Acute upper respiratory tract infection. Upper respiratory tract infection, symptoms, treatment

Bacteria, respiratory disease, URTI… All these concepts mean one thing - diseases of the upper respiratory tract. The list of their causes and manifestations is quite voluminous, so let's look at what a respiratory tract infection is, the treatment and drugs used in therapeutic methods, which medicine is the most effective, how viral and bacterial infections of the respiratory tract differ.

Respiratory diseases are the most common reasons for visiting general practitioners and pediatricians. This disease is mainly seasonal in nature, the peak incidence for such an ailment as viral and bacterial infections of the respiratory tract occurs in the autumn-winter months. Upper Respiratory Diseases – Infections range from trivial illnesses to life-threatening conditions.

In the vast majority of cases, respiratory diseases (acute infectious diseases) occur in children, but there is also an infection in adults, which is mainly of viral origin. Even in the absence of complications, the drugs of first choice are often antibiotics. One of the reasons for their use in children and adults is to meet the requirements of the patient or the parents of the child, aimed at the best and effective treatment. It is clear that antibiotic therapy should be used for bacterial infections. It is estimated that in about 80% of cases, antibiotics are used to treat an ailment such as acute respiratory infections and respiratory diseases. For children, the situation is alarming. Approximately, in 75% of cases, drugs from the group of antibiotics are prescribed for inflammation of the upper respiratory tract. However, the so-called. prophylactic antibiotic therapy administered for upper respiratory infections does not speed up and shorten the duration of treatment, nor does it prevent possible complications that occur later. Therefore, in most cases, people without immunological disorders or other risk factors, without the presence of underlying chronic diseases, symptomatic therapy is recommended.

In uncomplicated infections of the upper respiratory tract and in immunocompetent people, the basis for treatment is symptomatology. Acute rhinitis, sinusitis, otitis, pharyngitis and laryngitis are caused by viruses in 80-90% of cases. Antibiotic therapy has practically no effect on their clinical course. In cases where the course of the disease is confirmed by evidence of bacterial agents from the selected biological material and with an increase in inflammatory parameters, antibiotics are prescribed. In addition, if stored for a long time at a high level (longer than a week), bacterial involvement may be recognized. With common pathogens - Streptococcus pneumoniae, haemophilus influenzae, Streptococcus pyogenes, Mycoplasma pneumonie a Chlamydia pneumonie - aminopenicillins or cotrimoxazole, macrolides or tetracycline preparations are prescribed.

Upper respiratory tract infection treatment of complications

Acute epiglottitis with bacterial etiology and streptococcal angina are diseases that require penicillin antibiotics. In particular, in the case of epiglottitis, hospitalization with parenteral administration of penicillin is advisable. a wide range action or cephalosporin II or III generation; therapy is supplemented with corticosteroids.

Similar recommendations apply for the treatment of lower respiratory tract infections such as tracheobronchitis and acute bronchitis. Viral etiology is the most common, accounting for up to 85% of cases. But, even in these cases, antibiotic treatment, both in children and adults, is not necessary, it is considered only in case of a serious course of the disease or in a person with immunodeficiency. If during a long and serious illness the presence of intracellular pathogens (mycoplasma pneumoniae, chlamydia pneumoniae) will be proven; macrolides, cotrimoxazole or doxycycline are the first choice drugs.

The most common infectious respiratory attacks include acute exacerbations of chronic obstructive pulmonary disease (COPD). Although it is known that exacerbations can be caused by several non-infectious causes, in practice antibiotics are also administered in these cases. The etiological agent, according to many studies, can be detected in COPD in 25-52% of cases. However, it is doubtful whether pneumococcus bacteria or Haemophilus influenzae, which chronically colonizes the airways (breathing difficulties) and leads to pathogenic exacerbations of the disease, causes the disease.

If upper respiratory tract infections occur, symptoms include increased production of colored purulent sputum, difficulty breathing and shortness of breath along with bronchitis symptoms, and sometimes high fever. The introduction of antibiotics is indicated for the detection of inflammatory markers, including C-reactive protein, leukocytes, sedimentation.

Procalcitonin is a sensitive acute phase reagent for distinguishing between bacterial and non-infectious causes of inflammation. Its value increases within 3-6 hours, peak values ​​are reached after 12-48 hours from the moment of infection.

The most commonly administered antibiotics include aminopenicillin, tetracycline, macrolide generation - clarithromycin, azithromycin. Quinolone drugs are suggested in the treatment of infections in which bacterial agents have been demonstrated. The benefit of macrolides lies in the wide antibacterial spectrum, high concentration antibiotic in bronchial secretion, good tolerability and relatively low resistance. Despite these positive sides, macrolides should not be administered as the first choice of antibiotics. Equally important are factors such as the relatively low cost of treatment. Therapy usually lasts 5-7 days. Its effectiveness and safety are comparable.

Influenza is a viral infectious, highly contagious disease that affects all age groups- can get sick, as a child of any age, and an adult. After incubation period, that is, from 12 to 48 hours, a rapid onset of fever, chills, headache, muscle and joint pain, a feeling of weakness. The disease is accompanied by cough, indigestion and can cause other serious secondary infectious complications. Adults who are already suffering from some chronic illnesses tend to have the worst flu. Young children and the elderly are the most vulnerable group. It is estimated that, on average, about 850,000 cases of the disease occur during the flu season. Necessary symptomatic treatment With bed rest. In case of secondary complications or in patients with serious risk antibiotics are administered.

Pneumonia

The main criteria for diagnosing pneumonia and distinguishing it from lower respiratory tract infections are the following factors: acute cough or a significant worsening of chronic cough, shortness of breath, rapid breathing, high fever lasting more than four days, new infiltrates on x-ray chest. Many studies have shown that consistently the most common cause community-acquired pneumonia in European countries is pneumococcus, in second place are Haemophilus influenzae, Moraxella catarrhalis, staphylococcus aureus, less often Gram-negative bacteria.

In the treatment of community-acquired pneumonia, two approaches are used, which are based on the findings of retrospective studies. We are talking about combination therapy with a beta-lactam antibiotic together with macrolides or doxycycline, or quinolone monotherapy. In the first variant, the immunomodulating effect of macrolides is positively used, which are also effective in cases of simultaneous infection with mycoplasma pneumonia, chlamydia pneumonia, legionella.

Mixed infection with the presence of more pathogenic microorganisms occurs in 6-13% of cases. If there is no improvement after 3 days clinical condition or there is progression of radiological findings, the original option should be reviewed and antibiotic treatment changed. New samplings of biological material from the respiratory tract, including bronchoscopic aspirates, can prevent this condition so that the treatment is fully targeted. In these cases, it is necessary to cover not only the usual bacterial spectrum, but also often resistant strains - pneumococcus, Pseudomonas aeruginosa, Staphylococcus aureus and anaerobic bacteria.

With nosocomial pneumonia, in which the infectious agent comes from the hospital environment, we are talking, most often, about enterobacteria - Pseudomonas aeruginosa, pneumococcus, staphylococcus, anaerobic bacteria. In this case, early treatment within 4 hours is very important, which is initially untargeted. Typically, therapy includes a combination of aminoglycosides to cover Gram-negative bacterial populations and drugs effective against anaerobic pathogens and fungi.

Epiglottitis is one of the most serious and life-threatening complications. In severe cases, it can even lead to suffocation. Pneumonia is another serious disease whose progress is accompanied by symptoms that affect the entire body. In some cases, a serious condition develops very quickly, requiring hospitalization. TO frequent complications pneumonia includes pleurisy. Sometimes an effusion may develop. In the case of these complications, it comes to the subsidence of pain and the onset of deterioration in breathing, since the lungs become oppressed by the fluid formed between the sheets of the pleura. In some cases, pneumonia is accompanied by a lung abscess, rarely gangrene in immunocompromised patients, or extensive bacterial infection.

Severe pneumonia can lead to sepsis and the so-called. septic shock. In this - fortunately, a rare - complication occurs severe inflammation whole body with the risk of multiple organ failure. In this case, it is necessary to artificially ventilate the lungs, the introduction of a combination is very strong antibiotics and support of vital functions. It should be expected that the move is relatively easy respiratory infections may be complicated by the adverse effects of several human risk factors. The most common include chronic smoking, including passive smoking, age over 65 years, alcohol abuse, contact with children, pets, poor social conditions, poor oral hygiene. Some people chronic diseases– diabetes mellitus, coronary heart disease, liver disease, kidney disease, immunosuppressive therapy for various other diseases – are a serious risk factor that can seriously complicate the situation and lead to a life-threatening condition in respiratory diseases.

Voluntary vaccination and vaccination of risk groups remains the only effective preventive measure. There are currently three main types of influenza vaccines. They differ in composition, containing either inactivated virus, inactivated viral particles, or only hemagglutinin and neuraminidase antigens. Another difference lies in reactogenicity and immunogenicity. The most commonly used is an inactivated vaccine made from trivalent inactivated viral particles. The World Health Organization (WHO) recommends that the trivalent vaccine be used for only two subtypes of influenza A and one influenza B. Subtype selection is made annually by WHO, in particular for the northern and southern hemispheres.

Vaccination against pneumococcal infection

The primary source of pneumococcal infection is pneumococcus bacteria, which differ in more than 90 serotypes. Invasive pneumococcal infection is considered dangerous, which causes pneumococcal pneumonia, meningitis, otitis media, sepsis, and arthritis. Risk groups are people over 60 years old, as well as children under the age of 5 years. The source of infection is a sick person or a carrier of the pathogen, the disease is transmitted by droplets. The incubation time is short, within 1-3 days. Vaccination against pneumococcal infection with a polysaccharide vaccine is given to persons who are in medical institutions and nursing homes, as well as for the long-term sick. In addition, immunization against pneumococcal infection is indicated for patients suffering from chronic respiratory diseases, heart diseases, blood vessels, kidneys, in insulin treatment of diabetes. Should be vaccinated patients after organ transplantation, people with cancer receiving long-term immunosuppressive therapy.

For vaccination, the most commonly used 13-valent conjugate vaccine containing serotype 13 polysaccharide, or 23-valent vaccine.

Respiratory infections are very common and affect almost all categories of the population. Most of the victims are being treated in outpatient settings, and this trend is expected to continue in the future. One of the most important points in deciding on therapeutic methods is to determine whether it is reasonable to introduce only symptomatic treatment, or antibiotic treatment is a prerequisite. Especially in the case of infections of the upper respiratory tract and acute bronchitis without a visible bacterial agent, a combination of antipyretic drugs is effective, a large number fluids and vitamins. Often the impact of this therapy is underestimated.

The individual's risk factors and the possible occurrence of complications should be taken into account. Currently, a wide variety of antibacterial drugs are used to treat bacterial infections. In addition to the undoubted advantages of such treatment, adverse effects should also be expected. They are individual, and for each person can have different manifestations.

In addition, the ongoing risk of spreading antibiotic resistance and the increase in the number of initially susceptible pathogens must be taken into account.

Skillful use of antibiotics can reduce the problem and prevent the devaluation of these drugs. Vaccination, healthy lifestyle life and reducing the risk factors mentioned above, a person can reduce the incidence and risk of complications of respiratory infections.

Respiratory diseases are more common during the cold season. More often they affect people with a weakened immune system, children and elderly pensioners. These diseases are divided into two groups: diseases of the upper respiratory tract and lower. This classification depends on the location of the infection.

According to the form, acute and chronic diseases of the respiratory tract are distinguished. The chronic form of the disease occurs with periodic exacerbations and periods of calm (remission). The symptoms of a particular pathology during periods of exacerbation are absolutely identical to those observed in the acute form of the same respiratory disease.

These pathologies can be infectious and allergic.

They are more often caused by pathological microorganisms, such as bacteria (ARI) or viruses (ARVI). As a rule, these ailments are transmitted by airborne droplets from sick people. The upper respiratory tract includes the nasal cavity, pharynx and larynx. Infections that fall into these departments respiratory system cause diseases of the upper respiratory tract:

• Rhinitis.
• Sinusitis.
• Angina.
• Laryngitis.
• Adenoiditis.
• Pharyngitis.
• Tonsillitis.

All these ailments are diagnosed year-round, but in our country the increase in incidence occurs in mid-April and September. Similar diseases respiratory tract in children are most common.

Rhinitis

This disease is characterized by inflammation of the nasal mucosa. Rhinitis occurs in acute or chronic form. Most often it is caused by an infection, viral or bacterial, but various allergens can also be the cause. In any case, a characteristic symptom is swelling of the nasal mucosa and difficulty in breathing.

The initial stage of rhinitis is characterized by dryness and itching in the nasal cavity and general malaise. The patient sneezes, the sense of smell is disturbed, sometimes rises subfebrile temperature. This state can last from several hours to two days. Further, transparent discharges from the nose join, liquid and in large quantities, then these discharges acquire a mucopurulent character and gradually disappear. The patient gets better. Breathing through the nose is restored.

Rhinitis often does not manifest itself as an independent disease, but acts as an accompaniment to other infectious diseases, such as influenza, diphtheria, gonorrhea, scarlet fever. Depending on the cause that caused this respiratory disease, treatment is directed to its elimination.

Sinusitis

It often manifests itself as a complication of other infections (measles, rhinitis, influenza, scarlet fever), but can also act as an independent disease. There are acute and chronic forms of sinusitis. In the acute form, a catarrhal and purulent course is distinguished, and in a chronic form, it is edematous-polypous, purulent or mixed.

Typical symptoms for both acute and chronic forms of sinusitis are frequent headaches, general malaise, hyperthermia (fever). As for the discharge from the nose, they are plentiful and have a mucous character. Can be observed only on one side, this happens most often. This is due to the fact that only some of the paranasal sinuses become inflamed. And this, in turn, may indicate a particular disease, for example:

• Aerosinusitis.
• Sinusitis.
• Etmoiditis.
• Sphenoiditis.
• Frontit.

Thus, sinusitis often does not manifest itself as an independent disease, but serves as an indicative symptom of another pathology. In this case, it is necessary to treat the root cause, i.e. those respiratory infections that provoked the development of sinusitis.

If nasal discharge occurs on both sides, this pathology is called pansinusitis. Depending on the cause that caused this disease of the upper respiratory tract, the treatment will be aimed at eliminating it. The most commonly used antibiotic therapy.

If sinusitis is caused by chronic sinusitis, when the acute phase of the disease passes into the chronic phase, punctures are often used to quickly eliminate undesirable consequences, followed by washing with the drug "Furacilin" or saline of the maxillary sinus. This method of treatment is short period relieves the patient of the symptoms that torment him (severe headache, swelling of the face, fever).

Adenoids

This pathology appears due to hyperplasia of the tissue of the nasopharyngeal tonsil. This is a formation that is part of the lymphadenoid pharyngeal ring. This tonsil is located in the nasopharyngeal vault. As a rule, the inflammatory process of the adenoids (adenoiditis) affects only in childhood (from 3 to 10 years). The symptoms of this pathology are:

• Difficulty breathing.
• Mucus discharge from the nose.
• During sleep, the child breathes through the mouth.
• Sleep may be disturbed.
• Annoyance appears.
• Possible hearing loss.
• In advanced cases, the so-called adenoid facial expression appears (smoothness of the nasolabial folds).
• There are laryngospasms.
• Twitching of individual muscles of the face may be observed.
• Deformation of the chest and skull in the front part appears in especially advanced cases.

All of these symptoms are accompanied by shortness of breath, cough and, if severe course- the development of anemia.

For the treatment of this respiratory disease in severe cases apply surgery- removal of adenoids. Washing is used in the initial stages disinfectant solutions and decoctions or infusions of medicinal herbs. For example, you can use the following collection:

All ingredients of the collection are taken in equal parts. If some component is missing, then you can get by with the composition that is available. The prepared collection (15 g) is poured into 250 ml hot water and boil on very low heat for 10 minutes, after which they insist for another 2 hours. The medicine prepared in this way is filtered and used in a warm form to wash the nose or instill 10-15 drops into each nostril.

Chronic tonsillitis

This pathology occurs as a result of the inflammatory process of the palatine tonsils, which has become chronic. Chronic tonsillitis often affects children, in old age it practically does not occur. This pathology is caused by fungal and bacterial infections. Other infectious diseases of the respiratory tract, such as hypertrophic rhinitis, purulent sinusitis, and adenoiditis, can provoke the development of chronic tonsillitis. Even untreated caries can become the cause of this disease. Depending on the specific cause that provoked this disease of the upper respiratory tract, treatment should be aimed at eliminating the primary source of infection.

In the case of the development of a chronic process in the palatine tonsils, the following occurs:

• The growth of connective tissue.
• Dense plugs form in the lacunae.
• The lymphoid tissue softens.
• The keratinization of the epithelium may begin.
• Lymphatic outflow from the tonsils is difficult.
• Nearby lymph nodes become inflamed.

Chronic tonsillitis can occur in a compensated or decompensated form.

In the treatment of this disease, physiotherapeutic procedures (UV irradiation) give a good effect, rinsing with disinfectant solutions (Furacilin, Lugolevy, 1-3% iodine, Iodglycerin, etc.) is applied topically. After rinsing, it is necessary to irrigate the tonsils with disinfectant sprays, for example, Strepsils Plus is used. Some experts advise vacuum suction, after which the tonsils are also worked out with similar sprays.

In the case of a pronounced toxic-allergic form of this disease and the absence of a positive effect from conservative treatment surgical removal of the tonsils.

Angina

The scientific name for this disease is acute tonsillitis. There are 4 types of angina:

1. Catarrhal.
2. Follicular.
3. Lacuna.
4. Phlegmous.

In the pure version, these types of angina are practically not found. There are always at least two varieties of this disease present. So, for example, with a lacuna, white-yellow purulent formations are visible in the mouths of some lacunae, and with a follicular, festering follicles shine through the mucous membrane. But in both cases, there are catarrhal phenomena, redness and enlargement of the tonsils.

With any type of angina, the body temperature rises, the general condition worsens, chills appear and an increase in the lymphatic regional nodes is observed.

Regardless of the type of angina, rinsing with disinfectant solutions and physiotherapy are used. In the presence of purulent processes, antibiotic therapy is used.

Pharyngitis

This pathology is associated with the inflammatory process of the pharyngeal mucosa. Pharyngitis can develop as an independent disease or concomitant, for example, with SARS. This pathology can be provoked by eating too hot or cold food, as well as inhaling polluted air. Allocate acute pharyngitis and chronic. Symptoms that are observed in acute pharyngitis are as follows:

• Sensation of dryness in the throat (in the region of the pharynx).
• Pain during swallowing.
• On examination (pharyngoscopy), signs of an inflammatory process of the palate and its rear wall.

The symptoms of pharyngitis are very similar to the signs of catarrhal angina, but, unlike it, the general condition of the patient remains normal, and there is no increase in body temperature. With this pathology, as a rule, the inflammatory process does not affect the palatine tonsils, and with catarrhal tonsillitis, on the contrary, signs of inflammation are present exclusively on them.

Chronic pharyngitis develops with an untreated acute process. Provoke chronic course others may inflammatory diseases respiratory tract, such as rhinitis, sinusitis, as well as smoking and alcohol abuse.

Laryngitis

In this disease, the inflammatory process extends to the larynx. It can affect individual parts of it or capture it completely. Often the cause of this disease is voice strain, severe hypothermia or other independent diseases (measles, whooping cough, influenza, etc.).

Depending on the localization of the process on the larynx, separate areas of the lesion can be identified, which become bright red and swell. Sometimes the inflammatory process also affects the trachea, then we are talking about a disease such as laryngotracheitis.

There is no clear boundary between the upper and lower airways. The symbolic boundary between them runs at the intersection of the respiratory and digestive systems. Thus, the lower respiratory tract includes the larynx, trachea, bronchi and lungs. Diseases of the lower respiratory tract are associated with infections of these parts of the respiratory system, namely:

• Tracheitis.
• Bronchitis.
• Pneumonia.
• Alveolitis.

Tracheitis

This is an inflammatory process of the mucous membrane of the trachea (it connects the larynx with the bronchi). Tracheitis can exist as an independent disease or serve as a symptom of the flu or other bacterial disease. The patient is concerned about the symptoms of general intoxication (headache, fast fatiguability, fever). In addition, there is a sore pain behind the sternum, which is aggravated by talking, inhaling cold air and coughing. In the morning and at night, the patient is disturbed by a dry cough. In the case of a combination with laryngitis (laryngotracheitis), the patient's voice becomes hoarse. If tracheitis is manifested in combination with bronchitis (tracheobronchitis), sputum appears when coughing. With the viral nature of the disease, it will be transparent. In case of joining bacterial infection sputum has grey-green color. In this case, antibiotic therapy is mandatory for treatment.

Bronchitis

This pathology manifests itself as inflammation of the bronchial mucosa. Acute diseases respiratory tract of any localization very often accompanies bronchitis. So, in inflammatory processes of the upper respiratory tract in the case of untimely treatment the infection goes down and bronchitis joins. This disease is accompanied by a cough. In the initial stage of the process, it is a dry cough with sputum difficult to separate. During treatment and the use of mucolytic agents, sputum liquefies and is coughed up. If bronchitis is bacterial in nature, antibiotics are used for treatment.

Pneumonia

This is an inflammatory process of the lung tissue. This disease is mainly caused by pneumococcal infection, but sometimes another pathogen can also be the cause. The disease is accompanied high temperature, chills, weakness. Often the patient experiences pain in the affected area when breathing. With auscultation, the doctor can listen to wheezing on the side of the lesion. Diagnosis is confirmed by x-ray. This disease requires hospitalization. Treatment is with antibiotic therapy.

Alveolitis

This is an inflammatory process of the terminal parts of the respiratory system - the alveoli. As a rule, alveolitis is not an independent disease, but a concomitant of another pathology. The reason for this may be:

• Candidiasis.
• Aspergillosis.
• Legionellosis.
• Cryptococcosis.
• Q fever.

Symptoms of this disease are a characteristic cough, fever, severe cyanosis, general weakness. Fibrosis of the alveoli can become a complication.

Antibacterial therapy

Antibiotics for respiratory disease are prescribed only in case of a bacterial infection. If the nature of the pathology is viral in nature, then antibiotic therapy is not applied.

Most often for the treatment of diseases of the respiratory system infectious nature use drugs penicillin series, such as medicines "Amoxicillin", "Ampicillin", "Amoxiclav", "Augmentin", etc.

If the selected drug does not give the desired effect, the doctor prescribes another group of antibiotics, for example, fluoroquinolones. This group includes drugs "Moxifloxacin", "Levofloxacin". These drugs successfully cope with bacterial infections that are resistant to penicillins.

Antibiotics of the cephalosporin group are most commonly used for the treatment respiratory diseases. For this, drugs such as Cefixime (its other name is Suprax) or Cefuroxime Axetil are used (analogs of this drug are the drugs Zinnat, Aksetin and Cefuroxime).

Antibiotics of the macrolide group are used to treat atypical pneumonia caused by chlamydia or mycoplasmas. These include the drug "Azithromycin" or its analogues - the medicines "Hemomycin" and "Sumamed".

Prevention

Prevention of respiratory diseases is reduced to the following:

• Try not to be in places with a polluted atmosphere (near highways, hazardous industries, etc.).
• Ventilate your home and workplace regularly.
• In the cold season, with bursts of respiratory diseases, try not to be in crowded places.
• Good results are given by tempering procedures and systematic physical exercises, morning or evening jogging.
• If you feel the first signs of malaise, you should not wait for everything to go away on its own, you need to seek medical help.

By following these simple rules for the prevention of respiratory diseases, you can maintain your health even during seasonal outbreaks of respiratory diseases.

Lewis Weinstein ( Louis Weinstein)

Diseases of the upper respiratory tract (nose, nasopharynx, paranasal sinuses nose, larynx) are among the most common human diseases. In the vast majority of cases, this pathology, accompanied by transient malaise, does not pose an immediate threat to life and does not cause long-term disability.

Diseases of the nose

Anosmia. Transient complete (anosmia) or partial (hyposmia) loss of smell is one of the frequent clinical manifestations of acute infectious lesions of the upper respiratory tract. As a rule, olfactory disorders are observed with swelling of the mucous membrane and swelling of the conchas of the nasal cavity, birth defects development, lake (fetid rhinitis), traumatic injuries of the olfactory nerve, polypous rhinosinusopathy.

Rhinitis (runny nose). Continuous or intermittent discharge of exudate from the nose is observed with hay fever, vasomotor rhinitis, nasal polyposis, acute rhinitis viral etiology, in case of damage to the upper respiratory tract with measles, congenital syphilis (syphilitic rhinitis of newborns), tuberculosis, nasal diphtheria, with foreign bodies, and also as a result of prolonged use of vasoconstrictors in the form of nasal drops.

Acute nasal congestion very often accompanies infectious diseases of the upper respiratory tract, mainly of viral etiology. The basis of the resulting violations of nasal breathing is often hypertrophy and swelling of the shells of allergic origin, accompanied by abundant discharge from the nose or without it. A very common cause of nasal breathing disorders is the curvature of the nasal septum. Sometimes transient nasal congestion occurs during menstruation or during pregnancy.

Rhinorrhea. Although unilateral discharge of exudate from the nasal cavity can be caused by foreign bodies, the possibility of rhinorrhea due to the outflow of cerebrospinal fluid must also be excluded. This pathological condition is diagnosed when detected in the departmentfrom the nasal cavity of a dye (fluorescein) or a radiopharmaceutical, previously introduced into the spinal canal.

Nose bleed. The most common cause of nosebleeds are scratches and abrasions that form when tightly adhering crusts are removed at the entrance to the nose, which is explained by the rich venous network of vessels located in this place (Kisselbach point). Minor bleeding from the nasal cavity is often observed in acute viral respiratory diseases. Among more serious illnesses infectious nature, complicated by nosebleeds, mention should be made of typhoid fever, nasal diphtheria, whooping cough and malaria. Possible reasons intermittent nosebleeds are uncontrolled arterial hypertension, vicarious menstruation, hemorrhagic diathesis, polycythemia vera, rhinolitis, acute sinusitis, especially with the involvement of cells of the ethmoid labyrinth in the pathological process and thrombosis of the ethmoid vein, tumors of the nose and paranasal sinuses, angiomatosis of the nasal cavity. Aspirin is often a risk factor for recurrent nosebleeds. Sometimes with hypovitaminosis C and a decrease in the level of prothrombin, increased bleeding is manifested by nosebleeds. It should be emphasized familial hemorrhagic angiomatosis (telangiectasia) - Osler-Rendu-Weber syndrome, which can manifest with nosebleeds.

Furunculosis outdoor or inner surface nose is a potentially life-threatening disease due to possible thrombosis cavernous venous sinus. In the early stages of the development of the disease, antibiotic therapy is very effective; while preference is given to antibiotics active against Staphylococcus aureus, administered in high doses. First, antibiotics are administered orally; however, with the development of systemic manifestations of the disease, parenteral administration of drugs is certainly indicated. In no case should a boil be squeezed out, as this can lead to the spread of infection into the intracranial venous sinuses. It is also not recommended to open the boil, except in cases where its size becomes extremely large or when the patient begins to experience unbearable pain.

Diseases of the pharynx

Acute pharyngitis. The main clinical sign of acute pharyngitis, regardless of the specific cause of its occurrence, is sore throat. Cause 60% of all cases acute pharyngitis- these are viral diseases of the upper respiratory tract, usually accompanied by discomfort or sore throat. Acute pharyngitis, taking into account the cause that caused it, is divided into the following three groups: curable infections, incurable infections and diseases not infectious origin.

The severity of changes in the mucous membrane of the pharynx varies from moderate redness and injection of blood vessels (in most viral respiratory infections) to purple-red hyperemia, yellowish patchy plaques, hypertrophy of the tonsils (for example, with inflammation caused by Streptococcus pyogenes group A).

Etiology of pharyngitis

I. Infectious

A. Curable

1. Streptococcus pyogenes group A

2. Hemophilus influenzae

3. H. parainfluenzae

4. Neisseria gonorrhoeae

5. N. meningitidis

6. Corynobacterium diphtheriae

7. Spirochaeta pallida

8. Fusobacterium

9. F. tularensis

10. Candida

11. Cryptococcus

12. Histoplasma

13. Mycoplasma pneumoniae

14. Streptococcus pneumoniae (?)

15. Staphylococcus aureus or Gram-negative bacteria (usually isolated from neutropenic patients or those treated with antibiotics)

16. Chlamydia trachomatis

B. Incurable

1. Primary (Influenza virus, Rhinovirus, Coxsackievirus A, Epstein-Barr virus, Echovirus, Herpes simplex, Reovirus)

2. Manifestation of a systemic disease (poliomyelitis, measles, chickenpox, smallpox, viral hepatitis, rubella, whooping cough)

II. non-infectious

A. Burn, traumatic injuries with sharp objects, etc.
B. Inhalation of irritants

B. Drying of the mucous membrane of the pharynx (when breathing through the mouth)
D. Glossopharyngeal neuralgia

D. Subacute thyroiditis (tends to a protracted or often recurrent course, often combined with subfebrile condition)

E. Psychogenic

G. Monomyelocytic leukemia

H. Immunodeficiency states

The clinical manifestations of the disease are also different - from sore throat to severe pain, making it difficult even to swallow saliva. Sometimes, with pharyngitis of streptococcal etiology, the lingual tonsils, located on the posterolateral surface of the tongue, are also involved in the pathological process, which is accompanied by pain during conversation. The presence of exudate does not yet indicate a specific etiology of pharyngitis and may be observed in infections caused by S. pyogenes, Hemophilus influenzae, H. parainfluenzae (in children), Corynobacterium diphtheriae, Streptococcus pneumoniae (rarely), adenovirus and Epstein-Barr virus. Ulcerative-necrotic lesions of the posterior pharyngeal wall and / or tonsils are characteristic of Plaut-Vincent angina, pharyngeal tularemia, syphilis (primary chancre), tuberculosis (developing with local damage to the pharyngeal mucosa), as well as in patients with immunodeficiency states and with agranulocytosis due to infection caused by fusiform bacteria or other saprophytic pharyngeal microflora. The formation of limited or widespread membranous plaques also does not necessarily indicate a specific microbial etiology of the disease. More often this nature of the lesion occurs with diphtheria of the throat, but it can also be observed with infectious mononucleosis (Epstein-Barr virus), agranulocytosis, staphylococcal pharyngitis, and also due to chemical, thermal or traumatic injury mucous membrane of the pharynx.

Often, with infectious or viral pharyngitis, the tonsils are involved in the process, which is accompanied by their swelling, redness, and discharge from the crypts of inflammatory exudate.

The etiological diagnosis of acute pharyngitis, based only on a visual assessment of the nature of the lesion, is extremely difficult. However, sometimes local symptoms "gives out" the nature of the disease: typical membranous raids and bad breath are characteristic of diphtheria, streptococcal infection(group A); mucosal ulceration and breath odor indicate the possibility of a fusobacterium infection, and irregularly shaped whitish plaques covering mucosal ulcers are specific for candidiasis.

For the purpose of etiological diagnosis of pharyngitis and the appointment of targeted antimicrobial therapy, bacteriological studies of smears from the mucous membrane of the pharynx, tonsils or inflammatory discharge are carried out. However, the effectiveness of this diagnostic approach is not absolute. So, for example, only in 70% of cases of severe pharyngitis caused by S. pyogenes , it is possible to isolate the culture of the corresponding pathogen. Patients with pharyngitis of presumably streptococcal etiology in the absence of cultural confirmation should be given appropriate treatment if this form of the disease is sufficiently common among the population examined. In subacute thyroiditis, sore throats regress on the background of taking thyroid hormone or prednisolone. Patients with acute pharyngitis of viral etiology are not prescribed any specific antimicrobial treatment.

Gonococcal pharyngitis almost always develops as a result of orogenital contacts. The prevalence of this disease in heterosexual men is 0.2-1.4%. In homosexual men, the frequency of specific pharyngitis is 5-25%, in 20% of them, along with a genital infection, a pharyngeal lesion is noted. From 5 to 18% of women with gonorrhea suffer from gonorrheal pharyngitis, and in 1-3% of patients, specific inflammation of the pharyngeal mucosa is the only manifestation of the disease. Sore throat, moderate or severe, is observed only in 30% of patients, while in the rest the disease is clinically asymptomatic. Since often the clinical signs of gonococcal pharyngitis are similar to those of pharyngitis of a different etiology, the isolation and identification of Neisseria gonorrhoeae , as well as differentiation of the pathogen from other microorganisms of the genus Neisseria , which are representatives of the saprophytic microflora of the pharynx.

Peritonsillar cellulitis and abscesses. This pathology, as a rule, is a complication of acute pharyngitis, etiologically associated most often with S. pyogenes And Staphylococcus aureus. The disease begins with a significant increase in the tonsils, hyperemia and swelling of the palatine arches. A progressive increase in the size of the tonsils and peritonsillar soft tissues due to edema is accompanied by a narrowing of the upper respiratory tract. Patients are concerned about chills, febrile fever; leukocytosis is noted in the blood. On early stages the disease is characterized as cellulitis, but in the absence of antimicrobial treatment, an abscess forms with the defeat of one or both tonsils, the surface of which is covered with an off-white coating. The diagnosis is established during a physical examination. Timely initiated (at the stage of cellulite) treatment with antimicrobial agents can lead to abortive flow abscess. If an abscess has already formed, then only one antibacterial treatment turns out not to be enough. At this stage of the course of the pathological process, of course, the opening of the abscess is shown, followed by its drainage until healing.

parapharyngeal abscess. As a rule, it is a complication of acute pharyngitis. Primary or secondary bacterial invasion of one of the tonsils may be accompanied by the formation of an intratonsillar abscess with edema and an inflammatory reaction of the parapharyngeal space. The pathological process is often one-sided: the affected tonsil swells towards the midline, while the patient experiences only discomfort or moderate soreness in the throat; however, when pressing on the side of the lesion, severe pain is determined in the region of the angle of the lower jaw. As a rule, the patient is worried about fever, leukocytosis is detected in the blood. With untimely diagnosis and late initiation of treatment, the inflammatory process spreads through the system of tonsillar veins to the jugular vein, and its thrombophlebitis is possible. The latter, in turn, is sometimes complicated by the formation of single or multiple metastatic abscesses in the lungs or sepsis of tonsil origin, characterized by high mortality. In this regard, early recognition and timely initiation of therapy before the development of jugular vein thrombophlebitis will contribute to the localization infectious process and cure.

Retropharyngeal abscess. This disease is most common in children under the age of 4 years, since at this age there are still lymph nodes in the pharyngeal region, which can be infected with acute pharyngitis. Adults get sick much less often. In the latter case, it is predisposed to its development acute otitis media, rhinitis, pharyngitis, inflammatory process in the oral cavity, local damage to the mucous membrane due to ingestion foreign body, oroendotracheal intubation, endoscopic procedure, external penetrating injury, fracture of the corresponding part of the spine, blunt trauma neck. Additional predisposing factors for the development of this disease are diabetes mellitus, alimentary dystrophy, immunodeficiency states. A very serious complication of a retropharyngeal abscess is osteomyelitis of the cervical vertebrae, which in turn is complicated by the formation of a paravertebral abscess. This complication is etiologically associated with infectious inflammation caused by Mycobacterium tuberculosis , pyogenic microorganisms and Coccidioides immitis.

Tumors and other causes of prolonged sore throat. Sometimes, some patients with malignant neoplasms have prolonged sore throats. At the same time, fever is by no means always evidence of microbial invasion, but may be due to pyrogenthe activity of the tumor itself. Carcinoma of the tonsils is the second most common among all tumors of the upper respiratory tract (the first place is occupied by osteoma). Other types of tumors that involve the pharynx and are accompanied by sore throat are nasopharyngeal carcinoma, multiple myeloma, myelomonocytic leukemia, and Hodgkin's disease. A solid tumor often affects only one tonsil; with leukemia, diffuse pharyngitis is observed. Often, antitumor treatment is characterized by the appearance of sore throats that were absent before. An immunodeficiency state due to ongoing anticancer treatment may be accompanied by the development of mucositis or infectious inflammation caused by Aspergillus, Mucor, Actinomyces and Pseudomonas.

Among the benign causes chronic pain in the throat consider breathing through the mouth. Most older people sleep with open mouth; resulting discomfort in the throat, as a rule, passes after the patient drinks a little liquid. Another cause of mouth breathing is obstruction of nasal breathing due to a deviated septum. In this situation, the expression clinical signs decreases only after surgical correction of the deviated nasal septum. Inhalation of irritants, particularly tobacco smoke, can also lead to persistent sore throats in heavy cigar or pipe smokers. Subacute thyroiditis is accompanied by severe sore throat for several weeks to several months. At the same time, patients often seek medical help for the first time due to severe manifestations of pharyngitis, and only during the subsequent examination, the fact of inflammatory lesions is established. thyroid gland. In this situation, a characteristic diagnostic sign is severe soreness in the throat, “adjacent” to the unchanged mucosa. IN rare cases long-term discomfort in the throat may be psychogenic in origin. As an exception, individual observations of glossopharyngeal neuralgia are described, which are clinically manifested by severe and prolonged pain in the throat.

sinusitis

Acute sinusitis.The most common causative agents of acute sinusitis are S. pneumoniae, S. pyogenes and H. influenzae . The etiological relationship of sinusitis with other pathogens is more often observed during immunosuppressive therapy, treatment with antibacterial drugs, penetrating wounds of the paranasal sinuses, local tumors or vasculitis. The etiology of chronic sinusitis is in most cases similar to that of acute sinusitis, but microbial associations are often distinguished. It should be emphasized, however, that with the development of sinusitis, the usual microflora of the upper respiratory tract is often isolated.

Most often, the factor predisposing to the development of acute purulent sinusitis is a viral respiratory infection of the upper respiratory tract, which causes impaired drainage of the paranasal sinuses and is accompanied by local pain, subfebrile condition, and weakness. These symptoms usually reflect the viral infection itself. However, sometimes purulent sinusitis can develop due to bacterial superinfection. The main causes of acute sinusitis are impaired outflow through the openings of the paranasal sinuses or bacterial invasion. The second most common cause of acute sinusitis is diseases of the roots of the four upper teeth: the small molars, I and II molars and the wisdom tooth. Traumatic damage to the walls of the sinus can lead to infection of the frontal sinus, cells of the ethmoid labyrinth and subsequent inflammation. With Wegener's granulomatosis and tumors of the nasal cavity can also appear clinical picture of acute or chronic sinusitis. In some of these patients (with the addition of a bacterial superinfection), the underlying disease may not be diagnosed at first. At the same time, repeated and prolonged episodes of sinusitis refractory to ongoing antibiotic therapy, recurrent course of sinusitis after discontinuation of treatment are characteristic, which ultimately prompts a more thorough examination and detection of the corresponding nature of the lesion.

The diagnosis of acute purulent sinusitis is based on characteristic symptoms, as fever, chills, local soreness, aggravated by pressure, nasal congestion, repeated headaches, varying in intensity depending on the position of the body and resuming shortly after waking up. The etiology of sinusitis is established during a bacteriological examination of nasal discharge or sinus contents obtained during a diagnostic puncture. In cases where marked swelling of the mucous membrane of the shells is observed, cocaine or any other vasoconstrictor is applied topically, which facilitates the drainage of inflammatory exudate from the affected paranasal sinus. In the case of radiologically confirmed inflammation of the paranasal sinuses, it is advisable to perform a diagnostic puncture.

Before starting treatment for acute sinusitis, it is desirable to isolate and identify (in the discharge from the nose or sinus contents) pathogenic microorganisms, to determine their sensitivity to various antibacterial drugs. And only then prescribe adequate antimicrobial therapy.

Topically applied vasoconstrictors are used to relieve local symptoms but should not be abused. Surgical drainage is indicated in cases of prolonged sinusitis or the development of intracranial complications.

Frontal sinusitis (frontal sinusitis) is characterized by pain in the projection of the frontal sinuses. At the same time, there may be swelling and redness in the forehead and upper eyelid. Characterized by increased pain when pressing on the anterior wall of the frontal sinus, especially at the upper inner corner of the orbit. With rhinoscopy, a purulent discharge is often found in front of the anterior end of the upper or middle turbinate.

Pain, swelling and sensitivity to pressure on the anterior wall of the maxillary sinus are characteristic clinical symptoms of acute sinusitis. There is also a toothache in the corresponding half of the upper jaw, aggravated by chewing. Anterior rhinoscopy reveals a purulent discharge flowing from under the middle shell.

Clinical manifestations of ethmoiditis are characterized by pain in the region of the root of the nose, bridge of the nose, headaches of frontal localization, reddening of the skin and pain on pressure in the region of the bridge of the nose and the lower edge of the palpebral fissure. During rhinoscopy, in case of damage to the anterior cells of the ethmoid labyrinth, inflammatory exudate is released from the middle nasal passage, in case of damage to the posterior cells, from the upper nasal passage. However, in most cases, due to inflammation of both the anterior and posterior cells of the ethmoidal labyrinth, pus is released both in the region of the middle and in the region of the upper nasal passages.

With acute inflammation of the main sinus (acute sphenoiditis), pains appear in the back of the head, parietal region, in the area mastoid process(with an intact eardrum), aggravated by pressure. Sometimes there is a linear reddening of the skin along the zygomatic arch due to involvement in the pathological process of the maxillary branch of the trigeminal nerve.

Among the rare complications of acute frontal sinusitis is osteomyelitis of the frontal bone, characterized by fever, chills, leukocytosis, cold, pale swelling of the frontal part of the head on the side of the lesion (the so-called Pott's tumor). When involved in the process bone tissue in patients with acute ethmoiditis, unilateral or bilateral exophthalmos may be observed. The cause of this pathological condition is aseptic or purulent inflammation of the orbital tissue, which in turn is caused by "sympathetic" inflammation or perforation of the papyrus plate - the lateral wall of the ethmoid labyrinth and the inner wall of the orbit. Violation of the venous outflow from the orbit can cause retinal hemorrhage. The consequence of the intracranial spread of the inflammatory process through the veins of the cancellous bone of the cranial vault are meningitis, thrombosis of the superficial cerebral veins or venous sinuses, paresis (paralysis) cranial nerves and extradural abscess.

Another possible complication of purulent sinusitis (usually frontal sinusitis) is bacterial meningitis, accompanied by osteomyelitis of the skull bones, subdural or intracerebral abscesses. A sudden worsening of the patient's condition, manifested by convulsions, hemiplegia and aphasia against the background of tolerated acute frontal sinusitis, indicates a subdural abscess with thrombophlebitis of the sagittal sinus or superficial cerebral vein. Acute ethmoiditis can be complicated by paralysis of the third pair of cranial nerves due to the spread of the inflammatory process to the sinuses of the dura mater or profuse nosebleeds due to thrombosis of the ethmoid veins with outflow of blood into the cells of the ethmoid labyrinth and its subsequent thrombosis. Chronic or recurrent purulent sinusitis can cause bronchiectasis. A rare pathological condition characterized by the presence of chronic sinusitis, bronchiectasis, and reversal internal organs, is described as Kartagener's syndrome. This category of patients is characterized by impaired mucociliary clearance of the distal airways - the so-called immobile cilia syndrome; in addition, in male patients, there is a decrease in the motor activity of spermatozoa, while their number remains normal.

Chronic sinusitis. It is very difficult to establish a diagnosis of chronic sinusitis in the absence of a history of recurrent episodes of acute sinusitis. purulent inflammation paranasal sinuses. Most patients complain of headaches predominantly frontal localization, nasal congestion and pain when pressed in the projection of the corresponding paranasal sinuses. When radiography of the paranasal sinuses, as a rule, note theswelling of the mucous membrane. In bacteriological studies of discharge from the nasal cavity, it is usually not possible to isolate a culture of pathogenic microorganisms. In most cases, chronic sinusitis is based on allergic inflammation of the mucous membrane; in such clinical situations, a distinct therapeutic effect is observed when vasoconstrictors are administered intranasally and specific antiallergic treatment is carried out. Often the above clinical manifestations are caused by inhalation of irritating dusts, gases, tobacco smoke.

Tumors of the paranasal sinuses.The most common benign tumor paranasal sinuses - osteoma. At the same time, 50% of patients are affected frontal sinus, 40% - cells of the ethmoid labyrinth and 10% - maxillary and sphenoid sinuses. Malignant neoplasms of the paranasal sinuses include maxillary sinus carcinoma, sarcoma, Burkitt's lymphoma, myeloma, and adenocarcinoma. Melanoma of the nasal cavity due to invasive growth can also spread to the paranasal sinuses. Sometimes tumors that are primarily localized in the paranasal sinuses can spread into the nasal cavity, causing its obstruction and making it difficult to determine the primary localization of the neoplasm (paranasal sinuses or nasal cavity). It is possible to suggest the possibility of a tumor lesion of the paranasal sinuses in patients with recurrent acute sinusitis or with chronic sinusitis accompanied by recurrent epistaxis, even if pathogenic microorganisms are not isolated from the discharge from the nasal cavity.

Diseases of the larynx

Clinical manifestations of diseases of the larynx.There are three main causes of diseases of the larynx: 1) intralaryngeal damage; 2) extralaryngeal pathological processes that cause compression of the larynx or nerves innervating vocal cords; 3) local or diffuse lesions of the nervous system with involvement in the pathological process of the nerves innervating the vocal cords.

Differential diagnosis for hoarseness and other clinical manifestations of damage to the larynx

I. Intralaryngeal diseases

A. Infectious origin Rhinitis

Viral laryngitis

Infection due to Hemophilus influenzae Membranous laryngitis Diphtheria of the larynx

Infection due to herpes simplex

Actinomycosis

Candidiasis

Blastomycosis

Histoplasmosis

Tuberculosis (ulcerogenic) Leprosy

Syphilis (secondary; perichondritis, gummous infiltration)

Infection due to Mycoplasma pneumoniae Helminth infestation ( Syngamus laryngeus)

B. Non-infectious origin Injury (edema or hematoma) Nodules on the vocal cords (nodules of singers) Papillomatosis of the vocal cords

Inhalation of tobacco smoke, irritating gases, thermal burn Larynx Leukoplakia of the vocal cords

Rheumatoid arthritis (with damage to the cricoarytenoid joints) Chronic alcoholism Benign tumors of the larynx Cancer of the larynx

Foreign bodies of the larynx

II. Extralaryngeal diseases

A. Hoarseness due to compression of the larynx and impaired movement of the vocal cords; swelling of the larynx due to violations of the venous or lymphatic outflow; damage to the laryngeal nerve with the development of paresis or paralysis of the vocal cords

Hemorrhage and / or edema due to trauma, sharp neck traction, thyroidectomy, tracheostomy, as a complication of prescale biopsy

Tumors of the laryngeal part of the pharynx (hypopharynx)

Tumors of the carotid body; thrombophlebitis in the bulb of the jugular vein

B. Local or systemic diseases located outside the neck; hoarseness due to compression of the laryngeal nerve along its entire length outside the neck; paralysis or paresis of the vocal cords as a manifestation of a systemic neurological disease

1. Local disorders [bacterial meningitis; syphilitic meningovasculitis; Infectious mononucleosis(with an increase in the lymph nodes of the mediastinum); angioedema; mitral stenosis(with dilatation of the pulmonary trunk); aneurysm of the aortic arch, carotid or innominate arteries; ligation of the botallian (arterial) duct; neoplasms of the mediastinum; tumors of the parathyroid glands; relapsing polychondritis; neoplasms of the meninges; fracture of the base of the skull; thyroid cancer; goiter (struma)]

2. Systemic disorders [diphtheria (peripheral neuritis); poliomyelitis (bulbar); infectious mononucleosis (involving nervous system); herpes zoster; cystic fibrosis; myxedema; acromegaly; Wegener's granulomatosis; systemic lupus erythematosus; diabetic neuropathy; poisoning with mercury, lead, arsenic, botulinum toxins]

Hoarse (hoarse) voice- the most common symptom in diseases of the larynx. To the number etiological factors This pathological condition includes inflammatory, non-inflammatory processes and functional disorders (hysterical aphonia). Although hoarseness, often caused by infectious inflammation, is rather transient, nevertheless, clinical situations characterized by a long course are not uncommon. Cough is also among the common signs of damage to the larynx, pain is less common, and pathological manifestations such as stridor and shortness of breath are described as casuistry. However, when the latter are present in the disease picture, this indicates a rapidly progressive obstruction of the upper respiratory tract. At the same time, obstruction of the upper respiratory tract can be the result of not only intralaryngeal damage or compression of the larynx from the outside, but also paralysis of both vocal cords. The specific cause of laryngeal obstruction is determined by direct and indirect examination of the larynx. It is certainly indicated in all cases where the symptoms of laryngeal obstruction persist for 2-3 weeks. However, in the case of a rapid increase in symptoms of laryngeal obstruction, immediate laryngoscopy and, if necessary, tracheostomy are indicated.

Epiglottitis (acute inflammation of the epiglottis). It is more commonly diagnosed in children than in adults. Clinical manifestations diseases and the results of bacteriological examination vary significantly depending on the age of patients. Men get sick 3 times more often than women. Predisposing factors are multiple myeloma, Hodgkin's disease, myelomonocytic leukemia, blastomycosis of the larynx and other diseases accompanied by immunodeficiency states. Epiglottitis is caused by N. influenzae, H. parainfluenzae, S. pneumoniae, S. pyogenes , "normal" microflora; sometimes, with primary blastomycosis of the larynx, inflammation can also spread to the epiglottis. Transient bacteremia is recorded in 50% of patients with epiglottitis. The clinical manifestations of epiglottitis in adults differ from those in children. Pain in the throat is characteristic of almost all patients. This is followed by fever (80%), shortness of breath, dysphagia and hoarseness (about 15%) with decreasing frequency. Objective signs of pharyngitis and pain on palpation of the neck are relatively rare. Abscess of the epiglottis develops in 12% of patients. With laryngoscopy, swelling and hyperemia of the epiglottis are noted, which protrudes significantly into the lumen of the lower part of the pharynx. The diagnosis is confirmed by multiprojection radiography of the neck. Of course, antimicrobial therapy is indicated, the choice of which is based on the results of a bacteriological study. In the case of progression of shortness of breath and an increase in the phenomena of laryngeal obstruction, a tracheostomy is urgently performed.

Fungal laryngitis. A rare disease caused by fungi of the genus Candida , which in more susceptible patients with immunodeficiency or receiving antibiotic therapy. Since candidal laryngitis is naturally associated with a fungal infection of the esophagus, in cases of diagnosis of candidal esophagitis, laryngoscopy is indicated. For this disease, hoarseness is uncharacteristic. In the absence of specific antifungal treatment, the outcome of candidal laryngitis may be cicatricial stenosis of the larynx.

Two more fungal infections Histoplasma capsulatum and Blastomyces dermatidis may lead to the development chronic laryngitis. These forms of fungal inflammation of the larynx are characterized by hoarseness, shortness of breath, dysphagia, obstruction of the upper respiratory tract, and sometimes hemoptysis. Characterized by ulcerative-necrotic lesions of the mucous membrane of the larynx, which can cause bleeding.

Tuberculosis of the larynx. Despite the decrease in the incidence of tuberculosis today, laryngitis caused by Mycobacterium tuberculosis retains clinical relevance. The symptomatology of tuberculous laryngitis has undergone a known pathomorphism for 40 years. Men of middle and old age (50-59 years) began to get sick more often, men in general get sick more often than women (3:1); often a specific lesion of the larynx is observed in the absence of clinical and radiological signs of pulmonary tuberculosis. Hoarseness of voice is one of the most common manifestations of tuberculous laryngitis. Quite characteristic in the past ulcerative lesion the back of the vocal cords is now relatively rare. In general, the vocal cords are involved in the pathological process in 50% of cases, and the false vocal cords and laryngeal (Morganian) ventricles are also relatively often affected. Sometimes, however, only hyperemia and edema of the mucosa are observed, which can cause an erroneous diagnosis of nonspecific laryngitis.

Foreign bodies of the larynx. Usually, aspiration of a foreign body is characterized by acutely developing clinical symptoms. There are "piercing" pains in the throat, laryngospasm. Due to swelling of the mucous membrane of the larynx, rapidly progressing shortness of breath joins. The phonation often changes as well.

If the aspirated foreign body turned out to be sharp (for example, a chicken bone), but edema of the upper respiratory tract can develop quite quickly, accompanied by increasing shortness of breath. In case of perforation of the wall of the larynx, an infectious inflammation of the soft tissues of the neck or mediastinitis joins. If aspiration of a foreign body in the larynx is suspected, an emergency examination (indirect or direct laryngoscopy) is necessary.

Cancer of the larynx. This form of malignant neoplasm is diagnosed mainly in the elderly (about 60 years), more often in men than in women. Cancer of the larynx is divided into two types: "internal" (cancer of the vestibule and vocal cords) and "external" (cancer of the subglottis). Hoarseness refers to the debut signs of "internal" cancer of the larynx, diagnosed in 70% of cases. On the contrary, with "external" cancer, this symptom appears relatively late (when the tumor grows into the vocal fold). Surgical treatment. The exception is a local form of neoplasm with damage to only the middle third of the vocal cords, when it is successfully used radiation therapy. However, in most cases, a total or partial laryngectomy is performed. When the tumor spreads to the epiglottis and/or false vocal cords, preference is given to partial laryngectomy (above the glottis), since in this case it is possible to preserve the voice function, and the operation itself is characterized by significant therapeutic efficacy. In some patients, better results can be achieved using preoperative irradiation of the larynx and regional lymph nodes. In more than 80% of cases, provided early diagnosis and treatment can achieve a cure.

T.P. Harrison. principles of internal medicine. Translation d.m.s. A. V. Suchkova, Ph.D. N. N. Zavadenko, Ph.D. D. G. Katkovsky

Respiratory tract infections are a group of diseases that develop when pathogenic microbes enter the respiratory system.

Causes

The causative agents of infectious diseases are:

• bacteria: gonococci, staphylococci, pneumococci, mycoplasma, streptococci, etc.;
• viruses: rotavirus, herpes, influenza, etc.;
• yeast-like and mold fungi.

If it was not possible to establish the pathogen, they speak of an unspecified infection. Pathogenic microorganisms are transmitted from a sick person to a healthy person during coughing and sneezing or by inhaling particles containing bacilli. In some situations, microbes enter the body through surrounding objects.

Respiratory tract infections are diagnosed at any age and affect both sexes.

The ease of entry and spread of pathogens leads to high level morbidity among the population, while respiratory pathologies occur in 20% of all cases, and can be diagnosed in one person more than once during the year.

The following categories of people are most susceptible to infectious diseases of the respiratory organs:

• infants;
• elderly people;
• patients who often suffer from colds, who have chronic pathologies of the upper ENT pathways;
• persons suffering from concomitant chronic diseases (oncological neoplasms, disorders of the nervous system, diabetes mellitus);
• people with a weakened immune system, prone to regular hypothermia.

An important role is played by timely vaccination: in people who have received immunoprophylaxis on time, infections are diagnosed much less frequently.

Depending on the method of entry and spread of microorganisms, diseases are divided into the following types:

• infectious diseases in which the pathogen multiplies at the site of penetration. These include influenza, SARS, whooping cough and others;
• pathologies that have a hematogenous mode of spread (through the blood), for example, parotitis, pneumonia, encephalitis;
• diseases in which infectious phenomena occur in the oropharynx and on mucous surfaces (tonsillitis, diphtheria, etc.);
• infections affecting the skin and mucous membranes (chickenpox, measles).

The first symptoms of AIVD usually occur 12 hours after pathogen entry, with symptoms becoming noticeable after about 3 days. Characteristic manifestations become: pain symptoms in the throat, itching in the nasal cavity, sneezing, nasal discharge, etc.

List of respiratory pathologies

The respiratory tract is conditionally divided into the upper section (nose, larynx, oropharynx) and the lower section (trachea, bronchi, lungs).

The list of diseases of infectious origin is quite extensive. Among the most common are: rhinitis, pharyngitis, influenza, sinusitis, tonsillitis, laryngitis, tracheitis, measles, diphtheria, bronchitis, pneumonia, etc. In addition, there is a simultaneous defeat of several departments (laryngotracheitis, tracheobronchitis and others).

Flu

Acute pathology of the respiratory system of viral origin, affecting the upper and lower parts of the respiratory system. Influenza begins with an intense intoxication syndrome: chills, deterioration in general well-being, an increase in body temperature above 38-40 ° C, pain in the joints and muscles. As a rule, there is no runny nose, there is a hacking cough.

Among the varieties of the disease are virus A, B and C. Influenza can lead to quite severe consequences and end in death.

Rhinitis

A disease in which inflammation occurs on the mucous surfaces of the nasal passages.

Among the characteristic symptoms there is a mucous exudate, the nature of which depends on the pathogen: if the cause is bacteria or fungi, the discharge has bad smell, yellow or green, when the virus enters the body - the snot is colorless and odorless. If a runny nose is accompanied by copious, colorless discharge, a rhinovirus infection or influenza can be suspected.

Other manifestations may be:

• violation of nasal breathing;
• itching in the nose;
• increased tearing;
• sneezing
• in some situations, there is a fever, general weakness.

Acute rhinitis often accompanies scarlet fever, diphtheria, gonorrhea, measles, etc.

Sinusitis

Inflammatory phenomena on the mucous membranes of the paranasal sinuses can occur in the form of sinusitis, frontal sinusitis, ethmoiditis, sphenoiditis. These diseases are of a bacterial or viral nature of origin, and are accompanied by the following symptoms:

• congestion of the nasal passages;
• violation of nasal breathing;
• increase in temperature indicators;
• smell disorder;
• a feeling of fullness in the bridge of the nose and frontal lobes;
• thick yellow-green discharge;
• general weakness.

Angina (tonsillitis)

Angina is an acute infection of the upper respiratory tract, which can be provoked by bacteria, viruses and fungi. Angina begins with severe pain in the throat and fever (up to 40 ° C), as well as an increase in lymph nodes. The palatine tonsils become swollen and edematous, with a lacunar, follicular and ulcerative membranous form, plaque appears on the tonsils. With the transition of angina into a chronic form, they speak of chronic tonsillitis.

Pharyngitis

Inflammatory phenomena affecting the mucous surfaces of the pharynx, most often occur when inhaled chemical substances, dirty air or are the result of hot or cold food intake. However, pharyngitis can be caused by pathogenic microorganisms - staphylococci, streptococci, pneumococci, fungi of the genus Candida, adenovirus. In this case, the pathology may accompany other inflammations of the respiratory tract (rhinitis, sinusitis, influenza, SARS, scarlet fever).

Symptoms of acute pharyngitis are:

• violation of respiratory function;
• intoxication syndrome;
• redness and swelling of the throat;
• dry cough, perspiration;
• general weakness.

Laryngitis

• hoarseness of voice, wheezing;
• barking cough;
• pain when swallowing;
• difficulty breathing;
• headache;
• increase in body temperature;
• white coating on the throat.

Laryngitis is dangerous for its consequences - stenosis of the larynx or croup.

Tracheitis

A disease characterized by damage to the trachea - the organ that connects the larynx to the bronchi. Frequent provocateurs are toxic substances, tobacco, polluted air, etc.. Tracheitis can be a manifestation of influenza and a bacterial infection, while patients experience:

• intoxication syndrome;
• pain symptoms in the pharynx and behind the sternum;
• a slight increase in temperature indicators;
• unproductive cough that occurs mainly in the morning and at night;
• if tracheitis is combined with laryngitis, hoarseness is observed.

Bronchitis

Pathology of the respiratory organs, in which inflammation occurs in the bronchi. The most common pathogens are rhinoviruses, adenoviruses, pneumococci, streptococci, Haemophilus influenzae. Symptoms of the disease include:

• intoxication syndrome;
• dry or wet cough;
• deterioration in general well-being;
• pain symptoms in the head.

Bronchitis has an acute or chronic course. Forms of leakage have significant differences in etiology, pathogenesis, and also differ in methods of therapy.

Pneumonia

Disease of the lung tissue is predominantly infectious. The causative agents of infection are pneumococci, Klebsiella, staphylococci, streptococci, cytomegalovirus, molds and yeast-like fungi. There are also pneumonias of other origins.

The following clinical picture is characteristic of the disease:

• intoxication, chills;
• general weakness;
• growing cough with sputum;
• temperature increase;
• sweating.

Most often, pneumonia develops as a complication of other systemic diseases.

Diphtheria

Infectious disease, the provocateur of which is Loeffler's bacillus. Most often affects the oropharynx, diphtheria of the larynx, bronchi, skin is less common. It is transmitted mainly through the air, less often through surrounding objects and food. The incubation period is 2-10 days.

The classic manifestation of diphtheria is the presence of a grayish film on the soft palate. Other symptoms include:

• increase in temperature indicators;
• skin blanching;
• discomfort when swallowing;
• hyperemia and swelling of the mucous membranes;
• swollen lymph nodes.

Measles

Acute infectious disease viral origin, characterized by sufficiently high temperature indicators (up to 40.5 degrees), inflammatory processes on the mucous membranes of the oropharynx and upper respiratory organs, inflammation of the conjunctiva, as well as the appearance of a characteristic red rash on the palate, face, neck, limbs. At the same time, papules have the ability to merge with each other.

The measles provocateur is an RNA virus from the paramyxovirus family. The pathogen is transmitted through the air during cough reflexes and sneezing from a sick person. Pathology occurs mainly in children under 5 years of age, but can also be diagnosed in adulthood.

Whooping cough

A serious infectious disease of the respiratory system, especially dangerous for children early age. The causative agent is the bacterium Bordetella pertussis, which is transmitted by airborne droplets. Characteristic manifestations of whooping cough are bouts of spasmodic cough, which can intensify. Other signs of whooping cough resemble SARS and appear as a runny nose, sneezing, and a slight increase in temperature.

Diagnostics

A diagnosis of AIVDP can be made on the basis of a comprehensive diagnosis. First of all, the doctor collects an anamnesis, listens to complaints and conducts an initial examination of the patient.

To confirm the diagnosis, laboratory tests will be required:

• general blood analysis. An increase in leukocytes in the blood indicates an acute stage of the course of the disease, while with viral infections there is an increase in the number of lymphocytes and monocytes, with bacterial infections - an increase in the number of neutrophils;
• to establish the pathogen, bakposev from the nose and throat is used, as well as a study of the secret for microflora and antibiotic sensitivity;
• a serological blood test will help determine antibodies and their titers;
• depending on the type of pathology used instrumental ways diagnostics - laryngoscopy, bronchoscopy, X-ray.

Treatment

Infectious pathologies of the upper and lower respiratory tract are usually not an indication for hospitalization of the patient. They are treated by a therapist or an otolaryngologist. The therapy uses an integrated approach:

• Etiotropic therapy consists in suppressing and stopping the spread of the pathogen:

• The viral origin of the disease, such as influenza, suggests the use antiviral drugs(Arbidol, Kagocel, Antigrippin, Remantadin, Isoprinosine, Tamiflu).
• Antimicrobial therapy is used for bacterial infections: for example, for tonsillitis, macrolide agents are indicated - Erythromycin, Clarithromycin, Azithromycin, penicillin preparations - Amoxicillin, Augmentin, Amoxiclav; for inflammation of the bronchi and lungs, both macrolides and penicillins, as well as fluoroquinolones - Levofloxacin, Ofloxacin, can be used.

• Pathogenetic treatment is aimed at restoring impaired body functions and accelerating recovery. For this purpose, the following immunomodulatory substances are prescribed:

• Cycloferon, Anaferon, Grippferon, Amiksin, Viferon are indicated for viral infections;
• IRS-19, Imudon, Bronchomunal - with bacterial;
• Moreover, in some cases, combined medicines that relieve inflammation (Erespal), if necessary, NSAIDs are used.

• Symptomatic therapy is carried out to improve the quality of life of the patient:

• for rhinitis, vasoconstrictors are used - Nazol, Tizin, Pinosol;
• to relieve pain in the throat with sore throat, pharyngitis, laryngitis, absorbable tablets Faringosept, Lyzobakt, aerosols for irrigation of the tonsils Geksoral, Tantum Verde, Yoks are used;
• for infections accompanied by a cough, mucolytics and expectorants (ACC, Mucobene, Acetylcysteine, Bromhexine, Ambroxol), herbal remedies based on licorice, thyme, as well as combined (Ascoril, Stoptussin, Gedelix) and antitussive drugs (Sinekod, Falimint, Tussin) are indicated .
• Analgesics (ibuprofen) will help relieve pain in the head and muscles.
• Also used antipyretic Paracetamol, Nurofen.
• To relieve nasal congestion and swelling of the mucous membranes, antihistamines are used (Suprastin, Claritin).

ethnoscience

It is necessary to treat infections of the respiratory organs in a complex manner. Traditional medicine can help with this:

• with rhinitis, an excellent result was shown by aloe juice, which can be instilled into nasal cavity 3-4 times a day;
• washing the nasal passages with a solution of salt with iodine will help to cope with a runny nose;
• with bronchitis, sage with milk is used. Honey can be added to the mixture and applied 2 times a day;
• the following recipe will help with pneumonia: for a glass of aloe juice, you need 1 tablespoon of ground birch buds and 2 tablespoons of eryngium leaves. A kilogram of propolis and liquid honey are added to the ingredients. The composition is heated in a water bath and used in a tablespoon 3 times a day;
• St. John's wort infusion will relieve sinusitis, which can be consumed orally and used for washing;
• for the treatment of sinusitis, the following recipe is used: 5 g pork fat mixed with 4 spoons sea ​​salt. The resulting mixture is treated with the area of ​​​​the nose and nasal sinuses;
• To alleviate the flow of tonsillitis, you can use the following mixture: coltsfoot juice, onion juice, dry red wine. The composition is taken orally, diluting it with water in a ratio of 1 to 3.
• to eliminate the manifestations of pharyngitis, garlic and honey syrup, which is consumed one spoon per day, will help;
• raspberries with ginger will help restore the lost voice: for 2 tablespoons of raspberries - a pinch of ginger, 2 tablespoons sunflower oil, a glass of boiling water;
• for the treatment of tracheitis, an infusion of marshmallow root is used. Take 1 spoon 4 times a day.

Infectious pathologies of the respiratory tract should be treated mainly with medicines. The choice of medication depends on the type and severity of the disease. However, any disease is easier to prevent than to cure, which is why it is necessary to undergo timely vaccination in advance, as well as follow preventive measures.

It so happened that respiratory tract infections give patients maximum discomfort and knock them out of normal rhythm. Most people do not tolerate infectious diseases well. But the sooner treatment of any ailment caused by harmful microbes begins, the sooner the infection can be dealt with. To do this, you need to know your enemies by sight.

The most well-known infections of the upper and lower respiratory tract

Almost all diseases are the consequences of the penetration into the body and the active reproduction of bacteria and fungi. The latter live in the organisms of most people, but strong immunity does not allow them to develop. Bacteria cannot miss their chance, and as soon as they manage to find a gap in the immune system, microorganisms begin to act.

Among the most frequently encountered viral infections of the respiratory tract, it is customary to include the following diseases:

1. Sinusitis characterized by inflammation of the nasal mucosa. The disease is often confused with bacterial rhinosinusitis, which usually becomes a complication of viral infections. Because of it, the patient feels unwell for more than a week.
2. Acute bronchitis is a common upper respiratory tract infection. In the disease, the main blow falls on the lungs.
3. So streptococcal tonsillitis Probably everyone has experienced it in their life. The disease affects the palatine tonsils. Against the background of it, many people wheeze and for a while completely lose their voice.
4. At pharyngitis an acute inflammatory process develops on the mucous membrane in the pharynx.
5. Pneumonia- one of the most dangerous respiratory tract infections. People are still dying from it today. It is characterized by a complex lesion of the lungs. The disease can be unilateral or bilateral.
6. No less dangerous flu. The disease almost always proceeds very hard with a high temperature.
7. Epiglottitis is not so common and is accompanied by inflammation of the tissues in the epiglottis.