Features of community5acquired pneumonia clinical recurrence in children

Abstract

Pneumonia is an acute nonspecific inflammation of the lung tissue, which is based on infectious toxicosis, respiratory failure, water-electrolyte and other metabolic disorders with pathological changes in all organs and systems of the child's body. Pneumonia is the cause of death in more children than any other infectious disease, killing more than 800 000 children under 5 each every year, or about 2 200 daily, including more than 153 000 newborns. Mortality from pneumonia in different regions of Ukraine is variable from 1.5 to 6.0 per 10 000 children, which is reflected in the structure of mortality of children in the first year of life, because respiratory diseases in it are 3–5%.

Purpose — to determine the features of the clinical course of pneumonia in young children.

Materials and methods. During 3 years, 2 groups of children aged from 1 month to 36 months were surveyed at the base of Vinnytsia children's regional clinical hospital. The main group consisted of 338 children with community-acquired pneumonia, the control group — 40 almost healthy peers. All children included in our study underwent analysis of complaints, medical history and life, physical and instrumental examination. Clinical and biochemical blood tests were performed using conventional techniques. Radiography was performed on a Jumong SG Health Care device according to standard methods. Ultrasound examination of the hepatobiliary system was performed using a Mindray scanner. Statistical processing of the obtained results was performed using the program IBM SPSS Statistics (version 20), using parametric and non-parametric methods of estimating the obtained results. The reliability of the difference between the values between the independent quantitative values in the correct distribution was determined using the Student's t test, the values of P<0.05 were considered reliable.

Results. 82.5% of the main group was diagnosed with bilateral community+acquired pneumonia, 14.5% — right-sided and 3.0% — left-sided. Focal pneumonia had 167 patients, segmental — 164 children and shared — 7 children. The majority (62.1%) of the surveyed children of the main group had grade III (severe) community-acquired pneumonia. Among the complaints in most patients documented fever (98.2±0.78%), dry cough (93.5±1.34%), runny nose (40.5±2.67%). In 54.1% the fever was febrile. The most frequent (63.9±2.61%) among the pathological changes in the clinical analysis of blood in the examined children were found to increase the level of ESR and leukocytosis (27.2±2.42%). In 95.9% of patients in the main group, X-ray examination revealed an increase in pulmonary pattern, homogeneous darkening had 53.2%, focal shadows were detected in 45.8%. Complications were found in 37.6% of the examined children. It was noted that during the objective examination of children with pneumonia, 23.1% (n=78) during palpation was found liver enlargement. 55.5% of our cohort was diagnosed with an increase in the size of the liver, 28.1% — deformity of the gallbladder, 12.0% — thickening of the gallbladder wall and 16.7% — dyskinesia of the biliary tract. We found that the level of ALT and AST in patients with community-acquired pneumonia was significantly (p<0.05) higher than in the control group.

Conclusions. The importance of the problem of pneumonia in childhood is due to the high incidence in children. In our study, we identified not only the typical clinical manifestations of the disease in question, but also identified a number of specific lesions of the hepatobiliary system. The obtained results are important practical findings for pediatricians, pulmonologists, infectious diseases physicians and pediatric gastroenterologists.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies.