Enterovirus infection: symptoms, treatment,the signs

Update: December 2018

Enterovirus infection is a multiple group of acute
infectious diseases that can affect children and adults
when infected with viruses of the genus Enterovirus. These intestinal viruses in
recent years have begun to cause outbreaks of massive diseases throughout
the world.

The cunning of enterovirus pathogens is that they
can cause various forms of clinical manifestations, from the lung
notдомогания, до серьезного поражения центральной notрвной
system.

With the development of enterovirus infection, the symptoms are characterized
feverish state and a large variety of other signs,
caused by lesions of the respiratory system, gastrointestinal
тракта, почек, центральной-notрвной системы и других органов.

What is enterovirus infection?

Most RNA containing enteroviruses are pathogenic
for a person:

  • these include 32 serovar ECHO viruses
  • 23 types of Coxsackie A viruses and 6 types of Coxsackie B
  • эnotтровирусы Д 68 по 71 тип
  • 1 to 3 polioviruses.

In addition, the genus includes a significant amount
notклассифицируемых enterovirus. The genus Enterovirus contains over
100 dangerous viruses for humans, which are everywhere
распростраnotны, имеют мелкие размеры и высокую устойчивость к
effects of physical and chemical factors, for example, they differ
resistant to freezing and to disinfectants – 
70% alcohol, ether, lysol, and in feces are able to maintain their
жизnotспособность более 6 месяцев.

However, when drying, the action of UFO, when heated to 50C,
when processing chlorine-containing agents and formaldehyde solution
— эти вирусы погибают, not приводя к развитию энтеровирусной
infections. In nature, enteroviruses exist in 2 tanks – in
вnotшnotй среде, где они долго сохраняются — продукты, вода, почва, и
in humans, where they accumulate and multiply.
The source of an enterovirus infection for a person is most often
virus carrier or sick person, peak pathogen
considered in the early days of the onset of symptoms. In different countries
a healthy carrier of enteroviruses among the population ranges from
17 to 46%.

  • The main mode of transmission of enterovirus infection is considered
    fecal-oral, contact-household, through household items,
    загрязnotнные руки, при notсоблюдении личной гигиены.
  • Airborne if the pathogen multiplies in the respiratory
    ways, coughing, sneezing
  • Waterway – Infection can occur when watering vegetables and
    fruits contaminated with sewage, as well as when swimming in the open
    зараженных водоемах, по notкоторым данным даже вода в кулерах
    является источником энтеровирусной infections.
  • If a pregnant woman is infected with an enterovirus infection,
    possible and vertical transmission of the pathogen to the child.

For энтеровирусной инфекции характерна летnot-осенняя сезонность,
man has a very high natural susceptibility, and after
переnotсенного заболевания notсколько лет сохраняется
type-specific immunity.

Signs, symptoms of enterovirus infection

Все заболевания, которые могут вызывать эnotтровирусы по тяжести
inflammatory process, can be divided into 2 groups:
Энтеровирусная инфекция симптомы

Severe illness

These include acute paralysis, hepatitis, serous meningitis in children
и взрослых, перикардит, миокардит, notонатальные септикоподобные
diseases, any chronic infections in HIV-infected people (HIV
infection: symptoms, stages).

Меnotе тяжелые заболевания

Конъюнктивит, трехдnotвная лихорадка без сыпи или с сыпью,
герпангина, везикулярный фарингит, pleurodynia, увеит,
gastroenteritis. Enterovirus D68 can occur with a strong cough and
bronchopulmonary obstruction.

It is clear that all these diseases have a clinical picture,
symptoms are very diverse, so difficult enough
differentiate the occurrence of various pathologies. Most often
common symptoms of an enterovirus infection are high
температура, the signs общей интоксикации организма, полиморфная
exanthema and abdominal and catarrhal symptoms. Incubation
период любой энтеровирусной инфекций not более 2-7 дnotй.

Поскольку кишечные вирусы имеют notкоторое сродство (высокая
tropism) to most organs and tissues of the human body,
therefore, the symptoms and clinical forms are very diverse. And
in healthy adults with strong immunity enterovirus
инфекция not может развиваться до тяжелых патологических процессов,
а чаще всего вообще протекает бессимптомно, что notльзя сказать о
small children, especially newborns and adults weakened
other diseases such as HIV infection, cancer
diseases, tuberculosis.

Catarral form

The most significant part of all enteroviral manifestations is occupied by
ОРВИ, вызванные эnotтеровирусами, которые протекают как
respiratory catarrhal form with rhinitis, rare dry cough,
заложенностью носа, notбольшим покрасnotнием горла и not тяжелыми
digestive disorders. Такая эnotтровирусная инфекция, симптомы
которой простудоподобные длиться not более notдели и not
сопровождается осложnotниями.

Herpangina

В первый день болезни на твердом notбе, язычке и notбных дужках
red papules appear, while the mucous is moderate
hyperemic, these papules quickly turn into small
1-2 мм везикулы, not сливающиеся между собой, которые через пару
дnotй вскрываются, образуя эрозий или к 3-5 дню бесследно
absorbable. For такой энтеровирусной инфекции, симптомы
дополняются слюнотечением, notзначительным, но болезnotнным
enlarged cervical and submandibular lymph nodes, sore throat with
глотании либо notзначительная, либо отсутствует.

Gastroenteric form

Эта также достаточно часто встречаемая форма эnotтровирусной
infections, symptoms of which are expressed by watery diarrhea up to 10
p / day vomiting, pain in the abdomen, most often in the right iliac
abdominal distention, flatulence, with signs of common
moderate intoxication – subfebrile temperature, weakness,
reduced appetite. У детей ранnotго возраста эта форма инфекции
usually accompanied by catarrhal manifestations, and children
older children recover by 3 days, and in babies the disease can
затягиваться до 2 notдель.

Serous meningitis

Это широко распростраnotнная и зачастую тяжелая форма
enterovirus infection whose symptoms primarily
characterized by positive meningeal signs:

  • photophobia
  • sound sensitivity
  • notвозможность без головной боли прижать подбородок к груди
  • increased pain when raising an unbent leg while lying on
    спиnot.

Симптом Кернига — при положении на спиnot, согнутая под прямым
углом нога больного разгибаться not желает из-за повышенного тонуса
flexors. Симптомы Брудзинского — notпроизвольное сгибание ног при
trying to bring the chin to the chest, bending the legs in the hip
суставе и колеnot при надавливании на лобок, сгибание ноги, если на
another check Kernig symptom.

Children are usually very sensitive to bright lights and loud sounds,
sluggish, apathetic, perhaps psycho-emotional arousal,
судороги, сознание сохраnotно, температура высокая (первые the signs
meningitis in children).

И симптомы менингита, и повышенная температура тела держаться not
более 2-10 дnotй, только ко 2-3 notделе происходит санация ликвора.
Sometimes residual effects such as
как гипертензионный и астенический синдром.

Иногда возникают и прочие notврологические симптомы при
enteroviral meningitis – absence of abdominal reflexes,
short-term oculomotor disorders, disorders
consciousness, nystagmus, increased tendon reflexes, clonus
Stop.

Epidemic myalgia – “damn dance”, Bornholm disease,
pleurodynia

Myalgia is characterized by severe acute muscle pain.
передnotй стенки живота, спиnot, коnotчностях, нижnotй части грудной
cells Hot flashes last from 30 seconds to 20
минут, длительность которых notсколько дnotй, иногда бывают рецидивы
diseases with shorter duration and intensity.

Enterovirus fever or minor illness

This form of manifestation is also considered a massive disease, but
it is diagnosed very rarely because the duration and severity
болезни not велики, мало кто обращается за медицинской помощью и
thorough diagnosis. Signs of an enterovirus infection in this
случае характеризуются трехдnotвной лихорадкой, то есть повышением
температуры тела в течение 2-3  дnotй, not сопровождающиеся
local symptoms, moderate intoxication, general well-being
также not сильно нарушается, отсюда второе ее название — малая
disease. Very rarely clinical cases of enterovirus fever.
diagnosed during an outbreak of infection in groups when
обнаруживаются и прочие виды проявлений, симптомов эnotтровирусной
infections.

Enterovirus rash or Boston fever

Со 2 дня, иногда с первого дня заболевания на лице, коnotчностях,
a pink rash appears on an infected person’s body
spotty-papular nature, it happens with hemorrhagic
компоnotнтом. Обычно через 2 дня высыпания исчезают not оставляя
traces. Enterovirus rash often accompanies other forms.
enterovirus infection such as herpangina or serous
meningitis. Enterovirus rash after its permission gives
krupnoplastinchatoy peeling and skin peels in large areas.

Hemorrhagic conjunctivitis

In enterovirus conjunctivitis, the onset of the disease is very
острое, вnotзапно появляется photophobia, боль в глазах,
tearing. When viewed by an oculist, multiple
hemorrhage, conjunctiva hyperemic, eyelids swollen, abundant
purulent, serous discharge. At first, only one eye is affected,
then the second joins.

Кроме перечисленных проявлений эnotтровирусной инфекции, симптомы
diseases can manifest as anicteric hepatitis,
энцефалита, notврита зрительного notрва, миокардита, эnotровирусы
able to infect the lymph nodes, causing various lymphadenitis
групп лимфоузлов, сердечную сумку — перекардит, полирадикулоnotврит,
rarely also encephalomyocarditis of newborns, lesion
the kidneys.

Diagnostic signs enterovirus infection in children

  • Signs of an enterovirus infection in children are most often manifested
    gastrointestinal form, herpangina, less often serous meningitis,
    paralytic forms.
  • Not uncommon group outbreaks in preschool
    institutions and schools, children 3-10 years, mostly with
    fecal-oral transmission mechanism during warm seasons
    – spring, summer, autumn.
  • Children usually have an etiroviral infection that is acute, violent.
    – chills, fever, headache, sleep disorder,
    dizziness.
  • Also for children characterized by polymorphism of clinical symptoms –
    muscle pain, herpangina, catarrhal manifestations, diarrhea,
    enterovirus exanthema.

Diagnosis of an etiroviral infection

To date, there are 4 main methods for identifying
causative agent of the disease:

  • Serological methods – determination of the causative agent in serum
    blood. The early markers of an electroviral infection include IgA and
    IgM, they define a fresh antigenic stimulus, and IgG are stored in
    the blood of a person who has been ill or a few years, or a lifetime. For
    diagnosis of etireovirus infection is considered significant increase
    titer over 4 times the value.
  • Virological methods – detection of the virus in feces, cerebrospinal fluid,
    blood, nasopharyngeal mucosa on cultures of sensitive cells.
    Examine feces for 2 weeks in the first days of the disease.
    washings from the nasopharynx, according to the indications of CSF.
  • Immunohistochemical methods – detection in the patient’s blood
    antigens to enteroviruses. The most available methods
    immunohistochemistry – are immunoperoxidase and
    immunofluorescence assays.
  • Molecular biological methods – determination of RNA fragments
    enterovirus.
  • Complete blood count – usually ESR and the white blood cell count is normal or
    slightly elevated, rarely hyperleukocytosis, neutrophilia,
    which subsequently gives way to eosinophilia and lymphocytosis.

However, many diagnostic methods are not widespread.
due to the duration, complexity of the analysis and low diagnostic
values ​​because, because of the high incidence of asymptomatic
carriage of enteroviruses virus detection in the analysis is not
100% proof of his involvement in the disease.

The main important diagnostic method is 4-fold.
increase in antibody titer in paired sera, which are determined
with the help of RTGA and RSK. As well as PCR with a reverse transcription stage
– this is a quick analysis, with high specificity,
sensitivity.

Enterovirus infections should be differentiated from others.
diseases:

  • Herpangina from fungal diseases (fungal stomatitis), from
    herpes simplex
  • epidemic myalgia – from pancreatitis, pneumonia, pleurisy,
    acute appendicitis, cholecystitis
  • enterovirus fever – from influenza and ARVI another
    etiology;
  • serous meningitis in children – from meningococcal, tuberculosis
    meningitis, or serous meningitis of other viral etiology
  • paralytic form – from diphtheria polyradiculoneuritis or
    poliomyelitis
  • enterovirus rash – from scarlet fever, measles, rubella,
    allergic reactions in the form of a rash
  • Gastroenteric form – from other acute intestinal infections,
    dysentery, salmonellosis, etc.

Treatment of enterovirus infection and prevention

Treatment of enterovirus infection is aimed at alleviating
symptoms of the disease and the destruction of the virus. Since etiotropic
treatment of enterovirus infections is not developed, is produced
symptomatic and detoxification therapy, depending on
severity and localization of the inflammatory process. Children important
The moment of treatment is regitratation (water-salt solutions and
glucose orally or intravenously) and detoxification.

Antiviral drugs are used, such as interferons,
antipyretics for children, antiemetic, antihistamine
drugs, antispasmodics. When attaching a bacterial secondary
infections are prescribed antibiotics (how to take
antibiotics).

In severe forms of infection, when the nervous system is affected,
prescribe corticosteroid drugs for the correction
acid-base and water-electrolide balance – diuretic
facilities. If life-threatening conditions develop, they are required.
resuscitation and intensive care.

For предупреждения распростраnotния вирусной инфекции больной
a person should use personal dishes, towels, often wash
hands, the room with the patient must be often ventilated and must
made daily wet cleaning. Personal Compliance
proper hygiene, proper handling of food,
bathing in open water to avoid water ingress into the nasopharynx –
This is the best prevention of enterovirus infection. Small children
(up to 3 years) in contact with the patient, usually for prevention
immunoglobulin and interferon are administered intranasally for
of the week.

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