FLU

FLU is an acute infectious disease that occurs with a predominant lesion of the mucous membrane of the respiratory tract and intoxication phenomena - chills, fever, breakdown, headache, muscle and joint pain. It is the most common epidemic disease.

Influenza viruses belong to orthomixoviruses and are subdivided into 3 serological types. The type A virus has a significant antigenic variability, which has led to the emergence of new strains causing epidemics every 2 to 3 years and pandemics - once every 10-30 years. Viruses of type B and C are characterized by greater stability. The type B virus can cause an epidemic usually in 3 to 4 years, the influenza C virus is only sporadic diseases or limited outbreaks. The stability of influenza viruses in the environment is small. Heat, drying, sunlight quickly kill them. Influenza viruses are more resistant to low temperatures.

The source of the pathogen of infection is a sick person, especially in the first 5 days of the disease. Infection occurs more often by airborne droplets, the virus is released by the patient into the air from the damaged cells of the airway epithelium with droplets of saliva, mucus, sputum, during breathing, coughing, talking, crying, coughing, sneezing; Less often, the transmission of the virus occurs through household items (towels, handkerchiefs, dishes, etc.), contaminated with discharges of the patient containing the virus. Susceptibility to influenza is very high. The frequency of epidemics depends on the level of population immunity and the variability of antigenic properties of viruses.

Clinical picture. The incubation period lasts from 12 hours to 3 days, usually 1-2 days. In typical cases, the disease begins suddenly. There is a chill, the temperature quickly rises to 38-40 0С. Patients complain of severe headache, sleep disturbance, pain in the movement of eyeballs, aches in the whole body, weakness, weakness, nasal congestion , photophobia, lacrimation, sore throat, lethargy, drowsiness, dizziness . In severe cases, there may be vomiting , fainting, nausea , convulsions, loss of consciousness, severe shortness of breath , decreased blood pressure, muffled heart tones, lability of the pulse. There may be meningeal phenomena. Characterized by hyperemia and puffiness of the face, hyperemia conjunctiva. The duration of fever in uncomplicated influenza is 2 to 5 days, rarely more.

After 2 - 3 days there are serous-purulent discharge from the nose. When examining the pharynx, hyperemia with a cyanotic shade, swelling of the soft palate, arches, and tongue are noted. Characteristic is also the fine granularity of the soft palate, the injection of vessels, and pinpoint hemorrhages. Most patients have a cough due to the development of tracheitis and tracheobronchitis, tracheitis is predominant, so coughing with the flu is painful, dry ("scratching"), sputum appears several days later. Sometimes, the flu does not cause fever or signs of respiratory tract damage.

The most common complication is pneumonia , which can be early (the first days of illness) and late. The development of pneumonia is accompanied by worsening of the general condition, increased dyspnea, cyanosis, increased body temperature. Often there are pains in the chest, a cough with phlegm, in which there may be an admixture of blood; Physical data, as a rule, meager.

Terrible complications are hemorrhagic pulmonary edema, cerebral edema, hemorrhagic encephalitis . Possible hemorrhages in the brain, myocardial infarction, etc. Frequent complications of influenza - sinusitis, otitis media , eustachitis, cystitis . Influenza often leads to an exacerbation of various chronic diseases.

The diagnosis is based on the epidemiological history (indication of contact with febrile patients, the presence of outbreaks, epidemics), the clinical picture and the results of laboratory studies. In the blood there is a leukopenia with relative lymphocytosis and monocytosis. ESR - within normal limits or moderately elevated. When accessing complications caused by bacterial flora, leukocytosis , neutrophilia and a significant increase in ESR are observed.

Treatment. Hospitalization is subject to patients with severe illness and complications, as well as suffering from severe chronic diseases of the cardiovascular system, respiratory organs, etc .; The rest of the patients are treated at home. Patients should comply with bed rest during the entire febrile period. The room where the patient is located should be warm and well ventilated. The patient should be warmly covered, when necessary (in case of sweating), change bed and underwear, give abundant warm drink with raspberries, honey, lime color (to increase sweating and detoxification), as well as warm milk with alkaline mineral water or bicarbonate Sodium (baking soda) in order to reduce the perspiration in the throat. The severely ill patient needs to turn in bed, offer him to take deep breaths so that there is no stagnation in the lungs, hold the toilet of the oral cavity and skin. Recommended milk and vegetable diet, rich in vitamins, plentiful drink.

Patients with severe intoxication irrespective of the day of the disease are administered intramuscularly donor anti- influenza immunoglobulin (gamma globulin). In the absence of anti-influenza immunoglobulin, normal human (anticorrosive) immunoglobulin is administered . For the purpose of detoxification, haemodez or rheopolyglucin is also used. Intravenous injection of 5% glucose solution, saline solutions are carried out carefully in a volume of not more than 500 ml. At the same time, lasix is ​​used to prevent the development of pulmonary edema or brain.

At the beginning of the disease, human leukocyte interferon is used in the form of a solution that is digested 5 drops into the nasal passages every 1-2 h for 2 to 3 days, or in the form of an aerosol used for inhalations.

A pronounced therapeutic effect at the onset of the disease, especially with influenza A, is given by remantadine . On the first day of treatment, adults are prescribed 300 mg of remantadine: 100 mg (2 tablets) 3 times after meals; On the second and third day - 200 mg (100 mg twice a day); The fourth day - 100 mg once a day, Remantadin is contraindicated in acute liver diseases, acute and chronic kidney disease, thyrotoxicosis and pregnancy. Apply oxolin in the form of 0.25% ointment, which lubricate the nasal mucosa 3 - 4 times a day. Persons who have an allergic manifestation should not use oxolin.

With nasal congestion, 2-3 drops of 2 - 3% solution of ephedrine or 1-2% solution of menthol oil, sanorin , naphthyzine , galazoline , etc. are applied by the nasal congestion. The use of antipyretic agents (acetylsalicylic acid, analgin, etc.) is indicated only with hyperthermia.

In order to reduce the permeability of blood vessels, calcium preparations, ascorbic acid, rutin are prescribed. Oxygen therapy is shown. According to the indications, enter korglikon or strophanthin. With insomnia, stimulation, sedatives are used. When coughing, expectorants, mustard plasters, alkaline warm inhalations, as well as solutan, bromhexine , libexin , etc. are prescribed. According to the indications, antihistamines are used - dimedrol , suprastin , tavegil, etc.

Antibiotic drugs (sulfonamides and antibiotics) should not be prescribed in uncomplicated influenza, as they do not act on influenza viruses and do not prevent complications, in particular pneumonia. On the contrary, pneumonia , which has developed against the background of taking antibiotics, is less treatable.

Antibiotics for influenza are used only in cases of development of protracted bronchitis, pneumonia, otitis and other complications caused by a secondary bacterial infection, or with exacerbation of concomitant diseases requiring antibiotics.

The prognosis is favorable, but in severe cases and complications serious, especially in the elderly and children.

Prevention. Patients undergoing treatment at home should be isolated (in a separate room, behind a screen). When caring for patients should wear a mask of 4 -6 layers of prostrated and ironed gauze. The room where the patient is located should be ventilated, do a wet cleaning with 0.5% chloramine solution, disinfect dishes, towels, handkerchiefs and other items that the patient uses. For disinfection of air, it is recommended to irradiate bactericidal ultraviolet lamps in hospitals and polyclinics (chambers, medical offices, corridors, etc.). Influenza patients should not visit a polyclinic. During epidemics, restrictive measures are carried out: they transfer kindergartens and orchards for round-the-clock work, close schools, prohibit mass entertainment events, visit patients in hospitals, etc. Introduce mandatory wearing gauze dressings by medical, transport, commercial, domestic and other enterprises associated with Service of the population.

Specific prevention of influenza is carried out through vaccination in the pre-epidemic period, as well as the appointment of antiviral drugs (emergency prevention) to persons who have been in contact with patients. In a specific prevention of influenza, inactivated and live vaccines are used.

For urgent prophylaxis, remantadine is used , which has a pronounced effect on influenza A. Remantadine is prescribed for adults who were in close contact with a sick flu (in families, hospital wards of any profile, office premises, etc.), 50 mg once a day for 2 days if the patient was immediately isolated, or 5 to 7 days if contact continues (for example, in families when leaving the patient for home treatment). For the preventive purpose, dibazol is often used in small doses (for example, 1 tablet per day), sometimes .- leukocyte interferon and donor anti-influenza gamma globulin, for example, a seriously ill patient with non-infectious diseases, who was in contact with a sick flu, especially if there are contraindications for use Remantadine.

Important measures to prevent influenza is tempering the body, exercise physical and sports, timely treatment of diseases of the paranasal sinuses.