Epidemic asthmatic pneumonia in children
Introduction
Introduction to Pediatric Epidemic Pneumonia Epidemic asthmatic pneumonia is a unique epidemic pneumonia in China. The disease is acute, widespread, rapid, and severe. The characteristics of this disease are: 1. There is a clear outbreak in the countryside. 2. Features of wheezing and paroxysmal wheezing. 3. Pulmonary manifestations with bronchiolitis and interstitial pneumonia. 4. Mainly invade infants and young children. basic knowledge The proportion of children: the incidence rate of children under 5 years old is about 0.02%-0.05% Susceptible people: children Mode of infection: droplet spread Complications: heart failure, respiratory failure, metabolic acidosis
Cause
Pediatric epidemic pneumonia
Causes
In 1971, Zhejiang had isolated the virus from the throat swab, but failed to identify it. In 1975, the two sera were taken during the epidemic period in Shantou, Guangdong, and the neutralizing test of the syncytial virus Long strain antibody 4 times increased accounted for 43 %, syncytial virus may be the main pathogen of this epidemic. The outbreaks in the Yuncheng area of Shanxi in early 1986 and the suburbs of Beijing in the winter of 1989 were confirmed by rapid diagnosis and serological examination. RSV is the main pathogen. Hebei, January 1992 The main pathogens in several districts and suburbs of Tianjin are RSV. The most recent one was from November 1999 to January 2000. An outbreak of asthmatic pneumonia occurred in Shuyang County, Henan Province. The pathogen was RSV.
Prevention
Pediatric epidemic pneumonia prevention
1. Extensive publicity of prevention methods.
2. Play the role of rural physicians, so that early detection, early reporting, early prevention, local isolation, on-site treatment, and critical cases are promptly transferred to higher-level hospitals.
3. Do a good job of family isolation of sick children, less than the patient's family door, reduce group activities, in order to prevent the spread of the disease.
Complication
Complications of pediatric epidemic pneumonia Complications, heart failure, respiratory failure, metabolic acidosis
Heart failure, respiratory failure, metabolic acidosis, or abdominal distension, gastrointestinal bleeding.
Symptom
Symptoms of pediatric epidemic pneumonia common symptoms irritability, pale, runny nose, increased heart rate, three concave signs, shortness of breath, heart sound, low blunt metabolic acidosis, high fever, respiratory failure
1. Classification: The disease is classified into ordinary type, heavy and extremely heavy according to the severity of symptoms:
(1) Ordinary type: good spirit, shortness of breath, mild nasal fan, no cyanosis, mild asthmatic symptoms and short duration, generally short course and good prognosis.
(2) Heavy: more irritability and lethargy, shortness of breath, baby breathing more than 60 times / min, heart rate of 160 beats / min or more, often accompanied by paroxysmal wheezing aggravation, nose fan, three concave sign and hairpin, Some sick children can be found to have suspected heart failure, auscultation with wheezing sounds and finer small and medium bubble sounds, and the lower bound of the liver is progressively decreased.
(3) Extremely heavy: small babies are more common, children with paroxysmal wheezing are not easy to relieve, breathing is very rapid, the baby reaches 70 times / min or more, nasal fans, three concave signs, cyanosis is extremely significant, in severe lower airway obstruction When you can't hear the breath sounds and blisters, the heart sounds are low and blunt, the heart rate can reach 200 times / min, the liver rapidly increases, often heart failure, respiratory failure, and more metabolic acidosis, or abdominal distension and gastrointestinal Road bleeding.
2. Staging: Clinically, it can be divided into several stages: onset, wheezing, alleviation and recovery.
(1) Incidence: The incubation period is 1 to 4 days, and most of the sudden onset occurs. Only some of the children have low fever, cough, runny nose, sneezing and other prodromal symptoms, and quickly enter the asthma stage after 24 hours.
(2) wheezing period: different degrees of wheezing and episodes of wheezing aggravate the characteristics of this disease, sick children have cough, nasal fan, shortness of breath, etc., when the onset of asthma is increased, there may be obvious irritability, heart rate and Breathing is more accelerated, pale (a few facial red), lips and fingers to the hair, the three concave signs are obvious, the lungs percussion has been unvoiced, auscultation has wheezing, most have small and medium bubble sounds, episodes of asthma There may be respiratory obstruction, no breath sounds and wheezing sounds, lower liver lowering due to emphysema, severe liver accompanied by large liver, the disease is mostly 37.5 ~ 39 ° C, a few is below 37 ° C or high fever, Most of the wheezing was relieved within 24h or 48h.
(3) Remission period: After the asthma is relieved, the general condition of the child is improved, and the pneumonia sign is more obvious. The two lungs can hear the small and medium bubble sounds and the sputum pronunciation. The liver is still large, about 2 to 4 days, and most children have signs of pneumonia gradually. cut back.
(4) Recovery period: Generally, on the 4th to 7th day of the onset, the respiratory and mental conditions improved, the lung blisters became coarse and even disappeared, and the body temperature gradually returned to normal.
Examine
Examination of pediatric epidemic pneumonia
1. General inspection
Most of the children had normal or low white blood cell counts. About half of the cases were below 10×10 9 /L, rarely reached 20×10 9 /L. The classification of neutral and eosinophils did not increase, and urine tests were mostly normal. In some cases, there are trace proteins and a few white blood cells.
2. Pathogen examination
The virus is isolated or immunofluorescent antibody test for nasopharyngeal secretions to prove the syncytial virus or other viruses; taking the double serum of the child to check the increase of specific antibodies, especially the syncytial virus, can not get double Partial serum can be used to determine the specific 1gM of the single serum. In the acute phase, most of the chest X-rays can be enlarged, the lungs are thickened and blurred, and the lesions are mostly bilateral, with small patches around the bronchi. The density of the shape is uneven and irregular, and there are interstitial lesions around some textures. Generally, emphysema is obvious, and some have a pleural reaction between the right upper middle lobe, and a few have atelectasis.
Diagnosis
Diagnosis and diagnosis of epidemic asthmatic pneumonia in children
The typical clinical manifestations of pancreatic pneumonia are basically the same as those of bronchiolitis, with obvious wheezing and paroxysmal wheezing, but there are some differences, such as asthma, pneumonia, lung inflammation may be heavier, age Not only less than 2 years old, 2 to 4 years old can account for 1/3, and a small number of children over 4 years old, about the discovery of the spread of pneumonia, as long as the specific type of pneumonia, known as pneumonia, is not difficult to find The signs of the epidemic are as follows:
1. Characteristics of outbreaks: In the short-term epidemic season, a large number of children with paroxysmal wheezing are present, and asthmatic pneumonia is more than doubled.
2. Characteristics of wheezing: Cases characterized by episodic wheezing and wheezing account for more than 50% of cases of pneumonia.
3. Characteristics of children: Most of the children are from rural areas, and children over 2 years old account for a considerable proportion.
4. The condition is serious: the inflammation of the lung is heavier than that of the general bronchiolitis, and the inpatients are more severe and extremely heavy.
Differential diagnosis
Different from other severe pneumonia, it is mainly diagnosed by laboratory examination. The disease is very similar to the bronchioles, but the latter has no obvious outbreak. The age of onset is small, mostly younger than 6 months old, wheezing The lung characteristics are lighter than epidemic wheezing pneumonia, with fewer complications and a better prognosis.
