Enterovirus infection treatment and symptoms

Enterovirus (EV) infection, causing a variety of diseases, from trivial to quite severe. This virus is often the cause of SARS, is not one of acute intestinal disease... some diseases caused by EV, even people might die!

It is important to know what is enterovirus infection, what are the signs of enterovirus infection, what can and cannot be done with the diseases caused by EV how to treat enteroviral infection (what are some methods of treatment of certain diseases – SARS, a disease of Bornholm, etc.).

Brief definition

Enterovirus infection in adults and children is widespread and sometimes serious disease. The body is a viral pathogen enters the fecal-oral route, colonize the gastrointestinal tract and excreted in feces. In accordance with the biological properties of the following types of EV as poliovirus, Coxsackie virus A and b, as well as Echovirus. EV infection in men also includes a new enteroviruses numbered 68 to 71.

Full definition

The source of enterovirus infection is a person with an obvious or asymptomatic infection. He spreads the virus throughout the period of illness and recovery in the faeces, and at the peak of the disease – also through the nose. Transmission is through contaminated hands and objects of everyday use, as well as through water and foods, especially in families and closed groups. Infection is also associated with bathing in polluted waters and lakes. Rarely, some serological strains can be transmitted droplets. In the temperate climate zone outbreak of enterovirus infection occur in the warm time of the year – summer and early fall. This files most often infected pre-school children.

Clinical implications

Clinical features and manifestations of infection are diverse, ranging from nonspecific symptoms to paretic diseases. Acute febrile disease ("summer influenza") is manifested mainly by catarrh of the upper respiratory tract, difficulty swallowing, fever, cough and sometimes laryngitis. The effects of selected EV and their serotypes, and what are the symptoms of enterovirus infection causes are listed below.

The clinical spectrum of infections caused by EV and their serotypes

Diseases common to the Coxsackie virus A and B and Echovirus

• asymptomatic infection,
• febrile illness accompanied by respiratory symptoms or without them,
• serous meningitis and encephalitis,
• paretic disease.

Diseases specific to certain groups of enteroviruses or serotypes

Coxsackie

• herpangina,
• syndrome hand-foot-mouth,
• lymphonodular pharyngitis,
• exanthema.

Coxsackie In

• exanthema,
• pleurodynia,
• pericarditis,
• myocarditis,
• generalized disease of the newborn.

New enterovirus: EV-70 and EV-71

• asymptomatic infection,
• fever and diseases of the respiratory system (the"summer flu»),
• meningitis/encephalitis,
• paretic disease (e.g. polio syndrome),
• acute hemorrhagic conjunctivitis (only EV-71).

Caution: viruses!

To viral infections, both cold and warm seasons, are infections caused by small, high stability, picornaviruses, which for a long time remain active in the environment, in contaminated food, water, multiply in the gastrointestinal tract and excreted with the feces.

This infection spread through contaminated water, food or dirty hands. The viruses in this group includes hepatitis a virus, which once again established itself as a common cause of epidemics that occur in late summer and early autumn, and enteroviruses. Preventionenterovirus infection is quite complicated, because in addition to the usual oral-fecal transmission mechanism, the virus can sometimes spread droplets.

Should take into account the fact that in addition to poliovirus, there are more than 60 different antigens of the types of EV, which historically divided into groups of Coxsackie A, Coxsackie and Echovirus (in accordance with the classification based on susceptibility and biological effects of infection in cell culture), also a relatively recent survey has allocated a new isolated species, known as EV-68-EV-71, whose existence and clinical significance of a wide range of doctors are less informed. This, to some extent, complicates the diagnosis and, therefore, the definition of treatment.

The increase in incidence of EV infection among the population is less pronounced than for other diseases. Many infections are inapparent, and clinical symptoms of enterovirus infection of the same type in different people can be very diverse. Most often, we are talking about transient fever, sometimes accompanied by respiratory disease or a rash in the mouth (like rashes that cause enterococci).

Serious, relatively common symptoms of EV infection include aseptic meningitis, less common paralysis, encephalitis, myocarditis, or pericarditis. All enterovirus infections are more or less genetically linked, different species can cause similar clinical symptoms, and antibodies against EV in some serological tests, to a large extent can cross-react. Although the symptoms of diseases caused by various enteroviruses are often similar, some species or strains with increased virulence can be especially dangerous. In recent years, researchers from Malaysia and Taiwan have confirmed that such threat include the enterovirus EV-71, the impact of which died today, reportedly, not one person.

Could it kill EV-71?

Since 1969, when it was first dedicated EV-71, is gradually repeatedly pointed out that in addition to the General manifestations of infection, this strain can cause serious, sometimes fatal, disease resembling poliomyelitis. In 1975 in Bulgaria were registered the epidemic paralytic disease with two dozen victims. As suspected factor has been studied polio. In professional circles this epidemic has caused a stir, because all the children were vaccinated against polio. After a careful examination, however, the diagnostic cent showed that the causative agent is a dangerous infection of EV-71. A similar epidemic has been too late in Bulgaria and Hungary.

In the period from 1997 to 1998, hazardous EV-71snova showed itself. During the 5 warm months, when it came to the increasing number of cases of febrile disease with vesicular rash, sometimes with a slight paralysis in 1997 in Sarawak (Malaysia) died 34 children aged 5 months to 7 years. The disease was characterized by rapid course with signs of encephalitis and cardiomyopathy. The cause of death was cardio-pulmonary failure. An autopsy confirmed significant signs of inflammation of the brain stem. Histological examination of the cardiac muscle shown by the results in the norm, in contrast to the clinical and pathological, in which echocardiography showed a decrease in myocardial contractility. This dissociation of clinical and histological definitions is typical of adenoviral myocarditis.

During detailed studies in children with uncomplicated illnesses and deaths were isolated EV-71 and adenovirus, which were not identical with any previously known human adenovirus. Genome sequencing has defined its affinity with adenovirus T-16. It has been suggested that in the case of severe and deadly diseases took place a synergistic effect of concurrent infection by a cardiotropic strain of adenovirus and EV-71.

In the following, 1998, for several months in all areas of the island and Taiwan was registered with clinical signs of enterovirus infection in more than 120,000 people. Symptoms, mostly, had a similar febrile respiratory illness with sore throat, herpetic or vesicular rash and ulcers on the legs (syndrome hand-foot-mouth), with short-term paralysis or aseptic meningitis.

According to epidemiological analysis of the dominant propagation mechanism was drip path. When it was proven enterovirus infection diagnosis showed the presence of different strains of enteroviruses. It was identified 62% of the isolates of EV-71, 27,5% – Coxsackie A-16, the remaining strains were represented by various other enteroviruses. As in Malaysia, was registered extremely high percentage of very serious and deadly disease, mostly in children under the age of 6 years.

Dominated by a large number of rhombencephalitis detected by means of MRI, a high incidence of pulmonary hemorrhage and pulmonary edema. Killed 78 children. Severe and fatal cases were mainly associated with isolated EV-71. It is not yet clear whether this strain rhombencephalic, cardio-pulmonary insufficiency and fatal infection, or severe disease in some people occurs as a result of double infection ordue to other circumstances.

In our country for detection of antibodies against EV, in particular, used diagnostic method ELISA with a kit for the detection of antibodies against EV-68-71. In some neurological diseases, including encephalitis and rhombencephalic, has been shown a significant increase in antibodies against these conjugated antigens. Therefore, it is believed that severe infection of EV-71 sporadically and us. Unfortunately, at the time of poliovirus infection, effectively preventable polio enterovirus infection this treatment currently has not, whether in the form of vaccination or specific treatment. The question of how to treat enterovirus 71, is under study.

Illness caused by enterovirus

Herpangina is caused mainly, Coxsackie virus group A, at least part of this other enteroviruses. The disease affects mainly children aged 3 to 10 years. The disease is manifested by a sudden fever, vomiting, headache, pain in muscles and throat. Common signs are redness of the throat and tonsils, the soft palate and the tonsils appear small vesicles, which later become ulcers. The mucous membrane is not damaged. Sometimes there can be signs lymphonodular pharyngitis. Fever lasts 2-4 days. Treatment of enterovirus infection in this case is only symptomatic, antibiotics are not used.

Pleurodynia (Bornholm disease) or epidemic myalgia, is usually caused by Coxsackie virus group B. the Disease begins with fever and severe pain, localized in the muscles of the chest, abdomen, and extremities. The pain is intense, increased by movement or coughing, a person suffers from excessive sweating. The disease can mimic pleurisy, coronary phenomenon, intestinal illness and, in the case of lesions of the extremities, may occur similarly paretic disease. Therapy is only symptomatic.

Acute hemorrhagic conjunctivitis is manifested by pain and burning sensation in eyes, hemorrhages of the conjunctiva. Illness during the week, spontaneously disappears. The infection transmitted through contaminated hands, the disease is very contagious. Usually, it begins in the unilateral sense of the presence of a foreign body in the eye, but within a few hours and affects other eye. Recovery occurs within 10 days. Conjunctivitis may be complicated by bacterial infections, in severe cases, keratitis. In the case of this complication requires the services of a therapist, the attending physician will direct the patient to an ophthalmologist to determine the treatment.

Nerve lesions caused by enterovirus, may manifest as aseptic meningitis, encephalitis or paretic disease. Meningitis and encephalitis its course does not differ from meningitis of other etiologies, for example, enterococcal.

The disease tends to be more severe in older children and adults. In addition to the fever and meningeal symptoms may be signs of respiratory disease, and myalgia. The symptoms usually disappear within 2-10 days.

Therapy is symptomatic, as in other serous meningitis and encephalitis. Rarely, especially in children of early age, the disease may manifest as focal encephalitis.

Enteroviruses can cause flaccid paralysis, resembling poliomyelitis paresis, but, as a rule, this condition is not permanent.

The diagnosis is established by isolating the virus from cerebrospinal fluid and stool associated with a significant increase of antibodies against a selected virus or detection of antigens by PCR.

Neonatal enterovirus infection form a special group because of their serious course. The majority of infections start between 3 and 7 day of age, infants manifest 1-2 main symptoms: myocarditis or hepatitis. The causative agent is Coxsackie virus group b, the disease is subacute. The prognosis is serious, the mortality rate exceeds 50%.

Enterovirus rash is a relatively common manifestation of EV infection. The clinical picture presented by various lesions. Special clinical unit is "Boston disease". Syndrome hand-foot-mouth manifested by fever and vezikulezny lesions in the oral cavity (stomatitis), on the palms of the hands and soles of the feet. The fever lasts about 2-4 days.