Enterovirus infections: symptoms

Enterovirus infection has an incubation period, which is from 2 to 10 days, an average of 3-4 days.

Symptoms of enterovirus infection make it possible to classify enterovirus diseases (OA Chesnokova, VV Fomin):

• typical forms:
  • herpangin;
  • epidemic myalgia;
  • aseptic serous meningitis;
  • exanthema;
• atypical forms:
  • inapparantnaya form;
  • a small disease ("summer flu");
  • catarrhal (respiratory) form;
  • encephalic form;
  • encephalomyocarditis of newborns;
  • poliomyelitis-like (spinal) form;
  • epidemic hemorrhagic conjunctivitis;
  • uveitis;
  • nephritis;
  • pancreatitis.

Often there are combined symptoms of various clinical forms - mixed forms of enterovirus diseases.

[1], [2], [3]

Herpangina

Coxsackie A viruses (serotypes 2, 3, 4, 6, 7 and 10) and Coxsackie B (serotype 3) are caused. A typical clinical picture of herpangina occurs in a third of the diseased, in others the disease occurs in the form of a mild febrile state. The onset is acute with a rapid rise in body temperature to 39.0-40.5 C, while the overall condition of patients can remain relatively satisfactory. Fever lasts from 1 to 5 days (usually 2-3 days). When examining the oropharynx, hyperemia of the mucous membrane of the soft palate, palatine arch, ligula, posterior pharyngeal wall is revealed. Within 24-48 h on the anterior surface of the tonsils, palatine arch appears from 5-6 to 20-30 small papules of grayish-white color 1-2 mm in diameter, which can occur in groups or separately. Soon they turn into bubbles filled with transparent contents. After 12-24 hours (less often on the 3-4th day of the disease), after their opening, erosions with a diameter of up to 2-3 mm are formed, covered with a grayish coating which can merge. Around the erosions a corolla of hyperemia is formed. The pain in the throat is moderate or absent, but may increase with erosion. Erosions heal within 4-6 days without mucosal defects. The disease often recurs. Sometimes the herpangina develops against the background of serous meningitis.

Epidemic myalgia

Pleurodinia (Bornholm disease) is caused by Coxsackie viruses (types 1-5), Coxsackie A (serotype 9) and ECHO (serotypes 1, 6, 9).

Prodromal phenomena occur rarely. A typically acute, sudden onset of chills and a rise in body temperature to 39-40 ° C, the appearance of general weakness, nausea, often vomiting, as well as severe headache, pain in the pectoral muscles, epigastric and umbilical regions, back, extremities. The appearance of myalgias is associated with the development of myositis. Pain increases with movement, coughing, often become painful and accompanied by heavy sweating. The duration of pain attacks ranges from 5-10 minutes to several hours (often 15-20 minutes). In a number of cases, seizures are accompanied by vomiting and repeated after 0.5-1 h. The appearance of tension in the muscles of the abdominal wall and their sparing during breathing often allow suggesting the syndrome of the acute abdomen, in connection with which patients are often sent to the surgical department. With pain in the chest area in some cases, mistakenly diagnose pleurisy, pneumonia or an attack of angina. When pain occurs, motor anxiety is noted. In the intervals between attacks, the patients are depressed, apathetic, lie quietly and make the impression of sleeping. The fever persists for 2-3 days. During painful attacks, tachycardia often occurs, but relative bradycardia is also possible. Zev is hyperemic, on the mucous membrane of the palate often reveals granularity, characteristic of cervical lymphadenitis. In some patients, hepatosplenomegaly is noted. Muscle pains on the third day of the disease become less intense or disappear, although they sometimes persist after the temperature normalization. The average duration of the disease is 3-7 days. When the wave-like course of the disease (2-3 exacerbations with an interval of 2-4 days), the duration of the disease increases to 1.5-2 weeks.

[4], [5], [6], [7], [8], [9], [10]

Serous enterovirus meningitis

One of the most common and severe forms of enterovirus infection. It is caused by neurotropic genotypes of enteroviruses: Coxsackie A (serotypes 2, 4, 7, 9), Coxsackie B (serotypes 1-5), ECHO (serotypes 4, 6, 9, 11, 16, 30). It is registered both in the form of epidemic outbreaks, and sporadic cases. Rarely a prodromal period lasting 1-2 days, at which there is weakness, irritability, drowsiness. A sharp onset of the disease with symptoms of general intoxication and an increase in body temperature to 38.0-39.0 ° C, less frequently to higher figures is characteristic. Symptoms of meningitis occur in the early days of the disease, sometimes on the 3-5th day, accompanied by a second increase in body temperature. Typical general hyperesthesia (hyperacusia, photophobia, hyperesthesia of the skin), intense headache of a bursting nature, vomiting "fountain" without previous nausea, which occurs during the first hours of the disease. In a number of cases, psychomotor agitation and convulsions are observed. Deep disorder of consciousness is extremely rare. In patients, meningeal symptoms are noted, in some cases dissociation of meningeal symptoms or incomplete meningeal syndrome (for example, the presence of neck stiffness with negative Kernig symptom and vice versa) is characteristic. Fever and meningeal symptoms usually persist for 3-7 days. In an acute period, more often a relative bradycardia, less frequent tachycardia and absolute bradycardia. With the development of edema-swelling of the brain, the increase in blood pressure is noted. Patients have no appetite, the tongue is covered with a whitish coating and thickened. Often there is flatulence, with palpation of the abdomen there is a rumbling. Catarrhal phenomena are possible. In the peripheral blood, moderate leukocytosis is noted, neutrophilia with a shift to the left. Which subsequently gives way to lymphocytosis. Spinal-cerebral fluid is colorless, transparent. With puncture emerges with increased pressure (250-350 mm of water). There is a lymphocytic pleocytosis (several tens and hundreds in 1 mm ³ ). However, in the first 1-2 days of the disease, neutrophils (up to 90%) can prevail in the cerebrospinal fluid. In a number of cases, the mixed nature of cytosis is noted. The protein content is within normal limits. The glucose level is within normal limits or increased. Perhaps a recurring course of meningitis. In this case, the growth of meningeal symptoms is accompanied by an increase in body temperature.

According to MA. Dadimonova (1986), in 15-30% of patients expressed meningeal symptoms are absent, while in the cerebrospinal fluid, inflammatory changes are detected. In some patients with a clear meningeal symptomatology, the composition of the cerebrospinal fluid does not change (meningism). The composition of the cerebrospinal fluid completely normalizes after 10-12 days (less often by the end of the third week after the onset of the disease).

Small disease

(Coxsackie and ECHO fever: a three-day, or uncertain, fever, "summer flu") can cause all types of malovirulent strains of enteroviruses. Clinically, a small disease is characterized by a short-term fever (not more than 3 days), weakness, frustration, mild headache, vomiting, myalgia. Pain in the abdomen. Catarrhal phenomena from the upper respiratory tract occur in less than two-thirds of patients. Perhaps the two-wave course of the disease.

Enterovirus exanthema

(Epidemic, or Boston, exanthema, and also korepodobnaya and krasnukhopodonaya exanthema) is caused by ECHO viruses (types 4, 5, 9, 12, 16, 18), less often Coxsackie viruses (types A-9, A-16, B-3) . Refers to the number of mild forms of enterovirus infection. Enterovirus exanthem is recorded more often in the form of small outbreaks, but large epidemics are also described. The disease develops sharply with a rise in body temperature to 38-39 ° C. Characterized by general weakness, severe head and muscle pain, sore throat, cervical lymphadenitis, exanthema on the face, trunk and extremities. The rash is rubella-like, less often maculopapular, bullous, petechial, stored 2-4 days. There is spotted enanthem on the mucous membrane of the oropharynx. In an acute period, pharyngitis, conjunctivitis often occurs. In a number of cases, the disease is accompanied by phenomena of meningism or combined with serous meningitis. Fever lasts 1-8 days

In a number of cases, enterovirus exanthema only occurs with lesions of the hands, feet, mouth (in the German literature - HFMK, short for Hand-Fuss- Mundkrankheit). The disease is caused by Coxsackie A viruses (serotypes 5, 10, 16). With this form, against a background of moderate intoxication and a slight increase in body temperature, a vesicular rash appears on the fingers and feet, with elements 2-3 mm in diameter, surrounded by an inflammatory corolla. Simultaneously in the tongue and mucous membrane cheeks, palate reveal single small aphthae.

The catarrhal (respiratory) form is a common enterovirus infection that is caused by many types of enteroviruses. This form predominates in case of infection caused by the Coxsackie A-21 virus. Both children and adults are ill. It develops sharply, in the form of an influenza-like illness with an increase in body temperature and symptoms of intoxication. Characteristic rhinitis with serous-mucous discharge, dry cough, hyperemia and granularity of the mucous membranes of throat. Possible manifestations of the disease in the form of pharyngitis with regional lymphadenitis and short-term subfebrile fever. Sometimes children develop false croup, and the course of the disease is in some cases complicated by pneumonia and myocarditis. In uncomplicated cases, fever persists for about 3 days, catarrhal phenomena - about a week.

[11], [12], [13], [14], [15], [16], [17]

Enteroviral diarrhea

(Viral gastroenteritis, "vomiting disease") is more often caused by ECHO viruses. Mostly sick children under 2 years. Less often - adults. A short prodromal period is possible, which is manifested by general malaise, weakness, headache, and lack of appetite. The disease develops sharply with a rise in body temperature to 38-39 ° C, less often to low-grade figures. The febrile period lasts an average of about a week. Simultaneously with the increase in body temperature, a liquid stool without pathological impurities is noted up to 2-10 times a day. The abdominal distension is characteristic, painfulness is possible on palpation (more pronounced in the ileocecal region). Appetite is absent. Language is imposed. In the first days, repeated vomiting is often noted, but even with the duration of dyspepsia from 2 days to 1.5-2 weeks, no significant dehydration occurs. Sometimes hepatosplenomegaly is noted. Often there are signs of catarrh of the upper respiratory tract.

[18], [19], [20], [21]

Encephalomyocarditis of newborns

The most severe variant of enterovirus infection caused by Coxsackie viruses (types 2-5) and arising as outbreaks in maternity hospitals. The source of infection can be mothers (infection is realized through the placenta or during labor) or medical personnel. Against the background of the rise in temperature, there is a violation of appetite, drowsiness, vomiting, diarrhea. Fever has a two-wave character (sometimes absent). Characteristic of cyanosis or gray skin color, tachycardia, dyspnea, expansion of the boundaries of the heart, deafness of the tones, disturbance of the heart rhythm, the appearance of noises in the heart, enlargement of the liver and spleen, edema, in rare cases jaundice and hemorrhagic rash. When the CNS is affected, convulsions occur, and a coma may develop. When examining the cerebrospinal fluid, lymphocytic pleocytosis is detected.

[22], [23], [24], [25], [26]

Paralytic form of enterovirus infection

(Spinal, poliomyelitis-like) form is caused by Coxsackie A viruses (types 4, 7, 10, 14) and B (types 1-6), and also by ECHO viruses (types 2, 4, 6, 1, 9, 11, 16). The disease is more often recorded in the warm season in the form of sporadic cases in children 1-5 years of age. It flows mainly in the form of mild paralytic forms. Heavy forms are rare. A third of patients are diagnosed with a preparative period characterized by symptoms. Characteristic of other forms of enterovirus infection (small disease, respiratory, herpagine). More often, pareses are acute, against a background of complete health, while the body temperature rises slightly or remains normal. Usually, the lower limbs are affected and the so-called morning limp develops. There is a violation of the gait in the form of limping, with the knee flexing, the foot is hanging, the foot is rotated outward and the muscle tone is reduced. Surface and deep reflexes are not violated; less often note hypo- or hyperreflexia. In the presence of fever in the cerebrospinal fluid, a slight increase in protein content is observed, a mild lymphocytic pleocytosis. Parezy pass relatively quickly, usually with complete recovery of motor functions, but in rare cases for several months, hypotension and hypotrophy of the affected muscles are maintained. In severe bulbar, bulbospinal forms of infection, deaths are described.

Rare forms of enterovirus infections include encephalitis, meningoencephalitis, myocarditis, pericarditis, epidemic hemorrhagic conjunctivitis. Uveitis, nephritis, pancreatitis, hepatitis.

Enteroviral encephalitis and meningoencephalitis

They are caused by different types of Coxsackie and ECHO enteroviruses. Characteristically acute onset with severe headache. Vomiting and fever, which can have a two-wave character. In severe cases, a violation of consciousness, cramps, focal neurological symptoms (nystagmus, paralysis of the cranial nerves, etc.) are possible.

[27], [28], [29], [30], [31], [32], [33],

Enterovirus pericarditis and myocarditis

They are caused by Coxsackie viruses (types 2-5). Less often by ECHO viruses (types 1, 6, 8, 9, 19). More often the defeat of the heart develops in older children and adults after the transferred respiratory form of enterovirus infection (after 1.5-2 weeks), less often - in isolation. At the same time against a background of moderate fever, general weakness grows, pains appear in the heart area. When examined, the enlargement of the heart borders, deafness of the tones, pericardial friction noise are revealed. The course of the disease is benign, the prognosis is favorable.

[34], [35], [36], [37], [38]

Epidemic hemorrhagic conjunctivitis

It is more often caused by enterovirus type 70, less often by other enteroviruses. The disease begins acutely with the defeat of one eye. In a number of cases, after 1-2 days another eye is affected. Characteristic sensation of a foreign body, "sand" in the eyes, lacrimation and photophobia. On examination, edema of the eyelids is revealed. Hemorrhages in the hyperemia conjunctiva and lean mucopurulent or serous discharge. The disease of the bowl is benign, the recovery comes in 1.5-2 weeks.

[39], [40], [41], [42], [43], [44], [45], [46], [47]

Complications of enterovirus infection

With epidemic myalgia, aseptic serous meningitis, encephalitis and meningoencephalitis, swelling and swelling of the brain develops in a number of cases. With bulbar disorders, severe aspiration pneumonia is possible. In some cases, the respiratory form is complicated by secondary bacterial pneumonia, croup. In 8-10 ° of cases, epidemic hemorrhagic keratoconjunctivitis and uveitis lead to the development of cataract and bilateral blindness.

[48], [49], [50]