COLD- PRACTICAL APPROACH OF FAMILY

DOCTOR

Paul Kolesnyk

International classification
of diseases
Acute infections of multiple and
unspecified upper respiratory locations
Acute lower respiratory infection
unspecified
Influenza virus not identified
The flu caused by an unidentified virus
Acute nasopharyngitis

J06
J22
J11
J10
J00

What is the frequency of cold with

viral and bacterial etiology?

Etiological structure of acute

respiratory disease

Typical bacterial pathogens:

- Str.pneumoniae
- H.Influensae
- Str.pyogenes

Etiological structure of acute

respiratory disease
Atypical bacterial pathogens:

- Cl.pneumoniae
- Mycoplasma pneumoniae
- Legionella

Who and where lives?

Location of infections in ENT organs

Non-sterile part

Sterile part

nasopharynx
oropharynx

Eardrum
Accessory sinuses of
Str.pneumoniae
nose

Sterile part
Trachea
Bronchi
Alveali Str.pneumoniae

Str.pyogenes

H.Influensae
M.catarrhalis

H.Influensae
M.catarrhalis

Laryngitis
tracheitis
pneumonia

tonsillopharyngitis
rhinitis

otitis
sinusitis

What are the complications

of flu?

Complications

Primary viral pneumonia - "lightning" deadly hemorrhagic

viral pneumonia
Secondary bacterial pneumonia (often due to
Streptococcus pneumoniae, Haemophilus influenzae,
Staphylococcus aureus)
bronchitis
Rhinitis, sinusitis, otitis
Myocarditis and pericarditis
Meningitis and encephalitis
Exacerbation of chronic diseases: asthma, chronic
bronchitis, heart disease, kidney disease

Is it possible to differentiate cold of viral and

bacterial etiology?
no
yes

The technique of "small groups"

Group 1 "Symptoms and data on the
objective examination, characterized purely
for viral etiology of the cold "
Group 2 "Symptoms and data on the"
objective examination, characterized purely
for the cold of bacterial etiology "

Clinical diagnosis while examining the

throat

Clinical differential diagnosis

bacterial

viral

Signs of destruction of one or two

parts of the upper respiratory tract;

Signs simultaneous destruction of several

respiratory tract;

cold symptoms;

More or less severe symptoms of general

intoxication, cold symptoms,, much less
sore throat, cough running nose;

Clear congestion in the oropharynx,

Moderate congestion brackets, posterior
and in the presence of nasopharyngitis, pharyngeal wall with the presence of
dull, with a bluish tinge on the back of enantema;
the throat
The changes most productive,
Congestion of the mucous membrane of
characterized by the formation of pus
the nasal passages;
secretions.
Tonsils are mostly intact (except
Clearly edema surrounding tissue is not adenoviral infection);
typical;

Clinical characteristics of the diseases

Flu

-intoxication syndrome:
short-term high fever
significant muscle pain
headache with localization in the superciliary arches,
paraorbital and temporal areas
-catarrhal syndrome:
bronchitis
rhinitis
edema and hyperemia of the person
vascular injection of the conjunctiva

Parainfluenza

Not acute onset and slow progress

weakness, appetite loss
sometimes single-vomiting
temp low-grade 1-8 days
catarrhal 1 day of illness (persistent, loud cough, running nose,
foundation and mucous discharge from the nose)
Oropharynx exam: edema, congestion of the mucous
membranes, posterior pharyngeal wall
the false croup syndrome heavy cough, hoarseness of voice,
noisy breathing, development of stenosis of the larynx

Adenoviral infection

t 38-39 * C
prolonged rhinitis (4 weeks) with mucosal secretion
granulose throat (a symptom of "roadway")
cough 2 days of illness-wet
conjunctivitis
lymphadenopathy
hepatolienal syndrome
intestinal disorders

Respiratory- syncytial infection

Children under 1 year of age:
-nasal congestion
-Dry, long, paroxysmal cough
-may increase as a result of effects of laryngotraheitis
Elder children:
-the disease is not severe
-cold symptoms of the upper respiratory tract
-cough, dry, stable, long-term
-Sometimes, chest pain

FEATURES OF THE BACTERIAL CAUSES

OF COLD
Str.pneumoniae
The frequency of spontaneous eradication - only
10%
Very frequent development of severe
complications
Unfavorable prognosis of pneumonia
Does not produce B-lactamase ,unstable to
penicillin

Str.pyogenes

The frequency of lesions of the pharynx and

tonsils - 30-40%
The reasons for poor eradication:
Patients dont keep the 10-day course of
penicillin
Reinfection from surrounding
Inactivation of antibiotics ko-patohens in the
mouth
Tolerance of bacteria to penicillin!
(via intracellular lesions "biofilm" - new
macrolides are more effective!)
Available in healthy carriers!

hl.pneumoniae
Very often in children with adenoid
vegetation
Both with M.pneumoniae 6-15% - the cause
of acute bronchitis and acute respiratory
disease in young people and children
It may be the cause of frequent recurrent ARI
in children
The new macrolides are effective for the
treatment!

M.catarrhalis
The

frequency of spontaneous eradication

- 20%
Producing B-lactamase in 90%
(sensitive to protected penicilins,
quinolones, macrolides)

H.Influensae
The

frequency of spontaneous
eradication (often with sinusitis,
COPD) - 40%
Natural resistance to macrolides due
to a mutation in the 23s rRNA
Producing B-lactamase (regional
dependence) - a natural resistance
to unprotected penicillins

Will the laboratory help to differentiate cold of

viral and bacterial etiology?
no
yes

Laboratory services

CBC
CRP
Rapid tests Rota, adeno, influenza
Strep Test

Clinical Case
The mother of 4 years Andrew complained
that the boy 2 days to 38S fever, sore throat,
runny nose. According to the mother, similar
symptoms were observed in her older son 10
days ago, called "connection with the older
child was assigned to ceftriaxone 1 g / m, but
no significant improvement was observed
after 7 days of treatment in the older child
and remained subfebrile a sore throat.

The results of objective

examination
The throat is red, hypertrophied tonsils, gaps
are clean. Submandibular l / n enlarged,
painful.
Lungs, heart - normal. Abdomen is slightly
sensitive in the right subcostal area, liver 2
cm.
What is the likely nature of the disease in a
child?
What is evidence of this?
How to clarify the diagnosis?

Do I need to assign this patient ABT?

no
yes

The results of the additional

methods of examination
GBA: e., L., ESR - the norm in the leukocyte formula
revealed moderate lymphocytosis, large cell
undifferentiated ++.
CRP- 12mMol / l
In re-examination of child after 2 ago- throat is
rapidly flushed, little white patches on the tonsils.
The skin of the abdomen, small papular rash, which
mother has related to allergic to nurofen. On
palpation the abdomen + 4cm liver, spleen palpable
..

results of additional tests

To differentiate the causative agent of angina
done rapid test for Streptococcus A-positive
result.
The result of ELISA - IgM to Epstein Bar Virus high titer

What is the diagnosis?

Do I need to assign this patient the

antibiotic treatment?
no
yes
If yes, what group of antibiotics does he
need?

Traditional non-drug
recommendations for cold

Warm drinking - conclusively washes the mucus easier with tickle

regardless of the type of liquid (tea, soup)
Garlic - 5 clinical trials, patients who continued to have used garlic
showed no effect on the frequency or duration of cold. A side effect
of garlic was found more frequently.
Vitamin C - 10 long large trails (11 thousand people) found no
evidence of influence of vitamin C on the incidence of SARS, little
evidence on the impact of the length. Feature - effect on certain
groups of people (athletes, marathon runners - is the impact on the
incidence of chronic administration of 200 mg / d)
Echinacea - had demonstrable efficacy of prolonged use of 8 weeks
before cold. The weak effect of SARS on the course and incidence of
complications.
Honey - not identified evidence-based efficacy
Banks mustard - not found evidence-based efficacy
UV premises - not identified evidence-based efficacy
Sleep - 8 hours of effective sleep demonstrably improved the
patient's condition and affect the duration of SARS
Frequent room ventilation - hydration has some evidence on the
effectiveness of the patient
Irrigation of the nose- the standpoint of evidence-based

medicine

Conclusion of the Cochrane Society

Symptomatic therapy for SARS? Where is the

myths?

NSAIDs (ibuprofen, aspirin) - demonstrably reduce temperature, sore

throat, headache. Good for 38.5 and above, not all children can
Paracetamol - demonstrable efficacy in temperature, it is possible for
children does not diminish the pain of the throat.
Decongestants - the average degree of evidence only if excessive
congestion, it is better to sleep with drip syndrom, side effects. Not
expediency with cold in children
Antihistamines - small evidence base, the advantage toward topical
vehicles
Immunomodulators - there is no evidence on the effect during the
SARS
Homeopathic remedies - there is no evidence on the effect during the
SARS
Probiotics - there was a little evidence base on the impact on the
prevention of cold in the missing side effects

Cold Therapy for SARS? Where are

the myths?
Therapy should be administered depending on the
cause:
Drip syndrome proved efetyvnist irihatsiyi,
decongestants at bedtime
Irritation of the posterior wall of the pharynx - the
effectiveness of NSAIDs
Antitussive - low effectiveness evidence, no evidence
on the use protykashlovyh + expectorant
(inappropriate for children)
Mucolytics and expectorant no effect on the course and
duration of the disease, only improves quality of life

Is there any evidence in the appointment of

nebulizer therapy during cold and its and
complications?
no
yes