Can enterovirus be without fever. Enteroviral infection in adults. Causes, symptoms and treatment. Prevention of infectious diseases. Possible symptoms are described below

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

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

Pathogens and ways of their transmission

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

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

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

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

Natural reservoirs for pathogens are water bodies, soil, some foodstuffs, as well as the human body.

note: in faeces, enteroviruses remain viable for up to six months.

In most cases, the source of the pathogen is a sick person or a virus carrier, who may have no clinical signs of an enterovirus infection at all. According to medical statistics, among the population of some countries, up to 46% of people can be carriers of pathogens.

The main ways of transmission of infection:

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

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

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

Symptoms of an enterovirus infection

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

The most severe pathologies include:

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

Less dangerous manifestations:

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

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

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

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

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

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

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

Symptoms of the catarrhal form of enterovirus infection:

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

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

Symptoms of enterovirus fever:

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

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

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

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

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

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

Symptoms of serous meningitis on the background of enterovirus infection:

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

There may also be oculomotor disorders, impaired consciousness, muscle pain and increased tendon reflexes.

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

Symptoms of enteroviral conjunctivitis:

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

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

Signs of enterovirus infection in children

For children (especially for babies under 3 years of age), an acute onset of the disease is characteristic.

The most common clinical manifestations of enterovirus infection are:

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

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

Changes in the general blood test:

• minor leukocytosis;
• hyperleukocytosis (rare);
• neutrophilia (at an early stage);
• eosinophioia and lymphocytosis (as the disease progresses).

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

Differential Diagnosis

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

With symptoms of the gastroenteric form, other intestinal infections should be excluded. Exanthema is important to differentiate from rashes on the background of rubella, and hypersensitivity reactions ( allergic).

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

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

In the treatment of enterovirus infection in children, rehydration therapy often comes to the fore, i.e., the elimination of dehydration of the body and the restoration of electrolyte balance. For this purpose, saline solutions and 5% glucose are either given orally or administered by intravenous infusion. Children are also given detoxification therapy and, if necessary, given antipyretics (antipyretics).

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

If there are complications due to the addition of a secondary bacterial infection, the patient is prescribed a course of antibiotic therapy. Damage to the nervous system often requires the use of hormonal therapy with the use of corticosteroids.

Enterovirus infection is a group of acute infectious diseases that affect not only adults but also children. A characteristic feature of this disorder is that enteroviruses initially multiply in the gastrointestinal tract, but do not cause the expression of symptoms of intestinal diseases. The second place of localization of bacteria reproduction is the mucous membranes of the respiratory organs. Bacteria often spread and affect the skin, heart, spinal cord, or brain. The activity of viruses can cause both a severe deterioration in the health of the child, and cause minor ailments. The incubation period ranges from two to thirty days, but often does not exceed a week. Children or young people are often affected.

The main ways of transmission of the disease are poor personal hygiene, contaminated hands or objects that children often pull into the oral cavity. In addition, there is the possibility of infection with this disease from an already infected person - by airborne droplets. There is a possibility of a congenital disease when the expectant mother is a carrier of a pathological virus.

Enterovirus infection in adults and children is characterized by the appearance of rashes on the skin, a significant increase in body temperature, malaise and diarrhea. The diseases of this group include - enterovirus fever,. Several times less common are such forms as, and. Treatment is focused on the use of specially prescribed drugs and diet.

Etiology

There are several ways the virus can be transmitted or entered into the human body. The main route is considered to be infection from another person who is a carrier of the disease or ingestion of food, liquid or soil (which is most common for children) with a high content of pathogenic bacteria. This is due to the fact that the virus can remain viable in the environment for a long time. The second most important is airborne infection. In such cases, the virus multiplies in the respiratory tract and is transmitted through coughing or sneezing. In addition, polluted wastewater, which is poured over vegetables or fruits, plays an important role in infection. It is also highly likely that a person will get sick when swimming in contaminated water bodies and if such a liquid accidentally enters the body of an adult or child.

Enteroviral infection is considered a highly contagious disease, since there are more than seventy types of viruses. The peak incidence is observed in the warm season. A large number of cases of the occurrence of such an ailment in children aged three to ten years have been recorded. After recovery, people develop immunity to the type of virus that has become the causative agent of the disease. Adolescents and people of the middle age group get sick much less often - infection may be due to a lack of immunity to a particular type of bacteria.

Varieties

According to the duration of the course of symptoms, such a disorder is divided into several stages and can be:

• acute - duration no more than one month;
• protracted - duration less than three months;
• chronic - from three or more months.

There is a classification of the disease according to the location of the pathological process. Thus, enterovirus infection in children and older people can cause:

• serous meningitis - there is inflammation of the hard tissues of the brain;
• herpetic sore throat - characterized by inflammation of the oral mucosa and tonsils;
• enterovirus fever - internal organs are not involved in the pathogenic process, but there is a sharp increase in body temperature;
• epidemic myalgia - characterized by the presence of muscle weakness;
• enteroviral exanthema - the occurrence of rashes and neoplasms on the skin;
• enteroviral encephalitis;
• encephalomyocarditis in newborns - differs in involvement in heart and brain disease in babies;
• paralysis - is the defeat of the spinal cord and nerves;
• enteroviral diarrhea.

Quite rarely, inflammation of other internal organs is observed, as well as a combination of several forms of the disease.

Symptoms

For each type and place of occurrence of the disease, there are characteristic signs. Symptoms of enterovirus infection, which are characteristic of all variants of the pathology:

• an increase in body temperature, from insignificant numbers to a feverish state;
• body weakness;
• decrease or complete aversion to food;
• chills;
• severe anxiety in adults;
• increased tearfulness in children.

In addition, this disease is characterized by a wave course, which is caused by apparent relief and recovery, followed by a sharp deterioration in the patient's condition.

In addition, enterovirus fever is characterized by such signs as:

• headache attacks;
• cramps in the abdomen;
• constant nausea;
• feeling of soreness in the muscles.

Herpetic sore throat is characterized by the following symptoms:

• severe sore throat;
• the appearance on the mucous membrane of the mouth of small bubbles with a cloudy liquid in the middle. After they burst, small wounds remain in their place;
• expression of such rashes on the skin.

Symptoms of enteroviral serous meningitis:

• increased sensitivity of the skin to external stimuli;
• increased susceptibility to too bright sunlight or artificial light;
• loss of consciousness, fainting. Often there is a coma;
• convulsions;
• in newborns, sharp cries, pulsation of the fontanel;
• strong excitement, followed by apathy.

The main signs of encephalomyocarditis of newborns:

• diarrhea;
• runny nose;
• increased heart rate;
• the appearance of a bluish tint on the skin;
• dyspnea;
• swelling of the upper and lower extremities.

With a severe form of the course of the disease, the death of the child occurs. This outcome is observed in half of the cases.

Pericarditis and myocarditis are characterized by pain in the heart and chest, rapid pulse and muscle pain. Enteroviral diarrhea is characterized by such signs as:

• foamy and liquid feces, which often have a green tint;
• severe pain in the abdomen;
• frequent vomiting.

For other forms, a mixed expression of symptoms of enterovirus infection in children and adults is characteristic, as well as damage to the organs of vision, their mucous or iris, and liver.

Complications

In almost all cases, the diseases of this group proceed without any complications and have a favorable prognosis. Possible consequences could be:

• increase in intracranial pressure;
• hearing loss;
• minor paralysis;
• weakening of one half of the body;
• attacks of weakness and migraine;
• death - often occurs with brain damage or paralysis.

Diagnostics

A group of these diseases in children and older people is diagnosed against the background of the manifestation of specific signs. To establish an accurate diagnosis, the doctor must study the entire medical history of the patient, find out the duration of the symptoms of enterovirus infection. Mandatory to determine the diagnosis are laboratory tests, including blood tests and feces, secreted conjunctival fluid, scrapings from rashes on the skin, as well as the study of cerebrospinal fluid, which is taken by puncture.

If the patients are children, they may need additional examinations by a pediatrician, cardiologist, neurologist, otolaryngologist and ophthalmologist. In addition, it is necessary to conduct a differential diagnosis with diseases such as, or.

In all cases, hardware examinations of the patient, both an adult and a child, are carried out. This is done to identify the form of this disease. These include:

• electroencephalography - with suspicion of encephalitis;
• echocardiography - is prescribed in cases of suspicion by the attending physician of myocarditis;
• chest x-ray;
• examination by an ophthalmologist using a special lamp.

Treatment

Treatment of an enterovirus infection consists in reducing the degree of symptoms and eliminating the virus that led to the appearance of a particular disease. Often, medications such as anti-inflammatory and antipyretic drugs, antispasmodics and antihistamines are prescribed. In cases of secondary infection, antibiotics are prescribed. If the nervous system is affected, the patient must take corticosteroids and diuretics. In addition, you can use decoctions of chamomile, rose hips and cranberries, which contain a high concentration of vitamin C. At mild stages, the prescription of drugs is carried out individually for each patient. In this case, the specialist is based on the form of the disease and the degree of expression of symptoms.

In severe cases, treatment of enterovirus infection in children and adults is carried out in a hospital. For this, injections of saline solutions, vitamin complexes and glucose are carried out. Antibacterial substances are also prescribed, but only in cases of a secondary inflammatory process.

An important role in therapy is played by the diet for enterovirus infection in children, middle-aged and older people. It is based on a plentiful drink of purified warm water, compotes, fruit drinks, weak tea, but in no case sweet sparkling water. This must be done in order to restore the water balance, which is disturbed in the body against the background of frequent diarrhea and vomiting. Preference in nutrition should be given to boiled, oven-cooked or steamed dishes, as well as first courses cooked in low-fat broth. Eating at the same time should occur in small portions five times a day. However, it should not be too cold or too hot. With timely treatment, in most cases, there is a complete recovery and restoration of the normal course of life.

There is no special prevention of this disease, you just need to thoroughly wash your hands, vegetables and fruits before eating, refuse to swim in polluted rivers, lakes or fountains. It is necessary to accustom the child to hardening and avoiding severe hypothermia of the body. Timely treat SARS and other viral diseases and take vitamin complexes in the cold season. It should be limited from any contact with a person infected with an enterovirus infection.

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The second thing you should do is to provide the sick person with plenty of fluids during the entire period of illness. This is especially important if the child is sick and has diarrhea and vomiting. Below in the answers to questions regarding treatment, you will find additional recommendations on this matter.

No other special treatment is needed. Currently, there are no drugs that could prevent the multiplication of enteroviruses and prevent the development of complications of this infection.

What are the symptoms and signs of enterovirus infection in children and adults?

In different people, an enterovirus infection develops in different ways and manifests itself with different symptoms: for some, it can proceed almost imperceptibly or cause only symptoms similar to a common cold, while for someone it can develop very hard.

Below we describe the main symptoms that can be observed with an enterovirus infection.

The first and only symptoms of an enterovirus infection may be:

• temperature from 38.5 to 40 C, which persists for several days
• severe weakness and chills;
• pain in muscles and joints;

a little later (but not necessarily) may appear:

• sore throat (tonsillitis).
• nausea and vomiting;
• stomach ache;
• diarrhea.

Can an enterovirus infection cause sores (stomatitis) in the mouth or throat?

In some people (especially in children from 3 to 10 years old), an enterovirus infection (especially its varieties Coxsackie virus A and enterovirus 71) often, along with fever and sore throat, causes numerous bubbles.

These bubbles quickly burst and turn into small whitish sores that heal within 5-10 days.

Such cases of illness in medicine are called Gerpangina.

In some children, enterovirus infection causes another form of the disease, which in medicine is called hand-foot-mouth syndrome .

With this form of the disease, simultaneously with the appearance of temperature

• in the child's mouth (on the tongue, on the inner surface of the lips and cheeks, on the gums, on the palate), a lot of very painful white sores with a diameter of 2 to 8 mm appear.
• on the skin of the hands and feet (on the fingers, on the palms and feet), several or many small (up to 5 mm) grayish vesicles surrounded by a red rim of inflamed skin may appear.
• The condition of the child can be very difficult. Due to painful sores, he may refuse to eat and drink.

Can an enterovirus infection cause a skin rash?

In addition to the rash described above in the form of grayish blisters on the arms and legs, an enterovirus infection can provoke the appearance of a more or less profuse rash in the form of red spots, which can be very similar to a rash with or when .

Can an enterovirus infection cause eye inflammation?

Yes it is possible. In some people, enterovirus infection causes the development of the so-called Acute hemorrhagic conjunctivitis , in which there is severe inflammation and redness of the eyes, accompanied by a strong burning sensation in the eyes.

Usually, the condition of the eyes improves on the second - third day and the disease completely disappears after 7-10 days.

Can an enterovirus infection cause testicular inflammation?

In some rare cases, an enterovirus infection can cause inflammation of the testicles (orchitis) in boys and men, which is manifested by swelling and pain in the scrotum. Such cases of illness may look like another infection called parotitis(piggy).

What treatment is needed for enterovirus infection in children and adults?

As mentioned above, at the moment there are no drugs that could stop the reproduction of an enterovirus infection.

For this reason, all adults and children who become infected with this disease are given so-called symptomatic treatment (that is, treatment that helps a person to tolerate the symptoms of the disease more easily until his body copes with the infection).

If you or your child has severe diarrhea, vomiting, or fever, see our recommendations in the articles.

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

What is an enterovirus infection

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

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

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

What provokes an enterovirus infection

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

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

Pathogenesis (what happens?) during Enterovirus infection

Enteroviral infections belong to the group of anthroponoses. The existence of entroviruses in nature is due to the presence of two main reservoirs - a person in whom the virus reproduces and accumulates, and the external environment (water, soil, food products), in which they are able to survive due to their high resistance. The risk of outbreaks increases significantly when a massive enterovirus contamination is 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. A high risk of congenital enterovirus infection, as a rule, is determined not by an acute enterovirus disease suffered by the mother during pregnancy, but by the presence of a persistent form of enterovirus infection in a woman. Sudden infant death syndrome is associated with congenital enterovirus infection.

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

Entry gate of infection- mucous membranes of the upper respiratory tract or digestive tract, where the virus multiplies, accumulates and causes 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 are hematogenously spread throughout the body and deposited in various organs and tissues.

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

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

Symptoms of Enteroviral Infection

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

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

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

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

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

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

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

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

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

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

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

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

8. Respiratory (catarrhal) form manifested by mild catarrhal phenomena in the form of nasal congestion, rhinitis, dry rare cough. On examination, hyperemia of the mucous membrane of the oropharynx, soft palate and posterior pharyngeal wall is revealed. Mild dyspeptic disorders may be noted. Recovery occurs in 1-1.5 weeks.

9. Myocarditis, neonatal encephalomyocarditis, hepatitis, kidney damage, eye damage (uveitis)- These forms of enterovirus infection in children are rare. Their clinical diagnosis is 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.

High tropism of enteroviruses to 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 the total number of infectious lesions of the central nervous system. Every year there is an increase in the incidence of enterovirus meningitis in the summer-autumn period. Predominantly children of preschool and school age are ill. Clinically, aseptic serous meningitis caused by different types of polioviruses, ECHO viruses, Coxsackie A and B viruses, is almost impossible to distinguish. Changes in the cerebrospinal fluid are also indistinguishable. To date, the most common clinical form of enteroviral meningitis has been well described.

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

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

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

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

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

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

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

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

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

Diagnosis of Enteroviral Infection

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

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

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

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

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

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

For the diagnosis of enterovirus infections, a polymerase chain reaction with a reverse transcription stage is used, which has several advantages over the above methods: high specificity, sensitivity and speed of execution.

Treatment of Enteroviral Infection

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

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

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

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

This drug can be used and is used in newborns with enteroviral meningitis at a dose of 5 mg/kg enterally 3 times a day for 7 days. There is a high level of pleconaril in the central nervous system and nasopharyngeal epithelium. When using pleconaril in different age groups, no side effects were noted. This drug is widely used for the treatment of meningitis, encephalitis, respiratory infections caused by enteroviruses. When using pleconaril in the treatment of meningitis in children, there was a significant reduction in meningeal symptoms by 2 days. INR days are held in Russia 14.10.2019

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The end of summer and autumn is a period of increased incidence of enteroviral infections. These diseases have many clinical manifestations similar to respiratory, intestinal infections, and allergic reactions. Children are predominantly infected, in most cases the disease is asymptomatic or mild. However, viremia (the spread of the pathogen throughout the body) leads to severe complications.

This term in medicine refers to a separate group of anthroponotic diseases caused by ECHO and picornaviruses. Getting into the human body mainly by the fecal-oral route, pathogens are localized in the intestinal mucosa and oropharynx. In the case of distribution with blood flow throughout the body, they affect the nervous system, muscle tissue, skin and mucous membranes.

The enterovirus infection code according to ICD 10 depends on the form of the disease:

• B34.1 - for unspecified forms of the infectious process;
• A85.0 - for enteroviral encephalitis and encephalomyelitis;
• A87.0 - for meningitis;
• B08.5 - for vesicular pharyngitis and herpetic tonsillitis, etc.

According to clinical manifestations, typical forms are distinguished:

• aseptic serous meningitis
• herpangina
• exanthema
• epidemic myalgia

And atypical ones, which include "summer flu", acute catarrh of the upper respiratory tract, encephalomyocarditis in newborns, epidemic hemorrhagic conjunctivitis, uveitis, pancreatitis, cystitis, nephritis, as well as encephalitic, poliomyelitis-like, gastrointestinal and innaparant (asymptomatic) forms.

Etiology

Microorganisms that cause enterovirus infection belong to the family of RNA-containing picornaviruses. Characteristic features: small size (diameter does not exceed 30 nm) and the absence of a capsid - the outer shell. The genus Enterovirus includes:

• polioviruses - the cause;
• two groups (A and B) of the Coxsackie virus;
• ECHO (abbreviation of the English name enteric cytopathogenic human orphan);
• five unclassified human viruses.

All intestinal viruses are characterized by increased resistance to such adverse external factors as low and high temperatures, exposure to ethanol and lysol solutions. In sewage, they remain viable for about 2 months, in feces - up to six months.

Enteroviruses are susceptible to a significant increase in temperature (they die instantly when boiled), drying, exposure to ultraviolet, radiation, and ultrasound. They are rapidly destroyed when treated with substances such as formaldehyde, hydrogen peroxide, potassium permanganate, heterocyclic dyes, free residual chlorine.

Epidemiology of enterovirus infection

Enterovirus infection in adults and children is transmitted from person to person. The sources are patients with clinical signs of the disease, as well as those who have recovered, but continue to isolate convalescent viruses and carriers without signs of the disease. Children are most susceptible to enteroviruses, especially in the first year of life. Immunity after enterovirus infection is formed resistant, type-specific. Cross-immunity to several strains of enterovirus infection may also develop.

Viruses are ubiquitous, a seasonal surge in incidence in the temperate climate zone occurs at the end of summer and autumn, in hot countries the epidemiological situation is unfavorable all year round. The factors contributing to infection are drinking non-disinfected water, non-compliance with hygiene standards, crowding of people (the latter is typical for children's groups).

How is an enterovirus transmitted?

Usually, the virus enters the body through the fecal-oral route, mainly through contaminated water, food, dirty hands and toys. Additional transmission mechanisms are airborne (due to reproduction in the nasopharynx, the pathogen can be released into the environment even before the end of the incubation period) and transplacental - from a pregnant woman to a fetus.

Pathogenesis

Enterovirus infection in children and adults is a consequence of the pathogen entering the mucous membranes of the intestine and oropharynx. There, the reproduction and primary accumulation of viruses take place, after which they spread to the lymphoid intestinal formations and the nearest lymph nodes, and if they enter the bloodstream, they spread throughout the body. Enteroviruses are characterized by a special affinity for nervous and muscle tissues, which explains the development of encephalitis, meningitis, myositis, etc.

At the same time, in 20-40% of patients, the multiplication of viruses in the intestine is asymptomatic (healthy carriage of viruses).

Symptoms and treatment of enterovirus infection in adults and children

The variety of signs of the disease does not always allow a reliable diagnosis at the initial stage of the disease without laboratory diagnostic methods. Reproduction and accumulation of viruses in the oropharynx causes symptoms typical of respiratory diseases, and in the intestine - for acute gastroenteritis.

Common characteristic reactions of the body to enterovirus are fever, intoxication symptoms, dyspepsia, headaches and muscle pains, hyperemia of the posterior pharyngeal wall, swollen lymph nodes (cervical and submandibular).

The incubation period for enterovirus infection ranges from 2 to 10 days, on average - from 3 to 4 days. Each form of the disease has its own clinical signs.

Serous meningitis

It is the most severe and common manifestation of enterovirus infection. It is caused by the neurotropic genotype of enterovirus infections.

It can occur both in the form of isolated cases and in the form of outbreaks. It always begins acutely, with a significant increase in body temperature (up to 39 ° C) and signs of intoxication. Symptoms of enterovirus infection in adults and children with serous meningitis appear as a meningeal syndrome, including:

• intense and persistent headaches of a bursting nature;
• skin hyperesthesia, light and noise fear;
• recurring vomiting fountain;
• profuse white coating on the tongue;
• lethargy or pronounced psychomotor agitation;
• the appearance of rigidity of the occipital muscles;
• increased blood pressure due to cerebral edema;
• decrease in heart rate;
• sometimes there are convulsions, flatulence, catarrhal phenomena.

In laboratory diagnostics, changes in the cerebrospinal fluid typical of serous meningitis are revealed.

Epidemic exanthema

Boston or enterovirus exanthema is one of the milder forms of infection and is caused mainly by ECHO virus serotypes. The onset of the disease is always acute, with febrile symptoms that can last from two to 8 days. An increase in temperature is accompanied by headaches, myalgia, sore throat. The body, face and limbs are covered with a rash during an enterovirus infection in this form. It is usually rubella-like, lasts from 2 to 4 days, but can be petechial, bullous, maculo-papular.

The acute period of the disease is often accompanied by conjunctivitis and pharyngitis, meningism phenomena, and can be combined with serous meningitis. There are cases when enterovirus exanthema causes a vesicular rash exclusively on the hands and feet, and single aphthae (“hand-foot-mouth”) appear in the oral cavity. At the same time, the temperature rises slightly, intoxication of the body is moderately expressed. It is often observed in a mild form and is called enteroviral pemphigus in children.

epidemic myalgia

It is distinguished by a sudden acute onset with a sharp rise in temperature up to 40 ° C and chills. At the same time, weakness, nausea, headache, pain in the chest, muscles of the back and limbs, epigastric pain are noted. When coughing, movement, pain in the muscles intensifies. There is also profuse sweating, vomiting, nausea, loss of appetite.

Tachycardia, enlargement of the liver and spleen, enlargement of the cervical lymph nodes, granularity and hyperemia of the posterior pharyngeal wall, and not intense catarrhal symptoms are often recorded.

The disease lasts from 3 to 7 days. With a wave-like course of the infectious process, it is possible to lengthen the febrile period up to two weeks.

After the third or fourth day of illness, the intensity of febrile symptoms decreases.

Gerpangina

Signs of enterovirus infection in adults and children in this form: acute onset with a temperature of 39.0-40.5 ° C (fever disappears after 3-5 days), the general condition of the patient is satisfactory. The pharynx is hyperemic, during the first two days vesicles appear on its mucosa, which open in a day, forming erosions covered with a grayish coating.

Vesicles cover the mucous membrane of the tonsils, soft palate, tonsil arches, posterior pharyngeal wall.

Pain is moderate, erosion heals in less than a week.

Atypical forms

For them, according to the totality of clinical symptoms, the following types of manifestations of infection are characteristic:

• Gastrointestinal (enteroviral diarrhea, enteroviral gastroenteritis) - there are feverish and intoxication symptoms, headaches, a sharp decrease in appetite, moderate abdominal pain, bloating, diarrhea and repeated vomiting, enlarged liver and spleen. Sometimes catarrhal symptoms are recorded (cough, runny nose, hyperemia of the mucous membrane of the posterior pharyngeal wall).
• Respiratory catarrh - short-term fever in combination with inflammation of the oropharyngeal mucosa.
• Enteroviral (aka three-day) fever or "minor" illness combines intoxication, fever, swollen lymph nodes, muscle and joint pain, catarrhal symptoms, abdominal pain.
• Neonatal encephalomyocarditis is the most dangerous enterovirus infection in children, where drowsiness, vomiting, diarrhea, anorexia, and dyspepsia are noted against the background of hyperthermia. Other characteristic symptoms are tachycardia, heart murmurs, and a gray or bluish tint to the skin.
• The poliomyelitis-like or spinal form is characterized by a mild course with the onset of acute paresis. Usually the legs are affected and "morning lameness" occurs with a characteristic change in gait. After recovery, all symptoms disappear, but rare severe cases can lead to death.
• Encephalitis and meningoencephalitis - symptoms of this form are vomiting, fever, intense headache, sometimes impaired consciousness and convulsions, the appearance of nystagmus, cranial nerve palsies.
• Myocarditis and pericarditis are the most common complications after a respiratory enterovirus. Symptoms are moderate fever and pain in the heart against the background of progressive general weakness. The appearance of pericardial friction noise, deafness of heart tones, expansion of cardiac boundaries is also noted.
• Hemorrhagic conjunctivitis is subjectively felt as a foreign body in one eye, photophobia and lacrimation appear. The eyelid swells, multiple hemorrhages appear in the conjunctiva, purulent or serous discharge is observed. The second eye is not always affected, recovery occurs within one and a half to two weeks.

In general, the treatment of various manifestations of enterovirus infection is reduced to hospitalization of the patient in severe cases, the appointment of antiviral drugs such as symptomatic and detoxification therapy.

Diagnostics

Diagnosis in the presence of typical clinical signs of enterovirus infection (exanthema, meningeal syndrome, myalgia, and others) does not cause difficulties, especially if an epidemic outbreak has been recorded. Difficulties can arise if the disease takes an atypical form or proceeds easily. Laboratory confirmation is mandatory in any case.

For serological analysis for enterovirus infection, blood, cerebrospinal fluid, nasopharyngeal mucus and feces are taken. In this case, the increase in antibody titer should be at least fourfold. The most informative method of research is the polymerase chain reaction. Instrumental methods can be used as additional confirmation: ECG, echocardiogram, MRI and others.

Treatment of enterovirus infection in children

A child with a mild form of the disease is treated on an outpatient basis, and moderate and severe require hospitalization.

The volume of drug therapy depends on the form of the disease and the severity of the patient's condition.

In a hospital, detoxification treatment is carried out, cardioprotectors, diuretics or blood circulation improvers, immunomodulators, multivitamins, anticonvulsant therapy, etc. are prescribed.

If the child is at home, then he is shown: strict bed rest for the entire period of fever, diet, since proper nutrition for enterovirus infection in children contributes to recovery, symptomatic and pathogenetic drug therapy. The latter consists in taking such groups of drugs as:

• antipyretics to reduce temperature during acute fever;
• analgesics and anti-inflammatory drugs - relief of pain attacks, especially with myalgia;
• antihistamines - in order to reduce the toxic-allergic reaction;
• antiviral drugs for enterovirus infection are ineffective, so they are replaced with immunomodulators or immunostimulants;
• enterosorbents will help reduce general intoxication;
• probiotics to activate the intestinal microflora in enteritis;
• vasoconstrictor in the nose to facilitate breathing and general condition with a strong ;

It is important to remember that antibiotics are not effective for viral infections.

However, the attending physician may prescribe these drugs in the event of a secondary infection of bacterial etiology.

Diet for enterovirus infection in children

For babies during treatment, the "menu" remains the same, since mother's milk will help the body cope with the virus faster. The diet of older children during the period of illness and recovery should be light to minimize the burden on the digestive tract, but nutritious. It is necessary to exclude raw fruits and vegetables, fried, smoked, pickled dishes, confectionery. The best food option is lean soups, boiled meat and vegetables, cereals, biscuits, teas, fruit drinks and compotes.

Treatment of enterovirus infection in adults

With age, the human body becomes less susceptible to enteroviruses. Therefore, adults get sick much less often than children, transferring the infection easily or asymptomatically. Hospitalization for this age group is indicated only for severe forms, all others require treatment at home. Therapy for enterovirus infection, both outpatient and inpatient, consists of the same items as in children.

Predictions and consequences

The outcome of the disease depends on the form in which the infection manifests itself, and the severity of the course of the disease. The most unfavorable forecasts are given for serous meningitis, encephalomyocarditis, severe spinal form. The rest of the varieties are easily cured and pass without consequences. For example, an enterovirus infection in children with a rash is easy, and the exanthema itself does not even require special treatment, disappearing without a trace in a maximum of four days.

Prevention

A vaccine that protects the body from enteroviruses has not been developed.

A healthy fortified and balanced diet and lifestyle, regular moderate exercise, and the absence of bad habits will help strengthen the latter. Spend more time walking outdoors.

Preventive measures in the outbreak include its regular ongoing disinfection, isolation of the sick person until complete recovery, and compliance with sanitary and hygienic requirements. For preschool institutions, quarantine for enterovirus infection for a period of two weeks is recommended.