List of upper respiratory tract diseases. Lower and upper respiratory tract infections, their complications and risks

Acute respiratory viral infections(ARVI) occupy one of the first places among all human infectious diseases. These are the most common globe diseases. Every year, tens of millions of people suffer from acute respiratory viral infections.

Acute respiratory viral infections are a large group of diseases that usually occur in acute form caused by viruses and transmitted by airborne droplets. The pathogen exists in two forms: virion - extracellular form and virus - intracellular form. Almost every person suffers from acute respiratory viral infections several times a year, especially children. Children from birth to six months of life get sick less often, since they have little contact with the outside world and have passive immunity received from the mother transplacentally. It should be remembered that innate immunity may be weak or completely absent, which means the child may get sick. The highest incidence occurs in children in the second half of the year and the first three years of life, which is associated with their attendance at kindergartens and, consequently, an increase in the number of contacts. All respiratory diseases have common clinical manifestations: fever, the presence of intoxication symptoms of varying severity and symptoms of damage respiratory tract, the clinical manifestations of which depend on the localization of the inflammatory process.

Acute respiratory viral infections must be differentiated from acute respiratory diseases(ARI), since the causative agents of the latter can be not only viruses, but also bacteria.

Consequently, it is not antiviral, but antibacterial treatment that is etiotropic.

The most common causes of acute respiratory viral infections are: influenza, parainfluenza, respiratory syncytial, adenovirus, coronavirus and rhinovirus infections. The etiological structure of acute respiratory viral infections is dominated by influenza viruses, parainfluenza and adenoviral infections.

As mentioned above, all these diseases are characterized by damage to the respiratory tract with different localization of the process. Thus, with influenza, the mucous membrane of the upper respiratory tract is affected, with parainfluenza - mainly the mucous membrane of the larynx (for serotypes 1 and 2) and the mucous membrane of the lower respiratory tract (for serotype 3). Adenovirus infection is characterized by damage to the mucous membrane of the respiratory tract, mostly the pharynx, as well as the mucous membrane of the eyes and gastrointestinal tract. For respiratory syncytial infection in pathological process the mucous membrane of the lower respiratory tract is involved; with coronavirus infection, the pathogen affects the upper respiratory tract, and in young children - the bronchi, lungs, and with rhinovirus infection, damage to the nasal mucosa is typical. Diseases caused by respiratory viruses are classified into a large number of syndromes: colds, pharyngitis, croup (laryngotracheobronchitis), tracheitis, bronchiolitis and pneumonia. The identification of these groups of diseases is advisable from both epidemiological and clinical points of view. However, most respiratory viruses can cause not one, but several clinical syndromes, and quite often one patient may simultaneously experience signs of several of them.

Almost all acute respiratory infections viral diseases belong to anthroponotic diseases, with the exception of coronavirus and adenoviral infections, which can also affect animals. The main source is a sick person, less often a convalescent (recovering person). In case of adenoviral and respiratory syncytial infections, the source of the disease can be a virus carrier (there are no clinical manifestations of the disease, a diagnosis can only be made using specific laboratory research methods (virological and serological methods). The aerogenic mechanism of infection is characteristic, airborne transmission of infection, but with adenovirus infection, a fecal-oral mechanism of infection is sometimes observed. Quite often, the source of infection for children is adults, especially those who suffer the disease on their feet. At the same time, adults often regard their condition as a “mild cold.” Almost all so-called colds are viral in nature, and such patients pose a great danger to children, especially young children.

A child of any age can get sick with acute respiratory viral infections, but each disease has its own age-specific characteristics. So, for example, in children preschool age parainfluenza is more common than acute respiratory diseases of other etiologies. It should be noted that parainfluenza affects children in the first months of life and even newborns, while transplacental transmission IgG antibodies provides a relatively low susceptibility to influenza in children under six months of age. Children aged six months to five years are most susceptible to adenovirus infection. A significant part of newborns and children in the first six months of life have natural (passive) immunity. Respiratory syncytial infection affects mainly young children and even newborns. For rhinovirus and coronavirus infections, susceptibility is observed equally in all age groups, but preschool children are more often affected.

With all acute respiratory diseases there is an incubation (latent) period, but with varying durations: with influenza it is the shortest (from several hours to 2-3 days) and the longest with adenovirus infection (from 5-8 to 13 days). For other infections, this period averages 2-6 days (parainfluenza - 3-4 days, respiratory syncytial infection 3-6 days, rhinovirus infection 2-3 days, coronavirus infection 2-3 days).

For all these diseases, the clinical picture is characterized by the appearance of intoxication syndrome and catarrhal syndrome of varying severity. Intoxication is most intense with influenza and least of all with rhinovirus infection, in which the patient’s general condition practically does not suffer. Despite its name - “acute respiratory viral infections” - an acute onset is characteristic only of influenza, adenoviral infection and can occur with parainfluenza. For other diseases, a gradual onset is more typical. Hyperthermia (increased body temperature) is also not always observed. Thus, with influenza, already on the first day the temperature becomes febrile, and in some cases even hectic (38-40 ° C); with adenoviral infection and respiratory syncytial infection, the temperature can rise to 38-39°C, but by the 2-4th day of the disease. In some cases, fever can be two-wave (occurs with adenovirus infection and less often with influenza). In the typical course of other acute respiratory diseases, body temperature is usually normal or subfebrile (if there are no complications).

Each acute respiratory viral infection is characterized by the presence of catarrhal syndrome in varying degrees of severity. This syndrome is manifested by redness, hyperemia, swelling of the nasal mucosa, posterior wall of the pharynx, soft palate, tonsils, as well as fine granularity of the posterior wall of the pharynx due to enlarged follicles. Typical damage is cardiovascular (tachycardia, muffled heart sounds, a systolic murmur is heard at the apex of the heart), respiratory (the presence of hard breathing and wheezing on auscultation of the lungs, in some cases the appearance of signs respiratory failure) systems. Less commonly, the pathological process involves the digestive (intestinal dysfunction, abdominal pain, liver enlargement), as well as the central nervous (in the form of convulsions, meningeal symptoms, phenomena of encephalitis) system. In the development of acute respiratory viral infections, an important role is played by mixed pathology (mixed pathology), caused by complex viral-bacterial associations (interactions) with the development of secondary processes: catarrh of the upper respiratory tract, tonsillitis, bronchitis, pneumonia. Essentially they enhance pathological effect each other and often cause a severe course of the disease and even its death. Immunity after acute respiratory viral infections is usually short-lived and type-specific.

All acute respiratory viral infections are characterized by great difficulty in diagnosis. Caused by these viruses clinical forms diseases rarely have enough specific signs, on the basis of which only clinical data can establish an etiological diagnosis, although taking into account epidemiological conditions it is possible to assume with high probability which particular group of viruses caused the disease. To make a final diagnosis, only clinical manifestations and taking into account epidemiological conditions are not enough. Nessesary to use specific methods research. These include methods early diagnosis- examination of smears from the mucous membrane of the oropharynx and nose using fluorescent antibodies or using enzyme-linked immunosorbent assay (ELISA) to identify viral antigens. Serological methods are used: the complement fixation test (FFR), the hemagglutination inhibition test (HIT) and the neutralization test (RN), which are retrospective, since in order to make a diagnosis, it is necessary to identify antibodies to the influenza virus in paired sera taken in the first days of the disease, and then after 5-7 days.
An increase in antibody titer of four times or more is diagnostic.

They also use virological methods. Influenza viruses can be cultured (grown) in chicken embryos and mammalian cell cultures.

Also, all these diseases have similar aspects of treatment and prevention.

The principles of treating a patient with acute respiratory viral infection can be formulated in the following basic principles.

1. A sick child should be on bed rest, especially during periods of fever, isolated as much as possible. Recommended drinking plenty of fluids as warm tea, cranberry or lingonberry juice, alkaline mineral waters.

2. Etiotropic therapy. Treatment aimed at suppressing reproduction and eliminating the effects of toxins and other factors of pathogen aggression ( antiviral drugs, immunoglobulins).

3. Pathogenetic therapy (treatment aimed at maintaining the normal function of the child’s most important life support systems). Interferon (leukocyte human), influenzae, glucocorticosteroid drugs, detoxification drugs (oral rehydration or infusion therapy), desensitizing agents, protease inhibitors, vasoactive drugs and other drugs are prescribed.

4. Symptomatic therapy: this includes antipyretics (paracetamol, ibuprofen), mucolytics (acetylcysteine), expectorants (lazolvan, ambrohexal, bromhexine), vasoconstrictors (nazivin, naphthyzin) and other drugs.

5. Local therapy - medicinal inhalations, gargling with antiseptic solutions.

Children with severe and complicated forms of the disease are subject to mandatory hospitalization. Frequent acute respiratory diseases lead to a weakening of the child’s body’s defenses, contribute to the formation of chronic foci of infection, cause allergization of the body 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.

Prevention consists of early identification and isolation of patients; increasing the body's nonspecific resistance (physical education and sports, hardening the body, rational nutrition, prescribing vitamins according to indications). During outbreaks of acute respiratory viral infections, visits to clinics, events, and sick relatives should be limited. Persons who have been in contact with patients are prescribed antiviral drugs (for example, oxolinic ointment). The room where the patient is located must be regularly ventilated and wet cleaned with a 0.5% chloramine solution. Current and final disinfection is carried out in the outbreak, in particular, boiling of dishes, linen, towels, and handkerchiefs of patients. Live or killed vaccines are used (for influenza).

The prognosis is favorable, but deaths are possible in severe and complicated cases of the disease, especially with influenza.

It just so happens that respiratory tract infections cause maximum discomfort to patients and knock them out of their normal rhythm for several days. Most people do not tolerate infectious diseases well. But the sooner treatment begins for any illness caused by harmful microbes, the faster the infection can be dealt with. To do this, you need to know your enemies by sight.

The most common infections of the upper and lower respiratory tract

Almost all diseases become the consequences of penetration into the body and active reproduction of bacteria and fungi. The latter live in the bodies of most people, but strong immunity prevents them from developing. Bacteria cannot miss their chance, and as soon as they manage to find a gap in the immune system, microorganisms begin to act.

The most common viral respiratory tract infections include the following diseases:

1. Sinusitis characterized by inflammation of the nasal mucosa. The disease is very often confused with bacterial rhinosinusitis, which usually becomes a complication of viral infections. Because of him bad feeling the patient remains for more than a week.
2. Acute bronchitis - An equally common upper respiratory tract infection. When the disease occurs, the main impact falls on the lungs.
3. Co streptococcal tonsillitis Probably everyone has encountered this in their life. The disease affects the palatine tonsils. Against its background, many people wheeze and temporarily lose their voice.
4. At pharyngitis An acute inflammatory process develops on the mucous membrane in the pharynx area.
5. Pneumonia– one of the most dangerous respiratory tract infections. People still die from it today. Characterized by complex lung damage. The disease can be one- or two-sided.
6. No less dangerous flu. The disease is almost always very severe with high fever.
7. Epiglottitis It is not so common and is accompanied by inflammation of the tissue in the epiglottis area.

Lewis Weinstein ( Louis Weinstein)

Diseases of the upper respiratory tract (nose, nasopharynx, paranasal sinuses nose, larynx) are among the most common human diseases. In the vast majority of cases, this pathology, accompanied by a transient illness, does not pose an immediate threat to life and does not cause long-term disability.

Diseases of the nose

Anosmia. Transient complete (anosmia) or partial (hyposmia) loss of smell is one of the common clinical manifestations of acute infectious lesion upper respiratory tract. As a rule, olfactory disorders are observed with edema of the mucous membrane and swelling of the nasal cavity, congenital developmental defects, ozena (fetid runny nose), traumatic damage to the olfactory nerve, and polypous rhinosinusopathy.

Rhinitis (runny nose). Constant or periodic discharge of exudate from the nose is observed with hay fever, vasomotor rhinitis, nasal polyposis, acute rhinitis of viral etiology, in case of damage to the upper respiratory tract due to measles, congenital syphilis (syphilitic rhinitis of newborns), tuberculosis, nasal diphtheria, foreign bodies, and also as a consequence of long-term use of vasoconstrictors in the form of nasal drops.

Acute nasal congestion very often accompanies infectious diseases of the upper respiratory tract, mainly of viral etiology. The underlying causes of nasal breathing disorders are often hypertrophy and swelling of the turbinates of allergic origin, accompanied by copious nasal discharge or without it. A very common cause of nasal breathing problems is a deviated nasal septum. Sometimes transient nasal congestion occurs during menstruation or during pregnancy.

Rhinorrhea. Although unilateral nasal discharge may be caused by foreign bodies, the possibility of rhinorrhea due to cerebrospinal fluid leakage must also be excluded. This pathological condition diagnosed upon detection in the departmenta dye (fluorescein) or radiopharmaceutical taken from the nasal cavity, previously injected into the spinal canal.

Nose bleed. The most common cause of nosebleeds are scratches and abrasions formed when tightly adhered crusts are removed from the entrance to the nose, which is explained by the rich venous network of vessels located in this place (Kiesselbach point). Minor bleeding from the nasal cavity is often observed in acute viral respiratory diseases. Among the more serious diseases of an infectious nature, complicated by nosebleeds, mention should be made of typhoid fever, nasal diphtheria, whooping cough and malaria. Possible causes of intermittent nosebleeds are uncontrolled arterial hypertension, vicarious menstruation, hemorrhagic diathesis, polycythemia vera, rhinolitis, acute sinusitis, especially with the involvement of ethmoidal labyrinth cells and thrombosis of the ethmoidal vein in the pathological process, tumors of the nose and paranasal sinuses, angiomatosis of the nasal cavity. A risk factor for recurrent nosebleeds is often taking aspirin. Sometimes, with hypovitaminosis C and a decrease in prothrombin levels, increased bleeding is manifested by nosebleeds. Particular attention should be paid to familial hemorrhagic angiomatosis (telangiectasia) - Osler-Rendu-Weber syndrome, which can manifest itself with nosebleeds.

Furunculosis outdoor or inner surface nose is a disease potentially life-threatening due to possible thrombosis of the cavernous venous sinus. In the early stages of the disease, antibacterial therapy is very effective; in this case, preference is given to antibiotics active against Staphylococcus aureus, administered into high doses. First, antibiotics are administered orally; however, with the development of systemic manifestations of the disease, it is certainly indicated parenteral administration drugs. Under no circumstances should the boil be squeezed out, as this may lead to the spread of infection into the intracranial venous sinuses. It is also not recommended to open the boil unless its size becomes extremely large or when the patient begins to experience unbearable pain.

Diseases of the pharynx

Acute pharyngitis. The main clinical sign of acute pharyngitis, regardless of the specific cause of its occurrence, is a sore throat. The cause of 60% of all cases of acute pharyngitis is a viral disease of the upper respiratory tract, usually accompanied by discomfort or sore throat. Acute pharyngitis, taking into account the cause that caused it, is divided into the following three groups: curable infections, incurable infections and diseases of non-infectious origin .

The severity of changes in the pharyngeal mucosa varies from moderate redness and injected blood vessels (with most viral respiratory infections) to purplish-red hyperemia, yellowish patches, hypertrophy of the tonsils (for example, with inflammation caused by Streptococcus pyogenes group A).

Etiology of pharyngitis

I. Infectious

A. Curable

1. Streptococcus pyogenes group A

2. Hemophilus influenzae

3. H. parainfluenzae

4. Neisseria gonorrhoeae

5. N. meningitidis

6. Corynobacterium diphtheriae

7. Spirochaeta pallida

8. Fusobacterium

9. F. tularensis

10. Candida

11. Cryptococcus

12. Histoplasma

13. Mycoplasma pneumoniae

14. Streptococcus pneumoniae (?)

15. Staphylococcus aureus or gram-negative bacteria (usually isolated from patients with neutropenia or treated with antibiotics)

16. Chlamydia trachomatis

B. Incurable

1. Primary (Influenza virus, Rhinovirus, Coxsackievirus A, Epstein-Barr virus, Echovirus, Herpes simplex, Reovirus)

2. Manifestation of a systemic disease (poliomyelitis, measles, chicken pox, smallpox, viral hepatitis, rubella, whooping cough)

II. Non-infectious

A. Burn, traumatic injury from sharp objects, etc.
B. Inhalation of irritants

B. Drying of the pharyngeal mucosa (when breathing through the mouth)
G. Glossopharyngeal neuralgia

D. Subacute thyroiditis (tends to be protracted or often recurrent, often combined with low-grade fever)

E. Psychogenic

G. Monomyelocytic leukemia

H. Immunodeficiency states

The clinical manifestations of the disease are also different - from a sore throat to severe pain, making it difficult even to swallow saliva. Sometimes, with pharyngitis of streptococcal etiology, the lingual tonsils, located on the posterolateral surface of the tongue, are also involved in the pathological process, which is accompanied by pain when speaking. The presence of exudate does not yet indicate a specific etiology of pharyngitis and can be observed in infections caused by S. pyogenes, Hemophilus influenzae, H. parainfluenzae (in children), Corynobacterium diphtheriae, Streptococcus pneumoniae (rarely), adenovirus and Epstein-Barr virus. Ulcerative-necrotic lesions of the posterior wall of the pharynx and/or tonsils are characteristic of Plaut-Vincent angina, pharyngeal tularemia, syphilis (primary chancroid), tuberculosis (developing with local damage to the mucous membrane of the pharynx), as well as in patients with immunodeficiency conditions and with agranulocytosis due to infection caused by fusiform bacteria or other saprophytic pharyngeal microflora. The formation of limited or widespread filmy plaques also does not necessarily indicate a specific microbial etiology of the disease. More often, this type of lesion occurs with diphtheria of the pharynx, but can also be observed with infectious mononucleosis (Epstein-Barr virus), agranulocytosis, staphylococcal pharyngitis, as well as due to chemical, thermal or traumatic damage to the mucous membrane of the pharynx.

Often, with infectious or viral pharyngitis, the tonsils are involved in the process, which is accompanied by their swelling, redness, and inflammatory exudate from the crypts.

The etiological diagnosis of acute pharyngitis, based only on a visual assessment of the nature of the lesion, is extremely difficult. However, sometimes local symptoms “give away” the nature of the disease: typical filmy plaque and bad breath are characteristic of diphtheria, streptococcal infection(group A); ulceration of the mucous membrane and bad breath indicate the possibility of fusobacterial infection, and irregular shape whitish plaques covering ulcerative defects of the mucous membrane are specific for candidiasis.

For the purpose of etiological diagnosis of pharyngitis and the prescription of targeted antimicrobial therapy, bacteriological studies of smears from the mucous membrane of the pharynx, tonsils or inflammatory discharge are carried out. However, the effectiveness of this diagnostic approach is not absolute. For example, only in 70% of cases of severe pharyngitis caused by S. pyogenes , it is possible to isolate the culture of the corresponding pathogen. Patients with pharyngitis of suspected streptococcal etiology in the absence of cultural confirmation should be treated appropriately if this form of the disease is common enough in the population studied. In subacute thyroiditis, sore throat regresses while taking thyroid hormone or prednisolone. Patients with acute pharyngitis of viral etiology are not prescribed any specific antimicrobial treatment.

Gonococcal pharyngitis almost always develops as a result of orogenital contacts. The prevalence of this disease in heterosexual men is 0.2-1.4%. In homosexual men, the incidence of specific pharyngitis is 5-25%, and in 20% of them, pharyngeal lesions are noted simultaneously with a genital infection. From 5 to 18% of women with gonorrhea also suffer from gonorrheal pharyngitis, and in 1-3% of patients, specific inflammation of the pharyngeal mucosa is the only manifestation of the disease. Sore throat, moderate or severe, is observed in only 30% of patients, while in the rest the disease is clinically asymptomatic. Since the clinical signs of gonococcal pharyngitis are often similar to those of pharyngitis of other etiologies, the isolation and identification of Neisseria gonorrhoeae , as well as differentiation of the pathogen from other microorganisms of the genus Neisseria , which are representatives of the saprophytic microflora of the pharynx.

Peritonsillar cellulitis and abscesses. This pathology, as a rule, is a complication of acute pharyngitis, etiologically associated most often with S. pyogenes And Staphylococcus aureus. The disease begins with a significant enlargement of the tonsils, hyperemia and swelling of the palatine arches. A progressive increase in the size of the tonsils and peritonsillar soft tissues due to edema is accompanied by narrowing of the upper airways. Patients are worried about chills, febrile fever; leukocytosis is observed in the blood. In the early stages, the disease is characterized as cellulitis, but in the absence of antimicrobial treatment, an abscess forms, affecting one or both tonsils, the surface of which becomes covered with a dirty white coating. The diagnosis is made during a physical examination. Treatment with antimicrobial agents started in a timely manner (at the stage of cellulite) can lead to an abortive course of the abscess. If an abscess has already formed, then antibacterial treatment alone is not enough. At this stage of the pathological process, of course, opening the abscess with its subsequent drainage until healing is indicated.

Parapharyngeal abscess. As a rule, it is a complication of acute pharyngitis. Primary or secondary bacterial invasion of one of the tonsils may be accompanied by the formation of an intratonsillar abscess with swelling and inflammatory reaction parapharyngeal space. The pathological process is often one-sided: the affected tonsil bulges towards the midline, while the patient experiences only discomfort or moderate soreness in the throat; however, when pressing on the affected side, severe pain is detected in the area of ​​the angle of the lower jaw. As a rule, the patient is worried about fever, and leukocytosis is detected in the blood. If diagnosis is untimely and treatment is started late, the inflammatory process spreads through the system of tonsillar veins to the jugular vein, and thrombophlebitis is possible. The latter, in turn, is sometimes complicated by the formation of single or multiple metastatic abscesses in the lungs or sepsis of almond origin, characterized by high mortality. In this regard, early recognition and timely initiation of therapy before the development of jugular vein thrombophlebitis will contribute to the localization infectious process and healing.

Retropharyngeal abscess. This disease is most common in children under 4 years of age, since at this age there are still lymph nodes in the retropharyngeal region, which can become infected in acute pharyngitis. Adults get sick much less often. In the latter case, one is predisposed to its development acute otitis media, rhinitis, pharyngitis, inflammatory process in the oral cavity, local damage to the mucous membrane due to ingestion foreign body, oroendotracheal intubation, endoscopic procedure, external penetrating injury, fracture of the corresponding part of the spine, blunt neck trauma. Additional predisposing factors for the development of this disease are diabetes mellitus, nutritional dystrophy, and immunodeficiency states. A very serious complication of retropharyngeal abscess is osteomyelitis of the cervical vertebrae, which in turn is complicated by the formation of a paravertebral abscess. This complication is etiologically associated with infectious inflammation caused by Mycobacterium tuberculosis , pyogenic microorganisms and Coccidiodes immitis.

Tumors and other causes of prolonged sore throat. Sometimes in some patients with malignant neoplasms there is prolonged pain in the throat. At the same time, fever is by no means always evidence of microbial invasion, but may be caused by pyrogenby the activity of the tumor itself. Carcinoma of the tonsils is the second most common among all tumors of the upper respiratory tract (the first place is occupied by osteoma). Other types of tumors that involve the pharynx and are accompanied by a sore throat are nasopharyngeal carcinoma, multiple myeloma, myelomonocytic leukemia, and Hodgkin's disease. A solid tumor often affects only one tonsil; with leukemia, diffuse pharyngitis is observed. Often, antitumor treatment is characterized by the appearance of a sore throat that was absent before. An immunodeficiency state caused by antitumor treatment may be accompanied by the development of mucositis or infectious inflammation caused by Aspergillus, Mucor, Actinomyces and Pseudomonas.

Among benign causes chronic pain in the throat consider breathing through the mouth. Most older people sleep with open mouth; the resulting discomfort in the throat, as a rule, goes away after the patient drinks a little liquid. Another reason for mouth breathing is difficulty in nasal breathing due to a deviated nasal septum. In this situation, the severity clinical signs decreases only after surgical correction deviated nasal septum. Inhalation of irritants, in particular tobacco smoke, can also lead to persistent sore throat in heavy cigar or pipe smokers. Subacute thyroiditis is accompanied by severe sore throat for several weeks to several months. At the same time, patients often seek medical help for the first time due to severe manifestations of pharyngitis, and only during a subsequent examination is the fact of an inflammatory lesion established thyroid gland. In this situation, a characteristic diagnostic sign is severe soreness in the throat, “adjacent” to the unchanged mucous membrane. In rare cases, long-term discomfort in the throat may be of psychogenic origin. As an exception, isolated observations of glossopharyngeal neuralgia, clinically manifested by severe and prolonged pain in the throat, are described.

Sinusitis

Acute sinusitis.The most common causative agents of acute sinusitis are S. pneumoniae, S. pyogenes and N. influenzae . The etiological connection of sinusitis with other pathogens is more often observed during immunosuppressive therapy, treatment with antibacterial drugs, penetrating wounds of the paranasal sinuses, local tumors or vasculitis. The etiology of chronic sinusitis in most cases is similar to that of acute sinusitis, but microbial associations are often identified. It should be emphasized at the same time that with the development of sinusitis, the usual microflora of the upper respiratory tract is often released.

Most often, a factor predisposing to the development of acute purulent sinusitis is a viral respiratory infection of the upper respiratory tract, which causes impaired drainage of the paranasal sinuses and is accompanied by local pain, low-grade fever, and weakness. Typically these symptoms reflect a viral infection itself. However, sometimes purulent sinusitis can develop due to bacterial superinfection. The main causes of acute sinusitis are impaired outflow through the openings of the paranasal sinuses or bacterial invasion. The second most common cause of acute sinusitis is diseases of the roots of the four upper teeth: small molars, I and II molars and wisdom teeth. Traumatic damage to the walls of the sinus can lead to infection of the frontal sinus, cells of the ethmoidal labyrinth and subsequent inflammation. With Wegener's granulomatosis and tumors of the nasal cavity, a clinical picture of acute or chronic sinusitis may also appear. In some of these patients (with the addition of a bacterial superinfection), the underlying disease may not be diagnosed at first. In this case, repeated and prolonged episodes of sinusitis, refractory to ongoing antibacterial therapy, and a recurrent course of sinusitis after discontinuation of treatment are characteristic, which ultimately prompts a more thorough examination and detection of the corresponding nature of the lesion.

The diagnosis of acute purulent sinusitis is made on the basis of such characteristic symptoms, such as fever, chills, local soreness, aggravated by pressure, nasal congestion, repeated headaches, varying in intensity depending on the position of the body and resuming soon after awakening. The etiology of sinusitis is established during bacteriological research discharge from the nasal cavity or sinus contents obtained during a diagnostic puncture. In cases where there is severe swelling of the mucous membrane of the turbinates, cocaine or any other vasoconstrictor is applied topically, which facilitates the drainage of inflammatory exudate from the affected paranasal sinus. In the case of radiographically confirmed inflammation of the paranasal sinuses, it is advisable to perform a diagnostic puncture.

Before starting treatment for acute sinusitis, it is advisable to isolate and identify (in nasal discharge or sinus contents) pathogenic microorganisms and determine their sensitivity to various antibacterial drugs. And only then prescribe adequate antimicrobial therapy.

Topically applied vasoconstrictors are used to relieve local symptoms, but should not be overused. Surgical drainage is indicated in cases of prolonged sinusitis or the development of intracranial complications.

Frontal sinusitis (frontal sinusitis) is characterized by pain in the projection of the frontal sinuses. At the same time, swelling and redness may occur in the forehead and upper eyelid. Characteristically, the pain increases when pressing on the anterior wall of the frontal sinus, especially at the upper inner corner of the orbit. During rhinoscopy, purulent discharge is often found in front of the anterior end of the superior or middle turbinate.

Pain, swelling and sensitivity when pressing on the anterior wall of the maxillary sinus are characteristic clinical symptoms of acute sinusitis. There is also toothache in the corresponding half of the upper jaw, which intensifies when chewing. Anterior rhinoscopy reveals purulent discharge flowing from under the middle concha.

Clinical manifestations of ethmoiditis are characterized by pain in the root of the nose, bridge of the nose, headaches in the frontal localization, redness of the skin and pain when pressing in the area of ​​the bridge of the nose and the lower edge of the palpebral fissure. During rhinoscopy, in case of damage to the anterior cells of the ethmoidal labyrinth, inflammatory exudate is released from the middle nasal passage, and in case of damage to the posterior cells, from the upper nasal passage. However, in most cases, due to inflammation of both the anterior and posterior cells of the ethmoidal labyrinth, pus is secreted in both the middle and upper nasal passages.

With acute inflammation of the main sinus (acute sphenoiditis), pain appears in the back of the head, parietal region, and in the area of ​​the mastoid process (with an intact eardrum), which intensifies with pressure. Sometimes linear reddening of the skin along the zygomatic arch is observed due to involvement of the maxillary branch of the trigeminal nerve in the pathological process.

Among the rare complications acute frontal sinusitis includes osteomyelitis of the frontal bone, characterized by fever, chills, leukocytosis, cold, pale swelling of the frontal part of the head on the affected side (the so-called Pott tumor). When involved in the process bone tissue in patients with acute ethmoiditis, unilateral or bilateral exophthalmos may be observed. The cause of this pathological condition is aseptic or purulent inflammation of the orbital tissue, which in turn is caused by “sympathetic” inflammation or perforation of the papyrus plate - the lateral wall of the ethmoidal labyrinth and the inner wall of the orbit. Violation of the venous outflow from the orbit can cause hemorrhage in the retina. The consequences of the intracranial spread of the inflammatory process through the veins of the spongy substance of the bones of the cranial vault are meningitis, thrombosis of the superficial cerebral veins or cavernous and sagittal venous sinuses, paresis (paralysis) cranial nerves and extradural abscess.

Another possible complication of purulent sinusitis (usually sinusitis) is bacterial meningitis, accompanied by osteomyelitis of the skull bones, subdural or intracerebral abscesses. A sudden deterioration in the patient’s condition, manifested by convulsions, hemiplegia and aphasia against the background of acute frontal sinusitis, indicates a subdural abscess with thrombophlebitis of the sagittal sinus or superficial cerebral vein. Acute ethmoiditis can be complicated by paralysis of the third pair of cranial nerves due to the spread of the inflammatory process to the sinuses of the dura mater or profuse nosebleeds due to thrombosis of the ethmoid veins with the effusion of blood into the cells of the ethmoidal labyrinth and its subsequent thrombosis. Chronic or recurrent purulent sinusitis can cause bronchiectasis. A rare pathological condition characterized by the presence of chronic sinusitis, bronchiectasis and inversus internal organs, is described as Kartagener's syndrome. This category of patients is characterized by disturbances in mucociliary clearance of the distal airways - the so-called immotile cilia syndrome; in addition, in male patients there is a decrease in the motor activity of sperm, while their number remains normal.

Chronic sinusitis. It is very difficult to establish a diagnosis of chronic sinusitis in the absence of anamnestic indications of repeated episodes of acute purulent inflammation of the paranasal sinuses. Most patients complain of headaches predominantly of the frontal localization, nasal congestion and pain when pressing in the projection of the corresponding paranasal sinuses. When radiography of the paranasal sinuses, as a rule, a decrease inthinning of the mucous membrane. Bacteriological studies of nasal discharge usually fail to isolate a culture. pathogenic microorganisms. In most cases, chronic sinusitis is based on allergic inflammation of the mucous membrane; in such clinical situations, a clear therapeutic effect is observed when vasoconstrictors are prescribed intranasally and specific antiallergic treatment is carried out. Often the above clinical manifestations are caused by inhalation of irritating dusts, gases, and tobacco smoke.

Tumors of the paranasal sinuses.Most common benign tumor paranasal sinuses - osteoma. In this case, in 50% of patients the frontal sinus is affected, in 40% - the cells of the ethmoidal labyrinth, and in 10% - the maxillary and main sinuses. Malignant neoplasms of the paranasal sinuses include maxillary sinus carcinoma, sarcoma, Burkitt's lymphoma, myeloma and adenocarcinoma. Melanoma of the nasal cavity due to invasive growth can spread to the paranasal sinuses. Sometimes tumors that are primarily localized in the paranasal sinuses can spread into the nasal cavity, causing obstruction and making it difficult to determine the primary location of the tumor (paranasal sinuses or nasal cavity). The possibility of tumor involvement of the paranasal sinuses can be assumed in patients with repeated acute sinusitis or chronic sinusitis accompanied by recurrent nosebleeds, even if pathogenic microorganisms are not isolated in the nasal discharge.

Diseases of the larynx

Clinical manifestations of laryngeal diseases.There are three main causes of laryngeal diseases: 1) intralaryngeal damage; 2) extralaryngeal pathological processes that cause compression of the larynx or the nerves innervating the vocal cords; 3) local or diffuse lesions of the nervous system involving the nerves innervating the vocal cords in the pathological process.

Differential diagnosis for hoarseness and other clinical manifestations of laryngeal lesions

I. Intralaryngeal diseases

A. Infectious origin Rhinitis

Viral laryngitis

Infection caused by Hemophilus influenzae Membranous laryngitis Diphtheria of the larynx

Infection caused by Herpes simplex

Actinomycosis

Candidiasis

Blastomycosis

Histoplasmosis

Tuberculosis (ulcerogenic) Leprosy

Syphilis (secondary; perichondritis, gummous infiltration)

Infection caused by Mycoplasma pneumoniae Helminth infestation ( Syngamus laryngeus)

B. Non-infectious origin Trauma (swelling or hematoma) Nodules on the vocal cords (singers' nodules) Papillomatosis of the vocal cords

Inhalation of tobacco smoke, irritating gases, thermal burn of the larynx Leukoplakia of the vocal cords

Rheumatoid arthritis (affecting the cricoarytenoid joints) Chronic alcoholism Benign laryngeal tumors Laryngeal cancer

Foreign bodies of the larynx

II. Extralaryngeal diseases

A. Hoarseness caused by compression of the larynx and impaired movement of the vocal cords; swelling of the larynx due to impaired venous or lymphatic outflow; damage laryngeal nerve with the development of paresis or paralysis of the vocal cords

Hemorrhage and/or swelling due to trauma, sharp traction of the neck, thyroidectomy, tracheostomy, as a complication of pre-scaling biopsy

Tumors of the laryngeal part of the pharynx (hypopharynx)

Tumors of the carotid body; thrombophlebitis in the area of ​​the jugular vein bulb

B. Local or systemic diseases located outside the neck; hoarseness due to compression of the laryngeal nerve along its entire length outside the neck; paralysis or paresis of the vocal cords as a manifestation of a systemic neurological disease

1. Local disorders [bacterial meningitis; syphilitic meningovasculitis; infectious mononucleosis (with increasing lymph nodes mediastinum); angioedema; mitral stenosis (with dilatation of the pulmonary trunk); aneurysm of the aortic arch, carotid or innominate arteries; ligation of the ductus arteriosus; mediastinal neoplasms; parathyroid tumors; relapsing polychondritis; neoplasms of the meninges; fracture of the base of the skull; thyroid cancer; goiter (struma)]

2. Systemic disorders [diphtheria (peripheral neuritis); polio (bulbar); infectious mononucleosis (with damage to the nervous system); herpes zoster; cystic fibrosis; myxedema; acromegaly; Wegener's granulomatosis; systemic lupus erythematosus; diabetic neuropathy; poisoning with mercury, lead, arsenic, botulinum toxins]

Hoarse (hoarse) voice- the most common symptom in diseases of the larynx. The etiological factors of this pathological condition include inflammatory, non-inflammatory processes and functional disorders (hysterical aphonia). Although hoarseness, more often caused by infectious inflammation, is quite transient, nevertheless, clinical situations characterized by a long course are not uncommon. Common signs of damage to the larynx also include coughing, pain syndrome observed less frequently, and such pathological manifestations as stridor and shortness of breath are described as casuistry. However, when the latter are present in the picture of the disease, this indicates a rapidly progressing obstruction of the upper respiratory tract. In this case, obstruction of the upper respiratory tract can be a consequence not only of intralaryngeal lesions or compression of the larynx from the outside, but also of paralysis of both vocal cords. The specific cause of laryngeal obstruction is determined during direct and indirect examination of the larynx. It is certainly indicated in all cases where symptoms of laryngeal obstruction persist for 2-3 weeks. However, in the case of a rapid increase in symptoms of laryngeal obstruction, immediate laryngoscopy and, if necessary, tracheostomy are indicated.

Epiglottitis (acute inflammation of the epiglottis). It is more often diagnosed in children than in adults. Clinical manifestations diseases and the results of bacteriological examination vary significantly depending on the age of the patients. Men get sick 3 times more often than women. Predisposing factors are multiple myeloma, Hodgkin's disease, myelomonocytic leukemia, blastomycosis of the larynx and other diseases accompanied by immunodeficiency states. The causative agents of epiglottitis are N. influenzae, H. parainfluenzae, S. pneumoniae, S. pyogenes , “normal” microflora; sometimes with primary blastomycosis of the larynx, inflammation can spread to the epiglottis. Transient bacteremia is recorded in 50% of patients with epiglottitis. The clinical manifestations of epiglottitis in adults differ from those in children. Sore throat is typical for almost all patients. This is followed with decreasing frequency by fever (80%), shortness of breath, dysphagia and hoarseness (about 15%). Objective signs of pharyngitis and pain on palpation of the neck are relatively rare. An epiglottic abscess develops in 12% of patients. During laryngoscopy, swelling and hyperemia of the epiglottis are noted, protruding significantly into the lumen of the lower part of the pharynx. The diagnosis is confirmed by multi-view radiography of the neck. Of course, antimicrobial therapy is indicated, the choice of which is based on the results of bacteriological testing. In case of progression of shortness of breath and increasing symptoms of laryngeal obstruction, tracheostomy is performed on an emergency basis.

Fungal laryngitis. A rare disease caused by fungi of the genus Candida , which is more susceptible to patients with immunodeficiency conditions or receiving antibiotic therapy. Since candidal laryngitis is naturally associated with fungal infection of the esophagus, laryngoscopy is indicated in cases of diagnosing candidal esophagitis. Hoarseness of voice is not typical for this disease. In the absence of specific antifungal treatment, the outcome of candidal laryngitis may be cicatricial stenosis of the larynx.

Two more fungal infections Histoplasma capsulatum and Blastomyces dermatidis may cause the development of chronic laryngitis. These forms of fungal inflammation of the larynx are characterized by hoarseness, shortness of breath, dysphagia, obstruction of the upper respiratory tract, and sometimes hemoptysis. Characteristic is ulcerative-necrotic damage to the mucous membrane of the larynx, which can cause bleeding.

Tuberculosis of the larynx. Despite the decline in the incidence of tuberculosis these days, laryngitis caused by Mycobacterium tuberculosis , remains clinically relevant. The symptomatology of tuberculous laryngitis has undergone a known pathomorphosis over the course of 40 years. Middle-aged and elderly men (50-59 years old) began to get sick more often; men in general get sick more often than women (3:1); Often, specific damage to the larynx is observed in the absence of clinical and radiological signs of pulmonary tuberculosis. Hoarseness is one of the most common manifestations of tuberculous laryngitis. Quite typical in the past, ulcerative lesions of the posterior part of the vocal cords are now relatively rare. In general, the vocal cords are involved in the pathological process in 50% of cases, and relatively often the false vocal cords and laryngeal (Morgani) ventricles are also affected. Sometimes, however, only hyperemia and swelling of the mucous membrane are observed, which can cause an erroneous diagnosis of nonspecific laryngitis.

Foreign bodies of the larynx. Typically, aspiration of a foreign body is characterized by acutely developing clinical symptoms. “piercing” pain in the throat and laryngospasm appear. Due to swelling of the mucous membrane of the larynx, rapidly progressing shortness of breath occurs. Phonation often changes as well.

If the aspirated foreign body turns out to be sharp (for example, a chicken bone), swelling of the upper respiratory tract may develop quite quickly, accompanied by increasing shortness of breath. In case of perforation of the laryngeal wall, infectious inflammation of the soft tissues of the neck or mediastinitis occurs. If aspiration of a laryngeal foreign body is suspected, an emergency examination (indirect or direct laryngoscopy) is necessary.

Laryngeal cancer. This form of malignant neoplasm is diagnosed mainly in elderly people (about 60 years), more often in men than in women. Laryngeal cancer is divided into two types: “internal” (cancer of the vestibule and vocal cords) and “external” (cancer of the subglottic region). Hoarseness is one of the first signs of “internal” laryngeal cancer, diagnosed in 70% of cases. On the contrary, with “external” cancer this symptom appears relatively late (when the tumor grows into the vocal fold). Treatment is surgical. The exception is the local form of the tumor affecting only the middle third of the vocal cords, when radiation therapy is successfully used. However, in most cases a total or partial laryngectomy is performed. When the tumor has spread to the epiglottis and/or false vocal cords, preference is given to partial laryngectomy (above the glottis), since in this case it is possible to preserve vocal function, and the operation itself is characterized by significant therapeutic effectiveness. In some patients best results can be achieved using preoperative irradiation of the larynx and regional lymph nodes. In more than 80% of cases, with early diagnosis and treatment, a cure can be achieved.

T.P. Harrison. Principles of internal medicine. Translation by Doctor of Medical Sciences A. V. Suchkova, Ph.D. N. N. Zavadenko, Ph.D. D. G. Katkovsky

The most common reason for seeking doctor's help is a cold. By this term, most average people mean diseases that are manifested by a runny nose and cough. But in fact, such ailments can be caused by a variety of factors, and even be localized in different organs respiratory system. Let's look at existing inflammatory diseases of the upper respiratory tract, as well as the lower ones, in a little more detail on this page www.site.

List of inflammatory diseases of the upper respiratory tract

This group of diseases includes many diseases that are familiar to everyone and us from childhood. These are acute respiratory infections and acute respiratory viral infections, rhinitis and pharyngitis, laryngitis and tracheitis. In addition, this group includes tonsillitis with tonsillitis, epiglottitis and sinusitis.

Inflammatory diseases of the lower respiratory tract

Such ailments are considered more complex, they are more likely to cause complications and require more thorough treatment. These include bronchitis, pneumonia and chronic obstructive pulmonary disease.

A little more about inflammatory diseases of the respiratory system

Sore throat is an inflammatory lesion of the respiratory tract, which is acute infectious nature and is accompanied by damage to the palatine tonsils. The inflammatory process with this disease can affect other accumulations of lymphadenoid tissue, for example, lingual, laryngeal and nasopharyngeal tonsils. Patients with a sore throat complain of severe pain in the throat, their temperature increases, and when examining the throat, reddened and enlarged tonsils become noticeable.

Rhinitis is an inflammatory lesion of the upper respiratory tract, which is localized on the mucous membranes of the nose. This disease can be both acute and chronic. This disease can develop after hypothermia or due to exposure to mechanical or chemical provoking factors. Rhinitis also often occurs as a complication of other infectious diseases(for flu, etc.).

Bronchitis is a disease of the lower respiratory tract, it manifests itself as a dry cough. First, the patient develops a runny nose, followed by a dry cough, which eventually becomes wet. Bronchitis can be caused by an attack by viruses or bacteria.

Acute respiratory infections and acute respiratory viral infections are ailments that we most often call a cold. In most cases, such diseases affect the nasopharynx, trachea, and bronchial tree.

Pneumonia is a disease of the lower respiratory tract that is localized in the lungs and can be caused by an infectious agent. This pathological condition is usually manifested by an increase in temperature up to thirty-nine degrees, the appearance of a wet cough, which is accompanied by copious sputum. Many patients also complain of shortness of breath and pain in the area chest.

Sinusitis is a fairly common disease of the upper respiratory tract, which is an inflammatory lesion of the mucous membranes of the paranasal sinuses, as well as the nasal passages.

Rhinopharyngitis is one of the ailments of the respiratory system, in which there is inflammation of the upper region of the larynx, nasopharynx, as well as the palatine arches, tonsils and uvula.

Laryngitis is a disease of the upper respiratory tract, which is manifested by inflammatory damage to the mucous membranes of the larynx.

Epiglottitis is another disease of the respiratory system. It is an inflammatory lesion of the epiglottis area.

Tracheitis is a fairly common disease in which the patient develops inflammation of the subglottic region, as well as the mucous membranes of the trachea.

Treatment inflammatory diseases respiratory system

The treatment of the above ailments is carried out by pulmonologists, as well as therapists. Most of them are quite treatable at home, but many patients with pneumonia and complicated bronchitis are asked to go to the hospital. inpatient department.
IN mild form diseases of the respiratory system (especially the upper respiratory tract) are successfully eliminated in just a few days, and the need to use medications does not always arise.

So, when symptoms of inflammation of the upper respiratory tract appear, it is recommended to eat lemon with honey, gargle with different solutions (solution of salt and iodine, solution of propolis or potassium permanganate, etc.) and herbal decoctions (etc.). For instillation into the nose, you can use honey water, aloe and beet juice. It is recommended to breathe over the steam of boiled potatoes, finely chopped onions and hot milk with soda. It is also worth drinking more liquid - plain water and various teas, for example, based on linden blossom, raspberry, etc.

If you suspect the development of inflammation of the lower respiratory tract, it is better to seek medical help. Bronchitis and pneumonia are most often treated with antibiotic compounds wide range actions, the patient must adhere to bed rest, Go to dietary food. It is recommended to take drugs that dilute sputum and facilitate its removal, as well as drugs that help activate the immune system.

Most diseases of the respiratory system are quite treatable self-treatment at home. However, if you suspect the development of pneumonia, you should definitely seek medical help.

Acute respiratory pathology is the most common in childhood. Diseases of the upper respiratory tract include those nosological forms of respiratory pathology in which the localization of lesions is located above the larynx: rhinitis, pharyngitis, nasopharyngitis, tonsillitis, sinusitis, epiglottitis. This group of diseases also includes otitis media.

TO etiological factors acute infectious diseases of the upper respiratory tract primarily include viruses (up to 95%). Viral pathogens have a tropism for certain parts of the respiratory tract. A high proportion falls on mixed viral-viral infections: among children attending children's preschool institutions, hospital infection.

The increase in the severity of the disease and its complications is often caused by the addition (superinfection) or activation bacterial infection due to impaired barrier function of the respiratory tract, decreased immunity.

There are also primary bacterial lesions of the upper respiratory tract:

Pharyngitis, follicular and lacunar tonsillitis in more than 15% of cases are caused by isolated exposure to group A beta-hemolytic streptococcus;

Acute suppurative otitis media and sinusitis are mainly caused by pneumococcus, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes;

The etiological role of Haemophilus influenzae (type B) has been proven in the development of acute epiglotitis. The role of atypical infection in inflammation of the respiratory tract is increasing. It is noted that mycoplasma occupies an important place in the pathology of the nose, paranasal sinuses and larynx: 35% of children and adolescents are carriers of this microorganism, which can lead to a recurrent course.

You should also remember about possible fungal infections of the pharyngeal ring, in particular when the yeast fungus candida albicans is a saprophyte, but under certain conditions acquires pronounced pathogenic (disease-causing) properties.

The diagnostic algorithm becomes more complicated with the development of pneumonia and its complications.

ARVI and acute respiratory infections: similarities and differences

Unlike ARVI, the term “ARI” is used not only for viral, but also for bacterial infections of the respiratory tract. Someone will think: “What’s the difference?”, but the difference is very big, and it concerns mainly the tactics of treating the disease.

Is it possible to distinguish a bacterial infection from a viral one based on clinical symptoms? In most cases, yes.

The following symptoms are typical for all viral infections of the upper respiratory tract:

Rapid rise in body temperature (from 37.5 to 40 °C depending on the pathogen).

Acute rhinitis, which has a number of typical features: tickling in the nose on the first day, copious clear liquid discharge, is often accompanied by lacrimation due to swelling of the nasolacrimal duct and impaired outflow of tear fluid.

Damage to the back wall of the pharynx (pharyngitis), larynx (laryngitis) or trachea (tracheitis): dry cough, sore and sore throat, hoarseness, feeling of rawness behind the sternum:

Severe symptoms of general intoxication: muscle aches, decreased or lack of appetite, weakness, headache, sometimes chills.

Upon examination, attention is drawn to the injection of scleral vessels, hyperemia and granularity of the pharynx mucosa, and hyperemia of the palatine arches. With fever, facial hyperemia is noted. The tongue is usually coated. In the first two days of the disease, swelling of the nose and eyelids is common. When listening to the lungs, pulmonary breathing is not changed or is harsh (with tracheitis). The presence of wheezing indicates severe course viral infection or the addition of bacterial flora and in any case requires active treatment and, preferably, hospitalization of the child.

For bacterial infection:

The temperature usually rises gradually (bacterial infections progress more slowly, as this is due to differences in bacterial growth and viral replication).

Symptoms of general intoxication are moderate or mild.

Symptoms of damage to the upper respiratory tract have their own characteristics: thick, mucopurulent nasal discharge; rhinitis is often complicated by otitis media (ear inflammation); The cough is often wet, with sputum difficult to separate.

When examining the pharynx, attention is drawn to plaque on the tonsils and/or mucopurulent discharge flowing down the back wall of the pharynx. Often, when listening to the lungs, large bubbling rales are detected - a sign of bronchitis,

ARI of bacterial etiology should always be differentiated from exacerbation of chronic diseases of the upper respiratory tract: adenoiditis, chronic sinusitis, rhinitis, pharyngitis, bronchitis.

In fact, acute respiratory infections are a pit into which insufficiently qualified specialists dump any disease of the respiratory tract.

Differentiating viral and bacterial infections is very important to determine patient treatment tactics. If, in acute respiratory infections and suspected bacterial infection, the prescription of antibiotics is etiotropic therapy, in acute respiratory viral infections, their prescription is permissible only in the event of a complication developing - the addition of bacterial flora, which is usually noted on the 4-6th day of illness if the patient behaves inappropriately , weakness of his immune system or high aggressiveness of the infectious agent.

For a bacterial infection, it is important to prescribe adequate treatment in a timely manner: in most cases of uncomplicated disease, the basis of therapy is local antibacterial agents (drops, sprays, nasal ointments, aerosols). Unjustified use of antipyretic and antitussive drugs, vasoconstrictors and other medications, not to mention antibiotics, often leads to an increase in the duration of the disease, an increased risk of complications and a significant decrease in the child’s immunity.

For a viral infection medications must be prescribed according to strict indications!

Incorrect management of patients with ARVI has led to a high prevalence of chronic rhinitis and pharyngitis, a large number of frequently and long-term ill children.

The basis of therapy for acute respiratory viral infections is:

Maintaining the temperature and humidity in the room at the proper level (recommended air temperature 18-19 C, humidity 75-90%).

Replenishment of fluid losses (due to fever, rapid breathing, increased secretion of the mucous membrane of the respiratory tract) - the amount of fluid consumed should ensure sufficient daily diuresis (urination at least 5-6 times a day) and skin moisture. It should be remembered that to improve absorption, the temperature of the drink should be approximately equal to body temperature. Decoctions of herbs, dried fruits, and table mineral water are recommended. Proper nutrition - small portions, 5-6 times a day, rich in carbohydrates and vitamins, with the exception of fatty, fried, salty, smoked foods. If you have no appetite, only drink plenty of fluids, fruits, and juices.

A little about ARVI

Acute respiratory viral infections (ARVI) are a large group of viral infections that affect the upper respiratory tract and have a similar clinical picture. ARVI is the most common reason visits to the doctor, especially in childhood, when each child experiences up to 8 illnesses per year.

ARVI is caused by about 200 viruses. These viruses are called respiratory (from the word “I breathe”), and the diseases they cause are called acute respiratory infections.

Before talking about the prevention of these diseases in children, let's consider the characteristics of the virus as a microorganism that causes ARVI in children, the routes of infection and transmission of infection, the reasons for the high prevalence of ARVI and their main symptoms.

The widespread spread of respiratory diseases is facilitated by airborne transmission of infection.

The source of infection is a sick child or adult who releases a large number of viral particles when talking, coughing, or sneezing. However, respiratory viruses are not very stable in the external environment. For example, the influenza virus remains in the air for up to 24 hours, and when heated to 60 °C, the virus dies within a few minutes. The greatest danger of transmission of infection is observed in the first 3-8 days of illness, but with some infections, for example adenovirus, it persists for up to 25 days.

Anatomical and physiological features. The structural features and imperfection of the functions of the respiratory organs in children are one of the reasons for the occurrence of ARVI in them. Compared to an adult, a child has small respiratory organs, narrow nasal passages, a narrow larynx, a very delicate mucous membrane of the nasal passages and larynx, in which there are many blood vessels. That is why, even with a slight inflammation of the larynx or a runny nose, the mucous membranes suddenly swell, the child begins to breathe through the mouth and therefore gets sick. In addition, in children, especially in the first 3 years of life, the body’s resistance to infections is significantly reduced compared to adults.

With rare exceptions, it is not possible to identify a specific pathogen, and this is not necessary, since the disease is treated the same for any etiology. Based only clinical picture a doctor can assume the presence of a specific infection in several cases: influenza, parainfluenza, adenovirus and respiratory syncytial infections, which most often occur in childhood.

Different forms of ARVI have their own clinical manifestations (symptoms), but they have much in common:

Damage to the respiratory tract or catarrhal symptoms (runny nose, cough, redness in the pharynx, hoarseness, suffocation);

The presence of general toxic symptoms or symptoms of intoxication ( elevated temperature, malaise, headache, vomiting, poor appetite, weakness, sweating, unstable mood).

However, the severity of intoxication and the depth of damage to the respiratory tract vary with different respiratory infections.

A distinctive feature of influenza is the acute, sudden onset of the disease with severe toxicosis: high fever, headache, sometimes vomiting, aches throughout the body, redness of the face, catarrhal symptoms with the flu, they appear a little later, most often these are symptoms of tracheitis - a dry, painful cough, runny nose.

With parainfluenza, catarrhal symptoms appear (unlike influenza) from the first hours of illness - runny nose, rough “barking” cough, hoarseness, which is especially noticeable when a child is crying. Choking often develops - false croup. Symptoms of intoxication with parainfluenza are almost not expressed, the temperature does not rise above 37.5 ° C.

With adenoviral infection, from the very first days of illness, there is a profuse mucous or mucopurulent runny nose, wet cough, characterized by sequential damage to all parts of the respiratory tract, as well as conjunctivitis, acute tonsillitis(inflammation of the tonsils), enlarged lymph nodes. Intoxication at the beginning of the disease is insignificant, but gradually increases with the development of the disease. Adenovirus infection is characterized by a longer course - up to 20-30 days, often a wave-like course, i.e. after the main symptoms disappear, they appear again after 2-5 days.

Respiratory syncytial infection mainly affects lower sections respiratory tract - bronchi and the smallest bronchioles, which is manifested in the child by a strong wet cough, often with an asthmatic component (obstructive syndrome).

It is important to remember that any respiratory viral infection significantly weakens the child’s body’s defenses. This, in turn, contributes to complications, often of a purulent nature, which are caused by various bacteria (staphylococci, streptococci, pneumococci and many others). That is why acute respiratory viral infections in children of early and preschool age are often accompanied by pneumonia (pneumonia), inflammation of the middle ear (otitis), inflammation of the paranasal sinuses (sinusitis or frontal sinusitis). In addition, under the influence of respiratory infections, dormant chronic foci are revived: exacerbations of chronic tonsillitis, chronic bronchitis, chronic diseases of the gastrointestinal tract, kidneys, etc. appear.

Everything that has been said about the characteristics of the pathogen (virus), the routes of infection by it, the diversity of the clinical picture and possible complications of ARVI emphasizes the importance of measures aimed at preventing these diseases in children.