Acute upper respiratory tract infection, unspecified (cold)

November 15, 2021

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20 minutes

Author, editor and medical expert – Klimovich Elina Valerievna.

Acute infections of the upper respiratory tract include inflammation of the nasal cavity, nasopharynx, pharynx and larynx (above the vocal cords) caused by various microorganisms. They all have similar symptoms (despite the variety of pathogens), so in everyday life they are often called “colds,” and doctors use the general term “acute respiratory diseases,” or acute respiratory infections, to refer to them.

Acute respiratory infections are observed all year round. On average, adults get colds 2 to 4 times a year, children get sick more often, 6-9 times - this is normal and necessary for the formation of a healthy immune system2. The peak incidence of acute respiratory tract infections occurs in the autumn-winter-spring period1. The likelihood of colds increases with the first cold snap, in September-October1, when we begin to go out less often and have longer contact with other people, among whom there may be carriers of pathogenic microbes or patients with acute respiratory infections. High humidity and cold outside often cause hypothermia and decreased immunity. Low air humidity in heated rooms leads to drying out of the nasal mucosa, increasing its permeability and susceptibility to infectious agents. Only in May, when the weather improves, does the incidence decline1.

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EXacERBATION OF CHRONIC BRONCHITIS

Chronical bronchitis

- a disease associated with prolonged exposure to nonspecific irritants (tobacco smoke, etc.) on the respiratory tract, accompanied by hypersecretion of mucus and inflammatory and degenerative changes in the bronchi and lung tissue. The key symptom of the disease is a chronic productive cough observed for at least 3 months over 2 consecutive years, with the exclusion of other diseases/pathological conditions (tuberculosis, congestive heart failure, etc.).

Exacerbation of chronic bronchitis

is accompanied by increased cough, shortness of breath, an increase in the volume of sputum produced, its purulent nature and/or an increase in body temperature. Bacterial and viral infections are responsible for exacerbations of chronic bronchitis in 1/2-2/3 of cases. Other causes of exacerbation of the disease may be allergens, air pollutants, etc.

Main pathogens

Among the bacterial pathogens of exacerbations of chronic bronchitis

H.influenzae, S.pneumoniae
and
occupy a key position .
In special clinical situations (age over 65 years, concomitant diseases, severe bronchial obstruction - FEV1 less than 50% of the required values, constant separation of purulent sputum),
P.aeruginosa, S.aureus
, and enterobacteria acquire a certain etiological significance. About 30% of infectious exacerbations of the disease are caused by influenza/parainfluenza viruses, RSV, rhinoviruses, and coronaviruses.

Choice of antimicrobials

When choosing AMPs, it is necessary to take into account the patient’s age, the severity of bronchial obstruction syndrome, the frequency of exacerbations, the presence of concomitant diseases, the use of glucocorticoids and AMPs (Table 1).

Table 1. Selection of antimicrobial drugs for exacerbation of chronic bronchitis

Due to the fact that exacerbation of chronic bronchitis in most cases is not severe, preference should be given to AMPs for oral administration. In cases of severe exacerbation in debilitated patients or those in hospital, parenteral administration of antimicrobial agents may be required. The duration of antibiotic therapy is 7-14 days.

Symptoms of acute respiratory infections

The clinical picture of all colds consists of the same general and local manifestations in varying degrees of severity and combinations.

General symptoms

Their severity depends on the type of pathogen and can vary from mild malaise to severe intoxication, accompanied by disruption of the functioning of internal organs and clouding of consciousness.

Local manifestations of acute respiratory infections

Their diversity is determined by the level of damage to the respiratory tract.

Additional symptoms

Along with the general manifestations typical of all diseases of the upper respiratory tract, in some cases specific symptoms are observed.

Thus, when infected with adenoviruses, signs of conjunctivitis appear; children often have abdominal pain associated with inflammation of the intra-abdominal lymph nodes5.

Respiratory syncytial virus tends to affect not only the upper, but also the lower parts of the respiratory tract, quickly causing the development of bronchitis and bronchiolitis1.

Bad breath is often a symptom of a bacterial respiratory tract infection. It is associated with the appearance of pus in the oropharynx - a product of inflammation and the activity of pathogenic microorganisms.

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PNEUMONIA

Pneumonia

- an acute infectious disease characterized by focal damage to the respiratory parts of the lungs with intra-alveolar exudation, detected by objective and x-ray examination, expressed in varying degrees by a febrile reaction and intoxication.

Clinically significant is the division of pneumonia into community-acquired

and
nosocomial (hospital, in-hospital)
. This division of pneumonia has nothing to do with the severity of their course. The main and only criterion for differentiation is the environment in which pneumonia developed.

Nosocomial pneumonia

- pneumonia that develops in a patient no earlier than 48 hours after hospitalization and was not in the incubation period.

Main pathogens

Community-acquired pneumonia

Pneumococcus remains the most common causative agent of community-acquired pneumonia (Table 2). Two other microorganisms are M.pneumoniae

and
C.pneumoniae
- often occur in young and middle-aged people (up to 20-30%), and their etiological role in patients of older age groups is less significant (1-3%).
L.pneumophila
is a rare causative agent of community-acquired pneumonia, but legionella pneumonia ranks second (after pneumococcal) in terms of mortality.
H.influenzae more often causes pneumonia in smokers, as well as against the background of chronic bronchitis. E.coli
and
K.pneumoniae
(less commonly other representatives of the
Enterobacteriaceae
) are found, as a rule, in patients with risk factors (diabetes mellitus, congestive heart failure, etc.).
The likelihood of staph pneumonia ( S. aureus
) increases in older people or in people who have had the flu.

Table 2. Etiology of community-acquired pneumonia

Nosocomial pneumonia

The etiology of nosocomial pneumonia is dominated by gram-negative microflora of the Enterobacteriaceae family, P.aeruginosa

(Table 3).

Table 3. Etiology of nosocomial pneumonia

There is a special type of nosocomial pneumonia - ventilator-associated pneumonia, the etiology of which depends on the length of the patient's stay on mechanical ventilation. With the so-called early VAP (development in the first 4 days of being on a ventilator), the most likely pathogens are S.pneumoniae, H.influenzae, S.aureus

(MSSA) and other representatives of the normal microflora of the oral cavity.
The development of late VAP (more than 4 days on mechanical ventilation) is associated with P.aeruginosa, Acinetobacter
spp., members of the
Enterobacteriaceae
, and less commonly MRSA.

Choice of antimicrobials

When treating patients with community-acquired pneumonia, a differentiated approach should be taken to the choice of antimicrobial agents, taking into account age, severity of the condition, the presence of concomitant diseases, location of the patient (at home, in the general ward of a hospital, in the ICU), previous antimicrobial therapy, use of glucocorticoids, etc. (Table . 4).

Table 4. Choice of antibiotics for community-acquired pneumonia

Prognostically, the rapid initiation of antimicrobial therapy, no later than 4 hours after diagnosis, is very important.

When choosing AMPs in a patient with nosocomial pneumonia

the nature of the department in which he is located (general profile or ICU), the use of mechanical ventilation and the time of development of VAP are taken into account (Table 5). Empirical therapy is planned based on local data on the sensitivity of likely pathogens. Sputum examination is mandatory, and it is desirable to obtain material by invasive methods with quantitative assessment of the results, and blood culture.

Table 5. Choice of antibiotics for nosocomial pneumonia

Risk factors: recent abdominal surgery, aspiration - anaerobes; coma, head injury, diabetes, chronic renal failure, influenza, “IV drug addicts” - S.aureus

;
large doses of glucocorticoids, cytostatics, neutropenia - Legionella
spp.,
P.aeruginosa, Aspergillus
spp.;
long stay in the ICU, treatment with corticosteroids, antibiotics, bronchiectasis, cystic fibrosis - P.aeruginosa
,
Enterobacter
spp.,
Acinetobacter
spp.

Routes of administration of antimicrobial drugs

In the treatment of outpatient forms of community-acquired pneumonia, preference should be given to oral antibiotics. However, in severe infections, AMPs must be administered intravenously. In the latter case, stepwise therapy is also highly effective, which involves switching from parenteral to oral administration. The transition should be made when the course of the disease stabilizes or the clinical picture improves (on average 2-3 days from the start of treatment).

Duration of therapy

For uncomplicated community-acquired pneumonia, antibiotic therapy can be completed once stable normalization of body temperature is achieved. The duration of treatment is usually 7-10 days.

If there are clinical and/or epidemiological data on mycoplasma, chlamydial or legionella pneumonia, the duration of antibacterial therapy should be longer due to the risk of relapse of infection - 2-3 weeks.

Duration of AMP use for complicated community-acquired pneumonia

and
nosocomial pneumonia
are determined individually.

In any case, the persistence of individual clinical, laboratory and/or radiological signs is not an absolute indication for continuation of antibacterial therapy or its modification. In most cases, these signs resolve spontaneously over time.

Prevention of respiratory diseases

Prevention of ARVI is aimed at increasing immunity. There are many known folk ways to increase the body's defenses: hardening, a diet rich in vitamins, and the use of natural phytoncides, for example, garlic.

In order not to become infected, it is necessary to take precautions: maintain a safe distance, reduce contact during periods of epidemics, wash your hands more often, ventilate the premises, dress according to the weather, avoiding hypothermia.

Vaccination provides the most effective protection against viruses. It is necessary to get vaccinated against influenza every year. You can get a pneumococcal vaccine to prevent severe pneumonia.

ABSCESS OF THE LUNG

Lung abscess

- a pathological process characterized by the formation of a limited cavity in the lung tissue as a result of its necrosis and purulent melting.

Main pathogens

Development of a lung abscess

binds primarily to anaerobic flora -
Bacteroides
spp.,
F. nucleatum, Peptostreptococcus
spp.,
P. niger
- often in combination with enterobacteria (due to aspiration of oropharyngeal contents).

Choice of antimicrobials

Drugs of choice

: amoxicillin/clavulanate, ampicillin/sulbactam or cefoperazone/sulbactam IV; benzylpenicillin intravenously, then amoxicillin orally (step therapy); benzylpenicillin + metronidazole IV, then amoxicillin + metronidazole orally (stepped therapy).

Alternative drugs

: lincosamides + aminoglycosides of II-III generation; fluoroquinolones + metronidazole; carbapenems.

Duration of therapy

determined individually.

PLEURAL EMPYEMA

Empyema of the pleura

(purulent pleurisy, pyothorax) is a pathological process characterized by the accumulation of pus in the pleural cavity and is an unfavorable variant of the course of exudative pleural effusion (pleurisy) of various origins.

Main pathogens

The composition of pathogens that are isolated during pleural empyema (Table 6) largely depends on the characteristics of pathogenesis. Thus, the main microorganisms in empyema associated with pneumonia (with or without lung abscess) are anaerobes. In contrast, the spectrum of pathogens after surgery is predominantly aerobic gram-negative bacteria or S. aureus

. In 5-20% of cases, the exudate turns out to be sterile.

Table 6. Etiology of pleural empyema

Choice of antimicrobials

In most cases, it is possible to carry out targeted antibacterial therapy taking into account data from microbiological examination of the contents of the pleural cavity.

If the purulent effusion turns out to be sterile, AMPs or their combinations that are active against anaerobes and aerobic gram-negative enterobacteria should be used: inhibitor-protected penicillins; III-IV generation cephalosporins or fluoroquinolones + metronidazole; lincosamides + aminoglycosides of the II-III generation, cefoperazone/sulbactam.

The development of pleural empyema as a complication after surgery is often associated with S.aureus

. Depending on sensitivity, ghbvtytys may be oxacillin, vancomycin, cefazolin, linezolid.

The main route of administration of AMPs for pleural empyema is intravenous. The duration of antibiotic therapy is determined individually.

Diagnosis of respiratory viral infections

If after a few days you cannot cope with the cold on your own, you should consult a doctor. Modern diagnostic methods make it possible to identify the type of virus at an early stage and prevent complications.

At the Anapa Diagnostic Center you can undergo examinations, undergo fluorography, and take sputum, blood and urine tests. If a bacterial infection is suspected, a bacteriological culture will be performed. Having identified the causative agent of the disease, effective treatment will be prescribed. Call and make an appointment; the earlier treatment is started, the lower the risk of complications.

FEATURES OF TREATMENT OF NPD INFECTIONS IN CHILDREN

In children, such a nosological form as exacerbation of chronic bronchitis practically does not occur. Acute bronchitis, which in adults usually has a viral etiology and does not require the use of antimicrobial agents, in childhood can be associated with a layer of bacterial flora (pneumococcus, mycoplasma, chlamydia). Therefore, in rare cases, acute bronchitis in children may require antibiotic therapy. The drugs of choice are amoxicillin or modern macrolides.

In newborns

Intrauterine
and
nosocomial
(including those associated with mechanical ventilation) infection predominates Community-acquired pneumonia is observed in full-term infants mainly after 3-6 weeks of life, in premature infants - after 1.5-3 months.

Intrauterine pneumonia

more often caused by group B streptococci and gram-negative bacteria (
E.coli, K.Pneumoniae
), less often -
S.aureus, L.monocytogenes, T.pallidum
.
Possible associations with CMV, HSV and fungi of the genus Candida
.
In rare cases, pneumonia can be caused by P. carinii
.

For intrauterine pneumonia

The drugs of choice are ampicillin or ampicillin/sulbactam in combination with aminoglycosides. For listeriosis, the drug of choice is ampicillin in combination with gentamicin. It should be emphasized that Listeria is resistant to cephalosporins, so the latter should be combined with ampicillin.

Treatment of pneumonia in newborns is almost always carried out in a hospital. AMPs are administered parenterally.

In the treatment of nosocomial pneumonia

, especially late ventilation, a combination of inhibitor-protected penicillins or third-generation cephalosporins with aminoglycosides or monotherapy with imipenem is preferable.

Pneumonia in children aged 1 to 6 months

can be divided into two groups:
typical
- focal (focal, confluent), developing against the background of high fever, and
atypical
- with predominantly diffuse changes in the lungs, at low or normal body temperature.

The most common causative agents of typical pneumonia

are viruses (RSV, parainfluenza, etc.),
E. coli
and other enterobacteria, staphylococci.
Pneumococci and H.influenzae
are rarely isolated at this age (about 10%).

For typical pneumonia

Amoxicillin/clavulanate, ampicillin/sulbactam, parenteral ampicillin are used. Alternative AMPs are II-III generation cephalosporins.

With chlamydia ( C. trachomatis

) for pneumonia, modern macrolides are the drugs of choice.

For anaerobic infections, inhibitor-protected penicillins, lincosamides, metronidazole, and carbapenems are effective; for Pneumocystis infection, co-trimoxazole is effective.

Among the causative agents of pneumonia in children from 6 months to 6 years

S.pneumoniae
predominates .
H.influenzae
is less common (up to 10%).
Pneumonia caused by M.pneumoniae
is observed in this age group in less than 10% of cases;
C.pneumoniae
.

Treatment of mild, uncomplicated pneumonia in children living in good social conditions is carried out on an outpatient basis using oral medications. AMPs of choice are amoxicillin and macrolides, alternatives are inhibitor-protected penicillins (amoxicillin/clavulanate), cefuroxime axetil.

In children with a tendency to allergic reactions or the development of antibiotic-associated diarrhea, macrolides are preferred.

In children over 7 years old

the main bacterial causative agent
of typical pneumonia
is
S. pneumoniae
(35-40%).
The frequency of atypical
pathogens -
M.pneumoniae
and
C.pneumoniae - is increasing.
Mild pneumonia is treated mainly at home using oral antimicrobial agents. The drugs of choice are amoxicillin or modern macrolides (clarithromycin, roxithromycin, azithromycin).

Severe forms of pneumonia

in children of all ages are an indication for hospitalization. In a hospital setting, it is advisable to carry out stepwise therapy. III-IV generation cephalosporins and inhibitor-protected penicillins are preferred. You can combine β-lactams with modern macrolides, less often with aminoglycosides (netilmicin, amikacin).

Nosocomial pneumonia

In children, the etiology is practically no different from pneumonia in adults. Treatment tactics are developed accordingly.

The use of fluoroquinolones is contraindicated in children. For health reasons, in the absence of a safer alternative, ciprofloxacin may be prescribed. Doxycycline is contraindicated in children under 8 years of age; Co-trimoxazole is not advisable to use in the first 2 months of life.

Complications of ARVI and their danger

In a person with good immunity, acute respiratory diseases go away within a few days, especially if the body is helped to cope with viruses. It is recommended to drink more water, rinse your nose, and gargle. Symptoms can be stopped - bringing down the temperature above 38 degrees, fighting a runny nose, treating the throat with emollients.

However, in some cases, severe viral intoxication or the addition of a bacterial infection can cause complications. Most often, complications arise in the respiratory system and lead to other diseases: tonsillitis, sinusitis, rhinitis, pharyngitis, laryngitis. Often, ARVI develops into bronchitis, otitis media, sinusitis, and pneumonia.

More serious consequences of ARVI threaten people with weakened immune systems. A respiratory infection may not be limited to the respiratory tract and spread to other organs. Severe complications include: pyelonephritis, nephritis, rheumatoid arthritis, neuroinfection.

FEATURES OF TREATMENT OF NPD INFECTIONS IN ELDERLY PEOPLE

In older people, the frequency of PD infections increases, which is associated with such predisposing factors as partial atrophy (especially in smokers) and low activity of the ciliated epithelium of PD, decreased general immunity, and the presence of concomitant diseases. Therefore, antibiotic therapy should be based on the possible influence of these unfavorable factors.

Due to age-related changes in kidney function, it may be necessary to adjust the AMP dosage regimen. This primarily concerns aminoglycosides and co-trimoxazole.

With existing pathology of the liver and gallbladder, it is possible to change the kinetics of a number of AMPs that are metabolized in the liver or excreted in the bile (lincosamides, metronidazole, macrolides). In patients with gallbladder pathology, ceftriaxone should be used with caution due to the increased risk of developing pseudocholelithiasis.

Table 7. Doses of antibiotics for the treatment of urinary tract infections in adults

Table 8. Typical errors in antibiotic therapy for NPD infections