Upper respiratory tract infections

Description:

Upper respiratory tract infections are an infectious damage of a mucous membrane of a respiratory path from a nasal cavity to a trakheoyobronkhialny tree, except for terminal bronchioles and alveoluses. Upper respiratory tract infections combines viral, bacterial, fungal, protozoan infections.

Reasons of Upper respiratory tract infections:

In most cases damage of upper airways has a virus origin.
The etiological agents causing damage of upper airways are various. There is a close dependence of a role of activators on option of a course of a disease: at an acute rinosinusit and an aggravation of a chronic rinosinusit major importance have Streptococcus streptococcus (Str.) pneumoniae  (20–35%) and hemophilic stick of Haemophilus (H.) influenzae (not typed strains, 6–26%). Heavier cases are more often connected with Str. pneumoniae. Much less often Moraxella are the reason of a rinosinusit (M.) catarrhalis (and other gram-negative bacilli, 0–24%), Str. pyogenes (1–3%; to 20% at children), Staphylococcus (S.) aureus  (0–8%), anaerobe bacterias (0–10%). Role of gram-negative bacteria (Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Proteus spp., Enterobacter spp., Citrobacter) at acute sinusitis is minimum, but increases at nozokomialny infection, and also at persons with immunosuppression (a neutropenia, at AIDS) and the persons receiving repeated courses of antibacterial therapy. Activators dontogenous (5–10% of all cases of antritis) maxillary sinusitis are: H. influenzae, is more rare than Str. pneumoniae, enterobakteriya and asporous anaerobe bacterias.

Symptoms of Upper respiratory tract infections:

Upper respiratory tract infections can proceed in the following clinical forms: sinusitis, rhinitises, pharyngitises, laryngitis, tracheitises.

                    Virus nasopharyngitis.

The incubation interval lasts 2-3 days. Symptoms of a virus nasopharyngitis last up to 2 weeks. If symptoms proceed longer than two weeks, it is necessary to consider alternative diagnoses, such as an allergy, antritis or pneumonia.

Symptoms from a nose. At the beginning of a disease there is a rhinorrhea, a nose congestion, difficulty of nasal breath and sneezing. Clinically significant rhinorrhea is more characteristic of a viral infection. But at a virus nasopharyngitis, within 2 - 3 days after emergence of symptoms, allocations from a nose often become viscous, muddy, coloring from white to flavovirent (activation living on a mucous membrane saprophytic, in normal conditions of nonpathogenic flora). Thus, color and transparency of separated cannot accurately help to differentiate bacterial and viral infections.

From a throat  pain and irritation, morbidity and difficulties when swallowing is observed. Pharyngalgias, as a rule, are present in the first days of a disease and only several days last. At complaints to feeling of a lump in throats it is necessary to pay attention to a back wall of a throat and a uvula – they can be involved in inflammatory process. Breath by a mouth because of a congestion of a nose can result in dryness in a mouth, especially after a dream.

Developing of cough can demonstrate involvement in process of a throat, or as a result of irritation of a wall of a throat allocations from a nose (post-nasal flowing). Cough usually develops for the fourth or fifth day after emergence of symptoms from a nose and a throat.

Also virus nasopharyngitis can be followed by such symptoms as:

    * An unpleasant smell from a mouth which  arises as a result of release of waste products of pathogenic flora and products of the most inflammatory process. The unpleasant smell from a mouth can be observed as well at allergic rhinitises.
    * The hyposmia - loss of sense of smell is secondary in relation to an inflammation in a nasal cavity.
    * Headache. It is observed at the majority of cases.
    * Sinus symptoms. Include a nose congestion, feeling of completeness and a raspiraniye in a bosom (to a thicket it is symmetric). Are quite characteristic of virus nasopharyngites.
    * The photophobia and conjunctivitis  are characteristic for adenoviral and other viral infections. Flu can be followed by pain in the depth of an eye-socket, morbidity at the movement of eyes or conjunctivitis. The itching, watering, "watery" eyes are more characteristic of allergic states.
    * Fever. Temperature increase usually insignificant or in general is absent, however at newborns and babies temperature can reach 39,4 °C (103 °F). Usually fever lasts only several days. At flu fever can be followed by temperature increase to 40 °C (104 °F) and even above.
    * Symptoms from digestive tract. Nausea, vomiting and a diarrhea can accompany flu, is especially frequent at children. Nausea and abdominal pains can be observed at virus ORZ and streptococcal infections.
    * Heavy mialgiya. Severe muscular pains are typical for flu, especially against the background of suddenly appeared pharyngalgias accompanied with fever, a fever, cough and headaches.
    * Fatigue and indisposition. Any IVDP type can be followed by these symptoms. The breakdown, exhaustion are characteristic of flu.

                            Bacterial pharyngitis.

When collecting the anamnesis it is almost impossible to carry out differential diagnosis for viral and bacterial pharyngitis. If symptoms do not pass within 10 days and gradually worsen after the first 5-7 days, it is quite possible to assume the bacterial nature of a disease. The special attention as the activator is deserved by a hemolitic streptococcus of group A. Existence in the personal anamnesis of an episode of acute rheumatic fever (especially with clinic of a carditis or complicated by defect), or household contact with the person which had the anamnesis of a streptococcal infection considerably increases risk of development in the patient of acute or repeated rheumatic fever. Suspicion of infection with a streptococcus of group A confirms existence of long fever, as well as absence of cough, the rhinorrhea and conjunctivitis more characteristic of a SARS. Seasonality of incidence from November to May is characteristic of bacterial pharyngitis, and also specifies age of patients from five to fifteen years.

Faringalny symptoms (from a throat).  Pain or irritation in a throat, morbidity and difficulty when swallowing take place. If process of an inflammation included a uvula and a back wall of a throat, there can be a feeling of a lump in a throat. Breath by a mouth, because of a nose congestion, leads to feeling of dryness in a mouth, especially in the first half of day. The sharp beginning and an acute pain in a throat is characteristic of the streptococcal nature of pharyngitis.

Allocations from a nose. Allocations, as a rule, viscous, mucous, whitish or flavovirent that, however, not always testifies to a bacterial infection.

Cough. It can be obliged by involvement in process of an inflammation of a mucous throat or upper respiratory tracts, or it is caused by allocations from a nose (post-nasal flowing).

Also following symptoms are characteristic:

    * An unpleasant smell from a mouth. Arises as a result of release of waste products of pathogenic flora and products of the most inflammatory process. The unpleasant smell from a mouth can be observed as well at allergic rhinitises.
    * Headache. It is characteristic of streptococcal (group A) and mycoplasmal infections, but it can be observed also at IVDP of other etiology.
    * Fatigue and febricula. It is observed at any IVDP, but the explicit breakdown is characteristic of an influenzal infection.
    * Fever. Temperature increase usually insignificant or in general is absent, however at newborns and babies temperature can reach 39.4 °C (103 °F).
    * Existence of skin rash. It is indicative for streptococcal infections, especially at children and teenagers 18 years are younger.
    * Pharyngalgia. It is characteristic of a streptococcal infection, but can accompany flu and other SARS.
    * The anamnesis of recent oral and genital sexual contacts that is especially urgent in cases of gonococcal pharyngitis.

                Acute virus or bacterial rinosinusit.

Initial displays of sinusitis are often similar to a nasopharyngitis and other viral upper respiratory tract infections as the nasal cavity is anatomically connected with okolonosovy bosoms, as defines generality of inflammatory process. The two-phase template of course at which originally there occurs temporary improvement is characteristic of sinusitis, then - deterioration. Unilateral localization of symptoms confirms suspicions concerning involvement in process of bosoms. At full fading of inflammatory symptomatology within a week can hardly there be a speech about sinusitis.

Allocations from a nose. Steady mucopurulent allocations, pale yellow or flavovirent color are characteristic that, however, is not the defining symptom as allocations can be observed also at an uncomplicated nasopharyngitis. The rhinorrhea is, as a rule, insignificant and does not answer use of antiedematous and antihistaminic drugs. At a part of patients the nose congestion prevails. The unilateral congestion of a nose and mucopurulent allocations from one nostril testify in favor of sinusitis.

The hyposmia or loss of sense of smell is secondary in relation to an inflammation of a mucous membrane of a nasal cavity.

Pain in the field of a projection of sinus bosoms. At children of advanced age and adults painful symptoms are, as a rule, localized in the field of a projection of the affected bosom. The pain localized in a forehead, an upper jaw, infraorbital area is characteristic. The inflammation of a genyantrum can be expressed by a dentagra on the struck party. The pain irradiating in an ear can testify to otitis or peritonsillar abscess.

Oropharyngeal symptoms. The pharyngalgia can be result of irritation the allocations from a nose which are flowing down on a back wall of a throat. Breath by a mouth, because of a nose congestion, leads to feeling of dryness in a mouth, especially after a dream and in the first half of day.

Galitoz or an unpleasant smell from a mouth. Arises as a result of release of waste products of pathogenic flora and products of the most inflammatory process. The unpleasant smell from a mouth can be observed as well at allergic rhinitises.

Cough. The inflammatory syndrome of upper respiratory tracts is followed by constant receipt of the mucous separated nose in a throat (post-nasal flowing) demanding more frequent cleaning of a throat, that is which is followed by cough. The cough accompanying rinosinusita usually is present throughout the day. Cough can be the most expressed in the mornings, after a dream, in response to irritation of a throat the secret which accumulated in a night. The day cough lasting more than 2 weeks assumes sinusitis, bronchial asthma and some other states. It is possible also that cough only can be at night a characteristic symptom of some other diseases. The cough caused by inflammatory process of upper respiratory tracts sometimes can be followed by vomiting because of irritation allocations of a root of language. Clinically significant quantity of a phlegm of purulent character can assume bronchitis or pneumonia.

Fervescence. Fever is not absolutely characteristic and is observed more often at children. Rise and recession of temperature happens almost synchronously to emergence and the termination of purulent discharges. At the SARS complicated by sinusitis, temperature increase often precedes emergence of purulent separated.

The fatigue and indisposition takes place as well as at any other upper respiratory tract infection.
                                                                                                      Epiglottiditis.

This disease meets at children at the age of 1 - 5 years more often, and is characterized by sudden emergence of clinical symptoms:

1. Pharyngalgias.
2. Hypersalivation, a dysphagy - difficulty or morbidity when swallowing, feeling of a lump in a throat.
3. A dysphonia - hoarseness or total loss of a voice.
4. Cough preferential dry, is observed an asthma.

Fervescence, weakness, asthenic syndrome are observed as well as at other upper respiratory tract infections.
                                                                                                      Laryngotracheitis.

Nasopharyngeal (nasopharyngeal) symptoms.  Laryngitis and tracheitis during several days are often preceded by a nasopharyngitis. Swallowing is complicated or is painful, there can be a feeling of a lump in a throat.

Hoarseness or total loss of a voice - one of the leading symptoms.

Cough can be several types:

    * Dry cough. At teenagers and adults laryngitis can be shown by the long, hoarse, dry cough following a typical prodromal stage of IVDP. There can be an insignificant pneumorrhagia.
    * The barking cough. Laryngotracheitis or a croup at children can be shown by the characteristic barking, so-called "copper" cough. Symptoms can be worse, at night. Diphtheria also makes the barking cough.
    * A pertussoid - attacks of convulsive uncontrollable cough of which the noisy "groaning" sounds on a breath and almost complete cessation of breath at attack height are characteristic. The pertussoid meets at children more often. Such cough often comes to cough paroxysms from ten or more attacks in a row, and often worsens at night. Cough can remain within several weeks.

Posttussivny symptoms - the subsequent to a pertussoid paroxysm attacks of nausea and vomiting.

Диспноэ - breath disturbance:

    * An asthma - increase in frequency and change of depth of breath. Can worsen because of reduction in the lying provision of a natural drainage of respiratory tracts and their motility in a dream at night.
    * The apnoea - the breath termination stepping on dive of an attack of convulsive cough (paroxysm) is the leading symptom of whooping cough. It is worth to remember that the apnoea can be result of obstruction of upper respiratory tracts and on other reasons.

Other symptoms:

    * Morbidity in muscles is characteristic of flu, especially against the background of hoarseness, suddenly appeared pharyngalgias, fever, a fever, cough and a headache.
    * Fever can be present, though is not characteristic.
    * Fatigue and an indisposition - as well as at any other upper respiratory tract infection.
    * Subkonyyunktivalny hemorrhages, as a result of long fits of coughing.
    * Morbidity and sensitivity of edges as manifestation of a traumatic miositis (intercostal muscles), fractures of edges and ruptures of costal cartilages as a result of heavy fits of coughing.

Treatment of Upper respiratory tract infections:

Usually existence of an infection верхнх respiratory tracts is not the indication for hospitalization. To patients there is quite enough explanation, assurances of lack of a reason for concern, and also instructions on a symptomatic treatment at home. Depending on indications with the preventive purpose appoint antimicrobic therapy.

Antibacterial drugs in combination with nasal and/or system antiedematous means including intranasal steroids and irrigation mucous a nose normal saline solution, take the main place in therapy acute, and also at an aggravation chronic, a rinosinusita.
Anticholinergic drugs are used: ipratropiya bromide; local decongestants: oxymetazoline hydrochloride; system decongestants: fenilyopropanolamina hydrochloride; pseudoephedrine combination hydrochloride + acetaminophen. According to indications (for example, for etiological diagnosis, especially at inefficiency of therapy for the 3rd days, suspicion of mycosis; at the expressed pain syndrome demanding a sine decompression etc.) the puncture of sine and other methods of treatment are applied.

Delusion is appointment (in the absence of strong indications of an allergic rinosinusit) the antihistaminic drugs promoting increase in viscosity of a secret and difficulty of a drainage of bosoms. One more mistake consists in preventive purpose of AP to patients with a SARS in the first days of manifestation of a rinosinusit. Attempt of prevention of bacterial complications including from sine, it is deprived of sense.

Antibacterial therapy. The main goal of AT consists:

    * in an eradikation of the activator and recovery of sterility of a sine;
    * reduction of risk of synchronization (currently there are not enough data proving ability of AT to prevent transition of process to a chronic form or to prevent development of serious complications);
    * prevention of complications;
    * simplification of clinical symptomatology.

At a virus etiology of a disease in the first days of a disease, especially at a respiratory and syncytial infection, purpose of antibacterial therapy is not justified. At preservation of symptoms of a rinosinusit> 7–10 days, at 60% of patients it is possible to assume existence of a bacterial infection. Within this group carrying out AT is reasonable. The last can begin earlier. For this purpose the fever and a cephalalgia which are badly giving in to action of analgetics forms the basis.

At an easy and medium-weight current of an acute rinosinusit therapy identical. Drug of the choice is amoxicillin. Considering variability of absorption of drug, for ensuring high-quality treatment use of the microionized form providing constancy of absorption at the level of 93% (солютаб) is advisable. Therapy duration — 7–14 days. In case of the epidemiological importance (it is offered> 5% of the allocated strains) resistant to penicillin Str. pneumoniae the minimum overwhelming concentration (MOC) of penicillin — 0,12–2,0 mg/l, the dose of amoxicillin makes 3 g/days. In this case advantage of a vysokoyoadsorbiruyemy soluble form is obvious.

Amoxicillin is adequate means of therapy of an acute rinosinusit, in case of a subacute current, as well as in the presence of following signs, use ingibitorozashchishchennykh aminopenicillin is required (amoxicillin/clavulanate).