Flu

Influenza is an acute viral disease, anthroponosis, transmitted by airborne droplets. It is characterized by an acute onset, fever, general intoxication and defeat of the respiratory tract.

Etiology, pathogenesis. Influenza pathogens belong to the family of orthomixoviruses, which include the genus of influenza A viruses, the genus of the influenza virus B and C. The influenza viruses of genus A are subdivided into many serotypes. Constantly there are new antigenic variants. The flu virus quickly dies when heated, dried and influenced by various disinfectants. Gateways of infection are the upper parts of the respiratory tract. The influenza virus selectively affects the cylindrical epithelium of the respiratory tract, especially the trachea. Increased permeability of the vascular wall leads to a violation of microcirculation and the emergence of hemorrhagic syndrome (hemoptysis, nasal bleeding, hemorrhagic pneumonia, encephalopathy). Influenza causes a decrease in immunological reactivity. This leads to an exacerbation of various chronic diseases - rheumatism, chronic pneumonia, pyelitis, cholecystitis, dysentery, toxoplasmosis, etc., as well as to the occurrence of secondary bacterial complications. The virus remains in the patient's body usually within 3-5 days from the onset of the disease, and in case of complication with pneumonia - up to 10-14 days.

Symptoms, course. The incubation period lasts from 12 to 48 hours. Typical influenza begins acutely, often with chills or cognition, the body temperature rises rapidly, and already in the first day the fever reaches its maximum level (38-40 g. C). There are signs of general intoxication (weakness, adynamia, sweating, muscle pain, severe headache, pain in the eyes) and symptoms of respiratory tract damage (dry cough, sore throat, sadness behind the sternum, hoarseness). At examination, hyperemia of face and neck, vascular injection of sclera, increased sweating, bradycardia, hypotension are noted. The defeat of the upper respiratory tract (rhinitis, pharyngitis, laryngitis, tracheitis) is detected. Especially often trachea is affected, whereas rhinitis is sometimes absent (the so-called acarral form of influenza). Characterized by hyperemia and a peculiar granularity of the mucous membrane of the throat. The tongue is covered, there may be a short stool disorder. Complications from the central nervous system manifest themselves in the form of meningism and encephalopathy. Characterized by leukopenia, neutropenia; ESR in uncomplicated cases is not increased. Light forms of influenza can sometimes occur without fever (afefrilnaya form of influenza). Complications: pneumonia (up to 10% of all patients and up to 65% of hospitalized patients with influenza), frontal sinusitis, maxillary sinusitis, otitis, toxic myocardial damage.

During the flu epidemic, the diagnosis of difficulties is not. In flu epidemics, this disease is rare (3-5% of all cases of ARI) and often occurs in the form of light and erased forms. In these cases, it is difficult to distinguish influenza from ARI of another etiology. To confirm the diagnosis of influenza virus detection is used in the material from the pharynx and nose, as well as the detection of the growth of the titer of specific antibodies in the study of paired sera: the first serum is taken until the 6th day of the disease, the second - after 10-14 days; The increase in antibody titers is 4 times or more.

Treatment. Influenza patients are treated at home. In the hospital refer patients with severe forms of influenza, with complications, with severe concomitant diseases, as well as epidemiological indications (from the hostel, boarding schools, etc.). The houses left for treatment are placed in a separate room or isolated from others by means of a screen. Allocate a separate dish, which is disinfected with steep boiling water. Persons caring for the patient should wear a four-layer mask of gauze. During the febrile period, the patient must comply with bed rest. Recommended warmth (warmers to the feet, a plentiful hot drink). To prevent hemorrhagic complications, especially for elderly people with elevated blood pressure, it is necessary to recommend green tea, jam or juice of chokeberry, grapefruit, as well as vitamins of group P (rutin, quercetin) in combination with 300 mg of ascorbic acid per day.

Effective means is anti-influenza donor gamma-globulin, which is prescribed for severe forms of influenza if possible at an earlier time (adults 6 ml, children 0.15-0.2 ml / kg). You can use normal human immunoglobulin, which is given in / m in the same doses.

Antibiotics and sulfonamides do not prevent complications, in particular pneumonia. They are shown only in case of complications. Most commonly used antibiotics penicillin group, tetracyclines, gentamicin. Widely used pathogenetic and symptomatic drugs. To reduce headaches and muscle pain, amidopyrine, ascofen, etc. are used. Therapeutic effect is provided by antihistamines (pifolen, suprastin, dimedrol). To improve the drainage function of the bronchi apply alkaline inhalation, expectorant, bronchodilators. With pronounced rhinitis locally apply a 2-5% solution of ephedrine, naphthysine, galazoline, sanorin, etc. Sometimes mixtures of drugs are used. The so-called antigrippin contains 0.5 g of acetylsalicylic acid, 0.3 g of ascorbic acid, 0.02 g of rutin, 0.02 gdimidrol and 0.1 lactate of calcium. Reconvalvesentam appoint banks, mustard plasters.

In extremely severe hypertoxic forms of influenza (temperature above 40 ° C, dyspnea, cyanosis, severe tachycardia, lowering blood pressure), patients are treated in intensive care units. These patients with / m injected with anti-influenza immunoglobulin (6-12 ml), prescribe antibiotic anti-staphylococcal action (oxacillin, methicillin, a chain of 1 g4 times a day). Twice a day in / in the injected mixture containing 200-300 ml gemodeza or 40% glucose solution, 0.25-0.5 ml 0.05% solution strofantina (or 1 ml 0.06% solution of Korglikona), 2 ml 1% solution of lasix, 250-300 mg of hydrocortisone or prednisolone, 10 ml of 2.4% euphilin solution, 10 ml of 5% solution of ascorbic acid, 10 ml of 10% calcium chloride solution, 400 ml of reopolyglucin, 10 000-20 000 units Kontrikala. Carry out oxygen therapy. If there is more than 40 breaths in 1 minute, if the breathing rhythm is disturbed, the patient is transferred to artificial ventilation.

Forecast. With uncomplicated influenza, work capacity is restored after 7-10 days, with "pneumonia-not before 3-4 weeks." The prognosis for life is favorable, severe forms with encephalopathy or pulmonary edema (usually during epidemics) can pose a threat to life.

Prevention. Vaccination is used live (intranasal) or inactivated (intradermally and under the skin) vaccines. To prevent influenza A, you can use rimantadine (0.1 g / day), which is given during the entire epidemic outbreak. In the hearth, the current and final disinfection is carried out (the dishes are steeped with boiling water, the laundry is boiled).