Upper respiratory tract infections are one of the most common reasons why patients visit their primary care physician. During the infection season – both spring and autumn – the number of cases increases sharply.
Common cold, or – according to the International Classification of Diseases – acute nasopharyngitis, is a viral disease. Patients present with a sore throat and runny nose, often accompanied by a dry cough (most often resulting from throat irritation and the feeling of nasal discharge running down the back of the throat), as well as low-grade fever and even fever (usually not high, around 38 degrees C). General symptoms include: a feeling of general breakdown, weakness, and muscle and joint pain. The symptoms persist for 7-10 days, although some of them (general weakness or dry paroxysmal cough) may persist for up to several weeks after recovery from the acute phase. In smokers, the duration of the disease itself is extended by an additional 3 days. There are hundreds of viruses that can cause symptoms. Epidemiological studies show that the most common culprits are rhinoviruses (with their subtype picornaviruses), adenoviruses, coronaviruses, parainfluenza virus, enteroviruses, and also the influenza virus.
Flu is an infectious disease caused by a specific type of virus. There are three main types of influenza viruses: type A, B and C with all their subtypes (around 140 possible variants). The symptoms of the disease are often difficult to distinguish from those of the “common cold”. In the case of flu, however, it is noted that its course is more severe and its symptoms are more severe. The fever is often high, even up to 40 degrees Celsius, and the general symptoms in the form of severe weakness and severe pain in the muscles and joints come to the fore. Patients complain of a sore throat, while a runny nose is less common than with colds. Some strains of the influenza virus, which evolve annually and undergo numerous mutations, are particularly infectious and tend to cause extremely severe infections. Examples of this type of event were recent epidemics of avian influenza (caused by a zoonotic virus) or swine flu (caused by a virus with a swine reservoir). These strains of influenza were characterized not only by a particular tendency to occupy the upper respiratory tract, but also by difficult-to-treat and rapidly progressive pneumonia leading to respiratory failure (it is known, however, that complications such as pneumonia are also possible in the case of ordinary seasonal influenza. especially in age groups with reduced immunity).
When it comes to treating viral infections, it is primarily a procedure aimed at alleviating and eliminating symptoms. Although influenza is an exception here (more on this below), treatment of viral infections is not aimed at fighting the virus that caused the infection itself, so none of the treatments used have a significant effect on reducing the duration of the disease or accelerating recovery. How long and how severe the course of a viral infection will be depends on many factors, including the virulence of the virus itself, the body’s individual defenses, and the occurrence of complications. The most commonly used medications are to remove and reduce the nuisance of symptoms: anti-inflammatory and antipyretic drugs are to remove fever and general breakdown symptoms, nasal decongestants – reduce the severity of runny nose, local disinfectants and painkillers – reduce sore throat and prevent secondary superinfection by bacteria, antitussive drugs – reduce the severity of cough. All this until the body fights the virus. It should be remembered that in the absence of evidence of a bacterial infection superimposed on the common cold, the use of an antibiotic is unjustified. Antibiotics do not work against viruses, and their excessive use exposes the patient to unnecessary side effects and leads to the development of antibiotic-resistant strains of bacteria.
Treatment is a bit different in cases of influenza. Some flu infections are mild and, based on the symptoms that patients report, they are indistinguishable from the common cold. Then the treatment does not differ significantly from the management of other viral infections. However, in severe cases, where there is an intense cough, often accompanied by dyspnea, the patient’s condition is severe, and the suspicion of influenza infection is high, the doctor may decide to include one of the two drugs that act directly against the influenza virus available in Poland: oseltamivir ( Tamiflu) or zanamivir (Relenza). Before starting these types of drugs, however, it is very important to try to confirm that the infection is caused by the influenza virus. Unfortunately, quick tests for detecting the virus in Poland are not widely available. Usually, tests for the presence of the virus are carried out in nasal and throat swabs performed at local sanitary stations. In life-threatening infections (especially when infection with particularly virulent strains is suspected), the patient is referred to the hospital, and antiviral treatment is started despite the lack of clear confirmation of virus infection. Antiviral medications to treat influenza should be started as soon as possible after symptoms start (up to 48 hours). They are also useful in preventing flu in people who come into contact with those who have been infected with the virus.
However, the most important way to prevent influenza is regular vaccinations in accordance with the recommendations issued by the National Institute of Hygiene (http://www.pzh.gov.pl/page/fileadmin/user_upload/zalecenia_do_szczepien_pazdziernik_2010.pdf) and the Chief Sanitary Inspectorate (www.gis. gov.pl). In everyday life, in order to prevent infections and their spread, strict hygiene rules are used: washing hands, covering the mouth and nose when sneezing and coughing, isolating the sick.
Paulina Jurek