Coxsackie and ECHO infection in children

Coxsackie and ECHO infection is a group of acute diseases caused by enteroviruses Coxsackie and ECHO, has a variety of clinical manifestations from mild febrile conditions and simple carriage of the virus to severe meningoencephalitis, myocarditis, myalgia.

ICD-10 code

B34.1 Enterovirus infection, unspecified.

Epidemiology

The source of infection is patients with a clinically expressed form and virus carriers.

The infection is transmitted by airborne droplets and feco-oral route, through contaminated water and food products. Transplacental transmission of Coxsackie and ECHO viruses is possible.

Children are highly susceptible to Coxsackie and ECHO viruses. Children aged 3 to 10 years are most often affected. Children under 3 months of age do not get sick due to their transplacental immunity. Older children and adults rarely get sick, which is explained by immunity acquired as a result of asymptomatic infection.

Large epidemics are known to cover large territories and entire countries. In Russia, particularly large epidemic outbreaks were observed in Primorsky Krai and the Far East.

Classification

According to the leading clinical syndrome, serous meningitis, epidemic myalgia, herpetic angina, paralytic form of enterovirus infection, Coxsackie and ECHO fever, Coxsackie and ECHO exanthema, gastroenteritic form, myocarditis, neonatal encephalomyocarditis, enterovirus uveitis and other rare forms are distinguished.

Each form can be isolated, but often along with the leading syndrome there are other clinical symptoms of the disease. Such forms are called combined.

Causes of Coxsackie and ECHO infections

There are two groups of Coxsackie viruses: group A (24 serological types) and group B (6 serological types).

• Coxsackie group A viruses are highly virulent in neonatal mice, in which they cause severe skeletal muscle myositis and death.
• Coxsackie viruses of group B differ in their ability to cause less severe myositis in mice, but they cause characteristic damage to the nervous system, and sometimes to the pancreas and other internal organs.

Causes and pathogenesis of Coxsackie and ECHO infections

Symptoms of Coxsackie and ECHO infections

The incubation period of Coxsackie and ECHO infections is from 2 to 10 days. The disease begins acutely, sometimes suddenly, with a rise in body temperature to 39-40 °C. From the first days, patients complain of headache, dizziness, weakness, poor appetite, and sleep disturbances. Repeated vomiting is often noted. In all forms, hyperemia of the skin of the upper half of the body, especially the face and neck, and injection of the scleral vessels are detected. A polymorphic maculopapular rash may appear on the skin. Hyperemia of the mucous membranes of the tonsils, granularity of the soft palate, arches, and back wall of the pharynx are more or less pronounced. The tongue is usually coated. The cervical lymph nodes are often slightly enlarged and painless. A tendency to constipation is noted.

Symptoms of Coxsackie and ECHO infections

Diagnosis of Coxsackie and ECHO infections

Coxsackie and ECHO infections are diagnosed based on a typical symptom complex (herpetic angina, epidemic myalgia, encephalomyelitis in newborns). The summer-autumn seasonality, information about contact with the patient, etc. are important. Laboratory confirmation of the diagnosis is based on the detection of viral RNA in biological fluids using the PCR method and specific IgM in ELISA. In some cases, they resort to identifying the antibody titer in RPGA, etc.

Treatment of Coxsackie and ECHO infections

Most patients with Coxsackie and ECHO infections are treated at home. Only children with severe forms of the disease (serous meningitis, meningoencephalitis, neonatal encephalomyocarditis, myocarditis, uveitis) are subject to hospitalization.

Etiotropic therapy has not been developed. Treatment is limited to symptomatic and pathogenetic agents. Bed rest is prescribed for the period of acute manifestations of the disease. Significant dietary restrictions are not necessary. In case of hyperthermia, an antipyretic is given, in case of headaches and muscle pain, paracetamol, ibuprofen, analgin, etc. are prescribed.

Treatment of Coxsackie and ECHO infections

Prevention of Coxsackie and ECHO infections

Specific prevention of Coxsackie and ECHO infections has not been developed. Early diagnosis and timely isolation of patients with Coxsackie and ECHO infections for up to 10 days - until the disappearance of clinical symptoms - have a certain anti-epidemic value. Patients with serous meningitis are discharged from the hospital no earlier than the 21st day of the disease, after the disappearance of clinical symptoms and normalization of the cerebrospinal fluid.

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