Symptoms of Coxsackie and EVD infection

The incubation period of Coxsackie and ECHO infections 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, and sleep disturbances. Repeated vomiting is often noted. In all forms, hyperemia of the skin of the upper half of the body, especially the face and neck, and injection of the scleral vessels are detected. A polymorphic maculopapular rash may appear on the skin. Hyperemia of the mucous membranes of the tonsils, granularity of the soft palate, arches, and back wall of the pharynx are more or less pronounced. The tongue is usually coated. The cervical lymph nodes are often slightly enlarged and painless. A tendency to constipation is noted.

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

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

Coxsackie and ECHO fever is a common form of enterovirus infection. It can be caused by different types of Coxsackie and ECHO viruses, but most often types are 4, 9, 10, 21, 24 from the Coxsackie B group and 1-3, 5, 6, 11, 19, 20 ECHO. The disease begins acutely, with a rise in body temperature. The child complains of headache, there may be vomiting, moderate muscle pain and mild catarrhal changes in the oropharynx and upper respiratory tract. The patient's face is hyperemic. The vessels of the sclera are injected, all groups of lymph nodes are often enlarged, as well as the liver and spleen. The disease usually proceeds mildly. The body temperature remains elevated for 2-4 days and only in isolated cases - up to 1-1.5 weeks, sometimes there may be a wave-like fever.

Serous meningitis (ICD10 - A87.0) is the most typical form of Coxsackie and ECHO infection. It is 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. Severe headache, dizziness, repeated vomiting, agitation, anxiety, sometimes pain in the abdomen, back, legs, neck, delirium and convulsions appear. The patient's face is hyperemic, slightly pasty, the sclera is injected. The mucous membrane of the oropharynx is hyperemic, granularity of the soft palate and the back wall of the pharynx is noted (pharyngitis). Meningeal symptoms appear from the first days: rigidity of the occipital muscles, positive Kernig and Brudzinsky symptoms. Abdominal reflexes are reduced. Often, the meningeal syndrome is weakly expressed or incompletely - individual signs are missing (there may only be a positive Kernig symptom or slight rigidity of the occipital muscles).

At lumbar puncture the fluid is transparent, flows out under pressure. Cytosis up to 200-500 cells in 1 μl. At the very beginning of the disease the cytosis is usually mixed (neutrophil-lymphocytic), and then exclusively lymphocytic. The content of protein, sugar and chlorides is usually not increased, Pandy reaction is weakly positive or negative. Coxsackie and ECHO viruses can be isolated from the cerebrospinal fluid.

Herpetic angina (ICD-10 - B08.5) is most often caused by Coxsackie A viruses (1-6, 8,10, 22), less often by Coxsackie B (1-5) and ECHO viruses (6. 9,16, 25). It occurs in children of different ages. It is usually combined with other signs of Coxsackie and ECHO infections - 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 typical changes are 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 arches of the tonsils, uvula, soft and hard palate, which quickly turn into delicate vesicles, and then into ulcers surrounded by a red rim. The number of such rashes is small, usually 3-8, in rare cases the rash can be abundant (up to 25). The elements never merge with each other. Pain when swallowing, enlargement of regional lymph nodes are possible.

Epidemic myalgia (pleurodynia, Bornholm disease) (ICD-10 - B33.O) is most often caused by Coxsackie B viruses (1, 2, 3, 5), less often by 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 varies, but most often it occurs in the muscles of the chest and upper abdomen, less often in the back and limbs. The pain is paroxysmal and intensifies with movement. During an attack of pain, children turn pale and sweat profusely. Due to severe pain, breathing becomes more frequent, shallow, reminiscent of breathing in pleurisy. During auscultation, changes in the lungs are usually not noted, only in rare cases at the height of the pain syndrome is pleural friction noise observed, which disappears immediately after the pain attack ceases. When pain is localized in the rectus abdominis muscles, palpation of the anterior abdominal wall is painful, active tension of the abdominal wall muscles and their sparing during breathing are noted, which can cause an erroneous diagnosis of acute appendicitis or peritonitis.

The duration of a pain attack is from 30-40 seconds to 1-15 minutes or more. The pain disappears as suddenly as it appears, after which the child's condition immediately improves and he often does not complain. The pain may recur several times during the day, and the disease may take a wave-like course. 1-3 days after the body temperature drops, it may rise again and the pain may recur. Rarely, relapses are repeated repeatedly for 7 days or more.

The intestinal form occurs mainly in young children and very rarely in children over 2 years of age. This form of the disease is more often associated with ECHO viruses (5.17,18), less often - Coxsackie B (1,2,5). The disease begins acutely, with an increase in body temperature to 38 ° C. Catarrhal symptoms occur: a slight runny nose, nasal congestion, cough, hyperemia of the mucous membranes of the oropharynx. Simultaneously or after 1-3 days, abdominal pain and loose stools appear, sometimes with an admixture of mucus, but there is never an admixture of blood. Repeated vomiting and flatulence are often present. Symptoms of intoxication are mild. Severe 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 up to 3-5 days, sometimes it has two waves.

Coxsackie and ECHO exanthema (ICD-10 - A88.0) is most often caused by the ECHO (5,9,17,22) and Coxsackie A (16) viruses. With this form of the disease, a rash usually appears on the 1st or 2nd day. The disease begins acutely, with a rise in body temperature, headache, anorexia. Sometimes muscle pain, scleritis, and catarrh of the upper respiratory tract are noted. Vomiting and abdominal pain are often present at the onset of the disease. Young children may have loose stools.

The rash appears either at the height of the fever or immediately after the body temperature drops. It is located on the skin of the face, body, less often on the arms and legs. The elements of the rash are pink on unchanged skin. The rash can be scarlet-like or small-spotted-papular, reminiscent of the rash with rubella. There may also be hemorrhagic elements. The rash lasts for several hours or days, disappearing, leaving no pigmentation, and there is no peeling.

The paralytic form is rare and is more often associated with viruses of the Coxsackie A group (4, 6, 7, 9, 10, 14), less often with Coxsackie B and ECHO viruses (4, 11, 20). Sporadic cases are noted, usually in young children. Poliomyelitis-like forms of Coxsackie and ECHO infections manifest themselves in the same way as paralytic poliomyelitis (spinal, bulbospinal, encephalitic, pontine, polyradiculoneuritic). The disease begins acutely, with a rise in body temperature, mild catarrhal phenomena and flaccid paralysis. In about half of the children, the paralytic period begins on the 3rd-7th day from the onset of the disease after normalization of body temperature and improvement of the general condition. Paralysis may occur without preceding prodromal phenomena. As with poliomyelitis, with the 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's gait is impaired, weakness appears in the legs, less often in the arms. Muscle tone decreases, tendon reflexes on the affected side are moderately reduced. The cerebrospinal fluid is often unchanged, but there may also be signs of serous meningitis. Cases with isolated damage to the facial nerve (pontine form) and other cranial nerves, as well as encephalitic and polyradiculoneuritic forms are also practically indistinguishable from similar forms in poliomyelitis. For differential diagnostics, it may only be important that paralytic forms of Coxsackie and ECHO infections are sometimes combined with other, more manifest manifestations of the disease - serous meningitis, herpetic angina, myalgia, etc. Unlike poliomyelitis, paralytic forms of Coxsackie and ECHO infections are mild and almost do not leave persistent paralysis.

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

The disease begins with an increase in body temperature (sometimes it can be normal or subfebrile), lethargy, drowsiness, refusal to breastfeed, vomiting, and sometimes loose stools. Symptoms of increasing cardiac weakness quickly join in: general cyanosis or acrocyanosis, dyspnea, tachycardia, enlargement of the heart, rhythm disturbances, and significant liver enlargement. Heart murmurs are heard. In encephalitis, in addition to the symptoms listed above, there may be convulsions and a bulging fontanelle. In the cerebrospinal fluid, the cytosis is mixed or lymphocytic.

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

Myocarditis and pericarditis are most often caused by Coxsackie viruses 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, most often proceeds as pericarditis, less often myocarditis and pancarditis. In the heart, there is usually a focal interstitial pathological process, often coronaritis develops.

Mesadenitis is an inflammation of the lymph nodes of the mesentery of the small intestine, caused by ECHO viruses (7, 9, 11), rarely Coxsackie group B (5). The disease develops gradually: subfebrile body temperature and abdominal pain of unknown etiology are observed for several days. Then the temperature rises, vomiting appears, abdominal pain intensifies, becomes paroxysmal, often localized in the right iliac region. During examination, abdominal distension, moderate tension of the muscles of the anterior abdominal wall, and sometimes a positive Shchetkin symptom are noted. Such patients are usually hospitalized in a surgical hospital with suspected appendicitis and sometimes they undergo surgery. During surgery, moderately enlarged lymph nodes of the mesentery of the small intestine and serous effusion in the abdominal cavity are found: there are no changes in the vermiform appendix.

Acute hepatitis. Experimental studies have shown the hepatotropism of Coxsackie viruses. Liver damage is found in newborns who died from the generalized form of Coxsackie infection. In recent decades, isolated reports have appeared in the literature on acute hepatitis of enterovirus etiology associated with Coxsackie viruses of group A (4, 9, 10, 20, 24). Coxsackie B (1-5). ECHO (1, 4, 7, 9, 11, 14).

The disease manifests itself as acute enlargement of the liver, jaundice and liver dysfunction. Other symptoms characteristic of Coxsackie and ECHO infections are also noted: increased body temperature, hyperemia of the skin, mucous membranes, soft palate, headache, sometimes vomiting, etc.

The course of the disease, unlike viral hepatitis, is mild, with rapid reverse dynamics.

Acute hemorrhagic conjunctivitis is usually caused by enterovirus type 70. In recent years, outbreaks of conjunctivitis caused by other serotypes of enteroviruses (Coxsackie A 24, etc.) have been increasingly described. The disease begins with sudden severe pain in the eyes, lacrimation, photophobia, sometimes an increase in body temperature to subfebrile numbers, headaches and mild catarrhal phenomena. Inflammatory changes in the eyes quickly increase. The eyelids turn red, swell, hemorrhages appear in the conjunctiva, sometimes in the sclera, small-focal epithelial keratitis often develops, from the first days serous discharge from the eyes appears, which in the following days becomes purulent due to the addition of a 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 ]