Enteroviral infections at children - acute infectious diseases as which causative agents serve intestinal viruses (enteroviruses) from family of picornaviruses. Clinical displays of an enteroviral infection at children of a polimorfna; the disease can proceed in the following forms: catarrhal, gastroenteritichesky, enteroviral fever, enteroviral ekzantema, gerpangina, serous meningitis, myocarditis, entsefalomiokardit of newborns, conjunctivitis, uveit, etc. For detection of viruses in biological liquids the PTsR, IFA, RPGA methods are used. Etiopatogenetichesky treatment of an enteroviral infection at children is carried out by interferona, immunoglobulins and other medicines.
Enteroviral infection at children
Enteroviral infections at children – extensive group of the diseases caused by the RNA-containing nepoliomiyelitny viruses (Koksaki, ECHO which are not classified by enteroviruses of the person) and a poliovirus. Owing to specificity of the caused damages, poliomyelitis costs a little separately among enteroviral infections at children therefore is considered by us separately. Within this review we will stop on the enteroviral infections of a nepoliomiyelitny etiology extended among children.
Along with a SARS, enteroviral infections meet in pediatrics quite often. Annually among total of patients with an enteroviral infection the specific weight of children makes 80-90%; from them a half of cases are the share of children of younger age. Considering polymorphism of clinical manifestations, enteroviral infections at children are of interest not only to experts in the field of infectious diseases, but also neurology, gastroenterology, cardiology, ophthalmology, otolaryngology.
The reasons of an enteroviral infection at children
Causative agents of enteroviral infections of a nepoliomiyelitny etiology at children Koksaki's viruses And (24 serotypes), as Koksaki In (6 serotypes), ECHO (34 serotypes) and not classified enteroviruses of the person of 68-71 serotpip act. All nepoliomiyelitny enteroviruses resistance to low temperatures (freezing, thawing) and a bystry inactivation in the conditions of high temperature (unites at boiling) or influence of chlorine-containing solutions, iodine, formalin, peroxide of hydrogen, Ural federal district.
Children and adults, being virus carriers or patients with a manifest form of a disease can be sources of an enteroviral infection. Transmission of infection from the person to the person is carried out airborne or fecal and oral in the ways; transplacentary transfer is less often noted. Seasonal rises in incidence of enteroviral infections among children are noted at the end of summer – an early autumn. The greatest incidence is registered among children aged from 3 up to 10 years. Adults and children of advanced age get sick less often that is explained by existence at them of the immunity created owing to an asymptomatic infection. Along with sporadic cases and the epidemic outbreaks of an enteroviral infection in children's collectives, the large epidemics striking the whole regions meet.
Penetration of enteroviruses into an organism happens through mucous membranes of a digestive and respiratory tract. Replication of viruses happens in lymphoid fabric, an epithelium of a rotoglotka and a GIT therefore early clinical displays of an enteroviral infection the child can have herpangina, a pharyngitis, diarrhea and so forth. Further spread of viruses on an organism happens in the hematogenic way. Possessing an organotropnost, enteroviruses can strike nervous tissue, muscles, integumentary tissues, vessels of eyes etc. After the postponed enteroviral infection at children type-specific immunity to that serological type of a virus which caused a disease is formed.
Classification of an enteroviral infection at children
In dependence of the leading clinical syndrome, distinguish typical and atypical enteroviral infections at children. Typical forms can be shown in the form of the isolated or combined defeats: herpangina, Qatar of the top airways, gastroenteritis, epidemic mialgiya, enteroviral fever, enteroviral ekzantema, hepatitis. Defeat of nervous system at an enteroviral infection at children can proceed as encephalitis, serous meningitis, an entsefalomiokardit of newborns, paralyzes; damage of heart – in the form of myocarditis and a perikardit; damage of eyes – in the form of hemorrhagic conjunctivitis and a uveit; defeat of urinogenital system – in the form of hemorrhagic cystitis, an orkhit, an epididymite. Cases of the erased and asymptomatic current belong to atypical forms of an enteroviral infection at children.
Taking into account expressiveness of clinical signs the enteroviral infection at children can have an easy, medium-weight and heavy current. Expressiveness of local changes and an intoksikatsionny syndrome act as criteria of severity. On character of a current enteroviral infections at children are subdivided on uncomplicated and complicated.
Symptoms of an enteroviral infection at children
Despite polymorphism of clinical manifestations, some common features are peculiar to the course of various enteroviral infections at children. Duration of the incubatory period makes from 2 to 10 days (on average 2-4 days). The demonstration of a disease takes place sharply, from high fever (39-40 °C), a fever, a headache, weakness, a sleep disorder, lack of appetite, repeated vomiting.
At any form of an enteroviral infection at children hyperaemia of face skin, neck and the top half of a trunk, an injection of vessels of a conjunctiva and skler is noted. Emergence of polymorphic spotty and papular rash, hyperaemia mucous almonds of handles and a back wall of a throat, cervical lymphadenitis is possible. It is considered that pre-natal infection of an enetrovirusama can serve as the reason of a syndrome of sudden children's death. Communication between an enteroviral infection at children and development of diabetes of 1 type is also proved.
Except the general symptomatology, at clinic of various forms of an enteroviral infection children have specific manifestations.
Enteroviral fever at children (a small disease, summer flu, three-day fever) is caused by different serotypes of viruses of Koksaki and ECHO. The sharp demonstration from fever, mialgiya, the moderate catarrhal phenomena is characteristic of an infection. At the child the general symptoms of an enteroviral infection are expressed: injection of vessels skler, hyperaemia of the person, increase in lymph nodes, etc.; increase in a liver and spleen can be noted. This form of an enteroviral infection at children proceeds easily, usually no more than 2-4 days. In rare instances enteroviral fever proceeds 1-1,5 weeks or has a wavy current.
The intestinal (gastroenteritichesky) form of an enteroviral infection meets at children up to 3 years more often. The disease proceeds with the insignificant catarrhal phenomena (rhinitis, a nose congestion, hyperaemia mucous rotoglotka, cough) and a dispepsichesky syndrome (diarrhea, vomiting, a meteorizm). Heavy intoxication, dehydration and the phenomena of colitis are not peculiar. Duration of an intestinal form of an enteroviral infection at children makes 1-2 weeks.
The enteroviral ekzantema associated with ECHO and Koksaki-virusami is characterized by emergence at height of fever of skin rash. On character rash can remind that at scarlet fever, measles or a rubella; elements settle down mainly on face skin and trunks. Less often vesiculate rashes in the oral cavities reminding herpes (a puzyrchatka of an oral cavity) meet. The course of an enteroviral infection at children favorable; rash and fever disappear within 1-2 days.
Epidemic mialgiya (disease of Bornholm, plevrodiniya) – the enteroviral infection at children caused by Koksaki and ECHO viruses. As the leading display of a disease serve the intensive muscular pains accompanying high fever. More often children complain of thorax pains and the top half of a stomach, is more rare – in a back and extremities. At the movement of pain amplify, causing a pobledneniye of integuments, plentiful sweating, . The epidemic mialgiya demands performing differential diagnostics with pleurisy, an acute appendicitis or peritonitis. Out of a painful attack children feel much better. This form of an enteroviral infection at children quite often proceeds together with gerpanginy and serous meningitis.
Serous meningitis is a typical form of an enteroviral infection at children. The clinical picture is characterized by high temperature of a body, a severe headache, repeated vomiting, concern and excitement of the child, nonsense and spasms. From a respiratory path the pharyngitis phenomena are noted. From the first days meningealny symptoms are expressed: positive symptoms of Brudzinsky and Kerniga, rigidnost of muscles of a nape. Usually in 3-5 days the symptomatology regresses, however the post-infectious adynamy and the residual phenomena can remain within 2-3 months.
The Poliomiyelitopodobny (paralytic) form of an enteroviral infection at children is one of the heaviest. As well as at poliomyelitis, damage of forward horns of a spinal cord can lead to development of sluggish paralyzes and paresis of the lower extremities. In mild cases the limping gait, weakness in legs, decrease in a muscular tone are reversible and gradually disappear in 4-8 weeks. At severe forms of an enteroviral infection at children the lethal outcome owing to malfunction of the respiratory and sosudodvigatelny centers is possible.
Entsefalomiokardit newborns is caused by Koksaki's viruses of type B and it is characteristic for premature and children of the first months of life. Against the background of the general symptomatology (slackness, refusal of a breast, a subfebrilitet) the phenomena of heart failure (tachycardia, short wind, cyanosis, arrhythmia, expansion of borders of heart and liver) accrue. At encephalitis the vybukhaniye of fontanels and a spasm develops. The lethality at this form of an enteroviral infection among children reaches 60-80%.
Hemorrhagic conjunctivitis is caused by an enterovirus of type 70. It is shown by a photophobia, dacryagogue, feeling of a foreign matter in eyes. Objectively hypostasis and hyperaemia of a conjunctiva, dot hemorrhages are defined. At accession of a secondary infection bacterial conjunctivitis can develop, keratit. Usually all symptoms of an enteroviral infection at children abate in 10-14 days.
Enteroviral uveit mainly strikes children of the 1st year of life. This form of an enteroviral infection proceeds with fever, intoxication, an intestinal and respiratory syndrome. Defeat of a vascular cover of an eye has resistant character and can lead to iris dystrophy, turbidity of a cornea, development of a uvealny cataract and glaucoma, an eyeball subatrophy.
Features of a course of herpangina are analysed in the corresponding review.
Diagnosis of an enteroviral infection at children
Enteroviral infections are diagnosed for children on the basis of typical simptomokompleks taking into account seasonality and epidemiological data. For establishment of the diagnosis laboratory confirmation of an enteroviral infection at children is obligatory: enterovirus RNA detection by the PTsR method, definition of a caption of specific antibodies by means of IFA, RSK or RPGA, etc.
Laboratory verification of activators can be carried out in various biological liquids: in blood, separated conjunctivas, washout from a nasopharynx, scrapes from skin rashes, samples of excrements, cerebrospinal fluid (in the presence of indications for a lyumbalny puncture), bioptata of bodies, etc.
Depending on the leading clinical syndrome children can need consultation of the pediatrician, children's cardiologist, children's neurologist, children's otolaryngologist, children's ophthalmologist, etc. experts. Various forms of an enteroviral infection demand performing differential diagnostics with poliomyelitis, measles, a rubella, scarlet fever, epidemic parotitis, a SARS from children, OKA.
Treatment of an enteroviral infection at children
Treatment of the easy isolated forms of an enteroviral infection at children is carried out on an outpatient basis; hospitalization is required at serous meningitis, encephalitis, myocarditis, the crushing combined defeats. In the feverish period rest, a bed rest, the sufficient drinking mode are shown.
Etiopatogenetichesky therapy of an enteroviral infection at children includes application of recombinant interferon (an interferon alpha), interferonogen (oxodihydroacridinylacetate, a meglyumin of an akridonatsetat), polyspecific immunoglobulins (at a heavy current).
At myocarditis, meningitis, etc. forms purpose of glucocorticosteroids is shown. Symptomatic treatment is at the same time carried out (reception febrifugal, dezintoksikatsionny therapy, irrigation of a cavity of a nose, rinsing of a pharynx, etc.).
The forecast and prevention of an enteroviral infection at children
In most cases the enteroviral infection at children comes to an end with a convalescence. The most serious concerning the forecast are enteroviral encephalitis, entsefalomiokardita of newborns, meningitis, a generalized infection, accession of bacterial complications.
The children who got sick with an enteroviral infection are subject to isolation; the quarantine for 2 weeks is put on contact persons. In the epidemiological center disinfection events are held. In view of a big variety of enteroviruses the specific vaccine against an infection is not developed. Nonspecific prevention includes endonasal instillation of leykotsitarny interferon to the children and adults contacting to the patient with an enteroviral infection.