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Enterovirus infection symptoms and treatment in children

What is enterovirus infection?

Enterovirusnaya infekciya simptomy i lechenie u detej

Enteroviruses belong to the family of Picornaviruses, along with the rhinoviruses, cardiovirus, astroviruses and hepatovirus. This is a small shell-less RNA viruses whose genome is a linear chain RNA with positive polarity.

Transmission of the disease

Enterovirus infection can be transmitted by airborne droplets, contact, water, fecal-oral, food.

Manifestations

Symptoms of enterovirus infection in children and adults in most cases do not exist. Sometimes enterovirus infection in children (symptoms of disease) is characterized by a short febrile manifestations of the disease and lasts about 2-3 days.

These diseases are usually indistinguishable from other viral infections, but some signs of enterovirus infection in children and adults characterized by specific etiology.

Consider the following questions:

  • enterovirus infection symptoms and treatment in children and adults (and how to treat enterovirus in children and adults?)
  • how is an enterovirus infection?
  • how long the disease of a child and an adult?
  • than the threat of enterovirus infection in children?

Cutaneous manifestations

Enterovirusnaya infekciya simptomy i lechenie u detej

Enterovirus infection in children and adults may be associated with skin damage, basically, we are talking about non-specific rash. Typical rash caused by enterovirus is a syndrome hand-foot-mouth. This disease is manifested by fever and the appearance of vesicles bounded by erythema. A person must not throw in the mandatory, but in most cases this sign is present.

Herpangina

There are often summer epidemics among children and young adults. We are talking about tonzillofaringit with typical plantings of papules on the soft palate and palatal arches. They can often cause severe pain when swallowing. Have younger children the disease may be associated with a low intake of fluids required for parenteral rehydration. Recovery is spontaneous, the fever lasts about 3-4 days, lesions in the throat persist for weeks. Enanthema is not always, therefore, a problem may arise in distinguishing clinical data from bacterial tonsillitis.

Hemorrhagic conjunctivitis

This is a very contagious disease. About the first outbreak was reported in 1969 (the year of the launch of Apollo 11) in Ghana, so the disease is sometimes called Apollo 11 disease. Since it is described in a number of major epidemics, especially in tropical and subtropical areas. The incubation period is very short – from 24 to 48 hours.

The disease often starts in one eye, and within 24 hours spread to the other eye. Typical symptoms presented severe watery eyes, redness of eyes, eyelid edema, photophobia, and pain. The pain is often described as burning or pinching, often the injured person also indicates a feeling of a foreign body in the eye. In severe disease also occurs subconjuctival bleeding.

These symptoms last about 3-5 days and completely disappear within 10 days. This disease involves the treatment of enterovirus infection in children and adults, only symptomatic. Local application of corticosteroids because of the possibility of worsening the course of disease and a longer duration of symptoms is contraindicated. In order to cure bacterial superinfection (in the case of its development), the doctor recommended by the local input of antibiotics.

Bornholm Disease

It is a disease of the chest muscles.The name of the illness became epidemic on the island of Bornholm in 1933. The disease is a benign febrile illness, accompanied by bouts of pain antispasmodic pectoral muscles, diaphragm and upper abdomen. Assumes direct muscle damage by replication of the virus, but this theory has not been confirmed.

The disease begins suddenly with fever and a severe attack of chest pain. The pain is severe, stabbing, mainly affects the intercostal muscles, rarely oblique and transverse abdominal muscles. Approximately 7% of affected people can be observed directly, swelling of the muscles. The attacks of pain recur within 4-6 days and gradually weaken. For elderly patients requires differential diagnosis aimed at excluding coronary heart disease and pneumonia.

Myocarditis and pericarditis

Enteroviruses are the most common cause of viral myocarditis, and entered as the etiologic agent of approximately half of the cases. The myocardium depends on direct viral replication and immune basis. The disease affects people of all ages, but in most cases adolescents and young adults.

Men suffering from disease in 2 times more often than women. In 2/3 of cases, myocarditis is preceded by catarrh of the upper respiratory tract. Typical symptoms are represented by pain in the chest, shortness of breath, fever and nausea. In severe disease there may be symptoms of heart failure.

Therapy is generally represented in supporting methods (management of heart failure and quiet mode). A good effect has shown intravenous immunoglobulin. The effect of corticosteroids and immunosuppressive drugs was confirmed by large prospective randomized studies. Recovery usually complete approximately 10-20% of people remain ECG changes, and 5% experience chronic congestive heart failure. Deaths are rare, and occur in the acute phase of the disease with acute heart failure. Induces myocarditis, in most cases, Coxsackie virus B.

Neurological complications of diseases caused by enteroviruses

Enteroviruses is neurotropic, and almost always manifest neurological complications of the disease. Their range is quite wide, from aseptic meningitis and paretic disease to rare fatal encephalitis.

Polio

It is exclusively a human disease, which is the only carrier of the polio virus in nature. The disease was known 200 years ago and evidence of its existence comes from ancient Egypt. Paretic forms of the disease did not happen until the first half of the 20th century, when they began to be epidemic.

The incubation period of the disease is 5-35 days. Poliovirus infection occurs in 95% of patients being completely asymptomatic. The other 5% there are signs of a febrile illness, sometimes aseptic meningitis. Paretic forms occur in 0.1% of cases. In children the disease usually has a biphasic. The first phase has no specific symptoms, only about 3 days there is fever.

Defeat is often more expressive in the lower extremities than the upper, more affects large muscle groups. The paresis progresses for 2-3 days. The most serious, and often fatal, is bulbar polio, which affects the cranial nerves. Man dies when stopping the circulatory and respiratory centers in the bone marrow. To improve the state comes about after 9 months, after which comes a permanent paralysis.

Aseptic meningitis. Enterovirus is the most common cause of aseptic meningitis during the epidemic he's responsible for 90% of cases. In children, the disease is benign in nature, but adults in the long term remain disorders of attention and headaches.

Symptoms appear suddenly – fever, vomiting, severe headaches, unresponsive to NSAIDs, signs of irritation of the meninges, it is also possible febrile convulsions. The symptoms usually only last for a short period of time, often 3-4 days. In addition, often comes significant relief after performing lumbar puncture.

Due to the rapid manifestation of symptoms, there can sometimes be problems with the distinction between viral and bacterial meningitis, particularly when there is a petechial rash. Foreign experts recommend the study of CSF for each case of meningitis (PCR) for the presence of enteroviruses and, in the case of a positive result, stop Prim antibiotics. In severe disease, it is recommended to exercise great caution, as it was repeatedly reported about cases of meningitis caused by a combination of enterovirus and bacterial nature.

Encephalitis/meningoencephalitis

This disease is one of the less frequent complications of infection. The clinical picture presented by the irritation of the meninges. In the cerebrospinal fluid is also present aseptic inflammation, manifested significant changes in the EEG, other imaging techniques usually do not show any abnormalities. Fatal and permanent effects arerarely.

Treatment

Therapy of enteroviral infections is still symptomatic, but 3 groups of drugs (A, B, C) showed efficacy in these infections, and some of them have already entered the third phase of clinical trials. In addition, in the treatment of severe infections is used to support the effect of immunoglobulins (D), treatment with interferons (E) in enterovirus infection is not indicated. If there is an enterovirus infection in children, treatment is based on drugs and methods appropriate to the age of the patient.

Inhibitors of degradation of the capsid

After the discovery of the structure of the capsid has been proposed a number of molecules that stabilize the binding between VP1 and VP3 (components of the viral capsid). This binding subsequently prevents the release of RNA from virus particles. The most promising molecule of this group is pleconaril. It is effective against a broad spectrum of picornaviruses, has excellent bioavailability after oral administration and good penetration into the CNS.

Inhibitors replication of RNA

The main molecule of this group is enviroxime. This molecule prevents the formation of a complex of viral proteins 3A and 3AB, which is necessary for the formation of new viral RNA. The substance has undergone clinical trials, but these studies were suspended due to side effects and poor bioavailability of the molecule. Currently undergoing a search for a suitable derivative, but so far none have reached clinical trials.

Protease inhibitors molecules of 3-C

Molecules of this group inhibit the viral protease C 3, which is involved in posttranslational modification of viral structural proteins. Clinical studies with the molecule AG7088 has been temporarily suspended.

Immunoglobulins

Immunoglobulins in connection with the enterovirus is recommended in two cases: in neonatal sepsis, and patients with congenital or acquired deficiency of antibodies that are at risk of chronic progressive meningoencephalitis.

Interferon

Experience with the use of interferon, in Association with enterovirus infection, is missing, due to which their use is not recommended.