CC BY
6Received by the Editor 14.10.2020
IRSTI 76.29.47+76.29.50 UDC 616-092.18:616-053.2
RECURRENT RESPIRATORYINFECTIONS IN CHILDREN A. Zhamankulov1, R. Rozenson1, M. Morenko1, G. Meral2, U. Akhmetova1
NcJSC «Astana Medical University», Nur-Sultan city, Kazakhstan 2Association for Epigenetics and Nutrigenetics, Turkey
Objective of the study: To identify the main clinical symptoms and their manifestations in children with recurrent respiratory diseases and their reduction
Materials and methods: a prospective study of 98 patients was conducted. The age of the children ranged from 1 to 15 years. There were 59 boys and 39 girls. The average age was 4,0± 3,3 years. The main diagnosis during hospitalization was community-acquired pneumonia, obstructive bronchitis
Results: during the study, the main clinical manifestations were: cough 97,9%, fever 79,5%, red throat 70,4%, lethargy, weakness, lack of appetite 86,7%, shortness of breath 51,0%, nasal congestion/rhinorrhea 68,3%, nausea/vomiting 8,1%. Main laboratory changes: decreased hemoglobin and insufficient vitamin D levels in 50%, increased IgE - 18,3%, increased white blood cells in 76,5%, moderate lymphopenia in 37,7%
Conclusion: by eliminating background factors that affect the immune system, such as anemia, allergies, D-deficiency, it is possible to achieve a reduction in the frequency of respiratory infections
Key words: recurrent respiratory infections, immunity, anemia, vitamin Ddeficiency.
РЕЦИДИВИРУЮЩИЕ РЕСПИРАТОРНЫЕИНФЕКЦИИ У ДЕТЕЙ А.А. Жаманкулов1, Р.И. Розенсон1, М.А. Моренко1^. Meral2 ,У.А. Ахметова1
1НАО «Медицинский университет Астана», Нур-Султан, Казахстан 2Ассоциация эпигенетики и нутригенетики, Турция
Цель исследования:Выявить основные клинические симптомы и их проявления у детей с рецидивирующими респираторными заболеваниями и их снижение
Материал и методы: Было проведено проспективное исследование 98 пациентов. Возраст детей составил от 1 года до 15 лет. Мальчиков было 59, девочек 39. Средний возраст составил 4,0 ± 3,3 года. Основной диагноз при госпитализации в стационар была внебольничная пневмония, обструктивный бронхит
Результаты: в ходе исследования основными клиническими проявлениями были: кашель 97,9%, лихорадка 79,5%, покраснение горла 70,4%, вялость, слабость, отсутствие аппетита 86,7%, одышка 51,0%, заложенность носа/ринорея 68,3%, тошнота/рвота 8,1%. Основные лабораторные изменения: снижение уровня гемоглобина и недостаточный уровень витамина D у 50%, повышение IgE-18,3%, повышение лейкоцитов у 76,5%, умеренная лимфопения у 37,7%
Заключение: при устранении фоновых факторов, влияющих на иммунную систему, такие как анемия, аллергия, Д-дефицит, возможно, достичь снижения кратности респираторных инфекции
Ключевые слова: рецидивирующие респираторные инфекции, иммунитет, анемия, витамин D дефицит, recurrentrespiratoryinfections.
БАЛАЛАРДАГЫ ЦАЙТАЛАНАТЫН РЕСПИРАТОРЛЬЩ ИНФЕКЦИЯЛАР
Жаманкулов А.А.1, Розенсон Р.И.1, Моренко M.A.1,MeralG.2, Ахметова У.А.1
1
«Астана медициналык университет» КеА^, Нур-Султанк., ^азакстан 2Эпигенетика жэне нутригенетика ассоциациясы, Typkm
Зерттеудщ мацсаты: кайталанатын тыныс алу аурулары бар балалардагы непзп клиникалы; белгшер мен олардыц кершютерш жэне олардыц темендеуш аныктау
Материал жэне эдктер: 98 наукаска проспективп зерттеу жYргiзiлдi. Балалардыц жасы 1 жастан 15 жаска дешн болды. ¥лдар 59, кыздар 39 болды. Орташа жасы 4,0 ± 3,3 жыл болды. Ауруханага жаткызу кезшдеп непзп диагноз ауруханадан тыс пневмония, обструктивп бронхит болды
Нэтижелерi: зерттеу барысында непзп клиникалык кершютер болды: жетел 97,9%, кызба 79,5%, тамактыц кызаруы 70,4%, летаргия, элсiздiк, тэбеттiц болмауы 86,7%, ентiгу 51,0%, мурынныц биелу^ринорея 68,3%, журек айну/кусу 8,1%. Непзп зертханалык езгерiстер: гемоглобин децгейiнiц темендеуi жэне D витаминiнiц жеткiлiксiз децгей 50%, IgE жогарылауы-18,3%, лейкоциттердiц жогарылауы 76,5%, калыпты
лимфопения 37,7%%
Кррытътды: иммундьщ жYЙеге эсер ететш анемия, аллергия, Д тапшылыгы сиякты фондык факторларды жою кезiнде тыныс алу жолдарынын инфекцияларыныц азаюына кол жетк1зуге болады
ТYЙiндi сездер: кайталанатын респираторлык инфекциялар, иммунитет, анемия, Д-витамин дефицитi.
Introduction
In Kazakhstan, respiratory diseases account for up to 30% of the total morbidity structure. Children of preschool and school age are more likely to get sick. Recurrent respiratory infections (RRI) play an important role in respiratory diseases. The main symptoms of which are recurrent cough, wheezing in the lungs, shortness of breath, sputum discharge with coughing, general poor health of the child. Many of these children have frequent colds, and for some, these symptoms may be the initial sign of asthma.
RRI of the respiratory tract are the most common problem in children. The course of the disease has a favorable prognostic outcome. But, nevertheless, RRI is a big burden for parents (psychoemotional, economic), primary health care doctors, as well as large economic costs of health care [1,2].
The RRI group can include a child if the frequency of respiratory episodes is 6 or more per year; acute bronchitis 3 or more times a year; pneumonia 2 or more during the year [4-8]. This frequency is due to early socialization of the child, the peak of respiratory infections in the autumn- winter period, smoking in the family, atopy in the anamnesis, anemia, dampness and mold at home, artificial nutrition of the child, poor socio-economic conditions, poor nutrition, and D-deficiency plays a role [3-5].
RRI with the right diagnostic approach have a quick recovery period after the disease. However, with incorrect treatment and the appointment of many antibacterial drugs, antibiotic resistance occurs [6]. Subsequently, there are chronic foci of infection, immunological resistance of the body, a decrease in adaptive defense mechanisms, and repeated relapses of diseases[7].
Objective of the study
Identify the main clinical symptoms and manifestations in children with RRIand their reduction
Materials and methods
A monocenter prospective study of 98 patients with RRI was conducted between November 2019 and February 2020. The age of the children ranged from 1 year to 15 years. All patients were admitted to the city children's hospital No. 1. The main diagnosis during hospitalization is community-acquired pneumonia, obstructive bronchitis. There were 59 boys (60%) and 39 girls (40%). The average age was 4 ± 3.3 years. The inclusion criteria were: RRI ( i.e. at least 6 episodes per year ;2 or more cases of pneumonia per year; acute bronchitis 3 or more times a year;), absence of severe comorbidities (diabetes, congenital malformations, cancer), childhood age, parental consent and informed consent of patients. Exclusion criteria: chronic foci of ENT pathology (chronic sinusitis, pharyngitis), primary immunodeficiency, acute diseases (kidney diseases, hepatitis, autoimmune diseases, etc.), parents ' refusal to study.
The study was approved by the local bioethical Commission of NJSC "Astana medical University".
Statistical data processing and compilation of tables and records was performed in Microsoft® Excel 2010 for the Windows version. For descriptive statistics, we used the Jamovi statistical package (version 1.2.27.0; www.jamovi.org).
Results and discussion
During the study, the average duration of inpatient treatment was Mean (SD) 6,4 ± 1,7 days, the average number of respiratory episodes per year was 6,9 ± 1,2 (fig. 1), the average duration of the catarrhal period was 10,8 ± 4,3, and the average duration of temperature (days) 3,8 ± 1,0 (fig. 2)
Figure 1-Shows the length of hospitalization and the number of respiratory episodes per year in boys and girls.
Figure 2 -Shows the duration of the respiratory period and the duration of temperature (days) in boys and girls.
The main clinical manifestations were: cough n=96 (97,9%), fever n=78 (79,5%), red throat
n=69(70,4%), lethargy, weakness, lack of appetite n=85 (86,7%), shortness of breath n=50 (51, nasal congestion/rhinorrhea n=67(68,3%), nausea/vomiting n=8 (8,1%). From laboratory parameters, reduced hemoglobin and insufficient vitamin D levels (<30 ng/ml) were detected n=49 (50%), increased IgE n=18 (18,3%), leukocytosis n=75 (76,5%), moderate lymphopenia n=37 (37,7%). Children were divided into the following groups: RRI with an allergic component n=18 (18,3%), RRI with anemia n=49 (50%), RRI with vitamin D deficiency n=48 (48.9%). No significant laboratory changes were found in the remaining children n=31 (31,6%). More often, anemia is combined with vitamin D deficiency (table).
Table - Main clinical and laboratory characteristics of children with RRI.
Main clinical and laboratory characteristics RRI with an allergic component RRI with anemic component RRI with vitamin D deficiency
Cough + + +
Temperature + + +
Redness of the throat + + +
Lethargy/weakness + + +
Bronchoobstructive syndrome + - -
Pneumonia +/- + +
Hemoglobin^ +/- + +/-
IgET + - -
25OHD| +/- +/- +
Children with a history of allergies (atopic dermatitis, urticaria, food allergies) or with an allergoanamnesis (parents have seasonal allergies) were more likely to have frequent respiratory infections with obstructive syndrome than children without allergies.
Children with anemia (often iron-deficient) are at risk of frequent respiratory infections, as iron plays an important role for proper cell differentiation and growth. It is an important component for enzymes that generate peroxide and nitrous oxide, which in turn play the role of enzymatic functioning of immune cells [8]. Iron deficiency leads to a decrease in the proliferation of T- lymphocytes, the production of secretory immunoglobulin A, interleukin-2, and interferon-gamma. Under conditions of hypoxia, spontaneous apoptosis of CD4 cells occurs, and the humoral immune response is impaired [9]. A randomized study showed that children with anemia were 5,7 times more susceptible to respiratory infections [10].
There are many randomized studies, systematic reviews, and various publications proving the role of vitamin D in the immune response. At its low values, the frequency of respiratory infections increases, and when it is added to the main therapy, the RRI multiplicity decreases [6,11,12].
Conclusion
Thus, if we eliminate comorbidities such as allergies, anemia, and D-deficiency, we may be able to increase the immune system's response to respiratory infections and reduce the RRI multiplicity. This requires further careful research and observation.
References
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Correspondence:Zhamankulov Adil -PhD student, 2 years of study in the specialty 8D10102 "Medicine", Department of children's diseases No. 1, Nur-Sultan, 11/1 Tauelsizdik str., 5th floor, tel.: 87011244548, e-mail: [email protected]
