Influenza: Diagnosis, Treatment, Prevention - V.D. Moskaliuk 2010

Characteristics of patients with influenza A, influenza B, adenoviral and respiratory syncytial infections, and ARVI of undetermined etiology
Clinical characteristics of the examined patients

Patients with Influenza A and B typically presented with two main syndromes—toxicosis and catarrhal symptoms—with toxicosis predominating from the first days of the illness. The disease began acutely, accompanied by symptoms of general intoxication. Almost all patients reported severe chills. Simultaneously, pain occurred in the frontal region, the superciliary arches, the temples, and the eyes. The pain intensified with eye movement and was accompanied by photophobia; 48 individuals (12.7%) experienced dizziness. All patients exhibited weakness, malaise, adynamia, sweating, body aches, arthralgia, myalgia (especially in the back Muscles), and Sleep disturbances.

From the first hours of illness, body Temperature reached 39–40 °C in 164 patients (43.4%) and 37.5–38.5 °C in the remaining patients, though it did not remain at this level for long. After 2–3 days, in 322 individuals (85.2%), the temperature decreased critically or via shortened lysis; in the rest, the fever lasted for more than 5 days. A second wave of fever was observed in 10 patients (2.6%), which was associated with The Development of bacterial complications. The temperature curve was most frequently recorded as *continua*; in 34 patients (9.0%), it assumed a remittent character, which was evidently linked to the administration of antipyretic agents.

On the 1st day of illness, intoxication symptoms dominated over the catarrhal syndrome in all patients, manifested by dryness and soreness in the throat and nasal congestion. By the end of the 1st day, or sometimes the 2nd day, a dry cough developed, the intensity of which rapidly increased. Soreness and retrosternal pain appeared, caused by the inflammatory process in the mucous membrane of the Trachea and Bronchi. The cough became painful, sometimes paroxysmal. Bouts of tracheitis occurred in 105 individuals (27.8%), and manifestations of hemorrhagic syndrome occurred in 7 (1.8%): nosebleeds in 3, and minor hemorrhages in the oropharyngeal mucosa in 4. On days 3–5, the cough became softer, scanty mucous sputum appeared, and the retrosternal pain diminished. In all patients, nasal breathing was impaired from the first day of the illness due to edema of the nasal mucosa, yet The amount of discharge was small. On the 2nd–3rd day of illness, scanty serous or mucous discharge appeared.

In the first days of the illness, attention was drawn to marked hyperemia and puffiness of the face, along with injection of the scleral and conjunctival vessels in all patients. Bright, diffuse hyperemia was noted on the mucosa of the palate, the faucial pillars, and the posterior pharyngeal wall. Enlarged cervical Lymph Nodes were palpated in 48 patients (12.7%). Lung Auscultation revealed vesicular breathing with a harsh tone in 206 individuals (54.5%) and scattered dry rales in 35 (9.2%). Radiographs showed enhanced vascular markings and widened lung roots in 296 patients (78.3%). In 24 patients (6.3%), the abdomen was slightly tender upon Palpation in the epigastric and umbilical regions, while remaining painless in the others. No enlargement of the Liver or Spleen was established. A total of 293 patients (77.5%) reported constipation, which was likely related to Changes in the tone of the Autonomic Nervous system under METABOLISM/18.html">The Influence of toxins. Central Nervous System involvement occurred in virtually all patients, manifested by headache, dizziness, sleep disturbances, and emotional lability. Clinical signs of Urinary System involvement were absent.

The severity of clinical signs depended on the course of the disease. In the severe course, observed in 36 individuals (9.5%), the clinical picture was dominated by symptoms of sharply pronounced intoxication, which manifested as delirium, hallucinations, insomnia, and symptoms of intracranial Hypertension in 3 patients (8.3%). Body temperature exceeded 39.5–40 °C.

Complications occurred in 16 patients (4.2%): sinusitis in 4, otitis in 3, Bronchitis in 6, and Pneumonia in 3. There were no fatalities.

The clinical picture of adenovirus infection (AI) in all individuals was characterized by a polymorphism of clinical symptoms, associated with the involvement of various Organs and systems—the respiratory tract, eyes, intestines, and lymphoid tissue. In the majority of patients—144 (73.5%)—a pronounced exudative component was noted upon admission to the hospital. At the same time, manifestations of general intoxication were moderate. Body temperature elevation within the range of 38–39 °C was observed in 96 patients (49.0%). In 48 patients (24.5%), the fever was of an irregular type; significantly less often—in 26 (13.3%)—it was continuous; in 10 (5.1%), remittent; and in 2 (1.0%), undulant. The first symptom of AI in all patients was Conjunctivitis. Patients complained of a cutting sensation and the feeling of "sand" in the eyes. In 32 patients (16.3%), the palpebral fissure was narrowed, the eyelids were edematous, and scanty discharge appeared. In the majority of individuals—146 (74.5%)—one eye was affected, and in the rest, both eyes. Conjunctivitis persisted in 47 patients (24.0%) even after the body temperature decreased, while in the others it disappeared with the normalization of body temperature.

Rhinitis was noted in 102 patients (52.0%), and 28 (14.3%) complained of difficulty in breathing. Pronounced rhinorrhea was present in 34 patients (17.3%). Nasal discharge was initially serous, became seromucous by the 2nd–3rd day, and acquired a mucopurulent appearance in 18 (9.2%). Symptoms of pharyngitis and tonsillitis appeared simultaneously in 37 patients (18.9%), and 1–2 days after the onset of the disease in 28 (14.3%). Pharyngitis was accompanied by moderate sore throat upon swallowing, a burning sensation, "scratching," and tickling in the pharyngeal region. The oropharyngeal mucosa was edematous, pale, or exhibited moderate hyperemia and cyanosis. Hyperplastic follicles were visible on the posterior pharyngeal wall in 44 patients (2.2%), creating a "cobblestone" appearance and providing grounds to speak of granular pharyngitis. In 95 patients (48.5%), pharyngitis was combined with tonsillitis; the Tonsils were moderately edematous and hyperemic. In 28 patients (14.3%), depositions appeared on the palatal tonsils resembling follicular tonsillitis, and in 14 patients (7.1%), resembling lacunar tonsillitis.

Simultaneous involvement of the posterior pharyngeal wall, nasal mucosa, and tonsils (rhinopharyngotonsillitis) was detected in 5 individuals (2.5%).

Enlargement of regional lymph nodes (submandibular, preauricular, cervical) was detected in 76 patients (38.8%), indicating the involvement of lymphoid tissue in the pathological process. In 3 patients (1.5%), the lymph nodes were slightly enlarged, painless, of soft-elastic consistency, and not fused to each other or to surrounding Tissues. An enlarged liver was palpated in 2 patients (1%).

Pharyngoconjunctival fever was observed in 48 individuals (24.5%) and manifested as conjunctivitis, pharyngitis, rhinitis, lymph node enlargement, and elevated body temperature. This form of AI began acutely: 22 patients (11.2%) experienced retrosternal scratching, sore throat, nasal congestion, body aches, and eye pain. These listed symptoms occurred During the first two days of illness.

Regional lymphadenitis continued to be detected in 6 convalescents (3.1%) at the time of discharge from the hospital. The disease was also accompanied by a general Intoxication syndrome (Muscle and HEAD pain, weakness, loss of appetite) in all patients. Diarrhea occurred in 7 individuals (3.6%), who complained of cramping pain throughout the abdomen and loose stools. Body temperature rose to 38–38.5 °C, with moderate general intoxication. Complications occurred in 5 patients (2.5%) and manifested as sinusitis in 3 and otitis in 2 patients.

Respiratory syncytial infection (RS infection) proceeded with symptoms of Upper Respiratory Tract involvement in 143 patients (80.3%), manifested by sneezing, runny Nose, cough, and sore throat. In 111 individuals (62.3%), the disease was accompanied by a low-grade (subfebrile) elevation of body temperature; in 58 (32.6%), by a febrile temperature; and in 9 (5.0%), body temperature remained within normal limits. At the height of the illness, conjunctivitis and scleritis developed in 136 patients (76.4%). Edema and hyperemia of the posterior pharyngeal wall and soft palate were observed in all patients.

More than 70% of patients with RS infection, as with other ARVI, were also hospitalized on the second day of illness. In 35 individuals (19.7%), RS infection proceeded with involvement of the bronchi and bronchioles. The clinical picture in these cases consisted of high body temperature, paroxysmal cough, periodic bouts of asphyxia, cyanosis, tachycardia, muffled Heart sounds, and, in 10 patients (5.6%), a drop in Blood pressure as well. Percussion revealed emphysematous areas in the Lungs in 68 individuals (38.2%). Upon auscultation, against the Background of harsh breathing, dry rales were heard in 16 patients (9.0%). In 36 patients (20.2%), signs of lung and bronchial involvement were combined with phenomena of rhinitis and pharyngitis. Exacerbation of chronic bronchitis occurred in 2 patients (1.1%), and purulent otitis in 1 (0.6%).