2 English reference acute nasopharyngitis
3 Overview Acute nasopharyngitis, also known as common cold, commonly known as "cold", is an acute inflammation of the entire nasopharyngeal mucosa, submucosa and lymphoid tissue, mainly occurring in the pharyngeal tonsils. Acute nasopharyngitis is the most common type of acute upper respiratory virus infection, which is mostly self-limited, but it has a high incidence, affects a wide range of people, has a large amount, and has huge economic losses, which can cause various complications. Infants and young children are seriously ill and often have symptoms of systemic poisoning such as high fever, convulsion, meninges, abdominal pain, diarrhea and dehydration. Adults and older children have obvious local symptoms, such as nasal congestion, runny nose, headache, dry and painful nasopharynx, burning sensation and foreign body sensation. Adults and older children have obvious local symptoms, and it is easy to see nasopharyngeal lesions under indirect nasoscope or fiberoptic nasoscope, so the diagnosis is not difficult. However, infant patients, with acute onset, often take systemic poisoning symptoms as the main symptoms and are often misdiagnosed as acute infectious diseases.
4 names of patients with acute nasopharyngitis
5 English name acute nasopharyngitis
6. Catarrhal rhinitis; , another name for acute nasopharyngitis; It is cold on Monday; Catarrhal rhinitis; Cold; Catarrhal rhinitis; Common cold; cold
7 classified respiratory department >; Infectious diseases > acute upper respiratory tract infection
8 ICD number J00
Epidemiological acute nasopharyngitis is mostly sporadic, but coronavirus infection can cause some epidemics and can be explosive in densely populated schools or military camps. With the increase of age, the number of cases decreases. Preschool children get sick 4-8 times a year, school-age children get sick 2-6 times and adults get sick 2-5 times. According to statistics, 20% of cold patients in the United States lose their ability to work every year, and their annual activities are limited by 65.438+700 million days, with an average of 0.8 days per person. 654.38+00% patients went to the hospital, and the per capita medical expenses were about $ 654.38+00. Every year, the national medical expenses lose $250 million, the annual absenteeism reaches 30 million working days, and students miss classes for 30 million days. It is generally believed that colds are more common in winter, but they are mainly infected by influenza virus or respiratory syncytial virus, while rhinovirus infection is not common in cold season, and the reason is not clear.
10 The pathogen of acute nasopharyngitis is virus, the common ones are rhinovirus, coronavirus, influenza virus and parainfluenza virus, and the rare ones are respiratory syncytial virus, adenovirus, enterovirus, reovirus, herpes simplex virus and EB virus. Mycoplasma pneumoniae, group A, C and G streptococci and abiotic pathogenic factors such as allergic rhinitis, atrophic rhinitis, vasomotor rhinitis, deviated nasal septum and foreign bodies can all cause cold-like symptoms, so it is not a real cold.
10. 1 rhinovirus rhinovirus 1956 was isolated from patients with cold. It is a genus of microRNA virus group, and it is an uncoated single-stranded RNA virus with a diameter of 15 ~ 30 nm. It is resistant to ether, but not to acid (it is easy to be inactivated in a solution with pH 3), and can survive for 3 days in a dry environment. According to the serum neutralization test, the serum strain exceeded 120. Diploid cell culture grows best at 33℃, can survive for a long time at -70℃, can survive for several weeks at 4℃, and can be inactivated at 56℃ for 30 minutes. 30% ~ 50% of cold patients are caused by a serotype of rhinovirus.
10.2 coronavirus is a coronavirus group, a single-stranded RNA virus with envelope and sensitivity to ether and acid. With a diameter of 80 ~ 150 nm, unique rod-shaped peplomers protrude from the cyst, proliferate in the cytoplasm, and germinate and mature through the cytoplasm network. At least three strains (B8 14, 229E and 0C43) can cause respiratory tract infection, among which 229E and OC43 are the causes of upper respiratory tract infection in children and adults, accounting for 15% ~ 20% of adult colds, and occasionally can cause pneumonia and epidemic chest pain.
10.3 adenovirus is a double-stranded DNA virus with no envelope, nuclear replication, 70 ~ 90 nm in diameter, symmetrical icosahedron, and stable at -20℃. 4 1 serum strains have been isolated from humans, and there are many intermediate strains. Clinically, it can be manifested as various types of infections.
10.4 respiratory syncytial virus (RSV) was first isolated from orangutans with respiratory infection in the laboratory on 1956. It is an enveloped single-stranded RNA virus with a diameter of 120 ~ 200 nm, belonging to the genus pneumovirus of paramyxoviridae, with only one serotype. The virus is extremely unstable, and the virus amount decreases 100 times in 2 days at room temperature and 100 times in 4℃ refrigerator for 4 ~ 6 days. It is the main pathogen of lower respiratory tract infection in children, usually causing mild upper respiratory tract infection in adults, but it is more critical in the elderly and immunosuppressed patients.
Coxsackie virus, echovirus, reovirus 1 ~ 3, herpes simplex virus 1 and EB virus can occasionally be used as pathogens of colds.
The pathogenesis of rhinovirus 1 1 is mainly contact transmission (hand-eye, hand-nose) caused by nasopharyngeal secretion pollution in cold patients, and there are also droplet transmission routes, which is far less important than influenza in acute nasopharyngitis. After rhinovirus infection, the virus replication reached the peak in 48 hours, and the transmission period lasted for 3 weeks. Individual susceptibility is related to nutrition and health status, upper respiratory tract abnormalities (such as tonsillar enlargement) and smoking. Cold itself does not cause a cold. Part of the reason for catching a cold in cold season is related to the type of virus, and it may also be related to the increase and crowding of indoor family members or people caused by cold. The symptoms of infection are affected by the host's physiological condition, which can be aggravated by overwork, depression, allergic diseases of nasopharynx and menstrual period.
Take rhinovirus as an example, the nasal cavity or eyes are the portal to enter the body, and the nasopharynx is the initial infection site. M cells in lymphoepithelial region of adenoids contain the receptor of rhinovirus intercellular adhesion molecule I (ICAM 1), where the virus first adheres and reaches the back of nasopharynx through mucociliary activity of nasal cavity. At this point, the virus quickly replicates and spreads forward to the nasal cavity. Biopsy of nasal epithelial cells and study of nasal secretions show that the secretion of inflammatory mediators (bradykinin, prostaglandin) and interleukin 1 and 8 increases, which may be part of the reason for the clinical symptoms of cold. The role of histamine is not clear. Although nasal instillation of histamine can cause cold symptoms, the therapeutic effect of antihistamines is uncertain. Parasympathetic nerve blockers can effectively relieve cold symptoms, suggesting that nerve reflex mechanism also plays a role in the pathogenesis of cold. Immune response (IgA, interferon production) is usually short-lived, coupled with the diversity and drift of viral antigens, so it is repeatedly infected in life.
Pathological changes are related to virus virulence and infection range. The respiratory mucosa is edema and hyperemia, and there is exudate (leakage or exudation), but the cell group has no important changes, which can be repaired quickly and generally does not cause tissue damage. Different viruses can cause different degrees of cell proliferation and degeneration. The destruction of nasal mucosa cilia can last for 2 ~ 10 weeks. When the infection is serious, the sinus, eustachian tube and middle ear canal may be blocked, resulting in secondary infection.
Clinical manifestations of acute nasopharyngitis 12 The incubation period of acute nasopharyngitis varies from 1 to 3 days, depending on the virus. Enterovirus is the shortest, adenovirus and respiratory syncytial virus are longer. Sudden onset. Most of them have a burning sensation in their nose and throat, followed by stuffy nose, sneezing, runny nose, general malaise and muscle pain. Symptoms peak in 48 hours (virus shelling), and acute nasopharyngitis usually has no fever or only low fever, especially when rhinovirus or coronavirus is infected. There may be conjunctival congestion, tears, photophobia, eyelid swelling and edema of throat mucosa. The appearance of throat and tracheitis varies from person to person and from virus to virus. Nasal secretions are watery and clear at first, and then become mucus or purulent. Mucous secretions do not necessarily indicate secondary bacterial infection. Cough is usually mild and lasts for up to 2 weeks. Purulent sputum or severe lower respiratory symptoms suggest that viruses other than rhinovirus are combined or secondary to bacterial infection. When children catch a cold, their symptoms are more serious than those of adults, and they often have symptoms of lower respiratory tract and digestive tract (vomiting, diarrhea, etc. ) Most colds are self-limiting. If there are no complications, the course of disease is 4 ~ 10 days.
Complications of acute nasopharyngitis 13 Complications of acute nasopharyngitis include suppurative pharyngitis, sinusitis, otitis media, bronchitis, acute exacerbation of original chronic respiratory diseases (chronic bronchitis and asthma) and deterioration of obstructive sleep-disordered breathing. In children, serious complications, such as viral or bacterial pneumonia, occasionally occur.
14 Laboratory examination 14. 1 The white blood cell count is normal or low when the peripheral blood picture is infected with the virus. The proportion of lymphocytes increased. During bacterial infection, the proportion of white blood cells increases and the nucleus moves to the left. The proportion of neutrophils increased and the nucleus moved to the left.
14.2 Etiological examination is generally not done. When necessary, the virus type can be determined by immunofluorescence, enzyme-linked immunosorbent assay, serological diagnosis or virus isolation and identification. Bacterial culture and drug sensitivity test are helpful for the diagnosis and treatment of bacterial infection.
15 Auxiliary examination Chest X-ray examination, no abnormality was found.
16 Diagnosis of acute nasopharyngitis According to the characteristics of clinical symptoms, the upper respiratory symptoms are obvious, and the systemic symptoms are relatively mild, so non-infectious upper respiratory inflammation such as allergic rhinitis can be ruled out. Because virus culture and immunoserological diagnosis need certain equipment, it is time-consuming and laborious, and besides influenza virus and respiratory syncytial virus can be applied with effective antiviral drugs, it has no practical significance for the specific etiological diagnosis of most virus infections.
17 differential diagnosis 17. 1 differential diagnosis between acute nasopharyngitis and influenza (1) influenza is a widespread disease, mainly occurring in winter and spring, and acute nasopharyngitis occurs all year round, especially in autumn, winter and spring.
(2) Clinical manifestations: The general symptoms of influenza poisoning are obvious, usually high fever, 39 ~ 40℃ for 3 ~ 5 days. Headache and general pain are common and serious, and fatigue occurs in the early stage and lasts for 2 ~ 3 weeks, which may be accompanied by nasal congestion, sneezing, sore throat, chest discomfort and cough. It is common and serious, and may be complicated with bronchitis, pneumonia and even life-threatening. Bronchitis and granular changes of soft palate mucosa are typical catarrhal symptoms of influenza. Acute nasopharyngitis is mainly characterized by nasal congestion, sneezing and sore throat, with mild systemic symptoms, headache, general pain, fatigue, fatigue, less fever, some of which may have mild to moderate chest discomfort and cough, and rare complications.
(3) Auxiliary inspection
①X-ray examination: Influenza is more prone to pulmonary complications such as bronchitis or pneumonia than acute nasopharyngitis, so chest X-ray examination is helpful for clinical diagnosis.
② Laboratory examination: a. Virus isolation and culture: nasal secretions, nasopharyngeal swabs and throat swabs were collected for furuncle virus isolation and culture to determine the pathogen, and the virus was cultured for about 3 ~ 10 days. B. Rapid influenza determination, with sensitivity > 70% and specificity > 90%, takes about 24 hours. C. Detection of serum antibody requires determination of antibody titers in acute phase and recovery phase. D. The examination of inferior turbinate mucosa print shows that a large number of degenerated columnar epithelial cells often appear in patients with influenza from the first day of onset, and there are aniline blue inclusions in cytoplasm or nucleus, while pus cells are the main ones in acute nasopharyngitis, and inclusions are rare.
17.2 differentiation between acute nasopharyngitis and nasal diseases (1) allergic rhinitis: allergic history, seasonal (hay fever) or perennial sneezing, runny nose, stuffy nose with itching. Symptoms and eosinophils in nasal secretions are helpful for the diagnosis of the disease.
(2) Vascular rhinitis: no allergic history, characterized by intermittent vascular filling of nasal mucosa, sneezing and runny nose. Dry air will aggravate the symptoms. According to the medical history, there is no pus scab, which can be distinguished from virus or bacterial infection.
(3) Atrophic rhinitis: the nasal cavity is unusually unobstructed, the lamina propria of mucosa is thinned, blood vessels are reduced, and the sense of smell is reduced with scab, which is easy to distinguish.
(4) Deviation of nasal septum and nasal polyp: It can be diagnosed by nasal endoscope.
17.3 is distinguished from some acute infectious diseases and upper respiratory tract inflammation in the pre-HIV infection period, and from some acute infectious diseases (such as measles, encephalitis, meningitis, polio, typhoid fever and typhus) and upper respiratory tract inflammation in the pre-HIV infection period. According to the history of symptoms, dynamic observation and related laboratory tests, it is not difficult to distinguish.
18 for the treatment of acute nasopharyngitis 18. 1 8.1.1(1) ipratropium bromide (ipratropium bromide) spray placebo-controlled trial proved that ipratropium bromide (ipratropium bromide) spray. The main adverse reaction was 15% ~ 20% patients with bloodshot mucus.
18. 1.2 (2) Pseudoephedrine acts on α -adrenergic receptors in respiratory mucosa to relieve nasal congestion, but has little effect on α -adrenergic receptors in heart and other peripheral vessels. Relieve nasal congestion and improve sleep. Not suitable for long-term application, limited to 3 ~ 5 days.
18. 1.3 (3) antihistamines The first generation antihistamines, such as chlorphenamine maleate, are effective in reducing sneezing and runny nose, and should be used with caution in the elderly with prostatic hypertrophy. Non-sedative antihistamines lack anticholinergic effect, and the effect is uncertain.
18. 1.4 (4) People with fever, muscle aches and headaches can choose antipyretic and analgesic drugs. Acetaminophen (paracetamol) is the most commonly used. Use with the anti-HIV drug zifuddin should be avoided. Repeated use of aspirin will increase virus output, but the effect of improving symptoms is slight, so it is not recommended.
18.10.5 (5) It is generally not recommended to use antitussive drugs to protect cough reflex, but it can be used as appropriate when severe cough affects rest, especially dextromethorphan.
18.2 possible drugs or treatments (1) vitamin c: the effect is uncertain. It is reported that taking large doses of vitamin C(8.0g/d) from the first day of infection 1 day can shorten the duration of symptoms and alleviate the illness. But most authors hold a negative attitude towards this.
(2) Zinc gluconate: In vitro experiments showed its inhibitory effect on rhinovirus, and clinical control experiments showed that the duration of symptoms was shortened, but the results were inconsistent and there were many adverse reactions.
(3) Breathing and heating humidified gas: Since the most suitable temperature for rhinovirus replication is 33℃, it is recommended to breathe and heat humidified gas to treat colds.
18.3 the antiviral drug ribavirin (ribavirin) has a certain inhibitory effect on influenza, parainfluenza virus and respiratory syncytial virus, and its clinical application is limited to children's lower respiratory tract infection with respiratory syncytial virus. There are no effective antiviral drugs for rhinovirus and other respiratory viruses.
The application of 18.4 antibiotics generally should not and need not be used. A placebo-controlled study showed that in a subgroup (20%), the symptom score was improved after antibiotic treatment with Streptococcus pneumoniae, Haemophilus influenzae or Moraxella catarrhalis cultivated by nasal and laryngeal lavage. Therefore, for cold patients with bacterial colonization, respiratory secretion granulocytopenia, sinusitis, otitis media and other complications, chronic obstructive pulmonary disease (COPD) and other basic diseases, and the course of disease exceeds 1 week, antibiotics can be used appropriately.
19 has a good prognosis for acute nasopharyngitis.
Prevent acute nasopharyngitis and avoid contact with cold patients, especially hand contact. It has been reported in experimental studies that using anti-virus paper towels and maintaining good personal hygiene habits can reduce the spread of rhinovirus colds. Vitamin C is often advocated to prevent colds, but well-designed controlled trials have not obtained supporting evidence. Interferon α2α2b has preventive effect after exposure, but it has adverse reactions such as nasal congestion, so the study was stopped.
2 1 Related drugs: histamine, interferon, ipratropium bromide, pseudoephedrine, ephedrine, epinephrine, chlorpheniramine, acetaminophen, aspirin, dextromethorphan, vitamin C, glucose, zinc gluconate and ribavirin.
Tianjin Ganmao Tablet, a Chinese patent medicine for treating acute nasopharyngitis, has sore limbs, dry mouth, sore throat and swollen cheeks. It can also be used for acute nasopharyngitis (common cold), influenza, mumps and acute pharyngitis. ...
Baiqianbiyan tablets are familiar to everyone. It can be used for treating acute nasopharyngitis (cold) caused by wind-heat invading the lungs, internal fire stagnation, and stagnation of qi and blood, with light nasal congestion, itchy and hot nose, and yellow and thick runny nose. ...
The main functions of Zhiganjia Capsule are: clearing away heat and toxic materials and relieving exterior syndrome. It is used for the first onset of febrile diseases, acute nasopharyngitis, fever and headache. It is suitable for common cold due to wind-cold, and is characterized by obvious aversion to cold and no cold. ...
Asarone