認識腸病毒
腸病毒是一群病毒的總稱，包含許多不同種類，如克沙奇病毒、伊科病毒、小兒麻痺病毒和腸病毒等，每種類型的病毒又有許多不同型別，像是腸病毒71型就是非常容易造成重症的其中一種。腸病毒是臺灣地區常見的地方性傳染疾病，主要經由糞口、飛沫或接觸傳染，傳染力極強且好發於嬰幼兒，因此容易在幼兒園、學校等場所造成群聚感染。雖然感染腸病毒後大多只會出現類似感冒的輕微症狀，但也可能導致腦膜炎、心肌炎等重症，甚至危及性命，尤其在屬於重症高危險族群的五歲以下幼兒中，其致死率更是高達1.3％至33.3％，家長們不可不慎。
腸病毒的常見症狀
腸病毒感染後大多症狀輕微，類似一般感冒，典型的症狀包括：
發燒
突發性發燒，體溫可能超過38.5°C。
食慾不振
孩子變得不想吃東西。
嗜睡、煩躁
精神狀態不佳，容易哭鬧。
腸胃道症狀
嘔吐、腹瀉、腹痛等。
上呼吸道症狀
喉嚨痛、流鼻水、咳嗽等。
皮疹
部分病例可能出現皮疹，常見於手、足、咽峽等部位。
腸病毒何時需要提高警覺？
大部分腸病毒感染會在數天內自行痊癒，但少數個案可能出現嚴重併發症，例如腦膜炎、腦炎、心肌炎、肺水腫等。五歲以下的嬰幼兒是腸病毒重症的高危險群，若出現以下情況，務必立即將孩子送醫：
持續高燒不退
發燒超過三天，或使用退燒藥後仍持續高燒。
精神狀態改變
嗜睡、意識不清、昏迷等。
心跳加快、呼吸急促
可能是心肌炎或肺水腫的徵兆。
持續嘔吐、腹瀉
容易導致脫水，尤其嬰幼兒更易發生。
肌肉抽搐
四肢無故出現抽蓄、抖動、全身肌肉收縮，特別是肢體不對稱的抽蓄，須特別留意，可能與腦炎或腦膜炎有關。
肢體無力
無法行走、舉手等。
新生兒感染
新生兒較容易出現嚴重併發症。
送醫後的處置
醫生會根據孩子的症狀和病史進行診斷，並安排相關的檢查，例如：
核酸增幅檢測
這是診斷腸病毒感染最有效的方法，可以檢測腦脊髓液、血液、糞便等樣本中的病毒類型。
腦脊髓液檢查
如果懷疑腦膜炎，醫生可能會進行腰椎穿刺，取得腦脊髓液進行分析。
血液檢查
可以評估感染的嚴重程度，以及是否有其他併發症。
腸病毒的治療
目前沒有特效藥可以治療腸病毒感染，主要以支持性療法為主，包括：
控制發燒和疼痛
可以使用退燒藥和止痛藥緩解症狀。
補充水分
避免脫水，尤其嬰幼兒需要特別注意。
住院觀察
對於出現嚴重症狀的患者，或新生兒感染，需要住院觀察和治療。
如何預防腸病毒感染？
預防腸病毒的關鍵在於保持良好的個人衛生習慣，像是勤洗手、降低接觸病人的機率、保持環境通風與衛生、避免出入過度擁擠的公共場所等。特別是在暑假和開學期間，是腸病毒流行的高峰期，家有幼兒的家長們要提高警覺，一旦發現腸病毒重症前兆，應立即將孩子送醫，避免延誤病情。早期診斷和治療，才能有效降低腸病毒感染的風險，守護孩子的健康！
Reference
[1] Enterovirus A71 Infection and Neurologic Disease, Madrid, Spain, 2016. /Emerging infectious diseases /2019 LINK
[2] Immune responses against enterovirus A71 infection: Implications for vaccine success. /Reviews in medical virology /2019 LINK
[3] Enterovirus A71 neurologic complications and longterm sequelae. /Journal of biomedical science /2019 LINK
[4] Hypoxia and therapeutic treatment of EVA71 with an immune modulator TLR7 agonist in a new immunocompetent mouse model. /Journal of biomedical science /2019 LINK
[5] Magnetic Resonance Imaging Features of Pediatric Coxsackievirus Encephalitis. /Journal of the Belgian Society of Radiology /2019 LINK
[6] Global epidemiology of nonpolio enteroviruses causing severe neurological complications: A systematic review and metaanalysis. /Reviews in medical virology /2020 LINK
[7] Molecular characterization of nonpolio enteroviruses isolated from acute flaccid paralysis patients in Uganda. /Journal of medical virology /2021 LINK
[8] Enteroviruses: The role of receptors in viral pathogenesis. /Advances in virus research /2022 LINK
[9] Diarrhea: An underestimated symptom in Coronavirus disease 2019. /Clinics and research in hepatology and gastroenterology /2020 LINK
[10] Gastrointestinal involvement in children with SARSCOV2 infection: An overview for the pediatrician. /Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology /2020 LINK
[11] Coronavirus disease2019 and the intestinal tract: An overview. /World journal of gastroenterology /2021 LINK
[12] Gastrointestinal, hepatic and pancreatic manifestations of COVID19 in children. /Clinics and research in hepatology and gastroenterology /2022 LINK
[13] Immune responses against enterovirus A71 infection: Implications for vaccine success. /Reviews in medical virology /2019 LINK
[14] EnterovirusAssociated HandFoot and Mouth Disease and Neurological Complications in Japan and the Rest of the World. /International journal of molecular sciences /2019 LINK
[15] Review of Cardiac Involvement in Multisystem Inflammatory Syndrome in Children. /Circulation /2021 LINK
[16] Molecular epidemiology and clinical features of hand, foot and mouth disease requiring hospitalization after the use of enterovirus A71 inactivated vaccine in chengdu, China, 20172022: a descriptive study. /Emerging microbes & infections /2022 LINK
[17] Screening for enteroviral meningitis in infants and childrenIs it useful in clinical practice? /Journal of medical virology /2019 LINK
[18] Laboratory Diagnosis of Sexually Transmitted Infections in Cases of Suspected Child Sexual Abuse. /Journal of clinical microbiology /2020 LINK
[19] Cerebrospinal Fluid Findings Are Poor Predictors of Appropriate FilmArray Meningitis/Encephalitis Panel Utilization in Pediatric Patients. /Journal of clinical microbiology /2020 LINK
[20] Diagnostic test accuracy of jolt accentuation for headache in acute meningitis in the emergency setting. /The Cochrane database of systematic reviews /2020 LINK
[21] Preliminary Recommendations for Surgical Practice of Neurosurgery Department in the Central Epidemic Area of 2019 Coronavirus Infection. /Current medical science /2020 LINK
[22] Three Taiwan’s domestic family cluster infections of coronavirus disease 2019. /Journal of medical virology /2020 LINK
[23] A systematic review of emerging human coronavirus (SARSCoV2) outbreak: focus on disinfection methods, environmental survival, and control and prevention strategies. /Environmental science and pollution research international /2021 LINK
[24] Challenges and Actions of IAQ under COVID19: A Survey of Taiwanese People’s Perception of Epidemic Prevention and Indoor Places Certification. /International journal of environmental research and public health /2022 LINK
[25] Knowledge of and attitudes toward COVID19 among parents of child dental patients during the outbreak. /Brazilian oral research /2020 LINK
[26] The Importance of Early Recognition, Timely Management, and the Role of Healthcare Providers in Multisystem Inflammatory Syndrome in Children. /Journal of Korean medical science /2021 LINK
[27] LifeChanging Experiences of Mothers with SchoolAge Children during the COVID19 Pandemic: Focusing on Their Health Risk Perceptions and HealthRelated Behaviors. /International journal of environmental research and public health /2021 LINK
[28] Knowledge, Awareness, and Prevention of Norovirus Infection among Kindergarten Parents in Chengdu, China. /International journal of environmental research and public health /2022 LINK
[29] Enterovirus A71 Infection and Neurologic Disease, Madrid, Spain, 2016. /Emerging infectious diseases /2019 LINK
[30] Screening for enteroviral meningitis in infants and childrenIs it useful in clinical practice? /Journal of medical virology /2019 LINK
[31] Clinical Implications of COVID19 Presence in CSF: Systematic Review of Case Reports. /Cells /2022 LINK
[32] Neurological Manifestations of SARSCoV2 Infection: A Narrative Review. /Brain sciences /2022 LINK