Influenza is an infectious viral disease that affects the respiratory system (respiratory tract) of a person. Despite the fact that the symptoms of influenza are pretty similar to the signs of an ordinary cold, these diseases are fairly easy to distinguish. The cold is characterized by a runny nose, throat pain and not heat. The disease usually passes in 3-5 days.
The flu has a sharp start. After an incubation period, which lasts from one to four days, the patient begins to complain about headaches, back pain, muscles, as well as trembling all over the body. The appearance of a runny nose, tracheitis, a patient may have an atponed voice, a dry cough, a loss of appetite, nausea and insomnia.
Different types of flu epidemics are determined by different symptoms. For example, besides the symptoms that are detected in the upper respiratory tracts, abdominal pains, diarrhea, vomiting may occur.
Basic symptoms
- Heat
- Loss of appetite
- Sore throat
- Total weakness and pain in the muscles
- Strong malaise and decay
Complications
Complications mainly occur due to additional contamination by pathogenic bacteria. Complications may be different:- hypertension is an extremely high body temperature, accompanied by a crazy condition, convulsions and a coma. Such a manifestation of the disease can occur in young children and in people of old age;
- acute bronchitis is especially characteristic of older people;
- flight disease - changes in the nervous system;
- pneumonia arises in people who have diseases of the cardiovascular system. Infection of pneumonia due to bacteria, Staphylococcuspyogenes can carry even more serious consequences;
- encephalitis - brain inflammation;
- myocarditis - inflammation of the heart muscle;
- aggravation of diabetes;
- depression;
- unexpected death (especially in people of old age).
Antigenic variability
The unusual structure of the influenza virus contributes to its rapid distribution among the population.The influenza virus shell contains two characteristic protein - hemagglutinin and neuraminidase. Hemagglutinin provides the ability of the virus to join a healthy cell. Neuraminidase is responsible for the ability to penetrate the host cell and leave it after breeding. These two surface antigens are very variable and determine different strains of one type of virus. The flu virus has two antigenic variability mechanism - antigen drift and antigenic shift.
In antigen drift, minor mutations occur in genes encoding the surface proteins of the virus. These changes lead to the fact that the existing antibodies in the human body do not cope with the modified virus, and re-infection occurs.
The antigenic shift (shift) is a more radical and long-term process, in which different viruses are exchanged by genetic material, as a result, absolutely new flu strains are formed to which the immunity is absent from the majority population. This process, as a rule, causes a pandemic.
Distribution and prevention
Most of the population over time acquires immunity to various kinds of infections, but the ability of influenza viruses A and in mutation leads to new epidemics each year, especially in winter.There are many strains of influenza virus. With the help of laboratory studies, scientists have learned to determine the type of virus that will play at the moment, as well as foresee the emergence of new strains. The peak of the activity of a new type of influenza virus occurs, as a rule, 2-3 years after its open. This makes it possible to prepare a vaccine and prevent a possible epidemic.
Due to the permanent genetic changes in influenza viruses, the composition of vaccines is updated annually, including the latest influenza A and V. Circulating viruses in it due to the fact that there is a risk of re-infection, it is recommended to conduct annual vaccination among the following groups of people:
- having chronic heart disease and chest organs;
- accepting immunization therapy;
- over 65 years old;
- living in homes for the elderly, boarding schools and other institutions;
- diabetics;
- having a kidney disease.
Diagnosis and forecasting
Clinical diagnosis that takes into account the history of the patient's disease is a sufficient reason for the start of treatment. Fuel complaints may be isolated, but if several patients have similar symptoms, it is possible to suspect the beginning of the epidemic.It is necessary to analyze the blood of patients with suspicion of flu in order to identify the type of virus. However, this procedure is carried out only if the risk of an epidemic is possible. Forecasts for treatment are usually favorable. Children and people of old age should be under the permanent supervision of the doctor, especially if there is a risk of complications.
The reasons
There are three types of influenza viruses - A, B and C. From year to year, these viruses are exposed to antigenous changes, which leads to various variations of this infection. Until recently, the variety of virus was considered to be called by the name of the terrain, where this species was recorded for the first time. For example, Peking, Gongkong or Russian flu.It is believed that the virus is easily transmitted by a person to a person with air-droplet while selecting the smallest particles during coughing or sneezing.
Treatment
The special method of treating the virus does not exist, but the following is recommended to combat infection:- bed mode;
- abundant drink;
- reception of paracetamol or acetylsalicylic acid in order to control the body temperature.
The human body. Outside and inside. №9 2008.
Flu - caused by a specific virus of various serological types acute infectioncharacterized by symptoms of general intoxication and lesions of mucous membranes respiratory tract.
Along with isolated cases, the disease may have a wide epidemic distribution.
Historical data. In antiquity, physicians were known for human diseases with a clinical picture of the modern flow of influenza.
Starting from the XII century, large flu epidemic was described, often taking the character of pandemic.
Throughout the XIX century, four influenza pandemics were observed in Europe (in 1830-1833, in 1836-1837, 1847-1848, 1889-1890).
The colossal dimensions took the influenza pandemic in 1918-1920, which covers not only America and Europe countries, but also other continents. Extremely seriously flowing flu during this pandemic took a lot of human lives. The extremely serious flow of influenza, apparently, was associated with a large, virulence of the pathogen - passage virus, which was highly adopted to the human body with continuous transmission of it in an epidemic from patients with healthy people. In the future, the influenza disease was significantly more favorable.
In 1957 there was a pandemic of influenza. The causative agent of the disease belonged to the type A2. In early 1959, in a number of settlements, flashes of influenza were noted caused by the same pathogen. These outbreaks circulated other strains in 1961 and 1965.
Etiology. The flu is caused by a specific virus (pheumophilus gripposus) of several serological types (A, B, C), in turn virus A has four serological subtype a 0, and 1, a 2, and 3. Meanwhile, they differ in antigenic structure, and in case of influenza of the same type, immunity against other varieties is not formed.
In the external environment, the influenza virus quickly dies under the action of sunlight, high temperature (over 30 ° C), as well as as a result of drying and action on it disinfectants. In the mucus, scattered sick of nasopharynx with chichany and cough, the flu virus can be maintained for quite a long time. At a temperature of 0-4 ° C and frozen form (from -20 to -70 ° C), the virus retains activity for several months.
It was revealed that there was not enough durable immunity, developing after the influenza disease, depends on the variability of its causative agent, the weak immunogenicity of the pathogen, this is a feature of a flu infection.
Epidemiology. In all cases, the source of infection is only a sick person, the patients in the first 1-2 days of the disease are also infectious.
When coughing, chihannia and conversation, the patient splashes into the air and on various items the smallest droplets of mucus containing the influenza virus. As a result, the flu is applied by air-droplet. Along with single cases of influenza, epidemic flashes are observed. In contact with people in everyday life, in transport and in the production setting creates the possibility of broad dispersion of infection. Finding on the mucous membranes of the zea, the nose and the upper respiratory tract of a healthy person, the influenza virus is embedded through the mucous membranes, falls into the blood flow and causes infection.
Effective means The fight against the spread of influenza is currently consisting only in measures of personal prevention and sanitation, as well as in the insulation of patients.
The immunity created by the transmitted disease is not sufficiently durable, and various strains of one or different serological types of the virus (A, A L, A 2 and B) do not create in the cross-cross immunity. Possible influenza diseases within 1 year.
It should be remembered that the factors contributing to infection with the influenza include cooling, colds of the upper respiratory tract, facilitating the introduction of the virus, the active activity of the pathogenic bacterial flora, usually dwelling in the mouth, the nose, on the mucous membrane of the trachea and bronchi.
The pattern of occurrence and development of flu flashes is that the greatest number of cases of diseases are observed after 15-20 days from the start of the outbreak with a further gradual decrease in the incidence rate. The total duration of the epidemic flash 2-2 1/2 months. The incidence of influenza outside the period of flashes is maintained due to sporadic cases.
Clinical picture. The duration of the incubation period of the influenza is an average of about 1-2 days with possible fluctuations from 12 hours to 3 days. First consider the usual course of the disease.
Figure 13 - Temperature Curve in the Patient
uncomplicated influenza.
Uncomplicated flu begins acutely and proceeds with severe intoxication and short (2-3 days) by the feverial period (Fig. 13).
At the beginning of the disease, the patient appears chills, then the temperature is rapidly rises, reaching after 4-5 hours 38.7-39.8 ° C. The health of the patient is significantly worse; His disturbed headacheEspecially in the field of forehead and abnormal arcs, general weakness, breakdown in all body, pain in the joints, dizziness, noise in the ears.
For the initial period of influenza, a feeling of dryness of "scratching" pain in Zev, in the field of pharynx and in the larynx (pharyngitis). Soon there are pain in the eyeballs, especially sharply pronounced when they assign them to the side. The smell is reduced, sound and visual sensitivity, on the contrary, exacerbated. Some patients have conjunctivitis, tearing, runny nose and dry cough. Appetite is usually lowered, the chair is detained. From the side of the neuropsychiatric sphere, irritability and significant excitability of patients are characteristic.
When examining a patient with flu draws attention to hyperemia of the skin of the face and conjunctiva; The number of breathing is rapidly. Blood pressure is somewhat reduced. The pulse frequency is usually lagging behind the temperature level (relative bradycardia), sometimes it is arrhythmic (extrasystole). Heart tones are muffled. In patients with a heavy flowing form of influenza, there is an expansion of the percussion boundaries of the heart (more often to the right), significant deafness of the tones on the top; Sometimes there is a blowing systolic noise associated with the myocardial dystrophy phenomena.
Clinical picture Influenza is rich in neurological symptoms. In some patients, mainly in patients with severe toxic influenza shape, these symptoms can be expressed particularly sharp due to the development of meningoencephalitis, encephalomyelitis, myeloadiculitis and peripheral neurites. The tongue is dry, covered with a white raid from the root, on the mucous membrane of the lips often there are cracks. The liver and spleen are usually not increased.
With an uncomplicated influenza, the fevering period on average lasts 2-3 days (see Fig. 13), occasionally lengthened up to 5 days or reduced to 1 day. At the end of the fevering period, the temperature curve is reduced to the norm critically or accelerated lysis.
In the study of blood in patients with influenza, leukopenia is detected (up to 3-10 3 -3.5-10 3 leukocytes in 1 μl), relative lymphocytosis, a neutrophilic series shift to the left and moderate ESP (an average of 20-22 mm per hour).
There are three main forms of uncomplicated influenza: 1) Light, 2) moderate gravity and 3) severe (toxic).
In addition to the described typical clinical flow of influenza, atypical and erased forms of the disease may be observed. Although such patients are observed easy flow Diseases with small severity and rapid elimination of pathological symptoms, their epidemiological significance as a source of infection is very large. Being unrecognized, these patients may be in the future the source of flu propagation.
With severe, toxic, flu forms, there is a sharply pronounced intoxication of the organism with a predominant damage to the nervous and cardiovascular systems; In such patients, hemorrhagic phenomena on the skin and mucous membranes, nasal bleeding. These severe forms of the disease pose a threat to the patient's life.
In typical cases, after a decrease in temperature, the patient's condition is rapidly improved, the appetite is improved, it becomes calm and long sleep.
Complications. The most characteristic complications of influenza include influenza and staphylococcal focal pneumonia, otitis, inflammation of the apparent cavities of the nose and the frontal sinuses (etmoidits, sinusites, frontitles).
In some patients, neurites of the cranial nerves and shoulder plexuses are developing. With a serious flow of influenza, a quarter of patients noted neurological complications in the form of brain edema and an increase in intracranial pressure. Children and adolescents sometimes there are sharp mental disorders. Immunity with influenza is unstable than the frequency of repeated diseases is explained.
Forecast. In cases of medium severity with light flu forms, the forecast is usually favorable, especially if the patient observed bed regime. With severe (toxic) flu forms, the forecast is doubtful.
Complications not only increase the total duration of the disease, causing a lot of suffering from the patient, but they can also be the cause of death, especially in people of old age, in infants, as well as in the presence of alimentary exhaustion, avitaminosis, chronic diseases Hearts, liver and kidneys. As a result of the influenza disease, the old pulmonary tuberculosis can be activated, and certain complications caused by the activity of staphylococcal and streptococcal flora living on the mucous membranes of the upper respiratory tract.
Treatment: With moderate severity, treatment is carried out at home. Only with the serious course of the disease and in complicated cases, hospitalization in the infectious hospital is practiced.
Bed regime is required for the whole fevering period regardless of the severity of the disease. The patient is placed in a warm, light and well ventilated room (or the ward). It is necessary to warm the patient with the patient to put the heating pads to the legs, give abundant hot drink (milk, fruit juices, tea with lemon and raspberry jam). Recommended a milk-vegetable diet enriched with vitamins. The patient for eating and drinking is distinguished by individual dishes, which is boiling after use.
Persons caring for sick influenza should more often wash their hands with hot water with soap, wearing gauze dressings, covering mouth and nose.
Medicia treatment Depends on the severity of the disease. Patients with light and medium severity forms in the first two days of the disease are prescribed remantadine at 50 mg 3 times a day, the treatment in combination with ascorbic acid continues 3-5 days. It is possible to use inhalation by anti-violence serum 2-3 times a day at 0.5 ml. In every nasal stroke for 2-3 days.
For the elimination of head, muscular and articular pains are prescribed nonarcotic analgesics (Analgin, Baratgin, etc.), for removing cough - anti-tech and expectorant means, etc. Patients suffering from insomnia are prescribed, Barbamil, in cases of stubborn dry cough - codeine. In pronounced violations of cardiovascular functions, patients are prescribed Cordiamine infections, ephedrine, camphor; In other cases, it is enough to limit the appointment of inside the caffeine.
With severe flu forming with pronounced inxication syndrome, anti-hygipose gammaglobulin is introduced intramuscularly.
In the occurrence of complications, antibiotics are used (metacycline, oxacillin, tetracycline, rondomycin, etc.).
In severe intoxication, disintellation solutions are intravenously poured (hemodes - 300-500 ml drip, repeated infusion after 12 hours) with the mandatory use of diuretics (Furademid, Laziks, etc.) and steroid hormones (prednisone, hydrocortisone).
Prevention Provided by sanitary and hygienic and anti-epidemic activities aimed at protecting the population from infection with influenza.
Special influenza prevention is based on the active immunization of the population of the influenza vaccine. There are two types of influenza vaccines - live and inactivated. Live vaccine is introduced into the upper respiratory tract through the nose, inactivated - parenterally with a uncoole injection.
During the epidemic of influenza, preventive measures provide for previously identified patients and isolation from healthy, the obligatory wearing of gauze protective masks by employees of medical, trade, transport and other institutions and enterprises.
For the epidemic outbreak of influenza in groups of children in the nursery, kindergartens, orphanages, and in schools, a quarantine is installed in schools. It should not be allowed to allow visitors to patients to hospitals.
In order to prevent influenza, it is recommended in residential and industrial premises, in children's institutions to systematically ventilate air and irradiate these rooms. ultraviolet lamp. Sanitary and educational conversations should be carried out, clarify the population as possible to protect themselves from the influenza disease.
For individual emergency prevention, leukocytar interferon is used, which has a wide range of action against influenza and other respiratory Viruses. It is introduced by instillation in the nose to 5 drops daily 1-3 times a day throughout the epidemic.
Millions of people are ill with influenza every year. The most severe forms of influenza are observed, first of all, in old people and children under the year. This infection causes huge damage to the health of the population and sometimes leads to serious complications. From influenza and accompanying complications every year hundreds of people die every year.
Due to the high level of variability of the antigenic structure in circulating viruses, immunity to viruses that circulate in the current year may be ineffective against viruses that will be circulated in the following. Annual epidemic flu flashes are explained precisely a high level of variability of the virus.
Path transmission infection
During sneezing, as well as when coughing, the smallest particles of saliva and sputum are flying out from the mouth of a sick person, in which viruses are contained in huge quantities. Therefore, the main mechanism of influenza transmission is called - the air-drip. Another transmission mechanism respiratory infection - Contact. He has long remained unproved and less obvious than airborne drip. However, it plays no less, and perhaps, and a greater role in distribution cold illness. It happens so. As a rule, a sneezing or coupling man covers his mouth with his hand, hoping to prevent the spread of infection with air-droplet way. At the same time, he does not suspect how simplifies the transfer of its infection with contact path. The fact is that the entire colossal mass of the microbes, which was supposed to go into an open space, settles on the hand of a sneeze or coughing person. Which safely distributes it in the subjects of everybody, including those to whom other people touch. Or spreads it for friends, colleagues and acquaintances with handshakes. Those, in turn, it remains only to touch his mouth to his mouth, the nose, or wipe the eyes, which are also lined with susceptible mucous viruses, and the complex air-drip transmission path is reduced for the virus in time and difficulty in tens of times. That is why it is important to wash your hands and avoid touching the hands to your own face when flashing respiratory infections.
It is worth adding that the influenza causative agent is sufficiently stable in the external environment, so outside the body, it can preserve vitality up to 3 weeks. Therefore, the infection can occur even after a significant time after contacting a patient with a person with household items, children's toys, dishes, handles of public institutions and so on. On the other hand, another factor is important for the successful introduction of the virus to the body - the number of viral particles entering the body. What it is less, the less likely the probability of the body's protective barriers will be overcome and the disease will arise. High concentration of viruses can be maintained in closed rooms, especially with large clusters of people: offices, schools, kindergartens, public transport, stores. On the contrary, the number of microbial particles is almost impossible to meet in the open air. Therefore, contrary to popular belief, even during the seasonal outbreak of the flu, walking outdoors is not at all dangerous. Much more important is on what transport you get to a walk or work.
Signs of the disease, the principles of treatment
The development of the clinical picture begins gradually. As a result of the lesion of the mucous membranes, dryness, error and sore throat, cough, nasal congestion, sneezing, voice change, redness of conjunctiva, tearing, sometimes - light-free.
Later there are signs of intoxication: an increase in temperature, chills, pain in the joints and muscles, in more severe cases - nausea, vomiting and loss of consciousness.
Despite the large variety of symptoms, for most people, the flu is a progressive disease. The danger they represent for people having heavy concomitant diseases: diabetes mellitus, heart failure, chronic renal failure, tuberculosis and others.
In the development of the disease, the appeal to the doctor is mandatory, it will help in a timely manner to diagnose and determine adequate treatment. It is necessary to immediately call a doctor at home, especially if a child or a pregnant woman fell ill. It is important not to give up the proposed hospitalization and remember that the flu may cause various complications in a child or disorder in the development of the fetus!
We remind you that antibiotics, successfully treating from bacterial infections, are ineffective for the treatment of influenza. They have completely different mechanisms of action that cannot affect viruses. The only case when the use of antibiotics is justified is the attachment of a bacterial infection. The doctor is appointed antiviral drugs, which are currently developed by many and they are selected individually. It is possible to appoint vitamins, disintellation and symptomatic therapy.
Prevention
To prevent the spread of infection, it is possible to protect the patient from contact with others. In order to reduce the selection of viruses during sneezing, you can use a mask, putting it on the patient. In order for the mask to perform its protective function, it is necessary that it closes and mouth, and the nose. Only in this case, it will delay the droplets of the liquid flying away during sneezing, conversation and cough.
Contrary to popular belief, the mask, which, reliably, does not fulfill the role of a filter delaying viruses (it is not sealed for this), and it prevents accidental contact of human hands with mouth and nose, reducing the risk of contacting the contact path of infection.
Rooming the premises will reduce the concentration of the virus in closed spaces. It should be individually avoided by handshakes, cut to a minimum stay in public transport and in places of large clusters of people. How often wash your hands. Avoid touching eyes, nose and mouth with hands.
Remember! Any viral disease transferred "on the legs" may not affect your health in the future. In any case, at the first signs of the disease, you need to call a doctor at home and get the recommendations of a specialist regarding the treatment strategy. Remember that any self-medium can lead to undesirable consequences and complications.
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Respiratory infections
Influenza (grippus) *
* Franz. GRIPPER - attack, grab.
The flu remains one of the most common infectious diseases. The most significant influenza pandemic was observed in 1889-1892., 1918-1920. And 1957 Pandemic of Influenza 1918-1920, which was then the name of Spanish, or Spanish, covered about 1.5 billion population of the globe, of which about 20 million people died.
Pandemic of influenza 1957 began in China and Southeast Asia (which gave the reason to call this influenza Asian). For six months, he spread to all the continents.
Etiology.
The influenza causative agent is a virus containing ribonucleic acid (RNA virus) and related to the mixing family, a group of olomixes. Depending on the antigenic structure, there are three types of virus A, B and C. Virus of the species, and in turn it is divided into subspecies, or types - a, a1 and a2. The main role in the appearance of flu epidemic is played by viruses of type A. View C causes only sporadic morbidity and mainly among children.
Epidemics caused by the type B virus are repeated after 3-6 years, 1V2-2 months is developing slowly and continued. These epidemics encompass one or more countries without taking a pandemic character. The main role in the occurrence of annual more or less intensive epidemics of influenza and periodic pandemic plays the virus of the form A with its subspecies or types. This is due to the fact that the virus of the species A has the ability to periodically change its antigenic structure, as a result of which the population becomes absolutely non-immune to the newly appeared type. This appeared the virus and in 1933, A1 - in 1946, A2 - in 1957
Influenza viruses of species B and C are characterized by a more stable antigenic structure. The virus is widespread in the animal world, and in a few years before the appearance of a new type, it is found in the body of animals - wild migratory birds, horses, calves, pigs, poultry. Bird viruses contain other options that people do not meet. The circulation of the influenza virus in animals, apparently, has an impact on the formation of new pathogenic variants of the influenza virus. The flu virus is malstainable in the external environment, quickly destroys when drying, the effects of disinfectants and when heating to 60 ° C.
In addition to a person, the flu virus is a pathogenten in an experiment for ferrets, white mice. Chicken embryos are used for cultivation and isolation.
Epidemiology.
The source of infection is a patient with influenza, especially contagious in the midst of the disease, in the feverish period. The contagious period lasts 4-7 days. Patients with light shapes of influenza are also greater danger to others.
Transmission of infection occurs with airborne droplets. When coughing, conversation and sneezing, the virus enters the air together with drops of mucus, saliva and sputum. The transfer of pathogens is also possible through household items (dishes, nipples, toys, towels, etc.), contaminated with the discharge of the patient. Due to the small resistance of the pathogen in the external environment, this path of transmission of infection does not play almost no role in the spread of influenza.
The spread of infection contributes bad housing conditions, a crowbility, conducive to close contact with the source of infection, poor working conditions, unsatisfactory hygienic condition and maintenance of common places, population migration, sharp cooling, raw cold weather, etc.
The epidemic process for influenza may flow in the following forms: in the form of sporadic cases and seasonal oscillations of morbidity, epidemic outbreaks and pandemic, which can quickly spread throughout the world.
In the epidemics of influenza, caused by viruses of type A and its varieties, there is a rapid beginning and coverage of a significant population. Total flash duration 1 - r / 2 months. At the same time there are from 20 to 50% of the population. Epidemics caused by B type virus are developing slowly and covered up to 25% of the population. The epidemics caused by the virus A is repeated after 1 -2 year, type B - after 3-6 years.
The incidence of influenza is celebrated from October to March. The highest incidence, and therefore susceptibility in the early childhood. At the same time, when the influenza is driving into small areas, where there were no flu diseases for a long time, there is a magnificent morbidity of people regardless of age.
After the suffering disease, a type-specific immunity is produced, which remains with influenza and up to 2 years, and with flu in - up to 3-4 years.
Pathogenesis.
The entrance gate of infection with influenza is the mucous membranes of the respiratory tract. The virus is multiplied in the cells of the cylindrical epithelium of the mucous membrane. Cells are subject to necrosis, which contributes to the penetration of the virus into the blood and the occurrence of virus. The barrier function of the mucous membrane of the respiratory tract is disturbed, as a result of which a secondary infection occurs caused by the accompanying microflora (Afanasyev's stick - Pfeiffer, staphylococci, etc.). The addition of secondary infection contributes to the oppression of the phagocytic activity of leukocytes, the reticuloendothelial system and immunogenesis. In addition, the nervous and cardiovascular systems are affected as a result of intoxication of the body.
Clinic.
The incubation period lasts 1-2 days with oscillations from several hours to 3 days.
The disease begins acutely with the rise of temperature and chills. Already after 4-5 hours, the temperature reaches 38.7-40 ° C. With a light course, it can stay on subfebrile numbers. The health of the patient is worsening. It complains of headache with localization in the forehead and abnormal arcs, pain when moving eyeballs, pain in the muscles, joints, bones, insomnia, feeling in the nose, dry throat, cough, sneezing, high sweating, weakness.
When examining the patient, hyperemia of the face, neck and injection of the spool vessels are noted. Breathing is rapidly, blood pressure is reduced, the tones of the heart are muffled, the pulse is lagging behind the temperature. Possible nasal bleeding. From the side of the respiratory, signs of Qatar of the upper respiratory tract are found (runny nose, chihannie, voice hoarseness, dry cough). Zev hypertized, language is covered. Cough in people of young people can last 10-12 days, and the elderly and longer. Sometimes there is a bowel disorder.
The influenza virus and its toxins affect the peripheral nervous system and the brain, which is manifested by neuralgia, neuritis, encephalitis symptoms.
With an uncomplicated flu, the fevering period continues on average 2-3 days, less often up to 4-5 days or shortened to 1 day.
The disease can occur in light, moderate gravity and severe forms. In case of severe (toxic) influenza shape sharply expressed intoxication: strong headache, high temperature (up to 40 ° C), shortness of breath, cyanosis, hypotension, frequent weak pulse, insomnia or drowsiness, sometimes nonsense, nausea, vomiting, loss of consciousness, convulsions, Meningkeal phenomena.
In the blood with influenza, characteristic leukopenia (3-10 + 3-3.5 10 + 3 in 1 μl) is found with relative lymphocytosis, a shift to the left neutrophilic row, aezinophyla.
Complications.
The influenza virus causes inflammation of the mucous membrane of the respiratory tract with the subsequent death of the epithelium. This creates conditions for the attachment of secondary infections caused by pneumococci, streptococci, staphylococci. The most frequent complications include samorites, frontitles, tracheites, tracheobronchites, bronchiolites, focal pneumonia, otitis, meningoencephalitis.
Pneumonia caused by the viruses themselves arise in the first days of the disease and occur hard by the type of hemorrhagic. In more late time Pneumonia arise as a result of attachment of the bacterial flora, more often staphylococcal.
In complications associated with secondary infection, leukopenia is replaced by leukocytosis. The transferred flu as a result of the weakening of the body can lead to exacerbation of a chronic disease existing in a patient (pulmonary tuberculosis, rheumatism, chronic cholecystitis, etc.).
Diagnosis. During the epidemic outbreak, diagnose flu is not difficult. In between-pharmaceutical time, when a light flow of influenza prevails, it is necessary to differentiate it with other acute respiratory diseases.
For flu, a sharp beginning is characteristic, the presence of pronounced intoxication, the weakness of catarrhal phenomena, leukopenia.
To clarify the diagnosis, the laboratory methods of the study are used: virological (release of influenza viruses from nasophal flippers), serological (study of paired blood serums of patient, taken in the midst of the disease and re-after 2-3 weeks. On the growth of antibodies in RSK and, better, in RZGA ) and cytological (method of immunofluorescence and fluorescent microscopy).
The specific method of immunofluorescence express diagnostics makes it possible to get an answer from the laboratory after 3-4 hours. For this purpose, the smear taken from the nasopharynx of the patient is treated with a purified immune horse serum labeled with fluorescene isocyanate. Antigens of the virus form with fluorescent serum antibodies glowing complexes that are detected with luminescent microscopy. With this method, you can diagnose not only flu, but also paragripp, adenoviral and other sharp respiratory viral diseasesagainst which there are labeled specific immune serums.
Luminescent microscopy method is used for differential diagnosis Influenza, whose virus contains ribonucleic acid (RNA virus), and adenoviral disease, whose pathogen contains deoxyribonucleic acid (DNA virus). To this end, drugs are prints from the patient's nose mucous membrane - paint acridine orange. Influencing inclusions containing ribonucleic acid are shining with bright red, with adenovirus infection - greenish yellow. RNA viruses can cause paragripp and other diseases, so the method of fluorescent microscopy has an auxiliary value.
Treatment.
Regardless of the severity of the disease, the patient must observe the bed mode until the temperature and disappearance of toxicosis should be normalized. It is warmed by heating, give a rich hot drink (tea with lemon, jam, honey, warm milk).
With severe flu flow in a complex with antibiotics and other drugs, an anti-violent donor gamma globulin is prescribed, which affects the deadlines for temperature reactions and the extinction of intoxication phenomena. The anti-happose gamma globulin is introduced intramuscularly: children at a dose of 1.5-3 ml, adults - 3-6 ml. With sharply pronounced symptoms of intoxication, gamma globulin is injected after 6-8 hours. Virostatic chemicals are also used to treat patients with influenza - remantadine and oxoline. Remantadine is considered the most effective drug. Assign it in patients inside 0.05 g 3 times a day for 5 days, but it is necessary to apply it from the 1st day of the disease. The appointment of remanptadine on the 2-3rd day is less efficient. Oxoline is used 3-4 times a day intranasally as 0.25% ointment.
For the treatment of influenza and other viral respiratory diseases, human leukocyte interferon is used, synthesized by human leukocytes in response to the effects of the virus - interferonogen. Interferon does not have electoral antiviral activity and acts the same almost all viruses. With therapeutic purpose, interferon is introduced 5 drops (0.25 g) into each nasal stroke after 1-2 hours at least 5 times a day for 2-3 days.
In order to prevent complications in the severe flow of influenza, antibiotics are prescribed (tetracycline, vitalcin, oleandomycin, etc.) and sulfonamide preparations. In addition, they are given to people of old age, children and weakened persons to prevent the exacerbation of concomitant diseases. To reduce temperature and reduce headaches, analgin and acetylsalicylic acid. In violation of the activity of the cardiovascular system, Cordiamine, caffeine, ephedrine, etc., is shown. To reduce the body intoxication, abundant drinking is recommended, with a serious flow - intravenous injection of the liquid (from 500 to 2000 ml).
Prevention.
Hardening of the body and general general measures are played in the fight against flu: venting, intensive insolation, wet cleaning of rooms, ultraviolet irradiation of premises, especially in children's and medical institutions, careful washing dishes hot water, compliance with personal hygiene rules (hand washing, use of a separate dish , towel, bed, etc.).
When insulated at home, the patient is placed in a separate room or its bed is soldered by the screen. Only patients with severe complicated flu forms are subject to hospitalization, or with particularly unfavorable living conditions. Isolation continues until complete recovery.
In order to prevent the dispersion of infection with patients during raising the incidence of influenza, it is necessary to strengthen medical care At home.
Specific prophylaxis is carried out by a lively influenza vaccine for intranasal use and a lively influenza vaccine for oral administration. Influenza vaccinations should be combined with other methods of flu warning. These include stimulation of endogenous interferon, chemoprophylaxis, seroprophylaxis. Specific prevention of a living weakened vaccine must be carried out before starting an epidemic lift of the influenza morbidity. Stimulation of endogenous interferon, chemoprophylaxis and seroprophylaxis are carried out already during the flash. To stimulate the products of interferon - active protective cell protein, overwhelming the reproduction of most viruses, use various "inductors" of antigenic and non-indenticated nature. A good interferon stimulation provides lively influenza vaccines introduced by spraying through nasal moves or orally with an interval of 7 days. During the flashes of the flu for individual prevention, it is recommended to take oxoline, Adamantine 1 tablet overnight, human interferon (leukocytar) 1-2 times a day at 0.25 ml (5 drops) of the solution into each nostril.
Events in the hearth.
Patient isolate. Indoor where it is located, provide regular ventilation and wet cleaning. The patient is distinguished by a towel and dishes. Persons who care for the patient must wear a gauze mask. Maximum limited communication of family members with patients.
With the prophylactic goal of persons in contact with the patient, it is recommended to introduce specific anti-influenza serum to respiratory tract through the nose (using a powder industry or by inhalation) or interferon. Weakened children under the age of 1 year it is recommended to introduce anti-violent human gamma globulin in a dose of 1.5 ml intramuscularly.
After recovering the sick room, where it was, carefully ventilated and is subjected to a wet cleaning with soap-soda mortar.
During the flu epidemic, there is a particularly strict sanitary and hygienic regime in children's institutions, clinics, hospitals, maternity homes and other institutions. Personnel of maternity homes, children's consultations and clinics, nursery and other medical and preventive institutions should work in respirators to avoid influenza infection and its distribution. In the hostels and places of stay of organized teams are deployed insulators.
In the children's institutions detected by the patient with the flu immediately isolated at home. With severe flow or adverse living conditions of the diseased hospitalized. After the insulation of the patient, the room of the group is ventilated and subjected to a wet cleaning of 0.5% clarified solution of chlorine lime. The service personnel should work in masks. In the group, a medical examination is carried out for the purpose of timely identification of patients. With the emergence of new cases of the disease, anti-happose gamma globulin, the human interferon is introduced. During the children's walks, ultraviolet irradiation of the premises is recommended.
Flu
MKB-10: J 10, J11
General
Flu- A acute infectious disease that is caused by Influenza Virus is transmitted by air-drip, manifested by pronounced intoxication and moderately pronounced catarrhal syndrome.
Etiology
The influenza virus belongs to the Ortortics family. It contains RNA in its composition. Based on the antigenic structure of the virus, the flu is divided into 3 types: A, B, C. Influenza A and B viruses have 2 surface antigen - hemagluutinin (H) and neuraminidase (N). The influenza virus also has 16 hemagluitinine subtypes (H1-H16) and 9 neuraminidase subtypes (N1-N9). People are caused by the disease 3 of the hemhaglutinine subtype (H1, H2, H3) and 2 subtype of neuraminidase (N1 and N2). Other subtypes of flu virus antigens A cause disease in animals and birds. However, the world describes the cases of lesions of people with subtypes (H5N1, H7N2, H9N2, H7N3, H7N7) influenza virus and birds.
The influenza virus in has 1 subtype of hemaglutinin and 1 subtype of neuraminidase and causes the disease only in humans.
The antigenic structure of the influenza virus with differs from such influenza viruses A and V. Instead of neuraminidase, it has neuromine-acetylaseserase.
The feature of the influenza virus A is the lability of the antigenic properties of surface antigens: hemagluutinin and neuraminidase. Point mutations of these proteins lead to changes in the immunological properties of the virus. Changing the properties of one of these antigens is called antigen drift. Mutations that lead to a change in two antigens and the appearance of a new combination H and N are called Shift. Draif is celebrated every 2-3 years, and Shift - 1 time in 10-40 years. Flu drift determines the occurrence of epidemics, and shift - pandemic.
The flu virus B has less variability, and the influenza virus C is a constant antigenic structure.
Influenza B often circulates simultaneously with the flu and during annual flashes. Hipp b flows less hard, although it can cause epidemics 1 time in 10-12 years. In children, the severity of the disease may be associated with the Association in the body of viruses A and V. Influenza C has a slight or asymptomatic flow, most often accompanied by rhinitis.
Epidemics caused by flu virus A, have an explosion, the peak of morbidity occurs already 2-3 weeks from its start. The epidemic continues 6-12 months, with a lesion of 30% -50% of the population. The flu epidemics are slower, 2-3 months continue, while not more than 25% of the population are affected. The flu C does not cause epidemic lifts of the disease and wears only sporadic.
Epidemiology
Source of influenza infection There is only a sick person with obvious, erased and subclinical, forms of the disease. The path of transmission of infection is air-drip. Maximum contagious is observed in the first days of the disease, when the virus is highlighted in the external environment when coughing and sneezing with droplets. The selection of the virus during the uncomplicated flow ends until the 5-6th day of the disease. At the same time, with pneumonia, which complicates the flow of influenza, the virus is revealed in the body up to 2-3 weeks from the beginning of the disease.
The flu is striking all age groups of people and has a certain seasonality. Maximum incidence is observed in the winter.
After the suffering disease, resistant type and strain-specific immunity is formed, repeated diseases are due to the new influenza virus.
Clinical picture
There are typical and atypical forms of the disease. The latter includes Africral, acataral, lightningry of influenza. For a typical clinical picture, a combination of two main syndromes of general intoxication and catarrhal phenomena of the upper respiratory tract are characteristic. The incubation period ranges from several hours to 1-2 days. In 10% of cases, there is a period of precursors (in the form of subfebilite, pain in the muscles). In most cases, the disease begins unexpectedly: the chills appears, the body temperature rises to
37.5-38 ° C, often up to 39-40 ° C. Chills quickly replaces the feeling of heat, general weakness, headache, mainly with localization in the forehead and temples, eyeballs, marked light, blessing, muscle pain, sweating, sleep disorders, noise in the ears. In severe cases, nausea, vomiting, disturbances of consciousness are joined. Temperature reaction, in most cases, is responsible for the severity of the disease. With a minor violation of the overall state, an increase in body temperature up to 38 ° C is estimated as a light fluid flow. An increase in body temperature up to 39 ° C and a pronounced violation of well-being meet the average severity of the disease.
Significant feverish reaction, sharp disorders of the general condition regard as a serious flow. Fever lasts 3-5 days. Hyperemia of the face, conjunctive, moderate cyanosis lips, eye glitter appear attention. The skin is hot to the touch, wet. The initial tachycardia is replaced by bradycardia. During the auscultation of the heart, the weakening of the second tone is listened, sometimes a functional systolic noise at the top.
There is a diffuse inflammation of the respiratory tract (rhinitis, tracheitis, laryngitis). The mucous membrane of the nasopharynx, soft and solid sky is hyperemic, swollen. With the flu, caused by the type B virus, the grainy enantum occurs.
For influenza, pronounced signs of tracheaitis are characterized, which are clinically manifested by a feeling of irritation of the throat or pain behind the sternum and throughout the trachea, an adsadous dry cough. At the same time, the face becomes red, the eyes are poured with blood and disappear. Temporary improvement occurs only after moving a small amount of moisture mucosa. The tongue is covered with a whitish flare. The belly is soft, painless. The liver and spleen are not enlarged. Patients are irritable, complain of insomnia.
If there is no complications during the flu, then after 2 days the patient begins to recover: the body temperature decreases, the cough becomes softer, the headache and Malgia disappears. GENERAL WEIGHT AND BREEDING CAN STARNED AT ABOUT DAYS AND RESCEMENT. Catarial syndrome disappears later. The course of hyperstoxic influenza is the same as severe neuroinfection or neuroinoxication, and is accompanied by hyperthermia, light-in-friendly, severe headache, pronounced adamisia and weakness, vomiting, meningeal symptoms.
There are easy, medigative, heavy, or toxic, and hypertoxic forms of influenza. The severity is determined by the degree of detection of general intoxication (hyperthermia, neurological symptoms - headache, dizziness, loss of consciousness, convulsions, meningeal symptoms, hemorrhagic syndrome, violation of cardiovascular activities, which are accompanied by circulatory disorders and heart muscle damage).
The light shape of the influenza can be observed with a slightly increased or normal temperature of the body, weakly pronounced symptoms of intoxication. An erased form of influenza can be attributed to a light form, the flow of which is carried out at normal body temperature and the absence of any symptoms of intoxication. In this case, there can be only weakly pronounced catarrhal phenomena (nasal congestion, small mucous discharge from the nose), shaking.
With a moderate form, there are all signs of influenza intoxication: headache, dizziness, pain in muscles and joints, etc. The body temperature rises to 39 ° C, the croup syndrome is possible, abdominal syndrome. A distinctive feature of a heavy form is a pronounced intoxication: criminalize consciousness, vomiting, short-term cramps, an increase in body temperature to
40-40.5 ° C. It is possible a violation of cardiovascular activities. For hyperstoxic shape, meningoencephalic, hemorrhagic and hyperthermic syndromes, a lightning flow and a fatal outcome are characteristic. The flow of influenza in children can be in an inapparantine form. In this case, the child remains practical healthy, but there is an increase in the titer of antibodies to the influenza virus.
With severe forms of the disease, the process is rapidly progressing with the development of different manifestations of respiratory infectious toxicosis: meningeal, encephalotic or union of reactions (hyperthermia, nonsense, general-selling disorders with convulsions, loss of consciousness, meningeal symptoms), as well as hemorrhagic syndrome (rash small or petechial, more often on The skin of the face, neck, chest and upper limbs, hemorrhage on the mucous membrane of the mouth, the sky, on the rear wall of the pharynx, conjunctiva; bleeding from the nose, microhematuria, traces of blood in the vomit masses and feces, etc.). Perhaps the development of cardiovascular failure: a sharp pallor with a gray (earthy) tint and marble of skin, cold sweat and pointed features of the face, a frequent weak pulse. The appearance of paroxysmal tachycardia, a collaptoid state with a drop of blood pressure, the deafness of the heart tones, the expansion of pupils, excitement, shortness of breath, sternum pain, cyanosis, swelling and pulsation of the cervical veins, tachycardia, increase in the liver and reduced diuresis.
Diagnostics
Diagnostic clinical flu criteria
- acute start;
- fever 38.5-40 ° C, sometimes a subfebrile or normal body temperature can be;
- pronounced symptoms of intoxication, which are developing on the first day of the disease (headache, pain in the muscles, joints, eyeballs, hyperasia, lethargy, adamiya, vomiting);
- It is possible hemorrhagic syndrome: nasal and other bleeding, phetechial rash on face, neck and upper body;
- Moderate signs of rinoporgitis (nasal congestion, small serous discharge from the nose, allocation and sore throat, hyperemia back wall pharynx, soft sky with the injection of vessels and phetechial hemorrhages on its mucous membrane);
- injection of blood vessels;
- Symptoms of tracheitis (dry painful cough with burning and sore throat);
- Sometimes there can be diarrhea, vomiting.
Paraklinic research
1. Detecting the antigen of the virus in a washcloth washed from the immunofluorescence reaction, the immunochromatographic method.
2. Detection of antibodies to the virus using the reaction of complement binding and the braking reaction of hemagluturation. The pair serum method is used when the increase in antibody titer is 4 times or more for 10-14 days.
3. Molecular genetic methods (polymerase chain reaction (PCR) on the detection of viral hemagluutinin (H)).
4. Virological methods (insulation of influenza virus).
The material for the study should be taken as early as possible, because after 4-5 days the adults ceases its allocation. In children under 5 years of age, the flu virus will allocate and after 5 days of a sharp period of the disease. Material for research can be any respiratory discharge (springs separated from the nose, saliva, washes from the nasopharynx).
Clinical picture of the disease. Infection caused by pandemic flu virus A (H1N1)
- incubation period from 1 to 7 days;
- a sudden body temperature rise of more than 38 ° C, sometimes the disease can occur without increasing body temperature;
Sore throat, headache;
- pharyngitis;
- cough;
- labored breathing;
- muscle pain;
- For 2-3 days, multiple vomiting is possible, diarrhea.
The diagnosis of infection that is caused by the pandemic strain of flu virus A (H1N1)
Primary diagnostics is based, first of all, on clinical data and epidemiological history:
1. High fever, combined with difficulty breathing and dry cough.
2. Contact with the patient who has confirmed infection with the influenza virus (H1N1) 7 days before the first clinical symptoms appear.
3. Contact with sore acute respiratory diseasewhich ended in a monthly 7 days before the emergence of the first clinical symptoms of the disease.
The final diagnosis can be set after laboratory confirmation by the molecular genetic method (PCR) or the release of the virus (positive viral culture).
Complications
Respiratory complications:
- acute bronchitis;
- Primary viral pneumonia;
- secondary bacterial pneumonia;
- aggravation of bronchial asthma;
- aggravation of chronic diseases of the respiratory system;
- abscess of the lungs;
- Sinusit.
Scope complications:
- febrile cramps;
- Otitis the middle ear;
- sepsis;
- Miostit;
- myocarditis;
- Reya syndrome;
- Encephalitis;
- myelitis;
- GUILLAIN-BARRE syndrome.
Complications of pandemic influenza A (H1N1)
Most deaths arise:
- viral pneumonia with a rapid development of respiratory failure;
- acute renal failure;
- polyorgan deficiency;
- Pankarditis with acute heart failure;
- Encephalitis, encephalopathy (more often develops in young children).
Treatment
Hospitalization is subject to patients with severe forms of the disease, persons with an increased risk of complications, with the impossibility of insulation of the patient in an outpatient basis, persons who constantly live in closed groups.
. Antiviral treatment of neuraminidase inhibitors is recommended for patients with severe complicated forms of the disease.
. Antiviral treatment with pulmonary and medium-free forms of influenza inhibitors of neuraminidase is not recommended.
. The antiviral treatment of flu is shown to children with various forms of influenza, which relate to risk groups on the emergence of complications:
- chronic respiratory diseases;
- chronic diseases of the cardiovascular system;
- immunodeficiency states;
- diabetes;
- chronic kidney diseases;
- Obesity.
For antiviral treatment of flu, WHO recommends applying Omeltamivir or Zanamivir.
Omeltamivir.Appointed children over 1 year old. The drug is most effective in the first 48 hours from the beginning of the disease.
Children over 12 years old, Ozheltonvir is appointed in capsules at 75 mg 2 times a day for 5 days.
Today there is no consensus on the influence of Ozheltonvira on renal function. Therefore, if a child has chronic kidney diseases, the drug should be prescribed with caution or to give the advantage of zanamivir.
Zanamivir. Assigned as a powder dosed for inhalations. Children over 5 years old 2 inhalations (5 mg x 2) 2 times a day for 5 days. The drug is most effective in the first 48 hours from the beginning of the disease.
There are single messages about the occurrence of bronchospasm and / or worsening the pulmonary function after applying the zanamivir in patients who were treated by them from influenza. Some of these patients had no diseases of the respiratory tract in an anamnesis. In such cases, it is necessary to stop treatment with zanamivir and seek medical attention.
In the absence of neuraminidase inhibitors or lack of indications for their purpose, the use of antiviral drugs is possible, the effectiveness of which is proved in a seasonal flu.
Antiviral Drugs Direct Action
Immunoflazide - combines direct antiviral activity (inhibits neuraminidase) and has a pronounced impact on the immune response, in particular increases the cytotoxic activity of natural killers, contributes to the synthesis of endogenous interferon (α-IFN), activates the phagocytic system and adaptive immunity factors.
Zanamivir for the prevention of influenza is appointed to children over 5 years of 2 inhalation (5 mg x 2) 1 time per day for 10 days. The course may continue up to 1 month if the risk of occurrence of the disease is preserved.
For the prevention of influenza after contact with the patient, it is also possible to use drugs, the effectiveness of which is proved during a seasonal flu.
Aflube.For preventing flu drops or tablets, take 2 times a day.
Planned prevention begins a month before a seasonal increase in morbidity or when an epidemic occurs. Duration - 3 weeks
Emergency prophylaxis is carried out at contact with patients with influenza / ORVI or under the action of provoking factors (supercooling, sharp climate change). Prevention duration: over the entire period and for more
2-3 days after stopping contact with patients with influenza / ORVI or the action of provoking factors.
During the flu epidemic and other ARVI, preventive reception is recommended to extend up to 6 weeks.