Adenovirus pharyngitis.

Adenoviral pharyngitis in most cases is based on a viral and adenoviral infection, causing so-called adenoviral diseases, which are a group of infectious diseases caused by adenoviruses, characterized by symptoms of damage to the mucous membrane of the respiratory tract, eyes, intestines, and lymphoid tissue.

In recent years, the composition of the adenovirus group has been constantly expanding. Currently, several dozen serotypes of adenoviruses are known, and different serotypes can cause the same form of the disease, and vice versa, one serotype - its different forms. During an adenovirus infection, antibodies are formed in the blood that are capable of inactivating the corresponding virus.

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Epidemiology of adenoviral pharyngitis

The source of adenovirus diseases is a sick person, as well as recovered individuals who excrete the virus for 50 days after the illness, and virus carriers. The transmission route is airborne when talking at close range, sneezing, coughing, and also the fecal-oral route. Children aged 6 months to 5 years are most susceptible to adenovirus infection. Crowding of people contributes to the occurrence of epidemic outbreaks, especially in the autumn and spring. The occurrence of adenovirus epidemics in school and army groups is mainly due to viruses of classes 1-5.

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How does adenoviral pharyngitis develop?

The ability of adenoviruses to reproduce in epithelial cells and lymphadenoid tissue of the respiratory tract, eyes, and intestines causes a variety of clinical manifestations, which are classified into the following forms of adenoviral diseases:

• ARI or nasopharyngitis, nasopharyngotonsillitis, nasopharyngolaryngitis, nasopharyngobronchitis;
• pharyngoconjunctival fever;
• acute follicular and membranous conjunctivitis;
• epidemic keratoconjunctivitis;
• adenoviral pneumonia;
• adenoviral gastroenterocolitis.

Symptoms of adenovirus pharyngitis

The incubation period is 5-7 (3-14) days. The onset of the disease is often acute: chills, moderate headache, loss of appetite, possible aching pains in the bones, spine, joints, muscles (this clinical picture resembles the onset of influenza infection). On the 2nd-3rd day of the disease, the body temperature can rise to 38-39 ° C. Adenovirus diseases (unlike influenza infection) are characterized by the sequence of appearance of new symptoms of the disease and the predominance of local symptoms over general ones. From the first day of the disease, a runny nose with abundant serous discharge is noted, later - mucopurulent. The mucous membrane of the oral cavity and pharynx is edematous, hyperemia is not pronounced; there is a sore throat and itching, hoarseness, cough and moderate pain with an "empty" throat. Along with oronasal inflammatory phenomena, acute adenoviral pharyngitis may also occur, in the etiology of which adenoviruses play a significant role. The mucous membrane of the pharynx is hyperemic, partially covered with mucopurulent plaque; on the back wall of the pharynx, individual large follicles are noted, protruding on the mucous membrane in the form of bright red grains (nasopharyngitis), swelling and hyperemia of the uvula. Enlargement of the palatine tonsils is possible, often with the appearance of whitish loose plaque in the form of dots or islands on their surface (nasopharyngotonsillitis). Body temperature may be subfebrile or increase at the height of the disease to 38 ° C. The absence of leukocytosis, some lymphocytosis are detected in the blood. An increase in the lymph nodes is often observed, mainly submandibular and posterior cervical.

One of the common forms of adenoviral diseases is pharyngoconjunctival fever, which is characterized by a combination of fever, conjunctivitis and pharyngitis with a local reaction of the lymph nodes. The temperature reaction in adenoviral diseases lasts on average 5-7 days, sometimes up to 14-18 days. Local catarrhal phenomena last up to 10-12 days or more. In many patients, conjunctivitis develops in the first 3 days of the disease, usually unilateral at first. It manifests itself as a burning sensation or pain in the eyes, abundant mucous discharge, hyperemia of the conjunctiva. In some cases, keratoconjunctivitis occurs. The eyelids swell sharply, profuse lacrimation appears. After the disappearance of the clinical signs of adenoviral disease, asthenic syndrome persists for a long time.

Complications of adenoviral diseases (otitis, sinusitis, vulgar tonsillitis, pneumonia, etc.) are associated with the addition of a bacterial infection or exacerbation of concomitant chronic inflammatory processes, such as chronic tonsillitis, sinusitis, etc.

How is adenoviral pharyngitis recognized?

The diagnosis is established based on the presence of conjunctivitis, erythematous pharyngitis, adenopathy of the cervical lymph nodes and the absence of leukocytosis. Laboratory diagnostics are based on the isolation of adenovirus from nasopharyngeal mucus, eye discharge, and in intestinal forms - from the patient's feces. Serological studies such as immunofluorescence, complement fixation reaction, hemagglutination inhibition reaction, etc. are also used to establish the diagnosis.

Differential diagnostics are carried out mainly with influenza, which is not characterized by such clinical manifestations as prolonged and pronounced catarrhal symptoms in the throat, primary rhinitis, moderate temperature reaction, minor intoxication, enlarged lymph nodes, conjunctivitis, and often gastrointestinal lesions.

The prognosis is usually favorable, but in young children, if pneumonia develops, fatal outcomes are possible.

Treatment of adenoviral pharyngitis

Treatment of adenoviral pharyngitis is usually carried out at home. The patient should be isolated in a separate room (a more than incorrect recommendation, since in Russia about 20% of families live in communal apartments, and it is there that various kinds of "popular" infectious diseases of the upper respiratory tract most often occur) or his bed should be fenced off with a screen. In the febrile period, bed rest, a complete diet rich in vitamins, alkaline inhalations and gargling are prescribed; intranasally - oxolin, tebrofen, microbiotenal in the form of ointments. Antibiotics are not indicated for the usual course of adenoviral diseases for the same reasons as for other viral infections of the upper respiratory tract. However, they are prescribed without fail for bacterial complications.

Adenoviral pharyngitis is prevented by generally accepted rules: isolation of patients, ventilation of the premises, wet cleaning, wearing of masks by service personnel, disinfection of secretions, etc.