Asthenia after influenza or physical fatigue. Types of asthenia

Asthenic syndrome, or asthenia (translated from Greek means “lack of strength”, “powerlessness”) is a symptom complex indicating that the body’s reserves are depleted, and it is working with its last strength. This is a very common pathology: according to various authors, the incidence of it ranges from 3 to 45% in the population. About why asthenia occurs, what are the symptoms, principles of diagnosis and treatment of this condition and will be discussed in our article.

Asthenia is a psychopathological disorder that develops against the background of diseases and conditions that deplete the body in one way or another. Some scientists believe that asthenic syndrome is a harbinger of other, very serious, diseases of the nervous system and mental sphere.

For some reason, many ordinary people think that asthenia and ordinary fatigue are one and the same condition, named differently. They are wrong. Natural fatigue is a physiological condition that develops as a result of physical or mental overload on the body, is short-term, completely disappears after a good rest. Asthenia is pathological fatigue. At the same time, the body does not experience any acute overload, but it experiences chronic stress due to one or another pathology.

Asthenia does not develop overnight. This term is applicable to people who have symptoms of asthenic syndrome for a long time. Symptoms gradually increase, the patient's quality of life decreases significantly over time. A good rest alone is not enough to eliminate the symptoms of asthenia: complex treatment by a neuropathologist is necessary.

Causes of asthenia

Asthenia develops when, under the influence of a number of factors, the mechanisms of energy production in the body are depleted. Overstrain, depletion of structures responsible for higher nervous activity, combined with a deficiency of vitamins, microelements and other important nutrients in food and metabolic disorders form the basis of asthenic syndrome.

We list the diseases and conditions against which, as a rule, asthenia develops:

• infectious diseases (influenza and other acute respiratory viral infections, tuberculosis, hepatitis, food poisoning, brucellosis);
• diseases of the digestive tract (peptic ulcer, severe dyspepsia, acute and chronic gastritis, pancreatitis, enteritis, colitis, and others);
• diseases of the heart and blood vessels (essential hypertension, atherosclerosis, arrhythmias, coronary heart disease, in particular myocardial infarction);
• diseases of the respiratory system (chronic obstructive pulmonary disease, pneumonia, bronchial asthma);
• kidney disease (chronic pyelo- and glomerulonephritis);
• diseases of the endocrine system (diabetes mellitus, hypo- and hyperthyroidism);
• blood diseases (especially anemia);
• neoplastic processes (all kinds of tumors, especially malignant ones);
• pathologies of the nervous system (, and others);
• mental illnesses (depression, schizophrenia);
• postpartum period;
• postoperative period;
• pregnancy, especially multiple pregnancy;
• lactation period;
• psycho-emotional stress;
• taking certain medications (mainly psychotropic), drugs;
• in children - an unfavorable situation in the family, difficulties in communicating with peers, excessive demands of teachers and parents.

It should be noted that prolonged monotonous work, especially with artificial lighting in a confined space (for example, submariners), frequent night shifts, work that requires processing a large amount of new information in a short time, may be important in the development of asthenic syndrome. Sometimes it occurs even when a person moves to a new job.

The mechanism of development, or pathogenesis, asthenia

Asthenia is a reaction of the human body to conditions that threaten the depletion of its energy resources. With this disease, first of all, the activity of the reticular formation changes: a structure located in the region of the brain stem, responsible for motivation, perception, level of attention, providing sleep and wakefulness, autonomic regulation, muscle work and activity of the body as a whole.

There are also changes in the work of the hypothalamic-pituitary-adrenal system, which plays a leading role in the implementation of stress.

Numerous studies have shown that immunological mechanisms also play a role in the development of asthenia: certain immunological disorders have been identified in people suffering from this pathology. However, the viruses known to date are not of direct importance in the development of this syndrome.

Classification of asthenic syndrome

Depending on the cause that caused asthenia, the disease is divided into functional and organic. Both of these forms occur with approximately the same frequency - 55 and 45%, respectively.

Functional asthenia is a temporary, reversible condition. It is a consequence of psycho-emotional or post-traumatic stress, acute infectious diseases or increased physical exertion. This is a kind of reaction of the body to the above factors, so the second name of functional asthenia is reactive.

Organic asthenia is associated with certain chronic diseases that occur in a particular patient. Diseases that can result in asthenia are listed above in the "causes" section.

According to another classification, according to the etiological factor, asthenia happens:

• somatogenic;
• post-infectious;
• postpartum;
• post-traumatic.

Depending on how long the asthenic syndrome has existed, it is divided into acute and chronic. Acute asthenia occurs after a recent acute infectious disease or severe stress and, in fact, is functional. Chronic, on the other hand, is based on some kind of chronic organic pathology and proceeds for a long time. Separately, neurasthenia is distinguished: asthenia resulting from the depletion of the structures responsible for higher nervous activity.

Depending on the clinical manifestations, there are 3 forms of asthenic syndrome, which are also three consecutive stages:

• hypersthenic (the initial stage of the disease; its symptoms are impatience, irritability, erratic emotionality, increased reaction to light, sound and tactile stimuli);
• a form of irritability and weakness (there is increased excitability, but the patient feels weak, exhausted; the person’s mood changes dramatically from good to bad and vice versa, physical activity also ranges from increased to complete unwillingness to do anything);
• hyposthenic (this is the last, most severe form of asthenia, characterized by reduced working capacity, weakness, fatigue, constant drowsiness, complete unwillingness to do something and the absence of any emotions; there is also no interest in the environment).

Symptoms of asthenia

Patients suffering from this pathology present a wide variety of complaints. First of all, they are worried about weakness, they constantly feel tired, there is no motivation for any activity, memory and quick wit are disturbed. They cannot focus their attention on something specific, they are absent-minded, constantly distracted, crying. For a long time they cannot remember a familiar surname, a word, a desired date. They read mechanically, not understanding and not remembering the material they read.

Also, patients are concerned about symptoms from the vegetative system: increased sweating, hyperhidrosis of the palms (they are constantly wet and cool to the touch), feeling short of breath, shortness of breath, pulse lability, blood pressure jumps.

Some patients also note various pain disorders: pain in the heart, back, abdomen, muscles.

On the part of the emotional sphere, it is worth noting the feeling of anxiety, internal tension, frequent mood swings, and fears.

Many patients are concerned about a decrease in appetite up to its complete absence, weight loss, decreased sexual desire, menstrual irregularities, severe symptoms of premenstrual syndrome, increased sensitivity to light, sound, and touch.

Of the sleep disorders, it should be noted heavy falling asleep, frequent awakenings at night, nightmares. After sleep, the patient does not feel rested, but, on the contrary, feels tired and weak again. As a result, a person's well-being worsens, which means that working capacity decreases.

A person becomes excitable, irritable, impatient, emotionally unstable (his mood deteriorates sharply at the slightest failure or in case of difficulty in performing any action), communication with people tires him, and the tasks set seem impossible.

In many individuals with asthenia, the temperature rises to subfebrile values, sore throats, some groups of peripheral lymph nodes are enlarged, in particular, cervical, occipital, axillary, their pain on palpation, pain in muscles and joints. That is, there is an infectious process and insufficiency of immune functions.

The patient's condition worsens significantly in the evening, which is manifested by an increase in the severity of all or some of the above symptoms.

In addition to all these symptoms related directly to asthenia, a person is concerned about the clinical manifestations of the underlying disease, the one against which the asthenic syndrome developed.

Depending on the cause that caused asthenia, its course has some features.

• The asthenic syndrome accompanying neurosis is manifested by tension of the striated muscles and an increase in muscle tone. Patients complain of constant fatigue: both during movement and at rest.
• In chronic circulatory failure in the brain, the patient's motor activity, on the contrary, decreases. Muscle tone is reduced, the person is lethargic, does not feel the desire to move. The patient is experiencing the so-called "incontinence of emotions" - it would seem that he is crying for no reason. In addition, there is difficulty and slowing down of thinking.
• With brain tumors and intoxications, the patient feels pronounced weakness, impotence, unwillingness to move and engage in any, even previously beloved, deeds. His muscle tone is reduced. A symptom complex resembling myasthenia gravis may develop. Mental weakness, irritability, hypochondriacal and anxious-fearful moods, as well as sleep disorders are typical. These disorders are usually persistent.
• Asthenia that occurs after injuries can be both functional - traumatic cerebral palsy, and be of an organic nature - traumatic encephalopathy. Symptoms of encephalopathy, as a rule, are pronounced: the patient experiences constant weakness, notes memory impairment; his circle of interests gradually decreases, there is a lability of emotions - a person can be irritable, “explode” over trifles, but suddenly becomes lethargic, indifferent to what is happening. New skills are hard to learn. Signs of dysfunction of the autonomic nervous system are determined. Symptoms of cerebrosthenia are not so pronounced, but it can last for a long time, for months. If a person leads a correct, sparing lifestyle, eats rationally, protects himself from stress, the symptoms of cerebrovascular disease become almost invisible, however, against the background of physical or psycho-emotional overload, during SARS or other acute diseases, cerebrovascular disease worsens.
• Post-influenza asthenia and asthenia after other acute respiratory viral infections are initially hypersthenic in nature. The patient is nervous, irritable, experiences a constant feeling of internal discomfort. In the case of severe infections, a hyposthenic form of asthenia develops: the patient's activity is reduced, he always feels drowsy, irritated over trifles. Muscle strength, sexual desire, motivation are reduced. These symptoms persist for more than 1 month and become less pronounced over time, and a decrease in working capacity, unwillingness to perform physical and mental work comes to the fore. Over time, the pathological process acquires a protracted course, in which symptoms of a vestibular disorder appear, memory impairment, inability to concentrate and perceive new information.

Diagnosis of asthenia

Often, patients believe that the symptoms they experience are not terrible, and everything will work out by itself, one has only to get enough sleep. But after sleep, the symptoms do not go away, and over time they only get worse and can provoke the development of very serious neurological and psychiatric diseases. To prevent this from happening, do not underestimate asthenia, but if symptoms of this disease occur, consult a doctor who will make an accurate diagnosis and suggest what measures to take to eliminate it.

Diagnosis of asthenic syndrome is based mainly on complaints and anamnesis data of the disease and life. The doctor will ask you how long ago certain symptoms appeared; whether you are engaged in heavy physical or mental work, whether you have recently experienced overload associated with it; whether you associate the occurrence of symptoms with psycho-emotional stress; whether you suffer from chronic diseases (which ones - see above, in the "causes" section).

Then the doctor will conduct an objective examination of the patient to detect changes in the structure or function of his organs.

Based on the data obtained, in order to confirm or refute a particular disease, the doctor will prescribe a series of laboratory and instrumental studies to the patient:

• general blood analysis;
• general urine analysis;
• biochemical blood test (glucose, cholesterol, electrolytes, kidney, liver tests and other indicators necessary according to the doctor);
• blood test for hormones;
• PCR diagnostics;
• coprogram;
• ECG (electrocardiography);
• Ultrasound of the heart (echocardiography);
• Ultrasound of the abdominal cavity, retroperitoneal space and small pelvis;
• fibrogastroduodenoscopy (FGDS);
• chest x-ray;
• Ultrasound of the vessels of the brain;
• computed or magnetic resonance imaging;
• consultations of related specialists (gastroenterologist, cardiologist, pulmonologist, nephrologist, endocrinologist, neuropathologist, psychiatrist and others).

Asthenia treatment

The main direction of treatment is the therapy of the underlying disease, the one against which asthenic syndrome arose.

Lifestyle

Lifestyle modification is important.

• optimal mode of work and rest;
• night sleep lasting 7-8 hours;
• refusal of night shifts at work;
• calm environment at work and at home;
• minimizing stress;
• daily physical activity.

Often, patients benefit from a change of scenery in the form of a tourist trip or a vacation in a sanatorium.

The diet of people suffering from asthenia should be rich in protein (lean meat, legumes, eggs), B vitamins (eggs, green vegetables), C (sorrel, citrus fruits), tryptophan amino acid (wholemeal bread, bananas, hard cheese) and other nutrients. Alcohol should be excluded from the diet.

Pharmacotherapy

Drug treatment of asthenia may include drugs from the following groups:

• adaptogens (eleutherococcus extract, ginseng, magnolia vine, Rhodiola rosea);
• nootropics (aminalon, pantogam, gingko biloba, nootropil, cavinton);
• sedatives (novo-passit, sedasen and others);
• preparations of procholinergic action (enerion);
• (azafen, imipramine, clomipramine, fluoxetine);
• tranquilizers (phenibut, clonazepam, atarax and others);
• (eglonil, teralen);
• B vitamins (Neurobion, Milgamma, Magne-B6);
• complexes containing vitamins and microelements (multitabs, duovit, berocca).

As it became clear from the list above, there are a lot of drugs that can be used to treat asthenia. However, this does not mean that this entire list will be assigned to one patient. The treatment of asthenia is predominantly symptomatic, that is, the prescribed drugs depend on the predominance of certain symptoms in a particular patient. Therapy begins with the use of the lowest possible doses, which, if tolerated normally, can subsequently be increased.

Non-drug treatments

Along with pharmacotherapy, a person suffering from asthenia may receive the following types of treatment:

1. The use of infusions and decoctions of soothing herbs (valerian root, motherwort).
2. Psychotherapy. It can be carried out in three directions:
   • impact on the general condition of the patient and on individual neurotic syndromes diagnosed in him (group or individual auto-training, self-hypnosis, suggestion, hypnosis); techniques can increase motivation for recovery, reduce anxiety, increase emotional mood;
   • therapy that affects the mechanisms of the pathogenesis of asthenia (conditioned reflex techniques, neuro-linguistic programming, cognitive behavioral therapy);
   • methods that affect the causal factor: gestalt therapy, psychodynamic therapy, family psychotherapy; the purpose of applying these methods is the patient's awareness of the connection between the occurrence of asthenia syndrome and any personality problems; during the sessions, children's conflicts or traits inherent in the personality in adulthood are revealed, contributing to the development of asthenic syndrome.
3. Physiotherapy:
   • exercise therapy;
   • massage;
   • hydrotherapy (Sharko shower, contrast shower, swimming and others);
   • acupuncture;
   • phototherapy;
   • stay in a special capsule under the influence of thermal, light, aromatic and musical influences.

At the end of the article, I would like to repeat that one cannot ignore asthenia, one cannot hope for “it will go away on its own, just get some sleep”. This pathology can develop into other, much more serious neuropsychiatric diseases. With timely diagnosis, it is quite simple to deal with it in most cases. It is also unacceptable to engage in self-medication: illiterately prescribed drugs can not only not give the desired effect, but also harm the health of the patient. Therefore, if you find yourself experiencing symptoms similar to those described above, please seek the help of a specialist, in this way you will significantly bring your day of recovery closer.

Many people who have just recovered from an acute respiratory viral infection complain of a lethargic and weakened state. Very often, fever, cough, runny nose and other symptoms of the disease are replaced by severe weakness.

In fact, this is not surprising. After all, during the fight against a cold viral disease, the human body spends a lot of energy and strength. Therefore, after the disease has receded, a person needs a few more days to return to normal.

The final recovery after SARS can be accelerated. To do this, you must adhere to the correct mode.

Symptoms of a weakened state

After SARS is left behind, adults and children often complain of new unpleasant symptoms. They are quite individual, however, general patterns can be traced in them. So, these include:

• persistent feeling of weakness;
• reduced performance;
• lack of proper appetite;
• poor concentration of attention;
• may feel dizzy;
• fast fatiguability;
• lethargy and drowsiness;
• irritability.

In such a situation, some doctors are talking about asthenia or asthenic syndrome. This pathological condition is characterized by a general weakness of the body, sudden mood swings, capriciousness and tearfulness. Also, a frequent symptom of asthenia is a low body temperature from 35.5 to 36.3 degrees. You can find all additional information in the publication "and an adult".

If the asthenic syndrome is not given due attention, it can become chronic. In addition, if you do not take action adequate to the situation, it can contribute to the development of diseases of the cardiovascular system.

What do we have to do?

If, after suffering ARVI, you have weakness and apathy, then a number of specific actions should be taken. You can even talk about the necessary regimen, which should be followed by a person recovering from a cold.

1. First of all, after the disappearance of the symptoms of the disease, you should not immediately return to your active, saturated rhythm of life. This process should be slow and gradual. You can't overwork.
2. It is very important to have a good rest. The quality of sleep is of great importance. Rest time should be sufficient.
3. Water procedures can help restore vitality. First of all, it is worth talking about a contrasting soul. Also a good option would be taking a bath with sea salt. However, such procedures should not be abused.
4. Be sure to take walks in the fresh air. It is best to get out into nature. For residents of large cities, a city park or square can become a place for such walks.
5. Nervous shocks and overloads should also be kept to a minimum. A positive mental state is very important. In this regard, you should do what you really love. Hobbies and socializing with friends can help beat asthenia.
6. Proper nutrition also plays an important, and perhaps decisive, role in the final victory over acute respiratory viral infection.

Proper nutrition after illness

You need to eat right not only during an acute respiratory viral infection, but also after its symptoms recede. It is the food factor that becomes one of the decisive ones during the fight against post-cold asthenia.

In the field of SARS, fatty and heavy foods must be completely excluded from your diet. Also, do not abuse flour products. Preference should be given to cereals, fish, lean meat, seafood, dairy products, fresh vegetables and fruits.

If, having had an acute respiratory viral infection, you are faced with a lack of appetite, then you should not force yourself to eat. In this case, we recommend chicken broth. You can add a hard-boiled egg and finely chopped greens to it.

Fresh bee honey can be a great alternative to confectionery sweets.

It is also important to drink enough fluids. You need to drink at least two liters of fluid per day. Preference should be given to warm and sweet tea with lemon. This will allow you to quickly defeat asthenic syndrome.

The main cause of asthenia in this case is the flu. How can this syndrome be overcome?

It is possible to judge the appearance of this condition only if there are such symptoms:

• fatigue.
• Excessive irritability.
• Sleep disturbance.
• Decreased memory, concentration and performance.

Neurologists note the main cause of this disease in violation of metabolism in the brain, which is observed after various somatic diseases.

Headache, fatigue and increased fatigue are observed in a person after suffering the flu. Fatigue becomes not only physical, but also neuropsychic. These symptoms appear without any exertion, and fatigue does not go away even after proper rest or sleep.

Violation of protein metabolism also affects the work of the central nervous system. The level of ammonia rises, due to which the activity of the transmission of nerve impulses decreases and the regulation of energy metabolism is disturbed.

Causes of asthenia

Asthenia may be preceded by many factors. Depletion of organs after various ailments is quite normal, which provokes asthenia. The main causes of asthenic syndrome are:

• Infectious diseases.
• Physical exercise.
• Mental stress.
• Emotional loads.
• Mental loads.
• The wrong mode of the day, that is, a combination of rest and work.
• Irregular and improper nutrition.

Neurasthenia is called an ailment that arose as a result of strong emotional experiences. This violation can occur before the manifestation of another disease of the body. It either accompanies a central disease, or occurs after a person has been ill.

Asthenia can manifest itself in various symptoms, which largely depends on the causes of its occurrence. The main symptoms by which it can be identified are:

1. Pain in the back, heart, abdomen.
2. Frequent heartbeat.
3. Increased sweating.
4. Decreased sex drive.
5. Increased sense of fear.
6. Sensitivity to light and sound.
7. Weight loss.

Common causes of asthenia are infectious diseases, which include bronchitis or influenza. Depending on individual characteristics, asthenia may prevail either in a state of irritation or in a state of rapid fatigue.

Often, asthenia is accompanied by increased fatigue. It can be eliminated with the help of a doctor who will first conduct a diagnosis to identify concomitant signs:

• Headache.
• Irritability.
• Dizziness.
• Digestive disorders: heartburn, belching, feeling of heaviness in the stomach, loss of appetite.

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Features of the development of asthenia

Each asthenic syndrome is accompanied by its own developmental features. It all depends on the factors that caused asthenia. If we talk about the flu, then a person with asthenic syndrome becomes irritable, fussy, his temperature rises slightly, and his capacity decreases. Post-influenza asthenia lasts for a long time, sometimes up to a month.

There is a tendency to increase asthenic conditions after flu or colds. Experts explain this by the fact that before the onset of these diseases, people experience asthenic syndrome, caused, for example, by nervous experiences or physical overwork. Thus, asthenia contributes to the occurrence of influenza, colds and other diseases, and then manifests itself again, but after recovery.

Asthenia is the main ailment of modern man. This is due to the lifestyle that everyone is forced to lead if they want to succeed, achieve something and become a successful person. The individual is constantly in working condition, not allowing himself to fully relax and even recover.

Asthenia does not go away on its own, it constantly develops if you do not deal with its elimination. First, a person feels tired, then feels a breakdown. Finally, now there are thoughts that it's time to relax. However, even this does not happen, because a person does not allow himself to sleep for a long time and gain strength. As soon as the state of health has improved, the person believes that he has already recovered. He again starts work, not completely getting rid of asthenia. The main factors are perceived as secondary, which allows the disease to calmly and gradually develop.

Untreated asthenia and strenuous work lead to even more fatigue. Here a person is already really thinking about rest. However, if he allows inertia to take over, then he begins to work through force. Now asthenia is gaining momentum, it is becoming progressive.

Soon there is apathy, which is accompanied by headaches. There is no more strength and energy, a person works forcedly, through willpower. All this leads to depression.

What are the ways to overcome asthenia?

Talking about asthenia, by and large it refers to tension, fatigue, fatigue and weakness. These symptoms can be eliminated in various ways that give energy, pleasure, moral satisfaction, peace or relaxation. What are the ways to overcome asthenia?

Let's consider some of them:

1. Avoid alcoholic drinks and strong coffee. These drinks stimulate the nervous system.
2. Engage in physical exercises that do not exhaust, but bring pleasure.
3. Take a contrast shower, especially before bed.
4. Swim, not necessarily in a big rhythm. The main thing is to enjoy the process.
5. Sleep fully. This helps the brain to be more saturated with useful elements. Special medications that a doctor can prescribe will also help here.
6. Eat well. The work of the brain improves protein foods: legumes, meat, soy. Liver products and eggs (vitamin B), cheese, turkey, banana, cereal bread (they contain tryptophan). These products contribute to the production of special hormones: methionine, choline, serotonin, norepinephrine. These food substances help brain activity, which contributes to the rapid elimination of forgetfulness and absent-mindedness. Positive emotions are formed.
7. Consume vitamin C. Ascorbic acid becomes important during the period after recovery from an illness. There are many vitamins in food. Iron, magnesium, manganese, phosphorus, calcium and other elements should also be added here.
8. Take vitamin complexes. There is no need to talk about the benefits of a particular group of vitamins. You should eat foods that fill the body with various vitamins. These are: vegetables, currants, sea buckthorn, wild rose, bananas, kiwi, pears, apples. From them you can make low-fat yogurts, salads, fruit drinks.
9. Take adaptogens. They become useful if after the flu there is constant fatigue, indifference, and blood pressure decreases. Adaptogens include leuzea, ginseng, pantocrine, which are added to your favorite drinks, but not to alcoholic ones.
10. Make decoctions of herbs. If insomnia develops after the flu, then before going to bed you should use decoctions of herbs: hops, geranium, valerian. If there is no desire to make a decoction, then you can apply essential oil of lavender, oregano, etc. to the pillow. Another method for insomnia can be pouring cold water on your feet before going to bed.
11. Observe the regime of going to bed and getting up. If you always go to bed and wake up at the same time, then the body will get used to the regimen and will feel good at the time when you need to wake up.

If necessary, before going to bed, you should take a shower at a pleasant temperature for yourself.

You should rest more often, especially after recovering from the flu or another illness. At other times, you should not overload yourself with excessive work, so as not to reduce the immunity and defenses of the body, making it weak before infections.

Forecast

Asthenia, or in other words - weakness, is always felt after an illness. Depending on the gravity and the duration of the illness, a person also recovers strength for a long time. The prognosis is comforting if a person allows himself to recover, gain strength, rest after an illness that can be compared with work.

Asthenia does not affect life expectancy. It affects the general well-being of a person and the strength of his immune system. If a person does not give himself proper rest, does not restore strength and does not calm his nervous system, then his immunity becomes weak. And this is fertile ground for the penetration of viruses and bacteria to provoke a new disease.

It is not surprising that people after one illness quickly fall ill again. It is generally accepted that immunity is "hardened" after the fight against the first infection. In fact, he is exhausted, since he directed all his strength and resources to recovery.

Asthenia after infectious diseases: what to do?

In acute respiratory viral infections (ARVI), catarrhal symptoms are often replaced by an asthenic condition, which is characterized by weakness, adynamia, complete indifference to the environment and loved ones. Asthenic syndrome can be due to various diseases, including those that occur after respiratory infections. The significance of asthenia after ARVI for clinical practice is confirmed by the fact that in the International Classification of Diseases of the 10th revision, G93.3 syndrome is separately identified - fatigue syndrome after a viral infection. The appeal rate for asthenic symptoms is high and reaches 64%. The presence of asthenic disorders in children contributes to a deterioration in the quality of life, difficulties in adaptation in preschool and school institutions, learning disorders, decreased communicative activity, problems in interpersonal interactions and tension in family relationships.

When we talk about asthenia after ARVI, we are talking about reactive asthenia, which occurs in initially healthy individuals as a result of stress adaptation under stress, as well as in the period of convalescence. The most susceptible to asthenic reactions are children with reduced adaptive capabilities of the body. The causes of asthenic syndrome are very diverse. Along with asthenia due to physiological and psycho-emotional causes, asthenia associated with convalescence after infectious diseases, injuries and operations is distinguished.

The leading pathogenetic mechanism of asthenia is associated with dysfunction of the reticular formation, which regulates the activity of the cortex and subcortical structures and is the "energy center" of the central nervous system (CNS), which is responsible for active wakefulness. Other mechanisms for the development of asthenia are autointoxication by metabolic products, dysregulation of the production and use of energy resources at the cellular level. Metabolic disorders that occur with asthenia lead to hypoxia, acidosis, followed by a violation of the processes of formation and use of energy.

Post-infectious asthenovegetative disorders can have both somatic manifestations (impaired thermoregulation, respiratory, vestibular, cardiovascular, gastrointestinal disorders) and emotional-behavioral disorders (fatigue, emotional lability, hyperesthesia, sleep disorders). It is important to remember that the clinical manifestations of asthenovegetative syndrome can be a "mask" for the debut of organic pathology. Treatment of asthenia largely depends on the factors that caused it and the clinical manifestations. There are 3 main directions in the treatment strategy:

1. etiopathogenetic therapy;
2. non-specific general strengthening, immunocorrective therapy;
3. symptomatic therapy.

An important component of the treatment of asthenia is the observance of the daily regimen, exposure to fresh air, exercise, and rational nutrition.

Considering the leading role of dysfunction of the reticular formation in the development of asthenia, the neurospecific S100 protein isolated from nervous tissue is of great interest. This protein is synthesized and localized exclusively in CNS cells and is extremely important for their normal functioning, since it performs neurotrophic functions, regulates calcium homeostasis in CNS cells, and is involved in the regulation of synaptic transmission. It has been experimentally established that the release-active forms of antibodies to the S100 protein have a fairly wide spectrum of psychotropic, neurotropic and vegetative modulating activity.

Due to the fact that Tenoten contains antibodies to the S100 protein in a release-active form, it modifies its functional activity of the S100 protein itself.

The study of the dynamics of asthenovegetative manifestations after infectious diseases in children against the background of Tenoten (E.V. Mikhailov, Saratov State Medical University) showed that the drug eliminates the manifestations of asthenia, improves autonomic homeostasis, reduces anxiety in children, improves mood, facilitates learning processes and stabilizes general condition (Fig. 1).

Dynamics of asthenovegetative manifestations after infectious diseases against the background of Tenoten for children (E.V. Mikhailov, Saratov State Medical University)

A comparative randomized study led by M.Yu. Galaktionova at the Krasnoyarsk State Medical University included 60 children and adolescents aged 11 to 15 years with a clinically and instrumentally confirmed diagnosis of "vegetative dysfunction syndrome" of a permanent paroxysmal course. The main group received Tenoten 1 tablet 3 times a day, the comparison group - a course of traditional basic treatment, including nootropic and vegetotropic drugs, sedatives and, in some cases, antipsychotics. The results are presented in fig. 2.

Dynamics of symptoms in children while taking the drug Tenoten for children (M.Yu. Galaktionova, Krasnoyarsk State Medical University)

At the end of the course of treatment, the majority of examined patients in both groups showed a decrease in the number and intensity of asthenoneurotic complaints, a decrease in the severity of pain syndrome (headaches, cardialgia, abdominal pain). At the same time, in 80% of patients of the main group, positive dynamics was observed already by the end of the 2nd week from the start of treatment (on the 10–14th day). An improvement in the psycho-emotional background, the disappearance of anxiety, a significant increase in working capacity, concentration of attention and normalization of sleep were noted by the 14–17th day in 73.3% of the patients of the main group, which indicated the nootropic effect of Tenoten. At the same time, the dynamics of the described clinical symptoms in patients of the comparison group was noted only in 43.3% of cases at the time of discharge from the hospital.

In the study by A.P. Rachin, while taking Tenoten, there was an improvement in concentration and productivity of attention compared to the control group.

As an antioxidant agent for asthenic syndrome, it is possible to use course Coenzyme Q10, a vitamin-like substance that is directly involved in the synthesis of adenosine triphosphate, antioxidant protection and helps restore other antioxidants (vitamin E). It is important to remember that omega-3 fatty acids, the main dietary source of which are fish and some plant products, have a significant neurometabolic effect.

Thus, only programmatic treatment of asthenovegetative syndrome, including minimization of risk factors, correction of autonomic dysfunction, immune imbalance (for frequently ill children), and sanitation of foci of infection will make it possible to cope with this pathological condition and prevent its development in the future.

Treatment of asthenia after influenza

Symptoms of postviral asthenia

The very word "asthenia" literally means "weakness". Asthenia can have various causes. Asthenic syndrome after the flu is a violation of well-being, provoked by the activity of the virus. The more severe the disease, the more pronounced its manifestations.

Usually, asthenia after the flu is accompanied by the following symptoms:

• lethargy;
• irritability, mood swings;
• apathy (unwillingness to do anything);
• fast fatiguability;
• sleep disturbance;
• recurrent headaches;
• dizziness;
• loss of appetite;
• constipation;
• deterioration of the skin and hair.

Often people attribute this condition to fatigue, hypovitaminosis, a bad day, etc. But if you recently had the flu, this is probably the reason.

Causes of asthenia after influenza

The main reasons for the development of post-viral asthenia:

• consequences of intoxication;
• side effects of drugs;
• fluid loss;
• lack of vitamins;
• weakening of the immune system by a viral infection.

Once in the body, the virus disrupts many biochemical processes. Changes affect first the respiratory organs, then the circulatory system (for example, the influenza virus is able to reduce the rate of blood clotting). Particles of viruses, their metabolic products, destroyed epithelial cells, etc. cause intoxication, i.e., poisoning of the body. Especially strongly intoxication affects the work of the nervous system.

With severe intoxication, convulsions, hallucinations, vomiting are possible in the acute period of the disease.

The consequences of exposure to toxins on the brain are felt for a long time after the victory of the body over the virus. That is why the head may hurt, the quality of sleep, the ability to concentrate, etc., may deteriorate.

Side effects of the drugs used also contribute to the development of asthenia. For example, large doses of interferon are known to be toxic. The abuse of antipyretic drugs adversely affects the circulatory system, liver and kidneys. If antibiotics were used to combat the complications of influenza, there is a risk of developing dysbacteriosis during the recovery period.

What to do?

How can you help your body recover from an infection? In most cases, it is enough to adjust the daily routine, diet, and some habits. It is necessary to ensure the intake of vitamins and nutrients with food, you can also take tableted vitamin-mineral complexes. However, in some cases, asthenia is so severe that it requires medical attention and special treatment.

Good Habits

To begin with, let's look at healthy habits that will help restore the balance of power and overcome the exhaustion of the body without resorting to medication.

First of all, it's food. Food should contain a large amount of vitamins, and at the same time, be easy on the intestines. The diet should include foods such as:

• fresh vegetables and fruits;
• lean meat and fish;
• dairy products;
• a variety of drinks - juices, teas with herbs and fruits, mineral waters;
• greens;
• cereal porridge.

An equally important role is played by the regime of the day.

It is necessary to allocate a sufficient number of hours for sleep and rest. Sleep in a ventilated room with a comfortable temperature. It's good to take a walk before bed.

To improve mood and speed up metabolism, there is nothing better than physical activity. Preference should be given to aerobic exercise. This is gymnastics, running, swimming. Even an ordinary walk on foot will positively affect the functioning of the brain, gastrointestinal tract and vascular-cardiac system.

medical treatment

In severe cases, asthenia after influenza requires treatment. Almost all patients with similar symptoms are prescribed vitamins, minerals, as well as biologically active additives - extracts of ginseng, eleutherococcus, magnolia vine. Echinacea tincture has an immunostimulating effect. Patients with dysbacteriosis are prescribed a course of lactobacilli. With a decrease in memory, anxiety, mood swings, sedatives are prescribed, for example, Glycine. In addition to medications, physiotherapy procedures are used.

Similar symptoms

Feeling unwell after a viral infection can speak not only about asthenic syndrome. Similar symptoms may indicate pathologies such as:

• hypovitaminosis - lack of vitamins, more often observed in winter and early spring;
• sluggish infection that arose as a complication of SARS;
• neuroinfection - inflammation of the nervous tissue caused by the entry of a virus or bacteria into the spinal cord or brain; accompanied by fever, headaches, dizziness;
• chronic fatigue is the result of constant stress at work or at home, lack of proper rest, etc.

Since many complications of viral infections are more dangerous than the primary disease, it is better to consult a doctor if suspicious symptoms appear, especially if you have recently had a severe acute respiratory infection.

Asthenia

Asthenia (asthenic syndrome) is a gradually developing psychopathological disorder that accompanies many diseases of the body. Asthenia is manifested by fatigue, decreased mental and physical performance, sleep disturbances, increased irritability, or vice versa, lethargy, emotional instability, autonomic disorders. To identify asthenia allows a thorough questioning of the patient, the study of his psycho-emotional and mnestic sphere. A complete diagnostic examination is also necessary to identify the underlying disease that caused asthenia. Asthenia is treated by selecting the optimal working regime and a rational diet, using adaptogens, neuroprotectors and psychotropic drugs (neuroleptics, antidepressants).

Asthenia

Asthenia is undoubtedly the most common syndrome in medicine. It accompanies many infections (SARS, influenza, food poisoning, viral hepatitis, tuberculosis, etc.), somatic diseases (acute and chronic gastritis, peptic ulcer of the 12th intestine, enterocolitis, pneumonia, arrhythmia, hypertension, glomerulonephritis, neurocirculatory dystonia, etc. .), psychopathological conditions, postpartum, post-traumatic and postoperative period. For this reason, asthenia is faced by specialists in almost any field: gastroenterology, cardiology, neurology, surgery, traumatology, psychiatry. Asthenia may be the first sign of an incipient disease, accompany its height, or be observed during the period of convalescence.

Asthenia should be distinguished from ordinary fatigue, which occurs after excessive physical or mental stress, change of time zones or climate, non-compliance with the regime of work and rest. In contrast to physiological fatigue, asthenia develops gradually, persists for a long time (months and years), does not go away after a good rest and needs medical intervention.

Reasons for the development of asthenia

According to many authors, asthenia is based on overstrain and exhaustion of higher nervous activity. The immediate cause of asthenia may be insufficient intake of nutrients, excessive energy expenditure or metabolic disorders. Any factors leading to depletion of the body can potentiate the development of asthenia: acute and chronic diseases, intoxication, poor nutrition, mental disorders, mental and physical overload, chronic stress, etc.

Asthenia classification

Due to the occurrence in clinical practice, organic and functional asthenia is distinguished. Organic asthenia occurs in 45% of cases and is associated with the patient's chronic somatic diseases or progressive organic pathology. In neurology, organic asthenia accompanies infectious organic lesions of the brain (encephalitis, abscess, tumor), severe traumatic brain injury, demyelinating diseases (multiple encephalomyelitis, multiple sclerosis), vascular disorders (chronic cerebral ischemia, hemorrhagic and ischemic stroke), degenerative processes (Alzheimer's disease, Parkinson's disease, senile chorea). Functional asthenia accounts for 55% of cases and is a temporary reversible condition. Functional asthenia is also called reactive, because in fact it is a reaction of the body to a stressful situation, physical overwork or an acute illness.

According to the etiological factor, somatogenic, post-traumatic, post-natal, post-infectious asthenia are also distinguished.

According to the features of clinical manifestations, asthenia is divided into hyper- and hyposthenic forms. Hypersthenic asthenia is accompanied by increased sensory excitability, due to which the patient is irritable and does not tolerate loud sounds, noise, bright light. Hyposthenic asthenia, on the contrary, is characterized by a decrease in susceptibility to external stimuli, which leads to lethargy and drowsiness of the patient. Hypersthenic asthenia is a milder form and, with an increase in asthenic syndrome, it can turn into hyposthenic asthenia.

Depending on the duration of the existence of asthenic syndrome, asthenia is classified into acute and chronic. Acute asthenia is usually functional. It develops after severe stress, acute illness (bronchitis, pneumonia, pyelonephritis, gastritis) or infection (measles, influenza, rubella, infectious mononucleosis, dysentery). Chronic asthenia is characterized by a long course and is often organic. Chronic functional asthenia refers to chronic fatigue syndrome.

Separately, asthenia associated with the depletion of higher nervous activity is distinguished - neurasthenia.

Clinical manifestations of asthenia

The symptom complex characteristic of asthenia includes 3 components: own clinical manifestations of asthenia; disorders associated with the underlying pathological condition; disorders caused by the psychological reaction of the patient to the disease. Manifestations of the asthenic syndrome itself are often absent or weakly expressed in the morning, appear and increase during the day. In the evening, asthenia reaches its maximum manifestation, which forces patients to rest without fail before continuing work or moving on to household chores.

Fatigue. The main complaint in asthenia is fatigue. Patients note that they get tired faster than before, and the feeling of fatigue does not disappear even after a long rest. If we are talking about physical labor, then there is a general weakness and unwillingness to do their usual work. In the case of intellectual labor, the situation is much more complicated. Patients complain of difficulty concentrating, memory impairment, decreased attentiveness and quick wit. They note difficulties in formulating their own thoughts and their verbal expression. Patients with asthenia often cannot concentrate on thinking about one specific problem, find it difficult to find words to express any idea, are absent-minded and somewhat slow in making decisions. In order to do the work that was feasible before, they are forced to take breaks, in order to solve the task they are trying to think about it not as a whole, but by breaking it into parts. However, this does not bring the desired results, increases the feeling of fatigue, increases anxiety and causes confidence in one's own intellectual failure.

Psycho-emotional disorders. A decrease in productivity in professional activities causes the emergence of negative psycho-emotional states associated with the patient's attitude to the problem that has arisen. At the same time, patients with asthenia become quick-tempered, tense, picky and irritable, quickly lose their temper. They have sharp mood swings, states of depression or anxiety, extremes in assessing what is happening (unreasonable pessimism or optimism). The aggravation of psycho-emotional disorders characteristic of asthenia can lead to the development of neurasthenia, depressive or hypochondriacal neurosis.

Vegetative disorders. Almost always, asthenia is accompanied by disorders of the autonomic nervous system. These include tachycardia, pulse lability, changes in blood pressure, chilliness or a feeling of heat in the body, generalized or local (palms, armpits or feet) hyperhidrosis, loss of appetite, constipation, pain along the intestines. With asthenia, headaches and a “heavy” head are possible. In men, there is often a decrease in potency.

Sleep disorders. Depending on the form, asthenia may be accompanied by various sleep disorders. Hypersthenic asthenia is characterized by difficulty falling asleep, restless and rich dreams, nocturnal awakenings, waking up early, and feeling overwhelmed after sleep. Some patients develop the feeling that they hardly sleep at night, although in reality this is not the case. Hyposthenic asthenia is characterized by the occurrence of daytime sleepiness. At the same time, problems with falling asleep and poor quality of night sleep persist.

Diagnosis of asthenia

Asthenia itself usually does not cause diagnostic difficulties for a doctor of any profile. In cases where asthenia is a consequence of stress, trauma, illness, or acts as a harbinger of pathological changes beginning in the body, its symptoms are pronounced. If asthenia occurs against the background of an existing disease, then its manifestations may fade into the background and be not so noticeable behind the symptoms of the underlying disease. In such cases, signs of asthenia can be identified by questioning the patient and detailing his complaints. Particular attention should be paid to questions about the patient's mood, sleep status, his attitude to work and other duties, as well as to his own condition. Not every patient with asthenia will be able to tell the doctor about his problems in the field of intellectual activity. Some patients tend to exaggerate existing disorders. To obtain an objective picture, along with a neurological examination, a neurologist needs to conduct a study of the patient's mnestic sphere, assess his emotional state and response to various external signals. In some cases, it is necessary to differentiate asthenia from hypochondriacal neurosis, hypersomnia, and depressive neurosis.

Diagnosis of asthenic syndrome requires a mandatory examination of the patient for the underlying disease, which caused the development of asthenia. For this purpose, additional consultations of a gastroenterologist, cardiologist, gynecologist, pulmonologist, nephrologist, oncologist, traumatologist, endocrinologist, infectious disease specialist and other narrow specialists can be carried out. Mandatory delivery of clinical tests: blood and urine tests, coprograms, determination of blood sugar, biochemical analysis of blood and urine. Diagnosis of infectious diseases is carried out by bacteriological studies and PCR diagnostics. According to the indications, instrumental research methods are prescribed: ultrasound of the abdominal organs, gastroscopy, duodenal sounding, ECG, ultrasound of the heart, fluorography or radiography of the lungs, ultrasound of the kidneys, MRI of the brain, ultrasound of the pelvic organs, etc.

Asthenia treatment

General recommendations for asthenia are reduced to the selection of the optimal mode of work and rest; refusal to contact with various harmful influences, including the use of alcohol; the introduction of health-improving physical activity into the daily routine; compliance with a fortified and appropriate diet for the underlying disease. The best option is a long vacation and a change of scenery: vacation, spa treatment, tourist trip, etc.

Patients with asthenia benefit from food rich in tryptophan (bananas, turkey meat, cheese, wholemeal bread), vitamin B (liver, eggs) and other vitamins (rose hips, black currants, sea buckthorn, kiwi, strawberries, citrus fruits, apples, raw vegetable salads and fresh fruit juices). A calm working environment and psychological comfort at home are important for patients with asthenia.

Drug treatment of asthenia in general medical practice is reduced to the appointment of adaptogens: ginseng, Rhodiola rosea, Schisandra chinensis, eleutherococcus, pantocrine. In the United States, the practice of treating asthenia with large doses of B vitamins has been adopted. However, this method of therapy is limited in its use by a high percentage of adverse allergic reactions. A number of authors believe that complex vitamin therapy is optimal, including not only vitamins of group B, but also C, PP, as well as microelements involved in their metabolism (zinc, magnesium, calcium). Often, nootropics and neuroprotectors (ginkgo biloba, piracetam, gamma-aminobutyric acid, cinnarizine + piracetam, picamelon, hopantenic acid) are used in the treatment of asthenia. However, their effectiveness in asthenia has not been definitively proven due to the lack of large studies in this area.

In many cases, asthenia requires symptomatic psychotropic treatment, which can only be selected by a narrow specialist: a neurologist, psychiatrist or psychotherapist. Thus, antidepressants are prescribed individually for asthenia - serotonin and dopamine reuptake inhibitors, antipsychotics (antipsychotics), procholinergic drugs (salbutiamine).

The success of the treatment of asthenia resulting from any disease largely depends on the effectiveness of the treatment of the latter. If it is possible to cure the underlying disease, then the symptoms of asthenia, as a rule, disappear or are significantly reduced. With a long-term remission of a chronic disease, the manifestations of asthenia accompanying it are also minimized.

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Rehabilitation of patients with post-infectious asthenia syndrome

The syndrome of post-infectious asthenia is an extremely common pathological condition in modern conditions that occurs after suffering (post-influenza asthenia), a respiratory viral infection, acute bronchitis, etc. and is characterized by weakness, severe general weakness, decreased physical and mental performance, increased fatigue. Often, patients are concerned about headaches: diffuse, without a clear localization, as well as aches in the muscles of the back and lower extremities. The frequent occurrence of this syndrome was the reason for its official inclusion as a separate category in the current International Classification of Diseases of the 10th revision (ICD-10). However, the existing guidelines for the treatment of infectious diseases devote only a few lines to this painful pathological condition for patients: general strengthening treatment is recommended (without specifying its methods), the appointment of vitamins, and prolonged exposure to air. Here are practically all the recommendations that cannot satisfy both the attending physicians and their patients.

Patients with post-infectious asthenia often turn to specialists, but without much clinical effect. Infectious disease doctors usually tell them that the infectious disease as such (flu, tonsillitis) has already ended, and now the patients are beyond their professional competence. Neurologists are used to treating patients with strokes, encephalitis, arachnoiditis, etc. and also do not see the need to deal with this contingent of patients. The drugs prescribed to such patients after consulting a psychiatrist also do not solve this clinical problem.

With an in-depth study of the causes and mechanisms of the formation of the syndrome of post-infectious asthenia, we found that in such patients, pronounced disturbances of metabolic (metabolic) processes persist with the presence of the syndrome of endogenous "metabolic" intoxication and a reduced level of energy metabolism, which causes a shortage of energy supply to organs and tissues and a decrease in energy charge. cell systems.

Against this background, there is a decrease in the factors of natural anti-infective resistance and immune homeostasis, which creates conditions for the long-term preservation of viruses (for example, the herpes simplex virus) in the body of these patients. In turn, viral persistence exacerbates disorders of the human immune system, resulting in recurrence of tonsillitis or respiratory viral infections against the background of immunodeficiency.

Our many years of clinical experience in the treatment of such patients made it possible to consider the use of bee products in this pathology, including in combination with adaptogenic herbal remedies, quite promising.

First of all, we recommended to our patients with post-infectious asthenia syndrome to consume, if possible, at least 60-80 g of honey per day with a piece of cheese and drink green tea with lemon. The combination of warm green tea, honey and lemon increased the elimination of toxic products from the body, saturating it with vitamins C and P. These vitamins have antioxidant properties, strengthen the walls of blood vessels and purify the blood and lymph from toxic substances, including the so-called "medium molecules" (toxic substances of molecular weight from 500 to 5000 daltons).

We conducted a special study together with the famous clinical biochemist Professor L.L. Gromashevskaya on the study of the detoxifying and antioxidant properties of honey-lemon drinks and green tea with honey and lemon, as a result of which it was found that with the systematic intake of these drinks 3-4 times a day after a week of such treatment, the level of toxic substances in the blood of patients with post-infectious asthenia decreases by 2-2.5 times, and the concentration of the most toxic fraction of medium molecular weight peptides - by 3-3.5 times. Clinical experience shows that even such a simple measure as drinking natural honey with green tea and lemon 3-4 cups a day for 2-3 weeks helps to reduce the level of intoxication in the blood. With severe asthenia, combined with depression or subdepression, it is advisable to add 1-2 teaspoons (5-10 ml) of syrup to tea, which helps to normalize immunity and natural anti-infective resistance.

In recent years, we have also widely used monofloral echinacea honey, obtained as a result of the collection of nectar by bees from a flowering field.

Along with honey, in patients with post-infectious asthenia syndrome, it is advisable to use propolis preparations to normalize metabolic processes and the immune system. Most often we use a 10% alcohol tincture of propolis, which we prescribe to patients 15-20 drops 2 times a day 30-40 minutes before meals with warm water, tea or milk. Experience shows that the course of treatment with propolis tincture should last at least 3-4 weeks, after which a month-long break should be taken.

As an additional means of medical rehabilitation of patients with post-infectious asthenia, one can recommend honey baths by the following method. In a bath with warm water (40-42 ° C), add 5-6 tablespoons of honey, preferably lime and buckwheat, put the patient in it for 10-15 minutes, during which he is given a decoction of lime blossom, elder flowers, dried raspberries (or raspberry jam) with honey. After the bath, the patient is wrapped for 30-40 minutes. Then the patient takes a warm shower, his bed linen is changed. Honey baths are repeated 2-3 times a week with an interval of 2-3 days between them. During the implementation of honey baths, we achieve the removal of various toxic substances from the blood with sweat, including "medium molecules". At the same time, patients should be prescribed a honey-lemon drink, which increases sweating and helps cleanse the blood of toxins.

If the patient is accustomed to visiting the bath, we recommend that he perform a bath procedure once a week, in which he treats the skin with honey. In this case, you should first warm up in the sauna, then smear yourself with a thin layer of honey in the steam room. This causes profuse sweating, which is aggravated by taking a warm lemon-honey drink in the steam room. The pores on the skin open wide and the patient loses from 3 to 6 liters of fluid with sweat in one procedure (losses are compensated with a lemon-honey drink and table mineral water). As a result, a huge amount of toxic substances are excreted from the body with sweat, and the patient's well-being improves. According to our data, this procedure helps to reduce the concentration of "medium molecules" in the blood of patients with post-infectious asthenia syndrome by an average of 1.5-2 times. Patients become active, cheerful, feel lightness throughout the body, an extraordinary vitality. We used data on the amount of microflora on the skin of such patients as an objective indicator indicating an improvement in the immunobiological properties of the patients' organism. Normally, there are about 20 bacteria on the forearm of a young adult on the area of ​​the sealant. In our patients, the number of colonies was increased by more than 10 times. This indicated a sharp decrease in the immunobiological properties of the skin and a drop in the indicators of the natural anti-infective resistance of the body as a whole.

After a course of honey baths for 2 weeks, the indicator of bacterial contamination of the skin decreased by 2-3 times, and the complex use of bee products (natural honey, propolis tincture, honey baths) provided a decrease in the level of bacterial contamination of the skin by 3-4 times within a month and more, that is, up to 40-50 bacterial cells per area of ​​the sealant, which corresponded to the simultaneous improvement in the well-being and general condition of the patient. It should be noted that the sauna with treatment of the patient's skin with honey has the greatest effect in improving the immunobiological properties of the body of patients with post-infectious asthenia syndrome. At the same time, the air temperature in the sauna should be kept within 85-90 ° C, since a higher temperature reduces the effect of removing toxins and other toxic substances from the bloodstream. The total duration of the procedure is 2-2.5 hours, of which the stay in the steam room is carried out in repeated cycles of 15-20 minutes (until profuse sweating), and the rest between procedures is 20-25 minutes in a warm room, wrapped in a bathrobe or thick terry sheet to keep sweating. During the rest period between visits to the steam room, it is necessary to take a honey-lemon drink and table mineral water, which improves the functional state of the blood capillaries and the entire microvascular bed as a whole and replenishes the loss of water and mineral salts with sweat. A day after such an intensive wellness procedure, the patient's general well-being improves significantly, weakness and malaise disappear, working capacity increases, and immune parameters improve. This allows us to recommend the use of a sauna with the obligatory treatment of the patient's skin with natural bee honey as an important component of the course of medical rehabilitation of patients with post-infectious asthenia syndrome.

Our long-term experience shows that the use of bee products for 30-40 days provides recovery or a significant improvement in the state of health in almost all patients with post-infectious asthenia. Nevertheless, in order to avoid relapses of this pathological condition and its transformation into chronic fatigue syndrome, we recommend that our patients continue to widely use honey in food (while refusing sugar) and also take propolis tincture 3 times a day 2-3 times a year. 10-15 drops for 2-3 weeks. It is very useful to take a honey bath or visit the sauna once a week and use a lemon-honey drink as a prophylactic. The complex use of bee products provides not only the elimination of the clinical manifestations of the syndrome of post-infectious asthenia, but also prevents the development of repeated cases of influenza, tonsillitis or respiratory viral infection.

Our personal experience in the use of bee products in the complex of medical rehabilitation of patients with manifestations of post-infectious asthenia has more than 30 years, and we have repeatedly been convinced of the high efficiency of the proposed medical complex.

V.M. FROLOV,
doctor of medical sciences, professor,
N.A. PERESADIN,
doctor of medical sciences, professor
j-l "Beekeeping" No. 8, 2008

For citation: Nemkova S.A. Modern principles of treatment of post-infectious asthenic conditions in children // RMJ. 2016. №6. pp. 368-372

The article presents modern principles for the treatment of post-infectious asthenic conditions in children.

For citation. Nemkova S.A. Modern principles of treatment of post-infectious asthenic conditions in children // RMJ. 2016. No. 6. S. 368–372.

Fatigue is the most common complaint when patients visit doctors. One of the causes of this symptom may be asthenic disorders, which, according to various researchers, affect 15–45% of people. Along with increased fatigue and mental instability in patients with asthenia, irritability, hyperesthesia, autonomic disorders, and sleep disorders are observed. If simple fatigue after the mobilization of the mental and physical forces of the body can be characterized as a physiological temporary state that passes quickly after rest, then asthenia implies deeper pathological changes that last for months and years, which are quite difficult to cope with without medical help.

Classification of asthenic conditions

1. Organic form
It occurs in 45% of patients and is associated with chronic somatic diseases or progressive pathologies (neurological, endocrine, hematological, neoplastic, infectious, hepatological, autoimmune, etc.).

2. Functional form
Occurs in 55% of patients and is considered a reversible, temporary condition. Such a disorder is also called reactive, because it is the body's response to stress, overwork, or an acute illness (including SARS, influenza).
Separately, mental asthenia is distinguished, in which, along with functional borderline disorders (anxiety, depression, insomnia), an asthenic symptom complex is detected.
When classifying according to the severity of the process, acute asthenia is distinguished, which is a reaction to stress or minor overload, and chronic asthenia that occurs after infectious diseases, childbirth, etc.
By type, hypersthenic asthenia is distinguished, which is characterized by hyperexcitability of sensory perception, and hyposthenic asthenia - with a reduced threshold of excitability and susceptibility to external stimuli, with lethargy and daytime sleepiness.
In the ICD-10, asthenic conditions are presented in several sections: asthenia NOS (R53), state of exhaustion of vital forces (Z73.0), malaise and fatigue (R53), psychasthenia (F48.8), neurasthenia (F48.0), as well as weakness - congenital (P96.9), senile (R54), exhaustion and fatigue due to nervous demobilization (F43.0), excessive exertion of forces (T73.3), prolonged exposure to adverse conditions (T73.2), exposure to heat (T67 .5), pregnancy (O26.8), fatigue syndrome (F48.0), fatigue syndrome after a viral illness (G93.3).

Post-infectious asthenic syndrome:
- occurs as a result of an infectious disease (ARVI, influenza, tonsillitis, hepatitis, etc.), occurs in 30% of patients who complain of physical fatigue;
- The first symptoms appear after 1-2 weeks. after an infectious disease and persist for 1-2 months, while if the root cause was of a viral origin, then periods of temperature fluctuations are possible;
- general fatigue, fatigue, aggravated by physical exertion, weakness, irritability, sleep disturbance, anxiety, tension, difficulty concentrating, emotional instability, resentment, tearfulness, irascibility, capriciousness, impressionability, decreased appetite, sweating, feeling of interruptions in the heart , lack of air, lowering the tolerance threshold for various stimuli: loud sounds, bright light, vestibular loads.
This is explained by the fact that after the cure of the underlying disease, small disturbances in energy and metabolic processes remain in the body, which provoke the development of malaise. If the asthenic syndrome is left unattended, then its progression can cause secondary infection, which will significantly worsen the functioning of the immune system and the patient's condition as a whole.
Allocate two main types of post-influenza asthenia:
- hypersthenic character: this type of asthenia occurs in the early stages with mild forms of the course of influenza, the main symptoms are internal discomfort, irritability, self-doubt, reduced performance, fussiness and lack of concentration;
- hyposthenic character: this kind of asthenia is characteristic of severe forms of influenza, while activity first of all decreases, drowsiness and muscle weakness appear, short-term outbursts of irritability are possible, the patient does not feel the strength for vigorous activity.

Clinical manifestations of post-infectious asthenia
- Increased exhaustion of mental and physical functions, while the leading symptoms are increased fatigue, fatigue and weakness, inability to fully relax, which leads to prolonged mental and physical stress.

Concomitant manifestations of asthenia
- Emotional instability, which is most often expressed in frequent mood swings, impatience, restlessness, anxiety, irritability, restlessness, internal tension, inability to relax.
- Vegetative or functional disorders in the form of frequent headaches, sweating, loss of appetite, interruptions in the heart, shortness of breath.
- Cognitive impairment in the form of memory and attention loss.
– Hypersensitivity to external stimuli, such as the squeak of a door, the noise of a TV or a washing machine.
- Sleep disturbance (difficulty falling asleep at night, lack of energy after a night's sleep, daytime sleepiness).
Follow-up observations of children who had influenza and acute respiratory viral infections with lesions of the nervous system revealed that the main disorder that occurs in children after influenza is asthenia, which has its own characteristics depending on age. In young children, asthenia is more often manifested by astheno-hyperdynamic syndrome, in older children - astheno-apathetic. It has been shown that cerebral asthenia in a child is characterized by exhaustion, irritability, manifested by affective outbursts, as well as motor disinhibition, fussiness, mobility; at the same time, long-term asthenic conditions that develop in children after influenza can lead to memory impairment, mental retardation and mental decline, as well as anorexia, excessive sweating, vascular lability, prolonged low-grade fever, and sleep disorders, which allowed researchers to talk about damage to the diencephalic region . Diencephalic pathology in children after influenza most often occurs in the form of neuroendocrine and vegetative-vascular symptoms, diencephalic epilepsy, neuromuscular and neurodystrophic syndromes. To a large extent, after the flu, the emotional sphere of the child suffers. D.N. Isaev (1983) noted in children post-influenza complications in the form of psychosis, in which emotional disorders came to the fore. This is also evidenced by the data of other researchers who described a mood disorder with a predominance of depression in children after the flu. The development of amental-delirious syndrome, psychosensory changes, impaired perception of the environment with insufficient orientation were noted. In addition to mental changes, after the flu, neurological disorders occur in the form of hearing, vision, speech, movement, and seizure disorders.
A study devoted to the study of psychoemotional disorders in patients with Epstein-Barr virus disease, viral infectious mononucleosis and mumps infection with serous meningitis showed that the disorders are presented in the form of three main syndromes: asthenic, astheno-hypochondriac and astheno-depressive, while the diversity and frequency of occurrence of psychoemotional disorders depend on the duration and severity of the post-viral asthenia syndrome and the state of autonomic regulation.
A number of studies devoted to the study of catamnesis in patients with lesions of the nervous system during influenza and enterovirus infection revealed functional disorders in the form of asthenia, lethargy, loss of appetite, absent-mindedness, autonomic lability (in the form of cardiovascular dysfunction and changes in the electrocardiogram) and emotional imbalance, with In this case, the frequency of occurrence of these syndromes was directly dependent on the severity of the course of the disease in the acute period and the premorbid characteristics of the organism. The premorbid state of the child in the development of post-influenza residual effects on the part of the nervous system is given very significant importance. An important role of the premorbid state in the development of the acute period of the disease, in the outcome of the disease, and, finally, in the formation of residual phenomena has been established. The unfavorable course of the post-influenza reparation period is aggravated by an early history of cerebral insufficiency (convulsions, rachitic hydrocephalus, irritability, cranial injuries), as well as hereditary burden. In order to study the functional state of the central nervous system (CNS) in patients with post-influenza complications, some authors conducted electroencephalographic studies, the results obtained most often indicated inhibition phenomena in the central nervous system in patients with post-infectious asthenia.
The largest follow-up study of the state of health and developmental characteristics of 200 children who recovered from influenza and adenovirus infection for 1–7 years after discharge from the hospital showed that 63% of patients developed normally in the future, and 37% had functional disorders in the form asthenia, emotional and vegetative lability, mild neurological syndromes (high tendon reflexes, stop clonus, etc.), while the frequency and severity of pathological changes depended on the severity of the nervous system damage in the acute phase of the disease, as well as on premorbid burden. The nature of neuropsychiatric disorders in the follow-up was different, the most common was cerebral asthenia (in 49 children out of 74 with residual effects), which manifested itself with a variety of symptoms (severe exhaustion, lethargy, easy fatigue, inability to concentrate for a long time, causeless whims, absent-mindedness, change behaviour). Schoolchildren showed a decrease in academic performance, slowness in preparing lessons, and poor memorization of what they read. Children under the age of 3-5 years had certain features in the manifestation of this syndrome (increased irritability, excitability, excessive mobility, frequent whims). The second most common syndrome was emotional disturbances, which consisted in a rapid change in mood, resentment, excessive impressionability, attacks of aggressiveness, anger, followed by depression and tearfulness. In third place were pronounced vegetative disorders (pulse lability, fluctuations in blood pressure, pallor, hyperhidrosis, cold extremities, prolonged subfebrile condition in the absence of any inflammatory processes), as well as poor appetite, a tendency to vomit during force-feeding. All these symptoms indirectly indicated damage to the diencephalic region, while the duration of these disorders was 1–3 months, less often 4–6 months. The frequency of residual effects was significantly lower in the group of children who had the correct regimen at home and followed all the instructions given to parents before discharge. With cerebral asthenia, great importance was attached to the creation of the necessary regimen, which involves: lengthening night and daytime sleep, prolonged exposure to air, reducing the school load (additional free day per week), temporary exemption from enhanced physical education (with the recommendation of daily morning exercises), the appointment of vitamins , especially group B, preparations containing phosphorus, enhanced, good nutrition. With pronounced emotional lability and vegetative imbalance, in addition to general strengthening treatment, preparations of valerian and bromine were given. All children who have had influenza and other respiratory viral infections with neurological disorders for 6 months. exempted from preventive vaccinations. The question was also raised about the advisability of creating sanatoriums, special forest schools and preschool institutions for children who have had respiratory viral and other diseases with damage to the central nervous system.

Basic principles of therapy for asthenic conditions
Treatment of asthenia involves a full recovery period after an infection, while strengthening the immune system, good nutrition, healthy sleep and rest, and rational pharmacotherapy are mandatory.
The use of psychostimulants for the treatment of patients with post-infectious asthenia is undesirable. Achieving a psychostimulating effect for such patients is possible with the help of neurometabolic drugs, nootropics, which are currently classified as anti-asthenic drugs (Nooklerin, ethylthiobenzimidazole, hopantenic acid), as well as adaptogens.
One of the most modern anti-asthenic drugs is deanol aceglumate (Nooklerin, PIK-Pharma, Russia) - a modern nootropic drug of complex action, which has a structural similarity to gamma-aminobutyric and glutamic acids, recommended for use in children from 10 years old. Nooklerin, being an indirect activator of metabotropic glutamate receptors (type 3), a precursor of choline and acetylcholine, affects the metabolism of neurotransmitters in the central nervous system, has neuroprotective activity, increases brain energy supply and resistance to hypoxia, improves glucose uptake by neurons, and modulates the detoxifying function of the liver.
The drug underwent a wide and multifaceted study in large medical centers in Russia (for 800 patients in 8 clinics), and the results obtained at the same time indicated a significant positive effect of Nooklerin on asthenic (lethargy, weakness, exhaustion, absent-mindedness, forgetfulness) and adynamic disorders.
It has been shown that Nooklerin has the most pronounced therapeutic efficacy in asthenia (in 100% of cases), astheno-depressive conditions (75%) and in adynamic depressive disorders (88%), increasing the activity of behavior in general and improving overall tone and mood. A study of the effectiveness of Nooklerin in psychogenic functional asthenia in 30 adolescents aged 13–17 years (with the determination of the patients' condition according to the MFI–20 Subjective Asthenia Scale and the Visual Analogue Scale of Asthenia) testified that the drug is an effective and safe antiasthenic agent in the treatment of this contingent of patients. It was found that the effectiveness of Nooklerin does not depend on the gender of the patient, his age and social status. After a course of Nooklerin, on the MFI-20 scale, the average total score decreased from 70.4 to 48.3 points, and on the scales reflecting general asthenia, from 14.8 to 7.7 points, while 20 out of 27 patients turned out to be responders people (74.1%). Non-responders were 25.9% of adolescents, among whom patients with asthenic manifestations on the background of long-term neurotic disorders (over 2 years) predominated. There were no other factors affecting the effectiveness of Nooklerin in the studied adolescents. The results of the study also indicated the need to take Nooklerin for at least 4 weeks, while the most pronounced anti-asthenic effect was noted at the last visit (day 28) and was absent at the 2nd visit (day 7), with the exception of the lungs. manifestations of insomnia (in 4 patients), which disappeared without medical intervention. No side effects were noted.
It has been shown that the use of Nooklerin in children aged 7–9 years with mental retardation, encephalopathy (with pronounced symptoms of asthenia and psychopathic behavior) contributed to a decrease in asthenic manifestations, improved memory, working capacity, the ability to maintain active attention, expansion of vocabulary, while headaches were leveled. , as well as manifestations of kinetosis (children tolerated transport better). When conducting a study of the effectiveness and tolerability of Nooklerin in borderline neuropsychiatric disorders, which are formed against the background of residual organic insufficiency of the central nervous system of the asthenic and neurotic spectrum, in 52 children aged 7–16 years, a positive distinct nootropic and mild stimulating effect of Nooklerin was revealed: decrease in fatigue, anxiety, decrease in emotional lability, strengthening sleep, weakening enuresis - in 83% of children, improvement in attention - in 80%, auditory verbal memory - in 45.8%, visual figurative memory - in 67%, memorization - in 36% , while the anti-asthenic and psycho-stimulating effect was not accompanied by the phenomena of psychomotor disinhibition and affective excitability. In another clinical study, involving 64 adolescents aged 14–17 years, suffering from neurasthenia against the background of school maladaptation, after treatment with Nooklerin, a significant decrease in fatigue and asthenia was noted. Deanol aceglumate is included in the standards of specialized medical care of the Russian Federation and can be used for organic, including symptomatic, mental disorders, depressive and anxiety disorders due to epilepsy. It was also revealed that Nooklerin has a positive effect on the visual analyzer in the form of an increase in its functional activity. Thus, the results of numerous studies indicate that Nooklerin is an effective and safe drug for the treatment of asthenic and asthenodepressive conditions, as well as cognitive and behavioral disorders of various origins in children.
The high therapeutic efficacy of Nooklerin in serous meningitis in children has been shown. A clinical and laboratory examination was carried out in 50 patients with serous meningitis aged 10 to 18 years, while 64% of patients had an enteroviral etiology of the disease, and 36% suffered serous meningitis of unknown etiology. During the study, the 1st group (main), along with the basic therapy of serous meningitis, received Nooklerin from the 5th day of hospitalization, the 2nd group (comparison group) received only basic therapy (antiviral, dehydration, detoxification drugs). The degree of asthenia was assessed using the Childhood Asthenia Symptom Scale and the Schatz Asthenia Scale, quality of life using the PedsQL 4.0 questionnaire, and EEG dynamics. The results obtained showed that in the period of convalescence after 2 months. after discharge from the hospital, manifestations of cerebrosthenic syndrome in the comparison group were detected much more often than in children receiving Nooklerin. Testing of patients with serous meningitis on two scales (Questionnaire for identifying the level of asthenia by I.K. Schatz and the Scale of symptoms of asthenia in children) to determine the level of asthenia in the acute period of the disease and in follow-up after 2 months. after discharge in various groups revealed a significantly lower level of development of asthenic manifestations in children treated with Nooklerin by the time of discharge from the hospital, as well as a significant decrease in the manifestations of asthenia after 2 months. taking the drug, compared with the comparison group. The data obtained confirm the fact that Nooklerin has not only a psychostimulating, but also a cerebroprotective effect. When assessing changes in the quality of life in these patients, the study revealed a decrease in the level of quality of life after 2 months. after suffering serous meningitis in children who received only basic therapy in the acute period of the disease, while in children who received serous meningitis together with basic therapy for 2 months. Nooklerin, the quality of life remained at the original level. The data obtained during the EEG examination in the acute period of the disease and in follow-up after 2 months. after discharge from the hospital, fully correlated with clinical observations and data obtained by questioning patients. The authors suggested that Nooklerin, as a drug, in its chemical structure close to natural substances that optimize brain activity (gamma-aminobutyric and glutamic acids), when used in children with serous meningitis, facilitates the process of nerve impulse transmission, improves fixation, consolidation and reproduction of memorable traces, stimulating tissue metabolism, helps to optimize neurometabolic processes, which prevents the formation of organic deficiency. The use of Nooklerin in the complex therapy of serous meningitis smoothes interhemispheric differences in the functioning of the brain, which also contributes to the protection of the development of symptomatic epilepsy in the period of late convalescence. In general, the results obtained in the study showed the high therapeutic efficacy of Nooklerin, and also confirmed its psychostimulating, neurometabolic and cerebroprotective effects along with good tolerance, which made it possible to recommend it for inclusion in the standard of care for children with serous meningitis for the prevention and treatment of post-infectious asthenia for improving disease outcomes.
Thus, the conducted studies indicate that Nooklerin is a highly effective and safe agent for the treatment of a wide range of conditions accompanied by asthenia. These conditions include increased chronic fatigue, weakness, chronic organic neurological mental and somatic diseases (infectious, endocrine, hematological, hepatological, schizophrenia, addiction to psychoactive substances, etc.). The drug Nooklerin causes a fairly rapid decrease in asthenic disorders in most patients, while the advantage of the drug is the absence of negative properties and complications characteristic of other psychostimulants. All of the above allows us to recommend Nooklerin as an effective and safe agent in the treatment of asthenic conditions in children, including post-infectious asthenia.
In the treatment of asthenia after influenza and acute respiratory viral infections, herbal tonic preparations are also widely used - eleutherococcus extract (Extractum Eleutherococci), lemongrass tincture (Tinctura fructuum Schizandrae), ginseng tincture (Tinctura Ginseng). If fatigue is combined with increased irritability, sedative preparations of plant or combined composition are recommended - tinctures of valerian, motherwort, passionflower extract, etc. Multivitamin preparations and magnesium-containing products are also indicated.

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