Adenovirus infection - Causes, symptoms and treatment. MF.

Adenovirus infection is an infectious disease belonging to the acute respiratory viral infection( ARVI) group, characterized by the damage of the lymphoid tissue and mucous membranes of the respiratory tract / eye / intestines, with concomitant moderate intoxication.

The causative agent was discovered very recently - in 1953 by a group of American researchers who isolated this virus in the tissues of the removed adenoids and tonsils. Virion( virus) contains double-stranded DNA coated with capsid - this causes relative stability in the external environment both at low temperatures and drying, and under normal conditions( safety for up to 2 weeks).Resistance to ether and chloroform, to alkaline media( soap solutions).The activator is inactivated by boiling and the action of disinfectants. The causative agent contains 3 pathogenic factors - antigens( Ar) "A", "B" and "C" - several of them and, depending on their combination, there are about 90 serovars, that is, variations of the adenovirus virion, about 6 of which aredangerous to humans. ArA - complement-binding( causes suppression of phagocytosis - absorption of the pathogen by cells of the immune system), B - toxicity, C - is adsorbed on erythrocytes.

Adenovirus

Causes of infection with adenovirus infection

The source is a sick person who excretes the pathogen with nasal and nasopharyngeal mucus, and later with feces. There is also a risk of infection from virus carriers( 95% of the total population).Ways of infection - airborne, and later fecal-oral. The most susceptible contingent is children from 6 months to 5 years, up to 3 months in infants have passive nonspecific immunity( as a result of the positive effects of breastfeeding).Also poorly diagnosed fall-winter epidemic outbreaks are characteristic because of a decrease in the systemic immune status.

Symptoms of adenovirus infection

When entering the epithelial cells, the incubation period begins( the period without symptoms - from the onset of infection to the first common manifestations), this period can last from 1-13 days. In this period, there is an attachment to cells, the introduction of the virus into the nuclei of cells, the synthesis of the DNA of the virus by suppressing the DNA of the cell, followed by the death of the affected cell. As soon as the ripening of the virus is over and the mature pathogens are formed, the prodromal period, characteristic for all SARS, begins, the disease lasts from 10-15 days.

The peculiarity of infection with adnovirus is a sequence of organ and tissue lesions: nose and tonsils, pharynx, trachea, bronchi, conjunctiva, cornea, intestinal mucosa. And so, consistently changing symptoms:

1. The onset of the disease can be either acute or gradual, it depends on the immune status.
In the beginning there will be symptoms of intoxication( chills, mild headache, aching in the bones / joints / muscles);
By 2-3 days the temperature rises to 38-39 ⁰С;
Nasal congestion with serous discharge, which is replaced by mucous, and then purulent.
Tonsils are hyperemic( reddened), with whitish coating in the form of dots.
Increased submandibular and cervical lymph nodes.

2. Lesion of the pharynx, trachea, bronchi - laryngopharyngotracheitis, followed by bronchitis;all this manifests itself:
- hoarseness of voice;
- there is a dry / barking cough, which in the future is replaced by a moist different. Chryps after a cough do not disappear, are present both on inhalation and exhalation;
- followed by shortness of breath, with the involvement of ancillary musculature( retraction of intercostal spaces);
- cyanosis of the nasolabial triangle indicates decompensation from the cardiovascular system, namely, increasing pressure in the small circle and increasing the load on the left heart.

The bright clinical picture, accompanied by severe respiratory manifestations, is more typical for young children, this is due to the hyperreactive response of lung tissue in children.

3. When the conjunctiva and the cornea are affected, the symptoms of keratoconjunctivitis-pain and eye pain, copious mucosal discharge, congestion hyperemia( redness and swelling), and scleral involvement are manifested. Often observed the formation of films on the conjunctiva.

4. When lesions of the intestinal mucosa, as a response, mesadenitis is manifested( hyperplasia of the lymphoid tissue of the intestine - as an increase in lymph nodes, only in the intestine), with the following clinic:
- paroxysmal pains in the navel and right iliac region( this symptom can beconfused with appendicitis, therefore urgent hospitalization is needed)
- bowel dysfunction

Diagnosis of adenovirus infection

1. More often diagnosis based on clinical manifestations successively replacing each otherRuga for 3 days
2. Additional methods of research:
- immunofluorescence( This is eksperess-by and gives the answer about the presence of the complex Ag-Ab( antigen-antibody) for a few minutes)! !!And therefore it is considered the most effective.
- Virological method( definition in smears of virus prints)
- Serological methods: RSK, RTGA, PH - these methods are highly sensitive and specific, but time consuming and long( waiting for the result to reach 3-7 days).

All these methods are aimed at detecting the pathogen andspecific antibodies( except virologic - in this case only the causative agent is detected).

Treatment of adenovirus infection

1. Etiotropic therapy( antiviral).Often people with the first symptoms of a cold do not turn to specialists, and engage in self-medication. In this case, the choice of drugs should fall on broad-spectrum virocidal drugs that are acceptable for use at an early age:

• Arbidol( from 2 years) is applied within 6 days, taking into account the age-related dosages of
• Ribovirin( virazole),
• Countercale or Gordox(blocks the entry of viruses into the cell and the synthesis of viral DNA);
• Oxalin ointment, or Bonaphoton, or Lokferon( antiviral therapy for topical application).
• Deoxyribonuclease in the form of ointments and eye drops( blocks the reproduction of DNA)

2. Immunomodulators - IF( interferon, sold in a pharmacy, in ampoules - the content is diluted with warm water until divided, pipetted and dripped into the nasopharynx, trying to get on the back wallpharynx).

3. Immunostimulants:

• Cycloferon,
• Anaferon( from 6 months after birth),
• Echinocicea( naturally added to tea)

4. Antibiotics: they are used when attaching secondary microflora as a local remedy and systemicapplication, in the absence of the effect of the therapy within 3 days, with the defeat of the respiratory tract( because bronchitis is rarely only bacterial or only viral origin - often combined).Local antibiotics( they can be used in combination with antiviral drugs):

• Hexoral,
• Lysobact,
• Jox( as antiseptic),
• Stopangin,
• Imudon.

Systemic antibiotics: the drug of choice are cephalosporins 2 or 3 generations( cefatoxime - bribes its cheapness and efficiency);but systemic antibiotics of this group only parenteral administration, ie intramuscularly or intravenously( which is not welcomed by children).

5. Symptomatic therapy:

- In case of a runny nose, it is necessary to start rinsing with a warm weak saline solution or an analogue of Aqua-Maris. After that, to remove the swelling of the mucosa and as an antiseptic drug, you can apply Pinosol or Xylen( very effective in severe swelling, but it is addictive).
- Antitussive therapy: inhalations with isotonic solutions + non-narcotic antitussives( Sinekod, Stoptussin) + Expectorants( decoction of thyme, mucaltin, "cough tablets", ACC) + Erespal( a complex drug, as an expectorant and as anti-inflammatory, but it is better to use it alreadyin the late stages of bronchitis, when the exhaust mucus is not so abundant, because it may reduce the availability of the drug).

Complications of adenovirus infection

otitis media, sinusitis, tonsillitis, pneumonia, exacerbation of chronic diseases, neurotoxication, DIC-syndrome, infectious-toxic shock, stenosis of the larynx, bronchial obstruction.

Prevention of adenovirus infection

For 1-2 weeks of rising incidence of SARS, immunomodulators and immunostimulants are used( the drugs are listed above), the use of Oksolin Ointment, IRS-19( it can be used from 3 months to stimulate specific and non-specific immunity - after preliminary cleansing from mucus, use 1 dose /on each nostril, 2 times a day, for 2 weeks).Specific vaccination has not yet been developed.

Consultation of a doctor for adenovirus infection

Question: Is it necessary to conduct routine vaccination at the time of rising morbidity?
Answer: Required! But at the same time, absolute contraindications( acute disease at the time of vaccination, exacerbation of chronic diseases, etc.) should be taken into account. Vaccination is necessary, because it is built on the basis of a genetically altered influenza virus, that is, that which will be distributed, also taking into account other pathogens.

Question: Is treatment at home acceptable?
Answer: If the patient's age is older than 5 years, then yes. Up to this point, there is a very high risk of generalization and lightning-fast infection with a high lethal outcome. It's just possible not to have time to save.

Physician therapist Shabanova IE