Swelling in the flu

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Manual for doctors, St. Petersburg - Kharkov, 2007 "

Influenza is an acute disease with a short incubation period, a sudden onset and a cyclic course that is characterized by severe toxemia and upper respiratory tract and lung damage.

The duration of the incubation period for influenza varies from several hours to 3 days, most often it is 1-2 days.

The influenza clinic can vary significantly independing on the age of the patients, the state of the immune system, the serotype of the virus, its virulence and the like. It is advisable to consider the following clinical forms of influenza: normal (typical) and atypical (afebrile, acaral); on the presence of complications - uncomplicated and complicated. The severity of uncomplicated influenza is determined by the severity and duration of intoxication.

In the clinical picture, there are two main syndromes: intoxication and catarrhal (with airway disease).

At the forefront are symptoms of intoxication: chills or chilliness, severe headache with overwhelming localization in the frontal region and temples, aching muscles, sometimes in the joints, pain when moving the eyeballs or pressing them, photophobia, lacrimation, severe weakness and fatigue, lethargy; these symptoms on the first day of the disease dominate the catarrhal syndrome. Weakness in severe cases can reach adynamia. Often it is accompanied by dizziness and fainting.

Already in the first hours of the disease, the body temperature reaches its maximum values ​​- 39-40 ° C. The level of fever reflects the degree of intoxication, but on the whole, these concepts can not be identified.

Sometimes at a sufficiently high temperaturesigns of intoxication are not pronounced, which is predominantly observed in young patients with influenza A (H1N1). Hyperthermia they have a short-term, and subsequently the disease manifests an average degree of severity. The temperature reaction for influenza is acute and relatively short. Fever lasts for influenza A from 2 to 5 days, with influenza B - a little longer, and then the temperature is reduced by accelerated lysis. In 10-15% of patients, fever has a two-wave character, which is associated with complications caused by bacterial flora, or exacerbation of chronic diseases.

Headache is the main sign of intoxication andone of the first symptoms of the disease. The pain is usually localized in the frontal region, especially in the region of the superciliary arches, sometimes has a retroorbital character. In elderly patients, the headache is often diffuse, its degree may vary, but in most cases it is moderate.

A severe headache in combination with insomnia,delirium, repeated vomiting is observed in patients with severe disease, may be accompanied by a meningeal syndrome. When studying cerebrospinal fluid changes are not detected. In adults, unlike children, rarely there is a convulsive syndrome.

Is one of the two leading syndromes, oftenrecedes into the background. In some cases, it is not sufficiently expressed or completely absent. It is manifested by dryness and sensation of perspiration in the throat, nasal congestion. But the most common sign of catarrhal syndrome is tracheobronchitis. It is manifested by a feeling of perspiration or pain behind the sternum, which is caused by the inflammatory process of the mucous membrane of the trachea and bronchi, a rough coughing, sometimes paroxysmal with a small amount of sputum. This can lead to increased pressure in the system of the inferior vena cava and, in case of increased fragility of the blood vessels, may contribute to the manifestation of hemorrhagic syndrome (nosebleeds, small hemorrhages in the mucous membrane of the oropharynx, sometimes on the skin). During an uncontrollable dry cough that connects to vomiting, very severe pain occurs in the upper sections of the rectus muscles and intercostal muscles along the line connecting the diaphragm to the chest. Subsequently, the cough becomes moist. Often joins the hoarseness of the voice, the feeling of squeezing in the chest. Some experts believe that "scratching" pain behind the breastbone is a pathognomonic sign of the flu. Catarrhal syndrome lasts about 7-10 days, the cough lasts longer.

With an objective examination of patients in the early daysFlu diseases marked hyperemia and swelling of the face, hyperemia of the neck, injection of vessels sclera, eye humidity, lacrimation, mild conjunctivitis. These symptoms together resemble the face of a tear-stained child. From the 3rd-4th day of the illness on the lips, the wings of the nose, there may appear herpetic eruptions. In severe disease, pale skin with a cyanotic shade (as manifestations of hypoxia and hypoxemia) is observed.

On the mucous membrane of the sky, arches, back wallpharynx - bright hyperemia, which in patients with severe course has a cyanotic hue (due to circulatory disorders), more pronounced injection of vessels of the soft palate. In some patients, the granularity of the soft palate is revealed, more rarely - the tongue and the arches. The posterior wall of the pharynx is rather dryish and has enlarged lymphatic follicles. By the 3rd-4th day of the disease, the hyperemia of the mucous membranes decreases and only the injection of the vessels remains. Against this background, the granularity of the soft palate becomes more noticeable and spot hemorrhages are often noticeable.

The nasal mucosa is usually hyperemic withcyanotic shade, edematic, so from the first day of the disease, nasal breathing is difficult, but the amount of discharge from the nose is small. There may be fullness and swelling of the lower nasal concha, dryness, sometimes bleeding of the mucous membrane. Later, as noted, there are uninfluous serous or mucous discharges. Abundant rhinorrhea for influenza is not peculiar. The tongue is moist, uniformly coated with a thin white coating. Sometimes there may be a slight increase in the cervical lymph nodes, but usually lymphadenopathy is not typical.

The defeat of the respiratory system for influenza isnatural. In febrile period there may be shortness of breath. When percussion of the lungs, a box sound is often detected. With auscultation of the lungs (in the absence of complications), breathing is vesicular, with a hard hue, sometimes dry wheezes are heard. On Rg-grams, visual enhancement of the vascular pattern, expansion of the roots of the lungs, which can be mistakenly diagnosed as pneumonia.

From the side of the cardiovascular system are notedthe following changes: the pulse initially responds more often to the temperature, rarely a relative bradycardia or tachycardia is noted. Persistent tachycardia at the height of the disease is prognostically unfavorable, especially in elderly and senile patients with chronic heart, vascular and respiratory diseases. In many patients, muffled heart sounds are heard, especially in severe forms of the disease. In older patients, in contrast to the young, complaints of pain in the region of the heart, attacks of angina pectoris are possible. Arterial pressure during the height of the disease tends to decrease. ECG reveals typical changes in the toxicosis: a decrease and serration of the tooth P, a decrease in the T wave in various leads, an elongation of the Q-T interval, an extension of the P-Q interval. This indicates a diffuse toxic damage to the myocardium. The described changes disappear within 1-2 weeks. However, the nature of myocardial damage in influenza has not yet been clarified. Some researchers consider it as a manifestation of influenza myocarditis, the latter refer to changes in the heart to nonspecific dystrophic disorders, while others attach primary importance to vascular lesions.

The use of echocardiography in the dynamics of the diseaseinfluenza expands the prevailing views about the nature of myocardial changes in this infection. Echocardiography makes it possible to detect changes in the myocardium in cases where it is not possible to diagnose changes in the myocardium clinically and through ECG. Echocardiographic changes are manifested by such signs: a moderately pronounced expansion of the ventricular cavity (mainly right), the appearance of local disturbances of the contractile function of the myocardium, changes in central hemodynamics with a tendency to hyperkinetic type. At the heart of these processes is the deterioration of blood circulation along a small circle, increasing the pressure in a. pulmonalis as a result of an increase in peripheral resistance in the vessels of the lungs, an increase in the load on the right heart.

Changes in the gastrointestinal tractfor influenza are not typical. In severe forms, the appetite is reduced to anorexia. The tongue remains moist, covered with a white coating. The abdomen is soft, painless on palpation. The liver and spleen do not increase. The chair is often detained, seldom can it be eased. Sometimes, with such erroneous diagnoses as "flu with intestinal syndrome," "intestinal flu", there is usually a pathology that is caused by adenovirus or intestinal Coxsackie viruses and ECHO, shigella and salmonella, and sometimes the effects of drugs. Sometimes short-term diarrhea with influenza can be associated with exacerbation of chronic diseases of the gastrointestinal tract. These changes are nonspecific, they are associated with changes in the tone of the autonomic nervous system under the influence of toxins. The opinion of some doctors about the "intestinal form" of influenza is completely unfounded.

Disorders of the central nervous system in severethe course of the disease manifested by dizziness, sleep disturbance, vomiting, manifestations of meningism. In the defeat of the peripheral nervous system, local hyperesthesia and paresthesia of the skin, trigeminal neuralgia, intercostal and other nerves occur. Particularly often there are functional disorders of the autonomic nervous system in the form of face hyperemia, sweating, and pulse lability.

Clinical signs of a lesion of the urinary system with uncomplicated influenza are not revealed.

Of general clinical laboratory research In influenza, general analysis is importantblood. On the first day in 1/3 of patients develop leukocytosis (up to 10-12x10 9 / l) with a moderate stab-shift caused by an increase in the number of circulating neutrophils. On the second day the number of neutrophils rapidly decreases, develops leukopenia, which persists until the end of the fever period, and sometimes longer.

Dynamics of lymphocyte count in such patientsthe other. When influenza infected with volunteers, there was a significant decrease in the number of lymphocytes in the circulating blood a few hours before the onset of the disease. Absolute lymphopenia is characteristic of influenza and is observed throughout the period of the disease. In the midst of the disease, there is relative lymphocytosis (due to neutropenia). At the beginning of convalescence, there is a tendency to normalize the blood formula. In most cases, the ESR remains close to normal. The parameters of hemoglobin, erythrocytes, hematocrit usually do not change.

Decrease in the level of neutrophils in peripheralblood is explained by their migration to the focus of inflammation, as well as increased production of cortisol in a stressful situation, which is an influenza infection for the body.

Changes in the urine are not characteristic. But at the height of the fever, slight proteinuria is possible as a consequence of toxicosis and circulatory disorders.

Based on the degree of toxicosis, severitycatarrhal syndrome secrete light, moderate, severe and fulminant (fulminant, hypertoxic) forms of influenza. The latter form is considered by many specialists as a complication of the flu.

When light form influenza body temperature does not exceed 38 ° C andnormalized after 2-3 days. Symptoms of general intoxication and catarrhal syndrome are poorly expressed. In some cases, the clinic does not differ much from ORZ of another etiology.

Medium-heavy form influenza is characterized by an increase in temperaturebodies up to 39 ° С, expressed by the phenomena of intoxication and defeat of the respiratory system. Fever lasts up to 4-5 days. This form of influenza is recorded most often.

Heavy Form influenza manifests itself in the rapid development and significant severity of intoxication, fever and catarrhal phenomena. Characteristic:
  • sharp beginning;
  • high and longer duration of fever (39-40 ° C) with pronounced intoxication;
  • sharp weakness right up to complete adynamia;
  • severe muscle pain and headache;
  • drowsiness or insomnia, dizziness;
  • possible delirium, hallucinations, loss of consciousness, convulsions;
  • nausea, repeated vomiting;
  • earthy shade of skin;
  • constant dyspnea, worse with movement;
  • positive symptom "pinch";
  • often develop meningeal and postencephalitic syndromes;
  • complications from respiratory organs are often observed, and in the first place - viral-bacterial pneumonia.

The extreme manifestation of a severe form of influenza, whichcharacterized by severe neurotoxicosis with the development of cerebral edema; cardiovascular, respiratory failure (acute hemorrhagic pulmonary edema, bronchiolitis, stenosis of the larynx and the like); progressive DVM-syndrome; characterized by rapidly progressive deterioration of the patient's condition, tachypnea, tachycardia, stitching pain in the chest, "rusty" sputum, increased dyspnoea, cyanotic skin with a gray tinge. The extreme severity and rapid course of the disease are noted.

The most common syndrome with severe and complicated forms of influenza is acute respiratory failure (ODN). It can be due to:
  • contraction of the respiratory surface of the lungs;
  • obstruction of the bronchial sputum tree;
  • violation of diffuse properties;
  • reduction of functioning sites (atelectasis, collapse);
  • defective function of the respiratory muscles;
  • a violation in the surfactant system;
  • violation of the respiratory center function or blockade of the afferent parts of the regulation of the respiratory muscles;
  • a mismatch between ventilation and perfusion.

The main clinical features of ODN aredyspnea, acrocyanosis, sweating, tachycardia, a disturbance in the rhythm of respiration and neuropsychiatric status, which depends on the degree of hypoxemia and hypercapnia, metabolic or mixed acidosis. The clinical picture of ODN is divided into three degrees.

I degree characterized by complaints of a sense of lackair, anxiety, euphoria. Skin moist, pale, with light acrocyanosis. There is an increasing shortness of breath (25-30 breaths in a minute), a moderate increase in blood pressure. Pa02 reduced to 70 mm Hg. Art. RaC02 is raised to 50 mm Hg. Art.

II degree. Delirium, excitement, hallucinations, profuse sweat, cyanosis (sometimes with hyperemia), significant shortness of breath (35-40 breaths per minute), tachycardia, arterial hypertension.

Pa02 reduced to 60 mm Hg. Art. RaC02 is raised to 60 mm Hg. Art.

III degree. There comes a coma with clonic and toniccramps, pupils wide, significant cyanosis, respiration - superficial, frequent (more than 40 per min.), and only before stopping the heart, breathing becomes rare. Blood pressure is sharply reduced. Pa02 is less than 50 mm Hg. Art. RaC02 is above 70 mm Hg. Art.

The second, no less frequent syndrome in severe andcomplicated forms of influenza is acute circulatory insufficiency, which, in particular, develops in patients with an infectious-toxic shock. The leading role in the development of this complication belongs to viral-bacterial toxins, which cause disturbance of the regulation of peripheral circulation.

Clinic ITSH is divided into 3 stages.

1st stage:
  • intoxication without clinical signs of shock. There is a chill with a subsequent increase in temperature to febrile numbers, nausea, vomiting, possible diarrhea;
  • hyperventilation - alkalosis (respiratory), cerebral disorders in the form of anxiety or inhibition;
  • The blood pressure is normal or somewhat reduced, sometimes it can be slightly increased.
2nd stage:
  • stage of "warm hypertension", which is characterized by low peripheral resistance and high cardiac output;
  • symptoms: tachycardia, tachypnea, hypotension, pallor of the extremities with acrocyanosis, oliguria and cerebral disorders. Mortality of patients reaches 40%.
3rd stage:
  • "Cold hypotension" - shock with high peripheral resistance and low cardiac output;
  • co-morbid state, which passes into coma. Skin pale, cold; can be a petechial rash. Tachycardia, tachypnea, oligoanuria. The violation of thermoregulation is hypothermia. Deep metabolic acidosis. Mortality of patients reaches 60%.

Depending on the phase and depth of shock, the minute volume of circulating blood can be normal, increased or decreased.

In the early stages of shock, a decrease in blood pressurepressure leads to a compensatory increase in the tone of the sympathetic-adrenal system with an increase in the content of adrenaline and norepinephrine in the blood, which cause a spasm of the vessels of the parenchymal organs (liver, kidneys), intestines, skeletal muscles. The result is the stabilization of blood pressure, improving the blood circulation of the brain and heart.

In the late stages of shock in the absence of compensatory mechanisms, vasospasm can lead to prolonged ischemia and the development of irreversible changes in tissues and the system of homeostasis.

In the terminal phase of the disease, such aa complication like a brain cave that is a consequence of hypoxia of the brain tissue, hypercapnia, metabolic acidosis, hyperthermia. The first clinical manifestations are severe diffuse headache, dizziness, nausea, vomiting, the presence of meningeal signs, stasis in the fundus, loss of consciousness, cramps, increased blood pressure, bradycardia. Bradycardia is the earliest, and oligopnea, in contrast, is one of the most recent symptoms of cerebral edema. When assisting to reduce intracranial pressure, lumbar puncture is indicated, and this should be done very carefully, because of the danger of wedging the cerebellum or medulla oblongata into the large occipital orifice.

Toxic hemorrhagic pulmonary edema canappear already in the first days of the disease and be the cause of death in severe and lightning-fast forms of influenza. On the background of severe intoxication, dyspnea appears, cyanosis increases; violation of breathing is accompanied by excitement. In the sputum appears an admixture of blood, although this impurity does not cause the development of hemorrhagic pulmonary edema. With auscultation of the lungs, a considerable number of different-sized moist wheezing is heard; shortness of breath, tachycardia. In such cases, death occurs very quickly in cases of severe respiratory failure.

The development of false groats can lead to swellingvocal cords, reflex spasm of the muscles of the larynx. This condition occurs in children and in young people and is characterized by a sudden appearance of an attack of suffocation. The attack usually occurs at night, accompanied by anxiety, tachycardia. If you do not provide emergency care, the illness can end with death.

The most varied changes in the heart muscle - fromnon-severe myocarditis, which are detected only on the ECG, before, although rarely, myocardial infarction - can cause vascular disorders. An important role in the development of such complications is played by the severe course of the flu, the age of the patient. In later terms, endocarditis of infectious and allergic origin may occur.

Complications of influenza can be causedbacterial flora. More often they appear after 4-5th day of illness, sometimes even earlier. The most characteristic of them is pneumonia of a diverse nature: focal, segmental, draining. The very presence of viral pneumonia is not recognized by all. It is assumed that viruses cause a violation in the local lung protection system (T-cell deficiency, phagocytic activity, damage to the ciliary apparatus), which contributes to the occurrence of bacterial pneumonia. Viral (or post-virus) pneumonia is often not recognized even in patients who have a "protracted course" of acute respiratory-viral infections, develop signs of bronchial obstruction, and detect changes in blood. Such patients are often exposed to the diagnosis: residual events of the advanced ARVI. In the clinical picture, the manifestations of the corresponding virus infection - influenza prevail. Physical and roentgenologic symptoms in viral pneumonia are generally scanty.

Clinically, pneumonia manifests itself as a cough, anddry influenza cough often replaced by a cough with phlegm (mucopurulent, purulent). Often, patients complain of chest pain, dyspnea. Objectively, over the focus of inflammation is determined by the change in percussion sound, against the background of weakened breathing, crepitus or small bubbling rales are heard. The right lung is more often affected.

The severe course of such complications is more commonis observed with pneumonia, which occurs in the first days of influenza infection, unlike pneumonia, which develops in later periods. Especially hard is pneumonia caused by staphylococcus, which, as is known, tends to form abscesses in weakened patients. The etiological factor of pneumonia may be another flora (enterobacteria, streptococci, pneumococci, hemophilic rod).

Severe forms of pneumonia can complicate adult respiratory distress syndrome (ARDS), which has a high lethality - up to 60%. The ARDS is known to have three stages:
  1. preclinical, which is characterized by morphological signs of damage to the capillaries of the alveolar membranes;
  2. acute stage that develops during thethe first week after the action of the damaging factor, characterized by the development of interstitial and alveolar edema, inflammatory changes with a large number of polymorphonuclear leukocytes and fibrin both in the exudate inside the alveoli, and in infiltrates of tissues, hyaline membranes;
  3. stage of the organization of exudate and proliferation of second-order pneumocytes, which lead to interstitial fibrosis. Organizational processes start from the 2nd-3rd day of the disease.

In the clinical picture, RDSD is divided into 4 periods.

I period - latent, or the period of action of the etiologicalfactor (lasts about 24 hours). In this period there are no clinical and radiological manifestations. However, tachypnea is often observed (the number of breaths is more than 20 per minute).

II period - initial changes that occur on the 1-2 thday from the onset of the etiological factor. The main clinical symptoms of this period are mild dyspnea, tachycardia. With auscultation of the lungs, severe vesicular breathing and scattered dry wheezing can occur. On the radiographs of the lungs there is an increase in the vascular pattern, mainly in the peripheral regions. These changes indicate the onset of interstitial pulmonary edema. The study of the gas composition of the blood or does not have deviations from the norm, or a moderate decrease in Pa02 is detected.

III period - deployed, or a period of expressed clinicalmanifestations, which is characterized by severe symptoms of acute respiratory failure. Appears pronounced dyspnea, in the act of respiration, the accessory musculature participates, the swelling of the nose wings and the retraction of the intercostal spaces are clearly visible, and a pronounced diffuse cyanosis is observed. With auscultation of the heart, tachycardia and deafness of cardiac tones are noted, blood pressure is significantly reduced.

With percussion of the lungs, dullnesspercussion sound, more in the lower parts, auscultatory - hard breathing, hard wheezing can be heard. The appearance of wet rales and crepitations indicates the appearance of fluid in the alveoli (alveolar edema of the lungs of different degrees).

On chest radiographs, a pronouncedinterstitial pulmonary edema, as well as bilateral infiltrative shadows of irregular cloudy form that merge with the root of the lungs and with each other. Very often in the marginal sections of the middle and lower lobes on the background of an intensified vascular pattern, foci of focal-shaped shadows appear.

A characteristic feature of this period is a significant fall in Pa02 (less than 50 mm Hg despite inhalation of oxygen).

IV period - Terminal. It is characterized by a pronounced progression of respiratory failure, the development of severe arterial hypoxemia and hypercapnia, metabolic acidosis, the formation of an acute pulmonary heart as a result of increasing pulmonary hypertension.

The main clinical symptoms of this period are:
  • severe shortness of breath and cyanosis;
  • profuse sweating;
  • tachycardia, deafness of cardiac tones, often various arrhythmias;
  • a sharp fall in blood pressure right up to the collapse;
  • cough with discharge of foamy sputum pink color;
  • a large number of wet rales of different calibres in the lungs, abundant crepitation (signs of alveolar edema of the lungs);
  • development of signs of increasing pulmonaryhypertension and acute pulmonary heart syndrome (splitting and accent of the 2nd tone on the pulmonary artery, ECG signs - high spike teeth P in leads II, III, avL, VI-2, marked deviation of the electric axis of the heart to the right, radiologic signs of pulmonary artery pressure increase , protrusion of its cone);
  • development of multiple organ failurekidney function, which is manifested by oligoanuria, proteinuria, cylindruria, microhematuria, increased urea blood content, creatinine; violation of liver function in the form of mild icterus, a significant increase in blood levels of alanine aminotransferase, fructose-1-phosphataldolase, lactate dehydrogenase; violation of brain functions in the form of inhibition, headache, dizziness, clinical signs of cerebral circulation disorders are possible).

The study of the gas composition of blood reveals a deep arterial hypoxemia, hypercapnia; study of acid-base balance - metabolic acidosis.

With influenza, it is also possible to develop arachnoiditis. At the heart of its development is the disturbance of liquorodynamics as a consequence of hyperproduction of cerebrospinal fluid and vascular damage with the formation of a focal adhesive process that disrupts the absorption of cerebrospinal fluid by a venous network, which in turn increases the disruption of the circulation of the cerebrospinal fluid. Clinical manifestations of this process are regularly recurring attacks of headache, dizziness, and also nausea, weakness. These symptoms can appear as early as 2-3 weeks after the flu.

Severe influenza, especially in people with a history of heaviness (hypertension, atherosclerosis), can be accompanied by a hemorrhage in the brain tissue with the subsequent development of paralysis.

Influenza can also cause a syndromeGuillain-Barre. It is characterized by the development of peripheral paralysis of the muscles of the extremities while maintaining surface sensitivity. The process can spread from the bottom up with damage to the muscles of the face, pharynx, larynx. In the cerebrospinal fluid, protein-cell dissociation is detected. Fortunately, this syndrome is very rare. Admit the infectious-allergic genesis of its development.

Defeats of the nervous system for influenza can beare also represented by radiculitis, neuralgia of different localization, polyneuritis. These complications develop more often already in the period of convalescence and can last from several days to several weeks.

A peculiar and infrequent complication of influenzais Reye's syndrome, which was described back in 1963. It is characterized by the development of acute encephalopathy and fatty degeneration of internal organs. More often, Ray's syndrome is associated with influenza A and occurs almost exclusively in children under the age of 16 years. This complication begins after the extinction of the clinic of the underlying disease in the period of initial convalescence. The first symptom is sudden vomiting. Growing then encephalopathy is manifested by increased excitement, extreme irritation, aggressiveness, but there are bright intervals of adequate behavior. This syndrome can develop very quickly: sometimes a few hours after the appearance of vomiting, the child quickly falls into a coma. In 30% of patients at the very beginning of the disease, a slight increase in the liver is also detected, but jaundice does not develop. This is characterized by an increase in the activity of transaminases and an increase in the concentration of ammonia in the blood in combination with hypoglycemia. It is important to note that the syndrome of Rhea is difficult to differentiate with acute encephalopathies of another etiology. The diagnosis is considered unquestionable only after its confirmation by the results of a liver biopsy. In patients, violations of amino acid and fat metabolism are detected. The reasons for the development of the syndrome remain unknown. Possible genetic predisposition. Unconditional is only that for the development of the disease an obligatory condition is the previous viral infection. Mortality is very high and is 20-56%.

Presence of symptoms of vegetative dystopia and generalasthenia is one of the most characteristic features of influenza infection. Usually all these disorders quickly disappear after the normalization of temperature, but in some patients they persist after the extinction of all clinical manifestations of infection, sometimes up to a month, that is, acquire the character of an influenza complication. Symptoms of asthenia (general weakness, sweating, poor sleep, decreased appetite, insomnia, fatigue, distracted attention) are combined with the lability of the pulse, unstable arterial pressure, frequent palpitations. Often there are violations of the emotional sphere (the patients become whiny, irritated). In connection with this, in medicine, the concept of Postvirus Asthenia Syndrome (SPA) was formed, which was described back in the 1960s by P. Kendell. Asthenia is associated with the action of a biological agent. Many researchers believe that a prolonged persistence of viruses is likely to be the main cause of the development of SPA. Viralemia is accompanied by infection of macrophages and other subpopulations of lymphocytes, which for a long time remain carriers of the pathogen, which forms the development of immunodepression. The spa occurs more often within a month after a previous viral illness. The duration of this syndrome can be years and depends on both the most persistent virus, and the state of the macroorganism and its immune system, as well as the quality of treatment for the viral infection that was carried out.

Spa can also be accompanied by mentaldisorders - from mild depressions to significant behavioral disorders. Neurological symptoms in SPA include a sensitivity disorder, vegetative disorders and myalgia. Often patients are disturbed by hyperesthesia in the form of "socks and gloves", a slight subfebrile increase in body temperature.

The greatest attention is drawn to the phenomenonneuromialgia. Pain occurs in an isolated group of muscles and is accompanied by muscle weakness and rapid fatigue, even with little physical exertion.

Results of clinical analysis of urine and bloodfluctuate within the norm, and serological examination often allows you to diagnose a previously transmitted viral infection. Assessment of the immune status indicates a change in the function of lymphocytes, a change in the complement system, as well as suppressor cells. The transferred flu causes oppression of activity of macrophages and neutrophils, in connection with which the syndrome of dysfunction of phagocytosis is formed. Against this background, unmotivated fatigue, increased emotional lability, cause a misunderstanding in the doctor who regards them as aggravation.

In addition to the central nervous system, complications fromother internal organs. Thus, the sensitization of the mucous membrane of the trachea and bronchi directly by the influenza virus and the products of the decay of cells infected with the virus is the basis for the development of bronchial asthma. Sensitization of the kidneys with this virus, its antigens, immune complexes underlies the development of glomerulonephritis 1-2 months after the transferred illness. The reliability of such a complication should be determined by a doctor who, in order to prevent it, can recommend a patient to avoid hypothermia in the coming months.

At the heart of long-term residual effects after a previous flu is vasculitis.

Influenced influenza, given the declineimmunological reactivity (anergy), can lead to exacerbation of chronic diseases that the patient had: tuberculosis, rheumatism, tonsillitis, cholecystocholangitis, pyelonephritis and the like.

Separately, it should be noted the possibility of complicationsinfluenza in pregnant women, which in the second and third trimesters of pregnancy can lead to miscarriages, stillbirths and congenital deficiencies. They can develop 9-14 days after the flu. If a woman has been ill with the flu in the first half of pregnancy, then the child subsequently increases the risk of developing schizophrenia.

Influenza in different age groups

There are some features of the influenza clinic in different age groups.

Have children of early age Symptoms may be symptomaticneurotoxicosis with multiple vomiting, phenomena of meningism, convulsions against the background of subfebrile or normal body temperature. Sometimes these patients develop bronchiolitis, laryngitis, croup. Cough with croup coarse, barking, noisy breathing, tension from the auxiliary respiratory muscles is observed. In contrast to diphtheria, laryngeal stenosis is poorly expressed.

For the elderly and senile influenza is dangerous primarily because of itsthe background worsens chronic cardiovascular diseases and diseases of the respiratory system, other chronic foci are activated. Clinically, these patients have a state of hyperactivity. Influenza in patients in this group often with a low body temperature, but with severe intoxication, complicated by severe pneumonia. Increases susceptibility to other diseases.

Fever in uncomplicated influenzashort-term and is from 2 to 5 days, much less often - 6-7 days. Body temperature decreases critically or accelerated lysis, accompanied by sweating. In the future, subfebrile may persist. Reduction and even normalization of body temperature does not mean a recovery from the flu. Since the temperature drops, the general condition of patients is improving, the intoxication syndrome is rapidly decreasing. Headaches disappear, catarrhal phenomena disappear, appetite renews and sleep improves. Cough by this time becomes softer, mucous sputum appears, which makes it easier, the sense of persecution behind the sternum disappears. Usually cough, gradually abating, lasts for 2-4 more days, but if it persists longer and purulent sputum appears, this is already an indication of the occurrence of a bacterial complication.

The period of convalescence for influenza lasts 1-2of the week. Many convalescents have asthenia, which lasts from a few days to 2-3 weeks (fatigue, irritability, sleep disturbance, sweating, sensory excitability to light, sound). There may be diencephalic disorders - subfebrile, vestibular disorders.

Predominantly the flu ends full