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МЕДИЦИНСКИЕ НАУКИ
MODERN ETHIOPATHOGENETIC ASPECTS OF BRONCHITIS
IN CHILDREN
Mamatkulova D.H. Email: Mamatkulova1169@scientifictext.ru
Mamatkulova Dilrabo Hamidovna - Candidate of Medical Sciences, Assistant, DEPARTMENT №3 PEDIATRICS AND MEDICAL GENETICS, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: in the practice of a pediatrician, acute respiratory infections occupy a leading place. Despite the achievements of modern medicine and the emergence of new drugs, the number of patients with acute respiratory diseases is increasing. Every second child receiving an outpatient doctor is a patient with acute respiratory infections. Among diseases of the respiratory tract in children, bronchitis is one of the most common. It should be noted that young children have certain anatomical and physiological characteristics that worsen the activity of mucociliary clearance, especially in inflammatory diseases of the respiratory tract. A decrease in immunoglobulins, and in particular secretory immunoglobulin A, in the mucosa of the respiratory tract was detected, which helps to reduce the protective barrier of the mucous membranes [2, 4]. Keywords: bronchitis, acute respiratory diseases, bacteria, viruses.
СОВРЕМЕННЫЕ ЭТИОПАТОГЕНЕТИЧЕСКИЕ АСПЕКТЫ БРОНХИТОВ У ДЕТЕЙ Маматкулова Д.Х.
Маматкулова Дилрабо Хамидовна - кандидат медицинских наук, ассистент, кафедра № 3 педиатрии и медицинской генетики, самаркандский государственный медицинский институт, г. Самарканд, Республика Узбекистан
Аннотация: в практике врача-педиатра острые респираторные заболевания занимают ведущее место. Несмотря на достижения современной медицины и появление новых лекарственных препаратов, число больных с острыми респираторными заболеваниями возрастает. Каждый второй ребенок на приеме амбулаторного доктора - это пациент с острыми респираторными заболеваниями. Среди заболеваний респираторного тракта у детей бронхит является одним из самых распространенных. Необходимо отметить, что у детей раннего возраста имеются определенные анатомо-физиологические особенности, которые ухудшают деятельность мукоцилиарного клиренса, особенно при воспалительных заболеваниях дыхательных путей. Выявлено снижение иммуноглобулинов и, в частности, секреторного иммуноглобулина А, на слизистой дыхательных путей, что способствует снижению защитного барьера слизистых [2, 4].
Ключевые слова: бронхиты, острые респираторные заболевания, бактерия, вирусы.
UDC: 616-092.11
Bronchitis in children is diverse and is one of the most common diseases of the respiratory tract. The course of the disease can be both acute and chronic.
The etiology of acute and recurrent bronchitis in the vast majority of cases is infectious agents. Of the infectious factors, viruses and virus-bacterial associations are of the greatest importance. In second place in importance is the bacterial nature of the disease, then - fungi and protozoa [1, 3].
Among viruses, the leading place is occupied by types 1 and 3 of parainfluenza, RS virus, adenovirus. Less commonly, viruses such as rhinovirus, influenza viruses, enterovirus, measles virus, cytomegalovirus, and others are the cause of bronchitis. The age aspect plays an important
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role in the possibility of the development of an infectious factor. Viruses such as parainfluenza, adenovirus, rhinovirus, influenza virus are found with almost the same frequency in all age groups. For them, the epidemiological situation, the time of year, the "crowded" population is of great importance [2, 6].
Rhinosynthial virus as the cause of bronchitis is more common in young children, and mainly from 6 months. up to 1 year, which, apparently, is associated with certain features of the bronchial mucosa of children of this age and is due to tropism of viruses. Seasonality and "crowding" play a much smaller role [3, 7]. In newborns and children the first 3 months. viruses such as cytomegalovirus, enterovirus, herpes virus are of leading importance. The type of viral infection has a significant effect on the nature of the mucosal lesion. So, with parainfluenza, cytomegalovirus infection, dystrophy of the epithelium with rejection of whole layers is characteristic. With rhinosynthial viral infection - hyperplasia of the epithelium of the smallest bronchi and bronchioles, cushion-like growth of the epithelium with a violation of bronchial conduction. It is this fact that is associated with the fact that with rhinosynthial viral infection, a viral infection, bronchiolitis or acute obstructive bronchitis more often develops [4, 8].
Adenovirus infection is accompanied by a pronounced exudative component, mucous deposits are often formed, loosening and rejection of the epithelium, and the formation of large-cell infiltrates in the bronchus wall are noted. This contributes to the formation of atelectasis and airway obstruction. As noted above, viruses can be an independent cause of the disease, but, as a rule, appear in association, more often with bacteria, less often with other representatives of the microbial world - fungi, protozoa. The purely viral nature of the disease is more often observed in older children and adolescents with acute and recurrent bronchitis [2, 4, 10].
In young children, especially in infants and newborns, and chronic bronchitis are more often viral-bacterial or bacterial in nature. The bacterial nature of bronchitis takes second place in the etiology of acute and recurrent forms of the disease and the first in the etiology of chronic bronchitis [3].
The etiological structure of acute community-acquired and nosocomial diseases varies significantly. In the etiology of community-acquired bronchitis, the dominant role is played by the hemophilic bacillus and Moraxella catarrhalis, somewhat less often - streptococci (among the latter - pneumococci).
Staphylococci as a cause of bronchitis are of very limited importance. In recent decades, among community-acquired bronchitis, the etiological role of intracellular pathogens has increased. These microorganisms are capable of long-term survival in the epithelial cells of the respiratory tract and reticulohistiocytic cells. These are chlamydia, mycoplasmas, legionella .
In most cases, intracellular pathogens are insensitive to traditional antibacterial therapy, which, along with the lack of a macrophage defense link, contributes to the protracted and recurrent course of the inflammatory process. Nosocomial acute bronchitis is more often caused by gram-negative microflora (Pseudomonas aeruginosa, Klebsiella, etc.) and staphylococci, in preterm infants - by ureaplasmas. Bronchitis, including chronic ones, can also be caused by fungi, more often of the genus Candida and Aspergillus. Most often, bronchitis of candidal etiology occurs in newborns and children of the first months of life, especially premature babies who were on mechanical ventilation, as well as in secondary chronic bronchitis in children suffering from cystic fibrosis. Bronchitis of aspergillus etiology is relatively rare, with almost the same frequency in all age periods of childhood, mainly in children who have been receiving antibacterial therapy or cytostatics for a long time. In addition to infectious agents, acute and recurrent bronchitis can be caused by exposure to inhalant allergens, dust particles, gases, cigarette and cigarette smoke with passive and explicit smoking, and exposure to low temperatures. In this case, a wide variety of mucosal reactions develop - from irritative, accompanied mainly by swelling of the mucosa and mucus hypersecretion, to a pronounced reaction of allergic inflammation with the development of bronchial obstruction due to bronchospasm and hypersecretion [2, 4, 7, 8].
In the development and maintenance of inflammation in the bronchopulmonary system, a certain place is occupied by prostaglandins, leukotrienes and other cytokines (IL-6, IL-8), which increase the permeability of capillaries, hypersecretion of mucus, reduce the smooth muscles of the
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bronchi, as well as a marked increase in the endogenous production of nitric oxide metabolites
(NO), decreased cellular energy metabolism, failure of local immunity [9].
Thus, the nature of the pathogen largely depends on the age and premorbid background of the
child and determines the severity, clinical options, the nature of the course and outcome of
bronchitis.
References / Список литературы
1. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 1995; 152: S77-S120.
2. Siafakas N.M., Vermeire P., Pride N.B., Paoletti P., Gibson J., Howard P., Yernault J.C., Decramer M., Higenbottam T., Postma D.S., Rees J. on behalf of the Task Force. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). A consensus statement of the European Respiratory Society (ERS). Eur Respir J, 1995. 8: 1398-1420.
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4. Peto R., Lopez A.D., Boreham J., Thun M., Heath C.Jr. Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet, 1992. 339: 1268-1278.
5. Standardization of lung function tests. Report Working Party. European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J, 199.; 6; Suppl.16: 1-121.
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7. Roberts C.M., Bugler J.R., Melchor R. et al. Value of pulseoxymetry for long-term oxygen therapy requirement. Eur Respir J, 1993. 6: 559-562.
8. Lehtonen J., Sutinen S., Ikaheimo M., Paakko P. Electrocardiographic criteria for the diagnosis of right ventricular hypertrophy verified at autopsy. Ibid., 1988. Vol. 93: 839-842.
9. BTS guidelines for the management of chronic obstructive pulmonary disease. Ibid., 1997. 5 suppl.: 1-28.
10. Fein A., Grossman R., Ost D., Farber B., Cassiere H. Diagnosis and Management of pneumonia and other respiratory infections. First Edition. Professional Communications, 1999.
