Coxsackievirus and echovirus enter the body orally, then invade the bloodstream, spreading to various organs and causing a range of clinical manifestations. The same virus can lead to different clinical symptoms, while the same symptoms may be caused by different viruses. This disease occurs worldwide, mostly sporadically, with higher incidence rates in summer and autumn. The source of infection includes patients, asymptomatic carriers, and virus carriers. The ratio of symptomatic to asymptomatic infections is 1:50 to 100. Daily oral contact is the primary mode of transmission, but it can also spread through drinking water, food, respiratory routes, and from mother to fetus via the placenta.

bubble_chart Clinical Manifestations

1. Encephalitis and myelitis: fever, headache, vomiting, myalgia, meningeal irritation signs appear within 1-2 days. Cerebrospinal fluid cell count (0.1-0.2)×10⁹/L, a few cases >×10⁹/L; neutrophils predominate initially, followed by an increase in lymphocyte proportion, normal glucose and chloride levels, slightly elevated protein. Some patients experience temporary muscle weakness. Paralysis is rare and recovery is rapid. A few patients exhibit consciousness disorders, similar to Japanese encephalitis.
2. Myocarditis and pericarditis: Myocarditis often occurs in newborns, mostly within the first week after birth, with acute onset, fever, upper respiratory infection symptoms, poor appetite, loose stools, followed by dyspnea, cyanosis, pallor, tachycardia, etc. Severe cases may rapidly progress to heart failure. In recent years, it has been found that adults and older children are also commonly affected. Respiratory symptoms often precede, and the pericardium may be involved simultaneously or the endocardium may also be affected, followed by precordial pain, pericardial friction rub, with half of the cases presenting muscle pain and arthralgia. X-ray shows pericardial effusion, often accompanied by left pleural effusion, and ECG reveals arrhythmia, conduction block, and pericarditis.
3. Epidemic myalgia or chest pain: Paroxysmal severe muscle pain, which can affect muscles throughout the body. Adults and older children often experience chest pain, usually in the hypochondrium, which may radiate to the shoulder and back; abdominal pain is more common in infants and young children, mostly in the upper abdomen, and occasionally misdiagnosed as appendicitis. Additionally, fever, sore throat, headache, anorexia, vomiting, and diarrhea may occur.
4. Herpangina: Fever, sore throat, gray-white herpes in the pharynx, which ulcerate to form superficial ulcers, a few cases may appear in the vulva, and may also present headache, nausea, vomiting, abdominal pain, etc. Another type is acute lymphonodular pharyngitis in children, with gray-white or pale-yellow nodules in the pharynx, without forming herpes or ulcers.
5. Respiratory infections: Upper respiratory infections are the most common, but it can also cause laryngitis, tracheitis, bronchitis, bronchiolitis, and pneumonia.
6. Infant diarrhea: Yellow-green watery stools, several times a day, without pus or mucus.
7. Exanthematous Rebing: Fever, rash, including macules and papules, maculopapules, urticaria, herpes, petechiae, etc. Non-pruritic, no desquamation. A few cases present herpes on the skin of hands and feet and oral mucosa. Also known as hand-foot-and-mouth disease.
8. Neonatal systemic infection: Sudden onset, refusal to feed, vomiting, convulsions, dyspnea, cyanosis, arrhythmia, rapid enlargement of the heart and liver. Extremely high mortality. Autopsy may reveal encephalitis, myocarditis, hepatitis, pancreatitis, and adrenal lesions.

bubble_chart Auxiliary Examination

1. The diagnosis can be confirmed by isolating the virus from the patient's body fluids (cerebrospinal fluid, herpes fluid, pericardial fluid, pleural effusion, etc.).
2. stage of convalescence Antibodies appear in the serum, or the antibody titer in paired sera increases by more than 4 times.

bubble_chart Treatment Measures

Currently, there is a lack of effective antiviral drugs. Rest is important, and symptomatic treatment should be provided based on clinical manifestations. Prevention of secondary infections is also necessary.

bubble_chart Prevention

Proper management of feces, environmental and dietary hygiene, and cultivating good personal hygiene habits.