RESPIRATORY-SYNCYTIAL INFECTION

The respiratory-syncytial virus causes an acute respiratory disease in which the lower parts of the respiratory tract are mainly affected with the development of bronchitis, bronchiolitis and pneumonia. The urgency of the problem is also due to the fact that the virus attacks the most sensitive age contingent - children under the age of one year old.

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Historic reference

The respiratory-syncytial virus was first isolated in 1956 by J.A.Morris and his co-authors from the respiratory tract of a chimpanzee and a laboratory worker who had been in contact with it. The increase of complementbound and neutralizing antibodies was observed in the blood of the chimpanzee and the man after the recovery. A year later R.Chanock and his co-authors reported on the isolation of the virus from the children with the affection of the lower parts of the respiratory tract. After this there were a number of reports on the role of the above mentioned virus in the respiratory diseases in children and adults. The viruses isolated from the humans and chimpanzees turned out to be identical. The pathogen received its name as a result of the peculiar cytopathogenic effect in the cells of the sensitive tissue cultures, it causes the formation of the syncytial areas.

Etiology

The RS virus has all the main characteristics of microviruses. Its peculiarity is in the absence of hemagglutination hemadsorption and its inability to reproduce in the chicken embryos. The antigenic structure of the virus is stable. The virus is very sensitive to freezing, that is why it is recommended to immediately use it for infection. The inoculum (nasal secrete) should be taken from the patients as soon as possible when the clinical symptoms develop.

Epidemiology

The RS virus is a pathogenic microorganism of the respiratory tract, it is airborne. It is highly contagious for the population of all age groups. The degree of contagiousness is especially high under the conditions of the nosocomial infection. However, it is still unclear which age groups of the population are considered to be the reservoir and source of the infection at the periods of annual seasonal increases of morbidity and between the epidemic periods. The especially urgent problem of the healthy virus carriage without any clinical symptoms for the RS virus still remains unsolved.

In the areas of the moderate climate the autumn-winter-spring seasonably is considered to be finally ascertained, and the increase of the RS infection morbidity is never observed in the summer, whereas in the tropical countries they can be observed in the hot season as well. Not only children, but also adults are highly susceptible to the RS infection in spite of the fact that in the majority of adults it is usually reinfection. The transmission of the RS virus from man to man is fast and effective.

In the experimental study of the RS virus transmission mechanisms, the observations of the volunteers show that the infection occurs mainly through the nose less frequently through the eyes. The study of the nosocomial outbreaks of the RS infection confirmed the mentioned facts and determined that the per oral infection does not play a considerable role in spreading the RS infection.

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The social-ecOnomic conditions noticeably influence the beginning and development of the RS infection epidemic outbreaks. There is a distinct correlation between the degree of overcrowding and the frequency of the virus isolation.

Pathogenesis

The mucous membrane of the respiratory tract is an entrance gate for the RS virus. The beginning of the virus replication occurs in the epithelial cells of the nose and nasopharynx causing the local inflammation which sometimes leads to the obstruction of the nasal paths and Eustachian tube. The process spreads to the trachea, bronchus, bronchioles and the lungs parenchyma in the majority cases in the children of an early age and in fewer cases in the people of other age groups.

Anatomic pathology

On the basis of the known tacts it is possible to come to the conclusion that a severe affection of the bronchioles is typical of the RS infection. The considerable proliferation of the epithelium with a big amount of mitosis figures and impurities of the cytoplasm are observed in them. The multcellular offshoots appear in them in the process of proliferation, they resemble symplasts in their form. The symplasts jut out into the bronchioles opening like buds. Sometimes they desquamate and partially obstruct the bronchus or fill the alveoli. There is a round-cell infiltration and thickening of the intra-alveolar partitions around the affected bronchus.

The virus is isolated in the nasal discharge a day before the disease onset and during the first 7-9 days of the disease. There is virusemia in the experimental infection.

Clinical manifestations

The incubation period lasts 4-5 days with the fluctuations from two to seven days. The characteristic features of the initial period are a moderate affection of the upper .parts of the respiratory tract with the slightly expressed catarrhal symptoms in the form of a labored nasal breathing,infrequent dry cough,scanty nasal discharge. The hyperemia of the throat, airfoils, back wall of the throat is expressed insignificantly. There is no temperature reaction or the temperature is subfebrile with a shivering, moderate headache and myalgia. In case of the mild form of the infection the symptoms disappear during 3-7 days and the recovery comes. However, during the first days or on the following days the lower parts of the respiratory tract very often get involved in the process, especially, in the children of an early age. In several hours a child's skin becomes cyanotic, an asthmatic dyspnea develops up to 60 a minute with a prolonged whistling expiration accompanied by pulling the compliant areas of the thorax. A number of dry and mixed moist rales suddenly appear in the lungs, the rale can be heard at a distance. The areas of a percussion sound shortening alternate the areas with a box shade. An asthmatic syndrome is one of the typical symptoms of the

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RS infection. The reverse development occurs very quickly - in 3-7 days, it indicates the affection of the bronchial tubes only.

In the development of pneumonia the temperature rises up to 39-40 °Ñ and remains for a long time. The condition of the patient considerably worsens and the reverse development of the process goes very slowly - up to 2-3 weeks. In such patient's blood analysis there is leukocytosis, neuthrophylia and increase of ESR.

The adults usually develop a mild form of the disease without fever and it is limited by the upper part of the respiratory tract only. The infection and the development of the disease occur irrespective of the presence of the high titers of the virus neutralizing antibodies in the serum. The ability of the RS virus to avoid the organism resistance mechanisms of the host and to cause the disease during reinfection is still a matter of meditation.

Complications

The acute complications of RS infection in infants include apnea, respiratory failure, and rarely secondary bacterial infection. The long term complications are pulmonary function abnormalities.

Diagnosis

The methods of the laboratory diagnosis are the same as in case of paragrippe.

Differential diagnosis

A great similarity of the RS infection to other ARVI complicates the diagnosis based on the clinical picture only. It is possible to clinically diagnose the disease for certain in the children under one year old if there is bronchiolitis and pneumonia with an asthmatic component on the background of the subfebrile temperature because the RS virus causes the affection of the lower parts of the respiratory tract in most patients. It is necessary to take into account the prevalence of the bronchitis symptoms over the symptoms of the upper parts of the respiratory tract affection accompanied by a slightly expressed intoxication. The laboratory diagnostics methods are of major importance.

Treatment

Good supportive care is of the utmost importance in the management of severely ill infants. Alleviation of the hypoxemia and monitoring of the infant's respiratory status and blood gas levels are essential in the management. Because the hypoxemia is related to an unequal ratio of ventilation to perfusion, most infants respond to relatively low concentrations of inspired oxygen of about 40 %. Corticosteroids in controlled studies have failed to show benefit in the clinical course of infants with bronchiolitis or in their pulmonary function during the acute or convalescent stages. The use of bronchodilators in bronchiolitis and other forms of RSV lower respiratory tract disease has been controversial, and studies evaluating their use have given conflicting results.

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Ribavirin, a synthetic-nucleoside that is a broad-spectrum antiviral agent, is the only currently approved specific treatment for RSV lower respiratory tract disease in hospitalized infants. The drug is administered as a small-particle aerosol into a tent, oxyhood, mask, or ventilator for a period of 12-20 hours each day, usually for 2-5 days, depending on the time to improvement. Shorter and intermittent periods of treatment may be as beneficial. Ribavirin also inhibits the RSV-specific IgE response in the nasal secretions, which has been associated with the development of wheezing and hypoxemia. Aerosolized ribavirin appears to be well tolerated, and toxicity has not been reported in controlled studies. Aerosol administration for 8-20 hours gives drug levels in secretions that are hundreds of times greater than the median inhibitory concentration for RSV, but relatively little is systemi-cally absorbed, and blood levels are low.

Prophylaxis

Prevention over treatment is the preferable but as of yet unattained goal for control of RSV infection. The very young age at which RSV first attacks and at which it has its greatest impact makes prophylactic intervention problematic. Breast-feeding appears to offer the infant some protection against RSV lower respiratory tract infection. Prevention of infection through interruption of transmission of the virus is probably impossible at home. However, on hospital wards attempts to prevent spread of the virus are warranted. RSV may be spread by close contact and by direct inoculation of droplets of the secretions from an infected person. In addition, however, RSV possibly may be spread indirectly from hands that touch infectious secretions that contaminate surfaces in the environment. Hence, careful handwashing by all personnel is of particular importance. The use of eye-nose goggles has been shown to diminish appreciably the nosocomial 'infection rate, presumably by decreasing self-inoculation of the virus into the eyes and nose.

ADENOVIRAL INFECTION

Adenoviral infection is a disease developing mainly in children and having the symptoms of the mucus affection of the respiratory tract, eyes, intestines as well as lymphoid tissue.

Historic reference

The pathogens of the adenoviral diseases were first isolated in 1953 by W. Rowe and his staff from the tissues of the surgically extracted glands and adenoids. The belonging of the isolated viruses to the respiratory infection pathogens was established in 1954 when M.R. Hilleman and J.H. Werner discovered the increase of the neutralizing complement binding to them antibodies in the blood serum. In April of 1954 F. Neva and J.F. Enders isolated a similar virus from the excrement of a two-year-old child who had a fever accompanied by conjunctivitis,

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pharyngitis and the increase of the neck and groin lymph nodes. A year later R. J. Huebner and W.P .Rowe reported on the isolation of more than 100 cultures of viruses from the nasopharynx, conjunctiva and excrement of the patients who had different forms of the acute febrile diseases of the respiratory tract.

In 1956 the commission at the International committee of the nomenclatures that studied viruses named the isolated viruses "Adenoviruses" as they had first been isolated from the adenoids and the diseases caused by them got the name "adenoviral diseases".

In 1962 J.Trentin and his co-author R.Huebner together with their coauthors made some experiments on the newborn hamsters that showed that the adenoviruses were oncologically active.

Etiology

The adenoviruses constitute a family of Adenoviridae including two clans: Mastadenovirus (M) (mammal) of more than 90 kinds and Aviadenovirus (A) (birds) ~ 18 kinds. The gene of the adenoviruses is a lineal double spiral DNA. They are thermolabile, get destroyed at 56 °Ñ in 30 minutes, stable to pH 5-9. They can be preserved in the frozen form. They can be lyophilized without losing the infectious titer.

Epidemiology

The adenoviral diseases are registered everywhere all the year round, more often in the cold seasons. The natural reservoir of the adenoviruses for humans is a human. The infection is spread by both the people with the clinically expressed disease and virus carriers. The adenoviruses are excreted from the respiratory tract till the 25th day of the disease, and from excrement for two months. Though the main way of the infection transmission is an airborne one, an alimentary way cannot be excluded. In the period of the epidemic spread the adenoviruses can also be isolated from the sewage. The diseases can be observed both in the form of the epidemic outbreaks and sporadic cases. The epidemic process during the outbreaks develops slowly. At first the single cases of the disease and then a more rapid growth. Taking into account the meaning of the separate serotypes in the pathology and the peculiarities of the epidemic process the adenoviruses are divided into epidemic, latent and a group which role in the pathology is unclear. The adenoviruses of the latent group also cause acute diseases but in this case there is a less intensive coverage of people at outbreaks, a higher per cent of the latent infection and a mild course are observed.

Pathogenesis

The adenoviruses usually affect different organs and tissues: the respiratory tract, eyes, lymphoid tissues, intestines and urinary bladder.

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The upper parts of the respiratory tract and conjunctivas are the most frequent entrance gates. The virus penetrates the lower parts from the upper part through the bronchial paths and causes atypical pneumonia in adults and children. The virus intensively reproduced in the parenchyma of the lungs and in the cells of the upper respiratory tract. Virusemia is one of the stages of the adenoviral infection. Because of virusemia the virus can penetrate not only the lower respiratory tract but also other organs and tissues by a hematogenic way. In the diseases connected with the adenoviruses of the academic type, virusemia is observed in the acute period from the 1st to the 8th day. In the latent type cases the period of virusemia lasts up to 2-3 weeks.

Anatomic pathology

The viruses are supposed to affect the endothelium of the vessels and thus cause the exudative type of affection, inclination towards the prolapse of fibrin, necrotic changes in the mucus membrane (exudative pharyngitis, tonsillitis, conjunctivitis).

Irrespective of the fact that an adenoviral disease has only respiratory or respiratory and intestines symptoms the reproduction of the adenoviruses is observed in the small intestine for longer periods of time (10 days and longer) than in the respiratory tract.

An association of the adenoviruses with the immune deficiency conditions has been described. They were isolated from the urine and excrements of the AIDS patients as well as from the urine of the patients who were ill with other immune deficiency illnesses.

Not only have the latent viruses a disposition for lymphadenopathy, but also a group of the epidemic ones. Lymphadenopathy has such symptoms as the increase of the tonsils, periphery lymph nodes, liver, spleen, tracheobronchial, bronchopulmonal and mesenteric nodes.

Clinical manifestations

The disease caused by the adenoviruses is characterized by the polymorphism of the clinical manifestations, that do not develop simultaneously. There are symptoms of the affection of the respiratory tract, eyes, intestines mucous membrane, the disease is accompanied by a prolonged fever and a moderately expressed intoxication. The incubation period lasts 5-7 days with the fluctuations from 4 to 12 days. The adenoviral infection is mainly characterized by a gradual development of the disease with the accumulation of the clinical symptoms, the replacement of some symptoms by others and the prevalence of the local symptoms over the general ones. Besides, an acute onset of the disease is also possible. As a rule the expressed catarrhal symptoms with a labored nasal breathing come to the foreground. The intoxication is expressed by flabbiness, adynamia, the appetite worsening, moderate and inconstant headaches, sometimes vomiting. The rise of

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the temperature is usually gradual, in the beginning 37.2 °Ñ, on the following days - 38 °Ñ and sometimes higher. The duration of the fever is 5-7 days less often -up to 12 days.

The acute respiratory disease is the most frequent clinical manifestation. There are usually no pathognomonic symptoms. In the beginning its diagnostics is considerably difficult, especially, in the first cases because they do not practically differ from catarrh caused by different other pathogens. The onset can be acute or gradual. Already on the first day there is a labored nasal breathing, and on the second-third day an abundant serous or serous-mucous discharge. There develops hyperemia of the nasopharynx mucous membrane, edema of the uvula, hyperplasia of the lymphoid tissue, especially, on the back wall of the throat. There is sometimes a vesicular rash on the mucous membrane of the mouth cavity. The submandibular lymph nodes and the ones on the back of the neck are enlarged. The cough is usually dry, it becomes rough, barking when laryngitis develops. Sometimes the voice becomes hoarse, but there is no aphonia. In contrast to influenza croup develops in the first hours of the disease. The physical manifestations in the lungs are absent or they are poorly expressed.

Acute pharyngitis. It is usually in the cold season of the year that the disease is observed, the general condition often remains satisfactory. The main complaint is pain in the throat at swallowing. Moderate hyperemia of the airfoils, back wall of the throat with hyperplasia of the lyinphoid tissue can be noticed during the throat examination. The mucous membrane of the throat, airfoils, uvula, tonsils is loosened, edematic. On the surface of the tonsils there is a thin whitish patch in the form of dots which covers the tonsils. The exudate often spreads beyond the borders of the airfoils to the soft palate, back wall of the throat. The patches disappear during 5-6 days, but the edema of the mucous membranes of the throat and rhinitis usually remain longer. At the same time the peripheral lymph nodes are often enlarged. The cough is frequent,but not constant,it is moist,rarely dry.

Pharyngoconjunctival fever is the most typical clinical variant of the adenoviral infection. The term "pharyngoconjunctival fever" (PCF) was proposed by J.A. Bell and his co-authors (1965) while describing an outburst in the children's summer camp. They also most fully described the clinical form characterized by the triad: fever, pharyngitis with the enlargement of the lymph nodes and conjunctivitis. As a rule, the disease starts with the increase of the temperature, which often increases up to 39-40 °Ñ and remains for 2-10 days (5-6 days on the average). There is a lytic temperature decrease. The main complaints of the patients are redness and uncomfortable sensation in the eyes, watery eyes, affection of the throat, headache. Somnolence and malaise often develop at the end of the feverish condition. Nausea, vomiting, diarrhea and nasal bleeding are observed very rarely. The bone-muscle aches and weakness are often observed in adults. During the throat examination the hyperemia of the back wall of the throat and lymphatic nodes is observed. The submaxillary lymph nodes are often

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enlarged even if there is no pain in the throat. The disease is accompanied by the one-side nonpurulent follicular conjunctivitis, which remains from several days to three weeks and is manifested by the injection of the eye and eyelid vessels. The enlargement of the parotid lymph nodes is sometimes observed. There is no photophobia and pain in the eyes. The iris of the eye and cornea are usually not involved in the process. The exudate is almost always serous. The clinical symptoms (fever, pharyngitis and conjunctivitis) are manifested in different combinations. The pharyngoconjunctival fever in the form of sporadic cases or outbursts is registered in different countries.

Eye affection. The intensely expressed inflammation of the conjunctiva with bright hyperemia and scarce discharge is a peculiarity of adenoviral conjunctivitis. The inflamed mucous membrane of the conjunctiva looks like a "conflagration without a fire". Unlike in conjunctivitis of another etiology only the lower eyelid is usually affected. In the beginning the inflammatory process in the eye develops only on one side and only later the second eye gets involved in the process, but the changes in it are less expressed. There are such forms of the eye affection as catarrhal follicular membranous conjunctivitis and keratoconjunctivitis. The last ones usually develop in adults; a long recurring course is typical of them.

In case of the catarrhal form hyperemia tissue infiltration, edema of the eyelids and conjunctiva are observed. The edema and the infiltration of the tissues usually disappear in 2-5 days, but the hyperemia of the conjunctiva remains up to three weeks, sometimes - up to a month.

In case of the follicular form of conjunctivitis along with conjunctiva infiltration and edema of the eyelids there is abundant eruption of the large follicles on the conjunctiva. There is no discharge or it is scarce. One third of the patients have a hemorrhage into the sclera of the eyeball. The hemorrhage dissolves slowly, during 7-9 days and then during 3-4 days a vessels netting "sclera injection" can be observed. Sometimes the hemorrhages are so large that the eye looks like a rabbit's one.

In case of membranous conjunctivitis the tissue infiltration, eyelid edema are much more expressed (often a patient cannot even open the eye) than in catarrhal or follicular forms, and the edema of the eyelids is soft in contrast to the diphtheritic one. The hemorrhages into the conjunctiva and sclera of the eye are more massive. The gray dense films appear on the 4-6th day of the disease. The bleeding surface remains after their removal. The discharge is scanty, very often there is sanioserous discharge. Parents say that "the child cries with bloody tears".

In case of keratoconjunctivitis the disease has an acute onset and is manifested by hyperemia and the conjunctiva edema. On the 2-3rd day together with the eyelid edema, redness of the eyeball conjunctiva, lachrymal muscle and semilunar fold, the hemorrhages appear on the eyelid conjunctiva and the hypodermic fold. In some cases the films appear on the eyelid conjunctiva. The abundant eruption on the eyelid conjunctiva and transitional folds of the superficial follicles is very typical. The

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discharge is usually scanty. The enlargement and tenderness of the parotid and sometimes submandibular lymph nodes are important diagnostic symptoms.

The typical changes in the cornea appear on the 7-14th day of the disease. Their appearance often coincides with the disappearing of the inflammatory processes in the conjunctiva. On the cornea, usually in the center, in the pupil zone, there are delicate subepithelial round infiltrates, which do not tend to ulceration. The disease is sometimes accompanied by the temperature increase. Quite often the patients complain of a headache and general malaise. A patient considers the dimness of the cornea to be a foreign body, photophobia and vision disorder. In half of the patients only one eye is affected, but in some time (7-10 days) the second eye can get involved in the process. The disease lasts from 8-10 days to 6-7 weeks. The foci of dimness on the cornea dissolve slowly, during 3 months. In some cases the dimness remains for a long time and causes the vision worsening. Pneumonia. Among different forms of the adenoviral diseases pneumonia causes the greatest alarm, especially, in the children of the young age. Clinically the symptoms of the pneumonia in case of the adenoviral infection are expressed quite distinctly. The disease has an acute onset with the temperature increase up to 38-39 °Ñ,the temperature curve is usually irregular,with oscillations,quite often the fever period has a lingering character up to 20 days and longer. The temperature reaction is not expressed or absent in the children of the first months. Pneumonia is accompanied by the expressed catarrhal manifeslations in the upper respiratory tract. The fauces mucous membrane is hyperemic, edematic, the tonsils are enlarged and in some cases they are covered with whitish fur. The nasal discharge is abundant. The discharge is mucous or mucopurulent. The cough is painful, often excruciating, dry or with the discharge of the mucopurulent sputum. During the first days of the disease the physical changes in the lungs may not be found, they usually develop later. From the 3-4th day of the disease along with the shortening of the resonance with the tympanic inflection there is a big amount of dry and mixed moist rale. The rale can disappear, and then come back again. Sometimes an asthmatic component joins these manifestations. The massive affection of the lung tissues is revealed during the X-ray examination. The inflammatory foci flow together. They dissolve slowly. A tendency to relapses, exacerbation and a slow reparation of the inflammatory process in the lungs are characteristic of adenoviral pneumonia. A severe course of pneumonia with an unfavorable outcome is usually observed in the children of the early age, and in other patients who are weakened by previous diseases or accompanied diseases. Pleuritis and abscesses can complicate pneumonia, but it occurs comparatively rarely.

Complications

The changes of some inner organs and systems, which are typical of the adenoviral disease (lymphadenopathy, hepatosplenic syndrome, changes in the cardiovascular, nervous system, hematological changes) are more expressed in

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case of pneumonia and occur more often comparing with the uncomplicated course of the disease. Encephalitis and meningoencephalitis cases occur sporadically. Adenoviruses have been implicated as a cause of pericarditis, chronic interstitial fibrosis, congenital anomalies.

Diagnosis

The clinical diagnostics of the RS infection is based on the primary affection of the lower parts of the respiratory tract, quite often with an asthmatic component and respiratory insufficiency. The changes in the upper parts are less expressed.

The confirmation of the diagnosis is based on the laboratory investigations. The collection of the material and the investigation methods are the same as in case of other viral infections of the respirators tract.

Differential diagnosis

The problems in the differential diagnostics of the diseases which form this group are due to the fact that different viruses can cause similar clinical syndromes and first of all the syndrome of the acute disease of the respiratory tract.

The differential diagnostics is possible only in case of the typical course of the disease during the clinical recognition of the nosologic forms taking into consideration the peculiarities of the location of the pathological process, the degree of the toxicosis, the presence and expressiveness of the catarrhal manifestations as well as changes in other organs and systems.

Times, in contrast to influenza in the adenoviral diseases the local limited outbreaks are registered, the incubation period in the infected patients is longer, the catarrhal manifestations with an abundant discharge are considerably expressed, there are typical changes in the fauces, the lymph nodes, liver and spleen are enlarged, relapses occur later.

In contrast to paragrippe the onset of the adenoviral diseases is often acute, the exudative component is more expressed, there is lymphoadenopathy one-side conjunctivitis.

Treatment

Treatment will carry out in view of gravity of current and the clinical form of disease. Localy there are used the etiotropic preparation desoxyribonucleasa which is instilated into conjunctival bag and nasal courses as the solution. Apply also a solution of oxolin, oxolin unguent, or florenal for pawning edges of blepharons and for greasing mucosa of nose. As agent of a choice use solution of human interferon as inhalations, dispersion or drops in a nose through every 1-2 hours during 2-3 days. Efficiency of treatment above correlates than earlier it is begun. Among inductores of interferon and imunomodulatores there are indicated amixin, amizin, cycloferon, proteflazid, erbisol. At serious forms of disease human placental or serumal immunoglobulin (3-6 mL unitary) is used, at absence of effect it is given repeatedly in 6-8 houres or on next day. 5 % glucose solution with

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ascorbic acid is infused according to the indications. Reopolyglucin, sault solutions, humidified oxygen are used through a nasal catheter.

There are recommended a hot drinks of tinctura of raspberries, lime color, flowers of a black elder, tea with lemon, sudorific collectings. For inhalations there should be used warm broths of leaves of eucalypt, sage, pine buds, grasses of thyme, buds of a birch (separately or in admixture), for a gargle of pharynx and an oral cavity there are given broths of flowers chamomiles, calendula, grasses of a yarrow, sage. There are indicated also sinapismuses on thorax and soles.

In case of rhinitis we instill into nose vasoconstrictive preparations,such as: naphthyzin, ephedrin hydrochloride, pharmasolin. For cupping of inflammatory process apply into nasopharynx faringosept or falimint. The other remedies recommended are pectusin or terpin hydrate, ascorutin, calci of gluconate, methyluracil, and also diazolinum, suprastin, tavegil, gismanal, zestra, loratidin, alegra, telfast.

In case of bacterial complications antibiotics and others chemotherapeutic agents are indicated in view of kind of the originator and its medicinal sensitivity, benzylpenicillin sodic salt, ampicillin sodium salt, carbapenicilin dinatri salt, ampiox, erythromycin, oleandomycin phosphas or doxycyclin hydrochloride, cefalosporines (cefazolin, cefotaxim, ceftriaxon ) are used.

Prophylaxis

Because of the ubiquity and severity of adenovirus respiratory disease in certain populations, vaccines were developed to prevent the disease. Although these live and inactivated virus vaccines were reasonably effective, the findings that adenoviruses were oncogenic and could combine with simiar virus 40 to produce an even more oncogenic hybrid virus curtailed the use of parenteral vaccines. Vaccines have also been produced by using capsid components free of DNA. These vaccines have been effective in volunteer studies but are not currently available for general administration.

Oral vaccines have been developed for use in military recruits. These vaccines contain live adenovirus types 4 and 7 in an enteric-coated capsule. These viruses are not attenuated, but advantage is taken of the fact that inoculation of these adenoviruses into the gastrointestinal tract does not result in illness, in contrast to inoculation into the respiratory tract. Their efficacy and safety have been well established in the past 10 years, and the problem of acute respiratory disease in recruits has been markedly diminished.

RHINOVIRAL INFECTION accompanied by the symptoms of the nose and nasopharynx mucous membrane affection.

Rhinoviral infection is an acute viral disease of the upper respiratory tract, which is

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Date: 2014-12-21; view: 1427