Adenoviral diseases

Pharyngoconjunctival fever - the acute virus illnesses proceeding with a primary lesion of a respiratory organs, eyes and lymph nodes.

Studying of illnesses of this bunch has begun since 1953. Adenoviruses have been secured for the first time by the American scientists led by Hubner in 1954 from a tissue of tonsils and the lymph nodes received from children during operations, and also found in persons with diseases of the top respiratory tracts accompanied by conjunctivitises. Since 1956 practice included the term "adenoviruses" offered Anders, Francis, and the illnesses caused by given bunch of viruses, have received the name of adenoviral diseases.

Now 32 phylums of the adenoviruses secured from the human and differing in the antigenic attitude are known. Flashes of diseases are is more often caused by phylums 3, 4, 7, 14 and 21. The phylum 8 causes epidemic kerato conjunctivitis. Adenoviruses contain a deoxyribonucleic acid (DNA). For all phylums of adenoviruses presence of the general complement-linked antigen is characteristic. Adenoviruses remain till 2 weeks at a room temperature, but perish from influence of an ultra-violet irradiating and chlorine.

Infection contamination source are patients with clinically expressed or erased forms of disease. Infestation descends air - drop by. However possibility and an alimentary path of a transmission of infection is not excluded.

The case rate raises in a cold season. Children and military men is more often are ill. The case rate in again generated collectives (in the first 2-3 months) is especially high.

Pathogenesis. Infection atriums are mainly mucosas of the top respiratory tracts, is more rare - conjunctivas. Adenoviruses propagate in a mucosa with characteristic gradual, consecutive involving in pathological process of descending departments of a respiratory tract. The reproduction of adenoviruses can descend in an intestine tissue, lymph nodes. Virus reproduction in an adenoid tissue is accompanied by a plural hyperadenosis. Besides aboriginal changes, adenoviruses have the general toxic influence on an organism in the form of a fever and symptoms of the general intoxication. Ability of adenoviruses to reproduction in epithelial cells of a respiratory tract, a conjunctiva, an intestine with occurrence on occasion a hematogenous dissimination frames a wide range of clinical implications of this infection contamination, including appearance generalised limfo - an adenopathy and a widespread exanthema.

Besides adenoviruses in a genesis of an acute pneumonia apposition of secondary bacterial flora that promoted by oppression of immune system matters.

Symptoms and flow. The incubation interval fluctuates from 4 till 14 days (more often 5-7 days). The basic clinical forms of adenoviral diseases are: nasopharyngites, febris pharyngoconjunctival, conjunctivitises and keratoconjunctivites, an adenoviral pneumonia. Besides it adenoviruses can cause and other clinical forms - a diarrhoeia, an acute nonspecific mesadenitis, etc. For any of clinical forms of an adenoviral infection contamination set of a lesion of a respiratory tract and other symptoms (a conjunctivitis, a diarrhoeia, a mesadenitis, etc.) is characteristic. The exception compounds a keratoconjunctivitis which can proceed separately, without a lesion of respiratory tracts.

Adenoviral diseases begin acutely with a fervescence, intoxication symptoms (a chilling, a headache, delicacy, appetite depression, muscular pains, etc.). But even at a high fever the general state of patients remains satisfactory and the toxicosis of an organism does not reach that degree which is inherent to a flu. The fever in typical cases long, lasts till 6-14 days, sometimes has two-wave character. At the adenoviral diseases proceeding only with a lesion of the top respiratory tracts, the temperature remains 2-3 days and quite often does not exceed subfebrile digits.

Obstruction of a nose and cold - early symptoms of adenoviral disease. The pharynx is often amazed. Inflammatory process seldom proceeds in the form of the isolated pharyngitis. The nasopharyngitis or rino - faringo - a tonsillitis is much more often educes. Seldom there are signs of a laryngitis, a tracheitis and a bronchitis. The acute laryngotracheobronchitis is observed at children of younger age. It is characterised by a voice hoarseness, appearance of rasping "barking" tussis, development stenosis respirations. Quite often there is a false croup syndrome, at which (unlike diphtheritic) aphonias does not happen.

The lesion of respiratory tracts can be combined with an inflammation of conjunctivas. Catarral bilateral conjunctivitises arise at 1/3 patients, however begin quite often as secund.

Membraneous conjunctivitises meet mainly at children of preschool age. Disease begins acutely and proceeds hardly. The body temperature reaches 39-40C° and remains till 5-10 days. At many patients peripheric lymph nodes, especially front and zadne - cervical, sometimes - axillary and inguinal are moderately enlarged. In peripheric blood at uncomplicated forms of illness - the normocytosis, is more rare - a leukopenia, ESR is not enlarged. As a whole for adenoviral diseases the small intoxication is characteristic at rather long low fever and sharply expressed catarral syndrome.

The adenoviral infection contamination proceeds more hardly and is long at children of early age with presence of repeated waves of disease, rather frequent apposition of a pneumonia. Persons of advanced age are ill with an adenoviral infection contamination seldom.

Complications. They can arise on any term of adenoviral disease and depend on bacterial flora apposition. Most often there is pneumonia, anginas, are more rare - genyantrites, frontal sinusitises.

With apposition of a pneumonia the state of the patient worsens, the temperature reaches 39-40C°, there is a dyspnea, a cyanosis, tussis, an intoxication strengthens. Clinically the pneumonia is focal or confluent. The fever remains till 2-3 weeks, and change in lungs (clinical and radiological) till 30-40 days from the illness beginning.

The diagnosis and the differential diagnosis. If diagnostics is possible in time epidemic flash (especially in the organised collective), recognition of sporadic cases difficultly because of polymorphism of a clinical picture and its resemblance to others Common cold. Characteristic lesions of eyes help With disease decoding (faringo - a conjunctival fever, conjunctivitises).

For early laboratory acknowledgement of the diagnosis detection of a specific viral antigen in epithelial cells of a mucosa of a nasopharynx with the help immuno - a fluorescent method is used. To retrospective diagnostics apply a serological method (complement fixation reaction with an adenoviral antigen). Diagnostic it is considered antiserum capacity increase in didymous Serums in 4 times and more. Differential diagnostics should be spent with a flu, a parainfluenza and others Common cold.