Pediatric Echo and Coxsackie Virus Infection
Introduction
Introduction to children's Echo and Coxsackie virus infection Echovirus, Coxsackie virus and poliovirus are collectively referred to as enteroviruses. Since the widespread use of live polio attenuated vaccines, the incidence of polio has decreased significantly, while the other two enterovirus infections have been relatively Increased attention and attention, the more comprehensive and deeper understanding of the prevalence and clinical manifestations of the two viral infections, clinical can cause meningoencephalitis, encephalomyelitis, myocardial-pericarditis, respiratory infections, diarrhea, etc. The damage of each system and each organ has various clinical manifestations. basic knowledge The proportion of children: the incidence rate of children is about 0.01% - 0.02% Susceptible people: children Mode of infection: fecal mouth spread Complications: sudden death, congestive heart failure, constrictive pericarditis
Cause
Pediatric Echo and Coxsackie virus infection etiology
Causes:
Enteroviruses are small ribonucleic acid (RNA) viruses, which are spherical in diameter from 20 to 30 nm. They are located in the human intestine and have strong resistance to general physical and chemical factors. According to the pathological changes of infected animals, Coxsackie virus can be divided into A. There are 24 types in group B, group A, which can cause extensive inflammation and necrosis of skeletal muscle in suckling mice, flaccid paralysis without invading the central nervous system, and 6 types in group B, which can cause localized muscle in suckling mice. Inflammation, adipose tissue necrosis, encephalomyelitis, focal lesions of the liver and pancreas, a total of 34 types of Echoviruses, of which 8, 10, 28, 34 have been classified into other viral groups, such as type 10 in the respiratory tract Oral virus or reovirus type I, Eke 8 is the same as type I antigen, collectively referred to as type I, type 28 is not acid resistant, different from other enteroviruses, and classified as rhinovirus, type 34 is considered An antigenic variant of coxsackievirus group A type 24, except that type 9 virus can cause disease in suckling mice, and other types do not infect suckling mice, which is different from coxsackie virus, but to human kidney and monkey kidney cells. Sensitive, it is used to isolate viruses. In recent years, it has been found everywhere in the world. Coxsackie virus antigenically distinct new enterovirus 68 to 71.
Pathogenesis:
Eke and Coxsackie virus enter the digestive tract through the respiratory tract or oral cavity, invade the intestinal mucosa, and reside and proliferate in the epithelial cells and intestinal lymphatic tissues, and can also stay and proliferate in the pharyngeal lymphoid tissue at an early stage. Shorter, the virus can reach the organs of the whole body through the lymphatic and blood circulation from the above-mentioned parts, causing pathological changes of the internal organs. It is easy to invade the nervous system, skin, mucous membrane, muscle, lung, heart and liver, and different pathological changes occur, such as Focal focal cell infiltration with degeneration, interstitial myocarditis, focal necrosis, pericarditis, focal liver cell infiltration, Coxsackie B virus infection in neonates, can cause extensive lesions Focal necrosis, serious condition.
Prevention
Pediatric and Coxsackie virus infection prevention
At present, there is no preventive vaccine, and there are difficulties in the development of vaccines. Because there are too many types, it is impossible to control all types. For those who have close contact with the body or have a close contact with newborns, they can inject gamma globulin 3-6 ml or placental balls. Protein 6 ~ 9ml.
Complication
Pediatric Echo and Coxsackie virus infection complications Complications, congestive congestive heart failure, constrictive pericarditis
Can cause meningoencephalitis, encephalomyelitis, myocardial-pericarditis, etc., can cause damage to various organs, neonatal disease can occur sudden death or chronic congestive heart failure, can develop chronic myocarditis, cardiomyopathy, constriction Pericarditis and endocardial fibroelastosis, myocardial ischemia and infarction, diarrhea can occur dehydration, in addition, hepatitis, mumps, pancreatitis, orchitis, etc., can be seen, neonatal disseminated infection can also be complicated by renal failure , hemorrhagic hepatitis syndrome, DIC, etc.
Symptom
Pediatric Echo and Coxsackie virus infection symptoms Common symptoms Pinchy rash, abdominal pain, pain, heart failure, chest pain, sore throat, pale, low heat, diarrhea, dehydration
When enterovirus infection, the clinical manifestations are extremely diverse, the severity of the disease is very different, and the same type of virus has different clinical manifestations. Different types of viruses may have similar symptoms, so it is difficult to determine the type from the clinical manifestation, often for multiple manifestations.
Nervous system infection
(1) meningoencephalitis: It is generally believed that the two viruses can cause encephalitis and aseptic meningitis syndrome. In fact, from the clinical manifestations and pathological changes, the two lesions cannot be distinguished, and many of them coexist. Known as meningoencephalitis, it is known that 12 types of group A in Coxsackie virus, 6 types in group B, and almost all types of Echovirus can cause meningoencephalitis, which is generally acute and has fever. Light and heavy, with light weight, lighter without the clinical manifestations and signs of meningoencephalitis, abnormal cerebrospinal fluid examination was found, common symptoms and signs have nausea, vomiting, headache, meningeal irritation, etc., accompanied by sore throat Non-specific manifestations such as abdominal pain and diarrhea. Cerebrospinal fluid is similar to meningoencephalitis caused by other viruses. The number of cells is slightly increased. The early stage of neutrophils is mainly classified, and lymphocytes are mainly in the late stage. Sugar and chloride are normal. The protein is slightly elevated.
(2) disease: compared with polio, the two viruses cause a low incidence of sputum, mild symptoms, rapid recovery, and good prognosis. There are 6 types in the Coxsack group A and 4 types in the B group. There are 10 types in Eke, which can cause spastic diseases.
2. Heart disease
These two viruses can cause myocardial-pericarditis, less invasive endocardium, 9 types in Coxsackie virus group A, 6 types in group B, and 11 types of Echovirus, which can affect the heart. In the prevalence of Coxsackie virus, about 33% of patients have various types of heart disease, which can occur in all age groups, including newborns and adults. Neonatal diseases can be intra-fetal infections, serious illness, poor prognosis, and can occur. Sudden death or chronic congestive heart failure, myocardial-pericarditis is very different in severity. Lighter only has ECG changes. In severe cases, pale, cyanosis, cough, difficulty breathing, increased heart rate, various heart rhythm abnormalities, heart enlargement, heart sounds Low blunt, audible murmur (apical apical systole), lung snoring, liver enlargement, clinical according to ECG friction sound, lateral perspective of the heart and waist widening, B-mode pericardial cavity with effusion and diagnosis of pericarditis, some cases Can develop into chronic myocarditis, cardiomyopathy, constrictive pericarditis and endocardial fibroelastosis, myocardial ischemia and infarction are the main causes of sudden death.
3. Respiratory infection
Many types of ecclesia and Coxsackie virus can cause upper respiratory tract infections, a few cause lower respiratory tract infections, herpes angina is caused by Coxsackie virus, and Echovirus can also be a pathogen, which is highly contagious and can occur epidemic. Due to different types, the same child can occur multiple times, sudden fever, sore throat, headache, abdominal pain, pharyngeal congestion, followed by grayish white herpes, herpes rupture, forming a yellow ulcer, visible in the tonsil anterior arch, soft palate , uvula and tonsil, but not in the gums and buccal mucosa, self-healing in 4 to 6 days, a few to 2 weeks.
4. Eruptive disease
When the rash appears in other parts of the infection, it is only a manifestation. The shape, quantity and distribution of the rash vary greatly. It can be rash, maculopapular rash, vesicular rash, urticaria, occasional sputum, irregular parts, and oral mucosa. To, and can form ulcers, usually 2 to 4 days subsided, leaving no traces.
There is a kind of hand, foot, mouth disease, mainly caused by Coxsackie virus A16, A5, A10, more common in young children under 4 years old, characterized by small herpes or ulcers in the mouth, located in the tongue, buccal mucosa and hard palate, Occasionally found in soft palate, gums, tonsils, limbs, especially in the hands and feet can be seen rash or herpes, occasionally legs, arms and torso, the number of indefinite, short course, can be accompanied by fever, with low heat.
5. Diarrhea
Diarrhea can be seen in the four seasons, especially in summer and autumn, more common in infants and young children, is a common cause of infantile diarrhea, stool is mostly yellow or yellow-green loose stools, can carry mucus, occasionally a small amount of blood, 5 to 6 times a day to More than 10 times, there are fewer dehydration, and more than 1 to 2 days to recover.
6. Other diseases
There are still epidemic chest pain or myalgia. The chest pain, the abdomen and the diaphragm are attached to the chest. The muscles of the limbs are sore, the muscle pain is different, the pain level is different, and the lightness is tight and the pain is painful. Severe cases like knife cutting, acupuncture, chest and abdominal pain, coughing and deep breathing, the abdomen may have tenderness, even abdominal muscle spasm and rigidity, there are fever, sore throat, headache, cough, vomiting, diarrhea and other performance.
Epidemic acute conjunctivitis, caused by the newly discovered enterovirus type 70, mainly manifested as red, swollen, painful, tearing and purulent secretions of the eye, 1 to 2 weeks.
Examine
Pediatric Echo and Coxsackie virus infection check
Blood routine examination
White blood cells are mostly in the normal range, and there is no significant change in classification.
2. Cerebrospinal fluid examination
Meningitis, cerebrospinal fluid in patients with encephalitis can be non-suppurative inflammatory changes, mildly increased pressure, mild increase in white blood cell count, mostly (100 ~ 300) × 106 / L, rarely more than 500 × 106 / L, initial multinuclear Mainly, after 2 days, lymphocytes accounted for about 90%, sugar and chloride did not change, and protein increased slightly.
3. Virus separation
Isolation of viruses by tissue culture and animal inoculation. If the virus can be isolated from the patient's blood, cerebrospinal fluid, pericardial fluid, herpes fluid and tissues, it can be used as a basis for diagnosis. For example, if the virus is isolated from feces and respiratory secretions, it needs to be combined with serology. Check to judge, because the throat and intestines have healthy carriers.
4. Serological examination
The antibody with high specificity is a neutralizing antibody, which starts to rise 2 weeks after the disease, reaches a peak at 3 weeks, and can be maintained for 3 to 6 years, so it cannot be used for early diagnosis. In recent years, a method for detecting specific IgM antibody has been established, such as The positive rate of virus IgM antibody in group B was detected by ELISA antibody capture method, the positive rate was 67%. The positive rate of virus isolation in the same group was 22%. Avidin-biotin complex enzyme-indirect immunohistochemistry (ABC-IPA) was used in China. It can detect Coxsackie B virus IgM antibodies in patients' serum and cerebrospinal fluid, and has early diagnostic value.
5. Molecular biology examination
Using the cDNA of the known sequence of the virus as a probe, detecting the viral RNA in the specimen such as blood and cerebrospinal fluid by molecular hybridization, or amplifying a small amount of viral nucleic acid in the specimen by RT-PCR can achieve the purpose of early diagnosis of pathogens. .
6. Molecular biology examination
RT-PCR has been applied to determine the ribonucleic acid of Echovirus in blood, cerebrospinal fluid and urine of patients, with high sensitivity and rapid diagnosis.
According to clinical needs, X-ray, B-ultrasound, electrocardiogram and other auxiliary examinations are selected.
Diagnosis
Diagnostic identification of children with ecco and Coxsackie virus infection
diagnosis
The manifestations of enterovirus infections are multifaceted and involve almost every system. Therefore, the possibility of the disease should be considered in infants and young children with infectious diseases. At the same time, combined with the epidemiological history, the necessary laboratory tests can be used to confirm the diagnosis, but healthy people can carry The virus cannot be isolated from throat swabs or feces as a basis for final diagnosis. Antigen-antibody assays have diagnostic value, but because of too many types, it is impossible to measure all types.
Differential diagnosis
Because of the many clinical manifestations, there are many types of diseases that need to be identified, most of them meningoencephalitis, myocardial-pericarditis, rash disease and infantile diarrhea.
1. Identification with viral encephalitis
The characteristics of cerebrospinal fluid are mainly differentiated from other viral encephalitis. In addition to the detection of antigen-antibody, it is difficult to distinguish by other methods. Of course, other viral encephalitis has other accompanying manifestations.
2. Identification with other myocardium, pericarditis
Myocardial-pericarditis needs to be differentiated from other viruses or bacteria caused by myocardium, pericarditis, rare in older children, and without endocardial lesions, and identification with rheumatic fever, no practical significance.
3. Indigestion, rotavirus enteritis, pathogenic Escherichia coli enteritis
Infant diarrhea needs to be differentiated from dyspepsia, rotavirus enteritis, and pathogenic Escherichia coli enteritis.
4. Identification with measles, rubella, infantile acute rash, drug rash, allergic sepsis, etc.
The rash needs to be differentiated from measles, rubella, children's acute rash, drug rash, and allergic sepsis.
