Enterovirus infection - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Infectious Diseases

annually recorded a high incidence of enterovirus infections, both in Russia and other countries.Even in the public memory is fresh epidemiological situation in 2013 in Russia.According to the Russian chief state sanitary doctor GGOnishchenko incidence in 2013 surpassed that of the previous year by more than 2 times.The alarming situation is compounded by the fact that most children affected age group that is most vulnerable and immunologically vulnerable part of the population.

With clinical positions noteworthy diversity of diseases that are often "disguised" under the traditional respiratory infections, therefore the difficult early diagnosis of enteroviral infections and timely medical care.The possibility of severe forms of the disease with the development of meningitis and encephalitis catches our attention precisely to the early diagnosis and timely hospitalization.

enterovirus infections - a group of human infectious diseases (anthroponoses) caused by enterovirus (non-polio), with the s

pring-summer-autumn season, primarily affecting the pediatric population and is characterized by fever, lesions of the tonsils, the central nervous system, gastrointestinaltract, skin manifestations and lesions of other organs and systems.

Pathogens - non-polio enterovirus Coxsackie group A (serovar 24), Coxsackie B (6 serovars), the ECHO (serovar 34) and neklassifitsirvoannye human enterovirus serotypes 68-72.This RNA-containing viruses, fairly stable in the environment.Resistant to low temperatures, withstand freezing and thawing.At room temperature, can remain viable for 15 days.Boiling kills instantly.Perniciously act on them bleach, hydrogen peroxide solutions, manganese potassium, ultraviolet irradiation.


reasons for the spread of enteroviral infections

source of infection are patients symptomatic form of the disease, asymptomatic forms of the disease, virus carriers.Infected media source of infection - nasopharyngeal mucus, feces, cerebrospinal fluid.As already in the incubation period (the period from infection to onset of symptoms) is the multiplication and accumulation of virus in the mucosa of the oropharynx and the gastrointestinal tract, the patient identifies the virus in a small number at this stage.Maximum virus excretion observed in the first days of the disease.Term contagious period can last 3-6 weeks, sometimes longer.An important role in the spread of infection play asymptomatic carriers, which the frequency of occurrence does not exceed 45% (mostly young children), and convalescents (recovering), who often continue to commit viruses.

There are two infection mechanism - fecal-oral and aerogenic, the leading of which is fecal-oral.The main transmission routes - water (bathing in waters contaminated with enteroviruses) and nutritional (eating contaminated water, dirty fruits and vegetables, milk and other products).Viruses can be transmitted through everyday objects (toys, towels), dirty hands.Another way of transmission - airborne (virus isolation from nasopharyngeal mucus during coughing, sneezing, talking).Remember that the risk group - persons who are in direct contact with the source of infection (sneezing and coughing - is an aerosol cloud of 3 meters in diameter).It is possible, and transplacental transmission of infection from mother to fetus (in the case of diseases of pregnant symptomatic form of the disease).

susceptibility of the population to enterovirus infection is high.Family outbreaks and outbreaks in organized children's collectives.infection risk groups - it is immunologically compromised persons, ie persons with reduced resistance of the organism - children, the elderly, persons with chronic diseases.After this illness formed strong immunity to a particular virus type, which often cross (ie to multiple serotypes of enteroviruses).

symptoms of enteroviral infections

brief path of enteroviruses in the human body: the entrance gate of infection are the mucous membranes of nose, throat and digestive tract, where the deposition and accumulation of enteroviruses, which coincides with the incubation period (from 2 to 10 days of time, usually 3-4day).Then lymphogenous viruses penetrate into the lymph nodes close to the entrance gate (regional), which coincides with the beginning of the disease - 1-2 days (the patient may be pharyngitis, diarrhea).Next, the virus enters the blood and hematogenous spread to different organs and systems (primary viremia) - with the third day of illness.Clinically characterized by many syndromes, depending on the tropism (favorite system or body) of a particular enterovirus.Possible secondary viremia (re-release of the virus in the blood), which is clinically accompanied by a second wave of fever.

Feature enteroviral infections - a variety of clinical forms, that is, even within a single flash may be recorded completely different symptoms.Clinical forms of enterovirus infections can be summarized in two major groups: typical and atypical (unusual and rarely encountered).
Typical forms:
1. Gerpangina
2. Enterovirus rash
3. Serous meningitis
4. Epidemic myalgia
Atypical forms:
1. Minor illness (3 day fever)
2. Respiratory (Bluetongue) form
3.enterovirus diarrhea
4. Enfefaliticheskaya form
5. Poliomielitopodobnaya (spinal) form
6. encephalomyocarditis newborns
7. Epidemic hemorrhagic conjunctivitis
8. Uveitis
9. Jade
10. Pancreatitis
11. inapparent form (subclinical, asymptomatic)

Gerpangina - one of the most common forms of enterovirus infection.Cause Coxsackie A viruses (types 2,3,4,6,7,10) and Coxsackie B (type 3).Typically the presence of syndromes 2 - infectious and toxic (ITS) and catarrhal.Home sharp.ITS appears to 39-400 fever, symptoms of poisoning - weakness, headache, nausea, but the well-being and can remain satisfactory.The fever lasts 2-5 days.Catarrhal syndrome appears at the end of 1x to 2x a day - redness arches, tongue, back of the throat.Within 2 days from the onset of the disease and on the tonsils shackle appear grayish white elements (papules) to 2 mm in diameter, the number of which varies from 4.5 to 20. Papules soon converted into 5 mm diameter bubbles which burst shortly after leavingself erosion (2-3 day of illness), covered with a grayish bloom with a red rim around the periphery.Erosions heal completely in 4-6 days.Feature catarrhal syndrome in enterovirus gerpangine - absence or weak expression of pain.Sore throat can appear only at the stage of erosion.
Gerpanginu can be confused with other angina, under which most often against a background of high temperature appears severe sore throat, difficulty swallowing food, as well as characteristic changes in the oropharynx.
When to see a doctor: emergence of a high temperature at a relatively satisfactory state of health, which is slightly docked;changes the appearance of the oropharynx without sore throat.To diagnose this form can only be a doctor (infectious disease specialist, pediatrician, therapist).Self-diagnosis and treatment gerpangine can lead to relapse (re-disease), as well as the appearance of other more severe forms of the disease (serous meningitis).


Enterovirus rash (Boston epidemichekaya or rash).Called ECHO viruses (types 4, 5, 9, 12, 16, 18) and Coxsackie (A-9, A-16, B-3).It is characterized by acute onset, the advent of high temperature up to 390, and symptoms of intoxication (weakness, muscle aches, headaches, sore throat).After 1-2 days a rash appears on the trunk, kinechnostyah, face and feet.By nature it can be morbilliform, krasnuhopodobnoy, skarlitinopodobnoy and petechial.Accordingly, it can be melkopyatnistaya rash punctulate, mottled papulleznaya.In some cases, you may receive meningism syndrome (headache, vomiting, photophobia, inability to tilt and rotate the head), and the combination of this form with serous meningitis.
When to see a doctor: high fever and rash;appearance repeated vomiting against high temperature.Determine the nature of the rash and the appropriate treatment can only physician.

Enterovirus rash

Serous meningitis - a common form of infection with enterovirus.Called Coxsackie virus (A-2, 4, 7, 9), coxsackievirus B (types 1-5), ECHO (types 4, 6, 9, 11, 16, 30).
meningitis begins acutely with the appearance of fever, increase t î to 39-40o (rarely remains normal t), there are symptoms of intoxication.After a few hours or by the end of the day there is growing rapidly diffuse headache Expander nature.In most patients, later joined by nausea, repeated vomiting, striking hyperemia and motor stimulation, increased sensitivity to all kinds of stimuli.During the first 12-24 hours after the onset of meningitis formed comprehensive picture of meningeal and cerebral syndromes.There are growing rapidly and meningeal symptoms: stiff neck muscles, Kernig symptom Brudzinskogo etc. For patients characterized by "meningeal pose" or "pose a gun dog.".Consciousness is first stored and then is replaced by the state of stupefaction, stop, coma.
Often these symptoms are accompanied by other symptoms of enteroviral infection - myalgia, rash on the body, damage to the myocardium, the oropharynx.The duration of fever and meningeal syndrome up to 7 days at a time begun treatment.Sometimes there is a second wave of fever.Analysis of the cerebrospinal fluid
: flows under pressure transparent cytosis 200-300 cells in 1 mm, up to 50% of neutrophils, lymphocytes often predominate.
When to see a doctor: high fever, severe headache, repeated vomiting, neck pain, inability to bend it - all of these symptoms for immediate treatment to the doctor.In infants - high temperature, constant crying, and the child's anxiety - a reason for immediate treatment to the doctor.Meningitis requires urgent medical intervention in a hospital.

Epidemic myalgia. caused by a virus Coxsackie B (tipy1-5), Coxsackie A-9, the ECHO (types 1,6,9).Home sharp.Among the symptoms of infectious-toxic syndrome, myalgia syndrome.Against the background of high temperature and symptoms of intoxication appear muscle pain (myalgia).Localization - the abdominal muscles, the lower parts of the chest, back, legs.Feature myalgia - their paroxysmal, attacks continued for 5-10 minutes and repeated at 20-30-60 minutes.In 50% of patients experiencing a second wave of fever.Often, there are other signs of enterovirus infection (rash, oropharyngeal loss, swollen lymph nodes).The average duration of 7-8 days, sometimes a second wave of repeated attacks.
When to see a doctor: paroxysmal fever and muscle aches.This form is difficult to diagnose, often the differentiation is carried out with myocarditis, pleurisy, acute abdomen and other conditions.

«Minor illness» (3 hdnevnaya fever, "summer flu") can be caused by all types of enteroviruses.Short-term (1-3 days) and light severity (mild temperatures, fatigue, myalgia, dizziness) to characterize this form of the disease.Often disguised as SARS.The correct diagnosis is usually only at the outbreak of enterovirus infection.
Respiratory (Bluetongue) form of enterovirus infection is caused by many types of enteroviruses.According to symptoms similar to acute respiratory disease of another etiology - temperature combined with the defeat of the upper respiratory tract (pharyngitis, laryngitis).Caution is required in the diagnosis of small children, who can syndrome "false croup" (barking cough, shortness of breath), appearing usually at night.

Enterovirus diarrhea (viral gastroenteritis) occurs in the nursery, and in the adult age group.Against the background of high fever (38-390) appears loose stools from 2 to 10 times a day, can appear abdominal pain, malaise, nausea, vomiting.Fever lasts an average week.The breakdown of the chair may be the only sign of disease.

Enfefaliticheskaya form of enterovirus infection uncommon.Mild forms are manifested only malaise, headaches unexpressed and difficult to diagnose.Severe forms may be accompanied by a convulsive syndrome, impaired consciousness, defeat certain cranial nerves.

Poliomielitopodobnaya (spinal) form manifested paresis and paralysis, but the nature of flows easier than poliomyelitis with rapid recovery of motor functions.

encephalomyocarditis newborns called coxsackie virus B (types 2-5).It is characterized by severe course and high mortality (80%).Against the background of high fever, the child becomes lethargic, refuses to eat, there convulsions, cyanosis of the skin, heart failure.

epidemic hemorrhagic conjunctivitis cause enterovirus serotype 70. Begins with acute injury of one eye, then the other eye is affected, and.Patient watering, fear of light, foreign body sensation in eyes.When viewed from a hemorrhage in the conjunctiva, swelling of the eyelids, muco-purulent discharge.

Hemorrhagic conjunctivitis

cases of enteroviral myocarditis and pericarditis, uveitis, nephritis, pancreatitis have also been described.

complications of enteroviral infections

complications of enteroviral infections are mainly associated with damage to the nervous system.One of the most dangerous complications - cerebral edema with risk of herniation syndrome (cardiac arrest and pulmonary activity).This complication is possible in severe forms of infection, as well as delays in seeking medical help.

Among other complications - the development of "false croup" when a respiratory form in young children, as well as the accession of a secondary bacterial infection to the development of pneumonia and other bacterial deposits.In rare cases, haemorrhagic keratokonyuktivita and uveitis may develop cataracts and blindness.

diagnosis of enterovirus infections

1. Preliminary diagnosis is a doctor at the examination of the patient on the basis of suspicious symptoms after the differential diagnosis.Taken into account the epidemiological situation and the possible development of the family and group outbreaks.
2. The final diagnosis is only after laboratory confirmation of the diagnosis.Indications for examination determines the doctor only.
Survey on enterovirus infections to individuals if they have one or more of the following clinical symptoms / syndromes:
- focal neurological symptoms;
- meningeal symptoms;
- sepsis newborns of non-bacterial nature;
- exanthema and mouth;
- gerpangina, aphthous stomatitis;
- myocarditis;
- hemorrhagic conjunctivitis;
- uveitis;
- myalgia;
- other (including respiratory syndrome, gastroenteritis, rash in the event of a group of morbidity in children's organized team).

To investigate selected: smear (flushing) of oropharyngeal / nasopharyngeal swab separated ulcers in gerpangine, fecal samples, cerebrospinal fluid, secretions of the conjunctiva, a smear separated vesicles, blood, biopsies of organs (sterile types of clinical material), autopsy material (non-sterile typesclinical samples).

take a certain type of material for laboratory analysis shall be based on the clinical picture of the disease.

Timing fence material: nasopharyngeal swabs taken within the first 3-4 days of illness;Two samples of faeces in the first 7 days of the disease at an interval of 24-48 hours;blood taken twice - the first sample as soon as possible from the onset of the disease, the second sample - 3-4 week of disease;parallel to the withdraw blood for virus isolation;spinal fluid taken the first days of illness in aseptic (sterile) conditions.

basic methods of laboratory confirmation of EVI are: - virological method (virus isolation);- Polymerase Chain Reaction (PCR) (detection of RNA);serological methods (detection of antibodies in paired sera);molecular-biological methods (to determine the serotypes of enteroviruses).
1) Virus Isolation: virological technique (in cell culture or animal) and enterovirus RNA detection by PCR.irrigation throat disinfectant to prevent bacterial contamination of the wound site;anti-inflammatory drops in the eye with conjunctivitis.

infectious disease doctor Bykov NI