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15FEATURES OF THE COURSE OF COMMUNITY-ACQUIRED PNEUMONIA IN CHILDREN WITH MYOCARDITIS Shavazi N.M.1, Kardjavova G.A.2, Lim M.V.3, Ataeva M.S.4
1Shavazi Nurali Mamedovich - Professor, Head of Department, Kardjavova Gulnoza Abdulkosimovna - Assistant; Lim Maxim Vyacheslavovich - PhD, Assistant; 4Atayeva Muhiba Sayfievna - Senior Lecturer,
DEPARTMENT OF PEDIATRICS № 1, SAMARKAND STATE MEDICAL INSTITUTE SAMARKAND, REPUBLIC OF UZBEKISTAN
Relevance. According to WHO, acute pneumonia in children in developed countries accounts for 3-4% of the total number of patients with pulmonary pathology per year, while in developing countries it is 10-20 %; moreover, 5.5 — 7.2% of cases are fatal, accounting for 15-20% in children under 6 months of age [2, 4]. In Uzbekistan (who, 2007), infant mortality is 13.2%, of which pneumonia accounts for 40% [1,5]. In pneumonia, the cardiovascular system is involved in the pathological process, and a combination of infectious and inflammatory processes in the lungs and heart is often observed [3]. The study of the clinical course and outcomes of carditis in acute pneumonia in young children, the identification of risk factors for the formation of chronic forms of carditis, the development of new and improvement of existing methods of treatment of this pathology is an urgent task in Pediatrics.
Objective: to study the paraclinical characteristics of carditis in acute pneumonia in children.
Research materials and methods: We observed 112 children aged 1 to 3 years. Of these, 20 conditionally healthy children made up the control group, and 92 patients — with acute pneumonia, including 49 boys (53.3%), and 43 girls (46.7 %). the 1st observation group consisted of 47 (51.1 %) young children with acute pneumonia complicated by carditis; the 2nd group-45 (48.9%) young children with acute pneumonia without carditis. The average age of children in group 1 was 2.5±0.16 years, and the average age
of children in group 2 was 1.9±0.17 years. A thorough history of the child's life was collected, and the course of pregnancy in the mother was analyzed, the clinical symptoms of the pathological process were evaluated in dynamics, and the results of x-ray examinations of the chest organs were analyzed. ECG, EchoCG, and transaminase levels (AST and Alt) were also studied in patients. Results of the study: the condition of 9 (19.1%) patients of group 1 was regarded as extremely severe, the severe condition was assessed in 34 (72.35%) patients, the moderate condition was noted in 4 (8.5 %) children. In group 2, severe condition was determined in 36 (80 %) patients, average severity — in 7 (15.6 %) , and extremely severe condition at admission was in 2 (4.4 %) young children with acute pneumonia without carditis. There were 4.3 times (P<0.05) more children with an extremely serious condition at admission in group 1 than in group 2. The study of the structure of transferred and concomitant diseases in children of the examined groups showed that previously transferred pneumonia in the anamnesis was 2 times more common in children of group 1 — 25 (53.2 %) cases against 12 (26.7%) cases in group 2. Sepsis was observed in 3 (6.4%) cases in patients of group 1 only. In terms of the frequency of occurrence, hypoxic-ischemic encephalopathy (HIE) in 4.8 and diathesis were almost 3 times more likely (P<0.05) in group 1 -21.3% and 6.4%, with 4.4 % and 2.2 % of patients in group 2, respectively. Anemia of varying severity was found in both groups with a high frequency, but with a predominance in group 1-in 42 (89.4 %) patients, and in group 2 — in 34 (75.6 %). Absence of respiratory failure was also significantly less frequent in group 1 of patients with carditis. Comparative analysis revealed that in pneumonia complicated by carditis, the phenomena of respiratory failure (DN) were more pronounced, so grade II DN was more than 2 times more frequent (P<0.05) in the group of patients with carditis. It should be noted that most of the clinical symptoms in patients of group 1 were more common than in children of group 2, but without establishing reliability for them. Analysis of heart symptoms revealed a high confidence (P<0.001) in the frequency of occurrence in children with carditis for such signs as an increase in the boundaries of the heart — 27 (57.4 %) vs. 3 (6.7 %) and circulatory disorders (NC) of
the first degree — 18 (38.3 %) vs. 1 (2.2 %), with a confidence of P<0.01, the frequency of occurrence of muffled heart tones was noted — 18 (38.3 %) vs. 31 (68.8 %) in group 2. One of the classic criteria for myocardial damage is changes in the ECG, which occur in 79-100% of patients with carditis, even if there are no or no symptoms of the disease. Thus, a significant difference (P<0.05) in the frequency of ECG signs was established for low voltage of the QRS complex, metabolic disorders in the myocardium and the presence of arrhythmias (sinus, extrasystole), other ECG signs (sinus tachy-and bradycardia, changes in the T wave and ST interval, blockage of the bundle of GIS, ventricular hypertrophy) were more common in acute pneumonia complicated by carditis. Echocardiography revealed expansion of the cavities of both ventricles in 1/3 of group 1 patients, as well as a decrease in their ejection fraction, while the contractility of the myocardium was reduced in all children of group 1. The heart valves remained intact in all the observed children. In children without carditis, EchoCG parameters were changed slightly and almost corresponded to the control group. Important information about the state of the chest organs is provided by x-ray examination, which all the observed patients underwent. In most cases, focal pneumonia was observed in 41 (91.1 %) children in the 2nd group of patients without carditis, in contrast to the 1st group, where this form was significantly less common (P<0.01) — 5 (10.6%). Focal-drain pneumonia was observed significantly more often in group 1-in 34 (72.3 %) cases with bilateral localization of the process — in 37 (78.7 %) cases, croup pneumonia was observed in two cases only in group 1. In the group without carditis, pneumonia was distributed approximately equally according to the localization of the process: one — sided-20 (44.4 %) cases and 2 — sided- 25 (55.6 %). An important diagnostic criterion for carditis is CTI, which in 43 (95.6 %) patients without carditis did not differ from the norm, and in children with carditis, normal CTI was noted only in 14 (29.8 %) patients and was determined to be reliable with P<0.05. A significant increase in grade I CTI (0.50-0.55) was observed in 19 (40.4 %) versus 2 (4.4%) cases in group 2. An increase in grade II CTI was observed in 13 (27.7%) children with carditis, while this was not observed in
the group of children without carditis. CTI of the III degree was detected in 1 child of the 1st group. As we can see, most of the children with carditis is marked cardiomegaly. A comparative analysis of the indicators of the General blood test revealed more pronounced anemia in group 1, which is a aggravating factor in children with pneumonia complicated by carditis. Patients in both groups showed an increase in the number of white blood cells relative to the standard values, but the indicators remained within the upper limit of the norm.
Conclusion. Significant differences are established for hemoglobin, leukocytes, lymphocytes, erythrocyte sedimentation rate, AST, Alt in patients with carditis compared to control, and in comparison with patients without carditis was significantly altered levels of leukocytes, lymphocytes, erythrocyte sedimentation rate, AST. To determine the significance of clinical signs of carditis development in children with acute pneumonia, we studied the correlation between various clinical and biochemical parameters.
References
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4. A formidable challenge: The diagnosis and treatment of viral myocarditis in children // Critical care clinics, 2003; 19/3: 87.
5. Ashurova D.T. Features of paraclinical studies of carditis in acute pneumonia in children / D.T. Ashurova, Sh3. Ergashev, Z.U. Sharipova. Text: direct // Young scientist, 2017. № 16 (150). Рp. 27-29. [Electronic Resource]. URL: https://moluch.ru/archive/150/42729/ (date of access: 12.10.2020).
