ADENOVIRUS DISEASES

ADENOVIRUS DISEASES (syn: adenovirus infection) - a group of infectious diseases caused by adenoviruses; Characterized by symptoms of the mucous membrane of the respiratory tract, eyes, intestines, as well as lymphoid tissue. They are included in the group of acute respiratory viral infections (ARVI). There are everywhere, making up 3-7% of all ARVI in children and 0.6-3% in adults.

The ability of adenoviruses to multiply in the epithelial cells of the respiratory tract, conjunctiva, intestine and lymphoid tissue causes a variety of clinical manifestations of the disease. In accordance with the prevalence of certain symptoms, the following clinical forms of adenoviral diseases are distinguished: acute respiratory disease (rhinopharyngitis, rhinopharyngonzillitis, rhinopharyngebronchitis), pharyngoconjunctival fever , acute follicular and membranous conjunctivitis , epidemic keratoconjunctivitis, adenovirus pneumonia , gastroenterocolitis.

From the person 37 serotypes of adenoviruses are allocated, and different serotypes can cause the same form of the disease and, on the contrary, one serotype - different forms. Adenoviruses are highly resistant to low temperatures and are easily inactivated when heated and exposed to disinfectants.

The source of infectious agents is a sick person, as well as those who have recovered from the virus, which secrete the virus for 50 days or more, and healthy virus carriers. The main way of transmission of pathogens is airborne (when talking, coughing, sneezing). It is also possible fecal-oral route of transmission of the virus (through food, dishes, toys, clothes, as well as stool containing the virus). The most susceptible to infection are children aged 6 months to 5 years. The disease is recorded throughout the year, especially in the cold season, in the form of epidemic outbreaks and sporadic diseases. The most common infection with adenovirus occurs in close contact with children.

Clinical picture . The incubation period averages 5 to 7 days with fluctuations of 3 to 14 days. The onset of the disease is more often acute: chills, moderate headache , decreased appetite, lomiting pain in bones, joints, muscles is possible. On the 2nd - 3rd day of the disease, the temperature can rise to 38 - 39 ° C. Characteristic for adenovirus infection is the sequence of appearance of new symptoms of the disease and the prevalence of local symptoms over the general. The first for the disease is rhinitis with abundant serous-mucous membranes, later mucopurulent discharge, mucous membrane of the mouth and throat edema, hyperemia is not pronounced; Often there are sore throats, cough and hoarseness. Often, there is pharyngitis. The posterior wall of the pharynx is usually edematous, slightly hyperemic, with large follicles protruding above the surface of the mucous membrane (rhinopharyngitis). Perhaps an increase in tonsils, often with the appearance of whitish loose raids in the form of dots or islets (rhinopharyngongzillitis).

Many patients develop conjunctivitis in the first 3 days of the disease, initially usually unilateral. It manifests itself as a cut or pain in the eyes, abundant mucous separable, hyperemia of the conjunctiva. Sometimes in 1-3 days on a conjunctiva appear films of grayish-white color. Conjunctivitis is often accompanied by a puffy eyelid, sometimes pronounced. In some cases, the cornea (keratoconjunctivitis) is affected.

Often there is an increase in lymph nodes, mostly submandibular and posterior. Sometimes mesenteric lymph nodes are affected (mesadenitis); Thus there are paroxysmal pains in the abdomen, there is pain in palpation of the lower abdomen.

For pharyngoconjunctival fever is characterized by a combination of fever, conjunctivitis and pharyngitis with a local reaction of the lymph nodes. Sometimes from the first days of illness clinical and radiological signs of small-focal or focal pneumonia, prone to protracted flow (adenovirus pneumonia), are noted.

In some patients, from the first days of the illness, the stool becomes more frequent, the bowel movements are liquid, sometimes with an admixture of mucus, pains in the epigastric region, nausea and vomiting (gastroenterocolitis) are observed. Especially frequent are diarrheal disorders in newborns. These phenomena are often combined with the defeat of the upper respiratory tract.

The temperature reaction for adenoviral disease on average lasts 5 to 7 days, sometimes up to 14 to 18 days. Local catarrhal phenomena last up to 10-12 days or more. Duration of catarrhal phenomena and temperature reaction, signs of moderate intoxication, conjunctivitis , enlarged lymph nodes, often lesions of the gastrointestinal tract distinguish adenovirus infection from influenza and most other respiratory viral diseases.

Complications of adenovirus disease (otitis, sinusitis, tonsillitis, pneumonia) are associated with the attachment of a bacterial infection or exacerbation of concomitant chronic inflammatory processes.

The diagnosis is made on the basis of the clinical picture and the results of laboratory tests. Laboratory diagnostic methods are rarely used in practice. It is possible to detect the virus antigen in the nasopharyngeal mucus that is separated by the eye with the help of an enzyme-linked immunosorbent assay, and the virus in the cell culture is less often isolated. Differential diagnosis is carried out with influenza and other respiratory viral infections, infectious mononucleosis, typhoparathyphoid diseases, HIV infection.

Treatment is usually done at home. The patient should be isolated in a separate room or his bed should be fenced off with a screen. In the feverish period, bed rest, adequate nutrition, and vitamin-rich food are needed. Assign vitamins, alkaline inhalation. Locally (intranasally) can be used oxolin, tebrofen, florenal in the form of ointments . Antibiotics are indicated only in complications of bacterial nature.

The forecast is usually favorable. However, in young children with the adherence of pneumonia, lethal outcomes are possible.

Prevention is reduced to early detection, isolation and treatment of patients, frequent ventilation of the premises where the patient is, disinfection of patient's discharge, dishes, linen, clothes, bedding, room, furnishings. Persons caring for patients should wear a mask of 4 to 6 layers of prostrated and ironed gauze, wash their hands after talking to the patient.