Enterovirus infection in infants treatment. Enterovirus infection in children: everything a parent should know. Nutrition rules for the infected

Children are often exposed to the development of various pathological processes. The reason for this is not only reduced immunity, but also being in crowded places. Yes, when visiting kindergarten or school, the risk of contracting an ailment, such as an enterovirus infection, increases significantly.

What is an enterovirus infection

Enterovirus infection is considered a cumulative concept of several pathological processes that can affect any internal organs, but most often the respiratory organs and the alimentary canal are affected. The causative agent of pathology are viruses of the genus Enterovirus.

This kind of disease is highly contagious. The infection is transmitted both by airborne droplets and by the fecal-oral route. Incubation period ranges from several hours to 2-3 days after the excitation has penetrated the body. When its amount increases, it accumulates in the lymph nodes, and then spreads to the internal organs along with the blood flow, which leads to the development of the first clinical symptoms.

The peak of the disease in children occurs between the ages of 3 and 12 years. In newborns, this pathology is rare, since being breastfed, the baby receives immunity from the mother along with milk.

Video about the disease

Causes

Enterovirus infection is considered the main cause of the development of the disease. The causative agent is divided into 60 species, which is the reason for the defeat of various internal organs. It contains elements of RNA, some serotypes - DNA.

Due to the many varieties of enterovirus, you can get sick with this disease more than once, in addition, even after the transfer of the disease, strong immunity is not formed. For the same reason, it is impossible to develop a vaccine that could prevent mass infection.

Enterovirus is sufficiently resistant to low temperatures, so it can long time survive in soil, water and air. When frozen, it retains the ability to become infected for several years. Also, the acidic environment does not have a detrimental effect on it, therefore, when it enters the digestive organs, it bypasses the stomach without problems.

To cope with the virus with the help of disinfectants, it is necessary to keep objects in them for at least 3-4 hours. However, high temperatures can kill the pathogen in a few minutes. He immediately dies if this figure exceeds 45 degrees.

Infection occurs directly through the use of food or water, which contains the pathogen. Also, a sick person and a virus carrier can serve as a source. In the first case, this is possible due to the fact that the incubation period can be several days, there are no symptoms, but the pathogen is actively excreted by the patient's body. In cases of virus carriage, a similar process occurs, but its duration can be up to 5 months.

Symptoms and signs

The first symptoms of enterovirus infection in children begin to appear when the pathogen has multiplied enough and reached the internal organs. The intensity of manifestation depends on the immune forces of the body and the type pathological process.

In some children, the illness begins with respiratory symptoms. They are worried about nasal congestion, sore throat, cough. This option is typical for those cases when the virus entered the body through the respiratory tract. If the fecal-oral route has become the way of infection, they develop signs of disruption of the intestines in the form of diarrhea, abdominal pain, and increased gas formation.

Also, with the development of pathology, there is an increase lymph nodes. This symptom is explained by the massive accumulation of the pathogen in these structures.

A characteristic sign of an enterovirus infection is an undulating fever. At first, the child's temperature rises, reaching 39 degrees, and lasts at least 3-5 days. Then the indicator normalizes, and after 2-3 days, hyperthermia occurs again and lasts about the same period. Thereafter this symptom usually disappears.

In addition, the nature of the clinical signs in the disease is determined by the target organs that were affected by the pathogen. In this regard, there are such forms of the course of the pathological process:

1. Enteritis. Manifested as a violation of the functions of the intestine. Accompanied by abdominal pain, flatulence, diarrhea. The stool contains elements of mucus. Also, children are worried about nausea and vomiting that occurs after eating food. These manifestations often occur against the background of elevated temperature.
2. Fever of enteroviral origin. Children show signs of respiratory illness: sore throat, cough. The temperature rises, vomiting is also disturbing, symptoms of conjunctivitis are noted: lacrimation, mucosal hyperemia (redness), itching, burning. Similar manifestations persist for a week.
3. Loose form. Rashes appear on the baby's body, which do not cause discomfort, itching, and subsequently they are not accompanied by skin peeling. Hyperthermia is also observed. The clinical picture appears about 4 days with adequate drug therapy.
4. Herpetic angina. This form causes a slight increase in temperature, severe sore throat, which becomes even more intense when swallowing, therefore, during the period of illness, there is a decrease in appetite. On visual examination, the mucous membrane of the pharynx and throat is covered with herpetic vesicles.
5. Myalgia. This type of pathology is characterized by the occurrence severe pain in the muscles abdominal wall and intercostal spaces. This symptom is observed even when breathing and in a state of complete rest. With myalgia, pain attacks last about 2 minutes and are repeated at an interval of about 1 hour.
6. Pemphigus. It is characterized by vesicular eruptions. Bubbles filled with serous fluid are localized on the palms, between the fingers, affect the mucous membrane of the oropharynx. Often this form of the disease is accompanied by hyperthermia.
7. . It is considered the most dangerous form of pathology, since the pathogen affects the soft membrane of the brain and causes loss or confusion of consciousness, intense headaches, nausea, vomiting, paresis, paralysis, convulsions, fever.

When the enterovirus spreads to the liver, children complain of:

• pain in the region of the hypochondrium on the right;
• heartburn;
• bitter taste in oral cavity;
• nausea.

On examination, the organ is enlarged in size.

If the cardiovascular system is involved in the pathological process, there is a huge risk of developing inflammatory diseases of the membranes of the heart: myocarditis. At the same time, tachycardia, arrhythmia, increasing weakness, pain behind the sternum of a compressive nature are noted.

In boys, any type of enterovirus infection may be accompanied by damage to the testicles and the development of orchitis (inflammation of the testicles). On examination, the scrotum is edematous, hyperemic, pain is noted. The spermatogenic epithelium does not suffer.

Meningitis in newborns stands out in a separate form, since the disease is extremely difficult and often leads to the death of the baby.

Any form of enterovirus infection is always accompanied by signs of intoxication of the body in the form of weakness, drowsiness, decreased appetite, and malaise. If any violations have developed, you should immediately seek medical help, since if left untreated, the disease becomes the cause severe complications and in some cases ends in death.

Diagnostics

To identify enterovirus infection, the following studies are carried out:

1. polymerase chain reaction. It allows you to determine traces of RNA or DNA of the pathogen, which confirms the diagnosis. To obtain data, it is necessary to take biological material. They can serve as swabs from the mucous membrane of the pharynx, nose, anus.
2. Serological diagnostic method. Excitation traces are determined by blood tests.
3. Virological method. It is based on the detection of enterovirus in the biological material in which it is likely to be present: blood, feces, swabs from the oropharynx.

However, it is worth noting that in order to obtain confirmation of the diagnosis, it is necessary to wait for the result for several days. In this regard, treatment is started immediately on the basis of clinical manifestations.

Treatment of the disease in children

Therapeutic measures depend on the severity of the enterovirus infection and the well-being of the child. In most cases, treatment is carried out at home, while the baby needs to be provided with bed rest until the moment of recovery. Hospitalization in this pathology is carried out only with damage to the nervous system, liver, of cardio-vascular system, as well as under the condition of persistent hyperthermia, which is not stopped by medications and other methods.

Medications

Specific treatment of enterovirus infection has not been developed. Drug therapy necessarily includes the use of antiviral drugs. Often prescribed medications such as:

• Viferon;
• Interferon.

The dosage is determined by the doctor, taking into account the severity of the disease and the age of the patient.

Next, the children are assigned symptomatic treatment, which depends on the localization of the pathological process. With hyperthermia, it is necessary to use antipyretic drugs based on Ibuprofen or Paracetamol. Also, these drugs have an analgesic effect, which is important in the development of myalgia.

Antibacterial agents (antibiotics) are used only in cases where a secondary infection is attached to an already developed pathological process. As a rule, drugs of the penicillin series are used.

In the intestinal form, first of all, it is necessary to provide the child proper nutrition. It is also necessary to use enterosorbents: Enterosgel, white or black coal. A drug such as Enterofuril has a positive effect on the condition of the intestine. These drugs help to remove enterovirus waste products from the body, thereby reducing the manifestations of intoxication.

Folk methods

Use your own tools traditional medicine for the treatment of the disease in children is impossible, as this can do even more harm. Such methods are used exclusively in combination with the main therapy and only after the permission of the doctor. Below are some of the most effective recipes:

• Infusion of calendula and mint. Connect the dried plants in equal proportions. Take 1 tablespoon of the mixture, pour 200 ml of boiling water and leave for half an hour. Next, the remedy must be filtered. Drink half a glass three times a day to speed up the elimination of toxins from the body.
• A decoction of viburnum. Take 1 cup of ripe viburnum berries, pour 1 liter of water, put on fire. When the medicine comes to a boil, it must be boiled for another 10 minutes. Next, filter the broth, mix with 3 tablespoons of natural honey. It is recommended to consume it 1 glass per day, this volume must be divided into 3 doses. With the help of viburnum decoction, it is possible to reduce body temperature, eliminate signs of inflammation, and increase immunity.

Folk remedies in the photo

Diet

Proper nutrition for enterovirus infection is an integral part of a speedy recovery, therefore, immediately after the diagnosis is established, it is necessary to adjust the child's diet.

It is imperative to ensure sufficient fluid intake in the body. The baby needs to be fed in small portions, about 1 tablespoon, but often every 10-15 minutes. It is allowed to use:

• weak green tea;
• decoctions of medicinal plants;
• dried fruit compotes;
• alkaline mineral water;
• liquid kissels.

But carbonated drinks are strictly prohibited.

As for feeding, that is, only thermally and mechanically processed food is possible in order to reduce the load on the digestive canal. You need to eat little by little, but often, in no case should you force it. Food temperature should be close to 38-40 degrees.

The child can eat;

• vegetables and fruits that have undergone heat treatment;
• fresh dairy products;
• lean meat;
• fish;
• porridge.

It is forbidden to use: fried, spicy, salty, fatty, smoked food, marinades, pickles. You will also have to give up:

• nuts;
• legumes;
• sweets;
• fresh pastries, including bread;
• butter and vegetable oil.

Prohibited products in the photo

On the first day of the development of the disease, you can eat only cereals cooked in water, crackers, baked apples. Next, soup-puree from vegetables, sour-milk products are introduced. Meat and fish are included in the diet last.

Features of the disease in infants

Infants suffer from enterovirus infection extremely rarely, since in most cases they are breastfed. With the development of such a pathology, the condition of a small patient becomes severe and requires immediate medical attention, as a rule, this diagnosis is an indication for hospitalization. Symptoms of the disease do not differ from those indicated above.

If the disease has developed in a newborn due to intrauterine infection from the mother through the placenta, then this type of course of the disease can be mild and can end quite favorably. However, sometimes pathology during pregnancy can cause miscarriage or premature birth.

Treatment in infants is symptomatic and is aimed at eliminating clinical signs, normalizing general well-being.

Prevention

Prevention of the development of enterovirus infection consists in observing the following rules:

• teach your baby to wash their hands after coming from a walk, visiting the bathroom, before eating;
• wash vegetables, fruits and other products well;
• drink filtered, boiled or bottled water;
• do not swim in pools with stagnant water;
• When caring for a sick child, follow the rules of hygiene.

Possible complications and consequences

With absence timely treatment or in severe forms of the course, enterovirus infection may be accompanied by complications such as:

• cerebral edema;
• pneumonia;
• acute respiratory failure;
• mental disorders;
• the development of orchitis - inflammation of the testicles in boys;
• disruption of the heart;
• development of epileptic seizures.

With regard to compliance hygiene rules during the course of the pathological process, then during the period of elevated temperature of the child it is better not to bathe. If necessary, you can wipe individual parts of the body with a damp cloth. When the child's condition improves, it is recommended to take a warm shower without the use of soap for no more than 5 minutes, especially if there are rashes on the body.

Throughout the illness, the child remains contagious, so it must be isolated until the moment of complete recovery. Walking with the baby is allowed only after its complete recovery and the disappearance of clinical symptoms.

Enterovirus infection, in fact, is not such a harmless disease as it seems at first glance. Therefore, it is worth observing preventive measures to prevent the development of this severe pathology.

Usually the season for enteroviruses lasts from July to October, so now is the perfect time for them. What should parents do when they hear from a doctor the diagnosis of "enterovirus infection" and how to properly treat this condition in children - in our today's material.

In the group of enteroviruses there are more than 60 types of pathogens, different in the form of the course and pathogens. These viruses can live on different surfaces for several hours, and even days, depending on the temperature and humidity of the environment. Enterovirus can be found on the mucous membranes, in the saliva and sputum of a sick person. Contact with an infected surface followed by touching the nose, mouth, or eyes is the easiest way to catch it.

What is enterovirus infection in children

Enterovirus infection in children is a large general group of diseases caused by RNA-containing non-polio viruses (Coxsackie, ECHO, unclassified human enteroviruses) and poliovirus.

Once in environment, viruses can persist for quite a long time, as they tolerate adverse effects well, persist in water and soil, can survive for several years when frozen, and the acidic environment of the stomach does not have any effect on them.

Enteroviruses are common in children's groups, as children aged 1 to 10 years are exposed to them. Enteroviruses also multiply in unsanitary conditions, and they are afraid of ultraviolet radiation, boiling and the action of disinfectant solutions with a high concentration of formalin and chlorine.

The peak incidence of enterovirus infections falls on the period from July to October - in warm weather. And often in these few months a child can get sick with an enterovirus infection repeatedly, because the pathogens are very diverse. And if a child has been ill with one type of virus, this will not protect him from other varieties. It is because of this feature that modern science cannot yet develop a vaccine against enterovirus infection in children.

Enterovirus infection in children: how does infection occur

Enterovirus infection in children is transmitted by airborne droplets and contact. When sneezing and coughing, the virus flies into the air along with droplets of saliva from an infected child to a healthy one. The incubation period of the disease is from 2 to 10 days, and a child can be a carrier of the virus for 5 months.

Often a child with a virus carrier does not have any external manifestations diseases, but the viruses are found in the intestines and are shed into the environment in the feces. Therefore, the second route of infection is fecal-oral, when the child does not observe personal hygiene measures and not after going to the toilet.

Also, infection can occur through toys, if children take them by mouth, when drinking raw water or dirty food.

Enterovirus infection in children: symptoms of infection

After an enterovirus infection enters the body, pathogens settle in the lymph nodes, where they multiply. How the disease will develop in a child in the future depends on factors such as:

• virulence - the ability of viruses to resist the body's defenses;
• tropism - the tendency of a virus to infect individual tissues and organs;
• child's immune status.

Enteroviruses can infect:

• central and peripheral nervous systems,
• oropharyngeal mucosa,
• mucous membrane of the eye,
• skin,
• muscle,
• heart,
• intestinal mucosa,
• liver,
• boys may have testicular involvement.

Common symptoms of enterovirus infection, regardless of the lesion:

• up to 38-39º C. The temperature lasts 3-5 days, it can have an undulating course (decrease-rise), after which it decreases
• enlargement of the cervical and submandibular lymph nodes
• weakness
• drowsiness
• nausea
• vomit

Enterovirus infection in children: varieties

There are several main types of enterovirus infection in children.

Enteroviral fever caused by different serotypes of Coxsackie and ECHO viruses. The course of the disease: temperature from 38.5-40 ° C, malaise, muscle pain, sore throat, headache, redness of the eyes, nausea, vomiting, rarely - diarrhea. Symptoms usually last 3-7 days. Caused by enteroviruses of all subtypes.

Intestinal (gastroenteric) form enterovirus infection is more common in children under 3 years of age. The course of the disease: nasal congestion, hyperemia of the mucous membranes of the oropharynx, cough, diarrhea, vomiting, flatulence. Symptoms usually last 1-2 weeks.

Catarrhal (respiratory) form enterovirus infection in children proceeds according to the type of acute respiratory infections. Course of the disease: transient fever, fever, sore throat, pain when swallowing and painful sores on back wall pharynx, tonsils, soft palate, lack of appetite, the development of false croup syndrome is possible. Causative agents: Coxsackie A and Coxsackie B viruses. Symptoms usually last 3-7 days.

intestinal form characterized by damage to the intestinal mucosa. The course of the disease: loose stools without pathological impurities up to 5-10 times a day, abdominal pain, flatulence, infrequent vomiting, fever is possible. In children under 2 years of age, catarrhal phenomena may occur in the nasopharynx. The duration of the disease in young children is 1-2 weeks, in older children 1-3 days.

Myocarditis or pericarditis characterized by a violation of the work of different parts of the heart: the muscle layer, the outer shell, valves. Course of the disease: fatigue, weakness, palpitations, falling blood pressure, cardiac arrhythmias, chest pain. Causative agents: Coxsackie B5 virus, also ECHO viruses.

Enteroviral exanthema characterized by the appearance of a skin rash on the skin of the face and trunk, resembling a rash in scarlet fever, or. Pathogens: ECHO and Coxsackie viruses. Symptoms usually last 3-5 days.

Hemorrhagic conjunctivitis begins suddenly with pain in the eye, blurred vision, photophobia and lacrimation. Fever, headache, swollen lymph nodes, and ocular hemorrhages may also occur. Causative agents: enterovirus serotype 70, Coxsackievirus A24. Symptoms usually last 10-14 days.

serous, are a typical form of enterovirus infection in children. The course of the disease: high fever, severe headache, repeated vomiting, anxiety, delirium, convulsions. This is the most severe form of enterovirus infection. Causative agents: Coxsackie virus group B and ECHO viruses. It usually occurs in outbreaks at intervals of several years. Symptoms may last up to 2 months.

Paralytic forms of enterovirus infection characterized by the development of acute paralysis of one or both legs, less often - hands. Paralysis is accompanied by muscle pain and can, in mild cases, lead to the development of a limping gait, weakness in the legs, and decreased muscle tone. These effects are reversible and gradually disappear after 4-8 weeks. At severe forms paralysis caused by enterovirus infection is possible fatal outcome due to dysfunction of the respiratory and vasomotor centers.

Neonatal encephalomyocarditis characteristic of children in the first months of a child's life. The course of the disease: lethargy, refusal of the breast, subfebrile condition, heart failure, bulging fontanelles, convulsions. Pathogens: Coxsackie viruses type B. Newborn encephalomyocarditis is a fatal disease, mortality reaches 60-80%.

epidemic myalgia - rare disease, which is manifested by severe muscle pain in the chest and abdomen, severe fever. The pain is paroxysmal, aggravated by breathing or coughing, accompanied by profuse sweating. Causative agents: Coxsackie virus B3 and B5. Symptoms usually last 8-10 days.

Prevention of enterovirus infection in children

To prevent enterovirus infections in children, it is necessary to wash hands frequently, boil water before drinking, avoid crowds during the epidemic, and also increase the child's immunity.

If one child falls ill in a family, then all family members, especially children under 10 years old, are at risk. Therefore, in order to prevent enterovirus infection in other family members, it is necessary to provide the sick child with separate dishes and toys. In no case should you eat up food for a sick child! All family members are advised to wash their hands more often with soap and treat them with alcohol antiseptics.

Enterovirus infection in children: diagnosis and treatment

In order to make an accurate diagnosis of "enterovirus infection" to a sick child, depending on the symptoms of the disease, swabs are taken from the pharynx, nose, conjunctiva, scrapings of the skin or anus. Blood, urine, and stool tests are also required.

Depending on the symptoms, the child may need to see a pediatrician, cardiologist, neurologist, otolaryngologist, ophthalmologist, or other specialist.

Hospitalization is necessary if meningitis, encephalitis, myocarditis, severe combined lesions are suspected. Treatment of mild forms of enterovirus infection in children is carried out at home.

There are no antiviral drugs capable of suppressing enteroviruses. In this case, the body is able to cope with this disease on its own. As a rule, the disease disappears in 3-7 days.

Treatment of enterovirus infection in children is limited to relieving symptoms, preventing dehydration, and identifying complications.

You can give your child ibuprofen or paracetamol based medications to reduce fever and relieve mouth pain, after consulting with the pediatrician about the optimal dosage.

A sick child is shown: rest, bed rest, plentiful drink, antipyretic therapy, antiviral drugs, if necessary, nasal lavage, gargling, combating dehydration, diet, taking enterosorbents, restoring intestinal microflora.

note that it is easier for a child with an enterovirus infection to drink cool drinks and eat puréed dishes at room temperature.

The gastrointestinal tract of a child has a number of fundamental differences from the gastrointestinal tract of an adult. It is more sensitive to new food components. Intestinal immunity is not yet formed and therefore the body of children is extremely susceptible to various viruses and bacteria. For children, the most characteristic are viral diseases, since in children's groups there is a high risk of infection and a high concentration of the pathogen.

At a tender age, one can most often encounter two types infectious diseases affecting the intestines and gastrointestinal tract - and enterovirus infection, in children the latter is quite common and, without proper treatment, can cause considerable damage to health. The peak incidence of enterovirus infection falls on the spring-summer period.

Enterovirus infection is a group of acute infectious diseases caused by enteroviruses. These include polioviruses and non-polioviruses. Most known disease caused by polioviruses is poliomyelitis. Today, this disease can be safely called rare, which cannot be said about diseases caused by non-polioviruses. These include Coxsackie A and B viruses, enteroviruses and ECHO viruses. It is non-polioviruses that are the causative agents of such enteroviruses that are now common.

Their characteristic features are:

• the content of RNA, and sometimes DNA in the structure of the virus;
• resistance of the capsule to heat and acidic environment;
• resistance to most antiviral drugs.

The difficulty in treating enterovirus infection in children lies in the fact that a child may well catch not one, but several types of enterovirus. In this case, antiviral treatment that is suitable for one type of pathogen is absolutely useless for another.

What types of enterovirus infection are more common in children?

People who are not associated with the clinic do not need to own a complete classification, but all responsible parents need to know the most common varieties and their symptoms, since there is more than 90% chance that the child will have an enterovirus.

So, all varieties of enterovirus infection can proceed according to a typical or atypical clinical picture.

Typical forms include the following.

1. Gerpangina is a catarrhal manifestation of an enterovirus. Herpangina occurs predominantly in children aged 3 to 10 years. The main symptoms are fever, sore throat when swallowing, and painful vesicles (vesicles) on the back of the throat, tonsils, and soft palate that burst easily and form painful sores. The causative agents are Coxsackie A and B. The disease lasts 5-7 days.
2. flu-like syndrome characterized by all the symptoms of a typical flu or a severe form of SARS - catarrhal phenomena (runny nose, stuffy nose and throat, swelling), fever up to 38-39 degrees, muscle pain, headache, general weakness. Among the typical symptoms of EV, which makes it possible to distinguish it from the flu, are vomiting, nausea, and upset stools (enteroviral diarrhea in children). Symptoms in most cases last 3-7 days. Enteroviruses of all subtypes are capable of causing such manifestations. This syndrome occurs in 99% of cases.
3. Intestinal form of enterovirus- one of the most obvious and dangerous forms. It proceeds in the form of a moderate rise in temperature (37–37.5 degrees), accompanied by profuse watery diarrhea, which is repeated at least 5 times a day. Also characterized by abdominal pain, bloating and flatulence, vomiting. The main danger is dehydration, which complicates the condition of the child. The disease lasts up to 3 days in older children and up to two weeks in babies. Enteroviral diarrhea in children requires constant monitoring of changes in the condition, as well as emergency treatment.
4. Enteroviral exanthema. One of the possible options for a typical manifestation of enterovirus infection in children is a rash. In most cases, this rash has two pronounced forms - rubella-like and roseolous. It appears on the face and body of the child on the first - second day of the disease and looks like small red rashes that can merge with each other. Sometimes, against the background of red rashes, vascular (hemorrhagic) elements appear. More often this form of enterovirus infection children get sick in the summer. Rashes rarely appear in children older than six years. As a rule, exanthema is caused by ECHO viruses.

In some cases, enterovirus infection can be complicated, with a layer of superinfection - from conjunctivitis to meningitis. In such cases, enterovirus infection is also called typical, but combined. At the same time, it also requires complicated treatment.

1. Acute hemorrhagic conjunctivitis is a complicated form of enterovirus infection. It starts suddenly with severe pain in the eye, loss of clarity of vision, photophobia, and constant tearing. The anterior lymph nodes are enlarged, hemorrhages in the retina and conjunctiva.
2. Myocarditis or pericardial t is also a very severe and dangerous clinical form of enterovirus infection in children, in which the corresponding structures of the heart suffer - the muscular membrane (myocardium) and pericardium. With myocardial damage, the contractile function of the heart can be disturbed, pericardial damage can give a violation of blood supply, thus, the work of the heart as a whole suffers.
3. Meningitis (meningococcemia) and encephalitis are one of the most severe and dangerous forms of enterovirus infection in children. They begin acutely with an increase in temperature up to 40 degrees. On the second day, an unbearable headache, repeated profuse vomiting, not associated with food intake, appear. Also frequent symptoms are abdominal pain, delirium, convulsions, hemorrhagic rash (the so-called vascular "asterisks").

Atypical variants of the course imply latent, dull or asymptomatic. At the same time, clinical diagnosis, as a rule, becomes possible with the appearance of visible complications.

As you can see, enterovirus infection in children has a wide variety of symptoms, and it is very important to seek a diagnosis from specialists in time, since it is necessary to distinguish it from ordinary respiratory infections, dermatological problems or poisoning.

How can a child get infected?

The source of infection, as a rule, is a sick person. There are two ways of transmission of the virus: airborne (when coughing or sneezing) and fecal-oral (when eating contaminated food, through dirty hands). There is not only the above horizontal transmission path, but also vertical - from mother to fetus.

The initial environment in the human body, into which the virus enters and from which it spreads throughout the body, is called the entrance gate of infection. For enterovirus, the entrance gates are the mucous membranes of the upper respiratory tract (in both variants) and the gastrointestinal tract. Getting on the mucous membrane, warm and moist, the virus begins to multiply actively, and the products of its "activity" cause the same local and general symptoms intoxication and signs of inflammation. Further, the population of enteroviruses enters the bloodstream and spreads throughout the body through the vascular bed.

How is an infection diagnosed?

The disease can be suspected by finding characteristics enterovirus infection in children. It is called clinical diagnosis. To confirm the diagnosis and identify the pathogen, it is necessary to resort to a number of laboratory tests:

• general analysis of urine and blood with a formula to identify the focus of inflammation and exclude a similar disease;
• biochemical blood test to determine markers of heart damage;
• a serological method that allows you to identify markers of enterovirus infection, such as IgM and IgA. They appear within the first week from the onset of the disease and disappear after six months. This makes serology the most convenient and accurate diagnostic method;
• the immunohistochemical method is aimed at the detection of specific antibodies to enterovirus infection;
• molecular biological analysis allows to determine fragments of DNA and RNA of viruses;
• the cultural method allows you to isolate the pathogen from the biomaterial and identify it.

In addition, the sensitivity to antibacterial drugs and identify allergens to avoid unpleasant consequences of treatment.

With the advances in microbiology, diagnosis is not a problem. With timely detection of the pathogen, enterovirus infection in children of any age can be cured relatively quickly and effectively.

Treatment of enterovirus infection in children

The answer to the question of how to treat enterovirus in children should be looked for exclusively in the office of your pediatrician or family doctor. Only he can correctly and timely recognize the symptoms and suspect an enterovirus infection in a child. Treatment should also be prescribed by a specialist after a thorough diagnosis and identification of the pathogen.

Doctors offer two components of treatment - etiotropic, that is, aimed at the cause (pathogen), and symptomatic, aimed at eliminating and alleviating symptoms.

From what a pediatrician or an infectious disease specialist can offer for the treatment of an enterovirus infection, the following should be noted.

Antiviral therapy

1. Interferons alpha-2a alpha-2b, which are similar to those that our body produces and are able to replace the missing interferons. These are the familiar Viferon and Laferobion in the form of drops and candles. The rectal form makes sense only when relieving the symptoms of diarrhea.
2. Immunoglobulins. They are prescribed for acute and extremely severe forms of enterovirus infection, such as meningitis or hemorrhagic conditions.
3. Capsidin inhibitor "Pliconaril", which has shown its effectiveness, but has not yet been registered in a number of CIS countries.

Symptomatic therapy

1. Anti-nausea drugs - relieve symptoms such as dizziness, nausea and vomiting. These include Cerucal, Motillium.
2. Antihistamines (antiallergic) drugs - eliminate allergic reactions, relieve catarrhal symptoms (runny nose, swelling, congestion). These are Desloratadine (Edam, Erius) and Fenistil.
3. Antipyretic - will help not only bring down the temperature, but also eliminate inflammatory signs - redness, pain, dryness. For children, this is Nurofen, Paracetomol or Analgin + No-shpa.
4. Means that promote intestinal detoxification - Atoxil, Smecta, Nifuroxazide, Enteros-gel, activated charcoal.
5. Auxiliary therapy (it is also the second most important after antiviral) - frequent fractional drinking of 5 ml every 5 minutes to avoid dehydration; cool humid indoor air (18-20 degrees), quarantine regimen and diet. More about her below.

With enerovirus infection in children food is one of the components of the treatment. It is very important to feed in small portions without forcing the baby. Nutrition should be enriched with vitamins - seasonal vegetables and fruits. In this case, it is necessary to take into account the specifics of the course of a viral infection. It is ideal to give fruits and vegetables steamed, stewed in water. Dairy products should be removed from the diet, with the exception of low-fat kefir or homemade yogurt. Do not give anything fried, fatty, spicy and salty. Nutrition should be high-calorie, but fractional. You can give food every two to three hours, but in small portions (2-3 tablespoons with a weight of 20-25 kg).

If the picture of the disease is dominated by disorders of the gastrointestinal tract, the first day of the child should be kept from hand to mouth, giving only water and absorbents. Then homemade white bread crackers, baked apples, fat-free kefir or yogurt are introduced into the diet. On the third day, you can start giving cereals (rice, buckwheat on the water), vegetable broths and soups, fresh oranges and bananas, biscuits, mashed potatoes without eggs and milk. From the fourth day, eggs and other typical foods can be introduced fractionally and often. But the most important rule is to give the child frequent and fractional water until recovery.

When the first symptoms of the disease appear in a child, you should immediately go to the pediatrician or family doctor. No Internet source will allow you to determine what exactly a child is sick with, this should be done by a doctor.

The diet for enterovirus in children is nonspecific, common with food poisoning and intestinal infection. Food is given little by little.

Enterovirus infection in infants is more severe. They need to follow the feeding regimen. Wherein the best option treatment for infants remains treatment in a hospital under the constant supervision of doctors.

Do not try to manage the symptoms on your own. If signs of illness such as nausea, vomiting, diarrhea, rash appear, the first thing to do is to go to the emergency room. Unskilled first aid can lead to complications of enterovirus infection in children.

Prevention

There is no specific prevention of enteroviruses of all types at the same time. Nevertheless, vaccinations against poliomyelitis and meningococcemia have shown good results.

Non-specific prevention consists in observing the rules of personal hygiene, preventive use interferons (Nazoferon, Laferon, Viferon).

It is important to remember that prevention is always better than treatment, and if the child is still sick, a timely visit to the doctor will help to avoid the unpleasant consequences of an enterovirus infection in children.

Educational program on the topic

Every year, a high incidence of enterovirus infections is recorded, both in Russia and in other countries. The epidemiological situation in Russia in 2013 is still fresh in the memory of the population, when the incidence exceeded the same indicator of the previous year by more than 2 times. By 2017, the situation has not changed much, besides, there are many undiagnosed cases when a person does not go to the doctor and is treated at home. The anxiety of the situation is aggravated by the fact that the children's age group most often suffers, that is, the most vulnerable and immunologically vulnerable part of the population.

From a clinical standpoint, attention is drawn to the variety of forms of the disease, which are often “disguised” as traditional respiratory infections, and therefore it is difficult early diagnosis enteroviral infections and timely medical care. The possibility of developing severe forms of the disease with the development of meningitis and encephalitis draws our attention to the early diagnosis and timely hospitalization.

So,
Enteroviral infections- a group of human infectious diseases (anthroponoses) caused by enteroviruses (non-poliomyelitis), having a spring-summer-autumn seasonality, affecting mainly the child population and characterized by fever, lesions of the tonsils, central nervous system, gastrointestinal tract, skin manifestations and damage to other organs and systems.

pathogens- a group of non-polio enteroviruses Coxsackie A (24 serovars), Coxsackie B (6 serovars), ECHO (34 serovars) and unclassified human enteroviruses 68-72 serotypes. These are RNA-containing viruses that are quite stable in the external environment. Resistant to low temperatures, withstand freezing and thawing. At room temperature, they can remain viable for 15 days. When boiled, they die instantly. Chlorine-containing solutions, solutions of hydrogen peroxide, potassium manganese, and ultraviolet radiation are detrimental to them.

Causes of the spread of enterovirus infections

source of infection are patients with a clinically pronounced form of the disease, asymptomatic forms of the disease, carriers of viruses. Infected environments of the source of infection are nasopharyngeal mucus, feces, cerebrospinal fluid. Since already in the incubation period (the period from the moment of infection to the appearance of the first symptoms of the disease) the virus multiplies and accumulates in the mucous membrane of the oropharynx and gastrointestinal tract, the patient secretes the virus in a small amount already at this stage. The maximum isolation of the virus is noted in the first days of the disease. The term of the infectious period can last 3-6 weeks, rarely longer. An important role in the spread of infection is played by asymptomatic carriers, the frequency of which does not exceed 45% (usually young children), and convalescents (recovering), who often continue to shed viruses.

There are two infection mechanism- fecal-oral and aerogenic, the leading of which is fecal-oral.

The main ways of transmission are water (when bathing in reservoirs infected with enteroviruses) and alimentary (eating contaminated water, dirty vegetables and fruits, milk and other products).

Viruses can be transmitted through household items (toys, towels), dirty hands. Another way of transmission is airborne (isolation of viruses with nasopharyngeal mucus during coughing, sneezing, talking). We remind you that the risk group is people who are in direct contact with the source of infection (when sneezing and coughing, this is an aerosol cloud 3 meters in diameter). Transplacental transmission of infection from mother to fetus is also possible (in the case of a pregnant woman with a clinically pronounced form of the disease).

The susceptibility of the population to enterovirus infections is high. Family outbreaks and outbreaks in organized children's groups are possible. Risk groups for infection are immunologically compromised persons, that is, persons with reduced body resistance - children, the elderly, people with chronic diseases. After past illness a strong immunity to a certain type of virus is formed, which is often crossed (that is, to several serotypes of enteroviruses at once).

Symptoms of enterovirus infections

A short path of enteroviruses in the human body: the entrance gates of infection are the mucous membranes of the nasopharynx and digestive tract, where enteroviruses settle and accumulate, which coincides in time with the incubation period (from 2 to 10 days, more often 3-4 days). Then the viruses lymphogenously penetrate into the lymph nodes close to the entrance gate (regional), which coincides in time with the onset of the disease - 1-2 days (the patient may have pharyngitis, diarrhea). Then the viruses penetrate into the blood and are spread hematogenously to different organs and systems (primary viremia) - from the 3rd day of illness. It is clinically characterized by many syndromes depending on the tropism (favorite system or organ) of a particular enterovirus. Possible secondary viremia (repeated release of the virus into the blood), which is clinically accompanied by a second wave of fever.

A feature of enterovirus infections is a variety of clinical forms, that is, even within the same outbreak, completely different symptoms illness. Clinical forms enteroviral infections can be summarized in two large groups: typical and atypical (unusual and rare).

Typical shapes:

2. Enteroviral exanthema (rash,)
3. Serous meningitis
4. Epidemic myalgia

Atypical forms:
1. Minor illness (3-day fever)
2. Respiratory (catarrhal) form
3. Enteroviral diarrhea
4. Encephalitic form
5. Poliomyelitis-like (spinal) form
6. Neonatal encephalomyocarditis
7. Epidemic hemorrhagic conjunctivitis
8. Uveitis
9. Jade
10. Pancreatitis
11. Inapparent form (subclinical, asymptomatic)

- one of the most common forms of enterovirus infection. Cause viruses Coxsackie A (types 2,3,4,6,7,10) and Coxsackie B (type 3). The presence of 2 syndromes is characteristic - infectious-toxic (ITS) and catarrhal. The beginning is sharp. ITS is manifested by fever up to 39-40 degrees, symptoms of intoxication - weakness, headache, nausea, but the state of health may remain satisfactory. The fever lasts 2-5 days. Catarrhal syndrome appears by the end of 1-2 days - redness of the temples, uvula, posterior pharyngeal wall. Within 2 days from the onset of the disease, grayish-white elements (papules) up to 2 mm in diameter appear on the tonsils and arches, the number of which varies from 4-5 to 20. Papules soon turn into vesicles with a diameter of 5 mm, which soon burst, leaving after erosion itself (2-3 days of illness), covered with a grayish coating with a reddish corolla along the periphery. Erosions heal without a trace in 4-6 days. A feature of the catarrhal syndrome in enteroviral herpangina is the absence or mild severity of the pain syndrome. Pain in the throat can appear only at the stage of erosion formation.
Herpangina can be confused with other tonsillitis, in which, most often, a severe sore throat, difficulty swallowing food, and characteristic changes in the oropharynx appear against the background of high temperature.
the appearance of a high temperature with a relatively satisfactory state of health, which is poorly stopped; the appearance of changes in the oropharynx without pain in the throat. Only a doctor (infectionist, pediatrician, therapist) can diagnose this form. Self-diagnosis and treatment of herpangina can lead to relapses (repeated illness), as well as the appearance of another more severe form of the disease (serous meningitis).

(Boston or epidemic exanthema). It is caused by ECHO viruses (types 4, 5, 9, 12, 16, 18) and Coxsackie (A-9, A-16, B-3). It is characterized by an acute onset, the appearance of a high temperature up to 390 and symptoms of intoxication (weakness, muscle pain, headaches, sore throat). After 1-2 days, a rash appears on the trunk, limbs, face and feet. In character, it can be morbilliform, rubella-like, scarlet-like and petechial. Accordingly, it can be a small-spotted rash, small-dotted, maculopapular. In some cases, the appearance of meningism syndrome (headache, vomiting, photophobia, inability to tilt and turn the head), as well as a combination of this form with serous meningitis, is possible.
When to see a doctor: high fever and rash; the appearance of repeated vomiting against the background of high temperature. Determine the nature of the rash and prescribe proper treatment only a doctor can.

Serous meningitis- one of the most common forms of enterovirus infection. It is caused by Coxsackie viruses (A-2, 4, 7, 9), Coxsackie B (types 1-5), ECHO (types 4, 6, 9, 11, 16, 30).
Meningitis begins acutely with the onset of chills, an increase in tо up to 39-40о (very rarely, t remains normal), symptoms of intoxication appear. A few hours later or by the end of the day, a rapidly growing diffuse headache of a bursting nature appears. In most patients, nausea, repeated vomiting join a little later, flushing of the face and motor excitation are striking, hypersensitivity to all kinds of irritants. During the first 12-24 hours from the onset of meningitis, a detailed picture of meningeal and cerebral syndromes is formed. Meningeal symptoms appear and rapidly increase: neck muscle stiffness, Kernig's symptom, Brudzinsky's symptom, etc. Patients are characterized by a "meningeal posture" or "pointing dog posture". Consciousness is first preserved, and then is replaced by a state of stupor, stop, coma.
Often these symptoms are accompanied by other symptoms of enterovirus infection - myalgia, rash on the body, myocardial damage, oropharynx. The duration of fever and meningeal syndrome is up to 7 days with timely treatment. Sometimes there is a second wave of fever.
Analysis of cerebrospinal fluid: flows out under pressure, transparent, cytosis of 200-300 cells in 1 µl, neutrophils up to 50%, lymphocytes predominate more often.
When to see a doctor: high fever, severe headache, repeated vomiting, neck pain, inability to bend it - all these symptoms for immediate medical attention. In young children - high fever, constant crying and anxiety of the child - a reason for an urgent visit to the doctor. Meningitis requires urgent medical interventions in a hospital setting.

epidemic myalgia. It is caused by Coxsackie B (types 1-5), Coxsackie A-9, ECHO viruses (types 1,6,9). The beginning is sharp. Symptoms include infectious-toxic syndrome and myalgia syndrome. Against the background of high fever and symptoms of intoxication, muscle pain (myalgia) appears. Localization - abdominal muscles, lower sections chest, back, limbs. A feature of myalgia is their paroxysmal, attacks last for 5-10 minutes and are repeated after 20-30-60 minutes. In 50% of patients, a second wave of fever is observed. Often there are other symptoms of enterovirus infection (rash, damage to the oropharynx, swollen lymph nodes). The average duration is 7-8 days, sometimes the second wave with repeated attacks.
When to see a doctor: fever and paroxysmal muscle pain. This form is difficult to diagnose, often differentiation is carried out with myocarditis, pleurisy, acute abdomen and other conditions.

"Little Illness"(3-day fever, "summer flu") can be caused by all types of enteroviruses. Short duration (1-3 days) and mild severity (moderate temperature, weakness, myalgia, dizziness) characterize this form of the disease. Often disguised as SARS. The correct diagnosis is usually established only with an outbreak of an enterovirus infection.

Respiratory (catarrhal) form Enterovirus infection is caused by many types of enteroviruses. The symptoms are similar to acute respiratory infections of another etiology - the temperature is combined with lesions of the upper respiratory tract (pharyngitis, laryngitis). Caution in diagnosis is required by young children who may have a syndrome of "false croup" ( barking cough, shortness of breath), appearing, as a rule, at night.

Enteroviral diarrhea(viral gastroenteritis) occurs in both children and adults. Against the background of high fever (38-390), loose stools appear from 2 to 10 times a day, abdominal pain, general malaise, nausea, and vomiting may appear. The fever lasts an average of a week. An upset stool may be the only sign of the disease.

Enfefalytic form of enterovirus infection occurs infrequently. Mild forms are manifested only by malaise, unexpressed headaches and are difficult to diagnose. Severe forms may be accompanied by a convulsive syndrome, impaired consciousness, damage to individual cranial nerves.

Poliomyelitis-like (spinal) form manifested by paresis and paralysis, but by nature it is easier than poliomyelitis with a rapid recovery of motor functions.

Neonatal encephalomyocarditis caused by Coxsackie B viruses (types 2-5). It is characterized by a severe course and high mortality (up to 80%). Against the background of a high fever, the child becomes drowsy, refuses to eat, convulsive syndrome, cyanosis of the skin, and heart failure appear.

Epidemic hemorrhagic conjunctivitis causes enterovirus serotype 70. It begins acutely with damage to one eye, then the second eye is also affected. The patient has lacrimation, fear of light, sensation of a foreign body in the eyes. On examination, hemorrhage in the conjunctiva, swelling of the eyelids, mucopurulent discharge.

Cases of enteroviral myocarditis and pericarditis, uveitis, nephritis, pancreatitis are also described.

Complications of enterovirus infections

Complications of enteroviral infections are mainly associated with damage to the nervous system.

One of dangerous complications- cerebral edema with the risk of herniation syndrome (cardiac and pulmonary arrest). This complication is possible with severe forms of infections, as well as with late seeking medical help.

Other complications include the development of a "false croup" in the respiratory form in young children, as well as the addition of a secondary bacterial infection with the development of pneumonia and other bacterial foci. In rare cases of hemorrhagic keratoconjunctivitis and uveitis, cataracts and blindness may develop.

Diagnosis of enterovirus infections

1. A preliminary diagnosis is made by a doctor when examining a patient based on suspicious symptoms after a differential diagnosis. The epidemiological situation with the possible development of family and group outbreaks of the disease is also taken into account.

2. The final diagnosis is made only after laboratory confirmation of the diagnosis. Indications for examination are determined only by the doctor.
Individuals should be screened for enterovirus infections if they have one or more of the following clinical symptoms/syndromes:
- focal neurological symptoms;
- meningeal symptoms;
- neonatal sepsis of non-bacterial nature;
- exanthema of the oral cavity and extremities;
- herpangina, aphthous stomatitis;
- myocarditis;
- hemorrhagic conjunctivitis;
- uveitis;
- myalgia;
- others (including respiratory syndrome, gastroenteritis, exanthema in the event of a group morbidity in an organized group of children).

For the study, the following are selected: a swab (wash) from the oropharynx / nasopharynx, a swab of discharge from ulcers with herpangina, fecal samples, cerebrospinal fluid, conjunctival discharge, a smear of discharge vesicles, blood, biopsy specimens of organs (sterile types of clinical material), autopsy material (non-sterile types of clinical material ).

Take a certain kind material for laboratory research is carried out taking into account clinical picture diseases.

Timing of material sampling: nasopharyngeal swabs are taken in the first 3-4 days of illness; two samples of faeces in the first 7 days of the disease with an interval of 24-48 hours; blood is taken twice - the first sample as early as possible from the onset of the disease, the second sample - at 3-4 weeks of illness; in parallel, blood is taken for virus isolation; cerebrospinal fluid is taken for the first time on days of illness in aseptic (sterile) conditions.

The main methods of laboratory confirmation of EVI are: - virological method (isolation of the virus); - polymerase chain reaction (PCR) (detection of virus RNA); serological methods (detection of antibodies in paired sera); molecular biological methods (to determine the serotypes of enteroviruses).

1) Virus isolation: virological method (in cell culture or in animals) and detection of enterovirus RNA by PCR. Isolation of the virus on media requires more time and gives the most unambiguous answer to the question of the etiology of the disease. PCR is more sensitive, faster, and can detect viruses that do not multiply in cell culture. PCR is used in the study of cerebrospinal fluid and materials from the upper respiratory tract. It should be borne in mind that the detection of enteroviruses in feces is also possible in healthy virus carriers, therefore, mandatory confirmation by serological reactions is required.
2) Detection of specific antibodies using reactions: RSK, RTGA, gel precipitation reaction, neutralization reaction with paired sera. An increase in antibody titer in paired sera by 4 or more times is considered diagnostic.
3) Molecular biological methods allow serotyping of the material on the 2nd-3rd day of the study.

Treatment of enterovirus infections

Basic therapy: the correct treatment regimen, rational medical nutrition, the use of a complex of vitamins.

Mode for 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 such patients are known to be in the majority. An invariable condition is compliance with bed rest for the entire febrile period, as well as until the elimination of complications.

The diet is aimed at increasing immunity, reducing intoxication, quickly resolving the inflammatory process, sparing the CCC organs and digestive systems, kidney function, and preventing the possible effects of drugs. The diet is differentiated depending on the condition of the patient and the stage of the disease.

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

Etiotropic treatment (antiviral chemotherapeutic and biological agents)

Etiotropic therapy includes antiviral drugs, which include:

1) interferons (grippferon drops with antiviral, immunomodulatory effects; viferon suppositories inhibit the reproduction of the virus, have an immunostimulating effect).
2) interferon inducers (amiksin, lavomax, which have a pronounced immunomodulatory effect; cycloferon, which improves immune status the patient, contributing to the production of interferons in the body, which 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 therapy(correction of the protective functions of the body)

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.

Pathogenetic and symptomatic therapy (antipyretics, 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 - remove pain syndrome especially in myalgia.
3. Antihistamines - diazolin, suprastin, claritin, zodak, zyrtec and others - to reduce the overall toxic-allergic reaction of the body.
4. Adsorbents (activated carbon, white coal, smecta, 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. When joining 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.
5) distraction 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 gestational age.

It is undesirable to engage in self-medication for 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 transferred forms with damage to the heart and nervous system, dispensary observation within 6-12 months with the involvement of a cardiologist, a neurologist. After suffering meningitis during the year, it is undesirable to fly, change the climate, and get vaccinated.

Prevention of enterovirus infections

Prevention of enterovirus infections is reduced to activities in the focus of enterovirus infection. The patient is isolated either at home or in a hospital. Contacts are monitored for 14 days. There is no vaccination for this infection.

For the purpose of non-specific prophylaxis, influenzaferon drops and normal human immunoglobulin intramuscularly can be prescribed to contacts.

Needs to be done regularly hygiene education children and adolescents (washing hands after using the toilet and before eating, hygiene, washing vegetables and fruits before eating, do not swallow water when swimming in open water).

Infectious disease specialist Bykova N.I.

Enteroviruses are a fairly large group of viruses that consist of ribonucleic acid (RNA) and protein. The best known are polioviruses - which are the cause of such diseases as paralytic poliomyelitis (commonly known as poliomyelitis). Less well-known, but more common, are non-polio enteroviruses - Echoviruses and Coxsackieviruses.

It is believed that paralytic poliomyelitis has been completely eradicated through vaccination. Echoviruses and Coxsackieviruses are the cause of a huge number of diseases caused by enteroviruses, today there are about 64 different strains (species) of enterovirus that cause disease in humans. More than 70% of infections are caused by only 10 strains. Any person can be infected with an enterovirus infection, which is the causative agent of more than a billion diseases worldwide. It is believed that 90% of enterovirus infections are asymptomatic or lead to mild form diseases, yet the number of people affected by serious diseases is high.

Children and adolescents are more susceptible to diseases caused by Enteroviruses, and the younger the age, the more dangerous the disease can be.

The alarming fact about enteroviruses is that they are able to spread in various organs and are able to persist in the human body for many years - which can lead to prolonged illness after primary infection.

Causes of enterovirus infection

Enteroviruses- so named because after infection occurs, they multiply initially in the gastrointestinal tract. Despite this, they usually do not cause intestinal symptoms, most often they actively spread and cause symptoms and diseases of such organs as: heart, skin, lungs, brain and spinal cord, etc.

Viruses are generally divided into those that use DNA (deoxyribonucleic acid) or RNA as their genetic material - all enteroviruses are RNA viruses. Enteroviruses are part of a larger group of viruses known as picornaviruses. The word comes from a combination of "pico" (Spanish for "little") and RNA (ribonucleic acid, an important component of the genetic material).

1. Polioviruses (3 strains)
2. Echoviruses (28 strains)
3. Coxsackie viruses (Coxsackie A - 23 strains, Coxsackie B - 6 strains)
4. Enteroviruses - not included in any of the groups (4 strains)

Enteroviruses are found throughout the world, but infection occurs most often in areas with low level hygiene and high overcrowding. The virus is most often transmitted by the fecal-oral route, as well as through contaminated food or water. Ingestion of certain strains of the virus by airborne droplets can lead to respiratory problems. The possibility of infection of the fetus through the placenta has also been documented. Breast milk contains antibodies that can protect newborns. The incubation period for most enteroviruses is 2 to 14 days. In temperate regions, infections occur mainly in summer and autumn.

Enterovirus most often enters the human body through gastrointestinal tract(GI) or respiratory tract. Once in the gastrointestinal tract, viruses stop in the local lymph nodes where they begin the first stage of reproduction. Around the third day after infection, the viruses enter the bloodstream and begin to circulate throughout the body. On the 3-7th day, viruses with blood can enter the organ systems where the second stage of reproduction can begin and, as a result, cause various diseases. The production of antibodies to the virus occurs during the first 7-10 days.

It is known that the Coxsackie virus most often begins to actively multiply and causes diseases when it enters such tissues and organs as: pharynx (tonsillitis), skin (viral pemphigus of the mouth and extremities), myocardium (myocarditis) and meninges (aseptic meningitis). The adrenal glands, pancreas, liver, pleura, and lungs may also be affected.

Echovirus - actively reproduces and causes diseases when it enters such tissues and organs as: liver (liver necrosis), myocardium, skin (viral exanthema), meninges (aseptic meningitis), lungs and adrenal glands.

Symptoms and signs of enterovirus infection

Non-polio Enteroviruses cause a huge number of infections per year. More than 90% of these cases are either asymptomatic or cause a nonspecific febrile illness. Usually the range of symptoms is very wide, but in most cases it almost always includes: fever (increase in body temperature up to 39-40 ° C), general weakness, headache, muscle pain and gastrointestinal symptoms.
Enteroviruses entering the human body can cause several symptoms in various combinations.

Possible symptoms are described below:

• Runny and stuffy nose and sinuses, sore nose, sore throat, earache, difficulty swallowing, loss of smell or taste.
• Nausea, indigestion, reflux, bloating, upper and lower abdominal pain, cramps, constipation alternating with diarrhea.
• Rapid weight loss due to indigestion and reduced calorie intake, or weight gain due to inactivity.
• Numbness in limbs, muscle twitching and spasms. Facial tingling and numbness may be observed.
• Different kinds headache (acute, aching, throbbing).
• Pain in bones, muscles and joints. Leg pain is quite common.
• Pain and tightness in the chest, palpitations.
• Cough, shortness of breath, wheezing.
• Abnormal heart rhythms (arrhythmias) or tachycardia (rapid heartbeat)
• Intermittent fever - characterized by a rapid, significant increase in temperature (38-40 ° C), which lasts for several hours, and then is replaced by a rapid drop to normal values), chills, and severe night sweats.
• Violation reproductive function as well as pain in the testicles. Pain in the pelvis.
• Blurred vision, decreased visual acuity.
• Blisters or ulcerations in the mouth, pharynx and, in women, in the vagina/cervix.
• Psychological problems - anxiety states or depression.
• Problems with concentration. Cognitive problems, short-term memory problems.
• Sleep disturbance.
• Seizures are rare, but they do happen.
• Enlarged lymph nodes in the neck and armpits
• Enterovirus infections should be suspected if the same symptoms recur every month.

It is impossible to talk about any specific symptoms characteristic of the entire group of enteroviruses in addition to those listed above, but it is possible to group the symptoms manifested in complications of an enterovirus infection:

Enterovirus fever (summer flu) - the most common form of enterovirus infection, begins with a sudden increase in temperature, the temperature usually stays in the range of 38.5-40 ° C. Clinical indicators include a flu-like syndrome consisting of general weakness, muscle aches, sore throats, headaches, eye inflammation (conjunctivitis), nausea, vomiting, and diarrhea. Genitourinary manifestations such as orchitis (inflammation of testicular tissue) and epididymitis (inflammation of the epididymis) are possible. Symptoms usually last 3-7 days and can generally be caused by all enterovirus subtypes.

Herpetic sore throat - These patients develop painful blisters filled with a clear liquid on the back of the throat and tonsils, the blisters are usually surrounded by a red border. These lesions are accompanied by fever, sore throat, and pain when swallowing (odynophagia). Mothers may notice a reluctance to eat in children due to painful sores. The causative agent is most often coxsackievirus group A and, sometimes, coxsackievirus group B. Angina is a self-limited disease, and its symptoms last 3-7 days.

Viral pemphigus of the mouth and extremities - manifests itself as a vesicular rash (small fluid-filled blisters that rise above the surface of the skin) in the oropharynx, on the palms, soles and in the area between fingers in infants and school-age children. Bubbles in the mouth are usually not painful. Often, patients have a fever for 1-2 days and small red spots on the skin of the hands and feet (characteristic viral exanthema). The lesions most commonly occur on the surface of the skin in the lower arms and legs. The most common causative agent is group A Coxsackievirus.
Viral exanthems - a common cause of visits to departments emergency care are viral exanthems, similar to rashes as with rubella or roseola; occur during the summer months. These exanthems occur in children under 5 years of age and resolve favorably within 3-5 days. The causative agents are usually Echoviruses.
Pleurodynia (Bornholm's disease, devil's flu) - Causes severe muscle pain in the chest and abdomen. These sharp pains are aggravated by breathing or coughing and are associated with profuse sweating. Cramping muscle pain lasts 15-30 minutes in children and adolescents. The condition can mimic severe surgical symptoms and can cause intermittent bouts of difficulty breathing. These symptoms are accompanied by fever, headache, sudden weight loss, nausea and vomiting. Symptoms last for 2 days. Coxsackievirus B3 and B5 infect the intercostal muscles, causing these frightening but rare outbreaks.

Myocarditis and/or pericarditis - includes infections of the heart muscle (myocardium) and the lining around the heart (pericardium). Babies and children preschool age are the most susceptible to this disease, and for some reason, more than two-thirds of the cases occur in the male sex. The disease usually begins as an upper respiratory tract infection with cough, shortness of breath, and fever. Chest pain, severe shortness of breath, heart rhythm disturbances, and heart failure may develop.

Acute hemorrhagic conjunctivitis refers to a viral infection of the conjunctiva of the eye, which is the covering around the eyes. Symptoms include: pain, blurred vision, decreased visual acuity, photophobia, and discharge from the eyes. Headache and fever occur in only one in five patients. The disease lasts 10 days.
Aseptic meningoencephalitis is a well-known syndrome caused by Enteroviruses. In fact, enteroviruses are responsible for about 90% of cases of aseptic meningitis, and most commonly affect children and adolescents. It is characterized by headache, fever, refusal of light, and eye pain. Symptoms may include drowsiness, sore throat, cough, muscle pain and rash. Sometimes not only the meninges are infected, but the brain tissue itself, causing encephalitis. The illness resolves in about a week, and irreversible damage is uncommon. Enteroviruses can also cause Guillain-Barré syndrome, which involves weakness and paralysis of the limbs and, less commonly, the respiratory muscles.

Diagnosis of enterovirus infection

In most cases, the diagnosis is based on characteristic symptoms caused by the virus, medical history and physical examination. Specific studies are needed in order to determine the causative agent of the infection, as this will greatly affect the approach to treatment (if the causative agent of the disease is a virus, then antibiotic therapy will not be required), as well as in case of complications.

Laboratory research:

Serology- a serological blood test can reveal an increase in the amount of antibodies produced by the body to fight enterovirus in acute and convalescent (recovery) periods of the disease. it diagnostic study can only detect Coxsackievirus B 1-6 and Echoviruses 6, 7, 9, 11, and 30. Other known enteroviruses cannot be identified with this test. A negative serological test does not necessarily mean the absence of enteroviruses.

Polymerase chain reaction (PCR)- This test is highly sensitive and specific for detecting enteroviral RNA in cerebrospinal fluid samples, with a sensitivity of 100% and a specificity of 97% to determine the causative agent of the disease. PCR gives fast results. PCR blood testing can detect the virus in only 30% of patients with chronic fatigue syndrome (myalgic encephalomyelitis).

Cardiac enzymes and troponin I- a blood test that is aimed at determining the level of specific cardiac enzymes and troponin 1, which, if their content in the blood is high, indicate damage to the muscles of the heart. The content of troponin I in serum is normal 0-0.5 ng/ml. Held at

Analysis of cerebrospinal fluid- carried out when symptoms of damage to the head and spinal cord and their shells. With the help of a puncture, a small amount of fluid is taken from the patient's spinal canal under sterile conditions. In patients with aseptic meningitis, it shows a moderate increase in the level of leukocytes. Glucose levels are normal or slightly low, while protein levels are normal or slightly elevated.

Reverse transcriptase polymerase chain reaction (RT-PCR)- This test is designed to detect common RNA genetic regions in most enteroviruses. Results can be available within 24 hours, making detection more sensitive (95%), more specific (97%) and efficient. This test is approved for the diagnosis of enteroviral meningitis. The best results are obtained when using cerebrospinal fluid for research. When using other body fluids such as feces, sputum and mucus from the respiratory tract and blood, this method does not show as good results.

Instrumental Research

Chest x-ray - In patients with myopericarditis, chest x-ray may reveal cardiomegaly (enlargement of the heart) after pericarditis or cardiac enlargement. In pleurodynia, chest x-ray findings are normal.

Electroencephalography - This test can be used to assess the extent and severity of the disease in patients with encephalitis.

Echocardiography - is prescribed for patients with suspected myocarditis, the study can show abnormalities in the movement of the walls of the heart chambers. In severe cases, this method can detect acute ventricular dilatation and a decrease in ejection fraction.

Ophthalmic examination with a slit lamp - In patients with acute hemorrhagic conjunctivitis, corneal erosions can be detected using a fluorescent spot. Enterovirus 70 and Coxsackievirus A24 can be isolated from conjunctival swabs during the first 3 days after infection.

Treatment of enterovirus infection

In most cases, enterovirus infection proceeds without complications and does not require any specific treatment. The basis is symptomatic and supportive treatment. Bed rest, plenty of fluids, vitamins, antipyretic in case of high temperature. No specific diet currently exists for patients with enterovirus infection. There is no specific antiviral treatment such as vaccination for the treatment and prevention of non-polio enterovirus infection.

In the table you can find a number of drugs that can help you cope with a particular symptom with a mild enterovirus infection. But do not forget that even if the slightest and slightest symptoms appear, you should immediately consult a doctor, especially if the child has symptoms!
Antipyretic and analgesic drugs - these drugs are used to treat fever, muscle pain and headache caused by an enterovirus infection.

Active substance	Name of the drug	Description	Method of application and dosage
Acetaminophen	Paracetamol Tylenol Efferalgan Panadol	The drug belongs to the group of non-steroidal anti-inflammatory drugs. It has antipyretic, analgesic and anti-inflammatory properties. Forms of release for children: Tablets - 80 mg, 160 mg; Chewable tablets - 80 mg; Syrup - 160 mg / 5 ml; 240 mg/7.5 ml; 320 mg/10 ml. Release form for adults: Tablets - 325 mg, 500 mg; Capsules - 500 mg; Chewable tablets - 80 mg, 160 mg; Suspensions - 160 mg / 5 ml.	Children: Under 12 years old - 10-15 mg / kg time between doses of 6-8 hours, but not more than 2.6 g per day. Over 12 years old - 40-60 mg / kg / day (divided into 6 doses). No more than 3.7 g per day. Adults: 500 mg. 3-4 times a day, but not more than 4 g per day.
ibuprofen	Advil Ibuprone MIG 200/400 Nurofen Profen Motrin Ibusan Iprene	The drug belongs to the group of non-steroidal anti-inflammatory drugs. It has analgesic, anti-inflammatory and antipyretic properties. Release form for children and adults: Tablets - 100 mg, 200 mg, 400 mg, 600 mg, 800 mg; Chewable tablets - 50 mg, 100 mg; Suspensions - 100 mg / 5 ml, 40 mg / ml.	Children: From 6 months to 12 years Body temperature below 39 ° C - 5-10 mg / kg / dose every 6-8 hours, but not more than 40 mg / kg / day. Body temperature above 39 ° C - 10 mg / kg / dose every 6-8 hours, but not more than 40 mg / kg / day. For muscle pain and / or headache - 4-10 mg / kg / dose every 6-8 hours, but not more than 40 mg / kg / day. A potentially dangerous dose for children under 6 years of age is 200 mg/kg. Take with meals. Adults: At elevated temperature - 400 mg every 4-6 hours, the maximum dose is not more than 3.2 g per day. For muscle pain and / or headache - 200 - 400 mg every 4-6 hours, the maximum dose is not more than 1.2 g per day.

Immunoglobulins are drugs that stimulate the immune system. Immunoglobulins are a purified preparation of gamma globulin derived from human plasma. Immunoglobulin preparations are administered intravenously or intramuscularly. In the treatment of enterovirus infections, intravenous immunoglobulins are more often used. The dose is prescribed strictly individually, depending on the severity of the disease, age and tolerability of the drug by the patient.

Specific antiviral therapy at this stage in the development of medicine has not shown any effective results, and is currently not included in the standard treatment regimens for enterovirus infection. Existing drugs can have any effect only when taken for a very long time. early stage development of enterovirus infection, in the first 5-10 hours, but it is not possible to determine the presence of infection during this period of time at home.

As a maintenance therapy, it is worth taking vitamins, the most important is vitamin D, since it is involved in the production of a peptide that is important for immune cells. It is also worth using supplements containing trace elements such as zinc, selenium, potassium, calcium and magnesium - they play an important role in the fight against viral infections.

Pharmaceuticals to avoid

Some drug treatments can do more harm than good. The following treatments should be avoided: antibiotic therapy - does not give any results in the treatment of enterovirus infections, since antibiotics only act on bacteria. However, in patients with severe disease where it is not clear whether the cause is viral or bacterial infection eg in the case of meningitis, antibiotics may be used until the results of the bacterial culture are known. If the cause is determined to be viral, antibiotics should be discontinued.

Corticosteroids should be avoided as a treatment for acute enterovirus infection whenever possible. Although these medications are often prescribed for acute enterovirus infections to treat acute asthmatic bronchitis and severe localized muscle pain (neck, chest, back), they should be avoided because they suppress the immune response and allow viruses to survive in the body. It should be noted that the use of steroids for myocarditis is harmful. If the use of steroids is considered medically necessary in a situation, life threatening(for example, in severe asthma or acute respiratory distress syndrome), steroid treatment should be deferred whenever possible until the body of the sick person has developed antibodies against the enterovirus.

Prevention

Currently, no vaccine is effective against non-polio enteroviruses. General hygiene and frequent handwashing are effective in reducing the spread of these viruses. If soap and clean water are not available, use an alcohol-based "hand sanitizer".

It is important to note that breast milk contains antibodies that can protect newborns.