Enteroviral infection of infants. Features of the treatment of enteroviral infections. Complications of enteroviral infections

enterovirus

Enterovirus infection- a separate group of diseases caused by enteroviruses. Characteristic symptoms: fever, rash on the skin and throat, vomiting, diarrhea. In severe forms, there are lesions of the muscle, central nervous system, heart and other organs. Clinical signs depend on the strain of the intestinal virus. Enterovirus infection in children is dangerous due to complications.

Enterovirus (from the Greek enteron means “guts”) belongs to a genus of viruses that penetrate the gastrointestinal tract (GIT). Here the enterovirus actively multiplies and disrupts the work digestive system. But the danger of this pathogen is that it is capable of infecting the central nervous system, tissues and organs (kidneys, heart, liver, lungs). There are many subspecies of enteroviruses, which are called serotypes. The most pathogenic of them are: Coxsackie A viruses (23 types), Coxsackie B viruses (6 types), polio viruses (3 types), enteroviruses 68–71 (4 types), echoviruses (31 types). Enteroviruses are incredibly tenacious and resistant to the external environment. They can be found in water and soil long time- up to several months. They can live in the refrigerator for weeks, and can be stored frozen for several years. They are not afraid of the acidic environment of gastric juice; they are not always killed by detergents and alcohol. What are enteroviruses afraid of? Temperatures above 50°C, drying, disinfection, ultraviolet radiation.

Routes of transmission

Enterovirus can live in the nasopharynx, mouth, mucous membranes of the eyes or in the intestines. The main routes of infection are fecal-oral, household contact and airborne. It is highly contagious. Incubation period can vary greatly - from several days to a month. Most often, infection occurs in summer and autumn.

• Contact with a sick person or carrier. The virus is transmitted not only through the mouth, nose, eyes, but also through dirty hands. If someone catches enterovirus in a family, the likelihood of infecting other members is very high.
• Contact with contaminated objects. The virus is transmitted through common household items, dishes, toys.
• Contaminated products. Most often these are unwashed or poorly washed fresh vegetables and fruits.
• Contaminated water. The main route of transmission, since enterovirus survives for a long time in water.

Children are often carriers of the virus. They get sick much more often. This is due to an unstable immune system and poor personal hygiene. Enterovirus most often affects children under ten years of age. If a child becomes infected before the age of two, this may lead to complications.

Main signs of the disease

What are the symptoms of enterovirus infection in children? Clinical picture, to put it medical language, erased. With enterovirus infection, there is a risk of damage to various organs, so the range of symptoms can be varied and nonspecific. In addition, there is another insidious feature of enteroviruses: similar symptoms can occur with different serotypes of enterovirus or, conversely, one subtype gives a different clinical picture. Symptoms may be similar to those of acute respiratory viral infections, volatile viral infections, and acute intestinal infection (AIE). Enterovirus can be accurately diagnosed using a blood test.

• Temperature increase. At the beginning of the disease it is usually high, then it decreases, and after a few days it jumps again. This wave pattern is characteristic of enterovirus. There is such a term as enteroviral fever. It lasts 3 days with minor discomfort. Vomiting and diarrhea are also possible, but it all ends as suddenly as it began.
• Symptoms similar to ARVI. The child may complain of a sore throat and sore throat. Coughing and snot may also begin. Sometimes enterovirus is difficult to recognize immediately because the disease is initial stage similar to ARVI.
• Rash due to enterovirus infection in children. Called enteroviral exanthema. Rashes may appear 2–3 days after the fever. Localized on the face, neck, arms, legs, chest, back. They have a characteristic appearance: red small dots on the skin, similar to rashes caused by measles and other volatile diseases. viral infections. Also, a rash may appear on the mucous membranes - in the throat or mouth. It looks like blisters filled with liquid, which then turn into ulcers. An experienced doctor can determine the “handwriting” of an enterovirus infection by the location of the rash: in the throat ( herpangina), simultaneously around the mouth, on the palms and soles.
• Muscle pain. More often the muscles of the chest and abdomen hurt, less often - the legs, arms and back. They intensify with movement, can be paroxysmal in nature, lasting from several minutes to half an hour. If the disease is not treated, muscle pain may later become chronic.
• Vomiting and diarrhea. Frequent symptoms enterovirus in children under two years of age. Enteroviral diarrhea may be accompanied by pain and bloating. Diarrhea lasts several days. It is important during this period to replenish fluid loss and prevent dehydration. Read about how oral rehydration therapy is performed at home in our other article.

Additional symptoms:

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

Enterovirus infection is dangerous for child's body complications: pulmonary edema, meningitis, encephalitis, myocarditis, neurological motor disorders (paralysis, paresis). The list is frightening, the threat is real, death is likely. Complications occur extremely rarely and develop when the infection is not treated with proper treatment. initial stage. How younger child(especially newborns and infants), the higher the risk of severe illness due to enterovirus.

Dangers of mild enterovirus infection

IN Lately A blurred course of the disease is becoming more common. The child may feel slightly unwell, tired, weak, dizzy, and have a slight increase in temperature. Usually all these symptoms are perceived as signs of a cold. If the baby has a weak immune system, enterovirus infection can develop further and cause complications and chronic forms of disease.

What is the treatment

Treatment of enterovirus infection in children is determined by the severity of the disease and the nature of complications.

• Bed rest. Indicated for all children with any form of enterovirus.
• Antipyretics for fever. Should always be in your home medicine cabinet.
• Restoring water-salt balance during diarrhea and vomiting. It is necessary to give the child as much water as possible and give rehydration solutions if there is excessive diarrhea and vomiting.
• Antiviral drugs. Most often this is a group of interferons. The dose and course are prescribed by the doctor.
• Antibiotics. Prescribed to children of any age if there are complications bacterial in nature, chronic form diseases, extensive foci of secondary infection.

Antiemetic, antidiarrheal, antispasmodic and painkillers are prescribed by the doctor if necessary. If a child has had damage to the nervous system, eyes, kidneys, liver, or lungs due to an enterovirus infection, he is advised to be monitored by a doctor for a year or more.

What should the diet be like?

Diet for enterovirus infection in children is important because the functioning of the gastrointestinal tract is disrupted. Nutrition includes the following principles:

• drink plenty of fluids to remove toxins and prevent dehydration;
• low-fat, boiled, stewed, oven-baked, pureed, chopped food;
• exclusion of spicy, fried, smoked, salty, sweet;
• exclusion of whole milk, eggs, vegetable and butter;
• all carbonated drinks are contraindicated;
• fresh ones are allowed dairy products(low-fat cottage cheese, biokefir);
• vegetables and fruits are allowed only in cooked form;
• Do not give legumes, nuts, meat broths, or fresh bread;
• meals should be fractional, the frequency of meals increases up to 6 times;
• dishes are served warm;
• You cannot force your child to eat or overfeed.

What can you eat if you have acute diarrhea?

• Hungry pause. It is beneficial to fast and skip one or two meals. Hungry pauses in infants are not allowed. How older child, the longer the interval between meals can be.
• Strict diet . On the first day, porridge with water, crackers, and baked apples are allowed. In the following days, you can introduce fermented milk products, pureed vegetable soups, and boiled potatoes. Lastly, dishes made from lean meats and fish (steamed cutlets, meatballs, meatballs) are introduced.

What can you drink if you have acute diarrhea?

Drinks should be offered often, in fractional portions.

7 preventive measures

Prevention is aimed at neutralizing enterovirus in environment. In what ways can this be done?

If sanitary and hygienic standards are not observed, the risk of contracting enterovirus infection in children increases significantly.

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

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

General information about the causative agent of the disease

Enterovirus infection is a whole group of diseases caused by certain intestinal viruses (enteroviruses). Enterovirus is widespread and is found even in the most remote corners of the globe. IN last years There is a tendency towards intensification of enterovirus infection throughout the world.

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

A feature of enterovirus infection is healthy virus carriage. The virus can exist in the human intestine for up to 5 months without losing its properties. Thus, the source of infection may be completely healthy man, unaware of the dangerous viral agents that have settled inside.

The disease is transmitted in three ways:

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

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

Basic forms

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

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

Herpangina

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

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

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

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

Serous meningitis

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

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

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

Epidemic myalgia

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

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

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

Consult a doctor when the first signs of illness appear!

Myelitis

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

Heart damage

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

Enteroviral diarrhea

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

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

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

Enteroviral fever

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

Enteroviral exanthema

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

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

Complications

Enterovirus infection in any form can cause the following pathology:

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

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

Principles of therapy

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

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

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

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

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

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

Prevention

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

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

• Prevention of Enterovirus infection
• Which doctors should you contact if you have an enterovirus infection?

What is Enterovirus infection

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

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

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

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

What causes enterovirus infection

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

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

Pathogenesis (what happens?) during Enterovirus infection

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

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

Source of infection- a sick person or a virus carrier. The transmission mechanism is airborne or fecal-oral. Children and young people get sick more often. Summer-autumn seasonality is typical. Immunity after past illness quite long (up to several years).

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

The tropism of enteroviruses for nervous tissue, muscles, and epithelial cells determines the variety of clinical forms of infection. When the virus penetrates the central nervous system, it may be damaged with the development of aseptic meningitis, meningoencephalitis or paralytic poliomyelitis-like forms.

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

Symptoms of Enterovirus infection

The wide pantropic nature of enteroviruses underlies the wide variety of clinical forms of infection they cause, affecting almost all organs and tissues of the human body: nervous, cardiovascular system, gastrointestinal, respiratory tract, as well as kidneys, eyes, skin muscles, oral mucosa, liver, endocrine organs. Enterovirus infections are particularly dangerous in immunocompromised individuals.

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

Conventionally, two groups of diseases caused by enteroviruses can be distinguished:
I. Potentially severe:
- serous meningitis;
- encephalitis;
- acute paralysis;
- neonatal septic-like diseases;
- myo-(peri-)carditis;
- hepatitis;
- chronic infections immunodeficient persons.

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

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

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

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

From others neurological symptoms with meningitis of enteroviral etiology, there may be disturbances of consciousness, increased tendon reflexes, absence of abdominal reflexes, nystagmus, foot clonus, short-term oculomotor disorders.

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

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

6. Enteroviral exanthema("Boston fever") It is characterized by the appearance of pink, maculopapular or maculopapular rashes on the face, torso, and limbs from the 1st to 2nd day of illness; sometimes there may be hemorrhagic elements. The rash lasts 1–2 days, less often longer, and disappears without a trace.

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

8. Respiratory (catarrhal) form manifests itself with mild catarrhal symptoms in the form of nasal congestion, rhinitis, and a dry, rare cough. On examination, hyperemia of the mucous membrane of the oropharynx, soft palate and back wall throats. Mild dyspeptic disorders may occur. Recovery occurs in 1–1.5 weeks.

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

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

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

According to WHO, enterovirus infections of the heart are a regularly recorded pathology around the world. Depending on the pathogen, enterovirus infections of the heart have a very definite share in the structure of general infectious morbidity, amounting to about 4% of the total number of registered viral diseases. Largest number Enteroviral infections of the heart are caused by Coxsackie B viruses, the second place among the causative agents of enteroviral infections of the heart (according to specific gravity in infectious pathology) are occupied by Coxsackie A viruses, followed by ECHO viruses and polioviruses.

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

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

Of interest are reports of vascular lesions during Coxsackie infections identified in patients with entroviral myocarditis.

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

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

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

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

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

Diagnosis of Enterovirus infection

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

Serological methods aimed at identifying markers of enteroviral infections in the blood serum of patients. Early markers of infection include IgM and IgA. When identifying serological markers of enterovirus infections, the most representative is the IgM titer, which indicates a recent infection. Therefore, virus-specific IgM are convenient markers of a “fresh” antigenic stimulus, while IgG can persist and circulate in the blood of a recovered person for several years or even the rest of his life. To indicate IgM, immunofluorescence and enzyme immunoassay. In patients with acute symptoms EV-specific IgM diseases are detected 1–7 days from the onset of infection. After 6 months, IgM usually disappears.

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

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

The main goal of immunohistochemical methods is the in situ detection of enteroviral antigens. The most accessible methods of immunohistochemistry include immunofluorescence and immunoperoxidase assays.

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

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

Treatment of Enterovirus infection

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

Currently as antiviral agents Alpha interferon preparations (alpha-2a, alpha-2b), both natural and recombinant, are mainly used. Interferons are used topically and parenterally.

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

The third group is capsidinhibiting drugs. The most effective of this group is pleconaril. This is the most widely used etiotropic drug that has undergone clinical trials. Pleconaril demonstrated wide range antiviral activity against both rhinovirus and enterovirus infections, and is characterized by high bioavailability (70%) when taken enterally.

This drug can be and is used in newborns with enteroviral meningitis at a dose of 5 mg/kg enterally 3 times a day for 7 days. Noted high level pleconaril in the central nervous system and nasopharyngeal epithelium. When using pleconaril in different age groups not noted side effects. This drug is widely used for the treatment of meningitis, encephalitis, respiratory infections caused by enteroviruses. When using pleconaril in the treatment of meningitis in children, a reduction in meningeal symptoms by 2 days was reliably noted. INR days are held in Russia 14.10.2019

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Enterovirus infection
Enterovirus infection is caused by a large group of viruses from the picornavirus family. Viruses are stable in the external environment, persist for a long time in soil, water, and on infected objects, but quickly die when boiled or exposed to disinfectant solutions and ultraviolet irradiation.
They get sick more often in the autumn-summer period.

Infection occurs from patients with enterovirus infection and virus carriers, who are most often children preschool age.

The infection is transmitted both by airborne droplets when coughing, sneezing, and by contact - when using objects contaminated with secretions

Sick. Infection through contaminated food and water is possible. Overcrowding and unsanitary conditions contribute to the spread of infection.

Children aged 3-10 years are most often affected. Children who are on breastfeeding, rarely get sick, as they receive immunity from their mother. After an enterovirus infection, repeated cases of the disease are possible due to the diversity of the pathogen.

Periods and forms of the disease

The following periods of the disease are distinguished:

Incubation, latent period - from 2 to 10 days;
period of pronounced manifestations of the disease;
recovery period.

The duration of the disease may vary depending on its form and severity.

Enterovirus infection is characterized by general symptoms that are detected in all patients.

The onset of the disease is acute: the condition worsens, weakness, lethargy, headache, and sometimes vomiting appear. The temperature rises, sometimes up to 39-40°. There may be redness of the skin of the upper half of the body, especially the face and neck, redness of the eyes - scleritis. Redness is visible in the throat soft palate, arches, granularity of the posterior pharyngeal wall. The tongue is covered with a white coating. A rash may appear on the skin of the torso of various nature. The cervical and axillary lymph nodes are enlarged, and the liver and spleen may be enlarged.

In addition to such common features, enterovirus infection may have various shapes. Against the background of the general symptoms of the disease, a leading sign arises, which determines the form of enterovirus infection.

One of the most common forms is herpetic sore throat. It occurs more often in young children. Against the background of elevated temperature, which lasts 1-3 days, small raised spots (papules) appear on the oral mucosa, in the pharynx, quickly turning into bubbles (vesicles), which last for 24-48 hours, after which they open, forming erosions with a white coating. The upper anterior cervical lymph nodes are often enlarged.

Epidemic myalgia (Bornholm's disease, "devil's disease") is the most striking form of enterovirus infection, allowing a diagnosis to be made on the basis of severe intoxication and pain in the muscles of the chest, abdomen, lower back and legs of a paroxysmal nature, lasting from several minutes to an hour. The disease often has a wave-like course, sometimes the temperature drops for 1-3 days and then rises again. The liver enlarges; in boys, especially in adolescence, the testicles may be involved.

Enteroviral exanthema is characterized by a rash that appears 2-3 days after the temperature drops. The rash can be varied - pinpoint, spotty, with small hemorrhages. It appears instantly, is located on the body, less often on the legs and feet, lasts 2-3 days, after which it disappears without a trace.

As with other forms of the disease, a combination of rash with changes in the pharynx, muscle pain, enlargement is possible. lymph nodes.

Enterovirus infection can affect the nervous system: meninges (serous meningitis), brain tissue (encephalitis) and spinal cord (myelitis). These forms are characterized by manifestations of intoxication, headache, vomiting, convulsions, and even loss of consciousness and paralysis are possible. In such cases, you should immediately consult a doctor and hospitalize the patient.

Very rare severe forms infections in newborns with damage to the heart and brain. Heart damage is also possible in older children.

Enteroviral diarrhea is one of the forms of enteroviral infection and occurs more often in children in the first years of life. Within 2-3 days, against a background of moderately elevated temperature and intoxication, loose stool, sometimes mixed with mucus.

With enterovirus infection, eye damage is also possible in the form of hemorrhagic conjunctivitis and inflammation of the mucous membrane of the eye - uveitis. With hemorrhagic conjunctivitis, photophobia, lacrimation, swelling of the eyelids, redness and pinpoint bleeding are observed on the conjunctiva of one or both eyes.

The listed forms do not exhaust the variety of clinical manifestations of enterovirus infection. With this disease, damage to the kidneys, biliary system, liver, lungs, and pancreas is possible. Combined forms of enterovirus infection are often observed, for example herpangina and myalgia, etc.

Treatment

Patients with enterovirus infection can be treated at home; children with moderate and severe forms of the disease, with damage to the central nervous system, eyes, heart, liver, as well as young children, are hospitalized.

When treated at home, bed rest is prescribed for 5-7 days.

The diet should be appropriate to the patient’s age, and drinking plenty of fluids is necessary.

Drug treatment is carried out as prescribed by a doctor.

The child is considered healthy after the temperature normalizes and all manifestations of the disease disappear, which usually occurs no earlier than 10-12 days. Observation after recovery, depending on the transferred form and severity of the disease, is carried out by a pediatrician, neurologist, cardiologist, or ophthalmologist.

Prevention

A vaccine against enteroviruses has not been developed.

A patient with an enterovirus infection is isolated for at least 10 days from the onset of the disease.

Contact children are monitored for 7 days. The patient's room and belongings should be washed and disinfected.

Enterovirus infection in children is a whole group of pathogenic microorganisms that can cause sore throat, conjunctivitis, dermatosis, damage to the heart and other internal organs of the baby. The variety of forms of the disease is due to the large number of microbes related to enterovirus infection; doctors count more than 70 types of them.

Clinical signs differ depending on the strain of the intestinal virus; the illnesses are dangerous to the baby’s health and cause many complications. To avoid negative consequences A timely visit to the doctor will help, correct treatment. The lack of qualified assistance leads to damage to the nervous system, heart, internal organs and systems of the child.

Causes and routes of infection with enterovirus infection

Enterovirus (translated from Greek language means “guts”), belongs to a number of viruses localized in the gastrointestinal tract. It is here that the microorganism settles down, begins active life, and disrupts the baby’s normal digestive process. The main danger of pathogenic microorganisms of this group is that they can affect the child’s nervous system, tissues, and internal organs.

The most dangerous enteroviruses include: Coxsackie A, Coxsackie B, polio, echoviruses, enteroviruses type 68-71. Enteroviruses are very tenacious microorganisms; they can exist on the surface of the Earth for up to two months. In the refrigerator, their lifespan increases even more; when frozen, viruses are stored for more than two years. Microorganisms are resistant to acidic environments, so they don’t care about gastric juice. Enteroviruses are not always killed by products containing alcohol.

What kills pathogens? Enterovirus dies at temperatures above 50 degrees Celsius, disinfection, drying, and exposure to ultraviolet radiation. Only these methods can cope with pathogenic microorganisms.

Enterovirus can live in the nasopharynx, intestines, mucous membranes of the eyes and oral cavity. The virus is particularly contagious, so enterovirus infection is usually epidemiological in nature. This is especially true for children's institutions (kindergartens, schools). Children aged three to ten years are most susceptible to the disease. Breastfed babies have maternal immunity, after switching to self-catering, weak protection quickly disappears.

The incubation period varies and depends on the baby’s immunity, the type of virus, and other unforeseen factors; it can range from several days to one month. Infection often occurs in summer or autumn. Enteroviruses are able to survive in food, water, soil, and virus carriers for a very long time, so the infection is ubiquitous and often occurs in children.

Doctors identify several main routes of transmission of enteroviruses:

• from a sick person to a healthy one. It is interesting that the virus is transmitted not only through the nose, mouth, eyes, but also through the hands. If one family member is infected, the likelihood of other members becoming infected increases many times;
• contaminated food. Often a child catches the virus after eating poorly washed vegetables and fruits;
• contact-household. Pathogenic microorganisms thrive in the environment; contact of a baby with contaminated objects (toys, towels, plates) risks infection.

Often, children are carriers of enterovirus infection; this category of the population gets sick more often than others, their immunity is weak, and they rarely observe the rules of personal hygiene. As mentioned above, children under 10 years old get sick; if an infant becomes infected, this may signal serious problems with health, complications in this case occur very often. It is important for young parents to find out the reason for the baby’s poor health and be sure to consult a doctor.

Clinical picture

How to determine the course of enterovirus infection in a child? The question is quite complex, even for experienced doctors. The clinical picture for this disease is blurry. The virus is capable of infecting the child’s internal organs and the central nervous system, so the symptoms can be specific and nonspecific. Signs of infection by enterovirus may be similar to the course of acute respiratory viral infection, acute intestinal infection, and other diseases. A baby's blood test will help confirm or refute the diagnosis. Treatment is prescribed only on its basis.

Enterovirus infection in children is manifested by the following symptoms:

• characteristic rash. Doctors call skin rashes enteroviral exanthema. Any formations on the baby’s skin appear 2-3 days after the body temperature rises. Typical localization area: arms, back, neck, face, chest, legs. The rashes are small red dots that resemble formations associated with measles and other viral infections. Sometimes bubbles form in the throat, lips, mouth, palms, feet;
• elevated body temperature. This symptom is characteristic of the course of ARVI in children. At the beginning of the disease, the fever appears rapidly, then subsides a little, and appears again. Attacks of high temperature have a wave-like character. The fever lasts no more three days, the child becomes noticeably weaker and feels slightly unwell;
• Often a young patient experiences vomiting and diarrhea. These symptoms are caused by damage to the system gastrointestinal tract. Signs appear suddenly and disappear without a trace. Diarrhea is accompanied by bloating and dehydration. It is important to replenish fluid loss in a timely manner by using home rehydration therapy methods;
• in the initial stage, symptoms similar to the course of colds are observed: cough, runny nose, sore throat, pain in the child to swallow. This aspect makes correct diagnosis difficult; parents begin to treat the baby with the wrong methods;
• pain in the muscles. Often the baby feels discomfort in the chest, back, and much less often in the arms and legs. Muscle spasms are paroxysmal in nature, lasting from several minutes to half an hour. Absence necessary treatment leads to the transition of temporary pain to a chronic nature.

Additionally, doctors identify several symptoms that are less common than others:

• swelling of the limbs;
• increased tearing, noticeable redness of the eyes;
• headaches, dizziness;
• there is a decrease in appetite, sharp pains in a stomach;
• enlargement of lymph nodes that are located in groin area, under the chin.

Methods and rules of treatment

The doctor determines how to treat enterovirus infection in a child. Simple cases can be treated at home. Damage to the nervous system, fever (it is not possible to bring down the fever for a long time), problems with the heart, kidneys - indications for hospitalization of a small patient. There are no specific drugs for enterovirus infection, treatment is aimed at eliminating nonspecific symptoms; compliance with special rules speeds up the healing process.

• keep bed rest. Rest and sleep are the best “medicines” in the fight against illness;
• in most cases the disease is accompanied elevated temperature bodies. Children are given antipyretic drugs, it is allowed to use rectal suppositories (if there is no severe diarrhea), drugs in the form of a suspension. For such purposes, Paracetamol, Ibufen and others are used;
• restoration of water-salt balance is necessary to normalize the condition of a small patient. Diarrhea, frequent vomiting may lead to dehydration. The treatment for this situation is drinking plenty of fluids, using Regidron, it is allowed to give the baby compotes and fruit drinks;
• to increase the baby’s immunity, interferons are prescribed (non-specific medications, they prevent the proliferation of pathogens and strengthen the child’s body’s defenses);
• Antibiotics are prescribed in cases where a bacterial infection occurs in a chronic form. The doctor chooses the specific drug; it is strictly forbidden to give the baby strong medications on your own;
• special diet. Includes an abundance of protein foods (lean meat), dairy products are allowed in small quantities. It is forbidden to give fresh fruits and vegetables to the baby; boiled vegetables and baked apples are suitable. It is strictly forbidden to feed your baby fried, smoked foods, soda, and sweets. The diet must be followed full recovery, preferably a few more days after its onset;
• It is important to isolate the child from all family members during treatment. Give your little one something special bed sheets, dishes. When in contact with the baby, wear a gauze bandage, then wash your hands thoroughly and change clothes.

Important! Multivitamins and immunostimulating medications are prescribed by the doctor. It is prohibited to give your child various folk remedies on your own. Any therapeutic effects must be agreed with the attending physician.

Possible complications

Negative consequences after infection are rarely observed. Complications occur in isolated cases; the disease often resolves on the seventh day after the onset of the disease. The lethal outcome of the pathology is extremely rare. Appearance negative effects seen in children with HIV infection up to one year old, children with a weak immune system, and diseases of the cardiovascular system.

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Preventive measures

Avoiding infection with enterovirus infection is quite difficult, especially for children. Their the immune system It hasn’t gotten stronger yet, there are a lot of carriers of the virus around.

• Teach your child the rules of personal hygiene. Before each meal, you must wash your hands with soap for at least 20 seconds;
• buy filtered water; tap liquid is strictly prohibited for drinking;
• Wash fruits and vegetables thoroughly before eating;
• buy food only from trusted places that have quality certificates;
• Swimming in open reservoirs should only be in specially designated areas. Where the water is stagnant, the risk of infection increases many times;
• Specific vaccinations against polio are permitted. This method will protect the baby only from this strain of the virus.

Enterovirus is dangerous due to complications and requires mandatory medical care. Self-medication is unacceptable especially in relation to children. Call a doctor at home in a timely manner, be sure to follow his recommendations.