Symptoms and treatment of enterovirus infection in children

Recently, the number of outbreaks of enterovirus infection has increased significantly. Either from one seaside resort, now from another, alarming data on the number of cases come. But even in cities far from the sea, enterovirus infections are very common, especially in children. What is it, what are the symptoms and treatment - you will learn about all this by reading this article.

What it is?

A large group of diseases belongs to enterovirus infections. They are united by the fact that they are all caused by viruses of the same family - picornaviruses. Enterovirus infection is sometimes called intestinal, but not for its manifestation, but for the ability of enteroviruses to enter the body and develop in the human gastrointestinal tract.

Enterovirus infection can manifest itself in completely different ways - from respiratory symptoms (runny nose, cough) to sore throat, from vomiting with diarrhea to disorders of the central nervous system. Viruses cause very specific diseases that cause specific symptoms.

Most often, children become infected and get sick with ARVI. Enterovirus infections are in second place after them. Children get sick more often than adults, this is due to the weakness of the immune system of babies. Eight out of ten people with established enterovirus infection are children, and many children are in preschool age.

The fact is that the immunity of an adult is able to quickly respond to enterovirus - thanks to antibodies developed during life. The child has little or no supply of such antibodies. While the immune defense is still only "learning" to recognize the causative agents of various ailments, the baby is vulnerable, and this is the reason for the high incidence of childhood diseases.

There are a lot of carriers of enteroviruses on the planet, and they themselves do not get sick, they are only carriers. But children and people with weakened immunity may well become infected by contact with such carriers. The virus itself lives long enough in the organism of its carrier - up to several months.

Most often, infection occurs through contact and household routes - through water, food, various objects, common toys. More cases of infection are recorded in regions with a significant population density, as well as where hygiene rules are not followed.

Not all diseases caused by enteroviruses have been well and in detail studied; in some areas, scientists and physicians are looking for answers to numerous questions. But most of the ailments that may be a consequence of the penetration of one or another enterovirus into the child's body are well known to doctors, as well as ways to combat these diseases.

About pathogens

The enterovirus family includes more than a hundred viruses dangerous to humans. It makes no sense to list everything, so you should limit yourself only to the most famous and most dangerous representatives of the family. Enteroviruses include 24 serotypes of Coxsackie A virus, as well as 6 serotypes of Coxsackie B.

The most numerous are the serotypes of the ECHO virus (there are 34 of them). The smallest are 4 enteroviruses, which do not belong to any group. They are designated by numbers from 68 to 71.

Enteroviruses are very resistant to low temperatures, but are quickly destroyed by exposure to high temperatures - when boiled, enteroviruses die almost instantly. Most often, diseases caused by an active enterovirus occur in late summer and early autumn.

These viruses do not like sunlight, or rather, its ultraviolet spectrum, chlorine-based disinfectants, hydrogen peroxide. Viruses of this genus survive well in water and soil.

Viruses enter the body through the mouth, sometimes through the nasopharynx. The most favorable for the development of viruses is the lymphoid tissue, of which the tonsils and the spleen are composed. Suitable for the replication of these viruses and epithelial cells of the oral cavity, pharynx and digestive tract.

Then the virus spreads through the child's body with the bloodstream, affecting the nerve tissues, muscles, blood vessels of the eyes. The incubation period, which lasts from the moment the virus enters the body until the first clinical symptoms appear, lasts from 2 to 14 days.

After an illness, which usually lasts about 10 days, the child develops a temporary immunity to the virus that caused him the illness.

This protection is not lifelong, but antibodies work and confidently resist a certain virus for several years.

Kinds

There are many diseases caused by enteroviruses. To make it easier to classify them, in the last century it was proposed to divide them into potentially dangerous and less severe. The first group includes:

serous meningitis;
sudden acute paralysis;
encephalitis;
myocarditis;
pericarditis;
hepatitis.

The group of less dangerous diseases caused by enterovirus infection includes:

fever "three days";
herpetic sore throat;
vesicular pharyngitis;
conjunctivitis;
gastroenteritis.

In addition, all enteroviral infections are divided into typical and atypical. Typical forms proceed with characteristic symptoms, and atypical forms can occur without symptoms at all. Almost half of cases of infection with Coxsackie, ECHO, as well as almost 90% of cases of infection with poliomyelitis viruses, which is also part of the enterovirus family, proceed atypically.

In terms of the severity of symptoms, infectious ailments of enteroviral origin can be mild, moderate and severe. According to the assessment of the consequences - complicated and uncomplicated.

Signs

Since the mouth, nasopharynx, and digestive tract are the “gateways” for infection, this is where the first symptoms appear. There is no clear list of clinical manifestations, but there is a rather impressive list of possible symptoms. Usually they are found in combination - 2-4 each, while the combinations are always quite unique. Here is an incomplete list of possible manifestations at an early stage of enterovirus infection:

Inflammation of the nasal cavity, sinuses... This is manifested by a runny nose, a feeling of congestion in the paranasal sinuses, heaviness when tilting the head down, and the loss of the ability to distinguish odors. Sometimes sinus inflammation leads to a feeling of stuffiness in the ears, temporary hearing loss.

Inflammation of the larynx and tonsils. The lymphoid tissue of the tonsils, in which enteroviruses actively multiply at the initial stage, noticeably increases in size, and can become covered with rashes. The larynx and tonsils become swollen, reddened. There is severe pain when swallowing.
Stomach and intestinal problems... If the enterovirus has begun to replicate in the membranes of the digestive tract, then the child may exhibit increased gas production, bloating, nausea, less often vomiting, diarrhea, and abdominal pain.
Sensitivity change... The child may experience numbness in the limbs, tingling in the area of numb fingers and feet. Sometimes there is numbness of the muscles of the face with a temporary change in facial expressions.

Headache... This symptom accompanies most diseases caused by enteroviruses. The pain itself can be quite strong, sharp and dull, aching. Much of its intensity depends on what kind of ailment develops, as well as on the age of the child.
Muscle and bone pain... This symptom is also very common. Children from 3 to 6 years old often have short spasms of the extremities, the child may complain that "the leg is driving".
Cough... It can be of different intensities. At the initial stage, the child usually has an unproductive dry cough, later - a wet, wet cough. Shortness of breath is possible, as well as whistling sounds when breathing.

Temperature, fever... At the onset of the disease, the temperature always rises to fairly high values - 38.0-40.0 degrees. The temperature decreases quite quickly (in 2-3 days) and subsequently remains at subfebrile values - from 37.0 to 37.9 degrees (until recovery).
Rash... It can appear in the mouth, on the mucous membranes of the inner surface of the cheeks, on the tongue, in the throat, on the tonsils, and it can appear on the palms, feet, in the skin folds of young children, and even in the genital area.
Violation of the general condition of the child... Appetite, sleep are disturbed, behavior changes. The toddler becomes more moody, restless, or lethargic and apathetic.
Swollen lymph nodes... Usually, the submandibular lymph nodes, as well as the occipital and cervical, become inflamed and become larger. Lumps in the armpits and groin may also grow.

Depending on the combinations that make up these and other symptoms, the child may have one or the other complication.

Herpetic sore throat

This fairly common disease is caused by Coxsackie A or B viruses. White sores appear in the child's mouth, surrounded by a red border. At the initial stage, there is a bubble inside the redness, which bursts and creates ulceration.

Usually the rash is located on the wall of the pharynx and on enlarged reddened tonsils. The temperature rises to 38.0-39.0 degrees, the child feels pain when swallowing. Babies may refuse to eat at all due to this pain.

Viral conjunctivitis

The defeat of the mucous membranes of the eyes of a child is usually caused by enterovirus type 70. The child begins to be afraid of bright light, his eyes are watery. The eyeballs turn red, pronounced blood streaks are noticeable.

An older child will complain that "something has got into the eye", the baby will simply constantly rub his eyes. Viral conjunctivitis is often complicated by a bacterial infection, which the child brings into the eyes by rubbing them. Microbial infection is characterized by the appearance of purulent discharge in the corners of the eyes. The disease lasts long enough - up to 14 days.

Viral pemphigus

This disease is always manifested by the appearance of blisters (vesicles) filled with light liquid in the mouth, on the palms, on the feet, on the fingers and in the space between the fingers. This phenomenon is most often caused by Coxsackie A enterovirus.

The blisters don't hurt or itch. When the vesicles burst, small ulcers with a light crust remain on the skin. During the first two days, such pemphigus is accompanied by an increase in temperature and symptoms of intoxication. The disease lasts about 7 days.

Myocarditis

Inflammation of the heart muscle is a fairly common complication of enterovirus infection. If only the space around the heart is inflamed, then they speak of pericarditis. Boys have this complication more often than girls.

It all starts as an acute respiratory illness, in which the child has a runny nose, cough. The disease progresses rather quickly, and the child begins to have severe shortness of breath, the heart rhythm is disturbed, and heart failure may develop.

Alarming symptoms are wheezing shortness of breath and severe chest pain. The process is often accompanied by fever.

Meningoencephalitis

Such a complication can be provoked by Coxsackie enteroviruses (A and B), ECHO viruses, as well as enteroviruses designated by numbers from 68 to 71. Photophobia, headaches, and fever are characteristic of serous meningitis. For children from 5 to 9 years old, among whom this complication is considered the most common, enteroviral meningitis is not as dangerous as it seems. However, the disease is dangerous for children in the first year of life.

The disease is diagnosed in about every third child with an enterovirus infection. Babies noticeably swelling of the fontanelle, stiff neck muscles. Children of any age with meningitis can experience vomiting, seizures, blurred consciousness, and delirium. The disease lasts about 10 days and usually goes away - with a completely favorable prognosis. Occasionally, in children, speech lag, as well as physical development, remains as a residual phenomenon.

Enterovirus fever

It is also called a three-day fever, because the temperature lasts exactly three days. Complications are caused by Coxsackie and ECHO viruses. The disease most often occurs in the summer, for which it is also called "summer fever".

This disease is characterized by a sharp fever, as well as redness of the throat, tonsils, the appearance of liquid discharge from the nose. The child has muscle pain, headaches, and swollen lymph nodes. Often enough the spleen and the liver also increase in size. After the third day, the child begins to feel much better, and by the end of 6-7 days he usually recovers completely.

Epidemic myalgia

This disease is also called pleurodynia or "devil's dance". This name is given to the ailment for the chaotic movements of the arms, legs and body that the child makes at moments of painful attacks in the muscles of the chest, abdomen, limbs. The attacks last from 10 seconds to 20 minutes and are repeated several times a day.

This condition is caused by ECHO enteroviruses, less often - Coxsackie. It is accompanied by a high fever, symptoms of intoxication. The disease lasts no more than 10 days.

Paralysis

They are usually caused by polioviruses, less commonly by Coxsackie and ESNO viruses. Spinal paralysis usually develops, resulting in a temporary inability to move the limbs. Usually, this is preceded by a high fever, severe intoxication, repeated vomiting, and convulsions. The paralysis is not persistent, it goes away after a few days.

Gastroenteritis (intestinal flu)

This complication is most common in children under 3-4 years of age. Runny nose, cough, and other respiratory symptoms are mild or absent. The disease proceeds against a background of high fever, diarrhea, vomiting, and gas formation. There are usually no severe intestinal symptoms, but the duration of this form of enterovirus infection is quite long - the symptoms can persist for up to two weeks. This condition is caused by Coxsackie A and B viruses, as well as ESNOs and viruses of 68-71 types.

Danger

The main danger of an enterovirus infection lies not in the virus itself, but in the complications that it can cause. A somatically healthy, strong child is able to cope with the infection, his immunity will develop the necessary antibodies to the penetrated virus in a few days. But children with chronic diseases, weakened immunity, HIV infection, congenital malformations, pathologies from the central nervous system, as well as babies under one year old are unable to resist enterovirus quickly and effectively. They are at risk of developing severe complications. The danger of enterovirus lies in its insidiousness.

Many forms are "disguised" as a harmless runny nose or cold, but the consequences can be much more severe. Therefore, it is important to make the correct diagnosis as soon as possible and start timely treatment.

The worst complication of enterovirus infection is large-scale lesions of the central nervous system... Possible swelling of the brain is dangerous, which can provoke heart or respiratory failure.Among other complications that are dangerous to the life and health of the baby are the development of false croup against the background of stenosis of the larynx, as well as the addition of an infection that can cause severe pneumonia. Not very often, but it happens that enteroviral conjunctivitis causes a decrease in vision, the occurrence of cataracts and the onset of blindness.

If we evaluate medical statistics objectively, then the onset of dangerous consequences with enterovirus infection does not happen so often. In most cases, doctors' forecasts are very favorable. About 90% of children are usually treated with no long-term health consequences.

In 7% of children, certain complications occur, which are reversible. Irreversible total complications are recorded only in 1-2% of cases and usually concern children from the risk group, which were mentioned above.

Diagnostics

Any pediatrician can diagnose enterovirus infection by a combination of signs and seasons. However, it is possible to say with confidence that it was enterovirus that caused the baby's illness only on the basis of laboratory studies.

Not all children with suspected enterovirus infection will be sent for tests. If the doctor has no fears for the child's condition, then he may not refer him to extended laboratory diagnostics. If the doctor notices neurological symptoms, signs of meningitis, sepsis in newborns, signs of exanthema, as well as a rash in the mouth, on the hands and feet, symptoms of herpetic sore throat, myocarditis, conjunctivitis or myalgia, then a laboratory test will be required.

A lavage from the oropharynx is sent to the laboratory, samples of the contents of the vesicles from the throat with herpetic sore throat, and an analysis of feces is also needed. For conjunctivitis, samples of discharge from the corner of the eye are needed. If meningitis and central nervous system damage are suspected, cerebrospinal fluid is needed, which is taken by puncture.

Donate blood for enterovirus infection twice. Once - at the onset of the disease, the second - 2-3 weeks after the onset of the disease.

Lab technicians will use several methods: virological will allow you to isolate the virus, serological - to determine the presence of antibodies to it, the molecular method will determine the serotype of the virus and its features.

In addition to laboratory tests, a chest x-ray may be prescribed for individual indications. This method will allow examining not only the state of the lungs. It allows you to monitor the size of the heart if the doctor suspects pericarditis or myocarditis. These children are additionally recommended several dynamic ECGs.

Electroencephalography will help examine the state of the brain if meningitis or encephalitis is suspected. Examination of the organs of vision by an ophthalmologist will help to predict possible complications with enteroviral conjunctivitis.

Often, children are prescribed additional consultations with a neurologist, gastroenterologist, infectious disease specialist, cardiologist.

Treatment

Treatment of an enterovirus infection is broadly similar to the treatment of any viral infection. The therapy is complex and includes not only medications, but also the correct treatment regimen and nutrition. Most children are allowed to undergo treatment at home, strictly observing all the prescriptions of the attending physician. Only children for whom enteroviruses pose a serious danger are trying to hospitalize - children with HIV infection, babies under one year old, children with congenital and severe chronic diseases of internal organs and systems.

Mild infections in children not at risk can be treated at home. Doctors try to treat moderate and severe forms of the disease in a hospital. In a hospital environment, it is possible to respond quickly to possible complications. Children with severe forms are prescribed antiviral drugs that are administered intravenously and intramuscularly.

You will not find such drugs on the shelves of pharmacies. They are proven to be effective - in contrast to the vast majority of products that are widely advertised and available in every pharmacy. There are only a few antiviral drugs with proven effectiveness in Russia. Children with a mild form of enteroviral infection do not need such medications, but doctors often prescribe "Anaferon", "Viferon" and other drugs.

This is done so that parents cannot later accuse the doctor of inattention, of indifference. If the doctor honestly says that with an enterovirus infection, the child does not need medicines, that there is no point in antiviral drugs, then many mothers and fathers simply will not understand such an honest specialist. And after the appointment of the homeopathic "Anaferon" and the doctor is calm, because the child takes a harmless (and useless) drug, and the parents - they take into account the recommendations and do everything for the baby's speedy recovery.

A big mistake with enterovirus infection is to give your child antibiotics. Some parents believe that intestinal flu (enteroviral gastroenteritis) simply cannot be cured without antibiotics. Unfortunately, doctors still work with children, who prescribe antibiotics to a child with a viral infection with the reservation “just in case” so that there are no complications.

The truth is that antibiotics have no effect on viruses. However, they affect the body as a whole, and the likelihood of complications does not decrease, but increases several times. In this case, the added bacterial infection will be difficult to cure, because the bacteria will form a certain "addiction" to the antibiotic.

Whether or not to give a child antiviral drugs with home treatment is up to the parents. If the baby does not swallow pills and syrups, nothing bad will happen. If there is, it will not affect the recovery process and timing in any way.

But antibiotics should be abandoned decisively and irrevocably.

Usually symptomatic treatment is prescribed at home:

Antipyretic drugs. At high temperatures, the child can be given "Paracetamol" and preparations based on paracetamol, as well as the anti-inflammatory nonsteroidal drug "Ibuprofen". It is strictly forbidden to give "Aspirin" and drugs based on acetylsalicylic acid, since their intake can provoke a deadly disease - Reye's syndrome.

Vasoconstrictor nasal drops. With a runny nose, you can relieve the child's condition with drops "Nazivin", "Nazol". It should be remembered that these medications should not be used for more than 5 days, as they cause persistent drug addiction. To prevent thickening of nasal mucus and bacterial complications, it is useful to often (every half hour) instill in the nose a regular saline solution prepared by yourself - from water and table salt.

Antihistamines. With severe swelling in the larynx and in the nasopharynx, you can take an age-related dose of antiallergic agent: "Suprastin", "Loratadin", "Tavegil". These funds are useful not only for allergies, but also when you need to quickly remove the puffiness.

Enterosorbents and preparations for oral rehydration. With the intestinal form of enterovirus infection, you cannot do without funds that will help replenish the water-salt balance, disturbed by repeated vomiting or prolonged diarrhea. Such funds include "Regidron", "Smecta", "Humana Electrolyte". When the bouts of vomiting have passed, it will be possible to give the child sorbents - for example, Enterosgel.

Probiotics... "Bifiform", "Bifistim" can be prescribed to a child after the acute phase of the intestinal form of enteroviral disease (to normalize the intestinal flora, which suffers significantly after prolonged diarrhea or vomiting).

Local antiseptics. With herpes sore throat, with vesicular pharyngitis and other diseases of the oropharynx caused by enteroviruses, local antiseptics are prescribed - for irrigating the throat and gargling. Usually it is a solution of furacilin, "Miramistin".

Mucolytic and expectorant drugs... They are prescribed for coughing - to remove excess phlegm. These drugs include "Mukaltin", "Codelak-Broncho", "Lazolvan".

In the hospital, treatment is also carried out with the use of symptomatic drugs. With pericarditis or myocarditis, cardioprotectors are prescribed. For severe intestinal infections - rehydration therapy, infusion of saline. Meningitis and encephalitis require the use of diuretics, which will help to quickly remove excess fluid and avoid cerebral edema, as well as nootropic drugs that improve blood supply.

Treatment of enterovirus infection at home and in the hospital requires adherence to bed rest - for the entire time while the child has a fever. It is important to ensure peace and a normal psychological state of the sick person. Outdoor walks are allowed one day after the temperature returns to normal values.

At the time of illness, the child is transferred to a special drinking regimen, this is especially important for the intestinal form of infection. The diet should provide a sufficient amount of protein foods, as well as foods containing vitamins A, E, C, B.

If it is painful for a child to swallow, food is given warm, mashed or mushy, in the form of mashed potatoes. In case of enteroviruses that cause vomiting and diarrhea, it is important to adhere to therapeutic fasting (for a day). After that, broth, jelly, rice broth, porridge without oil, vegetable soups in lean broth, and white bread croutons are gradually introduced into the child's menu.

All drinks should be warm. Optimally, if the temperature of the liquid matches the body temperature of the sick baby, so the water will be absorbed faster in the small intestine and absorbed.

It is impossible to wrap up the child, put heaters next to the patient's bed. This dries the air. For a successful recovery without complications, it is important that so that the child breathes clean air (it should not be overdried). The optimum humidity is 50-70%, the air temperature in the room should not be higher than 20 degrees Celsius.

Prevention

Prevention of enterovirus infection is not limited to vaccination, since there are no vaccinations against it. In the focus of infection, disinfection is carried out. If a kindergartener falls ill, then all the children in the kindergarten who have been in contact with him are closely monitored for two weeks. There is no quarantine, but every morning in the kindergarten begins with a temperature measurement. This is a must for all babies.

It is important to teach the child to wash his hands before eating and after visiting the street, and also not to take dirty hands and other people's toys and things in his mouth. It is important to monitor the quality of drinking water, as well as thoroughly wash vegetables and fruits bought in a store or market.

Especially often children get sick with enterovirus infection during a vacation at sea. Prevention in this case is of particular importance. If you have to take a baby or a preschool child to the resort, it is important to carefully study the epidemiological situation in this area. This can be done on the Rospotrebnadzor website. It contains all the current information, including about outbreaks of enterovirus infections.

A memo for vacationers who do not want to treat a child for enterovirus during their vacation looks simple:

you can not give the baby to drink water from unfamiliar sources;
it is important not to allow the child to swallow water from the sea or pool when swimming;
the child should not be given untested food (especially for resort catering and national cuisine of fish and meat), and fruits and vegetables should be washed well;
it is important to follow the rules that will reduce the impact of acclimatization on the baby's body: not to violate his usual daily routine, not to take a small child to exotic countries with a climate that is very different from the usual.