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Treatment for enterovirus


Enteroviruses in Children | Cedars-Sinai

ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS

What is an enterovirus infection in children?

An enterovirus is a very common type of virus. There are many types of enteroviruses. Most of them cause only mild illness. Infections most often occur in the summer and fall. The viruses mostly cause illness in babies, children, and teens. This is because most adults have already been exposed to many enteroviruses and have built up immunity.

The viruses may not cause any symptoms, or they may cause only mild symptoms. Enteroviruses often cause what is known as the “summer flu.” They can also cause a rash known as hand-foot-and-mouth disease. This is generally caused by coxsackievirus, a type of enterovirus.

But in some cases, an enterovirus can be more severe and cause complications. Some of the viruses, such as polio, can cause serious illness. Polio can be prevented with a vaccine and is uncommon in the U.S.. Some types of enteroviruses can cause inflammation of the tissue that covers the brain and spinal cord (meningitis). Enterovirus 68 can cause severe symptoms in some children, such as trouble breathing.

What causes an enterovirus infection in a child?

Enteroviruses can be spread when an infected person sneezes or coughs droplets into the air or on surfaces. A child may then breathe in droplets, or touch a contaminated surface and touch his or her eyes, mouth, or nose. Some of the viruses can spread through contact with infected feces (stool). This can happen when children don't wash their hands or don't wash them properly. It can also happen from eating or drinking food or water that contains the virus.

What are the symptoms of an enterovirus infection in a child?

In many cases, enteroviruses don’t cause symptoms. If they do, the symptoms are often mild. Most symptoms usually go away in a few days and can include:

  • Fever
  • Muscle aches
  • Sore throat
  • Runny nose
  • Sneezing
  • Coughing
  • Trouble breathing
  • Nausea and vomiting
  • Diarrhea
  • Red sores in the mouth, and on the palms of the hands and soles of the feet (hand-foot-and-mouth disease)
  • Red rash over large areas of the body

The symptoms of an enterovirus can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How is an enterovirus infection diagnosed in a child?

A healthcare provider will ask about your child’s symptoms and health history. The provider will do a physical exam. This may include an exam of the mouth, eyes, and skin. The healthcare provider will listen to your child’s chest as he or she breathes.

In the case of severe symptoms, your child may need certain tests. These are done to see if your child has an enterovirus, or has a different kind of illness. The tests can look for problems in the heart, lungs, and brain. The tests may include:

  • Virus culture. The healthcare provider takes a small sample of saliva, blood, urine, or stool. It is then tested for a virus.
  • Polymerase chain reaction (PCR). The healthcare provider takes a small sample of blood, urine, or saliva. The sample is tested for a virus.
  • Spinal fluid test. The healthcare provider takes a small sample of spinal fluid. This is done by putting a small needle into your child's back. The fluid is tested for levels of certain chemicals and cells.
  • Blood test. The healthcare provider takes blood from a vein. It is then tested for chemicals that may show the cause of your child's illness, or show organ problems.
  • X-rays. This test is done to look at the lungs and heart.
  • Electrocardiogram (ECG). This test is done to look at the electrical action of the heart.
  • Echocardiogram. This test uses sound waves and a computer to look at the structure and movements of the heart.

How is an enterovirus infection treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Antibiotics don't work on viral illnesses like enterovirus. And no antiviral medicines are available to help cure an enterovirus infection. Instead, treatment is done to help your child feel better while his or her body fights the illness. This includes:

  • Pain medicine. These include acetaminophen and ibuprofen. They are used to help ease pain and reduce fever. Don't give aspirin to your child if he or she has a fever.
  • Oral pain reliever (anesthetic). This is a gel used to help ease the pain of sores in the mouth.
  • Bed rest. This helps your child’s body fight the illness.
  • Change in diet. If your child has painful mouth sores, give only bland, soft foods. Don't give your child salty or crunchy foods.

In severe cases, treatment may include:

  • Opioid medicines for severe pain
  • Medicine for heart problems
  • IV (intravenous) fluids for dehydration
  • Medicine called immunoglobulin given through an IV
  • Antiviral medicine

Symptoms such as muscle aches, fever, and sore throat usually go away in a few days. The red sores known as hand-foot-and-mouth disease usually go away in 7 to 10 days.

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all medicines.

What are possible complications of an enterovirus infection in a child?

Complications from enteroviruses are not common. But they can cause severe problems such as:

  • Inflammation of the brain (encephalitis)
  • Inflammation of the tissues around the brain and spinal cord (meningitis)
  • Inflammation of the heart (myocarditis)
  • Inflammation of the liver (hepatitis)
  • Eye infection (conjunctivitis)
  • Severe illness in the lungs
  • Paralysis of muscles

How can I help prevent an enterovirus infection in my child?

Children are vaccinated against poliovirus. But there is no vaccine for other enteroviruses. Enteroviruses can spread easily from person to person. They are spread through stool and mucus from coughing or sneezing. They can live on surfaces that sick people have touched, coughed, or sneezed near. To help prevent illness:

  • Teach children to wash their hands after using the toilet, before eating, and before touching their eyes, mouth, or nose.
  • Wash your hands often, especially if caring for someone who is sick. Use a hand sanitizer if you don't have soap and water handy. 
  • Try to have less contact with people who are sick.
  • Clean surfaces at home regularly with disinfectant.

When should I call my child’s healthcare provider?

Call a healthcare provider right away if your child has:

  • Fever (see Fever and children, below)
  • Severe headache that doesn't get better after taking a pain reliever
  • Trouble breathing
  • Chest pain when breathing
  • Confusion
  • Seizures
  • Pain, swelling, and redness of the eyes
  • Stiffness and trouble moving
  • Yellow tint to the skin and eyes (jaundice)

Fever and children

Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.

For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.

Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.

Infant younger than 3 months old:

  • Ask your child’s healthcare provider how you should take the temperature.
  • Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider
  • Armpit temperature of 99°F (37. 2°C) or higher, or as directed by the provider

Child age 3 to 36 months:

  • Rectal, forehead (temporal artery), or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider
  • Armpit temperature of 101°F (38.3°C) or higher, or as directed by the provider

Child of any age:

  • Repeated temperature of 104°F (40°C) or higher, or as directed by the provider
  • Fever that lasts more than 24 hours in a child younger than age 2. Or a fever that lasts for 3 days in a child 2 years or older.

Key points about enteroviruses in children

  • Enteroviruses are very common. The viruses mostly cause illness in babies, children, and teens. This is because most adults have already been exposed to many enteroviruses and have built up immunity.
  • The viruses often don’t cause symptoms, or cause only mild symptoms.
  • Enteroviruses can be spread when an infected person sneezes or coughs droplets into the air or on surfaces. A child may then breathe in droplets, or touch a contaminated surface and touch his or her eyes, mouth, or nose.
  • The viruses are treated with supportive care such as pain medicine.
  • In some rare cases, the viruses may cause inflammation of the brain, heart, or other parts of the body.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Enterovirus Treatment | Everyday Health

Simple, at-home therapies can help treat most cases of enterovirus.

There is no medication that specifically treats an enterovirus infection.

Most cases of enterovirus get better on their own with common at-home supportive measures, such as rest, fluids, and the use of nonprescription drugs to help with symptoms, such as ibuprofen (Advil/Motrin) or acetaminophen (Tylenol) for pain.

Antibiotics should not be used because they are useless against any viral infection, including enterovirus.

Serious Cases

Medical attention should be sought, however, if the illness becomes serious.

Most of the severe cases are in infants, adults with weak immune systems, or children who already have lung problems, such as asthma.

Those experiencing severe respiratory problems may need to be hospitalized.

While there are antiviral drugs that may be used against viruses including enterovirus, none of them have been proven useful against enterovirus D68 (EV-D68) — the strain of enterovirus responsible for the 2014 outbreak — according to the Centers for Disease Control and Prevention (CDC).

Prevention

Enteroviruses are most likely passed from one person to another when an infected person coughs, sneezes, or touches a surface that is then touched by others.

An enteroviral infection starts when material contaminated with the virus is swallowed.

The virus reproduces in the digestive tract then — if it's not killed by the immune system — enters the bloodstream and begins to cause symptoms.

It only takes the tiniest bit of infected material — a drop of saliva too small to see with the naked eye, for example — to transmit a virus to a new host.

The same hygienic routines are recommended to prevent the spread of enteroviruses as those used to prevent the spread of colds and flu:

  • Wash your hands frequently and thoroughly, and have your children do likewise. It's especially important before meals and when you first come indoors.
  • Avoid touching your eyes, nose, or mouth with unwashed hands.
  • Stay home if you have symptoms of an upper respiratory infection.
  • Keep your children home if they have upper respiratory infection symptoms. Do not send them to school or to daycare.
  • Teach your children to cough or sneeze into their shoulder or elbow to protect those around them and avoid getting contagious droplets on their hands.
  • Do not share eating utensils, cups, glasses, or bottles with a person who is sick.
  • Disinfect hard surfaces that a sick person may have touched, such as toys, keyboards, phones, and the handles of doors, faucets, and flush toilets.

There is no vaccine for enteroviral infection.

The flu vaccine is important to protect against the influenza viruses that cause the flu, but it will not protect against enteroviruses.

Enterovirus and Children with Asthma

People who have asthma — a condition in which certain triggers cause the airways to become inflamed and narrowed — are more vulnerable to respiratory illnesses generally.

The 2014 outbreak of EV-D68 caused particularly severe respiratory illness in children with asthma.

The CDC had special advice for parents of children with asthma to prepare for the possibility of EV-D68 infection.

The advice is important even in years with less severe enterovirus outbreaks as well:

  • Discuss and update your child's asthma management plan with your child's doctor.
  • Monitor your child's use of prescribed asthma medications, especially long-term medications.
  • Ensure that your child has access to asthma-reliever medicine (also known as rescue medication such as an albuterol inhaler) at all times.
  • Follow your child's action plan if new or worsening asthma symptoms develop.
  • Vaccinate your child against the flu.
  • Call the doctor if symptoms do not go away or worsen when the action plan is followed.

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Enteroviral infection - Symptoms, treatment

Enteroviral infection is an intestinal disease that is provoked by enteroviruses. More than 60 varieties of pathogens of this pathology have been identified. They can be divided into four main groups. Most often, the development of the disease is caused by Coxsackie and polio viruses.

It is worth noting that enterovirus infection is extremely dangerous. Viruses are resistant to the external environment, do not die for a long time, even while in soil or water.

Infection occurs through contaminated water or unwashed and non-thermally processed food.

The last major outbreak of this disease occurred in China several years ago. Then more than 15 thousand children suffered, and 20 babies died. The disease was provoked by a dangerous enterovirus EV71. With the blood stream, it spreads throughout the human body and affects all organs, including the lungs and brain. Therefore, when making a diagnosis of an enterovirus infection, treatment should be taken very carefully.

Probable routes of infection

The causative agents of infection enter the body by airborne droplets, through contaminated water, dirty foods, or through contact with the patient and his household items.

A huge role in the prevention of this disease is played by the observance of sanitary and hygienic rules: washing hands, thermal processing of food and filtering drinking water.

Symptoms of enterovirus infection

The duration of the latent period of the disease depends on various factors. An important role is played by the type of pathogen and the state of the protective functions of a person.

At the end of the incubation period, the following symptoms may appear:

  • increase in body temperature;
  • headache;
  • painful sensations in life;
  • nausea;
  • vomit.

Before the pathogens enter the blood, the symptoms of pathology may be mild or not manifest at all. But when the virus spreads throughout the body, the symptoms of intoxication become very pronounced:

  • hyperthermia reaches values ​​of 39-40;
  • a rash appears on the limbs;
  • there are swelling of the hands and feet;
  • ulcers appear in the mouth.

If a person ignores the manifestations of the disease and does not start treatment of the pathology on time, enterovirus infection can cause complications. These include:

  • inflammation of the meninges;
  • encephalitis;
  • severe pulmonary edema.

These formidable diseases often lead to damage to the membranes of the brain and provoke paralysis or death of a person. They are especially dangerous for children of preschool and primary school age.

Recently, among the children's population, doctors most often began to diagnose a small enterovirus infection. The symptoms of this disease are mild and are manifested by a slight rise in body temperature, pain in the joints. As a rule, these manifestations of the disease disappear on their own after a few days and do not require specific treatment.

How is the diagnosis made?

A person can be diagnosed with an enterovirus infection only by the results of the tests. For the duration of their implementation, doctors recommend isolating the sick person so that he does not infect others.

Since the infection is easily transmitted, a preventive examination is carried out for all contact persons. Any case of infection requires registration.

Treatment of enterovirus infection

There is no specific therapy for the disease. Mostly symptomatic treatment is practiced. In the acute period, doctors prescribe the patient a pastel regimen, vitamin therapy, enhanced nutrition.

If a sick person has vomiting or diarrhea, large amounts of fluids are required to avoid dehydration. Also recommended drugs such as Regidron, restoring the water-salt balance.

In the presence of high body temperature and severe pain in the head, antipyretic and analgesic drugs are indicated.

Antibacterial drugs for viral infections are used only to prevent secondary infections of a bacterial nature.

As for the diet, foods that cause fermentation and increased peristalsis are removed from the diet of a person suffering from an enterovirus infection. These include sweet foods, sodas, smoked sausages, baked goods, fresh fruits and vegetables. You should also avoid any dairy products.

All of these rules apply to both adults and young children.

How to avoid infection?

To avoid infection with an intestinal infection, you can strictly observe the rules of hygiene. Be sure to wash your hands thoroughly before eating, and cook food and thoroughly clean before eating.

One of the preventive measures is also the use of only clean and high-quality drinking water from proven and equipped sources.

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Enteroviral infection in children

Enteroviral infections include a group of diseases. Their specificity is such that lifelong immunity is formed after an infection. However, immunity will only be to the type of virus, the type of which the child has been ill with. Therefore, a child can get sick with an enterovirus infection several times in his life. For the same reason, there is no vaccine for this disease.

Most often, children aged 3 to 10 get sick. Breastfeeding children have immunity received from the mother through breast milk, however, this immunity is not stable and quickly disappears after the cessation of breastfeeding.

The virus is transmitted from a sick child or from a child who carries the virus. Viruses are well preserved in water and soil, when frozen they can survive for several years, resistant to disinfectants, but susceptible to high temperatures (when heated to 45ºС, they die in 45-60 seconds).

Ways of transmission of the virus:

- airborne (when sneezing and coughing with droplets of saliva from a sick child to a healthy one)

- fecal-oral if personal hygiene rules are not observed not boiled) water

- it is possible to infect children through toys if children take them into their mouths

Symptoms of enterovirus infection

Enterovirus infections have both similar manifestations and different ones, depending on the type. Once in the child's body, the viruses migrate to the lymph nodes, where they settle and begin to multiply. The incubation period for all enterovirus infections is the same - from 1 to 10 days (usually 2-5 days).

The disease begins acutely - with an increase in body temperature to 38-39º C. The temperature most often lasts 3-5 days, after which it drops to normal numbers. Very often, the temperature has a wave-like course: the temperature stays for 2-3 days, after which it decreases and stays at normal levels for 2-3 days, then rises again for 1-2 days and finally returns to normal. When the temperature rises, the child feels weakness, drowsiness, headache, nausea, and vomiting may occur. With a decrease in body temperature, all these symptoms disappear, but with a repeated increase, they may return. The cervical and submandibular lymph nodes also increase, as viruses multiply in them.

Depending on which organs are most affected, there are several forms of enterovirus infection. Enteroviruses can affect: the central and peripheral nervous systems, oropharyngeal mucosa, eye mucosa, skin, muscles, heart, intestinal mucosa, liver; in boys, testicular damage is possible.

The most severe consequence of enterovirus is the development of serous enteroviral meningitis. It can develop in a child of any age and is recognized by the following signs:

- diffuse headache, the intensity of which increases every hour;

- vomiting without nausea, after which the child does not feel relief;

- increased pain and repeated episode of vomiting may be triggered by a bright light or loud sound;

- the child may be inhibited or, conversely, extremely agitated;

- in severe cases, convulsions of all muscle groups develop;

The final diagnosis of meningitis can only be made by a doctor after a lumbar puncture and examination of the laboratory parameters of the obtained cerebrospinal fluid.

Treatment of enterovirus infection

There is no specific treatment for enterovirus infection. Treatment is carried out at home, hospitalization is indicated in the presence of damage to the nervous system, heart, high temperature, which cannot be reduced for a long time when using antipyretics. The child is shown bed rest for the entire period of fever.

Meals should be light and rich in proteins. A sufficient amount of liquid is needed: boiled water, mineral water without gases, compotes, juices, fruit drinks.

Treatment is carried out symptomatically, depending on the manifestations of the infection. In some cases (tonsillitis, diarrhea, conjunctivitis), bacterial complications are prevented.

Children are isolated for the entire period of illness. In the children's team may be after the disappearance of all symptoms of the disease.

Prevention of enterovirus infection

For prevention, it is necessary to observe the rules of personal hygiene: wash hands after going to the toilet, walking on the street, drinking only boiled water or water from a factory bottle, it is unacceptable to use water from an open source (river, lake) for drinking a child ).

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