How does the rash go after coxsackie. Coxsackie virus in adults - causative agent, incubation period, manifestations, diagnosis and how to treat

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Which doctor should I contact with the Coxsackie virus?

If the Coxsackie virus provoked an infection like a minor illness (summer flu), when the body temperature rises sharply, the lymph nodes increase, appears headache, weakness, lethargy, muscle aches, loss of appetite, redness of the pharynx and palatine arches, redness of the eyes, then you need to contact general practitioner (make an appointment) or pediatrician (make an appointment).

If the Coxsackie virus provoked the development of herpangina (the arches, tonsils and uvula are red, there are whitish papules on the palate, tonsils and arches, after 2-3 days they turn into vesicles that burst and leave ulcers, while there is high fever, weakness, body aches , headache and other symptoms of intoxication), you should contact otolaryngologist (make an appointment) or a general practitioner (in the case of children, a pediatrician).

If the Coxsackie virus provoked an infection of the hand-foot-mouth syndrome type, when the body temperature first rises, and then, against the background of its fall, red viral rashes appear on the skin (such rashes are most often localized around the mouth, on the palms and feet, but can be on the body, under the hair, on the buttocks), it is advisable to refer to infectious disease doctor (make an appointment), but you can go to an appointment with a therapist or pediatrician.

If the Coxsackie virus proceeds according to the type of Bornholm's disease, when a person has paroxysmal very severe muscle pain (often there is pain in the intercostal muscles, causing shortness of breath, and pain in the upper abdomen, similar to appendicitis, peritonitis, etc.), which pass in 3-4 days, you should definitely contact an infectious disease specialist. This is due to the fact that after the disappearance of pain in the muscles in most cases, meningitis develops, which is a continuation of the course of the disease. Actually, to prevent the development of meningitis or to maximize it effective treatment at the very beginning of the development of the disease, it is necessary to contact an infectious disease specialist with hospitalization in the infectious department.

If the Coxsackie virus causes meningitis or encephalitis (high body temperature, vomiting, severe headaches, neck stiffness - when it is impossible to reach the chest with the chin), then you should urgently call " ambulance"and be hospitalized in the infectious diseases department. If it is impossible to call an ambulance for any reason, then you should get to the nearest infectious diseases department in your own transport as soon as possible.

If the Coxsackie virus causes an infection like poliomyelitis (flaccid paralysis lower extremities, pain in the legs and arms, decreased muscle tone, attacks of muscle tremors, upset stool and urination), then you should contact an infectious disease specialist. If for some reason there is none, you should contact your pediatrician or therapist.

If the Coxsackie virus provokes mesadenitis (high body temperature, attacks acute pain in the abdomen, constipation, enlargement of the cervical, inguinal, axillary lymph nodes), then you should contact surgeon ().

If the Coxsackie virus causes symptoms of an intestinal infection (low body temperature, vomiting, diarrhea, dry skin and inflammation in the upper respiratory tract - runny nose, pain and redness in the throat, cough), then you should contact an infectious disease specialist.

If the Coxsackie virus provokes pericarditis or myocarditis (prolonged fever, pain in the heart, arrhythmia, shortness of breath, fainting, cyanosis of the nasolabial triangle), then you should be hospitalized under observation cardiologist () or a therapist.

If the Coxsackie virus provokes catarrh of the upper respiratory tract(high body temperature, runny nose, pain and redness of the throat, cough, hoarse voice, etc.), then you should contact a general practitioner, or a pediatrician in the case of a child.

If the Coxsackie virus provokes hemorrhagic conjunctivitis (redness and pain in the eyes, swollen eyelids, lacrimation, photosensitivity), then you should contact ophthalmologist () so that he prescribes treatment and prevents possible complications.

If the Coxsackie virus occurs in the form of orchitis or epididymitis (high fever, pain in the testicles, enlargement of one or both testicles, enlargement of the inguinal lymph nodes), then you should contact an infectious disease doctor or urologist ().

Diagnosis of the Coxsackie virus. What tests can the doctor order?

With typical manifestations enteroviral infections the diagnosis can be determined on the basis of characteristic symptoms: herpangina, exanthema, hand-foot-mouth syndrome, fever. In this case, specific virological studies are often not required. But since coxsackie virus often proceeds atypically, then it is possible to prove an enterovirus infection only with the help of special laboratory tests.

To identify enterovirus, two types of laboratory diagnostics are used:

1. PCR diagnostics - identification of the virus in the biological fluids of the patient (feces, swabs of mucus from the nasopharynx, urine, and others).
2. Serological research methods - detection of specific antibodies (immunoglobulins) to the virus in the blood.

In addition, the patient will need to additional examination:

general analysis blood;
general urine analysis;
analysis of cerebrospinal fluid (if there are symptoms of meningitis);
other types of research, prescribed depending on the lesion of a particular organ ( X-ray (book), MRI of the brain (make an appointment), ECG (sign up) And so on).

General analysis of blood and urine

In the general blood test with the Coxsackie virus, changes are observed that are typical for many viral infections (moderate increase in leukocytes due to lymphocytes, ESR acceleration). In severe cases, a decrease in the level of lymphocytes (lymphopenia) is possible.

Blood test for antibodies to Coxsackie viruses

With enterovirus infections from the first days of the disease, human immunity reacts with the formation of specific antibodies, or immunoglobulins. They are detected by serological blood tests.

Coxsackie virus markers:

Class M immunoglobulins (IgM) to Coxsackie viruses - antibodies of the acute period of the disease;
Immunoglobulins of class G (IgG) to Coxsackie viruses are antibodies of a past disease.

It is possible to say that a person is sick with the Coxsackie virus when class M immunoglobulins are detected, and their titers are several times higher than normal (reference) values.

This method cannot determine the serotype of the virus. The accuracy of such diagnostics is more than 90%.

Treatment of the Coxsackie virus

In most cases, diseases associated with the Coxsackie virus do not require hospitalization, but there are cases when inpatient treatment is indispensable.

When is it necessary to urgently call a doctor?

The child is not yet one year old and has a high body temperature;
Fever for more than 3 days, the temperature is poorly controlled by antipyretic drugs;
The child has not eaten or drunk for more than 24 hours;
Loss or confusion of consciousness, delusional state;
Severe weakness, constant drowsiness;
There were signs of meningitis (severe headaches, vomiting, convulsions, and others);
"Uncaused" bruises appeared on the skin;
Repeated vomiting and diarrhea (more than 6 times a day), against which the child becomes lethargic;
The child does not urinate for more than 12 hours;
Severe pain in the abdomen, in young children this symptom is characterized by constant strong crying and pulling the legs to the stomach;
Paroxysmal dry cough, shortness of breath;
The appearance of cyanosis (cyanosis of the skin of the face and extremities);
Suspicion of paralysis of the muscles of the limbs.

If the child does not have such symptoms indicating a severe or complicated course of an enterovirus infection, then the child can stay at home and follow the doctor's recommendations, and he will have to be contacted in any case.

How to treat the Coxsackie virus at home?

1. Required bed rest to normalize body temperature and general well-being.

2. Plentiful drink- a prerequisite for the treatment of enteroviral viral infections. The child should drink often and a lot, it can be anything - water, tea, fruit drink or compote.

Acyclovir for Coxsackie virus

Acyclovir is an antiviral drug used for herpes infections. Coxsackie virus has nothing to do with herpes viruses, therefore, acyclovir is not used for enterovirus infections and is absolutely ineffective.

Consequences and complications of enterovirus infections

Any infectious pathology has a risk of complications. Since the Coxsackie virus is very diverse, the complications can be very diverse. It all depends on which organs are affected by the virus.

Most dangerous complication Coxsackie virus is a cerebral edema, which always threatens the patient's life and requires resuscitation.

Possible complications and consequences of the Coxsackie virus:
1. Cerebral edema.
2. Accession bacterial infections: sinusitis, bronchitis, pneumonia, purulent conjunctivitis, purulent meningitis, etc.,

Why is the Coxsackie virus dangerous for a woman during pregnancy?

The possible development of a severe course of enterovirus infection with damage to the nervous system, heart and other organs;
high risk of life-threatening complications of the disease;
miscarriage (miscarriage), premature birth.

Pregnant women in most cases tolerate Coxsackie viruses favorably, but the risk of negative consequences is much higher than without pregnancy.

How dangerous is the Coxsackie virus for the fetus?

Intrauterine infection of the fetus;
the development of anomalies in the development of the central nervous system of the child (anencephaly - the absence of the cerebral hemispheres, hydrocephalus - dropsy of the brain, and other severe pathologies);
intrauterine growth retardation and pregnancy fading;
intrauterine fetal death.

This does not mean that if a pregnant woman has had an enterovirus infection, the child will be born sick or die. But there are still such risks, since group B Coxsackie viruses are able to cross the placenta and infect the fetus.

What is dangerous enterovirus infection for a newborn baby?

Group B coxsackievirus is most dangerous not during pregnancy, but during and immediately after childbirth. In newly born children, the risk of infection with the Coxsackie virus is very high. Neonatal encephalomyocarditis may develop, in which there is a high mortality rate (about 40% of cases) and a high risk of developing severe neurological pathologies.

Interesting that if a newborn child was not infected immediately after birth, but after a while, and receives breastfeeding, then the risk of infection is practically absent. This is due to the mother's antibodies she passes on with her milk.

In what trimester of pregnancy is the Coxsackie virus most dangerous?

Enteroviral infections are undesirable throughout pregnancy. In the early stages, there is a risk of miscarriages and fetal abnormalities, since all the organs and tissues of the fetus are only being laid and formed. But in the later stages, the risk of developing enterovirus infections in a newborn increases, which also has negative consequences for the health and life of the child.

What to do if a pregnant woman becomes infected with the Coxsackie virus?

Firstly, do not panic, in most cases, enterovirus infection does not become a tragedy for the expectant mother and child. Often it proceeds as SARS, herpetic sore throat or exanthema. Such women are usually hospitalized in a hospital and monitor the condition of the patient herself and her baby. Of the treatment, Paracetamol and detoxification therapy are usually prescribed (enterosorbents, infusion solutions in the form of droppers, vitamins, etc.). You will have to regularly take stool tests to determine the virus carrier, blood to control the production of antibodies, and monitor the ultrasound of the fetus.

How contagious is a patient with the Coxsackie virus? Quarantine for enterovirus infections

The beginning of virus isolation is 1-2 days before the onset of the disease, and the "peak of infectivity" falls on the 2-3rd day of the disease. After recovery, the patient is excreting enteroviruses for several more weeks, in rare cases - several months and even years. During illness, all biological fluids are contagious, but a longer shedding of the virus is observed with feces.

If a child who attends Kindergarten or school, then the baby must be isolated for the period of the entire illness, and allowed into the children's team only after complete recovery, normalization of body temperature and cleaning of the skin from rashes, but not earlier than after 14 days. For serous meningitis, children are isolated for 21 days.

Quarantine in the children's team is usually announced for 14 days, that's how long it can last incubation period. If during this time new patients are detected, then the quarantine is extended for another 14 days.

After identifying a patient with an enterovirus infection in children's institutions, final disinfection is mandatory, and sanitary and epidemic services are usually involved in this.

Also, quarantine is imposed on maternity and children's departments in which sick children, parents or medical personnel were identified.

Immunity after the Coxsackie virus

After an enterovirus infection, specific antibodies to the virus are formed in the human body, which protect against re-infection. That is, a strong immune system is developed. But such antibodies are effective only against those serotypes of the virus that a person has been ill with. Recall that there are 29 Coxsackievirus serotypes and 32 ECHO serotypes. Therefore, repeated enterovirus infections caused by "new" virus serotypes are possible.

Prevention of enterovirus infection

A vaccine against Coxsackie viruses (specific prophylaxis) does not currently exist, this is due to the large number of serotypes and the variability of the virus.

What to do if a child is sick with the Coxsackie virus?

It is desirable to isolate the patient from other children in a separate room;
carefully monitor the cleanliness of the hands of all family members;
regularly carry out wet cleaning, disinfection of pots and toilets, wipe door handles, ventilate rooms;
for disinfection, disinfectants containing active chlorine, hydrogen peroxide, 0.3% formalin solution are used;
quartz lamps are effective, but people should not be allowed to stay in the room where quartzing takes place, and after the procedure, thorough ventilation is necessary;
allocate separate dishes for the patient, it must be processed;
toys, towels and various "common use" items will have to be processed;
for contact children, the introduction of gamma globulin is recommended, which will enhance protection against the Coxsackie virus and its severe manifestations, and for children with weakened immunity, the use of interferon preparations and immunostimulants is recommended;
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Coxsackie virus - description, incubation period, symptoms and signs of enterovirus infection in children and adults, photo. How can a child become infected with the Coxsackie virus?

Coxsackievirus is one huge group of microorganisms from the enterovirus family. It "lives" and reproduces in the digestive tract, but other vital organs can also be affected. To date, all serotypes are classified into A, B - groups of enteroviruses. Depending on the type of virus of a sick person, and often a child, it is determined which organ they affect, and what complications and diseases they cause. The infection is transmitted from one person to another, so it can be found in children and adults. But more frequent cases are predominantly characteristic of the younger generation. To understand what we are dealing with, you need to familiarize yourself with the information about the Coxsackie virus symptoms and treatment in adults.

In this article you will learn:

Treatment of the Coxsackie virus in adults

In adults, Coxsackie enterovirus is quite rare. Weak immunity increases the chances of infection due to non-compliance with the rules of personal hygiene from your child, and not only. If we talk about close contact with an infected person or his things, then the ability to succumb to the habitation of the virus increases by more than 95%.

The infection is treated by two methods: pathogenetic and symptomatic.

The first way is the use of antiviral drugs.

If the disease lasts more than three days, you can not do without symptomatic therapy:

Strictly adhere to bed rest. It is recommended to sleep soundly at least 9 hours a day, while eliminating any physical or mental stress.
Only warm drinks. This will help restore the balance of fluid in the body and protect yourself from dehydration. It is recommended to drink water, teas, natural fruit drinks and compotes.
Strict diet. It is important not to overload the digestive organs already affected by the virus. Health professionals advise eating light, low-fat foods. Vitamins in the form of vegetables and fruits should be consumed boiled and stewed.
Take drugs that improve metabolic processes: for example, B vitamins and nootropics.

There is no specificity of the strongest feature of the treatment of a severe rash of infection, since the Coxsackie virus is not of particular concern. The treatment of clinical forms of the disease is best carried out completely according to the clear instructions of the attending physician.

Medications

The main thing is to be able to detect the virus in the first 72 hours from the moment of infection. If you managed to do this, and all the symptoms point to the habitation of the infection in the body, then it is possible to quickly recover by using potent drugs against the disease.

Treatment of the Coxsackie virus in adults can be facilitated by the following medications:

Rimantadine;
Amizon;
Tamiflu;
Relenza;
Lavomax;
Arbidol;
Kagocel;
Amiksin;
Tiloron;
Ingavirin.

If the thermometer does not show a temperature of more than 38.5 degrees, do not knock it down, give the human body the opportunity to fight the infection. With inflammation of the mucous membranes and throat - it is not advisable to diagnose this type of disease, but observe the appearance on the skin small rash it would not hurt.

If the ongoing process was an infection infectious disease, ARVI disease, Coxsackie virus infection, then the consequences can carry severe complications for internal organs.

Symptoms of the Coxsackie virus in adults

Depending on the immunity of the older generation and, possibly, those present, the symptoms of Coxsackie virus diseases in adults are subtle, especially in group A of the enterovirus. Adults often do not even pay attention to the first signs, because they can be generally invisible.
For this viral disease, as well as for any other, the incubation period is characteristic. It lasts for several days - then the rash begins to actively manifest itself and entails a short-term fever. Specially prescribed treatment for this group of infections is not required, so after 3-7 days your body will return to normal.

The Coxsackie virus in adults is more pronounced with symptoms in group B. First of all, it carries the consequences of a complex nature.

When infected with this type of microorganism, the following is observed:

temperature rise to 39 degrees;
progressive abdominal pain;
unpleasant aches in the hands and feet;
continuous coverage with red spots of the body as a whole;
sudden sore throat (since a rash appears on the mucous membranes in the form of crimson-colored bubbles with liquid inside, the oral cavity may be felt);
convulsions;
headache;
orchitis (in males, which can subsequently cause infertility);
aching muscle pain;
conjunctivitis, hemorrhage eyeball, negative attitude to the brightness of light;
weakness;
malnutrition;
enlargement of the lymph nodes.

A person who has been infected with a category B virus, often undergoing home treatment, experiences various dyspeptic disorders, for example: vomiting, diarrhea, and the like. This process is caused by the reproduction and progression of infectious microorganisms in the alimentary tract, diverging from the source to all the internal organs of a person.

Complications

The coxsackie virus in adults, as previously indicated, passes without leaving consequences. But in some cases, it entails unpleasant and serious complications.

The most frequent are:

dehydration of the body (therefore, drinking plenty of water is very important to enter into the treatment regimen for an adult);
pulmonary edema (it is necessary to maintain the regularity of consultations and appointments with a doctor);
severe meningitis or myocarditis;
diabetes.

The type of severe manifestation directly depends on the clinical form of the disease. It is worth noting that infection of the human body with a group B virus, the duration of the course is actually until complete recovery - lasts 21 days. This period consists of an incubation, febrile, and convalescent phase.

Each of them proceeds much faster than it would seem. Therefore, it is very important to catch on and treat an adult in time in order to avoid undesirable consequences.

Other coxsackie virus syndromes

In addition to a skin rash, there are atypical forms of the Coxsackie virus infection.

Among these types of diseases are divided into forms:

encephalitis, meningoencephalitis - inflammation of the human brain. Most often, the syndrome develops against the background of meningitis. The main symptoms of damage to the cerebral hemispheres are mental disorders and impaired speech, swallowing, paralysis;
poliomyelitis is a similar course of enterovirus infection (neuronal damage). This form of enterovirus infection is easier than polio itself, and often without complications. The main symptoms of this form are similar to the form of poliomyelitis, but there are additional attacks of trembling in the muscles, flaccid paralysis, impaired urination and stool;
enteroviral mesadenitis. Other in simple words This is an inflammation of the intestinal lymph nodes. Usually the disease passes favorably, but in rare cases it may not be possible without surgical intervention;
enteroviral diarrhea. Sometimes it is very difficult to distinguish from other foodborne infections, because it also begins acutely, with mild vomiting (up to 3 times a day). The fever is characterized by a gradual increase in weakness, but proceeds favorably and after 2-3 days the patient feels better;
pericarditis. One of the severe manifestations of a viral infection, occurs infrequently, but is dangerous with the possibility of developing heart failure;
fever, headache, high fever. In some cases, intoxication (manifestations such as nausea and vomiting). If these symptoms are not accompanied by any other manifestations, the only way to make a diagnosis is to take tests;
epidemic myalgia (severe pain in the striated muscles).

It is possible to carry out during clinical symptoms lasting 6 or more weeks.

Can the Coxsackie virus be chronic

In most cases, the manifestation of the virus ends in a favorable outcome, acute, but fleeting. However, in some individual situations, even after recovery, the remnants of the genetic material may remain in the cells of the muscles, the central nervous system. This is typical for carriers of the B virus.

However, this is not a cause for concern, because such complications are typical only for people with severely damaged immunity or autoimmune diseases (such as AIDS).

If you let the development of the Coxsackie virus take its course, then its chronic form will annoy the patient with long and debilitating myocarditis (heart) or encephalitis (brain).

Even if you are confident in the strength of your body, do not neglect rehabilitation therapy after clinical treatment. Any disease is exhaustion, and you will need rest, as well as re-diagnosis. Remember that a person does not develop permanent immunity to Coxsackie viruses, of which there are 29 serotypes.

Methods of infection with Coxsackie viruses

The source of infection with the virus is always only the second person. Coxsackie infection from an animal is impossible, but there are many ways for the pathogen to enter the body. This contributes to its propensity to cause epidemics.

There are three main ways of infection:

airborne: by coughing, sneezing, very close conversation;
contact and fecal-oral: with a disregard for the rules of hygiene, it becomes possible to swallow the virus;
transplacental: occurs when the mother becomes ill during pregnancy. Least common.

What is the possible conclusion from all this? As in the case of any other disease, a person must remember the rules of behavior with the carrier of the disease: avoid close contact, share household items and strictly monitor personal hygiene. This greatly reduces the chances of contracting the Coxsackie virus.

General analysis of blood and urine

If the symptoms of the disease can not be sure of the presence of the virus in your body, it is recommended to do a complete blood and urine test. This will help to understand whether there are changes since the last visit to the doctor, and which organs may be affected.

The news of the outbreak of infection with this virus stirred up the ranks of vacationers in hot countries and their compatriots spending the summer in Russian resorts. Citizens frightened by the “epidemic” are hastily looking for a panacea, and those who have a vacation ahead of them decide in a panic to completely abandon the tours they bought in advance on the coast. And if you cool down and calmly figure out what kind of virus this is with the mysterious name of Coxsackie and what kind of disease does it cause?

Who is Coxsackie?

These enteroviruses were accidentally discovered in 1949 when American scientist Gilbert Dalldrof was examining the faeces of polio patients to create a cure or vaccine. An attempt to create a remedy for polio failed, but Dalldrof went down in history as the discoverer of enteroviruses, to which he gave the name Coxsackie - after the small town on the Hudson River, from where the scientist received the first samples of material for research.

Despite the rather exotic sonorous name, Coxsackie viruses are nothing extraordinary. These are common enteroviruses that thrive in gastrointestinal tract person. They are distributed throughout the world, their activity depends on the season and climate.

Enteroviral infections are common in summer and early autumn in countries with a temperate climate, and in the semitropics and tropics throughout the year. At the same time, the number of cases every year is approximately the same. So the rumors about the epidemic, which is harvesting an unprecedented harvest this year, to put it mildly, are not true. As the stories about the danger of diseases associated with the Coxsackie virus do not correspond to it.

Hand-foot-mouth

This is not an empty set of nouns describing parts of the body - this is the name of a disease that develops as a result of infection with enteroviruses, including the Coxsackie virus. Most often, it affects infants and toddlers under 5 years of age, but the incidence is not excluded among school-age children and adults.

It all starts like the flu: with a sharp rise in temperature, loss of appetite and weakness. But unlike the flu, after 1-2 days, small red rashes appear in the mouth, which turn into ulcers - this condition is called herpangina. Of course, it has nothing to do with the herpes virus - it just looks like herpetic lesions.

At the same time, the palms of the hands and soles of the feet are “colored” with pink spots (sometimes with blisters, as with chicken pox), justifying the funny name of the disease. The rash can also appear on the knees, elbows, buttocks, in the genital area. Sometimes (but not always) nails are affected: they can exfoliate, crack, and then completely peel off. Fortunately, this process is usually painless, and the nails grow back safely.

With a good immune response, especially in children, an asymptomatic course of the disease is also possible, while a person, without knowing it, is a source of infection. Viruses are found in secretions from the patient's nose and throat, fluid that is released from ulcerative lesions, and feces.

Infection occurs through personal contact, with particles of saliva when coughing or sneezing, as well as when touching contaminated surfaces (door handles, household items, etc.). Infectious patients can be up to a full recovery, although the maximum probability of “giving the virus to a friend” remains during the first week from the day the fever began.

Will we treat or let him live?

With the question "who is to blame?" we figured it out, there was no less burning and traditional “what to do?”. And there is nothing special to do. Enterovirus infection, like, in fact, most diseases associated with viruses, cannot be treated. No antiviral agents, interferons or homeopathic pills can change the course of the disease.

Recovery occurs "automatically", on average after 7 days, when enteroviruses die ingloriously. In the meantime, the disease is in full swing, one simple but important rule should be followed - to compensate for fluid losses in order to avoid dehydration. Ordinary drinking water, compotes or special rehydration mixtures, preferably cold ones, will help to reduce the sensitivity of pain receptors and reduce sore throat.

At high temperature or pain syndrome, antipyretics and analgesics are indicated, for example, Paracetamol (Panadol). The patient before recovery should not go outside or in crowded places, as it is a source of infection. To reduce the likelihood of infection of relatives, it would be good to increase sanitary vigilance: ventilate the premises, carry out regular cleaning, provide the patient with individual dishes and hygiene items. If the infection "found" you on vacation, focus on washing your hands often hot water with soap.

Complications: rare, but aptly

In the vast majority of cases, the hand-foot-mouth syndrome is well tolerated and passes without a trace. However, occasionally the disease can give a rather serious complication - serous meningitis. Therefore, if symptoms such as headache, stiffness in the neck and back pain appear, a doctor should be called immediately. All other problems associated with the Coxsackie virus are solved almost on their own. The main healer of this disease is time, and a rather short one at that. And, of course, Coxsackie is not the reason why you should deprive yourself of a long-awaited vacation at the resort.

Marina Pozdeeva

Photo istockphoto.com

Coxsackie virus is a group of enterovirus serotypes that negatively affect the immune system, reducing the protective resistance of the body. It is highly contagious for children under 5 years of age, adults rarely get sick. According to statistics, the total number of people who have been ill from an early age is 95% of the world's population. How to understand when a child is infected and how many days a patient with the Coxsackie virus is contagious to others?

The first identification of the virus was made in 1950, by serological samples from an infected resident of the city of Coxsackie (USA), the pathogen was isolated - RNA-picornovirus of the enterovirus family. Further studies determined the resistance of the Coxsackie virion to freezing, its ability to actively develop under the influence of acid, esters, lysol and alcohols. High boiling point, ultraviolet radiation, drying and the action of a chlorine-containing solution with the addition of formalin can destroy the virus outside the host.

High humidity conditions in the human habitat (subtropical climate) activate the rapid spread of the Coxsackie virus. The disease is characterized by seasonal manifestations - summer and autumn.

An epidemic enterovirus infection was recorded in 1997 - 30% of children died (Malaysia). In 2002, out of 40 infected in Greece, 3 children died. In 2007, a pandemic outbreak swept eastern China - more than 1,000 people were infected, 20 children died, 200 were hospitalized with a severe form of the disease.

The main sources of infection are dirty water, food and common household items.

Ways of transmission of the virus

The source of popularization of the virus among the population is a latent carrier or a sick person.

The latent carrier is contagious to others during the period of incubation, the asymptomatic course of the disease, or in the case of an already transferred enterovirus. The period of contagiousness of the carrier is the first two months after the disease. The isolation of the pathogen occurs with biological fluids - saliva, urine, feces.

The contagiousness of the Coxsackievirus is due to its high level viability outside the vector. Airborne transmission is a fundamental reason for the rapid spread of the virus in social gatherings.

The main ways the virus enters the body

Contact - in direct contact with a virus carrier or a patient in the active stage;
fecal-oral - polluted public waters, household items, food, dirty hands;
airborne - the likelihood of infection a second time in those who have been ill increases significantly when air is inhaled after sneezing and coughing an infected person;
transplacental - transmission to a child by an infected mother.

As a rule, children up to a year have innate immunity from the mother. Breastfeeding also reliably protects the baby from infection - the maternal immunoglobulins contained in it support and strengthen the immune defense of the baby. Exceptions may be rare cases of transmission of the virus from the mother during pregnancy.

Symptoms

Entering the body through the mouth, the Coxsackie virus multiplies in the area of the lymph nodes. Then, through the lymph, the pathogen enters the bloodstream and spreads through the circulation throughout the body.

The main viral lesions of certain organs depend on the condition immune system person and predetermine the further development of symptoms.

Organs most susceptible to injury

Oral cavity, tonsils, mucous membrane of the nasopharynx.
Lymphatic system, especially Peyer's patches (intestines).
Brain.
Skin covers.
Muscle tissues.
Intestinal mucosa, eyes and liver (rare).
Embryo in the womb.

To date, the pathogenesis of the Coxsackie virus has not been reliably studied, since infection and disease are most often asymptomatic. This minimizes the possibility of detailed study of the behavior of the virus in the human body.

Enterovirus is characterized by an acute onset of the disease. The child suddenly stops playing, becomes lethargic and apathetic, begins to act up and refuses food, complains of pain in the head. At the same time, there is a sharp increase in temperature up to 40 degrees, which is difficult to bring down. The first symptoms of enterovirus are also characteristic of other diseases of viral etiology.

Considering that the disease provoked by the Coxsackie virus manifests itself in different ways, it is very important to seek medical attention in a timely manner. medical care. A qualified specialist will identify a dangerous pathology at an early stage, which will ensure the effectiveness of subsequent treatment.

According to medical observations, the general symptoms of the development of the Coxsackie virus are divided into atypical and typical pathology. Due to asymptomatic signs of the disease, atypical manifestation of the virus is more common.

The typical type of pathology includes the occurrence of symptoms herpetic sore throat, aseptic meningitis, enteroviral exanthema or hand-foot-mouth syndrome, myalgia.

Atypical forms of manifestation

Asymptomatic course of the disease;
summer flu;
catarrh of the respiratory tract or respiratory disease;
encephalitis of enteroviral origin;
hemorrhagic conjunctivitis;
spinal or poliomyelitis-like enterovirus;
acute phase mesadenitis;
defeat digestive system- pancreatitis, hepatitis, gastroenterocolitis;
nephritis.

A severe form of enterovirus disease is identified by intoxication symptoms and the degree of damage to the internal organ (determined on the basis of clinical tests).

The defining feature of viral pathology is the accompanying respiratory tract infection. The child notes redness in the throat, perspiration, pain and symptoms of rhinitis. Then rashes appear. Localization of the rash on the palms, feet and mouth is classified as hand-foot-mouth syndrome. With angina, rashes are localized only in oral cavity. Enteroviral conjunctivitis begins with swollen eyelids and hemorrhages around the corners of the eyes.

A characteristic feature of the rash with enterovirus infection is that it never appears in the area of \u200b\u200bthe hair on the head.

Incubation time

The period of internal development of Coxsackie's viral pathology (incubation) is asymptomatic for a week. Then the initial signs of the disease appear in children, which indicates the contagiousness of the patient to others.

In order to protect others, a patient with the Coxsackie virus is placed in complete isolation. Contacting people are under medical observation for 10-14 days from the moment an active infected person is discovered.

How to treat the Coxsackie virus

There is no drug that completely destroys the virus. However, under the influence of additional immunostimulating drugs, the human defense system successfully copes with the virus. Complete recovery in a child with a mild form of the disease occurs after 5 days. Symptoms serious illness requires strict medical supervision and hospital treatment.

The fundamental task of the prescribed therapy is to support the body during the period of acute symptoms (the first days of the disease).

Basic Treatments

give interferon-based drugs that strengthen the child's immunity;
reduce high temperature it is not recommended to bring down subfebrile indicators - this means that the body fights the virus on its own;
drinking plenty of fluids (water, tea, mineral drinks);
treat rashes with antiseptics;
take fortified preparations (B1, B2, B6, B12).

If your child's condition worsens, contact your doctor immediately. Consultation with a specialist will help prevent the occurrence of complications of the disease in time.

The consequences of the disease appear when the infection passes from the intestines to other organs against the background of a weak immunity of the child (children under 3-4 years old).

Types of complications after the Coxsackie virus

A child up to a year may develop a sore throat, the duration of the disease is up to two weeks.
Cellular inflammation of the brain (meningitis). Convulsions appear, the child is delirious.
Paralysis. Weak manifestations of the disease are rare. Violation of stability, gait.
Inflammation of the heart muscle (myocarditis). Mostly chest pain.
Change of nail plates. Appears a month after the disease with the Coxsackie virus.

Infection prevention

If the child has not yet been ill, it is very important to take timely precautions.

Basic rules of prevention:

personal hygiene: mandatory hand sanitizing before and after meals;
when visiting the pool, do not drink water from tanks, avoid swallowing water when swimming;
when washing fruits and vegetables, use boiled water;
disinfection of dirty household surfaces (at home, use a spoonful of bleach in 4 cups of water);
after the child is in the playroom, use antiseptics.

You can prevent infection with plain water and soap or any alcohol-based remedy.

After the illness, the child acquires immunity to the Coxsackie virus. However, in practice, isolated cases of re-infection of a person have been recorded. Fortunately, known facts with a favorable outcome.

Careful observance of safety precautions, personal hygiene and medical assistance- the normal behavior of a caring mother who monitors the health of the child. Coxsackie is one of the virions that causes rare and serious diseases, which are much more difficult to prevent than viral pathology at the initial stage.

Thanks

Coxsackie virus very common throughout the world, and has many manifestations. It was identified back in 1950 in the USA, in the small town of Coxsackie, hence it got its name. But, despite its ubiquity, this virus is still underdiagnosed infrequently, in many cases the diagnosis sounds like "fever of unknown origin"," allergic dermatitis", "chicken pox", "flu" or "ARVI". All due to the fact that Coxsackie is many-sided, and it is not always possible to single out specific specific symptoms. And tests for viruses in our country, unfortunately, it is not customary to carry out in all cases of acute viral infections, it is expensive. Coxsackie can be asymptomatic, in the form of a three-day fever, typical manifestations of a virus, serous meningitis, or a severe infectious process with damage to vital organs.

Interesting facts about the Coxsackie virus

Sooner or later, more than 95% of people in the world are infected with the Coxsackie virus, mostly this happens in childhood.
Enteroviral infections in most cases affect young children (up to 5 years). In adults, this infection is detected quite rarely, which is due to the fact that by adulthood a person has already had this virus and has specific antibodies to it. Coxsackie does not affect children under 3 months of age, except in cases of congenital infection transmitted from the mother during pregnancy or childbirth.
Mother's milk protects the baby from Coxsackie and its severe course throughout the entire period of breastfeeding - it's all about maternal immunoglobulins.
It is very easy to get infected with the Coxsackie virus, up to 85-90% of contacts with infectious patients become infected. Therefore, outbreaks and epidemics of this infection are very often recorded, especially in preschool children's groups. Children's institutions may be quarantined.
Coxsackie is often manifested by the hand-foot-mouth syndrome. The syndrome gets its name from the typical rashes that cover these parts of the body.
Coxsackie often manifests itself as "summer flu", "intestinal virus", "herpetic sore throat". This is due to the peculiarity and diversity of his clinical picture.
Like many viruses, the Coxsackie virus negatively affects the immune system, reducing defensive forces to other viruses and bacteria.
The Coxsackie virus is especially dangerous for children under two years of age, pregnant women, HIV-positive people and people with various immunodeficiencies.
Coxsackie is not a herpes infection, as many people think, although these viral pathologies are often very similar in clinical manifestations.

Coxsackie epidemics in the resorts of Turkey, Cyprus and Sochi

For several years, a massive epidemic of the Coxsackie virus has been observed in the popular resorts of Turkey, Cyprus, Sochi, Thailand and other exotic places. It is easiest to get infected there directly in hotels and in their pools. As a result, children quite often, coming from a summer holiday in Turkey, bring enterovirus infections with them. Unfortunately, almost all tour operators are silent about this fact so as not to reduce the flow of tourists. Therefore, it is very important to clarify the epidemic situation at the resort before planning a trip with your children.

Interesting! Epidemics of Coxsackie are found everywhere, and do not depend at all on the level economic development countries. If other intestinal infections lead to epidemics mainly in "poor" countries, then Coxsackie epidemics periodically occur in Europe, the USA and Japan. This is due to the fact that the virus is transmitted not only by the fecal-oral route, but also by airborne droplets.

The causative agent of the infection

Coxsackievirus is an RNA virus that belongs to the genus Enteroviruses. Representatives of this genus multiply in the human intestine, regardless of how the virus enters the body. Hence the name (from the ancient Greek "entero" - gut).

The Coxsackie virus is the largest group in the genus of enteroviruses, but not the only one.

Other representatives of enteroviruses:

ECHO - echoviruses, are very similar to the Coxsackie virus in their characteristics and clinical manifestations of the disease they cause, they are often combined into one group;
Virus poliomyelitis - especially dangerous infection, striking nervous system, and leading to paralysis and disability;
Rhinoviruses- viruses that cause ARVI affect to a greater extent the mucous membrane of the upper respiratory tract, especially the nose and paranasal sinuses;
Human enteroviruses including the hepatitis A virus.

Characterization of Coxsackie and ECHO viruses

Family	picornoviruses (Picornavirales)- small RNA viruses
Genus	Enteroviruses (Enterovirus)
Groups and serotypes	There are two groups and 29 serotypes of Coxsackieviruses: group A consists of 23 serotypes; group B consists of 6 serotypes of viruses. The ECHO virus includes 32 serotypes.
Dimensions	About 28 nm, and the ECHO virus is even smaller - up to 14 nm.
How does the cold affect the virus?	Koksaki does not die even after freezing to -70 o C. Under such conditions, it remains for years, and after thawing continues its vital activity.
High temperature resistance	The virus is poorly resistant to high temperatures, at 60 o C is destroyed within 30 minutes. And when boiled, it dies almost instantly.
Are there enteroviruses in the environment?	Coxsackie virions are determined in the patient's feces. With faeces, the virus can get into sewage, reservoirs, reservoirs and water pipes, and even into fields and gardens. The virus retains its pathogenic properties in water and food for a sufficiently long period, 18-100 days. On ordinary objects (toys, dishes, door handles) at room temperature, the virus does not die within a week.
What kills the Coxsackie virus and ECHO?	High temperatures, boiling, drying; sun and ultraviolet rays; exposure to concentrated chlorine-containing disinfectants and 0.3% formalin solution; *the virus is resistant* to acids, esters, alcohols and lysol (ingredients of many disinfectants, including for the treatment of hands).
Who is affected by the Coxsackievirus and ECHO?	Human, as well as some types of monkeys. Mice are infected in the laboratory.
Epidemiology	Coxsackie and ECHO are distributed on all continents and in all countries of the world, especially in regions with a temperate and subtropical climate. The virus loves high humidity. Enteroviruses can cause isolated cases, outbreaks and epidemics within a single region or an entire country. The most susceptible contingent is children, especially preschoolers. The Coxsackie virus is usually seasonal, with peaks in incidence between July and October. But even in cold weather, outbreaks of enterovirus infections also occur.

* All serotypes of Coxsackie and ECHO viruses can cause diseases that are exactly the same in terms of symptoms and severity. Coxsackie A virus is much more common and milder. Also, these group A serotypes are characterized by an asymptomatic or typical course of the disease. The most common variant of Coxsackie A is the hand-foot-mouth syndrome and herpangina. The Coxsackie B virus often has a severe and atypical course of the infectious process, may be accompanied by various complications, and is more dangerous for pregnant women than the A virus.

How is Coxsackie virus infection transmitted?

The Coxsackie virus can enter the body in completely different ways, which makes this infection very contagious and prone to causing epidemics.

Source of infection:

sick person;
virus carrier.

Humans cannot become infected from sick animals.

Ways of infection with the Coxsackie virus:

1. Contact and fecal-oral route from a patient or a virus carrier - viruses that are excreted with the feces and saliva of the patient can get on various household items, in water bodies, including swimming pools, in drinking water or food (if personal hygiene is not followed). When swallowed, the virus enters the intestine, then in Peyer's patches (intestinal The lymph nodes), where it reproduces.

2. Airborne way from a sick person - viruses from a patient enter the air during coughing, sneezing and loud conversation, where they are in suspension for some time. When such air is inhaled, the virus enters the nasopharynx, where it multiplies.

3. Transplacental route- from mother to child (rare).

Coxsackie pathogenesis: what happens in the body?

The virus enters the nasopharynx or Peyer's patches of the intestine. In the lymph nodes, it multiplies, after which the viruses end up in the blood and are carried throughout the body with its current. Depending on the state of the human immune system, the amount of the virus or its serotype, the infection affects one or another organ. This will determine the variety of symptoms and the severity of the disease.

What organs and tissues can the Coxsackie virus infect?

Mucous membranes of the nasopharynx, oral cavity and tonsils;
lymph nodes of all groups, especially the intestines (Peyer's patches);
muscle tissue, including myocardium;
less often - mucous membranes of the intestines, eyes, liver cells;
embryos and fetus during pregnancy.

But at the moment, the Coxsackie virus and its pathogenesis are not well understood, many questions do not have their own answers, remain controversial. It is not clear why Coxsackie has such a varied course and is often asymptomatic, the causes of virus carriage and other features of the Coxsackie virus and other enterovirus infections have not been clarified.

Who is a virus carrier?

One of the sources of infection with the Coxsackie virus is the virus carrier. This term refers to a person who does not have symptoms of the disease, but sheds the virus into environment with feces, saliva, urine and other body fluids.

Isolation of the virus is always noted in patients after an acute Coxsackie virus infection. The patient seems to have recovered, but the virus still lives and multiplies in his intestines. Isolation of the virus can persist for a long time, up to 2 months, on average 10-21 days. It all depends on the characteristics of both the virus and the human body.

But the virus carrier can also be determined in people who did not have symptoms of the disease, that is, in clinically healthy people, and these are up to 40% of all coxsackie virus excretors. This suggests that the person suffered Coxsackie asymptomatically. Asymptomatic isolation of the virus is also characteristic of other enterovirus infections.

The excretors of the virus are patients with a chronic course of Coxsackie infection, they can be contagious for a year or more.

Virus carrying is probably the factor that favors the development of outbreaks and epidemics of Coxsackie.

Incubation period

The incubation period, or the time from infection to the first symptoms of the disease, with the Coxsackie virus is usually 3-6 days, less often from 2 to 10 days. A child already in this period may have a poor appetite, become lethargic and drowsy, act up. The patient is already contagious.

Symptoms and signs of the Coxsackie virus, photo

The disease usually comes on sharply, the child becomes very lethargic, capricious, often refuses to eat. An increase in body temperature is almost always characteristic of the Coxsackie virus. The thermometer usually rises to very high numbers, up to 39-40 o C, and even higher, the temperature is hard to go astray. All this is often accompanied by an ache all over the body, severe weakness and headaches. But these are just symptoms that are characteristic of most cases of enterovirus infections. Diseases associated with the Coxsackie virus can proceed in completely different ways. Among the many symptoms that occur with the Coxsackie virus, a number of syndromes can be distinguished. In some patients, only one syndrome can be seen, in others - their various combinations. Among them, typical and atypical syndromes for the Coxsackie virus can be distinguished. If a patient has atypical syndromes, it is almost impossible to suspect and diagnose an enterovirus infection without laboratory diagnostics.

Interesting that the typical form of the Coxsackie virus is less common than its atypical course. All this is due to the asymptomatic manifestation of the virus, enterovirus fever and catarrhal phenomena of the upper respiratory tract.

Syndromes of a typical enterovirus infection associated with the Coxsackie virus:

herpangina (herpetic sore throat);
Boston (enteroviral) exanthema and hand-foot-mouth syndrome;
epidemic myalgia;
aseptic meningitis.

Atypical forms of enterovirus infection Coxsackie:

asymptomatic (inapparent) course of the disease;
enterovirus fever, which is often also called "minor illness" or summer flu;
respiratory form or catarrh of the upper respiratory tract;
enteroviral encephalitis and meningoencephalitis;
hemorrhagic conjunctivitis and uveitis;
spinal or poliomyelitis-like form of enterovirus infection;
neonatal encephalomyocarditis;
acute mesadenitis;
enterovirus infection with damage to the digestive organs: acute hepatitis, pancreatitis, gastroenteritis, gastroenterocolitis;
acute nephritis and other syndromes associated with the defeat of the virus of internal organs.

In addition to these types of diseases, the forms and variants of the course of enteroviral diseases are divided:

1. Flow options:

lung;
average;
heavy.

The severity of the course of the disease primarily depends on the degree of damage to vital organs (the brain and its membranes, heart, liver), as well as the severity of intoxication.

In addition, the course of enteroviral infections can be:

smooth - recovery occurs within 10-20 days;
wavy;
recurrent;
with complications.

2. Forms of the disease:

isolated - in the presence of only one syndrome;
combined - when the virus affects several organs and systems.

Let's take a closer look at how diseases associated with the Coxsackie virus can occur.

Minor illness or summer flu (enterovirus fever)

Enterovirus fever is called the summer flu because the symptoms this disease very similar to the flu, but children usually get sick in the summer - the period of epidemics of Coxsackie viruses and trips to the beaches. A small illness was attached to enterovirus fever due to the fact that this is the easiest course for enterovirus infections.

Summer flu can cause all serotypes of Coxsackie and ECHO viruses.

This form is characterized only by intoxication syndrome. That is, the Coxsackie virus does not affect vital organs, and usually does not lead to a complicated course of infection.

Symptoms of intoxication with the Coxsackie virus:

acute onset;
an increase in body temperature above 39 o C;
headache;
weakness, lethargy;
body aches;
loss of appetite, up to refusal to eat;
redness of the pharynx and palatine arches, slight graininess of the posterior pharyngeal wall;
a feeling of heat, which can be replaced by bouts of chills;
redness of the eyes may be observed;
infrequently in the background high temperature vomiting and stool disorders develop;
many children have enlarged peripheral lymph nodes, they are small, painless, elastic when palpated;
some children have an enlarged liver and spleen.

A minor illness usually lasts from two to five days, then there is a complete recovery, regardless of the treatment received. Such a fever is very exhausting for the child, often parents notice weight loss and weakness after illness, the child tries to sleep. Within a few days after the fever, appetite is restored, the child returns to his usual active life. Such a disease ends as suddenly as it begins. Many parents and even doctors do not have time to understand what happened to the baby.

In some cases, an undulating course can be observed, that is, after relief, a repeated febrile period occurs, which ends just as quickly, and recovery occurs.

Herpangina (herpangina)

A fairly common manifestation of the Coxsackie virus. Many confuse this condition with a herpetic lesion of the oral cavity (with stomatitis). But such a sore throat has nothing to do with herpes viruses. Herpangina is usually caused by Coxsackievirus type A or ECHO virus. In practice, the diagnosis of "herpetic sore throat" from doctors can be heard infrequently.

Herpetic sore throat always has an acute onset, proceeds with severe intoxication and with the appearance of specific changes in the mouth.

Interestingly, with catarrhal and other forms of angina, the tonsils increase, and with herpetic angina, changes appear on the mucous membrane covering the tonsils, while they do not increase. The main part of the rashes is noted on the soft palate, palatine arches and tongue - this is what distinguishes herpangina. Herpetic stomatitis differs from herpangina in that a herpetic rash appears on the mucosa throughout the oral cavity, more often in the mucous membranes of the cheeks, lips, gums, and hard palate.

A photo: healthy pharynx. Structure of the soft palate.

Symptoms of intoxication are the same as with a minor illness, fever usually persists for up to 5 days.

Symptoms in the oral cavity with herpetic sore throat:

1st day - redness of the tonsils, arches and tongue;
1-2 day - whitish papules (or nodules) up to 4 mm in size appear on the soft palate, tonsils and arches;
2-3rd day - papules become vesicles with red contours;
3-4th day - the bubbles burst, erosions (sores) are formed with redness around;
After the 4-5th day, the ulcers heal and the mucous membranes recover.

A photo: symptoms of the Coxsackie virus, herpetic sore throat.

These changes are accompanied by itching and soreness in the throat, aggravated by swallowing and eating. In young children this symptom can be manifested by crying and a complete refusal to eat.

With herpetic sore throat, rashes are multiple or single, sometimes only one element of the rash is found.

Complete recovery from herpetic sore throat occurs in 5-7 days.

Enteroviral exanthema and hand-foot-mouth syndrome

Enteroviral exanthema is also called Boston and epidemic exanthema. Exanthema- this is an infectious viral rash on the skin, and the same rash on the mucous membranes of the mouth is called enanthem.

This syndrome is more common for Coxsackieviruses of group A, less often for group B, as well as for the ECHO virus.

Exanthema, like other manifestations of enterovirus infection, begins acutely, with an increase in body temperature. Unlike summer flu, body temperature may not be as high, but other symptoms of intoxication are also expressed. There may be redness of the throat and eyes. The fever is usually not prolonged, after 1-2 days the body temperature returns to normal or drops to lower numbers. But against the background of a decline in intoxication, a rash appears on the skin and on the mucous membranes of the oral cavity.

Localization of the rash:

face, most often in the area around the mouth, sometimes the rash appears on the scalp;
torso, more in its upper part;
limbs, especially on the palms and feet;
buttocks and groin.

Syndrome "hand-foot-mouth"- This is the most common variant of enteroviral exanthema. With this syndrome, the main part of the rash is located around the mouth, on the palms and feet. There are almost always single rashes in the oral cavity.

Changes in the oral cavity. First, small nodules appear, which quickly become bubbles, they burst and sores (aphthae) form. Ulcers are almost always accompanied by pain. The child refuses to eat, cries, does not allow to examine the oral cavity. There is increased salivation, as in the eruption of milk teeth in infants. After 3 days, the oral mucosa is usually completely restored.

Rash with enteroviral exanthema - viral pemphigus:

Usually Boston exanthema and hand-foot-mouth syndrome proceeds favorably, but there are situations when meningitis and other severe manifestations of Coxsackie develop against the background of exanthema. This form of enterovirus infection is often combined with other syndromes.

Coxsackie virus and nails. Many people who have had enteroviral exanthema have nail changes in 2-8 weeks. This may be their fragility, detachment from the nail plate ("nails peel off"), a change in the shape and color of the nail. Many note the total defeat of all nails on the hands and feet. And it can go on for more than one month. But after a complete renewal of the nails, they will definitely return to their previous healthy state.

The causes and mechanism for the development of nail problems after the Coxsackie virus are still not known. Many scientists do not associate this symptom with enterovirus infections at all, explaining them by reduced immunity, fungal infection of the nails, or a deficiency of vitamins and microelements. But the relationship between Coxsackie and nail disease is still observed in most patients.

A photo: a late symptom of the Coxsackie virus, "nails peel".

Epidemic myalgia (Bornholm's disease)

This enteroviral disease, fortunately, is rare. It is most often caused by group B Coxsackieviruses, less often by other enteroviruses. Epidemic myalgia is the result of muscle damage by viruses, that is, myositis (inflammation of muscle tissue).

The disease begins acutely, with a sudden increase in body temperature up to 40 o C. This is accompanied by chills, headaches, severe weakness. On the same day, muscle pains appear - this is the main syndrome of epidemic myalgia.

The nature of the pain syndrome in epidemic myalgia:

Muscle pains are acute in nature, manifested by attacks that usually last from 30 seconds to 10 minutes, recur every few hours. At the same time, the patient experiences unbearable torment, for which this pathology was called "damn fight". Cases of the duration of such an attack up to 2 days are described.
The pains of the intercostal muscles in the lower part of the chest are most pronounced. They are accompanied by respiratory failure, shortness of breath, aggravated by a deep breath or cough. All this reminds clinical picture pleurisy (inflammation of the serous membranes of the lungs - the pleura). This is where epidemic myalgia got its name. pleurodynia(translated from Latin as "pain in the pleura").
Pain is also intense in the upper abdomen and in the navel. This condition is often mistaken for acute abdomen(appendicitis, peritonitis, intestinal obstruction, etc.).
Myalgia is also observed in the muscles of the limbs, neck, face, but the pain in them is less pronounced.
The pain syndrome usually lasts from 2 to 4 days, then relief comes, but there are cases of the development of a second wave of fever and "damn fight".

Epidemic myalgia is not so common as a separate pathology, in most cases it is combined with herpetic sore throat and exanthema. Often a week after the onset of the disease, serous meningitis develops.

Serous (aseptic) meningitis

Meningitis is a disease associated with inflammation of the membranes of the brain, always threatening the patient's life. With viral infections, serous, that is, not purulent meningitis, develops. It can be isolated, but often develops against a background of a minor illness, herpetic sore throat, epidemic exanthema, or myalgia. Unfortunately, this is a fairly common manifestation of an enterovirus infection, and can be caused by all types of Coxsackie and ECHO viruses.

How to suspect meningitis?

Acute onset: with an increase in body temperature to high numbers, weakness, sore throat;
severe headaches: are of a permanent nature, appear during the first day from the onset of the disease;
vomiting that is not associated with food intake (the so-called "brain vomiting");
infants and young children may develop convulsions, adults may have impaired consciousness;
stiff neck muscles appear - it is impossible to reach the sternum with your chin; in young children, when you try to raise your head in a supine position, the entire body rises;
other symptoms of meningitis develop - meningeal signs, such as the symptoms of Kernig and Brudzinsky, but only a doctor can determine them;
in the hospital of the infectious diseases department, an analysis of the cerebrospinal fluid is carried out, it flows out under high pressure, in the laboratory changes are revealed that are characteristic of all serous meningitis.

A photo: determination of meningeal signs in case of suspected meningitis.

When meningitis is combined with other manifestations of the Coxsackie virus, all of their symptoms can develop in parallel. But most often meningitis joins with the second wave of fever, that is, on the 5-7th day from the onset of enterovirus infection.

The prognosis for such meningitis is usually favorable, with adequate treatment started in a timely manner, after 3-7 days, the patient's condition is relieved, and after 2-3 weeks - complete recovery.

Other coxsackie virus syndromes

Other variants of the course of the Coxsackie virus are rare, they belong to atypical forms of enterovirus infections.

Syndrome	Main symptoms	Peculiarities
Encephalitis, meningoencephalitis- inflammation of the brain.	*Intoxication syndrome* (fever, weakness, body aches, etc.); meningitis symptoms: headache, vomiting, impaired consciousness, meningeal signs, etc.; focal symptoms of brain damage: imbalance, swelling of the cheeks on exhalation, impaired swallowing and speech, convulsions, paresis and paralysis, mental disorders and other manifestations of brain damage.	Encephalitis most often develops against the background of meningitis, and has a long and severe course. After such encephalitis, brain atrophy, epilepsy and mental illness can develop, and in children of the first years of life - hydrocephalus.
Poliomyelitis-like course of enterovirus infection- damage to the neurons of the spinal cord and medulla oblongata.	Acute onset; absence of intoxication syndrome; *symptoms similar to paralytic poliomyelitis* ; flaccid paralysis, most often of the lower extremities; pain in the limbs; decreased muscle tone; bouts of muscle tremors; decreased tendon reflexes; violation of stool and urination.	Unlike poliomyelitis, this form of enterovirus infection is much easier and, in most cases, without complications. After 4-8 weeks, recovery usually occurs, paralysis disappears, muscle functions are restored. It is the polio-like form of the Coxsackie virus that is often mistaken for an outbreak of polio, terrifying all doctors and the population.
Enteroviral mesadenitis- inflammation of the intestinal lymph nodes.	Acute onset; fever and other symptoms of intoxication; acute attacks of pain in the abdomen, in the area around the navel; no stool or