Enteroviral infection: ways of transmission, symptoms, diagnosis and treatment. Ways of transmission of enterovirus infection in children: symptoms and treatment, general recommendations

Along with rotavirus, enterovirus infection is often diagnosed in childhood and adolescence. Often, mothers identify these two diagnoses, but the latter is a much more serious disease both in terms of coverage of the affected systems and organs of the baby, and in terms of consequences for the body. In addition, due to the diversity of virus strains, a vaccine against enterovirus infection has not yet been developed. Therefore, it is important for every parent to know the characteristics of the virus habitat, infection and the course of the disease in children, as well as methods of treatment and prevention of this insidious disease.

What is an enterovirus infection

Under the name "enterovirus infection" hides large group diseases caused by intestinal viruses. The main types of viruses are:

1. Coxsackie viruses. In this group, two subgroups are distinguished - A and B, each of which contains 24 and 6 types of virus, respectively.
2. ECHO viruses - there are 34 types of pathogens.
3. Polioviruses are of 3 types.

The group of enteroviruses that pose a danger to humans includes more than 100 types of the virus, each of which is capable of high survival in the natural environment, and lives in the human intestine for up to 5 months.

Depending on the type of virus, the disease can affect a variety of systems and organs of the human body:

• central nervous system;
• cardiovascular system;
• gastrointestinal tract;
• muscular system;
• respiratory system;
• liver;
• eyes;
• endocrine system;
• urinary system.

Enteroviruses can live for a long time in the body of a healthy person, whose high level of immune protection did not allow the disease to begin. At the same time, the carrier of the virus easily infects surrounding people with less strong immunity.

After a disease, a person develops a strong immunity to only one specific type of pathogen virus. This means that another type of enterovirus infection will easily overcome the barrier of the body's defenses.

The susceptibility of the considered group of viruses to the effects of external factors is very low:

• enteroviruses easily survive freezing - in this state they are able to survive for several years;
• when exposed to chemical disinfectants such as chlorine and formalin, they die only after three hours;
• the group of viruses under consideration is resistant to an acidic environment (this helps them to safely pass the human stomach on their way);
• The only reliable way to fight viruses is exposure to high temperatures. Heating up to 45–50 ºС can have a detrimental effect on them.

The disease is characterized by seasonality: outbreaks of enterovirus infection, as a rule, are observed in summer and autumn. Most often, enterovirus affects children and young people.

Epidemic outbreaks of entero disease viral infection various types have a clear tendency to increase and expand the geography of coverage at the beginning of the 21st century. Thus, epidemics of this disease, accompanied by a certain amount deaths, have been registered in the period from 2000 to the present in many countries of Western Europe and the post-Soviet space, in the USA, Japan, Turkey, etc.

Enterovirus transmission routes

The habitats of enteroviruses, as noted above, are:

1. natural environment. The most common source of infection is contaminated water, which was consumed without careful pre-treatment.
2. The intestines of a person who has had an enterovirus infection, or its healthy carrier.

Viruses are transmitted in the following ways:

• fecal-oral - non-compliance with the rules of personal hygiene, the use of common objects with a sick person or a carrier of the disease (for example, toys that children so often put in their mouths);
• airborne - sneezing, coughing, screaming, crying and even talking;
• water or food - through contaminated water or products;
• vertical - from mother to fetus during pregnancy.

Getting on the mucous membranes of the upper respiratory tract and digestive tract, the virus causes local inflammatory reactions in the form of herpetic sore throat, pharyngitis, SARS, intestinal dysfunction. There it multiplies, accumulates, is absorbed into circulatory system, through which it spreads throughout the body, affecting the nervous, muscle tissue, epithelial cells, etc.

Entrance gates for enteroviruses - the mouth and nose of a person, penetrating into the circulatory system, the virus spreads throughout the body

Among children, the main risk group are babies from 3 to 10 years old. Children during the period of breastfeeding receive protective forces from the mother's body. However, this immunity is not very strong and disappears almost immediately after the cessation of breastfeeding.

The incubation period is approximately the same for all types of enterovirus and ranges from 1 to 10 days (average - 5 days).

Symptoms

Rashes with enterovirus infection are localized in the head, upper body

Among the symptoms of enterovirus infection in children, two groups of signs can be distinguished:

1. The first one includes general symptoms, characteristic of the disease regardless of the type of pathogen.
2. The second group combines subgroups of signs, the nature of which depends on the type of pathogen and on its localization.

Common to all types of enterovirus infection in children are the following symptoms:

1. Increase in body temperature. The onset of the disease is characterized jump- up to 38–39ºС, this temperature lasts for several (up to five) days. Often, a couple of days after the temperature drops, a "second wave" of manifestations of the infection is observed - the temperature rises again for 1-2 days. Periods of fever during enterovirus infection in children are characterized by the appearance of:
   • weaknesses;
   • drowsiness;
   • headache;
   • nausea;
   • vomiting.
2. An increase in the submandibular and cervical lymph nodes, which is due to the localization and reproduction of viruses in them.

Specific signs of the disease - table

There are frequent cases of asymptomatic enterovirus infection, as well as short-term fever without the manifestation of specific symptoms of the lesion. This fever is characterized by a three-day rise in temperature. Diagnosis of enterovirus infection in such cases is difficult - the basis for making a diagnosis is often an epidemic situation (for example, an outbreak of enterovirus in kindergarten where the child goes).

Diagnostics

The diagnosis of "enterovirus infection" can be made to a child if the following factors are present:

• current epidemic of enterovirus infection;
• characteristic symptoms;
• data obtained as a result of laboratory studies.

For research, swabs are taken from the affected mucous membranes (nose, throat, anus etc.), stool, blood tests.

The presence of an enterovirus infection can be reliably established by the following methods:

• serological - detection of enterovirus markers in blood serum;
• virological - detection of viruses from clinical material(blood, feces, etc.);
• immunohistochemical - detection of antibodies to the virus in the blood;
• molecular biological - detection of the genetic material of viruses.

These methods are not used in every case of suspected enterovirus infection. The duration and complexity of their implementation are incommensurable with the practical value - by the time the result of the analysis is ready, the patient may already have recovered. In addition, viruses can be detected in the case of carriage of the infection.

A general blood test will show minor deviations from the norm during the acute course of the disease:

• slight increase ESR level(erythrocyte sedimentation rate) and leukocytes;
• rarely - neutrophilia (increased levels of neutrophilic granulocytes);
• eosinophilia (increased levels of eosinophils);
• lymphocytosis (an increase in the number of lymphocytes).

Treatment

Modern pharmacology does not have drugs that can overcome or stop the reproduction of enterovirus in the human body. Therefore, the treatment of such infections includes only methods symptomatic therapy.

The main directions of symptomatic therapy - table

Treat enterovirus infection in children, usually at home. Hospitalization is indicated only in severe cases of the disease - with damage to the nervous system, heart, liver, with a high, long-lasting body temperature. During the entire period of increasing body temperature, the patient must comply with bed rest.

In the acute period of the course of the disease (especially at elevated body temperature), it is strictly forbidden to bathe a child and walk with him on the street, in the recovery period such measures are even necessary.

Photo gallery: Drugs for the symptomatic treatment of the disease

The drug Linex contains live lactobacilli Enterosgel - a drug from the group of sorbents Regidron is produced in the form of a water-soluble powder Viferon can even be used to treat infants, it is produced in the form rectal suppositories
Enterofuril is an effective antimicrobial agent that can be used to treat a bacterial infection in children.

ethnoscience

Traditional medicine offers a decoction of viburnum with honey as a way to treat infection. Kalina is not contraindicated in childhood, its useful properties include:

• antipyretic action;
• getting rid of cough;
• strengthening immunity;
• disinfectant and bactericidal properties.

The presence of honey in this folk remedy suggests its use in children older than one year who do not have an allergy to this product.

In order to prepare a decoction, you will need 250 grams of viburnum berries, 3 tablespoons of honey and 1 liter of water. Viburnum berries are boiled in water for 10 minutes, then filtered and honey is added. Use a decoction of 3 tablespoons three times a day.

A decoction of viburnum is one of the few folk remedies used to treat enterovirus in children.

Diet

During the course of an enterovirus infection of any type in a child, the main rule for parents should be feeding according to appetite - all the forces of a small organism during this period are aimed at fighting the virus, and not at digesting food. The nutrition of the child should be light, with a predominance of protein foods.

The use of a large amount of fluid during the period of illness is designed to minimize the risk of dehydration due to high body temperature, vomiting, and diarrhea.

Among the general requirements for the diet of a sick child:

• a ban on spicy, salty, fatty, fried, smoked;
• recommendations for eating boiled, steamed, baked, low-fat.

During the treatment of enterovirus infection, it is recommended to offer the child the following products:

• boiled meat of low-fat varieties (chicken breast, beef, turkey, rabbit);
• boiled or stewed vegetables;
• porridge cooked in water;
• dried fruits compote;
• kefir;
• cracker.

Prohibited for use:

• milk products;
• raw vegetables and fruits;
• baking and confectionery;
• juices;
• meat broths;
• fat meat.

Prohibited products in the photo

Raw vegetables

Despite the above restrictions, the child's diet during the period of illness must be balanced, contain all essential vitamins and minerals.

Features of the disease and its treatment in infants

Children under one year old, especially those who are on breastfeeding are rarely infected with enterovirus infection. This is due to several factors:

• during this period, the protective power of antibodies received from the mother while in the womb and breastfeeding is still in effect;
• in infancy children do not attend kindergarten, therefore, the risk of infection is minimized.

If we talk about the course of the disease in infants, then it is characterized by:

• increased duration compared to the duration of illness in older children;
• in young children, in most cases, a mixed form of infection occurs (for example, both catarrhal and intestinal types).

Treatment of infants is based on the same principles as for older adults. The priority ones are:

• replenishment of fluid loss (frequent fractional drinking);
• the use of antipyretic drugs if the body temperature has risen above 38 ºС.

Possible complications and consequences

In most cases, enterovirus infection develops without consequences and ends with a complete recovery on the 5-7th day. Complications are more often associated with severe forms of infection or its inadequate treatment. Among these dangerous consequences:

• cerebral edema in severe infections that affect the central nervous system;
• the development of a "false croup" (narrowing of the airways leading to difficulty breathing) with a respiratory form of infection;
• accession of a secondary bacterial infection with the development of pneumonia and other dangerous diseases;
• syndrome sudden death an infant with intrauterine infection with an enterovirus;
• aspermia (lack of sperm) in adulthood after a viral orchitis.

Prevention of enterovirus infection in children

Compliance with the basic rules of personal hygiene - important rule prevention of enterovirus infection

General measures to prevent infection with enterovirus infection include:

• compliance with the rules of personal hygiene (washing hands after using the toilet, upon arrival from a walk, before eating);
• drinking boiled or bottled water;
• thorough washing of products;
• refusal to swim in reservoirs with questionable water quality;
• regular wet cleaning and ventilation of residential premises.

For children who come into contact with people who are suspected to be infected with the virus (for example, during an epidemic outbreak in a kindergarten), it is advisable to instill leukocyte interferon nasally for one week to prevent the disease.

The group of diseases caused by enteroviruses is very diverse not only in the localization of the lesion, but also in the severity of the course of the disease. Since this kind of infection is most common in children from 3 to 10 years old, it is important for their parents to know the basic rules for the treatment of enterovirus: therapy should be symptomatic, the priority goal is to restore the water-salt balance of the body. Prevention of enterovirus infections, like all diseases of "dirty hands", is to follow the rules of personal hygiene.

Enterovirus infection refers to acute diseases of the gastrointestinal tract caused by enteroviruses.

At the moment, more than 60 types of pathogens of enterovirus infection are known. All of them are divided into 4 groups depending on the serotype. Most often, enterovirus infection is provoked by the activity of Coxsackie and polio viruses. The danger of enterovirus infection lies in the fact that its pathogens are extremely resistant to the action of aggressive environmental factors.

They can long time persist in moist soil and water, then entering the human body through city water supply or contaminated food.

What it is?

Almost all types of enteroviruses are pathogenic for humans. Their danger lies in the fact that enteroviruses are microorganisms that are extremely resistant to various environmental factors. The virus can live outside the host's body. long time, for example, in faeces, in milk, as well as in waste liquids and even in chlorinated water, they remain viable for up to 3-4 months. Microorganisms can live in moist soil, from where they get into some foodstuffs (root crops, vegetables), can infect animals and often live in water. Together with water and food, the virus enters the human body - this means that the most common route of spread of the pathogen is fecal-oral.

The name "enteroviruses" is due to the fact that, after penetrating the body, through the mucous membranes of the upper respiratory tract or digestive tract, 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, due to which the patient may experience symptoms of various ailments.

There are 23 serotypes of Coxsackieviruses of the enterovirus A subgroup, and 6 types of the enterovirus B subgroup. Among the ECHO viruses, 32 serotypes are known. In addition, there are human enteroviruses of groups 68 to 72 (68 types, 70 types and 71 types are somewhat more common than others). Enterovirus 70 provokes the development of hemorrhagic conjunctivitis, and type 72 virus corresponds to the causative agent of the hepatitis A virus. Enterovirus D68 is also known, which is highly contagious, and several years ago provoked an epidemic in the United States.

All types of pathogens show high resistance in the environment, are ubiquitous in nature, normally tolerate negative temperatures. They are not deactivated. antiseptic solutions such as lysol, ether, 70% ethanol solution. Microorganisms can be destroyed by exposure to temperatures above 50 degrees Celsius, drying, antiseptics. The natural reservoir of existence is only a person - a sick person or a virus carrier. Enteroviral pathogens are 20-30 nm in size, contain a small amount of capsomeres without any shell, with cubic symmetry of the capsid.

How can you get infected?

The causative agents of enterovirus infection enter the external environment from the intestinal tract and nasopharynx, which determines the main routes of infection: airborne, water, food, contact-household. The role of individual factors in the mechanism of transmission is not completely clear, so the timing of the incubation period may vary depending on the condition. immune system human, the characteristics of a particular type of virus and environmental conditions.

As a rule, enterovirus infection proceeds quite easily and does not lead to any serious complications. However, advanced forms of enterovirus infection affect a variety of organs and systems, provoke the development of serious diseases, and in some cases end in death, which we actually observed during the Chinese epidemic.

Symptoms of an enterovirus infection

The intestinal form of enterovirus infection is characterized by severe pain in the abdomen, diarrhea (stool frequency - up to 10 times a day), debilitating vomiting and flatulence. With a respiratory form, the patient is tormented by a dry cough and runny nose. These symptoms may last one or one and a half weeks. On the part of the cardiovascular system, manifestations of enterovirus infection are myocarditis and pericarditis.

If a person is healthy, then an enterovirus infection is not capable of provoking him severe complications. Sometimes the disease is completely asymptomatic and resolves on its own. A severe course of the pathology is observed with a weak immunity of the patient (against the background of HIV infection, with cancerous tumors, with tuberculosis), as well as in young children, especially in newborn babies.

Symptoms are also distinguished depending on the type of enterovirus infection:

• catarrhal symptoms. Most often, enteroviruses lead to disturbances in the functioning of the respiratory system. The patient develops a dry cough, stuffy nose, reddened throat, in parallel, there may be problems with the functioning of the organs digestive systems s. As a rule, enterovirus infection occurring in catarrhal form, passes quickly. A full recovery occurs after a week, complications do not develop.
• Gerpangina. If an enterovirus infection proceeds according to the type of herpangina, then red vesicles form on the tongue, palate, and arches of the patient. They merge with each other, then open, and erosion appears in their place. Alternatively, merged erosions may disappear on their own in 3-5 days. In addition, the patient's salivation increases, the lymph nodes increase in size and become painful, and mild sore throats appear.
• Damage to the digestive organs. Often enterovirus infection occurs in the gastroenteric form. The patient develops diarrhea, it can happen up to 10 times a day. A person complains of pain in the abdomen, suffers from vomiting, flatulence. Body temperature rises to subfebrile levels, appetite decreases. In young patients, catarrhal phenomena most often develop. Older children recover in 3 days, and children younger than 1.5-2 years old can get sick for 2 weeks or even more.
• Serous meningitis. This form of enterovirus infection is observed frequently.

Symptoms from which a person suffers:

• Fear of the world.
• Increased sensitivity to loud sounds.
• Inability to press the chin to the chest.
• Increased pain when trying to raise the leg in the supine position.

There are several symptoms that allow doctors to diagnose meningitis. This is a symptom of Kernig and a symptom of Brudzinski. In the first case, the patient, while lying down, cannot straighten his leg, which will be bent at a right angle. This is due to the fact that the flexor muscles in meningitis are in increased tone. The second symptom is characterized by involuntary bending of the legs when trying to press the chin to the chest. They bend into hip joint. When pressing on the pubis, the legs bend at the knees.

Serous meningitis in childhood is accompanied by the occurrence of convulsions, an increase in body temperature to high levels, and psycho-emotional arousal. The child becomes lethargic, but he is conscious.

Symptoms of the disease can persist for 2-10 days, sanitation of the cerebrospinal fluid occurs only by 2-3 weeks. After the illness, high blood pressure and asthenic syndrome may persist for a long time.

Other signs of enteroviral meningitis include: oculomotor disturbances, loss of consciousness, strabismus, absence of abdominal reflexes, fainting, foot clonus.

1. Enteroviral fever. This type of enterovirus infection is also called the minor illness. The fever is characterized by a massive lesion, but it is rarely diagnosed, since those who fall ill for medical assistance are rarely addressed. A person's body temperature rises, which returns to normal after 3 days. Intoxication of the body is weakly expressed, the state of health is not strongly disturbed. It is for this reason that enterovirus fever is called a minor illness.
2. epidemic myalgia. With this form of the disease, a person develops intense pain in the muscles. Pain in the stomach, back, arms and legs, rib cage. The pain has a paroxysmal course. It can last from a few seconds to 20 minutes. The disease disappears after a few days, but may be accompanied by repeated exacerbations, but relapses are short and less intense.
3. Hemorrhagic conjunctivitis. The disease develops suddenly for a person. The patient develops photophobia, eyes begin to hurt, lacrimation intensifies. The doctor visualizes hemorrhages in the eyeballs. The conjunctiva swells, the eyelids are filled with blood, purulent contents are separated from the eyes. At first, the disease affects only one organ of vision, but after a short time it passes to the second. Enteroviral infection is not limited to the listed manifestations. The disease can proceed as anicteric hepatitis, encephalitis, neuritis optic nerve. Patients may become inflamed myocardium, kidneys, lymph nodes, pericardium, joints.
4. Enteroviral exanthema. This type of exanthema is also called Boston fever. She manifests from the 2nd day after the infection happened. In a person, on the face, on the legs and arms, on the torso protrudes small rash color pink. Sometimes there are small subcutaneous bruises (hemorrhages). After another 2 days, the rash completely disappears, after which the skin begins to peel off strongly, peels off in large areas. In addition to a rash, the patient may develop serous meningitis, herpetic sore throat and other forms of the disease.

Symptoms of enterovirus infection in children

Enteroviral infection in childhood, it most often manifests itself in the defeat of the digestive system, herpangina. Less commonly, serous meningitis or paralytic forms of the disease develop.

In preschools, mass outbreaks of the disease are often observed. The high-risk group includes children aged 3-10 years. The disease is transmitted mainly by the fecal-oral route. Mass outbreaks of enterovirus infection are observed in autumn and summer.

In children, the disease progresses rapidly. It is accompanied by fever, fever, headache, chills, dizziness, etc. Children complain of muscle pain. A rash appears on the skin, herpangina and diarrhea develop. The infection is accompanied by a runny nose and sore throat.

Diagnostics

To date, there are 4 main methods for detecting the causative agent of the disease:

1. Serological methods - determination of the pathogen in the blood serum. Early markers of an enterovirus infection include IgA and IgM, they determine a fresh antigenic stimulus, and IgG remain in the blood of an ill person for several years, or for life. For the diagnosis of enterreovirus infection, an increase in titer over a 4-fold value is considered significant.
2. Virological methods - detection of the virus in feces, cerebrospinal fluid, blood, nasopharyngeal mucosa on cultures of sensitive cells. Excrements are examined for 2 weeks, in the first days of the disease, swabs from the nasopharynx, according to the indications of the CSF.
3. Immunohistochemical methods - detection of antigens to enteroviruses in the patient's blood. Most available methods immunohistochemistry - are immunoperoxidase and immunofluorescence assays.
4. Molecular biological methods - determination of RNA fragments of enteroviruses.
5. Complete blood count - usually ESR and the number of leukocytes are normal or slightly increased, rarely hyperleukocytosis, neutrophilia, which is subsequently replaced by eosinophilia and lymphocytosis.

However, many diagnostic methods are not widespread due to the duration, complexity of the analysis and low diagnostic value, since due to the high number of asymptomatic carriage of enteroviruses, the detection of a virus in the analysis is not 100% proof of its involvement in the disease.

The main important diagnostic method is a 4-fold increase in antibody titer in paired sera, which are determined using RTGA and RSK. And also PCR with a reverse transcription stage is a fast analysis, with high specificity, sensitivity.

Differential Diagnosis

Enteroviral infections should be differentiated from other diseases:

• herpangina from fungal diseases (fungal stomatitis), from herpes simplex
• epidemic myalgia - from pancreatitis, pneumonia, pleurisy, acute appendicitis, cholecystitis
• enterovirus fever - from influenza and SARS of other etiologies;
• serous meningitis in children - from meningococcal, tuberculous meningitis, or serous meningitis of other viral etiology
• paralytic form - from diphtheria polyradiculoneuritis or poliomyelitis
• enterovirus exanthema - from scarlet fever, measles, rubella, allergic reactions in the form of a rash
• Gastroenteric form - from other acute intestinal infections, dysentery, salmonellosis, etc.

Treatment of enterovirus infection

Hospitalization is carried out selectively according to clinical indications, taking into account the possibility of treating patients at home. Treatment of mild forms of enterovirus infection in children and mild, moderate forms in adults is carried out at home, and the majority of such patients are known. An invariable condition is the observance of bed rest for the entire febrile period, as well as until the elimination of complications.

The diet is aimed at increasing immunity, reducing intoxication, rapid resolution of the inflammatory process, sparing the organs of the cardiovascular system and digestive systems, kidney function, preventing possible action medicines. The diet is differentiated depending on the condition of the patient and the stage of the disease.

1. To increase immunological reactivity, a physiologically complete diet is prescribed with a sufficient amount of protein and an increased content of vitamins A, C, group B.
2. To reduce intoxication, the introduction of a sufficient amount of liquid is indicated (preferably fruit drinks from blackcurrant, rosehip, chokeberry, lemon).
   All products are prescribed in a warm form, spicy, fatty, fried, salty, pickled dishes are avoided.

Etiotropic treatment

Etiotropic therapy includes antiviral drugs, which include:

1. Interferons (grippferon drops with antiviral, immunomodulatory effects; viferon suppositories suppress the reproduction of the virus, have an immunostimulating effect).
2. Interferon inducers (amiksin, lavomax, which have a pronounced immunomodulatory effect; cycloferon, which improves the patient's immune status by promoting the production of interferons in the body, has anti-inflammatory, antiviral effects; anaferon for children and adults is an immunomodulator that stimulates both humoral (general) and cellular (local) immunities ; aflubin is a complex homeopathic preparation with immunomodulatory, antiviral, antipyretic action.).

Pathogenetic intensive care

In a hospital for severe forms of enterovirus infections, detoxification treatment is prescribed, for meningitis and meningoencephalitis - dehydration therapy using forced diuresis (diuretics) under strict control of laboratory changes in water-salt metabolism. With damage to the heart - cardioprotectors, the brain - means that improve blood circulation and rheological properties of blood. This section of therapy is possible only in a hospital.

Symptomatic therapy

Symptomatic therapy (antipyretic, analgesics, anti-inflammatory, antihistamines, intestinal adsorbents, nasal vasoconstrictors):

1. Antipyretics (Nurofen, Panadol for children, Theraflu, Coldrex, Fervex, Efferalgan for adults) to reduce fever and improve general well-being.
2. Anti-inflammatory therapy and analgesics - ibuprofen, paracetamol, ketorol - relieve pain, in particular with myalgia.
3. Antihistamines - diazolin, suprastin, claritin, zodak, zyrtec and others - to reduce the overall toxic-allergic reaction of the body.
4. Adsorbents (activated charcoal, white charcoal, smectite, polyfepam, enterosgel) - to bind toxins and viral particles in the intestine.
5. With severe rhinitis, nose drops are recommended: nasol, nazol advance - convenience in the form, nazivin, aquamaris, tizin.
6. With the addition of a secondary bacterial infection - antibacterial agents, which in certain categories of patients (persons with chronic bacterial foci) are prescribed prophylactically. And the drug, and the dose, and the course is selected strictly by the attending doctor. Self-appointment and treatment threatens with the addition of unpleasant complications.
7. Probiotics in case of development of enteritis (bifiform, yogulact, bifistim, bifidum forte, etc.) in order to activate normal microflora and fight enterovirus infection in the lesion.
8. To intensify treatment for herpangina and the respiratory form, IRS-19, immudon, immunal are prescribed in order to maintain local immunity and prevent fairly rapid bacterial contamination.
9. Distracting and local therapy includes steam inhalations with a solution of soda, herbal solutions - sage, chamomile (which is important for catarrhal form and herpangina); irrigation of the pharynx with disinfectant solutions to avoid bacterial contamination of the affected area; anti-inflammatory eye drops for conjunctivitis.

Treatment of children and pregnant women should be carried out only by a doctor who will accurately determine both the group of drugs and the dosages required in this age group and at this stage of pregnancy.

It is undesirable to self-medicate with an enterovirus infection, since the symptoms of the disease (as you can easily notice) are nonspecific, that is, they occur in many diseases. Therefore, it is easy for a person without special education to confuse a viral and bacterial infection, and, accordingly, to be treated in the wrong direction.

Dispensary supervision is established individually. On average, the recovery period for an infection lasts from 1 to 3 months. During this period, the ill person needs not to overcool, follow a therapeutic diet without excesses, drink vitamins, and restore immunity. After the transferred forms with damage to the heart and nervous system, dispensary observation is required for 6-12 months with the involvement of a cardiologist, a neuropathologist. After suffering meningitis during the year, it is undesirable to fly, change the climate, and get vaccinated.

Complications

Enterovirus infection in most cases has a favorable prognosis for the child and ends in complete recovery. It poses the greatest danger to newborns and children with weakened immune systems, oncological diseases, HIV-infected.

Serious complications such as cerebral edema, epilepsy, mental disorders, increases in intracranial pressure are possible with enteroviral encephalitis, neonatal encephalomyocarditis, meningitis. At severe course disease, there is a possibility of generalization of infection, the development of pneumonia, acute respiratory failure, the addition of a secondary bacterial infection.

Prevention

Specific prophylaxis for enterovirus infection has not been developed. Main activities:

1. Isolation of the patient
2. room disinfection,
3. regular ventilation,
4. Compliance with hygiene standards and rules,
5. Observation of contacts for 2 weeks,
6. Prophylactic use of "Grippferon" or "Interferon" in drops,
7. Carrying out hygienic education of children and adolescents,
8. Compliance with the rules of personal hygiene,
9. Avoid hypothermia and drafts,
10. Take vitamin complexes twice a year,
11. Properly handle food.

Pathological conditions in which there are rashes on the skin, fever, vomiting and diarrhea are caused by a number of infectious diseases. The penetration of pathogenic microflora into the body of a baby can lead to severe forms of pathology and cause damage to muscle tissue, heart or internal organs.

Enteroviral infection - what is it

To this disease include all forms of the condition caused by enteroviruses - bacteria localized in the intestinal region. Mass immunization reduced the number of cases of infection, but did not provide 100% protection against the disease.

The main source of infection is both the carrier and the person with severe symptomatic manifestations. The ways of transmission of the disease are divided into three types:

• airborne - the transition of bacteria occurs at the time of talking, coughing or sneezing;
• fecal-oral - through dirty hands and non-compliance with the rules of personal hygiene;
• contact - a direct route of infection through open sources of water - wells, columns and taps.

Isolation of pathogenic microorganisms occurs within three weeks after recovery. AT feces bacteria continue to be dangerous up to 2 months. Breastfed babies get immune defense from the mother, but it is short-lived - from the moment of weaning, its effect gradually weakens.

Signs of occurrence

The initial manifestations of infection with an enterovirus infection are blurred - there are no obvious symptoms. Pathogenic microflora affects various internal organs, due to which nonspecific manifestations occur. The main difficulty in diagnosing the disease is similar symptoms in different serotypes of this subgroup.

In some variants of the development of the disease, it is easy to confuse it with SARS. The exact indicators for determining the subspecies of the disease are clinical tests blood. Common symptomatic manifestations depend on the location of the lesion:

Enteroviral fever- fixed when coughing, runny nose and a feeling of tickling in the throat. An increase in temperature and feverish conditions - in the first few days the indicators are high, then an independent fall occurs and after a couple of days - again an increase. Total time clinical picture- from 3 to 5 days, with constant malaise. At the end of the period, the child may experience:

• dyspeptic disorders;
• nausea with the transition to vomiting.

Disorders of the gastrointestinal tract begin and end unexpectedly.

Exanthema- rashes on the skin appear from the second day from the onset of the acute period.

The main location of the rash:

• cervical region;
• lower and upper limbs;
• back;
• face.

In some cases, rashes are noted on the mucous membranes of the oral cavity and look like bubbles filled with liquid. In case of accidental damage, ulcerations form in their place.

Papules visually resemble the manifestation of measles - small reddish dots.

Pain in the muscles- some variants of the disease involve damage to muscle tissue. Main localization pain syndrome located:

• in the chest area;
• abdomen
• in rare cases - in the lower and upper limbs, on the back.

Deterioration of the condition is recorded during movements, pain is paroxysmal in nature. The duration of the negative state can last from several minutes to half an hour. In the absence of symptomatic treatment, pain can develop into a chronic form.

Dyspeptic disorders- accompanied by bloating, pain. Most often manifested in babies under 2 years of age. The duration of symptoms is several days. The main task for parents during this period is the replenishment of fluid in the body of the child, preventing the development of dehydration.

Additional symptoms of enterovirus infection include:

• persistent drowsiness;
• lethargy;
• loss of appetite;
• swelling of the limbs;
• dehydration;
• eye hyperemia;
• involuntary lacrimation;
• enlargement of the lymph nodes.

Incubation period

The time from the moment the bacteria enters the baby's body to the appearance of primary signs of the disease is from 2 to 10 days. According to the average data, in most children the incubation period passes in 4 days.

The rate of development of the disease depends on the general condition of the body, the functionality of the autoimmune system, the ability of bacteria to infect internal organs.

Treatment of the disease

specialized medicinal product against enterovirus infection does not exist. Therapy aims to suppress symptomatic manifestations and maintenance of the body. Treatment often occurs at home, but under certain conditions, the baby can be hospitalized in the infectious diseases department:

• at high temperatures that do not decrease under standard antipyretics;
• with damage to the central nervous system and cardiac muscle.

During the entire period of therapy, the child must comply with bed rest - until the temperature returns to standard values.

Medical

Treatment with pharmacological drugs is based on the main symptoms:

1. Antivirals- "Viferon", "Laferobion" - designed to suppress the activity of viruses and restore immunity with the help of substitutes for human interferon. Immunoglobulins are prescribed for severe developmental options pathological process- hemorrhagic conditions or meningitis.
2. Antiemetics- designed to eliminate dizziness, nausea and suppress the gag reflex.
3. Antihistamines- are prescribed to suppress allergic reactions, alleviate existing catarrhal manifestations- rhinitis, congestion and swelling of the nasal passages.
4. Antipyretic- will help to reduce temperature indicators and eliminate signs of the inflammatory process - hyperemia, pain and increased dryness of the mucous membranes.
5. Adsorbents- help reduce the manifestations of toxic processes in the intestines - loose stools, gas formation, flatulence.

The second most important therapy is replenishment of body fluid losses - babies are given drinking water according to the scheme - 5 ml every 5 minutes. To general requirements with enterovirus infection and outpatient treatment include:

• constant airing of the children's room;
• stabilization of temperature in residential premises up to 18-20 degrees;
• quarantine regime;
• adherence to the dietary table.

Diet

Intestinal diseases of any etiology require changes in the diet throughout medical procedures. To restore functionality gastrointestinal department Parents should strictly follow medical advice.

During this period, it is prohibited:

• salty;
• smoked;
• sharp;
• fried;
• sweet dishes;
• butter and vegetable oils;
• chicken eggs;
• whole milk;
• sweet carbonated drinks;
• legumes;
• freshly baked bread;
• nuts;
• fatty broths.

The daily menu includes:

• vegetables and fruits cooked in the oven;
• fat-free cottage cheese and kefir;
• weakly brewed green tea;
• dried fruits compote;
• jelly;
• alkaline mineral water without gas.

There should be at least six feedings per day, in small portions. It is forbidden to force a child to eat by force, without his desire. All prepared meals should be warm - approximately equal to the body temperature of the baby.

Accurate recommendations on the treatment table will be given by the attending pediatrician, in accordance with the condition of the child and the need to prevent dehydration. Without the permission of a specialist, all familiar foods are removed from the diet.

Prevention

To avoid infection with an enterovirus infection, a number of recommendations should be followed:

• personal hygiene standards - the child must be taught to wash their hands with baby soap after walking, going to the toilet and before eating;
• adults who are in constant contact with children also need to follow the rules of hygiene;
• use of quality drinking water- filtered (jugs or cleaning systems), bottled, in the absence of opportunities - exclusively boiled;
• purchases of food products in stores, retail outlets, markets - where there is a check by the sanitary and epidemiological station;
• all fruits, vegetables and berries must be washed under running water.

With the implementation of these simple preventive measures, the threat of infection with enteroviruses is reduced several times.

The health of the child depends on the parents and their understanding of the need to comply with hygiene and other procedures. The disease is not difficult to modern medicine, but in the absence of symptomatic treatment can lead to serious consequences.

Enterovirus in children is dangerous complications. Therefore, it is so important to seek medical help in time and take preventive measures with responsibility.

Acute infectious diseases caused by intestinal viruses belong to the group of enterovirus infections. Pathology strikes various bodies a person and is manifested by fever and a wide range of clinical signs.

Enterovirus infection is characterized by outbreaks of mass diseases, especially in children's organized groups and families. The risk group includes people with reduced immunity - children, the elderly, people with chronic pathologies.

Enterovirus infection is characterized by a high susceptibility of the population and seasonality - an increase in the incidence in the summer-autumn season. A feature of enteroviruses is the ability to cause clinical symptoms of varying intensity: from mild discomfort to the development of paralysis and paresis.

Etiology

The causative agents of enterovirus infection are RNA-containing, ECHO, polioviruses. Microbes are relatively resistant to physical factors- cooling and heating, as well as some disinfectants. Boiling for a long time, disinfectants with chlorine, formaldehyde and UV radiation have a detrimental effect on viruses.

Enteroviruses remain viable during external environment pretty long. High air temperature and high humidity increase the life of the virus.

Sources of infection - patients and virus carriers.

Infection occurs:

• The fecal-oral mechanism, which is realized by water, alimentary and contact-household ways infection;
• An aerogenic mechanism, implemented by airborne droplets,
• Transplacental mechanism using a vertical path when the pathogen is transmitted from a sick mother to the fetus.

Microbes multiply on the mucous membrane of the pharynx, accumulate in the discharge of the nasopharynx, feces, cerebrospinal fluid. AT incubation period the virus is shed in environment in small quantities. Patients remain dangerous to others for a month, and in some cases longer.

Microbes enter the mucosa of the esophagus and upper respiratory tract, multiply and cause local inflammation, which occurs in the form of a respiratory disease, and intestinal disorders. The period of reproduction and accumulation of viruses coincides with incubation and ranges from one to three days. Pathogenic biological agents enter the cervical and submandibular lymph nodes. At this time, patients develop pharyngitis and diarrhea. With the blood flow, microbes spread throughout the body, affect the internal organs with the development of another pathology and the appearance of corresponding symptoms.

Symptoms

Enteroviral infection often proceeds without any characteristic signs and looks like a banal one. Viruses, affecting various organs and systems, usually cause herpangina, hemorrhagic inflammation of the conjunctiva, fever, gastroenteritis, and in rare cases - severe diseases: inflammation of the brain, liver, myocardium.

Symptoms of enterovirus infection:

1. intoxication syndrome,
2. Exanthema,
3. respiratory catarrh,
4. Abdominal signs.

Persons who have strong immunity and relatively healthy body, rarely suffer from severe enteroviral diseases. Their infection is usually asymptomatic. Newborns, young children, the elderly and the debilitated chronic diseases are more susceptible to the development of enteroviral meningoencephalitis, hepatitis, myocarditis, paralysis. Herpetic sore throat, acute respiratory infections and pharyngitis are less severe, but are accompanied by stubborn, painful.

Herpangina

- one of the most common forms of enterovirus infection. Its causative agents are Coxsackie viruses. The disease is manifested by symptoms of intoxication and catarrhal syndromes.

Herpetic (herpes) sore throat

• Herpangina begins acutely. body in patients rises to 40 degrees, there is nausea, malaise, headache.
• Approximately on the second day, signs of catarrh of the pharynx appear.
• After a couple of days, papules form on the tonsils, arches, tongue and palate, eventually turning into red blisters. They burst, forming on the mucous erosion, covered with plaque, which resolve without a trace in 5 days.
• Regional lymphadenitis is expressed slightly.
• Sore throat with herpangina is often absent or appears only during the formation of erosions.

ORZ

The respiratory form of enterovirus infection is manifested by symptoms similar to any other etiology. Patients complain of fever, sore throat, hoarseness, dry cough, runny nose and nasal congestion. Usually these signs are combined with symptoms of indigestion.

The temperature remains high for 4-5 days, and then gradually decreases. Other signs of the disease remain for another 2-3 weeks.

The catarrhal form is more common than others and proceeds according to the type of pharyngitis, or comorbidity. In young children, a symptom occurs that requires special attention. This makes it difficult for the child to breathe, especially at night. Attacks of "false croup" are a great danger to children's health.

A cold-like form of enterovirus infection usually does not last long and is rarely accompanied by complications.

Enteroviral exanthema

In patients with enterovirus infection, from about 2-3 days of pathology, a rash appears on the skin in the form of pink spots and papules, often with hemorrhages. For two to three days, the rashes remain on the body, and then gradually disappear without a trace. Exanthema is often combined with herpangina, stomatitis and meningitis.

Enteroviral exanthema

Rare clinical manifestations of enterovirus infection:

1. anicteric hepatitis,
2. meningoencephalitis,
3. inflammation of the optic nerve
4. Inflammation of the myocardium and pericardium,
5. Lymphadenitis,
6. Nephritis,
7. Paralysis and paresis.

Complications

Inflammation of the brain and peripheral nerves are the most common and dangerous complications of enterovirus infection.

Patients who turn to the doctor late and have a severe form of pathology may develop life-threatening diseases - cerebral edema, respiratory and cardiac arrest.

In young children, ARVI of enteroviral etiology is often complicated by the development of "false croup", and in adults - by secondary bacterial infection with the development of bronchopneumonia.

Features of pathology in children

Enterovirus infection in children occurs in the form of sporadic diseases, but more often in the form of epidemic outbreaks in organized children's groups. The incidence increases with warm time of the year. For children of preschool and primary school age, the fecal-oral mechanism of transmission of the pathogen is characteristic.

Enterovirus infection in children usually occurs in the form of tonsillitis, serous inflammation of the meninges, paralysis.

The clinic of pathology is developing rapidly. The temperature rises sharply, chills, dizziness and headache appear, sleep and appetite are disturbed. Against the background of severe intoxication, they begin to appear characteristics-, catarrh of the nasopharynx, myalgia, stool disorder, enteroviral exanthema.

Enteroviral stomatitis

Enteroviral stomatitis develops in children aged 1-2 years after the penetration of enteroviruses into the body.

Symptoms of the disease are:

• increased salivation,
• subfebrile temperature,
• Arthralgia and myalgia
• Runny nose,
• Chills,
• Malaise,
• Swelling of soft tissues in the mouth.

The child becomes lethargic, restless, capricious. Typical vesicles with a characteristic red corolla appear on the skin and mucous membranes. The rashes hurt and itch. These symptoms increase with the appearance of new lesions.

The disease develops rapidly: on the third day of infection, blisters appear, and on the seventh day the patient recovers.

Usually enteroviral stomatitis is combined with exanthema, gastroenteritis, fever, tonsillitis. In more rare cases, stomatitis is asymptomatic.

Due to the abundant symptoms, doctors often misdiagnose patients with SARS, allergic dermatitis, rotavirus or herpetic infection. The prescribed drugs eliminate the main symptoms of the pathology, but do not treat it completely.

Diagnostics

Diagnosis of enterovirus infection is based on characteristic clinical symptoms, patient examination data, epidemiological history and laboratory results.

The following clinical signs make it possible to suspect enterovirus infection:

1. Gerpangina,
2. enteroviral exanthema,
3. Enteroviral stomatitis,
4. meningeal signs,
5. nonbacterial sepsis,
6. respiratory syndrome,
7. Conjunctivitis,
8. Gastroenteritis.

Material for research - a swab from the pharynx, discharge of oral ulcers, feces, cerebrospinal fluid, blood.

Virological study- the main diagnostic method. For the detection of enteroviruses use:

• PCR - polymerase chain reaction. This method is highly specific, highly sensitive and fast. It is designed to identify viruses that are not able to multiply in cell culture. PCR is used to investigate cerebrospinal fluid secreted by the respiratory organs.
• Detection of pathogens in cell culture or laboratory animals. This method is more time-consuming, but accurately determines the type of microbe.

Serodiagnostics is aimed at determining the antibody titer in paired sera taken from a patient in the first and third weeks of the disease. To do this, put a compliment binding reaction or a hemagglutination inhibition reaction. A fourfold increase in antibody titer in paired sera is considered diagnostically significant. IgA and IgM are markers of the acute period of the disease, and IgG is a marker past infection, which persists for a long time in the blood. Serological testing is intended to confirm the virological method, since in the feces healthy people enteroviruses may be detected.

Molecular biological method allows you to determine the serotype of the isolated pathogen.

Immunohistochemistry– immunoperoxidase and immunofluorescent methods.

All of these methods are rarely used in the mass examination of patients, since they are lengthy, complex and do not have a high diagnostic value, which is associated with a large number of asymptomatic carriers of enteroviruses.

Differential diagnosis of enterovirus infection:

1. Herpetic sore throat is differentiated from a fungal infection of the oropharynx and herpes simplex;
2. Epidemic myalgia - with inflammation of the pancreas, pleura, gallbladder, appendix, lungs;
3. Enteroviral fever - with acute respiratory viral infections;
4. Serous meningitis - with inflammation of the meninges of other etiologies;
5. Enteroviral exanthema - with, allergies;
6. Enteroviral gastroenteritis - with salmonellosis and shigellosis.

Treatment

Treatment for enterovirus infection includes:

• Compliance with the regime
• Balanced and rational nutrition,
• Taking multivitamins,
• Etiotropic and pathogenetic therapy.

Mode and diet

Mild and moderate forms of pathology are treated at home with strict bed rest. Patients with severe forms, prolonged fever and the presence of complications are hospitalized in a hospital.

Patients are shown a diet that reduces intoxication, increases immunity, and spares the digestive organs. Nutrition of patients should contain a sufficient amount of protein, vitamins, minerals. It is recommended to drink plenty of water to detoxify the sick organism.

Etiotropic treatment

1. Specific therapy for enterovirus infection has not been developed.
2. Antiviral drugs - "Remantadin", "Kagocel".
3. Immunostimulants - "Grippferon", candles "Viferon", "Kipferon". These medicines have a double therapeutic effect: help get rid of viruses and stimulate cellular and humoral immunity.
4. Immunomodulators - "Amiksin", "Cycloferon", "Citovir". They have a pronounced anti-inflammatory effect and stimulate the body to produce its own interferon, which increases overall resistance and protects against the destructive effects of viruses.

Pathogenetic therapy

Pathogenetic treatment of enterovirus infection is carried out in a hospital.

• Detoxification measures are indicated for severe pathology.
• With the help of diuretics, dehydration is carried out with the development of complications - inflammation of the brain and its membranes.
• Cardioprotectors are prescribed for viral heart disease.
• For treatment, drugs are used that improve blood microcirculation in the vessels of the brain.
• Corticosteroids are used to treat pathologies of the nervous system.
• resuscitation and intensive therapy necessary in the development of emergency conditions.

Symptomatic therapy

Pregnant women and children should be under the supervision of a specialist throughout the illness. Only a doctor, after making a diagnosis, should prescribe drugs and their dosages that are allowed for a certain gestational age and age group.

Self-treatment of enterovirus infection is strictly prohibited. This is due to the non-specificity of the symptoms of the disease, the possibility of confusing the pathology and treating it incorrectly.

Prevention

Specific prophylaxis for enterovirus infection has not been developed. Main activities:

Video: enterovirus infection, “Live healthy”

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

General information

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

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

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

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

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

Treatment of enterovirus infection in children

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

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

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

Forecast and prevention of enterovirus infection in children

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

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