Paragripp - Causes, symptoms and treatment. MF.

Paragripp is an acute infectious disease( referred to as acute respiratory viral infection) caused by viruses from the family of paramyxoviruses, and mainly affecting the mucous membrane of the nose and larynx, with concomitant moderate general intoxication.

Paragripp combines 5 types of RNA-containing viruses, but they are larger than other RNA viruses. Like all virions, they have an antigenic structure, but it is stable( which is not typical for most viruses), there is also no species variability of the genome - all this relative stability gives confidence for further successful prevention and treatment, and also prevents epidemic prevalence. Antigenic structure - type-specific proteins that cause certain symptoms in humans, in parainfluenza viruses their 2( H and N) - they are responsible for fixing viruses to cells( H) and blocking receptors for viruses on these cells( N), especially in mucous membranes, inincluding causing erythrocyte agglutination( H).

Parainfluenza virions are not stable in the external environment, so at normal room temperature die in 2-4 hours, and at 50 ° C - for 30 minutes. For parainfluenza infection, seasonality is not typical, but sporadic outbreaks are characteristic in the autumn-winter months. It is believed that the parainfluenza virus is more common in preschool and primary school children than other ARI at the time of morbidity, and is often the cause of group outbreaks.

Causes of parainfluenza

The source is a sick person. The path of infection - airborne( ie, with direct and prolonged contact, for example, during a conversation).But even with such contact, there is no absolute certainty of infection, but only 6-22%, and the sensitivity level is affected by the initial level of antibodies at the time of contact.distance from the source of infection, duration of contact, phase of the infectious process in the patient.

Symptoms of parainfluenza

The incubation period( from the moment of introduction of the virion, to the first symptoms) is 2-7 days;The entrance gate of the pathogen is the mucosa of the upper respiratory tract, the antigens of the virion cause the attachment to the mucosa( due to the "H") of the VDP and the penetration into the gliding tissues( due to "N") - after the incubation period, because of sufficient accumulationthe causative agent and reducing the protective forces of the body, there is a prodromal period.

The prodromal period is the beginning of common catarrhal phenomena. Lasts for an average of 7 days and begins earlier, the weaker the body, characterized by the symptoms:

• temperature rise to subfebrile-febrile digits( up to ≈38.5 ° C),
• swelling of the nasal mucosa followed by rhinorrhea( nasal flow, often mucous),
• general malaise, common to all SARS,
• reddening of the walls of the oropharynx, especially the posterior wall,
• barking cough almost from the first day of the disease, it is coarse, debilitating, dry, accompanied by hoarse voice and suffocationfor children under 5 years of age),
• a moist cough may be added in case of compromised respiratory tract of the lower parts( ie, smokers, people with chronic bronchitis, who have transferred tuberculosis, etc.).This period can last a little longer with the addition of a secondary bacterial flora.

Diagnosis of parainfluenza

1. Objective characteristic - the primary lesion of the larynx with the formation of a "barking" cough.
2. Immunofluorescence refers to the express method and gives an answer in a few minutes about the presence of the Ar-Am complex( antigen-antibody), ie it indicates the presence of the virus from the nasal discharge and the presence of specific antibodies.
3. Serodiagnostics( RTGA, DSC, ELISA) - also shows the presence of the Ar-Am complex, but in the blood and after a while waiting for the results;The advantage is due to ELISA because of its high sensitivity, because it indicates an increase in the titer of At IgG and M( immunoglobulins = antibodies of class M-indicates an acute period, and G-characterizes the infectious process approaching the end or already about its termination);But these methods are not specific, because they have cross-sensitivity to other SARS( in particular, to influenza and mumps).
4. The general analyzes( OAB and OAM) are not very informative and will only indicate the inflammatory picture( UAC) or complications / decompensation of the renal and pelvic system( OAM)

. Usually, doctors are limited to examination and objective characteristics when diagnosing without differentiatingparainfluenza and ARVI, that is, the diagnosis of acute respiratory viral infection is made, the other methods of examination are used in the presence of complications.

Parainfluenza treatment

Because of the similarity of parainfluenza symptoms to other acute respiratory viral infections, the choice is made in favor of broad-spectrum virocidal medications, narrow-spectrum can and should be used only after laboratory confirmation of the alleged diagnosis.

1. Etiotropic therapy( directed against the pathogen):
- Arbidol( inhibits the fusion of viruses with epithelial cells) - can be from 2 years. From 2-6 years, 2 tablets a day before meals.6-12 years for 4 tablets. From the age of 12 - 8 tab. Take before meals, for 5 days.
- Ribavirin( virazol) - is prescribed for children over 12 years of age at a dose of 10 mg / kg / day, for 5-7 days.
- Isoprinosine - 50 mg / kg and divided into 3 doses for 10 days, taken after meals.
- For topical application Oksolinovaja ointment intanazalno( in a nose), Bonafton, Lokferon.

2. Interferons are immunomodulators, they have universal virocidal properties, because they suppress the replication( splitting) of DNA and RNA of viruses, and stimulate immunological reactions of the organism.
- Interferon-α 5 drops every 30 minutes for 4 hours, in the following days - 5 times a day for 5-7 days.
- Viferon in candles - 2 candles per day.

3. Interferonogenesis inductors - immunostimulants.
- Cycloferon: from 4-6 years, 1 tablet, 7-11 years - 2 tablets, adults 3 tablets.
- Anaferon - it is possible for children from 6 months of age: on the first day 4 tablets, after - 1 tablet 3 times a day. Course 5 days.

4. Symptomatic treatment:

• antipyretic drugs( Ibuprofen, Nurofen),
• antitussives are prescribed taking into account the nature of the cough and its localization( with laryngitis at the time of parainfluenza - Sinecod, Stoptusin, Tusuprex, if the process descended lower and the cough acquired a different character,then appoint expectorants, mucolytics);
• anti-inflammatory( respiratory tract) - Erespal;
• If the treatment does not give positive dynamics for 3 days and the temperature continues to rise, reaching critical figures, then after consultation with a doctor, they switch to antibiotic therapy.
• cupping of rhinitis( washing of the nasopharynx - AquaMaris or weak saline solution, withdrawal of puffiness - Pinosol or Xylen).

Treatment with folk remedies

This path is acceptable, but if an older child, tk younger children or patients with concomitant severe pathology are prone to lightning current and generalization of the process. Especially dangerous is the development of croup( a triad of symptoms, the leading of which is a symptom of suffocation - in this case, immediate hospitalization is necessary).

1. Antimicrobial and anti-inflammatory folk remedies: St. John's wort, chamomile, sage, eucalyptus, calendula.
2. Antiviral / antibacterial: garlic, onion, raspberry, blackberry, Echinocice, pomegranate skins( the strongest antibacterial properties to which there is no stability).
3. Sugary / fever: linden, raspberry, mother and stepmother.
4. Expectorants: mother and stepmother, quince, oregano, licorice, breast-feeding №1.Spasmolytic effect on the bronchi: chamomile, dill, breast collection number 1.Complications of parainfluenza:

   pneumonia( due to secondary bacterial complications), croup( barking cough, hoarse voice with suffocation attacks due to stenosis of the larynx, occurring more often at night and in children under 5 years), exacerbation of chronic diseases.

   Parainfluenza prophylaxis:

   preparations used for treatment, but in prophylactic dosages.

   Arbidol with 2-6 years for ½ tablets before or after meals for 30 minutes;up to 12 years - 1 tablet;after 12 years - 2 tablets;course of admission - 2 weeks.

   Interferon-α( dilute the ampoule with warm water to the label and pipet, then apply intranasal 2-3 times a day.) Try to get on the back wall of the pharynx( where the lymphoid tissue is concentrated), and not on the back of the nose).Cycloferon, Echinocicea( the same immunal, but cheaper) add a few drops to the tea.

   The patients should also be isolated for 7-14 days, a two-time wet cleaning with disinfectants is carried out, a separate dish is allocated for the patient.

   A good prevention of viral and bacterial diseases is a full breakfast, because thus the antibodies are activated and there is an easy sensitization of the organism to foreign agents. Specific prevention in the form of vaccination - no.

   Consultation of the parainfluent physician

   Question: Why is there no vaccine against parainfluenza infection?
   Answer: yes, it is not advisable, because it causes an increase in specific antibodies in the blood, and the site of the pathogen introduction remains intact( ie, in the nasal mucosa) and the virus freely penetrates the body, causing moderate intoxication. In the case of prophylaxis, it is more appropriate to use local antiviral ointments( Oxolinic) before visiting public places.

   Doctor therapist Shabanova IE