Which infectious diseases are prevalent this time of year? Have summer gut infections completely subsided? Are diseases like chicken pox and scarlet fever seasonal? Are we in for a more severe flu epidemic? On these and other questions, we talk with Prof. Dr. Mariyana Stoycheva-Vertigova, PhD - specialist in infectious diseases. She is the head of the infectious disease clinic at the University Hospital "St. Georgi" and a teacher at the Medical University in Plovdiv. Prof. Stoycheva is in the leadership of the Society for Infectious Diseases in our country
- Prof. Stoycheva, in the middle of autumn and before the beginning of the flu season, what infections are going around at the moment. Who are your most frequent patients?
- Hepatitis A is booming right now. It has a pronounced seasonality and usually at this time of the year the incidence increases. It is the same this year, we have too many patients with hepatitis A - mostly children of school age due to more frequent contacts at the beginning of the school year. This virus is transmitted by a fecal-oral mechanism, i.e., the virus is shed from the feces. Therefore, infection most often occurs through contact-household contact with sick people. In addition, good personal hygiene, the crowding of more people in one place, poor sanitation are of great importance for the occurrence of this disease. This is the mildest viral hepatitis, other types are more severe. In hepatitis A, there is no chronicity, i.e., the disease ends with complete recovery and fatal cases are very rare indeed.
And do the so-called still meet? summer virus infections or have they completely subsided?
- No, they haven't died down. And in autumn some intestinal infections have their boom. These are the food poisonings, simply because the temperatures outside are supposedly not very high and some of the food products are not kept in the refrigerator. People decide they can leave them out, but when these food items come into contact with staphs, especially when they're not refrigerated, the staphs in them multiply. They release toxins and when people consume such food, they get sick very quickly. Just a few hours after consuming such foods, they experience vomiting and abdominal pain.
Most often this poisoning is associated with the consumption of syrupy confectionery that is stored outside the refrigerator. Tolumbiki, for example, and other similar sweets. Staphylococci are very fond of sugar and prefer these food products. Some salads are also dangerous in this respect, for example potato salad, various pastas as well, which are prepared in advance and are not stored in the refrigerator. Therefore, although the weather outside seems cooler, it gets quite warm at lunchtime, and if such products and foods are stored outside the refrigerator, this is a risky time for the development of staphylococci. Dysentery also occurs in autumn, so let readers keep these dangers in mind.
In recent weeks we have been talking a lot about the expected new flu strains. As a specialist, what do you expect from the flu season?
- Yes, we talked a lot about the flu and now it's clear that the strains we're expecting are Michigan and Hong Kong. This year according to preliminary data
flu will start sometime around December
December-January-February - this is the period during which we most often observe flu epidemics. We haven't had a major flu epidemic in a long time, and we always expect that after a lull, albeit a relative one, the incidence will be higher. The difference between the flu and the rhinovirus infections we talked about is that the flu starts with a high fever, suddenly, with chills, with very strong fatigue, malaise. The sick simply cannot get out of bed, they need to lie down. Intoxication is very pronounced. High fever and intoxication are the most characteristic symptoms of the flu. I want to take this opportunity to recommend the flu shots. Now is the time to do it, October is a very suitable month for flu vaccines, so that the body has time to build up immunity to these antigens that we inject with the vaccine. The minimum time for this is 15-20 days, but some people require a month for this so that the immune system is ready to meet this virus.
Is the number of people willing to get the flu shot still low? As if the effect of the vaccine is being neglected?
- Few wanted to be vaccinated - 5 to 7% of people. Yes, it is neglected. But even if complete protection is not achieved with vaccination, at least we do not expect them to suffer from complications. The expectation is that they will acquire some immunity and that the disease will progress milder. But let people keep in mind that no one is immune to catching the flu, unfortunately. The disease is most severe in older people because they have a variety of chronic diseases: diabetes, diseases of the cardiovascular system, of the respiratory system. Although with them with this vaccination
immunity is hard to build, again it is desirable that they do it. This is what we can do for ourselves.
Do you have any idea if these new strains will change the clinical picture, the course of the flu?
- This is quite speculative, I can't say how it will be. The clinical picture depends not only on the causative agent, but also on the infecting dose. It also depends a lot on the patient himself, on what his immunity is like, what other diseases he has. It is also very important that people stay home at the first symptoms of the flu. It is important to stop the spread of infection because the contagious period is 2-3 days. If the person continues to go to work, he will infect colleagues and others. Everyone thinks that he is irreplaceable in his work and without him they will not do, but there is always a way. No matter how urgent it seems to him, it is important for society, but it is also important for the patient himself. He needs to stay in bed, lie down, rest, give his body a chance to deal with this infection. Otherwise, the disease drags on, complications become more frequent and more severe.
And when should antiviral preparations be taken? What is their effect? There was controversy about their effectiveness, if I'm not mistaken? Are they also suitable for prevention or is there no point?
- Antiviral preparations should be taken at the first symptoms of the disease. As early as possible. But not for the purpose of prevention, it makes no sense. In a word, drug prophylaxis is not recommended. Prevention is specific and that is the vaccine. Regarding the effect of antiviral drugs, I can assure you that Tamiflu now gives very good results. If it is started on time, it has an extremely good effect, but if it is after the 48th hour from the onset of the disease, then it no longer makes sense. These viruses multiply very quickly and it is extremely important that antivirals are taken early.
Prof. Stoycheva, let's recall the complications of the flu
- The most common complications of the flu are pneumonia and bronchitis. However, these pneumonias are by no means mild, because they are most often associated with the flu virus itself. They occur with respiratory failure. Pneumonia can also be bacterial. You see, the flu is a disease that collapses, collapses the immune system and already the body becomes very susceptible and susceptible to bacterial and other viral infections. If pneumonia occurs in the first week of the onset of the disease, it is most often associated with the influenza virus, but if it occurs after that, the cause is more often in different bacteria. And bacterial pneumonia requires treatment with antibiotics. As you know, there is no point in an antibiotic for the flu itself, it does not work on viruses, so I will say again - drink antiviral preparations. As I said, pneumonia and bronchitis are the most common, but not the worst. The most severe are the complications from the central nervous system, neuroinfections - meningitis, encephalitis. Fortunately, they are much less common than respiratory complications, but they have a more severe course. I want to point out one more characteristic thing - all the chronic diseases that the respective patient has are getting worse. In fact, this is also the reason for the high death rate in the elderly after the flu.
Prof. Stoycheva, let me ask you to briefly discuss another disease - scarlet fever. What is the characteristic?
- A completely different disease. Scarlet fever is a bacterial infection that is caused by streptococci through the air-droplet route, but it is not as contagious. There may be small epidemic outbreaks in kindergartens, in schools, generally in closer contact. The characteristic symptoms of this infection are purulent angina, an increase in cervical lymph nodes, high fever. It usually starts with high fever, sore throat and vomiting - these are the first symptoms. It's as if the symptoms tell where the lesions are. And in the first one to two days, the scarlet fever rash appears, which is very small. These are tiny spots, the size of the head of a wart, it appears most often under the armpits, on the neck as well. Very small pinkish-red spots that make the skin itchy and dry like goosebumps. You know how fine, soft and velvety soft the skin of children is. That's why it makes an impression when these hair follicles rise up on the skin. And when pardoning, you can feel how she has become rough. Regarding the localization of the rash, as I said under the armpits, on the neck, in addition, it can appear on the lower abdomen, in the folds of the arms as well. There is no rash on the face, but the cheeks are burning, very red, the chin is pale. That is, a triangle is drawn and on the side are very red flaming cheeks. A characteristic symptom is the color of the tongue - we call it raspberry tongue.
We are exposed to over 100 rhinoviruses
Viral respiratory infections, i.e., viral infections of the respiratory system, are especially relevant for the season. No flu yet, but there are rhinoviruses, it's the seasonal cold. There are over 100 serotypes of rhinoviruses, and you should also know that the immunity that builds up after getting sick is very short. We can encounter these 100 serotypes of rhinoviruses and get sick many times in the fall. These are the seasonal, ordinary runny noses, and the viruses that cause them multiply at a temperature of up to 35 degrees, so they thrive only in the nose and nasopharynx. For this reason, there are no bronchitis and pneumonias due to rhinoviruses. The main characteristics of the disease are runny nose - in the beginning with a serious secretion, later it can become a little cloudy. But, of course, these diseases are associated with a certain malaise - a temperature slightly increased to 37.5 degrees, although most often they occur without it. A person breathes hard, the nose is blocked. These are the seasonal colds that we go through several times in these transitional seasons when the temperature amplitudes are too great for one to judge how to dress
“These infections suggest only symptomatic treatment and nasal drops. But with or without treatment, they last up to a week or so. There are good drops for the nose, which, by the way, should not be overused - no longer than 3-4 days, because prolonged treatment with drops dries out the nasal mucosa. New saline solutions are now available for children. After 3-4 days of nose drops, you can use them, as the nasal mucosa will not be damaged," explained the expert.