What disease is most often caused by rs infection. Symptoms and treatment of respiratory syncytial infection in children

Causes

Respiratory syncytial infection is widespread; according to various data, the proportion of cases of infection in the structure of the overall incidence of acute respiratory viral infections ranges from 3 to 16%. Despite the fact that both a child and an adult can get sick, the virus is extremely dangerous for young children. Observations have shown that when an infected child appears in a group of children's institutions, all other children under the age of 1 year fall ill.

The highest incidence rates are observed in the winter and spring months, but a case of infection can be registered at any time of the year. The forms of the disease can be different - there are both lesions of the upper respiratory tract, typical for uncomplicated SARS, and severe bronchiolitis, pneumonia. Older children and adult patients most often tolerate the disease easily - in contrast to children of the first 6 months of life.

The provocateur of respiratory syncytial infection is a virus belonging to the Paramyxoviridae family. It is called RS-virus, RSV-infection and belongs to the group of causative agents of SARS (acute respiratory viral infections) in children and adults. Sensitive to the effects of the external environment, quickly inactivated already at a temperature of about 55 ° C (on average - in 5 minutes). Contains ribonucleic acid (RNA), causes the formation of syncytium, or pseudo-giant cells, in tissue culture.

Respiratory syncytial virus is transmitted by airborne droplets (during coughing, sneezing), household contact (when shaking hands, using any objects that the infected person has touched - for example, toys).

The source of infection is a sick person, and the "entrance gate" is the epithelial cells of the upper respiratory tract.

Risk factors for a severe course of MS infection have been identified:

In children under the age of 1 year, the respiratory syncytial virus causes lung damage with episodes of apnea (breathing stops).

Pathogenesis

Penetration of the RS virus into epithelial cells leads to their death. Pathological changes also include:

• edema, thickening of the walls of the bronchi;
• necrosis of the tracheobronchial epithelium;
• blockage of the lumen of the bronchi with mucous lumps, epithelium;
• the formation of atelectasis;
• formation of immune complexes.

The process is characterized by rapid progression, a high probability of spreading to the lower parts of the respiratory system.

The RS virus is able to suppress the activity of the interferon system, which slows down the formation of the immune response. Secondary immunodeficiency leads to a weakening of the immune defense and an increased risk of bacterial infection.

Symptoms

The incubation period for respiratory syncytial virus infection lasts from 3 to 6 days. The course of the disease largely depends on age. Adults tolerate RSV infection easily in the form of a classic ARVI without severe intoxication. Patients are concerned about:

• weakness, lethargy of a moderate degree;
• headache;
• increase in body temperature up to 37.5-38 ° C;
• nasal congestion;
• sore throat;
• dry paroxysmal cough;
• dyspnea.

A non-productive cough turns into a wet one after a few days. Even after the disappearance of the fever, it can persist for 3 weeks - this is one of the typical signs RS infections. When the condition worsens, patients complain of shortness of breath, a feeling of heaviness in the chest.

Bronchiolitis - inflammatory disease lower divisions respiratory system characterized by damage to the small bronchi and bronchioles. Children under the age of 2 years are sick, although in the vast majority of cases bronchiolitis is recorded in patients no older than 9 months. One of the most likely provoking etiological agents is the respiratory syncytial virus. Symptoms usually appear a few days after the onset of SARS (runny nose, fever), the clinical picture includes:

1. Severe weakness, lethargy, or agitation.
2. Excruciating headache.
3. Appetite disturbance.
4. Fever (37.5-38.5 ° C).
5. Spasmodic cough, runny nose, pharyngitis.

Sometimes there is vomiting, stool disorder - as a rule, on the first day after the onset of vivid symptoms. Breathing in patients is frequent, short, wheezing with labored exhalation; accompanied by the participation of auxiliary muscles. Bloating is noted chest, gray-cyanotic shade of the skin, cyanosis of the lips. During auscultation of the lungs, dry whistling and moist rales can be heard from both sides. Cough at first dry, hoarse; after acquiring a productive character, sputum is separated with difficulty.

Diagnostics

Rapid confirmation of the diagnosis requires, as a rule, only respiratory syncytial infection in children. Adults carry it as a normal ARVI without the need for hospitalization and making a decision on the tactics of urgent measures. Used:

• general blood analysis;
• chest x-ray;
• pulse oximetry;
• linked immunosorbent assay;
• immunofluorescent method;
• polymerase chain reaction.

The choice of studies is carried out by the attending physician.

Treatment

Patients are treated on an outpatient basis or in a hospital setting. Hospitalization required:

• children under the age of 6 months;
• children with episodes of apnea;
• patients with signs of respiratory failure;
• patients with a need for permanent sanitation respiratory tract;
• in the presence of severe comorbidities.

It is also recommended to hospitalize children who have signs of malnutrition, difficulty in feeding. Social indications are important - the absence of persons who can take care of the patient during the period of illness, the patient's stay in constant contact with other children in orphanages.

When infected with respiratory syncytial virus, treatment includes the following measures:

1. Hydration, that is, drinking plenty of water, the introduction of glucose-salt solutions intravenously, through a nasogastric tube.
2. Inhalation of short-acting B2-agonists (salbutamol).
3. Clearing the nose of mucus.
4. Oxygen therapy according to indications.

Antibacterial therapy is used only if the patient has a proven bacterial infection.

Mucolytics (Ambroxol) should not be used without a doctor's prescription, as the volume of bronchial secretions increases and respiratory failure worsens. In addition, the secret is liquid, and it is not required to dilute it additionally.

The expediency of using glucocorticosteroids, both inhaled and systemic, is discussed. It is not recommended to include vibration massage in the treatment regimen for bronchiolitis due to low efficiency.

In severe respiratory failure, apnea, mechanical ventilation (artificial ventilation of the lungs) is used. The need to prescribe ribavirin as an antiviral drug is determined by the doctor.

Prevention

• preservation breastfeeding at least during the first 6 months of life;
• prevention of passive smoking;
• reducing the frequency and time spent in crowded places;
• limiting and avoiding contact with people who have symptoms of SARS;
• frequent hand washing, refusal to touch the eyes, nose and mouth with hands before hygiene procedures.

Children at risk for severe MS infection are immunized with palivizumab (monoclonal antibodies to the RS virus).

Our expert is the head of the department of arrhythmology of the Research Clinical Institute of Pediatrics, SBEE HPE "Russian National research university named after N. N. Pirogov" of the Ministry of Health of Russia, Vice-President of the Association of Pediatric Cardiologists of Russia Igor Kovalev.

unusual cold

Respiratory syncytial infection, despite the unfamiliar name, is quite common. Both children and adults can get sick with it during the cold season - that is, from October to May - along with other viral infections: SARS, para-influenza, influenza, adenovirus ... But if clinical manifestations influenza, for example, heat and damage to the mucous membrane of the upper respiratory tract, then with RSV, the lower sections are affected with the frequent development of bronchitis, bronchiolitis and pneumonia in children of the first two years of life.

The bronchial tree at this age is not yet developed, the lumen of the bronchi is small. Under the influence of the RS virus, swelling of the bronchial mucosa occurs, an excessive amount of thick sputum is produced, which accumulates and blocks the lumen. If an adult or an older child can cough, then very young children cannot do it because of the peculiarities anatomical structure respiratory tract. The baby develops respiratory failure - breathing quickens, the skin becomes pale or blue. Doctors in this case diagnose bronchiolitis or obstructive bronchitis. Sometimes respiratory failure is so severe that mechanical ventilation is required. As a result, this infection, which is not terrible for adults, is so severe in babies that, as a rule, they have to be hospitalized.

Who gets sick more often

There are a lot of rumors about RSV. One of them is that boys get sick more often than girls. Yes, this is true, but this fact does not matter for the prevention and treatment of the disease. Another myth is that children from families with a socially low status are susceptible to this disease. In fact, infection does not depend on the level of wealth of the family. But it is true that RSV infection is more often diagnosed in large families. Infection is always where there is a lot of contact between children.

Actually, RSV can also be picked up by the only child in the family, who is regularly taken to kindergarten, developing circles, to children's performances.

life threat

For some groups of children, RS infection can be life-threatening. These are, first of all, children of the first two years, especially premature babies born before the 32nd week of pregnancy, who have immaturity of the airways and lungs. Also at risk are children with cardiomyopathies, birth defects heart, with excess blood flow in the lungs, or with heart defects, accompanied by cyanosis (cyanosis) of the skin. Many experts refer to the risk group of children with Down syndrome, congenital lung anomalies, neuromuscular pathology. All these kids need seasonal immunization to prevent RS infection. It is passive, that is, not a weakened or killed pathogen is introduced, as with other vaccinations, but ready-made antibodies that will protect the body from the RS virus.

The use of antibodies to the RS virus as a means of preventing the disease has proven its effectiveness over the years. But unfortunately, this vaccine is not included in the national vaccination schedule, so each region vaccinates its children to the best of its ability at the expense of local budget. Essentially, prevention of RS infection is new technology for domestic health care and requires finding additional ways of financing. Because for children at risk this is the only possible protection.

Although, of course, in matters of prevention, one should not neglect the observance of banal precautions: limit the contact of the child during the cold season, follow the rules of personal hygiene. The latter applies to all family members.

Respiratory syncytial virus belongs to the group of acute infections that affect a fairly large number of the population, mainly early age. One-year-old children occupy the main place among the infected. If the disease is superficial in adults, then serious complications can develop in babies.

Definition

This is a virus that causes respiratory infections. The insidiousness is that it is difficult to diagnose, as it can easily be confused with a simple cold. At the moment, no vaccine has yet been developed, so the disease is sometimes fatal. In hospitalized, the appearance of bronchitis, whistles and asthma is provoked.

Etiology

Respiratory syncytial virus concentrates in the cytoplasm, after maturation begins to bud into the membrane. It belongs to the Paramyxoviridae family and is the only member of this group that can cause serious illness. Although the various stamps have some antigenic heterogeneity, the variation is predominantly in one of several glycoproteins, but the epidemiological and clinical significance of these differences is unclear. The infection grows in a number of cell cultures, causing the formation of a characteristic syncytium.

Causes

The human respiratory syncytial virus is one of the diseases that are transmitted by airborne droplets. They can infect both sick people and carriers. Collective and family outbreaks are characteristic, and cases have also been recorded, often in pediatric hospitals. Distribution is ubiquitous and round-the-clock, most often in winter-spring time. The greatest susceptibility is observed in children from 4-5 months to 3 years. At an early age, most of the babies suffer from this disease, since then unstable immunity is observed, and repeated cases of the disease are quite common, only in a more erased form. However, after the complete disappearance of antibodies (IgA) from the body, respiratory syncytial virus may reappear.

Spread through close contact with infected people. It was analyzed and found that if a sick person sneezes, then the bacteria easily spread to 1.8 m. This group of pathogens can survive on hands for up to 30 minutes, and on objects for several hours.

The pathogenesis of infection is very similar to the mechanism of development of influenza and parainfluenza, as it is associated with the movement of the disease to the epithelium of the respiratory tract. The respiratory tract serves for penetration, and the primary reproduction begins in the cytoplasm of the nasopharynx and then spreads to the bronchi. At this point, hyperplasia of affected cells and symplasts occurs. Such phenomena are accompanied by hypersecretion and narrowing of the bronchioles, which further leads to blockage of their thick mucus. Then the development of infection is determined by the degree of accession of the flora and respiratory failure.

Symptoms

Respiratory syncytial virus, whose microbiology is complex and difficult to diagnose, is an early spring and winter disease.

To date, it has not been revealed why the lower respiratory tract is affected in babies and the upper respiratory tract in adults.

In children, the disease begins with a fever, severe pain in the throat and runny nose. Other symptoms soon follow that resemble asthma. The infection is characterized by the following symptoms:

- (more than 40 breaths per minute);
- bluish skin tone (cyanosis);
- sharp and frequent cough;
- heat;
- intermittent and uneven breathing;
- coarse seals;
- piercing breaths and wheezing;
- Difficulty exhaling.

Lower respiratory tract infections occur when the bronchioles swell. If at this moment the patient is experiencing problems with the oxygen supply, then it is imperative to consult a doctor for immediate medical care. Such ailments most often appear in children under one year old, and they quickly worsen.

Classification

There are a large number of factors by which respiratory syncytial virus can be characterized, namely:

- typical- develop rhinitis, laryngitis, pneumonia, nasopharyngitis, bronchitis, bronchitis, segmental pulmonary edema and otitis media;
- atypical- erased or asymptomatic course of the disease.

There are 3 main forms of the disease.

1. Light occurs more frequently in adults and children school age. Manifested as moderate nasopharyngitis, respiratory failure is not observed. Most often, body temperature remains normal or rises slightly, but literally by a few degrees. Signs of intoxication are completely absent.

2. Moderate symptoms can be seen acute bronchitis or bronchiolitis, accompanied by obstructive syndrome and respiratory failure. The patient has oral cyanosis and dyspnea. If a child is sick, he may be overly restless, drowsy, agitated, or lethargic. Often there is a slight increase in the liver or spleen. The temperature is often elevated, but it is normal. Moderately expressed intoxication is observed.

3. heavy, at this point bronchiolitis and obstructive bronchitis develop. There is a severe lack of air, in which only an oxygen mask for breathing can help. Whistles and noises are traced, there is a pronounced intoxication and a strong enlargement of the liver and spleen.

The criteria for severity most often include the following characteristics:

Presence of local changes;
- difficult respiratory failure.

By the nature of the flow:

Smooth - no bacterial complication;
- non-smooth - the appearance of pneumonia, sinusitis and purulent otitis media.

Story

Respiratory syncytial virus, the symptoms of which can be confused with other diseases, was identified in 1956 by Dr. Morris. He, observing a chimpanzee who was diagnosed with rhinitis, found a new infection and named it CCA - Chimpanzeecoriraagent (causative agent of the common cold of a chimpanzee). At the time of examination of the sick employee who cared for the monkey, an increase in antibodies was noticed, very similar to this virus.

In 1957, R. Chenok identified a similar pathogen in sick children and determined that it was he who was responsible for the excitation of bronchitis and pneumonia. Since then, and until today, scientists have been unsuccessfully trying to develop a vaccine.

Diagnostics

The clinical definition of the disease is problematic, due to its similarity with other ailments. In adults, the symptoms of bronchitis and pneumonia most often predominate. During laboratory research used to detect antibody titer. If necessary, the doctor prescribes x-rays and specific laboratory tests, for example, virological testing of nasopharyngeal washings.

Therapy

For patients who have been diagnosed with respiratory syncytial virus, treatment is prescribed in a complex manner in order to strengthen the body. Bed rest is recommended for the entire period of exacerbation. Hospitalization is indicated for children with a severe form of the disease, babies preschool age with moderate severity and persons who have complications. A prerequisite is the presence of a diet appropriate for age. It should include mechanically and chemically sparing food, full of a variety of trace elements and vitamins.

It is also carried out for which the use of drugs such as leukocyte human interferon, "Anaferon", "Grippferon" and "Viferon". In severe forms, it is recommended to take Immunoglobulin and Ribavirin, the price for it varies from 240-640 rubles, depending on the dosage. Perfectly helps to prevent the occurrence of consequences in bronchitis drug "Sinagis". If a bacterial complication is detected, then antibiotic therapy is indicated.

Broncho-obstructive syndrome is well removed by symptomatic and pathogenetic treatment. In this case, an oxygen mask for breathing is used, it relieves severe symptoms and simplifies the supply of air.

required for complications. After pneumonia, it is recommended to conduct examinations after 1, 3, 6 and 12 months until complete recovery. Prophylactic diagnosis is necessary after recurrent bronchitis and is prescribed after a year of correction. If necessary, a consultation with an allergist or pulmonologist is attended, and laboratory tests are also done.

Treatment of children

Toddlers always get sick more difficult, and the consequences are much more serious than in adults, so therapy should be thorough and intensive.

Antiviral:

- "Ribavirin", the price of this drug, as described earlier, is affordable, so it will not hit hard on the pocket of parents;
- "Arbidol", "Inosin", "Tiloran" and "Pranobex" are also often prescribed.

Syndromic therapy should be carried out in accordance with the relevant protocols for the treatment of acute respiratory failure, bronchitis and Croup's syndrome.

Basic antihomotoxic therapy:

- "Gripp-Heel", "Engistol" (the initiating scheme is used);
- "Euphorbium compositum C" (nasal spray);
- "Lymphomyositis".

Additionally:

- "Viburkol" (rectal suppositories);
- "Echinacea compositum C" (ampoules);
- "Angin-Heel S";
- "Traumeel S" (tablets).

All these tools are great help to overcome the respiratory syncytial virus in children.

First steps

In order to quickly defeat the disease, it is necessary to correctly respond to the symptoms that have appeared, so that you can get the right help if necessary.

1. Seek medical attention if you have small child symptoms of SARS, namely sore throat, runny nose and severe wheezing.
2. Must be called ambulance if there is a high temperature, intense noises, difficulty breathing and a general severe condition.

It is required to contact such doctors as a general practitioner and an infectious disease specialist.

Complications

Respiratory syncytial virus has a negative effect on the respiratory tract. The consequences of this disease are considerable, since secondary bacterial flora can join and cause such ailments as:

Sinusitis;
- otitis;
- bronchitis;
- pneumonia;
- bronchiolitis.

Prevention

All viral diseases difficult to treat, as their symptoms are often latent. One of the measures is early detection of the disease and isolation of patients until their full recovery. During outbreaks of such an infection Special attention sanitary and hygienic measures are required. In children's groups and hospitals, it is proposed to wear gauze bandages for staff. Babies must and systematically disinfect their hands using alkaline solutions.

Emergency prevention measures in the foci of infection include the use of drugs such as Anaferon, Viferon, Imunal and various endogenous interferon inducers.

Immunoprophylaxis includes such means as Motavizubam, RespiGam and Palivizubam.

Vaccine

To date, no component has yet been developed that will prevent this disease. The creation is quite active, experiments began to be carried out since the 1960s, after which the substance was inactivated with formalin and precipitated with alum. Such a vaccine caused a pronounced formation of serum antibodies, although as a result of the application, the tested people developed an even more serious disease. Live attenuated components cause not very pleasant symptoms or turn into the same virus, only the wild type. Today, a method is being considered for purifying subunit antibodies against one of the surface proteins or attenuated elements, and then trying to adapt them to cold.

Frequent respiratory diseases of the lower respiratory tract in children and adults may be the result of damage to the body by a syncytial virus. syncytial virus(RSV), for which there is no vaccine, commonly affects newborns and children younger age causing respiratory failure. Peak incidence occurs in winter and early spring. Without timely treatment disease caused by syncytial virus can develop into chronic bronchitis and bronchial asthma.

Facts to Know

• The source of infection is a sick person and a virus carrier
• Mechanism of infection - aerogenic
• Way of transmission - airborne
• 1-2 days before the onset of the first symptoms, the patient becomes contagious and remains so for 3-8 days
• At a heating temperature of 55-60 ° C, the virus disappears within 5 minutes, when boiled instantly

• Immunity after MS infection is weak, not more than 1 year
• When frozen (minus 70°), the virus is active, but does not withstand repeated freezing
• Before the age of 3, almost all children have already had a respiratory syncytial infection.
• Average duration of illness is 14 to 21 days
• 5-6 hours it can be present in a viable state on clothes, toys and other items

Symptoms of RS virus infection

About the treatment of respiratory syncytial virus

Treatment of respiratory diseases consists in observing bed rest, eating foods rich in vitamins, prescribing etiotropic and antibacterial therapy for severe and protracted forms of bronchiolitis.

Prevention

Nonspecific prophylaxis consists in the timely isolation of the patient until his full recovery. During outbreaks of infection, special attention should be paid to sanitary and hygienic measures in children's institutions, work groups and at home.

galavit in MS infection

Immunoprophylaxis plays an important role in preventing such diseases. An immunomodulator with anti-inflammatory properties Galavit is recommended for children and adults suffering from frequent respiratory diseases, especially during seasons of increased morbidity. Clinical trials have shown that taking the drug Galavit allows not only to avoid the occurrence of infection, but also to promote a speedy recovery.

Galavit restores the protective properties of the body at any stage of the disease, enhances the action antiviral drugs and at the same time has an anti-inflammatory effect. Galavit is a reliable means of preventing respiratory diseases.

It is an acute viral infection with predominant involvement in pathological process lower respiratory tract, with frequent development of broncho-obstructive syndrome. In this article, you will learn the main causes and symptoms of respiratory syncytial infection, how respiratory syncytial infection is treated, and what preventive measures you can take to protect your child from this disease.

Causes

The first strain of the PC virus was isolated in 1956 by American scientists led by J. Morris from chimpanzees with acute respiratory diseases. In 1957, R. Chanock and colleagues isolated similar viruses from children with severe lesions of the lower respiratory tract. The respiratory syncytial infection virus (PC virus) is so called because its name reflects the place of its reproduction (respiratory tract) and the characteristic changes caused in the cell culture - the formation of syncytial fields.

Etiology

Respiratory syncytial infection in children appears due to RNA-containing viruses belonging to the Paramyxoviridae family, Pneumovirus genus. Virions are characterized by high polymorphism, often have a round or filamentous shape, ranging in size from 100-200 nm to 800 nm, contain a lipoprotein shell. Unlike other members of the family, PC viruses lack hemagglutinin and neuraminidase. Reference strains of viruses are strains of Long, Randall and Schneider, identical in antigenic structure. All isolated strains of PC virus have a single complement-fixing antigen. The heterogeneity of the population of RS viruses consists in the presence of subtypes (A, B), the detection of highly virulent and weakly virulent strains. RS viruses are characterized by high antigenic stability, have a tropism for the epithelium of the respiratory tract, and are localized mainly in the bronchi and bronchioles.

Respiratory syncytial infection in children is unstable in environment, thermolabile - inactivated at a temperature of +37 ° C for 7 hours, and at +55 ° C - instantly; die under the action of ether, acid-resistant. In droplets of mucus, they remain from 20 minutes to 6 hours. They are well tolerated. low temperatures.

The respiratory syncytial infection virus is cultivated in cell culture with the development of a cytopathogenic effect - the formation of extensive fields of syncytium (fusion of many cells) throughout the cell layer. The phenomenon of hemadsorption was not revealed.

Epidemiology

The source of respiratory syncytial infection is a person (patient and virus carrier). The patient is most contagious within 3-6 days from the onset of the disease. The duration of virus isolation does not exceed the duration of clinical manifestations.

Transfer mechanism: drip. Way of transmission - airborne; infection through objects is not significant. A case of transmission of the virus to the recipient along with transplanted organs is described.

Susceptibility is greatest in babies of the first two years of life.

Seasonality and periodicity. This infection is ubiquitous. In the cold season, epidemic outbreaks are recorded, in the inter-epidemic period - sporadic cases. Outbreaks caused by the PC virus occur every year, mostly among young children. Characterized by the rapid spread of the virus in the team and high contagiousness covering all children born after the last epidemic rise. Nosocomial outbreaks of respiratory syncytial infection occur with infection not only of patients, but also of medical personnel.

Immunity after the transfer of RS infection is unstable.

Pathogenesis

The entrance gate of respiratory syncytial infection is the mucous membrane of the upper respiratory tract. The PC virus replicates in the cytoplasm of nasopharyngeal epithelial cells. The causative agent from the place of primary localization penetrates into the blood. The stage of viremia lasts no more than 10 days.

In young children, the virus spreads bronchogenically and / or hematogenously into the lower parts of the respiratory tract. The greatest severity of the pathological process is observed in the epithelium of the bronchi of medium and small caliber, bronchioles, alveoli. In the process of proliferation, multicellular papillary growths of the epithelium appear in them. The lumen of the bronchi and alveoli is filled with deflated epithelium, inflammatory exudate, which leads to impaired bronchial patency. Bronchitis and bronchiolitis with airway obstruction, typical of MS infection, develop. In the pathogenesis of the disease, the layering of the secondary bacterial flora is of great importance.

Elimination of the virus from the macroorganism and clinical recovery occur due to the formation of virus-specific secretory and serum antibodies.

Pathomorphology

Morphological examination determines diffuse hyperemia of the mucous membrane of the trachea and large bronchi, reveals the accumulation of serous exudate. The lungs are enlarged in volume, with severe emphysema and areas of tissue compaction in the posterior sections. At histological examination determine pronounced changes in the small bronchi and bronchioles, filling the lumen with deflated epithelium, macrophage cells and mucus; the epithelium grows, grouped into multinuclear clusters, protruding like papillae. In the lumen of the bronchi, giant multinucleated cells are often observed. The alveoli contain a thick exudate, occasionally there are large multinucleated cells, in the cytoplasm of which a viral antigen is found.

Symptoms of MS Infection

Respiratory syncytial infection mainly affects children of the first year of life. Susceptibility to PC infection in infants is 100% and decreases with age. The incubation period is 3 - 7 days.

Respiratory syncytial infection in children often begins gradually, without an increase in body temperature or with a slight rise in it, but it can begin acutely, violently, with a sharp increase in body temperature to 39 ° C and above. The appearance of signs of catarrhal phenomena from the upper respiratory tract is characteristic. In all patients with this infection, symptoms and signs of rhinitis are detected: nasal congestion, thickening of the nasal mucosa, swelling of it, at first mild serous, and then grayish-mucous discharge, cough, sneezing, and sometimes a hoarse voice.

The infection is accompanied by such symptoms: fever, loss of appetite, anxiety, and sometimes lethargy and drowsiness. The child often refuses to breastfeed due to nasal congestion and difficulty breathing through the nose. Catarrhal lesions of the upper respiratory tract is the most common syndrome in this disease, but far from the only one. Signs of intoxication, unlike the flu, are not pronounced. Seniors sometimes have a headache, loss of appetite, lethargy, fever. The duration of the disease is from 2 to 10 days.

The virus of respiratory syncytial infection is distinguished by another important feature: involvement in the pathological process of the lower respiratory tract and the development of bronchiolitis and pneumonia.

Clinic of the disease

Clinical forms can vary from blurred, mild to very severe. In newborns and children of the first year of life, moderate and severe forms of the disease predominate. Respiratory syncytial infection is characterized by moderate damage to the upper respiratory tract and lower sections - acute bronchiolitis.

At the onset of the disease, there is a moderate increase in body temperature (up to 37.5 ° C), with mild catarrhal symptoms in the form of difficult nasal breathing, a rare superficial dry cough, and mild mucous discharge from the nasal passages. Hyperemia of the pharynx, arches, posterior pharyngeal wall is slightly expressed. At mild form clinical symptoms disappear within 3-7 days.

Symptom of respiratory syncytial infection - respiratory failure

In young children, the bronchopulmonary apparatus is involved in the pathological process from the first days of the disease. The cough intensifies, which becomes obsessive, paroxysmal. Appetite decreases. During the peak of a respiratory syncytial infection, symptoms of respiratory failure rapidly increase (rapid breathing, perioral cyanosis), retraction of compliant chest areas, an abundance of sonorous small-bubbling wet rales suddenly appears everywhere in the lungs due to impaired bronchial patency in the terminal section bronchial tree.

The discrepancy between severe respiratory failure and moderate intoxication is an important feature of the respiratory syncytial infection clinic. Physical changes in the lungs undergo rapid regression and are not detected after 3-7 days. In the blood - moderate leukopenia, without pronounced changes in the blood formula, normal or slightly increased ESR. In some children, eosinophilia is observed in the peripheral blood at the height of the disease.

Intestinal dysfunction in respiratory syncytial infection among young children during the peak period or from the 4th to 6th day of the disease is expressed as a mushy stool, without impurities, up to 3-7 times, and the stool returns to normal in a short time.

bronchiolitis

This symptom of a respiratory syncytial infection usually develops after the appearance of catarrhal phenomena or simultaneously with it. Bronchiolitis comes on suddenly, often accompanied by an increase in body temperature up to 38-39°C. In this case, the phenomena of general intoxication are usually expressed implicitly, although drowsiness, lethargy, refusal of the breast in a small child are not very rare signs of the disease. They are characterized by a sharp deterioration in the condition, the appearance of signs of respiratory failure, anxiety, increased breathing, retraction of compliant chest areas, cyanotic skin, and frequent wet cough.

Almost the same signs and symptoms are accompanied by pneumonia, which are caused by both the syncytial virus and the bacterial flora. Bronchiolitis and pneumonia are serious diseases that manifest RSI in babies. They are observed mainly in young children and require careful and urgent treatment.

Croup

The defeat of the larynx (croup) is characterized by a rough, barking cough, and then hoarseness, difficulty breathing. Croup usually develops suddenly, often at night. Fortunately, it happens less frequently than with parainfluenza infection.

obstructive syndrome

Often against the background of respiratory syncytial viral infection an obstructive syndrome occurs. It is observed more often in babies with manifestations of exudative diathesis, with increased sensitivity to food, drug allergens, with hereditary allergies. The mechanism of development of obstructive syndrome is based on the narrowing of the bronchial lumen due to inflammatory edema and increased secretion of the mucosa, as well as bronchospasm. obstruction syndrome significantly impairs general state baby, accompanied by shortness of breath, cough, often wheezing, audible wheezing even without a phonendoscope. It tends to be repetitive and lingering.

The diagnosis is established by clinical symptoms, confirmed isolation of the virus from the mucus of the nasopharynx, by an increase in antibody titer, by the detection of a viral antigen in the epithelium of the nasal mucosa by the method of fluorescent antibodies.

Reinfection with PC virus

The slow rise of specific antibodies in response to a developing infection, as well as the lack of stable immunity after the disease, create the possibility of reinfection with the PC virus. In children of the first months of life, re-infection with the PC virus (after 2-3 weeks) leads to a more severe course of the disease with the development of bronchiolitis with obstructive syndrome and hepatolienal syndrome. Severe forms of the disease with a widespread lesion of the bronchopulmonary apparatus, severe respiratory failure, obstructive and hepatolienal syndrome are most often observed in children of the first year of life with rickets, malnutrition, and congenital malformations.

Classification

Type:

Typical.

Atypical:

• erased;
• asymptomatic.

By gravity:

Light form.

Medium form.

Severe form.

Severity Criteria:

• severity of respiratory failure syndrome;
• the severity of local changes.

Downstream (by nature):

Non-smooth:

• with complications;
• with a layer of secondary infection;
• with exacerbation of chronic diseases.

Forms of MS infection

Typical forms of MS infection (with a primary lesion of the bronchi and bronchioles).

The incubation period lasts from 2 to 7 days.

Initial period. It starts gradually. Most boys and girls have a normal or subfebrile body temperature. The catarrhal syndrome is poorly expressed. Rhinitis is manifested by difficult nasal breathing and mild serous discharge from the nasal passages. posterior pharyngeal wall and palatine arches slightly hyperemic. There is a rare dry cough.

The peak period begins after 2 - 3 days from the onset of the disease. Young children develop symptoms of respiratory failure due to involvement in the pathological process of the lower parts of the respiratory tract with a primary lesion of the small bronchi, bronchioles and alveoli. Bronchitis (acute, obstructive) and bronchiolitis develop.

The discrepancy between the severity of damage to the lower respiratory tract (pronounced DN) and the height of fever ( subfebrile temperature body) and intoxication (mild or moderate).

Body temperature rises to 38 ° C, in infants for the first 6 months. often remains normal. Symptoms of intoxication are moderately expressed, mainly, there is a decrease in appetite and sleep disturbance, the child's well-being is slightly disturbed. In infants, the most common manifestation of MS infection is bronchiolitis. The cough intensifies, becomes whooping-like - spasmodic, paroxysmal, obsessive, unproductive.

The severity of the condition is due to rapidly developing respiratory failure. There is a pronounced expiratory dyspnea up to 60-80 per minute. with retraction of the intercostal spaces and the epigastric region, the participation of auxiliary muscles and swelling of the wings of the nose. Other signs of respiratory failure are significantly expressed - pallor and marbling of the skin, perioral or general cyanosis, agitation or adynamia, tachycardia. Hypoxemia develops, and in severe cases, hypercapnia. Bronchiolitis is characterized by emphysematous swelling of the chest. There is a box shade of percussion sound. The liver and spleen are palpated below the costal arch due to the descent of the diaphragm. Abundant scattered small bubbling and crepitating rales, sometimes dry whistling, are auscultated over the lungs against the background of an elongated exhalation. After coughing, the auscultatory picture does not change. An x-ray examination reveals emphysema of the lung tissue without focal inflammatory shadows.

Children, especially older than a year, develop acute bronchitis, the main symptom of which is a dry, quickly turning into a wet cough. Shortness of breath is rarely observed. Auscultatory bronchitis is characterized by scattered dry, medium and coarse bubbling wet rales, decreasing or disappearing after coughing. For clinical picture respiratory syncytial infection is characterized by the development of obstructive bronchitis, which is manifested by an elongated and noisy exhalation. During auscultation, profuse dry whistling rales are heard, sometimes coarse and medium bubbling wet, decreasing after coughing. Emphysematous swelling of the lungs is revealed. The severity of the condition, as well as with bronchiolitis, is determined by the severity of respiratory failure.

Atypical forms of MS infection

Atypical forms of respiratory syncytial infection develop mainly in older girls and boys and adults. The erased form is characterized by a mild catarrhal syndrome, the absence of fever and intoxication. The child's condition is satisfactory, he feels good, sleep and appetite are not disturbed. Symptoms of nasopharyngitis are revealed - a slight serous discharge from the nasal passages and slight hyperemia of the posterior pharyngeal wall. Asymptomatic form: clinical manifestations are absent. It is diagnosed by an increase in the titer of specific antibodies by 4 times or more in the dynamics of the study.

Forms of MS infection by severity

According to severity, mild, moderate and severe forms of MS infection are distinguished.

The mild form develops more often in older boys and girls. It is manifested by symptoms of moderately severe nasopharyngitis. Respiratory failure is absent. Body temperature is normal or subfebrile. Symptoms of intoxication are not expressed.

In the moderate form, symptoms of bronchiolitis, acute bronchitis develop, often with obstructive syndrome and respiratory insufficiency I-II degree. The patient is noted for shortness of breath up to 60 per minute with a slight retraction of the pliable places of the chest during excitement, an elongated and noisy exhalation, perioral cyanosis, which increases with anxiety and disappears with oxygen inhalation. The child is restless, agitated or lethargic, drowsy. Perhaps a slight increase in the liver and spleen. Body temperature is subfebrile, sometimes normal. Symptoms of intoxication are expressed moderately.

In severe form, bronchiolitis, obstructive bronchitis or bronchopneumonia with respiratory failure of II-III degree develops. The patient is noted: severe shortness of breath at rest with the participation of auxiliary muscles, tension of the sternocleidomastoid muscle, sharp retraction of the intercostal spaces and epigastric region, persistent perioral cyanosis and acrocyanosis. The child is lethargic, adynamic, breathing is noisy, wheezing on exhalation. With decompensation of respiratory failure - shortness of breath more than 80 per minute, take-off and apnea, weakening of breathing on inspiration, diffuse cyanosis, coma and convulsions are periodically noted. Body temperature subfebrile; with pneumonia, hyperthermia develops. The syndrome of intoxication is expressed. Perhaps an increase in the liver and spleen, the development of cardiovascular insufficiency.

Forms of MS infection by duration

Signs of respiratory failure have a rapid reverse dynamics (within 1 - 3 days). Cough and changes in the lungs disappear after 5-7 days, sometimes persisting up to 2-3 weeks. Infection is of great importance in the formation of bronchial asthma and chronic bronchitis.

Complications. Specific (stenosing laryngotracheitis, etc.) Nonspecific - pneumonia, purulent otitis media.

Features of PC infection in young children

Babies aged 4 months and older are most susceptible to PC infection. up to 2 years. In infants of the first year of life, RS infection ranks first in the structure of SARS. In newborns in early dates bronchiolitis and obstructive bronchitis develop, occurring with symptoms of respiratory failure of II-III degree (obstructive bronchitis and bronchiolitis are not typical for newborns). The rapid development of obstruction is facilitated by the anatomical and physiological features of the respiratory system (narrow lumen of the larynx, trachea and bronchi, rich vascularization of the mucous membrane, underdevelopment of the respiratory muscles, etc.). The onset of the disease is gradual. The body temperature does not exceed 38 ° C, and in newborns it often remains normal. Patients develop nasopharyngitis, paroxysmal spastic cough occurs. The syndrome of intoxication is expressed slightly. Pneumonia, atelectasis, and emphysema are common. Enlargement of the liver and spleen is characteristic. Lethal outcomes are possible; in some cases, sudden death occurs (sudden death syndrome).

Diagnostics

PC infection is diagnosed on the basis of the characteristic clinical picture of bronchiolitis with obstructive syndrome, severe oxygen deficiency with low or normal temperature bodies, in the presence of an appropriate epidemic situation - the occurrence of a mass disease of the same type, mainly among young children.

Supporting and diagnostic signs of respiratory syncytial infection:

• characteristic epidemiological anamnesis;
• the disease is often found in babies of the first year of life;
• gradual onset of the disease;
• the syndrome of intoxication is poorly expressed;
• body temperature subfebrile;
• minor catarrhal syndrome;
• typically the defeat of the lower parts of the respiratory tract (bronchiolitis, obstructive bronchitis);
• severe respiratory failure with rapid reverse dynamics;
• discrepancy between the severity of lower respiratory tract lesions and the severity of fever.

Laboratory diagnosis is crucial in making a diagnosis of MS infection.

Detection of antigens of the PC virus in the cells of the cylindrical epithelium of the nasopharynx is carried out by direct or indirect immunofluorescence.

Serological diagnosis RS infections are carried out using RSK or RN in the study of paired sera taken at intervals of 10-14 days. Diagnostic is the increase in the titer of specific antibodies by 4 times or more.

Virological diagnosis - isolation of the PC virus in tissue culture.

In the blood test, normocytosis is noted, sometimes moderate leukopenia, lymphocytosis, eosinophilia.

Differential diagnosis of MS infection is carried out with other acute respiratory viral infections, as well as with allergic bronchitis and bronchial asthma, whooping cough.

Allergic bronchitis develops with a aggravated allergic history, is characterized by a persistent relapsing course, the presence of concomitant allergic skin lesions, and eosinophilia.

At bronchial asthma there are attacks of suffocation, removed by antispasmodic drugs.

In patients with whooping cough, catarrhal phenomena (except for cough) are absent, body temperature is normal. Characterized by paroxysmal convulsive cough, delays and stops in breathing, tear or sore of the frenulum of the tongue. In the blood test: leukocytosis and lymphocytosis with normal ESR.

Treatment

When MS infection is diagnosed, patients are prescribed bed rest for the entire acute period. Children with a severe form of the disease are subject to hospitalization, young children with a moderate form, as well as with the development of complications.

The diet corresponds to age, the food is mechanically and chemically sparing, rich in vitamins.

Medication treatment

Etiotropic therapy. Patients with severe forms are prescribed high-titer immunoglobulin to the PC virus, normal human donor immunoglobulin, chigain, human leukocyte interferon, rimantadine, ribavirin (virazole).

Pathogenetic and symptomatic therapy is aimed primarily at combating respiratory failure and restoring bronchial patency. Patients undergo oxygen and aerosol therapy, prescribe bronchodilators (eufillin), desensitizing drugs (tavegil), according to indications, glucocorticoids (prednisolone).

From the first day of illness, expectorants are used - tussin, mixtures with thermopsis, marshmallow, warm drink - tea with raspberries, milk with Borjomi, bromhexine, acetylcysteine; carry out exercise therapy, breathing exercises, vibration massage. Physiotherapeutic procedures are shown - UHF, electrophoresis of eufillin, platifillin, ascorbic acid. Antibacterial therapy prescribed for young children with severe forms of the disease, with the development of bacterial complications.

Dispensary supervision. Dispensary observation for 1 year with a pediatrician is subject to convalescents of complicated forms of PC infection: after pneumonia, the examination is carried out after 1, 3, 6, 12 months, after recurrent bronchitis - after 6-12 months. Consultations of a pulmonologist and an allergist, as well as laboratory examinations, are carried out according to indications.

Antiviral therapy

• Ribavirin for PC infection inhalation form);
• it is possible to use Arbidol, Tiloron, Inosin, Pranobeks.

Syndromic therapy is carried out according to the relevant protocols for the treatment of bronchiolitis, acute respiratory failure, heart failure, croup syndrome.

Alternative Therapy

Basic AGTT:

• Engystol, Gripp-Heel (according to the initiating scheme);
• "Lymphomyosot";
• "Euphorbium compositum C" (nasal spray).

Additional antihomotoxic therapy:

• "Traumeel S" (tablets);
• "Viburkol" (rectal suppositories);
• "Angin-Heel S";
• "Echinacea compositum C" (ampoules).

Most cases of respiratory syncytial infection are treated at home. The child is prescribed arbidol, anaferon or gepon or other immunocorrective agents, as well as symptomatic agents, as in other acute respiratory viral infections. Mukaltin, mixture with marshmallow, thermopsis, sodium bicarbonate are shown. In severe cases, hospitalization is necessary. With a combination of obstructive syndrome with pneumonia, antibiotics are prescribed.

Prevention

Nonspecific prophylaxis provides for early detection and isolation of patients (until complete clinical recovery). During outbreaks of PC infection in children's groups and hospitals, special attention is paid to sanitary and hygienic measures: the wearing of four-layer gauze masks by medical workers, the regular change of overalls by attendants, and the systematic washing of hands using disinfectant solutions. Carry out wet cleaning with soap-alkaline solutions, ventilation of rooms and air treatment with bactericidal lamps. They stop accepting and transferring children from one group or ward to another. In the outbreak, contact young children, especially those who are weakened, are recommended to carry out passive immunization with normal human immunoglobulin. For the purpose of emergency prevention of PC infection in the focus, drugs are prescribed that increase the child's defenses - human leukocyte interferon, endogenous interferon inducers, chigain, immunal, rimantadine, oxolinic ointment.