Respiratory tract infections - Causes, symptoms and treatment. MF.

Causes of
Symptoms of a respiratory infection
Complications of
Diagnosis of infection
Treatment of
Prevention of

Respiratory infections occupy a leading place in the infectious pathology of various organs and systems, traditionally the most massive in the population. Respiratory infections of various etiologies are averaged every year, and every year, more than once a year. Despite the prevailing myth about the favorable nature of most respiratory infections, one should not forget that pneumonia( pneumonia) is the first cause of death from infectious diseases, and is also among the five common causes of death.

Respiratory tract infections are acute infectious diseases that result from the ingress of infectious agents through the aerogenic mechanism of infection, that is, they are contagious, affecting the respiratory system both primary and secondary, accompanied by inflammatory conditions and characteristic clinical symptoms.

Causes of development of respiratory tract infections

The causative agents of respiratory infections are divided into groups according to the etiologic factor:

1) Bacterial causes of ( pneumococci and other streptococci, staphylococcus, mycoplasma, pertussis, meningococcus, diphtheria, mycobacteria and others).
2) Viral causes of ( influenza virus, parainfluenza, adenovirus, enterovirus, rhinovirus, rotavirus, herpetic virus, measles virus, mumps, etc.).
3) Fungal causes of ( fungi of the genus Candida, aspergillus, actinomycetes).

Respiratory infections

Source of infection is a sick person or carrier of an infectious agent. The infectious period with respiratory tract infections usually begins with the onset of symptoms of the disease.

The infection mechanism is aerogenic, which includes an airborne pathway( infection in contact with a patient by inhaling aerosol particles during sneezing and coughing), airborne dust( inhalation of dust particles with infectious agents contained therein).With certain infections of the respiratory system due to the stability of the pathogen in the external environment, transmission factors - household items, which are allocated to the discharge of the patient when coughing and sneezing( furniture, handkerchiefs, towels, dishes, toys, hands, etc.) are important. These factors are relevant in the transmission of infections for diphtheria, scarlet fever, mumps, angina, tuberculosis.

Mechanism of infection with respiratory infection

Susceptibility of to pathogens of respiratory tract infections is universal, people can be infected from early childhood to the elderly, but the special feature is the mass coverage of a group of children of the first years of life. There is no dependence on sex, they are equally sick, both men and women.

There is a group of risk factors for respiratory disease:

1) The resistance of the entrance gate of infection, the degree of which is exerted by
is significantly affected by frequent colds, chronic process in the upper respiratory tract.
2) The general reactivity of the human body - the presence of immunity to a particular infection.
Vaccination with controlled infections( pneumococcus, whooping cough, measles, mumps), seasonally controlled infections( influenza), vaccination according to epidemiological indications( in the first days after contact with the patient) plays a role.
3) Natural factors( hypothermia, dampness, wind).
4) The presence of secondary immunodeficiency due to concomitant chronic diseases
( pathology of the central nervous system, lungs, diabetes, liver pathology, oncological processes and others).
5) Age factors( in the risk group, preschool age and elderly people
are over 65 years old).

Infections of the respiratory tract, depending on the distribution in the human body, are conventionally divided into four groups:

1) Infections of the respiratory organs with propagation of the pathogen in the entrance gates of the infection, that is, at the site of implantation( the whole group of acute respiratory infections, whooping cough, measles and others).
2) Infections of the respiratory tract with the place of introduction - the respiratory tract, but with the hematogenous spread of the pathogen in the body and its multiplication in the organs of damage( this is how epidemic parotitis, meningococcal infection, encephalitis of the viral etiology, pneumonia of various etiologies develop).
3) Infections of the respiratory tract with subsequent hematogenous spread and secondary damage to the skin and mucous membranes - exanthem and enanthema( chickenpox, smallpox, leprosy), and the respiratory syndrome in the symptoms of the disease is not typical.
4) Respiratory tract infections with oropharyngeal and mucous membrane damage( diphtheria, angina, scarlet fever, infectious mononucleosis and others).

A brief anatomy and physiology of the respiratory tract

The respiratory system consists of the upper and lower respiratory tract. The upper respiratory tract includes the nose, the paranasal sinuses( the maxillary sinus, the frontal sinus, the trellis labyrinth, the sphenoid sinus), partially the oral cavity, the pharynx. The lower respiratory tract includes the larynx, trachea, bronchi, lungs( alveoli).The respiratory system ensures gas exchange between the human body and the environment. The function of the upper respiratory jackets consists in warming and disinfection of the air entering the lungs, and direct gas exchange is performed by the lungs.

Diagram of the respiratory system

Infectious diseases of the anatomical formations of the respiratory tract include:
- rhinitis( inflammation of the nasal mucosa);sinusitis, sinusitis( inflammation of the nasal sinuses);
- tonsillitis or tonsillitis( inflammation of the palatine tonsils);
- pharyngitis( inflammation of the pharynx);
- laryngitis( inflammation of the larynx);
- tracheitis( inflammation of the trachea);
- bronchitis( inflammation of the bronchial mucosa);
- pneumonia( inflammation of lung tissue);
- alveolitis( inflammation of the alveoli);
- combined defeat of the respiratory tract( the so-called acute respiratory viral infection and acute respiratory disease, in which there are laryngotracheitis, tracheobronchitis and other syndromes).

Symptoms of respiratory infections

The incubation period for respiratory tract infections varies from 2-3 days to 7-10 days, depending on the pathogen.

Rhinitis - inflammation of the nasal mucosa. The mucous membrane becomes swollen, inflamed, maybe with exudation and without it. Infectious rhinitis is a manifestation of ARVI and ARI, diphtheria, scarlet fever, measles and other infections. Patients complain of nasal discharge or rhinorrhea( rhinovirus infection, influenza, parainfluenza, etc.) or nasal congestion( adenovirus infection, infectious mononucleosis), sneezing, malaise and lacrimation, sometimes a small temperature. Acute infectious rhinitis is always two-sided. Discharge from the nose can have a different character. Viral infection is characterized by clear liquid, sometimes dense discharge( so-called serous-mucous rhinorrhea), and for bacterial infection mucous discharge with a purulent component of yellow or greenish flowers, turbid( purulent purulent rhinorrhea).Infectious rhinitis rarely occurs in isolation, in most cases other symptoms of mucosal infection of the respiratory tract or skin soon join.

Inflammation of the nasal sinuses ( sinusitis, etmoiditis, frontalitis).More often has a secondary character, that is, develop after the defeat of the nasopharynx. Most of the lesions are due to the bacterial cause of respiratory tract infections. With genyantritis and etmoiditis patients complain of stuffiness in the nose, difficulty in nasal breathing, general malaise, runny nose, temperature reaction, impaired sense of smell. At the front, patients are concerned about the thrust in the nose, the headaches in the frontal region are more in the upright position, thick discharge from the nose of purulent nature, fever, small cough, weakness.

Where is the sinus and how is its inflammation called

Angina( tonsillitis) can be both viral and bacterial aetiology. Tonsillitis is an inflammatory process in the oropharynx in the area of ​​palatine tonsils. Patients are concerned about sore throat when swallowing( except diphtheria, when the pain is minor), difficulty drinking, eating, temperature, general weakness. Upon examination, the mucous membrane of the oropharynx is hyperemic( reddened), a slight swelling of the throat( except for diphtheria, in which the edema can be significant and is a dangerous symptom in terms of the development of the toxic form of the disease), tonsils increase in size to 1-3 degrees depending on the severity of the process,on tonsils appear overlap. If the process is catarrhal, the relief of the tonsils is smoothed and there are no overlaps, the same is true for the viral etiology of the sore throat. If this is purulent angina, then the suppuration of the purulent nature is greenish-yellowish, loose, easily removed by a spatula, located in lacunae of tonsils or on all surfaces( except diphtheria, in which the overlays are grayish white, dense, hard to remove spatula, leaving a bleeding surface after itself).In the fungal process, the overlays on the tonsils look like curdled milk, whitish-grayish color, easily removed by a spatula from the surface of enlarged tonsils, often spread to the sky, tongue. With a widespread process, the overlays can extend beyond the borders of the tonsils.

Viral angina

Purulent angina

Diphtheria

Pharyngitis is an inflammation of the pharyngeal mucosa. It is often associated with other symptoms, but it is also found in isolation. Patients complain of perspiration in the throat, subfebrile temperature or lack thereof, dry cough, which is sometimes rather painful, difficulty breathing, general malaise. Pharyngitis is a manifestation of many ARVI, in particular influenza, parainfluenza, scarlet fever, measles.

Laryngitis - inflammation of the mucous larynx, and sometimes epiglottis, vocal cords. It can be a manifestation of various respiratory infections( influenza, parainfluenza, whooping cough, scarlet fever, measles, diphtheria and others).In patients, laryngitis is characterized against a background of general malaise and temperature by the appearance of hoarseness, coarseness and hoarseness up to loss of voice, barking coughing, difficulty breathing. The danger of developing laryngitis is that it is possible to develop complications - croup or stenosis of the larynx - a sharp violation of breathing due to swelling of the mucous membrane and narrowing of the larynx lumen, as well as spasm of the laryngeal muscles. The croup can be true( diphtheria), which develops gradually after the appearance of all the symptoms of diphtheria, and false( parainfluenza), when the child has a sharp difficulty in breathing against the background of acute respiratory infections. And in that, and in another case, you urgently need to call a doctor.

Tracheitis - inflammation of the mucous membrane of the trachea - a tube that connects the larynx with the main bronchi. Tracheitis is the main clinical syndrome for influenza, but it can also occur in bacterial infections. Patients are troubled by symptoms of intoxication( temperature, general weakness and malaise), sore pain in the upper chest behind the sternum, the appearance of a dry night and morning cough, and during the day provoking cough irritants - talking, laughing, cold air, deep breath and exhalation. With combined laryngotracheitis, the voice can be hoed. Most cough is dry, but with the addition of bronchitis can be with spitting phlegm as a mucus( viral nature), and purulent( bacterial process).

Bronchitis is an inflammation of the bronchial mucosa. Bronchitis accompanies the majority of respiratory tract infections and is manifested by common symptoms of intoxication, possibly previous symptoms of upper respiratory tract infection, and is characterized by the appearance in patients of a cough both dry and wet with the departure of sputum mucous or mucopurulent.

Pneumonia is an inflammation of the lung tissue, the bulk of which is caused by bacteria, in particular pneumococcus, but there are also pneumonia of another etiology. The main complaints are fever from subfebrile to febrile, increasing weakness, decreased appetite, chills and excessive sweating, general malaise, an intensifying productive cough( with phlegm).The nature of sputum will completely depend on the cause that caused the disease( in more detail in the article: pneumonia).

Pneumonia

Alveolitis is an inflammation of terminal airways that can occur in candidiasis, legionellosis, aspergillosis, cryptococcosis, Ku-fever and other infections. In patients, there is a pronounced cough, shortness of breath, cyanosis against the background of temperature, weakness. The outcome may be fibrosing of the alveoli.

Alveolitis

Complications of respiratory infections

Complications of respiratory tract infections can develop with prolonged process, lack of adequate medication and late referral to a doctor. This can be a syndrome of croup( false and true), pleurisy, pulmonary edema, meningitis, meningoencephalitis, myocarditis, polyneuropathy.

Diagnosis of respiratory infections

Diagnosis is based on a combined analysis of the development( history) of the disease, an epidemiological history( previous contact with sick respiratory infections), clinical data( or objective examination data), laboratory evidence.

The general differential diagnostic search is reduced to the division of viral infections of the respiratory tract and bacterial infections. So, for the viral infections of the respiratory organs, the following symptoms are typical:

• acute onset and rapid rise in temperature to febrile digits depending on
of severity, expressed symptoms of intoxication - myalgia, malaise, weakness;
• development of rhinitis, pharyngitis, laryngitis, tracheitis with secretions of mucous nature,
transparent, watery, sore throat without overlap;
• On objective examination, the injection of scleral vessels,
pointwise hemorrhagic elements on the mucous throat, eyes, skin, facial pastness, often with hard breathing and absence of wheezing are often detected in case of auscultation. The presence of wheezing, as a rule, accompanies the attachment of a secondary bacterial infection.

In the bacterial nature of respiratory tract infections:
• subacute or gradual onset of the disease, blurred temperature rise to 380, rarely
higher, mild symptoms of intoxication( weakness, fatigue);
• secretions with bacterial infection become thick, viscous, acquire
color from yellowish to brown-green, cough with sputum of various amounts;
• objective examination shows purulent overlays on tonsils, with auscultation
dry or differently-sized wet rales.

Laboratory diagnostics of respiratory tract infections:

1) The general blood test changes for any acute respiratory tract infection: leukocytes, ESR,
increase for bacterial infection is characterized by an increase in the number of neutrophils, the acceptance of a stabbing inflammatory shift to the left( increase in rods against segmented neutrophils)lymphopenia;for viral infections, the shifts in leukoformula are of the nature of lymphocytosis and monocytosis( an increase in lymphocytes and monocytes).The degree of disturbance of the cellular composition depends on the form of severity and the course of infection of the respiratory system.
2) Specific assays for identifying the causative agent of the disease: analysis of mucus of the nose and throat on
viruses, as well as on the flora with the detection of sensitivity to certain drugs;sputum analysis on flora and antibiotic sensitivity;bactose mucus throat on BL( Leffler's bacillus is a causative agent of diphtheria) and others.
3) If a specific infection is suspected, taking blood for serological tests for
will determine the antibodies and their titers, which are usually taken in dynamics.
4) Instrumental methods of examination: laryngoscopy( determination of the nature of
inflammation of the larynx mucosa, trachea), bronchoscopy, radiographic examination of the lungs( identification of the nature of the process in bronchitis, pneumonia, the extent of inflammation, the dynamics of treatment).

Treatment of respiratory infections

The following types of treatment are distinguished: etiotropic, pathogenetic, symptomatic.

1) Etiotropic therapy is directed to the causative agent that caused the disease and has the goal of
stopping its further reproduction. It is from the proper diagnosis of the causes of the development of respiratory tract infections that the tactics of etiotropic treatment depend. The viral nature of infections requires the early administration of antiviral agents( isoprinosine, arbidol, kagocel, remantadine, tamiflu, relenza and others), which turn out to be completely ineffective in ARD of bacterial origin. In the bacterial nature of infection, the doctor prescribes antibacterial drugs taking into account the localization of the process, the timing of the disease, the manifestation of symptoms, the age of the patient. With angina, these can be macrolides( erythromycin, azithromycin, clarithromycin), betta-lactams( amoxicillin, augmentin, amoxiclav), in bronchitis and pneumonia, it can be both macrolides and betta-lactams and fluoroquinolone formulations( ofloxacin, levofloxacin, lomefloxacin) and others. The appointment of antibiotics to children has a serious testimony for this, which only the doctor adheres to( age points, clinical picture). The choice of the drug remains only for the doctor! Self-medication is fraught with the development of complications!

2) Pathogenetic treatment of is based on the interruption of the infectious process with the aim of facilitating the course of infection and shortening the duration of recovery. The drugs of this group include immunomodulators for viral infections - cycloferon, anaferon, influferon, lavomax or amixin, viferon, neovir, polyoxidonium, for bacterial infections - bronchomunal, immunon, IRS-19 and others. Also in this group may include anti-inflammatory combination drugs( erespal, for example), non-steroidal anti-inflammatory drugs in the presence of indications.

3) Symptomatic therapy of includes tools that facilitate the quality of life for
patients: in rhinitis( nasol, pineasol, tizin and many other drugs), with angina( pharyngosept, falimint, hexoral, yox, tantum verde and others),when coughing, expectorants( preparations of thermopsis, licorice, althaea, thyme, mucaltin, pertussin), mucolytics( acetylcysteine, ACC, mucobenes, carbocysteine ​​(mucodine, bronchkatar), bromhexine, ambroxol, ambrohexal, lazolvan, bronhosan), combined preparations( broncholitin,gedelix, bronchocin, Ascoril, Stoptussin), antitussives( sinecode, glaucent, glaucin, tussine, tusuprex, libexin, falimint, bitiodine).

4) Inhalation therapy ( steam inhalation, use of ultrasound and jet
inhaler or nebulizer).

Nebulizer

5) Folk remedies for the treatment of in respiratory infections include inhalation and ingestion of infusions and infusions of chamomile, sage, oregano, linden, thyme.

Prevention of respiratory infections

1) Specific prevention includes vaccination in a number of infections( pneumococcal
infection, influenza - seasonal prophylaxis, childhood infections - measles, rubella, meningococcal infection).
2) Nonspecific prophylaxis - the use of prophylactic drugs in the season of colds
( autumn-winter-spring): remantadine 100 mg 1 time / day during an epidemic rise, amixine 1 tablet 1 time / week, dibazol ¼ tablets 1 p / day, withcontact - arbidol 100 mg 2 times a dent every 3-4 days for 3 weeks.
3) Folk prophylaxis( onions, garlic, decoctions of lime, honey, thyme and oregano).
4) Avoid overcooling( clothing for the season, a short stay in the cold, keep your feet warm).

The doctor infektsionist Bykova N.I.