Treatment of enterovirus in children. What is enterovirus infection and how to fight it? Routes of infection and mechanism of development of enterovirus

Entero viral infection name a whole group of acute infectious diseases, the causative agents of which are intestinal viruses. Outbreaks of disease, often reported in different countries, allow us to conclude that this type of infection is intensifying throughout the world. The occurrence of mass diseases and sporadic (single) forms of it is due to healthy virus carriage, the duration of which is no more than 5 months.

Causes, pathogenesis and epidemiology of the disease

The main route of transmission is airborne, that is, the virus enters the human body when someone else coughs or sneezes.

Intestinal viruses, or enteroviruses, include:

• Coxsackie viruses A (23 types) and B (6 types);
• polioviruses (types 1,2,3);
• enteroviruses 68-71 types;
• ECHO viruses (32 serovars).

Enteroviruses exist in nature due to the presence of 2 reservoirs: the external environment (soil, water, food), where they long time are preserved, and the person in whose body they multiply and accumulate.

The source of infection is a virus carrier or a sick person. The virus is transmitted by airborne droplets (coughing, sneezing) or fecal-oral route (through dirty hands). Seasonality – summer-autumn. The bulk of the sick are children and people young. Immunity after an illness lasts for several years.

There is also a vertical route of transmission of infection, that is, from mother to fetus. It has been proven that if a woman catches an enterovirus during pregnancy, the risk of congenital infection in the child increases significantly.

The entry gates for enteroviruses are the mucous membranes of the upper respiratory tract And gastrointestinal tract, upon contact with which the virus multiplies, causing local symptoms inflammation: acute respiratory infections, intestinal dysfunction. Subsequently, the pathogen penetrates the blood, with a current that spreads throughout the body.

Symptoms of enterovirus infection

Intestinal viruses have a high tropism (affinity) for many tissues and organs of our body, so the manifestations and clinical forms of the disease can be very diverse.

It is worth saying that in a practically healthy organism, enterovirus infection in most cases is asymptomatic. It is most dangerous for people with immunodeficiencies (cancer patients, HIV-infected people) and for newborns.

The lion's share of clinically noticeable manifestations are cold-like diseases - enterovirus is one of the main causative agents of acute respiratory viral infections.

As already mentioned, the forms of the disease can be very diverse. Let's look at the main ones.

1. Catarrhal (respiratory) form. Patients are concerned about nasal congestion, runny nose, rare dry cough, and sometimes mild digestive disorders. Symptoms persist for 7–10 days, after which they disappear without a trace.
2. Gastroenteric (intestinal) form. Patients complain of abdominal pain of varying intensity, bloating, loose, watery stools up to 10 times a day, and sometimes vomiting. There may be weakness, lethargy, loss of appetite, and an increase in temperature to subfebrile (up to 38ºC). In children early age this form can be combined with catarrhal. Young children are sick for 7–14 days, children over 3 years old – 1–3 days.
3. Enteroviral fever. This form is the most common manifestation of the infection we describe, but in sporadic cases it is rarely diagnosed. It is characterized by an increase in temperature for 2–4 days without the presence of local symptoms. Symptoms of intoxication are moderate, general health is usually not affected.
4. Enteroviral exanthema (“Boston fever”). From 1–2 days of illness, pink rashes of a macular and maculopapular nature, sometimes with a hemorrhagic component, appear on the skin of the face, torso, and limbs of the infected person. After 1–2 days, the elements of the rash disappear without a trace.
5. In addition to exanthema, manifestations of enterovirus infection on the skin and mucous membranes are herpetic sore throat, vesicular pharyngitis, conjunctivitis, and in some cases uveitis.
6. Sometimes the nervous system is also affected - meningitis develops (70–80% infectious lesions CNS in children), encephalitis, neuritis facial nerve, polyradiculoneuritis.
7. Also rare forms of infection include neonatal encephalomyocarditis, myocarditis, and kidney damage.

Diagnostics

This is what enteroviral exanthema looks like - a maculopapular rash mainly on the arms, legs and in the mouth.

• Serological methods(detection of enterovirus infection markers in blood serum).
• Virological methods (isolation of viruses from the clinical material being studied).
• Immunohistochemical methods (detection of antigens to enteroviruses in the patient’s blood).
• Molecular biological methods (detection of RNA fragments of viruses).

Treatment

Therapy for enterovirus infection should be aimed at destroying the virus and alleviating the symptoms of the disease.

• To combat pathogens they are used antiviral drugs(in particular, interferons).
• Symptomatic therapy includes drugs that relieve one or another condition causing discomfort to the patient (antiemetics, painkillers, antispasmodics, and others).
• If a secondary bacterial infection occurs, antibiotics must be prescribed.

Prevention

To prevent the spread of infection, the patient should frequently wash their hands, dry them with an individual towel, and use personal utensils. Also, in the source of infection, you should often wet clean the room and ventilate it.

Specific prevention of enterovirus infection has not been developed.

Which doctor should I contact?

When signs appear acute infection you need to contact a pediatrician or therapist, and in severe cases, an infectious disease specialist. If complications develop, the patient is examined by a specialized specialist - a gastroenterologist, neurologist, ENT doctor, cardiologist, nephrologist, ophthalmologist.

Along with rotavirus, enterovirus infection is often diagnosed in childhood and adolescence. Often mothers equate these two diagnoses, but the latter is a much more serious disease, both in terms of the affected systems and organs of the baby, and in terms of the 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 characteristics of the virus, infection and progression of the disease in children, as well as methods of treatment and prevention of this insidious disease.

What is enterovirus infection

The name “enteroviral infection” hides a large group of diseases caused by intestinal viruses. The main subtypes of viruses are as follows:

1. Coxsackie viruses. In this group, there are two subgroups - 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 have 3 types.

The group of enteroviruses that pose a danger to humans includes more than 100 types of 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 in the body of a healthy person for a long time, high level immune defense which 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 suffering from the disease, a person develops stable immunity to only one specific type of causative virus. This means that another type of enterovirus infection will easily overcome the barrier of the body’s defenses.

The susceptibility of the group of viruses under consideration to the effects external factors 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 formaldehyde, they die only after three hours;
• the group of viruses in question is resistant to an acidic environment (this helps them 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 are usually observed in summer and autumn. Most often, children and young people suffer from enterovirus.

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

Routes of transmission of enterovirus

The habitats of enteroviruses, as noted above, are:

1. Natural environment. Most often, the source of infection is contaminated water that has been consumed without careful pre-treatment.
2. The intestine of a person who has had an enterovirus infection or its healthy carrier.

Viruses are transmitted in the following ways:

• fecal-oral - failure to comply with personal hygiene rules, sharing objects with a patient or 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, ARVI, intestinal dysfunction. There it multiplies, accumulates, and is absorbed into circulatory system, through which it spreads throughout the body, affecting nervous, muscle tissue, epithelial cells, etc.

The entry gate for enteroviruses is the human mouth and nose, penetrating into the circulatory system, the virus spreads throughout the body

Among children, the main risk group is children from 3 to 10 years old. During the period of breastfeeding, children receive protective forces from the mother's body. However, such immunity is not very stable and disappears almost immediately after stopping breastfeeding.

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

Symptoms

Rashes due to enterovirus infection are localized in the head and upper torso

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 causative virus.
2. The second group combines subgroups of symptoms, the nature of which depends on the type of causative virus and its location.

The following symptoms are common to all types of enterovirus infection in children:

1. Increased body temperature. In this case, 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 infection is observed - the temperature rises again for 1–2 days. Periods of increased temperature during enterovirus infection in children are characterized by the appearance of:
   • weaknesses;
   • drowsiness;
   • headache;
   • nausea;
   • vomiting.
2. Enlargement of the submandibular and cervical lymph nodes, which is due to the localization and reproduction of viruses in them.

Specific signs of the disease - table

An organ or organ system affected by a virus	Disease caused by enterovirus	Specific symptoms
Oropharyngeal mucosa	Herpetic (enteroviral) sore throat	Hyperemia (redness) of the mucous membranes of the oropharynx (palatine arches, uvula, soft and hard palate, tonsils); the appearance of vesicular (air-filled) bubbles that do not merge with each other (bubble diameter - 1–2 mm, number - from 3 to 18); transformation of blisters into ulcers 1–2 days after their appearance; pain when swallowing; salivation; soreness of the lymph nodes upon palpation.
Mucous membrane of the eye	Conjunctivitis	Redness of the eyes; swelling of the eyelids; minor hemorrhages in the conjunctiva; lacrimation; photophobia.
Upper respiratory tract	Catarrhal form of enterovirus infection (acute respiratory viral infection)	Nasal congestion; runny nose; cough; digestive disorders (rare). Symptoms persist for 7–10 days, then disappear without a trace.
Intestines	Enteritis	Bloating; abdominal pain of various localizations; frequent (up to 10 times a day) loose stool; nausea; vomit; weakness. This form of enterovirus infection in children is often combined with catarrhal disease. Young children (up to three years) are sick for 7–14 days, older children - 1–3 days.
Skin	Enteroviral eczema (“Boston fever”)	Hyperemia of the skin without elevation general level skin; Rashes in the form of blisters, sometimes with elements of subcutaneous hemorrhages, on the skin of the upper body, arms, and head. The listed symptoms appear immediately and disappear within 1–3 days.
Muscles	Myositis	Soreness muscle tissue in the chest, arms, legs. The pain syndrome has a wave-like character: periods of increased temperature correspond to periods of particular pain.
Heart	Myocarditis (damage to the muscle layer of the heart); endocarditis (inflammation of the inner lining of the heart); pericarditis (inflammation of the pericardial sac); pancarditis (damage to all layers of the heart).	Heart rhythm disturbances; cardiopalmus; decline blood pressure; pain in the heart area; fatigue; weakness.
central nervous system	Meningitis (inflammation of the meninges); encephalitis (inflammation of the brain).	Headache; disturbances of consciousness; damage to reflexes; nausea; vomit; paresis and paralysis (impaired motor functions); convulsions.
Liver	Hepatitis	Nausea; bitterness in the mouth; heartburn; weakness; heaviness and pain in the right hypochondrium.
Genital organs in boys (testicles)	Orchitis	Pain in the scrotal area; tissue hyperemia; swelling; weakness; headache; nausea. Orchitis, as a rule, does not act as separate disease. More often it is combined with other forms of enterovirus infection; symptoms of testicular inflammation appear after the signs of the underlying disease have disappeared.

There are frequent cases of asymptomatic enterovirus infection, as well as short-term fever without symptoms. specific symptoms defeats. This fever is characterized by a three-day increase 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 kindergarten, where the child goes).

Diagnostics

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

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

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

The presence of enterovirus infection can be reliably determined using the following methods:

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

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

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

• slight increase ESR level(erythrocyte sedimentation rate) and leukocytes;
• rarely - neutrophilia (increased level of neutrophil granulocytes);
• eosinophilia (increased level of eosinophils);
• lymphocytosis (increased number of lymphocytes).

Treatment

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

The main directions of symptomatic therapy - table

Direction of therapeutic effect	Features of treatment in the specified way symptoms of enterovirus infection	Medicines	The effect of these drugs
Restoring the body's defenses	One of natural ways The body's defense against viruses is the production of interferon at the very beginning of the disease - a substance that increases the resistance of cells against the effects of the virus. The use of drugs containing interferon is allowed for children of any age. Such means are also used to prevent infection with enterovirus if it is impossible to exclude the child’s contact with an infected person.	Nazoferon; Cycloferon; Reaferon; Leukocyte interferon	Immunomodulatory; antiviral; antimicrobial; anti-inflammatory; antiproliferative (preventing the proliferation of tumor cells).
Decreased body temperature	A high temperature that persists for several days sharply increases the risk of dehydration. It is recommended to use antipyretic drugs in children if the temperature remains above 38 ºС.	Ibufen D; Nurofen; Panadol; Efferalgan; Tsefekon D.	Pain reliever; antipyretic; anti-inflammatory.
Preventing dehydration	Dehydration in children occurs very quickly - it can develop within 24 hours after the onset of the illness. You can drink your child with both special industrial solutions and home-prepared drinks (tea with sugar, raisin or rice decoction, salted boiled water). Liquids should be given frequently, but in small portions to avoid provoking vomiting: Children under one year of age should be given a teaspoon of liquid every 10 minutes; children aged from one to three years - 2 teaspoons every 10 minutes; children over three years old - a dessert spoon at the same time.	Oralit; Glucosan; Humana electrolyte.	Restoration of water and electrolyte balance.
Removing toxic substances from the body	To remove toxins from the intestines, enterosorbent drugs are used, which accumulate all harmful substances and leave the body unchanged. Thanks to this effect, symptoms such as nausea, stool upset, vomiting, and headache disappear.	Lactofiltrum; Smecta; Atoksil et al.	Sorptive; detoxification.
Restoration of intestinal microflora	After destruction normal microflora intestinal viral infection or antibacterial therapy It is important to take measures to replenish the required amount of beneficial microorganisms. Preparations containing lacto- and bifidobacteria serve this purpose.	Bifiform; Laktomun; Lactovit.	Normalization of intestinal microflora; maintaining balance and proper functioning of the intestinal microbiocenosis.
Treatment of secondary, bacterial infection	Against the backdrop of a weakening of the body's defenses due to exposure to enterovirus, a secondary infection, a bacterial one, often develops. In such cases, it is advisable to use antibiotics and other antimicrobial drugs. Selecting a specific antibacterial drug depends on the species of the causative agent of the bacterial infection.	Antibiotics: Furazolidone; Stopdiar. For children, it is preferable to prescribe drugs from a number of aminopenicillins or macrolides.	Antibacterial; antimicrobial; bactericidal

Enterovirus infection in children is usually treated at home. Hospitalization is indicated only in severe cases of the disease - with damage to the nervous system, heart, liver, and with high, long-lasting body temperature. During the entire period of increased body temperature, the patient must remain in bed.

During the acute period of the disease (especially with elevated temperature body) bathing a child and walking with him on the street is strictly prohibited, in recovery period such events are even necessary.

Photo gallery: Drugs for symptomatic treatment of the disease

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

ethnoscience

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

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

The presence of honey in this folk remedy suggests its use in children over one year of age 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. Drink 3 tablespoons of the decoction three times a day.

Viburnum decoction 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 the small organism during this period are aimed at fighting the virus, and not at digesting food. The child's diet should be light, with a predominance of protein products.

Drinking large amounts of fluid during 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:

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

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

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

Prohibited for use:

• dairy products;
• raw vegetables and fruits;
• baked goods and confectionery;
• juices;
• meat broths;
• fat meat.

Prohibited products in the photo

Raw vegetables

Despite these restrictions, a child’s diet during illness must be balanced and 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 on breastfeeding, rarely become infected with 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, it is characterized by:

• increased duration compared to the duration of the disease 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 adults. The most important of them are:

• replenishment of fluid loss (frequent small drinks);
• use of antipyretic drugs if body temperature rises above 38 ºС.

Possible complications and consequences

In most cases, enterovirus infection develops without consequences and ends with complete recovery within 5–7 days. Complications are more often associated with severe forms of infection or inadequate treatment. Among these dangerous consequences:

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

Prevention of enterovirus infection in children

Compliance with basic rules of personal hygiene - important rule prevention of enterovirus infection

TO general measures Prevention of infection with enterovirus infection should include:

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

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

The group of diseases caused by enteroviruses is very diverse not only in the location of the lesion, but also in the severity of the disease. Since this kind of infection most often occurs in children from 3 to 10 years old, it is important for their parents to know the basic rules for treating enterovirus: therapy should be symptomatic, the priority goal is to restore the body’s water-salt balance. Prevention of enterovirus infections, as well as all diseases of “dirty hands,” consists of observing the rules of personal hygiene.

Typically, the season for enteroviruses lasts from July to October, so now for them perfect time. What should parents do if they hear from a doctor a diagnosis of “enteroviral infection” and how to properly treat this condition in children - in our material today.

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

What is enterovirus infection in children

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

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

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

The peak incidence of enterovirus infections occurs from July to October - during warm times. Moreover, over the course of these few months, a child can often get ill with an enterovirus infection more than once, because the pathogens are very diverse. And if a child has been ill with one type of virus, this will not protect him from other types. It is precisely because of this feature modern science cannot yet develop a vaccine against enterovirus infection in children.

Enterovirus infection in children: how does infection occur?

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

Often, a virus-carrying child does not have any external manifestations of the disease, but the viruses are in the intestines and are released into the environment with feces. Therefore, the second route of infection is fecal-oral, when the child does not observe personal hygiene measures and not after visiting the toilet.

Infection can also occur through toys if children put them in their mouths when consuming raw water or dirty food.

Enterovirus infection in children: symptoms of infection

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

• virulence - the ability of viruses to resist defense forces body;
• tropism - the tendency of the virus to infect individual tissues and organs;
• the state of the child's immunity.

Enteroviruses can infect:

• central and peripheral nervous systems,
• mucous membrane of the oropharynx,
• mucous membrane of the eyes,
• skin,
• muscles,
• heart,
• intestinal mucosa,
• liver,
• In boys, testicular damage may occur.

General symptoms of enterovirus infection, regardless of the lesion:

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

Enterovirus infection in children: varieties

There are several main types of enterovirus infection in children.

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

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

Catarrhal (respiratory) form enterovirus infection in children occurs as an acute respiratory infection. Course of the disease: short-term fever, temperature, sore throat, pain when swallowing and painful ulcers on back wall pharynx, tonsils, soft palate, lack of appetite, possible development of false croup syndrome. Pathogens: Coxsackie A and Coxsackie B viruses. Symptoms usually last 3-7 days.

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

Myocarditis or pericarditis characterized by disruption of different parts of the heart: the muscle layer, the outer shell, the valves. Course of the disease: increased fatigue, weakness, rapid heartbeat, drop in blood pressure, disorders heart rate, chest pain. Pathogens: Coxsackievirus B5, also ECHO viruses.

Enteroviral exanthema characterized by the appearance skin rash on the skin of the face and torso, similar in nature to scarlet fever rashes, or. Pathogens: ECHO and Coxsackie viruses. Symptoms usually last 3-5 days.

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

Serous, are typical form enterovirus infection in children. Course of the disease: high fever, severe headache, repeated vomiting, anxiety, delirium, convulsions. This is the most severe form of enterovirus infection. Pathogens: Coxsackievirus group B and ECHO viruses. It usually occurs in outbreaks with intervals of several years. Symptoms may last up to 2 months.

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

Neonatal encephalomyocarditis typical for children in the first months of a child’s life. Course of the disease: lethargy, breast refusal, low-grade fever, heart failure, bulging fontanelles, convulsions. Pathogens: Coxsackie viruses type B. Encephalomyocarditis of newborns - fatal disease, mortality reaches 60-80%.

Epidemic myalgia - rare disease, which manifests itself as severe muscle pain in the chest and abdomen, and severe fever. The pain is paroxysmal, worsens when breathing or coughing, and is accompanied by profuse sweating. Pathogens: Coxsackie virus B3 and B5. Symptoms usually last 8-10 days.

Prevention of enterovirus infection in children

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

If one child in a family gets sick, then all family members, especially children under 10 years of age, are at risk. Therefore, to prevent enterovirus infection in other family members, it is necessary to provide the sick child with separate dishes and toys. Under no circumstances should you finish eating food for a sick child! All family members are recommended to frequently wash their hands with soap and treat them with alcohol-based antiseptics.

Enterovirus infection in children: diagnosis and treatment

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

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

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

There are no antiviral drugs that can suppress enteroviruses. At the same time, the body is able to cope with this disease on its own. As a rule, the disease goes away in 3-7 days.

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

Your child can be given medications based on ibuprofen or paracetamol to reduce fever and relieve mouth pain, after consulting with the pediatrician about the optimal dosage.

A sick child is prescribed: rest, bed rest, plenty of fluids, antipyretic therapy, antiviral drugs, nasal rinsing, gargling if necessary, combating dehydration, diet, taking enterosorbents, restoring intestinal microflora.

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

Acute infectious diseases caused by intestinal viruses belong to the group of enteroviral infections. The pathology affects various human organs and is manifested by fever and a wide range of clinical signs.

Enterovirus infection is characterized by outbreaks of mass diseases, especially in children's organized groups and families. The risk group includes people with reduced immunity - children, the elderly, people with chronic pathologies.

Enterovirus infection is characterized by high susceptibility of the population and seasonality - an increase in incidence in the summer-autumn season. A feature of enteroviruses is the ability to cause clinical symptoms of varying intensity: from mild discomfort to the development of paralysis and paresis.

Etiology

The causative agents of enterovirus infection are RNA-containing viruses, ECHO, polioviruses. Microbes have relatively high resistance to physical factors- cooling and heating, as well as some disinfectants. Prolonged boiling, disinfectants with chlorine, formaldehyde and ultraviolet radiation have a detrimental effect on viruses.

Enteroviruses remain viable in the external environment for quite a long time. High air temperatures and high humidity increase the lifespan of the virus.

Sources of infection are patients and virus carriers.

Infection occurs:

• The fecal-oral mechanism, which is realized by water, nutritional and contact-household routes of infection;
• An aerogenic mechanism implemented by airborne droplets,
• Transplacental mechanism using a vertical route during transmission of the pathogen from a sick mother to the fetus.

Microbes multiply on the mucous membrane of the pharynx and accumulate in nasopharyngeal discharge, feces, and cerebrospinal fluid. During the incubation period, the virus is released into the environment in small quantities. Patients remain dangerous to others for a month, and in some cases longer.

Microbes enter the mucous membrane of the esophagus and upper respiratory tract, multiply and cause local inflammation, which occurs as respiratory disease, and intestinal disorders. The period of reproduction and accumulation of viruses coincides with incubation and ranges from one to three days. Pathogenic biological agents enter the cervical and submandibular lymph nodes. At this time, patients develop pharyngitis and diarrhea. Microbes spread throughout the body through the bloodstream and infect internal organs with the development of another pathology and the appearance of corresponding symptoms.

Symptoms

Enterovirus infection often occurs without any characteristic signs and reminds me of a banal one. Viruses, affecting various organs and systems, usually cause herpangina, hemorrhagic inflammation of the conjunctiva, fever, gastroenteritis, and in rare cases - serious illnesses: inflammation of the brain, liver, myocardium.

Symptoms of enterovirus infection:

1. Intoxication syndrome,
2. Exanthema,
3. Qatar of the respiratory system,
4. Abdominal signs.

Persons with strong immunity and a relatively healthy body rarely suffer from severe enteroviral diseases. Their infection is usually asymptomatic. Newborns, small children, elderly and frail chronic diseases are more susceptible to the development of enteroviral meningoencephalitis, hepatitis, myocarditis, and paralysis. Herpangina, acute respiratory infections and pharyngitis are less severe, but are accompanied by persistent, painful symptoms.

Herpangina

– one of the most frequently occurring forms of enterovirus infection. Its causative agents are Coxsackie viruses. The disease manifests itself with symptoms of intoxication and catarrhal syndromes.

Herpetic (herpetic) sore throat

• Herpangina begins acutely. The body temperature in patients rises to 40 degrees, nausea, malaise, and headache occur.
• Around the second day, signs of catarrhal inflammation of the pharynx appear.
• After a couple of days, papules form on the tonsils, arches, tongue and palate, which eventually turn into red blisters. They burst, forming erosions on the mucous membrane, covered with plaque, which resolve without a trace in 5 days.
• Regional lymphadenitis is slightly expressed.
• Sore throat with herpangina is often absent or appears only during the formation of erosions.

acute respiratory infections

The respiratory form of enterovirus infection manifests itself with symptoms similar to any other etiology. Patients complain of fever, sore throat, hoarseness, dry cough, runny nose and nasal congestion. Usually these signs are combined with symptoms of indigestion.

The temperature remains high for 4-5 days and then gradually decreases. Other signs of the disease remain for another 2-3 weeks.

The catarrhal form is more common than others and occurs as pharyngitis, or a combined pathology. In young children, a symptom occurs that requires special attention. This makes it difficult for the child to breathe, especially at night. Attacks of “false croup” represent great danger for children's health.

The cold-like form of enterovirus infection usually does not last long and is rarely accompanied by complications.

Enteroviral exanthema

In patients with enterovirus infection, from about 2-3 days of pathology, a rash in the form of spots and papules appears on the skin Pink colour, often with hemorrhages. For two to three days, the rash remains on the body, and then gradually disappears without a trace. Exanthema is often combined with herpangina, stomatitis and meningitis.

Enteroviral exanthema

Rare clinical manifestations enterovirus infection:

1. Anicteric hepatitis,
2. Meningoencephalitis,
3. Inflammation of the optic nerve
4. Inflammation of the myocardium and pericardium,
5. Lymphadenitis,
6. Nephritis,
7. Paralysis and paresis.

Complications

Inflammation of the brain and peripheral nerves are the most common and dangerous complications of enterovirus infection.

Patients who consult a doctor late and have a severe form of pathology may develop life-threatening diseases - cerebral edema, respiratory and cardiac arrest.

In young children, ARVI of enteroviral etiology is often complicated by the development of “false croup,” and in adults, by secondary bacterial infection with the development of bronchopneumonia.

Features of pathology in children

Enterovirus infection in children occurs in the form of sporadic diseases, but more often in the form of epidemic outbreaks in organized children's groups. The incidence increases in the warm season. For children of preschool and primary school age, the fecal-oral mechanism of transmission of the pathogen is characteristic.

Enterovirus infection in children usually occurs in the form of sore throat, serous inflammation of the meninges, and paralysis.

The pathology clinic is developing rapidly. The temperature rises sharply, chills, dizziness and headache appear, sleep and appetite are disturbed. Against the background of severe intoxication, characteristic features- catarrhal inflammation of the nasopharynx, myalgia, stool disorder, enteroviral exanthema.

Enteroviral stomatitis

Enteroviral stomatitis develops in children aged 1-2 years after enteroviruses enter the body.

Symptoms of the disease are:

• Increased salivation
• Low-grade fever,
• Arthralgia and myalgia,
• Runny nose,
• Chills,
• Malaise,
• Swelling of soft tissues in the mouth.

The child becomes lethargic, restless, and capricious. Typical vesicles with a characteristic red rim appear on the skin and mucous membranes. The rashes hurt and itch. These symptoms intensify with the appearance of new lesions.

The disease develops quickly: blisters appear on the third day of infection, and on the seventh day the patient recovers.

Typically, enteroviral stomatitis is combined with exanthema, gastroenteritis, fever, and sore throat. In more rare cases, stomatitis is asymptomatic.

Due to the abundant symptoms, doctors often misdiagnose patients as ARVI, allergic dermatitis, rotavirus or herpetic infection. Prescribed drugs eliminate the main symptoms of the pathology, but do not cure it completely.

Diagnostics

Diagnosis of enterovirus infection is based on characteristic clinical symptoms, patient examination data, epidemiological history and laboratory test results.

The following clinical signs allow one to suspect enterovirus infection:

1. Gerpangina,
2. Enteroviral exanthema,
3. Enteroviral stomatitis,
4. meningeal signs,
5. Nonbacterial sepsis,
6. respiratory syndrome,
7. Conjunctivitis,
8. Gastroenteritis.

Material for research - a swab from the throat, discharge from oral ulcers, feces, cerebrospinal fluid, blood.

Virological research- the main diagnostic method. To detect enteroviruses use:

• PCR – polymerase chain reaction. This method is highly specific, highly sensitive and fast. It is designed to identify viruses that are not able to reproduce in cell culture. PCR is used to examine cerebrospinal fluid and respiratory secretions.
• Detection of pathogens in cell culture or laboratory animals. This method is longer, but accurately determines the type of microbe.

Serodiagnosis is aimed at determining the antibody titer in paired sera taken from a patient in the first and third weeks of the disease. To do this, a complement binding reaction or a hemagglutination inhibition reaction is performed. A fourfold increase in antibody titer in paired sera is considered diagnostically significant. IgA and IgM – markers acute period diseases, and IgG is a marker of past infection that remains in the blood for a long time. Serological testing is intended to confirm the virological method, since enteroviruses can be detected in the feces of healthy people.

Molecular biological method allows you to determine the serotype of the isolated pathogen.

Immunohistochemistry– immunoperoxidase and immunofluorescent methods.

All of these methods are rarely used in mass examination of patients, since they are lengthy, complex and do not have high diagnostic value, which is associated with a large number of asymptomatic carriers of enteroviruses.

Differential diagnosis of enterovirus infection:

1. Herpetic sore throat is differentiated from fungal infection of the oropharynx and herpes simplex;
2. Epidemic myalgia - with inflammation of the pancreas, pleura, gall bladder, appendix, lungs;
3. Enteroviral fever - with acute respiratory viral infections;
4. Serous meningitis - with inflammation of the meninges of other etiologies;
5. Enteroviral exanthema - with, allergies;
6. Enteroviral gastroenteritis - with salmonellosis and shigellosis.

Treatment

Treatment of enterovirus infection includes:

• Compliance with the regime
• Balanced and rational nutrition,
• Taking multivitamins,
• Etiotropic and pathogenetic therapy.

Regime and diet

Mild and moderate forms of pathology are treated at home with strict adherence to bed rest. Patients with severe forms, prolonged fever and complications are hospitalized.

Patients are prescribed a diet that reduces intoxication, increases immunity, and spares the digestive organs. The patient's diet should contain sufficient amounts of protein, vitamins, and minerals. Drinking plenty of fluids is recommended to detoxify the sick body.

Etiotropic treatment

1. Specific therapy for enterovirus infection has not been developed.
2. Antiviral drugs - Remantadine, Kagocel.
3. Immunostimulants - “Grippferon”, suppositories “Viferon”, “Kipferon”. These medicines have double therapeutic effect: help get rid of viruses and stimulate cellular and humoral immunity.
4. Immunomodulators – “Amiksin”, “Cycloferon”, “Tsitovir”. They have a pronounced anti-inflammatory effect and stimulate the body’s production of its own interferon, which increases overall resistance and protects against the destructive effects of viruses.

Pathogenetic therapy

Pathogenetic treatment of enterovirus infection is carried out in a hospital setting.

• Detoxification measures are indicated for severe pathology.
• With the help of diuretics, dehydration is carried out when complications develop - inflammation of the brain and its membranes.
• Cardioprotectors are prescribed for viral heart disease.
• For treatment, drugs are used that improve blood microcirculation in the vessels of the brain.
• Corticosteroids are used to treat pathologies of the nervous system.
• Resuscitation measures and intensive therapy necessary in case of emergency conditions.

Symptomatic therapy

Pregnant women and children should be under the supervision of a specialist throughout the entire illness. Only a doctor, after making a diagnosis, should prescribe medications and their dosages allowed for a certain period of pregnancy and age group.

Self-medication of enterovirus infection is strictly prohibited. This is due to the nonspecificity of the symptoms of the disease, the possibility of confusing the pathology and being treated incorrectly.

Prevention

Specific prevention for enterovirus infection has not been developed. Main events:

Video: enterovirus infection, “Live Healthy”

With the birth of a baby, young parents gain not only joy and boundless happiness. Unfortunately, the world is fraught with many dangers, and none of the children are immune from contracting various infections. Very often, the symptoms of diseases are so similar that it is very difficult to determine at first glance which one the child caught.

Enteroviral diseases pose a particular danger to newborn babies, because initial stage It is very easy to confuse this illness with a cold and start the wrong treatment.

What is enteroviral infection?

The group of enteroviral infections includes many diseases with different manifestations and forms of progression (coxsackie, foot, hand, mouth, grpangina), but all of them are united by the same method of infection. The virus enters the human body from the external environment through the mouth (in exceptional cases through the nose) and is sent to the intestines, where its active reproduction occurs. Latin name disease comes from the word entero - stomach.

One of the most well-known enteroviruses is polio. This disease is well known to every parent. After all, one of the first vaccinations given to children is to prevent this particular disease. Vaccination is carried out in 3 stages and is carried out in accordance with generally accepted vaccination calendar at 3, 4 and 5 months of life.

But if it was possible to create a vaccine for polio, then with other viruses the situation is more complicated. A large number of boles does not make it possible to combat them using routine vaccinations. This means that the possibility of illness in the newborn cannot be ruled out. Most often, children become victims of diseases such as herpangina and hand, foot and mouth, better known as the Coxsackie virus.

Enteroviruses are heat-loving, so the peak of diseases most often occurs at the end of summer and the first ten days of autumn. Most often, disease outbreaks are recorded in places where large numbers of vacationers gather, on the shores of seas and rivers. However, this does not mean at all that there is no risk of infection in other regions of the country.

Enteroviruses are well tolerated negative temperatures and retain signs of vital activity even after several freezing cycles. They can for a long time"live" outside the human body. But boiling is the best way to destroy the coxsackie virus. Therefore, never be lazy to boil the pacifier, bottle and dishes for preparing baby food.

Once the virus enters the body, the disease does not appear immediately. The first manifestations can be noticed only after 3 – 10 days, when it ends incubation period and the disease will enter the active acute phase.

How can you become infected with enterovirus?

The virus most often enters the baby’s body from adult relatives. And from the parents themselves external symptoms of this disease may not appear at all. This is due to stronger immunity, which prevents coxsackie disease from developing. It is also possible that adults have acquired resistance to this virus as a result of infection at a young age. But this does not prevent them from being carriers and spreaders of a dangerous disease.

A child may become infected:

1. Airborne droplets;
2. Through dishes, if an infected mother or father licks a pacifier, eats from the same plate, or uses a baby spoon;
3. Just one kiss from a sick person is enough for the baby to catch the “infection”;
4. If he swallows water in a pool or in an open body of water infested with viruses;
5. When regularly visiting crowds of people in risk areas during the hot season;
6. Oral to fecal. Despite the fact that the baby is still quite small, there are huge risks of such infection. Any toy picked up from the ground in a sandbox, on a playground, or on the seashore poses a huge danger to the baby’s health;
7. Drinking unboiled water from wells, pumps or household water supply can also cause the development of intestinal illness.

The fact that a person has been spreading an enteroviral disease for 5 months poses a great danger to others.

Compliance with personal hygiene rules is the most important condition necessary to prevent any enterovirus infection.

Of course, breastfed babies are much less likely to get sick. After all, along with mother’s milk, it absorbs a large amount of antibodies, which to some extent protect it from viruses.

Symptoms

General symptoms by which you can recognize this type diseases:

1. fever, accompanied by an increase in body temperature to 39 - 40 degrees;
2. swollen lymph nodes;
3. headache and muscle pain;
4. drowsiness;
5. vomiting and diarrhea may occur;
6. pain in the eyes with visual signs of conjunctivitis (sour eyes, redness eyeball, involuntary release of tear fluid, fear of bright light);
7. rash on the body;
8. ulcers on the mucous membranes of the mouth. First, bubbles appear filled with clear liquid, then they burst and in their place ulcerative formations with a whitish coating appear;

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To date, there are no special drugs to combat enteroviral infections. Only time and bed rest can help. Typically, children are not hospitalized in a clinic, but treatment is carried out at home on an outpatient basis. The only exceptions are those cases when parents cannot feed the baby on their own. Then the baby is taken to the hospital and the necessary solutions are administered intravenously through droppers to prevent dehydration.

Drinking plenty of fluids and oral rehydration solutions is essential for recovery. Most often due to strong pain sore throat, babies refuse to drink. However, parents must be persistent and pour liquid into the mouth in small portions and ensure that the baby does not spit, but swallows.

If the illness is accompanied by diarrhea in addition to fever, it is necessary to drink constantly, even through force. Every 5 - 10 minutes, take a few sips of liquid - this will be the main treatment.

Suitable antipyretics are given to lower body temperature.

To determine the severity of the baby's condition, you need to consult a doctor. Indeed, in some cases, the disease can be accompanied by complications and affect internal organs, the brain and the central nervous system.

Enterovirus poses a particular danger to children with diseases of the cardiovascular system and. Such babies should be treated under the constant supervision of specialists.

What is a substitute for oral rehydration?

If for some reason you do not have the opportunity to purchase an oral rehydration solution in a pharmacy chain, then you can always prepare it yourself. Everything you need.

1. Rock salt – 3 g;
2. Granulated sugar – 20 g;
3. Purified drinking water – 1 l.

Mix all the ingredients and feed your baby this solution throughout the day.

Herpangina

Herpangina, perhaps, this particular disease is a real scourge for parents of infants. Despite the similarity of names, this disease has nothing to do with ordinary sore throat or herpes and requires a completely different approach to treatment.

An increase in body temperature to high levels and the appearance of ulcers in the mouth are the main symptoms of herpangina. Moreover, the ulcers affect not so much the tonsils, which is typical for a sore throat, but the palate, tongue and cheeks.

The severe pain in the throat, which is necessarily present with this disease, incredibly worries the baby, and this in turn leads to a refusal to eat and drink. And if eating can be postponed for some time, then giving the child something to drink is a must. Fluid should be supplied to the body regularly, in the maximum possible quantity. This can be ordinary purified water, compote, sweet drinks or herbal decoctions.

Please note that drinking cool drinks causes much less pain when swallowing than drinking hot teas. Therefore, cast aside your fears and give your baby some water at room temperature.

Lack of the required amount of fluid in children's body can lead to double pneumonia within a short time. Sometimes a few days are enough for pneumonia to develop, but its treatment will require more than one week in the hospital.

In addition to drinking plenty of fluids, the child needs. These can be either syrups and tablets, or suppositories. Be sure to listen to the drug manufacturer's recommendations and do not increase the acceptable average daily dose on your own.

With herpangina, improvements occur no earlier than 8–10 days. During this time, be sure to show the baby to your doctor. Moreover, this must be done on the first day after the temperature rises. Only a doctor can make the correct diagnosis, assess the risks and prescribe adequate treatment.

Hand-foot-mouth

Hand-foot-mouth is a disease that affects almost all children during the first 10 years of life. However, it is infants who suffer this disease especially hard, because by its nature it is a viral infection spreading in the intestines. And the baby’s body is not yet fully formed; the gastrointestinal tract does not have enough vital enzymes.

Coxsackie virus, there is probably not a single parent who has not heard about this disease. This is largely due to the outbreak of the disease on the shores of Turkish resorts.

High fever, rash on the feet, palms and mouth ulcers are symptoms characteristic of hand-foot-mouth disease. However, one should not think that all children have exactly the same symptoms. In some babies, rashes can affect almost the entire skin on the arms and legs, while others have very few red spots and pimples. A similar pattern is also typical for rashes on the mucous membranes of the oral cavity. Just a few ulcers may appear, or it may completely cover the tongue, cheeks, palate, and tonsils.

As with herpangina, plenty of regular drinking is required. Intestinal infection, accompanied high temperature, very quickly leads to dehydration and complications. In addition to regular water, teas, compotes and drinks, it is recommended to give your baby oral rehydration solutions. This allows you not only to maintain the water-salt balance in the body at the proper level, but also promotes the active removal of toxins from it.

Elevated body temperature should be brought down immediately. Any antipyretic drug for children of this age group will be suitable for this.

Living in a civilized world, it is impossible to protect your baby from viral and bacterial diseases. However, adults are quite capable of reducing his suffering and hastening recovery. But before you apply all sorts of advice you hear on forums and start self-treatment, be sure to consult with your local pediatrician.