Acute, chronic and fatal diseases. ARVI: causes and mechanisms of occurrence, symptoms in adults

The disease can occur in acute and chronic forms. At acute form the pathological process usually forms in the terminal ileum near the ileocecal anastomosis - terminal ileitis. Clinical picture resembles a disease acute appendicitis. Patients suddenly begin to experience pain in the right iliac region. Diarrhea mixed with blood, vomiting, fever with chills appear. Palpation in the right iliac region, in the ileocecal zone, reveals a painful, thickened segment of the ileum.

The chronic form of CD is characterized by more pronounced general, systemic manifestations. Depending on the location of the affected intestinal segment, it occurs in three variants: small intestinal, large intestinal and mixed.

In all cases, the disease begins gradually, with general malaise, unmotivated weakness, low-grade fever not associated with a cold, and arthralgia. Facial puffiness and a tendency to edema appear as a result of chronic protein loss. Various skin lesions, cracks in the corners of the mouth, and hair loss due to hypovitaminosis occur. Dark spots may appear in the future age spots on the skin, lethargy, tendency to convulsions, polyuria, thirst, caused by polyglandular insufficiency of the endocrine system.

Sometimes at the beginning of the chronic variant CD comes to the fore systemic lesions- erythema nodosum, pyoderma gangrenosum, ulceration of the perianal area, iridocyclitis, keratitis, conjunctivitis. arthritis with damage is formed large joints, ankylosing spondylitis.

Whenever small intestinal variant Patients with chronic CD begin to notice that their stool gradually becomes semi-liquid or liquid, foamy, sometimes mixed with blood. Periodic and then constant pain appears in the projection of the inflamed segment of the intestine. If the duodenum is affected - on the right in the epigastrium, jejunum - above and to the left of the navel, ileum - below the navel on the right, ileocecal anastomosis - in the right iliac region.

Localization pathological process in the esophagus or stomach is accompanied by symptoms reminiscent of chronic esophagitis, gastritis, and peptic ulcer.

At the height of the disease, patients develop a slight low-grade fever. On palpation, dense, painful conglomerates and resistance are determined in the affected areas. abdominal wall. The granulomatous inflammatory process, passing into the stage of fibrosis, causes stenosis of the intestine, leading to gradually worsening intestinal obstruction. Patients begin to experience persistent abdominal pain without specific localization, loud rumbling, nausea, and vomiting.

Slow, covered perforation of the intestinal wall leads to the formation of intra-abdominal interloop fistulas, and often external ones, opening into the lumbar or groin area. Such complications are accompanied by excruciating pain, fever, and rapid exhaustion.

Defeat small intestine often manifests itself as malabsorption syndrome. Along with damage to the visceral lymph nodes, a syndrome of exudative enteropathy often occurs with protein loss through areas of the inflamed intestinal wall.

Quite often, symptoms of cholelithiasis are detected, which is formed due to impaired recirculation bile acids, urolithiasis resulting from calcium metabolism disorders.

Damage to the stomach, duodenum and ileum may be complicated by vitamin B 12 -deficiency anemia, aggravating iron deficiency anemia resulting from blood loss from ulcerations in the intestines.

At colonic variant chronic CD with diffuse damage throughout the colon, extraintestinal predominates, systemic manifestations diseases.

Segmental damage to the intestine is characterized by complaints of cramping pain that appears after eating, bowel movements, and tenesmus. Worrying about diarrhea with frequent stools, up to 10 times a day, with blood and purulent mucus in the stool. In some cases there are long-term constipation. In these same cases, a pronounced distension of the intestine may form above the site of segmental inflammation - megacolon. Fistulas of the intestinal wall often occur, usually together with infiltrates in the abdominal cavity

Damage to the anorectal zone is very typical in the form of multiple fissures, pararectal fistulas, paraanal “lip-protruding” granulations, pronounced weakening of tone, and gaping of the rectal sphincter.

In case of total defeat transverse colon Acute toxic dilatation of the intestine (toxic megacolon) may develop.

For mixed version Chronic CD is characterized by a combination of symptoms of the small intestinal and large intestinal variants with a predominance of one of them. Thus, when the colon is damaged in combination with damage to the terminal ileum, the symptoms of colitis predominate. Intestinal obstruction with the mixed variant it occurs more often than with other variants of chronic VK.

At long term chronic forms of CD often occur inflammatory lesion small intrahepatic bile ducts - sclerosing cholangitis, manifested by itching skin. Formed secondary amyloidosis. Kidney amyloidosis inevitably leads to nephrotic syndrome and renal failure.

ARVI– various acute infectious diseases resulting from damage to the epithelium respiratory tract RNA and DNA viruses. Usually accompanied by fever, runny nose, cough, sore throat, lacrimation, symptoms of intoxication; may be complicated by tracheitis, bronchitis, pneumonia. Diagnosis of ARVI is based on clinical and epidemiological data confirmed by the results of virological and serological tests. Etiotropic treatment of ARVI includes taking antiviral drugs, symptomatic - the use of antipyretics, expectorants, gargling, instillation vasoconstrictor drops in the nose, etc.

General information

ARVI is an airborne infection caused by viral pathogens that mainly affect the respiratory system. ARVIs are the most common diseases, especially in children. 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 highest incidence is typical for children aged 3 to 14 years. An increase in incidence is observed in the cold season. The prevalence of infection is widespread.

ARVIs are classified according to severity: mild, moderate and severe forms are distinguished. The severity of the course is determined based on the severity of catarrhal symptoms, temperature reaction and intoxication.

Causes of ARVI

ARVIs are caused by a variety of viruses related to various kinds and families. They are united by a pronounced affinity for the epithelial cells lining the respiratory tract. ARVI can cause various types influenza viruses, parainfluenza, adenoviruses, rhinoviruses, 2 RSV serovars, reoviruses. The overwhelming majority (with the exception of adenoviruses) are RNA viruses. Almost all pathogens (except for reo- and adenoviruses) are unstable in the environment and quickly die when dried and exposed to ultraviolet light, disinfectants. Sometimes ARVI can be caused by Coxsackie and ECHO viruses.

The source of ARVI is a sick person. Patients are most at risk in the first week clinical manifestations. Viruses are transmitted through the aerosol mechanism in most cases by airborne droplets, in rare cases, the implementation of a contact-household route of infection is possible. The natural susceptibility of people to respiratory viruses is high, especially in childhood. Immunity after an infection is unstable, short-term and type-specific.

Due to the large number and diversity of types and serovars of the pathogen, multiple incidences of ARVI in one person per season are possible. Approximately every 2-3 years, influenza pandemics are recorded, associated with the emergence of a new strain of the virus. ARVI of non-influenza etiology often provokes outbreaks in children's groups. Pathological changes in the epithelium of the respiratory system affected by viruses contribute to a decrease in its protective properties, which can lead to bacterial infection and the development of complications.

ARVI symptoms

Common features of ARVI: relatively short-term (about a week) incubation period, acute onset, fever, intoxication and catarrhal symptoms.

Adenovirus infection

The incubation period for infection with adenovirus can range from two to twelve days. Like any respiratory infection, it begins acutely, with a rise in temperature, runny nose and cough. Fever can persist for up to 6 days, sometimes lasting for two weeks. Symptoms of intoxication are moderate. Adenoviruses are characterized by the severity of catarrhal symptoms: profuse rhinorrhea, swelling of the nasal mucosa, pharynx, tonsils (often moderately hyperemic, with fibrinous plaque). The cough is wet, the sputum is clear and liquid.

There may be enlargement and tenderness of the lymph nodes of the head and neck, and in rare cases, lymph node syndrome. The height of the disease is characterized by clinical symptoms of bronchitis, laryngitis, tracheitis. A common sign adenovirus infection is catarrhal, follicular or membranous conjunctivitis, initially, usually unilateral, predominantly of the lower eyelid. After a day or two, the conjunctiva of the second eye may become inflamed. Children under two years of age may experience abdominal symptoms: diarrhea, abdominal pain (mesenteric lymphopathy).

The course is long, often wave-like, due to the spread of the virus and the formation of new foci. Sometimes (especially when affected by adenoviruses 1, 2 and 5 serovars), long-term carriage is formed (adenoviruses remain latent in the tonsils).

Respiratory syncytial infection

The incubation period, as a rule, takes from 2 to 7 days; adults and children of the older age group are characterized by a mild course such as catarrh or acute bronchitis. A runny nose and pain when swallowing (pharyngitis) may occur. Fever and intoxication are not typical for respiratory syncytyl infection; low-grade fever may occur.

For diseases in children younger age(especially infants) is more typical severe course and deep penetration of the virus (bronchiolitis with a tendency to obstruction). The onset of the disease is gradual, the first manifestation is usually rhinitis with scanty viscous discharge, hyperemia of the pharynx and palatine arches, pharyngitis. The temperature either does not rise or does not exceed subfebrile levels. Soon a dry, obsessive cough appears, similar to that of whooping cough. At the end of the coughing attack, the release of thick, transparent or whitish, viscous sputum is noted.

As the disease progresses, the infection penetrates into smaller bronchi and bronchioles, tidal volume decreases, and respiratory failure gradually increases. Dyspnea is mainly expiratory (difficulty in exhaling), breathing is noisy, and there may be short-term episodes of apnea. On examination, increasing cyanosis is noted, auscultation reveals scattered small and medium bubbling rales. The disease usually lasts about 10-12 days; in severe cases, the duration may increase and recur.

Rhinovirus infection

Treatment of ARVI

ARVI is treated at home; patients are sent to the hospital only in cases of severe course or development dangerous complications. The set of therapeutic measures depends on the course and severity of symptoms. Bed rest Recommended for patients with fever until body temperature normalizes. It is advisable to comply with full, rich in protein and vitamins diet, drink plenty of fluids.

Medicines are mainly prescribed depending on the predominance of one or another symptom: antipyretics (paracetamol and complex preparations containing it), expectorants (bromhexine, ambroxol, marshmallow root extract, etc.), antihistamines to desensitize the body (chloropyramine). Currently there are a lot complex drugs, including active ingredients all these groups, as well as vitamin C, which helps increase the body’s natural defenses.

Prescribed locally for rhinitis vasoconstrictors: naphazoline, xylometazoline, etc. For conjunctivitis, ointments with bromonaphthoquinone and fluorenonylglyoxal are placed in the affected eye. Antibiotic therapy is prescribed only if an associated bacterial infection is detected. Etiotropic treatment of ARVI can only be effective on early stages diseases. It involves the administration of human interferon, anti-influenza gammaglobulin, as well as synthetic drugs: remantadine, oxolinic ointment, ribavirin.

Among the physiotherapeutic methods of treating ARVI, mustard bath, cupping massage and inhalations are widely used. Persons who have had an acute respiratory viral infection are recommended maintenance vitamin therapy, herbal immunostimulants, and adaptogens.

Forecast and prevention of ARVI

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, old age. Some complications (pulmonary edema, encephalopathy, false croup) can be fatal.

Specific prevention consists of the use of interferons in the epidemic focus, vaccination using the most common strains of influenza during seasonal pandemics. For personal protection, it is advisable to use gauze bandages covering the nose and mouth when in contact with patients. Individually also recommended as a preventive measure viral infections increase the body's protective properties ( rational nutrition, hardening, vitamin therapy and the use of adaptogens).

Currently, specific prevention of ARVI is not effective enough. Therefore it is necessary to pay attention general measures prevention of respiratory infectious diseases, especially in children's groups and medical institutions. General prevention measures include: measures aimed at monitoring compliance with sanitary and hygienic standards, timely identification and isolation of patients, limiting population overcrowding during periods of epidemics and quarantine measures in the outbreaks.

Sometimes, feeling very unwell, we come to the clinic or call a doctor at home, and after carefully asking about the symptoms, he gives us an incomprehensible diagnosis - acute respiratory infection. What this is is sometimes unclear. This article is devoted to a detailed explanation of this issue.

Acute respiratory infection, or acute respiratory infection

If a person has caught a cold, has a cough, a sore and sore throat, and a fever, this means that his respiratory organs are affected by an acute respiratory infection; accordingly, he is sick with an acute respiratory disease, abbreviated as ARI. This concept contains enough big circle diseases caused by a huge range of different bacteria and viruses: streptococci, meningococci, staphylococci, influenza viruses A, B and C, parainfluenza viruses, adenoviruses, enteroviruses, etc.

All these countless harmful microorganisms getting inside human body, can cause acute respiratory infections. What it is will become even more clear after reading the list of the most common symptoms of ARVD (acute respiratory viral diseases).

Symptoms of acute respiratory infection

4. Rotavirus infection(intestinal or has a fairly long incubation period - up to six days. The onset of the disease is acute: vomiting, diarrhea, fever. Most often observed in children.

5. Respiratory syncytial infection is characterized by the occurrence of bronchitis and pneumonia, i.e. damage to the lower respiratory tract. At the very beginning of the disease, a person feels general malaise, runny nose, and headache. The most characteristic symptom are attacks of painful dry cough.

6. Coronavirus infection It is most severe in children. Affects the upper respiratory tract. Main symptoms: inflammation of the larynx, runny nose, and sometimes the lymph nodes may become enlarged. The temperature may be in the low-grade range.

ARI has a synonym - ARI, or acute respiratory infection. In common parlance, acute respiratory infections are usually referred to by the more familiar word “cold.” Also, in connection with colds and flu, you can often hear the abbreviation ARVI.

ARI and ARVI - what's the difference?

Many people believe that acute respiratory infections and acute respiratory viral infections are identical concepts. But this is not entirely true. Now we will try to explain to you what the difference is.

The fact is that the term acute respiratory infections refers to the entire wide group of acute respiratory tract diseases caused by any microbes - bacteria or viruses. But ARVI is a narrower and more precise concept, defining that the disease has precisely viral nature. This is what they are - acute respiratory infections and acute respiratory viral infections. We hope the difference has become clear to you.

Need for more accurate diagnosis arises in a number of cases due to the fact that the treatment of diseases that have a viral or bacterial origin, may be radically different, but not always.

During the development of an acute respiratory viral infection, a bacterial factor may also join it. That is, for example, first a person is affected by the influenza virus, and after a few days the situation is further complicated by bronchitis or pneumonia.

Difficulties with diagnosis

Due to the similarity of different acute respiratory infections to each other, a doctor can sometimes make a mistake and make an incorrect diagnosis. Confusion often arises with influenza and acute respiratory infections of other etiologies: parainfluenza, adenovirus, rhinovirus and respiratory syncytial infection.

Meanwhile, it is very important to identify influenza at an early stage of the disease in order to prescribe necessary medications and prevent the development of complications. In order to help the doctor, the patient must identify all the symptoms he has as accurately as possible. It should be remembered that influenza is rarely associated with a cold, while most other acute respiratory infections (especially of a bacterial nature) begin after hypothermia, just like a cold.

Another important note about influenza (ARI): you can most often get sick with it only during an epidemic, while other ARIs are active all year round. There are other differences between influenza and other acute respiratory diseases.

Attention - flu!

This disease always has a very acute onset. In just a couple of hours, a person turns from healthy to completely sick. The temperature quickly rises to the highest values (usually above 38.5 degrees), symptoms such as:

headache;
pain in the muscles of the arms and legs, cramps;
pain in the eyeball area;
severe chills;
complete breakdown and weakness.

Other acute respiratory infections are characterized by a gradual increase in disease processes, reaching a peak on the second or third day of illness. If you feel unwell and are trying to determine whether you have the flu or acute respiratory infections (we already know what these “sores” are), remember what you just read, and if all the signs indicate that you have the flu , then immediately go to bed and call a doctor at home.

How does acute respiratory infection occur?

Microorganisms that cause colds and flu are transmitted primarily through airborne droplets. Let's consider acute respiratory infections. What is it, how does it affect the body of a healthy person?

When talking, and especially when coughing and sneezing, a person who falls ill, without meaning to, throws it into the environment a huge number of viruses and bacteria. Moreover, the patient becomes dangerous to others not only acute phase illness, but also in its erased form, when he considers himself only a little ill - he goes to work, communicates freely with others, “generously” sharing the illness with all citizens who meet on his way.

Pathogens of acute respiratory infections can live not only in the air, but also on various objects: on dishes, clothes, door handles, etc. That is why during periods of epidemics it is recommended not only to refrain from visiting public places, but also wash your hands with soap more often.

For a person to become infected, it is enough for microbes to enter the mucous membranes of the nasopharynx and oral cavity. From there, they quickly and freely penetrate the respiratory tract and begin to multiply rapidly, releasing toxins into the blood. Therefore, with acute respiratory infections, intoxication of the human body always occurs to one degree or another.

Treatment of acute respiratory infections

It is good if a medicine for acute respiratory infections is prescribed by a qualified therapist who has established exactly what infection caused the disease. In this case the treatment will work most successfully and quickly. But many of our compatriots simply love to treat themselves, without wasting time visiting a clinic or calling a doctor. We would like to say right away that if you, reading these lines now, belong to this category, then we do not urge you to take the information presented in this chapter as a guide to action. We do not give recommendations here on how to treat acute respiratory infections. This is only an introductory general overview, which cannot in any way replace consultations and doctor’s prescriptions.

General principles of treatment, remedies for acute respiratory infections:

2. If the temperature exceeds 38.5 degrees, then this is an indication for taking any antipyretic drug. Here is a partial list of such medications:

"Paracetamol";
"Aspirin";
"Efferalgan";
"Ibuprofen";
"Nurofen";
"Panadol";
"Anapirin";
"Tylenol";
"Calpol";
"Ibusan";
"Fervex" and many other similar drugs.

An important addition: antipyretic drugs are intended primarily for symptomatic and complex therapy. They reduce the temperature, soothe the pain, but cannot completely cure the underlying disease. That is why timely medical diagnosis and prescription of treatment by the doctor.

3. Since acute respiratory diseases are almost always accompanied by severe intoxication of the body, the patient needs to drink more. The most suitable drinks for a sick person are:

weak warm tea with a slice of lemon;
fruit drink made from cranberries;
mineral water (it is better if it is without gas);
juices (preferably natural, freshly squeezed, not from packages).

4. Respiratory diseases are cured much more effectively and quickly if a person, at the first signs of illness, begins taking vitamins such as ascorbic acid (vitamin C) and rutin (vitamin P). Both components are included in the excellent vitamin complex "Ascorutin".

5. In some cases, doctors consider it necessary to prescribe antihistamines.

6. When active inflammatory processes in the bronchi, lungs and larynx with the formation of sputum, broncho-secretolytic drugs are prescribed:

"Bronholitin";
"Ambroxol";
"ACC";
"Bromhexine";
"Ambrobene";
marshmallow root syrup;
"Ambrohexal";
"Bronchicum";
"Gedelix";
"Lazolvan";
"Mukodin";
"Mukosol";
"Tussin" and others.

7. For acute respiratory viral infections, it is recommended to take antiviral drugs. These include the following medications for acute respiratory infections of viral etiology:

"Interferon";
"Kagocel";
"Amiksin";
"Grippferon";
"Arbidol";
"Rimantadine" and others.

8. If the course of an acute respiratory infection is complicated by a severe bacterial infection, the doctor may prescribe antibiotics.

"Sanorin";
"Xymelin";
"Tizin";
"Nazol";
"Rinostop";
"Nazivin" and others.

10. The following lozenges and sprays are used to treat sore throat:

"Hexoral";
"Strepsils";
"Kameton";
"Faringosept";
"Pro-Ambassador";
"Inhalipt" and others.

About antibiotics

We consider it useful to remind you that antibiotics for acute respiratory infections, as well as for any other ailments, should not be prescribed to yourself! These are powerful drugs that can defeat an infection where other drugs may be completely powerless. But at the same time, they have a lot of side effects and contraindications. Taking advantage of the fact that today many potent drugs can be purchased at pharmacies without a prescription, people are beginning to take powerful pills in order to get better quickly and in some cases they get the exact opposite effect.

For example, at the initial stage of the flu, taking antibiotics is not only useless (wasted money), but even harmful. This group of drugs does not have any effect on viruses; they are intended to fight other microorganisms (bacteria and fungi). When antibiotics enter the body of a flu patient, they destroy useful bacterial microflora, thereby weakening immune system the sick person, who is already in a state of exhaustion, because to fight dangerous viruses the body has to use all its strength and reserves.

If you have signs of acute respiratory infections, do not rush to resort to antibiotics without serious reasons and without a doctor’s prescription! Here are some side effects, which one of the most powerful and popular antibiotics today can cause latest generation- "Sumamed", belonging to the group of macrolides:

dysbacteriosis (disturbance of the natural microflora in the intestines);
candidiasis and other fungal infections;
various allergic reactions;
arthralgia (joint pain):
many other troubles.

When a child gets sick

And now a little introductory consultation for parents. Acute respiratory infections are especially difficult in children. Here, as a rule, there are both high temperatures and wild pain sore throat and runny nose. The child is suffering a lot, how can I help him as quickly as possible? Of course, first of all you need to call a doctor and give the baby the medications that he prescribes. You also need to do the following:

In order to avoid stagnation in the lungs, it is necessary to sit the little patient on the bed several times a day, tucking pillows under his back so that the baby can sit comfortably. The baby must be carried in your arms, pressed against you so that his body is in an upright position.
When children become ill, they often refuse to eat. There is no need to force them to eat; it is better to give your child plenty of tasty drinks in the form of warm cranberry juice.
The child's room must be cleaned (wet) daily. It is recommended to throw a terry towel over the heating radiator, which should be periodically moistened - this will help humidify the air. Remember that germs that cause respiratory diseases feel most comfortable in dry air.
The room must be ventilated several times a day, since the little patient needs clean, fresh air. During this time (5-10 minutes) it is best to transfer the child to another room.

Errors in the treatment of acute respiratory infections

If acute respiratory infections are treated incorrectly, complications will not keep you waiting. Here are a number of typical mistakes that people who have caught a cold often make:

1. Until the last moment, while they have at least some strength, they try to stand on their feet, go to work, women are busy around the house, run to the shops, etc., and meanwhile the disease develops. It is necessary to take care not only of yourself, but also of those around you (for example, your co-workers), because they are also at risk of getting sick if there is an infected person next to them.

2. They don’t trust the doctor’s recommendations and don’t take the medications he prescribed. It often happens that the doctor considers it necessary for the patient to undergo full course treatment with antibiotics, but he, having taken one or two tablets and feeling better, stops taking the drug and thereby does not allow the medicine to cope with the bacterial infection, which can quietly become chronic.

3. Take antipyretics without special need. Remember that by raising the temperature, the body fights infection, and if the thermometer shows no more than 38.5 degrees, then there is no need to stuff yourself with pills.

Folk recipes

How to treat acute respiratory infections traditional methods? Well, there are a lot of recipes here! Here are just a small part of them:

1. Various teas(with honey, linden, raspberries) help to quickly bring down the temperature. It is recommended that after giving the patient this antipyretic tea, wrap him up warmly and let him sweat thoroughly. After the fever subsides and sweating stops, you need to change the bedding and underwear sick and let the person sleep.

2. If a cold occurs in mild form without increasing the temperature, you can do it before bed foot baths with mustard. Speaking in simple language, soar legs. Important Note: You can’t do this even with a slight low-grade fever - hot water can cause it to rise further.

3. Gargling with warm decoctions of herbs such as sage, chamomile and calendula is very helpful for inflammation of the tonsils.

4. In the room where a sick person is lying, it is good to put fresh pine branches in water. The needles secrete beneficial phytoncides that have the ability to destroy microbes.

5. Everyone knows how strong antiviral effect has a bow. You can give the patient some onion milk and honey. To prepare it, milk is poured into a small ladle, and an onion cut into several pieces is placed there. The drug needs to be boiled for several minutes (3-5 will be enough). Then the milk is poured into a cup, a spoonful of honey is placed there, and the patient is given all this to drink. This milk has anti-inflammatory, antipyretic, calming properties and helps you fall asleep.

Let's talk about prevention

Prevention of acute respiratory infections is quite simple and, in principle, has long been known to everyone. But the carelessness characteristic of the human race and hope for chance often force us to ignore basic rules behavior during the season of epidemiological danger and pay for their carelessness with illness and suffering. We advise you to read carefully about preventive measures to prevent acute respiratory diseases. Here they are:

1. It is necessary to take care of strengthening your body ahead of time! A person with a strong immune system cannot catch a cold. To do this you need:

study health activities sports (running, skiing, skating, swimming, etc.);
temper yourself, for example, douse yourself with cool water in the morning;
Make sure that all vitamins are present in sufficient quantities in the diet; ascorbic acid is especially important - it is not synthesized in our body and can only be supplied to it with food.

2. During an epidemic of acute respiratory infections, before going outside, it is recommended to lubricate the nasal mucosa with oxolinic ointment.

3. When the flu is rampant, don't tempt fate - refrain from visiting crowded places.

Conclusion

Now you know a lot about acute respiratory infections - what it is, how to treat it, how to avoid infection, and more. We tried to convey quite complex and extensive information in a simple and concise form that is most understandable to most people. We hope that our article was useful to our readers. We wish you to always remain healthy, may illnesses pass you by!

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Enteroviral infections

Group enteroviral infections includes diseases caused by the entry into the body of viruses of the enterovirus genus from the picornavirus family. In addition to enteroviruses, this family includes 3 more genera: rhinoviruses, cardioviruses and aphthoviruses. As for the genus of enteroviruses, it includes the polio virus (type 3), Coxsackie viruses of group A and group B, ECHO viruses, hepatitis A virus, as well as animal enteroviruses, etc.
Coxsackie viruses were isolated relatively recently - in 1948. They have relatively high resistance in external environment, are able to survive for some time in sewer water, as well as on household items and food products. Humans are the sole host of Coxsackie viruses.
ECHO viruses isolated in 1951 from feces healthy people. These viruses exhibit sufficient resistance in the external environment and remain active for a long time in wastewater, open water bodies, swimming pools, as well as on bread, vegetables, and feces. They are quickly inactivated by heating and boiling.
The source of infection is patients and virus carriers, who play an important role in the spread of infection. The pathogen is transmitted by airborne droplets and fecal-oral routes, the possibility of transplacental route transmission of viruses.
The susceptibility of children to enteroviruses is high, and children from 3 to 10 years of age are most often susceptible to infection, but children under three months of age do not get sick, since they have transplacental immunity.
Older children rarely get sick due to the presence of acquired immunity as a result of an asymptomatic previous infection.
There is a seasonality of incidence, it is especially high in the spring and summer, periodic increases in incidence are also possible, recorded at intervals of 3–4 years.
How does enterovirus develop?

Penetrating into the human body by airborne droplets or orally, viruses settle on epithelial cells and lymphoid formations of the upper respiratory tract and intestines, from where they are carried through the bloodstream to various organs and systems, depending on the location, causing the development of serous meningitis or meningoencephalitis, myositis, myalgia , myocarditis, hepatitis, etc.
Damage to the mucous membrane of the oropharynx is most often recorded, but there are also cases of simultaneous damage to many organs and systems.
The severity of the disease is determined by the severity of intoxication and symptoms characteristic of this clinical form.
How does enterovirus infection manifest?

For all typical forms, there are common symptoms of the disease. The incubation period usually lasts 2–4 days, sometimes up to 10 days. The disease is characterized by an acute onset, body temperature suddenly rises to 39–40 °C. Signs of intoxication appear, headaches and dizziness appear, appetite decreases, sleep is disturbed, and weakness appears. Many patients experience repeated vomiting. All forms of the disease are characterized by hyperemia of the skin of the upper half of the body, especially the face and neck (up to the appearance of a polymorphous maculopapular rash). The mucous membranes of the nasopharynx are also markedly hyperemic, and the tongue is coated. Cervical lymph nodes increase slightly and are painless when pressed. Some patients have a tendency to constipation.
At laboratory research peripheral blood reveals a normal or slightly increased content of leukocytes, in rare cases - leukocytosis up to 20–25 H109/l. Moderate neutrophilia is often detected, which in the later stages of the disease is replaced by lymphocytosis and eosinophilia. ESR usually remains within normal limits or increases slightly.
Coxsackie and ECHO fever are one of the most common forms of enterovirus infection. It is characterized by an acute onset with a rise in body temperature to high numbers, which can persist for 2–4 days, less often - up to 1.5 weeks. In some cases, a wavy course of fever is noted. The patient develops headaches, vomiting, some complain of muscle pain, and there are catarrhal changes in the oropharynx and upper respiratory tract. Upon examination, hyperemia of the upper part of the body, especially the face, is detected; often the vessels of the sclera are injected; all lymph nodes are enlarged in size and painless on palpation; the liver and spleen are also enlarged.
As a rule, Coxsackie and ECHO fever are detected only in the presence of an outbreak of enterovirus infection in a children's group, when other, more manifest forms of the disease are detected.
Serous meningitis is typical form Coxsackie and ECHO infections. As usual, the disease begins acutely, the patient’s body temperature rises to 39–40 °C. Headaches, dizziness, repeated vomiting, agitation and anxiety exhaust the patient. In some cases, the patient's condition is aggravated by the appearance of pain in the abdomen, back, legs, and neck. Muscles cramp, delirium is possible. The patient's appearance changes: facial hyperemia appears, which becomes slightly pasty, the sclera is injected. The oropharynx is also hyperemic; upon examination, granularity is found on soft palate and the back wall of the pharynx. Already from the first days of the disease, at the peak of the temperature reaction, meningeal symptoms: rigidity occipital muscles and Kernig's and Brudzinski's symptoms. Abdominal reflexes are reduced. In some cases, meningeal symptoms are mild or some symptoms disappear altogether.
Clinical manifestations of meningitis usually persist for 3–5 days. Headache, vomiting, increased tendon reflexes and other signs of the disease may persist for 2–3 months after the illness. In some cases, relapses of serous meningitis are observed.
Herpangina caused by Coxsackie viruses of group A, less commonly by group B and ECHO viruses. Children of all age groups get sick. Often this form of the disease is combined with other manifestations of Coxsackie and ECHO infection (for example, serous meningitis or myalgia), but it may be the only manifestation of the disease. The onset of the disease is always acute and is accompanied by a rise in body temperature to 39–40 °C, which persists for 1–3 days and then drops critically. The patient's condition worsens: headaches, vomiting, abdominal and back pain appear. Typical for this form of infection are changes in the oropharynx: from the first days of illness, single small red papules appear on the mucous membrane of the palatine arches, soft and hard palate, turning into blisters, vesicles, and then into ulcers with a red rim. In some cases, such rashes can be profuse, but they never merge with each other. Symptoms such as pain when swallowing and enlarged regional lymph nodes are also typical. Changes in the oropharynx disappear within 1 week. If herpetic sore throat develops against the background of other severe manifestations of Coxsackie and ECHO infections, then activation of the secondary microflora is possible, and then the disease is delayed.
Epidemic myalgia usually caused by Coxsackie viruses of group B, less often by group A. The onset of the disease is usually acute, body temperature rises to high values, and children develop severe headaches. For this form of infection characteristic feature is the appearance of severe muscle pain, the localization of which can be different, but more often in the chest muscles, upper half abdomen and, less frequently, in the back and limbs. The pain is paroxysmal in nature, especially aggravated by movement. During an attack of pain, the child turns pale, sweats profusely, breathing quickens and becomes superficial, painful, but no changes in the lungs are detected during auscultation. When the pain is localized in the rectus abdominis muscles, their palpation causes unbearable pain in the patient, the muscles of the abdominal wall actively tense. Such painful attacks continue for half a minute - several minutes, sometimes reaching up to 15 minutes. and longer, but they disappear as suddenly as they appear, after which the child’s condition immediately improves. Similar attacks are repeated several times during the day. In some cases, the disease takes on a wave-like course, and then 1–3 days after the body temperature drops, when it seems that the patient is getting better, a new wave of the disease occurs and the pain resumes. Relapses can occur repeatedly over a period of a week or more. Usually the duration of the disease is short - from 3–5 to 7–10 days. Epidemic myalgia, like herpetic sore throat, can be combined with other manifestations of Coxsackie and ECHO infection, and then the patient’s condition worsens and the disease prolongs.
Intestinal form is typical for young children, much less often it affects children over 2 years of age, and it is caused by ECHO viruses, less often by Coxsackie viruses type B. The disease begins acutely, body temperature rises to 38 ° C, which persists for 3–5 days , or may have a two-wave character. The patient has a slight runny nose, nasal congestion, he coughs, and the mucous membrane of the oropharynx is hyperemic. 1–3 days after the onset of the disease, the patient complains of abdominal pain; loose stool, sometimes with an admixture of mucus, but never with an admixture of blood. Repeated vomiting and flatulence are also characteristic signs of this form of infection. Symptoms of intoxication in this case are mild; severe dehydration usually does not occur. Tenesmus, spasm sigmoid colon are missing. The illness lasts for 1–2 weeks.
Coxsackie and ECHO exanthema usually caused by ECHO viruses and one of the Coxsackie types, belonging to group A. The onset of the disease is acute, body temperature rises to high numbers, the patient complains of headaches, less often - muscle pain. Scleritis and catarrhal symptoms in the upper respiratory tract are detected, and anorexia (refusal to eat) develops. In some cases, children experience vomiting and abdominal pain, and young children have loose stools.
A characteristic sign of this form of infection is a rash that appears on the 1st–2nd day of illness at the peak of fever or immediately after a decrease in body temperature. As a rule, it is located on the skin of the face, torso and, less commonly, on the arms and legs. The rash can be scarlet-like or small-spotty-papular, as with rubella, and there may also be hemorrhagic elements. The rash usually lasts for several hours or days, and then disappears, leaving no pigmentation or peeling. Usually the course of the disease is pleasant, the febrile period is short.
The paralytic form of Coxsackie and ECHO infections is rare (usually in young children) and is associated with Coxsackie viruses of group A, less often - Coxsackie viruses of group B and viruses from the ECHO group, manifests itself in the same forms as paralytic poliomyelitis: spinal, bulbospinal , encephalitic, polyradiculoneuritic. The disease begins acutely with a rise in body temperature, mild catarrhal symptoms and flaccid paralysis. In half of the cases, the paralytic period begins on the 3rd–7th day from the onset of the disease, when the body temperature normalizes and the patient’s condition improves somewhat. To differentiate from paralytic poliomyelitis What is important is the fact that the paralytic forms of Coxsackie and ECHO infections can be combined with other, more manifest manifestations of the disease, and they also occur more easily and leave almost no permanent paralysis.
Encephalomyocarditis caused by group B Coxsackie viruses, more often observed in newborns and children in the first months of life, when intrauterine infection is possible, or infection of newborns occurs from the mother and family members or attendants of maternity hospitals. The onset of the disease is acute, body temperature may rise to high levels, or may remain normal or subfebrile. The baby becomes lethargic, drowsy, refuses to breastfeed, and vomits and loose stools. Very quickly, the listed symptoms are joined by signs of increasing cardiac weakness: general cyanosis, shortness of breath, tachycardia, expansion of the boundaries of the heart, cardiac arrhythmia are observed, and heart murmurs are heard. In addition, the liver is significantly enlarged. If a child has encephalitis, the above symptoms are accompanied by convulsions and bulging of the fontanelle. Often the disease is severe and fatal, but recently, with timely treatment with steroid hormones, this figure has decreased significantly.
Myocarditis and pericarditis are caused by Coxsackie viruses type B, less commonly - A and ECHO and occur with equal frequency in children and adults, and occur as pericarditis, less often - myocarditis and pancarditis. The disease is manifested by symptoms of more or less pronounced myocarditis: the patient exhibits an enlarged heart, dullness of heart sounds, systolic murmur at the apex, ECG changes, pericarditis. The patient complains of pain in the heart area, shortness of breath, a pericardial friction rub, changes in the ECG, etc. are detected. The course of the disease is not accompanied by heart failure and is benign.
Mesadenitis is caused by ECHO viruses, less commonly by Coxsackie group B viruses and is characterized by inflammation of the lymph nodes of the mesentery of the small intestine and a gradual onset. Low-grade fever lasts for several days, the patient complains of abdominal pain, the cause of which is inexplicable. Over time, the temperature rises, the patient begins to vomit; abdominal pain increases significantly and is dull in nature, often located in the right iliac region. Objectively, the patient has bloating, muscle tension in the anterior abdominal wall, and a positive Shchetkin’s sign. Very often, such patients are hospitalized in a hospital with suspected appendicitis and even undergo surgical intervention. But the distinctive signs of mesadenitis from appendicitis are facial hyperemia, injection of scleral vessels, hyperemia of the oropharyngeal mucosa, and enlargement of peripheral lymph nodes. Mesadenitis usually ends with complete recovery.
Acute hepatitis enteroviral etiology is associated with Coxsackie viruses of group A and group B, ECHO. The disease is characterized by an acute increase in the size of the liver, impaired liver function, the appearance of jaundice, as well as an increase in body temperature, headache, hyperemia of the skin of the mucous membranes of the oropharynx, less often - vomiting, etc. As a rule, the disease has a mild form, patients recover quickly.
Acute hemorrhagic conjunctivitis is caused by enterovirus type 70 or other serotypes of group A Coxsackie enteroviruses. Characteristic of this form of the disease is the sudden appearance severe pain in the eyes, photophobia, lacrimation. Sometimes there is an increase in body temperature within 37 -37.9 °, headaches and mild catarrhal phenomena (inflammation of the mucous membrane of the upper respiratory tract). Inflammatory changes in the eyes quickly increase, the eyelids become red and swollen, the patient develops hemorrhages in the conjunctiva, sclera, and also serous discharge from the eyes appears, which over time becomes purulent due to the addition of a bacterial infection. In patients, the parotid lymph nodes are enlarged. (see Viral conjunctivitis)
These same enteroviruses can also cause uevitis- damage to the vascular tract of the eye. It is more often observed in children of the first year of life. The onset of the disease is acute: body temperature rises to high levels, a rash appears, lymph nodes and parenchymal organs enlarge. Damage to the vascular tract of the eye is detected.
In parallel with the symptoms of intoxication, moderate symptoms of damage to the upper respiratory tract appear, and in some cases, intestinal syndrome. An unfavorable course of the disease is observed in children in the first 3 months of life and in cases where uveitis is combined with other forms of enterovirus infection or diseases. Changes in the eyes are persistent and often result in grade 3–4 iris dystrophy, the development of uveal cataracts, corneal opacification or subatrophy of the eyeball.
At puberty, group B Coxsackie enteroviruses and, less commonly, ECHO viruses are capable of causing damage to the genital area, which manifests itself with clinical signs of parenchymal orchitis and epididymitis and occurs in two stages. In this case, at the first stage, symptoms of another form of enterovirus infection develop (for example, myalgia, serous meningitis), and only after 2–3 weeks do signs of orchitis and epididymitis appear. The disease is usually benign, but in rare cases it can result in the development of azoospermia and subsequent infertility.
Congenital Coxsackie and ECHO infections are possible when a pregnant woman becomes ill. In this case, the disease in newborns is manifested by the development of myocarditis, encephalomyocarditis, encephalomyelitis and hepatitis. Signs of the disease may appear at birth or in the first days of life. Usually the course of the disease is extremely severe and often ends in death.
Coxsackie and ECHO infections in newborns and children of the first year of life are characterized by a variety of clinical manifestations and can be asymptomatic or in the form of severe generalized forms. Mild forms of the disease occur in healthy children whose mothers have a residual level of specific IgG antibodies to enteroviruses. Premature children and children with organic damage to the central nervous system and developmental defects are susceptible to severe forms of the disease. The onset of the disease is acute, body temperature rises to high levels, and neuromuscular excitability also increases. Children refuse to breastfeed, become restless, they may vomit, develop catarrhal symptoms, and possibly have upset stools. If the course is favorable, after 3–5 days the patient’s condition improves and recovery occurs.
In severe cases, the symptoms of the disease quickly progress, general intoxication increases, repeated vomiting, loose stools, bloating, and cramps appear. The liver and spleen enlarge, jaundice is possible, signs of meningitis, meningoencephalitis, and myocarditis appear. Without started treatment, cardiovascular and respiratory failure, leading to death.
Due to the difficulty of diagnosing Coxsackie and ECHO infections in sporadic diseases and the low availability of laboratory diagnostic methods in widespread practice, the diagnosis is made on the basis of clinical manifestations and analysis of epidemiological data.
DIFFERENTIAL DIAGNOSIS
Differential diagnosis is carried out with acute respiratory viral diseases, typhoparatyphoid infection, serous meningitis of tuberculous etiology. Epidemic myalgia is differentiated from acute appendicitis, pancreatitis, cholecystitis. Coxsackie and ECHO exanthemas are differentiated from rubella, drug rash and yersiniosis, which is characterized by a pinpoint scarlet-like rash. Herpetic sore throat is differentiated from aphthous and herpetic stomatitis. The intestinal form of Coxsackie and ECHO infections are differentiated from bacterial intestinal infections(shigellosis, salmonellosis, escherichiosis, etc.). Paralytic forms of Coxsackie and ECHO infections are differentiated from polio.
For this they use laboratory methods studies to exclude polio. Coxsackie and ECHO mesadenitis are differentiated from appendicitis, adenoviral mesadenitis, yersinia and other etiologies using laboratory tests.
Treatment of enterovirus infection

In most cases, patients with Coxsackie and ECHO infections undergo treatment at home; children with severe forms of the disease are subject to hospitalization. To this day, etiotropic therapy has not been developed, and doctors are limited to prescribing symptomatic and pathogenetic drugs. The patient should remain in bed throughout the entire period of acute manifestations of the disease. Patients are not limited in their diet and eat in accordance with their age needs. High temperature is reduced with antipyretic drugs.
For serous meningitis or meningoencephalitis, it is indicated infusion therapy, for this purpose, the patient is administered a 20% glucose solution, a 10% calcium gluconate solution, a 25% magnesium sulfate solution according to the patient’s age, as well as 1 tsp of glycerol. or 1 dec. l. Oral 3 times a day. Diuretics are also prescribed. For relief serious condition patient and with diagnostic purpose appoint lumbar puncture. Newborns with severe generalized forms are administered immunoglobulin at the rate of 0.2–0.5 ml/kg per day, prednisolone at 3–5 mg/kg per day, plasma, albumin, etc.
In case of secondary bacterial infection, antibiotics are indicated.
For neonatal encephalomyocarditis, dehydration and anticonvulsant therapy is combined with the prescription of hormonal drugs, nootropics, trental, cardiac glycosides in cases of heart failure with ATP and cocarboxylase, antibiotics, etc.
In cases of acute heart failure, a 0.05% solution of strophanthin is administered intravenously at an age-specific dosage in 20 ml of a 20% glucose solution.
Prevention of enterovirus infection

There is no specific prevention of enterovirus infections Coxsackie and ECHO, but human leukocyte interferon and immunoglobulin. Timely diagnosis and isolation of patients with Coxsackie and ECHO infections for a period of 10 days, i.e. until disappearance, are of great anti-epidemic importance. clinical symptoms. Patients who have had serous meningitis, are discharged from the hospital no earlier than 21 days of illness, also after the disappearance of clinical symptoms and normalization of the cerebrospinal fluid.

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