COLD- PRACTICAL APPROACH OF FAMILY DOCTOR

Paul Kolesnyk

International classification of diseases

• Acute infections of multiple and unspecified upper respiratory locations

• Acute lower respiratory infection unspecified

• Influenza virus not identified • The flu caused by an unidentified virus • Acute nasopharyngitis

• J06

• J22

• J11• J10

• J00

What is the frequency of cold with viral and bacterial etiology?

Etiological structure of acute Etiological structure of acute respiratory diseaserespiratory disease

- Str.pneumoniaeStr.pneumoniae - - H.InfluensaeH.Influensae - - Str.pyogenesStr.pyogenes

Typical bacterial pathogens:

Etiological structure of acute Etiological structure of acute respiratory diseaserespiratory disease

- Cl.pneumoniaeCl.pneumoniae -- MycoplasmaMycoplasma pneumoniaepneumoniae - Legionella- Legionella

Atypical bacterial pathogens:

Who and where lives?

Location of infections in ENT organsLocation of infections in ENT organs

Sterile partNon-sterile part Sterile part

TracheaBronchiAlveali

nasopharynx oropharynx

Eardrum Accessory sinuses of nose

Laryngitis tracheitis pneumonia

tonsillopharyngitis rhinitis

otitis sinusitis

Str.pneumoniaeH.InfluensaeM.catarrhalis

Str.pyogenesStr.pneumoniaeH.InfluensaeM.catarrhalis

What are the complications of flu?

Complications

• Primary viral pneumonia - "lightning" deadly hemorrhagic viral pneumonia

• Secondary bacterial pneumonia (often due to Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus)

• bronchitis • Rhinitis, sinusitis, otitis • Myocarditis and pericarditis • Meningitis and encephalitis • Exacerbation of chronic diseases: asthma, chronic

bronchitis, heart disease, kidney disease

Is it possible to differentiate cold of viral and bacterial etiology?

–no–yes

The technique of "small groups"

• Group №1 "Symptoms and data on the objective examination, characterized purely for viral etiology of the cold "

• Group №2 "Symptoms and data on the" objective examination, characterized purely for the cold of bacterial etiology "

Clinical diagnosis while examining the throat

Signs of destruction of one or two parts of the upper respiratory tract;

Signs simultaneous destruction of several respiratory tract;

cold symptoms; More or less severe symptoms of general intoxication, cold symptoms,, much less sore throat, cough running nose;

Clear congestion in the oropharynx, and in the presence of nasopharyngitis, dull, with a bluish tinge on the back of the throat

Moderate congestion brackets, posterior pharyngeal wall with the presence of enantema;

The changes most productive, characterized by the formation of pus secretions. Clearly edema surrounding tissue is not typical;

Congestion of the mucous membrane of the nasal passages; Tonsils are mostly intact (except adenoviral infection);

Clinical differential diagnosisbacterial viral

Clinical characteristics of the diseasesFlu -intoxication syndrome: short-term high fever significant muscle pain headache with localization in the superciliary

arches, paraorbital and temporal areas -catarrhal syndrome: bronchitis rhinitis edema and hyperemia of the person vascular injection of the conjunctiva

Parainfluenza

Not acute onset and slow progress weakness, appetite loss sometimes single-vomiting temp low-grade 1-8 days catarrhal 1 day of illness (persistent, loud cough,

running nose, foundation and mucous discharge from the nose)

Oropharynx exam: edema, congestion of the mucous membranes, posterior pharyngeal wall

the false croup syndrome –heavy cough, hoarseness of voice, noisy breathing, development of stenosis of the larynx

Adenoviral infection t 38-39 * C prolonged rhinitis (4 weeks) with mucosal

secretion granulose throat (a symptom of "roadway") cough 2 days of illness-wet conjunctivitis lymphadenopathy hepatolienal syndrome intestinal disorders

Respiratory- syncytial infectionChildren under 1 year of age: -nasal congestion -Dry, long, paroxysmal cough -may increase as a result of effects of laryngotraheitisElder children: -the disease is not severe -cold symptoms of the upper respiratory tract -cough, dry, stable, long-term -Sometimes, chest pain

FEATURES OF THE BACTERIAL CAUSES OF COLD

Str.pneumoniae

The frequency of spontaneous eradication - only 10%

Very frequent development of severe complications

Unfavorable prognosis of pneumonia Does not produce B-lactamase ,unstable to

penicillin

Str.pyogenesThe frequency of lesions of the pharynx and

tonsils - 30-40% The reasons for poor eradication:

Patients don’t keep the 10-day course of penicillin

Reinfection from surrounding Inactivation of antibiotics ko-patohens in the

mouth Tolerance of bacteria to penicillin!

(via intracellular lesions "biofilm" - new macrolides are more effective!)

Available in healthy carriers!

Сhl.pneumoniaeVery often in children with adenoid

vegetation Both with M.pneumoniae 6-15% - the

cause of acute bronchitis and acute respiratory disease in young people and children

It may be the cause of frequent recurrent ARI in children

The new macrolides are effective for the treatment!

M.catarrhalisM.catarrhalis

The frequency of spontaneous eradication - 20%

Producing B-lactamase in 90% (sensitive to protected penicilins,

quinolones, macrolides)

H.InfluensaeH.InfluensaeThe frequency of spontaneous

eradication (often with sinusitis, COPD) - 40%

Natural resistance to macrolides due to a mutation in the 23s rRNA

Producing B-lactamase (regional dependence) - a natural resistance to unprotected penicillins

Will the laboratory help to differentiate cold of viral and bacterial etiology?

–no–yes

Laboratory services

• CBC• CRP • Rapid tests Rota, adeno, influenza • Strep Test

Clinical Case

• The mother of 4 years Andrew complained that the boy 2 days to 38S fever, sore throat, runny nose. According to the mother, similar symptoms were observed in her older son 10 days ago, called "connection with the older child was assigned to ceftriaxone 1 g / m, but no significant improvement was observed after 7 days of treatment in the older child and remained subfebrile a sore throat.

The results of objective examination

• The throat is red, hypertrophied tonsils, gaps are clean. Submandibular l / n enlarged, painful.

• Lungs, heart - normal. Abdomen is slightly sensitive in the right subcostal area, liver 2 cm.

• What is the likely nature of the disease in a child?

• What is evidence of this? • How to clarify the diagnosis?

Do I need to assign this patient ABT?

–no–yes

The results of the additional methods of examination

• GBA: e., L., ESR - the norm in the leukocyte formula revealed moderate lymphocytosis, large cell undifferentiated ++.

• CRP- 12mMol / l • In re-examination of child after 2 ago- throat is

rapidly flushed, little white patches on the tonsils. The skin of the abdomen, small papular rash, which mother has related to allergic to nurofen. On palpation the abdomen + 4cm liver, spleen palpable ..

results of additional tests

• To differentiate the causative agent of angina done rapid test for Streptococcus A-positive result.

• The result of ELISA - IgM to Epstein Bar Virus - high titer

• What is the diagnosis?

Do I need to assign this patient the antibiotic treatment?

–no–yes

– If yes, what group of antibiotics does he need?

Traditional non-drug Traditional non-drug recommendations for coldrecommendations for cold

Warm drinking - conclusively washes the mucus easier with tickle regardless of the type of liquid (tea, soup) Garlic - 5 clinical trials, patients who continued to have used garlic showed no effect on the frequency or duration of cold. A side effect of garlic was found more frequently. Vitamin C - 10 long large trails (11 thousand people) found no evidence of influence of vitamin C on the incidence of SARS, little evidence on the impact of the length. Feature - effect on certain groups of people (athletes, marathon runners - is the impact on the incidence of chronic administration of 200 mg / d) Echinacea - had demonstrable efficacy of prolonged use of 8 weeks before cold. The weak effect of SARS on the course and incidence of complications. Honey - not identified evidence-based efficacy Banks mustard - not found evidence-based efficacy UV premises - not identified evidence-based efficacy Sleep - 8 hours of effective sleep demonstrably improved the patient's condition and affect the duration of SARS Frequent room ventilation - hydration has some evidence on the effectiveness of the patient Irrigation of the nose- the standpoint of evidence-based medicine

Conclusion of the Cochrane Society

Symptomatic therapy for SARS? Where is the myths?

NSAIDs (ibuprofen, aspirin) - demonstrably reduce temperature, sore throat, headache. Good for 38.5 and above, not all children can

• Paracetamol - demonstrable efficacy in temperature, it is possible for children does not diminish the pain of the throat.

• Decongestants - the average degree of evidence only if excessive congestion, it is better to sleep with drip syndrom, side effects. Not expediency with cold in children

•  Antihistamines - small evidence base, the advantage toward topical vehicles

• Immunomodulators - there is no evidence on the effect during the SARS

• Homeopathic remedies - there is no evidence on the effect during the SARS

• Probiotics - there was a little evidence base on the impact on the prevention of cold in the missing side effects

Cold Therapy for SARS? Where are Cold Therapy for SARS? Where are the myths?the myths?

Therapy should be administered depending on the cause:

Drip syndrome proved efetyvnist irihatsiyi, decongestants at bedtime

Irritation of the posterior wall of the pharynx - the effectiveness of NSAIDs

Antitussive - low effectiveness evidence, no evidence on the use protykashlovyh + expectorant (inappropriate for children)

Mucolytics and expectorant no effect on the course and duration of the disease, only improves quality of life

Is there any evidence in the appointment of nebulizer therapy during cold and it’s and

complications?

–no–yes