appears on the scalp;
• body, more in its upper part;
• limbs, especially on the palms and soles;
• buttocks and groin.

Changes in the oral cavity. First, small nodules appear, which quickly become bubbles, they burst and ulcers (aphthae) form. Ulcers are almost always accompanied by pain. The child refuses to eat, cries, and does not allow the oral cavity to be examined. Increased salivation is observed, as when teething in infants. After 3 days, the oral mucosa is usually completely restored.

Rash with enteroviral exanthema - viral pemphigus:

Typically, Boston exanthema and hand-foot-mouth syndrome proceed favorably, but there are situations when meningitis and other severe manifestations of Coxsackie develop against the background of exanthema. This form of enterovirus infection is often combined with other syndromes.

Coxsackie virus and nails. Many people who have had enteroviral exanthema, after 2-8 weeks, changes in the nails appear. This may be their fragility, detachment from the nail plate (“nails peel off”), changes in the shape and color of the nail. Many people note total defeat all fingernails and toenails. And this can continue for more than one month. But after a complete renewal of the nails, they will definitely return to their previous healthy state.

The causes and mechanism of development of nail problems after the Coxsackie virus are still not known. Many scientists do not associate this symptom with enteroviral infections at all, explaining them with reduced immunity, fungal infection of the nails, or a deficiency of vitamins and microelements. But the relationship between Coxsackie and nail disease is still observed in most patients.

Photo: late symptom Coxsackie virus, "nails peel off."

Epidemic myalgia (Bornholm disease)

The disease begins acutely, with a sudden increase in body temperature to 40 o C. This is accompanied by chills, headaches, and severe weakness. On the same day, muscle pain appears - this is the main syndrome of epidemic myalgia.

Character pain syndrome for epidemic myalgia:

• Muscle pains are sharp character, manifest themselves in attacks that usually last from 30 seconds to 10 minutes and are repeated every few hours. At the same time, the patient experiences unbearable torment, for which this pathology was called "damn fight". Cases of such an attack lasting up to 2 days have been described.
• Pain in the intercostal muscles in the lower part is most pronounced. chest. They are accompanied by difficulty breathing, shortness of breath, and worsen with a deep breath or cough. All this reminds clinical picture pleurisy (inflammation of the serous membranes of the lungs - pleura). This is where epidemic myalgia got its name - pleurodynia(translated from Latin as “pain in the pleura”).
• Pain in the upper abdomen and navel area is also intense. This condition is often mistaken for acute stomach(appendicitis, peritonitis, intestinal obstruction, etc.).
• Myalgia is also observed in the muscles of the limbs, neck, and face, but the pain in them is less pronounced.
• The pain syndrome usually lasts from 2 to 4 days, then relief occurs, but there are cases of the development of a second wave of fever and “devil’s contraction”.

Serous (aseptic) meningitis

How to suspect meningitis?

• Acute onset: with an increase in body temperature to high numbers, weakness, sore throat;
• severe headaches: they are constant and appear within the first day from the onset of the disease;
• vomiting not associated with food intake (so-called “cerebral vomiting”);
• In infants and young children, convulsions may develop; in adults, consciousness may be impaired;
• rigidity of the muscles of the back of the head appears - it is impossible to reach the sternum with the chin; in small children, when trying to raise their head while lying on their back, the entire torso rises;
• other symptoms of meningitis develop - meningeal signs, such as Kernig's and Brudzinski's symptoms, but only a doctor can determine them;
• In the inpatient department of the infectious diseases department, an analysis of the cerebrospinal fluid is carried out; it flows out under increased pressure; in the laboratory, changes characteristic of all serous meningitis are detected.

When meningitis is combined with other manifestations of the Coxsackie virus, all their symptoms can develop in parallel. But most often, meningitis occurs with the second wave of fever, that is, on the 5-7th day from the onset of enterovirus infection.

The prognosis for such meningitis is usually favorable, if it is started in a timely manner. adequate treatment After 3-7 days, the patient’s condition improves, and after 2-3 weeks, complete recovery occurs.

Other Coxsackievirus syndromes

Syndrome	Main symptoms	Peculiarities
Encephalitis, meningoencephalitis- inflammation of the brain.	Intoxication syndrome (fever, weakness, body aches, etc.); symptoms of meningitis: headache, vomiting, impaired consciousness, meningeal signs, etc.; focal symptoms of brain damage: imbalance, swelling of the cheeks when exhaling, impaired swallowing and speech, convulsions, paresis and paralysis, mental disorders and other manifestations of brain damage.	Encephalitis most often develops against the background of meningitis, and has a long and severe course. After such encephalitis, brain atrophy, epilepsy and mental illness, and in children of the first years of life - hydrocephalus.
Poliomyelitis-like course of enterovirus infection– damage to neurons of the spinal cord and medulla oblongata.	Acute onset; absence of intoxication syndrome; symptoms similar to paralytic polio ; flaccid paralysis, most often of the lower extremities; pain in the limbs; decreased muscle tone; attacks of muscle tremors; decreased tendon reflexes; disturbance of stool and urination.	Unlike polio, this form of enterovirus infection is much milder and, in most cases, without complications. After 4-8 weeks, recovery usually occurs, paralysis goes away, and muscle function is restored. It is the polio-like form of the Coxsackie virus that is often mistaken for an outbreak of polio, horrifying all doctors and the population.
Enteroviral mesadenitis– inflammation of the intestinal lymph nodes.	Acute onset; fever and other symptoms of intoxication; acute attacks of pain in the abdomen, in the area near the navel; lack of stool or

Prevention of diseases caused by enteroviruses is based on compliance general rules sanitation and quality control food products. The polio vaccine is an urgent means of prevention.

Enterovirus infection is an infectious disease caused by the Coxsackie virus, polioviruses and ECHO. The pathology affects the lymph nodes, nervous system, mucous membranes, organs digestive tract, heart, eyes and muscle tissue. Prevention of enterovirus infection reduces the risk of contracting EVI and prevents severe complications.

There is currently no specific vaccine. This is due to the fact that in nature there are more than 60 strains of enteroviruses that are capable of constantly changing and developing resistance to medicines. About 90% of the adult population are asymptomatic or are carriers of the infection.

At risk are pregnant women, children, adolescents, people with severe immunodeficiency, suffering oncological diseases. Children are difficult to tolerate infection, long-term symptomatic therapy is required, and possible development severe complications. After the disease is cured, the human body develops immunity.

Nonspecific prevention of enterovirus infection in children includes:

• compliance with hygiene rules;
• instead of tap water, you need to drink boiled or bottled;
• washing fresh vegetables and fruits before eating;
• swim in clean waters;
• destroy insects, set traps, mosquito nets;
• do not buy food products of questionable quality;
• drinking boiled or pasteurized milk;
• washing hands with soap after using the restroom or public places, before eating;
• healing of the body.

Since enterovirus infection is transmitted through contact with an infected person, it is necessary to isolate the patient and provide him with separate utensils and personal hygiene items. It is necessary to disinfect things and bedding regularly wet cleaning with the addition of disinfectants and ventilate the room. People caring for an infected patient should wear a gauze mask and wash their hands thoroughly with soap and water.

Viruses can survive for a long time at low temperatures, but when things and food are heat treated, the pathogens die. Chlorine-containing preparations, ultraviolet radiation can have a detrimental effect on enteroviruses.

During the spread of the epidemic, you should try to avoid visiting places large cluster people, public events. The main peak of incidence occurs in the summer-autumn period, the largest percentage of cases are children under 14 years of age. With local outbreaks of infection, the time of year does not matter. If the first symptoms of illness appear, you should immediately consult a doctor!

Anti-epidemic measures

Enterovirus infection occurs everywhere, most often outbreaks are recorded in kindergartens and schools. The reason for the formation of local foci may be non-compliance sanitary standards in a particular institution, the unsatisfactory condition of sewerage and water supply.

In accordance with planned activities, employees of the sanitary and epidemiological service examine tap water and water in reservoirs for the presence of enterovirus and microbial contamination. In order to prevent epidemics, explanatory conversations are held among employees Food Industry related to the production, delivery and sale of food products.

Children infected with enterovirus infections are identified during admission to kindergartens, schools, and summer camps. It is important to detect the patient in a timely manner, conduct medical examination and further investigation specific case infection.

If an enterovirus infection is detected or suspected, the sanitary-epidemiological service will close a school, kindergarten or a separate group for quarantine, place children in an isolation ward, where patients will be examined. Whether there is a need for hospitalization of children is determined by an infectious disease doctor.

Health workers are monitoring preschool employees, parents of infected children and people who had contact with the children. A child who feels unwell is not allowed into kindergarten and is required to urgently see a doctor.

In all groups, utility rooms, and the kitchen, disinfection is carried out using special means in double dosage. It is prohibited to conduct social events, welcoming new children. Outdoor walks should be carried out separately for each group.

The management of the preschool institution should issue a memo to parents, which indicates the basic measures for the prevention of enterovirus infection and early Clinical signs that appear after infection.

Preventive work in the epicenter of the epidemic

To localize the source of the epidemic, infected people are actively identified by interviewing and examining employees at enterprises, kindergartens and schools. Health workers conduct door-to-door surveys of residents and, if enterovirus infection is suspected, carry out hospitalization.

People who have had contact with an infected patient are monitored for 20 days, and if necessary, patients are quarantined. Persons with severe symptoms of illness are placed in a hospital setting; for mild manifestations (myalgia, hyperthermia, herpangina), it is enough to isolate the patient for 10 days. After this, the person is not contagious to others and is immune to enterovirus infection.

Sanitary and epidemiological service workers take water samples for laboratory testing. Patients undergo analysis of feces, nasopharyngeal swabs and blood. In the epicenter of the epidemic, it is prohibited to hold public events, swimming in open water bodies, or swimming pools. Suspending training in preschool institutions and in children of primary school.

In places where enteroviruses are detected, disinfection is carried out with drugs with virucilidal activity. If necessary, tap water is chlorinated, and a mandatory regime for drinking boiled or bottled water is introduced. Supervision of water supply and sewerage systems is being strengthened.

Urgent methods of prevention

An immediate method of prevention is to administer polio vaccine. The principle of action is based on the colonization of the gastrointestinal tract of children a certain type poliovirus, which can displace other strains from the body. Vaccination is carried out once in children under 14 years of age for medical reasons.

Children located in the epicenter of the epidemic can have Leukocyte Interferon instilled into their nose. The drug has antiviral, immunomodulatory and anti-inflammatory effects. Thanks to the composition of active substances, the immunological status is enhanced, the body's resistance to the penetration of viruses is increased and the risk of complications is reduced. Interferon is instilled 5 drops into each nasal passage 2 times a day.

How to recognize enterovirus infection

Infection occurs through airborne droplets, household contact, and fecal-oral routes. The source of infection can also be contaminated tap water, living in unfavorable sanitary conditions, swimming in stagnant bodies of water, or failure to comply with hygiene rules.

In most cases, EVI infection occurs in mild form or practically asymptomatic. Severe clinical manifestations occur in children with weak immunity.

With a mild form of enterovirus infection, the following signs are observed:

• fever;
• increased body temperature;
• general weakness, malaise;
• body aches, muscle pain;
• the appearance of a rash on the feet, hands, face and mouth.

Sporadic enterovirus infection is characterized by a three-day fever without other symptoms. The patient's well-being is slightly affected; hyperthermia can persist for 2–4 days. The disease is difficult to diagnose, so it is often mistaken for ARVI; the diagnosis of EVI is confirmed if outbreaks of infection are detected in one team.

The rash looks like spots, vesicles, and may contain bloody spots. Skin manifestations occur 1–2 days after the temperature rises and go away on their own. a short time without special treatment.

Enterovirus infection can be complicated by herpetic sore throat, vesicular pharyngitis, conjunctivitis, stomatitis, uveitis, meningoencephalitis, and heart disease. In some cases, paresis of the limbs occurs and the reproductive organs in boys.

Caring for a sick child

The incubation period of the disease is 3–10 days. The first sign of the development of pathology is an increase in body temperature to 38–39°; hyperthermia can persist for up to 5 days. The child complains of general malaise, poor appetite, headache and muscle pain. After the temperature normalizes, a characteristic rash forms on the feet, palms and mouth (hand-foot-mouth syndrome). The severity of symptoms depends on the state of the immune system.

A sick child must be isolated, the doctor decides whether it is necessary to place the baby in a hospital or whether therapy can be carried out at home. If there is no damage to internal organs or the central nervous system, the viral infection is mild, children are on outpatient treatment under the supervision of parents and pediatrician.

In the room where the patient is located, it is necessary to regularly carry out wet cleaning with the addition of chlorine-containing detergents into water (formalin 0.3%, hydrogen peroxide), wipe the door handles with a disinfectant solution. The room should be ventilated daily. Personal belongings, hygiene items, potties and toys of the child must be disinfected. Bed linen should be washed at 95° and ironed with a hot iron. The baby must have individual personal hygiene items, towels, and dishes.

The duration of treatment is 7–14 days. If the infection does not cause serious complications, the child can attend kindergarten or school. In case of damage to the central nervous system, after meningoecephalitis, children are on dispensary observation at the doctor's.

Infection with enterovirus infection can cause damage to the cardiovascular, nervous, digestive system, upper respiratory tract, eyes. Preventing the epidemic and infection with polioviruses helps to avoid severe complications of the disease. It is enough to follow simple preventive measures and consult a doctor when the first symptoms of illness appear.