As winter and spring arrive, respiratory diseases are prevalent. What should the elderly do?

This is the 4759th article of Da Yi Xiao Hu

The Chinese New Year is approaching, and emergency departments in hospitals across the country are crowded with patients. Looking around, there are long queues of people day and night, with the elderly and children being the hardest hit. The emergency rooms of many tertiary hospitals often have dozens of people queuing up for treatment at night, and it takes 2 to 3 hours to see a doctor. Most of these patients come for fever.

For these patients with fever, as soon as they arrive at the hospital, they are generally tested for influenza A, influenza B, mycoplasma and other pathogen antibodies. We found that some people were mycoplasma positive, many were influenza A positive, some were influenza B positive, and some even had mixed infections, with two to three infections combined. Some of them had signs of lung inflammation on chest X-rays or lung CT scans. Some people's tests showed elevated white blood cell counts, while some did not.

For this epidemic of respiratory infections, each patient may be infected with different types of pathogens, so targeted medication and symptomatic treatment are required accordingly.

Characteristics and treatment of mycoplasma infection

Mycoplasma is neither bacteria nor virus, but the smallest prokaryotic pathogenic microorganism between them. Currently, more than 60 species of mycoplasma have been discovered, among which Mycoplasma pneumonia is the main culprit causing mycoplasma pneumonia.

Epidemic characteristics of mycoplasma pneumonia:

1. It spreads quickly. It is widely present in nature and can spread quickly in communities and nursing homes through droplets and contact.

2. The incubation period is long, which can last for 1 to 3 weeks after infection, and can easily lead to further expansion of the scope of transmission.

3. The infectious period is long, and the patient is contagious from the incubation period to the several weeks during which symptoms are relieved.

4. The epidemic season is mostly in autumn and winter.

Mycoplasma pneumoniae can be widely prevalent due to the above four characteristics. The respiratory symptoms of mycoplasma pneumonia are fever and cough. Coughs are mostly paroxysmal dry coughs, and a few have sticky sputum. The cough will gradually worsen and spasmodic coughs will occur. The course of the disease can last for 2 weeks or even longer. Severe cases may be accompanied by pleural effusion and atelectasis. Some elderly people with low immunity are in critical condition and develop rapidly. Respiratory distress may occur and even respiratory support may be required, which can lead to death.

Methods for rapid and accurate diagnosis of mycoplasma infection include mycoplasma culture, serological examination, mycoplasma antigen test, and mycoplasma nucleic acid test. Among them, the simplest and most feasible is serological examination. Antibody IgM is an indicator of recent infection. Generally, it begins to rise within 1 week of the initial infection, reaches a peak in 3 to 4 weeks, and gradually decreases in 1 to 3 months.

The main treatments for mycoplasma infection are:

1. General and symptomatic treatment: adequate rest, ensuring water and electrolyte balance, and appropriate oxygen therapy.

2. Take antipyretics correctly, such as acetaminophen.

3. For severe cough, you can use nebulizer preparations, mechanical expectoration, percussion expectoration and other physical methods.

4. Anti-infection treatment: Early, adequate, and sufficient course of anti-mycoplasma treatment, such as azithromycin, 0.5 g at a time, once a day, for 3 consecutive days.

5. Some elderly critically ill patients can be treated with glucocorticoids and immunoglobulins.

For azithromycin, we should pay attention to the interaction with other drugs such as compound licorice mixture. When azithromycin and compound licorice mixture are used at the same time, it may cause rapid heartbeat, palpitations, and prolonged QT interval on the electrocardiogram.

Characteristics and treatment of influenza virus infection

Influenza viruses are divided into four types: A, B, C, and D. The most common are A and B. Influenza A and B viruses are the protagonists of the influenza epidemic. For example, influenza A, also known as influenza A, is an acute respiratory infectious disease caused by influenza A virus. According to the National Influenza Center's supervision data for the 52nd week of 2023 (as of December 31, 2023), this influenza is still dominated by influenza A, but the proportion of influenza B is increasing.

Characteristics of influenza A and influenza B

1. The incubation period is generally 1 to 7 days, mostly 2 to 4 days. The patient is contagious at the end of the incubation period and is highly contagious on the 3rd to 5th day of onset. The contagious period is longer in people with pneumonia and low immunity.

2. Transmission routes: through droplets such as sneezing and coughing; through direct or indirect contact with mucous membranes such as the mouth, nose, and eyes; and through contact with objects contaminated by the virus; in relatively closed places with poor air circulation, the virus can be transmitted in the form of aerosols.

3. Clinical features: sudden high fever, obvious aversion to cold; severe headache, body aches; persistent fatigue, weakness; chest pressure, etc.

Whether it is influenza A or influenza B, the symptoms are almost the same clinically and it is difficult to distinguish them. They mainly show fever, cough, sore throat, body aches, etc., while influenza A may also have diarrhea, abdominal pain, etc., while influenza B is more likely to have eye pain. Generally speaking, a variety of pathogens of upper respiratory tract infection may cause such symptoms. Therefore, it is difficult to judge whether it is influenza virus infection based on symptoms alone, let alone whether it is influenza A or influenza B infection. To confirm the diagnosis, blood tests or respiratory mucus tests are required. The simplest and most common way is the screening of influenza A and influenza B antigens.

Treatment of influenza A and B

1. General treatment: Patients should rest, drink plenty of water, and gargle with salt water to keep the mouth, nose and pharynx clean.

2. Give antipyretic and analgesic drugs when the temperature exceeds 38.5°C

3. When coughing, cough suppressants can be given, such as compound licorice mixture, loquat juice, etc.

4. Antiviral drugs, such as oseltamivir, a specific drug for influenza A, should be taken twice a day, 75 mg each time. In principle, the sooner the anti-influenza virus treatment is started, the better, preferably within 24 hours of onset.

A bacterial infection often occurs several days after a viral infection, indicating an increase in white blood cell count. At this time, antibiotics such as cephalosporins can be used appropriately. While using the drugs reasonably and in a standardized manner, attention should also be paid to drug interactions.

In winter and spring, when there are multiple pathogens with high incidence, the elderly should take good protection

1. Keep warm and wear a mask if necessary;

2. Pay attention to hand hygiene and wash your hands frequently;

3. Take in enough fresh fruits and vegetables, supplement vitamin C, drink plenty of water, and keep enough drinking water;

4. Exercise appropriately to strengthen immunity;

5. Pay attention to the ventilation of the room and avoid areas where people gather or where the air is not circulating;

6. Get influenza vaccine as needed, especially for the elderly and infirm.

Author: Shanghai Fifth People's Hospital Affiliated to Fudan University

Emergency Department Attending Physician Li Qingqing