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Teacher

Article Review   by:Saule     Original Authors: Z. Mazhitova; R.K. Musabekova
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CLINICAL PECULIARITIES OF PNEUMONIA IN CHILDREN OF THE EARLY AGE Z. Mazhitova, R. Musabekova Kazakh National Medical University n.a. S.D. Asfendiarov Pneumonia as a hard type of acute respiratory infections in children was in the limelight of pediatrysts of dominating conditions and high level in the structure of children’s illnesses and mortalities. Contemporary log-books of pneumonia treatment include an obligatory microbiological observation which help to make a right choice of an antibacterial remedy. But quick and reliable etiological verification of pneumonia especially in early age children (1 year) is still a problem for practical doctors. Lack of reliable information of stimulis implies an empiric approach with an account of clinical-radiological signs and hematological changes. But even these objective changes do not allow to differ an etiological nature of an illness. Nevertheless, in practice a doctor relies not only on above-mentioned facts, but he takes into account patient’s age, which gives a reason to suppose a possible etiology of stimulus. Etiological pneumonia structure changes, high steadiness of bacterias to applied antibiotics, prematuredness, persistant innerwomb infections, perinatal pathology of CNS, unsatisfactory social conditions, age factor, transmittable humoral immunedeficitis having an unfavourable affect, cause new clinical features of pneumonia, aptitude to a slow course of inflammation process. Taking into account that bacteria and microorganism interrelations are mainly defined by reactive peculiarities of children’s organism, immunobiological body state has much affection to the pneumonia. Persistent innerwomb infection defines violation process of immune adaptation in early age children, helps to create second immune deficitis state, which comes in development of intercurrent infectional pathology. The aim of research was clinical peculiarities of pneumonia in children at the age of 1 month till 1 year. Patient’s observation ill with pneumonia was held in the pulmonology department of Children’s City Clinical Hospital № 2. Complex research was in 142 patients at the age of 1 month till 1 year, half of them were boys -61,9 %, girls – 38,1 %. Pneumonia diagnosis was on the basis of anamnestic, clinical-radiological signs, hematological index. For having premorbid background, persistence of innercell stimulus was held an immune fermental analysis to define antibody to CMV, herpesis, chlamidin and micoplasm. In immune ferment analysis of blood cerum were found out high titles: from 4 till 6 level of title growth antibody to Mycoplasma pneumoniae, Chlamydia trachomatis and CMV was found in 28,3 % of children, indeed Ig G was found, which defined an aptitude to slow course of cataral syndrome. Perinatal infectioning does not only reduce an immune reactivity, but also plays an important role in lungs defeat when connecting intercurrent infection. Patient anamnesis observation showed that 17 of children were born premature, 65 mothers had obstetric and somatic pathology in ghestosis type, threat to non-time pregnancy, chronic pielonephritis, viral infections, anemia. Most children before these illnesses had acute respiratory infections and bronchitis, 12 % of them had pneumonia. Unfavourable social conditions (private houses, room in a dormitory, overpopulation) had 54% of children.
In early times (from 3 days till 1 week) from the beginning of illness were hospitalized 33,3 % of kids, on the 2nd week 35%, later 19% of patients. Practically all children ill with pneumonia had an unfavourable premorbid background, most children had different factors of illnesses:19 (45%) suffered from anemia, 4(9%) from rachitis, 6(14%) paratrophy, 2(8%) from protein energetic insufficieincy, 10 (33%) from allergic dermatitis, 7 (17%) from timomegalia. Scale of seasonal analysis illnesses in children showed that it had 2 peaks – winter-spring (February-March) and autumn (September-October). Clinical scheme showedthat children had hard types of pneumonia, only 2 (5%) of children showed an average degree. All children had an acute beginning of an illness: body temperature increasing till febril figures was in 12 (28%), subfebrilitet was in 21 (50%) children, rest of them had a normal body temperature. Longitude of fever period consisted 5 days, temperature reaction was in children with segmentary pneumonia. Clinical scheme showed that most children had signs of respiratory deficiency, caused by moderate but persistent bronchial obstruction. Constant symptome had less attacks of cough. Physical changes in lungs were in 16 % of children by steady local blistered crepitations, 73 % showed humid and dry crepitations of different calibre, difused dry crepitations were in 11% of children. Correlation of clinical and radiological facts was defined. In radiological observation all patients had an increased lung scale and bronchial obstructive obstruction together with nidus-infiltrative shadows in both lungs. 5% of children had segmentary pneumonia of different localization, physical changes were small, only on the 7th -8th day were auscultative changes in blistered crepitations. Hemodynamic changes were on the 3d -4th days of illness. All patients received etiopatogenetic therapy, together with antibiotics and mucoregulators nebulization by broncholitics (ventolin or berodual). Choice depended on obstruction type and cataral pnenomenons. Children having persistant inner cell stimulus had a longtime course of treatment by antibiotics of macrolid group, which allowed to stop cataral syndrome in lungs. The results show that children’s maturity (prematuredness, pathology, neurological illnesses) cause to the character and pneumonia flow, longitude of bronchial obstruction, persistent inner womb infection. Well-timed diagnostics and ethiotropic therapy, respiratory sanation allow to prevent infections, development of chronic process.
Published: August 15, 2007   
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