Enterovirus infection. Enterovirus infection in children and adults: signs, treatment. How long does an enterovirus infection last in children

Enterovirus infections include a group of infectious diseases resulting from the ingestion of intestinal viruses. They can manifest themselves in the form of a very diverse clinical picture due to damage to the cardiovascular and nervous systems, muscle tissue, liver, gastrointestinal tract, kidneys, respiratory organs or other organs. In most cases, enterovirus infection in children is mild and is accompanied by symptoms such as a sharp increase in temperature, general malaise, rashes on the skin and mucous membranes, and gastrointestinal disorders.

Content:

Exciter characteristic

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

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

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

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

Ways of infection

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

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

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

• non-compliance with the rules of personal hygiene (lack of thorough washing of hands with soap after using the toilet and before eating);
• consumption of raw water;
• contact with household items and toys of a sick child;
• bathing in public waters;
• eating unwashed fruits and vegetables;
• the use of dairy products in thermally unprocessed form.

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

Forms and symptoms of the disease

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

With good local immunity, the spread of the virus through the child's body is limited to the entrance gate, the infection is asymptomatic or in a very mild form only with damage to the mucous membranes. With an insufficient level of immunity, a large number of viral particles that have entered, or a high virulence of the virus, generalization of the infection is observed. After reproduction in the intestine, viruses enter the systemic circulation and spread throughout the body, affecting those organs and tissues to which they have a tropism. The observed clinical picture in this case can be very diverse. The pathogenic activity of the virus in children is declining from the moment the body produces specific antibodies.

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

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

Atypical forms are:

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

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

Herpangina

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

Serous meningitis

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

• symptoms of Brudzinsky and Kernig;
• photophobia;
• increased sensitivity to sounds;
• severe headache when trying to press the chin to the chest;
• neck stiffness and others.

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

Enteroviral exanthema

Enteroviral exanthema in a child manifests itself in the form of a skin rash. Its elements are present on the skin of the face, trunk, limbs, less often in the oral cavity. They are pink spots or papules that disappear quickly within three days without leaving any traces behind. In some cases, for a short time after the disappearance of the rash, peeling and slight pigmentation are noted on the skin.

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

epidemic myalgia

The main symptom of epidemic myalgia is intense muscle pain. Children have complaints of attacks of acute pain in the chest and upper abdomen, less often in the back, arms and legs. When moving, pain intensifies, the skin becomes pale, there is increased sweating, increased breathing. Like enteroviral exanthema, this form can occur in conjunction with herpetic sore throat and serous meningitis.

Diagnostics

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

• general blood analysis;
• detection of specific fragments of enterovirus RNA in the test material;
• serological studies based on immunity reactions to the virus (enzymatic immunoassay, complement fixation and hemagglutination inhibition reactions, and others) and performed in paired sera at certain intervals.

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

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

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

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

Treatment

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

There are currently no specific drugs for the treatment of the disease that directly affect enteroviruses, so the main therapy is to support and strengthen the immune system, increase its protective functions. To do this, if necessary, use immunoglobulins, immunomodulatory drugs and interferon preparations.

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

• antipyretic drugs based on paracetamol or ibuprofen at high temperature;
• means for rehydration and removal of intoxication (water-salt solutions rehydron, human electrolyte, hydrovit and others, glucose, smecta, enterosgel);
• antihistamines;
• antiemetics;
• painkillers;
• gargles and throat sprays;
• preparations for the restoration of intestinal microflora (linex, lactovit, bifiform).

At high temperatures, bed rest is indicated. An important element in the treatment of enterovirus infection in children during the entire period of illness is drinking plenty of water (still mineral water, compotes, fruit drinks, tea), frequent wet cleaning and regular ventilation of the room where the child is located, which pediatrician E. O. Komarovsky pays special attention to . Nutrition should be at the request of the child and consist of easy-to-digest foods (cereals on the water, boiled lean meat, vegetables, soups without rich broth, kefir, biscuits).

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

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

Complications

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

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

Prevention

Prevention of enterovirus infection consists of the following measures:

• strict observance of the rules of personal hygiene;
• drinking only boiled or bottled water;
• general strengthening of the immune system;
• thoroughly washing raw fruits and vegetables before eating;
• frequent airing and wet cleaning indoors;
• avoiding visits to crowded places during an outbreak of an epidemic;
• a ban on swimming in open waters that do not have a special permit.

Given the large number of enterovirus serotypes, effective prevention of infection in children by vaccination has not yet been developed.

Along with rotavirus, enterovirus infection is often diagnosed in childhood and adolescence. Often, mothers identify these two diagnoses, but the latter is a much more serious disease, both in terms of the coverage of the affected systems and organs of the baby, and in terms of consequences for the body. In addition, due to the diversity of virus strains, a vaccine against enterovirus infection has not yet been developed. Therefore, it is important for every parent to know the features of the virus habitat, infection and the course of the disease in children, as well as methods of treatment and prevention of this insidious disease.

What is an enterovirus infection

Under the name "enterovirus infection" a large group of diseases is hidden, the causative agents of which are intestinal viruses. The main types of viruses are:

1. Coxsackie viruses. In this group, two subgroups are distinguished - A and B, each of which contains 24 and 6 types of virus, respectively.
2. ECHO viruses - there are 34 types of pathogens.
3. Polioviruses are of 3 types.

The group of enteroviruses that pose a danger to humans includes more than 100 types of the virus, each of which is capable of high survival in the natural environment, and lives in the human intestine for up to 5 months.

Depending on the type of virus, the disease can affect a variety of systems and organs of the human body:

• central nervous system;
• cardiovascular system;
• gastrointestinal tract;
• muscular system;
• respiratory system;
• liver;
• eyes;
• endocrine system;
• urinary system.

Enteroviruses can live for a long time in the body of a healthy person, whose high level of immune protection did not allow the disease to begin. At the same time, the carrier of the virus easily infects surrounding people with less strong immunity.

After a disease, a person develops a strong immunity to only one specific type of pathogen virus. This means that another type of enterovirus infection will easily overcome the barrier of the body's defenses.

The susceptibility of the considered group of viruses to the effects of external factors is very low:

• enteroviruses easily survive freezing - in this state they are able to survive for several years;
• when exposed to chemical disinfectants such as chlorine and formalin, they die only after three hours;
• the group of viruses under consideration is resistant to an acidic environment (this helps them to safely pass the human stomach on their way);
• The only reliable way to fight viruses is exposure to high temperatures. Heating up to 45–50 ºС can have a detrimental effect on them.

The disease is characterized by seasonality: outbreaks of enterovirus infection, as a rule, are observed in summer and autumn. Most often, enterovirus affects children and young people.

Epidemic outbreaks of various types of enterovirus infection have a clear tendency to increase and expand the geography of coverage at the beginning of the 21st century. Thus, epidemics of this disease, accompanied by a certain number of deaths, have been registered in the period from 2000 to the present in many countries of Western Europe and the post-Soviet space, in the USA, Japan, Turkey, etc.

Enterovirus transmission routes

The habitats of enteroviruses, as noted above, are:

1. natural environment. The most common source of infection is contaminated water, which was consumed without careful pre-treatment.
2. The intestines of a person who has had an enterovirus infection, or its healthy carrier.

Viruses are transmitted in the following ways:

• fecal-oral - non-compliance with the rules of personal hygiene, the use of common objects with the patient or the carrier of the disease (for example, toys that children so often put in their mouths);
• airborne - sneezing, coughing, screaming, crying and even talking;
• water or food - through contaminated water or products;
• vertical - from mother to fetus during pregnancy.

Getting on the mucous membranes of the upper respiratory tract and digestive tract, the virus causes local inflammatory reactions in the form of herpetic sore throat, pharyngitis, SARS, intestinal dysfunction. There it multiplies, accumulates, is absorbed into the circulatory system, through which it spreads throughout the body, affecting the nervous, muscle tissue, epithelial cells, etc.

Entrance gates for enteroviruses - the mouth and nose of a person, penetrating into the circulatory system, the virus spreads throughout the body

Among children, the main risk group are babies from 3 to 10 years old. Children during the period of breastfeeding receive protective forces from the mother's body. However, this immunity is not very strong and disappears almost immediately after the cessation of breastfeeding.

The incubation period is approximately the same for all types of enterovirus and ranges from 1 to 10 days (average - 5 days).

Symptoms

Rashes with enterovirus infection are localized in the head, upper body

Among the symptoms of enterovirus infection in children, two groups of signs can be distinguished:

1. The first includes general symptoms characteristic of the disease, regardless of the type of pathogen.
2. The second group combines subgroups of signs, the nature of which depends on the type of pathogen and on its localization.

Common to all types of enterovirus infection in children are the following symptoms:

1. Increase in body temperature. At the same time, the onset of the disease is characterized by a sharp jump - up to 38–39ºС, this temperature lasts for several (up to five) days. Often, a couple of days after the temperature drops, a "second wave" of manifestations of the infection is observed - the temperature rises again for 1-2 days. Periods of fever during enterovirus infection in children are characterized by the appearance of:
   • weaknesses;
   • drowsiness;
   • headache;
   • nausea;
   • vomiting.
2. An increase in the submandibular and cervical lymph nodes, which is due to the localization and reproduction of viruses in them.

Specific signs of the disease - table

There are frequent cases of asymptomatic enterovirus infection, as well as short-term fever without the manifestation of specific symptoms of the lesion. This fever is characterized by a three-day rise in temperature. Diagnosis of enterovirus infection in such cases is difficult - the basis for making a diagnosis is often an epidemic situation (for example, an outbreak of enterovirus in a kindergarten where a child goes).

Diagnostics

The diagnosis of "enterovirus infection" can be made to a child if the following factors are present:

• current epidemic of enterovirus infection;
• characteristic symptoms;
• data obtained as a result of laboratory studies.

For research, swabs are taken from the affected mucous membranes (nose, throat, anus, etc.), stool and blood tests.

The presence of an enterovirus infection can be reliably established by the following methods:

• serological - detection of enterovirus markers in blood serum;
• virological - detection of viruses from clinical material (blood, feces, etc.);
• immunohistochemical - detection of antibodies to the virus in the blood;
• molecular biological - detection of the genetic material of viruses.

These methods are not used in every case of suspected enterovirus infection. The duration and complexity of their implementation are incommensurable with the practical value - by the time the result of the analysis is ready, the patient may already have recovered. In addition, viruses can be detected in the case of carriage of the infection.

A general blood test will show minor deviations from the norm during the acute course of the disease:

• a slight increase in the level of ESR (erythrocyte sedimentation rate) and leukocytes;
• rarely - neutrophilia (increased levels of neutrophilic granulocytes);
• eosinophilia (increased levels of eosinophils);
• lymphocytosis (an increase in the number of lymphocytes).

Treatment

Modern pharmacology does not have drugs that can overcome or stop the reproduction of enterovirus in the human body. Therefore, the treatment of such infections includes only methods of symptomatic therapy.

The main directions of symptomatic therapy - table

Treat enterovirus infection in children, usually at home. Hospitalization is indicated only in severe cases of the disease - with damage to the nervous system, heart, liver, with a high, long-lasting body temperature. During the entire period of increasing body temperature, the patient must comply with bed rest.

In the acute period of the course of the disease (especially at elevated body temperature), it is strictly forbidden to bathe a child and walk with him on the street, in the recovery period such measures are even necessary.

Photo gallery: Drugs for the symptomatic treatment of the disease

The drug Linex contains live lactobacilli Enterosgel - a drug from the group of sorbents Regidron is available in the form of a water-soluble powder Viferon can even be used to treat infants, it is available in the form of rectal suppositories
Enterofuril is an effective antimicrobial agent that can be used to treat a bacterial infection in children.

ethnoscience

Traditional medicine offers a decoction of viburnum with honey as a way to treat infection. Kalina is not contraindicated in childhood, its useful properties include:

• antipyretic action;
• getting rid of cough;
• strengthening immunity;
• disinfectant and bactericidal properties.

The presence of honey in this folk remedy suggests its use in children older than one year who do not have an allergy to this product.

In order to prepare a decoction, you will need 250 grams of viburnum berries, 3 tablespoons of honey and 1 liter of water. Viburnum berries are boiled in water for 10 minutes, then filtered and honey is added. Use a decoction of 3 tablespoons three times a day.

A decoction of viburnum is one of the few folk remedies used to treat enterovirus in children.

Diet

During the course of an enterovirus infection of any type in a child, the main rule for parents should be feeding according to appetite - all the forces of a small organism during this period are aimed at fighting the virus, and not at digesting food. The nutrition of the child should be light, with a predominance of protein foods.

The use of a large amount of fluid during the period of illness is designed to minimize the risk of dehydration due to high body temperature, vomiting, and diarrhea.

Among the general requirements for the diet of a sick child:

• a ban on spicy, salty, fatty, fried, smoked;
• recommendations for eating boiled, steamed, baked, low-fat.

During the treatment of enterovirus infection, it is recommended to offer the child the following products:

• boiled meat of low-fat varieties (chicken breast, beef, turkey, rabbit);
• boiled or stewed vegetables;
• porridge cooked in water;
• dried fruits compote;
• kefir;
• cracker.

Prohibited for use:

• dairy;
• raw vegetables and fruits;
• baking and confectionery;
• juices;
• meat broths;
• fat meat.

Prohibited products in the photo

Raw vegetables

Despite the above restrictions, the child's diet during the period of illness must be balanced, contain all the necessary vitamins and minerals.

Features of the disease and its treatment in infants

Children under one year old, especially those who are breastfed, rarely become infected with an enterovirus infection. This is due to several factors:

• during this period, the protective power of antibodies received from the mother while in the womb and breastfeeding is still in effect;
• in infancy, children do not attend kindergarten, therefore, the risk of infection is minimized.

If we talk about the course of the disease in infants, then it is characterized by:

• increased duration compared to the duration of illness in older children;
• in young children, in most cases, a mixed form of infection occurs (for example, both catarrhal and intestinal types).

Treatment of infants is based on the same principles as for older adults. The priority ones are:

• replenishment of fluid loss (frequent fractional drinking);
• the use of antipyretic drugs if the body temperature has risen above 38 ºС.

Possible complications and consequences

In most cases, enterovirus infection develops without consequences and ends with a complete recovery on the 5-7th day. Complications are more often associated with severe forms of infection or its inadequate treatment. Among these dangerous consequences:

• cerebral edema in severe infections that affect the central nervous system;
• the development of a "false croup" (narrowing of the airways leading to difficulty breathing) with a respiratory form of infection;
• accession of a secondary bacterial infection with the development of pneumonia and other dangerous diseases;
• sudden infant death syndrome with intrauterine infection with an enterovirus;
• aspermia (lack of sperm) in adulthood after a viral orchitis.

Prevention of enterovirus infection in children

Compliance with the basic rules of personal hygiene is an important rule for the prevention of enterovirus infection.

General measures to prevent infection with enterovirus infection include:

• compliance with the rules of personal hygiene (washing hands after using the toilet, upon arrival from a walk, before eating);
• drinking boiled or bottled water;
• thorough washing of products;
• refusal to swim in reservoirs with questionable water quality;
• regular wet cleaning and ventilation of residential premises.

For children who come into contact with people suspected of being infected with the virus (for example, during an epidemic outbreak in a kindergarten), it is advisable to instill leukocyte interferon nasally for one week to prevent the disease.

The group of diseases caused by enteroviruses is very diverse not only in the localization of the lesion, but also in the severity of the course of the disease. Since this kind of infection is most common in children from 3 to 10 years old, it is important for their parents to know the basic rules for the treatment of enterovirus: therapy should be symptomatic, the priority goal is to restore the water-salt balance of the body. Prevention of enterovirus infections, like all diseases of "dirty hands", is to follow the rules of personal hygiene.

Enteroviral infection. The name is one, but there are a great many diseases that can be attributed to this type. Evgeny Komarovsky, a well-known doctor, author of books and articles on children's health, tells about what it is, how it is transmitted and what to do if a pediatrician makes an appropriate diagnosis for a child.

What it is?

Enterovirus infection is a disease that is caused by viruses that enter the body through the gastrointestinal tract. In the people, the disease is called the "disease of dirty hands", although the spectrum of action of enteroviruses is quite wide. The causative agents include:

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

All these viruses are very resistant to the acid environment, so they easily manage to survive in the conditions of the attack of gastric juice and get into the intestines, where they begin to show their pathogenic activity. In addition, these viruses can exist at normal room temperature for several days.

Symptoms

Recognizing an enterovirus infection is not as easy as it seems. About 90% of polio infections are silent, almost half of the remaining enteroviruses also do not give any specific symptoms. Only a few pathogens are able to give a definite clinical picture, which makes it possible to suspect an enterovirus infection in a child:

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

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

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

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

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

Transmission routes

Enteroviruses enter the body most often through the mouth - with dirty hands, water, food. From a sick person, a child may well become infected by airborne droplets. The most frequent outbreaks of infection occur in summer and early autumn. In cities and countries with a hot climate, outbreaks up to epidemics are observed more often than in northern latitudes.

From this follows a fairly wide geographical distribution of enteroviruses in resort towns, on popular crowded sea coasts. In 2017, the Coxsackie virus raged in Turkey, in 2000, the ECHO virus affected hundreds of people in Singapore, Taiwan. From time to time, small foci are also recorded on the Black Sea coast in Russia. However, this does not mean at all that there are no such viruses far from the sea and the sun. They are ubiquitous.

Treatment

Yevgeny Komarovsky claims that it is not entirely correct to call enterovirus infection intestinal. That is, it is essentially intestinal, but has a strictly viral origin. Whereas an intestinal infection, in the broadest sense of the word, can be caused by both toxins and bacteria.

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

Taking antiviral drugs, which with a high degree of probability will be prescribed by the same called pediatrician, according to Yevgeny Komarovsky, does not make much sense. After all, there are very few antiviral agents with proven clinical efficacy in Russia. All of them belong to the category of "heavy and serious" drugs that are used intravenously in infectious diseases hospitals. Tablets sold without a prescription in any pharmacy and positioned as an “effective remedy for viruses” have nothing to do with such serious and truly effective remedies.

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

However, at the same time, many doctors are cunning, saying that pills will definitely help the child. Most physicians are aware that immunoglobulins show relative clinical efficacy only when given intravenously and only in certain groups of patients - neonates and people with HIV infection.

For everyone else, tablets and drops containing immunoglobulin are prescribed on the basis of the principle "something must be done." The child drinks a practically harmless remedy, his parents treat him, the doctor's conscience is calm, because he knows perfectly well that after 3-6 days an uncomplicated enterovirus infection will pass by itself, without any pills at all.

Based on all this, Komarovsky recommends that parents whose child is ill with an enterovirus infection simply create the right conditions for him to contribute to a speedy recovery. The sooner the immune system copes with the "invader", the sooner the child will recover. Truly effective treatment measures should be:

• the microclimate in the room should be favorable- air temperature from 18 to 20 degrees, regardless of the season, and relative humidity - 50-70%;
• drinking plenty of fluids at body temperature- under such conditions, the liquid is absorbed faster;
• saline rinsing of the nose and nasopharynx in the presence of respiratory symptoms (runny nose, cough) - every half an hour, if the child is not sleeping;
• thorough ventilation of the room, frequent wet cleaning;
• in the absence of fever - walks in the fresh air.

Prevention

There is no specific prophylaxis against enteroviruses. There is not a single medication that would reduce the risk of infection, although some sources indicate antiviral drugs of the interferon group as a prophylactic. This statement, from the point of view of evidence-based medicine, has no real evidence, says Yevgeny Komarovsky.

Vaccinations against enteroviruses as such have not been developed, with the exception of the vaccine against poliomyelitis and hepatitis. But there are more varieties of viruses, as well as the diseases they cause. After illness, immunity to most enteroviruses is developed persistently, it lasts for several years.

In the next video, Dr. Evgeny Komarovsky talks about enterovirus infection in children.

Enterovirus infection is a whole group of pathologies of an infectious nature, the causative agents of which are recognized intestinal viruses. Outbreaks of disease are recorded annually in various parts of our planet. The emergence of mass epidemics and sporadic forms is explained by a healthy virus carrier, the average duration of which does not exceed five months.

general information

Enterovirus infection refers to a whole group of acute diseases of the gastrointestinal tract. Today, scientists know about 60 types of pathogens that provoke the development of many pathologies. Their main danger lies in the fact that viruses are extremely resistant to various environmental factors. They can live for a long time in moist soil, then penetrating into the human body through urban water supply or contaminated food.

Enterovirus infection in adults can manifest itself with various symptoms, ranging from general malaise to disruption of the central nervous system and internal organ systems. The most formidable is the appearance of serous meningitis (inflammation of the meninges).

Causes of infection

Enteroviruses are so named because after the onset of infection, they begin to actively multiply in the gastrointestinal tract. As a result, a person develops symptoms of various diseases.

Enteroviruses are conditionally divided into four groups:

• Polioviruses.
• Enteroviruses.
• ECHO viruses.

The source of infection is usually considered to be a sick person. Transmission of the virus usually occurs by airborne droplets. According to experts, immunity after an infection persists for several years.

Cases of vertical transmission of the virus are also known. If a lady catches it during pregnancy, it is possible that the fetus will be diagnosed with an enterovirus infection. Symptoms and treatment in this case will be somewhat different.

Main routes of infection

Infectious agents enter the human body through the intestinal tract and nasopharynx, which determines the main ways of infection: food, water, airborne, household. Once in the gastrointestinal tract, they remain for some time in the local lymph nodes, where the first stage of reproduction begins. After about three days, the viruses enter the bloodstream, where circulation throughout the body begins. On the seventh day, pathogens may be in organ systems, where the second stage of reproduction begins. As a result, a person is diagnosed with various diseases.

The role of some factors in the transmission mechanism has not yet been elucidated. That is why the time of the incubation period in each case may vary. It depends on the state of the body's defenses, the parameters of a particular virus and environmental conditions. Usually, the pathologies caused by these viruses are mild. With timely and competent treatment, enterovirus infection in adults does not lead to dangerous complications. Launched forms affect the systems of internal organs, provoke the development of diseases dangerous to health, and in some cases lead to death.

What symptoms should alert?

At the end of the incubation period, the first signs indicating an enterovirus infection are noted in the infected: fever, headache, nausea. These symptoms are usually expressed implicitly, and in some cases they are completely absent. That is why sometimes the diagnosis of enterovirus infection is difficult.

It is possible to suspect malfunctions in the body only when pathogens penetrate the circulatory system and spread through vital organ systems. From this moment on, patients complain of fever, swelling of the limbs, the appearance of a rash and sores in the oral cavity.

It is a mistake to say that the above signs of enterovirus infection are common and occur in all infected people. For each clinical form, experts identify their characteristic symptoms. We will talk about them in more detail later in this article.

Clinical forms of enterovirus infection

Diagnostic measures

Enterovirus infection in adults is confirmed based on the results of laboratory tests, patient complaints and history taking. Usually, doctors prescribe a clinical blood test. An increase in the number of leukocytes and ESR indicates the development of inflammation in the body. In addition, if serous meningitis is suspected, CSF analysis is required. To identify the causative agent of the disease, the ELISA method and PCR smears are used.

It takes some time to conduct these tests, so for this period it is desirable to isolate the potential patient from healthy family members. Due to the rapid spread of infection, every case of infection must be recorded without fail. At the same time, unscheduled examinations of those people who have had direct contact with an infected person over the past few days can be carried out. If during the diagnosis the doctor confirms the diagnosis of "enterovirus infection", the symptoms and treatment are necessarily reflected in the individual card of the so-called epidemiological investigation.

What treatment is required?

When infected with enteroviruses in adults, there is no specific therapy. Patients are recommended symptomatic treatment, the specific tactics of which depend on the type and characteristics of the pathology.

In intestinal forms, drugs are prescribed to restore the water-salt balance ("Regidron"), drinking plenty of water, antidiarrheal and antiemetics. Detoxification therapy is mandatory.

For muscle and headaches, antipyretics (Panadol, Paracetamol) and painkillers, antispasmodics (Ibuprofen, Advil) are taken. In especially serious cases, when there are clear signs of CNS damage, patients are prescribed corticosteroids.

It is mandatory to include antiviral agents in therapy. Antibiotics are indicated only in case of secondary infection. Immunoglobulins and capsiding inhibitors are also prescribed, which have a wide spectrum of action against viruses.

Diet for enterovirus infection

In addition to drug therapy, patients with this diagnosis are advised to reconsider nutrition. Foods that affect intestinal motility should be excluded from the diet. These include carbonated drinks, sweets and pastries, fresh vegetables and fruits, and all fried foods.

It is advisable to stop eating your favorite dairy products. Prevention of infectious diseases accompanied by putrefactive processes implies the inclusion of baked apples in the diet. They have been proven to absorb certain toxic substances.

It is better to eat often, but in small portions. At the initial stage of infection, only cereals on the water and plenty of fluids are allowed. After the end of the acute period, you can begin to add familiar dishes to the diet (lean meat, vegetable soups, baked fruits, wheat bread croutons). In each case, the duration of the diet and the products allowed for consumption are determined by the attending physician.

Possible Complications

In most cases, enterovirus infection in adults proceeds without serious complications. In paralytic forms and pathologies with brain damage, the possibility of death is not excluded.

To avoid such negative consequences, when primary symptoms appear, you should seek help from a doctor. After the diagnosis and the results of the tests, the doctor should tell you how to treat an enterovirus infection in a particular case. For each patient, therapy is selected individually. You should not follow the example of acquaintances who have already had to deal with this kind of pathology and take medications that are not prescribed.

How to prevent infection?

Doctors give some simple tips on how to prevent infection with enteroviruses.

1. First of all, it is recommended to avoid crowded places during the epidemic. These include theaters, cinemas, shops.
2. If a doctor diagnoses an adenovirus infection in any of the family members, it is better to isolate him for a while, give him separate dishes and personal hygiene products. The patient must wear a medical mask.
3. Prevention of infectious diseases involves hardening the body. Such procedures should be started gradually, preferably under the supervision of a specialist.
4. It is important to thoroughly wash vegetables and fruits before eating.
5. Swimming in polluted waters and lakes should be avoided.
6. During the rise in viral incidence, you can take multivitamin complexes and vitamin C separately.

Specific prevention of enterovirus infection has not yet been developed. However, if everyone follows the above recommendations, you can avoid the appearance of unpleasant symptoms, treatment with potent drugs.

Conclusion

Today, more and more often doctors make such an unpleasant diagnosis as "enterovirus infection". In fact, you should not be afraid of infection ahead of time. Depending on its form, the doctor must prescribe the appropriate treatment. Strict adherence to all his prescriptions is the key to a quick recovery.

Enterovirus infection in children is a disease that affects the internal organs. Various symptoms appear, there may be lesions digestive tract or signs of respiratory disease.

The causative agents of the infection are intestinal viruses, the incubation period is from three to ten days. The level and severity of the course of the disease varies in different countries.

Causes of infection - intestinal viruses, are classified into the following categories:

• 23 type A;
• 6 types of Coxsackie virus B;
• the first, second and third types of poliovirus;
• from 68 to 71 types of enteroviruses;
• 32 serovars of ECHO viruses.

In the external environment, viruses can live for two months, remaining quite viable. After heat treatment, they instantly die. Therefore, it is so important to properly and thoroughly prepare food.

The source of infection is a healthy or sick virus carrier - a person. The virus is transmitted by airborne or fecal-oral route.: being nearby a sneezing or coughing virus carrier, not following the rules of hygiene - dirty hands while eating and after a walk. A vertical path from the infected mother to the fetus is highly likely.

Enteroviral infections are seasonal. Most often, symptoms are observed in the autumn-summer period. The age category is also specific: children, youths and middle-aged people. After a disease, the body develops immunity. The gateway for the virus is the damaged mucosa.

Classification and symptoms

Enteroviruses are one of the causative agents of acute respiratory infections. The symptoms are most dangerous for people with acquired immunodeficiency syndrome. Infection is fraught with serious complications in newborns, therefore, timely diagnosis of the infection, which is most often asymptomatic, is so important.

When classifying an infection, several varieties of the disease are distinguished, taking into account the localization and the symptoms that appear:

Respiratory (catarrhal)

Signs: stuffy nose due to swelling of the nasal mucosa, dry and infrequent cough, possible digestive disorders and diarrhea, sometimes rash. After a week (maximum ten days), the symptoms go away on their own.

Intestinal (gastroenteric)

The main symptoms: disruption of the digestive tract. Frequent watery stool(diarrhea), pain in the stomach, painful flatulence. Possible signs: nausea, vomiting. General state of weakness, apathy and lethargy. Appetite decreases, temperature rises to 38⁰, sometimes a rash appears.

In babies up to 2-3 years old, the gastroenteric form can be combined with the respiratory one. The painful condition lasts up to two weeks in newborns and infants. Children over three years of age cope with the virus in three days, the rash disappears quickly.

Enteroviral fever

There is a strange paradox: enterovirus fever is most often manifested in the overall picture of signs of intestinal infection. But this form is rarely diagnosed due to the lack of local symptoms. Main symptoms: fever for a period of not more than four days, moderate symptoms of intoxication, the state of health is often normal, a rash is possible, sometimes nausea and vomiting.

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Enteroviral exanthema

Another name is Boston fever. From the very first days, a reddish rash appears on the child's body. After a couple of days, the rash disappears completely. Enteroviral exanthema is characterized by the possible manifestation of symptoms, vesicular pharyngitis of the throat, conjunctivitis, sometimes. In rare cases, CNS disorders are possible: infectious meningitis, encephalitis, polyradiculoneuritis, neuritis of the facial nerve.

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Rare forms in newborns and consequences: encephalomyocarditis, impaired renal function and MPS. How long the illness lasts and what the consequences are depends on each individual case.

Diagnostics

• Serological method: markers of infection are detected in the blood serum by laboratory means.
• Virological method: a virus is isolated from clinical material submitted to the laboratory.
• Immunohistochemical method: in the laboratory, blood is examined for the detection of antigens to possible enteroviruses.
• Molecular biological method: RNA fragments of viruses are detected in the laboratory.

Treatment

Epidemiology does not imply the treatment of infection in each case with specific drugs. A sick child is contagious and is treated at home for the entire period, taking medicine and observing bed rest. until the temperature subsides to rule out complications from infection in newborns. How long the disease lasts depends on the immunity of the child.

Preparations

How to treat an infection? Prescribe antiviral drugs antibiotic – only in case of concomitant bacterial infection. In a hospital, treatment is carried out for children with complications in the CNS, heart, liver, MPS and kidneys. In such cases, be sure to select the appropriate antibiotic.

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Epidemiology implies not only treatment with medications, but also the observance of a special sparing diet. You need to drink plenty of fluids, prolonged diarrhea and vomiting can cause dehydration.

If the disease is mild, the antibiotic is not prescribed, only antiviral drugs. Epidemiology practices treatment with drugs that relieve the symptoms of angina (sprays, rinses). Antipyretics are used to lower the temperature. Diarrhea is treated with rehydration.

Epidemiology is focused on the study of viruses, including intestinal ones. Treatment of all manifestations is carried out under the strict supervision of a doctor who prescribes drugs and monitors the dynamics. Sick children are subjected to complete isolation to avoid the spread of the virus.

Diet

Epidemiology involves treatment by following the strictest dietary rules. Nutrition is aimed at avoiding dehydration, which is possible with symptoms such as diarrhea and high fever. The diet includes several important items.

• It is necessary to drink liquid every hour in small doses.
• Categorical ban on fried, fatty and spicy foods, including pickles.
• A healthy diet is recommended. You can eat only fat-free mashed foods: vegetable soups, mashed potatoes.
• Categorically fresh vegetables and fruits, milk and dairy products are excluded. Vegetables can be boiled, stewed and baked, rubbing into a soft puree.
• The nutrition of a sick child excludes foods that enhance peristalsis - this can provoke painful diarrhea.
• Plan the diet so that the food is as fractional as possible. The best thing feed a sick child 5-6 times a day and give more to drink.
• One of the negative aspects of the infection is diarrhea and putrefactive processes. To remove poisonous elements from the child's body, you need to include baked apples in the menu.

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Prevention

The best prevention of enterovirus infection is personal hygiene. It is necessary to teach a child from infancy wash hands after walking, going to the toilet and before eating. Children should have individual dishes and bath accessories: towels, soap.

There are no specific methods of prevention. Cleanliness, daily wet cleaning of the premises, isolation of sick and healthy children, until the incubation period is over - the most effective methods that will protect against infection.