Enterovirus infection in children. Symptoms, treatment, diet

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

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

What is enterovirus infection?

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

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

How dangerous is entorovirus in children? The seriousness of the infection lies in the fact that its pathogens are highly resistant to aggressive external factors. They can exist for a long time in moist soil and water, then penetrate into human body through contaminated products.

At the beginning of 2008, a large-scale epidemic among children was recorded in China. Its appearance was provoked by the EV71 virus. It enters the human body through the respiratory tract and mucous membranes. digestive tract. It then spreads throughout the body circulatory system, affecting the lungs and brain. The infection was detected in 15 thousand children, and 20 of them died. This once again demonstrates that enterovirus in children and adults requires timely and comprehensive treatment.

Causes of infection

The infection develops against the background of activation of groups that cause certain symptoms. They all differ in a number of common characteristics. At the heart of every virus is a core represented by a molecule nucleic acid. In some cases, DNA plays its role, in others - RNA. On the outside, the internal structure is surrounded by a capsule, which has some special features. Depending on the configuration of shell elements, viruses are divided into different subtypes.

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

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

How long is the incubation period? Enterovirus may not manifest itself in children external symptoms from 1 to 12 days. Typically, the incubation period is five days. Clinical picture specific disease depends directly on the serotype of the pathogen. Enterovirus usually becomes active in spring and autumn. At other times of the year, the incidence is much lower.

Routes of transmission

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

Enterovirus in children under one year of age has similar causes. However, in babies who are on breastfeeding, there is innate immunity to most serotypes. On the other hand, a child can pick up an infection immediately after finishing drinking breast milk.

Clinical picture

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

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

Sometimes children experience enlarged lymph nodes, mainly submandibular and cervical. Another symptom of the disease is exanthema. The rash appears simultaneously on the head, chest and arms. They look like red spots. After they disappear, small pigment marks remain on the body, which disappear on their own after a few days.

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

Frequent forms of enterovirus infection

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

1. Herpetic sore throat. This is a catarrhal manifestation of enterovirus. Herpangina usually occurs in children between three and ten years of age. Its main manifestations are high fever, sore throat and vesicles on back wall throats. The blisters burst and form ulcers. The main pathogens are considered to be Coxsackie viruses A and B.
2. Exanthema. This is one of the most common examples of how enterovirus can manifest itself. In children, the rash has two distinct types: red ear-like and roseolous. Exanthema may appear on the first or second day after infection. Rashes appear on the face, body and look like small red spots. Sometimes they merge together. Against the background of red rashes, hemorrhagic elements may also appear. Enteroviral exanthema in to a greater extent Children under six years of age are susceptible.
3. Flu-like syndrome. This form of enterovirus infection is characterized by symptoms of typical influenza or ARVI. Children experience (runny nose, swelling, nasal congestion), fever, weakness, muscle pain. Typical symptoms of the syndrome that distinguish it from ordinary flu include stool upset and vomiting.
4. Intestinal form. This is one of the most dangerous options enterovirus infection. Accompanied by a moderate rise in temperature, watery diarrhea, bloating and flatulence. The main danger intestinal form counts high probability dehydration of the body, which complicates the condition of the little patient. This disorder requires constant monitoring by doctors and emergency care.

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

Rare forms of infection

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

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

Atypical variants of infection are characterized by an asymptomatic and hidden course. Clinical diagnosis becomes possible only if visible complications appear.

Enterovirus infection in children has a varied course. Therefore, it is important to consult a doctor in time to undergo diagnostic examination. It allows you to differentiate infection from ordinary respiratory diseases, poisoning and dermatological problems.

Medical examination

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

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

• Serological (detection of the virus in blood serum). Early markers of pathology include IgA and IgM. An increase in titer of 4 times is also considered significant for diagnosis.
• Virological (determination of the infectious agent in cerebrospinal fluid, feces, blood). The stool is examined over a period of two weeks.
• Immunohistochemical (detection of antigens to enteroviruses in the blood).
• Molecular biological methods (study of enterovirus RNA fragments).

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

Drug therapy

How to treat enterovirus in children? This is the question many parents ask after hearing the diagnosis. At mild flow illness, a small patient can stay at home. The following conditions are considered indications for immediate hospitalization: damage to the central nervous system, heart, high fever.

Modern medicine cannot provide a single universal remedy against infection. In the acute period, young patients are recommended to adhere to bed rest, a fortified diet and drinking plenty of fluids. How to treat enterovirus in children?

If the illness is accompanied by fever, headaches and muscle pain, it is considered advisable to take analgesics and antipyretics (Nurofen, Paracetamol). For diarrhea, medications are prescribed to normalize water-salt balance(“Regidron”). Antibiotics are used only in case of bacterial infections.

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

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

Diet for enterovirus in children plays an important role, since the functioning of the gastrointestinal tract is disrupted. First of all, it means drinking plenty of fluids. Drinking regular still water large quantities helps remove toxins from the body and prevents dehydration.

Pediatricians recommend excluding fried and smoked foods, all sweets and baked goods from the diet. It is important to limit your consumption of whole milk products, butter, eggs. Meat broth, nuts, legumes and bread are also prohibited. Food should be steamed or baked in the oven.

What can you eat? The diet should consist of fresh vegetables and heat-treated fruits. Allowed dairy products(biokefir, low-fat cottage cheese). You can eat lean meat and fish. It is better to serve them to the child in crushed or even pureed form. In general, meals should be fractional. It is recommended to eat often, but in small portions. If a child refuses to eat, he should not be forced or force-fed.

What to do when acute diarrhea accompanied by enterovirus? Treatment in children school age in this case, it means observing the so-called fasting break. It is helpful to skip one or two meals. Hungry pauses in infants are unacceptable. Then the young patients are prescribed a strict diet.

On the first day you can eat porridge with water and baked apples. As the child’s general condition improves, fermented milk products and vegetable puree soups should be introduced into the diet. Meat and fish dishes are allowed last.

Complications of enterovirus infection

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

These diseases affect the brain of a young patient, which can lead to epilepsy, paralysis or death. There are also cases of secondary infection, which requires additional therapy. Fatal outcomes are usually caused by acute cardiac or pulmonary insufficiency. If comprehensive examination confirms enterovirus, treatment in children should be prescribed by a pediatrician. Trying to overcome the disease on your own is strictly prohibited. Parents can cause irreparable harm to the baby's health.

Prevention methods

Specific prevention of enterovirus in children has not been developed. However, vaccinations against meningococcemia and polio show good results. In many European countries Vaccination is now used against the most common pathogens of enterovirus infection. However, such prevention does not provide an absolute guarantee due to the variety of viruses. Research and clinical trials By this issue continue.

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

Now you know how enterovirus differs in children. Symptoms and treatment of diseases caused by this pathogen require a competent approach from specialists. If you don't delay visiting your doctor, you can prevent life-threatening complications. Be healthy!

Enteroviral infections is a group of diseases that are caused by several types of viruses. The disease is caused by Coxsackie viruses, polioviruses and ECHO (ECHO).

After an enterovirus infection, persistent lifelong immunity is formed, however, it is serospecific. This means that immunity is formed only to the serological type of virus that the child has had and does not protect him from other varieties of these viruses. Therefore, a child can get sick with enterovirus infection several times during his life. Also, this feature does not allow us to develop a vaccine to protect our children from of this disease. The disease is seasonal: outbreaks of the disease are most often observed in the summer-autumn period.

Causes of enterovirus infection.

Infection occurs in several ways. Viruses can enter the environment from a sick child or from a child who is a virus carrier. Virus carriers do not have any manifestations of disease, but the viruses are in the intestines and are released into the environment with feces. This condition can be observed in children who have been ill after clinical recovery, or in children in whom the virus entered the body, but was unable to cause illness due to the child’s strong immunity. Virus carriage can persist for 5 months.

Once in the environment, viruses can persist for quite a long time, as they tolerate adverse effects well. Viruses are well preserved in water and soil, can survive for several years when frozen, are resistant to the action of disinfectants (when exposed to solutions of high concentrations of phenol, chlorine, formaldehyde, viruses begin to die only after three hours), but are susceptible to high temperatures (at when heated to 45ºС they die in 45-60 seconds).

How is enterovirus infection transmitted?

The transmission mechanism can be airborne (when sneezing and coughing with droplets of saliva from a sick child to a healthy one) and fecal-oral if personal hygiene rules are not observed. Most often, infection occurs through water, when drinking raw (not boiled) water. It is also possible to infect children through toys if children put them in their mouths. Children aged 3 to 10 years are most often affected. Breastfed children have immunity in their bodies, received from the mother through breast milk, however, this immunity is not stable and quickly disappears after stopping breastfeeding.

Symptoms of enterovirus infection.

Viruses enter the body through the mouth or upper respiratory tract. Once in the child’s body, the viruses migrate to the lymph nodes, where they settle and begin to multiply. The further development of the disease is associated with many factors, such as virulence (the ability of the virus to resist the body’s protective properties), tropism (the tendency to infect individual tissues and organs) of the virus and the state of the child’s immunity.

Enterovirus infections have both similar and different manifestations, depending on the type and serotype. The incubation period (the period from the virus entering the child’s body until the first clinical signs appear) is the same for all enterovirus infections - from 1 to 10 days (usually 2-5 days).

The disease begins acutely - with an increase in body temperature to 38-39º C. The temperature most often lasts 3-5 days, after which it drops to normal numbers. Very often, the temperature has a wave-like course: the temperature lasts for 2-3 days, after which it decreases and remains at normal levels for 2-3 days, then rises again for 1-2 days and returns to normal again completely. When the temperature rises, the child feels weak, drowsy, and may experience headache, nausea, and vomiting. When the body temperature decreases, all these symptoms disappear, but when the body temperature rises again, they may return. The cervical and submandibular lymph nodes also enlarge, as viruses multiply in them.

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

When the mucous membrane of the oropharynx is damaged, the development occurs enteroviral sore throat. It is manifested by an increase in body temperature, general intoxication (weakness, headache, drowsiness) and the presence of a vesicular rash in the form of bubbles filled with liquid on the mucous membrane of the oropharynx and tonsils. These bubbles burst, and in their place ulcers filled with white plaque form. After recovery, no traces remain at the site of the ulcers.

When the eyes are affected, it develops conjunctivitis. It can be one- or two-sided. Manifests itself in the form of photophobia, lacrimation, redness and swelling of the eyes. There may be hemorrhages in the conjunctiva of the eye.

When muscles are damaged, it develops myositis– muscle pain. Pain appears against the background of rising temperature. Soreness is observed in chest, arms and legs. The appearance of muscle pain, like fever, can be wave-like. As the body temperature decreases, the pain decreases or disappears completely.

In case of damage to the intestinal mucosa (enteritis) presence of loose stools is observed. The stool is of normal color (yellow or brown), liquid, without pathological (mucus, blood) impurities. The appearance of loose stools can be either against the background of an increase in temperature or isolated (without an increase in body temperature).

Enteroviral infections can affect various areas hearts. So, when the muscle layer is damaged, it develops myocarditis, when the inner layer is damaged with the capture of the heart valves, it develops endocarditis, with damage to the outer lining of the heart - pericarditis. The child may experience: increased fatigue, weakness, rapid heartbeat, falling blood pressure, rhythm disturbances (blockades, extrasystoles), chest pain.

When the nervous system is damaged, they can develop encephalitis, meningitis. The child experiences: severe headache, nausea, vomiting, increased body temperature, convulsions, paresis and paralysis, loss of consciousness.

When the liver is damaged, it develops acute hepatitis. It is characterized by an enlarged liver, a feeling of heaviness in the right hypochondrium, and pain in this place. Nausea, heartburn, weakness, and increased body temperature may occur.

If the skin is damaged, it may appear exanthema– hyperemia (red coloring) of the skin, most often on the upper half of the body (head, chest, arms), does not rise above the skin level, appears simultaneously.

In boys, there may be inflammation in the testicles with the development orchitis. Most often, this condition develops 2-3 weeks after the onset of the disease with other manifestations (angina, loose stool and others). The disease goes away quite quickly and does not have any consequences, however, in in rare cases it is possible to develop aspermia (lack of sperm) at puberty.

There are also congenital forms enterovirus infection when viruses enter the child’s body through the placenta from the mother. Typically, this condition has a benign course and is cured on its own, however, in some cases, an enterovirus infection can cause termination of pregnancy (miscarriage) and the development of the syndrome in the child sudden death(the death of a child occurs against the background of full health).

Very rarely, damage to the kidneys, pancreas, and lungs is possible. Defeat various organs and systems can be observed both isolated and combined.

Treatment of enterovirus infection.

There is no specific treatment for enterovirus infection. Treatment is carried out at home, hospitalization is indicated in the presence of damage to the nervous system, heart, high temperature, which cannot be reduced for a long time with the use of antipyretics. The child is prescribed bed rest for the entire period of increased body temperature.

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

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

Children are isolated for the entire period of illness. They can stay in the children's group after all symptoms of the disease disappear.

Prevention of enterovirus infection.

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

There is no specific vaccine against enterovirus infection, since environment There are a large number of serotypes of these viruses.

At the first signs of illness in a child - consult a doctor immediately!!!

Sanitary and epidemiological department of the State Budgetary Healthcare Institution of the Leningrad Region "Kirishi City Clinical Hospital".

Enterovirus infection is a group acute diseases digestive tract, which are caused by RNA-containing pathogens of the Enterovirus genus.

Nowadays, outbreaks of enterovirus infection are increasingly observed in many countries around the world. The danger of this group of diseases is that clinical symptoms can be very diverse. In most cases, there is a mild course, characterized by minor discomfort, but serious complications may occur, including - severe lesions respiratory system and central nervous system, as well as kidneys and digestive tract organs.

Pathogens and routes of their transmission

The vast majority of RNA-containing enteroviruses are pathogenic for humans.

To date, over 100 types of pathogens have been identified, including:

• ECHO viruses;
• Coxsackie viruses (types A and B);
• pathogens (polioviruses);
• unclassified enteroviruses.

The pathogens are ubiquitous. They are characterized by a high degree of stability in the external environment, tolerate freezing, as well as treatment with antiseptics such as 70% ethanol, Lysol and ether. Enteroviruses quickly die during heat treatment (they cannot tolerate heating up to 50°C), drying and exposure to formaldehyde or chlorine-containing disinfectants.

Natural reservoirs for pathogens are water bodies, soil, some food products, and the human body.

note: In feces, enteroviruses remain viable for up to six months.

In most cases, the source of the pathogen is a sick person or a virus carrier, who may completely lack Clinical signs enterovirus infection. According to medical statistics, among the population of some countries, up to 46% of people can be carriers of pathogens.

Main routes of transmission:

• fecal-oral (with a low level of hygiene);
• contact-household (through contaminated objects);
• airborne (if the virus is present in the respiratory system);
• vertical transmission (from an infected pregnant woman to a child);
• water (when swimming in polluted waters and watering plants with wastewater).

note: cases of infection with enteroviruses have been recorded even through water in coolers.

This group of acute diseases is characterized by seasonal outbreaks in the warm season (summer-autumn). Human susceptibility to enteroviruses is very high, but after an infection it is quite for a long time(up to several years) type-specific immunity is maintained.

Symptoms of enterovirus infection

Enterovirus infection in adults and children can cause a number of pathologies characterized by varying degrees of severity of the inflammatory process.

The most severe pathologies include:

• inflammation of the myocardium (heart muscle);
• pericarditis (inflammation of the pericardial sac);
• hepatitis (anicteric);
• serous (damage to the soft membranes of the brain);
• acute paralysis;
• kidney damage;
• newborns.

Less dangerous manifestations:

• three-day fever (including with skin rashes);
• gastroenteritis (inflammation of the digestive tract);
• herpetic sore throat;
• lymphadenopathy;
• polyradiculoneuropathy;
• inflammation of the conjunctiva;
• inflammation of the choroid;
• damage to the optic nerve;
• vesicular pharyngitis.

note: When enterovirus D68 enters the body, bronchopulmonary obstruction often develops. A characteristic symptom is a severe cough.

Severe complications rarely develop in adult patients with good immunity. They are typical for people with reduced body resistance - children (especially - early age) and persons suffering from serious diseases (, malignant tumors).

note: the variety of clinical manifestations is due to a certain affinity of enteroviruses for many tissues of the human body.

The most characteristic clinical signs of enterovirus infection in children and adults:

The duration of the incubation period for enteroviral infections in most cases ranges from 2 days to 1 week.

Most often, when infectious agents of this type enter the body, a person develops ARVI.

Symptoms of the catarrhal form of enterovirus infection:

• runny nose;
• cough (dry and rare);
• increased temperature (usually within subfebrile range);
• hyperemia of the mucous membrane of the throat;
• digestive disorders (usually not very significant).

As a rule, a person recovers within a week from the onset of the disease.

Symptoms of enteroviral fever:

• febrile reaction within 3 days from the onset of the disease;
• moderate signs of general intoxication;
• skin rashes (not always);
• deterioration in general health (mild or moderate).

note: Enteroviral fever is also called " minor illness", since the symptoms do not last long and their severity is low. This form of pathology is relatively rarely diagnosed, since most patients do not even seek medical help.

With this form of enterovirus infection, children may experience symptoms of damage to the upper respiratory tract(catarrhal manifestations). In young children, the disease can last up to 2 weeks or more.

A sign of herpangina against the background of an enterovirus infection is the formation of red papules on the mucous membranes. They are localized in the area of ​​the hard palate, uvula and arches. These small rashes quickly transform into vesicles, which after 2-3 open with the formation of erosions or gradually resolve. Herpangina is also characterized by enlargement and pain of the submandibular and cervical lymph nodes, as well as hypersalivation (salivation).

The main clinical manifestation of enteroviral exanthema is the appearance on the skin of patients of a rash in the form of spots and (or) small blisters Pink colour. In most cases, the skin elements disappear after 2-3 days; At the site of their resolution, peeling of the skin is observed, and the upper layers come off in large fragments.

Important: exanthema can be diagnosed in parallel with meningeal symptoms.

Symptoms of serous meningitis against the background of enterovirus infection:

• photophobia (photophobia);
• increased sensitivity to sounds;
• severe headache when bringing the chin to the chest;
• lethargy;
• apathy;
• psycho-emotional arousal (not always);
• high body temperature;
• convulsions.

Oculomotor disorders, disturbances of consciousness, muscle pain and increased tendon reflexes are also possible.

Meningeal symptoms last from 2 days to one and a half weeks. IN cerebrospinal fluid the virus can be detected within 2-3 weeks.

Symptoms of enteroviral conjunctivitis:

• pain (stinging) in the eyes;
• tearfulness;
• photophobia;
• redness of the conjunctiva;
• swelling of the eyelids;
• copious discharge (serous or purulent).

note: with enteroviral conjunctivitis, one eye is initially affected, but soon the inflammatory process spreads to the second.

Signs of enterovirus infection in children

Children (especially children under 3 years of age) are characterized by an acute onset of the disease.

Most common clinical manifestations enterovirus infections are:

• sleep disorders;
• fever;
• chills;
• diarrhea;
• catarrhal symptoms;
• myalgia;
• dizziness;
• weakness;
• exanthema and (or) sore throat (not always).

Currently, the causative agent of enterovirus infection can be identified in one of four ways:

Changes in general analysis blood:

• slight leukocytosis;
• hyperleukocytosis (rare);
• neutrophilia (on early stage);
• eosinophytosis and lymphocytosis (as the disease progresses).

Important:establishing the presence of a virus in the body is not indisputable evidence that it was this pathogen that provoked the disease. Asymptomatic carriage occurs quite often. The diagnostic criterion is an increase in the number of antibodies (in particular, immunoglobulins A and M) by 4 or more times!

Differential diagnosis

Herpes sore throat, which is caused by the Coxsackie virus, should be differentiated from herpes simplex and oral candidiasis (fungal). Serous meningitis caused by infection with enteroviruses should be distinguished from lesions meninges meningococcal etiology.

If symptoms of the gastroenteric form occur, other intestinal infections should be excluded. It is important to differentiate exanthema from rashes caused by rubella and hypersensitivity reactions (allergic).

Etiotropic (i.e., specific) treatment methods have not been developed to date.

Treatment of enterovirus infection in adults involves detoxification and symptomatic therapy. Therapeutic tactics are determined individually for each patient depending on the nature, location and severity of the course. pathological process. According to indications, patients are given antiemetics, painkillers and antispasmodics.

When treating enterovirus infection in children, rehydration therapy often comes to the fore, i.e. eliminating dehydration and restoring electrolyte balance. To this end saline solutions and 5% glucose is either given orally or administered via intravenous infusions. Children are also given detoxification therapy and, if necessary, given antipyretics (antipyretics).

To combat viruses, intranasal administration of a solution of leukocyte interferon is indicated.

If complications occur due to the addition of a secondary bacterial infection, the patient is prescribed a course of antibiotic therapy. Lesions of the nervous system often require the use of hormonal therapy with corticosteroids.

Enteroviral infections include a group of infectious diseases that occur as a result of intestinal viruses entering the body. They can manifest themselves in a wide variety of clinical pictures due to damage to the cardiovascular and nervous systems, muscle tissue, liver, gastrointestinal tract, kidneys, respiratory organs or other organs. In most cases, enterovirus infection in children occurs in mild form and is accompanied by symptoms such as a sharp rise in temperature, general malaise, rashes on the skin and mucous membranes, gastrointestinal disorders.

Content:

Characteristics of the pathogen

The causative agents of enterovirus infection are viruses of the genus Enterovirus, from the family Picornaviridae. They consist of a linear, single-stranded RNA molecule enclosed in an outer shell of a protein nature. All enteroviruses contain a common antigen, characteristic of the entire genus, and a specific antigen, typical only for specific type(serotype). About 70 types of enteroviruses are considered pathogenic for the human body, which are divided into the following groups:

• polio viruses (3 serotypes);
• Coxsackie viruses type A (includes 24 serotypes) and type B (includes 6 serotypes);
• ECHO viruses (34 serotypes);
• unclassified enteroviruses.

Enteroviruses are ubiquitous. In conditions external environment they can remain viable for up to one month, and in feces for up to 6 months. They can be found in soil, water, and food. They are resistant to low temperatures, even to freezing, acidic environments, exposure to 70% ethyl alcohol, diethyl ether, phenolic compounds, however, they are quickly inactivated by drying, heating to 50 ° C or more, exposure to ultraviolet irradiation, ultrasound, radiation. They also lose viability when treated with chlorine-containing disinfectants, oxidizing agents (hydrogen peroxide, potassium permanganate), methylene blue, and formaldehyde.

The main place of reproduction of enteroviruses in the human body is lymphoid structures small intestine, epithelial cells and lymphoid tissue pharyngeal ring. After suffering an enterovirus infection, the child remains stable for life, but only to the type of virus with which the body had contact, and in relation to other serotypes it turns out to be ineffective and useless.

Routes of infection

Enteroviral infections are most often recorded in summer and autumn. Young children under 10 years of age are most susceptible to the disease. Older children and adults get sick less often, since they already have developed immunity to the pathogen due to an asymptomatic infection, and are well trained in the rules of personal hygiene and preventive measures. In breastfed infants, the disease occurs quite rarely, since along with mother's milk the child receives antibodies to this pathogen.

Infection occurs from a healthy carrier of the infection or an already sick person. Moreover, in the case of healthy virus carriers, which can be observed in children who have already recovered from the disease or in children with strong immunity who have had the disease asymptomatically, the period of contagiousness for others can reach 5 months. The duration of the incubation period after infection ranges from 2 to 10 days.

The main mechanism of infection transmission is the fecal-oral route and, less commonly, the airborne route. Infection occurs due to:

• failure to comply with personal hygiene rules (failure to thoroughly wash hands with soap after visiting the toilet and before eating);
• drinking raw water;
• contact with household items and toys of a sick child;
• swimming in public reservoirs;
• eating unwashed fruits and vegetables;
• consumption of dairy products in thermally unprocessed form.

Transplacental transmission of enterovirus infection from an infected pregnant woman to the fetus is also possible.

Forms and symptoms of the disease

The entry gates of enterovirus infection are the mucous membranes of the nasopharynx and digestive tract, where in response to ingestion infectious agent a local inflammatory reaction is observed.

With good local immunity, the spread of the virus throughout the child’s body is limited to the entrance gates, the infection is asymptomatic or in a very mild form only with damage to the mucous membranes. With insufficient immunity, large quantities ingested viral particles or high virulence of the virus, generalization of the infection is observed. After multiplying in the intestines, viruses enter the systemic bloodstream and spread throughout the body, affecting those organs and tissues to which they have tropism. The observed clinical picture can be very diverse. The pathogenic activity of the virus in children declines from the moment the body produces specific antibodies.

Enterovirus infections, depending on the observed clinical picture, are divided into typical and rare (atypical) forms. Typical ones include:

• serous meningitis;
• epidemic myalgia;
• enteroviral exanthema.

Atypical forms are:

• myocarditis;
• encephalitic and or polio-like form;
• encephalomyocarditis of newborns;
• enteroviral uveitis;
• epidemic hemorrhagic conjunctivitis;
• enteroviral fever;
• respiratory (catarrhal) form;
• enteroviral diarrhea (gastroenteritis);
• defeat genitourinary system(hemorrhagic cystitis, nephritis, ochritis, epididymitis);
• pancreatitis.

The development of the disease in children, as a rule, is acute and begins with a sharp increase in body temperature to 39–40°C, lasting from 3 to 5 days, chills, general weakness, headache, loss of appetite. Possible nausea and vomiting, enlargement of the cervical and submandibular lymph nodes, where the virus multiplies. The listed symptoms of enterovirus infection are characteristic of almost all clinical forms of its course.

Herpangina

A typical sign of herpetic sore throat in a child is moderate hyperemia and the appearance of rashes on the mucous membranes oral cavity and throat (palatine arches, tonsils, soft and hard palate, uvula) on the first day of illness. Initially, the elements of the rash are red papules that do not merge with each other, and then turn into vesicles with a diameter of 1–2 mm. Their number can vary from 3 to 18. After 2 days, the bubbles spontaneously open with the formation of small wounds or resolve without leaving a trace. Herpetic sore throat is characterized by pain on palpation of the cervical and submandibular lymph nodes.

Serous meningitis

Serous meningitis is the severe and most common form of enterovirus infection in children. Its symptoms include severe headache, apathy, fever, vomiting, restlessness, anxiety, convulsions, as well as a number of symptoms resulting from irritation and inflammation of the meninges:

• Brudzinski's and Kernig's symptoms;
• photophobia;
• increased sensitivity to sounds;
• severe headache when trying to press your chin to your chest;
• stiff neck and others.

After 3–5 days, the clinical picture begins to regress, while symptoms can persist for up to 10 days, and the virus is detected in the cerebrospinal fluid for 2–3 weeks. Residual effects after serous meningitis in the form of hypertension and asthenic syndrome can be observed for another 2–3 months.

Enteroviral exanthema

Enteroviral exanthema in a child manifests itself in the form of a skin rash. Its elements are present on the skin of the face, torso, limbs, and less often in the oral cavity. They appear as pink spots or papules that quickly disappear within three days, leaving no traces behind. In some cases, for a short time after the rash disappears, peeling and slight pigmentation are observed on the skin.

Enteroviral exanthema can develop together with serous meningitis or herpetic sore throat.

Epidemic myalgia

The main symptom of epidemic myalgia is intense muscle pain. Children complain of seizures acute pain in the chest and upper abdomen, less often in the back, arms and legs. When driving painful sensations intensify, the skin becomes pale, increased sweating and increased breathing occur. Like enteroviral exanthema, this form can occur together with herpetic sore throat and serous meningitis.

Diagnostics

If you suspect an enterovirus infection, you should contact the child's pediatrician. Depending on the specific form of the disease, you may additionally need to consult an ophthalmologist, otolaryngologist, neurologist, cardiologist or other specialists. The doctor will be able to confirm the diagnosis based on visible symptoms, assessment of the general epidemiological situation in the region and test results. The main laboratory tests indicated in this case are:

• general blood analysis;
• identification of specific enterovirus RNA fragments in the test material;
• serological studies based on immune responses to the virus ( linked immunosorbent assay, complement fixation reactions and hemagglutination inhibition, etc.) and performed in paired sera at certain intervals.

To identify infectious agents in children, depending on the affected area, various biological materials: blood, discharge from the eyes, nasopharyngeal swabs, skin scrapings, feces.

In a general blood test for enterovirus infection, an increase in the concentration of leukocytes, neutrophils (at an early stage of the disease), eosinophils and lymphocytes (as the disease progresses), a shift in the leukocyte formula to the left and an increase in ESR are observed. During serological studies, in the case of the presence of enteroviruses in the body, at least a 4-fold increase in antibody titer between paired sera should be observed.

In some forms of enterovirus infection, differential diagnosis with other diseases that occur with similar symptoms is necessary:

• herpetic sore throat is differentiated from damage to the mucous membrane of the mouth and throat by the herpes simplex virus and fungi of the genus Candida;
• serous meningitis should be distinguished from damage to the meninges caused by meningococcal infection, tuberculosis and others infectious diseases;
• enteroviral exanthema differentiated from rubella, scarlet fever, measles, allergic reaction in the form of urticaria;
• Epidemic myalgia is distinguished from pleurisy, acute appendicitis, peritonitis, pancreatitis, cholecystitis.

Treatment

Enterovirus infection in relatively healthy children occurs predominantly in a mild form. Treatment is carried out at home, except in cases of damage to the nervous system and vital important organs(heart, liver, kidneys). Hospitalization is also indicated if the child has a high fever for a long time, which does not decrease in response to taking antipyretic drugs.

Specific drugs for the treatment of disease that directly affect enteroviruses, on this moment no, therefore the main therapy is to support and strengthen the immune system, increase its protective functions. For this purpose, if necessary, immunoglobulins, immunomodulating drugs and interferon drugs are used.

The following medications can be used to eliminate and alleviate the symptoms of enterovirus infection in children:

• antipyretic drugs based on paracetamol or ibuprofen for high temperature;
• means for rehydration and relief of intoxication (water-salt solutions rehydron, humana electrolyte, hydrovit and others, glucose, smecta, enterosgel);
• antihistamines;
• antiemetics;
• painkillers;
• gargles and throat sprays;
• preparations for restoring intestinal microflora (Linex, Laktovit, Bifiform).

At high temperatures, bed rest is indicated. An important element in the treatment of enterovirus infection in children throughout the entire period of illness is drinking plenty of fluids (still mineral water, compotes, fruit drinks, tea), frequent wet cleaning and regular ventilation of the room where the child is, which is especially emphasized by pediatrician E. O. Komarovsky . Meals should be at the child's request and consist of easy-to-digest foods (porridge with water, boiled lean meat, vegetables, soups without rich broth, kefir, biscuits).

During the treatment period and until complete recovery, the sick child should be isolated from healthy children. In order to avoid the massive spread of infection, he is prohibited from visiting kindergarten, school or other children's groups.

Video: Pediatrician Komarovsky E. O. about enteroviral infections and their features

Complications

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

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

Prevention

Prevention of enterovirus infection consists of the following measures:

• strict adherence to personal hygiene rules;
• drinking only boiled or bottled water;
• general strengthening of the immune system;
• Thoroughly wash raw fruits and vegetables before eating;
• frequent ventilation and wet cleaning of the room;
• avoiding visiting crowded places during an epidemic outbreak;
• a ban on swimming in open waters without special permission.

Given the numerous serotypes of enteroviruses, effective prevention infection of children by vaccination has not yet been developed.

Enterovirus infection. There is only one name, but there are a great many diseases that can be classified as this type. A famous doctor, author of books and articles about children's health, Evgeny Komarovsky.

What it is?

Enterovirus infection is a disease that is caused by viruses that enter the body through the gastrointestinal tract. People call the disease “dirty hands disease,” although the spectrum of action of enteroviruses is quite wide. Pathogens include:

• enteroviruses - 4 types;
• polio viruses - 3 types;
• echoviruses - 31 types;
• Coxsackie viruses (A and B) - about 30 types.

All these viruses are very resistant to an acidic environment, so they can easily survive the attack of gastric juice and enter the intestines, where they begin to exhibit their pathogenic activity. In addition, these viruses can exist at normal room temperature for several days.

Symptoms

Recognizing enterovirus infection is not as easy as it seems. About 90% of polio infections are secretive; almost half of the remaining enteroviruses also do not cause any specific symptoms. Only some pathogens are capable of producing a certain clinical picture, which allows one to suspect an enterovirus infection in a child:

• fever, increased body temperature;
• respiratory manifestations – runny nose, cough, sore throat;
• abdominal pain, diarrhea. This symptom is rare.

Typically, enteroviruses cause diseases that doctors conditionally divide into potentially severe and less dangerous. The former include encephalitis and serous meningitis, myocarditis and hepatitis. Less dangerous include fever with or without a rash, herpetic sore throat, conjunctivitis, pharyngitis, gastroenteritis, three-day fever.

Diagnosis, due to the vagueness of symptoms, is difficult. The doctor whom the parents call to the house can only make a presumptive diagnosis, but only the laboratory research:

• serological blood test;
• virological study blood and feces;
• molecular biological method for isolating enteroviruses from a laboratory sample.

Therefore, if a child has nothing but a fever, a feeling of aching muscles and a slight runny nose, the pediatrician will be right in assuming that the baby has an enterovirus infection.

Transmission routes

Enteroviruses enter the body most often through the mouth - with with dirty hands, water, food. A child can easily become infected from a sick person through airborne droplets. Most often, outbreaks of infection occur in summer and early autumn. In cities and countries with hot climates, outbreaks and even epidemics are observed more often than in northern latitudes.

This implies a fairly wide geographical distribution of enteroviruses in resort towns, on popular crowded sea coasts. In 2017, the Coxsackie virus was rampant in Turkey, and in 2000, the ECHO virus affected hundreds of people in Singapore and Taiwan. From time to time, small lesions are recorded on Black Sea coast in Russia. However, this does not mean that there are no such viruses far from the sea and sun. They are widespread everywhere.

Treatment

Evgeniy Komarovsky argues that calling enterovirus infection intestinal is not entirely correct. That is, it is essentially intestinal, but has strictly viral origin. Whereas intestinal infection, in the broad sense of the word, can be caused by both toxins and bacteria.

It follows that enteroviral diseases should be treated according to all the rules for the treatment of viral infections. This means that antibiotics are contraindicated because they do not have the slightest effect on viral particles. At the same time, they increase the risks of secondary complications, including those affecting the central nervous system.

Taking antiviral drugs, which with a high degree of probability will be prescribed by the same pediatrician called, according to Evgeniy Komarovsky, does not make much sense. After all, there are extremely few antiviral agents with proven clinical effectiveness in Russia. All of them belong to the category of “heavy and serious” drugs that are used intravenously in infectious diseases hospitals. Tablets, sold without a prescription in any pharmacy and positioned as “an effective remedy against viruses”, to such serious and truly effective means, have no relation.

There are anti-enteroviruses special drugs- This virus cannot be defeated with universal antiviral tablets. Quite often, doctors recommend products that belong to the groups of interferons and immunoglobulins.

However, many doctors are disingenuous, saying that the pills will definitely help the child. Most doctors know that immunoglobulins show relative clinical effectiveness only when given intravenously and only in certain groups of patients - in newborns and in people with HIV infection.

For everyone else, tablets and drops containing immunoglobulin are prescribed based on the principle “something needs to be done.” The child drinks an almost harmless drug, the parents treat him, the doctor’s conscience is calm, since he knows perfectly well that in 3-6 days an uncomplicated enterovirus infection will go away on its own, without any pills at all.

Based on all this, Komarovsky recommends that parents whose child has an enterovirus infection simply create for him the right conditions promoting speedy recovery. The faster the immune system copes with the “invader”, the sooner the child will recover. Truly effective treatment measures should be as follows:

Prevention

Specific prevention does not exist from enteroviruses. There is not a single medication that can be used to reduce the risk of infection, although some sources indicate that prophylactic antiviral drugs of the interferon group. This statement is from the point of view evidence-based medicine, has no real evidence, says Evgeny Komarovsky.

Vaccinations against enteroviruses as such have not been developed, with the exception of vaccines against polio and hepatitis.

But there are more varieties of viruses, as well as the diseases they cause. After illness, immunity to most enteroviruses develops lasting and lasts for several years.