influenza in children
influenza in children - an infectious pathology with acute course, called the RNA-containing agent of virus, transmitted mainly by airborne droplets way related to the category of highly contagious, pronelightning-fast distribution. susceptibility to influenza in children general.
Acute viral influenza in children refers to the most frequent diseases and a major cause of hospitalization.High-risk for the development of influenza are children of early age.The flu epidemic among children age accompanied by a sharp jump in mortality due to infectious pathology that this can be attributed not only to health as a social problem in the world.If
regarded the incidence of influenza in children, it should be noted that it is significantly prevails over the incidence in the adult population.
influenza in children in the neonatal period is different increased risk of bacterial complications that develop in any period of pathogenesis, so to this pathology is directed increased
Causes influenza in children
source of the spread of influenza virus in children is a sick person of any age who have had a symptomatic or subclinical form of the disease, with the highest level of infectiousness is observed on the first day of illness.At the beginning of influenza in children have increased virus isolation from the mucous membranes of the nasopharynx and oropharynx into the environment during coughing, sneezing and even talking.Flu in children is also quite quickly spreads by contact through various objects and dirty hands, which is the maximum concentration of viruses.
during coughing and sneezing with saliva and sputum is a sharp release from nasal influenza viruses in connection with which, around the child, in contact with the flu infection zone is formed, which contains the maximum concentration of infected aerosolized particles.Globular particles are prone to rapid settling, while the fine particles are rapidly dispersed.
After suffering flu in the body of the child formed persistent type-specific immune mechanisms, and repeated cases of influenza in children develop as a result of infection with new antigenic types of the virus, the causative agent.
antigenic variability of the composition and biological properties of influenza in children as adults is not in doubt.The changes relate more to the surface antigens of the virus - hemagglutinin and neuraminidase.This ability of the influenza virus is nothing more than a mechanism for evolutionary adaptations of the virus to improve its survival.Under the variability of influenza virus, usually implies "drift antigen" and "antigen shift".The result of antigenic drift is the annual flu epidemic in children, while antigenic shift leads to the development of the pandemic.
With flu in children all the pathological processes associated with the reproduction of the virus occur in the cells of the columnar epithelium of the upper respiratory tract.After the primary barrier mechanisms influenza virus in children is attached to epithelial cells via the HA.The function of neuraminidase is the destruction of the cell membranes of the mucous membrane, allowing the viruses to freely penetrate the epithelial cells by endocytosis.The next step is the penetration of the pathogenesis of viral RNA in the nucleus of the cell, thereby violating the basic functions of the cell.Replication of the viral RNA, and assembly of viral particles occurs intracellularly.The newly formed viruses are released from the epithelial cells by their intracellular lysis.
Clinical display of viral replication in epithelial cells is the appearance of signs of catarrh, mainly in the projection of the oropharynx and trachea.In the future spread of the virus in the body is through the blood, which manifests itself in the form of intoxication syndrome, that distinguishes the flu in children by SARS.Toxic effect of viremia in influenza occurs mainly in the form kapillyarotoksikoz, hemodynamic disorders with damage to the structures of the central nervous system.The result hemodynamic disturbances is increased permeability of the vessel walls of different caliber, that provokes the development of hemorrhagic syndrome, manifested epistaxis, the appearance of hemorrhages in the skin and mucous membranes, toxic structures of the nervous system in the form of toxic encephalopathy, neurotoxicity, and meningoencephalitis-brain reactions.
hypertoxic With the development of forms of influenza in children formed a hemorrhagic pneumonia, pulmonary edema, or on the background of DIC caused by massive hemorrhage into the alveoli, thereby provoking the development of signs of acute respiratory failure.
Signs and symptoms of influenza in children
generally accepted clinical classification of influenza in children does not exist, unlike many other viral diseases.In practice, pediatricians and infectious disease division used typical and atypical forms of influenza and complications of influenza or occur without bacterial complications.
typical form of influenza in children can occur in varying degrees of severity, however, the most difficult on the impact on the health of the child is hypertoxic variants of influenza.
classical clinical picture of influenza in children presented symptoms of catarrhal symptoms as well as symptoms of influenza intoxication.The average duration of the incubation period of the virus of the flu in children is not more than three days.The debut of the disease is usually acute, manifested hectic type of fever, chills sharp.Specific manifestations of intoxication symptom of the flu in children is the appearance of a constant headache preferentially localized in the frontal and temporal areas, pain in the projection of the orbit, arthralgia and muscle pain, severe weakness, lack of appetite, vomiting.
Infants with influenza tend to develop increased seizure at high temperature fever, and older children are more likely to suffer hallucinatory disorders at the height of the fever.
An objective examination of the child, suffering from flu, usually there is a pronounced pallor of the skin, and in some cases their "marbling".The skin of the upper half of the body, especially the head, on the contrary, bloodshot with fever.With regard to the effect of the toxic effects of influenza viruses on the structure of the cardiovascular system of the child should be noted that there is sinus tachycardia, which has a clear correlation dependence improve the performance of the temperature curve.
specific manifestation of influenza in children is specific to this age group is the appearance of signs of abdominal syndrome, which manifests itself in the expression of pain in the belly of the diffuse nature.
on the impact of influenza on the mucous membranes of the upper respiratory tract of the child should be noted that the manifestations of this is the emergence of pathogenesis of rhinitis, which manifests itself in the form of swelling and bright redness of the mucous membrane of the nasal cavity.The mucous membrane in the projection of the tonsils and the back wall of the oropharynx hyperemic sharply with the presence of abundant grain punctate.
Pathognomonic manifestation of the child's flu is the appearance of signs of laryngotracheitis in a dry, bruised, painful cough, accompanied by pain behind the breastbone.Laryngitis specific signs of the flu in children is aphonia and / or hoarseness.
At the initial examination a child suffering from the flu, keep in mind that laryngotracheitis may be accompanied by obstruction and early addition of a bacterial component that triggers the development of purulent inflammation in the respiratory system.Pathognomonic radiographic criteria of lung disease in influenza in the child is the development of segmental edema and atelectasis.Objective auscultation signs in this situation will be hard breathing with the presence of diffuse wheezes, wearing short-term nature.
in the definition of the severity of influenza in children should be guided by the severity of the manifestations of intoxication, as well as disorders of life and functions of the various organs and structures.The most striking criteria for severe influenza in children include the early development of toxic damage structures of the central nervous system, gemorrazha and microscopic hematuria.
Atypical for influenza in children is most often associated with the presence of minimal and short-term symptom relief, as well as hypertoxic form of flu.Manifestations hypertoxic influenza in children is an infectious-toxic shock, hemorrhagic pneumonia and hemorrhage in all vital organs: adrenals, lungs, liver, kidneys, and others. The temperature of a child with influenza occurring in hypertoxic form rises to very high numbers and hardtreatable antipyretic drugs.
high-risk groups account for newborns and infants, as they have often observed an atypical onset of the disease, which manifests itself in the form of ill-defined signs of toxicity and minimal catarrhal symptoms in the projection of the nasopharynx, but it is marked tendency tofrequent spitting up, vomiting, sleep disorders.Bacterial complications of influenza in infants occur in 70% of cases, and without timely medical correction may have a poor outcome.
In children under the age of five are at risk of severe influenza accession-brain reactions and neurotoxicity signs of meningoencephalitis, and mild catarrhal phenomena.With this pathological condition, there is a threat to the life of a child, as a result of swelling of brain structures.Among the complications of influenza in children should also be noted loss of lung parenchyma segmental nature, stenosis of the larynx and asthma status.
Depending on the period in which influenza complications develop a child differ early and late complications, and in principle etiological complications may be both viral and bacterial origin.In the overall structure of complicated flu cases are prevalent in children of primary viral or secondary bacterial pneumonia and inflammatory lesions of the ear.
Viral pneumonia with influenza in children differs very severe, due to severe manifestations of acute respiratory failure, the presence of bloody sputum, dry and moist rales in the lungs.Radiological signs in this situation is the presence of focal-infiltrative shadow on the background of increased pulmonary pattern.
When you join a bacterial component in the patient notes the rapid development of bacterial pneumonia caused by staphylococcus, streptococcus, pseudomonas, mycoplasma, chlamydia flora.
diagnosis of influenza in children
In a situation when a child is sick with influenza, the original and the main task of the physician is to conduct qualitative differential diagnosis of available patient clinical manifestations with the clinical picture of other viral diseases affecting the organs of the respiratory system, which include:respiratory syncytial, adenovirus, parainfluenza, rhinovirus, and other acute viral infections.If you have a child symptom of hemorrhagic manifestations, influenza should be differentiated from such diseases as meningococcemia, hemorrhagic fever, measles, hepatitis A, typhoid fever, enterovirus fever, mononucleosis.
laboratory criteria of influenza in children is to identify in a blood test leukocytosis due to pre-emptive increase in the absolute number of neutrophils in the beginning of the disease, and neutropenia with an increase in the number of lymphocytes in the crisis period.Joining bacterial component manifested by leukocytosis with a shift of leukocyte formula to the left.
As regards instrumental diagnosis of influenza in children should note ray imaging techniques, which are a great help in the identification of complicated flu, accompanied by a lesion of the lung parenchyma.In this situation it is visualized on the radiograph and a sharp increase in local thickening of the pulmonary lesion pattern in the projection, as well as the presence of infiltration of lung tissue corresponding localization.
Reliable verification of influenza in children is possible only under certain antigens in smears of the mucous membrane of the nasal cavity, oropharynx, which are taken during the acute phase of the disease using immunofluorescence.For laboratory methods with maximum reliability in determining the influenza virus in children include PCR diagnostics and enzyme immunoassay.
Currently, analyzes types of serological tests are not carried out due to the complexity of the implementation.However, in the period of convalescence serology as hemagglutination inhibition and complement fixation enable us to determine the dynamics of growth or reverse the development of the infectious process.Secondary bacterial component in the form of pneumonia, otitis media, is verified on the basis of bacteriological examination of sputum and other biological materials, aimed at the identification of bacteria.
Treatment of influenza in children
In determining the tactics of treatment of the child suffering from flu, infectious disease primarily direct all efforts to suppress virus replication activity that is the basis of pathogenetic therapy.In addition, drugs used against influenza in children, the effect of which is to eliminate signs of toxicity in the body, as well as prevention of bacterial complications.
causal agent of the influenza children should be appointed as early as possible.Among the variety of drugs in pediatric practice is most often used in the form of Remantadin 0.2% syrup.Another representative of antiviral agents is Arbidol, which in addition to suppressing replication of the virus also has the ability to induce interferon, which is crucial for improving the protective forces of the child's body.
Antivirals group of neuraminidase inhibitors zanamivir and the type of Tamiflu, has a pronounced positive effect in reducing the severity of clinical manifestations, as well as their duration.For drugs the flu in children include second-line agents having the ability to induce interferon-type Amiksina.
Antibiotic child with influenza appointed with extreme caution in the presence of absolute indications, which include complicated bacterial pneumonia, acute otitis media, sinusitis for influenza.Among the wide range of antibiotics in this situation it is better to give preference cefuroxime calculated dose of 100 mg / 1 kg body weight rate of up to seven days, at a daily azithromycin calculated dose of 10 mg / 1 kg body weight of the patient to a course of three days.
Drug prevention of influenza in children is widely used in a variety of preschool and school facilities, which greatly reduces the risk of an outbreak.
flu shot for children is an introduction into the body of the inactivated vaccine is field-proven with the help of a randomized trial.After the introduction of the vaccine in the child developing type-specific immunity within fourteen days of not less than six months.As preparations for the vaccine is currently being used by the type of subunit vaccine "influvac" split vaccine "VAXIGRIP."