Nasopharyngitis

Acute nasopharyngitis has a viral or, less commonly, bacterial etiology; chronic nasopharyngitis is usually bacterial, sometimes fungal. However, the starting point in the development of the disease is almost always a viral infection.

Infectious agents of a viral nature are mainly rhinoviruses , of a bacterial nature - streptococci , staphylococci , diplococci (including meningococcus ), pneumococci and other microflora, usually found in the nasopharynx in non-pathogenic form.

The causes of chronic nasopharyngitis are regular inflammation of the nasopharynx and untreated acute nasopharynitis, abnormalities in the structure of the nasopharynx, frequent hypothermia, stagnant processes in diseases of the heart, liver , kidneys , infections, frequent inhalation of dust and gas, smoking and alcohol abuse.

Chronic nasopharyngitis has two forms - hypertrophic and atrophic. Hypertrophic causes edema and thickening of the mucous and submucous layer of the nasopharynx, which causes a feeling of soreness and tickle in the throat and tickling in the nose, increased secretion of a clear, clear liquid and tearing, which intensifies in the morning. The atrophic form, on the contrary, leads to thinning of the mucous membrane of the nasopharynx, which leads to dryness in the pharynx, problems with swallowing and the appearance of halitosis. A characteristic symptom of this form of nasopharyngitis is that during a conversation a person wants to take a sip of water ^[3] .

The disease begins acutely, often accompanied by an increase in body temperature to subfebrile numbers (37.5 ° C – 38.0 ° C). Complaints of headache , sore throat, pain when swallowing , nasal congestion, difficulty in nasal breathing, runny nose are characteristic ^[4] . In addition, nasopharyngitis is characterized by unpleasant sensations in the nasopharynx: burning, tingling, dryness, often an accumulation of mucous discharge, which sometimes acquires a bloody appearance and is difficult to leave the nasopharynx. Often the pain in the back of the head is disturbing. Often there are difficulties in nasal breathing and nasal , especially in children. In cases of the spread of inflammation to the mucous membrane of the auditory tubes (the occurrence of eustachitis ), clicks, noise and pain in the ears, and hearing loss appear. On examination, lethargy, adynamia , pallor of the skin, hyperemia and swelling of the posterior pharyngeal wall, its granularity caused by hyperplasia of lymphoid follicles, and swelling of the lateral rollers are noted. A small amount of mucus ( catarrhal inflammation of the pharynx) is noticeable on the posterior pharyngeal wall ^[4] .

Nasopharyngitis in adults often occurs without an increase in body temperature, satisfactory condition and well-being, with moderately pronounced catarrhal phenomena from the nasopharynx. In childhood, the temperature reaction is often significant. On examination, hyperemia and swelling of the mucous membrane of the nasopharynx, viscous discharge on the palatine tonsils ( lat. Tonsíllae ) and the posterior pharyngeal wall are noted.

Meningococcal infection

Meningococcal infection ( meningococcal meningitis ) is an acute infectious disease characterized by significant clinical polymorphism (various in nature and severity of clinical manifestations) and occurring in the form of nasopharyngitis, meningitis or meningococcal sepsis ^[5] .

The causative agent of meningococcal meningitis is meningococcus ( Latin Neisseria meningitidis ) - a round-shaped microorganism; in the smears of the cerebrospinal fluid and blood of a patient, meningococci are paired, the grams of the bacteria ( cocci ) are well stained with aniline dyes ( gram-negative are weak, are weak, direct sunlight, temperature below 22 ° C, drying, the action of disinfectants lead to the rapid death of meningococci ^[6] . The cell wall of meningococcus contains endotoxin , which is a lipopolysaccharide in chemical structure. The only source of infection is human . The incubation period is 2-10 days. In the body, meningococcus spreads only through the hematogenous route. There are two forms of meningococcal infection:

• patients with localized forms of the disease (acute nasopharyngitis and bacterial carriage);
• patients with generalized forms of the disease (purulent meningitis, meningoencephalitis , meningococcal sepsis, meningococcemia (meningococcemia) with damage to various organs and systems in the form of: typical, fulminant or chronic forms).

Thus, the clinical picture of meningococcal infection has several forms, one of which, acute nasopharyngitis, is manifested by an increase in temperature to 38.5 ° C, weakness, headache , and dry throat.

Male Flu

The concept of male flu arose, often with a mockery, that many men suffer from a cold in the form of nasopharyngitis or SARS more severely than women, that men are not entitled to declare the severity of their condition when they say that they actually have the flu . It is understood that women do not do this. A scientific rationale for the legitimacy of the concept of “male flu” as a more severe form of nasopharyngitis is accumulating. ^[7] At the end of 2006, Nuts (magazine) conducted a survey of readers on this issue via the Internet and spurred interest in this concept, which was criticized as unscientific and unreliable. ^{[8] [9] [10]} It has been suggested that such an exaggeration is pseudoscientific. ^{[11] [12]} However, despite the presence / absence of any scientific justification, the idea of ​​male flu became entrenched in popular culture and became a source of controversy during use in advertising media ^[13] .

In the peripheral blood, a moderate neutrophilic leukocytosis is sometimes observed. In 50% of cases of acute nasopharyngitis, the picture of peripheral blood does not change pathologically ^[4] .

The course of nasopharyngitis is favorable: after 2–4 days, body temperature normalizes, and complete clinical recovery occurs on the 5th – 7th days ^[4] .

Staying in the cold lowers the temperature of the human body (at a rate of 36.6 ° C). In air at 27 ° C, a naked man keeps his normal temperature, and in water, whose heat capacity is much greater, only at 32–36 ° C. But cooling causes an organism reaction: involuntary - contraction of the smooth muscles of the skin and blood vessels, reducing heat loss of the body, plus increased metabolism, increasing heat production, and voluntary muscle movements, which also lead to increased heat production. In intoxicated, sleeping, paralyzed this active reaction does not occur, because they are more easily exposed to the harmful effects of a cold. But with a longer and more intense exposure to cold, a healthy body is not able to maintain a normal temperature. Due to the fact that cooling the surface of the body causes a contraction of blood vessels, blood flows to other areas, causing hot flashes to the internal organs, which cannot be indifferent to them, especially if they already have painful changes; in heart disease, for example, or fragility of blood vessels, such flushing can lead to bleeding . Internal organs are even more sensitive to direct cooling, for example, strong cooling of the peritoneum can directly lead to death. Favorable moments for the common cold should be considered ^[14] :

1. Overfilling with blood of skin vessels - a heated person catches a cold easier.
2. Through moisturized sweat the skin is more rapid cooling of the body than through dry.
3. Draft - due to the fact that with intense convection of air near the skin, the near-surface layer of air in which the heat flux is limited by the rate of heat transfer rather than by replacing the air mass is thinned, which contributes to a more efficient heat dissipation and, consequently, tissue cooling. Alternatively, air in strong motion more easily penetrates through pores and open areas of clothing and causes more cooling of the body surface than air in a state of comparative rest.
4. Weakened immunity.
5. Fatigue after increased muscular work ^[14] .

An essential way to prevent colds , including nasopharyngitis, is hardening. Hardening consists in accustoming the skin and its vessels to quickly respond to changes in temperature. In order not to harm the body, it should be conducted gradually and carefully. It is advisable to begin hardening from early childhood, after four weeks of life, gradually lowering the temperature of the bath for the newborn to a temperature consistent with the recommendations of specialists. After the bath there is a quick dousing of the body with slightly colder water and a firm wiping with a dry (terry) towel. From the second year you can be content with one dousing, which is done every morning. But hardening has its limits. Thermal energy is generated from the food we take; if we didn’t protect ourselves with clothes from excessive heat loss, we would have, according to the apt expression of Jurgensen, only to warm our body ^[14] .

They also carry out activities to destroy pathogens in their home. For this they use, among other things, modern disinfection methods: a wet kitchen towel for dishes is placed for 2 minutes in a microwave oven , all pathogenic microbes die from high temperature and steam. It is necessary to regularly clean, air the rooms, wash hands after visiting public places and before eating ^[15] . Proven means of prevention are personal hygiene (regular hand washing) ^[16] . Wearing a mask can reduce the spread of infection, and the mask should be worn by a sick person, not a healthy person ^[16] .

During epidemics , prolonged stays in public places should be avoided, the outer sections of the nasal passages are lubricated with oxolin ointment. Garlic is used as a natural antibiotic ^[15] . Supplementing with vitamin C in some cases can reduce the duration of the disease, but does not affect the risk of infection. Moreover, the use of vitamin C during illness does not have a positive effect ^[17] . In one small study, the benefits of rinsing were found ^[18] .

In cool time, it is useful to wear not very dense woolen fabrics directly on the body, which, in addition to being highly elastic and, moreover, densely seated on the surface with thin, elastic hairs, so they do not adhere as tightly to the body as linen, silk and other, but there is always air space between them and the skin; air, like a poor conductor of heat, mainly delays heat transfer. Wool for legs is especially recommended. Compared to its mass, the legs have a large surface, in addition, they lie farthest from the heart downward, so the heat transfer from them takes place faster and penetrates deeper. You should avoid getting wet feet, which is so often the cause of colds, it is useful to wear high-quality, warm and waterproof shoes, preferably made of genuine leather ^[14] .

An important prevention of colds is a healthy lifestyle: full sleep (about 8 hours a day), exercise, walking, eating a variety of foods containing vitamins , regular outings from large industrial cities ^[15] .

Currently, there are no drugs for which their ability to reduce the duration of the disease in question has been convincingly demonstrated ^[19] . By virtue of this, the treatment of nasopharyngitis is aimed at alleviating the symptoms ^[20] . Reasonable conservative measures include long rest, increased fluid intake to avoid dehydration , and gargling with warm salt water ^[21] . However, the positive effect of treatment in this case is associated mainly with the placebo effect ^[22] .

Symptomatic

To mitigate the manifestations of the disease, simple analgesics and antipyretics are used , such as, for example, ibuprofen ^[23] and paracetamol ^[24] . As for antitussive drugs , the observations did not show their greater effectiveness in comparison with analgesics ^[25] ; due to this, as well as taking into account the possible negative impact on the state of health, it is not recommended to use them in the treatment of nasopharyngitis in children ^{[26] [27]} .

Rhinorrhea can be alleviated with first-generation antihistamines , although they can cause various kinds of side effects such as drowsiness ^[20] . Other anti-congestants , such as, for example, pseudoephedrine , are also effective in the treatment of nasopharyngitis in adults ^[28] . The ipratropium bromide aerosol can also reduce the manifestations of rhinorrhea, but it weakly affects nasal congestion ^[29] . Second-generation antihistamines did not demonstrate efficacy in this case ^[30] .

Due to the insufficient number of studies in this area, it is unclear whether increased fluid intake affects the symptoms and duration of respiratory disease ^[31] . A similar situation exists in relation to the use of heated humidified air ^[32] . There is a study showing the relief of night cough , hyperemia of the mucous membranes and difficulty sleeping when using rubbing and ointments for colds ^[33] .

• Kryukov A.I., Turovsky A. B. Acute inflammatory diseases of the pharynx // Directory of outpatient physician. - 2002. - T. 02 , No. 4 .