Enterovirus Infections - Diagnosis

Diagnosis of enterovirus infection during an epidemic outbreak and typical clinical manifestations is usually not difficult, but requires laboratory confirmation. Diagnosis of atypical and mild forms of the disease is often difficult.

The final diagnosis is established using serological tests and virus isolation from nasopharyngeal mucus, cerebrospinal fluid, feces, and blood. The PCR method is highly effective. For serological testing in RN, RSK, RTGA, and gel precipitation reaction, paired sera are used, obtained at an interval of 10-12 days (the first on the 4th-5th day of illness, the second after the 14th day of illness). The diagnostic criterion is an increase in antibody titer by 4 times or more. Detection of the virus in feces in the absence of an increase in antibody titer over the course of the disease does not serve as a basis for diagnosing enterovirus infection, since asymptomatic carriage is often observed.

Instrumental diagnostics of enterovirus infections:

• ECG;
• chest x-ray;
• CT and MRI of the brain:
• EchoCG.

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Indications for consultation with other specialists

Indications for consultation with other specialists are determined by the form of infection:

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

Differential diagnostics of enterovirus infections

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

Serous meningitis and meningoencephalitic form of enterovirus infection are differentiated from serous meningitis and meningoencephalitis of other etiologies. In this case, both epidemiological and clinical features of enterovirus meningitis are taken into account: characteristic summer seasonality, frequent group nature of the disease, benign course with rapid regression of meningeal syndrome. In mumps meningitis, in most cases, damage to glandular organs is noted (inflammation of the salivary, pancreas and gonads), a significant increase in the level of amylase and lipase is noted in the blood serum. In case of neutrophilic pleocytosis, differential diagnostics are performed with bacterial purulent meningitis, which is characterized by severe intoxication, meningeal syndrome, 4-5-digit pleocytosis of the cerebrospinal fluid, decreased glucose levels and increased lactate content. Tuberculous meningitis and meningoencephalitis are characterized by gradual development and progressive neurological symptoms. Moderate weakness, depression, gradual increase in body temperature from subfebrile numbers to 38-39 °C, gradually increasing headache, loss of appetite, vegetative-vascular disorders (persistent red dermographism, Trousseau spots) develop within 1-2 weeks. Studies are conducted to identify a tuberculous process of another localization. In the cerebrospinal fluid, a progressive decrease in glucose content, a 1.5-2-fold decrease in chloride levels, and the appearance of a fibrin film when left to stand in a test tube are detected.

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

Poliomyelitis (unlike the poliomyelitis-like form of enterovirus infection) is characterized by an acute onset with a rapid rise in temperature, pronounced catarrhal (rhinitis, tonsillitis, tracheitis, bronchitis) and dyspeptic symptoms.

The presence of exanthema in enterovirus infection requires differential diagnostics with such diseases as scarlet fever, measles, rubella. In this case, it is necessary to pay attention to the prodromal period characteristic of these diseases, the stages of the rash, the nature and localization of the exanthema and other clinical signs, as well as the data of the epidemiological anamnesis. It is also necessary to exclude allergic rash in the patient.

Herpangina is differentiated from aphthous stomatitis.

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

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