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«Наука через призму времени»

Июнь, 2023 / Международный научный журнал
«Наука через призму времени» №6 (75) 2023
Автор: Ибрагимова Марина Федоровна, PhD, и.о. доцент
Рубрика: Медицинские науки
Название статьи: Features of the course of atypical pneumonia in children against the background of myocarditis
Дата публикации: 03.06.2023
FEATURES OF
THE COURSE OF ATYPICAL PNEUMONIA IN CHILDREN AGAINST THE BACKGROUND OF
MYOCARDITIS.
Shavazi
Nurali Mamedovich
Professor,
Doctor of Medical Sciences, Head of the Department № 1
Pediatrics and Neonatology of the Samarkand
State Medical University.
Ibragimova Marina Fedorovna
PhD, acting assistant professor, Department №1
Pediatrics and Neonatology of Samarkand State Medical
University.
Shavkatova Zilola Shobiddin kizi
Master of
the 1st year of study of the Department № 1 Pediatrics and
Neonatology Samarkand State
Medical University.
Annotation. At present,
despite the regular introduction of new diagnostic methods, improvement of
preventive and therapeutic measures, the results have not yielded significant
success and atypical pneumonia remains a leading cause of morbidity and
mortality in children. Myocarditis is an inflammatory
lesion of the layers of the myocardium caused by various etiologies:
infectious, toxic, infectious-allergic, autoimmune. The aim of the study was to
study the features of the course of atypical pneumonia in children against the
background of myocarditis. Materials and
methods of research: 64 children aged from 1 to 14 years old with pneumonia
were treated in the departments of emergency pediatrics and the department of
pediatric resuscitation on the basis of the Samarkand
branch of the Republican Scientific Center for Emergency Medical Care. Of
these: Group I - 32 patients with severe atypical pneumonia on the background
of myocarditis. Group II - 32 patients with mild and
moderate course of atypical pneumonia against the background of myocarditis. Analysis of the data showed that pneumonia in
children is manifested not only by respiratory, but also by cardiovascular
insufficiency, the cause of which is pathogenetically
determined circulatory disorders, overload of the pulmonary circulation that
occurs when organs are damaged.
Key words: atypical
pneumonia, children, myocarditis.
Relevance. Currently,
ideas about the etiology of pneumonia in children differ significantly: for
example, according to some authors, the main causative agents of bacterial
pneumonia are S. pneumoniae and H. influenzae b, and it is indicated that the largest number
of severe cases of pneumonia in children is attributed to the disease caused by
these etiological factors [1,3].
The
etiological structure of CAP in children often includes Streptococcus pneumoniae, Mycoplasmapneumoniae,
relatively rare Staphylococcus Aureus, Clamydophylapneumoniae, Chlamydiatrachomatis,
Bordetellapertussis, and rarely Haemophilusinfluenzae,
Streptococcus pyogenes, Streptococcus agalactiae and Escherichiacoli
infectious agents [2,5].
When
studying the etiological structure of atypical pneumonia, it was revealed that
it has age-related features. Thus, the main causative agent of pneumonia is
Streptococcus pneumoniae, a certain role is assigned
to atypical pathogens, such as Mycoplasma pneumoniae and Chlamydophilapneumoniae,
the role of viruses in them. The authors point out that the etiological agents
of the development of atypical pneumonia in children depend on the geographical
region, the calendar of preventive vaccinations and antibiotic therapy of the
disease. [4]. Most often, myocarditis is of a viral
nature. At the same time, if earlier the group of Coxsackie viruses was in the
first place in terms of the frequency and severity of the lesion, now
parvovirus B19, herpes virus type 6 and the Ebstein-Barr
group are more often determined. Currently, cardiotropic
viruses include enteroviruses, adenoviruses,
polioviruses, herpes viruses types 1 and 6, and some types of influenza virus
[6,7].
The most
common cause of myocarditis in children is Coxsackie enteroviruses and ECHO. Currently, when using polymerase
chain reaction, an increase in the frequency of parvovirus (PVV19), herpesvirus (HHV6), and up to 25% of cases reveal the
combination of two or more different pathogens (PVV19 and HHV6) in myocarditis. [1,2,5].
But until
now, the characteristics of the course of community-acquired pneumonia in
children with myocarditis have not been revealed in
detail, which requires us to conduct research.
Purpose of
the study: to study the features of the course of atypical
pneumonia in children against the background of myocarditis.
Materials
and methods of research:
64 children
aged from 1 to 14 years with pneumonia were treated in the departments of
emergency pediatrics and the department of pediatric resuscitation on the basis
of the Samarkand branch of the Republican Scientific
Center for Emergency Medical Care. Of these: Group I - 32 patients with severe
atypical pneumonia on the background of myocarditis.
Group II - 32 patients with mild and moderate course of atypical pneumonia
against the background of myocarditis. Patients were
collected anamnestic data, examined by conventional
clinical, laboratory and instrumental, as well as special methods. To establish the atypical genesis of pneumonia, the
polymerase chain reaction method was used, which detects and identifies
bacteria. Highly diagnosed with accuracy to detect atypical
bacteria. They took a smear from the mucous membranes, blood, sputum. If there was a positive result for one of the
atypical pathogens, the etiology was considered established. Detection of IgM antibodies by enzyme immunoassay simultaneous detection
of mycoplasma and chlamydial
infections and a positive result of the polymerase chain reaction increases the
reliability of the diagnosis of atypical infectious agents and allows more
accurate identification of the pathogen in the case of seropositive
variants simultaneously for mycoplasma and chlamydial pneumonia.
Research results and
discussion:
Examination of 64 children with atypical pneumonia and pneumonia with myocarditis showed that the clinical symptoms basically
correspond to the main manifestations of the disease, while the clinical
manifestations of the diseases are characterized not only by pathological
changes in the lungs, but also by the frequent involvement of other vital
organs and systems in the pathological process.
The condition of patients upon admission to the hospital was assessed
from moderate to extremely severe. Moderate forms of the disease accounted for
a smaller proportion (19.4%) and were observed mainly in patients with
pneumonia without myocarditis, the severe course of
the disease was in the majority of children (78.3%). Extremely severe forms
(2.3%) were observed mainly with late admission to the hospital of patients
with pneumonia with myocarditis.
A comparative analysis of clinical symptoms and syndrome complexes
showed that an increase in body temperature was characteristic of 83.3% of
patients with pneumonia against the background of myocarditis.
Complaints about fatigue and loss of appetite were mainly presented by children
with pneumonia against the background of myocarditis
compared with patients with community-acquired pneumonia (68.4% and 46.7%).
Cyanosis of the skin and mucous membranes was observed much more often
in patients with pneumonia against the background of myocarditis.
Data in the
group of patients with atypical pneumonia on the background of myocarditis showed that tachycardia developed more often by
3 times, bradycardia by 2.8 times, arrhythmia by 3.1
times, an increase in the boundaries of the heart by 4.9 times and systolic
murmur by 2 times compared with patients without myocarditis
and only the frequency of muffled heart sounds was almost the same - 68.4% and
66.8%.
The study
showed that in 89% of cases of typical pneumonia, the level of Procalcitonin was 0.5 ng / ml, C
reactive protein up to 35 mg / l. In atypical pneumonia, the concentration of
C-reactive protein did not exceed 20 mg/l in 72% of cases, and in the remaining
28%, the indicator ranged from 21 to 70 mg/l. The level of procalcitonin
in these patients did not exceed 0.5 ng/ml
in 96% of cases. Based on the foregoing, a low level of markers helps in
the diagnosis of atypical pneumonia flora in the early stages of the disease.
Conclusions: Thus,
the analysis of the data showed that pneumonia in children is manifested not
only by respiratory, but also by cardiovascular insufficiency, which are caused
by pathogenetically caused circulatory disorders,
overload of the pulmonary circulation that occurs when the respiratory and
cardiac systems are affected.
References:
- Fedorovna I. M. The influence of risk factors on the development of atypical pneumonia in young children //Asian journal of pharmaceutical and biological research. – 2022. – Т. 11. – №. 2.
- Ibragimova M. F. Diagnostic criteria for pneumonia of atypical etiology in children //British Medical Journal. – 2022. – Т. 2. – №. 5.
- Mamedovich S. N., Fedorovna I. M. Efficacy of vilprafen and resistol in community-acquired pneumonia with atypical etiology in children //Thematics Journal of Applied Sciences. – 2022. – Т. 6. – №. 1.
- Shavazi, N., Kardzhavova, G., Lim, M., & Ibragimova, M. (2021). Features of the current of acute myocarditis in children on the background of community-acquired pneumonia. Journal of Hepato- Gastroenterological Research,2(3.2), 143-145.
- Diagnosis and treatment of myocarditis. Tereshchenko S.N., Zhirov I.V., Masenko V.P., Narusov O.Yu., Nasonova S.N., Samko A.N., Stukalova O.V., Sharia M.A. Eurasian Journal of Cardiology, 2019. p.4-33
- Myocarditis in children: problems and solutions. Nikitina I.L., Vershinina T.L. Medical Council №. 1, 2017. p.238-245
- Myocarditis. Melekhov A.V., Ostrovskaya Yu.I. Myocarditis. News of cardiology №. 2, 2018. p.32-38
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