Respiratory tract infection. Infectious diseases

Winter is not only New Year, long weekends and ski trips also mean colds. Respiratory diseases, like love, are susceptible to all ages, but children, whose immunity is not yet fully functional, are especially defenseless against such diseases. Respiratory diseases in children are often severe and require special attention, since the risk of complications in children is higher than in adults.

Respiratory diseases in children and adults are the most common infectious diseases in the world. They account for more than 90% of all diseases that are caused by bacteria, viruses or fungi. Every year, about 30 million cases of acute respiratory infections are registered in our country - that is, they affect every fifth resident of Russia.

Surveys show that almost two-thirds of Russians at the first symptoms respiratory infection They go not to the clinic, but to the pharmacy to buy “something for a cold.” Many people do not trust medicine at all and prefer to be treated with home remedies. Such carelessness very often ends in complications and the spread of infection.

Respiratory diseases are especially dangerous for older people and children preschool age, since the first protective forces The body has already been weakened, and in others, the immune system is in the process of formation and cannot always repel bacteria and viruses.

What are the causes of respiratory diseases in children?

Of course, walking in the cold with an unbuttoned jacket and without a hat does not add to your health, but this is not the main reason for the development of diseases respiratory tract in children. Hypothermia only leads to narrowing of capillaries and decreased immunity. Respiratory diseases in children are infectious in nature, and it is much easier for infections to enter the body if its defenses are weakened, even if only for an hour.

Respiratory diseases are mainly transmitted by airborne droplets or through dirty hands. They can affect the upper respiratory tract and lead to otitis media, sinusitis or sore throat. If the infection spreads to the lower respiratory tract, pneumonia and bronchitis develop.

Often the culprit of the disease is bacteria, in particular streptococci, staphylococci and Haemophilus influenzae. But just as often, doctors deal with viruses, primarily the influenza virus. Very often, against the background of a viral respiratory disease, a complication occurs in the form of bacterial infection. The mucous membrane is the first line of defense against bacteria, but with inflammation and irritation that come with it viral diseases respiratory tract, it loses its protective properties.

What symptoms should you look out for?

Doctors divide respiratory diseases in children and adults into two groups – diseases of the lower and upper respiratory tract. Actually, there is no generally accepted boundary between the upper and lower respiratory tract. The upper ones include: the nose and its paranasal sinuses, pharynx and upper section larynx. The lower respiratory tract area includes the lungs, trachea, larynx and bronchi.

The following signs indicate respiratory diseases in children:

• Stuffy nose, mucous or mucopurulent nasal discharge;
• Sneezing;
• Cough – both dry and with sputum;
• Sore throat, plaque on the surface of the tonsils;
• Enlarged cervical lymph nodes;
• Increased body temperature (in young children it can rise quickly and very significantly, up to 40°C);
• Nausea and vomiting caused by intoxication of the body.

If you notice these symptoms in your child, do not try to diagnose it yourself. It is very difficult to distinguish a viral infection from a bacterial one based on symptoms alone. Identify the causative agent of the disease and prescribe effective treatment possible only after laboratory diagnostics. Accurate diagnosis is extremely important, since viral, bacterial and mixed infections are treated differently.

Diseases of the upper and lower respiratory tract can occur in both acute and chronic form. At the same time, an erased form of the disease with subtle symptoms can correspond to both an acute and chronic process.

If at acute course of respiratory tract diseases in children, the symptoms are pronounced and cause concern for parents, while in the chronic course of the disease the signs respiratory diseases are often ignored. And this is very dangerous, because it is chronic course infection is fraught with the most serious complications.

Self-medication also leads to the development of complications. Most often, home “therapy” includes remedies that relieve symptoms, fever, inflammation of the mucous membranes and cough, but do not in any way affect the cause of the disease - viruses and bacteria. As a result, the disease in some cases can become chronic.

Often parents, seeing that “ folk remedies“They don’t help, but they still take the child to the doctor. But in such cases, treatment takes longer, since the disease is already advanced.

How to properly treat respiratory diseases in children?

The main remedy in the fight against bacterial respiratory tract infections in children and adults is antibiotics. However, parents usually view them with suspicion. Around antibiotics there is great amount myths and misconceptions. And all because people sometimes have very little idea of ​​how these tools work. Let's try to understand what antibiotics are, why they are prescribed, and whether they can help cure respiratory diseases in children.

Myth No. 1. Antibiotics cause allergies This is not exactly a myth - allergic reaction really possible. But medicine has a lot in its arsenal different types antibiotics. And if one drug conflicts with the patient’s immune system, the doctor will immediately select another.

Myth No. 2. Antibiotics destroy the immune system This myth has no basis at all. There is not a single study that proves that antibiotics weaken the body's defenses. But advanced respiratory diseases in children can indeed lead to suppressed immunity and frequent recurrent colds.

Myth No. 3. Antibiotics kill all living things This is also not true. Moreover, antibiotics do not kill absolutely all harmful bacteria at once. Antibiotics are not a cure mass destruction, they act very selectively. Each product is designed to target a specific type of bacteria, and what will help with streptococcal infection, will not help if another is infected. The confusion stems from the fact that most antibacterial agents called "antibiotics" wide range actions,” and to the uninitiated it seems that such drugs should kill many types of bacteria. In fact, this term means that the antibiotic is effective against several dozen bacteria, but nothing more.

Antibiotics are constantly being improved, modern, even more safe drugs, new comfortable ones are being released dosage forms– for example, dispersible tablets that dissolve in water, which makes them much easier to take.
There is no reason to be afraid of antibiotics - of course, if they are prescribed by a doctor, the medications are taken under his supervision and all recommendations are strictly followed.

Antibiotics are the only known to medicine effective method fight bacterial infections, and no raspberry tea can replace them.

46-47.RESPIRATORY DISEASES

In children, respiratory diseases are much more common than in adults and are more severe, due to the peculiarities of the anatomical and physiological characteristics of children and the state of immunity.

Anatomical features

The respiratory organs are divided into:

1.Upper respiratory tract (UR): nose, pharynx.

3. Lower DP: bronchi and lung tissue.

Respiratory diseases

Upper respiratory tract diseases: Rhinitis and tonsillitis are the most common.

Angina- an infectious disease that affects the palatine

tonsils. The causative agent is most often streptococcus and viruses.

There are acute and chronic tonsillitis.

Clinical picture of acute tonsillitis:

Symptoms of intoxication: lethargy, muscle pain, lack of appetite.

Fever

Pain when swallowing

The appearance of plaque on the tonsils

Principles of therapy:

Antibacterial therapy! (The drug of choice is penicillin (amoxicillin)).

Drink plenty of fluids (V = 1.5-2 l)

Vitamin C

Gargling with disinfectant solutions.

Clinical picture chronic tonsillitis:

The main symptom: repeated exacerbations of sore throat.

Symptoms of intoxication may be present, but less severe

Frequent nasal congestion

Unpleasant smell from mouth

Frequent infections

Long-term low-grade fever

Principles of therapy:

Rinsing lacunae and tonsils with antiseptic solutions (course 1-2 times per year).

Local antiseptics: ambazon, gramicidin, hepsetidine, falimint.

General strengthening measures

Regular spa treatment

Vitamin-rich food (Vit.C at a dose of 500 mg per day)

Herbal medicine: tonsilgon for children 10-15 drops x 5-6 r/day for 2-3 weeks.

Acute rhinosinusitis– an infectious disease, the causative agent is most often viruses. Depending on the type of pathogen, rhinosinusitis is divided into catarrhal (viral) and purulent (bacterial).

Clinical picture:

Difficulty in nasal breathing

Headache

Discharge from the nose (can be mucous - with a viral infection, and purulent - with a bacterial infection).

Less common: increased body temperature, cough

Principles of therapy:

In case of mild flow, early stages For diseases, rinsing the nose with a warm solution (saline, furatsilin), hot foot baths, moisturizing sprays (to thin the mucus) - Aquamoris or mucolytic agents - is effective.

Mucolytic drugs: rinofluimucil for 7-10 days.

Vasoconstrictor drugs are prescribed for a period of no more than 7-10 days.

For viral rhinitis with severe course bioparox is effective..

Antibacterial drugs are prescribed only in the presence of purulent discharge (the drug of choice is amoxicillin, in the presence of an allergy to penicillin - sumamed (macropen)).

Diseases of the middle respiratory tract

Of the lesions of the SDP, laryngotracheitis is the most common.

Acute laryngotracheitis – acute illness, the causative agent of which is most often viruses, but can also be allergens.

Clinical picture:

Sudden onset, usually at night

Noisy wheezing and shortness of breath

Less common: increased body temperature

Principles of therapy:

Distraction therapy (hot foot baths, mustard plasters on calf muscles, plenty of warm drinks).

The air in the room should be cool and humidified.

Inhalation of bronchodilators (Ventolin) through a nebulizer.

If there is no effect, hospitalize the patient.

Lower respiratory tract diseases

The most common lesions of the upper respiratory tract are:

Airway obstruction

Bronchitis

Pneumonia

Bronchial asthma

Obstructive bronchitis appear more often in children in the first 2 years of life

due to the anatomical features of the respiratory tract: narrow

lumen of the bronchi. Obstruction is associated either with a narrowing of the lumen or with blockage of the airways by thick mucus. The causative agent in 85% is viruses.

Clinical picture:

At the onset of the disease, there is a clinical picture of acute respiratory disease (runny nose, malaise, maybe fever). Later the cough joins: at the beginning it is dry, but then turns into wet. Subsequently

shortness of breath occurs, characterized by difficulty inhaling and exhaling

with a characteristic whistling, pecking breath or noise heard on

distance, rapid breathing, retraction of all compliant places

chest (jugular fossa, intercostal spaces).

Principles of therapy:

For mild cases, outpatient treatment:

Frequent ventilation of the room

Inhalation through a nebulizer or spacer with bronchodilators:

Berodual, Ventolin, soda-salt inhalations.

Bronchial drainage and vibration massage

Acute bronchitis – characterized by inflammation of the bronchial mucosa and accompanied by hypersecretion of mucus. The cause of the disease is most often viruses.

Clinical picture:

In the first days of the illness, an acute respiratory infection clinic: malaise, runny nose, maybe an increase in body temperature

Dry cough, which subsequently (after 2-5 days) becomes moist

Principles of therapy:

Drink plenty of warm drinks ( mineral water, decoction of expectorant herbs)

For a dry, hacking cough - antitussives (libexin, sinekod)

Mustard plasters and jars are not recommended (as they injure the skin and can cause an allergic reaction).

Acute pneumonia– an infectious disease in which inflammation of the lung tissue occurs. The causative agent in 80-90% is bacterial flora, much less often - viruses or fungi.

Clinical picture:

Symptoms of intoxication are expressed: body temperature > 38-39, persisting for more than 3 days;

lethargy, weakness,

There may be vomiting, abdominal pain

Lack of appetite

Principles of therapy

Rapid breathing (dyspnea) without signs of obstruction.

For mild forms, treatment can take place on an outpatient basis; in severe cases, as well as in children under 3 years of age, hospitalization is indicated:

Antibacterial therapy: the drug of choice for mild forms is amoxicillin.

Expectorants (ambroxol, lazolvan, acetylcysteine)

Drink plenty of fluids (mineral water, fruit drinks, decoctions).

Bed rest in the first days of illness

From the fifth day of illness - breathing exercises

Vitamins (aevit, vit. C)

Physiotherapy Bronchial asthma is a chronic allergic disease of the respiratory tract, characterized by periodic attacks of difficulty breathing or suffocation. The cause of the disease in the vast majority of cases is allergens. Factors that aggravate the effect of causative factors are: ARVI, tobacco smoke, strong odors, cold air

, physical activity, food coloring and preservatives.

Clinical picture:

Dyspnea associated with wheezing

Dry, paroxysmal cough

Possible sneezing, nasal congestion

Usually the condition worsens over several hours or

days, sometimes within a few minutes.

In addition to the classic signs of bronchial asthma, there are probable signs of the disease:

The presence of frequent episodes of paroxysmal cough and wheezing

Lack of positive effect from the antibacterial treatment

The appearance of cough at night

Seasonality of symptoms

Identifying allergies in the family

Principles of therapy

The presence of other allergic reactions in the child (diathesis)

Preventive therapy is the prevention of exacerbation attacks, i.e. eliminating contact with the allergen;

Pathogenetic therapy is aimed at the cause of the disease, i.e. if elimination of the allergen is impossible, then specific immunotherapy (allergen vaccination) is indicated.

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 does not allow them to develop. 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 strikes 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 infections respiratory tract. 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.

Description:

Upper respiratory tract infections are infectious lesion mucous membrane of the respiratory tract from the nasal cavity to the tracheobronchial tree, with the exception of the terminal bronchioles and alveoli. Upper respiratory tract infections include viral, bacterial, fungal, and protozoal infections.

Causes:

In most cases, damage to the upper respiratory tract is of viral origin.
Etiological agents causing damage upper respiratory tract are different. There is a close dependence of the role of pathogens on the course of the disease: in acute rhinosinusitis and exacerbation chronic rhinosinusitis the main ones are Streptococcus (Str.) pneumoniae (20–35%) and Haemophilus influenzae (H.) influenzae (nontypeable strains, 6–26%). More severe cases of the disease are more often associated with Str. pneumoniae Much less common causes of rhinosinusitis are Moraxella (M.) catarrhalis (and other gram-negative bacilli, 0–24%), Str. pyogenes (1–3%; up to 20% in children), Staphylococcus (S.) аureus (0–8%), anaerobes (0–10%). The role of gram-negative bacteria (Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Proteus spp., Enterobacter spp., Citrobacter) in acute sinusitis is minimal, but increases with nosocomial infection, as well as in persons with immunosuppression (neutropenia, AIDS) and persons receiving repeated courses antibacterial therapy. The causative agents of odontogenic (5–10% of all cases of sinusitis) maxillary sinusitis are: H. influenzae, less commonly Str. pneumoniae, enterobacteria and non-spore-forming anaerobes.

Symptoms:

Upper respiratory tract infections can occur in the following clinical forms: sinusitis, rhinitis, pharyngitis, laryngitis, tracheitis.

                              Viral nasopharyngitis.

The incubation period lasts 2-3 days. Symptoms of viral nasopharyngitis last up to 2 weeks. If symptoms last longer than two weeks, alternative diagnoses such as allergies or allergies should be considered.

Nasal symptoms. At the onset of the disease, rhinorrhea, nasal congestion, difficulty in nasal breathing, etc. occur. Clinically significant rhinorrhea is more typical of a viral infection. But with viral nasopharyngitis, within 2 - 3 days after the onset of symptoms, nasal discharge often becomes viscous, cloudy, white to yellow-green in color (activation of the saprophytic substance living on the mucous membrane, in normal conditions Not pathogenic flora). Thus, the color and transparency of the discharge cannot help clearly differentiate bacterial and viral infections.

In the throat there is pain and soreness, soreness and difficulty swallowing. Sore throat, as a rule, is present already in the first days of illness and lasts only a few days. If you complain of a feeling of a lump in the throat, you should pay attention to the back wall of the pharynx and the uvula - they may be involved in the inflammatory process. Mouth breathing due to nasal congestion can lead to dry mouth, especially after sleep.

The occurrence of a cough may indicate involvement of the larynx, or as a result of irritation of the pharyngeal wall by nasal discharge (postnasal drip). usually develops on the fourth or fifth day after the onset of nasal and pharyngeal symptoms.

Viral nasopharyngitis can also be accompanied by symptoms such as:

      * Bad breath, which   occurs as a result of the release of waste products of pathogenic flora and products of the inflammatory process itself. Bad breath can also occur with allergic rhinitis.
      * - loss of smell is secondary to inflammation in the nasal cavity.
      * . Observed in most cases.
      * Sinus symptoms. They include nasal congestion, a feeling of fullness and distension in the sinus area (usually symmetrically). Quite typical for viral nasopharyngitis.
      * Photophobia and    are characteristic of adenovirus and other viral infections. may be accompanied by pain in the depths of the orbit, pain with eye movement, or conjunctivitis. Itchy, watery, watery eyes are more common in allergic conditions.
      * Fever. The fever is usually mild or absent, but in newborns and infants the temperature can reach 39.4°C (103°F). The fever usually lasts only a few days. With the flu, fever can be accompanied by a temperature of 40°C (104°F) or even higher.
      * Side symptoms gastrointestinal tract. , and diarrhea can accompany the flu, especially often in children. Nausea and abdominal pain may occur with viral acute respiratory infections and streptococcal infections.
      * Heavy. Strong muscle pain typical for influenza, especially against the background of a sudden onset of sore throat, accompanied by fever, chills, cough and headaches.
      * Fatigue and malaise. Any type of URTI can be accompanied by these symptoms. Complete loss of strength and exhaustion are characteristic of the flu.

                                          Bacteria.

When collecting anamnesis it is almost impossible to carry out differential diagnosis for viral and bacterial pharyngitis. If the symptoms do not go away within 10 days and gradually worsen after the first 5-7 days, it is quite possible to assume the bacterial nature of the disease. Special attention group A hemolytic streptococcus deserves to be considered as the causative agent. The presence of an episode in a personal history (especially with clinical carditis or complicated by a defect), or household contact with a person who had a history of streptococcal infection, significantly increases the patient’s risk of developing acute or recurrent rheumatic fever. Suspicion of infection with group A streptococcus is confirmed by the presence of prolonged fever, as well as the absence of cough, rhinorrhea and conjunctivitis, which are more characteristic of. Bacterial pharyngitis is characterized by seasonal incidence from November to May, and also indicates the age of patients from five to fifteen years.

Pharyngeal symptoms (from the pharynx).   There is pain or sore throat, soreness and difficulty swallowing. If the uvula and the back wall of the pharynx are involved in the inflammation process, there may be a sensation of a lump in the throat. Breathing through the mouth, due to nasal congestion, leads to a feeling of dry mouth, especially in the first half of the day. The streptococcal nature of pharyngitis is characterized by abrupt start And sharp pain in the throat.

Nasal discharge. The discharge is usually viscous, mucous, whitish or yellow-green, which, however, does not always indicate a bacterial infection.

Cough. It may be due to the involvement of the mucous membrane of the larynx or upper respiratory tract in the process of inflammation, or due to nasal discharge (postnasal drip).

The following symptoms are also characteristic:

      * Bad breath. It arises as a consequence of the release of waste products of pathogenic flora and products of the inflammatory process itself. Bad breath can also occur with allergic rhinitis.
      * Headache. It is typical for streptococcal (group A) and mycoplasma infections, but can also be observed with URTI of a different etiology.
      * Fatigue and general malaise. It is observed with any URTI, but a clear loss of strength is characteristic of an influenza infection.
      * Fever. The fever is usually mild or absent, but in newborns and infants the temperature can reach 39.4°C (103°F).
      * Availability. Indicative for, especially in children and adolescents under 18 years of age.
      * . It is typical for streptococcal infection, but can accompany influenza and other acute respiratory viral infections.
      * History of recent oral-genital sexual intercourse, which is especially important in cases of gonococcal pharyngitis.

                        Acute viral or bacterial.

The initial manifestations of sinusitis are often similar to nasopharyngitis and other viral infections of the upper respiratory tract, since the nasal cavity is anatomically connected to the paranasal sinuses, which determines the generality of the inflammatory process. Sinusitis is characterized by a two-phase progression pattern, in which initially there is a temporary improvement, then a deterioration. Unilateral localization of symptoms confirms suspicions of sinus involvement. With complete extinction inflammatory symptoms within a week there can hardly be any talk of sinusitis.

Nasal discharge. Characterized by persistent mucopurulent discharge, pale yellow or yellow-green in color, which, however, is not a defining symptom, since discharge can also be observed with uncomplicated rhinopharyngitis. Rhinorrhea is usually mild and does not respond to decongestants or antihistamines. In some patients, nasal congestion predominates. Unilateral nasal congestion and mucopurulent discharge from one nostril indicate sinusitis.

Hyposmia, or loss of smell, is secondary to inflammation of the nasal mucosa.

Pain in the area of ​​projection of the sinuses. In older children and adults painful symptoms, as a rule, are localized in the area of ​​projection of the affected sinus. Characterized by pain localized in the forehead area, upper jaw, infraorbital region. Inflammation of the maxillary sinus can result in toothache on the affected side. Pain radiating to the ear may indicate otitis media or peritonsillar abscess.

Oropharyngeal symptoms. A sore throat may be the result of irritation from nasal secretions running down the back wall throats. Breathing through the mouth, due to nasal congestion, leads to a feeling of dry mouth, especially after sleep and in the first half of the day.
or bad breath. It arises as a consequence of the release of waste products of pathogenic flora and products of the inflammatory process itself. Bad breath can also occur with allergic rhinitis.

Cough. Inflammatory syndrome upper respiratory tract is accompanied by a constant flow of nasal mucous into the pharynx (postnasal drip), requiring more frequent cleaning throat, that is, accompanied by a cough. The cough that accompanies rhinosinusitis is usually present throughout the day. The cough may be most severe in the morning, after sleep, in response to irritation of the throat with secretions that have accumulated overnight. A daytime cough lasting more than 2 weeks suggests bronchial asthma and a number of other conditions. It is also possible that coughing exclusively at night may be characteristic symptom some other diseases. Cough caused by inflammatory process upper respiratory tract, can sometimes be accompanied by vomiting due to irritation by secretions from the root of the tongue. Clinically significant amount purulent sputum may suggest pneumonia.

Increased body temperature. Fever is not entirely typical and is observed more often in children. The rise and fall of temperature occurs almost synchronously with the appearance and cessation of purulent discharge. In ARVI complicated by sinusitis, an increase in temperature often precedes the appearance of purulent discharge.

Fatigue and malaise occur as with any other upper respiratory tract infection.

This disease is more common in children aged 1 - 5 years, and is characterized by sudden appearance clinical symptoms:

1. Sore throat.
2. Drooling - difficulty or pain when swallowing, feeling of a lump in the throat.
3. - hoarseness or total loss vote.
4. The cough is predominantly dry, shortness of breath is observed.

Increased body temperature and weakness are observed in the same way as with other upper respiratory tract infections.
                                       sp                                        sp                                        sp              .

Nasopharyngeal (nasopharyngeal) symptoms. Laryngitis and tracheitis are often preceded by nasopharyngitis for several days. Swallowing is difficult or painful, and there may be a sensation of a lump in the throat.

Cough can be of several types:

      * Dry cough. In adolescents and adults, it can manifest as a protracted, hacking, dry cough that follows the typical prodromal period of URTI. Minor hemoptysis may be present.
      * Barking cough. Laryngotracheitis or croup in children can manifest itself as a characteristic barking, so-called “copper” cough. Symptoms may be worse at night. also produces barking cough.
      * Whooping cough is an attack of convulsive uncontrollable cough, which is characterized by noisy “moaning” sounds during inspiration and an almost complete cessation of breathing at the height of the attack. Whooping cough is more common in children. This cough often comes in coughing paroxysms of a dozen or more attacks in a row, and often worsens at night. The cough may persist for several weeks.

Posttussive symptoms are attacks of nausea and vomiting following a paroxysm of whooping cough.
- breathing disorder:

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 tropism for certain parts of the respiratory tract. A high proportion falls on mixed viral infections: environment of children attending nurseries preschool institutions, hospital infection.

The increase in the severity of the disease and its complications is often caused by the addition (superinfection) or activation of a bacterial infection due to a violation barrier function 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 important place in 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 mucous membrane of the pharynx, hyperemia 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 rigid (with tracheitis). The presence of wheezing indicates a severe course of a 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,

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

In essence, acute respiratory infections are a pit into which there is not enough qualified specialists blame 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 , his weaknesses 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- in small portions, 5-6 times a day, rich in carbohydrates and vitamins, excluding fatty, fried, salty, smoked foods. In case of lack of appetite - only drinking plenty of fluids, fruits, 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 childhood, when for each child there are up to 8 diseases 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 spread of respiratory diseases contributes to airborne transmission of infection.

The source of infection is a sick child or adult who, when talking, coughing, sneezing, secretes a large number of viral particles. 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's why even with slight inflammation In the larynx or runny nose, the mucous membranes swell sharply, the child begins to breathe through the mouth and therefore falls ill. 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 influenza they appear a little later, most often these are symptoms of tracheitis - 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.

At adenovirus infection from the very first days of the illness, profuse mucous or mucopurulent runny nose, wet cough are noted, 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 smallest bronchioles, which manifests itself in a child as 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). This is why acute respiratory viral infections in infants and children pre-school age often accompanied by pneumonia (pneumonia), inflammation of the middle ear (otitis), inflammation paranasal sinuses nose (sinusitis or frontitis). In addition, under the influence of respiratory infections, dormant chronic lesions: 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.