Acute Respiratory Viral Infections Upper Respiratory Tract

Acute Respiratory Viral Infections = Upper Respiratory Tract Infections

URTI – group of self-limited viral diseases, characterized by : - catarrhal syndrome; - intoxication.

Examples of URTI viruses Family Representatives Paramyxoviridae Parainfluenza virus Respiratory syncytial virus Orthomyxoviridae Influenza virus types A, B, C Coronaviridae Coronavirus Nucleic acid RNA RNA Picornaviridae Rhinovirus RNA Adenoviridae Adenovirus DNA

Seasonal characteristics Season September October November Winter February – March Spring All the year Viruses Rhinovorus Parainfluenza RS-virus Influenza Rhinovorus Adenovirus

Frequency of URTI Age Under 1 year 1 -5 years Teenagers Adults Case Frequency 3 -6 times per year Up to 8 times per year 4 -5 times per year 2 -4 times per year

Main clinical syndromes • Short incubation period • Catarrhal syndrome (by topics) • Intoxication

Topics of different URTI Virus Rhinovirus Clinics Rhinitis Adenovirus Rhino-pharyngealconjunctival fever Parainfluenza Laryngo-tracheitis, virus laryngitis Influenza virus Tracheitis RS virus Bronchiolitis

Differential diagnosis Disease Allergic rhinitis Foreign body of the nose Sinusitis Streptococcal nasopharyngitis Pertussis Clinics 1. Itching and sneezing are predominating 2. Nasal eosinophylia 1. One-side purulent discharge 2. Bloody discharge 1. Headache, tenderness at percussion, periorbital edema; 2. Cough and/or rhinorrhea more than 10 -14 days. Purulent exudate from the nose 1. 2. Inborn syphilis 1. 2. Prolonged beginning; Cough paroxizmes. Persisting rhinorrhea; Beginning at the first 3 months of age.

Laboratory diagnosis Express methods Electronic microscopy IFA Light microscopy Luminescent microscopy Amplification methods Serological methods Immuno-chemical analysis PCR DNA hybridization Кгибридизация IFA

Antiviral therapy (First 48 hours!) Virus Drug RS-virus Ribavirin Influenza Oseltamivir (Tamiflu) Zanamivir Remantadin Amantadin Rhinovirus Pleconaril Adenovirus Cydofovir

URTI prophylaxis – vaccines l Influenza l Adenovirus (for military personnel) l RSV (for newborns, high risk infants)

Influenza

Epidemiology • Winter-Spring • А, В, С types of virus • Hemagglutinin and neuraminidase typing (H & N) • Pandemias – mostly type A (1918, 1977 yy. ) • Epidemics - mostly for type B • Sporadic cases - mostly for type C

Clinics • Acute beginning • Intoxication syndrome first ØFever 39 -410 С ; ØAstenic syndrome, myalgias • Catarrhal syndrome – tracheitis, tonsilopharyngitis, conjunctivitis • Severe cases – hemorrhagic syndrome and neurotoxicosis

Particularities in newborns Sepsis-like clinics: • Lethargy • Feeding refusal • Capillary refill decreased • Apnoe • Petechia rash

Complications • Bacterial: otitis, sinusisits, pneumonia, etc. • Acute myositis • Reye syndrome • Neurologic (encephalitis neurotoxicosis, Guilliene-Barre syndrome, myelitis) • Cardiological (myocarditis)

Mortality risk factors • Age under 3 years or elderly • Chronic lung diseases • Chronic heart diseases • Diabetes mellitus • Neurological and muscle diseases • Malignancy

Therapy • Oral or IV desintoxication • NSAIDs – ibuprophen, paracetamole Aspirin contraindicated! • Antivirals – first 48 hour, 5 days (Oseltamivir (Tamiflu), Zanamivir, Remantadin)

Parainfluenza

Croup – inflammation of larynx: - “Barking” cough; Dysphonia and aphonia ; Inspiratory shortness of breath at stenosis

Differential diagnosis l Epiglottitis l Diphtheria l Bacterial laryngitis l Retropharyngeal abscess l Spasmodic croup l Foreign body l Angioneurotic laryngeal edema

Therapy of stenosis 1. 2. 3. 4. 5. Epinephrin - inhalations through nebulizer Cortocosteriods - IM, PO Oxygen Moist air Comfortable surrounding for the child

Acute bronchiolitis

Acute bronchiolitis First two years of life Obstruction of small bronchi and bronchiolae Etiology: l RSV (60 -85 %); l Parainfluenza 3 rd type; l CMV; l Adenovirus; l Micoplasma; l Chlamydia.

Main symptoms Dry cough for 2 -4 days → more moist l Dyspnea (expiratory, apnea) l Respiratory insufficiency l Thorax emphysema (severe cases) l Hemodynamic disturbances l Mild intoxication syndrome l

Treatment Bronchodilators – salbutamol l Oxygen l Antivirals – ribavirin l Adequate fluid balance l

Adenoviral infection

Etiology DNA containing l Persists in lymphoid tissue → clinics, chronic tonsillitis and adenoiditis l Oncogenic ability and long-life carriage l Tropic to respiratory, GI and conjunctival mucous l Infections - all the seasons l

Clinical forms URTI Rhino-pharyngeal fever Follicular conjunctivitis Epidemic kerato-conjunctivitis Pertussis-like disease Hemorrhagic cystitis Acute diarrhea Reye or Reye-like syndrome In immunodeficient patients (pneumonia with bronchiolitis, bronchoectasis, pneumofibrosis)

Clinics l Subfebrile fever l Prominent catarrhal syndrome l Under 3 years of age – often + diarrhea l Rhinitis, conjunctivitis, pharyngitis l Poly-lymphadenopathy l Pneumonia and OM complications