Symptoms of Coxsackie and ECHO Infection

The incubation period of Coxsackie and ECHO infection is from 2 to 10 days. The disease begins acutely, sometimes suddenly, with a rise in body temperature to 39-40 ° C. From the first days, patients complain of headache, dizziness, weakness, poor appetite, sleep disturbance. Often observed repeated vomiting. At all forms reveal a hyperemia of integuments of the upper half of the trunk, especially the face and neck, the injection of the vessels of the sclera. A polymorphous patchy-papular rash may appear on the skin. More or less pronounced hyperemia of the mucous membranes of the tonsils, the granularity of the soft palate, the arches and the posterior pharyngeal wall. The language is usually covered. Cervical lymph nodes are often somewhat enlarged, painless. There is a tendency to constipation.

In peripheral blood, the number of leukocytes is normal or slightly increased. In rare cases, the number of white blood cells can increase to 20-25x10 ⁹ / l. Often noted moderate neutrophilia, followed in later periods by lymphocytosis and eosinophilia. ESR is usually within normal limits or slightly increased.

The course of the disease, the outcome and duration of the febrile period depend on the severity and form of the disease.

Coxsackie and ECHO fever are a common form of enterovirus infection. It can be caused by different types of Coxsackie and ECHO viruses, but more often types 4, 9, 10, 21, 24 of the Coxsackie group B and 1-3, 5, 6, 11, 19, 20 ECHO are more often detected. The disease begins acutely, with the rise in body temperature. The child complains of a headache, there may be vomiting, mild muscle pains and poorly pronounced catarrhal changes in the oropharynx and upper respiratory tract. The patient's face is hyperemic. Scleral vessels are injected, all groups of lymph nodes, as well as the liver and spleen are often enlarged. The disease usually proceeds easily. The body temperature is kept elevated 2-4 days and only in some cases - up to 1-1,5 weeks, sometimes there may be a wave-like fever.

Serous meningitis (ICD10 - A87.0) is the most common form of Coxsackie and ECHO infection. Usually associated with serotypes 1-11, 14, 16-18, 22, 24 Coxsackie A; 1-6 Coxsackie B and 1-7, 9.11, 23, 25, 27, 30, 31 ECHO.

The disease begins acutely, with a rise in body temperature to 39-40 ° C. There is a severe headache, dizziness, repeated vomiting, agitation, anxiety, sometimes pain in the abdomen, back, legs, neck, delirium and cramps. The face of the patient is hyperemic, slightly pasty, the sclera are injected. Mucous membrane of the oropharynx is hyperemic, note the granularity of the soft palate and the posterior pharyngeal wall (pharyngitis). From the first days there are meningeal symptoms: rigidity of the occipital muscles, positive symptoms of Kernig and Brudzinsky. Abdominal reflexes are reduced. Often the meningeal syndrome is weakly or incompletely expressed - there are individual symptoms (there may be only a positive Kernig symptom or a slight stiff neck).

With a lumbar puncture fluid is transparent, flows out under pressure. Cytosis up to 200-500 cells in 1 μl. At the very beginning of the disease, cytosis, as a rule, is mixed (neutrophilic-lymphocytic), and then - exclusively lymphocytic. The content of protein, sugar and chloride is usually not increased, the Pandi reaction is weakly positive or negative. From the cerebrospinal fluid can be identified viruses Coxsackie and ECHO.

Herpetic angina (ICD-10 - B08.5) is more often caused by Coxsackie A viruses (1-6, 8,10, 22), less often Coxsackie B (1-5) and ECHO viruses (6. 9,16, 25). Meet in children of different ages. Usually combined with other signs of Coxsackie and ECHO infection - serous meningitis, myalgia, etc., but may be the only manifestation of the disease.

The disease begins acutely, with a sudden increase in body temperature to 39-40 ° C. The most common changes in the oropharynx. From the first days of the disease, single small red papules 1-2 mm in diameter appear on the mucous membrane of the palatine arch of the tonsils, the tongue, soft and hard palate, which quickly turn into tender vesicles, and then into the jaundice, surrounded by a red corolla. The number of such rashes is small, usually 3-8, in rare cases, rashes can be abundant (up to 25). Elements never merge with each other. Possible pain when swallowing, increasing regional lymph nodes.

Epidemic myalgia (pleurodynia, Bornholm disease) (ICD-10 - VZZ.O) is more often caused by Coxsackie viruses (1, 2, 3, 5), less often - Coxsackie A (1, 4, 6, 9) and ECHO (1- 3, 6-9, 12). The disease manifests itself with severe muscle pain and begins acutely, with a rise in body temperature to 38-40 ° C, often with chills and vomiting. The localization of pain is different, but still more often they are in the muscles of the chest and upper abdomen, less often - back and limbs. The pains are paroxysmal and worse with movement. During an attack of pain, the children turn pale and sweat profusely. Because of severe pain, breathing becomes more frequent, becomes superficial, resembles breathing in pleurisy. With auscultation, changes in the lungs are usually not noticed, only in rare cases, at a height of the pain syndrome, a pleural friction noise is observed disappearing immediately after the cessation of the pain attack. With the localization of pain in the rectus abdominal muscles, the palpation of the anterior abdominal wall is painful, the active tension of the muscles of the abdominal wall and their sparing during breathing are noted, which can cause erroneous diagnosis of acute appendicitis or peritonitis.

The duration of the pain attack is from 30-40 seconds to 1-15 minutes and more. The pains disappear as suddenly as they do, after which the child's condition immediately improves and he often does not make any complaints. Pain can be repeated several times a day, and the disease can take a wavy course. One to three days after the fall of body temperature, its new ascent and renewal of pain are possible. Rarely relapses are repeated repeatedly for 7 days or more.

Intestinal form occurs mainly in young children and very rarely in children older than 2 years. This form of the disease is more often associated with ECHO viruses (5.17,18), more rarely - Coxsackie B (1,2,5). The disease begins acutely, with an increase in body temperature to 38 ° C. There are catarrhal phenomena: a small runny nose, stuffy nose, cough, hyperemia of the mucous membranes of the oropharynx. Simultaneously with it or in 1-3 days there are pains in a stomach and a liquid chair, sometimes with an admixture of slime, but never there is an admixture of blood. Often there are repeated vomiting, flatulence. Symptoms of intoxication are not very pronounced. Heavy dehydration does not develop. Colitis syndrome (tenesmus, spasm of the sigmoid colon, gaping of the anus) is absent. The duration of the disease does not exceed 1-2 weeks. The body temperature lasts for 3-5 days, sometimes it is two-wave.

Coxsackie and ECHO exanthema (ICD-10 to A88.0) are more often caused by ECHO viruses (5,9,17,22) and Coxsackie A (16). With this form of the disease on the 1-2 day usually there is a rash. The disease begins acutely, with a rise in body temperature, headache, anorexia. Sometimes note muscle pains, scleritis, the phenomena of catarrh of the upper respiratory tract. Often at the beginning of the disease, vomiting and abdominal pain occur. Infants may have a loose stool.

The rash appears either at the height of the fever, or immediately after a drop in body temperature. It is located on the skin of the face, trunk, less often on the hands and feet. Elements of a rash pink on unchanged skin. The rash may be scar-latino-like or small-spotted-papular, reminiscent of a rash with rubella. There may be hemorrhagic elements. The rash keeps for several hours or days, disappearing, does not leave pigmentation, peeling also does not happen.

The paralytic form is rare, more often associated with the viruses of the Coxsackie A group (4, 6, 7, 9, 10, 14), less often - Coxsackie B and ECHO viruses (4, 11, 20). Sporadic cases are noted, as a rule, in young children. Poliomyelitis-like forms of Coxsackie and ECHO infection appear in the same way as paralytic poliomyelitis (spinal, bulbospinal, encephalitic, pontine, polyradiculoneuritis). The disease begins acutely, with the rise in body temperature, light catarrhal phenomena and flaccid paralysis. Approximately half of the children begin the paralytic period on the 3rd-7th day after the onset of the disease after normalizing the body temperature and improving the general condition. There may be paralysis without previous prodromal phenomena. As in poliomyelitis, with paralytic form of Coxsackie and ECHO infection as a result of damage to the cells of the anterior horns of the spinal cord, flaccid peripheral paralysis develops. In this case, the child is broken gait, there is weakness in the legs, less often in the hands. Muscle tone is reduced, the tendon reflexes on the side of the lesion are moderately reduced. The cerebrospinal fluid is often unchanged, but there may be signs of serous meningitis. Cases with isolated lesion of the facial nerve (Pontine form) and other cranial nerves, as well as encephalitic and polyradiculo-neuritic forms, are also virtually indistinguishable from similar forms in poliomyelitis. For differential diagnosis, it may only matter that the paralytic forms of Coxsackie and ECHO infection are sometimes combined with other, more manifest manifestations of the disease-serous meningitis, herpetic angina, myalgia, etc. Unlike poliomyelitis, the paralytic forms of Coxsackie and ECHO infections flow easily and almost do not leave persistent paralysis.

Encephalomyocarditis (ICD-10 - A85.0) is usually caused by Coxsackie viruses in group B. This form is observed in newborns and in infants of the first months of life. Infection of newborns occurs from the mother or other sick family members, as well as from the staff of maternity hospitals, departments for premature babies. It is possible and intrauterine infection.

The disease begins with an increase in body temperature (sometimes it can be normal or subfebrile), the appearance of lethargy, drowsiness, rejection of the breast, vomiting, sometimes a loose stool. Symptoms of increasing cardiac weakness are very fast: general cyanosis or acrocyanosis, dyspnea, tachycardia, widening of the heart, rhythm disturbance, and a significant increase in the liver. Listen to heart murmurs. In encephalitis, in addition to these symptoms, there may be convulsions, bulging fontanel. In the cerebrospinal fluid, cytosis is mixed or lymphocytic.

The course of the disease is severe and often ends in death.

Myocarditis and pericarditis are more often caused by Coxsackie viruses of type B (1, 2, 3, 5), rarely Coxsackie A (1, 4, 15) and ECHO (6). Currently, many clinicians believe that most non-rheumatic carditis is etiologically associated with Coxsackie and ECHO viruses. The disease occurs in both children and adults, often proceeds according to the type of pericarditis, less often myocarditis and pancarditis. The heart usually has a focal interstitial pathological process, often coronary disease develops.

Mesadenitis is inflammation of the lymph nodes of the mesentery of the small intestine, is caused by ECHO viruses (7, 9, 11), rarely Coxsackie of group B (5). The disease develops gradually: within a few days subfebrile body temperature, abdominal pain of unclear etiology are noted. Then the temperature rises, vomiting arises, abdominal pain intensifies, becomes paroxysmal, often localized in the right ileal region. On examination, bloating is noted, moderate tension of the muscles of the anterior abdominal wall, sometimes a positive symptom of Schetkin. Such patients are usually hospitalized in a surgical hospital with suspicion of appendicitis and sometimes they undergo surgical intervention. In the course of surgery, moderately enlarged lymph nodes of the small intestine mucosa and serous effusion in the abdominal cavity are detected: there is no change in the vermiform appendage.

Acute hepatitis. Experimental studies show hepatotrophy of Coxsackie viruses. In newborns, who died from the generalized form of Coxsackie infection, liver damage is detected. In recent decades, there have been reports in the literature of acute hepatitis of enterovirus etiology associated with Coxsackie A viruses (4, 9, 10, 20, 24). Coxsackie B (1-5). ECHO (1, 4, 7, 9, 11, 14).

The disease is manifested by acute enlargement of the liver, jaundice and impaired liver function. Other symptoms of Coxsackie and ECHO infection are noted: fever, hyperemia of the skin, mucous membranes, soft palate, headache, sometimes vomiting, etc.

The course of the disease in contrast to viral hepatitis is mild, with a fast reverse dynamics.

Acute hemorrhagic conjunctivitis is usually caused by enterovirus type 70. In recent years, more and more outbreaks of conjunctivitis. Caused by other serotypes of enteroviruses (Coxsackie A 24, etc.). The disease begins with sudden severe pain in the eyes, lacrimation, photophobia, sometimes a rise in body temperature to subfebrile digits, headaches and weak catarrhal phenomena. Inflammatory changes in the eyes grow rapidly. The eyelids turn red, swell, hemorrhages in the conjunctiva, sometimes in the sclera, often develop small-focal epithelial keratitis, from the first days there is a serous discharge from the eyes, which in the following days becomes purulent due to the attachment of bacterial infection.

In addition to acute hemorrhagic conjunctivitis, enteroviruses can cause severe damage to the vascular tract of the eye (uveitis), as well as orchitis, epididymitis, etc.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15]