According to modern concepts, the term “enterovirus infection” unites a group of diseases caused by numerous viruses of the genus Enterovirus and Parechovirus of the Picornaviridae family, characterized by an intoxication syndrome and polymorphism of clinical manifestations.

Enteroviruses (EV) and parechoviruses (PE) are ubiquitous microorganisms that are transmitted from person to person through direct and indirect contact. They cause a wide range of diseases in people of all ages, but most often in children.

Enterovirus infection (EVI) is a typical anthroponosis, the sources of infection in which are patients or virus carriers. Among healthy children, the percentage of virus shedding varies from 7.2 to 20.1%, and at the age of under 1 year it reaches 32.6%. The relative contribution of symptomatic and asymptomatic forms to maintaining viral circulation is unknown, but it is likely that all are important.

The level of natural immunity increases with age. In some areas, over 90% of children are immune to enteroviruses by the age of 5 years. Between 30 and 80% of adults have antibodies to the most common serotypes. Seropositivity of the population is higher in regions with low social and hygienic levels. Therefore, it is often considered as an indicator of the standard of living of the population and the effectiveness of anti-epidemic protection in general.

Traditional classification divides enteroviruses into five groups. Each of them contains a variable number of serotypes.

• Polioviruses - serotypes 1-3.
• Coxsackie viruses group A - serotypes 1-22, 24.
• Coxsackie viruses group B - serotypes 1-6.
• Echoviruses (ECHO) - serotypes 1-9, 11-21, 2427, 29-33.
• Enteroviruses - serotypes 68-71, 73-91, 93102, 104-107, 109-111, 113, 114, 116.

The number of new enterovirus serotypes continues to grow.

ECHO viruses 22 and 23, previously classified as enteroviruses, were isolated in 1999 into the independent genus Parechovirus and received the designations HPEV1 and HPEV2. Parechoviruses share biological, clinical and epidemiological characteristics with enteroviruses, but differ significantly from them in their genomic sequence. Currently, 11 serotypes of parechoviruses have been described.

According to the latest classification of viruses (2003), based on genomic characteristics, non-polio human enteroviruses are represented by 4 species (A, B, C, D).

Enteroviruses are RNA viruses. They are stable in the external environment, but are inactivated at temperatures above 50°C (at 60°C in 6-8 minutes, at 100°C instantly). At a temperature of 37°C they can be stored for 50-65 days. Viruses survive for a long time in water (in tap water - 18 days, in river water - 33 days, in sewage water - 65 days). They die under the influence of ultraviolet irradiation and when dried. Solutions of iodine, 0.3% formaldehyde, 0.1 N HCl or chlorine at a concentration of 0.3-0.5 mg/l quickly destroy viruses.

Epidemiology

Enteroviruses exist in nature thanks to two reservoirs: natural (soil, water, food) and the human body, in which they can accumulate and through which, accordingly, spread.

The main epidemiological feature of the infection is the ability to form the so-called in humans. “healthy virus carrier” with long-term, up to several weeks, release of the pathogen into the external environment. This factor contributes to the survival of the virus in the human population, despite the high level of immune individuals. For the same reason, enteroviruses, along with influenza viruses, are the most common cause of nosocomial viral infections.

Infection with enteroviruses and parechoviruses occurs throughout the year, but a significant increase in the incidence of EVI in the northern hemisphere occurs in the summer and autumn months. In warm regions, this periodicity is absent; in the tropics, the infection is recorded all year round.

EVI occurs in all age groups. However, its incidence is inversely proportional to age. Approximately 75% of EVIs recorded annually by WHO occur in children under 15 years of age. Children under 1 year old get sick several times more often than older children and adults. For unknown reasons, males are at greater risk of developing EVI.

The main mechanism of infection transmission is fecal-oral, carried out through food, water and household contact. Less commonly, the infection is transmitted by airborne droplets and transplacentally (from mother to fetus). Apparently, droplet introduction of the virus into the respiratory tract is accompanied by subsequent evacuation of the pathogen into the oropharynx, where, after ingestion, it enters its ecological niche - the intestines, followed by the traditional development of the infectious process.

Direct contact with infected feces occurs when swaddling infants. Therefore, infants are the most “effective” transmitters of infection. Indirect transmission occurs in poor sanitation conditions through contaminated water, food and household items.

An important route of spread is through contact with contaminated objects and the hands of another person, followed by inoculation of the virus through the mouth, nose or eyes. Cases of infection have been described when swimming in sea water contaminated by sewage. Studies show that secondary infections occur in 50% of family contacts. Infected individuals are most contagious during the first week of illness.

Every 3-4 years there are epidemic outbreaks of the disease caused by various serotypes of viruses. The serotypes that infect humans change significantly every year. The reasons why specific virus serotypes appear and disappear are not known. It has been suggested that the accumulation of a "critical mass" of susceptible young children may be necessary to maintain the epidemic process.

Examples of previously unknown serotypes that have emerged to cause disease outbreaks include:

• Coxsackie A6, which has caused outbreaks of an atypical form of enteroviral exanthema in children in several countries in Europe, the Far East and North America.
• Enterovirus D68, which has been responsible for an increase in respiratory illnesses in the United States and other countries since 2008, and most recently in Missouri, Illinois, and several other states in the late summer/early fall of 2014. Rare cases of polymyelitis-like illness associated with enterovirus D68 also occurred in New Hampshire in 2011 and in California in 2012–13.

During outbreaks, the number of cases of EVI can increase several times. The world often experiences almost global epidemics. For example, the epidemic caused by ECHO 9 in the late 50s or the pandemic of acute hemorrhagic conjunctivitis caused by enterovirus 70 in 1969 and ECHO 11 in 1979-80. Enterovirus 71 has caused local outbreaks of EVI involving a small number of patients over several years and regional epidemics in the Far East involving hundreds of people.

Pathogenesis and pathomorphology

The entry points for infection are the mucous membranes of the oral cavity, intestines and upper respiratory tract. Enteroviruses, which do not have an outer protein shell, freely pass the “gastric barrier” and settle on the cells of the small intestinal mucosa. It is this natural feature of the infection that served as the reason for the single taxonomic name “enterovirus” for this large and quite different group of viruses in their characteristics (by the way, contrary to the popular belief about their frequent and almost obligatory participation in the development of viral diarrhea!).

Subsequently, the pathogen replicates in the lymphoid tissue and epithelial cells of the intestine and mesenteric lymph nodes. Once in the blood, the virus causes primary viremia, which corresponds to approximately the third day of illness.

Enteroviruses exhibit the greatest tropism for cells of the central nervous system and muscle tissue. However, other organs are also involved in the process: heart, liver, pancreas, lungs, kidneys, intestines; blood vessels of the eyes.

Clinical manifestations, the nature of the course, and the outcome of the disease depend on the biological properties of the virus, its predominant tropism, and the state of cellular and humoral immunity. In particular, Coxsackie A viruses experimentally cause muscle damage and flaccid paralysis in newborn mice, and Coxsackie B viruses cause central paralysis without muscle pathology.

At the same time, the same serotype of enterovirus can cause different clinical forms of the disease. But there is also a certain organotropy of some serotypes of enteroviruses, which is confirmed by the uniformity of clinical manifestations during epidemic outbreaks (with a predominance of myalgia, for example, serous meningitis, lesions of the heart, eyes). In all affected organs, swelling, foci of inflammation and necrosis are detected.

Persons who have undergone EVI develop type-specific immunity that lasts for many years, possibly for life.

Clinic

Incubation period with EVI it lasts from 2 to 35 days (usually 2-3 days). A unique feature of enteroviruses is their ability to cause “unpredictable variants” of the disease. The same type of virus can cause both very mild, erased forms of the disease affecting, for example, the respiratory tract or intestines, and extremely severe variants affecting the nervous and cardiovascular systems.

One type of virus can cause both large epidemics and isolated diseases. At the same time, enteroviruses of different serotypes can cause the same clinical syndromes.

Some syndromes are more common in certain age groups: for example, aseptic meningitis is usually observed in infants, and myalgia and myopericarditis - in adolescents and young adults; herpetic sore throat - in children aged 3 months to 16 years, acute hemorrhagic conjunctivitis - in patients aged 20 to 50 years.

The vast majority of cases of EVI (more than 80%) are asymptomatic, about 13% of cases are mild febrile illnesses, and only 2-3% of cases develop a severe form of the disease, mainly in young children and people with impaired immune systems.

Main clinical forms of acquired enterovirus infection

Herpangina(vesicular stomatitis, Zagorsky disease) is most often caused by Coxsackie viruses A and B, less often by ECHO viruses. This form of EVI is mainly registered in children 3-10 years old. Occurs both in the form of sporadic cases and epidemic outbreaks; can occur in an isolated form, but is often combined with meningitis, myalgia, and exanthemas.

The onset of the disease is acute. The intoxication syndrome is moderately expressed, characterized by decreased appetite, headache, weakness, and lethargy. Body temperature rises to febrile levels and persists for 1-3 days.

Local changes are characterized by hyperemia of the mucous membrane of the soft palate, palatine arches and tonsils, uvula and the appearance of small papules 1-2 mm in size with a red rim, transforming into vesicles. They persist for 24-48 hours, then open and form erosions with a gray-white coating. The number of vesicles usually correlates with the severity of the disease. Pathological changes in the pharynx disappear after 6-7 days. There is an increase in tonsillar and submandibular lymph nodes.

Herpetic sore throat should be differentiated from herpetic stomatitis caused by the herpes simplex virus (HHV types 1 and 2). The symptoms of these processes are very similar, but stomatitis is characterized by the predominant location of the enanthema on the mucous membrane of the hard palate, cheeks, tongue and gums. Since EVI is more common in children than herpes simplex, herpangina should be considered as a more likely disease in such cases.

Epidemic myalgia(pleurodynia, Bornholm's disease, "devil's disease"). Myalgia is most often caused by Coxsackie B viruses (serotypes 1-6), less commonly by Coxsackie A viruses. This form is in most cases observed in adolescents and young adults and, in essence, is a viral myositis.

Palpation of the affected muscle is always painful, the muscle is swollen. The pain is usually localized around the costal margin. About half of patients experience pain in the lower pectoral muscles on one or both sides, while the other half experience pain in the upper abdominal muscles. In children, the pain can be localized lower, simulating the clinical picture of an “acute abdomen.”

Characterized by the sudden onset of severe spastic pain in the muscles, which intensifies with a change in body position or inhalation. The attack of spasm ends the same way it begins - suddenly. Damage to the muscles of the limbs is often observed. The attack lasts from 30-40 seconds to 15-30 minutes, rarely - 1 hour. After an attack of pain, body temperature may rise to high levels and myoglobinuria may appear.

The duration of the disease is short, from 1 to 6 days, the course is wavy, after 1-3 days there may be a repeated rise in body temperature.

Serous meningitis. Aseptic meningitis caused by enteroviruses is the most common form of central nervous system (CNS) damage associated with this infection. Parechovirus (PeV3) should be considered the second most common viral cause of meningitis in young children.

It is characterized by an acute onset, body temperature rises to 38-39°C and is constant. A sharp headache, vomiting, and sometimes impaired consciousness and convulsions appear. Positive meningeal symptoms are noted. Fever and meningeal symptoms usually persist for 3-7 days, and a two-wave temperature curve is possible.

The diagnosis is confirmed by examining cerebrospinal fluid. The liquor flows out under pressure, transparent or slightly opalescent. Cytosis of up to 100-500 cells in 1 μl is typical. In the first days of the disease, cytosis can be neutrophilic, later - lymphocytic. The amount of protein is normal or increased. The content of sugar and chlorides is within normal limits. Normalization of the composition of the cerebrospinal fluid usually occurs by the end of the 3rd week.

In infants, severe intoxication syndrome, cerebral symptoms, and pathological changes in the cerebrospinal fluid can be observed in the absence of positive meningeal signs (“asymptomatic liquor-positive meningitis”). This form is extremely difficult for clinical diagnosis.

In practice, aseptic meningitis is often diagnosed by lumbar puncture in children with fever without a visible source of infection. The presence of genetic material of the virus in the cerebrospinal fluid (positive PCR result) reliably confirms the etiology of the disease.

Encephalic form(stem, cerebellar). The disease begins acutely. Body temperature rises to 39-40°C, chills and vomiting are noted. Then changes in consciousness, convulsions, focal symptoms appear, and there may be brainstem disorders (swallowing, breathing and cardiovascular disorders).

In the cerebrospinal fluid there is slight cytosis, high protein content. Severe cases of damage to the nervous system were observed during infection caused by enterovirus type 71 (outbreaks in Transbaikalia and China). Clinical symptoms were described as rhombencephalitis (lesions in the area of ​​the bottom of the 4th ventricle) involving all centers located in this area: severe bulbar syndrome with impaired swallowing, phonation and respiratory disorders.

The outcome is often favorable with recovery within 2-4 weeks, usually without residual effects. However, mono- or hemiparesis may persist. Residual effects are observed mainly in young children.

Characterizing this type of pathology, it is necessary to point out the predominantly demyelinating type of changes in the structures of the central nervous system according to the type of acute disseminated encephalomyelitis (encephalitis, ADEM), which actually explains many points in the development of the disease: features of symptoms, prognosis, connection with a possible severe progressive process like multiple sclerosis or panencephalitis.

Paralytic form(spinal) can be caused by various serotypes of enteroviruses, the most important of which is enterovirus 71, the only serotype associated with outbreaks of paralytic diseases. Large outbreaks involving hundreds of cases, mostly in children over the age of six, have been reported in eastern Europe, Russia, Taiwan and Thailand.

Clinically, it resembles the spinal form of poliomyelitis with the development of asymmetric flaccid paralysis without sensory disorders. The disease is typical for young children. Often the disease begins with symptoms characteristic of other forms of EVI (respiratory, intestinal, etc.).

However, more often paresis develops acutely; in the midst of complete health, gait disturbance (limping), recurvation in the knee joint, rotation of the foot, and muscle hypotonia appear. Reflexes on the affected side are preserved or even increased. The disease progresses favorably and ends with the restoration of all functions. In rare cases, residual effects may persist.

Transverse myelitis- damage to the spinal cord: spastic paresis and paralysis of the arms (less often) and legs (more often) with dysfunction of the pelvic organs (retention or incontinence of urine and stool).

Possible damage to the nervous system in the form of Guillain-Barré syndrome. It is characterized by an acute onset, severe intoxication, an increase in body temperature to febrile levels, and the rapid development of muscle paralysis, mainly of the lower extremities, neck, and intercostal muscles. Breathing, swallowing and speech are quickly impaired. Death in some cases occurs on the 2-4th day from the onset of the disease.

Enteroviral fever(“minor illness”, three-day fever, summer flu) The disease is caused by all serotypes of Coxsackie viruses A and B, less commonly ECHO. The onset is usually acute, moderate intoxication is possible, body temperature rises to 38.5-40°C and often has a biphasic character.

Abdominal pain, myalgia, conjunctivitis, and enlarged cervical lymph nodes are possible. In some cases, fever is the only symptom of the disease. The duration of the disease is often 3-4 days.

Along with the catarrhal form, it also occurs quite often and forms a symptom complex of a mild disease with a three-day fever, clinically reminiscent of the flu (“dry catarrh”, absence of pronounced respiratory manifestations). It occurs mainly in the summer, and is often recorded as one of the forms of the disease during an outbreak in children's groups.

Enteroviral exanthema(epidemic exanthema, Boston exanthema, Berlin exanthema) is caused by the ECHO, Coxsackie A and B viruses. It is most common among children in the first years of life. The main symptom of the disease is maculopapular exanthema, moderate intoxication, and increased body temperature.

The rash appears simultaneously on an unchanged skin background, can be quite varied in morphology (spotty, maculopapular, pinpoint, hemorrhagic), persists for 1-2 days and disappears without a trace.

One of the most common variants of enteroviral exanthema is a disease that occurs with damage to the skin of the hands and feet, and the mucous membrane of the oral cavity (hand, foot and mouth disease - HFMD, translated as hand-foot-mouth syndrome), caused by Coxsackie A viruses (5th, 10th, 16th serotypes). In domestic practice, until recently it was called foot-and-mouth disease-like syndrome.

This disease, pathognomonic for enterovirus infection, is characterized by moderate intoxication and increased body temperature. At the same time, a rash appears on the fingers and toes - spots, papules and vesicles with a diameter of 1-3 mm, surrounded by a halo of hyperemia.

The elements are located in the interphalangeal folds, both on the palmar and on the back of the hands. The arrangement of elements on the feet is similar. Vesicular rashes are possible on the mucous membrane of the tongue and oral cavity (usually on the mucous membrane of the cheeks and palatine arches), quickly turning into small erosions (herpangina). Vesicular rashes are often located on the skin of the nasolabial triangle (a fairly typical symptom) and the gluteal region. Proximal separation of the nail plate from the nail bed has also been associated with HFMD.

The very fact of the appearance of symptoms of stomatitis and exanthema directly indicates that herpangina, Boston exanthema, and hand-foot-mouth syndrome are, in fact, variants of the infectious process with the dominance of one or another topic of the lesion. We should not forget that the described form can be combined with more severe damage to the brain and heart.

Intestinal form(enteroviral diarrhea, gastroenteritis) is usually caused by Coxsackie B viruses (serotypes 1-6), Coxsackie A (2nd, 9th serotypes), and some serotypes of ECHO viruses. Mostly young children are affected. Sporadic diseases and local outbreaks are often recorded, mainly in the spring and summer.

The onset is acute, with an increase in body temperature to 38-39°C. Intoxication is not expressed, the condition is slightly disturbed. Vomiting is a common symptom, often repeated (2-3 times), abdominal pain and flatulence are possible; stool becomes more frequent up to 6-8 times a day and is enteritic in nature (thin, watery).

Respiratory form(catarrhal). During the inter-epidemic period for influenza, this form of EVI accounts for 2.5 to 11% of respiratory infections in children. Young children are more often affected. The onset is acute, intoxication syndrome is characteristic (weakness, headache, malaise), chills are possible against the background of increased body temperature.

Catarrhal syndrome is manifested by rhinitis with serous-mucous discharge, dry cough, hyperemia and granularity of the posterior pharyngeal wall. Quite rarely, the bronchi and lung tissue are involved in the process. Fever lasts 3-5 days, catarrhal symptoms last about a week. Young children may develop laryngeal stenosis caused by the ECHO11 virus. The lack of specific signs that fundamentally distinguish this form from other respiratory viral infections makes its identification difficult.

Enterovirus infections of the heart(EVIS). The most common are myocarditis and encephalomyocarditis of newborns - an extremely severe variant of Coxsackie B infection (serotypes 1-5). The sources of infection are postpartum women or medical staff. Routes of transmission: transplacental and household contact.

The onset of the disease is acute or gradual, body temperature rises to febrile levels and may have a two-wave character. Cardiac syndrome is pronounced: general cyanosis of the skin, acrocyanosis progresses, the boundaries of the heart expand, dullness of heart sounds appears, systolic murmur occurs, and edema is possible.

Damage to the central nervous system is observed: the child refuses to breastfeed, becomes lethargic, drowsy, does not respond to people around him, tonic-clonic convulsions occur, and the large fontanelle bulges. Coma may develop. Most patients have an enlarged liver, and possible disruption of its functions.

Death can occur in the first hours from the onset of the disease or on the 2-3rd day from cardiovascular failure. The tropism of the virus to the cells of striated muscle, as was shown in the example of pleurodynia, indicates that damage to the heart muscle may be more frequent than is commonly believed. And the process does not always end fatally. Myocarditis is “visible”, and forms without pronounced manifestations of heart failure are not diagnosed in a timely manner.

Enteroviral eye infection(uveitis, hemorrhagic conjunctivitis, Apollo disease). The disease affects children in the first year of life with a burdened premorbid background, and often develops as a nosocomial infection. Has a short incubation period - 3-48 hours.

The disease begins acutely. Manifestations of intoxication are pronounced: fever up to 38-39°C, anxiety, sleep inversion, loss of appetite, regurgitation or vomiting. Catarrhal syndrome is often observed. Possible enlargement of the lymph nodes and liver, the appearance of exanthema.

On the 3-4th day, inflammation of the vascular tract of the eyes develops with injection of the eyeball, serous or serous-fibrinous effusion into the anterior chamber, pupil area or retina.

On examination: severe photophobia, lacrimation, sensation of a foreign body in the eye, swollen eyelids, mucous and mucopurulent discharge. The conjunctiva is sharply hyperemic, infiltrated, and small follicles are often visible. The color of the iris becomes darker than on the healthy side, the pupil narrows. Both eyes are almost always affected (77.2-90.8% with an interval of 4-24 hours).

The infection clears up within 10 days without complications. In severe cases, keratitis can persist for several weeks, but usually does not lead to irreversible changes. Outbreaks of this disease, caused by enterovirus 70 and Coxsackie A24, occur mainly in tropical coastal countries.

Immunodeficient patients tolerate EVI with difficulty. Severe paralytic forms of the disease develop in HIV-infected people and in patients with a deficiency of the humoral immune system. Children with X-linked agammaglobulinemia often develop chronic meningoencephalitis. At the same time, immune T-lymphocytes can be responsible for a number of severe, destructive changes in tissues (damage to myocardiocytes in EVIS, myelin sheaths in NS lesions).

In addition to acquired forms of the disease, it is also possible to develop a congenital form of Coxsackie and ESNO infection with symptoms of severe myocarditis and (or) fulminant hepatitis, often in combination with encephalitis. Infants aged 1 week to 3 months may develop a syndrome that is difficult to distinguish from a severe bacterial infection with multiple organ failure (“viral sepsis”). The most common viruses isolated from such children are Coxsackie B, ECHO 11 and parechoviruses of the 3rd serotype (PeV 3).

The role of enteroviruses in the occurrence of kidney pathology, the development of appendicitis, hepatitis, cholecystitis, pancreatitis, endocarditis, and juvenile rheumatoid arthritis has been proven. There is a connection between EVI and the development of diabetes, Reye's syndrome and chronic fatigue.

The prognosis for most forms of enterivirus infection is favorable. However, CNS infections can lead to the development of neurological complications, and myopericarditis in newborns and chronic meningoencephalitis in immunocompromised patients are often fatal. Myocarditis in adults can also have serious complications.

Diagnostics

In a typical clinic, diagnosing EVI is not difficult, but in the Russian Federation mandatory laboratory confirmation of the diagnosis is required.

Laboratory diagnosis of EVI is carried out by isolating and identifying the virus in cell culture (virological method), by identifying enterovirus RNA using polymerase chain reaction (PCR).

Each method has its own advantages and disadvantages. Problems with the specificity of a positive result should be taken into account due to the high prevalence of virus carriage in certain areas. This point almost completely eliminates the use of serological tests.

The following are selected for the study: cerebrospinal fluid, conjunctival discharge, smear of discharged vesicles, blood, organ biopsies (sterile types of clinical material); smear (wash) from the oropharynx/nasopharynx, smear of herpangina ulcer discharge, fecal samples, autopsy material (non-sterile types of clinical material). Taking a certain type of material for laboratory research is carried out taking into account the clinical picture of the disease.

Laboratory confirmation of the diagnosis of EVI is:

• detection of enteroviruses or their RNA in sterile types of clinical material;
• detection of enteroviruses or their RNA in non-sterile types of clinical material in the presence of an etiologically deciphered outbreak of EVI and if the patient has a clinical picture of the disease characteristic of this outbreak;
• detection of enteroviruses or their RNA in non-sterile types of clinical material in the absence of an outbreak and their sero- or genotype matching the specific clinical picture of the disease (HFMD, herpangina, acute hemorrhagic conjunctivitis, uveitis and others);
• detection of enteroviruses or their RNA in two samples of non-sterile clinical materials of different types.

In case of registration of an outbreak or group incidence, the diagnosis of “enteroviral infection” can be established on the basis of clinical and epidemiological data.

The features of clinical forms also require special laboratory diagnostics that clarify the topic and nature of the lesion: for lesions of the nervous system - the results of lumbar puncture and neuroimaging studies of the process (MRI, CT), for lesions of muscle tissue - increased activity of “muscle” enzymes (CPK, LDH, BNP, urine myoglobin).

Treatment

There is currently no etiotropic treatment for EVI. The drug Pleconaril, developed abroad and considered promising, has not received wide recognition and is not registered in Russia.

Treatment of patients is reduced to pathogenetic and symptomatic therapy, depending on the form and severity of the disease. Painkillers and antipyretics include paracetamol and ibuprofen.

Patients with pleurodynia are advised to apply dry heat to the affected muscles. For severe pain, the use of non-opioid analgesics (diclofenac, ketoprofen, ketorolac, lornoxicam, etc.) may be required.

Immunoglobulin preparations are used as a means of preventing the disease in newborns and persons with agammaglobulinemia. Considering the extremely unfavorable prognosis, they are indicated as a therapeutic agent in newborns and patients with myocarditis (2 g/kg), although their effectiveness has not been proven.

Patients with myopericarditis are prescribed long-term bed rest, relief of heart failure and arrhythmia.

Antibiotics for EVI are used only when bacterial complications occur.

Prevention

Active immunoprophylaxis against EVI has not been developed (with the exception of poliomyelitis). Preventive measures come down to compliance with sanitary and hygienic standards.

In foci of infection, medical observation of contact persons is established: 10 days - when registering mild forms of EVI (in the absence of obvious signs of damage to the nervous system): enteroviral fever, epidemic myalgia, herpetic sore throat and others; 20 days - when registering forms of EVI with damage to the nervous system.

V.A. Anokhin, A.M. Sabitova, I.E. Kravchenko, T.M. Martynova

Herpes sore throat, despite its name, is neither a sore throat nor herpes. Its causative agents are Coxsackie viruses or echoviruses, and not the herpes virus. The official name of the disease is enteroviral vesicular pharyngitis or stomatitis. Most often the disease is diagnosed in children. Adults can also get sick, but their pathology is milder. People get sick with herpes sore throat once, since the body develops a specific immunity to the enterovirus.

What is herpes sore throat and what does it look like?

Herpes sore throat is an acute infectious inflammatory process of enteroviral etiology. It has all the symptoms of an infectious disease: fever, sometimes nausea and vomiting. A characteristic sign of herpes sore throat is a rash on the oropharynx, tonsils and palate, reminiscent of herpes and causing significant discomfort.

Because the infection affects the tonsils, it is also called herpetic tonsillitis. The disease received such a common name because of its similarity with herpetic stomatitis. Rashes on the surface of the mucous membrane of the oropharynx are similar to the manifestations of herpes, but are caused by a different pathogen.

The disease is nicknamed angina because it affects the throat. However, the localization of the pathological process in these diseases is different. Sore throat affects only the tonsils, and herpetic tonsillitis can be localized on the entire surface of the oropharynx, tongue, and palate.

Causes of the disease in children

Herpes sore throat is provoked by enteroviruses that cause intestinal infections. These pathogenic microorganisms are widespread, so there is always a chance of infection. The pathogen is transmitted by airborne droplets, contact and fecal-oral routes.

You can become infected not only from a person whose disease is in an acute form, but also from someone who is completing the recovery process. In some children, even after all signs of the disease have disappeared, the body continues to release virus virions into the surrounding space. This process may continue for another three or four weeks.

The cause of the disease is most often contact with an infected person or his household items. A healthy child with a strong immune system may not become infected, since his body will cope with the pathogen and prevent it from spreading.

The risk of illness increases if the child is weakened and his immune system is not functioning well. This may occur due to the natural imperfection of the child’s immunity. The body's defenses may also be weakened due to the fact that the child has recently had an infection.

It should be noted that in infants, the imperfection of the immune system is compensated by passive immunity received with mother's milk. That is why breastfed children rarely get herpes sore throat.

Symptoms of herpetic sore throat with photos

The most characteristic symptom of herpetic sore throat in children is the appearance of vesicles in the oral cavity. You can see what these formations look like in the photo.

The disease is accompanied by severe pain in the throat and difficulty swallowing. That is why it is called sore throat, although, in fact, it is not. In addition, the disease is characterized by the following manifestations:

• a sharp increase in temperature almost to critical values ​​(40-41 degrees);
• runny nose, swelling and nasal congestion;
• general malaise, aches in joints and muscles;
• lack of appetite;
• enlargement of the postauricular and cervical lymph nodes.

Enteroviruses can cause digestive upset, so herpes sore throat in children is often accompanied by dyspeptic symptoms: nausea, vomiting, diarrhea, abdominal pain. Occasionally, skin manifestations are observed that resemble urticaria in appearance.

Most often, herpetic sore throat in children with normal immunity occurs with moderate severity of symptoms and resembles the signs of ARVI, differing only in the presence of vesicles in the oropharynx.

In rare cases, when the child’s immunity is severely weakened for some reason or if an enterovirus enters the bloodstream, more dangerous signs of the disease may be observed:

• inflammation of the eye mucosa occurs, usually occurring on one side;
• inflammatory processes of the meninges and tissues of the brain and spinal cord develop - encephalitis and meningitis;
• cardiac pain, convulsions, confusion are observed;
• If the kidneys are damaged, pain in the lumbar region may occur.

The development of these symptoms means an extremely complicated course of the disease and requires immediate placement of the child in a hospital setting.

Length of incubation period

Many parents whose children have contracted herpetic sore throat ask doctors what the incubation period of the disease is and how long the disease will last. From the moment the enterovirus enters the body until the first signs of the disease appear, on average, it takes from a week to ten days. The disease always begins suddenly, with a sharp and significant rise in temperature - within two or three hours it rises to 40 degrees or more.

Feverish symptoms develop, the patient shudders, he feels weakness, lethargy, and malaise. On the second or third day after the first symptoms appear, reddish rashes appear on the throat, palate and tonsils (we recommend reading:). After a day or two, the nature of the rash changes: it turns into vesicles with serous contents.

On the second day after the first symptoms appear, a runny nose, cough, sore throat, muscle pain and headaches appear. Digestive disorders may occur.

The peak of the disease occurs on the third day - the temperature becomes very high, all signs of infection are fully manifested.

When the vesicles open and turn into ulcerations on the mucous membrane, the temperature drops slightly and the patient feels lighter. The body produces enough antibodies to the virus that it begins to weaken. The disease finally goes away six or seven days after the first symptoms appear, when the immune system suppresses the activity of enteroviruses.

There may be residual effects that may bother you for another two or three days after the illness. In cases where the immune system is initially weakened, the disease lasts slightly longer. Complications may also develop.

Features of treatment

Treatment of herpetic sore throat consists of symptomatic therapy (we recommend reading:). To date, scientists have not developed effective medications against enterovirus. All treatment regimens are aimed at alleviating the symptoms of the disease while the body forms an immunological response.

During treatment, the patient is prescribed bed rest and plenty of warm drinks. It is necessary to exclude from the diet foods that can irritate the stomach, since enterovirus tends to infect the mucous membranes of the digestive organs. A large amount of warm liquid helps the body normalize the process of thermoregulation, so the more the patient drinks, the faster the need for antipyretic drugs will disappear.

Dragee Diazolin 100 mg

1. To relieve swelling, it is recommended to take antihistamines, for example, Diazolin.
2. Analgesics are used to relieve pain in the throat, muscles and joints.
3. In order to bring down the temperature, antipyretics are used (based on Paracetamol or Ibuprofen). For children, you can use special medications developed taking into account the characteristics of the child’s body and containing smaller amounts of active substances, or use conventional medications, reducing their dosages.
4. To treat the throat and gargle, you can use topical products. You can gargle with Furacilin solution or herbal decoctions. Plants for rinsing should be chosen those that have a pronounced antiseptic and analgesic effect. These include chamomile, sage, celandine, calendula, and yarrow.
5. In some cases, doctors prescribe broad-spectrum antibiotics to suppress the activity of pathogenic microflora. Antibiotics can be used only if the disease is complicated by a bacterial infection and nonspecific infectious agents are present in the body (we recommend reading:).
6. It is not advisable to treat the disease with Acyclovir and similar antiviral drugs in this case, since herpes sore throat is not caused by a herpes virus infection (we recommend reading:).
7. In order to help the body cope with a viral infection, drugs that provoke the synthesis of interferons (for example, Viferon, Arbidol) are prescribed.

If the disease proceeds without complications, then treatment is carried out at home. The exception is cases of herpes sore throat in infants. Then doctors recommend treatment in a hospital setting.

Possible complications of the disease

In most cases, in children with good immunity, the disease can be cured completely, without dangerous consequences. A complicated course of the disease is more often observed in young patients under the age of one year, since their immune system is still in the process of formation.

The main danger of Kosaka viruses is that they are able to integrate into nerve fiber cells. Once in the blood, along with its current, the virus can enter the tissues of various organs: the brain and spinal cord, heart, liver, and digestive organs. Penetrating into the tissue cells of the central nervous system, the virus is able to provoke inflammatory processes in various parts and membranes of the brain.

The danger of enterovirus is also that after the symptoms of herpes sore throat have completely passed, individual virions can remain viable. In such cases, delayed consequences may develop. Heart complications may occur - the development of cardiomyalgia, myocarditis. If the virus penetrates the cells of the liver and kidneys, inflammatory processes in these organs may develop.

Preventive measures

To date, no specific preventive agents have been developed against herpes sore throat. The main method of resisting the disease is to strengthen the immune system. To do this, it is recommended to harden the child, prepare a complete diet for him, including the necessary set of nutrients, make sure that he receives sufficient physical activity, and try to prevent hypothermia.

It is necessary to follow the rules of hygiene: bathe the child, make sure that he washes his hands after being outside and before eating. Preventive measures also include preventing contact with sick children and adults.

Preventive measures will not protect a child from infection with herpes sore throat, but strong immunity can contribute to an easier and faster progression of the disease. With a good immune system, the likelihood of developing dangerous complications is reduced.

If a child shows signs of herpetic sore throat, it is very important to promptly seek qualified medical help. A sick child needs competent treatment, and this requires differential diagnosis, which only specialists can carry out. It is very easy to mistake herpangina for herpes, but treatment with antiherpetic drugs can be not only useless, but also dangerous. For this reason, independent treatment of a child is unacceptable.

Enterovirus infection is a group of acute diseases of the digestive tract that are caused by RNA-containing pathogens of the Enterovirus genus.

Nowadays, outbreaks of enterovirus infection are increasingly observed in many countries around the world. The danger of diseases of this group is that the clinical symptoms can be very diverse. In most cases, there is a mild course, characterized by minor malaise, but serious complications can occur, including severe damage to the respiratory system and central nervous system, as well as the kidneys and digestive tract.

Pathogens and routes of their transmission

The vast majority of RNA-containing enteroviruses are pathogenic for humans.

To date, over 100 types of pathogens have been identified, including:

• ECHO viruses;
• Coxsackie viruses (types A and B);
• pathogens (polioviruses);
• unclassified enteroviruses.

The pathogens are ubiquitous. They are characterized by a high degree of stability in the external environment, tolerate freezing, as well as treatment with antiseptics such as 70% ethanol, Lysol and ether. Enteroviruses quickly die during heat treatment (they cannot tolerate heating up to 50°C), drying and exposure to formaldehyde or chlorine-containing disinfectants.

Natural reservoirs for pathogens are water bodies, soil, some food products, and the human body.

Please note: In feces, enteroviruses remain viable for up to six months.

In most cases, the source of the pathogen is a sick person or a virus carrier, who may completely lack clinical signs of enterovirus infection. According to medical statistics, among the population of some countries, up to 46% of people can be carriers of pathogens.

Main routes of transmission:

• fecal-oral (with a low level of hygiene);
• contact-household (through contaminated objects);
• airborne (if the virus is present in the respiratory system);
• vertical transmission (from an infected pregnant woman to a child);
• water (when swimming in polluted waters and watering plants with wastewater).

Please note: cases of infection with enteroviruses have been recorded even through water in coolers.

This group of acute diseases is characterized by seasonal outbreaks in the warm season (summer-autumn). Human susceptibility to enteroviruses is very high, but after an infection, type-specific immunity remains for quite a long time (up to several years).

Symptoms of enterovirus infection

Enterovirus infection in adults and children can cause a number of pathologies characterized by varying degrees of severity of the inflammatory process.

The most severe pathologies include:

• inflammation of the myocardium (heart muscle);
• pericarditis (inflammation of the pericardial sac);
• hepatitis (anicteric);
• serous (damage to the soft membranes of the brain);
• acute paralysis;
• kidney damage;
• newborns.

Less dangerous manifestations:

• three-day fever (including with skin rashes);
• gastroenteritis (inflammation of the digestive tract);
• herpetic sore throat;
• lymphadenopathy;
• polyradiculoneuropathy;
• inflammation of the conjunctiva;
• inflammation of the choroid;
• damage to the optic nerve;
• vesicular pharyngitis.

Please note: When enterovirus D68 enters the body, bronchopulmonary obstruction often develops. A characteristic symptom is a severe cough.

Severe complications rarely develop in adult patients with good immunity. They are typical for people with reduced body resistance - children (especially young children) and people suffering from serious diseases (malignant tumors).

Please note: the variety of clinical manifestations is due to a certain affinity of enteroviruses for many tissues of the human body.

The most characteristic clinical signs of enterovirus infection in children and adults:

The duration of the incubation period for enteroviral infections in most cases ranges from 2 days to 1 week.

Most often, when infectious agents of this type enter the body, a person develops ARVI.

Symptoms of the catarrhal form of enterovirus infection:

• runny nose;
• cough (dry and rare);
• increased temperature (usually within subfebrile range);
• hyperemia of the mucous membrane of the throat;
• digestive disorders (usually not very significant).

As a rule, a person recovers within a week from the onset of the disease.

Symptoms of enteroviral fever:

• febrile reaction within 3 days from the onset of the disease;
• moderate signs of general intoxication;
• skin rashes (not always);
• deterioration in general health (mild or moderate).

Please note: Enteroviral fever is also called “minor illness” because the symptoms do not last long and their severity is low. This form of pathology is relatively rarely diagnosed, since most patients do not even seek medical help.

With this form of enterovirus infection, children may experience symptoms of damage to the upper respiratory tract (catarrhal manifestations). In young children, the disease can last up to 2 weeks or more.

A sign of herpangina against the background of an enterovirus infection is the formation of red papules on the mucous membranes. They are localized in the area of ​​the hard palate, uvula and arches. These small rashes quickly transform into vesicles, which after 2-3 open with the formation of erosions or gradually resolve. Herpangina is also characterized by enlargement and tenderness of the submandibular and cervical lymph nodes, as well as hypersalivation (salivation).

The main clinical manifestation of enteroviral exanthema is the appearance on the skin of patients of a rash in the form of spots and (or) small pink blisters. In most cases, the skin elements disappear after 2-3 days; At the site of their resolution, peeling of the skin is observed, and the upper layers come off in large fragments.

Important: exanthema can be diagnosed in parallel with meningeal symptoms.

Symptoms of serous meningitis against the background of enterovirus infection:

• photophobia (photophobia);
• increased sensitivity to sounds;
• severe headache when bringing the chin to the chest;
• lethargy;
• apathy;
• psycho-emotional arousal (not always);
• high body temperature;
• convulsions.

Oculomotor disorders, disturbances of consciousness, muscle pain and increased tendon reflexes are also possible.

Meningeal symptoms last from 2 days to one and a half weeks. The virus can be detected in the cerebrospinal fluid for 2-3 weeks.

Symptoms of enteroviral conjunctivitis:

• pain (stinging) in the eyes;
• tearfulness;
• photophobia;
• redness of the conjunctiva;
• swelling of the eyelids;
• copious discharge (serous or purulent).

Please note: with enteroviral conjunctivitis, one eye is initially affected, but soon the inflammatory process spreads to the second.

Signs of enterovirus infection in children

Children (especially children under 3 years of age) are characterized by an acute onset of the disease.

The most common clinical manifestations of enterovirus infection are:

• sleep disorders;
• fever;
• chills;
• diarrhea;
• catarrhal symptoms;
• myalgia;
• dizziness;
• weakness;
• exanthema and (or) sore throat (not always).

Currently, the causative agent of enterovirus infection can be identified in one of four ways:

Changes in general blood test:

• slight leukocytosis;
• hyperleukocytosis (rare);
• neutrophilia (early stage);
• eosinophytosis and lymphocytosis (as the disease progresses).

Important:establishing the presence of a virus in the body is not indisputable evidence that it was this pathogen that provoked the disease. Asymptomatic carriage occurs quite often. The diagnostic criterion is an increase in the number of antibodies (in particular, immunoglobulins A and M) by 4 or more times!

Differential diagnosis

Herpes sore throat, which is caused by the Coxsackie virus, should be differentiated from herpes simplex and oral candidiasis (fungal). Serous meningitis caused by infection with enteroviruses should be distinguished from damage to the meninges of meningococcal etiology.

If symptoms of the gastroenteric form occur, other intestinal infections should be excluded. It is important to differentiate exanthema from rashes caused by rubella and hypersensitivity reactions (allergic).

Etiotropic (i.e., specific) treatment methods have not been developed to date.

Treatment of enterovirus infection in adults involves detoxification and symptomatic therapy. Therapeutic tactics are determined individually for each patient depending on the nature, location and severity of the pathological process. According to indications, patients are given antiemetics, painkillers and antispasmodics.

When treating enterovirus infection in children, rehydration therapy often comes to the fore, i.e. eliminating dehydration and restoring electrolyte balance. For this purpose, saline solutions and 5% glucose are either given orally or administered through intravenous infusion. Children are also given detoxification therapy and, if necessary, given antipyretics (antipyretics).

To combat viruses, intranasal administration of a solution of leukocyte interferon is indicated.

If complications occur due to the addition of a secondary bacterial infection, the patient is prescribed a course of antibiotic therapy. Lesions of the nervous system often require the use of hormonal therapy with corticosteroids.

Every year, hundreds of Ukrainian children become infected with enterovirus infections, which manifest themselves in the form of rashes and sores on the hands, soles of the feet, mouth and throat against the background of a rise in body temperature to +38°C or more. Infection occurs most often in summer at beach resorts. Many people infected with enteroviruses experience the disease with minimal complaints or are completely asymptomatic, but can remain carriers of the viruses for several months. Once the infection enters the body, it usually disappears within 5-10 days on its own without any special treatment. Enterovirus infections are transmitted by airborne droplets or fecal-oral routes. Most often they affect children under the age of 10 years (children under the age of 5 are especially susceptible to these diseases).

There are typical and atypical forms of enteroviral infections. Typical forms of infection include herpangina, exanthema, epidemic myalgia and aseptic serous meningitis. Atypical - uveitis, pancreatitis, nephritis, encephalomyocarditis of newborns, mixed infections.

Symptoms of enterovirus infection

They begin to appear approximately 3-7 days after the first contact with the virus. The symptoms are quite varied: nausea, vomiting, watery stools up to 10 times a day, various rashes. Body temperature is high, sometimes up to 40 degrees. Usually 1-2 days after the end of the fever, a rash appears on the arms, legs, and mouth in the form of red spots with blisters (vesicles).

The rash on the skin may resemble chickenpox, and in the mouth - (it is important to remember that these diseases are caused by various pathogens, and the herpes virus has nothing to do with enterovirus infection, so in the latter case it is useless to lubricate the blistering rashes with acyclovir ointment). Other symptoms of this disease: loss of appetite, headache, ulcers in the mouth, tongue, and throat. Sometimes patients may have almost no symptoms of the disease, but at this time they are still a source of infection of the virus to other people.

Most often, enteroviruses cause diseases in children, as well as in patients with weakened immune systems. In both cases, patients may have a fever and sore throat, followed by mouth sores a few days later.

Complications resulting from enterovirus infection occur rarely, and the disease usually goes away on its own, but there are exceptions. Sometimes dehydration occurs and a secondary bacterial infection develops. Very rarely, meningitis, encephalitis, acute flaccid paralysis, and heart damage may develop

Treatment and prevention of enterovirus infection

There are no special medications for the treatment of enterovirus infection. There is also no vaccine against these diseases. The disease goes away on its own in 3-10 days (sometimes two weeks). It is not recommended to use antibiotics, antivirals, etc., since in this case they do not bring benefit, but, on the contrary, can even cause harm. Therefore, doctors advise that in case of enteroviral exanthemas, relieve pain, alleviate the patient’s well-being with the help of non-steroidal anti-inflammatory drugs and rinsing the mouth with a special solution, prevent dehydration (drink plenty of fluids), and also monitor for complications (if they appear, consult a doctor immediately). The best prevention of enterovirus infection is to avoid contact with infected people, disinfect objects that may have the virus and, of course, drink only boiled or bottled water. You should also wash your hands regularly with soap and hot water.

General information

The infectious disease, which is herpetic sore throat, like other representatives of this category of diseases, most actively affects human bodies in the autumn and spring periods. The disease tends to manifest itself in various symptoms, but almost all patients experience problems with swallowing and a high rise in body temperature. Compared to adults, children suffer from herpetic sore throat much more often; the main reason is the child’s body unprotected from exposure to pathogens and a weakened immune system.

What is herpangina?

Herpangina (aphthous, vesicular pharyngitis) or herpetic tonsillitis is one of the types of respiratory tract diseases. Children under 3 years of age have the most difficulty coping with the disease; in general, older children and adults can cope with the disease provided they receive proper treatment and care quickly and without complications.

The disease occurs due to infection with one of the pathogens. It is not uncommon for herpetic sore throat to become an epidemic, spreading most actively in children's institutions and other crowded places.

The causative agent of herpangina

The main causative agent of herpetic sore throat are representatives of enteroviruses, or rather the Coxsackie virus of groups A and B, as well as a group belonging to the category of serotypes (2-4; 6; 8; 10). Less commonly, infection with the disease is provoked by the ESNO virus.

In very rare cases, the causative agent of the disease is a common herpes virus, but this fact must also be taken into account when diagnosing. In other words, any carrier of the herpes virus can provoke infection with the disease.

How does infection occur?

You can become infected with herpangina in three main ways: by consuming food that has not undergone special heat treatment, fecal or oral, and airborne transmission (airborne). Penetrating the surface of the respiratory mucosa, the pathogen reaches places with ideal conditions for reproduction, namely areas of the lymph nodes and intestinal walls. The ability to overcome various barriers and settle on the surface of the mucous membrane of the small intestine is characteristic of viruses of the toxonomic group (enteroviruses).

After penetration, which due to the absence of an outer protein shell does not present any particular difficulty for infection, the pathogen, having established itself on the lymphatic and mesenteric nodes, as well as penetrating the epithelial cells of the intestine and lymphoid tissue, begins to actively multiply.

The peak activity of the pathogen occurs on the second or third day, during which the amount of viruses necessary for penetration into the blood is formed. After entering the bloodstream, the final phase of infection begins: the viruses, having gained access to muscle and nervous tissue, enter the active stage of the disease. In rare cases, the incubation period can be prolonged (up to 10 days), but generally on the 3-4th day the disease begins to enter the active phase of development.

Symptoms of herpetic sore throat

In children and adults, the disease may manifest itself differently, but the general symptoms manifest themselves in the same way:

• Swelling of the nasopharyngeal mucosa.
• Pain when swallowing.
• My head hurts.
• A sharp increase in temperature.
• The presence of a red rash in the throat, followed by the appearance of blisters.

During the period of sore throat development, children's appetite decreases, they may almost completely refuse to eat due to difficulty swallowing, and they may develop a cough and runny nose. In adults, some of the symptoms, except for the main ones, may not appear at all. Cases when a patient is bothered only by a sore throat are far from an isolated manifestation.

State

The condition of a patient with herpetic sore throat is conventionally divided into two stages, and this manifestation is very characteristic of the disease. Initially, pain is felt in the areas of inflammation, often the body temperature rises to 400C or higher, and the patient himself has difficulty swallowing solid food. A little later, the pain decreases slightly, this is due to the fact that the red rash in the throat area is independently destroyed. The damaged integrity of the membrane of the vesicles turns into a state of formation of small ulcers, which gradually heal and heal, while simultaneously reducing pain.

When the patient completes the process of destroying the bubbles that were previously filled with liquid, an increase in the volume of saliva secreted is observed. This phenomenon is fraught with consequences for other people, since a patient in this condition is a carrier of infection. When sneezing and coughing, saliva saturated with viruses quickly multiplies, which leads to massive infection of people nearby.

Herpangina rash

One of the symptoms characteristic of herpangina is the presence of rashes in the throat and mouth. The rash, gradually spreading, contributes to the development of an inflammatory process that affects the base of the palate and tonsils.

Almost immediately, in places of redness, a mass of bubbles forms, inside of which there is liquid. The rash makes it difficult to swallow, a sharp increase in temperature is observed, and patients complain of a sore throat. After 30-40 hours, after the first manifestations, the bubbles turn from transparent to dull, which, soon collapsing, release particles of viral infection into the oral cavity, thereby forming a focus of infection that is most dangerous for people around the patient.

Features in children and adults

The disease can affect both children and adults; the virus affects the body of children much more often. According to statistics, boys become infected with the virus twice as often as girls, and this feature is also characteristic of the disease. The general symptoms of the disease are expressed by the presence of fever, difficulty swallowing, and pain in places where inflammatory processes are present.

In children, the disease initially proceeds violently: a jump in temperature and immediate manifestation of other symptoms; in adults, only a slight rise in body temperature can be observed, and then everything takes on a blurry format. Children under three years of age may have flu-like symptoms: body and bone aches, malaise, nausea, diarrhea, vomiting.

Common symptoms of tonsillitis are toxicosis, dyspepsia, and abdominal pain. Manifestations in the form of rashes are observed in all patients, but in children with atypical tonsillitis, the symptom may additionally appear on the palms and soles. Most often, tonsillitis affects children under 10 years of age; the disease is most severely suffered by children under 3 years of age. Infants up to six months old, due to the influence of maternal antibodies, which still protect the child, get sick extremely rarely.

Diagnosis of herpangina

The disease is pre-diagnosed based on the symptoms of the disease; only a therapist or pediatrician can immediately and relatively accurately determine the type of sore throat without undergoing tests. To study and determine the type of virus that has infected the patient, material is collected from the oral cavity using a rinsing procedure or taking a smear.

The first test is scheduled in the first days; blood is given again (up to 3 weeks) to determine the presence of the pathogen and the presence of antibodies. A serological examination will help to accurately determine the patient’s condition. If at the time of the study there is an outbreak of mass herpangina diseases, this factor should be taken into account by the doctor first.

What to pay attention to

If in the observed region the disease has become widespread, or there are individuals in the family or group who have recently had or continue to have tonsillitis, these factors are paid attention to first.

The primary factor that will help to correctly diagnose is the presence of symptoms, and especially those that clearly indicate a particular disease. It is important not to confuse herpangina with other similar diseases: influenza, ARVI, intestinal diseases, due to the similarity of factors and symptoms.

Which doctor should I contact?

When treating herpetic sore throat in infants, the baby is hospitalized for the period of illness, where he and his mother remain until complete recovery. Children aged three years and older at the time of illness are monitored by a children's doctor (pediatrician) who, together with other specialists (allergist and ENT doctor), monitor the child's condition until complete recovery, while the sick person is isolated from contact with other children.

In adults, the disease does not require special treatment; the usual types of medications for this case are used: antiviral, antibiotics, antiallergic. All medications must be prescribed by a specialist, but regardless of this, patients are prescribed constant gargling and mouth rinsing. For children, immunomodulatory drugs are prescribed at the end of treatment.

What tests should I take?

A full diagnosis of the disease is carried out using a number of studies:

• Blood donation. The material is studied for the number of leukocytes in the blood. Moderate leukocytosis indicates the presence of a pathogen in the blood.
• Serological and virological studies to identify and determine the type of pathogen.
• Feces.
• Pharyngeal rinse. Using a special solution, the patient rinses the mouth and spits the material into a sterile glass container.

Possible complications

Self-treatment of such diseases is widely practiced among the people, often even without proper diagnosis by a specialist. Like other infectious diseases, herpangina, if the patient is not cared for correctly and treatment is not carried out in a timely manner, is fraught with complications:

• Pyelonephritis. Children, especially girls, are most often affected by the disease.
• Meningitis. This implies the development of a viral type of disease, as a consequence of inflammatory processes caused by exposure to group A Coxsackie viruses.
• Encephalitis. The complication has similar symptoms, the repeated manifestation of which at the very beginning is occasionally perceived instead of a complication as a secondary phase of angina.
• Rheumatism. The disease develops against the background of inflammatory processes, which in essence is a kind of allergic reaction to the activity of infection in the body.

Treatment of herpetic sore throat

Children diagnosed with herpetic sore throat are placed on inpatient treatment only if the child has not reached 3 years of age; in most cases, children are treated on an outpatient basis, at home.

Medicines should be prescribed by a specialist; the basis of treatment is the following categories of medicines:

• Antiviral. Drugs are prescribed from the onset of the first moments of the disease. In early manifestations of tonsillitis, the drug group is especially good at inhibiting the further development of viruses.
• Antipyretic. The medicine helps improve the child's general condition by controlling symptoms.
• Antiallergic. The drug is prescribed by a specialist based on the characteristics of the treatment of sore throat.
• Medicines for topical use. It is intended to use solutions to wash out the infection by rinsing.
• Use of physical therapy.
• Immunomodulatory drugs. Prescribed at the end of treatment.

Antibiotics for the treatment of sore throat are prescribed only if the sore throat threatens to change from viral etiology to diseases that are caused by complications.

When treating herpetic sore throat in adults, the following types of drugs are used:

• Desensitizers and antigestamines. To relieve pain and improve the condition, it is recommended to use “Diazolin”, “Suprastin”.
• “Viferon, or “Acyclovir”, both drugs are drugs from the group of drugs that counteract the formation of ulcers with subsequent treatment of manifestations.

During the treatment process, it is recommended to drink plenty of fortified drinks: juices, compotes. For both adults and children, when treating a sore throat, it is recommended to eat soft foods with good digestibility. In addition to making it difficult to swallow, solid food can cause mechanical damage to the back of the throat in the form of scratches, so it is recommended to cook liquid porridges, jelly, light soups, rich meat and chicken broths at the time of treatment.

Preventive measures

A contagious disease, which includes herpetic sore throat, requires the use of a period of isolation of the patient in relation to other family members.

The main preventive action is strict adherence to the rules of personal hygiene. The room where the patient is located must be regularly ventilated and wet cleaned. There are a number of folk remedies that can be used to cleanse a room of harmful microorganisms. Traditional healers advise placing finely chopped garlic in the room; this remedy actively fights viruses.