PARAINFLUENZA DISEASES (synonym parainfluenza) — group of the acute infectious diseases of the virus nature, similar on a clinical picture, which are characterized by moderate intoxication and damage of airways.
A short historical sketch
In 1956 Mr. Chanok (R. M of Chanock), etc. allocated from the child with a false croup a virus, the called CA (croup-associated virus) and afterwards designated as a virus of a parainfluenza of type 2. In 1957 Mr. Chanok described two gemadsorbiruyushchy viruses called then viruses of a parainfluenza of types 1 and 3. In 1958 it allocated a virus of a parainfluenza of type 4.
According to the decision of Committee of WHO experts on viral respiratory infections (1958) diseases caused by the specified viruses were called parainfluenza.
P. are widespread everywhere. Viruses of a parainfluenza of types 1, 2, 3 are found in all countries; type 4 — in the USA, England, ChSSR, in 1973 it is allocated also in the USSR. Cases of a parainfluenza make to 20% of total number acute respiratory bolezpy adults.
P. cause viruses of a parainfluenza from the family Paramyxovirus of the Paramyxoviridae family.
On structure and a way of replication parainfluenza viruses do not differ from others paramyxoviruses (see), are rather unstable at t ° 37 ° above, are inactivated at pH 3,0 below, and also at effect of ether. Well remain at t ° — 60 ° below in the environment of cultivation, the blood serum of hens containing 5% or 0,5% of a seralbumin of cattle.
A number of strains of viruses of a parainfluenza of types 1, 2 and 3 breeds in chicken embryos at infection of amnion, and nek-ry and at introduction to an allantoisny cavity. Viruses of all types cause latent infection in Guinea pigs, and strains of types 1 — 3 as well in the Syrian hamsters at introduction in Nov. Parainfluenza viruses breed in cultures of cells of kidneys of monkeys and the person, and also in the nek-ry intertwined lines of cells of the person. They agglutinate erythrocytes of Guinea pigs, hens, the person and lyse them.
Parainfluenza viruses of different types are differentiated in neutralization tests, fixations of the complement, braking of hemagglutination, braking of hemadsorption.
the Source of an infection is the sick person, to-ry allocates the activator to the environment within the first week of a disease. The virus extends from the person to the person in the airborne way. Epid, flashes arise usually in cold season, is preferential among children of preschool age. In the period of flu epidemics P. often are associated diseases. During the period between flu epidemics P. take an important place among other viral acute respiratory diseases. The main role in developing of diseases of the person is played by viruses of types 1, 2 and 3.
The pathogeny and pathological anatomy
Disease-producing factors are implemented into epithelial cells of a mucous membrane of upper respiratory tracts, preferential a nose and a throat. In the place of their implementation there is an inflammatory process, serous, and then mucous and mucopurulent exudate collects, to-ry obturirut the nasal courses and acoustical (eustachian) pipes. Further process can pass into the lower respiratory tracts. At sharp swelling of a mucous membrane of a throat, accumulation of a secret in its gleam and emergence of a reflex spasm there is a false croup — a stenosis of a throat of various degree.
At gistol, a research of the piece of tissue of trachea received in an experiment on hamsters in 48 — 72 hours after implementation of a virus in cells swelling of kernels with redistribution of chromatin is observed. Epithelial cells lose usual orientation, localization of their kernels changes. On 5 — the 7th day of a disease in an epithelium multinucleate cells appear. In cells of an epithelium there are various dystrophic changes therefore they collapse, and with the smallest drops of a secret the activator is allocated to the environment. The antigens coming to blood promote formation of the hemagglutinating, complement-linked and virus neutralizing antibodies.
the Postponed disease leads immunity to formation of type-specific virus neutralizing antibodies, to-rye do not provide full protection against repeated infection, but prevent development of severe forms of a disease. Throughout life of people can repeatedly catch parainfluenza viruses, preferential type 3. Recurrent diseases can arise in 9 months after the postponed disease. The neutralized antibodies found in a secret of respiratory tracts concern to the IgA group and play a big protective role, than circulating in blood. The serumal virus neutralizing antibodies relating to the IgG group promote shortening of the period of allocation of a virus at repeated infection. In an experiment on eanlings it is shown that antibodies in nasal secrets appear earlier, than in blood serum, but remain shorter time, than serumal.
The clinical picture
the Incubation interval of 2 — 7 days, is more often 3 — 4 days. Process develops gradually, poorly expressed intoxication and symptoms of damage of airways are characteristic. Body temperature usually subfebrile or normal. Less often it rises within the first days to 38 — 38,5 °.
Coloring of skin does not change, herpetic rashes are not characteristic. During the first hours rhinitis of various degree of manifestation is often observed (from a congestion of a nose to a plentiful rhinorrhea), pharyngitis is possible. Damage of a throat is the most typical. At adults symptoms of laryngitis are expressed moderately, the sadneniye, irritation, a pharyngalgia, dry cough, change of a timbre of a voice, hoarseness, sometimes an aphonia appear, the stenosis of a throat (false croup) occasionally develops. Changes in a pharynx are continuous: bright hyperemia of a soft palate, handles or back wall of a throat. On 4 — the 5th day of a disease arises the bronchitis proceeding 7 — 14 days. In lungs scattered dry rattles are listened. The cardiovascular system of considerable changes does not undergo. Pulse corresponds to temperature, the ABP does not change. At a part of patients the abdominal pain and the liquefied chair is observed.
In blood in the first days of a disease note small increase or decrease in quantity of leukocytes. ROE normal or is a little accelerated.
Disease to a certain extent depends on type of a virus. The disease caused by viruses of types 1 and 2 proceeds as an easy form of flu: temperature subfebrile (at infection with a virus of 2 type can be higher), a congestion of a nose is expressed slightly, dry cough, a febricula is observed. The false croup would arise at P. more often., caused by a virus of 1 type. Damage of the lower airways is usually connected with a virus of 3 type. Adults have a disease, caused by a virus of 4 type, differs in the expressed intoxication, development of an encephalomeningitis is possible.
Most often there is pneumonia, the cut is the reason a bacterial flora. P.'s current. can be also complicated by quinsy, sinusitis, otitis, an eustachitis, tonsillitis.
the Diagnosis is made on the basis by a wedge, pictures and these laboratory researches.
Laboratory diagnosis is carried out by allocation of a virus, electronic and microscopic, immunofluorescent and serol, researches. It is possible to allocate a virus in the first 6 days of a disease, and at a recurrent disease — during less long term. From children material for a research is taken a tampon from a pharynx, at adults receive washouts from a nose and a throat. Material is investigated at once or store at t ° — 60 ° below. Viruses allocate in cultures of cells of kidneys of monkeys or a fruit of the person. As cells of monkeys are often infected with the parainfluenza SV5 virus, to a medium add 0,2% of hyperimmune serum to this virus. All parainfluenza viruses create eosinophilic cytoplasmic inclusions, to-rye reveal by fixing of cells in Buen's liquids and colourings hematoxylin-eosine. The virus is revealed a hemadsorption virus test for the 3, 5, 10, 15 and 20 day of cultivation. For identification of a virus it is browned on fabric of the same look then investigate in hemagglutination-inhibition reactions, braking of hemadsorption, fixation of the complement or neutralization (see. Virologic researches ) with serums against viruses of a parainfluenza, flu and parotitis. For a submicroscopy use material of washouts.
For an immunofluorescent research of cells of respiratory tracts dry gauze tampons take material from the lower nasal sink and from a pharynx. Prepare 3 — 4 smears and investigate them by method immunofluorescence (see) with marked serums against viruses of a parainfluenza of all types and an influenza virus.
Blood sera of patients for serol, receive researches in the first days of a disease and then in 3 — 4 weeks. Serums investigate at the same time in reactions of binding complement, braking of hemagglutination or neutralization. Antigens for reaction of binding complement and braking of hemagglutination are prepared by reproduction of viruses in cultures of cells or chicken embryos. As blood sera of people often contain inhibitors of hemagglutination, it is desirable to process their receptor - the destroying enzyme.
Allocation of a virus is the most reliable diagnostic method allowing not only to establish the parainfluenza nature of a disease, but also to define type of a virus. As for serol, researches, increase in an antiserum capacity by 4 times and more demonstrates only existence of a parainfluenza infection. Increase in a caption of parainfluenza antibodies is often observed at adults and at parotitis.
P. differentiate with flu (see), adenoviral diseases (see) and respiratory and syncytial infection (see). The acute, sudden course of a disease with high temperature in the first days, dominance of intoxication over the catarral phenomena appearing later 1 — 2 day is peculiar to flu.
Laryngitis at flu is, as a rule, combined with tracheitis while at a parainfluenza it arises separately. Adenoviral diseases are characterized rinofa-ringotonzillity, conjunctivitis, increase cervical and submandibular limf, nodes, by increase in a liver.
At a respiratory and syncytial infection bronchitis with moderately expressed rhinitis and pharyngitis prevails.
Recommend a bed rest, a diet with an exception of the products irritating went. - kish. path, warm drink. At easy disease it is possible to be limited to purpose of symptomatic means. In cases of a heavy current use of placental gamma-globulin, and also donor immunoglobulins (anti-influenza gamma-globulin, serumal polyglobulin) is necessary, to-rye contain antibodies to parainfluenza viruses of types 1 — 3.
At emergence of a stenosis of a throat appoint hot foot baths, steam inhalations; inside — spasmolytic and corticosteroid drugs in an age dosage. Development of the complications caused by a bacterial flora demands use of antibiotics and sulfanamide drugs.
Forecast at uncomplicated forms favorable.
San. - a gigabyte. and the same anti-epidemic actions, as for the prevention flu (see). Are necessary isolation of the patient (in house conditions or in the insulator of a nursing home, the hostel, etc.), airing and wet cleaning of the room, in Krom is the patient, boiling of the linen used by it, ware. The persons who are looking after the patient shall be masked, to them recommend to apply interferon.
Features of parainfluenza diseases at children
the Parainfluenza — a disease of preferential children's age; from 15 to 50% of all patients — children up to 2 years. In child care facilities P.'s flashes would sometimes be observed., at to-rykh also even 90% of children are surprised to 50. At children's age the specific weight of P. among other acute respiratory diseases makes from 6 to 30%. Often the disease proceeds in the form of the mixed viral and virus and bacterial infections.
The disease begins with moderate rise in temperature or proceeds without fever; high temperature is observed rather seldom. Intoxication is expressed poorly or moderately, and at nek-ry patients is absent at all. Children of early age sometimes have a vomiting. Occasionally asthmatic and Meningeal syndromes develop. The catarral phenomena, a hyperemia of a pharynx, cold with plentiful serous, serous and mucous allocations, hoarseness, the rough, often persistent, sometimes barking cough are typical. In 20 — 30% of cases, it is preferential at children up to 3 years, there is a symptom complex grain (see). These manifestations stick to 1 — 3 day. General duration of a disease of 1 — 6 days (on average 2 — 3 days).
Complications arise at children of early age at the aggravated anamnesis and stratification of a bacterial flora more often (staphylococcus, a pneumococcus, a streptococcus, gram-negative flora is more rare).
At P.'s diagnosis. consider weak intoxication inherent to them, considerable expressiveness of the catarral phenomena. Damage of a throat and development of a syndrome of a croup is especially characteristic. The situation matters and epid.
Hospitalization of patients is carried out only on a wedge, to indications: at heavy disease, in the presence of complications.
Symptomatic and pathogenetic treatment of a parainfluenza at children the same, as at treatment of adults.
Forecast, as a rule, favorable. P.'s prevention. children have the same, as at prevention of a parainfluenza at adults.
See also Respiratory viral diseases .
Bibliography: Vashchenko M. A., Rybinsk L. N. and Trinus E. K. Neurologic syndromes at patients with a parainfluenza infection, Zhurn, nevch grumble, and psikhiat., t. 71, No. 7, page 976, 1971; Zlydnikov D. M. and Smorodintsev A. A. Acute respiratory diseases, page 163, D., 1974; Zlydnikov D. M., Kazantsev A. P. and Starshov P. D. Therapy of viral diseases, page 116, JI., 1979; Laboratory diagnosis of viral and rickettsial diseases, under the editorship of E. Lennet and N. Schmidt, the lane with English, page 349, M., 1974; Piskareva N. A. The mixed viral infections at children, L., 1975, bibliogr.; The guide to infectious diseases at children, under the editorship of S. D. Nosov, page 239, M., 1972, bibliogr.; With m and at l about I To. 3. and Bol boat W. I. Differential diagnosis of a parainfluenza and flu A2 (England) 42/72 at the patients observed in policlinic, Klin medical, t. 50, No. 2, page 143, 1975; The p e sh and to S. G. Topical issues of acute respiratory viral diseases at children, Vopr. okhr. mat. also it is put., t. 23, No. 8, page 7, 1979; Express diagnosis of flu and other acute respiratory viral diseases by method of an immunofluorescence, under the editorship of E. S. Ketiladze, page 56, L., 1979; Epstein F. G. Flu and grippopodobny diseases, M., 1972; A g and-w and 1 S. Page of a. S e h g and 1 S. Para-inf-luenza virus, Infection in respiratory illnesses of infants and children, Indian J. med. Res., y. 59, p. 206, 1971; Heinz F. Januska J. Prispevekm k proble-matice podilu parachripkovych vizu typ 1, 2, 3 na etiologii sporadickych akutnich respirachich onemocneni u predskolnich deti an u dospele populace, Cs. Epidem., sv. 24, s. 70, 1975.
H. V. Astafyeva; S. D. Nosov (ped.), 3. R. Peele (etiol., laboratory diagnosis).