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«Наука через призму времени»
Апрель, 2023 / Международный научный журнал
«Наука через призму времени» №4 (73) 2023
Автор: Ahmedova DIlbar Yusufjanovna, Assistant
Рубрика: Медицинские науки
Название статьи: Recurrent respiratory infections in children as a precursor of primary immunodeficiencies
Дата публикации: 4.04.2023
RECURRENT RESPIRATORY INFECTIONS IN CHILDREN AS A PRECURSOR OF PRIMARY
IMMUNODEFICIENCIES
Ahmedova Dilbar Yusufjanovna
assistant of department pediatrics №1 and neonatology
Kayumova Amira Temurovna
2nd year student of Samarkand State Medical
University, Samarkand, Uzbekistan
Respiratory tract infections
in children are one of the most common causes of medical visits and
hospitalizations and are associated with significant morbidity and mortality.
Respiratory infections are common and frequent diseases and represent one of
the main complaints in children and adolescents. The role of physicians and
other healthcare professionals has expanded from simply treating illness to
implementing measures to maintain health and prevent disease. The appointment
and use of each immunomodulating agent should be carried out correctly only in
these cases with an individual approach to each child, taking into account all
the rules of immunomodulatory therapy.
Key words: recurrent respiratory infections, primary immunodeficiency,
gastroesophageal reflux, cystic fibrosis.
Respiratory tract
infections in children are one of the most common causes of medical visits and
hospitalizations, and are associated with significant morbidity and mortality.
Respiratory infections are common and frequent diseases and represent one of
the main complaints in children and adolescents. The role of physicians and
other healthcare professionals has expanded from simply treating disease to
implementing measures aimed at maintaining health and preventing diseases [1, 6,
15, 16]. Respiratory infections (RI), mainly affecting
the upper respiratory tract, are common in children, and their recurrence is a
serious problem for pediatricians. There are many children suffering from
so-called recurrent respiratory infections (RRI). A child with recurrent
respiratory infections presents a difficult diagnostic problem. Children with a
simply manageable cause of symptoms such as recurrent viral infections or
asthma must be distinguished from children with more severe underlying
conditions such as bronchiectasis or immune dysfunction. Thus, many different
diseases manifest themselves including cystic fibrosis, various
immunodeficiency syndromes, congenital anomalies of
the respiratory tract. According to epidemiological studies, it has been
estimated that about 6% of children under the age of 6 have RRI. In developed
countries, up to 25% of children under the age of 1 year and 18% children aged
1-4 years experienceRRI [2, 4, 13].
At the same time, ENT infections are the most common pathology in children from
6 months to 6 years. Although the ethnological agents responsible for RRIare not always easily identified, viral agents are
usually the underlying cause. The real challenge for pediatricians is to
distinguish normal children with a high incidence of respiratory infections
associated with increased exposure to environmental risk factors from those
with other underlying pathological conditions (immunologic or not),
predisposing to infectious respiratory diseases. As a rule, there are no
obvious changes in children with RRI, and this is mainly the result of
increased exposure to infectious agents caused by environmental factors in the
first years of life.
Primary
immunodeficiencies (PID), are usually the result of
genetic defects that affect the component of the immune system. In general,
these disorders are rare, with some exceptions such as selective IgA deficiency
and mannose-binding lectin deficiency. Most common PIDs are usually
asymptomatic or have only mild clinical symptoms.
Examination of children
with RRI requires a lot of attention to the history and examination, and in
some cases to extensive research. Early and accurate diagnosis is essential to
ensure optimal treatment and minimize the risk of progressive or irreversible
lung damage. The challenge for doctors is to distinguish a child with
self-limiting or minor problems from a child with a serious, possibly
progressive, lung disease. The most common and common symptom of recurrent
respiratory infections is chronic cough [12, 13, 17, 18, 19]
The diagnostic algorithm
should be aimed at excluding the underlying serious disease. The diagnosis of
RRI is highly appropriate if:
- more mild respiratory INFECTION characteristics similar to respiratory infections in children with normal respiratory “illness” (Severity. duration. no complications, good response to conventional symptomatic therapy and empiric antibiotic therapy),
- absence of severe and invasive systemic infections,
- absence of inability to develop
- negative family history of immune disorders.
The RRI diagnostic
algorithm includes the study of possible causes of chronic cough, such as
allergies, asthma, al-antitrypsin deficiency, primary or secondary paired
dyskinesia, congenitalanomalies, gastroesophageal reflux
(GER), recurrent pulmonary aspiration, postnasal drip syndrome (most common
cause of chronic cough in children) [3,4,5]. Recurrent or chronic infections
may be associated with anatomical defects that are characteristic of one body
system (9,10,11). Foreign bodyshould
be suspected when infections are chronic and localized in one anatomical canal,
for example, in one ear canal or one nostril.
Symptoms in young children with malabsorption or nasal polyps should be
re-evaluated for possible cystic fibrosis (CF), in spite of negative result of
neonatal screening. The incidence of CF is more common in some countries.
Therefore, the combination of the above symptoms is an indication for a sweat
test followed by genetic analysis. RRI can also be a sign of re-aspiration of
gastric contents in GER, swallowing dysfunction, undiagnosed bronchial asthma,
or immobile cilia syndrome. Recurrent otitis media is associated with
Eustachian tube dysfunction due to atopy [12. 13, 14]. GER is commonly
associated with asthma symptoms but sometimes it can be confused with
bronchitis or lead to aspiration and recurrent pneumonias. GER involved in
pathogenesis may also be a factor in recurrent otitis media sinusitis.
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