Acute upper respiratory tract infection, referred to as upper respiratory tract infection. Commonly known as the flu, it is a common and frequent disease in children, and can develop throughout the year, several times a year per person. The pathogen mainly invades the nose, throat, tonsils and larynx and causes inflammation. If the inflammation is confined to a certain part, it is named according to the inflammation of that part, such as acute rhinitis, acute tonsillitis, etc. Otherwise, it is collectively referred to as upper respiratory tract infection.
I. Etiology
(A) pathogens
1, virus: about 90% of acute upper respiratory tract infections.
2, bacteria: bacterial infections are mostly secondary, because viral infections damage the local defense function of the upper respiratory tract, resulting in the upper respiratory tract latent bacteria to take advantage of the opportunity to invade. A small number of primary infections, but also for viral and bacterial mixed infections.
(B) Predisposing factors
1, anatomical and physiological characteristics, indicating poor defensive capabilities.
2, in the long development of the price section of the whole body and local immune function is low.
3.Disease influence
(1) congenital diseases: common ones such as harelip, cleft palate, precocious heart disease and immunodeficiency disease, etc.
(2) acute infectious diseases: such as measles, chicken pox, scarlet fever and mumps. In addition, tuberculosis becomes a common cause.
(3) Nutritional diseases: such as malnutrition, anemia, rickets, and pediatric diarrhea, etc.
4.Environmental factors
(1) poor health habits and living conditions: such as crowded accommodation, poor ventilation, darkness and humidity, lack of sunlight, parental smoking, poor nursing care and lack of forging of the child’s defense function is even lower.
(2) Sudden changes in climate, such as cold, can easily cause disruption of the mucosal diaphragm of the nose, which is conducive to the occurrence of upper respiratory tract infections.
Second, the clinical characteristics
The basic symptoms of upper respiratory tract infection are fever and upper respiratory tract catarrhal symptoms, and the severity of the symptoms is related to the age and the degree of infection.
(A) the clinical characteristics of upper respiratory tract infections in children of different ages
1. Infants under three months of age: fever is mild or absent. Symptoms due to nasal congestion and congestion are more prominent. Such as crying and restlessness, open-mouth breathing, difficulty in sucking, refusal of milk, sometimes accompanied by vomiting and diarrhea.
2. Infants and young children show.
(1) The symptoms of systemic toxicity are heavy, with a sudden high fever of 39.5-40℃ at the beginning of the disease, lasting 1-2 days, or several days;
(2) General nasal congestion, runny nose, cough or sore throat and other symptoms are heavy.
(3) Often accompanied by gastrointestinal symptoms such as refusal to eat, vomiting, diarrhea or constipation.
(4) No abnormal signs on physical examination other than congestion in the pharynx.
(3) Children over 3 years old mostly have no fever or low fever, but some have high fever, accompanied by chills, headache, generalized body aches, loss of appetite, and generally other symptoms of the upper respiratory tract, such as nasal congestion, runny nose, sneezing, hoarseness and pharyngitis. This abdominal pain may be associated with increased intestinal peristalsis, mesenteric lymphadenitis and intestinal roundworm stirring.
(B) Two special types of upper respiratory tract infections
1, pharyngeal combined with membrane fever: adenovirus infection. The clinical characteristics of the disease are common in children aged 2-3 years. There is often high fever, variable fever pattern, sore throat, unilateral or bilateral eyelid redness and swelling and congestion of the conjunctival membrane, with varying severity on both sides (no suppuration). The nodes behind the ear, bilateral neck and submandibular gonads are enlarged, the pharynx is congested, and there is occasional diarrhea. The duration of the disease is 3-5 days, or up to 7 days, and occasionally extended to 2-3 weeks.
2, herpes pharyngitis: the main pathogen is coxsackie A virus. Clinical features: Most often seen in infants and young children, high fever, increased salivation, swallowing discomfort, manifested as refusal of milk, irritability, crying. Infants may complain of sore throat and have characteristic lesions in the pharynx, initially a scattered red rash that turns into a herpetic rash, about 2-4 mm in diameter, which breaks down into a yellowish-white shallow ulcer surrounded by a red halo, with variable numbers, mainly on the pharyngopalatine arch, soft palate, tonsils and pendulous. The fever decreases after 2-4 days and the ulcers usually last 4-10 days. Laboratory tests show low white blood cells and slightly increased neutrophils in the early stages. In combination with bacterial infection, total leukocytes and neutrophils may be increased.
III. Complications
If the upper respiratory tract infection is not treated in time, the inflammation may spread to other organs and cause corresponding symptoms, and the systemic symptoms may be aggravated. Common complications may include sinusitis, otitis media, ocular conjunctivitis, cervical lymphadenitis, and posterior (or lateral) pharyngeal wall abscess. In the case of acute otitis media, the fever is high and does not subside, the patient cries due to ear pain, shakes his head and scratches his ears, the tympanic membrane is congested and swollen in the early stage, and later perforates and exudes plasma or pus. In young and frail children, the upper respiratory tract infection tends to progress downward, causing bronchitis and pneumonia. In the presence of mesenteric lymphadenitis, there is paroxysmal abdominal pain around the umbilicus, with no fixed pressure points or muscle tension. In a few cases of co-infection with bacterial infection, it may lead to systemic and other complications such as sepsis, meningitis, and renal nephritis in frail children.
In children with upper respiratory infection caused by streptococcal infection, it is often complicated by acute glomerulonephritis, rheumatic fever and other allergic diseases.
IV. Treatment
(A) General treatment and care
1. The living environment should be clean, quiet and well-lit, the room temperature should be kept at 20-22℃, the relative humidity should be 55-60%, the windows should be opened regularly for ventilation (2-3 times a day, 30 minutes each time), and the convective wind should be avoided to blow directly on the child.
2.Rest in bed during high fever
3.Give easily digestible food (such as fat-free yogurt) and supply enough water.
4. Pay attention to the local cleaning of the mouth, nose and eyes.
5.For children with rickets, give intramuscular VitD330-600,000U/time or oral VitD2100000U/day.
6, pay attention to respiratory isolation to reduce the chance of secondary bacterial infection.
(II) Symptomatic treatment
1.Cooling The following cooling measures can be used for high fever above 39℃
(1) physical cooling head and neck cold compresses, 35-50% alcohol rubbing large blood vessel travel parts (neck, axilla, thigh root, leg bend), pay attention not to apply back, abdomen.
(2) Drug cooling: should be applied under the guidance of a doctor, APC, paracetamol, ibuprofen can be used. The common trade names are Alben tablets, Tylenol, Enrico, etc.
2, nasal congestion First clear nasal secretions, use 0.5% furosemide combination in bed or 10-15 minutes before milk nasal drops, 1-2 drops / time, for 2-3 days or use the new can be nasal drops, the use of the same as before.
3, cough Generally do not use cough suppressants, commonly used expectorants and cough suppressants such as Bixuping, pediatric cough mixture, snake bile and Chuanbei liquid. Please use them under the guidance of physicians.
(C) Anti-viral treatment
Commonly used drugs include virazole, acyclovir, etc.
(D) Indications for antibiotics
Antibiotics are generally not recommended for viral infections. For younger children (infants and toddlers), with high body temperature (anal temperature 39.5-40℃ or more), and high total white blood cell count, accompanied by nuclear left shift, or existing bacterial tonsillitis, otitis media, pharyngitis, etc., appropriate antibiotics can be used for oral penicillin amoxicillin, roxithromycin, azithromycin, etc.
(E) Chinese medicine treatment
Chinese medicine is effective in treating common cold. Commonly used are Dazhong Ye Compound, Banlangen Punch, Fishy Herb and so on.
It should be noted that there should not be too many medicines, usually 2~3 kinds can be used. In case of aggravation of the disease, especially in the case of mental discomfort, convulsions, etc., you should go to the hospital in time to avoid delaying the treatment.
V. Prevention
Enhance the body’s resistance to prevent the invasion of pathogens is an important key to prevent upper respiratory tract infections. The main measures are.
(a) pay attention to physical exercise on weekdays and arrange outdoor activities reasonably to adapt to changes in the environment and climate.
(2) Dress appropriately, increase or decrease in time with climate change to prevent cold or overheating.
(3) Feeding, actively preventing and treating malnutrition, anemia and rickets, etc.
(d) Avoid crowded and poorly ventilated places.
(5) Actively treat acute and chronic infectious diseases of the respiratory tract, and pay attention to respiratory isolation to prevent cross-infection.