acute nasopharyngitis
Introduction
Introduction to acute nasopharyngitis Acute nasopharyngitis (acutenasopharyngitis) is an acute inflammation of the mucosa, submucosa and lymphoid tissues of the whole nasopharynx, mainly occurring in the pharyngeal tonsils. It is the most common type of acute upper respiratory virus infection, and it is more common in adults and older children. The prodromal symptoms of respiratory infections are mostly self-limiting, but the incidence is high, affecting a wide range of people, large amounts of money, economic losses are quite large, and can cause a variety of complications. basic knowledge The proportion of illness: 8.5% Susceptible people: no specific population Mode of infection: non-infectious Complications: otitis media, sinusitis, laryngitis
Cause
Cause of acute nasopharyngitis
Rhinovirus (30%):
Isolated from a cold patient in 1956, it is a genus of microRNA virus population, a genus of non-enveloped single-stranded RNA virus, a non-enveloped single-stranded RNA virus with a diameter of 15-30 nm and resistance to ether. It is not acid resistant (easy to be inactivated in a solution of pH 3) and can survive for 3 days in a dry environment. According to the serum neutralization test, there are more than 120 serum strains, which are best grown at a temperature of 33 °C in diploid cell culture, long-term survival at -70 °C, and can survive for several weeks at 4 °C, while 56 °C It can be inactivated in 30 minutes.
Coronavirus (15%):
A coronavirus group, which is an enveloped single-stranded RNA virus, sensitive to both ether and acid. The diameter of 80 ~ 150nm, there are unique rod-shaped granules (peplomers) protruding from the capsule, proliferating in the cytoplasm, mature through the cytoplasmic network. At least 3 strains (B814, 229E and 0C43) can cause respiratory infections, of which 229E and OC43 are the cause of upper respiratory tract infections in children and adults, accounting for 15% to 20% of adult colds, occasionally causing pneumonia and epidemics. Chest pain.
Adenovirus (10%):
It is a double-stranded DNA virus with no envelope and nuclear replication. It is 70-90 nm in diameter and has a symmetrical 20-facet body. It is stable at -20 °C at low temperature. 41 strains have been isolated from humans, and there are still many intermediate strains. It can be clinically manifested as various types of infections.
Respiratory syncytial virus (10%):
In 1956, it was first isolated from the orangutan with upper respiratory tract infection in the laboratory. It is an enveloped single-stranded RNA virus with a diameter of 120-200 nm. It belongs to the genus Pneumovirus of the Paramyxoviridae family and has only one serotype. . The virus is extremely unstable, reducing the amount of virus by a factor of 100 in 2 days at room temperature and 100 times in 4 to 6 days in a refrigerator at 4 °C. It is the main pathogen of lower respiratory tract infection in children. It usually causes mild upper respiratory tract infection in adults, but it is more critical in elderly and immunosuppressed patients.
Other viruses (5%):
Coxsackie virus, echovirus, reovirus type 1 to 3, herpes simplex virus type 1 and EB virus in enterovirus can be used as pathogens of colds.
Pathogenesis
The rhinovirus is mainly caused by the contact of the nasopharyngeal secretions of the cold patients (hand-eye, hand-nose), and there are also droplets. The latter is far less important than the flu in acute nasopharyngitis. After rhinovirus infection, virus replication reached a peak concentration at 48h, and the transmission period lasted for 3 weeks. Individual susceptibility is associated with nutritional health and upper respiratory tract abnormalities (such as tonsil enlargement) and smoking. The cold itself does not cause a cold. Part of the reason for the cold in the cold season is related to the type of virus, and may also be related to the increase in congestion and the crowds of indoor family members or people. Symptoms of infection are affected by the physiological state of the host. Overwork, depression, nasopharyngeal allergic diseases, and menstrual periods can all aggravate symptoms.
In the case of rhinovirus, the nasal cavity or the eye is the portal to the body, and the nasopharynx is the initial site of infection. M cells in the adenoid lymphoid epithelial area contain the rhinovirus intercellular adhesion molecule-I (ICAM-1) receptor, where the virus first adheres and reaches the posterior nasopharynx by the mucociliary activity of the nasal cavity. At this point the virus replicates quickly and spreads forward to the nasal passages. Nasal epithelial cell biopsy and nasal secretion studies suggest that increased secretion of inflammatory mediators (bradykinin, prostaglandins), interleukin-1 and -8 may be partially responsible for the clinical symptoms of the cold. The role of histamine is unclear. Although intranasal instillation of histamine can cause cold symptoms, the anti-histamine treatment effect is not certain. Parasympathetic blockers are effective in relieving cold symptoms, suggesting that the nerve reflex mechanism also plays a role in the pathogenesis of colds. The immune response (IgA, interferon production) is usually transient, plus the diversity and drift of viral antigens, so repeated infections throughout life.
Pathological changes are related to viral virulence and the extent of infection. Respiratory mucosa edema, hyperemia, exudate (leakage or exudation), but no significant changes in cell population, repair is relatively rapid, generally does not cause tissue damage. Different viruses can cause different degrees of cell proliferation and degeneration. The destruction of nasal mucociliary can last for 2 to 10 weeks. When the infection is severe, the sinus, eustachian tube and middle ear canal may be blocked, causing secondary infection.
Prevention
Acute nasopharyngitis prevention
1. Actively exercise, enhance disease resistance, keep warm, avoid cold, quit smoking, avoid spicy.
2. Pay attention to rest during the illness, drink more water, and increase nutrition.
3. Repeated acute disease, may consider pharyngeal tonsillectomy.
4. Avoid contact with cold patients, especially hands.
5. There are experimental research reports that the use of anti-virus paper towels and maintaining good personal hygiene can reduce the spread of rhinovirus colds.
6. Vitamin C is often advocated for the prevention of colds, but rigorously designed controlled trials do not receive supporting evidence.
7. Interferon -2b has a preventive effect after exposure, but it has caused adverse reactions such as nasal congestion and stopped the study.
Complication
Acute nasopharyngeal complications Complications, otitis, sinusitis, laryngitis
Common acute upper and lower respiratory tract inflammation, otitis media, sinusitis, laryngitis, posterior pharyngeal abscess and kidney disease in infants and young children.
Symptom
Acute nasopharyngitis symptoms Common symptoms Dehydration throat lymphoid follicular hyperplasia pharyngitis Abdominal pain Meningeal irritation Symptoms Low heat throat phlegm mucus Throat tingling Nasal diarrhea
Infants and young children are seriously ill, often have high fever, convulsions, meningeal irritation and abdominal pain, diarrhea, dehydration and other symptoms of systemic poisoning. Adults and older children have obvious local symptoms such as nasal congestion, runny nose, headache and dryness of the nasopharynx, burning sensation, and foreign body sensation. Nasopharyngeal examination showed acute congestion and edema of the mucosa, and a large amount of mucopurulent secretions were attached, and secretions could flow down the posterior pharyngeal wall. The nasopharyngeal part of infants and young children is not easy to see clearly, but due to pharyngeal secretions and severe nasal congestion, it may cause difficulty in sucking breasts, prone to coughing, breathing at the mouth, and affecting sleep. The disease can reach the upper cervical lymph nodes and tenderness.
Examine
Examination of acute nasopharyngitis
1. Peripheral blood: The number of white blood cells is normal or low in viral infection. The proportion of lymphocytes is elevated. In the case of bacterial infection, the proportion of white blood cells increases and the left side of the nucleus shifts. Increased proportion of neutrophils and nuclear left shift.
2. Etiology check: Under normal circumstances, do not do. If necessary, immunofluorescence, enzyme-linked immunosorbent assay, serological diagnostic method or virus isolation and identification methods can be used to determine the type of virus; bacterial culture and drug sensitivity test can help the diagnosis and treatment of bacterial infection.
3. Indirect nasopharyngeal mirror: Or fibrous nasopharyngoscopy can easily see the lesions of the nasopharynx, showing that the nasopharynx is dry and congested or red and swollen, with secretions.
4. Chest X-ray examination, no abnormalities.
Diagnosis
Diagnosis and diagnosis of acute nasopharyngitis
diagnosis
In adults and older children, the local symptoms are obvious, and it is easy to see the lesions of the nasopharynx under indirect nasopharyngoscopy or fiberoptic nasopharyngoscopy, so it is not difficult to diagnose. However, infants and young children, with acute onset, often have symptoms of systemic poisoning and are often misdiagnosed as acute infectious diseases. Therefore, infants and young children with the above systemic symptoms, and there are nasal congestion, runny nose, accompanied by fever, etc., should consider the possibility of the disease. Lymph node enlargement and tenderness in the upper neck are helpful for diagnosis. And pay attention to the diagnosis of complications.
Differential diagnosis
1. Identification with influenza:
(1) Epidemiology Influenza is a widespread epidemic disease, mainly in winter and spring. Acute nasopharyngitis occurs throughout the year and is common in autumn, winter and spring.
(2) Clinical manifestations: The symptoms of systemic poisoning of influenza are obvious, often high fever, 3940°C, lasting for 3 to 5 days, headache, common and severe systemic pain, early appearance of fatigue and weakness, lasting for 2 to 3 weeks, can be accompanied There are nasal congestion, sneezing, sore throat, chest discomfort and cough are common, and the degree is heavier, can be complicated by bronchitis, pneumonia, and even life-threatening. The granule change of bronchitis and soft palate mucosa is a typical catarrhal symptom of influenza, acute nasopharyngitis Mainly manifested as nasal congestion, sneezing, sore throat, mild systemic symptoms, headache, generalized pain and fatigue, less fatigue and less, less fever, some may have mild to moderate chest discomfort and cough, complications are rare.
(3) Auxiliary inspection:
1X-ray examination: Influenza is more prone to pulmonary complications than acute nasopharyngitis, such as bronchitis or pneumonia, so chest X-ray examination is helpful for clinical diagnosis.
2 laboratory examination: A. virus isolation and culture, by collecting nasal secretions, nasopharyngeal swabs, throat swabs for sputum isolation and culture to determine the pathogen, virus culture for about 3 to 10 days. B. Rapid influenza assay, sensitivity >70%, specificity >90%, about 24h. C. Serum antibody assay, which requires determination of antibody titers in the acute and convalescent phases. D. Inferior turbinate mucosal print examination, influenza patients often appear on the first day of the onset of a large number of degenerative columnar epithelial cells, arginine blue inclusion bodies in the cytoplasm or nucleus and acute nasopharyngitis is mainly pus cells, including The body is rare.
2. Identification of nasal diseases
(1) allergic rhinitis: a history of allergies, seasonal (hay fever) or sneezing all year round, nasal overflow, nasal congestion with itching, symptomatic features and increased eosinophils in nasal secretions contribute to the diagnosis of this disease .
(2) vasomotor rhinitis: no history of allergies, characterized by intermittent vascular filling of the nasal mucosa, sneezing and sneezing, dry air can make the symptoms worse, according to the history and no purulent and molting, etc. Identification of sexual or bacterial infections.
(3) Atrophic rhinitis: the nasal cavity is abnormally patency, the lamina propria is thinned and the blood vessels are reduced, the sense of smell is reduced and there is molt formation and odor, which is easy to identify.
(4) nasal septum deviation, nasal polyps: nasal examination can confirm the diagnosis.
3. Identification with certain acute infectious diseases (such as measles, encephalitis, epidemic cerebrospinal meningitis, poliomyelitis, typhoid fever, typhus) and upper respiratory tract inflammation in the prodromal phase of HIV infection, according to the history of symptoms, dynamic observation and Relevant laboratory tests are not difficult to identify.
