Information gathering and patient examination
The foundation of successful diagnosis for any infectious pathology is the detailed collection and thorough analysis of information regarding the patient's current health status. A physician must be able to purposefully elicit complaints presented by the patient and skillfully gather not only the history of the present illness but also the epidemiological history. It is important to pay attention to the patient's recent travel to other countries, especially regions with an unfavorable epidemiological situation (for example, countries in Southeast Asia, which are frequently visited for business purposes).
The next stage is conducting a full physical examination and physical assessment. During patient management, it is necessary to determine the character of various secretions and assess the general condition. In addition to physical examination, a comprehensive approach requires prescribing laboratory and instrumental diagnostic methods for precise verification of the diagnosis.
Leading clinical syndromes and severity of condition
When interacting with a patient, the clinician must be able to identify leading symptoms and group them into clinical syndromes. Among the most significant manifestations are:
- Intoxication syndrome, reflecting the body's general reaction to the infectious agent.
- Colitic manifestations, indicating the involvement of the gastrointestinal tract in the pathological process.
- Damage to other organs and systems, including pathological changes in the liver, lungs, brain, and skin.
Based on the identified syndromes, the physician must adequately assess the severity of the patient's condition. The essence of clinical symptoms and potential complications (including conditions requiring emergency care) must be understood exclusively from the perspective of pathogenesis.
Laboratory diagnostics and formulation of diagnosis
To confirm clinical hypotheses, the ability to substantiate a laboratory examination plan is required. The physician must analyze the results of a spectrum of studies:
- Parasitological and bacteriological methods.
- Immunological (serological) tests to detect antibodies.
- Biochemical blood tests.
- Instrumental visualization methods.
Mastering the algorithm for formulating a clinical diagnosis allows for the timely prescription of therapy. Principles of diagnosis, treatment, and prevention must be considered in inseparable connection with the etiology, pathogenesis, and immunogenesis of the disease. Special attention is paid to knowing the principles of treating various clinical forms, as well as the indications and rules for hospital admission and discharge of patients.
Epidemiology using protozoan infections as an example
Although transmission mechanisms may vary, understanding global statistics is critically important. For example, amebiasis (as one of the most relevant protozoan diseases) annually causes 40–50 million cases of colitis and liver abscess worldwide. Mortality from this condition ranges from 40,000 to 110,000 cases per year.
Due to active migration processes and tourism (as in the case of a 34-year-old businessman frequently traveling to Southeast Asia), imported cases of infections are possible in almost all regions of the Russian Federation. This requires high vigilance from specialists and readiness to diagnose and provide emergency medical care if severe complications develop.
Briefly: answers to topical questions
Which viruses are included in the human enterovirus group?
The human enterovirus group includes the following viruses:
- Polioviruses.
- Coxsackie A viruses (Coxsackie A) — 23 serotypes.
- Coxsackie B viruses (Coxsackie B) — 6 serotypes.
- ECHO viruses (Enteric Cytopathogenic Human Orphans) — 29 serotypes.
- Numbered (unclassified) enteroviruses — serotypes 68–72.
In modern taxonomy, they are grouped into species: Enterovirus A, B, C, D.
What are the main mechanisms and routes of transmission of enteroviral infection?
The main routes of transmission of enteroviral infection are:
- Aerosol (airborne droplet) — realized primarily in the first days of the disease.
- Fecal-oral — caused by the prolonged persistence of the pathogen in the intestine.
- Vertical — transplacental transmission from mother to fetus is possible.
What typical clinical forms of enteroviral infection are distinguished?
The following typical clinical forms of enteroviral infection are distinguished:
- Herpangina — vesicular rashes on the posterior pharyngeal wall.
- Hand, foot, and mouth disease (hand-foot-mouth syndrome).
- Epidemic myalgia (Bornholm disease) — painful spasms in the chest and abdomen.
- Serous (aseptic) meningitis.
- Myocarditis and pericarditis.
- Enteroviral exanthem (polymorphic rash).
- Intestinal manifestations (diarrhea in children).
- Acute flaccid paralysis (poliomyelitis-like diseases).
What laboratory diagnostic methods are used for specific confirmation of enteroviral infection?
For the specific confirmation of enteroviral infection according to sources, the following are used:
- Virological method.
- Serological method: study of paired sera; diagnostic criterion is a 4-fold or greater increase in antibody titer.
- Material for study: in living patients — nasopharyngeal mucus (in the first days), feces, cerebrospinal fluid (CSF); postmortem — tissues of affected organs.
For Coxsackie viruses, the sources indicate: inoculation of cell cultures (HeLa, monkey kidneys) for Coxsackie B and individual serotypes of A, inoculation of newborn mice, identification via HI, CF, NT, and ELISA tests.
PCR is explicitly indicated in sources for detecting enterovirus genomes in pericardial fluid.
What changes in the cerebrospinal fluid are characteristic of serous meningitis of enteroviral etiology?
Serous meningitis of enteroviral etiology is characterized by:
- The fluid is transparent or slightly turbid.
- Lymphocytic pleocytosis is detected (up to 100 or more cells per 1 mm³).
Sanation of the CSF occurs by the 2nd–3rd week.
What diseases should enteroviral exanthema be differentiated from?
Due to the pronounced polymorphism of the rash, enteroviral exanthema must be differentiated from classic childhood infections:
- measles;
- rubella;
- scarlet fever.
Is there a specific etiotropic therapy for enteroviral infections?
Standardized etiotropic therapy for routine practice in enteroviral infection has not yet been approved; effective etiotropic treatments are practically absent.
Symptomatic therapy is the mainstay of treatment in most cases. Sources also indicate non-specific antiviral and immunotherapy: interferon preparations, as well as intravenous immunoglobulins for newborns and children with underlying immunodeficiency states.
Pleconaril, a capsid inhibitor that blocks the viral capsid, is considered as a promising etiotropic therapy. Acyclovir, oseltamivir, and inosine are not used for enteroviral infection as they are ineffective.
For a complete examination, remember the "AFLE" rule: Anamnesis (including epidemiological), Physical examination, Laboratory tests, Instrumental data.
Class and exam questions
What leading syndromes must be identified during the examination?
First and foremost, it is necessary to identify intoxication syndrome, colitic manifestations, as well as signs of damage to the liver, lungs, brain, and skin.
What types of laboratory tests should one be able to analyze?
The physician must analyze the results of parasitological, immunological (serological), biochemical, and instrumental studies.
What are the WHO statistics on amoebiasis morbidity?
Annually, 40–50 million cases of amoebic colitis and liver abscess are registered worldwide, with mortality ranging from 40 to 110 thousand cases.
What else to study on this topic
- Pathogenesis of intoxication syndrome and colitic manifestations
- Criteria for assessing the severity of the patient's condition
- Principles of emergency medical care for complications
- Rules for hospitalization, patient discharge, and prevention measures
- Specifics of liver, lung, and brain damage in infectious processes
Master the complete topic in the «Infectious Diseases» course
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- Complete study guide on "Enteroviral Infections" and 3,312 more pages of the subject
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Other topics in the "Acute Intestinal Infections" section
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