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Ganiev Abdurashid Ganievich,
Associate Professor, Department of Hospital
Pediatrics, Andijan State
Medical Institute. Andijan, Uzbekistan
Teshabaev Umidjаn Muhammadjanovich,
Assistant of the Department of Hospital
Pediatrics, Andijan State
Medical Institute. Andijan, Uzbekistan
Abdullayeva Shahnoza Nurulla kizi,
Master of the II course of the Department
of Hospital Pediatrics, Andijan State
medical Institute. Andijan, Uzbekistan
FEATURES OF ACUTE RESPIRATORY VIRAL INFECTIONS IN YOUNG CHILDREN WITH ATOPIC
DERMATITIS
ABSTRACT
Atopic dermatitis (AD) is a very common disease in children. According to epidemiological studies, in
different countries atopic dermatitis affects from 10 to 20% of children. The aim of the study was to define predisposing
factors to the development of AD in children, to follow up the prevalence of some objective signs of this disease, and to
study the peculiarities of the course of acute respiratory viral infections (ARI) in children with AD. In work the data of
objective research of 80 children at the age of 1-7 years old with objective signs of AD (group 1) attached to the
polyclinic ¹ 3 of Andijan were used. Andijan, and also the retrospective analysis of their ambulatory cards was carried
out. For the comparison group, 25 healthy children 1-7 years old (group 2) with no objective signs of abnormal
constitution were selected and their ambulatory cards were retrospectively analyzed. As a result, children with ADs
contracted acute respiratory infections for the first time in their lives much earlier than children in the control group.
The average duration of illness in the first group is 17 days versus 8 days, respectively. The incidence of acute
laryngotracheitis, acute bronchitis, pneumonia, and acute sinusitis is significantly higher than in Group II. The
prescription of antiviral, antibacterial, and physiotherapy was also more frequent in children with this constitutional
abnormality than in Group II.
In AD the concordance of immunologic and metabolic disorders, apart from joint immunity lowering, also
increases the risk of anaphylactic reactions and hyperergic course of inflammation, acute respiratory infections appear
at much earlier age, get complicated more often, which leads to prolongation of terms of illness, appearance of
complications requiring bactericidal therapy and physiotherapy.
Key words
: constitutional anomalies, atopic dermatitis, acute respiratory viral infections
Ганиев Абдурашид Ганиевич,
Доцент кафедры больницы
Педиатрия, Андижанская область
Медицинский институт. Андижан, Узбекистан
Тешабаев Умиджан Мухаммаджанович,
Ассистент отделения больницы
Педиатрия, Андижанская область
Медицинский институт. Андижан, Узбекистан
Абдуллаева Шахноза Нурулла кызы,
Магистр II курса кафедры
кафедры госпитальной педиатрии Андижанской области
медицинский институт. Андижан, Узбекистан
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ОСОБЕННОСТИ ОСТРЫХ ДЫХАТЕЛЬНЫХ ВИРУСНЫХ ИНФЕКЦИЙ У ДЕТЕЙ С АТОПИЧЕСКИМ
ДЕРМАТИТОМ
АННОТАЦИЯ
Атопический дерматит (АД) - очень распространенное заболевание у детей. Согласно
эпидемиологическим исследованиям, в разных странах атопическим дерматитом страдают от 10 до 20% детей.
Целью исследования было определение предрасполагающих факторов к развитию БА у детей, проследить
распространенность некоторых объективных признаков этого заболевания, а также изучить особенности
течения ОРВИ. В работе использованы данные объективного исследования 80 детей в возрасте 1-7 лет с
признаками БА (1 группа), прикрепленных к поликлинике № 3 г. Андижана, а также проведен ретроспективный
анализ их амбулаторных карт. В группу сравнения были отобраны 25 здоровых детей 1-7 лет (группа 2) без
объективных признаков аномального телосложения и ретроспективно проанализированы их амбулаторные
карты. Установлено, что дети с БА впервые в жизни заболели острыми респираторными инфекциями намного
раньше, чем дети контрольной группы. Средняя продолжительность болезни в первой группе составляет 17
дней против 8 дней в контрольной группе, соответственно. Заболеваемость острым ларинготрахеитом, острым
бронхитом, пневмонией и острым синуситом значительно выше, чем во II группе. Назначение
противовирусных, антибактериальных и физиотерапевтических средств у детей с данной конституциональной
аномалией также чаще, чем во II группе.
Довольно часто встречается такое конституциональное отклонение, как АД. Его развитию
предрасполагают аллергические заболевания у родственников, патология беременности и родов. При БА
сочетание иммунологических и метаболических нарушений, помимо снижения иммунитета, также
увеличивается риск анафилактических реакций и гиперергического течения воспаления, ОРЗ возникают в
гораздо более раннем возрасте и чаще осложняются, что приводит к увеличению сроков лечения болезни,
появлению осложнений, требующих бактерицидной терапии и физиотерапии.
Ключевые слова
: конституциональные аномалии, атопический дерматит, ОРВИ.
Atopic dermatitis (AD) is the most common
inflammatory skin disease in children and occupies the
leading place in the structure of allergic diseases [1,2,16].
According to epidemiological studies in different
countries AD affects from 10 to 28% of children
[3,5,7,9]. The prevalence of AD and acute respiratory
infections is the most common in childhood [2,8,9]. Their
share together with influenza is at least 70% in the
structure of all morbidity in children, with the highest
incidence rate observed in children attending children's
educational institutions [4,3,10,11]. In recent years,
compared with the previous decade, there has been a 30-
40% increase in the number of AD patients. Until
recently, AD was thought to be a genetically determined
predisposition to IgE synthesis in response to low doses
of allergens and was detected by increasing levels of total
and/or specific IgE in blood serum, as well as by positive
skin testing with exoallergens [6,9,11]. According to
current literature data, a quarter of patients with this
pathology have no sensitization to environmental
allergens and have low levels of serum IgE, i.e., no
evidence for an IgE-mediated immune response
mechanism [2,7,11,12,15]. Immune abnormalities in AD
are currently being discussed and the search continues for
the best diagnostic criteria for detecting AD in children
with normal and elevated serum total IgE levels, as well
as with positive and negative allergen-specific IgE values
[5,8,14]. Thus, the study of predisposing factors of AD is
an urgent problem of the present time and requires further
study. The aim of investigation was to determine
predisposing factors to AD in children, to follow up
prevalence of some objective signs of this disease, to
study peculiarities of acute respiratory viral infections
(ARI) course in children with AD in comparison with
those without this disease, to consider the opportunities
of individual prevention of ARI in AD.
Materials and
methods of research. The data of objective research of 80
children at the age of 1-7 years old with objective
symptoms of AD (group 1) assigned to the policlinic ¹ 3
of Andijan were used in the work. Andijan, and also the
retrospective analysis of their ambulatory cards was
carried out. For the comparison group, 25 healthy
children 1-7 years old (group 2) that had no objective
signs of abnormal constitution were selected and their
ambulatory cards were retrospectively analyzed.
Results and discussion. Acute respiratory tract
infections are caused by various viruses, transmission is
characterized by airborne droplets. ARI is characterized
by high morbidity in Uzbekistan: 20 thousand cases per
100 thousand people. According to WHO, 2.5-4 million
severe cases of influenza and 20-300 thousand deaths as a
result of influenza infection are registered in the world
every year. On average, children can fall ill from 4 to 8
times a year, and those who attend educational
institutions up to 10 times [3,13,14].
Тable 1
Treatment for influenza / ARVI in children's age groups per 100 thousand population in 3 cities of Uzbekistan
Age(years)
Epidemiological seasons (years)
2017-18
2018-19
2019-20
2020
0-2
27,4
32,4
40,
41,2
3-4
34,5
28,6
36,9
46,5
5-7
28,5
20,2
15,4
22,7
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Increased incidence of the disease in children is
noted in the cold season, during the off-season and under
the influence of stressful situations. ARI is characterized
by an extremely easy mechanism of transmission, high
intensity of the epidemic process, the mass nature of the
disease and high variability of viruses, which requires
both individual and mass prevention. But personal
prophylaxis does not work identically: some patients
really get infected less often, while in other patients the
frequency and duration of diseases does not change
significantly, regardless of the measures taken. Because
of this, a specific concept was introduced: children with
recurrent infections (CRIs) [13]. Recurrent infections are
defined as children according to the infection index (II ),
defined as the ratio of the sum of all cases of acute
respiratory diseases (ARI) during the year to the patient's
age. The index ranges from 1.1 to 3.5 for PDRs and
from 0.2 to 0.3 for occasional sufferers. Currently, there
are five groups of PDD that differ significantly in their
own characteristics [3,16]: Five groups of PDD are
distinguished according to predisposing mechanisms:
Group 1. It includes patients with predominant allergies
and allergic pathology in anamnesis, both maternal and
paternal. Group 2. Patients with mostly neurological
pathology.
Group 3. Patients with primary hereditary
vascular dystonias.
Group 4. Patients with a predominant loss of
lymphatic system from birth.
Group 5. Patients with predominant metabolic-
constitutional abnormalities.
As we can see, this classification is mainly based
on diathesis - extreme, borderline with pathological
variants of the constitution. The concept of diathesis is
essential for pediatrics. Numerous evidences of the
dependence of the state of health and psychomotor
development of children on the presence of certain
constitutional abnormalities made the teaching of
diathesis an important part of pediatric medicine [9, 12].
The introduction into clinical practice of such terms as
"exudative
diathesis,"
"childhood
eczema,"
"neurodermatitis," and others has often complicated the
formulation of such terms. Often complicates the
formulation of the results of scientific examinations and
the implementation of diagnostic and therapeutic
benchmarks. In addition, the substitution of clinical
diagnosis with similar terms to an appropriate extent
predetermines the carrying out of unreasonable and
inadequate help to the patient.
AD
is
based
on
chronic allergic skin inflammation. It is no coincidence
that the infant's skin becomes the "target organ" of the
allergic reaction in AD.
The skin proper (dermis) and
subcutaneous fat in infants is a concentration of cells
involved in the recognition, presentation of antigens, and
effector response to them. Numerous papers have shown
a variety of changes in immunological reactivity in the
peripheral blood of patients with AD. Basically, in
children and adults diagnosed with atopic dermatitis,
various authors have revealed a decrease in the total
number of T-lymphocytes, the absolute number of CD8+
(T-cytotoxic). According to various researchers, the
relative and absolute numbers of CD4+ (T-helpers) and
B-24-lymphocytes (CD20+) in patients with AD vary:
their number may increase as well as decrease. According
to the literature, children with elevated levels of total IgE
have significantly lower CD4+ than children with normal
levels of total IgE. The SCORAD index is inversely
proportional to the CD4+/CD8+ ratio [15 According to
the
literature,
children
with
AD
often
show
multidirectional dynamics of antidivogenesis indices,
consisting both in a decrease of IgG, IgM, and IgA levels
and in their increase [15]. According to different authors,
the dynamics of the indices reflecting the state of the
complement system mostly coincide. Both in children
and in adult patients with AD, the content of complement
components decreases. The results of the study of the
functional activity of leukocytes in children with AD by
different authors coincide. A decrease in phagocytic
activity of neutrophils, phagocytic index, and NCT-test
values was observed in children with AD. Predominance
of Th2 activity in children with AD is accompanied by
high levels of IL-4, IL-5 and general blood IgE. At the
same time, a decrease in IFN - y production is noted.
Thus, the data available in the literature on the dynamics
of general and local immunoreactivity indices in patients
with AD are contradictory. The search for the most
optimal
clinical
and
immunological
differential
diagnostic criteria of AD with different values of total and
allergen-specific IgE continues. It will allow to deepen
representation about pathogenetic mechanisms of AD
development, age peculiarities of clinical manifestations,
variants of course and reasons of AD different forms
exacerbation in children and teenagers and to improve
treatment and rehabilitation measures at this disease. AD
is characterized by polymorphism of rash. In typical
cases the disease has a characteristic clinical picture and
clear criteria for diagnosis. However, symptoms and
morphological signs of skin lesions typical of atopic
dermatitis in the form of erythema, papular and papulo-
vesicular
elements,
dryness,
peeling,
cracking,
excoriations, infiltration and lichenification of the skin
can occur in other skin diseases, and also be
manifestations of a variety of metabolic, neoplastic and
immunodeficiency conditions. The combination of
immunological and metabolic disorders allow us to
determine in such children in addition to a general
decrease in immunity, also an increased risk of
anaphylactic reactions and hyperergic course of
inflammation, which is reflected in the nature and
spectrum of pathological conditions and the course of
psychomotor development To assess the features of
development and nature of the course of ARVI, 80
children aged 1-7 years with objective signs of AD
(group 1), assigned to the polyclinic № 3 of Andijan were
examined. Andijan, and a retrospective analysis of their
outpatient records was carried out. For the comparison
group, 25 normosthenic children 1-7 years old (group 2)
who
had
no
objective
signs
of
constitutional
abnormalities were selected, and their outpatient records
were retrospectively analyzed. One of the important
questions is what predisposes to the formation of AD. In
the course of the study, interviews with mothers and
analysis of outpatient records identified the most frequent
pathologies of the antenatal and intrapartum periods in
children with this type of diathesis (Table 2).
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Table 2
The frequency of pathologies of the antenatal and intrapartum period in children with blood pressure (group I)
and children (group II)
Pathologies
Group I
Group II
Hereditary burden of allergic diseases
95%
9%
Risk of termination of pregnancy
69%
23%
Toxicosis of pregnancy
84%
36%
Disorders of the mother's diet (consumption of obligate allergens, large
amounts of animal protein and small amounts of vegetable carbohydrates)
97%
54%
Complications during childbirth (hypoxia, operative labor, prolonged and rapid
labor)
72%
32%
High birth weight (> 4000 g)
80%
5%
Thus, Table 2 shows that hereditary peculiarity
for allergic diseases [20] in the group of children with AD
was observed in 96% of cases while in Group II in 10%.
Pregnancy abnormalities in the form of threat of
termination, toxicosis were present significantly more
often in the mothers whose children had an abnormal
constitution. The complicated course of childbirth
occurred in 74% of cases in group 1, which was more
than 2 times higher than in group II children. Heavy birth
weight was present in 82% of the children in Group I and
only 4% in Group II.
After determining the predisposing factors to the
formation of AD, the question of the frequency of
objective signs of this anomaly draws attention.
Cutaneous manifestations of AD were noted in 100% of
cases in the first group of children (48% had them during
objective examination, and according to retrospective
analysis of medical records, 100% of children in this
group had from 1 to 6 episodes of atopic dermatitis or
urticaria a year). In the second group of children, no skin
manifestations were found either objectively or
retrospectively.
Catarrhal
pharyngeal
mucosa,
adenoid
overgrowths, and enlargement of peripheral lymph nodes
(mainly submandibular and cervical) were noted more
frequently in the first group compared to the second.
After analyzing the severity of clinical signs of
AD on the basis of retrospective analysis of outpatient
records, the peculiarities of the course of acute
respiratory infections in children of Group I as compared
to Group II were noted. These data are summarized in
Table 4. This table shows that children with AD fall ill
with acute respiratory infections for the first time in their
lives much earlier than children in the control group. The
average duration of illness in the first group is 17 days
versus 8 days, respectively. Frequency of acute
laryngotracheitis, acute bronchitis, pneumonia, and acute
sinusitis was significantly higher than in Group II. There
was also a more frequent prescription of antiviral,
antibacterial, and physical therapy in children with this
constitutional anomaly than in Group II.
Conclusion.
This constitutional abnormality, as
AD, is encountered quite frequently. Allergic diseases in
guardians, pregnancy and childbirth pathology predispose
to its development. Among the objective symptoms of
AD are always present skin manifestations in the form of
eczema, seborrhea, dermatitis, urticaria. Due to the fact
that in AD the immunological and metabolic disorders are
hoped, not counting the joint decrease in immunity, and
increased risk of anaphylactic reactions and hyperergic
course of inflammation, acute respiratory infections occur
at a much younger age, more often complicated, which
leads to prolongation of the disease, complications that
require bactericidal therapy and physical therapy. For
example, as frequently ill children AD refer to the 1st
group of frequently ill children, in correcting the immune
protection of these children, special care should be given
to the formation of rational eating habits and optimization
of life.
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