Catarrhal form of enterovirus infection. Symptoms and treatment of enteroviral exanthema. Symptomatic treatment of enterovirus

Information taken from the website of Dr. Komarovsky

What is an enterovirus infection?

Enterovirus infection is an infectious disease caused by viruses belonging to the genus Enterovirus or intestinal viruses. These include enteroviruses Coxsackie, ECHO, enteroviruses 68-71 types. These viruses cause disease with a variable clinical presentation, manifested by fever, rash, sore throat (so-called herpangina), gastrointestinal upset intestinal tract, damage to the central nervous system (meningitis), paralysis and paresis.

What are the modes of transmission of enteroviruses?

Main route of transmission enterovirus infection- water, also possible food way transmission, possible airborne infection by drip and in contact with a sick person. You should know that enteroviruses are well preserved in the external environment.

How to prevent infection with enterovirus infection?

There are no specific means of prevention.

Prevention measures are the same as for any other intestinal infection:

It is necessary to observe the rules of personal hygiene, wash hands thoroughly before preparing food, before eating, after using the toilet;

Thoroughly wash fruits and vegetables;

Swimming should only be in places designated for this purpose; teach children not to swallow water when bathing;

Drink only boiled or bottled water.

Enterovirus (enterovirus) - a virus that enters the human body through gastrointestinal tract, multiplying there and then (usually) affecting the central nervous system. There are many varieties (serotypes) of enteroviruses.
Enteroviruses can infect many tissues and human organs (central nervous system, heart, lungs, liver, kidneys, etc.) and this determines the significant clinical polymorphism of the diseases they cause. A feature of enterovirus infections is that similar clinical manifestations diseases can be etiologically associated with various serotypes of enteroviruses; however, members of the same serotype can cause different clinical forms diseases.
Sustainability enteroviruses in the external environment. Enteroviruses are highly resistant in the external environment , are able to remain viable in surface water and moist soil for up to several months. At 50 0C, enteroviruses are rapidly destroyed. In a frozen state, the activity of enteroviruses persists for many years, when stored in a conventional refrigerator (+4. - +6.C) - for several weeks, and when room temperature- for several days. Enteroviruses are rapidly destroyed by exposure to disinfectants, ultraviolet irradiation or when dried.
The source of infection is a sick person or an asymptomatic carrier of the virus. The virus is shed from the nasopharynx and intestinal tract and can be transmitted by both the fecal-oral and respiratory routes. An important route is contact with contaminated objects and the hands of another person, followed by autoinoculation of the virus through the mouth, nose, or eyes. The virus can be transmitted through water, vegetables, hands, toys and other environmental objects.
Due to the lack of immunity, children are most susceptible to enteroviruses and serve as their main distributors. Level natural immunity increases with age. The virus spreads in unsanitary conditions - the worse sanitary conditions, the more early age infection occurs and immunity develops.
The incubation period varies widely, ranging from 2 to 35 days, with an average of up to 1 week. The high contagiousness of enteroviruses has been convincingly proven. Often there is intrafamilial spread of infection. Epidemiological data indicate that the contagiousness of infected individuals is higher in early periods infections when the pathogen is present in the body's excretions in the highest concentrations.
Clinical picture: when infected with the EV71 virus, the temperature rises, a rash appears on the skin of the arms and legs, on the palms, feet, mouth, and swelling of the extremities. The infection can cause complications such as meningitis, encephalitis, pulmonary edema, and paralysis. In severe form, enterovirus can lead to lethal outcome. The EV71 virus mainly infects children under the age of 10. serious complications The virus most often causes in children under two years of age.
The diagnosis of enterovirus infection is established only on the basis of laboratory confirmation. .
Preventive measures are aimed at preventing pollution by the pathogen of environmental objects, sanitary improvement of water supply sources, compliance with the rules for removing and neutralizing sewage, providing the population with safe food and good-quality drinking water.
Methods for specific prevention (vaccination) of non-polio enterovirus infections have not been developed, both because of the peculiarities of their epidemiology and a large number serotypes. However, one of effective methods fight against entero viral infections is vaccination against poliomyelitis, since the vaccine strain of the virus has an antagonistic effect on enterovirus. This method has been successfully used to stop outbreaks of polio-like disease caused by EV71 in Bulgaria and outbreaks of acute enteroviral uveitis in a number of cities in the Siberian Federal District.
The Office of Rospotrebnadzor in Novosibirsk recommends that citizens traveling to areas with an increased incidence of enterovirus infection:
- Refrain from swimming in open water, especially for young children.
- use good-quality water for drinking (tea, bottled water).
-vegetables, fruits, berries should be eaten only after you wash them thoroughly and pour boiling water over them.
- Strictly follow the rules of personal hygiene. Wash your hands with soap before every meal and after every use of the toilet.
In addition, it is recommended to check your child's vaccination history, that is, whether your child has been vaccinated against polio as part of the national calendar vaccination.

The causative agents of enterovirus infection are a group of acute diseases caused by viruses of the enterovirus genus, characterized by intoxication syndrome and polymorphism of clinical manifestations.

Ways of infection transmission.

Infection occurs in several ways. Viruses in environment can get from a sick child or from a child who is a virus carrier. The transmission mechanism can be airborne (when sneezing and coughing with droplets of saliva from a sick child to a healthy one) and fecal-oral if personal hygiene is not observed. Most often, infection occurs through water, when drinking raw (not boiled) water. It is also possible to infect children through toys if children take them in their mouths. Most often, children aged 3 to 10 years are ill. In children who are on breastfeeding, in the body there is immunity received from the mother through breast milk However, this immunity is not stable and quickly disappears after the cessation of breastfeeding.

Symptoms of an enteroviral infection.

Viruses enter the body through the mouth or upper Airways. Once in the child's body, the viruses migrate to the lymph nodes, where they settle and begin to multiply.

Enteroviral infections have both similar manifestations and different ones, depending on the species and serotype. The incubation period (the period from the entry of the virus into the child's body, until the appearance of the first clinical signs) all enterovirus infections are the same - from 2 to 10 days (usually 2-5 days). The disease begins acutely - with an increase in body temperature to 38-39º C. The temperature most often lasts 3-5 days, after which it decreases to normal numbers. Very often, the temperature has a wave-like course: the temperature stays for 2-3 days, after which it decreases and stays at normal levels for 2-3 days, then rises again for 1-2 days and finally returns to normal. When the temperature rises, the child feels weakness, drowsiness, headache, nausea, vomiting. With a decrease in body temperature, all these symptoms disappear, but with a repeated increase, they may return. The cervical and submandibular lymph nodes because viruses multiply in them.

Every day, local pediatricians in their practice encounter various skin rashes in babies. One of the pathologies that is accompanied by the appearance skin rash, is an exanthema.

What it is?

Acute reaction of the child's body in response to various infections with the appearance of a rubella-like rash on the skin is called exanthema. The prevalence of this childhood disease throughout the world is quite high. Infectious exanthema can occur in both boys and girls. Doctors register quite a lot of cases of the disease in newborns and infants.

Most common in pediatric practice sudden exanthema. The peak of its incidence falls on the age of 2-10 months.

The first adverse signs occur even in the smallest patients. A specific rash on the skin appears, as a rule, after a very high temperature.

Such acute reaction the child's body is due to a bright immune response to the penetration of an infectious agent into it.

Older children and adolescents suffer from this disease much less often. In adults, infectious exanthems practically do not occur. Such a high incidence in children is associated with the special functioning of their immune system. The immunity of some babies reacts to various infections quite violently and brightly, which is accompanied by the appearance of specific symptoms of the disease on the skin.

Many years ago doctors used the term "Six Day Sickness" That's what they called sudden exanthema. The essence of this definition is that clinical symptoms diseases completely disappear in a sick child on the sixth day. This name is not currently in use. Doctors in some countries use different terminology. They call sudden exanthema roseola infantum, pseudorubella, 3-day fever, roseola infantum.

Roseola

There is also another, fairly common form of the disease called Boston exanthema. This is an acute pathological condition that occurs in babies as a result of ECHO infection. During the course of the illness, the child develops a macular rash, high fever, as well as severe symptoms intoxication syndrome. Scientists have already identified the causative agents of the disease. These include some subspecies of ECHO viruses (4,9,5,12,18,16) and less commonly Coxsackie viruses (A-16, A-9, B-3).

With Boston exanthema, pathogens enter the baby's body by airborne droplets or alimentary routes (along with food). Cases of the occurrence of Boston exanthema in newborn babies are described. In this case, the infection occurred in utero.

Scientists say that lymphogenous spread of viruses also takes an active part in the development of Boston exanthema.

The reasons

The causative agent of sudden exanthema was identified by scientists at the end of the 20th century. It turned out to be herpes virus type 6. This microorganism was first discovered in the blood of the examined people who suffered from lymphoproliferative diseases. The herpes virus has its main effect on specific cells of the immune system - T-lymphocytes. This contributes to the fact that there are significant violations in the work of immunity.

HHV type 6

T-lymphocyte

Currently, scientists have received new results of scientific experiments, which indicate that the type 6 herpes virus has several subtypes: A and B. They differ from each other in molecular structure and virulence properties. It has been scientifically proven that sudden viral exanthema in babies is caused by the herpes virus type B. Subtype A viruses can also have a similar effect, but there are currently no confirmed cases of the disease. After the viruses enter the body, the processes of a violent immune response are triggered, which in some cases proceeds quite violently.

Inflammatory process leads to severe edema of collagen fibers, expansion blood vessels, pronounced cell proliferation, and also contributes to the development of characteristic rashes on the skin.

Scientists identify several reasons that can cause signs of infectious exanthema in a child. These include:

What happens in the body?

Most often, babies become infected from each other by airborne droplets. There is another variant of infection - contact-household. Doctors note some seasonality in development this disease in children. The peak incidence of infectious exanthems usually occurs in spring and autumn. This feature is largely due to a decrease in immunity during seasonal colds.

Microbes that enter the child's body contribute to the activation of the immune response. It should be noted that after past infection herpes type 6, many children have strong immunity. Statistically, Most often, babies of the first year of life and children under the age of three are sick. American scientists conducted scientific studies in which they showed that the majority of the examined externally healthy people have antibodies to the herpes virus type 6 in the blood. Such a high prevalence indicates the importance of studying the process of formation of infectious exanthems at different ages.

Sources of infection are not only sick babies. They can also become adults who are carriers of the herpes virus type 6.

Doctors believe that the infection of this herpetic infection occurs only if the disease is in acute stage, and a person releases viruses into the environment along with biological secrets. A large concentration of microbes is usually found in the blood and saliva.

When viruses enter the child's body and act on T-lymphocytes, a whole cascade of inflammatory immune responses is triggered. First, Ig M appears in the child. These protective protein particles help children's body recognize viruses and activate the immune response. It is important to note that in newborn babies who are breastfed, the level of Ig M significantly exceeds that of children receiving artificially adapted mixtures as food.

After 2-3 weeks from the onset of the disease, the baby has other protective antibodies - Ig G. An increase in their concentration in the blood indicates that the child's body "remembered" the infection and now "knows it by sight." Ig G can remain for many years, and in some cases even for life.

The peak increase in their concentration in the blood is usually the third week after the onset of the disease. Detection of these specific antibodies is very simple. For this, special serological laboratory tests are carried out. To conduct such an analysis, the baby is preliminarily fenced. venous blood. The accuracy of the result of a laboratory test is usually at least 90-95%.

For a long time, scientists were worried about the question: is it possible to re-infect (infect) with the virus. In order to find the answer, they spent a lot of time scientific research. Experts have found that the herpes virus type 6 is able to infect and persist in monocytes and macrophages of various body tissues for a long time.

There are even studies confirming that microbes are able to manifest on cells. bone marrow. Any decrease in immunity can lead to reactivation of the inflammatory process.

Symptoms

The appearance of a rash on the skin in babies is preceded by an incubation period. For sudden exanthema, it is usually 7-10 days. At this time, as a rule, the baby does not have any signs of the disease. After graduation incubation period the child has a high temperature. Its values can reach 38-39 degrees. The severity of the increase in temperature can be different and depends mainly on the initial state of the child.

Very young kids usually endure the disease quite hard. Their body temperature rises to febrile values. Against the background of severe febrile condition, the child, as a rule, has a fever and severe chills. Toddlers become easily excitable, whiny, they do not make contact even with close relatives. The baby's appetite also suffers. During acute period sick children usually refuse to eat, but may beg for "snacks".

The baby has a pronounced increase in peripheral lymph nodes. Most often involved in the process cervical lymph nodes, they become dense to the touch, solder with the skin. Palpation of enlarged lymph nodes can cause pain in the child. The baby appears severe congestion in the nose and runny nose. Usually it is slimy, watery. The eyelids swell, the baby's facial expression takes on a somewhat sullen and painful look.

When examining the pharynx, you can notice moderate hyperemia (redness) and friability rear wall. In some cases on upper sky and uvula appear specific areas of maculopapular rash. Such foci are also called Nagayama's spots. After a while, the conjunctiva of the eyes becomes injected. The eyes look painful, in some cases they may even water.

Usually 1-2 days after the onset of a high temperature, the child develops feature -roseola rash. As a rule, it does not have a special localization and can occur in almost all parts of the body. During a rash on the skin, the temperature continues to rise in the child. In some cases, it rises to 39.5-41 degrees.

However distinctive feature febrile condition with infectious exanthema is that the baby practically does not feel it.

During the entire period of high body temperature, the child's well-being does not suffer much. Many babies remain active despite persistent febrile condition. Usually the temperature returns to normal by 4 or 6 days from the onset of the disease. Infectious sudden exanthema is a very mysterious disease. Even the absence of treatment leads to the fact that the child's condition returns to normal on its own.

The spread of the rash throughout the body usually occurs when the temperature drops. Skin rashes begin to spread from the back to the neck, arms and legs. Loose elements can be different: maculopapular, roseolous or macular. A separate skin element is represented by a small red or pink spot, the size of which is usually does not exceed 3 mm. When pressing on such elements, they begin to turn pale. As a rule, rashes with infectious exanthems do not itch and do not bring any discomfort to the child. It should also be noted that skin rashes practically do not merge with each other and are located at some distance from each other.

In some babies, the rash also appears on the face. Usually loose elements remain on the skin for 1-3 days, after which they disappear on their own. Traces and residual effects on the skin, as a rule, does not remain. In some cases, only a slight redness may remain, which also disappears on its own without the appointment of any special treatment.

It should be noted that infectious exanthema in children under three years of age is much easier than in older children. The most severe course of this pathological condition doctors note in adolescents.

Their body temperature rises greatly, and their well-being worsens significantly. Paradoxically, kids infancy tolerate high febrile condition with infectious exanthema much easier than schoolchildren.

What does exanthema look like in a baby?

Babies under one year often have specific symptoms of this disease. The appearance of a skin rash leads parents to real confusion. A high body temperature in a child makes them think about a viral infection. This leads to the fact that frightened parents urgently call a doctor at home. The doctor usually diagnoses a viral infection and prescribes the appropriate treatment, which does not save the baby from the fact that rashes appear on the skin.

Infectious exanthema is a specific manifestation of an altered reaction of the immune system in response to the ingress of a pathogen. If the baby has individual hypersensitivity, skin rashes will occur even with the use of special antiviral drugs. Many parents ask a reasonable question: is it worth treating? Helping the child's body in the fight against infection is certainly worth it.

Infectious exanthema in a newborn child does not have pronounced clinical features. For 1-2 days from the moment of high temperature, the baby also develops skin rashes. Skin babies are quite tender and loose. This leads to the fact that the rash spreads over the body quickly enough. A day later, skin rash elements can be found in almost all parts of the body, including the face.

The well-being of the child during a period of high temperature suffers slightly. Some children may refuse breastfeeding however, most babies continue to actively eat. One of the manifestations of infection in infants is often the appearance of diarrhea. Usually this symptom is transient and disappears completely when the temperature returns to normal.

The course of the disease in a child under three years of age is the most favorable. Recovery usually occurs 5-6 days after the appearance of the first adverse symptoms.

Many children have strong immunity for life after past illness. Only in a small number of cases do repeated cases reinfection.

The starting point in the appearance of an exacerbation in such a situation, doctors consider a decrease in immunity.

Treatment

Infectious exanthema is one of the few childhood diseases that has the most favorable prognosis. Usually it proceeds quite easily and does not cause any symptoms in the child. long-term effects or complications of the disease. Severe course doctors note diseases only in children with pronounced manifestations immunodeficiency states. In this case, to eliminate adverse symptoms, such children undergo a mandatory course of immunostimulating therapy. it specific treatment appointed by a pediatric immunologist.

During severe fever, do not wrap the child too tightly. This only contributes to the strong overheating of the baby and disrupts the process of protective natural thermoregulation. Fever with infectious exanthema is curative. It helps the child's body fight viruses. Choose comfortable warm clothes for your child that will protect the baby from hypothermia.

Opinions of doctors about carrying out hygiene procedures are separated. Some experts believe that bathing a baby with infectious exanthema is possible and even contributes to the fact that the child begins to feel much better. Other children's doctors recommend postponing bathing and baths for several days until body temperature returns to normal. The choice of tactics remains with the attending physician who observes the baby. However, the daily toilet of the child can be performed without any restrictions.

Prevention

Specific prevention At the present time, unfortunately, scientists have not developed infectious exanthema. As non-specific preventive measures doctors recommend that you follow all the rules of personal hygiene and avoid any contact with feverish and sick people. During outbreaks infectious diseases in children's educational institutions must be quarantined. Such measures will significantly reduce the possibility of infection with viral infections and help prevent signs of infectious exanthema from appearing on the baby's skin.

Symptoms viral meningitis similar and does not depend on the virus-causative agent. The onset of the disease is acute. The onset of meningitis may be preceded by a "flu-like" prodrome, as is the case with lymphocytic choriomeningitis. A similar biphasic course of the disease can also be seen in young children with polio and diseases caused by insect-borne viruses. The defeat of the central nervous system is manifested by an intense headache of frontal or retroorbital localization. There may be malaise, nausea and vomiting, lethargy, photophobia. As a rule, disturbances of consciousness are insignificant. The patient may be drowsy or slightly confused, but is usually oriented and logical. Stupor and coma are rare. The temperature is usually raised to 38-40°C. Rigidity of the occipital muscles is revealed when the head is bent. In most patients, symptoms of Kernig and Brudzinsky are found, but with slight irritation of the meninges, they may be absent. Stiffness of the spine is so pronounced that the child goes into a sitting position with his head extended and his arms extended back with his arms extended - a symptom of a tripod. Symptoms focal lesion The CNS is rarely seen. Sometimes it is possible to identify strabismus and diplopia, asymmetry of tendon reflexes, and a non-permanent extensor plantar reflex.

Boston disease, also known as Boston's disease, infectious exanthema, or Boston rash, affects children more often than adults. It is caused by the Boston virus, which spreads in the fall. Characteristic symptoms infectious exanthema include rash, sore throat and fever. What is the treatment for Boston disease, what should you know about it?

What viruses cause Boston disease?

This is a viral disease caused by viruses from the ECHO group of viruses. They cause colds, sore throats, viral angina, and summer diarrhea in babies. They are also the reason serious illnesses: inflammation of the heart muscle and pancreas. There is a theory that combines the Coxsackie virus with type 1 diabetes. According to this, it is these viruses that destroy cells islet cells pancreas responsible for the production of insulin.

Who is primarily affected by Boston?

Boston disease, also known as infectious exanthema, mainly affects children. It is also called hand, foot and mouth disease. Adults can also get sick. Boston rash is spread by droplets and is highly contagious. Fortunately, it goes away on its own, you only need to relieve its symptoms.

How does the Boston virus manifest itself?

The disease is easily transmitted, which means that most effective way protection against it is hygiene - as with any virus.

What are the symptoms of infectious exanthema?

The disease is easily confused with chicken pox. Infectious exanthema manifests itself in a characteristic rash that occurs on the hands, feet, mouth and throat. The rash is in the form of blisters and causes discomfort for the patient - it can interfere with eating and drinking. It is often accompanied by pharyngitis and fever. In addition, with Boston exanthema, malaise, nausea, diarrhea, and vomiting can occur.

How can children and adults protect themselves from the virus?

1. Thorough hand washing- this is simple thing, which is very effective in protecting against viruses and Boston disease. Teach your children to wash their hands after returning from a walk, kindergarten, or other place. Remember that only helps proper washing- for at least 30 seconds under warm water. After washing your hands, dry them well.

2. Own towels Each family member must have their own towel. Wash it and change it as often as possible, which will limit the possibility of viruses, including those responsible for Boston disease. The towel is best changed every 3 days, provided that it is thoroughly dried after each use. In moist and wet tissues, bacteria and fungi multiply several times faster than in dry ones. It is not recommended to change towels every day - over-concern about cleanliness and panic fear before bacteria reduce the immunity of the child.

3. Thorough dishwashing- Boston disease viruses, like other viruses, settle everywhere and appear within a few days. That is why it is very important to clean dishes, cutlery and mugs used by family members. It's also important to keep things organized - don't put off washing the dishes until later, as you'll only increase your chances of getting sick.

What is the treatment for Boston flu in children?

Because he is viral disease, antibiotics are not prescribed, but only symptomatic treatment. The only cure- the introduction of antipyretics, analgesics and drying of the rash with the help of drugs prescribed by the doctor. In most cases, the disease does not cause complications. Very rarely there are complications in the form of meningitis.

Fortunately, Boston's disease can be prevented - just like other viruses. If, however, your child gets sick, follow a few of the following rules:

Do not overheat your child - dress according to the weather, but avoid overheating, because it can reduce his immunity. When sending him to school or kindergarten, put him on a sweater that he can always take off if it gets too hot. Don't panic and equip him with multiple sweaters. Small child energetic and active, so he can quickly overheat. And this will make it more susceptible to viruses.
Pay attention to the diet - the autumn diet should contain a lot of vitamins and nutrients which strengthen the immune system. Make sure to include seasonal vegetables such as pumpkin, zucchini or peppers, fish, and dairy products. For breakfast, give your child something warm to warm up the body before leaving the house. Also cook warming soups and give up cold snacks.
Walk outside even though bad weather- do not make this mistake and do not close the child within four walls as soon as the temperature drops. Go for walks with him every day to calm him down and strengthen his immune system. All you need to do is take care of warm clothes, and Boston's illness will not affect the child.
Leave the baby at home - when the Boston virus appears in kindergarten or school, consider leaving your child at home. This virus is highly contagious, so there is a high chance that a child will get sick. And finally, prevention is better than cure.