Influenza in children - Causes, symptoms and treatment. MF.

Influenza is an acute anthroponotic disease caused by an RNA-containing virus, very infectious, with aerogenic and contact-household transmission routes, characterized by acute onset, short incubation period and general toxoxic symptoms with predominant airway disease.

In the current epidemic setting, according to the Institute of Influenza Institute, the increase in epidemics in 2016 belongs to the serotype H1N1pdm09, the so-called swine flu. In this case, the presence of drift, both in the antigen H and in the N antigen, is possible - these factors aggravate the links of the pathogenesis, which leads to a rapid onset of the disease, and to the formation of irreversible lesions in both children and adults. At present, the analysis of internal gene sequencing data( PB1, PB2, PA, NP, M, NS) of these viruses is carried out. But according to official WHO data, the seasonal virus A( H1N1) has not undergone significant changes in comparison with the pandemic strain of 2009, so there is much to think about. ..

Causes of high morbidity:

• high variability mentioned above;
• high infectiousness, especially in crowded children's groups;
• The main source is a sick person, but the most dangerous are people with abortifacial course, tronzotornye virus carriers and reconnaissance. In the first case, there are no symptoms yet, but there is a source, in the second there may be no symptoms( a rare case), and in the third symptom there is already no, but there is excretory excretion. The virus is released from the infected into the environment for 7 days. Under certain conditions, the virus release may be about 3-4 weeks, in particular with H1N1 serotype, with type B - up to 30 days.
• Epidemiology depends on the severity of catarrhal symptoms.

In contrast to epidermal distribution, other data can be compared:

• Relative non-resistance in the external environment: influenza viruses are squeezed in air for up to 4 hours;in dried and settled droplets of aerosol to 2 weeks;in indoor dust for up to 5 weeks;So, wet cleaning with the use of any disinfectant almost completely eliminates the danger of resistance.
• Low volatility - the dispersion radius of the viral aerosol is about 1 m, but drops of 1000 μm in diameter are removed by 11 m.
• Rapid transition of the aerosol into a dispersed phase: particles with a diameter of up to 25 μm dry instantly, about 200 μm in 5,2 s. The time of activity of the drop phase is insignificant, and the infected particles are localized directly in front of the patient in a radius of up to 1 m.
• Strong immunity. This factor depends on: local factor( secretory) + general( humoral and serum) + cellular immunity;Viruses should be blocked at the level of secretory( IgA) and humoral immunity( M G), and infected cells - are blocked at the level of cellular immunity with the help of Tk( T-killers).With an immune response, interferon comes to the fore. Further, a complex chain of the immune response is included, with the formation of memory cells. Protective titers of antibodies persist about 6 months after the transferred disease, and titres of antibodies to hemagglutinin and neuraminidase 1: 40 and above are also indicators of protection. After a year or more, after the flu, influenza immunity is realized through immune memory.

Symptoms of influenza in children

The incubation period - from several hours, up to 2 days at A, and up to 4 days - with B. The onset is acute, almost lightning fast, and the most common symptoms are as a rise in temperature to febrile digits( 38, 8-39'C), weakness, dizziness. Headaches are noted, more often in the frontal lobe, painful eyebrows, eyeballs can be painful. Perhaps immediately, or a little later - there are myalgia and arthralgia. General toxication syndromes in influenza often begin without precursors.

By clinical forms:

1. Typical: catarrhal, subtoxic, toxic
2. Atypical: stunted, moleinous( hypertoxic)

According to the leading clinical syndrome( including AFD of childhood):

1. Stenosing laryngitis( croup syndrome)
2(Asthmatic syndrome)
3. Primary early lung lesions( interstitial pneumonia), segmental lung lesions
4. Cerebral syndrome and neurotoxicosis
5. Abdominal
6. Hemorrhagic
7. Syndrome of sudden smBy gravity mouths

process:
1. Light
2. Srednetyazholaya
3. A hard

By the nature of complications: pneumonia, myocarditis, encephalitis, meningitis, etc.

.

Changes in the respiratory tract are due to two factors - epitheliotropic and capillarotoxic action. But this tropism is reciprocal, that is, not every tissue has receptors for this virus. Thus, rhinopharyngitis, laryngitis, laryngotracheitis with croup syndrome, bronchitis with prevalence of bronchial obstructive syndrome, various pneumonia( different in localization, morphology and course of the process), depending on the topic of lesions, will predominate, such as: dry or unproductive cough more often inthe beginning of the disease, distant wheezing and shortness of breath - in the midst of the disease. The severity of the flow is explained in this case by the rapid multiplication of the virus, massively colonizing the epitheliocytes of the respiratory tract, with the parallel replication of the virion and the gradual destruction of the host cells and, as a consequence, the formation of autoantibodies. Morphologically it is manifested by hemorrhagic and purulent-hemorrhagic tracheobronchitis, pneumonia. At untimely beginning of treatment( in the first 48 hours), the processes can 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 processes can be the genetic predisposition of a person to the development of severe complications + rapid attachment of bacterial infections( including endogenous nature).So, in some lethal cases, there is no iatrogenic cause, the irreversibility of the processes is already predetermined by genetics in case of infection, including the current strain of swine flu.

Description of the leading clinical symptoms of influenza( including swine) in childhood:

- Croup syndrome: acute onset, accompanied by anxiety, hoarseness( but not reaching the aphonia), rough barking cough, increased dyspnoea, cyanosis of the skin.

- Bronchoconstriction( asthmatic syndrome): anxiety with panic component, chest in the phase of maximum inspiration, participation of auxiliary muscles in the phases of breathing, retraction of intercostal spaces, percussion-timpanic hue of sound, in auscultation - wheezing, with decompensation of process - cyanotic nasolabial triangle.

- Primary early lung lesions:

• Interstitial pneumonia - In addition to general toxication symptoms, hand in hand are respiratory disorders in the form of shortness of breath of a mixed nature( reaching 100 per min), frequent, painful coughing, coughing with vomiting, in children of the first months of life - foamydischarge in the corners of the mouth;
• Segmental lung lesions - 2,3,4,5 segments of the right lung are more often affected, which is associated with circulatory disorders and swelling of the interstitial lung tissue within one segment;a distinctive feature of segmental lesions is the discrepancy between clinical and radiological data - that is, with a complete absence or very weak clinical symptoms, the radiograph determines homogeneous large shadows corresponding to the location of the pulmonary segment.

- Cerebral syndrome and neurotoxicosis:

• Cerebral syndrome includes convulsive, meningeal and encephalic manifestations: tonic-clonic seizures predominate, covering the upper limbs and facial muscles lasting about 2 minutes;Meningitis symptoms are manifested by headache and vomiting and stiff neck, while there are no changes in cerebrospinal fluid;Encephalic syndrome is manifested by prolonged tonic-clonic seizures.
• Neurotoxicosis manifests itself as a headache of intense pain without clear localization, often accompanied by vomiting, not bringing relief.

-Abdominal syndrome: abdominal pains, localized more often around the navel, episodic cases of diarrhea are possible.

-Hemorrhagic syndrome: nasal bleeding, small spotted hemorrhages in the mucous membranes, hemorrhagic rash on the skin.

Changes in the cardiovascular system: myocarditis, manifested sluggishness and lack of mobility in children, pallor of the skin, pulsation of the pulse, on the ECG - decrease in the voltage of all teeth. But often, these myocarditis have a favorable outcome.

From the CNS side: meningitis, meningoencephalitis, hemorrhagic encephalitis. The clinical symptoms such as convulsions, photophobia, hyperesthesia and paresthesia can come to the fore, and focal neurological symptoms can also join in addition to cerebral palsy.

Clinical manifestations can be very variable, because capillary and epithelotoxicity include the possibility of extensive lesions due to a large area of ​​histological prevalence, and because of the antigenic "similarity" of different tissues.

Features of the course of influenza in children from 1 to 3 years:

during this age is especially severe with severe intoxication, CNS damage, development of meningoencephalic syndrome. Weak manifestations of catarrhal phenomena. Segmental lesions of the lungs, croupous and asthmatic syndrome.

Influenza in newborns and infants of the first years of life:

gradual onset of the disease, with a slight rise in temperature, an acute onset. Symptoms of influenza intoxication are often expressed only slightly. At the forefront are objective changes: pallor of the skin, rejection of the breast, lack of gain in weight. Sometimes - weak catholic phenomena in the form of nasal congestion( sniff), a rare cough. Despite the mild symptoms of initial manifestations, the subsequent course of influenza is severe with the risk of deaths, which increase with swine flu by 3 times. This is due to the anatomical and physiological features of the child's body and the lack of memory immunology.

The most unfavorable complication, which develops more often in children, is Reye's syndrome, which is predetermined by acute encephalopathy and fatty liver dystrophy( the pathogenesis of this syndrome has not been studied enough).

Diagnosis of influenza in children

1. Express diagnostics for the detection of viral antigen 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 detecting the growth of antibody titer in 4( for children in 2) and more times in paired sera taken at the onset of the disease and during the period of reconvalescence. In practice, RCC and RTGA are commonly used.

Newborns are given maternal anti-influenza antibodies that receive breast milk - up to 10 months of life, and with artificial feeding - up to 3 months. Passive immunity received from the mother is inadequate, so when outbreaks occur in maternity hospitals, the incidence of newborns is higher than among their mothers.

Treatment of influenza in children

Before talking about treatment, it is always worth remembering many factors: levels of evidence, bureaucratic obstacles( not always, what is not proven is ineffective and vice versa), the formation of resistance to the drug. Either way, only you are responsible for the health of your children. Think carefully.

Currently, according to the WHO and the Institute of Influenza( the latter personally I am more inclined to trust), the following are considered the drugs of choice:

- Neuraminideadine inhibitors( "Tamiflu" and "Relenza"), "Arbidol", are used at the first sign of the fluand for prophylaxis in children at age-related dosages. These are antiviral drugs that act directly on the virus.

- alpha and gamma interferons: viferon, interferon, cycloferon, etc. These are immunomodulators.

A combination of the above drugs is acceptable, but only a doctor can be competent in this, because with improper selection of funds, there may be unforeseen complications due to individual intolerance.

Regarding the well-known "Remantadine", at present this preparation is not recommended for the treatment of influenza A /H1N1/ 2009. And this is due to the fact that the isolated modern strains of the H1N1pdm2009 virus are resistant to this drug.

Symptomatic therapy should also be included:

- temperature medicines( ibuprofen, paracetamol, but by no means aspirin),
- mucolytics / mucoregulators for cough( mucaltin),
- antihistamine( suprastin),
- multivitamin preparations.

Main findings regarding treatment and seeking help:

• with the first and possible contact of a child with a potentially infectious patient, it is necessary to increase their vigilance in the form of temperature control, the taking of preventive anti-influenza drugs( Arbidol);

• If the symptoms of the child have already appeared( meaning in the epidemic season): a rise in temperature, which is not easily reduced by antipyretics, a rapid increase in general infectious-toxic symptoms - it is necessary to seek medical help from a doctor.

• If you are questioning hospitalization, you should discuss all the nuances with your treating doctor: if you refuse to go to hospital yourself or your child, do you understand all the cunning of the lightning current and the development of irreversibility in a matter of hours;
If your doctor does not see the need for hospitalization, discuss with him all the options for cooperation on mutually beneficial terms, so that the current disease that has already happened is always under strict control.

In any case, the flu is better prevented than treated.

Prevention of influenza in children

Vaccines of different groups are used as a preventive vaccine according to the vaccination scheme. When vaccinated, live attenuated, and inactivated vaccines( whole-virion, split, subunit) are used. When choosing this or that vaccine prevention, it is always worth remembering that each type of vaccine has different terms and ways of forming postvaccinal immunity. The question should be solved systematically and individually, since postmissive immunity persists for several years.

Vaccinations against influenza, if possible, should be received by all children, starting at 6 months of age, according to some sources. Contraindications to vaccination are children of the following category:

- Children with chronic lung diseases;
- Children with heart and vascular disease 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 epidemically favorable conditions in the form of immunization of adults who are in close contact with these children.

It is also important that a child's nutrition is adequate to support immunity.

Therapist doctor Shabanova I.Е.