Eng / RESPIRATORY SYNDROME

Viral infection of the lungs

Clinical signs of early influenza pneumonia:

•localized chest pain

•dyspnea,

•acrocyanosis,

•hypoxemia develops (oxygen saturation - SpO2 <93%).

•On auscultation: weakened breathing, crepitus, and sometimes dry wheezing in the lower parts of the lungs are heard.

•On radiographs: pneumonia is more often focal, with largefocus opacities of a heterogeneous structure, as well as confluent, focal polysegmental and lobar.

General pathogenetic aspects of acute respiratory infections

The reproduction of viruses occurs in the cells of the epithelium of the

respiratory organs and consists of several main stages:

•adsorption of the virus on the epithelial cell wall

•entry of a virus or its nucleic acid into a cell

•In influenza, this is due to the enzyme of the virus - neuraminidase. Active absorption of the virus by the cell is also possible ("viropexy" or "pinocytosis")

•Only a few tens of minutes can elapse between the penetration of a virus into a cell and the appearance of viral offspring in it.

Flu

(seasonal, epidemic)

•characteristic epidemiological history;

•acute sudden onset;

•high fever, severe intoxication with mild catarrhal syndrome;

•severe headaches, especially in the frontotemporal region, superciliary arches, retroorbital pain, intense muscle pain in the back, limbs, sweating;

•signs of rhinitis and tracheitis (nasal congestion, coughing), "viral throat";

Flu

(seasonal, epidemic)

•Rapid accession of a bacterial infection: purulent runny nose, wet cough, plaque on the tonsils;

•lack of inflammatory changes in the blood, a tendency to leukopenia;

•positive response PCR, ELISA, green glow in the immunofluorescent study of smears-prints from the nasal mucosa

Clinical picture of pandemic influenza A (H1N1) / California / pdm09

•The onset of pandemic influenza A(H1N1) is not always acute

•It is possible to increase the temperature both to febrile (over 38 ° C) and to subfebrile numbers (37-38 ° C)

•Pain in the muscle, aches in the joints and headache are present in less than half of the patients (47-48%), weakness is pronounced (59%)

•From the first days of the disease, the clinic of severe catarrhal-respiratory syndrome comes to the fore: cough (98%), shortness of breath (51%), cyanosis.

•50% of patients complain of sore throat, while signs of pharyngitis are observed only in 39%, moderate runny nose is present in one third (33%) of cases

•Fever associated with cough and tracheitis is typical (81%)

•X-ray examination determined multifocal changes (27%), less often - single foci of blackout (18%)

•Dyspeptic syndrome may develop: nausea, vomiting (18%), diarrhea (13%)

The nature of the damage to the mucous membranes of the respiratory tract

•sharp hyperemia of the soft palate with injection of blood vessels and with a cyanotic tint;

•pinpoint hemorrhages in the soft palate mucosa;

•swelling and cyanosis of the tongue;

•hyperemia of the posterior pharyngeal wall and hyperplasia of lymphoid follicles;

•diffuse bright hyperemia of the mucous membrane of the oropharynx.

Complications

•Pneumonia is the most frequent complication of influenza and determines the severity of the disease.

•The more severe the flu, the more often early pneumonia occurs.

•Pneumonia, which developed early on days 1-3, is characterized by a combination of symptoms of a viral and bacterial infection:

High fever, local chest pain, tachypnea, cyanosis, blood in the sputum are signs of advanced pneumonia

Bilateral pneumonia