Coxsackie virus: calm, only calm

Enterovirus infection is a multiple group of acute infectious diseases that can affect children and adults when infected with viruses of the Enterovirus genus. In recent years, these intestinal viruses have begun to cause outbreaks of mass diseases throughout the world. The insidiousness of the pathogens of enterovirus infection is that they can cause various forms of clinical manifestations, from mild malaise to serious damage to the central nervous system. With the development of enterovirus infection, the symptoms are characterized by a feverish state and a wide variety of other signs caused by damage to the respiratory system, gastrointestinal tract, kidneys, central nervous system and other organs.

Childhood infections are caused by a huge number of microorganisms. One of these is the Coxsackie virus. It is one of the causative agents of childhood enteroviral infections, is highly contagious and prefers the acidic environment of the stomach. However, it settles not only in the human gastrointestinal tract; practically any tissue and organs can become its target. The nervous system is often affected when infected. But the most likely manifestation of infection is diarrhea, general intoxication, and a characteristic rash. The disease is characterized by a generally favorable course, however, in some cases dangerous complications develop.

History of appearance

It cannot be said that infections caused by the Coxsackie virus have been thoroughly studied. People have long been faced with diseases that have characteristic symptoms. At the end of the 19th century, an epidemic of myalgia - muscle and joint pain - was noted in Spain. And at the beginning of the 20th century, outbreaks of serous meningitis were observed in the USA and France. Coxsackie viruses had not yet been discovered at this time. And only successful research in the field of virology in the middle of the 20th century made it possible to isolate viral particles from the fecal masses of sick people.

In recent years, it has been found that many Coxsackie viruses cause large epidemics of serous meningitis in children (less often in adults) - inflammation of the soft membranes of the brain and diseases resembling foot-and-mouth disease in animals. Here the picture is more severe: not only does the temperature rise, but there are also convulsions, temporary paralysis, and a whole “set” of symptoms of damage to the peripheral nervous system, as well as muscle inflammation.

Other forms of infection

The Coxsackie virus manifests itself not only in general, but also in local symptoms on the body. There are typical and atypical forms of the disease. In the first case, the following develop:

• combined inflammation of the stomach and small intestine;
• angina;
• serous meningitis;
• encephalitis;
• exanthema;
• enteroviral fever;
• myalgia;
• hepatitis;
• pemphigus;
• inflammation of the heart muscle;
• pericarditis;
• inflammation of the conjunctiva;
• cystitis;
• orchiepididymitis.

With the skin form of the disease, itching is often observed. Atypical enterovirus infection has a mild or asymptomatic course.

Herpangina

An oral virus in children can cause acute inflammation of the palatine or pharyngeal tonsils. A sore throat (acute tonsillitis) develops. The disease is caused by the Coxsackie virus and is diagnosed mainly in children 3-10 years old. In young people, angina is more severe. Often acute inflammation of the tonsils is combined with impaired brain function.

Coxsackie groups A and B enter the body and cause viremia. The causative agent of the infection has a tropism for the mucous membrane of the upper respiratory tract. Coxsackie causes an inflammatory reaction and also leads to dystrophic and necrotic changes in tissue. The asymptomatic period is 1-2 weeks.

Herpangina caused by Coxsackie is similar in its course to the flu. The following symptoms are observed:

• bowel dysfunction such as diarrhea;
• fever up to 40 ºC;
• pain in the abdomen, muscles and back;
• decreased appetite;
• headache;
• vomit;
• weakness;
• sore throat at rest and when swallowing;
• increased secretion of saliva;
• runny nose;
• cough.

When the oral mucosa and tonsils are affected, rashes appear in the form of small papules and vesicles. They are filled with serous secretion. After 2-3 days, the elements of the rash open, and small ulcers appear in their place. When examining the pharynx of sick children, redness of the arches, tonsils and uvula is detected.

Coxsackie in the oral cavity often leads to enlargement of the submandibular, parotid and cervical lymph nodes. In some children, sore throat occurs in an erased form. In this case, local symptoms in the form of a rash may be absent. Weak children suffer the most from enterovirus infection. They often experience several waves of rashes. Sometimes exanthema appears on the limbs and torso. The general condition of children infected with Coxsackie improves after 3-5 days.

Enteroviral exanthema

Enterovirus Coxsackievirus often causes Boston fever (exanthema).
Such children develop a rash on the skin that resembles rubella, measles and scarlet fever. The rashes are localized mainly in the face and torso. Children under 5 years of age are affected. Sometimes the oral mucosa is involved in the process. Blisters appear on it, reminiscent of herpes. In this case we are talking about pemphigus. Symptoms of viral dermatitis last for 1-5 days. This clinical form of enterovirus infection in children is characterized by a benign course and ends with recovery.

Types of Coxsackie virus

There are about 30 varieties of the Coxsackie virus. But according to the method of parasitism, they can be divided into 2 types:

Most of the known species (24) belong to type A. Their localization is mucous membranes and skin. If a child is infected with this particular serotype of the virus, then the disease may manifest itself in the form of herpangina, serous meningitis, vesicular stomatitis, and acute hemorrhagic conjunctivitis. The question of the pathogenicity of type A virus species still remains open.

All type B viruses are pathogenic. They affect the pleura, heart, and pancreas. The liver is especially affected.

How is the virus transmitted?

The virus is extremely contagious, so it is quite easy to catch it in childhood, because children do not pay too much attention to hygiene, and if parents do not keep an eye on the child, he can easily put dirty hands in his mouth, which will cause the development of viral pathology. Both sick children and surrounding objects that these children have touched can be contagious. In addition, the infection can be on unwashed fruits and vegetables, water, sand in which children play, etc. Therefore, the routes of infection with the virus can be the following: airborne; contact and household; food.

Sometimes the Coxsackie virus develops in adults, and pregnant women may encounter it. In itself, it is not too scary for the expectant mother, since in adults the symptoms of the virus are even less pronounced than in children, but in this case it can be transmitted through the placenta to the child, who will be born with symptoms of viral pathology. In this case, the route of transmission of the virus is intrauterine. You can become infected with the virus through drinking water and swimming pool water, as well as through contaminated food. Therefore, doctors strongly recommend that all parents allow their children to drink only purchased filtered water, and wash fruits and vegetables thoroughly before consumption.

Other virus syndromes

The presence of Coxsackie virus in a child leads to the appearance of several clinical syndromes. These include:

• meningeal;
• dyspeptic;
• respiratory;
• intoxication;
• asthenic;
• visual disorders.

With alimentary infection, dyspeptic syndrome often develops. It includes signs of gastroenteritis. These include loose, watery stools up to 10 times a day, vomiting, nausea, pain in the epigastric or ileal region, bloating and lack of appetite.

Frequent signs of the Coxsackie virus in children are headache, drowsiness, eye pain, impaired sensitivity and movement in the limbs, fear of bright light and noise, as well as meningeal symptoms (Kernig, Brudzinsky). All this indicates inflammation of the membranes or substance of the brain.

Coxsackievirus often leads to epidemic myalgia. This is a condition characterized by severe muscle and chest pain, fever, rapid breathing, pale skin and profuse sweating. Sometimes the disease occurs like polio. Such children develop movement disorder syndrome. It is possible to develop flaccid paresis or paralysis of the legs. Weakness and lameness are common concerns.

Sometimes, when infected with the Coxsackie virus, the heart is affected. Myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the pericardial sac) develop. With cardiac syndrome, shortness of breath, chest pain and rhythm disturbances appear. With enterovirus infection, a febrile syndrome often develops.

This form of the disease usually progresses favorably. The temperature rises to 38.5-40 ºC. It lasts no more than 3-4 days. Some children infected with Coxsackievirus develop hepatolienal syndrome. It is characterized by an increase in the size of the liver and spleen. The function of the organs may not be impaired.

Symptoms

Most often, the Coxsackie virus in children manifests itself in the form of rashes on the mucous membranes and skin. These rashes have a specific character - they are small blisters surrounded by a red halo, which can appear on the baby’s palms and soles, as well as in the genital area and in the child’s mouth (tonsils, palate).

The incubation period from the moment of infection until the first symptoms appear in the form of rashes is about 10 days. In some cases, the incubation period is rapid - 2 days.

Other symptoms also appear, such as:

• a sharp increase in body temperature to 38 degrees and above;
• coated tongue;
• general weakness;
• a sore throat;
• eating disorders;
• enlarged cervical lymph nodes.

Symptoms of the disease can be either severe or mild, making diagnosis difficult. Parents usually begin to treat the disease in cases where the child’s condition is significantly impaired. If the baby feels normal and his temperature rises slightly, many parents mistake the symptoms of the virus for symptoms of a common cold (and sometimes chickenpox).

As mentioned above, the symptoms of diseases caused by the virus in children are not too pronounced, therefore the pathologies themselves proceed without serious consequences and sometimes, even without treatment, the process ends with the recovery of small patients. However, timely diagnosis and treatment can shorten the course of the disease and prevent possible complications in severe forms of the pathology.

Hand foot mouth syndrome

In nature, there are many enteroviral infections that develop in the human gastrointestinal tract. They can cause pathological conditions accompanied by different symptoms.

One such manifestation may be the common but underdiagnosed hand-foot-mouth syndrome. This term characterizes the appearance of specific skin rashes on the extremities, oral mucosa and around the lips. These signs are common in children. Such formations can be provoked by the Coxsackie virus, the photo of the rash in which is similar to the rash caused by chickenpox or rubella.

Hand-foot-mouth syndrome most often occurs when infected with a type A virus. There are also type B and type 71 (EV71) viruses. Each of these pathogenic agents is highly persistent in the environment and, under suitable conditions, remains viable for several months. Natural reservoirs for infectious agents are bodies of water, soil, some food products and the intestinal system of people and animals.

At room temperature they can live for about two weeks. In the body of a sick person, these viruses are concentrated in saliva and feces. Therefore, infection most often occurs in three ways:

• food (fecal-oral route);
• airborne;
• contact and household.

Typically, infection occurs during conversation, eating at the same table and using common household items. In addition, it must be remembered that this is a virus that lives in the environment for a long time, which means that direct contact with an infected person is not necessary for the development of hand-foot-mouth syndrome.

The causative agent of infection

There are many varieties (serotypes) of enteroviruses. If the infection is not eliminated in a timely manner, a number of serotypes subsequently affect the nervous system.

Coxsackie infection, in addition to the intestinal mucous membranes, also parasitizes the cells of other human organs and systems. Having accumulated in the tissues of the nasopharynx and small intestine to a threshold volume, pathogenic agents enter the blood. So they move to different organs and attack their cells, causing an inflammatory process.

Modern virology includes about 30 serotypes of this enterovirus infection, and each of them has its own selective ability in relation to tissues. Representatives of type A (there are 24 species in total) settle mainly on the skin and mucous membranes. Type B viruses are pathogenic. They often parasitize in the muscles and affect internal organs. During the development of the virus in the body, the immune system turns on its own defense mechanisms: its T-lymphocytes begin to fight pathogens.

There is usually a seasonality of the Coxsackie virus, the peak of which falls from May to October.

How does the infection progress?

Pathogenic agents, entering the mucous membranes of the nasopharynx and esophagus, multiply and provoke local inflammation. According to clinical signs, the onset of the infectious process is usually similar to the symptoms of a respiratory disease, pharyngitis, sore throat or digestive disorder. The virus penetrates the cervical and submandibular lymph nodes and, along with the bloodstream, spreads throughout the body. More pronounced external symptoms are observed in children, but the manifestations of the pathological process are difficult to diagnose. Acne with Coxsackie in appearance resembles skin rashes with other diseases (photos of the appearing rash are widely presented in medical sources). Manifestations of Coxsackie can be expressed in different ways, and it is not always possible to identify similar symptoms.

Most often, the infectious process occurs in a mild form and is accompanied by minor malaise, but severe complications can also occur with damage to the central nervous system, as well as the genitourinary, cardiovascular and digestive systems.

The development of infection in the body can manifest itself in a number of pathological conditions, which depend on the highest concentration of pathogenic agents in the body. Common forms of manifestation of this enterovirus infection:

1. Flu-like form. In this case, the clinical symptoms are similar to ARVI. The duration of the disease is 3-5 days.
2. Enteroviral exanthema. It is characterized by a rash on the chest, arms and head, with a temperature above 37 °C. The symptoms are similar to chickenpox in that a skin rash also appears. The duration of the disease is 3-5 days.
3. Herpetic sore throat. As the virus develops, the following appear: general malaise, weakness, headaches, fever up to 39 °C, white blisters on the oral mucosa (mainly on the palate and tonsils), enlarged submandibular lymph nodes. The disease develops for 1-2 weeks, then gradually goes away.
4. Hemorrhagic conjunctivitis. There is a feeling of sand in the eyes, lacrimation and swelling of the conjunctiva. Hemorrhages and purulent discharge from the eyes appear. The duration of this manifestation is up to 2 days.
5. Intestinal form. Vomiting, diarrhea, abdominal pain, and sore throat occur. Duration: 1-3 days.
6. Poliomyelitis-like form. It is characterized by short-term muscle paralysis, diarrhea, skin rash, fever and fever similar to polio.
7. Hepatitis. Appear: general malaise, weakness, headaches, fever up to 39 ° C, enlarged liver, heaviness and tingling in the right side.
8. Pleurodynia. In this case, pain and muscle damage (myositis), difficulty breathing, and a temperature above 38 ° C occur.
9. Disturbances in the functioning of the cardiovascular system. Appear: weakness, convulsions, chest pain, myocarditis, tachycardia, shortness of breath, body temperature - up to 38 ° C and above.
10. Serous meningitis is accompanied by fever, drowsiness, diarrhea, pain in the abdomen, throat or muscles. Fainting, convulsions and paresis are possible.

The outcome of the infection depends on the type of virus and the characteristics of the infected person’s body. There are 3 possible options for the course of the pathological process:

1. The patient recovers completely.
2. The process becomes chronic as the infection persists in neurons and cells of internal organs.
3. A person who has recovered from such a virus becomes an asymptomatic carrier of the infection.

All enteroviral diseases leave immunity to the transferred type of virus.

Incubation period

The incubation period for Coxsackie infection lasts from 2 days to 3 weeks. However, in the early stages a person is more contagious. Maximum isolation of viral serotypes in feces most often occurs within 3-4 weeks from the onset of infection. In nasopharyngeal discharge - no more than 3-4 days. The disease syndrome may manifest itself in different ways, since the clinical picture of the first phase of the virus may have different symptoms.

Types of virus

Flu-like form

The mildest course of the disease. Its symptoms are very similar to a common ARVI. The period of infection development is about 3–4 days. True, the body temperature can rise to 39–40˚ C, but in a short time everything goes away without consequences, and the child recovers.

Enteroviral exanthema

A distinctive feature of this form is a rash on the arms, chest and even head. The bubbles that appear burst and form crusts. In these places, the skin may peel and flake off. At the same time, the child’s body temperature rises. This manifestation of the disease is often confused with rubella or chickenpox. But it passes, like the flu-like form, quite quickly (from 3 to 5 days) and without consequences.

Herpangina

The incubation period for such an infection is 1–2 weeks. In this case, the virus infects the mucous membrane of the pharynx. Signs of the disease: high fever, weakness, sore throat. The condition is aggravated by headache. The lymph nodes may become enlarged and a runny nose may develop. Bubbles with liquid appear on the mucous membrane of the tonsils and oral cavity. After a while they burst. Upon examination, you can observe a cluster of small erosions covered with a white coating. The disease is even more similar to stomatitis than to a sore throat. All symptoms disappear in about a week.

Hemorrhagic conjunctivitis

It develops at lightning speed - no more than 2 days pass from the moment of infection to the first signs. This form of infection is characterized by a feeling of sand in the eyes, pain, photophobia, lacrimation, swelling of the eyelids, numerous hemorrhages, and purulent discharge from the eyes. Usually one eye is affected first, then symptoms appear in the other eye. At the same time, the patient feels relatively well. The illness lasts for two weeks.

Intestinal form

Symptoms are typical for intestinal infections: dark diarrhea (up to 8 times a day), vomiting. The condition is aggravated by abdominal pain and fever. In young children, in addition to intestinal symptoms, a runny nose and sore throat may begin. Typically, diarrhea lasts from 1 to 3 days, complete restoration of intestinal functions occurs after 10–14 days. Children (up to 2 years old) may develop complications in the form of intolerance to dairy products.

Poliomyelitis-like form

All manifestations are similar to polio. But unlike it, paralysis develops at lightning speed, it is not so severe, the affected muscles recover quickly. With this form, as with others, all the classic symptoms of infection with the Coxsackie virus may be observed: rash, fever, diarrhea.

Hepatitis

The Coxsackie virus can attack liver cells. The organ increases in size, and there is a feeling of heaviness in the right side.

Pleurodynia

The disease manifests itself in the form of muscle lesions. When the virus settles in the muscles, myositis develops. Pain is noted in different parts of the body. Very often, painful manifestations are localized in the intercostal muscles. In this case, breathing may be difficult, but the pleura is not damaged, despite the name “pleurodynia.” When walking or performing any other movements, the pain intensifies. Usually they are wavy in nature (repeated after a certain period of time). The temperature may persist for several days. Fortunately, this form is quite rare.

Heart problems

Endocarditis, pericarditis, and myocarditis may develop. Chest pain and weakness are noted. The disease develops when infected with type B viruses. A very severe form. Blood pressure may drop, temperature may rise, and the child constantly wants to sleep. Manifestations of tachycardia, shortness of breath, arrhythmia, edema and liver enlargement are also common. If the central nervous system is affected, convulsive attacks are observed. A child can die literally a few hours after the first signs appear. This form of infection often develops in newborns, but can appear in older children and adults.

Serous meningitis

In another way, this type of meningitis is called viral, as it occurs as a result of a viral infection. It can be caused by various viruses, including the Coxsackie virus. As the disease develops, the meninges are affected. The clinical picture becomes less pronounced after 3–5 days. If serous meningitis is detected in a timely manner and treated correctly, it resolves without complications.

Symptoms of the coxsackie virus in children

What is usually called the Coxsackie virus is actually a group of enteroviruses (29 strains) that enter the human body through the oral mucosa and then, reaching the intestines, begin to actively multiply there. The symptoms of the disease are very similar to chickenpox, which is why it is often called “Turkish chickenpox.” But there are also differences: in adults the disease is less severe than in children. Children, due to their underdeveloped immune system, are the easiest prey for the virus. In severe form, the disease can affect the nervous system, including the brain, as well as disrupt the functioning of the heart and affect changes in the muscle tissue of this organ, and negatively affect the liver.

The virus is extremely stable in the external environment and is perfectly preserved in the aquatic environment (drinking water from fountains, ice from raw water, swimming pools). You can also become infected with the virus through airborne droplets (from one person to another), contact (toys in the children's room, swimming in the pool) and food (through dirty dishes, unwashed vegetables and fruits, water). The contagiousness (infectiousness) of the virus is almost 100%. That is, if one child in the playroom gets sick, after a couple of days everyone who came into contact with him will feel unwell, including adults. Only in adults the disease can pass almost unnoticed; many tourists do not even realize that they are sick, attributing the malaise to fatigue or overheating on the beach, since they already have an established immune system. But if a person has reduced body resistance, then you cannot do without a doctor. So what symptoms indicate this enterovirus infection?

Symptoms in the initial stage of the disease:

• Intoxication, which is often indicated by a brown or yellowish coating on the tongue;
• High temperature up to 39-40ºС, against this background convulsions are possible;
• Headache, weakness and drowsiness, aches throughout the body;
• Loss of appetite, nausea, vomiting;
• Redness in the throat, enlarged submandibular lymph nodes.

Rash period: mouth-hand-foot syndrome

• After 1-2 days, watery blisters with a diameter of about 2 mm form on the inner surface of the cheeks and lips, and around the outside of the mouth. They open themselves, which leads to the formation of ulcers.
• Simultaneously with the rashes in the mouth, the same blisters appear on the skin of the palms and soles. The rash may also appear on other parts of the body.

Recovery period

After 5 days, the immune system begins to produce antibodies. The temperature drops, the general condition of the child gradually improves. The recovery period lasts 5-7 days: ulcers on the mucous membrane heal, appetite returns. On average, the disease lasts 10 days. However, if the child’s immunity is weakened, the virus remains in the nervous tissue and periodically causes relapses of diseases: for example, serous meningitis, herpetic sore throat, conjunctivitis, viral heart disease, and so on.

Prevention and treatment

This disease most often occurs in the fall, less often in the spring. There are no special preventive measures to combat it, and the degree of infection during the epidemic is quite high, especially if the child has never had the Coxsackie virus. It should be noted that the disease does not induce immunity, that is, having had it once, you can become infected again, but the disease will be easier than the first time.

The only thing that can be recommended to parents as preventive measures is to prevent their child from visiting places where there are large concentrations of children during epidemic periods (theatres, children's clinics, etc.). You also need to wash your child’s hands more often and ventilate the room in which he is located during the day, as well as buy bottled filtered water, and monitor the cleanliness of the vegetables and fruits that the child eats.

There is no treatment for the Coxsackie virus, as such. Therefore, it should be treated symptomatically: drinking plenty of fluids to better remove toxins from the body and reduce the temperature, antipyretics, sprays for the throat and mouth, if the rash causes itching - antihistamines. As mentioned above, there is no special treatment for this virus; the disease goes away on its own in 10-14 days. There are usually no complications after it, but several cases of meningitis caused by the Coxsackie virus have been reported.

If a child shows one or more signs of this disease, he should be isolated from other children (not taken to kindergarten or school) and a local pediatrician should be called.