Defining The ‘Flu-Type’ Differences
Such definitions as ‘flu’, ‘acute respiratory infection’, ‘acute respiratory viral diseases’, ‘cold’ and a number of other firmly established terms have rooted in the lexicon of both clinicians and a significant part of the population of the globe. Apparently, one of the main reasons for this is the extremely high incidence of these diseases.
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It is believed that during the year an adult carries an average of 2-3 episodes of acute respiratory viral infections (ARI), while the child deals with the disease from 6 to 10 times per year. Despite the development and implementation of effective diagnosis and prevention methods in daily practice, ‘flu-type’ diseases have long occupied the highest row in the list of the most common diseases, accounting for over 90% of all infectious diseases of modern man. According to incomplete statistics of the WHO, nearly 10 billion records of acute respiratory infections (ARI) cases are made during the year.
Another major reason for such attention to these diseases is their active role in the pathogenesis of numerous complications. According to the averaged data, the maximum mortality from influenza and acute respiratory infections (34.5) in infants is 14-69 times higher than in other age groups. As is known, a relatively common complication of such infections as influenza, parainfluenza and respiratory syncytial virus infection (MS) infection is an acute pneumonia, the average annual mortality rate of which in individuals over the age of 30 years is 23,2-50,5 times higher than average rates of mortality from influenza and acute respiratory infections.
Another common disease associated with acute respiratory infections is characterized by inflammatory changes in the paranasal sinuses, which are recorded in 5-10% of patients with acute respiratory disease, characterized by a tendency to relapse, and in 10-15% of cases take a chronic course. In turn, acute and chronic sinusitis are often the cause of severe orbital and intracranial complications with frequency of 6,6-12,4% and finds no noticeable tendency to decrease. At the same time more than one third of patients (38.5%) with clinical manifestations of orbital/intracranial complications occur within a few days after the first signs of ARI. Orbital complications of acute sinusitis on the background there is 2 times more often than due to chronic inflammation of the paranasal sinuses. In this connection, the relevance of materials that promote awareness in internists and pediatricians in the aspects of etiology, pathogenesis, clinical manifestations and treatment of acute respiratory infections is absolutely vital.
Differentiating the diseases
Despite the fact that the flu is often diagnosed as an independent nosological disease, there are certain difficulties in the clinical differentiation of influenza and acute respiratory infections. In this connection, attention should be paid to the existence of particular features of lesions of the upper respiratory tract, allowing a sufficient degree of probability to speak about the etiology of the disease.
Respiratory syncytial virus infections are characterized by moderately high fever, general toxic manifestations, mainly affecting the lower respiratory tract (bronchitis, bronchiolitis). Inflammatory changes in the nasal cavity and pharynx are poorly expressed in the larynx (rarely monitored).
Adenovirus infections are manifested by a combined lesion of the mucous membranes of the upper respiratory tract tissue of lymphadenoid throat and eyes. In pharyngoscope often determined by the increase in size, swollen tonsils, sometimes with fibrin coating.
Inflammatory changes during rhinovirus infections usually occur in the form of moderate sickness and acute rhinitis.
Given the above facts, acute respiratory infections are often associated with inflammatory diseases of ENT organs. Primarily it is an acute viral rhinosinusitis, which is believed to be recorded more frequently than bacterial types. In this disease, influenza viruses, parainfluenza, rhinoviruses may play an independent etiologic role or defined as a viral-microbial associations in 20% of patients with acute rhinosinusitis. It is believed that the main feature is the preservation of bacterial rhinosinusitis symptoms of ARI for 10 days. However, the definition of the etiology of rhinosinusitis is extremely important to choose a rational treatment strategy, in particular the sound administration of antibiotics.
Unfortunately, acute rhinitis, as with SARS in general, the tendency to unwarranted use of antibiotic therapy. Undoubtedly, the use of antibiotics in acute respiratory infections may be reasoned, but most often it is the lack of a balanced approach in determining the indications for antibiotic treatment of respiratory infections. This applies especially to patients with uncomplicated respiratory viral infection.
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