Enterovirus diseases

Enterovirus diseases is infectious diseases caused by intestinal viruses.
To include enteroviruses viruses, Coxsackie and ECHO, which have a great variety of serological types. Enteroviruses breed in the digestive tract and then enter the blood stream.
Epidemiology. The source of infection is a sick, especially during the first days of the disease. Children are very susceptible to enterovirus diseases. In institutions can be observed outbreak. Spreading speed of the disease suggest that transmission is possible fecal-oral and airborne.
The clinical picture. The incubation period of 2-5 days. The disease begins abruptly, with increase of temperature to 38-39 degrees. Runny nose, cough, headache. In severe cases, marked insomnia, vomiting, diarrhea, asthma klonico-tonic convulsions with loss of consciousness, meningeal symptoms, disorder hemodynamics. Less frequent muscle pain. Symptoms of enterovirus diseases are very diverse. There are several clinical forms that can be isolated and combined. More common undifferentiated fever (low disease and acute respiratory syndrome, which is characterized by redness and granularity of the mucous membrane of the mouth, sero-slimy rhinitis, dry rare dry cough and wheezing in his lungs. The disease may be as herpes sore throat, pleurodynia, exanthema, bowel syndrome, meningitis and encephalitis, myocarditis, etc., In all cases has increased and the richness of the lymph nodes. For the combined form of the disease is most characterized by a combination of respiratory syndrome with diarrhea (diarrhea) and exanthema. Liquid stool with admixture of mucus and greenery up to 6-8 times a day joins mainly through 3-4-5 days from the onset of the disease. Impurities in the blood is not observed, there is no also of tenesmus. In bowel syndrome often vomiting, which may be associated with abdominal pain. Despite vomiting and diarrhea, sudden weight loss and dehydration not observed. General intoxication insignificant. Combined form of the disease is more common in children 1 year of life.
Diagnosis is based on epidemiological, clinical and laboratory research. Virological studies are crucial and are based on the allocation of enteroviruses by the mucous membrane in the throat and nose, as well as from the feces of patients; in addition, produce definition titer neutralizing antibodies in the serum in the dynamics of the disease.
Differential diagnosis should be carried out with the flu, dysentery, coli infection by Salmonella, as well as with polio, serous meningitis different etiology and other viral diseases.
The prognosis of the disease in the majority of cases favourable.
Treatment of symptomatic: acetylsalicylic acid, amidopyrine, analgin a dose of age, chlorpromazine is based 1-2 mg per 1 kg of body weight per day (3 injections). When expressed neurotoxicosis and meningeal symptoms with the aim of dehydration injected 10-20% glucose in 20 to 40 ml, plasma based 5-7 ml per 1 kg of body weight, and intramuscularly 25% solution of magnesium sulfate at the rate of 0.2 ml per 1 kg of body weight per day. Recommended vitamins and restorative therapy, to prevent stratification of bacterial infections shown antibiotics, especially when pneumonia and otitis media.
Prophylaxis with enterovirus diseases is reduced to immediate isolation of children from the team for the entire period of illness.

Enterovirus diseases - diseases caused by enteroviruses.
Enteroviruses. The group of enteroviruses (synonym intestinal viruses are viruses polio (types I, II, III), Coxsackie (23 type a, 6 types), ECHO (32). Such a Union is due to their predominant localization in the intestines of humans and emitting them from faeces. Enteroviruses are also from the pharynx, spinal fluid and blood sick with respiratory and neurological symptoms, often from healthy children aged 1-4 years. Poliovirus was isolated in 1909, but studied in detail after 1949 in connection with the opening of cytopathic effect in a tissue of humans and monkeys (see Polio). Non-polio enteroviruses have become known since 1948, when from the feces of patients were allocated for newborn mice viruses, which received its name by the place of allocation (village Coxsackie, new York). Development of the technique of tissue cultures contributed to the opening of a large number cytopathogenic agents intestinal group, whose role in infectious human pathology was not installed. In 1955, these viruses was awarded the title of "orphan"or ECHO (enteric - intestinal, cytopathogenic - cytopathogene, human - human, orphan - orphanage). There are various serotypes orphan virus animals (cows, pigs, monkeys, cats, birds). In 1962, was the classification of enteroviruses person in order another numbering: № 1-3 polio viruses, № 4-26 Coxsackie-A, № 27-32 Coxsackie-In, no 33-62 ECHO.
Later it was found that the Coxsackie virus-A23 immunologically identical to the virus ECHO 9. Virus ECHO 10 belongs to the group of reovirus. Viruses ECHO 1 and 8 antigenically similar. Viruses ECHO 6 consist of three antigenic variants.
Enteroviruses together with respiratory rhinoviruses and FMD viruses are a group of tiny viruses (picornaviruses). Enteroviruses are characterized by small sizes (15-35 MMK), cubic symmetry, do not contain lipids and therefore resistant to air. After processing 1M solution of magnesium chloride and other salts of divalent cations enteroviruses become resistant to warming at temperature 50 degrees for 1 hour, not sensitive to antibiotics and drug administration (70% solution of alcohol, 5% solution of Lysol), bile and acid reaction environment; stored in frozen state for many years, at temperature of 4 OC for several months and at room temperature for several days. Inactivated when processing a 0.3% solution of formaldehyde, and 0.1 G. hydrochloric acid, chlorine (0.5 g/l), while heating, drying, UV-irradiation, direct sunlight. Most non-polio enteroviruses has hemagglutinins activity in respect of human erythrocytes. Enteroviruses are allocated in the primary tissue culture monkeys and humans or in the culture of transplantable cells. Cultivation in the tissues accompanied cytopathic effect. Many enteroviruses form in sensitive tissue cultures under a layer agar plaques, which vary in shape and size. Coxsackie virus (except A9) a hard time adapting to the tissue culture, being pathogenic for newborn mice, cotton rats, hamsters, causing diffuse myositis (hyaline necrosis in skeletal muscle). Coxsackie virus is easily cultivated in culture cells that cause disease of newborn mice with characteristic changes detected by histological examination of the brain and brown interscapular fat. Viruses ECHO allocated in primary cultures of tissues of the apes and humans, non-pathogenic for laboratory animals. For non-polio enteroviruses characteristic antigenic differences found in serological reactions. For the separation of enteroviruses in three main groups use some cultural properties. By culturing on transplantable cells Detroit 6 and primary cell cultures of monkeys in a mixture with polio immune sera exclude polioviruses. The presence of cytopathic effect on cell Detroit 6 speaks of the Coxsackie virus-Century and kidney cells of monkeys - about ECHO or Coxsackie-A9 motorway. Cm. also Coxsackie viruses, echo-viruses.


Epidemiology. Sources of infection are sick, media-convalescents and those with asymptomatic infection. Among healthy children, especially in summer and autumn, there is a widespread carriage, accompanied by hidden immunization.
Transmission occurs through the feces and airborne. The last mechanism of infection many researchers believe the main one.
Susceptibility to these infections is particularly high among children under 10 years of age she falls. Adults suffer relatively rare, as they retain immunity from my childhood after suffering clinically apparent disease or asymptomatic infection.
Enterovirus diseases in children's institutions often occur in the form of epidemic outbreaks, which are of a character similar outbreaks of respiratory viral infections (see). Sometimes there epidemic across large territories. The incidence characterized by pronounced summer-autumn season.
Clinical forms. On the main clinical syndrome there are the following forms of enterovirus diseases: herpes sore throat (Coxsackie-And, rarely Coxsackie-B); epidemiological mialgia (Coxsackie-B); serous meningitis (Coxsackie-And, Coxsackie-IN, ECHO); paralytic form (Coxsackie-And, Coxsackie-IN, ECHO); small disease, enterovirus or fever (Coxsackie-And, Coxsackie-IN, ECHO); exanthema (ECHO, rarely Coxsackie-A); interfizika (intestinal) form (Coxsackie-And, Coxsackie-In, ECHO); catarrhal form (Coxsackie-And, Coxsackie-IN, ECHO); myocarditis, entsefalomiokardita newborns (Coxsackie-In).
There are often combined forms, which combine various syndromes (for example, serous meningitis epidemic and myalgia). Clinical presentation is determined not only by the properties of the pathogen, but also (and mostly) by the individual reactivity of organism of the patient.
The incubation period for various forms Coxsackie and echo infections 2-7 days (usually 2-4). Common clinical signs of various forms are acute, sometimes violent, start, short-term (2-5, rarely up to 7 days) fever, often with a two character, and usually benign course (except myocarditis newborns).
Serous meningitis is one of the frequent and typical forms Coxsackie and echo infections (see Meningitis, serous, Polimaltosny disease).
Herpes sore throat (Coxsackie And characterized, in addition to the above General symptoms, appearing on the mucous membrane of the mouth transparent bubbles, soon turning into erosion.
Epidemiological mialgia (Coxsackie-B) is characterized by fever and acute emerging sharp pain in his chest and abdomen, often in epigastralna area. Sometimes misdiagnosed as appendicitis.
Low disease (Coxsackie and echo-fever) is a common form. Symptoms: fever (1-2-3 day), headaches and often vomiting. In practice, often mistakenly recognized as influenza.
Echo-exanthema is manifested by the rise of temperature (sometimes abrupt and significant) and eruption rash on the face, extremities and trunk. This form of enterovirus infection is often mistaken for a variety of acute infection (infectious erythema, rubella and other).
Other forms of enterovirus diseases occur much less frequently. Gastroenteriticheskaya form is observed in young children, characterized by diarrhea and often vomiting; disease lasts several days. Catarrhal form is characterized by the presence of acute respiratory catarrh. Paralytic form, resembling the picture of mild form of polio, manifested light paresis and paralysis, which usually disappear; severe paralysis is extremely rare. Myocarditis newborns is a very serious disease with significant lethality. Characterized by acute febrile beginning, expressed deafness tones heart and severe symptoms of heart weakness. Sometimes simultaneously observed phenomena encephalitis (entsefalomiokardita). Described benign flowing myocarditis in older children and adults.
Accurate diagnosis virological research (see). Only typical form of enterovirus diseases (epidemic mialgia, serous meningitis, herpes sore throat), especially in the presence of epidemic outbreaks, can be established clinically. Outbreak presence, at least in some patients, such a typical forms allows approximately diagnosis of enteroviral diseases and patients with the disease occurs by type of low disease. To install enterovirus nature of other clinical forms is possible only with virological tests.
The treatment is symptomatic. Antibiotics have no effect give. When expressed meningeal phenomena with the aim of dehydration are recommended intravenous infusion of hypertonic glucose solution and intramuscular injection of 25% solution of magnesium sulfate; facilitating patient may also have a lumbar puncture.
Prevention. A specific vaccine is still under research. Preventive measures in epidemic foci should be approximately the same as in other drip infections with the addition of measures to prevent the spread of the pathogen through the feces. The isolation of the sick, if it is held on the first day of the disease, epidemiological measure may provide some effect.