Flu in Children - Causes, Symptoms and Treatment .MF .
Influenza - an acute anthroponotic disease caused by an RNA virus, highly contagious, with the airborne and contact-household transmission paths, characterized by acute onset, short incubation period and symptoms obscheintoksikatsionymi with a primary lesion of the respiratory tract.
epidobstanovke In the current, according to the Research Institute of Influenza Institute, raising epidporoga in 2016 belongs to serotype H1N1pdm09, the so-called swine flu.This does not exclude the presence of drift in the antigen H, and the antigen N - these factors contribute patoneza units, which leads to more frequent and lightning current, and to the formation of irreversible lesions in both children and adults.At present, the analysis of data sekveknirovaniya internal genes (PB1, PB2, PA, NP, M, NS) of virus.But according to the official WHO data, the seasonal virus A (H1N1) has not changed significantly in comparison with the pandemic strain of 2009, so there is something to think about ...
reasons for the high i
• high variability, referred to above;
• high infectivity, especially in crowded groups of children;
• the main source - a sick man, but the most dangerous are the people with abortive course, tronzitornye virus carriers and rekonvolistsenty.In the first case the symptoms yet, and the source is, in the second - the symptoms may not be (a rare event), and the third has no symptoms, but there is abjection.Isolation of virus from infected to the environment occurs over 7 days.Under certain conditions, viral shedding may be about 3-4 weeks, in particular when the H1N1 serotype, in type B - up to 30 days.
• Epidznachimost depends on the severity of catarrhal symptoms.
In contrast epidrasprostranёnnosti can associate other data:
• Relative stability is not in the external environment: vyzhyvayut influenza viruses in the air up to 4 hours;in dried and deposited aerosol droplets up to 2 weeks;a dust room to 5 weeks;So wet cleaning using any disinfectants almost completely eliminate the risk of stability.
• Low volatility - the radius of the dispersion of viral aerosol is about 1 m, but a drop in diameter 1000mkm - removed 11 m
• Jump aerosol dispersed phase:. Particles with a diameter up to 25 mm - dries instantly, 200 m - 5,2.Time activity drop phase - a small, localized particles and infected just before the patient within a radius of 1 meter.
• Strong immunity.This factor depends on: the local factors (secretory) + total (humoral and serum) + cell-mediated immunity;Viruses should be blocked at the level of secretory (of IgA) and humoral immunity (M G), and the infected cells - are blocked at the level of cellular immunity using Tk (T-killers).When the immune response to the forefront of interferon.Then turn on a complex chain of immune response to the formation of memory cells.Protective titers stored for about 6 months after suffering the disease, and antibody titers to the hemagglutinin neyraminidaze1 and 40 above are also indicators of protection.A year or more after suffering flu, influenza immunity is realized through the immune memory.
Flu symptoms in children
incubation period - from a few hours to 2 days at A, and up to 4 days - at B. Getting sharp, almost lightning, and come to the fore: obscheintoksikatsionnye symptoms as a rise of temperature to febrile digits(38,8-39'C), weakness, dizziness.There have headaches more often in the frontal lobe, can be painful eyebrows, eyeballs.Perhaps soon, or later - there myalgia and arthralgia.Obscheintoksikatsionnye syndromes with influenza, not rarely begin without warning.
In clinical forms:
1. Typical: catarrhal, sub-toxic, toxic
2. Atypical: Sturt, molneinosnaya (hypertoxic)
As a leading clinical syndrome (including AFI childhood):
1. Stenosing laryngitis (syndromecroup)
2. bronchial obstruction (asthma syndrome)
3. Primary early lung lesions (interstitsinalnaya pneumonia), segmental lung damage
4. Cerebral syndrome and neurotoxicosis
7. The syndrome of sudden death
By the nature of complications: pneumonia, myocarditis, encephalitis, meningitis and other
Changes in the respiratory tract due to two factors - epiteliotropnostyu kapillyarotoksicheskim and action..But this tropism reciprocity, ie not every tissue has receptors for this virus.Thus, formed rhinopharyngitis, laryngitis, laryngotracheitis with the syndrome of croup, bronchitis with prevalence of bronchial obstruction, a variety of pneumonia (excellent localization, morphology, and during the process), depending on the topics of defeats, will prevail or that the symptoms: dry or unproductive cough more oftenonset, wheezing and shortness of distance - in the midst of disease.The severity is explained in this case, the rapid multiplication of the virus, massively colonizing epithelial cells of the respiratory tract, with parallel replication of the virion and the gradual destruction of the host cell, and as a result - the formation of autoantibodies.Morfologiecheski it appears haemorrhagic and purulent-hemorrhagic tracheobronchitis, pneumonia.At untimely beginning of treatment (first 48 hours), the processes may be irreversible.
in favor of the development of pneumonia, the severity of the disease and the complications caused by them, as well as the irreversibility of the process may be a genetic predisposition to the development of severe complications + rapid accession of bacterial infections (incl and endogenous nature).So, in some cases fatal, iatrogenic causes and not at all, the irreversibility of processes is already predetermined by genetics by infection, including and the current strain of swine flu.
Description of the leading clinical symptoms of the flu (including swine) as a child:
- croup syndrome: acute onset, accompanied by anxiety, hoarseness (but not reaching the Athos), a rough barking cough, increase dyspnea, cyanosis of the skin.
- bronchial obstruction (asthma syndrome): anxiety with panic component, the chest in the phase of maximum inhalation, participation of auxiliary muscles of respiration phases retraction intercostal gaps perkutorno- tympanic sound tint auscultation - wheezing, decompensation process - cyanotic nasolabialtriangle.
- Primary early lung damage:
• Interstitsionalnaya pneumonia - in addition obscheintoksikatsionnyh symptoms, hand in hand go respiratory disorders in the form of shortness of breath mixed character (reaching 100 m), frequent, painful attacks of coughing, culminates vomiting in children during the first months of life- frothy in the corners of the mouth;
• Segmental pulmonary lesions - often affects 2,3,4,5 segments of the right lung, which is related to circulatory disorders and lung edema interstitial tissue within the same segment;the hallmark of segmental lesions is a discrepancy of clinical and radiological data - ie, in the complete absence or very weak intensity of clinical symptoms, on the radiograph defined homogeneous large shade appropriate location pulmonary segment.
- Cerebral Syndrome and neurotoxicosis:
• Cerebral syndrome includes convulsive, meningeal and-brain symptoms: often prevail tonic-clonic seizures, covering the upper limbs and facial muscles, lasting about 2 minutes;Meningeal symptoms are headache and vomiting and a stiff neck, thus, no changes in the cerebrospinal fluid;-Brain syndrome manifests longer tonic-clonic seizures.
• neurotoxicity manifests as intense headache pain without clear localization, often accompanied by vomiting, not bringing relief.
-Abdominalny syndrome: abdominal pain, often localized around the navel, there may be sporadic cases of diarrhea.
-Gemorragichesky syndrome: nosebleeds, small petechial hemorrhages in the mucous membranes, hemorrhagic rash on the skin.
Changes in the cardiovascular system: myocarditis manifested by lethargy and sedentary children, skin pallor, lability of heart, the ECG - decrease in the voltage of all the teeth.But often, these myocarditis have a favorable outcome.
CNS: meningitis, meningoencephalitis, hemorrhagic encephalitis.At first the plan may extend such clinical symptoms like cramps, photophobia, hyperesthesia and paresthesia, and besides of brain, can join and focal neurological symptoms.
Clinical manifestations can be very variable, because kappilyaro- epiteliotoksichnost and include the possibility of large losses due to a large area of the histological prevalence and because of antigenic "similarity" of different tissues.
The course of influenza in children 1 to 3 years:
for at this age especially heavy with severe intoxication, CNS, development meningoentsefalicheskogo syndrome.Weak symptoms of catarrhal phenomena.Segmental lung damage, asthma, and croupous syndrome.
influenza in infants and children during the first years of life:
gradual onset of the disease, with a slight rise of temperature, acute onset.Symptoms of influenza intoxication often expressed slightly.At the forefront objective changes: pale skin, the rejection of the chest, lack of weight gain.Sometimes - katoralnye weak phenomena in the form of nasal congestion (heavy breathing), cough rare.Despite the mild initial symptoms, the flu during the subsequent heavy with risk of death increases with swine flu 3 times.This is due to the anatomical and physiological characteristics of the child's body and the lack of immunologiechkoy memory.
most adverse complication that develops most often in children - is Reye's syndrome, based on predetermined acute encephalopathy and fatty liver disease (pathogenesis of this syndrome has not been studied).
diagnosis of influenza in children
1. Express-diagnostics to detect viral antigens in the epithelium of the mucous membranes of the upper respiratory tract by ELISA;the result is ready in 3 hours.
2. Serological diagnosis is aimed at the detection of the rise in antibody titer in 4 (for children under 2) or more times in paired serum samples taken at the beginning of the disease and during rekonvolestsentsii.In practice, typically use RAC and HAI.
Newborns defined maternal influenza antibodies are receiving breast milk - up to 10 months of life, and in bottle-fed - up to 3 months.Passive immunity received from the mother - defective, so the outbreaks in hospitals neonatal morbidity is higher than among their mothers.
Treatment of influenza in children
Before talking about treatment, is always mindful of the many factors: the level of evidence, bureaucratic obstacles (not always something that is not proven is inactive and vice versa), the formation of resistance to the drug.Anyway, only you are responsible for the health of their children.Think carefully.
At this point, according to the WHO and the Research Institute instuta influenza (the last person I'm more inclined to trust), the drugs of choice are considered:
- inhibitors neyraminidazdy ( "Tamiflu" and "Relenza"), "Arbidol», used in the firstflu symptoms, and for the prevention of children in the age dosages.This antiviral drugs act directly on the virus.
- Interferons alpha and gamma: viferon, interferon, etc. tsikloferonIt immunomodulators.
valid combination of the above products, but this can only be a competent doctor, because if the wrong choice of means, there may be unforeseen complications due to individual intolerance.
With regard to the well-known "rimantadine", at the present time, this drug is not recommended for the treatment of influenza A / H1N1 / 2009.This is due to the fact that contemporary strains isolated H1N1pdm2009 resistant to the drug.
also necessary to include symptomatic therapy:
- a cure temperature (ibuprofen, paracetamol, but in any case not aspirin),
- mucolytics / mukoregulyatory when coughing (mukaltin),
- antihistamines (suprastin),
- multivitamin preparations.
Main conclusions regarding the treatment and recourse:
• during the first and possible contact with the child potentsialnoinfektsionnym patients, it is necessary to increase their vigilance in the form of temperature control, receiving prophylactic influenza medications (Arbidol);
• If you (meaning in the epidemiological season) symptoms in a child already appeared: temperature rise, poorly amenable to reduction antipyretic, a rapid increase in the overall symptoms of infectious-toxic - it is necessary to seek medical advice.
• If the question of hospitalization, you should discuss all the details with your treating doctor if you refuse to be hospitalized for yourself or your child, whether you understand all deceit lightning currents and irreversibility of a few hours;
If your doctor does not see the need for gospitolizatsii, discuss with him all the options for cooperation on mutually beneficial terms, to have happened during the disease has always been under a clear control.
In any case, flu prevention is better than cure.
Prevention of influenza in children
As a preventive vaccine used different groups according to the scheme of vaccination.With vaccination, using live attenuated and inactivated vaccines (whole virus, shaded, subunit).When choosing a particular vaccination, always worth remembering that each vaccine type has different terms and ways of formation of post-vaccination immunity.The question should be addressed systematically and individually, because postrivivochny immunity lasts for several years.
Vaccinations against influenza as possible, should receive all children from 6 months of age, according to some reports.Contraindications to vaccination have children following categories:
- Children with chronic lung diseases;
- Children with heart disease and blood vessels in the stage of incomplete compensation;
- Children receiving immunosuppressive therapy and immunopathology;
- Children with metabolic disorders.
For children up to 6 months, it is important to create favorable conditions in epidemic form of immunization of adults who are in close contact with these children.
nutrition is also important to support the child's immunity.
therapists Shabanova IE