Enterovirus infection in children and adults: signs, treatment. Symptoms and treatment of enterovirus infection

In adults, it leads to the development of a wide variety of diseases - some of them are extremely dangerous, such as meningitis and polio, while others are quite harmless. The prevalence of this variety of viruses is of concern, since they can remain active for quite a long time even when exposed to aggressive environmental factors.

Enterovirus infection in adults can lead to the so-called "Boston fever", which is accompanied by fever and a characteristic skin rash. Interestingly, all these symptoms disappear on their own after a few days.

Representatives of this also cause conjunctivitis, tonsillitis, otitis media, hepatitis and other diseases.

Enterovirus infection in adults: methods of treatment

Unfortunately, at present there is no single effective treatment. In most cases, doctors are not even able to establish which virus caused a particular disease. Of course, therapy is primarily symptomatic. Patients are given antipyretic and pain medications. It is extremely important that the patient's diet is complete and saturates the body. useful substances and vitamins. Patients are also advised to drink plenty of fluids, which prevents dehydration and speeds up the process of removing toxins. Immunomodulators are also used for treatment, since the only way to protect the body is to strengthen its defenses.

It applies whole group infectious acute diseases capable of infecting adults and children with viruses of the genus Enterovirus. The virus often causes entire outbreaks of mass infections around the world. The infection can cause various clinical manifestations, which makes it difficult to diagnose and diagnose.

What is an enterovirus

This type of infection is named so because they initially multiply in the gastrointestinal tract. Enterovirus is the common name for a whole list of infections that can cause different symptoms, can affect the skin and internal organs: lungs, heart, spinal cord and brain (meningitis). Viruses are divided into those that use RNA or DNA as genetic material. They are all part of an even larger group called picornaviruses. As a rule, RNA-containing enteroviruses are pathogenic for humans. This group includes:

• 5 types of Cox B and 23 group A viruses;
• 32 ECHO serovars;
• From 68 to 71 types of enteroviruses D;
• 1-3 polioviruses.

In addition to them, many unclassified enteroviruses also belong here. The genus consists of over 100 infections that are dangerous to human health and are widespread throughout the world, which have a high resistance threshold to physicochemical factors. Some of the enteroviral bacteria do not die after freezing or treatment with ether, Lysol or 70% alcohol. Remain viable in faeces for more than six months.

Incubation period

A person can become infected from a carrier by airborne droplets, fecal-oral route. For some time, the disease does not manifest itself, the incubation period of enterovirus infection is up to 14 days, but, as a rule, clinical signs appear on the 5-7th day. The virus can remain active for a long time, especially in children's feces, which can be contagious for more than 5 months.

Enterovirus infection symptoms

This group of viruses is great amount diseases every year. Symptoms of enterovirus infection do not always appear, more than 90% of cases go unnoticed for a person, sometimes nonspecific febrile illnesses are provoked. Once in the body, pathogens can cause signs of the disease in different combinations. There are such possible common symptoms of enterovirus:

• Reflux, nausea, bloating, indigestion, pain in the lower or upper abdomen, constipation alternating with diarrhea, cramps.
• Muscle twitching, spasms, numbness of limbs, tingling of the face.
• Nasal congestion, sinus congestion, runny nose, sore throat, nose, ears, loss of sense of taste, smell, difficulty swallowing.
• Sudden weight loss due to indigestion, reduced calories, but possibly weight gain due to lack of activity.
• Throbbing, aching, sharp headache.
• Pain in joints, bones, muscles.
• Wheezing, shortness of breath, cough (various).
• Pain in the pelvis, testicles, violation reproductive function.
• Palpitations, chest tightness, pain.
• A sharp rise in temperature (fever), after a few hours there is a rapid fall, severe night sweats, chills.
• Tachycardia.
• Sleep disturbance, concentration, short-term memory problems, cognitive disorders.
• Ulceration, vesicles in the oropharynx, in women sometimes on the cervix/vagina;
• Decreased acuity, blurred vision.
• AT armpits, neck area enlarged lymph nodes.

In children

Clinical picture when a child is infected, it is usually erased. Enterovirus in children can affect various organs, so the palette of signs is diverse, non-specific. Similar symptoms appear with different serotypes of infection or, conversely, different manifestations in one subspecies. Symptoms of enterovirus infection in children are often similar to SARS or AII (acute intestinal infection). An accurate diagnosis can only be made after a blood test. Clinical signs diseases:

1. Similar to SARS symptoms. The child, as a rule, complains of perspiration, which causes a sore throat. Symptoms include cough, snot.
2. Temperature rise. At the first stage of infection, it is very high, then there is a strong decrease, and after a couple of days it rises again. This "wave" is characteristic of an enterovirus. The disease can be accompanied by diarrhea, vomiting, which suddenly appeared and just as suddenly ended.
3. Muscle pain. As a rule, pain is localized in the abdomen, chest, sometimes on the back, arms or legs. Pain increases with movement, sometimes it is paroxysmal in nature, lasting from a couple of minutes to 30. If treatment is not started on time, this symptom can become chronic.
4. Diarrhea, vomiting. A common sign of this type of infection in children under 2 years of age. Diarrhea is sometimes accompanied by bloating and pain. Diarrhea lasts 2-3 days, it is important to constantly replenish water balance to prevent dehydration due to enterovirus infection.
5. Eruptions. In children, they are called enteroviral exanthema. They usually appear 2-3 days after the temperature on the neck, face, chest, legs, arms and back. Have a characteristic appearance: small red dots on skin, similar to the measles rash. Sometimes a child develops rashes on the mucous membrane of the mouth and throat. They look like bubbles, which then burst, turning into sores. A doctor with experience will be able to determine enterovirus disease at the location of the rash: on the palms, around the mouth, on the throat (herpangina)

There are additional symptoms:

• drowsiness, lethargy;
• loss of appetite, general malaise;
• swelling of the extremities;
• dizziness, headache;
• enlarged lymph nodes;
• stomach ache;
• dehydration;
• conjunctivitis, redness of the eyes, lacrimation.

In adults

The danger of the pathogen lies in the fact that it penetrates the intestines, from where it can affect any human organ. Enterovirus in adults manifests itself depending on the type of virus. Different strains can cause certain signs, both specific and non-specific. The exact classification of the infection can be determined using a blood test. known the following symptoms enterovirus infection in adults:

1. Epidemic myalgia causes paroxysmal acute pain in the limbs, abdomen, back.
2. Enteroviral exanthema manifests itself in the form of maculopapular skin rashes on different parts body.
3. Indigestion, dry rare cough, rhinitis, slight reddening of the throat is accompanied by catarrhal form illness.
4. With the development of herpetic sore throat on the mucous membrane in the oral cavity, painful sores are observed on the tongue. A person's temperature rises to 39-40 degrees, he should swallow the patient.
5. Hemorrhagic conjunctivitis is accompanied by lacrimation, pain in the eyes, photophobia, swelling of the eyelids, serous, purulent discharge.
6. Gastroenteritis is characterized by vomiting, diarrhea, flatulence, bloating, nausea, and abdominal pain. It is extremely difficult for a child to endure this form of illness.
7. Rash all over the body, high fever - signs of Boston fever.

Rash

Such a symptom manifests itself in the form of small, flat red dots on the back, chest in large numbers. The rash of an enterovirus infection may at first be mistaken for measles. When a child becomes infected, abdominal pain, diarrhea, and vomiting begin. An enterovirus rash is not the only sign of infection; papules filled with liquid form on the tonsils and in the mouth, which then burst and turn into sores.

As a rule, the disease has a duration of 5-7 days, in the last stages symptoms similar to a typical cold appear: runny nose, cough, sore throat. The rash persists for some time after recovery, it begins to disappear 1-3 days after the disappearance of other signs. After that, the child is no longer contagious and recovers completely.

Enteroviral infection treatment

Specific (etiotropic) therapy of the disease on this moment does not exist. Treatment of enterovirus infection is carried out by introducing a solution of leukocyte interferon. If consequences are observed due to complications due to the attachment of a secondary bacterial infection The patient is prescribed a course of antibiotics. In the presence of lesions of the nervous system by infection, hormonal therapy with the use of corticosteroids is prescribed. A blood test will help determine the correct course of therapy.

In children

First place in therapy small child it becomes a question of restoring electrolyte balance, eliminating dehydration of the body. There are several options for treating an enterovirus infection, depending on the type of virus. For rehydration therapy use saline solutions, 5% glucose. Another milestone– compliance bed rest, which will not allow the virus to develop actively, save the child's strength.

Treatment of enterovirus infection in children includes dietary adjustments. For a speedy recovery, the child must follow a diet, because a weakened body is not able to absorb normally heavy food. For the duration of therapy, you should come up with a light menu so that there is more protein food. If necessary, the baby can be given antipyretics (antipyretics), if there is a concomitant bacterial infection, antibiotics are prescribed.

In adults

With this disease, it is very important to alleviate the patient's condition, get rid of the symptoms and the virus. Treatment of enterovirus infection in adults consists in the selection of the right medications based on the severity of the course of the disease, inflammatory process. As a rule, painkillers, interferon, antihistamines, antipyretics, antispasmodics are used for therapy. Treatment of enterovirus is supplemented with antibiotics when a bacterial infection is attached.

Prevention

There are no specific actions that will help protect against infection by 100%. If there is an asymptomatic carrier near you, then only a mask will help prevent the transmission of the virus, strong immunity can protect you. Enteroviral infection prevention includes general protective actions that theoretically help you avoid infection. You should:

1. Handle fruits and vegetables carefully before eating. Enteroviral bacteria long time can survive outside the human body.
2. After being in public places, the restroom should wash your hands. If this is not possible, then you need to have sanitary napkins with you.
3. If there is an infectious person in the family, then the dishes from which he ate should be thoroughly washed, things should be washed (the infection can also be transmitted through them).
4. For prevention, it is necessary to regularly ventilate the room, carry out wet cleaning.
5. In case of mass infection of people, children are injected with interferon, immunoglobulin in small doses to improve the protective mechanism, adults are advised not to attend public places where there are many people.

Video

In summer and winter, adults and children, low-income and frankly rich - enterovirus infections do not spare anyone. The symptomatology of diseases that are associated with this pathogen has a wide range. The geography of viruses and their diversity is amazing. Let's try to understand the etiology, sources, routes of infection, methods of treatment and clinical recommendations for enterovirus infection.

Relevance of the topic

Data on epidemiological outbreaks recorded in different countries, demonstrate the activation of enterovirus infections in the world. The geography of distribution of this group of pathogens is ubiquitous, clinical manifestations are diverse.

The peculiarity of infections of this kind is associated with the concept of virus carriers. This means that the virus can be in the human body, but manifests itself in special occasions- with a weakening of natural immunity. In addition, virus carrying 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 harm a person too much. 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:

• a person 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 enterovirus infections - airborne - is the fastest and most unpredictable. No less effective is the way the infection enters the human body through the food route and oral-fecal. 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 members of the picornavirus family (Picornaviridae). This family includes more than 60 pathogens from the genus enteroviruses (Enterovirus), rhinoviruses (Rinovirus), cardioviruses (Cardiovirus) and autoviruses (Aphtovirus).

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

• These are small viruses (from pico - "small"), measuring in the range of 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 resistant to the environment. That is why they are not killed by stomach acid.

Pathogenicity and resistance

Representatives of this genus are ubiquitous, affecting plants, animals, bacteria. Enteroviruses enter the body different ways, mainly through the digestive tract, are reproduced in the mucosa and lymph nodes enter the bloodstream 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. Frost-resistant, 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 ultraviolet and ultrasound.

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

Diagnosis of enterovirus infections

The specificity of diagnosing pathogens of this group of the disease is based on the identification of all pathogens present in the body. Material for research - feces and urine, swabs from the affected areas of mucous membranes, blood and cerebrospinal fluid. The following methods are used to diagnose enterovirus infections:

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

Many pathogens - many manifestations

Forms of enterovirus infections according to modern classification:

• Intestinal, or gastroenteric. The illness 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, in rare cases - diarrhea. The disease lasts 3-7 days. The causative agents are enteroviruses of all subtypes.
• Catarrhal or respiratory (herpangina). The disease lasts up to a week and proceeds as acute respiratory. Caused by Coxsackie 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. Duration of illness in children younger age up to 2 weeks, for 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 in connection with the defeat of its different layers. Symptoms are associated with increased heart rate, fatigue, weakness, decreased pressure, and chest pain. Pathogens - Coxsackie B5 and ECHO.
• Exanthema. Within 3-5 days, a rubella-like rash appears on the face and body.
• Conjunctivitis. Symptoms: pain in the eye, blurred vision, lacrimation and hemorrhage, there may be an increase in lymph nodes. The illness lasts up to two weeks. Causative agents: 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 is intermittent outbreaks that can last up to 2 months. The causative agents of this form are Coxsackie B and ECHO viruses.
• paralytic form. It is accompanied by unilateral or bilateral paralysis of the limbs, a decrease in muscle tone. Symptoms can persist for up to 8 weeks, with severe development, death is possible due to violations of the respiratory center.
• epidemic myalgia. Enough rare disease, manifested in paroxysmal pain in the muscles, in the chest and abdomen. Accompanied by fever and increased sweating. The duration of the course is up to 10 days. Pathogens - Coxsackie B3 and B5.
• Neonatal encephalomyocarditis - in 60-80% leads to death. The causative agents are Coxsackie viruses of group B. Symptoms: lethargy, convulsions, heart failure, refusal of the breast.

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 how to treat an enterovirus infection in children, let's figure out how it enters the body. In this case, the mucous membranes serve as the entrance gate. respiratory tract and digestive tract, where viruses enter the fecal-oral or airborne routes.

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

Depending on the affected organ or tissues, the clinic and symptoms of the disease can be very diverse.

General symptoms and course of the disease

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

1. The virulence of the pathogen (the ability to resist defense mechanisms organism).
2. Features of tropism - the focus of the virus on the defeat of certain organs and tissues.
3. The immune status of the infected. The higher it is, the more likely the organism's victory over the pathogen.

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

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

Preventive measures

special ways prevention in this case does not exist. In order to avoid infection, it is necessary first of all to observe the rules of personal hygiene: wash hands and food, drink boiled and purified water. During an outbreak, avoid visiting crowded places. But, perhaps, the main thing is to monitor the state of the body and increase immunity. healthy image life, proper nutrition and physical exercise minimize the possibility of a virus attack.

In the case of an infected family member, all contacts 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, during outbreaks of enterovirus infections, quarantine is introduced, which is set for 14 days from the moment of the last contact, and anti-epidemic measures (disinfection) are carried out. In maternity hospitals, quarantine is also being introduced, and all employees who have had contact with patients are sent on vacation for two weeks.

How to treat enterovirus infection in children?

It is children who, due to their immune status, are more susceptible to such diseases. If you suspect an enterovirus infection in a child, you should contact a pediatrician and get a referral for the research necessary in a particular case. Sometimes it may be necessary to consult doctors of narrow specialties - a cardiologist, an otolaryngologist or an 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 may be hospitalized. There are no specific drugs for enterovirus infection. Treatment is to reduce negative symptoms, preventing dehydration of the body and timely detection of side effects.

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

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

The most common enterovirus diseases

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

• Summer flu. The most common infection occurs when swimming in rivers and at sea. Overheating and hypothermia contribute to the development of infection. Symptoms combine flu-like symptoms and disorder intestinal tract. The disease lasts from 3 to 7 days, accompanied by fever, diarrhea, sore throat, sometimes conjunctivitis.
• Gerpangina. Eruptions like herpes in the back of the throat and on the tonsils. The disease disappears in 3-5 days.
• Viral blister. 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 rubella-like rash all over the body. It is not so common, the symptoms disappear within ten days.

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

Enteroviral infection is a group of acute infectious diseases caused by intestinal viruses(enteroviruses), characterized by fever and polymorphism of clinical symptoms caused by lesions of the central nervous system, cardiovascular system, gastrointestinal tract, muscular system, lungs, liver, kidneys, and other organs.

In recent years, there has been a clear trend of activation of enterovirus infection in the world, as evidenced by epidemiological rises in incidence and outbreaks that are constantly recorded in different countries. The geography of enterovirus infections is extremely wide and covers all countries of the world, including the post-Soviet space. Yes, in scientific literature outbreaks of enteroviral (aseptic) meningitis are described in France (2002, 559 cases, ECHO viruses 13, 20, 6), in Japan (2000, several hundred people fell ill, there were deaths, enterovirus type 71), USA (2001, more than 100 cases, ECHO 13 virus), Spain (2000, 135 cases, ECHO 13 virus), Germany (2001, 70 cases, Coxsackie B5 virus), Turkey. The largest of the described outbreaks were noted in Taiwan (1998, 2000, about 3 thousand people fell ill, viruses ECHO 13, 30, enterovirus type 71 prevailed) and in Singapore (2000, 1 thousand cases, 4 deaths, the outbreak is caused by enterovirus type 71), Tunisia (2003, 86 people, represented by ECHO viruses 6, 13). In the post-Soviet space, the largest outbreaks in recent years have been observed in Russia, in Primorsky Krai (Khabarovsk, 1997, Coxsackie viruses B3, 4, 5, ECHO 6, 17, enterovirus type 70 prevailed) and in Kalmykia (2002. , 507 cases, ECHO 30 virus), as well as in Ukraine (1998, 294 people fell ill, Coxsackie B4 virus).

One of the main features of these infections is a healthy virus carrier, which constantly causes the emergence of sporadic forms and mass diseases, which, like the incidence, is observed not only among young and older children, but also among adults. It has been established that the duration of stay of enteroviruses in the intestine does not exceed 5 months.

However, two factors seem to be of primary importance in maintaining the circulation of enteroviruses among the population - the presence of susceptible contingents and the significant duration of the virus carrier. The latter feature allows the virus, after infecting non-immune individuals, creating a highly immune layer, to wait for new susceptible contingents.

What provokes / Causes of Enteroviral infection:

The modern classification of enteroviruses was developed in 2000 on the basis of data accumulated by that time on the genetic structure and phylogenetic relationships of different representatives of the genus Enterovirus. This genus includes the Picornoviridae family, which, in turn, includes 5 types of non-polio enteroviruses, namely Enterovirus A, B, C, D, E. According to this classification, polioviruses constitute a separate species within the Enterovirus genus. Type A includes Coxsackieviruses A2-8, 10, 12, 14, 16 and enterovirus 71.

Type Enterovirus B is the most numerous and includes all Coxsackie B and ECHO viruses, with the exception of ECHO 1, as well as Coxsackie A9 and enteroviruses 69, 73, 77, 78 types. Type Enterovirus C unites the remaining representatives of Coxsackie A viruses, including types 1, 11, 13, 15, 17–22, and 24. Types of Enterovirus D and E are relatively few and include 2 (Enterovirus68 and 70) and 1 (A2 plaque virus) representatives, respectively. In addition, the genus includes a significant number of unclassified enteroviruses. Thus, the genus Enterovirus includes more than 100 viruses dangerous to humans. They are ubiquitous and highly resistant to physical and chemical factors.

Pathogenesis (what happens?) during Enteroviral infection:

Enteroviral infections belong to the group of anthroponoses. The existence of entroviruses in nature is due to the presence of two main reservoirs - a person in whom the virus reproduces and accumulates, and the external environment (water, soil, food products), in which they are able to survive due to their high resistance. The risk of outbreaks increases significantly when a massive enterovirus contamination is “thrown” into the human population, which can most often be realized through water and food transmission.

The vertical route of transmission of enteroviral infections is described. high risk congenital enterovirus infection, as a rule, is determined not by an acute enterovirus disease suffered by the mother during pregnancy, but by the presence of a persistent form of enterovirus infection in a woman. Sudden infant death syndrome is associated with congenital enterovirus infection.

Source of infection- a sick person or a virus carrier. The transmission mechanism is airborne or fecal-oral. Children and young people are more often ill. Typical summer-autumn seasonality. Immunity after the disease is quite long (up to several years).

Entry gate of infection- mucous membranes of the upper respiratory tract or digestive tract, where the virus multiplies, accumulates and causes local inflammatory response, which is manifested by symptoms of herpetic sore throat, acute respiratory infections, pharyngitis or intestinal dysfunction. As a result of subsequent viremia, viruses are hematogenously spread throughout the body and deposited in various organs and tissues.

The affinity of enteroviruses to nervous tissue, muscles, epithelial cells causes a variety of clinical forms of infection. When the virus enters the central nervous system, it may be damaged with the development of aseptic meningitis, meningoencephalitis, or paralytic poliomyelitis-like forms.

ECHO viruses usually do not disseminate from the sites of primary penetration, only sometimes they are hematogenously introduced into other organs.

Symptoms of Enteroviral Infection:

The wide pantropism of enteroviruses underlies great variety clinical forms of infection caused by them, affecting almost all organs and tissues of the human body: nervous, cardiovascular system, gastrointestinal, respiratory tract, as well as kidneys, eyes, skin muscles, oral mucosa, liver, endocrine organs. Of particular danger of enterovirus infections is in immunodeficient individuals.

Most cases of enterovirus infections are asymptomatic. Most of the clinically noticeable manifestations are cold-like diseases, and enteroviruses are considered the second most common causative agent of SARS.

It is conditionally possible to distinguish two groups of diseases caused by enteroviruses:
I. Potentially severe:
- serous meningitis;
- encephalitis;
- acute paralysis;
- neonatal septic-like diseases;
- myo-(peri-)carditis;
- hepatitis;
- Chronic infections of immunodeficient persons.

II. Less dangerous:
- three-day fever with or without rash;
- herpangina;
- pleurodynia;
- vesicular pharyngitis;
- conjunctivitis;
- uveitis;
- gastroenteritis.

1. Herpangina. On the first day of the disease, red papules appear, which are located on the moderately hyperemic mucosa of the palatine arches, uvula, soft and hard palate, quickly turn into vesicles 1–2 mm in size, from 3–5 to 15–18 in number, not merging with each other. After 1–2 days, the vesicles open with the formation of erosions or dissolve without a trace by the 3–6th day of illness. Pain when swallowing is absent or insignificant, sometimes salivation appears. Enlargement of the neck and submandibular lymph nodes small, but their palpation is painful.

2. epidemic myalgia(Bornholm's disease, "devil's dance", pleurodynia). Characterized sharp pains with localization in the muscles of the anterior abdominal wall abdomen, lower chest, back, limbs. The pains are paroxysmal in nature, lasting from 30-40 seconds to 15-20 minutes, repeated for several days, may be recurrent, but with less intensity and duration.

3. meningeal syndrome persists from 2-3 days to 7-10 days, sanitation of the cerebrospinal fluid occurs on the 2nd - 3rd week. Possible residual effects in the form of asthenic and hypertensive syndromes.

Other neurological symptoms in meningitis of enteroviral etiology may include disorders of consciousness, increased tendon reflexes, absence of abdominal reflexes, nystagmus, stop clonus, short-term oculomotor disorders.

4. Paralytic forms of enterovirus infection differ in polymorphism: spinal, bulbospinal, pontine, polyradiculoneuric forms can develop. More common than others is the spinal form, which is characterized by the development of acute flaccid paralysis one or both legs, less often - hands with pronounced pain syndrome muscular character. The course of these forms is easy, does not leave persistent paresis and paralysis.

5. Enteroviral fever (minor illness, 3-day fever). This is the most common form enterovirus infection, but difficult to diagnose with sporadic incidence. It is characterized by short-term fever without pronounced symptoms of local lesions. It proceeds with moderate general infectious symptoms, the state of health is slightly disturbed, there is no toxicosis, the temperature persists for 2–4 days. Clinically, it can be diagnosed in the presence of an outbreak in the community, when other forms of enterovirus infection also occur.

6. Enteroviral exanthema("Boston fever"). Characterized by the appearance of rashes on the face, trunk, limbs from the 1st - 2nd day Pink colour, maculopapular or maculopapular in nature, sometimes there may be hemorrhagic elements. The rash lasts 1-2 days, less often - longer and disappears without a trace.

7. Intestinal (gastroenteric) form. Leaks with watery diarrhea up to 5-10 times a day, abdominal pain, flatulence, infrequent vomiting. Symptoms of intoxication are moderate. In children under 2 years of age intestinal syndrome often combined with catarrhal phenomena from the nasopharynx. The duration of the disease in young children for 1-2 weeks, in older children 1-3 days.

8. Respiratory (catarrhal) form manifested by mild catarrhal phenomena in the form of nasal congestion, rhinitis, dry rare cough. Examination reveals hyperemia of the oropharyngeal mucosa, soft palate and posterior pharyngeal wall. Mild dyspeptic disorders may be noted. Recovery occurs in 1-1.5 weeks.

9. Myocarditis, neonatal encephalomyocarditis, hepatitis, kidney damage, eye damage (uveitis)- These forms of enterovirus infection in children are rare. Clinical diagnostics they are possible only in the presence of manifest forms of enterovirus infection or epidemic outbreaks of the disease. More often they are diagnosed during virological and serological studies.

The high tropism of enteroviruses to the nervous system is characterized by a variety of clinical forms of the most common lesions. nervous system: serous meningitis, encephalitis, polyradiculoneuritis, neuritis of the facial nerve.

The leading place among childhood neuroinfections is still occupied by meningitis, which accounts for 70-80% of total number infectious lesions of the central nervous system. Every year there is an increase in the incidence of enterovirus meningitis in the summer-autumn period. Predominantly children of preschool and school age. Clinically aseptic serous meningitis caused by different types polioviruses, ECHO viruses, Coxsackie A and B viruses are almost impossible to distinguish. Changes in the cerebrospinal fluid are also indistinguishable. To date, the most common clinical form of enteroviral meningitis has been well described.

According to the WHO, enteroviral heart infections are a regularly recorded pathology in the world. Depending on the causative agent, enteroviral infections of the heart have a very definite share in the structure of the total infectious disease, accounting for about 4% of the total number of registered viral diseases. The largest number of enterovirus infections of the heart is caused by Coxsackie B viruses, the second place among the causative agents of enterovirus infections of the heart (according to specific gravity in infectious pathology) are occupied by Coxsackie A viruses, followed by ECHO viruses and polioviruses.

The following clinical forms of virus-induced heart diseases are distinguished: myo-, peri-, endocarditis, cardiomyopathy, congenital and acquired heart defects.

Clinical manifestations of enteroviral heart infections depend on the degree of myocardial involvement in pathological process and can be accompanied by both the almost complete absence of violations of the functional activity of the myocardium, and severe defeat cardiac activity, accompanied by dilatation of all chambers of the heart with significant breach systolic function. Enteroviruses have a high tropism for heart tissues, in which alternative destructive processes first develop due to the direct cytopathic effect of the virus, and subsequently virus-induced inflammation occurs with the formation of myo-, endo- and epicarditis, diffuse cardiosclerosis, leading to the development of dilated cardiomyopathy.

Of interest are reports of vascular lesions with Coxsackie infections detected in patients with enteroviral myocarditis.

Enterovirus 70 in recent years has caused numerous outbreaks of acute epidemic hemorrhagic conjunctivitis, prone to spread. In some patients, after a period of time from the onset of the disease, paralysis and paresis of various severity and localization developed. There are uveitis caused by ECHO 11, 19.

Enteroviral infections pose the greatest danger to immunosuppressed individuals: patients with malignant diseases blood, newborns, persons after transplantation bone marrow, HIV-infected patients.

Coxsackie A9 infection is associated with the development autoimmune diseases. The role of enteroviruses in the development of type 1 diabetes has been proven.

The literature discusses the role of enterovirus infections, in particular Coxsackievirus, in the etiology of spontaneous miscarriages.

Damage to the genital area is manifested by the clinic of parenchymal orchitis and epididymitis, most often caused by Coxsackie B1-5, ECHO 6, 9, 11 viruses. Enteroviruses as the cause of infectious orchitis take second place after the virus mumps. Peculiarity this disease lies in the fact that at the first stage, a clinic of another symptom complex develops, characteristic of enterovirus infection (herpangina, meningitis, etc.), and after 2–3 weeks, signs of orchitis and epididymitis appear. The disease occurs in children of puberty and proceeds relatively benignly, but may also result in the development of azospermia.

Diagnosis of Enteroviral infection:

Diagnosis of enterovirus infection includes 4 main methods:
1) serological;
2) immunohistochemical;
3) molecular biological;
4) cultural.

Serological methods aimed at identifying markers of enterovirus infections in the blood serum of patients. Early markers of infection include IgM and IgA. When detecting serological markers of enterovirus infections, the most representative is the IgM titer, which indicates a recent infection. Therefore, virus-specific IgM are convenient markers of a "fresh" antigenic stimulus, while IgG can persist and circulate in the blood of an ill person for several years or even for the rest of his life. For the indication of IgM, methods of immunofluorescence and enzyme immunoassay are used. In patients with acute symptoms of the disease, EV-specific IgM is detected after 1-7 days from the onset of infection. After 6 months, IgM usually disappear.

Among the oldest, but relevant serological methods is the detection of virus-neutralizing antiviral antibodies in the neutralization reaction, a 4-fold or more increase in titer is considered diagnostically significant.

Virological methods studies are aimed at isolating enteroviruses from clinical material (blood, feces, cerebrospinal fluid) on sensitive cell cultures.

The main purpose of immunohistochemical methods is the in situ detection of enteroviral antigens. Among the most available methods immunohistochemistry includes immunofluorescence and immunoperoxidase assays.

Molecular biological methods research is aimed at identifying the genetic material of enteroviruses.

Polymerase is used to diagnose enterovirus infections. chain reaction with a reverse transcription stage, which has a number of advantages over the above methods: high specificity, sensitivity and speed of execution.

Treatment of Enteroviral infection:

Interferons are used to prevent viral infections. This group of compounds belonging to low molecular weight glycoproteins, which also have antipicornoviral activity, is produced by body cells when exposed to viruses. An increase in the level of endogenous interferon in the cerebrospinal fluid in children with acute epidemic enteroviral meningitis has been shown, which plays an important role in the release from infection. Interferons are formed at the very beginning of a viral infection. They increase the resistance of cells to the defeat of their viruses. Interferons are characterized by a wide antiviral spectrum (they do not have a specific action against individual viruses). Viruses do not develop resistance to interferons.

At present, preparations of alpha-interferons (alpha-2a, alpha-2b), both natural and recombinant, are mainly used as antiviral agents. Interferons are used topically and parenterally.

The second group of drugs used to treat enterovirus infections are immunoglobulins. Shown them clinical efficacy in patients with enterovirus infection on the background immunodeficiency state(congenital or acquired), as well as in neonatal practice in newborns with enterovirus infections who did not have antibodies to enterovirus infections (with neonatal sepsis in congenital enterovirus infection). It turned out to be the most effective intravenous administration drug widely used in the treatment of immunodeficient patients with acute and chronic meningoencephalitis caused by enteroviruses. However, the experience of using immunoglobulins in this situation has not been sufficiently studied. There is evidence of a successful cure for meningoencephalitis with intraventricular administration of gamma globulin.

The third group is capsid inhibitory drugs. The most effective of this group is pleconaril. It is the most widely used etiotropic agent that has passed clinical trials. Pleconaril demonstrated a wide spectrum of antiviral activity against both rhinovirus and enterovirus infections, and has a high bioavailability (70%) when taken enterally.

This drug can be used and used in newborns with enteroviral meningitis at a dose of 5 mg/kg enterally 3 times a day for 7 days. noted high level pleconaril in the central nervous system and epithelium of the nasopharynx. When using pleconaril in different age groups no side effects were noted. This drug is widely used for the treatment of meningitis, encephalitis, respiratory infections caused by enteroviruses. When using pleconaril in the treatment of meningitis in children, there was a significant reduction in meningeal symptoms by 2 days.

Prevention of Enterovirus infection:

Specific prophylaxis. Not developed.

Non-specific prophylaxis. In the focus of infection, contact children can be instilled leukocyte interferon 5 caps. in the nasal passages 3-4 times a day for 7 days. Protective action renders immunoglobulin at a dose of 0.2 ml/kg, i.m.
Ventilation and disinfection of premises, compliance with the rules for the removal and disinfection of sewage, providing the population with epidemiologically safe products.

Which doctors should be contacted if you have an Enterovirus infection:

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Enterovirus infection caused by an enterovirus has various clinical symptoms manifestations. More common in newborns, occurs in the form of meningitis, mental disorders, epileptic seizures.

Main routes of transmission:

Often, infection is diagnosed in pregnant women and the fetus against the background of the transmission of the pathogen through birth canal. Enterovirus is one of the few that quickly migrates to the lymph nodes, settles and multiplies, leading to damage to nearby tissues and organs in the baby against the background of unformed immunity.

How long is the incubation period?

The incubation period for enterovirus infection is 2-7 days and the signs are very diverse, even several pathologies are present at once. Usually the child has:

• severe attacks of tachycardia,
• signs of polymorphic exanthema,
• undulating feverish state,
• temperature increase up to 40 gr,
• body intoxication,
• weakness,
• approaches of nausea and vomiting,
• diarrhea on the background of recurrence of the disease,
• hyperemia and redness of the mucous membrane of the larynx,
• granular eruptions on the back of the throat.

Many mothers are interested in how many days does the incubation period last? Usually does not exceed 5 days, but in some cases it can reach 10 days with an increase in temperature up to 5-6 days and then a gradual decrease to normal values.

In order not to become infected after contact with sick children, it is possible to prescribe interferon nasally with a course of treatment - up to 7 days. Also the course disinfectants, other measures to suppress infectious focus at the initial stage of development.

Usually, children over the age of 3 easily tolerate enterovirus and recovery occurs in 5-7 days. Sometimes deterioration of work of heart and nervous system is possible. The risk group includes newborns with a weakened immune system, also HIV-infected with the presence malignant form blood diseases, when a virus enters the body, it begins active reproduction and distribution throughout the body by the hematogenous route.

It is possible to infect babies during breastfeeding against a background of weakened immunity.

The main thing is to prevent complications due to the intensive development of infection. At the first manifestations, it is urgent to show the baby to the doctor, especially when:

• occurrence of seizures
• loss of consciousness
• severe headache along with nausea,
• neck muscle tension
• visual impairment,
• redness of the eyelids of the eyes by the type of conjunctivitis,
• pain in the chest and in the region of the heart,
• cough with aggravation when bending forward,
• complaints of shortness of breath, palpitations and shortness of breath,
• difficulties even to speak,
• appearance severe drowsiness, anxiety and tearfulness in babies under 1 year old,
• the appearance of loose stools, vomiting, diarrhea.

Home, avoid dehydration. Give babies as much liquid as possible, try to induce vomiting. self-medication medical preparations unacceptable. Moms are advised to consult a doctor more often, is it possible to treat babies at home with certain drugs? When severe symptoms need to urgently call an ambulance.

Take multivitamin preparations, in particular vitamin C. At the peak of the incidence of acute respiratory infections, acute respiratory viral infections, colds, avoid hypothermia, visiting crowded places, shops. Isolate the patient from all family members at the time of treatment. Do not allow children to swim and wash in dirty water bodies, lakes, reservoirs. Carry out hardening procedures to increase the body's resistance to the effects of temperature extremes.