EnglishУкраїнська
  • Main
  • Useful links
  • Information for Contributors
  • About
  • Editorial board

  • Article
    Koloskova О.К., Bilous Т.М., Hnatiuk М.G., Kukhta О.Y., Bilous V.V

    EFFICACY OF NONINVASIVE DIAGNOSTICS OF ACUTE INFLAMMATORY RESPIRATORY DISEASES IN SCHOOL-AGE CHILDREN


    About the author: Koloskova О.К., Bilous Т.М., Hnatiuk М.G., Kukhta О.Y., Bilous V.V
    Heading CLINICAL MEDICINE
    Type of article Scentific article
    Annotation Objective: to improve the diagnostics of acute infectious-inflammatory respiratory diseases in school-age children by means of finding diagnostic value of certain noninvasive methods to examine patients. Materials and methods. 172 school-age patients were comprehensively examined and diagnosed with community-acquired uncomplicated pneumonia (І clinical group, 43 children), community-acquired pneumonia against the ground of bronchial-obstructive syndrome (ІІ clinical group, 19 school-children), acute or obstructive uncomplicated bronchitis (ІІІ group, 110 patients). The comprehensive examination of patients included cytological tests and microbiological inoculation of sputum, viral examination of swabs from the nasal pharynx, chest X-ray, C-reactive protein in the blood serum, biochemical examination of lung expiration condensate. Results and discussion. The results of microbiological examination of sputum taken from the patients of clinical groups were indicative of bacterial flora occurring in 83,9% of children from І group, 72,7% patients of ІІ group and 52,6% representatives of ІІІ group (р˂0,05 with І:ІІІ), fungal flora was found in 1,4% children of ІІІ group, and fungal-bacterial association in 9,7% patients of І group and19,7% of ІІІ group. It should be noted that pneumococcus was determined to be the most frequent causative agent, especially in association with Staphylococcus aureus (26,9%), and in the representatives from ІІ group – enterococcus (37,5%). The viral examination with negative results of bacteriological tests of sputum taken from patients of the clinical groups found respiratory-syncytial virus in all the patients from І group (100%), adenovirus in 33,3% of children and respiratory-syncytial virus in 66,7% from II group, in ІІІ group – adenovirus in 25,0% of patients, and respiratory-syncytial infection – in 55,0% of patients, their combination in 5,0% of cases and none of the agents – in 15,0% of examinations. The content of nitrogen monoxide metabolites in the lung expiration condensate of children from I and III clinical groups was practically similar: 35,4±7,02 and 39,3±3,63 micromole/L respectively, and in the representatives of II clinical group it appeared to be 1,5 higher and in an average was 52,3±7,51 micromole/L (P>0,05). The indices of the most optimal diagnostic value to determine infectious-inflammatory process of the lower respiratory tract were the markers of proteolytic activity by azoalbuminolysis higher than 1,4 ml/hour and azocasein more than 1,24 ml/hour. At the same time, C-reactive protein in the blood serum more than 24,0 mg/ml and nitrogen monoxide metabolites concentration in the lung expiration more than 45,0 micromole/L were associated with a probable risk of infectious-inflammatory process of the lower respiratory tract available. Conclusions: Routine diagnostic methods enable to verify severity of infectious-inflammatory process mainly but not its causes. High concentrations of C-reactive protein in the blood serum (more than 24,0 mg/ml) is the most specific although low sensitive in verification of pneumonic process, when the evidence of this process increases in 12 times as much. At the same time, satisfactory indices of sensitivity and specificity in detection of pneumonia belong to the markers of proteolytic activity by small and middle molecular proteinolysis in the lung expiration condensate, although they are not associated with statistically reliable risk of this inflammatory process of the alveolar part of the respiratory tract. The studies concerning optimization of diagnostic methods of acute respiratory pathology in children require further investigation on larger groups of patients with greater arsenal of noninvasive diagnostic procedures.
    Tags children, diagnostic, respiratory diseases
    Bibliography
    • Vorotniak TM, Bezrukov LO, Koloskova OK, Bilous VV, vynakhidnyky; Bukovynskyi derzhavnyi medychnyi universytet, patentovlasnyk. Prystrii dlia zboru kondensatu vydykhuvanoho povitria. Patent Ukrainy № 45346 UA MPK A61V 5/08, № u200904537; zaiavl. 07.05.2009; opubl. 10.11.2009, Biul. №21.
    • Yulish EI, Soroka YuA, Chernyisheva OE, Klevtsova IA, Levchenko SA, Fomenko TA, ta In. Osobennosti bronhoobstruktivnogo sindroma pri vnebolnichnoy pnevmonii u detey rannego vozrasta. Zdorove rebenka. 2010;5(26):14-18.
    • Angeles MM, Camps M, Pumarola T, Antonio Martinez J, Martinez E, Mensa J, et al. The role of viruses in the aetiology of community-acquired pneumonia in adults. Antivir Ther. 2006;11(3):351-9. PMID: 16759052.
    • Bénet T,   Picot VS, Awasthi S,  Pandey N, Bavdekar A, Kawade A, et al. Severity of Pneumonia in Under 5-Year-Old Children from Developing Countries: A Multicenter, Prospective, Observational Study. Am J Trop Med Hyg. 2017 Jul 12; 97(1): 68–76. PMCID: PMC5508893, doi: 10.4269/ajtmh.16-0733.
    • Davies HD. Community-acquired pneumonia in children. Paediatr. Child Health. 2003;8(10):616–619.  PMCID: PMC2795279.
    • Horvath I, Hunt J, Barnes PJ. Exhaled breath condensate: methodological recommendations and unresolved questions. Eur. Respir. J. 2005;26:523-548.
    • Jennings LC, Anderson TP, Beynon KA, Chua A, Laing RT, Werno AM, et al. Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax. 2008 Jan;63(1):42-8. PMID: 17573440, DOI: 10.1136/thx.2006.075077.
    • Korppi M, Don M, Valent F, Canciani M. The value of clinical features in differentiating between viral, pneumococcal and atypical bacterial pneumonia in children. Acta Paediatr. 2008 Jul;97(7):943-7. doi: 10.1111/j.1651-2227.2008.00789.x. Epub 2008 Apr 15.
    • Nair H, Nokes DJ, Gessner BD, Dherani M, Madhi SA, Singleton RJ, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet. 2010 May 1; 375(9725): 1545–1555. PMCID: PMC2864404, doi:  10.1016/S0140-6736(10)60206-1.
    • Pavord ID, Pizzichini MM, Pizzichini E, Hargreave FE. The use of induced sputum to investigate airway inflammation. Thorax. 1997 Jun;52(6):498-501. PMID: 9227713, PMCID: PMC1758588.
    • Pickering LK, Baker CJ, Kimberlin DW, Long SS, editors. Respiratory syncytial virus. American Academy of Pediatrics; 2009 Red Book: Report of the Committee on Infectious Diseases;2009:560-569.
    • Templeton KE, Scheltinga SA, van den Eeden WC, Graffelman AW, van den Broek PJ, Claas EC. Improved diagnosis of the etiology of community-acquired pneumonia with real-time polymerase chain reaction. Clin. Infect. Dis. 2005;41(3):345-51. PMID: 16007532, DOI: 10.1086/431588.
    • Virkki R, Juven T, Rikalainen H, Svedström E, Mertsola J, Ruuskanen O. Differentiation of bacterial and viral pneumonia in children. Thorax. 2002;57(5):438–441. PMCID: PMC1746322. doi: 10.1136/thorax.57.5.438.
    Publication of the article «World of Medicine and Biology» №1(63), 2018 year, 032-036 pages, index UDK 612.018:616.248-053.2
    DOI 10.26724/2079-8334-2018-1-63-32-36