Enterovirus infection in children. Enterovirus infection in adults. Causes, symptoms and treatment. Prevention of infectious diseases. Possible complications of EVI

Enterovirus infection is a group of acute infectious diseases caused by intestinal viruses. Outbreaks of morbidity, often recorded in different countries, allow us to conclude that this type of infection is intensifying throughout the world. The occurrence of mass diseases and sporadic (single) forms of it is due to healthy virus carriage, the duration of which is no more than 5 months.

Causes, pathogenesis and epidemiology of the disease

Intestinal viruses, or enteroviruses, include:

• Coxsackie viruses A (23 types) and B (6 types);
• polioviruses (types 1,2,3);
• enteroviruses 68-71 types;
• ECHO viruses (32 serovars).

Enteroviruses exist in nature due to the presence of two reservoirs: the external environment (soil, water, food), where they persist for a long time, and humans, in whose body they multiply and accumulate.

The source of infection is a virus carrier or a sick person. The virus is transmitted by airborne droplets (coughing, sneezing) or fecal-oral route (through dirty hands). Seasonality – summer-autumn. The bulk of the sick are children and young people. Immunity after an illness lasts for several years.

There is also a vertical route of transmission of infection, that is, from mother to fetus. It has been proven that if a woman catches an enterovirus during pregnancy, the risk of congenital infection in the child increases significantly.

The entry gates for enteroviruses are the mucous membranes of the upper respiratory tract and gastrointestinal tract, upon contact with which the virus multiplies, causing local symptoms of inflammation: acute respiratory infections, intestinal dysfunction. Subsequently, the pathogen penetrates the blood, with a current that spreads throughout the body.

Symptoms of enterovirus infection

Intestinal viruses have a high tropism (affinity) for many tissues and organs of our body, so the manifestations and clinical forms of the disease can be very diverse.

It is worth saying that in a practically healthy organism, enterovirus infection in most cases is asymptomatic. It is most dangerous for people with immunodeficiencies (cancer patients, HIV-infected people) and for newborns.

The lion's share of clinically noticeable manifestations are cold-like diseases - enterovirus is one of the main causative agents of acute respiratory viral infections.

As already mentioned, the forms of the disease can be very diverse. Let's look at the main ones.

1. Catarrhal (respiratory) form. Patients are concerned about nasal congestion, runny nose, rare dry cough, and sometimes mild digestive disorders. Symptoms persist for 7–10 days, after which they disappear without a trace.
2. Gastroenteric (intestinal) form. Patients complain of abdominal pain of varying intensity, bloating, loose, watery stools up to 10 times a day, and sometimes vomiting. There may be weakness, lethargy, loss of appetite, and an increase in temperature to subfebrile (up to 38ºC). In young children, this form can be combined with catarrhal disease. Young children are sick for 7–14 days, children over 3 years old – 1–3 days.
3. Enteroviral fever. This form is the most common manifestation of the infection we describe, but in sporadic cases it is rarely diagnosed. It is characterized by an increase in temperature for 2–4 days without the presence of local symptoms. Symptoms of intoxication are moderate, general health is usually not affected.
4. Enteroviral exanthema (“Boston fever”). From 1–2 days of illness, pink rashes of a macular and maculopapular nature, sometimes with a hemorrhagic component, appear on the skin of the face, torso, and limbs of the infected person. After 1–2 days, the elements of the rash disappear without a trace.
5. In addition to exanthema, manifestations of enterovirus infection on the skin and mucous membranes are herpetic sore throat, vesicular pharyngitis, conjunctivitis, and in some cases uveitis.
6. Sometimes the nervous system is also affected - meningitis develops (70–80% of infectious lesions of the central nervous system in children), encephalitis, neuritis of the facial nerve, polyradiculoneuritis.
7. Also rare forms of infection include neonatal encephalomyocarditis, myocarditis, and kidney damage.

Diagnostics

• Serological methods (detection of enterovirus infection markers in blood serum).
• Virological methods (isolation of viruses from the clinical material being studied).
• Immunohistochemical methods (detection of antigens to enteroviruses in the patient’s blood).
• Molecular biological methods (detection of RNA fragments of viruses).

Treatment

Therapy for enterovirus infection should be aimed at destroying the virus and alleviating the symptoms of the disease.

• Antiviral drugs (in particular, interferons) are used to combat the pathogen.
• Symptomatic therapy includes drugs that relieve one or another condition causing discomfort to the patient (antiemetics, painkillers, antispasmodics, and others).
• If a secondary bacterial infection occurs, antibiotics must be prescribed.

Prevention

To prevent the spread of infection, the patient should frequently wash their hands, dry them with an individual towel, and use personal utensils. Also, in the source of infection, you should often wet clean the room and ventilate it.

Specific prevention of enterovirus infection has not been developed.

Which doctor should I contact?

If signs of an acute infection appear, you should contact a pediatrician or therapist, and if the condition is severe, contact an infectious disease specialist. If complications develop, the patient is examined by a specialized specialist - a gastroenterologist, neurologist, ENT doctor, cardiologist, nephrologist, ophthalmologist.

The child's body is highly susceptible to the influence of various infectious processes. For example, they often catch rotavirus or enterovirus infection. For most parents, these diseases are almost identical, but in reality they are not. Enterovirus infection in children can be much more dangerous.

This disease according to the International Classification of Diseases (ICD 10) has code B34.1, where the pathology is noted as a viral infection of unspecified localization. On forums, many parents study instructions and reviews of drugs for enterovirus together, but to make the right choice you need to consult a doctor. The specialist will have to identify the causative agent of EVI and study the characteristics of a particular situation.

Pathogen

The development of the described disease is caused by the activity of picornaviruses of the enterovirus genus. The pathogen consists of a single strand of ribonucleic acid, which is located inside a protein shell. The pathogen contains two antigens, one of which unites it with the entire genus, and the other is specific only for this serotype.

In total, about seventy strains of enteroviruses can cause disease in humans. They are divided into the following groups:

• polio viruses,
• ECHO viruses,
• Unclassified enteroviruses.

The Coxsackie virus is also isolated in children. It comes in two types - A and B. The first includes 24 serotypes that are dangerous to the human body, and the second another 6. Such pathogens can be found almost anywhere. The pathogen can survive in difficult conditions. Being in the external environment, it remains viable for a month, and if it gets into the feces, it can live for six months.

The virus will easily tolerate low temperatures, exposure to acids, ethyl alcohol, phenolic compounds and diethyl ether. But relatively high temperatures are destructive for it - more than fifty degrees. Strains are also killed by drying and disinfection, such as formaldehyde, potassium permanganate and hydrogen peroxide.

Virus activity in the body

Entering the human body, enterovirus primarily affects lymphoid tissues. It affects them in the small intestine and pharyngeal ring. Most often this happens in the summer-autumn period with children under ten years of age. Thanks to stronger immunity, older children are able to more easily endure the disease. If they follow preventive and sanitary rules, then usually the disease is asymptomatic and does not bother the child.

It is also difficult for enterovirus to infect newborns, because babies are breastfed. Mother's milk gives them all the necessary antibodies, and therefore they are protected from the disease. Later, the child can become infected from a sick person or a carrier of the virus. Often children who have had an enterovirus infection asymptomatically remain carriers for another five months after recovery.

Note. Sometimes the infection is transmitted to the child from a sick mother during pregnancy.

The most common route of transmission of the pathogen is fecal-oral. Airborne droplets are somewhat less common, but they are also possible. Typically, the pathogen enters the child's body if he does not follow hygiene rules, drinks unboiled water or unprocessed milk, does not wash fruits or vegetables, or bathes in untested places. The virus is also transmitted through toys and other things of sick people.

Forms of the disease

The incubation period can range from two to ten days. Initially, the pathogen encounters the nasopharynx and digestive tract. If the baby has a strong immune system, then the disease may be limited to weak local inflammatory reactions or there may be no symptoms at all. Otherwise, the pathology spreads through the intestines, penetrates the circulatory system and gradually reaches almost any organ.

Symptoms of enterovirus infection in children can be very diverse, since the disease has many forms. All of them are divided into typical and atypical. Among the first are:

• Herpetic sore throat,
• Exanthema,
• Epidemic myalgia,
• Serous meningitis.

If the pathogen leads to the appearance of an atypical form of the disease, then the child may develop pancreatitis, gastroenteritis, nephritis, epididymitis and other diseases of the genitourinary system. Enteroviral fever, uveitis, myocarditis and catarrhal form of infection occur. Encephalomyocarditis occurs in newborns.

Symptoms

In children, the symptoms of enterovirus infection may have similar signs. These include severe fever, poor appetite, headache, weakness and chills. Some experience enlargement of the submandibular and cervical lymph nodes, vomiting and nausea. To these standard symptoms, others are added, depending on the form of the disease.

Herpangina sometimes develops due to Coxsackie infection. Characteristic manifestations are:

• Rashes on the palate, tonsils and palatine arches,
• Red papules gradually turning into vesicles
• Pain when feeling the affected lymph nodes.

The rash in the throat of children due to enterovirus infection is usually small, about two millimeters, and the total number of vesicles, as a rule, is no more than eighteen. They usually open on their own on the second day of illness. At this time, small wounds form, but then they disappear without a trace.

If the pathogen leads to the appearance of serous meningitis, then the signs of enterovirus infection in children will be as follows:

• Heat,
• Apathy or anxiety
• Strong headache,
• Cramps.

Serous meningitis is considered one of the most dangerous forms of infection, since during the illness the membranes of the brain become inflamed. This leads to a stiff neck, Brudzinski and Kerning signs, and other manifestations. Usually the disease begins to subside after five days, but some residual effects persist for three months.

Polio

Another dangerous form of enterovirus infection is polio. When it develops, the gray matter of the spinal cord is damaged, which disrupts the state of the central nervous system. In particularly serious cases, complications arise in the form of paresis or paralysis. The latter usually occurs with few symptoms.

There are different forms of polio, but more than 80% of cases of the disease occur in the visceral or abortive form. With this option, the patient suffers from:

• Diarrhea,
• Catarrhal phenomena,
• Pain in the head and stomach,
• Symptoms of intoxication,
• Fevers.

Most often, this form goes away after a week of treatment and does not affect the neurological functions of the body. How many days the symptoms will persist largely depends on the child’s immunity. The paralytic form is considered the most severe, in which pain in the limbs, confusion, hyperesthesia and convulsions appear in the second wave. Paresis and paralysis occur already on the sixth day of the course.

Medical institutions have special clinical recommendations, that is, a protocol for the treatment of children with polio. It is impossible to diagnose the disease from a photo or cure it at home, so parents should take their child to the clinic as soon as possible to avoid negative consequences if signs occur.

Diagnostics

If an infectious process is suspected, the baby is taken to a pediatrician. He can redirect the child to a neurologist, cardiologist or other doctor, depending on the form of the disease. To clarify the diagnosis, use:

• Linked immunosorbent assay,
• Blood analysis,
• Serological studies.

The search for the pathogen is carried out by collecting biological material in the area where the lesion is observed. Sometimes discharge from the eyes or nasopharynx is taken; in case of intestinal manifestations, feces are examined, or scrapings from the skin are taken. In some cases, it is necessary to differentiate the pathology from other diseases with similar manifestations.

It is very important to correctly identify the causative agent of herpetic sore throat. It can develop due to the activity of Candida fungi, in which case drugs against viruses will be ineffective. If the doctor suspects serous meningitis, he must make sure that it is not tuberculosis or, for example, meningococcal infection.

Treatment

Enterovirus infection can be treated at home only in mild cases. If your baby has a high fever that cannot be brought down with pills, he will have to be hospitalized. At the moment, there are no therapeutic agents that act directly on the pathogen, so treatment is symptomatic. Since the body is affected by a virus and not a bacterium, antibiotics are not used.

Note. After an enterovirus infection, a child receives immunity for life, but only to the single strain that entered the body.

Therapy for this disease usually includes medications aimed at strengthening the immune system. This may be interferon, immunomodulatory agents or immunoglobulins. Depending on the symptoms, children are given ibuprofen, paracetamol, water-salt solutions, antiemetics and antihistamines. Sometimes it is necessary to gargle or restore intestinal microflora.

Nutrition and prevention

To quickly cope with the disease, a diet is used for enterovirus infection in children. First of all, it includes a sufficient amount of liquid, avoidance of fatty, fried, smoked, spicy and salty foods. You should not eat fresh fruits and vegetables, as well as foods that increase intestinal motility.

Usually children are given buckwheat or rice porridge, baked apples and pears, compote and other warm liquid. Vegetable soups and white bread are acceptable. When the condition of the gastrointestinal tract improves, you can add steamed meat dishes to the menu. The therapeutic diet allows the consumption of biscuits and green tea without sugar.

There are special instructions for parents that discuss the prevention of enterovirus infection in children. It includes tips such as washing hands, washing fruits and vegetables, drinking bottled water and other personal hygiene practices. You can get vaccinated, but it will only protect against the Coxsackie virus or ECHO. This will reduce, but not eliminate, the risk of infection.

Doctor Komarovsky's opinion:

Enterovirus infection has another name - “hand - foot - mouth”, because, despite the great variety of clinical manifestations, a rash is more often observed on the above parts of the body. The disease often has a smooth course, but, at the same time, requires immediate consultation with a specialist and the prescription of the correct treatment.

Enterovirus infection in children is a disease that occurs with a pronounced clinical picture of general intoxication. Since there is more than one causative agent (a group of intestinal viruses, genus Enterovirus), the clinical manifestations are characterized by significant diversity.

Pediatrician

Enterovirus in children is quite common. Pediatricians can confidently say that this disease occurs as often as a banal acute respiratory viral infection. Young children and those with weakened immune systems are more often affected. Outbreaks of infection in closed institutions are often observed.

The causative agent of enterovirus infection

It is known in the scientific world that enterovirus infection is caused by intestinal viruses - Coxsackie, ECHO, as well as unnamed enteroviruses, united according to the similarity of symptoms and designated as 68-71. Most often it is possible to identify the first two pathogens in the biological material of a patient.

Also, these viruses have been sufficiently studied today. Namely, the Coxsackie pathogen has about 30 serological variants, and the ECHO virus has 34. In addition, it is divided into 2 groups - A and B.

All enteroviruses are capable of persisting for a long time in the external environment.

The Coxsackie and ECHO viruses are capable of maintaining long-term viability and the ability to cause diseases under normal “room” conditions. For example, a favorite place is a public swimming pool and open reservoirs. Also, the pathogen can often be detected in food products, such as milk, bread, vegetables and fruits. In the feces of a sick person, viruses remain active for 6 months or more.

Spread of enterovirus

Source of infection

The source of infection can be a virus carrier or a sick person. Infection is possible in several ways. The fecal-oral route occurs when a person is infected through contaminated food or water. The airborne mechanism of infection is possible when infected secretions enter the upper respiratory tract. Quite rarely, infection occurs through household means, that is, through contaminated hands, household items, and personal belongings. The disease is most often detected in children.

More often, enteroviruses affect children aged 1 to 3 years and preschoolers.

Enterovirus infection is characterized by seasonality, namely, it has a peak of infection in the summer-autumn period. After suffering from the disease, the convalescent has only type-specific immunity, that is, tolerance to only one serological variant of the virus.

Pathogenesis

How can we explain the polymorphism of clinical manifestations for the same virus? The thing is that the pathogen, settling on epithelial cells, lymphoid formations of the mucous membrane of the upper respiratory tract or intestines, spreads through the blood to various tissues and organs, thereby affecting them, causing many clinical symptoms.

Classification of enterovirus infection

There are several types of classifications of this disease.

By type of pathogen:

• Coxsackie;
• ECHO;
• enteroviruses 68-71.

By type of disease:

• typical(herpetic tonsillitis, intestinal, respiratory, paralytic forms, epidemic myalgia, myacarditis, meningitis, enteroviral exanthema, and combinations of these forms of the disease are also possible).
• atypical(erased, asymptomatic).

According to the severity of the symptoms of the disease:

• lung;
• moderate severity;
• heavy.

According to the course of the disease:

• smooth;
• not smooth (with complications, with layering of secondary flora).

Symptoms of enterovirus infection in children

General symptoms

Despite the fact that there can be a great variety of clinical manifestations, the incubation period for all forms is the same and ranges from 1 to 10 days. General symptoms also have similarities and are characteristic of all types of manifestations of the disease. The disease begins acutely, with an increase in temperature to high numbers (39 - 40 ºC).

Symptoms of intoxication quickly appear:

• headache;
• fatigue;
• malaise;
• lack of appetite;
• nausea;
• vomit;
• lethargy.

A distinctive feature of the general symptoms may be redness of the upper half of the body (face, neck, chest), as well as dilation of the blood vessels in the sclera of the eyes.

The appearance of a maculopapular rash on favorite areas of the skin (legs, hands, palms, feet) is often observed. Upon examination, redness of the mucous membrane of the oropharynx is revealed, the tongue is covered with a white coating. may persist for 3 - 5 days, after its normalization, the symptoms of intoxication disappear.

A general blood test allows us to conclude that there is a viral infection (normal or slightly increased number of leukocytes, increased lymphocytes and eosinophils).

Clinical variants of enterovirus infection

Serous meningitis

Serous meningitis is characterized by an acute onset. The temperature rises to febrile levels, symptoms of general intoxication appear, which tend to increase. Against the backdrop of high temperatures, children often develop fevers. Due to the involvement of the meninges in the inflammatory process, meningeal symptoms (Brudzinsky, Kernig, neck muscle tension) are added to the above-described symptoms.

Only a specialist can identify such symptoms. Meningeal signs are more pronounced at the height of the fever and disappear a week after the onset of the disease. This form of the disease requires the collection of cerebrospinal fluid (CSF). Analysis of the cerebrospinal fluid shows an increase in lymphocyte cells.

Inflammatory manifestations in the cerebrospinal fluid (cerebrospinal fluid) disappear only by the end of the fourth week from the onset of the disease. Normalization of cerebrospinal fluid parameters is observed a month after the onset of the disease. This form of enterovirus infection is one of the most severe; recovery from infection takes a long time; some symptoms (nausea, loss of appetite, headache) may bother the patient for several months after the tests have normalized.

Herpangina

It has nothing to do with herpes; it is so named because the elements of the rash are similar to herpetic elements. There is no enterovirus infection without other symptoms. As a rule, it is combined with other forms. It is also characterized by an acute onset and the appearance of general intoxication symptoms.

With this clinical form of enterovirus, the oral mucosa is necessarily affected - a fine blistered rash appears on the soft and hard palate, on the palatine arches. Elements of the rash can open, merge and form extensive erosions. This causes discomfort to the child, he refuses to eat and cries.

Children who can already speak will complain of pain. Regional lymph nodes are involved in the inflammatory process.

Epidemic myalgia

A feature of the course of this form of enterovirus infection is the appearance of muscle pain. The pain increases with movement, the attack of pain goes away after 3-5 minutes. Absolutely any muscles can hurt, including intercostal muscles (superficial gentle breathing), abdominal muscles (it is necessary to exclude acute abdominal surgical pathology during examination - for example, appendicitis).

Intestinal form

Typical for infants. The disease also has an acute onset. The intestines are involved in the inflammatory process, which means that characteristic pain and stool type disturbances appear (when examined, mucus is often found in the stool). Abdominal bloating is observed. The combination of the above-described symptoms with catarrhal symptoms testifies in favor of enterovirus infection.

Myocarditis

Occurs in newborns and children up to six months. It is very difficult and often fatal. General symptoms are not specific: fever, shortness of breath, lethargy, vomiting, diarrhea. On auscultation, this form is characterized by the appearance of heart murmurs and cardiac arrhythmias. Other physical methods can detect an increase in the size of the heart and liver.

Enteroviral exanthema

The rash due to enterovirus infection has one characteristic feature. It always appears after the temperature has normalized. Typical locations for enterovirus rash are the limbs and face. The rash rarely appears in the torso area. More often, the elements of the rash look like small pink spots, a little less often papules can form.

Enteroviral infection can persist for up to several days, sometimes it can resolve within a few hours.

Paralytic form

Against the background of normal temperature, signs of damage to nerve endings appear - weakness in the limbs, gait disturbance. It is necessary to differentiate from polio.

How is the diagnosis confirmed?

In the initial stages of diagnosis, it is necessary to obtain a thorough medical history in adults.

The time of year, the child’s contacts with sick people, any information will help the specialist make the correct diagnosis and, accordingly, prescribe the necessary treatment. Laboratory research methods should be prescribed to the patient to exclude controversial diagnoses.

Non-specific methods(complete blood count) do not have typical signs of the disease. Therefore they use specific. These include virological and serological methods. For virological research, biological material from the patient is required (mucus from the nasopharynx, feces, blood, cerebrospinal fluid).

The most significant for diagnosis is the isolation of the virus from the blood and cerebrospinal fluid. For serological research, special reactions are used (neutralization and inhibition of hemagglutination). The necessary material is blood, which is taken at the beginning of the disease and after 3 weeks.

The diagnostically significant result will be a 4-fold increase in antibody titer. Enzyme immunoassay can detect protective antibodies.

Treatment of enterovirus infection

Main groups of drugs

Unfortunately, there is no specific treatment for enterovirus infection.

The principles of treatment for this disease are symptomatic:

• antipyretics(, Ibuprofen) are used at temperatures above 38.5 ºC;
• antiseptics(Hexoral, Miramistin) for treating the mucous membrane of the oropharynx, as well as for relieving sore throat - Tantum Verde;
• dehydration therapy(Lasix, Diacarb) for serous meningitis;
• hormone therapy(Prednisolone) for myocarditis.

Treatment of enterovirus infection is based more on compliance with routine measures and diet. During the period of fever, patients are prescribed strict bed rest. Mild and moderate course of the disease can occur at home.

And patients with severe forms of the disease should be observed in a 24-hour hospital. The average length of treatment in hospital is 21 days.

Diet for enterovirus infection in children

The diet has some features. On the first day, patients are offered only plenty of fluids. The drinking regime must be appropriate throughout the treatment of the disease. Fried foods are excluded, as well as fresh vegetables, fruits, and meat. Food should be pureed, gentle, warm and well digested. Broths, porridges, and vegetable purees are recommended.

Complications of enterovirus infection

As a rule, enterovirus infection has a smooth course and complications rarely develop. But severe forms of the disease can be complicated by cerebral edema and seizures. The addition of secondary bacterial flora (otitis media, pneumonia) is possible.

Dispensary observation

Discharge from the hospital should occur upon complete disappearance of clinical symptoms (no earlier than 2 weeks). If other organs are affected (kidneys, heart, eyes, liver), the child is taken under the supervision of appropriate specialists.

Specific prevention against enterovirus infection exists, but not everyone does it. It is indicated for seriously ill children, as well as in the presence of concomitant pathology. Prevention is carried out urgently according to epidemic indications. The drug is oral polio vaccine.

When a doctor discovers a patient with enterovirus infection, he must immediately submit an emergency notification to the Center for Hygiene and Epidemiology. Contact children under 6 years of age are isolated and monitored for 20 days. Patients are isolated for 10 days provided there is no damage to the nervous system. In the room where the patient was, current and final disinfection is carried out.

In summer and winter, adults and children, low-income and frankly rich - enterovirus infections spare no one. The symptoms of diseases associated with this pathogen have a wide range. The geography of viruses and their diversity is amazing. Let's try to understand the etiology, sources, routes of infection, treatment methods and clinical recommendations for enterovirus infection.

Relevance of the topic

Data on epidemiological outbreaks recorded in different countries demonstrate an increase in enteroviral infections in the world. The geography of distribution of this group of pathogens is ubiquitous, clinical manifestations are varied.

The peculiarity of infections of this kind is associated with the concept of virus carriage. This means that the virus can be in the human body, but manifests itself in special cases - when natural immunity is weakened. In addition, virus carriage contributes to the formation of spores, leading to mass diseases and infection of a large number of non-immune recipients.

Pathogenicity and manifestation

This is a group of infections that are mostly asymptomatic or do not cause too much harm to a person. But there are exceptions to every rule. It is enterovirus infections that are in second place in the frequency of cold-like diseases.

The infection can be extremely dangerous and affect all systems and organs, muscles, and mucous membranes. This anthroponosis has two reservoirs:

• humans, where the pathogen multiplies and accumulates;
• environment (water, air, food), where virions are able to maintain virulence for a long time.

The main route of transmission of enteroviral infections is airborne - the fastest and most unpredictable. No less effective is the route of infection into the human body through the food route and oral-fecal route. There is also a vertical route of infection - from the carrier mother to the newborn. And it is with this phenomenon that many pediatricians associate sudden infant death syndrome.

What kind of animal is this?

Microbiology of enteroviruses

The group of human pathogens includes representatives of the picornovirus family (Picornaviridae). This family includes more than 60 pathogens from the genus Enterovirus, Rhinovirus, Cardiovirus, and Aphtovirus.

The genus of enteroviruses includes polio viruses (3 forms or serotypes), Coxsackie viruses of group A (24 serotypes) and B (6 serotypes), ECHO (Enteric Cytopathogenic Human Orphans - intestinal cytopathogenic human orphans, 34 serological types), hepatitis A virus and many unclassified enteroviruses. They all have a number of similar structural features:

• These are small viruses (from pico - “small”), measuring within 28 nanometers.
• They have a cubic type of capsid, built from 4 types of proteins.
• They have a common complement-fixing antigen for the entire genus; serotypes differ in type-specific protein antigens.
• The genetic material is single-stranded linear RNA.
• The outer supercapsid shell, carbohydrates and lipids are absent.
• They are highly stable in the external environment. That is why they are not killed by stomach acid.

Pathogenicity and resistance

Representatives of this genus are ubiquitous and infect plants, animals, and bacteria. Enteroviruses enter the body in various ways, mainly through the digestive tract, reproduce in the mucous membrane and lymph nodes, penetrate the blood and spread throughout the body. Damage to one or another organ depends on the type of pathogen and the immune status of the recipient.

Enteroviruses are common on all continents of the planet. They remain contagious (infectious) in the environment for up to a month, and in feces for up to six months. They are resistant to freezing, but die when heated to 50 °C. They remain pathogenic in acidic environments (they are not afraid of gastric juice), are resistant to the action of 70% alcohols, but are destroyed by the action of ultraviolet radiation and ultrasound.

When disinfecting premises and objects, oxidizing agents (hydrogen peroxide and potassium permanganate), chlorine-containing agents, and formaldehyde are used, which inactivate the pathogen.

Diagnosis of enteroviral infections

The specificity of diagnosing pathogens of this group of diseases is based on identifying all pathogens present in the body. The material for research is feces and urine, washings from the affected areas of the mucous membranes, blood and cerebrospinal fluid. The following methods are used to diagnose enteroviral infections:

1. Virological research. This technique uses cell cultures and laboratory animals. For example, to determine all serotypes of the polio virus, clinical material is used using continuous cultures of the renal epithelium of monkeys. The polymerase chain reaction reaction is also used.
2. Serological tests. The method of paired sera and color samples is used. The method is based on the ability of viruses to suppress metabolism in a cell, change the pH of the environment and, accordingly, the color of the test sample.
3. Express method. Quite complex and not widespread. Cardiac analysis (changes in the nuclei of affected cells) is used for diagnosis.

Many pathogens - many manifestations

Forms of enteroviral infections in accordance with modern classification:

• Intestinal, or gastroenteric. The disease lasts from one to two weeks. Clinical manifestations: rhinitis, swelling of the mucous membranes of the oropharynx, cough, flatulence, diarrhea and vomiting.
• Enteroviral fever. Symptoms: fever up to 40 °C, weakness, muscle pain, redness of the sclera of the eyeball, nausea and vomiting, and in rare cases, diarrhea. The disease lasts 3-7 days. Pathogens are enteroviruses of all subtypes.
• Catarrhal or respiratory (herpangina). The disease lasts up to a week and proceeds as an acute respiratory disease. Caused by Coxsackie viruses A and B. Symptoms: short-term fever with a slight increase in temperature, sore throat, ulcers on the walls of the pharynx and tonsils, loss of appetite.
• Intestinal infection. The duration of the disease in young children is up to 2 weeks, in older and adults - 1-3 days. Only the intestinal mucosa is affected. Clinic: abdominal pain, frequent and loose stools, diarrhea, possibly a slight increase in body temperature.
• Myocarditis. Disorders of the heart due to damage to its different layers. Symptoms include increased heart rate, fatigue, weakness, decreased blood pressure and chest pain. The causative agents are Coxsackie B5 and ECHO.
• Exanthema. Within 3-5 days, a rubella-type rash appears on the face and body.
• Conjunctivitis. Symptoms: pain in the eye, blurred vision, lacrimation and hemorrhages, enlarged lymph nodes may be observed. The illness lasts up to two weeks. Pathogens: enterovirus serotype 70, Coxsackie 24.
• Meningitis and encephalitis. The most severe form of enterovirus infection. Clinical manifestations: severe pain, high fever, vomiting, delirium, convulsions. The course of the disease occurs in periodic outbreaks, which can last up to 2 months. The causative agents of this form are the Coxsackie B and ECHO viruses.
• Paralytic form. Accompanied by unilateral or bilateral paralysis of the limbs, decreased muscle tone. Symptoms can persist for up to 8 weeks; with severe development, death is possible due to disturbances in the respiratory center.
• Epidemic myalgia. A rather rare disease that manifests itself in paroxysmal pain in the muscles, chest and abdomen. Accompanied by fever and increased sweating. Duration of the course is up to 10 days. The causative agents are Coxsackie B3 and B5.
• Encephalomyocarditis of newborns leads to death in 60-80% of cases. Pathogens are Coxsackie viruses of group B. Symptoms: lethargy, convulsions, heart failure, breast refusal.

The incubation period in all cases lasts from 2 to 15 days. The onset of the disease is always acute. There may be mixed forms of infection.

Pathogen entry gate

Before asking the question of how to treat enterovirus infection in children, let’s figure out how it enters the body. The entry gates in this case are the mucous membranes of the respiratory tract and digestive tract, where viruses enter through the fecal-oral or airborne routes.

When a pathogen enters the mucous membranes, a local inflammatory reaction begins. This will end the infection if the immune system is strong enough. But if the immune status is weakened, and the virulence of the virus is high and its quantity is quite large, then generalization of the infection occurs. It penetrates the bloodstream and spreads throughout the body in accordance with the tropic characteristics of the pathogen.

Depending on the affected organ or tissue, the clinical picture and symptoms of the disease can be very diverse.

General symptoms and course of the disease

The severity and duration of enterovirus infection depends on many factors. These include:

1. Virulence of the pathogen (the ability to resist the body’s defense mechanisms).
2. Features of tropism - the direction of the virus to damage certain organs and tissues.
3. Immune status of the infected person. The higher it is, the more likely the body’s victory over the pathogen.

As is already clear, viruses of this group can infect various systems and organs of our body. But regardless of the source of infection, the common symptoms of such infections are the following:

• The temperature during enterovirus infection rises from 38 ºС to 40 ºС.
• Swelling of the submandibular and other lymph nodes.
• Weakness and drowsiness.
• In some cases, rash.
• Nausea, vomiting and diarrhea.

Preventive measures

There are no special methods of prevention in this case. To avoid infection, you must first of all follow the rules of personal hygiene: wash your hands and food, drink boiled and purified water. During a disease outbreak, avoid visiting crowded places. But, perhaps, the main thing is to monitor the condition of the body and increase immunity. A healthy lifestyle, proper nutrition and exercise will minimize the possibility of a viral attack.

If there is an infected family member, all those in contact should be more careful about preventive measures. Separate utensils and personal hygiene items for the patient and increased attention to the personal hygiene of all family members should be a priority.

In children's institutions, in case of outbreaks of enterovirus infections, quarantine is established for 14 days from the date of last contact, and anti-epidemic measures (disinfection) are carried out. Quarantine is also introduced in maternity hospitals, and all employees who had contact with patients are sent on vacation for two weeks.

How to treat enterovirus infection in children?

Children, due to their immune status, are more susceptible to such diseases. If you suspect an enterovirus infection in a child, you must contact your pediatrician and receive a referral to conduct research necessary in a particular case. Sometimes it may be necessary to consult doctors of narrow specialties - a cardiologist, otolaryngologist or ophthalmologist.

Treatment of mild forms of the disease is carried out on an outpatient basis and only if meningitis, myocarditis and other combined lesions are suspected, the child can be hospitalized. There are no special drugs for enterovirus infection. Treatment boils down to reducing negative symptoms, preventing dehydration and promptly identifying side effects.

As a rule, the body copes with the infection on its own within a week, and no significant consequences of enterovirus infections are observed. To maintain the body, drugs of a symptomatic (for example, antipyretic) and pathogenetic nature (sorbents and antiseptic ointments) are usually prescribed. There are no restrictions on the diet, but it is worth remembering that nutrition for enterovirus infection must be balanced and take into account the nature of the disease. So, if the oropharynx is infected, food should not be hot or cold, which will ease the pain when swallowing it.

Antibiotics are prescribed for secondary infections and complications of enterovirus infection, such as pneumonia, otitis, myocarditis. For some forms of disease, hormonal drugs are prescribed. But all these appointments should be made by a doctor after carefully studying the research results and taking into account the patient’s condition.

The most typical enteroviral diseases

It is impossible not to list the most common and considered typical infections that are caused by enteroviruses. These include:

• Summer flu. The most common infection occurs when swimming in rivers and the sea. Overheating and hypothermia contribute to the development of infection. The symptoms combine flu-like symptoms and intestinal upset. The disease lasts from 3 to 7 days, accompanied by fever, diarrhea, sore throat, and sometimes conjunctivitis.
• Herpangina. Herpes-like rashes in the back of the throat and on the tonsils. The disease goes away in 3-5 days.
• Viral pemphigus. The appearance of bubbles filled with liquid on the palms, between the fingers, on the soles. Fever accompanies infection in the first 1-2 days; symptoms disappear within a week.
• Viral exanthema. It is caused by echoviruses and is accompanied by a rash all over the body, similar to rubella. It is not so common, symptoms disappear within ten days.

In conclusion, I would like to note that this group of diseases is characterized by the phenomenon of virus carriage. Often adults do not get sick, but are virus carriers. But children, with their immune system not yet stable, become easily infected. Therefore, observing the rules of personal hygiene is mandatory for both adults and children. And remember - the key to the body’s victory over viruses that constantly attack it is strong natural immunity. Be healthy and take care of yourself and your children!

How does enterovirus infection manifest itself in children? The symptoms of this group of diseases are very diverse, and parents are not always able to quickly recognize the insidious virus. How does the disease manifest in children? How dangerous is enterovirus infection for a child?

General information about the causative agent of the disease

Enterovirus infection is a whole group of diseases caused by certain intestinal viruses (enteroviruses). Enterovirus is widespread and is found even in the most remote corners of the globe. In recent years, there has been a tendency towards an increase in enterovirus infection throughout the world.

The causative agents of the disease are various representatives of the Enterovirus genus. This large group includes such well-known viruses as Coxsackie and ECHO. The Enterovirus genus includes more than 100 infectious agents that are potentially dangerous to humans. Viruses are very persistent in the environment, which partly explains the ubiquity of the infectious diseases they cause.

A feature of enterovirus infection is healthy virus carriage. The virus can exist in the human intestine for up to 5 months without losing its properties. Thus, the source of infection can be a completely healthy person, who is not even aware of the dangerous viral agents that have settled inside.

The disease is transmitted in three ways:

• airborne;
• fecal-oral;
• vertical (from mother to fetus).

Enterovirus infection is more common in children and adolescents. The peak incidence occurs in summer and autumn. After recovery, long-term immunity remains for several years.

Basic forms

Enterovirus, penetrating the child’s body, is able to settle in a variety of tissues. Epithelial and muscle cells, the nervous system and internal organs are not protected from the harmful effects of the virus. Quite often, the disease occurs without severe symptoms, forming stable type-specific immunity. The body’s protective reaction is developed only in response to the type of virus that has entered the cells and caused a certain immune reaction.

The incubation period lasts 2-10 days. There are many forms of enterovirus infection. The following varieties deserve special attention:

Herpangina

The causative agent of herpangina is the Coxsackie virus. The first signs of the disease appear acutely 3-4 days after infection. Symptoms of herpangina include:

• high body temperature (up to 40°C) with relatively good health;
• moderate or mild sore throat;
• typical changes in the pharynx.

Fever lasts from 2 to 5 days. During this period, the mucous membrane of the pharynx becomes hyperemic (red), after which single bubbles appear on it, filled with transparent contents. The blisters quickly open, and in their place ulcers appear, covered with a typical gray coating. Individual ulcers can merge with each other. Changes in the pharynx persist for 7 days from the onset of the disease.

Do not open the blisters yourself to avoid introducing a secondary infection into the oral cavity.

Serous meningitis

Meningitis is an inflammation of the lining of the brain. Caused by all groups of enteroviruses. The disease begins suddenly with a sharp rise in body temperature, weakness and chills. In the future, signs of damage to the membranes of the brain appear:

• stiff neck;
• severe bursting headache;
• vomit;
• disturbance of consciousness;
• intolerance to noise and bright light.

To diagnose meningitis, cerebrospinal fluid is collected. In some children, a second wave of fever occurs due to the appearance of meningeal symptoms.

Epidemic myalgia

Another name for this pathology is Bornholm disease. The causative agents of the disease are considered to be Coxsackie viruses and some serotypes of ECHO. Signs of viral infection appear suddenly on the first day of illness:

• high body temperature;
• severe muscle pain (abdominal and chest area);
• increased pain with any movement.

Attacks of pain occur every hour and last no more than 10 minutes. Fever persists for 3 days. Many children develop typical symptoms of meningitis against the background of myalgia.

Consult a doctor when the first signs of illness appear!

Myelitis

Inflammation of the spinal cord occurs when affected by the Coxsackie and ECHO viruses. The disease occurs in the form of mild forms of paralysis. Recovery from the disease occurs quite quickly. Persistent paresis and paralysis are not typical.

Heart damage

Myocarditis (damage to the muscular lining of the heart) and pericarditis (inflammation of the heart sac) have a favorable course. Against the background of fever, moderate pain occurs in the heart area. On examination, the muted heart sounds are noticeable. Recovery from illness occurs quite quickly. No serious consequences are observed.

Enteroviral diarrhea

Signs of the intestinal form of infection are known to all parents:

• frequent watery stools;
• moderate abdominal pain;
• rare vomiting;
• flatulence;
• high body temperature.

In children under 2 years of age, diarrhea is often accompanied by a runny nose, sore throat, and other signs of a respiratory infection. The duration of the illness is no more than 7 days.

Enteroviral fever

Another name for this form of infection is “minor disease.” Characterized by a moderate increase in body temperature without a pronounced disturbance in the general condition. Mild catarrhal symptoms in the form of a slight runny nose and redness of the throat are possible. Recovery occurs within 3 days. The disease is rarely diagnosed due to very nonspecific symptoms.

Enteroviral exanthema

Boston fever manifests itself as a typical rash in the form of pink spots on the face, limbs and torso. The rash occurs against a background of high body temperature on days 1-2 of illness and lasts no more than 3 days. After the rash disappears, no traces remain on the skin.

Various forms of enterovirus infection are often combined with each other. In the same child one can encounter manifestations of herpangina, myalgia or meningitis at the same time. In most cases, the diagnosis is made based on the typical symptoms of the disease.

Complications

Enterovirus infection in any form can cause the following pathology:

• myocarditis (inflammation of the heart muscle);
• pericarditis (damage to the pericardium);
• disruption of the heart valves;
• changes in heart rate.

The severity of complications can be very different, from minor functional disturbances in the functioning of the heart to the formation of serious defects. It is quite difficult to predict in advance how the virus will behave in a child’s body. Heart complications should not be confused with a special form of enterovirus infection - acute myo- and pericarditis. In the latter case, the disease goes away within 7-10 days without any consequences for the child.

Principles of therapy

Treatment of enterovirus infection in children, regardless of the form of the disease, can only be symptomatic. At the moment, there are no effective drugs that can cope with the cause of the disease – enterovirus. To enhance nonspecific immunity, human interferon preparations are actively used. The virus does not develop resistance to interferons, which allows the use of such drugs even during re-infection.

Immunoglobulins are also used for nonspecific therapy of enterovirus infection. These products increase the child’s immunity, allowing the body to cope with the dangerous virus and its consequences. The most effective use of interferons for the treatment of infection in newborns and children of the first year of life.

Antibiotics are not used in the treatment of enterovirus infection. These drugs can be prescribed by a doctor only when a secondary infection occurs. In most cases, this treatment regimen is used in weakened and premature infants.

Diet for enterovirus infection in children is of particular importance. In case of damage to the gastrointestinal tract, it is recommended to adhere to the following rules:

1. A child's diet should be varied and balanced in essential vitamins and microelements.
2. Meal frequency – up to 6 times a day in small portions.
3. In the first days of illness, it is not recommended to eat fried, hot and spicy foods. All dishes must be steamed or baked in the oven. For babies, it is best to serve familiar dishes in the form of purees.
4. On the first day of illness, the volume of food is reduced by 50%, on the second and third – by 30%. In the future, it is recommended to gradually return to your usual diet.
5. The child should drink as much as possible throughout the entire period of illness. It can be plain water, natural juice, fruit drink or compote. Weak sweet tea is allowed. In cases of severe dehydration, saline solutions are prescribed.

If the enterovirus infection has not affected the digestive tract, a special diet is not required. The child can eat whatever he is used to, provided he feels well.

Prevention

No specific prevention of enterovirus infection has been developed. Some experts recommend using interferon drugs to protect against possible infection. Before using interferons, you should consult your doctor.

Nonspecific prevention includes daily ventilation and wet cleaning of the premises in which the child is located. Compliance with the simplest rules of personal hygiene and eating only proven food products significantly reduces the risk of developing enterovirus infection in children and adults.