Enterovirus infections: diagnosis

Diagnosis of enterovirus infection in the event of an epidemic outbreak and typical clinical manifestations usually does not cause difficulties, but requires laboratory confirmation. It is often difficult to diagnose atypical and mild forms of the disease.

Finally, the diagnosis is established with the help of serological studies and isolation of the virus from nasopharyngeal mucus, spinal cord fluid, feces, blood. High efficiency differs PCR method. For serological testing, paired sera obtained at an interval of 10-12 days (the first on the 4th-5th day of the disease, the second after the 14th day of the disease) are used in PH, RNC, RTGA and the precipitation reaction in the gel. Diagnostic criterion - an increase in antibody titer 4 times or more. Detection of the virus in feces in the absence of growth of antibody titer in the course of the disease does not serve as a basis for the diagnosis of enterovirus infection, since asymptomatic carriage is often observed.

Instrumental diagnostics of enterovirus infections:

• ECG;
• chest X-ray;
• CT and MRI of the brain:
• Echocardiography.

[1], [2], [3], [4], [5], [6], [7], [8]

Indications for consultation of other specialists

Indications for consultation with other professionals determine the form of infection:

• with epidemic myalgia - consultation of the surgeon;
• with meningitis and meningoencephalitic form of enterovirus infection - consultation of a neurologist;
• with epidemic hemorrhagic conjunctivitis - consultation of the ophthalmologist;
• with pericarditis and myocarditis - consultation of a cardiologist.

Differential diagnosis of enterovirus infections

Differential diagnosis of enterovirus infections is carried out with a large number of diseases due to the large number of clinical forms of enterovirus infections.

Serous meningitis and the meningoencephalitic form of enteroviral infection are differentiated with serous meningitis and meningoencephalitis of another etiology. At the same time, both epidemiological and clinical features of enteroviral meningitis are taken into account: characteristic summer seasonality, frequent group nature of the disease, benign flow with rapid regression of the meningeal syndrome. In mumps in most cases, lesions of glandular organs (inflammation of the salivary, pancreatic and sexual glands) are noted, in the serum of blood there is a significant increase in the level of amylase and lipase. In neutrophilic pleocytosis, differential diagnostics with bacterial purulent meningitis is performed, with pronounced intoxication, meningeal syndrome, 4-5-digit pleocytosis of the cerebrospinal fluid, a decrease in glucose level in it and an increase in lactate content. Tuberculosis meningitis and meningoencephalitis are characterized by gradual development and progressive neurological symptoms. Within 1-2 weeks, moderate weakness, depression, a gradual rise in body temperature from the low-grade figures to 38-39 ° C, a gradually growing headache, lack of appetite, vegetative-vascular disorders (persistent red dermographism, Tussauds spots) develop. Conduct studies to identify the tuberculosis process of other localization. In the cerebrospinal fluid, a progressive decrease in the glucose level, a chloride level of 1.5-2 times, an appearance when the fibrin film is settled in a test tube is detected.

In a number of cases, with epidemic myalgia it is necessary to conduct differential diagnosis with acute surgical diseases: acute appendicitis, cholecystitis, intestinal obstruction, and exclude the development of pleurisy or an attack of angina pectoris.

For poliomyelitis (in contrast to poliomyelitis-like form of enterovirus infection) is characterized by an acute onset with a rapid rise in temperature. Expressed by catarrhal (rhinitis, tonsillitis, tracheitis, bronchitis) and dyspeptic phenomena.

The presence of exanthema in enterovirus infection requires differential diagnosis with diseases such as scarlet fever, measles, and rubella. Thus it is necessary to pay attention to the prodromal period characteristic for these diseases, the stage of the rash, the character and localization of the exanthema and other clinical signs, as well as the data of the epidemiological anamnesis. It is also necessary to exclude from the patient an allergic rash.

Herpangin is differentiated from aphthous stomatitis.

With enteroviral diarrhea, differential diagnosis of enterovirus infection is carried out with other acute diarrheal infections.

[9], [10], [11], [12], [13]