Cockles in children, despite the modern level of medicine, the most dangerous children's infectious disease, which is caused by the Bordatella pertussis bacterium and is manifested by an adsadal parietal cough.
Dr. Komarovsky, who, in the past, worked as a infectious doctor, believes that the pertussus is a controlled disease that is controlled by vaccination. But the vaccination ADC is transferred to the kids hard, so many parents, making it once, refuse to further vaccine.
They simply do not understand that after one-time immunization, immunity is produced against the cough, only half of the graft children. Therefore, in recent times, despite the high level of medicine, the incidence of cough has grown significantly.
For 100% of the child's immunization, you need to pick up a cough 4 times.
The disease is called bordtella pertussis or, as it is called - a flop of a cough. For the first time, the pathogen was able to identify in 1906 by the year and boron.
Also was allocated a view of a pertussis bacterium - a parapertussis stick (Bordella Parapertussis), which causes Parakoclush - a disease, a clinical flow with a cough, flowing in a light form.
Bordetella Pertussis has a kind of shallow oval stick that cannot move. Cockstitch sticks not painted in gram.
Bordetella pertussis is isolated thermostable toxins, hyaluronidase, lecithinase and plasmoagulase. Bacteria have heart-shaped antigen and capsule antigens.
A cough stick is unstable in an external environment, as is inactivated under the action of ultraviolet rays for 60 minutes. Also, a fever is adversely on the causative agent, a high temperature affects (when heated to 56 ° C, the sticks die after 15 minutes, and when boiling - instantly) and dezers (phenol, lysol, ethyl alcohol).
There is no congenital immunity to the cough, so the symptoms of the cough can occur even in newborns.
The only source of the disease is a patient of any form of a man.
The patient is considered contagious from the first day of the catarrhal and up to 30 days from the beginning of the disease. The most dangerous to others - patients in the catarrial period and with asymptomatic flow, emphasizes Komarovsky, because there are no such persons, and they have time to infect cough other children or adults.
Coplush vaccination is not 100% measure of disease prevention, but immunized children disease occurs in a light form and without serious complications.
The susceptibility to the column of a cough in unmapped children is higher than that of graft and is 80-100%. The child had a persistent coupling, a persistent life immunity is produced. The re-infection of the pertussis stick is rare.
Cocky is sick more often than young children. In adults, the disease is not always possible to recognize, since its current is mostly asymptomatic.
The propagation mechanism of the flop of a cough is aerogenic, which is carried out by air-droplet. But, since the causative agent is unstable in the external environment and cannot move, the infection occurs only with direct communication with the patient.
The peak of the incidence of the cough falls on the autumn-winter period. Also for the cough is characterized by cyclicity with raising morbidity every 4 years.
The invasion of Bordetella pertussis into the body occurs through the epithelium of the upper respiratory tract. The pathogen does not penetrate into the cells of the cylindrical soliculous epithelium of the respiratory tract, and is attached to them. The enzymes highlighted by a floppy stick are affected by the epithelial layer of larynx, trachea and bronchi.
Bordetella pertussis toxins penetrate the nerve endings of the wandering nerve and irritate them, forming this focus of excitement in a part of the oblong brain, which adjusts the respiratory function.
Therefore, a sick child arises a strong cough on various stimuli (pain, sound, light, etc.). Dr. Komarovsky calls a cough of a unique disease and considers it rather a nervous system disease than the upper respiratory tract.
In the oblong brain there are a vomiting center, a vasodent center and a center that is responsible for skeletal muscles, which can also be annoyed by Bordellaly toxins, as a result of which the child has vomiting, arterial hypertension, convulsions.
Bordetella pertussis toxins have an immunosuppressive effect, due to which the secondary bacterial and viral flora is often joined to the pertussis.
Classification of Cocktle
Polysh can flow typically and atypically.
For typical forms of the disease, a cyclic flow is characterized in which sequential periods can be distinguished:
- incubation;
- catarrhal;
- spasmodic or convulsive;
- permissions;
- recovery or reconciliation.
Interesting! By severity, the symptoms of the cough can be divided into light, moderate and heavy.
Among the atypical forms of the cough is observed erased, abortive and asymptomatic forms.
The incubation period begins from the moment of invasion of the pathogen in the epithelium of the upper respiratory tract and continues until time when the first signs of the catarrhal period of the cough appear. The average duration of the bordell incubation period in the body is 5-7 days.
In the catarrial period, the pertussis are observed symptoms of intoxication in the form of a subfebrile fever (37-37.9 ° C), rare body temperature rises to febrile figures (38-38.9 ° C), general weakness, irritability, capriciousness, poor appetite.
Also, the child is concerned with the catarrhal phenomena from the side of the upper respiratory tract (nasal congestion, Rinorea, cough). Dry cough, growing at night, is not removed by antitussive means, which should push the thought of cough.
The period of catarrhal phenomena lasts on average 2 weeks, but in severe cases there may be diagnosed.
Period of spasmodic cough. In this period, the cough becomes parole and adsadd, and at the end of the attack comes a long whistling inhale, which is called reprise.
After an attack of a cough cough, the child feels satisfactory, can play, sleep, eat.
Before the attack, the child may have harbingers, such as a throat, anxiety, fear, etc.
What does a cough cough continues? During the attack, the child bluses the face, the eyes are wide open, the cervical veins swell swell, the tongue is dried with a tube, there may be cyanosis of the nasolabial triangle.
After the attack hears the reprise, it may be a thick wet or vomiting, as well as involuntary urination or defecation, loss of consciousness, convulsions can occur. Long-term cough attacks lead to the fact that the face of the child becomes puffy, with point hemorrhages in the conjunctival of the eyes. Cough attack can last up to 4 minutes.
Important! To factors provoking cough attacks, list bright lights, sudden beep, excitement, fright and severe baby emotions. In patients with cough, it is forbidden to inspect the throat with a spatula or spoon, as it can cause a cough attack.
The severity of the patient's condition is determined by the number of cough attacks:
- Easy degree - Up to 10 attacks per day without vomiting. The general condition of the patient is not disturbed.
- Medium-heavy degree - 11-15 attacks per day that end with vomiting. The patient's condition during the intergreacar period is normal.
- Heavy degree - 20 attacks and more. Children present hypoxia, anxiety, the pallor of the skin, acricyanosis, donkeys and ulcers of the bridle of the tongue, loss of consciousness, convulsions, dysnae.
The spasmodic period lasts up to 2 months, after which the number of attacks decreases and the permission period occurs.
The period of resolution of the disease lasts up to 30 days. Syptoms of the cough gradually subside. The child's condition is improving.
The recovery period can take up to 6 months. The child is still weakened and susceptible to other infections.
Important! The flutter form of the pertussis is characterized by a long cougium (1-3 months), which is not quenched with antitussive means, without attacks of an adsadd cough and reprises.
Abortive coop shape. For this form of the disease, a characteristic paroxysmal adsissal cough for 2-3 days, which passes independently.
In the asymptomatic flow of the cough, the symptoms are absent, and the disease can be recognized only after bacteriological analysis or serological examination.
Cocktle in children up to year
Cocal is the most dangerous for newborns and infants, since congenital immunity is absent.
You can highlight the following features of the flow of cough in infants:
- the period of spasmodic cough in infants is stretched for 2-3 months;
- the course of the disease is wave-like;
- body temperature is not increased;
- at the height of the attack often there is a stop of breathing;
- the attack of the cough can manifest itself by sneezing, which is completed with nasal bleeding;
- there is a risk of violation of cerebral circulation and hypoxic encephalopathy;
- coplush complications are often developing, especially the inflammation of the lungs, which can lead to the death of the baby.
Treatment of cough in children under the year should be carried out exclusively in the conditions of an infectious hospital. Antibiotics are necessarily assigned to prevent bacterial consequences.
Parakoclus meets more often in children of preschool age and even at the busted perters. Children are less susceptible to Parakoclusha than koklum.
Parakoclus has a mechanism for the development of a similar pertussus.
Signs of Parakoclusha:
- low-heated catarrhal phenomena from the side of the upper respiratory tract;
- the condition of the child is not broken;
- body temperature within the normal range;
- dry adsatory parlor cough with reprises;
- rare attacks of a cough cough;
- dry wheezes in the lungs;
- on the radiograph of the breastfeed organs, signs of expanding the roots of the lungs, amplification of the vascular component and rarely peribrous inflammation of the pulmonary fabric are determined;
- blood test within the normal range. There may be a moderate increase in the number of white blood cells and the growth of lymphocytes;
- the consequences of the disease in the form of inflammation of the lungs are very rare.
Coplush complications in children
Cockles in children can be complicated by inflammation of bronchi and / or lungs, otitis, media tray, pleurrites, atelectasis of lung, hypoxic encephalopathy, hemorrhoids, umbilical hernia
Inflammation of the lungs, pleurisy and media trays arise due to the layering on a cough infection of another pathogenic flora.
Interesting! The symptoms of these complications are not always able to determine during the spasmodic period of the cough, since the bakery cough appears on the fore.
Pellower hypoxic encephalopathy joins 2-3 weeks of the disease. The child has such symptoms as loss of consciousness, convulsions, fainting, reduced hearing and vision. If you do not seek medical care on time, encephalopathy can cause the death of the baby.
From the cough dies 0.04% of patients.
Diagnosis of cough in children
Typical signs of the cough - the parole cough and reprises will allow unmistakably to make a diagnosis.
The diagnosis of typical and atypical flows of laboratory diagnostics is confirmed:
- common blood test: leukocytosis, lymphocytosis, elevated ESP;
- bacteriological analysis of mucus from the rear wall of the pharynx, which is carried out in the first 14 days of the disease and allows you to get the result in 5-7 days;
- serological methods, such as agglutination reactions, complement binding, passive hemagglutination. Analysis in which the titer of antibodies to Bordetella pertussis has increased 4 times with vaccinated children, and the non-vaccinated is 1:80.
Treatment of cough in children with a slight flow is carried out at home under the control of the Pocketonian pediatrician and infectious doctor.
The medium and heavy forms of the cough require inpatient treatment.
The child needs to ensure peace, eliminate the factors that can cause cough, as well as allocate a well-ventilated separate room.
Provide sufficient air humidity - humidifier, bowl with water, wet towels. It is possible to walk on the street, only away from other children if the body temperature is patient within the normal range.
To facilitate Cough Dr. Komarovsky recommends in the summer time to walk in the early morning near the lake, as well as a few hours before bedtime.
If you live in the city where there are no water bodies, it is better to go to relatives to the village or to the cottage.
Food with pegshe
Kinder baby needs 5-6 times in small portions. Breasts should increase the amount of feedings for 2 per day.
Increase the baby's drinking mode due to compotes, tea, horses, juice, mineral water without gas, REGIDROON, HUMANOV electrolyte.
The menu of the patient of the cough must consist of rubbing soups, liquid porridges, broths, vegetable and fruit purees, fermented milk products.
Etiotropic treatment
With cough, antibiotics of a wide range of action for 5-7 days are prescribed, such as protected semi-synthetic penicillins, aminoglycosides and macrolides in doses of the patient's age.
Important! Antibiotics are applied to kill Bordetella pertussis and prevent the bacterial consequences of a cough. But to cure cough antibacterial therapy can not be cured, since the cough excitement is already formed and is in the brain.
Also in patients with cough use a specific anti-sliced \u200b\u200bgammaglobulin.
Pathogenetic therapy
Pathogenetic means are used to reduce cough reflex, improving the oxygenation of brain tissues and eliminate hemodynamic disorders. The following pathogenetic means are prescribed patients:
- neuroleptics and sedatives (aminazine (only in hospital conditions), Seduksen, Sibaz);
- antihistamines (Tueva, Supratin, Zetrin, Pipolfen);
- infusion rehydration (sodium solutions chloride, Locke Ringer, Trisole, Dzer);
- oxygen therapy;
- vitaminotherapy (vitamins of groups B, C, A, E).
Ineffective antipheral with cough. It is strictly forbidden to use mustard pieces, banks and other distracting agents.
Milking products, such as ambroxol, acetylcysteine, grass-based syrups, it is advisable to prescribe, as the blockage of bronchi thick wet is the main factor in the development of lung inflammation with cough.
At body temperature above 38.5 ° C, antipyretic drugs are used - nourofen, efferralgan, etc.
Also, to relieve cough in children, you can taste folk remedies, such as boiled milk with chopped cloths of garlic, decoction of figs, a mixture of oil with honey, tea from the leaves of the plantain, a decoction of a bow with honey, a decoction of licorice root, etc.
Prevention of Cockle
Cocktle vaccination is carried out by DC vaccine according to the national vaccination calendar at 3, 4-5, 6 and 18 months.
Non-specific children up to a year at contact with patients with cough, human immunoglobulin in 3 ml has been introduced for 48 hours.
On vaccinated contact children of preschool age, quarantine is superimposed on 14 days from the moment of contact with the sick child.
Ministry of Health of the Russian Federation
ORDER
In accordance with Article 37 of the Federal Law of November 21, 2011, N 323-F3 "On the Fundamentals of the Protection of Citizens in the Russian Federation" (Meeting of the legislation of the Russian Federation, 2011, N 48, Article.6724; 2012, N 26, Article 3442, 3446)
order:
To approve the standard of specialized medical care to children with a cough of moderate severity according to the annex.
Minister
V.I.Skvortsov
Registered
in the Ministry of Justice
Russian Federation
February 7, 2013,
registration N 26888.
Application. Standard of specialized medical care for children with a cough of moderate severity
application
to order
Ministry of Health
Russian Federation
of November 9, 2012 N 806n
Floor: any
Phase: acute
Stage: Average severity
Complications: regardless of complications
Type of medical care: Specialized medical care
Conditions for medical care: stationary
Medical assistance form: Emergency, Emergency
Average treatment time (number of days): 14
Code of POICB H. *
________________
* International statistical classification of diseases and problems associated with health, X revision.
Nonological units
Cocktle caused by bordetella pertussis |
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Cocktle caused by Bordetella Parapertussis |
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Poklusch is unspecified |
1. Medical activities for disease diagnosis, state
Reception (inspection, consultation) of a specialist doctor |
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Medical service code | |||
________________ |
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Reception (inspection, consultation) Infectious doctor primary | |||
Reception (inspection, consultation) Neurologist primary doctor | |||
Reception (inspection, consultation) otorinolaryngologist primary doctor | |||
Reception (inspection, consultation) ophthalmologist primary | |||
Reception (inspection, consultation) Pediatric Pediatrician Primary | |||
Medical service code | Name of medical services | Averaged frequency rate | Averaged scope of application |
Microscopic examination of prints from the surface of the perianal folds on the eggs of helminths | |||
Defining antibodies of classes A, M, G (IGA, IGM, IGG) to chlamydia pneumonia (chlamidia pneumoniae) in the blood | |||
Determination of antibodies of classes M, G (IgM, IgG) to the pneumonia myoplasm (Mycoplasma Pneumoniae) in the blood | |||
Bacteriological examination of feces on the causative agent of dysentery (Shigella SPP.) | |||
Bacteriological Research Cala on Tiffo Parathine Microorganisms (Salmonella Typhi) | |||
Microscopic Cala on Eggs and Helmint Eggs | |||
Urine analysis common | |||
Medical service code | Name of medical services | Averaged frequency rate | Averaged scope of application |
Light radiography | |||
2. Medical services for the treatment of disease, condition and treatment control
Reception (inspection, consultation) and observation of a doctor |
|||
Medical service code | Name of medical services | Averaged frequency rate | Averaged scope of application |
Daily inspection by a doctor infectious person with the observation and departure of secondary and junior medical personnel in the hospital department | |||
Reception (inspection, consultation) of an otorinolaryngologist repeated | |||
Reception (inspection, consultation) ophthalmologist repeated | |||
Reception (inspection, consultation) Pediatrician doctor repeated | |||
Inspection (consultation) of a physiotherapist | |||
Laboratory research methods |
|||
Medical service code | Name of medical services | Averaged frequency rate | Averaged scope of application |
Determination of antibodies to staphylococcus (Staphilococcus SPP.) In the blood | |||
Bacteriological examination of mucus with the tonsils and the rear wall of the pharynx on aerobic and elective-anaerobic microorganisms | |||
Bacteriological survey of mucus from the rear wall of the throat on the koky stick (Bordetella pertussis) | |||
Common (Clinical) Blood Analysis Deployed | |||
Biochemical Blood Blood Analysis | |||
Urine analysis common | |||
Instrumental research methods |
|||
Medical service code | Name of medical services | Averaged frequency rate | Averaged scope of application |
Registration of electrocardiogram | |||
Radiography of the apparent sinus | |||
Light radiography | |||
Non-media methods of prevention, treatment and medical rehabilitation |
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Medical service code | Name of medical services | Averaged frequency rate | Averaged scope of application |
Exposure to an electric field of ultra-high frequency (EP UHF) | |||
Medical physical education for diseases of the bronchopulmonary system | |||
Massage of chest | |||
Impact of short ultraviolet radiation (KUF) | |||
3. The list of drugs for medical applications registered in the territory of the Russian Federation, indicating the average daily and termal doses
Anatomy | Drug Name ** | Averaged frequency rate | Units | |||
________________ |
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Stimulants Motoric Gastrointestinal Tract | ||||||
Metoclopramid | ||||||
Antiodeary microorganisms | ||||||
Bifidobacteria bifidum | ||||||
Acidophilic lactobacillia | ||||||
Other minerals | ||||||
Potassium and magnesium asparaginat | ||||||
Other systemic hemostatics | ||||||
Ethailate | ||||||
Sulfonamida | ||||||
Furosemid | ||||||
Penicillins of a wide range of action | ||||||
Amoxicillin | ||||||
Combinations of penicillins, including combinations with beta-lactamase inhibitors | ||||||
Amoxicillin + [Clawulanic Acid] | ||||||
Cephalosporins of the 3rd Generation | ||||||
Ceftriaxon | ||||||
Macrolids | ||||||
Azithromycin | ||||||
Roxitromycin | ||||||
Other immunostimulators | ||||||
Anaferon Children | tablet | |||||
Barbiturates and their derivatives | ||||||
Phenobarbital | ||||||
Benzodiazepine derivatives | ||||||
Diazepam | ||||||
Adrenomimetics | ||||||
Xylometazoline | ||||||
Selective beta 2-adrenomimetics | ||||||
Salbutamol. | ||||||
Other means of systemic effects for the treatment of obstructive respiratory diseases | ||||||
Fenspirid | ||||||
Derived phenothiazin | ||||||
Promethazine | ||||||
Carboanhydrase inhibitors | ||||||
Acetazolamide | ||||||
Solvents and diluents, including irrigation solutions | ||||||
Water for injections | ||||||
4. Types of therapeutic nutrition, including specialized foods
Name of the type of healing food | Averaged frequency rate | amount |
Basic version of the standard diet | ||
Notes: |
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Electronic document text
prepared CJSC Codex and drilled by:
official website of the Ministry of Justice of Russia
www.minjust.ru (copy scanner)
as of 02/14/2013
The distribution area of \u200b\u200bthis Protocol is medical organizations regardless of their ownership forms.
Methodology
Methods used to collect / selection of evidence:
search in electronic databases.
Description of methods used for collecting / selection of evidence:
electronic library (www.elibrary.ru). The depth of search was 5 years.
Methods used to assess the quality and force of evidence:
expert consensus; Evaluation of significance in accordance with the rating scheme (scheme
Description |
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proof |
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Meta test |
high |
qualities |
systematic |
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randomized controlled studies (RCC), or RCK with very |
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Qualitatively conducted meta-analyzes, systematic reviews or RCCs with |
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low risk of systematic errors |
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Meta-analyzes, systematic reviews or RCCs with high risk |
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systematic errors |
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High-quality systematic research reviews |
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control or cohort studies. High-quality reviews |
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studies Case control or cohort studies with very low |
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Well-carried out research case-control or cohort |
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studies with the average risk of mixing effects or systematic |
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errors and average probability of causal relationship |
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Research case-control or cohort studies with high |
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risk of mixing effects or systematic errors and medium |
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probability of causal relationship |
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Not analytical studies (for example: descriptions of cases, series of cases) |
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Opinion experts |
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Methods used to analyze evidence:
Systematic reviews with evidence tables.
Description of methods used to analyze evidence:
When selecting publications, as potential sources of evidence, a methodology used in each study is studied in order to make sure its validity. The result of the study affects the level of evidence assigned to the publication, which in turn affects the strength of the recommendations arising from it.
Methodological study is based on several key issues that are focused on the features of research design that have a significant impact on the validity of the results and conclusions. These key questions may vary depending on the types of research, and the applied questionnaires used to standardize the publication evaluation process.
On the evaluation process, undoubtedly, a subjective factor may also affect. To minimize potential errors, each study was evaluated independently, i.e. At least two independent members of the working group. Any differences in estimates were discussed by the whole group in full. If it is impossible to achieve consensus, an independent expert was attracted.
Proof Tables:
the proof table was filled with members of the Working Group.
Methods used to formulate recommendations:
Description |
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At least one meta-analysis, systematic overview, or RCK, |
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estimated as 1 ++, directly applicable to the target population and |
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demonstrating the sustainability of the results or group of evidence, |
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applicable to target population and demonstrating common |
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stability of results |
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A group of evidence that includes the results of the study, assessed as 2 ++, |
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directly applicable to the target population and demonstrating the overall |
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sustainability of results or extrapolated evidence from |
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research rated as 1 ++ or 1+ |
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A group of evidence, including research results estimated as 2+, |
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directly applicable to target population and demonstrating |
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general sustainability of results; or extrapolated evidence from |
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research rated as 2 ++ |
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Proof of level 3 or 4; or extrapolated evidence from |
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research rated as 2+ |
Indicators of benign practice (Good Pratice Points - GPPS):
Economic analysis:
In the presence of domestic data on the efficiency of costs for the analyzed interventions in recommended for selection / collection of evidence of databases, they were taken into account when making a decision on the possibility of recommending their use in clinical practice.
external expert assessment;
internal expert assessment.
These recommendations in the preliminary version were reviewed by independent experts who were asked to comment primarily how to interpret evidence underlying recommendations is available for understanding.
Comments from primary regulatory doctors regarding the accountability of the presentation of recommendations and their assessment of the importance of recommendations as a working tool of everyday practice are obtained.
The preliminary version was also sent a reviewer who does not have medical education to receive comments, in terms of perspectives of patients.
Comments received from experts were carefully systematized and discussed by the Chairman and members of the Working Group. Each item was discussed, and made as a result of this change in the recommendations were registered. If the changes were not made, the reasons for refusing to make changes were recorded.
Consultation and expert assessment:
The latest changes in these Recommendations were presented for discussion in the preliminary version at the All-Russian Annual Congress "Infectious Diseases in Children: Diagnostics, Treatment and Prevention, St. Petersburg, 8-9 October 2013. The preliminary version is exhibited for a broad discussion on the website www.niidi.ru, so that those who do not participate in Congress have the opportunity to participate in the discussion and improvement of recommendations.
Working group:
For the final editorial board and quality control, the recommendations were re-analyzed by members of the Working Group, which concluded that all comments and comments of experts were taken into account, the risk of systematic errors in the development of recommendations is minimized.
Maintenance of the Protocol:
Conducting clinical recommendations (protocol of treatment) for medical care to children (Protocol) Patients with cough is carried out by the federal state budgetary institution "Research Institute of Children's Infections of the Federal Medical and Biological Agency" and MBUZ "GDKB №1" GUZ administration of Krasnoyarsk, FBUN MNIIM . G.N. Gabrichevsky and GKUZ "IKB №1 DR", which developed a protocol and bringing correction during its use. The system of reference provides for the interaction of the Russian Federation NIIIDI FMBA of Russia with all interested organizations providing medical care for children in infectious diseases.
4.1 Definition and concept.
PERTUSSIS (A37.0, A37.9) - acute anthroponous infectious disease caused by Bordetella genus bacteria, mainly Bordetella Pertussis, transmitted by air-droplet, characterized by a long-sided convulsive (spasmodic) cough, lesion of respiratory, cardiovascular and nervous systems.
Cocktle, called Bordetella Pertussis, is a typical controlled infection. Achieving coverage of the victims of children of the first year of life (more than 95%) and maintaining it at this level in the last decade ensured not only the decrease in the incidence of cough, but also stabilization of indicators at the minimum level (3.2 - 5.7 per 100 thousand population). In major cities, which marks a large population density, modern diagnostic methods (PCR, IFA), incidence rates are more accessible. Maintaining the circulation Borgetiel ensures the preservation of the main epidemiological patterns of the cough:
- periodicity (increasing the incidence of coup every2-3 years);
Seasonality (autumn-winter);
- foci (mainly in schools).
The source of infection is patients (children, adults) with typical and atypical forms. Patients with Atypical Forms of Pertenship represent a special epidemiological danger in family foci with close and long-term contact (mother and child). The transmission mechanism is drip, the path of transmission of the pathogen - the air-droplege. The risk of infection for others is especially large in the foresight period of the disease and the beginning of the period of a convulsive cough (spasmodic), then gradually decreases. By 25 days from the beginning of the cough, the patient, as a rule, it becomes not contagious. In the absence of antibacterial therapy, the risk of infection is not an invoked child, which is close contact, is preserved up to 7 weeks of a convulsive cough.
Sweatshi susceptibility is high: the contagiosity index is up to 70.0% - 100.0% of non-vaccinated children of the first year of life, especially newborns and premature. In the age structure, most of the sicks make up schoolchildren 7 - 14 years old - up to 50.0%, children 3 - 6 years - up to 25.0%, the smallest share - children aged 1 - 2 years - 11.0% and children under 1 - 14.0%. Frequent diseases among adults. According to observations conducted in the foci, the frequency of adult diseases is up to 23.7%.
After the undergoing cough under the conditions of high coverage of children by vaccinations and low level circulation levels, persistent immunity is preserved for 20-30 years, after which repeated cases of the disease are possible.
Mortality is currently low, however, the risk is preserved in newborns and premature babies, as well as patients with congenital infections.
4.2. Etiology and pathogenesis.
Cockpit Cockpiece (Bordetella Pertussis) is a gram-negative hemolytic stick, a fixed, not forming a capsule and dispute, unstable in an external environment.
Other Bordellala (B. Parapertussis, rare B. bronchiseptica) also cause a faded disease (clinical pertussus). B. Bronchiseptica more often causes Bordelalles in animals.
A cough stick forms an exotoxin (cough toxin, a lymphocytomulating or histaminesensitising factor), which has the main value in the pathogenesis and the systemic effect (hematological and immunosuppressive).
IN the antigenic structure of the cough sticks also includes: filament hemagglutinin, perthatin and protective agglutinogen (contribute to bacterial adhesion and colonization);adenylate cyclase hemolysin (an adenylate cyclase exoferment complex, which catalyzes the formation of CAMF, with toxin - hemolysin; along with a cough toxin, it determines the development of the characteristic convulsive (spasmodic) cough); tracheal cytotoxin (damages the epithelium cells of the respiratory tract); dermontoxin (possesses vasoconstrictor activity); Lipopolisaccharide (possesses the properties of endotoxin).
The causative agent has 8 agglutinogen, leading are 1, 2, 3. agglutinogens
– full antigens on which antibodies (agglutinins, complement-binding) are formed during the disease. Depending on the presence of leading agglutinogenes, four serotype of the cough sticks (1, 2, 0; 1, 0, 3; 1, 2, 3 and 1, 0, 0, 0) are isolated. Serotypes 1, 2, 0 and 1, 0, 3 are more often isolated from the grafts, patients with light and atypical shapes of the cough, serotype 1, 2, 3 - from non-vaccinated, patients with severe and medigative forms.
Entrance gateis the mucosa of the upper respiratory tract. Cocktle microbes are distributed by bronchogen, reaching bronchioles and alveoli.
Bacteremia for patients with cough is not characteristic.
IN the development of a cough infection is distinguished by three stages, a leading role in which various pathogenicity factors play:
1 - adhesion in which perthatin is involved, filament hemagglutinin, agglutinogen;
2 - local damage, the main factors that are tracheal cytotoxin, adenylate cyclase hemolysin and cough toxin;
3 - systemic lesions under the action of a cough toxin.
Cockless toxin, possessing adenosine infatinbosyltransferase activity, has an impact on the intracellular exchange of ionized calcium (the work of the "calcium pump"), determining the development of the convulsive component of cough, seizulum in the severe form of a cough, as well as hematological and immunological changes (including the development of leukocytosis and lymphocytosis, raising The sensitivity of the body to histamine and other biologically active substances with the possibility of the development of hypergia with an IgE-mediated allergic reaction mechanism).
IN the structure of systemic lesions with cough dominate:
1. Disorder of the central regulation of breathing;
2. Violation of the function of external respiration with the development of the spastic state of the respiratory tract in combination with productive inflammation in peribroscial, perivascular and interstitial tissue;
3. Disruption of capillary blood flowdue to the damage to the vascular wall with a sharp disorder of blood and lymphorage (full-blooded, hemorrhage, swelling, lymphostasis) mainly at the place of inflammation (respiratory organs);
4. Discirculatory disorders in the brain and disorders of intracellular metabolism of cerebral tissue mainly due to hypoxia with the possibility of necrobiotic changes of nerve cells (their lysis, followed by a glial reaction with severe forms of the disease);
5. The inhibition of vascular centers and the blockade of β-adrenoreceptors under the action of a cough toxin along with a disturbance of capillary blood flow and the effects of hypoxia are the cause of violations from the cardiovascular system.
6. Reducing non-specific resistance (phagocytosis) and violation of cytokine regulation mechanismsT-cellular immunity with the development of secondary immunodeficiency state.
Copllow wand and products of its livelihoods cause long irritation of rampant nerve receptors, impulses with which are sent to the CNS, in particular, the respiratory center, which, according to domestic authors, leads to the formation of a stagnant focus of excitation characterized by signs of dominants by A.A. . Ukhtomsky.
The main signs of the dominant focus with cough are:
increased infusion of the respiratory center and the ability to summarize irritation (sometimes a sufficiently minor stimulus for the occurrence of an attack of a convulsive cough);
the ability of a specific response to a non-specific irritant: any stimuli (pain, tactile, etc.) can lead to a convulsive cough;
the possibility of irradiation of excitement to neighboring centers:
a) a vomit (the response is vomiting, which often end the attacks of a convulsive cough);
b) vascular (response is an increase in blood pressure, spasm of vessels with the development of brain circulation disorder and brain edema);
c) skeletal Musculature Center (with a response in the formtonic-clonic convulsion);
resistance (activity is still preserved);
inertia (formed, the focus periodically weakens and enhanced);
the possibility of the transition of the dominant focus to the state of parabiosis (the state of the parabiasis of the respiratory center is explained by delays and stopping respiration in patients with cough).
The formation of a dominant foculation occurs already at the beginning of the disease (in
the prevailing period), but its most bright signs appear in the convulsive period, especially on the 2-3 week.
The response is the cough (by the type of unconditional reflex), which at the stage of local damage (premissant, catarrhal, initial period of the cough) has the nature of the usual tracheoobronchial, subsequently (at the system of systemic lesions during a convulsive cough, spasmodic, illness of the disease) acquires an attack-like convulsive nature .
4.3. Clinical picture and classification.
4.3.1. Clinical picture.
The typical form of a cough (with an approached convulsive cougium) is characterized by cyclical flow.
Incubation periodit lasts from 3 to 14 days. (on average 7-8 days).
Premons (catarrhal, initial) period ranges from 3 to 14 days.
The following clinical and laboratory signs are characteristic: gradual start; satisfactory condition of the patient; normal body temperature; dry, obsessive, gradually increasing cough (main symptom); Cough strengthen, despite the symptomatic therapy; lack of other catarrhal phenomena; the absence of pathological (auscultative and percussion) data in the lungs; Typical hematological changes - leukocytosis with lymphocytosis (or insulated lymphocytosis) with normal ESO; Selection of a coup sticks made of mucus taken from the rear wall of the pharynx.
The period of parietal convulsive (spasmodic) cough continues from 2 - 3
weeks to 6 - 8 weeks and more. A characteristic Symptom of Coculus, the parliamentary convulsive cough is due to the tonic convulsion of the respiratory muscles.
Cough attack represents the breathing jiggests on each other in exhalation, interrupted by a whistling convulsive breath - reprise that occurs during the passage of air through a narrowed voice gap (due to laryngospasm). Ends the attack by the disorder of thick, viscous, vitreous mucus, sputum or vomiting. The attack may precede a aura (feeling of fear, anxiety, sneezing, rings, etc.). Cough attacks can be short-lived or last 2-4 minutes. Possible paroxysms are possible - the concentration of cough attacks on a short period of time.
In a typical bout of cough, the view of the patient is characteristic: the face is blushing, then shines, it becomes tense, swelling subcutaneous veins of the neck, face, head; There is a tear. The language is supervised from the oral cavity, the tip it rises up. As a result of the friction of the bridle of the tongue on the teeth and its mechanical relention, a supervision or formation of an ulcer occurs.
The tongue supervision or ulcers is a characteristic symptom of a cough.
Outside, the cough is preserved endlessness and pastosity of the face of the patient, eyelidity, the pallor of the skin, perioreral cyanosis; Subconjunctivinal hemorrhages are possible, phetechial rash on face and neck.
Characteristically gradual development of symptoms with the maximum participation and weighting of seizures of convulsive cough on the 2nd week of a convulsive period; On the 3rd week, specific complications are detected; On the 4th week - nonspecific complications against the background of secondary immunodeficiency.
In the convulsive period there are pronounced changes in the lungs: at percussion, a tympanic tint is noted, shortening in the inter-opumen space and lower departments. Auscultation over the entire surface of the lungs are suspended dry and wet (medium and large-tangible) wheezing. Challenged with cough is the variability of symptoms: the disappearance of wheezing after coughing and the appearance again after a short period of time. Cough attacks gradually grow and reach their maximum in the second week of the spasmodic period.
The defeat of the respiratory organs is the main symptom complex with cough. There are variants of pathological changes: 1) pneumoclush or "cough light"; 2) bronchitis; 3) pneumonia and 4) atelectasis.
With pneumoclushe ("Copllow Easy"), physical data are limited to simtoms of blurry of pulmonary fabric. Breathing remains normal (pouryl) or becomes hard. Characteristic radiological symptoms are:
horizontal standing edges, increased transparency and expansion of pulmonary fields, amplification of the pulmonary pattern in medial departments, low location and flattening of the diaphragm dome, as well as the appearance of infiltrates in the cardiovascular corner or in the lower departments on both sides, which in some cases are interpreted by radiologists as pneumonia .
The changes described may be observed with any side of the cough. They appear already in the extended period, grow in spasmodic and remain for a long time, often for many weeks.
Bronchitis is a complication of a cough. The presence of bronchitis can be judged by the emergence of a large number of wet solid-caliber wheels in the lungs, while there is an increase in temperature, catarrhal syndrome on the side of the upper respiratory tract and oralogotens, as well as the phenomena of intoxication and respiratory failure due to the damage to the bronchial tree. The wet acquires an inflammatory nature. Evidence of engaging in the process of small bronchi is a bronchicistic syndrome, which is not observed with a cough monoinfection.
To the morphological signs described above, characteristic of the "cough light", with bronchitis, concomitant ARVI, joins damage to the mucous membrane of the bronchi, destruction of the epithelium and its submissible base.
Pneumonia with coughs more often occurs due to the addition of secondary respiratory infection - more often than ORVI and mycoplasma infection.
Atelectaz develops in connection with the obturation of the brightness of the bronchus by a viscous mucus and impaired by the engine function of the bronchi. Clinical manifestations of atelectasis are usually associated with its size. Only with massive atelectasas there is a tachipne, the appearance or strengthening of the signs of respiratory failure, shortening of the percussion sound, impaired breathing. The occurrence of atelectasis is accompanied by an increase or strengthening of paroxysmal cough attacks.
The development of atelectasis, which are more often localized in the field of IV-V lung segments.
Reverse development period (early reconvalues) continues from 2 to 8
weeks Cough loses a typical character, it becomes less and becomes easier. The state of health and condition of the child is improved, vomiting disappears, sleep and appetite normalizes.
Later reconnaissance periodit lasts from 2 to 6 months. At this time, the increased excitability of the child is maintained, trace reactions are possible (return of the paroxy convulsive cough during the layering of intercurrent diseases).
4.3.2. Classification of cough.
Generally accepted clinical classification of pertussis corresponds to the principle of A.A. Koltypina, who has substantiated the unified principle of the classification of infectious diseases in children by type, gravity and flow (1948).
1. Typical.
2. Atypical:
Abortive;
Erased;
Asymptomatic;
- transient bacteridation.
By severity:
1. Easy form.
2. Medium-heavy shape.
3. Heavy shape.
Severity criteria:
- severity of symptoms of oxygen deficiency;
- frequency and character of convulsive cough attacks;
- the state of the child in the intergenial period;
- severity of edema syndrome;
- the presence of specific and nonspecific complications;
- the severity of hematological changes.
By the nature of the flow:
1. Smooth.
2. Non-smooth:
With complications;
- with the layering of secondary infection;
- with the exacerbation of chronic disease.
Classification of cough on the ICD X: A37
A37.0 Cocal, caused by Bordetella pertussis. A37.1 Cocktle caused by Bordetella Parapertussis.
A37.8 Cocal, caused by another refined caser of Bordetella. A37.9 Pocklush is unspecified.
Atypical flutter forms. Abortive form- The period of convulsive cough begins typically, but it ends very quickly (during the week). Erased form
In a child during the entire period of the disease, a dry obsessive cough is preserved, the parloring convulsive cough is missing. Asymptomatic (subclinical) form- The clinical manifestations of the disease are absent, but there is a height of the causative agent, the re-release of its DNA from the smear from the rear wall of the pharynx / nasopharynx and (or) the increase in the titers of specific antibodies in the blood. Transient bacteridation- Sewing or discharge of a Cockstand DNA in the absence of clinical manifestations of the disease and without increasing the titers of specific antibodies in the dynamics of the study. Bacteridation in children is rarely observed (in 1.0-2.0% of cases), as a rule, in graft children.
Atypical flutter forms are more often celebrated in adults and grafted children.
Complications.
Specific:
atelectasis, expressed emphysema of the lungs, mediastinal emphysema,
breath rhythm disorders (breathing delays - up to 30 seconds and stop - apnea - more than 30 seconds),
cough encephalopathy,
bleeding (from the nose, gauge space, bronchi, outdoor auditory pass), hemorrhage (in the skin and mucous membranes, scler and retina, head and spinal cord),
hernia (poucher, groove), loss of the mucous membrane of the rectum,
breaks of the eardrum and the diaphragm.
Nonspecificcomplications are due to the layering of secondary bacterial
microflora (pneumonia, bronchitis, angina, lymphadenitis, otitis, etc.).
Residual changes.Chronic bronchopulmonary diseases (chronic bronchitis, bronchiectatic disease); retreat of psychomotor development, neurosis, convulsive syndrome, various speech disorders; enuresis; Rarely in unmatched in the absence of etiopathogenetic therapy - blindness, deafness, paresis, paralysis.
Features of the cough in unmaded young children. Incubation and predominant periods are shortened to1-2 days, a period of convulsive cough is elongated to6-8 weeks Heavy and medigative forms of the disease prevail. The cough attacks can be typical, but the reprises and tongue leading are observed less often and are unmatched. Cyanosis of the nasolabial triangle and face is marked. In newborns, especially premature, the cough is weak, little sonorous, without reprises, without a sharp hyperemia of the face, but with cyanosis. The wets of the cough stand out less, as the children swallow it. As a result of the discoordination of various respiratory departments, including a soft sky, the mucus can be released from the nose.
W. children of the first months of life instead of typical kola attacks are marked by their equivalents (sneezing, unmotivated crying, cry). It is characterized by hemorrhagic syndrome: hemorrhage in the central nervous system, less often - in sclera and skin. The overall condition of the patients in the intergovernmental period is violated: the children are sluggish, the skills acquired by the time of the disease are lost. Often developing specific, including threatening life of complications (apnea, cough encephalopathy) with the development of urgent states (violation of the rhythm of breathing, convulsions, oppression of consciousness, hemorrhage and bleeding).
Disturbance of respiratory rhythm (breathing delay and stop) may occur both during cough attack, and outside the attack (in a dream, after eating). Apnea with cough in children of the first months of life is divided into spasmodic and syncopal. Spasmodic apnea occurs during cough attack, continues from 30 seconds to 1 minute. Syncopal apnea, otherwise called paralytic, is not associated with a cough attack. The child becomes sluggish, hypotonic. The pallor appears first, and then cyanosis of the skin. There is a cessation of breathing while maintaining cardiac activity. Similar apnea lasts 1 - 2 minutes.
W. the premature babies in the presence of morphofunctional immaturity, perinatal damage to the central nervous system or the concomitant CMWC CMW apnea occurs more often and can be long. Apnea is observed mainly in children of the first months of life. Currently, there are no severe disorders of respiratory rhythms in children aged older than the year.
Cocktle encephalopathy is a consequence of discirculatory disorders in the brain against the background of hypoxia and develops after frequent and long respiratory stops in non-vaccinated young children, as well as as a result of intracranial hemorrhage.
The first signs of beginning neurological disorders are general anxiety or, on the contrary, hypodynamine, increased drowsiness during the day and sleep breaking at night, tremor limbs, increasing tendon reflexes, lightly convulsive twitching of individual muscle groups. With a more severe flow of cough encephalopathy, a convulsive syndrome with a short loss of consciousness is observed.
From nonspecific complications most often occurs pneumonia. Falling outcomes and residual phenomena are possible.
Secondary immunodeficiency develops in early terms (from 2-3 weeks of spasmodic cough) and expressed significantly. Hematological changes are saved for a long time.
The serological response is less pronounced and noted at the later dates (4-6 weeks of the period of spasmodic cough).
Features of a cough in graft children. Vaccinated against a cough kids can get sick due to insufficient development of immunity or reduce its intensity. Especially there are light and medigative forms of the disease, severe flow is not typical. Specific complications are rare and do not wear threatening life
Currently, the Problem's problem is relevant to the practical health care of all countries of the world. Despite the vaccinocylaxis of this disease, the intensity of the epidemic process and the incidence of incidence from the late 1990s of the 20th century, grow steadily.
At the same time, the increase in the number of manifest forms of the Pellower creates conditions for engaging in the epidemic process of children of the first months of life, which is associated with an increase in the severity of the course of the disease and mortality, and atypical, clinically not expressed forms - to the lack of alertness of clinicians to this infection from the first days of illness, which are The most favorable for laboratory diagnostics.
Etiology Cocktle
Poklush is an acute air-drip infection caused by microorganisms of the form Bordetella pertussis characterized by the lesion of the mucous membrane is predominantly larynx, trachea, bronchi and the development of a convulsive parrorion cough.
Bacteria - Cockpaths of the Coculus were first highlighted from a sick child in 1906 by two scientists - Belgian Jille Bordea (in honor of him the genus) and French Oktava Gengu (in honor of them both the causative agent of Coklush also refer to the Bordean-Genga ladder). In addition to the description of the microbe, they developed a nutrient medium for its cultivation, which is widely used to this day and is also called in their honor to the Word Geng State.
In modern systematics, Bordellala belonged to the Bacteria domain, the order of Burcholderiales, the Alcoligenaceae family, the genus Bordetella. Within the genus described 9 species, 3 of which are predominantly pathogenic for humans:
- most often, the disease causes B. pertussis - the causative agent of a cough, bonded pathogen;
- B. PARAPERTUSIS - Parakoclusha causative agent (Coklice-like, clinically similar to cough disease), is also distinguished from some animals;
- B. Trematum - the causative agent of wound and ear infections described relatively recently.
There are 4 more species that are causative agents of animal diseases, but also potentially pathogenic for a person (cause infections in particularly rare cases, as a rule, immunocomplete patients):
- B. Bronchiseptica is the causative agent of bronchisepticosis (Coklice-like animal disease, in the person flowing along the type of ORZ);
- B. AnSorpii, B. Avium, B. Hinzii. B. Holmesii is allocated only from people, as a rule, with invasive infections (meningitis, endocardits, bacteremia, etc.), however, the etiological role of this type in the development of infections has not been proven.
- B. Petrii is the only representative of the genus allocated from the environment and capable of living in anaerobic conditions, but the possibility of its long-term persistence in humans is described.
Earlier, up to the 30s of the last century, Bordelasels mistakenly attributed to the genus Haemophilus only on the grounds that in the medium for their cultivation it was necessary to make human blood.
In the majority of environments and now make a defibrous human blood. However, Breadford in later studies showed that blood is not for Borgetchel a growth factor and a mandatory component in cultivation, but performs a greater extent the role of adsorbent toxic products of metabolism of bacteria.
According to the genotype and the phenotypic properties, Bordellala also differ significantly from hemophiles, which proved LOPES in the 50s of the 20th century. This made it possible to allocate them in an independent genus.
Epidemiology Cockles
It is necessary to note the epidemiological features of the cough. This is strict anthroponosis, in which the main source of infection is a sick person, bacteridation, as it is still considered, does not have epidemiological significance and in groups free from cough, not registered, and among the passing children is no more than 1-2%, with a slight duration His (up to 2 weeks).
Cocalus belongs to "child infections": up to 95% of cases are detected in children and only 5% in adults. Although the actual frequency of the cough in adults in official statistics can hardly be reflected due to the incomplete registration of all cases, firstly, due to the prejudice of the therapists about the age-related category, subject to this infection - and therefore, a low alertness in relation to it, secondly, Because the pertussis in adults often flows in atypical forms and is diagnosed as an ARZ or ARVI.
Mechanism of transmission Aerogenic diseases, and the path is air-drip. The susceptibility of the population in the absence of anticulous immunity is very high - up to 90%.
But despite this, as well as the massiveness of the excitation of the pathogen into the external environment, the transmission is possible only with closely long communication for the following reasons: the aerosol, which is created during the cough of the patient of the cough, largely dispersed and quickly sends to the objects of the environment, spreading no more than a radius of 2- 2.5 m, and his penetrating ability in the respiratory tract is small, since large particles are delayed in the upper airway departments.
In addition, Borkidella Coplush Structuca to the action of natural environmental factors - to insolation (and both by the action of UV rays and elevated temperatures), and at 50 ° C are dying for 30 minutes, to drying. However, in the wet sputum that fell to the objects of the external environment can be maintained for several days.
Analyzing the incidence of cough, recall that during the pre-extent period, until 1959, in our country, it reached 480 cases per 100 thousand people with very high mortality (0.25% in the structure of total mortality, or 6 per 100 thousand); By 1975, due to the successes of the mass vaccination of the ADC vaccine, the incidence fell to 2.0 per 100 thousand, and it was a record low level, and mortality decreased several hundred times and is now registered in isolated cases - no more than 10 year.
By the end of the 20th century, and to the present, the steady annual growth of the incidence of cough is noted. So, in 2012 compared to 2011, it increased almost 1.5 times and amounted to 4.43 and 3.34 cases per 100 thousand population, respectively. Traditionally, the incidence is higher in megalopolis (the first place in the Russian Federation is held in recent years in St. Petersburg).
It should be noted that the actual incidence of cough, apparently, is even higher than the statistical numbers. This can be associated with incomplete registration due to the presence of a large number of "atypical" clamsha forms, the lack of reliable methods of laboratory diagnostics, the difficulty of differentiation with Parakoclush, etc.
Peculiar features of the modern period is:
- "Molding" - an increase in the specific gravity of patients in the age group of 5-10 years (maximum falls on 7-8 years), since the formative postal immunity is not sufficiently strained and long and long and 7-year-old age accumulates a significant number of non-immune kids to the kids (more fifty %); In this regard, foci of infection have emerged mainly in secondary schools with repeated cases of diseases in organized groups;
- last periodic lifts arise against the background of increasing the coverage of early child children (under the above reason);
- the return of the high-tech strain 1, 2, 3 (this Serbianart circulated and prevailed during the pre-registration period, in the first 10 years of vaccine-philaxciaxis, it was shifted to Serzrigrant 1.0.3) and a large number of medium-and-heavy and heavy forms of the cough; Now Serbianart 1, 2, 3 is found in 12.5% \u200b\u200bof cases, it is allocated mainly from children of early age, unmet, with severe cough form;
- dominance of Serisant 1, 0, 3 (up to 70% among "decryne cases"), which is allocated mainly from graft and patients with a light form;
- increase the number of atypical Forms of Cockles.
Biological properties of the pathogen
The causative agents of the cough are gram-negative small sticks, the length of which is approaching the diameter in size, and therefore reminiscent of oval cocci, called coccobackets; They have microcapsule, drank, stationary and do not form a dispute.
They are aerobones, better develop in a humid atmosphere at a temperature of 35-36 ° C, belong to "whimsical", or "capricious" to cultivation conditions, bacteria with complex nutritional needs. In addition to nutrient base and growth factors, the adsorbents of the toxic products of Bordellel metabolism are actively allocated during their livelihoods.
There are 2 types of adsorbents:
- defibrified human blood introduced in an amount of 20-30% on Wednesday Bordeland (potato-glycerin agar) and is not only an adsorbent, but also an additional source of native proteins, amino acids;
- activated coal used in semi-synthetic media such as casein-coal agar (Kua), Bordelandellabar. The quality of semi-synthetic media can be improved by adding 10-15% of defibrous blood.
The colonies of a cough microbe are small (about 1-2 mm in diameter), very convex, spherical, with smooth edges, gray with a silver tint, resembling droplets of mercury or pearls. They have a viscous consistency and grow in 48-72 hours, sometimes growth is drawn up to 5 days.
The colony of a paracken microbe is similar to cough, but larger (up to 2-4 mm), a darkening of the medium can be detected around them, and the cream and even brown tint appear on the Kua, the formation time is 24-48 hours.
When studying the colonies Bordellel using a stereomicroscope with lateral lighting, the so-called tail of the comet is visible, which is a cone-shadow of the colony on the surface of the medium, but this phenomenon is not always observed.
B. pertussis Unlike other representatives of the genus biochemically inert and do not decompose urea, tyrosine, carbohydrates, do not utilize citrates.
The antigenic and toxic substances of Borkhetell are quite diverse and are represented by the following groups: surface structures (microcapsule, frAMities), structures localized in the outer membrane of the cell wall (filament hemagglutin, pertakin) and toxins, the main of which participating in the pathogenesis is a cough toxin (CT ), consisting of component A (S1 subunit), which causes toxicity, and in (S2-, S3-, S4-, S5 subunits), which is responsible for attaching toxin to the cells of the wildlife epithelium.
An important role is also played by endotoxin, thermolabile toxin, tracheal cyilotoxin, adenylate cyclase. All of the above factors are present in the cooled strains of a cough microbe.
Surface, localized in frmps, so-called agglutinogens are of the greatest interest from Bordalell antigens, are otherwise called "factors". These are non-toxic proteins with low molecular weight, which are important in the formation of protection in a cough infection and detectable in agglutination reactions, which served as a reason for their name.
Anderson and Eldering in the 50s of the last century described 14 agglutinogen Bordethel, denoting their Arabic figures (already known already 16). Rodov, common to all Bordethel, is agglutinogen 7; species for B. pertussis - 1 (mandatory), intraspecific (strains) - 2-6, 13, 15, 16 (optional); For B. Parapertussis - respectively 14 and 8-10, for B. Bronchiseptica - 12 and 8-11. The detection is used in the laboratory diagnosis of cough in differentiation of the corresponding species and to separate the strains of B. pertussis on serological options.
Four existing Serisants B. pertussis are set by combinations of factors 1, 2, 3; one hundred; 1, 2, 0; 1, 0, 3; 1, 2, 3.
Pathogenesis of a pertussic infection
The entrance gate of the infection is the mucous membrane of the respiratory tract. Cocky sticks show strict tropism to the cells of the fiscal epithelium, are attached to them and multiply on the surface of the mucous membrane, not penetrating into the bloodstream.
The reproduction usually occurs for 2-3 weeks and is accompanied by the release of a number of strong exotoxins, the main of them are CT and adenylate cyclase. After 2-3 weeks, the pertigis causative agent is destroyed with the release of a large complex of intracellular pathogenic factors.
In the place of the colonization and invasion of the pathogen, inflammation is developing, the activity of the creation epithelium is depressed, the secretion of mucus increases, the respiratory tract epithelium (DP) and focal necrosis appear. The pathological process is most pronounced in bronchi and bronchioles, less - in the trachea, larynx, nasooplot.
Forming mucous-purulent plugs clog the lumen of the bronchi and lead to focal atelectasis. Continuous mechanical irritation of DP receptors, as well as the effect on them, CT, Dermonekrotisin and life products B. pertussis determine the development of cough attacks and lead to the formation of a dominant type of initiation focus in the respiratory center, as a result of which the characteristic spastic cough is developing. By this time, the pathological process in bronchi self-sustained already in the absence of pathogen.
And even after the complete disappearance of the pathogen from the body and inflammatory processes in DP, the cough can be maintained very long (from 1 to 6 months) due to the presence of a dominant focus in the respiratory center. It is possible to irradiation of excitation from DP into other departments of the nervous system, resulting in symptoms from the respective systems: a reduction in the muscles of the face, body, vomiting, an increase in blood pressure, etc.
The peculiarities of the infectious process with pertussis are the absence of a phase of bacteremia, primary infectious toxicosis with a pronounced temperature reaction and catarrhal phenomena, as well as slow, gradual development of the disease. The absence of pronounced primary toxicosis is explained by the fact that B. pertussis at its reproduction and death forms a small amount of CT.
Despite this, CT has a pronounced effect on the entire body, and above all on the respiratory, vascular and nervous system, causing a spasm of bronchi, increasing the permeability of the vascular wall and the tone of peripheral vessels. The emerging generalized vascular spasm can lead to the development of arterial hypertension, the formation of venous stagnation in a small circulation circle.
In addition, the pertussis causative agent is able to have an adverse effect on the gastrointestinal tract, enhancing intestinal peristalsis and contributing to the development of diarrheal syndrome, lead to the disappearance of bonded representatives of intestinal microflora and as a result of a decrease in colonization resistance, reproduction of conditionally pathogenic enterobacteria, cockkops and fungi and development Intestinal dysbiosis. These effects are due to the action of mainly CT and adenylate cyclase.
An important meaning in the pathogenesis of cough in modern concepts has the apoptogenic effect of toxins B. pertussis on the cells of the body's immune system. The secondary immunodeficiency arising from this is a predisposing factor for the development of non-specific cough complications, such as bronchitis and pneumonia, which are most often associated with the activation of their own bacterial respiratory tract flora or "layering" of ARVI, chlamydial, mycoplasma infections, being an excellent "conductor" for them. Such complications significantly increase the risk of briefcase and respiratory failure.
Clinical picture of Cockles
Cocktle in typical manifest form ("standard definition" of the case) is characterized by the following symptoms:
- dry cough with gradual strengthening and acquisition of the character of the parlor of spasmodic on the 2-3rd week of the disease, especially at night or after physical and emotional load;
- apnea phenomena, facial hyperemia, cyanosis, tearing, vomiting, leuko- and lymphocytosis in peripheral blood, the development of "cough light", hard breathing, branch of viscous sputum;
- weakly spent ridiculous phenomena and a minor temperature increase.
Cocalus refers to the number of diseases with cyclic flow. 4 consecutive periods are distinguished:
- incubation, the duration of which on average is 3-14 days;
- catarial (predominant) - 10-13 days;
- convulsive, or spasmodatic, - 1-1.5 weeks in immunized children and up to 4-6 weeks in unvacted;
- the reverse development period (reconvalued), in turn, divided into early (developing in 2-8 weeks from the beginning of clinical manifestations) and late (after 2-6 months).
The main symptom of the catarrhaling period is a dry cough, increasing, obsessive day. With light and medium-free forms, the temperature remains normal or gradually rises to subfebrile numbers. Catarial phenomena from the mucous membranes of the nose and the rotogling are practically absent or very scarce. General health is not too suffering. The duration of this period correlates with the severity of further flow: the way it is shorter, the worse the forecast.
During a convulsive cough, the cough acquires an approachability of the exhaust jackets that followed by a friend with a whistle in the reprise. It should be remembered that reprises are only half of the patients. The cough attacks may be accompanied by cyanosis of the face and a branch of viscous transparent sputum or vomiting at the end, in early age children are apnea.
With frequent attacks, the poverty of the face, eyelids, hemorrhagic petechia on the skin appear. Changes in the lungs, as a rule, are limited to the symptoms of the swelling of the lung tissue, single dry and wet wets can be served, which disappear after the cough attachment and reappear after a short time.
With the development of spastic cough, the infectiousness of the patient decreases, however, at the 4th week, 5-15% of patients continue to be sources of the disease. During the permission period, cough loses its typical character, becomes less and easier.
In addition to typical forms, it is possible to develop atypical Forms Cockles –
- erased, characterized by weak caddling, the absence of a consistent change of periods of the disease, with vibrations of cough duration from 7 to 50 days;
- aburient - with the typical start of the disease and the disappearance of cough after 1-2 weeks;
- subclinic forms of the cough are diagnosed, as a rule, in the foci of infection during bacteriological, serological examination of contact children.
In gravity, there is a light, medigative and severe forms, which are determined by the duration of the catarrhal period, as well as the presence and severity of the following symptoms: the frequency of cough attacks, the cyanosis of the face with cough, apnea, respiratory failure, violations of the cardiovascular system, encephalitic disorders.
Poklong is dangerous with its frequent complicationswhich are divided into specific and nonspecific.
Specific are associated directly with a cough infection and are due to the effects of toxins B. pertussis mainly on cardiovascular, respiratory and nervous systems, whose cells they have tropiness.
Non-specific complications are developing as a secondary infection with the most frequent localization in the respiratory tract. On the one hand, local inflammatory processes caused by Bordellalia, leading to the emergence of epithelium ulcerations in bronchops and bronchioles (less often - in the trachea, larynx, nasopharynk), focal necrosis and the formation of mucous-purulent traffic jams, blocking bronchial clearance; On the other hand, immunodeficiency states forming against the background of a cough infection.
The leading role among the causes of death associated with nonspecific cough complications is played by pneumonia (up to 92%), which increase the risk of briefcase and respiratory failure with specific complications - encephalopathy.
Methods of laboratory diagnostics of cough
The laboratory diagnosis of the pertussis acquires particular importance due to the difficulty of clinical detection of the cough and is currently an important link in the system of anti-epidemic events. In addition, only on the basis of the selection of the causative agent, you can differentiate cough and parackenush.
Laboratory studies are carried out with a diagnostic purpose (children who cough for 7 days or more or suspected of cough clinical data suspicion, as well as adults with suspicion of cough and focusless diseases working in maternity hospitals, children's hospitals, sanatoriums, children's educational institutions and schools) and by epidemic testimony (persons who were in contact with the patient).
The laboratory diagnosis of a cough infection is carried out in two directions:
- direct detection of the pathogen or its antigens / genes in the studied material from the patient;
- detection using serological reactions in biological fluids (serums, saliva, secrets of nasopharynx) of specific antibodies to a cough stick or its antigens, the number of which is usually increasing in the dynamics of the disease (indirect methods).
The group of "direct" methods includes a bacteriological method and express diagnostics.
Bacteriological method It is the gold standard, allows you to select the culture of the pathogen on the nutrient medium and identify it to the species. But he was successful only in the early periods of the disease - the first 2 weeks, despite the fact that its use is regulated by the 30th day of the disease.
The method has extremely low sensitivity: Since the beginning of the 2nd week, the pathogen is rapidly falling, on average, the confirmation of the diagnosis is 6-20%.
This is due to "worst", slow growth of B. pertussis on nutrient media, their insufficient quality, using as a selective factor added to the primary sowing medium, antibiotics to which are not all strains of the pathogen, as well as late examination, especially The background of the reception of antibacterial drugs, the wrong fence of the material and its contamination.
Another significant disadvantage of the method is a long period of study - 5-7 days before issuing a final response. Bacteriological discharge of the pertussis causative agent is carried out both with a diagnostic target (with suspicion of cough, if there is a cough of unidentified etiology, over 7 days, but not more than 30 days) and by epidemiological indications (when observing contact people).
Express methods Aimsally aimed at detecting genes / antigens B. pertussis directly in the material under study (mucus and gantry-sofa washes from the rear wall of the pharynx, saliva), respectively, with the help of a molecular genetic method, in particular the polymerase chain reaction (PCR), and immunological reactions (reactions of indirect immunofluorescence, in immuno-immunimal analysis - IFA, microlatecgglutination).
PCR is a highly sensitive, specific and rapid method that allows you to issue an answer for 6 hours, which can be used in different times of the disease, even against the background of taking antibiotics, when detecting atypical and broken flush forms, also with retrospective diagnostics.
PCR for the diagnosis of pertussis is widely used in foreign practice, and on the territory of the Russian Federation remains only the recommended method and is not available to all laboratories, since it requires expensive equipment and consumables, highly qualified personnel, a set of additional premises and areas, and currently cannot be Introduced into the practice of basic laboratories as a regulated method.
Direct methods used for rapid diagnostics can also be used when identifying B. pertussis in pure cultures, including material from isolated colonies, in the process of bacteriological research.
Methods aimed at identifying anti-bone antibodies include serodiagnostics based on the determination of serum antibodies and techniques that allow you to register specific antibodies in other biological fluids (saliva, nasophaling secrets).
Serodiagnostics can be applied at later deadlines, starting from the 2nd week of the disease. In the presence of typical clinical manifestations of the cough, it allows only to confirm the diagnosis, while with the erased and atypical forms, the number of which at the present stage has increased sharply and when the results of the bacteriological method are usually negative, serodiagnosis may be decisive in identifying the disease.
Conducted treatment with antibacterial drugs does not affect the results of this method. The prerequisite is the study of "paired" serums of patients taken with an interval of at least 2 weeks. Diagnostically significant is pronounced seroconversion, i.e. An increase or decrease of 4 times and more levels of specific antibodies.
One-time detection of B. pertussis IgM, and / or IgA, and / or IgG in IFA or antibodies in the titer 1/80 and more in the reaction of agglutination (RA) in unvaccasted and non-pertussis kids not older than 1 year and in adults If they detect specific IGM in the ELISA or when antibodies are detected to B. parapertussis, the RA method in the titer of at least 1/80.
In the literature described 3 types of reactions that can be used for this purpose: RA, the reaction of passive hemagglutination (RPGA), IFA. However, it should be borne in mind that there are no standard immunological test systems for industrial production to produce RPGA, and an ELISA test system, allowing to register the amount of serum immunoglobulins of classes G, M and secretory and to individual antigens B. pertussis, are not produced by the Russian Industry, overseas test systems have a high cost.
RA, despite the relatively low sensitivity, is the only affordable response for any Russian laboratories, which allows to obtain standardized results, since commercial cough (paracken) diagnosticum are produced for its production.
In connection with the foregoing in the territory of the Russian Federation for medical institutions that provide diagnostic services to the public on a budgetary basis, the following methods of diagnosis of cough, regulated by regulatory documents: Basic - bacteriological and serodiagnostics and recommended - PCR.
Bacteriological diagnostic diagnosis scheme includes 4 stages
Stage I (1st day):
- Material fence (twice, daily or every other day):
- the main material - mucus from the rear wall of the pharynx, which can be selected in two ways - "gasket" tampons (sequentially dry, then with a moistened physiological solution on the register E.A. Kuznetsova) and / or the "nasopharynk" tampon (the tampon method is used as in diagnostic research and research on epidemiological indications), as well as by the method of "cough plates" (only in diagnostic research);
- additional material - Gundy-silence washes from the rear wall of the throat, the washing waters of the bronchi (if bronchoscopy is performed), the sputum.
- Sowing on plates Bordean-genua with 20-30% of blood or Kua, Bordelallabar with the addition of the selective cefalexin factor (40 mg per 1 L medium); Thermostatting at 35-36 ° C, 2-5 days with daily viewing.
Stage II (2-3 days):
- Selection of characteristic colonies and explorer on sectors of the Kua or Borkidellaghar plates for accumulation of pure culture, thermostatting.
- The study of morphological and tinnicial properties in a lip of gram.
- In the presence of a set of typical colonies, the study of antigenic properties in slide agglutination with polyvalent pertussic and paracken serums and a preliminary response.
I I I Stage (4-5th day):
- Check the purity of the accumulated culture in the smears in gram.
- Studying antigenic properties in slide-aggutination with polyvalent flush, paracken and adsorbed factor serum 1 (2, 3) and 14, issuing a preliminary response.
- The study of biochemical properties (ureaznaya and tyrosine activity, the ability to dispose of sodium citrate).
- Studying mobility and ability to grow on simple environments.
IV Stage (5-6th day):
- accounting for differential tests; The issuance of the final response on the complex of phenotypic and antigenic properties.
Depending on the availability of laboratory confirmation and other criteria, there is the following grace of cough cases:
- the epidemiologically related case is the case of an acute disease in which there are clinical signs that meet the standard definition of a cough case and epidemiological connection with other suspicious or confirmed cough case;
- the likely case meets the clinical definition of the case, laboratory is not confirmed and does not have an epidemiological connection with a laboratory confirmed case;
- confirmed - meets the clinical definition of the case, laboratory is confirmed and / or has an epidemiological connection with a laboratory confirmed case.
The laboratory confirmation is considered a positive result of at least one of the listed methods: bacteriological selection of the culture of the pathogen (B. pertussis or B. parapertussis), the detection of specific fragments of the genomes of these micorganisms by the PCR method, detecting specific antibodies during serodiagnostics.
Accordingly, the diagnosis is confirmed: Cocal, caused by B. pertussis, or Parakoclush, caused by B. parapertussis. A laboratory confirmed case does not necessarily have to meet the standard clinical definition of the case (atypical, erased forms).
Principles of pertussis treatment
The basic principle of the treatment of cough - pathogenetic, directed primarily to eliminating respiratory failure and subsequent hypoxia (long-term stay in the fresh air, especially near water bodies, in severe cases - oxygen therapy, glucocorticoid hindorates) and improved bronchial conductivity (the use of bronchodulators, mucolytics), and also Symptomatic therapy of specific complications of a cough.
It is possible to conduct specific immunotherapy of severe forms with the help of anti-flow immunoglobulin.
Etiotropic antibacterial therapy is carried out at the risk of development or developed non-specific complications associated with secondary bacterial flora (with bronchitis, pneumonia, etc.), while the choice of antibacterial drugs should be made taking into account the sensitivity to them precisely the causative agents of "weeding" infection.
Specific prophylaxis of cough infection
Poklush - "Controlled infection", against which the planned vaccination of the population is being carried out in accordance with the national vaccination calendar.
The first cough vaccine appeared in the United States in 1941. Currently, the pertussis vaccination is carried out by all countries of the world, and DC vaccines are included in the mandatory set of vaccines recommended by the World Health Organization. There are two fundamentally different types of vaccines used for pertussis prevention:
- Adsorbed coup-diphtheria-tetanomy vaccine (DTA, international abbreviation - DTP) containing a corpuscular cough component (109 killed microbial cells per dose) and diphtheria (15 LF / dose), tetanome (5 EU / dose) of anatoksins, currently Used on the territory of the Russian Federation and some other countries, and until the end of the 70s - and all over the world.
- AACDS caseless vaccines - contain a acellular cough component (based on cough animalcisin with different combination of a number of protesting antigens), deprived of lipopolis-saccharides of the bacterial membrane and other cell components capable of providing unwanted reactions in vaccinated; Used in the USA, Japan, most European countries.
It was believed that the ADH vaccine is the most reactor at the expense of the corpuscular cough component. In some cases, it causes the following adverse reactions and complications in children: local (hyperemia, swelling and pain in place of administration) and general - shrill cry, convulsions and the most serious - post-validity encephalitis, the development of which is associated with the presence of non-nixicated cough toxin in the DC vaccine . However, currently similar cases are deciphered as having another etiology.
In this regard, in the 80s of the XX century, a number of countries refused to vaccinate DC. The first version of the COPSOID-based cell-free vaccine was developed in Japan after the official refusal of the Ministry of Health of this country from the use of all-cell vaccines and followed by the pertussis epidemic - regularity, which has suffered other countries that have been refused at least during vaccination.
Later, numerous, more efficient variants of acellular vaccines were created, including various combinations from 2 to 5 components of B. pertussis, meaningful in the formation of effective immunity - modified cough toxin (anatoxin), filament hemagglutinin (FGA), perthatin and 2 agglutininogen Fimmanity. Now they constitute the basis of calendars of vaccination against the cough of all developed countries of the world, despite their relatively high cost.
Low reactogenicity of acellular cough vaccine allows them to be introduced as a second revaccination dose aged 4-6 years, which allows you to prolong the immunity. There is still no such vaccine of Russian production.
In the Russian Federation, the use of the following AAKDS-vaccines, which in its composition Cocktle Anatoksin, FGA and Pertaktin are officially allowed: Infanrix and Infanrix Hex (Smithklein-Bichich-Biomed LLC, Russia); "Tetraksyim" and "Pentaxim" ("Sanofi Pasteur", France). In addition to diphtheria, tetanus and cough components, they include inactivated polyivirus and / or hib component, and / or a vaccine against hepatitis V.
The vaccination diagram of ACDA provides for the introduction of three doses at the age of 3; 4.5 and 6 months with revaccination in 18 months. According to the calendar of the preventive vaccinations of Russia, the 2nd and 3rd revaccination against diphtheria and tetanus drug ADS-M at 6-7 and 14 years, respectively, and further adult revaccination every 10 years. At will, in commercial structures at the age of 4-6 years, it is possible to revaccinate against cough vaccine AAKDS.
To achieve a satisfactory level of collective immunity, a timely principle (at 3 months) should be at least 75% of children, coverage of vaccination (three vaccine vaccine vaccinations) and revaccination should be 95% of children aged 12 and 24 months of life, respectively, And to three years - not less than 97-98%.
An important way to assess the effectiveness of the vaccination of the population is serological monitoring for the level of collective anti-flow immunity at the graft-vaccine-vaccine in the "indicator" groups of children aged 3-4 years, not coughing cough, with a documented vaccine history and a period of not more than 3 months.
Persons protected from cough are considered to be in serums of which are determined by agglutinins in the titer 1: 160 and higher, and the criterion of epidemiological well-being is the identification of no more than 10% of persons in the examined group of children with an antibody level of less than 1: 160.
Tubavkina S.Yu., Kharseeva G.G.
Introduction
Clinic Cocky
Cocktle in adults
Parakoclus
Introduction
Despite the sharp decrease in the incidence and mortality of the cough, achieved as a result of mass specific prophylaxis, the problem of combating this infection remains relevant and at present.
The planned pertussis vaccine vaccination was introduced in the USSR since 1959. During the first five years, with the maximum coverage of children by vaccinations, the incidence rate decreased by 4.5 times, in 1965 - 82.4 against 367.5 in 1959. In the subsequent decade there was a further decrease in the incidence of cough and in 1976 the incidence rate was 12.9. Since 1977, there has been a relative stabilization of the incidence of incidence with small oscillations during periodic rates (9.5 in 1979, 10.2 - in 1982).
The preservation of periodic lifts is due to the accumulation of a significant number of children of the first year of life, unsecured against the cough, despite the publication of the order of the USSR Ministry of Health No. 50 dated 14.01.80. The beginning of the immunization of DC vaccine from 3 months, practically children begin to vaccinate later, often without sufficient The grounds, therefore, the share of non-nasty children in this age group is still great. The number of unsecured children of the first 3 years of life is also increasing, due to the increase in the number of children with medical disks. In addition, children over 3 years old are susceptible to cough, which has lost post-specific immunity, but they are easily ill.
It has a distribution and a paracken infection that is registered only when applying bacteriological diagnostics. The similarity of clinical manifestations of the cough and Parakoclusch makes their differential diagnosis, and therefore detection and accounting.
Significant changes over the years of specific prophylaxis occurred in the clinic of a cough infection. Due to the reduction in the severity of the flow of infection and the predominance of light and erased forms of the disease (95%), the diagnosis of cough without bacteriological studies is very difficult. The third of the sick does not appeal to the doctor, i.e. The well-being of patients is not significantly violated, and those who contracted often put various diagnoses of the disease of the upper respiratory tract. Only careful observation of the dynamics of the disease, the recording of the epidemiological situation and bacteriological research allow you to diagnose a cough with an erased and lightweight.
Difficulties in the diagnosis of pertussis led to incomplete registration of the disease and understatement of the true incidence. The late detection of patients with the lungs and erased Forms of Cockles, demanded the revision of the main anti-epidemic events in the foci of the cough.
Moskovsky NIIEM NIM N.Gabrichevsky, together with SanEpidadzor of Moscow, clinical and epidemiological observations were conducted on the abolition of mandatory insulation of patients with cough in schools and kindergartens. As a result, it was shown that the lack of insulation of patients did not lead to an increase in the distribution in the focus, the duration of the separation of the pathogen and the more severe course of the disease, and the number of days missed patients in schools and kindergartens was significantly reduced. Based on these observations in 1976, mandatory insulation of coulter patients in schools was canceled in Moscow, and since 1990 - in kindergartens.
^ Experience of cancellation II revaccination against cough aged 6-7 years in Moscow showed the possibility of restricting the vaccinations against the cough of 3 years.
Changes that occurred in the clinic, diagnosis, cough epidemiology, as well as in approaching anti-epidemic activities and immunization against the cough, demanded the publication of new methodological instructions.
The purpose of this document is to familiarize the practical doctors of epidemiologists and pediatricians with the peculiarities of the clinic, diagnosis, treatment, prevention and anti-epidemic measures with cough and Parakoclus in modern conditions.
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Clinic Cocky
Typical flutter forms
Bacteridation
Treatment of Cockles
For 20 years of a wide conduct of prophylactic coughing against the cough, the main manifestations of the cough infection became light and erased forms of the disease, the frequency and severity of complications have decreased, chronic pulmonary changes disappeared as the consequence of the cooled cough, decreased mortality.
In addition to active immunization in facilitating a cough, the improvement of medical care and more efficient pathogenetic therapy is of great importance. Reducing the severity of the cough is also due to a decrease in the pathogenic properties of a cough microbe against the background of the increased, due to vaccinations, specific immunity and the use of antibiotics.
Select typical and atypical flutter forms. Typical should include diseases in which the cough has an attacking character, regardless of whether it is accompanied by reprises; To atypical, erased - diseases in which cough is not spastic.
For a typical cough, 4 periods are distinguished: 1) incubation, 2) catarrhal, 3) spasmodic and 4) reverse development or permission. There are lighter, medigative and heavy powders.
Currently, most children vaccinated vaccine vaccine, a cough infection is manifested in light and erased forms. The medium-haul form is found only in a small group of patients, some children turn out to be bacteria carriers.
Among the unmavited children, the slight form of the cough is registered less often. At the same time, the medium-heavy form arises, mainly in children of the first year of life, and more older - in the presence of an exeued premorbide background. The heavy form of the cough is detected almost exclusively in the unmailing children of the first half of life.
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Typical flutter forms
Light form
Medium-heavy form
Heavy form
Light form
To the easy forms of a typical pertussis include diseases at which the number of cough attacks does not exceed 15 per day, and the general condition is violated to a small extent.
^ The incubation period lasts an average of 14 days.
The catarrial period lasts from 7 to 21 days, an average of 10 to 13 days. The main symptom of a starting cough is a cough, which is not much different from cough with the kabar of the respiratory tract of various etiology. Cough is usually dry, in half cases obsessive, is observed more often at night or before bedtime. Much less often than in previous years, the Qatar of the respiratory tract and fever arise. The temperature remains normal or in the course of several days rises to subfebrile numbers. The well-being of the child and his behavior, as a rule, do not change. The cough is gradually enhanced, becomes becoming increasingly resistant, obsessive, and then the parietal character, and the disease passes into the spasmodian period.
^ During the period of spasmodic cough, the cough characteristic of the cough cough appears and reaches the maximum development of the symptoms of a cough infection.
The bake-up cough is characterized by a number of exhalations quickly following each other, replacing with a convulsive whistling in the reprise.
^ During an attack of cough, the face of the child bluses, becomes tense. At the end of the attack, a viscous sputum is distinguished, sometimes vomiting occurs.
With a light form of modern cough, the number and severity of attacks are reduced. In most patients, the frequency of cough attacks does not exceed 10 and almost half - 5 times a day. Reprises, considered in previous years, as a mandatory symptom of a typical cough in children over a year, is currently observed only by half of the fallen. Vomiting does not occur in all patients and only with individual cough attacks. In single children, it is possible to note the light cyanotic shade of the nasolabial triangle, amplifying during the bump attack. A more permanent symptom is a small swelling of the face and especially an eyelid, which is detected by almost half of the patients. Hemorrhagic syndrome, usually in the form of single petechs on the skin, is rarely observed.
In a physical examination, pathological manifestations of respiratory authorities are limited to emphysemic lungs. Auscultation reveals hard breathing from a number of children. Whees, as a rule, are not listened.
Only in the part of the patients with a light form there are changes in the blood formula, characteristic of the cough: a tendency to an increase in the total number of leukocytes and to the lingocytosis, but these shifts are minor and cannot be used for diagnostic purposes.
^ Despite the easiest current, the spasmodic period retains a greater duration and averages 4.5 weeks.
In the period of permission, which continues 1-2 weeks, cough loses its typical character, becomes less and easier.
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Medium-heavy form
It is characterized by an increase in the number of cough attacks from 16 to 25 times a day or more rare, but severe attacks, frequent reprises and a noticeable deterioration in the overall state.
^ Promotional period is shorter, on average 7 - 9 days, the spasmodic period is 5 weeks and more.
There are changes in behavior and health of the patient, there is an increase in mental excitability, irritability, weakness, lethargy, sleep disorder. The kashel's attacks are accompanied by cyanosis of the face and causes fatting a child. Respiratory failure can be saved outside coughing.
Almost constantly observed the face of the face, signs of hemorrhagic syndrome appear. In the lungs, dry and solid-caliber wet wets are often listened. Wars can completely disappear after the cough attack and again appear a short time.
With great constant, changes from white blood are revealed: an absolute and relative increase in lymphocytes with normal or reduced ESP.
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Heavy form
For heavy forms, the cough is characterized by great severity and variety of clinical manifestations. The frequency of cough attacks reaches 30 or more per day.
The long period is usually shortened to 3 - 5 days. With the onset of the spasmodic period, the general condition of children is significantly violated. They become sluggish, the appetite is reduced, sleep is disturbed. It is possible to increase the temperature to high numbers, but this symptom is not constant.
^ There is a standing or drop in body weight. Coughs long-term attacks are accompanied by cyanosis of the face. Constantly observed respiratory failure.
In the lungs, a large number of solubular wet wheels is usually listened.
In children, the first months of life, breathing stops - apnea associated with the excitation of the respiratory center and the spastic state of respiratory muscles. Breath stops are usually short-lived.
^ In premature babies, as well as the defeat of the central nervous system, apnea occurs more often and can be long.
In the spasmodic period, the symptoms of violations of the cardiovascular system are more often observed: an increase in blood pressure, face-mindedness, sometimes swelling on brushes and footsteps, petechia on the face and upper part of the body, hemorrhage into sclera, nasal bleeding.
In most cases, pronounced changes from blood are observed. The number of leukocytes increases and can reach 40-80 thousand in 1 mm3 of blood. The proportion of lymphocytes is 70 - 90%.
In children with the defeat of the central nervous system "as well as the combination of cough with flu, encephal disorders may occur, accompanied by convulsions of a clonic and clonic-tonic nature, inhibition of consciousness, sometimes the development of a comatose state with a violation of cortical and subcortical functions.
Along with long respiratory stops, severe encephal disorders and are currently the most dangerous manifestations of a cough infection and remains one of the main causes of death during cough.
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Atypical erased face
It is characterized by atypical cadiating, the lack of a consistent change of periods of the disease.
The cough is usually dry, half of the patients are obsessive, is observed predominantly at night, and intensifies in time corresponding to the transition of the catarrhal period to the spasmatic (at the 2nd week of the disease). Often during coughing the face of a child becomes tense. Sometimes single typical cough bouts appear with the child's excitement, while eating or under the layering of intercureant diseases.
Of the other features of the broken form, it should be noted a rare temperature increase and the weak severity of the catarm of the mucous membrane and zea. In physical examination of the lungs, emphysema is detected.
^ The cough duration ranges from 7 to 50 days, the average is 30 days.
Bacteridation
Belloweer's causative carrier is observed in children at the age of 10 years and older, whipped against a cough or overgrowing with this infection. In young children, bacteriath cases are found extremely rarely. In teams free from cough disease, bacteria carriers are not detected. The duration of bacteria is usually does not exceed two weeks.
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Broncho-pulmonary changes with cough
Pathological changes in the broncho-pulmonary system with cough are observed often. They have a different character and can be associated with both the exposure to the causative agent of the cough, and with the layering of the secondary microbial flora. There are 3 groups of pathological changes: 1) "Copllow light", 2) bronchitis and bronchiolites and / 3) pneumonia. The first two groups most authors are considered as a manifestation of a cough infection; Pneumonia are complicated cough.
Under the term "cough light" means a change due to the causative agent of a cough, characterized by the productive process in an interstitial tissue with hemodynamic disorders. Physical data are limited to the symptoms of the ochoism of the pulmonary fabric.
^ Breathing remains normal (pouryl) or becomes hard.
The X-ray picture is richer and discovered along with the fracture of the lungs, the strengthening of the vascular pattern, the appearance of radar gravity, shadows of a mesh and cellular character. Often revealed expanded shadow of the lung roots. The changes described may be observed with any side of the cough. They appear already in the catarrial period of the cough, grow in the spasmodic period and hold it for a long time, often for weeks.
Clinical signs of bronchitis appear on 1-2 weeks of the spasmatic period and disappear in parallel with other symptoms of the cough. Bronchitis with cough is poorly amenable to antibiotic therapy.
Pneumonia occurs with coughus due to the attached secondary microbial flora. The causative agent of Poklum is given the role of a factor prepare the soil for the development of pneumonia. Pneumonia are the main complication of the cough. Currently, they arise much less frequently than in previous years, and are observed mainly in the children of the first year of life. The overwhelming majority of pneumonium with cough are associated with the layering of sharp respiratory viral infections.
^ As a rule, pneumonia develops for 2-3 weeks of the spasmodic period of the disease against the background of already existing bronchitis.
Clinical symptoms are similar to the symptoms of pneumonia, complicating sharp respiratory viral infections, however, the current of the local process is often longer, because Antibiotics do not proper effect on bronchitis, accompanying lung parenchyma.
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Diagnosis of typical kokyusha
In the catarrhal period, the suspicion of cough should occur in the case of a stubborn, obsessive, increasing cough in the absence of or weak severity and short-term catar of the respiratory tract, which cannot explain either the perseverance of cough or its increasing. In the case of suspicion of cough cough, the doctor must send a patient for bacteriological examination.
^ Clinical diagnosis in the spasmodic stage of a typical cough is facilitated by the presence of characteristic coughing attacks.
The purposeful collection of anamnesis in all cases when it comes to the dragging cough, greatly facilitates the diagnosis of the pertussis. In addition to additional cough nature, it is necessary to take into account its dynamics preceding the "ordinary cough" period, the gradual increase in spasmodic attacks, their occurrence, mainly at night hours or before falling asleep, after eating, while running or other than physical and emotional tension .
Attention should be paid to the presence of caution of the face, the absence of the Qatar of the upper respiratory tract, during the peaks of the chest - on the tympanic shade of the percussion sound, the expansion of the lung boundaries, which is significantly expressed already in the catarial period of the cough. Auscultation of the lungs often does not identify pathological changes.
In the diagnosis of cough in the children of the first year of life, the detection of severe and medium-free forms of leukocytosis with severe lymphocytosis and normal ESO is very important. With light shapes of a cough shift, the blood formula is small and have no diagnostic value.
^ Epidemiological history has great help in the diagnosis of light forms.
The gradual development of the disease, the poorly pronounced Qatar of the respiratory tract, the lack of intoxication and the cough duration helps to distinguish the cough from an acute respiratory viral infection (ORVI). In cases where adenovirus or respiratory syntial infection (PC) is accompanied by an approached cough, it is necessary to take into account the main symptoms of these infections: conjunctivitis and cathars with abundant exudation with adenovirus infection and the fast dynamics of bronchipolites in respiratory and syntial infection.
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Diagnosis of broken Forms of Cockles
Clinical diagnostics of worn outflows are great difficulties.
The obsessive character of the cough should be taken into account, its growth in the 2-3rd week, the strengthening of cough at night and mainly the cough duration in the absence of temperature, the Qatar of the upper respiratory tract and the broncho-pulmonary changes that could explain the persecution of cough. When taking into account all these signs, the erased form of a cough can be suspected by a clinician.
Epidemiological data and especially the detection of a cough microbe in the crops are crucial in the diagnosis of broken cough. The detection of a cough of topics complete and timely, the more often, and in earlier terms, doctors resort to bacteriological diagnostics and the systematic (at least once in 3-5 days) is monitored by coughing children.
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Hospitalization of patients cough
The predominance of light and erased forms sharply reduced the need for hospitalization of patients with cough. At the same time, the need to ensure appropriate hospitalization conditions for patients with severe and complicated cough forms has been preserved.
Considering that the heavy forms of the cough are currently being discovered mainly in children up to 6 months, hospitalization is mainly the children of the first half of the year with the pronounced severity of the disease. Older children are hospitalized in cases where heavy cough occurs in weakened children or when combined with other diseases. In the presence of complications, the testimony for hospitalization is determined by their weight, regardless of the age of patients.
Hospital assistance should provide for the need to fencing patients from superinfection; For this purpose, it is advisable to put the first year's children in the bauxated departments, and more senior patients - in small chambers, providing for insulation of patients with mixed infections from the moment of admission.
Heavy manifestations of a cough infection - deep respiratory rhythm disorders and encephal syndrome can imagine a danger to life and require resuscitation events. In this regard, children under the year with heavy coup is recommended to be hospitalized in children's hospitals, which have in its composition resuscitation branches or specially equipped chambers.
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Treatment of Cockles
The use of various methods of treatment requires mainly patients with heavy and complicated cough. The most responsible therapy of heavy cough in children of the first year of life. Erased flush therapy forms do not require; With the lungs - it should be limited to a small circle of syntomatic measures.
Antibacterial therapy is effective only in the early deadlines of an uncomplicated cough in catarrhal and no later than 2-3 days of a convulsive period of the disease. The best effect is ampicillin, gentamicin, erythromycin. When choosing antibiotics, ampicillin preference is given. The daily dose of ampncillin for children up to 2 years of 50-100 mg / kg, for older 25-60 mg / kg body weight, is given in 4 reception within 7 days.
In case of early establishment, the diagnosis can be recommended antibiotics to children under the age of 2, and weakened children and at an older age. First of all, take into account acute and chronic diseases of the respiratory tract and the defeat of the central nervous system.
The purpose of antibiotics in the spasmodic stage of the disease with an uncomplicated cough is recommended: 1) with a combination of cough with a sharp respiratory viral disease, 2) with common bronchitis and bronchiolites, 3) in the presence of chronic pneumonia.
The treatment of secondary bronchopulmonary complications that develop in the convulsive period of the disease are produced using antibacterial drugs and all other therapeutic agents that are accepted in the treatment of sharp pneumonia. In connection with the development of hypochemia and hypocheses, the fight against respiratory failure is one of the main tasks of its pathogenetic therapy.
^ With light diseases of the disease, it is possible to be limited to a long stay in the fresh air.
With severe and complicated female powders, especially in children under the year, with significantly pronounced symptoms of hypoxemia and hypoxia, there are direct readings to hydrochiotherapy using systematic oxygen supply.
When the respiratory is stopped, it is necessary to achieve the restoration of normal respiratory movements as quickly as possible by sucking the mucus from the respiratory tract and the use of artificial respiration.
With the initial and sharply pronounced signs of brain disorders in the form of tremor, short-term cramps of individual muscle groups, reinforcement of concern are prescribed by Seduksen and for the purposes of dehydration of the Lazix or sulfate magnesia. Seduksen is used inside and parenterally (0.1-1.5 ml of 0.5% solution depending on age: up to 3 months - 0.1 -0.3 ml, 4-6 months - 0.3-0, 5 ml, 7-12 months. - 0.5-1 ml, from 1 to 4 years - 1.0-1.5 ml, over 5 years - 1.5 yl). Laziks is given per OS or parenterally at the rate of 2 mg per 1 kg of body weight.
^ In the fight against hypoxia, which is of great importance in the occurrence of encephal disorders, is carried out oxygenation and cleaning of respiratory tract from mucus and saliva.
Antihistamines (Supratin, Tuegil, Dimedrol) are used in the treatment of cough. In order to improve bronchial patency, as well as to reduce the pressure in a small circulation circle, Ehuchillin can be recommended.
In the treatment of cough, negative electro-plants of drugs are also recommended. Spraying is performed using a domestic electro-aerosol generator "Electrosol". The course of treatment consists of 10 - 15 single daily inhalations. One inhalation is prescribed depending on the age of 8 - 10 ml of the medicinal mixture.
Aerosols of the mixture of drugs with antispasmodic effect are used; Their composition includes ephedrine - 0.2, eufilin - 0.3, novocaine - 0.25, ascorbic acid - 1.0, distilled water - 50.0.
The overwhelming majority of patients with cough are treated at home, and the surrounding must be accurately oriented in matters of care for a sick child. Walks should be daily and durable. It should be achieved that the room in which the patient is systematically ventured and its temperature did not exceed 20 ° C. Mother should know that during an attack of cough you need to take a child in my hands, slightly lowering his head, and when the mucus is clusted in the oral cavity with the help of a finger wrapped in pure marks, freeing the mouth of the child from the mucus.
Feed the patient is recommended often and gradually. Food should be full and contain enough vitamins. If the bout of coughing arose after meals and ended with vomit, it is necessary, after a while, to feed the baby again.
^
Cocktle in adults
Cocky is sick not only children, but also adult people of any age. According to the observations of Moscow NIIEM. NI. G. Gabrichevsky 23 - 24% of adults are overdivering cough in family foci and 10% in children's institutions. More often than other family members are sick kids cough.
The deadlines for the separation of the pathogen in adult patients and bacteria carriers are the same as in children; The greatest number of positive results of bacteriological research is observed in the first two weeks of the disease. Adults are predominated by light (64%) and erased (19%) of the form of a cough. Heavy forms of illness are not found. Bacteria carriers among those in contact with patients with cough adults are significantly more (up to 12%) than among children (1-2%). The clinical course of the cough in adults is similar to the clinical manifestations of the disease at the grafted older children. Adults, sick cough, in most cases do not turn to the clinic for medical care, which is due to the easy course of the disease and the lack of need to exemp them from work (maternity leave, care for the sick child, vacation, retirees).
When treating patients with cough into the clinic, they tend to diagnose acute respiratory disease, asthmatic bronchitis, laryngitis and other diseases of the upper respiratory tract. Particular attention to the diagnosis of the cough must be addressed in adults working with children. When coughing appears, they should carry out systematic medical observation and directly directly to bacteriological examination.
^
Preventive Copy Vaccinations
For active immunization against the cough, an adsorbed coup-diphtheria-tetanus vaccine (DPS) is used. In 1 ml of vaccine, 20 billion cough microbial cells, 30 flocculating diphtheria units and 10 binding units of tetanus anatoxine are contained. Vaccine vaccinations vaccine carry out all children aged 3 months to 3 years (with the exception of children who have flown cough on the following scheme:
a) The vaccination rate consists of three intramuscular injections of the drug (0.5 ml each) with an interval of 1.5 months. The abbreviation of the intervals is not allowed.
If it is necessary to lengthen the intervals after the first or second vaccination over 1.5 months, another vaccination should be carried out at the nearest possible period determined by the state of the child's health. When vaccination, the child should receive only three injections of the drug.
If up to 3 years (3 years, 11 months, 29 days), the child will not vaccinate against the cough, due to the presence of contraindications, then immunization should be carried out against diphtheria and tetanus.
Note. With the development of an unusual reaction to the first or second vaccination in the first two days after the introduction of ADA vaccine or post accmineous complications (temperature 39 ° C and higher, allergic rash, skin croup, cramps, shock, etc.) Further use of this drug is terminated And the child should be vaccinated only against diphtheria and tetanus.
b) the revaccination of DCDS vaccine is carried out once, at a dose of 0.5 ml 1.5-2 years after the completed three-year vaccination. If vaccination has been carried out at the age of 2-3 years, then the revaccination against the cough children over 3 years is not spending.
c) The second revaccination against the cough is not carried out.
^
On the rules of vaccination
In the selection of children for preventive vaccinations, prevention and post-certification complications must be observed. The main ones are as follows:
1. Individual approach to the child. It is necessary to take into account the presence of transferred infections, generic injuries, reactions to drugs and previous vaccinations, epidemobor.
2. Do not appoint vaccinations before entering a child in a children's institution or in the first days of stay in it. It is necessary to find out the features of the development and behavior of the child and provide him with time to adapt in new conditions (at least a month).
^ 3. Health events (treatment of rickets, anemia, degelminting, nasopharynx sanitation and other chronic infection) should be carried out before vaccination.
4. When examining the child, the main attention should be paid to the presence of various kinds of allergic manifestations, in these cases the blood and urine analysis should be made. High eosinophilia and lymphocytosis in peripheral blood can be a signal of a changed reactivity of the body.
5. You can not overload children with changed reactivity by vaccine antigens for a short period of time. To this end, you can conduct vaccine vaccination with longer intervals than 45 to 60 days, as well as increase the interval between the introduction of DC and other vaccines (more than two months).
Analysis of the immune interlayer to cough, diphtheria and tetanus should be carried out separately, because Medical taps to cough are much larger than to diphtheria and tetanus.
^
Anti-epidemic events in the focus of the cough
Events in relation to persons communicated with cough patients (in children's
institution, School, Family, Apartment)
In order to prevent cough bays to a children's institution in the daily reception of children, it is necessary to find out the data on the presence of cough. Coughing children are not allowed into the team and direct the observation of the district doctor. The staff of the Children's Institution is obliged to inform medical professionals about the appearance of coughing persons.
The lightest flow of cough, the impossibility of early and complete identification of patients led to the need to change the system of anti-epidemic measures.
^
Events regarding the source of infection
Insulation for 25 days from the beginning of the disease are subject to:
- All patients with cough (children and adults), identified in the nursery, nursery groups of nasal-gardens, children's homes, maternity homes, children's departments of hospitals, children's sanatoriums and summer wellness children's institutions. Bacteriamers from these teams are isolated until two negative results of bacteriological examination of the 2 days in a row or intervals 1-2 days.
- In schools, boarding schools, orphanages and gardens, as well as in pre-school groups of nursery-gardens of isolation for 25 days from the beginning of the disease, only the first patient cough, (child or adult).
In the spread of infection (the presence of two or more cases) of all patients with cough and bacteriamers, isolate inexpediently. Insulation is carried out by clinical indications, i.e. Isolate only those patients who are temporarily cannot be in the team for health.
^ Adults who do not work with children are removed from work only in the presence of clinical readings.
When insulating patients with coulter under clinical indications, the first illness in the focus is also allowed in the team in the absence of contraindications.
Patients with coulter, isolated on clinical indications, allow for a team and to work when improving well-being, relief and decreasing the number of attacks, regardless of the term that has passed since the beginning of the disease.
The question of admission of a patient to work or in the children's team solves the district doctor. On average, children, isolated on clinical indications, are missing 7 - 8 days in schools and 12 - 14 days - in kindergartens. At the same time, 20-5% of patients with coulter's entire period of illness are carried out in the team, not missing a single day.
^
Clinical indications for insulation of cough patients
a) severe and medium-severe forms of illness;
b) the light shape of a cough at the frequency of attacks of 10 and less a day for adults and school children, 5 and less - for preschool children. With a smaller number of attacks of patients, is isolated in cases where the attacks are accompanied by vomiting, fatigue, sleep impairment and appetite;
c) availability of complications;
d) a combination of cough with other acute diseases;
e) the presence of concomitant chronic diseases of the respiratory tract during their exacerbation; hypertension; epilepsy; and other diseases of the central nervous system with a tendency to cramps.
^
Events in relation to persons communicated with cough patients
(in children's institution, school, family, apartment)
Children under the age of 7, in contact with coup patients, are subject to disunity for a period of 14 days from the date of the patient's isolation;
- Children of 7 years and older, visiting schools, as well as adult people working with children, are not subject to disunity; They are allowed in the team or to work and establish medical observation for them within 14 days;
- when insulating patients with coulter patients under clinical indications, the term of disagreement of contacting children increases to 25 days from the beginning of the cough in the last patient in the focus;
- In order to actively identify patients with cough coulter in the nursery in kindergartens, as well as in other institutions for children of nursery and preschool age, two-time bacteriological examination of children and staff staff (two days in a row or every other day) are carried out. With a positive result, bacteriological examination is repeated with an interval of 7 - 14 days before receiving a negative result;
- The expiration of 14 days from the date of insulation of the patient is not the basis for the refusal of bacteriological examination of contacting persons in the focus, because When conducting an examination for epidemias and in a later dates (for 3 to 4 weeks from the beginning of cough at the first patient), positive results are often found. These dates coincide with the catarrhal period of the disease in most persons infected by cough;
- In schools, bacteriological examination for epidemiological indications are not carried out. Surveys are subject to coughing children with a diagnostic purpose.
In the family and apartment, children under 7 years old and adults working in the nursery and homes of a child, maternity hospitals, children's departments of hospitals, kindergartens, sanatoriums and summer wellness children's institutions are subject to two-time bacteriological surveys.
In the absence of bacteriological diagnosis, the detection of patients with cough is carried out on the basis of clinical and epidemiological data. To clarify the diagnosis of coughing children, they are sent under the supervision of a precinct doctor.
Children in contact with patients with cough, gamma globulin with a prophylactic goal is not introduced, because The drug does not protect against the disease, but may have a negative effect on the child's body.
A cough monovaccine for epidospositiones is not introduced, because It does not interrupt the spread of infection in the focus.
^
Organization of identification and observation of patients cough in a clinic
Cough is the main symptom of a cough. Therefore, the appearance of cough, especially without pronounced catarrhal changes of the upper respiratory tract, should alert a doctor with respect to this infection. Each child coughing for 5 to 7 days, the doctor should be directed to a double bacteriological study (two days in a row or every other day) and establish active observation after it.
Coughing children examine in a specially dedicated room of clinics or at home. Adults working with children examine in the bacteriological laboratory of SanEpide or in the focus of the cough at the place of work.
^ About each case, the cough or parackulus must be informed in SanEpidance and a children's institution that the child visits.
Parakoclus
Parakoclush is an acute infectious disease, similar to a clinical picture with a cough, but flowing easier. Parakoclus people are sick of any age, but more often children 3 - 6 years old. The incubation period with parackenly is 4 - 14 days. The development of the disease is characterized by weakly pronounced catarphic phenomena: rhinitis, moderate hyperemia, rarely - conjunctivitis. The overall condition of the patient is usually not enough: the body temperature is usually normal, sometimes rises to 37.5 - 38 ° for 1-3 days.
The main symptom of Parakoclus is cough. Depending on the presence and nature of cough, it is possible to distinguish 3 forms of a paracken infection: a perturbed, erased and asymptomatic.
In the focusing course of the disease after a short prodromal period, the parole cough appears, which is accompanied by redness of the face, reprises and sometimes pumped with vomiting. However, cough bouts arise rarely and are less long than when Cocklesha. For most children, Parakoclush proceeds as an erased form of a cough. The frequency of the cockoclusha's collow-like form is 12 - 15%.
With erased the course of the disease, the cough is the character of tracheal or tracheobronchial. The diagnosis of parackulus in such patients can only be installed after bacteriological confirmation. The frequency of this form is 60-70%.
^ In 10 - 15% of children who communicated with patients with Parakoclush, there is bacteriampsia, i.e. Isolation of the paracken microbe without clinical signs of the disease.
Changes in the lungs with Parakoclus are insignificant. Some children appear unstable dry wheels. X-ray is revealed to expand the shadow of the roots, the amplification of the vascular pattern, less often the sealing of the recurrent tissue.
^ In peripheral blood, there are moderate leukocytosis and short-term lymphocytosis in some patients with parackenis.
Complications for Parakoclusha are extremely rare, usually in the form of pneumonia, developing, as viced due to the layering of acute respiratory viral infection.
^ There are no deaths from Parakoclusha.
Differential diagnosis of cough and paracculus based on clinical data presents great difficulties and is carried out using a bacteriological method.
^ Parakoclusha treatment is symptomatic. Due to the ease of the flow of the disease, the use of antibiotics is not required.
Parakoclushe is sick as clapped against a cough and face, and cough cough.
^
Anti-epidemic events in the area of \u200b\u200bParakoclusha
Parakoclush patients (children and adults) isolate for 25 days from the beginning of the disease only from children's teams for children of the first year of life and children's departments of hospitals. The carriers of the paracken microbe from these teams are isolated until two negative results of a bacteriological study conducted in a row or every other day. In the rest of the children's teams, isolate on 25 days only the first patient by Parakoclush; In the spread of infection, the insulation of patients is carried out according to clinical indications; Bacteriamers do not isolate.
^ Clinical indications for the insulation of patients with Parakoclush and the criteria for their admission are the same as patients with cough.
Children under the age of one year, in contact with patients with Parakoclush, are subject to disunity by 14 days from the date of insulation of the patient. If the patient is not isolated, then the duration of disagreement increases to 25 days. Children of one year and older, as well as adults not subject to adults. They are allowed in the team, but establish medical observation within 14 days.
^ Children visiting preschool institutions and adults working in them are subject to two-time bacteriological surveys.
In order to actively identify patients with Parakoclush, in the nursery and preschool children's institutions, children and staff of the group doublely examine bacteriologically. Upon receipt of positive results, bacteriological examination is repeated with an interval of 7 - 14 days.
With the insulation of patients with Parakooclusha under clinical indications, observation of the hearth is stopped in 25 days from the beginning of the cough in the last patient in the focus and obtaining a negative result of bacteriological surveys of contacting persons.
Children under 7 years old and adults working in pre-school children's institutions, when contacting patients with Parakoclush, the family and apartment are subject to two-time bacteriological surveys. School children examine bacteriologically only with a diagnostic goal (with cough).
^
Organization of bacteriological examination
The main method of laboratory diagnostics of a cough and collow-like diseases is the selection of microbes of the Bordetella genus (B. pertussis, B.parapertussis, B.Bronchiseptica). Bacteriological studies are conducted by laboratories of regional, regional, urban and district SES in the presence of a doctor-bacteriologist who has passed special training, and a laboratory assistant that owns the method of preparation of nutrient media.
The laboratory must be equipped with a stereoscopic microscope or a binocular magnifying glass with a large focal length, a thermostat with a temperature of 35 - 37 ° C, a cough and paracculously agglutinating and monoroceptor serums to 1, 2, 3, 12, 14 factors.
^ Bacteriological studies are carried out with a diagnostic target for epipocations.
With the diagnostic purpose, the examination is carried out to confirm or establish a diagnosis of a cough or paracken. The examination with the diagnostic purpose is subject to:
^ 1) children with suspicion of cough and collow-like diseases on clinical data;
2) Children who cough for 5 to 7 days or more, regardless of the instructions for contact with the patients with coup and paracken.
3) adults with suspicion of cough and collow-like diseases working in maternity hospitals, children's hospitals, sanatoriums, nursery, kindergartens, schools and closed institutions for children of preschool and school age;
4) Adults operating in the above institutions whose cough continues within 5 - 7 days or more, regardless of the instructions on contact with the patients with coup and paracken.
^ Responsible for the timely direction of patients for bacteriological examination is a district doctor.
The survey on epidemias is subject to persons communicating with patients with cough and paracken:
1) Children attending nursery, kindergartens, closed children's teams for children of nursery and preschool age or in children's hospitals, sanatoriums, as well as children up to 7 years old, communicated with coup coulter or paracken at home.
^ 2) Adults working in the above-mentioned children's institutions, when communicating with coup coulter or paracken at home.
The need for bacteriological surveys in children's institutions and its deadlines establishes an epidemiologist.
An examination with a diagnostic goal should be conducted twice, daily or every other day for 1 - 3 weeks of illness. During the examination in a later date, the seizurement of the pathogen is sharply reduced.
^ The survey on epidapositions is also conducted twice 2 - 4 weeks from the beginning of the cough at the first patient in the focus.
Taking and sowing a material with a diagnostic goal and contacts in areas conducts trained medical personnel in Boxes Polyclinic. In some cases, the material can be taken at home. Adults working with children are sent to the examination in the bacteriological laboratory of SanEpidstation or examine in the focus of the cough at the place of work.
^ Taking and sowing in children's institutions is carried out by laboratory technicians or assistants of epidemiologists who have passed special training in the laboratory.
Materials for the study (mucus from the rear wall of the pharynx) are taken by an empty stomach or 2 - 3 hours after meals. To do this, use two methods: potassium plates and gas tampon.
The method of cough plates is used only with a diagnostic goal in the presence of cough. To do this, during cough, the cover from Petri dishes and make a cup with a coupling mouth at a distance of 10 - 12 cm so that the individual small droplets of the mucus of the respiratory tract fall on the surface of the nutrient medium. The cup is kept in this position for 5 - 6 cough jolts. It is necessary to monitor that saliva, vomit, sputum, moctea. Then the cup is closed and delivered to the laboratory.
^ Taking the material with cough plates, except for medical personnel, can conduct parents after the appropriate briefing.
The gauge tampon is used to take material both with the diagnostic target and the epipocation. In children of the breast, the material is taking only a tampon. At the same time, it is necessary to monitor the solid fixation of the wool on the metal rod.
^ To take a material, use dry or "moistry" tampons, which should be curved at an angle before sterilization.
For the manufacture of a "moist" swab, a dry cotton swab twice with a small interval (2 - 5 minutes) is immersed in a buffer mixture or a semi-liquid coo. These tampons can be stored for several days. The advantage of "moistened" tampons is the possibility of sowing the material is not at the site of the fence, but in the laboratory, but no later than 3 - 4 hours from the moment of his take. This method exempt employees from the need to transport cups with a nutrient medium to the place of taking material.
The method of taking the material with dry and "moistry" tampons is the same and consists in the following: the child's head is fixed, after which the tampon is administered under the control of the spatula in the oral cavity, promoting it for the root of the tongue. It should not touch the mucous jack, language and almonds. The tampon tip is convex part of it relate to the posterior wall of the pharynx, making 2-3 smears. Then the tampon is carefully removed from the oral cavity and, when taking the material with a dry tampon, sowing the nutrient medium immediately, and the "moisturized" tampon is placed in the tube and sowing are produced in the laboratory. In both cases, it is desirable to use 2 cups of Petri with a nutrient medium.
During transportation, the material from direct sunlight and low temperature should be protected (freezing). For this, crops are placed in special boxes, suitcases or bixes with a protecting gasket - gauze vocals, heating plants, etc.
During the direction of crops to the laboratory, the direction should be made correctly, which indicates the name of the institution that sent material for the study: surname, name, age, home address of the surveyed, reason for the survey, the method of taking the material, the date of the disease, the multiplicity of the survey, the date and time of the taking Material and signature responsible person.
^ The crops are placed in a thermostat, which, for humidification, put water tanks.
Due to the slow growth of the causative agent, the pertussis bacteriological research continues within 5 - 7 days. The preliminary answer can be issued for 3 - 5 days, the final - 5 - 7th day.
Blood media (bordean-khangu, milk-blood agar) and a synthetic medium on a casein basis are used as nutritional media for research - casein-coal agar (CUA). Blood environments are optimal, but due to the deficiency of the main ingredient - blood, they are few applied. The nutrient medium Kua widely entered the practice. It can be made in a bacteriological laboratory from the necessary ingredients or obtained in a finished form from institutions producing nutrient media. Dry Wednesday Kua can be obtained in the Dagestan Research Institute of Nutritional Media. To improve the growth of a cough microbe to this medium, you can add 0.5% of chopped activated carbon or 4 - 5% of any sterile defibrous blood.
To oppress the increase in the concomitant microflora onto the CU medium before bottling at a temperature of 45-50 C, an antibiotic is added (Penicillin or bicillin at the rate of 0.3 - 0.6 units per 1 ml of medium). Each QU series must be checked, and they take only the series on which the freshly lean strain B.pertussis is growing well.
The sessions of the microbes of the genus Bordetella depends on the timely and correct taking of the material, the multiplicity of the examination, the quality of the nutrient media, the timing and the conditions of delivery of the material to the laboratory, as well as the qualifications of the doctor of the bacteriologist. When viewing cups with crops, it is necessary to take into account that the cough microbe can grow in the form of atypical colonies.
^
Serological diagnostic method
The serological method of diagnostics can be used to retrospective confirmation of the diagnosis. It is based on the detection of specific antibodies in the studied sera. For this purpose, the reaction, agglutination (RA), complement binding response (RSK) and the reaction of passive hemagglutination (RPGA) are used. The most accessible under practical laboratories reaction agglutination.
Serological studies are an additional diagnostic method in the presence of antibody dynamics. Blood research should be started at 2-3 weeks of the disease with repeated determination of the content of antibodies after 1.5 - 2 weeks.
An indication of blood test is a long cough in the absence of bacteriological confirmation of the diagnosis. Serological examination of blood is especially shown in case of contact of a long coughing child with a sick cough or paracken.
For the differential diagnosis of cough and paracculus, serological reactions should be placed with two diagnosticum - cough and paracken, since anti-flow immunization causes an antibody formation to the causative agents of both infections.
The disease occurs, as a rule, in the absence of antibodies or low content of them in the blood (1:10 - 1:80). However, there are cases of disease and with a high content of antibodies (1: 320 and higher), when the child falls soon (no more than 6 - 8 months) after vaccination against the cough. Therefore, the diagnostic value is the increase in antibody titers in 4 or more times.
^ For children who are unsecured against the cough and no previously pegs and paracle, the presence of specific antibodies in the Titres 1:80 and above has a diagnostic value.
Blood for research takes from the finger in compliance with the usual rules of aseptics, make a series of serum dilutions and add diagnosticum. The results take into account the next day.
Chief
Main Department
quarantine infections
| Ministry of Health of the USSR | V.P.Sergeev |
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