Cough

Type of acute respiratory viral pathologies. Respiratory viral diseases

Acute respiratory viral infections (ARVI) is a group of common infectious diseases that manifest themselves by damage to the respiratory tract, conjunctiva and lymph nodes and are accompanied by moderate general intoxication and catarrhal symptoms. It includes parainfluenza, respiratory syncytial, rhinovirus, adenovirus infections, etc.

Cause of acute respiratory viral infections (ARVI)

Most ARVI pathogens contain RNA, adenoviruses contain DNA. Based on their antigenic structure, they are divided into many serogroups and types and have different etiological significance.

Epidemiology of acute respiratory viral infections (ARVI)

The source of infection is sick people and virus carriers who secrete viruses with nasal and nasopharyngeal mucus. Infection occurs through airborne droplets, mainly during coughing, sneezing, and talking. Adenoviruses can also be transmitted through food and water.
Susceptibility is greater in children than in adults, with the exception of newborns, who often have immunity from the mother. Single diseases and group outbreaks are observed, mainly in the cold season. Repeated cases are caused by different serotypes of viruses.

Pathogenesis of acute respiratory viral infections (ARVI)

Viruses multiply primarily in the epithelium of the upper respiratory tract, less often in the lower sections. In this case, hyperemia and swelling of the mucous membrane with abundant secretion develop, which can lead to a narrowing of the lumen of the larynx. Viremia is often short-term, with moderate intoxication. In young children, parainfluenza and respiratory syncytial infection most often affect the lower respiratory tract. In adenovirus infections, viremia lasts relatively longer; the virus also multiplies in the lymph nodes and epithelium of the small intestine.

Clinical manifestations of acute respiratory viral infections (ARVI)

Parainfluenza

The incubation period lasts 2-7 days. The onset is acute or gradual, most often with a moderate runny nose, dry cough, scratching sensation in the throat. Intoxication of the body is mild or absent. Body temperature is often subfebrile, but can be high. Occasionally, patients complain of feeling feverish.
Half of the patients have conjunctivitis. The nose is stuffy, the discharge is first liquid, serous, then thick or mucopurulent. There may not be a runny nose. The mucous membrane of the pharynx is hyperemic, and lymphoid granules appear on the back wall of the nasal pharynx. The pulse corresponds to body temperature. When analyzing blood, no changes are detected or slight lymphocytosis and monocytosis are determined.
With the development of laryngitis or laryngotracheitis, the voice becomes hoarse and the cough becomes barking. In children of the first years of life, parainfluenza can be complicated by laryngeal stenosis, and then attacks of dry cough turn into noisy stenotic breathing with retraction of the intercostal space and the development of cyanosis. Parainfluenza croup lasts 1-3 days, the course is favorable. The infectious process can spread to the lower respiratory tract with the development of a clinical picture of bronchitis, bronchiolitis or pneumonia.

Respiratory syncytial infection

The incubation period lasts 3-7 days. Patients complain of nasal congestion, sore throat, sneezing, and coughing. The nasal mucosa is hyperemic and swollen. On the 2-3rd day, a profuse runny nose appears with the release of liquid mucus. Body temperature is normal or subfebrile. Peripheral blood is normal or moderate lymphocytosis and monocytosis are determined. The duration of the disease is 5-7 days.
At an early age, bronchitis with an asthmatic component or bronchiolitis often occurs. The cough is observed in the form of painful attacks, the respiratory rate is up to 60-80 per minute. Many moist rales are heard in the lungs. Dyspnea of mixed type with predominance of expiration. If pneumonia occurs, the body temperature rises, shortness of breath, acrocyanosis, and leukocytosis increase.

Rhinovirus infection

The incubation period is - and -6 days. It starts with a stuffy nose, sneezing, mucous and watery discharge, the amount of which increases. Many patients with a sore throat experience coughing, conjunctivitis with lacrimation, and a dull sense of smell and taste. However, general intoxication is mild or absent, Tila’s temperature is normal.
The nose swells, the nostrils macerate. The nasal mucosa is red and swollen. The soft palate and the posterior wall of the nasal pharynx are hyperwashed, the submandibular and upper cervical lymph nodes are enlarged. These hemograms are normal or there is slight leukocytosis. The disease lasts about 1 week.

Adenovirus infection

The duration of the incubation period ranges from 4 to 12 days. The disease begins with an increase in body temperature, chilliness, and headaches. Often the body temperature is subfebrile; the febrile reaction can consist of two waves. The symptoms of intoxication are weakly expressed. The face is red and somewhat puffy. The eyes are watery, the vessels of the sclera are sharply injected. The mucous membrane of the nasal pharynx and conjunctiva are hyperemic. From the first day of the disease, a large amount of liquid mucus is released from the nose, and over time it becomes thick. The palatine tonsils are enlarged and films may form on their surface. The submandibular and posterior cervical lymph nodes are often enlarged. The pulse is accelerated. The liver and spleen are often slightly enlarged.
Adenoviral infection can occur as an acute respiratory disease, isolated conjunctivitis, pharyngitis or pharyngokonjunctival fever, pneumonia, and very rarely mesadenitis occurs. Pneumonia is often caused by the addition of a pneumococcal or staphylococcal infection and may be complicated by lung abscessation. For adenoviral mesadenitis, which occurs against the background of other clinical manifestations (for example, pharyngoconjunctival fever), a characteristic attack of pain in the lower abdomen is accompanied by dyspeptic symptoms.
Complications: laryngeal stenosis, sinusitis, otitis media, meningitis, encephalitis, myocarditis.

Diagnosis of acute respiratory viral infections (ARVI)

Parainfluenza can be suspected if symptoms of acute laryngitis or laryngotracheitis predominate without significant intoxication, as well as in the case of early development of laryngeal stenosis. One can think about the likelihood of respiratory syncytial infection if the respiratory infection quickly spreads among children in the first years of life, and the course of the disease is often complicated by bronchiolitis and pneumonia with an asthmatic component. A rhinovirus infection is indicated by a mild respiratory illness with a predominant runny nose. Adenovirus infection is characterized by severe catarrhal symptoms, conjunctivitis, enlarged lymph nodes and spleen. The diagnosis is confirmed using virological and serological methods.

ARVI (acute respiratory viral infection) is a disease of the respiratory tract caused by a viral infection entering the body. The route of transmission of viruses is airborne droplets. People with weakened immune systems are most susceptible to contracting an acute infection during cold periods, and this occurs especially often.

To provide the patient with quality care, the doctor prescribes drugs with a complex spectrum of action. Next, we’ll look at what kind of disease this is, what the causes and symptoms are in adults, and how to treat ARVI to quickly restore the body.

What is ARVI?

ARVI is an airborne infection caused by viral pathogens that mainly affect the respiratory system. Outbreaks of respiratory viral infections occur all year round, but the epidemic is more often observed in autumn and winter, especially in the absence of high-quality prevention and quarantine measures to identify cases of infection.

During periods of peak incidence, ARVI is diagnosed in 30% of the world's population; respiratory viral infections are many times higher in incidence than other infectious diseases.

The difference between acute respiratory viral infections and acute respiratory infections is at first glance insignificant. However, there may be a virus (influenza) or bacteria (streptococcus), but the causative agent of ARVI is only a virus.

Reasons

ARVIs are caused by a variety of viruses belonging to different genera and families. They are united by a pronounced affinity for the epithelial cells lining the respiratory tract. Acute respiratory viral infections can be caused by different types of viruses:

flu,
parainfluenza,
adenoviruses,
rhinoviruses,
2 RSV serovars,
reoviruses.

Entering the body through the mucous membrane of the upper respiratory tract or the conjunctiva of the eyes, viruses, having penetrated the epithelial cells, begin to multiply and destroy them. Inflammation occurs at the sites where viruses are introduced.

Source of infection- a sick person, especially if this person is in the initial stage of the disease: feeling unwell and weak until the moment the person realizes he is sick, already releasing the virus, he infects his environment - the work team, fellow travelers on public transport, family.

Main route of transmission airborne, with small particles of mucus and saliva released when talking, coughing, sneezing.

For the development of ARVI, the concentration of the virus in the environment is of great importance. So, the smaller the number of viruses that reach the mucous membranes, the lower the percentage of the likelihood of developing the disease. A high level of virus saturation remains in closed spaces, especially with large crowds of people. The lowest concentration of viruses, on the contrary, is observed in the fresh air.

Risk factors

Provoking factors contributing to the development of infection:

hypothermia;
stress;
poor nutrition;
unfavorable environmental conditions;
chronic infections.

It is best for a doctor to determine how to treat ARVI. Therefore, if the first symptoms appear, you must call your local physician or pediatrician.

Incubation period

The incubation period of ARVI in adults can last from 1 to 10 days, but is generally 3-5 days.

The disease is highly contagious. Viruses enter mucous membranes through airborne droplets. You can get sick through touching your hands, dishes, or towels, so communication with the sick person should be strictly limited.

To avoid infecting other family members, the patient should:

wear a special gauze bandage;
use only your own personal hygiene items;
process them systematically.

After an illness, the immune system does not develop resistance to ARVI, which is due to a large number of different viruses and their strains. Moreover, viruses are subject to mutation. This leads to the fact that an adult can get ARVI up to 4 times a year.

If a patient is diagnosed with an illness, he is prescribed antiviral drugs and bed rest until complete recovery.

The first signs of acute respiratory viral infection

It usually starts with minor discomfort and a sore throat. Some people experience an exacerbation of chronic herpes at this time, accompanied by the appearance of characteristic blisters with liquid in the lip area.

The first signs of an acute respiratory viral infection will be:

pain in the eyes;
increase in general body temperature;
a situation in which the eyes are watery and runny;
sore throat, dryness, irritation, sneezing;
increased size of lymph nodes;
sleep disorders;
coughing attacks;
changes in voice (if the mucous membranes of the larynx are inflamed).

How contagious is ARVI for an adult? Experts have found that a person who has contracted the virus becomes infectious 24 hours before the very first symptoms of the disease are detected.

Thus, if signs of a respiratory infection appeared 2.5 days after the introduction of the pathogen into the body, then the sick person could infect others starting 1.5 days after communicating with the previous carrier of the virus.

Symptoms of ARVI in adults

Common features of ARVI: relatively short-term (about a week) incubation period, acute onset, fever, intoxication and catarrhal symptoms. Symptoms of acute respiratory viral infection in adults develop rapidly, and the faster responses to the invasion of infection are taken and treatment is started, the easier the immune system will cope with the disease.

The main symptoms of ARVI in adults and children:

Malaise - weakness in the muscles and aching joints, you want to lie down all the time;
drowsiness - constantly makes you sleepy, no matter how long a person sleeps;
runny nose - not severe at first, just like clear liquid coming from the nose. Most people attribute this to a sharp change in temperature (you went from a cold room into a warm room and condensation appeared in your nose);
chills – unpleasant sensations when touching the skin;
sore throat - it can be expressed as a sore throat or a tingling sensation or even a pain in the neck.

Depending on the state of the immune system, the symptoms of ARVI may increase or decrease. If the protective functions of the respiratory organs are at a high level, it will be very easy to get rid of the virus and the disease will not cause complications.

In addition, if the usual symptoms of ARVI do not go away after 7-10 days, then this will also be a reason to consult a specialist (usually an ENT doctor).

Species	Symptoms in an adult
Adenovirus infection	High fever that lasts from five to ten days; severe wet cough, worsening in a horizontal position and with increased physical activity; enlarged lymph nodes; runny nose; sore throat when swallowing.
	Occurs: Very high temperature; dry cough that causes chest pain; sore throat; runny nose; dizziness and sometimes loss of consciousness.
Parainfluenza	The incubation period lasts 2–7 days. This form of ARVI is characterized by an acute course and an increase in symptoms: Body temperature up to 38 degrees. It lasts for 7–10 days. Rough cough, hoarseness and change in voice timbre. Painful sensations in the chest. Runny nose.
MS infection	Its symptoms are generally similar to parainfluenza, but its danger is that bronchitis may develop as a result of untimely treatment.

If the patient has chronic diseases, this can lead to exacerbation. During the period of exacerbation, diseases develop: bronchial asthma, bronchitis, sinusitis,. They worsen a person’s condition and make it difficult to treat.

Symptoms of ARVI that require emergency medical attention:

temperature above 40 degrees, with little or no response to antipyretic medications;
disturbance of consciousness (confusion, fainting);
intense headache with inability to bend the neck, bringing the chin to the chest
the appearance of a rash on the body (stars, hemorrhages);
pain in the chest when breathing, difficulty inhaling or exhaling, feeling of lack of air, cough with sputum (pink color - more serious);
prolonged fever of more than five days;
the appearance of green or brown discharge from the respiratory tract, mixed with fresh blood;
chest pain independent of breathing, swelling.

Complications

If you do not take the necessary measures to treat ARVI, complications may develop, which are expressed in the development of the following diseases and conditions:

acute sinusitis (inflammation of the sinuses with the addition of a purulent infection),
the infection descends down the respiratory tract with the formation and,
spread of infection to the auditory tube with the formation,
the addition of a secondary bacterial infection (for example),
exacerbation of foci of chronic infection both in the bronchopulmonary system and in other organs.

The so-called “adult” teenagers who cannot sit at home for a minute are especially susceptible to this. It is necessary to have a conversation with them, because... complications after ARVI can not only spoil life, there have been cases with a fatal outcome.

Diagnostics

Which doctor will help? If you have or suspect the development of ARVI, you should immediately seek advice from doctors such as a therapist or an infectious disease specialist.

To diagnose ARVI, the following examination methods are usually used:

Examination of the patient;
Immunofluorescent rapid diagnostics;
Bacteriological research.

If the patient develops bacterial complications, he is referred for consultation to other specialists - a pulmonologist, an otolaryngologist. If pneumonia is suspected, an X-ray of the lungs is performed. If pathological changes occur in the ENT organs, the patient is prescribed pharyngoscopy, rhinoscopy, and otoscopy.

How to treat ARVI in adults?

At the first symptoms of the disease, bed rest is required. You need to call a doctor to make a diagnosis and determine the severity of the disease. Mild and moderate forms of ARVI are treated at home, severe forms are treated in an infectious diseases hospital.

Mode.
Reduced intoxication.
Impact on the pathogen - the use of antiviral drugs for acute respiratory viral infections.
Elimination of the main manifestations - runny nose, sore throat, cough.

Drugs for the treatment of ARVI

It is imperative to treat ARVI with antiviral drugs, because the main cause of the disease is a virus. From the first hours of the onset of ARVI symptoms, no later than 48 hours, begin taking one of the drugs 2 times a day:

Amiksin;
rimantadine or amantadine – 0.1 g each;
oseltamivir (Tamiflu) – 0.075 – 0.15 g;
zanamivir (Relenza).

You need to take antiviral drugs for 5 days.

Nonsteroidal anti-inflammatory drugs drugs. This category includes:

Ibuprofen,
Paracetamol
Diclofenac.

These drugs have an anti-inflammatory effect, reduce temperature, and relieve pain.

Can be taken combination type drugs containing paracetamol - for example:

Fervex,
Teraflu

Their effectiveness is the same as that of regular paracetamol, but they are more convenient to use and reduce the intensity of other symptoms of ARVI due to the presence of phenylephrine and chlorphenamine.

Antihistamines needed to reduce signs of inflammation: nasal congestion, swelling of the mucous membranes. It is recommended to take "", "Fenistil", "Zyrtec". Unlike first-generation drugs, they do not cause drowsiness.

Against nasal congestion and runny nose during ARVI in adults, vasoconstrictor nasal drops Vibrocil, Nazivin, Otrivin, Sanorin are used.

Are antibiotics needed?

The prognosis for ARVI is generally favorable. The prognosis worsens when complications occur; a more severe course often develops when the body is weakened, in children of the first year of life, and in the elderly. Some complications (pulmonary edema, encephalopathy, false croup) can be fatal.

The main indications for taking antibiotics for colds are the following:

chronic inflammation of the middle ear;
purulent otitis;
purulent;
quinsy;
abscess;
phlegmon.

An important action is isolation of the patient from society, since the infection will then spread. Being in crowded places, an infected person will expose them to danger.
A number of rules must be observed regarding the room where the patient is located. This includes its wet cleaning, mandatory ventilation (every 1.5 hours), temperature conditions (20-22°), it’s good if the indoor humidity is 60-70%.
Need to drink plenty of fluids, it should only be warm. In fact, this is any drink: tea, decoctions, compote, just warm water, etc.
Taking a loading dose of vitamin C. In the first days of ARVI, you need to take ascorbic acid up to 1000 milligrams per day.
Warming up your feet and hands using hot baths. Warming procedures can be carried out if the patient does not have a fever.
Gargling. The throat must be gargled to prevent the infection from spreading. Gargling helps relieve cough. Soda-salt solution, decoctions of chamomile, calendula, and sage are suitable for gargling.
Rinse your nose regularly with saline solutions. The cheapest option is saline solution, you can also use modern Dolphin preparations or - their effectiveness in comparison with regular saline solution is absolutely identical.
Inhalations. This procedure is aimed at relieving cough. Among folk remedies, steam from jacket potatoes, as well as decoctions of chamomile, calendula, mint and other medicinal herbs, can be used for inhalation. Among modern means, a nebulizer can be used for inhalation.

In the acute stage of the disease, a person’s temperature rises, their condition is severe, apathy, loss of appetite, pain in joints, muscles, etc. As soon as the virus begins to “give up”, the temperature balance normalizes - perspiration occurs, the pallor of the skin turns into a blush, the patient wants to eat and craves sweets.

Nutrition

Food during treatment for ARVI should be light and quickly digestible. It is important to maintain a balance of fats, proteins and carbohydrates. For a speedy recovery, you should limit the amount of fat you consume. But you don’t need to give up easily digestible carbohydrates. They will replenish energy reserves.

Depending on the stage of recovery, the nutrition of a patient with ARVI can be structured as follows:

On the first day of illness - baked apples, low-fat yogurt, fermented baked milk.
On the second or third days - boiled meat or fish, porridge with milk, fermented milk products.
On days of complications of the disease - boiled or stewed vegetables, low-fat fermented milk products.

Folk remedies for ARVI

ARVI can be treated using the following folk remedies:

Brew 1 tablespoon of boiling water in a glass. ginger powder, ground cinnamon, add ground black pepper on the tip of a knife. Leave covered for 5 minutes, add 1 tsp. honey Take a glass every 3-4 hours.
Modern healers recommend treating colds with a special mixture of juices. You will need: juice from 2 lemons, 1 crushed clove of garlic, 5 mm fresh ginger root, 1 apple with peel, 1 pear with peel, 300 gr. water, 1 tablespoon honey. If the juice is intended for adults, you can add a 2 cm thick slice of radish to it. Drink the resulting mixture 2 times a day until complete recovery.
You can do inhalations over a container of hot water. To increase efficiency, add a clove of garlic, pine needle extract, fir and eucalyptus oil to the liquid. Also, nasal drops are made based on these oils.
To disinfect indoor air, you should place a container with onions or garlic in the room. They are rich in beneficial phytoncides that destroy viruses.
Loss of smell is one of the most frustrating symptoms of a cold (especially for an aromatherapy practitioner!) Chervil, geranium and basil oils can help your woes. Use them when taking baths and during inhalations.

Prevention

Preventive methods for ARVI include:

limiting contact with a sick person;
use of a protective gauze mask;
humidifying the air to prevent drying out of the mucous membranes;
quartzing of premises;
ventilation of premises;
good nutrition;
playing sports;
the use of vitamins and restorative drugs in the off-season;
personal hygiene.

You will get maximum results if you carry out comprehensive treatment for ARVI, take all medications prescribed by your doctor and remember to stay in bed.

This is all about ARVI in adults: what are the main symptoms, treatment features, is treatment possible at home. Don't get sick!

Acute respiratory viral infections (ARVI) represent a large group of diseases that are clinically and morphologically similar to acute inflammatory diseases of the respiratory system caused by pneumotropic viruses. The frequency of acute viral infections varies significantly at different times of the year, increasing in the autumn-winter period. However they are constantly encountered in the population, this even applies to the flu during non-epidemic times. All these viruses are like RNA-containing- influenza (family Orthomyxoviridae), parainfluenza, respiratory syncytial (family Paramohoviridae), and DNA-containing- adenoviruses (family Adenoviridae), enter the human body through airborne droplets. The pathological process that occurs in all these diseases proceeds in a fundamentally similar way.

Among ARVI are of greatest importance influenza, parainfluenza, adenoviral and respiratory syncytial infections.

Pathogenesis. Reproduction of these viruses occurs primarily in the epithelial cells of the respiratory organs and consists of several main stages. First, the virus is adsorbed on the membrane of a susceptible cell, apparently due to interaction with cell receptors. The next step is the penetration of the virus or its nucleic acid into the cell. For the flu this happens due to the enzyme of the virus - neuraminidase. Active absorption of the virus by the cell (“viropexy” or “pinocytosis”) is also possible. Only a few tens of minutes can pass between the penetration of a virus into a cell and the appearance of its offspring in the form of many hundreds of viral particles. Virus reproduction is carried out by the host cell on viral matrices, so its speed depends on the rhythm of the initial metabolism in the host cells.

Viruses can be detected by electron microscopy, although this is only possible in cases where the virus particles are fully formed. It is easier to detect their antigen with immunofluorescence testing. Large accumulations of viruses are also detected by light microscopy in the form of basophilic granules.

Under the influence of a multiplying virus, cell damage occurs. First of all, alterative changes occur, reaching partial necrosis or leading to the death of the entire cell. Such areas of necrosis, intensely stained with basic fuchsin, are designated by the term fuchsinophilic inclusions. Their partial rejection along with the apical part of the cytoplasm is possible. Along with this, a change in the shape of the affected cell occurs - giant cell metamorphosis. Such cells increase significantly in size, both due to the cytoplasm and the nucleus. During RNA viral infections, the nucleus remains light. In infections caused by parainfluenza and respiratory syncytial viruses, the affected cells are closely connected to each other. In this regard, they form outgrowths or thickenings similar to those simplastam, which arise in tissue cultures.

Circulatory disorders also occur, manifested primarily by increased permeability of the walls of blood vessels. As a result, moderate edema develops, sometimes combined with the formation of hyaline membranes - dense protein masses formed from blood plasma proteins and located on the walls of the alveoli, as well as hemorrhages, usually small.

Naturally, focal collapse of the lungs is also observed, more often with viral infections with a longer course. These focal collapses of the lungs (partial atelectasis or dyselectasis) are associated with impaired surfactant formation.

In the later stages of the disease, regeneration of the epithelium occurs, growing from the growth zones onto the exposed surface. Regeneration is often complete. But sometimes, especially with repeated acute respiratory viral infections, multi-row epithelium and even true metaplasia of the epithelium develop.

Macroscopic changes in uncomplicated acute respiratory viral infections, including influenza, are moderate and consist of catarrhal inflammation of the respiratory tract. Their mucous membrane is pink, with delicate yellowish overlays. In the respiratory sections, sunken areas of moderate compaction of a reddish-bluish or red-violet color are found. Without a secondary infection (bacterial, in particular staphylococcal, or mycoplasmosis), hemorrhagic or fibrinous-necrotic tracheobronchitis or foci of abscessing or hemorrhagic pneumonia (“large motley lung”), even with influenza, no visible changes are detected.

In immunodeficiency states (primary or secondary), and in children without them, the emergence of foci of generalization is observed with damage to many organs (intestines, liver, kidneys, brain, etc.), where a process similar to the lungs develops with predominant damage to the epithelium or neuroepithelium.

FLU

Flu(from French. grippe- grasp) - ARVI caused by influenza viruses. In addition to humans, it affects many mammals (horses, pigs, dogs, cattle) and birds. Source human diseases are only sick person. Hybridization of animal and human viruses is possible, which leads to variability of the pathogen and the emergence of pandemic-dangerous strains.

Etiology. Influenza pathogens - pneumotropic RNA viruses three antigenically determined serological variants: A (A1, A2), B and C, belonging to the family Orthomyxoviridae. Influenza virus particles (virions) are round in shape, 80-100 nm in diameter, and consist of an RNA molecule surrounded by a lipoglycoprotein shell (capsid). Influenza viruses have hemagglutinins, which bind tightly to the carbohydrates of the outer membrane of epithelial cells and thus inhibit the actions of the ciliated epithelium.

Pathogenesis. The infection is spread by airborne droplets. The incubation period lasts 2-4 days. Primary adsorption, introduction and propagation of the virus are happening in the cells of the bronchiolar and alveolar epithelium, in the capillary endothelium, which leads to primary viremia. By using neuraminidase virus dissolves the shell and penetrates the host cell. RNA polymerase activates virus reproduction. Reproduction of the virus in the epithelial cells of the bronchioles and lungs is accompanied by their death and the release of the pathogen, which populates the epithelium of the bronchi and trachea. Acute bronchitis and tracheitis are the first clinical signs of the onset of the disease.

The influenza virus has:

cytopathic (cytolytic) effect on the epithelium of the bronchi and trachea, causing its degeneration, necrosis, and desquamation;

vasopathic (vasoparalytic) effect(plethora, stasis, plasma and hemorrhage);

immunosuppressive effect: inhibition of the activity of neutrophils (suppression of phagocytosis), monocytic phagocytes (suppression of chemotaxis and phagocytosis), the immune system (development of allergies, the appearance of toxic immune complexes).

Vasopathic and immunosuppressive effects of the influenza virus determine addition of a secondary infection, the nature of local (rhinitis, pharyngitis, tracheitis, bronchitis, pneumonia) and general (dyscirculatory disorders, degeneration of parenchymal elements, inflammation) changes. The introduction of a virus does not always lead to the development of an acute infectious process. Latent (asymptomatic) and chronic forms of the disease are possible, which are of great importance, especially in perinatal pathology.

Pathological anatomy. Changes in influenza are different and depend on the severity of its course, which is determined by the type of pathogen (for example, influenza A2 is always more severe), the strength of its impact, the state of the macroorganism and the addition of a secondary infection. They are distinguished according to the clinical course:

light (outpatient);

moderate severity;

severe forms of influenza.

Mild form of flu characterized by damage to the mucous membrane of the upper respiratory tract and the development acute catarrhal rhino-laryngo-tracheobronchitis. The mucous membrane is hyperemic, swollen, edematous with serous-mucous discharge. Microscopically: hydropic degeneration of ciliated epithelial cells, loss of cilia, plethora, edema, infiltration of the subepithelial layer by lymphocytes. Desquamation of epithelial cells is noted. In goblet cells and in the cells of the serous-mucosal glands there is an abundance of CHIC - a positive secretion. Characterized by the presence of epithelial cells in the cytoplasm basophilic and oxyphilic (fuchsinophilic) inclusions. Small basophilic inclusions represent influenza virus microcolonies, which is confirmed by the method of fluorescent antibodies. Oxyphilic inclusions are a product of a cell’s reaction to the introduction of a virus and focal destruction of its organelles. Electron microscopic examination of the bronchial epithelium, in addition to viral particles, can reveal ultrastructures associated with the cell membrane, which form pseudomyelin figures of a bizarre spiral shape. Cytoplasmic inclusions and influenza antigen can be detected in fingerprint smears from the nasal mucosa at the earliest stage of influenza, which is important for its diagnosis. A mild form of influenza progresses favorably and ends after 5-6 days with complete restoration of the mucous membrane of the upper respiratory tract and recovery.

Moderate flu occurs with the involvement in the pathological process of the mucous membrane of not only the upper respiratory tract, but also small bronchi, bronchioles, as well as the pulmonary parenchyma. Develops in the trachea and bronchi serous-hemorrhagic inflammation, sometimes with foci of necrosis of the mucous membrane. There are virus inclusions in the cytoplasm of the bronchial and alveolar epithelium.

Microscopically in the lungs: plethora, serous, sometimes hemorrhagic exudate, desquamated alveolar epithelial cells, single neutrophils, erythrocytes, areas of atelectasis and acute emphysema are visible in the alveoli; the interalveolar septa are thickened due to edema and infiltration by lymphoid cells, sometimes hyaline membranes are found.

The course of moderate influenza is generally favorable: recovery occurs in 3-4 weeks. In weakened people, the elderly, children, as well as patients with cardiovascular diseases, pneumonia can become chronic and cause cardiopulmonary failure and death.

Severe flu has two varieties:

influenza toxicosis;

influenza with predominantly pulmonary complications.

In case of severe influenza toxicosis comes to the fore severe general intoxication, caused by the cyto- and vasopathic effect of the virus. Serous-hemorrhagic inflammation and necrosis occur in the trachea and bronchi. In the lungs, against the background of circulatory disorders and massive hemorrhages, there are many small (acinous, lobular) foci of serous-hemorrhagic pneumonia, alternating with foci of acute emphysema and atelectasis. In cases of fulminant influenza, toxic hemorrhagic pulmonary edema is possible. Pinpoint hemorrhages are detected in the brain, internal organs, serous and mucous membranes, and skin. Often such patients die on the 4-5th day of the disease from hemorrhages in vital centers or respiratory failure.

Severe flu with pulmonary complications caused by the addition of a secondary infection (staphylococcus, streptococcus, pneumococcus, Pseudomonas aeruginosa).

The degree of inflammatory and destructive changes increases from the trachea to the bronchi and lung tissue. In the most severe cases, fibrinous-hemorrhagic inflammation with extensive areas of necrosis in the mucous membrane and the formation of ulcers is found in the larynx and trachea. All layers of the bronchial wall are involved in the process - fibrinous-hemorrhagic panbronchitis or ulcerative-necrotic panbronchitis occurs. In the presence of diffuse bronchiolitis, the inflammatory process spreads to the lung tissue and the most common complication of influenza occurs - pneumonia. Influenza pneumonia has a number of its own characteristics:

this is, first of all, bronchopneumonia;

in terms of affected area it focal: lobular or lobular confluent;

according to the localization of the inflammatory process from the very beginning it carries stromal-parenchymal nature;

by the nature of the exudate it hemorrhagic (fibrinous-hemorrhagic).

Influenza pneumonia differs in severity and duration of clinical course. This is due to immunosuppressive effect of influenza virus, which determines joining secondary infection. This is also facilitated by severe damage to the entire drainage system of the lungs: diffuse panbronchitis and lympho-, hemangiopathy. Destructive panbronchitis can lead to the development of acute bronchiectasis, foci of atelectasis and acute emphysema. A variety of morphological changes give the section of the affected lung a mottled appearance, and such a lung is designated as “large mottled influenza lung.” The lungs are macroscopically increased in volume, in places dense, dark red (hemorrhagic exudate), in places grayish-yellow (abscess formation), grayish (fibrinous exudate) color.

Influenza pneumonia prone to such menacing complications How abscess formation, lung gangrene. The inflammatory process can spread to the pleura and then destructive fibrinous pleurisy develops. Perhaps development pleural empyema which can be complicated purulent pericarditis and purulent mediastinitis. Due to the fact that influenza exudate does not resolve for a long time, it can occur carnification(replacement of exudate with connective tissue). Among other extrapulmonary complications, it should be noted the development of a very serious complication - serous or serous-hemorrhagic meningitis, which can be combined with encephalitis. For influenza encephalitis characterized by perivascular lymphocytic infiltrates, neuroglial nodules, dystrophic changes in nerve cells, and many small hemorrhages. In the brain, in severe cases of influenza, circulatory disorders lead to acute swelling of its substance, accompanied by wedging of the cerebellar tonsils into the foramen magnum, and the death of patients. In addition, it is possible to develop acute non-purulent interstitial myocarditis. Dystrophic changes in the cells of the intramural ganglia of the heart can cause acute heart failure. Patients with influenza often develop thrombophlebitis and thrombarteritis. Finally, acute purulent otitis (inflammation of the middle ear), inflammation of the paranasal sinuses is often observed - sinusitis, frontal sinusitis, ethmoiditis, pasinusitis.

Features of the course of influenza in children. In young children, the disease is more severe than in adults; Pulmonary and extrapulmonary complications often develop. There is a predominance of general intoxication with damage to the nervous system, an abundance of petechiae in the internal organs, serous and mucous membranes. Local changes are sometimes accompanied by catarrhal inflammation and swelling of the mucous membrane of the larynx, narrowing of its lumen (false croup) and asphyxia.

Acute respiratory viral infections.

Acute respiratory viral infections (ARVI) are a group of diseases transmitted by airborne droplets and characterized by damage to various parts of the upper respiratory tract in humans. These include influenza, parainfluenza, respiratory syncytial infection, rhinovirus disease, adenoviral diseases, etc. Differentiation of this group of diseases is carried out using the complement fixation reaction, RNHA and hemagglutination inhibition reaction (HIT), and rapid diagnosis using the immunofluorescence method in direct or indirect modification.

ARVI is the most common disease on the globe. It is impossible to fully take into account the incidence. Almost every person suffers from ARVI several times a year. ARVI is especially common in children. Children in the first months of life rarely get sick because they are in relative isolation and many of them retain passive immunity received from the mother transplacentally. However, they can also suffer from ARVI, especially if the innate immunity turns out to be weak or completely absent.

The highest incidence occurs in children in the second half of the year and the first three years of life, which is usually associated with their visits to child care institutions and a significant increase in the number of contacts. Repeated diseases significantly affect the development of the child. They lead to a weakening of the body's defenses, contribute to the formation of chronic foci of infection, cause allergization of the body, interfere with preventive vaccinations, aggravate the premorbid background and delay the physical and psychomotor development of children. In many cases, frequent acute respiratory viral infections are pathogenetically associated with asthmatic bronchitis, bronchial asthma, chronic pyelonephritis, polyarthritis, chronic diseases of the nasopharynx and many other diseases.

Often the source of infection for children is adults, especially those who suffer from ARVI “on their feet” in the form of mild catarrh of the upper respiratory tract, rhinitis or tonsillitis. At the same time, adults often regard their condition as a “mild cold.” It has now been established that almost all so-called colds are viral in nature, and such patients pose a great danger to children, especially young children.

Clinically, all acute respiratory viral infections are manifested by varying degrees of severity of symptoms of intoxication, fever and catarrh of the upper respiratory tract. At the same time, each nosological form is characterized by characteristic features that allow differential diagnosis. For example, influenza is distinguished by symptoms of severe intoxication (specific influenza intoxication), adenoviral infection - damage to the lymphadenoid tissue of the oropharynx, moderate enlargement of the lymph nodes, often the liver and spleen, as well as the presence of an exudative component of inflammation and damage to the conjunctiva of the eyes. Parainfluenza is characterized by croup syndrome, and MS infection is characterized by obstructive bronchitis and bronchiolitis. Rhinovirus infection can be suspected by abundant mucous discharge from the nose in the absence or mild symptoms of intoxication.

The occurrence of a particular clinical syndrome is to some extent predetermined by the place of predominant localization of the infection in the respiratory tract. It is known that influenza viruses primarily affect the mucous membrane of the trachea, parainfluenza - the larynx, RS virus - small bronchi and bronchioles, adenoviruses - the nasopharynx and alveoli, rhinoviruses - the mucous membrane of the nasal cavity. However, this division is of very relative importance, since it is not always possible to identify the site of the greatest damage and only at the first stage of the disease. At the height of the disease, the process in the respiratory tract often becomes widespread, often involving the entire mucous membrane of both the upper and lower sections of the respiratory tract.

Influenza is an acute viral infectious disease with airborne transmission, clinically characterized by a short-term but pronounced febrile reaction, symptoms of general toxicosis and damage to the upper respiratory tract; periodically it assumes epidemic and pandemic spread.

Flu clinic.

After an incubation period lasting from several hours to 1-1.5 days, the disease usually begins acutely and violently, with a rise in body temperature to high numbers (39-40°C), chills, dizziness, general weakness, weakness, muscle and joint pain. Body temperature reaches its maximum at the end of the first day, less often on the second day of illness. By this time, all flu symptoms are most pronounced. Children complain of headaches, often in the temples, forehead, brow ridges, and eyeballs; their appetite disappears, sleep deteriorates, delirium, hallucinations, nausea, vomiting occur (usually after taking medications, food, water).

Characterized by mild catarrhal symptoms in the form of coughing, nasal congestion, scanty mucous discharge from the nose, pain or sore throat, especially when swallowing. In severe cases, there are often nosebleeds, convulsions, short-term loss of consciousness, meningeal symptoms, stiff neck, and a weakly positive Kernig sign. At the height of intoxication, the skin is pale, isolated petechial rashes, increased sweating, abdominal pain, short-term stool disorders, pulse lability, and decreased blood pressure are possible. The liver and spleen are not enlarged.

One of the severe complications of influenza that develops in children due to the addition of a bacterial process with subsequent necrotic lesions and swelling of the laryngeal mucosa is influenza croup. It begins acutely, on the 3-4th day of illness, with stenosis, but without the characteristic phases of diphtheria croup, although with severe shortness of breath, cyanosis, and barking cough (false croup).

According to the clinical course, influenza is divided into mild, moderate, severe and fulminant forms. The last two forms, often unreasonably called toxic flu (toxicosis is a characteristic feature of any form of influenza, and not just its severe forms), often occur with convulsions, vomiting, agitation, hallucinations, delirium, even with loss of consciousness, that is, as a syndrome Rhea. These forms often occur in children and elderly patients and, as a rule, are a consequence of extensive hemorrhagic pulmonary edema and cerebral edema. A progressive deterioration in general condition and an increase in temperature, tachypnea and tachycardia, the appearance of stabbing pain in the chest and rusty sputum and increasing shortness of breath allow us to correctly approach the recognition of pathology and take the necessary measures. The lightning-fast form gives the greatest lethality. Along with this, there are also atypical forms of the disease with low-grade fever with mild intoxication. They are more often observed in middle-aged people, especially those who are physically well developed.

Diagnosis and differential diagnosis of influenza is based on the epidemiological features of the infection and on the above-mentioned clinical symptom complex of the disease, the essence of which seems to be as follows: always a steep rise in incidence, more often in the autumn-winter period with the appearance of large foci; susceptibility to all age groups of the population; high contagiousness; duration of incubation period within 12-36 hours; acute onset of the disease; severe toxicosis; always high temperature, sometimes biphasic, duration 3-6 days; hyperemia and injection of scleral vessels and facial hyperemia; hyperemia of the nasopharyngeal mucosa and nosebleeds; absence of enlargement of the spleen and lymph nodes; leukopenia with relative lymphocytosis from the third day of illness; normal or slightly elevated ESR.

Confirmation of the diagnosis and its differentiation in a clinical setting and at home, both during epidemics and in sporadic diseases, is carried out by the method of immunofluorescence (IF), which acts as a method of express diagnosis, not only of influenza, but also of other acute respiratory viral diseases . The IF method allows, within 2-3 hours, to carry out differential diagnosis of influenza A and B, parainfluenza, adenovirus, RS virus and other infections in clinical diagnostic laboratories equipped with a fluorescent microscope, a centrifuge and a thermostat in the presence of material for the study of columnar epithelial cells of the nasal passages .

Serological diagnosis is also carried out using RPGA.

Treatment of influenza.

Treatment of influenza should be carried out differentiated depending on the severity of the disease, its complications and the age of the patients. In mild and moderate forms of the disease, treatment is carried out at home with bed rest, drinking plenty of fluids (tea, fruit juice, milk, preferably with Borjomi, fruit juices, coffee), and a gentle diet (at the patient’s request).

Of the anti-influenza drugs, in the first two days of the disease it is recommended to prescribe rimantadine, which has antiviral activity against all known strains of the serotype A virus. For mild forms of the disease, it is prescribed 0.05 g 3 times a day in the first 2 days. For moderate and severe forms, the drug is prescribed 0.3 g on the first day (first dose 0.2 g and second 0.1 g) and 0.05 g 3 times a day in the next 2 days.

It is also recommended to inject into the nasal passages using a cotton swab 2-3 times a day 0.25% oxolinic ointment and leukocyte interferon, which is instilled 3 drops into each nasal passage after 1-2 hours for 2-3 days or used in the form of double inhalation of its aerosol at a dose of 3 thousand units and above. Moreover, in cases of nasal congestion and runny nose, 5-10 minutes before the administration of oxoline or interferon, 5% ephedrine 5 drops are administered into each nasal passage or close-acting drugs sanorin, naphthyzin, galazolin, which, however, are contraindicated in hypertension, tachycardia, severe atherosclerosis.

Pathogenetic and symptomatic (painkillers and antipyretics) drugs include acetylsalicylic acid (aspirin), amidopyrine (pyramidon), analgin, phenobarbital (luminal), barbamyl, etc. You can also use a complex in the form of phenalgin (analgin 0.125; amidopyrine 0.125; phenacetin 0.125) or antigrippin (aspirin 0.5 g, ascorbic acid 0.3 g, rutin 0.02; diphenhydramine 0.02 g and calcium lactate 0.1 g) 2 powders 3 times a day.

Treatment of patients with severe influenza should be carried out in a hospital setting, where, first of all, it is recommended to administer donor anti-influenza gamma globulin in a dose of 3-6 ml for adults (in its absence, anti-measles gamma globulin can be used), a complex of pathogenetic and symptomatic agents, including administration of fluids for the purpose of detoxification, antigrippin, cardiovascular drugs (according to indications).

In case of severe toxicosis, detoxification administration of liquid (saline solution, hemodez, polyglucin, reopoliglucin) is carried out, but not more than 800-1000 ml per day in order to avoid the development of pulmonary and cerebral edema, and always with saluretics (Lasix, Uregit, Brinaldix) or osmotic diuretics ( urea, mannitol), inhalation of humidified oxygen, alkaline inhalation. As antitoxic and anti-inflammatory drugs for severe influenza, steroid hormones are prescribed parenterally (prednisolone up to 300 mg or more or hydrocortisone 250-500 ml per day) in a course of 1-2 days.

Antibiotics should not be promoted to prevent complications from influenza, as this contributes to the development or intensification of allergization of the body and the development of resistance of some bacteria to chemotherapy. In the future, this can lead to complications that are not amenable to antibiotic therapy. And only in hypotrophic children, in pregnant women, in people with chronic diseases of the respiratory and cardiovascular systems, in patients with diabetes and in very old people, preventive treatment with antibiotics can be considered to some extent justified. However, if influenza is complicated by pneumonia, treatment with antibiotics is necessary. Penicillins are usually used intramuscularly or intravenously, including semisynthetic ones, most often methicillin or oxacillin, which are especially effective in combination with lincomycin or gentamicin, as well as zeporin.

With the development of influenza croup, hot compresses, warm drinks, inhalations, baths, as well as chlorpromazine in usual therapeutic doses are effective (a single dose is determined at the rate of 1-1.2 mg/kg body weight and is given 3-4 times a day) or chloral hydrate in therapeutic doses. If there is no effect from conservative therapy, it is necessary to resort to an extreme treatment method - tracheotomy, after which the whole range of therapeutic measures is carried out, including preventive antibacterial treatment. Sometimes such patients are transferred to controlled breathing.

Parainfluenza.

Parainfluenza is an acute viral infectious disease with airborne transmission and clinically similar in many ways to influenza, but differs from it in less toxicosis, a slightly longer course and more pronounced changes in the upper respiratory tract.

Parainfluenza clinic.

The incubation period is 2-7 days, more often 3-4 days. The illness usually begins gradually, with a runny nose, which is one of the common symptoms, a dry cough, sore throat and often hoarseness of the voice. In the presence of a febrile reaction, parainfluenza is most characterized by laryngitis and laryngotracheitis with pain in the throat and chest, and a barking cough. Bronchitis, bronchiolitis and pneumonia are also possible, and in children, especially newborns, the disease occurs with severe acute laryngotracheobronchitis, a typical picture of false croup, and severe pneumonia. The older the children, the milder the disease progresses.

Adults almost always tolerate the disease easily. Headache is moderate. Upon examination, moderate hyperemia of the arches of the soft palate and the posterior wall of the pharynx is revealed. The temperature is most often low-grade and only rarely in adults is it higher than 38°C. In children, it may be higher, especially with the development of pneumonia; laryngitis is almost always pronounced, while rhinitis and pharyngitis are moderate. The course of the disease is longer and more sluggish than with the flu.

The most common complication in both children and adults is pneumonia. With its appearance, the clinical picture changes: the process becomes acutely febrile in nature with a significant increase in temperature, chills, severe headache and even signs of meningism, chest pain, increased cough and the release of sputum of different types, sometimes with an admixture of blood, cyanosis of the lips and usually with pronounced physical symptoms. data, up to the appearance of pleural friction noise. Severe forms of the disease are rare and are caused by pneumonia. Complications can include tonsillitis, sinusitis, otitis and exacerbation of chronic processes.

Diagnosis of parainfluenza.

The clinical picture of parainfluenza has much in common with influenza. In this regard, objective differentiation of the process can so far only be done using laboratory research methods. Of these, RNGA is the most significant, while RSK is often cross-functional. However, using serological methods, the diagnosis can only be confirmed retrospectively. Detection of the virus in epithelial cells of the upper respiratory tract is possible using a direct immunofluorescence reaction.

Treatment of parainfluenza.

In the absence of complications, treatment of parainfluenza is reduced to the appointment of simple measures in the form of baths, distractions and sometimes antipyretics. In complicated forms of the disease, in particular pneumonia, antibacterial therapy is indicated (antibiotics and sulfonamides, taking into account sensitivity to the identified microflora). If necessary, cardiovascular drugs and symptomatic therapy are used. Treatment of croup is carried out according to the principle of intensive care.

Respiratory syncytial infection (RS infection) Respiratory syncytial infection (RS infection) is an acute viral disease with moderate symptoms of intoxication, predominantly affecting the lower respiratory tract and frequent development of bronchiolitis.

Clinic of MS infection.

The incubation period lasts from 3 to 7 days. In half of the cases the disease begins acutely, with fever, chills or chills. Often, although not from the first day, headache, weakness, muscle pain, and less often body aches appear. These general toxic signs of the disease usually occur against the background of low-grade or normal temperature, which in such cases rises at a later date and lasts until the 10th day from the onset of the disease. General symptoms of toxicosis, even at high temperatures, remain moderate.

Severe toxicosis with more severe headache, weakness, dizziness and vomiting is rarely recorded. In these cases, nosebleeds and hemorrhages on the soft palate are possible. It is believed that in terms of general toxic manifestations, RS viral disease occupies an intermediate position between influenza and parainfluenza. Catarrhal changes in the nasal cavity and pharynx are insignificant and present in the form of cough, runny nose, moderate or weak hyperemia of the soft palate, arches, less often the posterior wall of the pharynx, and only sometimes laryngitis.

Typical symptoms of RS viral disease include difficulty breathing, sometimes shortness of breath with cyanosis of the lips of varying degrees. With the development of bronchitis, bronchiolitis and pneumonia, wheezing of various characteristics (dry and wet), sometimes pleural friction noise, and shortening of percussion sounds are detected.

Diagnosis of MS infection.

Diagnosis of MS infection and its differentiation is carried out according to the same principle as influenza. In most cases, treatment is carried out at home. Bed rest, a gentle nutritious diet, and symptomatic medications are prescribed, as with other acute respiratory viral infections. For obstructive syndrome, aminophylline is given with diphenhydramine or other antihistamines. Mucaltin, a mixture with marshmallow, thermopsis, and sodium bicarbonate are shown. In severe cases, hospitalization is necessary. When obstructive syndrome is combined with pneumonia, antibiotics are prescribed.

Rhinovirus infection.

Rhinovirus infection, or contagious runny nose (common cold), is an acute viral disease of the respiratory tract, occurring with primary damage to the mucous membrane of the nose and nasopharynx.

Rhinovirus infection clinic.

The incubation period is from 1 to 5 days, more often 2-3 days. The disease begins acutely, with general malaise, chills, low-grade body temperature, nasal congestion, sneezing, feeling of a foreign body in the throat or awkwardness, scratching, coughing. A mild headache in the bridge of the nose and aches throughout the body are often noted. By the end of the first day, the nose was completely stuffy. Copious watery-serous discharge appears. The mucous membrane of the nasal cavity is hyperemic and swollen. Due to copious nasal discharge and frequent use of handkerchiefs in the vestibule of the nose, the skin is macerated. Sometimes herpes appears on the lips and in front of the nose.

The child's face is somewhat pasty, there is profuse lacrimation from the eyes, and the sclera is injected. Slight hyperemia and swelling of the mucous membrane of the palatine tonsils, anterior arches, and posterior pharyngeal wall are possible. Coughing may occur due to a sore throat; laryngitis with some hoarseness is often recorded. Tracheitis and bronchitis are not detected in adults. On the 2-3rd day of illness, nasal discharge becomes thicker, mucopurulent, which indicates the addition of a bacterial infection. Duration of illness: up to 5-7 days.

When differentiating the disease, the prevalence of catarrhal syndrome against the background of mild intoxication is taken into account. For laboratory confirmation, virus isolation on tissue culture is used. For rapid diagnosis, the immunofluorescence method is used, which detects antigen in epithelial cells taken from the inferior nasal turbinates.

Treatment of rhinovirus infection.

Symptomatic. To improve nasal breathing, instillation of vasoconstrictors into the nasal cavity is indicated: 1% or 2% solution of ephedrine hydrochloride, 0.05% solution of naphthyzine or galazolin, 1-2 drops in each nasal passage 3 times a day, boron -adrenaline drops, etc. Warm drinks, hot foot baths are indicated for headaches: analgin, amidopyrine, antihistamines (suprastin, tavegil), calcium gluconate. On the first day of illness, leukocyte interferon can be sprayed into the nasal passages.

Adenoviral infection.

Adenoviral diseases are a group of cyclic infectious diseases of the respiratory tract, lungs, eyes, and intestines, caused by peculiar viruses transmitted from patients by airborne droplets and nutrition.

Clinic of adenoviral lesions.

The clinical picture of adenoviral lesions is varied. The incubation period lasts 4-7 days. The disease begins acutely, often with chills, body temperature rises to 39°C. A common symptom is oropharyngeal hyperemia and tonsillitis. Usually, damage to the respiratory tract is combined with damage to the conjunctiva with a pronounced exudative reaction; sometimes there is swelling of the tonsils with film-like deposits on them. The course of the disease in uncomplicated cases is longer than with influenza; the febrile period lasts up to 5-7 and even 8-14 days.

When complications such as pneumonia and inflammation of the paranasal cavities occur, the disease can take on an undulating course. With the onset of pneumonia, the patient's condition worsens, the temperature reaches 40°C, shortness of breath, cyanosis, intoxication, and physical phenomena in the lungs appear. These forms of the disease can be fatal, especially in children. With a successful outcome, recovery is delayed, and the pathological process in the lungs can be detected even after several months.

Diagnosis of adenoviral lesions.

Isolation and identification of adenoviruses are not used in widespread medical practice due to their complexity. But to confirm individual outbreaks and their etiological characteristics, this method plays a leading role. Among serological methods, RTGA is used. An earlier and more specific method of laboratory diagnosis is the immunofluorescence method, with the help of which it is possible to identify the viral antigen in the epithelial cells of the respiratory tract affected by adenoviruses in the first days of the disease by the presence or absence of luminescence under fluorescent microscopy. Adenoviral diseases can be reasonably diagnosed only if clinical, epidemiological and laboratory data are fully taken into account.

Treatment of adenoviral diseases.

Treatment is carried out depending on the form of each of them. Interferon, donor anti-influenza or anti-measles gamma globulin, serum polyglobulin according to the appropriate scheme, as well as oxygenation, cardiovascular drugs, plasma, vitamins, and hormonal agents are used. For acute and respiratory adenoviral disease, it is recommended to instill a 0.2% solution of deoxyribonuclease into the nose or administer it 3 ml 2-3 times in the form of aerosol inhalation, galazolin. The use of UHF and mustard plasters is effective.

Infectious mononucleosis.

Infectious mononucleosis is an acute infectious disease characterized by fever, enlargement of all groups of lymph nodes (mainly cervical), lesions of the oropharynx, hepatolienal syndrome and the presence of atypical mononuclear cells in the peripheral blood.

Clinic of infectious mononucleosis.

The duration of the incubation period is generally 5-20 days. In most cases, the disease begins acutely, with a rise in body temperature to high numbers, but the entire clinical symptom complex characteristic of infectious mononucleosis usually develops by the end of the first week. The earliest symptoms are increased body temperature, swelling of the cervical lymph nodes, overlays on the tonsils, and difficulty in nasal breathing. By the end of the first week from the onset of the disease, in most patients an enlarged liver and spleen are already palpable, and atypical mononuclear cells appear in the blood.

The most characteristic is an increase in the cervical and especially posterior cervical lymph nodes, which are located as if in a chain behind the sternocleidomastoid muscle. They become visible to the eye, when palpated they are dense, elastic, not fused to each other and the surrounding tissue, and are not painful. Often, swollen lymph nodes are the first symptom of the disease. Polyadenia is an important symptom of infectious mononucleosis; it is the result of hyperplasia of lymphoid tissue in response to the generalization of infection. Sometimes with infectious mononucleosis there is an increase in bronchial and mesenteric lymph nodes.

Damage to the pharynx and pharynx permanent infectious mononucleosis syndrome. There is an increase and swelling of the palatine tonsils and uvula, sometimes the tonsils are so swollen that they come into contact with each other. Severe nasal congestion, difficulty in nasal breathing, constriction of the voice and wheezing breathing through a half-open mouth are also noted. Despite nasal congestion, there is usually no nasal discharge during the acute period of the disease; sometimes they appear after nasal breathing is restored. This is explained by the fact that infectious mononucleosis affects the mucous membrane of the inferior turbinate and the entrance to the nasopharynx (posterior rhinitis). The posterior wall of the pharynx is also swollen, hyperemic, granular, with hyperplasia of lymphoid tissue (granulosa pharyngitis), and covered with thick mucus. Hyperemia of the pharynx (tonsils, uvula and arches) is usually moderate, sore throat is minor.

Very often (up to 85%) in children with infectious mononucleosis, overlays in the form of islands and stripes appear on the palate and nasopharyngeal tonsils; sometimes they completely cover the palatine tonsils. The overlays are often whitish-yellowish or dirty gray in color, loose, lumpy, rough, easy to remove, and the tonsil tissue usually does not bleed after removing the plaque. Sometimes when you try to remove them with tweezers, they crumble and seem to tear. Overlays on the tonsils may appear in the first days of the illness, sometimes after 3-4 days. When overlays appear on the tonsils, the body temperature usually rises even more and the general condition worsens significantly.

An increase in the size of the liver and spleen in infectious mononucleosis is observed almost constantly (in 97-98% of cases). The size of the liver begins to increase from the first days of the disease and reaches a maximum by the 4-10th day from the onset of the disease. The edge of the liver becomes dense, sharp, sometimes rounded. Mild pain may be noted on palpation. Sometimes a slight yellowing of the skin and sclera appears. Jaundice usually occurs at the height of infectious mononucleosis and disappears in parallel with the disappearance of other manifestations of the disease.

The size of the liver decreases more slowly than other manifestations of the disease. In most patients, they normalize only at the end of the first or beginning of the second month from the moment of the disease; in some cases, the size of the liver remains enlarged for three months from the onset of the disease. An enlarged spleen is one of the early symptoms of infectious mononucleosis. The maximum size of the spleen is observed on days 4-10. The size of the spleen is reduced and completely normalized earlier than the size of the liver. In half of the patients, by the end of the 3rd week from the onset of the disease, the spleen is no longer palpable.

Diagnosis of infectious mononucleosis.

Infectious mononucleosis is diagnosed on the basis of such clinical manifestations as fever, difficulty in nasal breathing, swelling and moderate hyperemia of the oropharynx, plaque on the palatine and nasopharyngeal tonsils, enlargement of all groups of lymph nodes (especially posterior cervical ones), the size of the liver and spleen, as well as hematological changes (moderate lymphocytic leukocytosis, the presence of atypical mononuclear cells, increased ESR).

Serological diagnosis of infectious mononucleosis is based on the detection of heterophilic antibodies to the red blood cells of various animals (sheep, bull, horse, etc.). A reaction based on the detection of antibodies against sheep red blood cells in the blood serum of a patient with infectious mononucleosis was proposed in 1932 by J. R. Paul and W. Bunneil. However, later they became convinced of its nonspecificity. In 1938, J. Davidson proposed using a modified Paul-Bunnell reaction, which is more specific, to diagnose infectious mononucleosis.

A very simple and highly specific reaction is RA of horse erythrocytes on glass. This reaction was proposed by G. Hoff and S. Bauer (1965). In infectious mononucleosis, this reaction is positive in more than 90% of patients, while in other diseases it is almost always negative. To perform this reaction, only one drop of the patient's blood serum is required. The answer is immediate.

Treatment of infectious mononucleosis.

There is no specific therapy for infectious mononucleosis, so symptomatic therapy is used in practice. During the period of fever, the prescription of antipyretic drugs and plenty of fluids is indicated. Nasal congestion can be easily relieved by prescribing drops of ephedrine solution or other vasoconstrictors, up to 4-5 times a day. Calcium gluconate and diphenhydramine in appropriate age-appropriate dosages help reduce inflammation.

It is recommended to resort to antibiotic treatment when the fever lasts more than 6-7 days, the symptoms are pronounced and are accompanied by a significant increase in regional tonsils (tonsillars) and lymph nodes. The course of antibiotics should be short. In case of severe difficulty in nasal breathing and severe intoxication, glucocorticoids (prednisolone 2 mg/kg per day) are indicated for 2-3 days. At the height of the disease, bed rest is necessary to avoid rupture of the spleen in cases of its sudden enlargement.

The nutrition of patients with a successful course does not require any special restrictions; the diet can be the usual one adopted in the treatment of febrile infectious patients. Individual recommendations should be based on clinical evidence.

Respiratory syncytial infection (RS infection) is an acute disease of a viral nature, which is characterized by a moderately severe intoxication syndrome, damage to small bronchi and bronchioles with the possible development of their obstruction.

Young children are most susceptible to this infection. However, the disease also occurs in children of older age groups and adults. Sporadic cases of the disease are recorded throughout the year; group incidence increases during the cold period. After an infection, the body develops unstable immunity, so repeated cases of infection are possible.

Reasons

The causative agent of MS infection - the same name Vrus - enters the human body mainly through airborne droplets.

The causative agent of the disease is an RNA-containing respiratory syncytial virus from the paramyxovirus family. It is unstable in the external environment and does not tolerate both low and high temperatures.

The source of infection can be a sick person or a virus carrier. Moreover, contagiousness appears 2 days before the first symptoms and can persist for 2 weeks. Infection occurs mainly by airborne droplets, and in the presence of close contact, it is possible through hands and household items.

Development mechanisms

Infectious agents enter the human body through the mucous membrane of the respiratory system. The virus begins to multiply in the epithelial cells of the upper respiratory tract, but the pathological process quickly spreads to the lower respiratory tract. At the same time, inflammation develops in them with the formation of pseudogiant cells (syncytium) and hypersecretion of mucous secretion. The accumulation of the latter leads to a narrowing of the lumen of the small bronchi, and in children under one year of age – to their complete blockage. All this contributes to:

violation of the drainage function of the bronchi;
the occurrence of areas of atelectasis and emphysema;
thickening of the interalveolar septa;
oxygen starvation.

In such patients, broncho-obstructive syndrome and respiratory failure are often detected. If a bacterial infection occurs, pneumonia may develop.

Symptoms of MS infection

The clinical picture of the disease has significant differences depending on age. After infection, it takes 3 to 7 days for the first symptoms to appear.

In adults and older children, the disease occurs as an acute respiratory infection and has a fairly mild course. General condition, sleep and appetite are not affected. Its characteristic manifestations are:

increase in body temperature to subfebrile levels;
non-intensive;
nasal congestion and slight discharge from it;
dryness and sore throat;
dry cough.

Usually all symptoms regress within 2-7 days, only the cough may persist for 2-3 weeks. However, in some patients the patency of the small bronchi is impaired and symptoms of respiratory failure develop.

In young children, especially in the first year of life, MS infection has a severe course. From the first days of the disease, the lower respiratory tract is involved in the pathological process with the development of bronchiolitis. In these cases:

cough intensifies and becomes paroxysmal;
breathing rate increases;
pallor and cyanosis of the skin appears;
auxiliary muscles are involved in the act of breathing;
fever and intoxication are moderate;
possible enlargement of the liver and spleen;
A large number of moist fine bubbling rales are heard above the surface of the lungs.

If the bacterial flora is activated during this period, the pathological process quickly spreads to the lung tissue and develops. This is evidenced by the deterioration of the child’s condition with high fever, lethargy, weakness, and lack of appetite.

In addition to pneumonia, the course of MS infection can be complicated by false croup, and sometimes by croup.

The disease is most severe in infants who have a burdened premorbid background (rickets, congenital malformations).

Diagnostics

The diagnosis is confirmed by the detection of a high titer of specific antibodies in the patient’s blood.

The doctor can assume the diagnosis of “respiratory syncytial infection” based on clinical data and a characteristic epidemiological history. Laboratory diagnostic methods help confirm it:

virological (nasopharyngeal swabs are used for analysis to isolate the virus);
serological (paired blood sera are examined with an interval of 10 days using the complement fixation reaction and indirect hemagglutination to detect specific antibodies; an increase in their titer by 4 times or more is considered diagnostically significant);
immunofluorescent (carried out to detect the antigen of the RS virus; for this purpose, fingerprint smears from the nasal mucosa treated with a specific luminescent serum are examined).

A blood test reveals a slight increase in the number of leukocytes and an acceleration of ESR, monocytosis, and sometimes a neutrophil shift of the leukocyte count to the left and atypical mononuclear cells (up to 5%).

Differential diagnosis for this pathology is carried out with:

others;
mycoplasma and chlamydial infection.

Treatment

In the acute period of the disease, bed rest, a gentle diet and plenty of fluids are prescribed. In the room where the patient is located, it is necessary to maintain optimal microclimate parameters with a comfortable temperature and sufficient humidity.

The following medications are used to treat MS infection:

(interferon inducers);
specific immunoglobulin with antibodies to the RS virus;
in case of bacterial flora, antibiotics (aminopenicillins, macrolides);
to reduce body temperature - non-steroidal anti-inflammatory drugs (Paracetamol, Ibuprofen);
expectorants (Ambroxol, Bromhexine);
bronchodilators for the development of bronchial obstruction (Salbutamol, Berodual);
vitamins.

In severe cases, patients are hospitalized in a hospital for intensive care.

With early diagnosis and treatment, the prognosis for recovery is favorable. However, cases of the disease in children of the first year of life, which require constant monitoring of the child and timely adjustment of treatment, are cause for concern.

Which doctor should I contact?

This infection is usually treated by a pediatrician. In more severe cases, consultation with an infectious disease specialist and pulmonologist is necessary, and less often with an ENT doctor.

About MS infection in the program “Live Healthy!” with Elena Malysheva (see from 30:40 min.):