SARS in children
SARS in children - a set of viral infections with an acute clinical course, that affect the respiratory tract at various levels and have similar clinical syndrome. Etiopatogenetichesky this category of diseases presented by viruses, is tropic to epithelial cells and organs of the lymphatic system.
Each etiopathogenetic form of SARS in children is different semiotic features, selectivity depends on the degree of variability of the virus, the child's age, his immune status, environmental conditions, the tactics used by the therapy.The incubation period of SARS in children varies in a wide range of time, depending on the specific pathogen, which explains the high incidence among children.
right virological analysis allows us not only to determine the type of virus, the causative agent of SARS in children, as well to verify the diagnosis with the code of ICD-10, which has individual sections parainfluenza, rhinovirus and SARS etc.
essence of the term of SARS in children is to
Causes SARS in children
main etiopathogenetic factors of acute respiratory viral infections in children is the presence of a virus agent, which act as the different types of influenza virus are four types of parainfluenza virus, adenovirus, two serovar RSV, rhinovirus.Virtually all children SARS pathogens are RNA viruses except adenovirus containing DNA.
maximum durability in the environment have adenovirus, while other agents of SARS in children die from the effects of ultraviolet irradiation, heat and disinfectants in the short term.
pediatric rarely observed cases of incidence of SARS in children, triggered by the ingestion of a child enterovirus ECHO and Coxsackie types, but each practitioner pediatrics and infectious diseases should be aware of these pathogens because they cause atypical form of the disease.
emergence of SARS are children of any age, who briefly or for a long time been in close contact with the SARS patient man.In pediatrics, unlike SARS in adult widespread notion of contact-household transmission mechanism of viral infection, though airborne droplets of SARS in children is also quite rapidly spreading.
particularly young children is their increased sensitivity to the natural occurrence of SARS.The maximum level of infectiousness during acute respiratory viral infections in children under one year of the first week of illness.As with all infectious diseases, acute respiratory viral infections in children and there is some seasonality or cyclicality of the disease, which accounts for the cool season.A notable fact is that after the facts available adjourned SARS in children formed only type-specific immunity, which explains the frequent acute respiratory viral infections in the child that may occur even within one year.
In situations where SARS in children are not caused by the influenza virus, there are sporadic outbreaks of the disease, and the propensity to develop full-scale epidemics with the defeat of a large number of child population, there is only the flu.
If we consider the pathogenesis of acute respiratory viral infections in children, the infectious disease focuses on the issue of "Atrium", the role of which can be not only the proximal airways and conjunctiva of the eye, but even the digestive tract, which is different from the pathogenesis of SARS in the adult patient population.A feature of all the agents of ARI in children is their epiteliotropnost.The primary stage of etiopathogenesis is SARS virus adsorption on the surface of epithelial cells with subsequent penetration into the cytoplasm and the enzymatic disintegration.
SARS virus reproduction in children occurs intracellularly, which inevitably provokes the development of degenerative changes in the cells and the subsequent development of inflammatory processes in the mucous membrane in the projection of the entrance gate.
inevitable outcome of the pathogenesis of acute respiratory viral infection in children is getting a high concentration of virus in the bloodstream, the severity of which depends on the intensity of dystrophic epithelial damage, and the extent of the pathological process.
Pathogenesis of SARS in children is a propensity for rapid development of toxic-allergic reaction provoked by getting into the bloodstream, not only viruses, but also the decay products of epithelial cells.The toxic influence in this situation is all the organs of life, but the most detrimental effect is exposure to toxins in the brain and heart of a child.
SARS in children is often complicated character, as in the site of the lesion of the proximal airway epithelium develops violation of their barrier function, which is accompanied by a massive multiplication of the bacterial flora.
symptoms and signs of SARS in children
SARS at the baby and children over age group has always characterized the acute onset of a maximum rise in body temperature in the first hours of the disease.Children younger age group are different in that they occur more pronounced manifestations of intoxication syndrome in the form of lethargy, weakness, poor appetite.Intoxication with SARS in children older manifested headache, decreased activity, vomiting, and in severe cases, the appearance of meningeal signs.
The height of the clinical picture of SARS in children manifests the appearance of symptoms of catarrhal syndrome as coughing, discharge meager amounts of mucous discharge nature of the nasal passages, a little redness of the mucous membranes of the oropharynx, "grain" of the walls of the pharynx.A common manifestation of acute respiratory viral infections in children is the appearance of vascular injection sclera and epistaxis non-intensive nature.
At considerable fever during the illness of the child may experience heart palpitations, and muffled heart sounds.Amelioration of SARS in children, usually observed from the third day and manifests a decrease in body temperature, fainting intoxication at safety catarrhal symptoms or even enhancing their intensity.
duration of ARI in children varies between 7-10 days and depends primarily on the type-specific virus-parasite.A typical consequence of SARS in children during convalescence is long-term preservation astenizatsionnogo syndrome.
When parainfluenza, which also belongs to the category of SARS in children, there is a gradual onset of the disease, manifested by cough, runny nose a little, a slight increase in body temperature.Deterioration occurs usually on the fourth day of the disease when the growing manifestations of intoxication syndrome, bronchitis and laryngotracheitis.The child, after SARS to normal body temperature and symptoms of laryngotracheitis can be confusing even longer period of time as a feeling of rawness and oropharyngeal pain behind the sternum when coughing.In infancy when SARS caused by parainfluenza virus marked hoarseness and "barking" cough.
adenoviral SARS in children characterized by acute onset opposite with fulminant increase of symptoms.Fever in this situation is of an undulating nature due to the advent and generalization of inflammatory changes in organs of the lymphatic system.A typical manifestation of adenoviral SARS in children is the emergence of so-called pharyngoconjunctival fever.
When respiratory syncytial virus infection inflammatory changes mainly affect the lower respiratory, manifested symptoms of bronchitis.Intoxication symptoms are a low-intensity in nature or may be absent altogether.
Typical pathognomonic rhinovirus manifestations of SARS in children is the appearance of abundant serous-mucus from the nasal passages without concomitant toxicity and fever.
Clinical symptoms of enterovirus SARS in children is similar to rhinovirus, but different appearance of a violation of the digestive function of the gastrointestinal tract.Diarrhea with SARS in a child lasts about three days, and pain in the abdomen is paroxysmal in nature.Other manifestations of enterovirus SARS in children is the appearance of serous meningitis, rash, herpes angina.
SARS Complications in children are to join a mixed bacterial and viral flora to form foci of infiltration of the lung tissue with the involvement of the pleura.Suspicious symptoms in this situation are: increased body temperature to febrile digits, the occurrence of respiratory disorders in the form of shortness of breath, finely wheezing lungs with their local location.
In the case where the child is not provided timely drug correction with SARS pneumonia may develop destructive processes in the lung tissue, the outcome of which is the formation of focal fibrosis.
Temperature SARS in children
Fever is a typical clinical manifestation of SARS, not only in children, but also for other diseases of infectious nature, as it represents a kind of a compensatory response of the body of the child in response to receipt of the viral agents.
An increase in skin temperature observed stimulation of the substances, the effect of which is aimed at combating viruses.Among such substances takes interferon leader, which is a proteinaceous substance capable of neutralizing viral particles.There is a clear correlation between the production of interferon and the temperature response of the body.So, if there is a high temperature in children with SARS, so in this period a child says the maximum production of interferon.
Of course, every child is characteristic of the individual tolerability fever.In some situations, when SARS child can safely tolerate the temperature rise even to 39 degrees, while others even a minimal increase provokes frustration being expressed.In this regard, infectious disease specialists and pediatricians do not give universal recommendations on what the numbers on the thermometer are a signal for the use of drugs.
In respect of non-drug interventions that are shown to all children with SARS, regardless of the severity of the fever should be viewed two ways: increasing the drinking regime and access cool humidified air to the room where there is a child with a fever.
Reduced body temperature in this situation will occur by increasing perspiration.As for drinks otpaivaniya child at elevated temperature should be preferred decoction of dried fruit.Increasing fluid intake can not only reduce the temperature with SARS, but also prevent the development of blood clots.
There are some situations in which even a minimal increase in temperature is dangerous for the child's life condition.These situations include burdened premorbid background of the child, in which there is any disease of the nervous system.The danger lies in the increased risk of seizures, which in the absence of timely medical correction can cause death.
most effective treatment for fever, which occurs in children with SARS is Paracetamol, which is available in different dosage forms, which allows its use even in the home for children of different age period.
diagnosis of SARS in children
Features verification of the diagnosis of SARS in children, as well as the differential diagnosis depends on the patient's age, premorbid background, presence of concomitant viral infection, the possibility of atypical and asymptomatic forms of the disease, as well as complications.In this regard, etiopathogenetic diagnosis of SARS in children is very complicated, especially in the case of sporadic destruction of the child population.
Thus, a large group of infections that affect the organs of the respiratory system and having epiteliotropnostyu, pediatricians and infectious disease combined into a single diagnosis of "SARS", except for the flu in children.
Laboratory verification etiopathogenic forms of SARS by using virological examination methods is essential during epidemics, as well as a significant increase in morbidity among children in schools, kindergartens.
most effective laboratory determination of type-specific virus with SARS in children is the "causative virus isolation and cultivation of biological material on it."
Historical data about the virus, the causative agent of SARS in children can also be obtained by serology as complement fixation, neutralization paired sera, which is carried out with strict periodicity in fourteen days.
Of course, the above method is very time-consuming to implement, and require a long time, which can not meet the requirements of the attending physician.
Currently virologists developed a method for rapid diagnosis of acute respiratory viral infections in children by immunofluorescence detection of antigens of a respiratory virus in the epithelial cells of the nasal passages.For fair conclusion takes about four hours.
In practice, pediatricians and infectious disease are often faced with an atypical course of acute respiratory viral infections in children, when clinical manifestations available to the child, are similar to symptoms of other diseases.So, during the height of SARS in children must be differentiated manifestations of the prodromal period of measles and catarrhal symptoms of asthma.
Severe acute respiratory viral infections in children can pretend to meningitis and meningoencephalitis, which requires differential diagnosis method application study of CSF after lumbar puncture.Pharyngoconjunctival fever, which is observed when adenoviral SARS in children needs to be differentiated from diphtheria lesions of the conjunctiva.In addition, experienced infectious disease always assess the epidemiological situation, allowing them even in the absence of laboratory diagnostics correctly establish the diagnosis.
Treatment of SARS in children
In any type of acute respiratory viral infections in children pathogenetically substantiated treatment is the appointment of an adequate scheme of antiviral chemotherapy.Unfortunately, many antiviral drugs manufactured in large quantities by various pharmaceutical companies increasingly have expressed a positive effect.At the same time, the flu is a form of acute respiratory viral infections in children the appointment of antiviral drugs in the first day of the disease is mandatory.
Currently, the most common pediatric antiviral agent is Rimantadine which exerts an inhibitory effect not only against the influenza virus, and respiratory syncytial virus, parainfluenza infection.Recommended therapy for SARS in children is a five-day course in the rimantadine estimated daily dose of 1.5 mg per kg of body weight of the child.For the treatment of infants with symptoms of SARS, Rimantadine is used in the form of syrup in a daily dose of 10 ml.To improve the pharmacological effect of rimantadine antiviral therapy should be combined with the appointment of shpy a daily dose of 400 mg.
A similar antiviral effect was observed in the appointment of the children suffering from SARS, Arbidol, which also increases the production of endogenous interferon.