Parainfluenza in children

Parainfluenza is an acute disease of the respiratory tract with moderate intoxication and a predominant lesion of the mucous membranes of the nose and larynx. Human parainfluenza viruses (HPIVs) are a group (types 1-4) of organisms that cause various respiratory infections (croup, pneumonia, and bronchiolitis).

[1], [2], [3], [4], [5], [6], [7]

Epidemiology

In the general structure of viral diseases of the respiratory system in children, parainfluenza accounts for 10 to 30%. The proportion of cases of parainfluenza depends on the time of year, the incidence of influenza and other acute respiratory viral infections, the age of children and the completeness of diagnosis. The highest incidence is registered among children of the first 2 years of life. Sporadic morbidity is recorded year round with a rise in winter. In children's groups often there are flashes. Almost all children have parainfluenza several times.

The source of infection is only a sick person who is dangerous during the entire acute period of the disease - up to 7-10 days. The virus is transmitted from person to person by airborne droplets. The highest importance in human pathology are viruses of types 1,2 and 3.

[8], [9], [10], [11], [12], [13]

Causes of the parainfluenza

The pathogen belongs to the family of paramyxoviruses. There are 5 types of human parainfluenza viruses. All of them have hemagglutination activity. Neuraminidase was found in all types. They contain RNA, have large sizes - 150-200 nm, are unstable in the environment. From the Influenza viruses are distinguished by the stability of the antigenic structure and the absence of visible variability of the virion genome.

[14], [15]

Pathogenesis

The virus with droplets of saliva and dust enters the mucous membranes of the upper respiratory tract and penetrates into the epithelial cells of the nose and larynx. As a result of cytopathic action in the epithelial cells, the phenomena of dystrophy and necrobiosis arise with their complete destruction. The inflammatory process develops locally and mucous exudate accumulates, edema appears. Especially pronounced local changes are found in the larynx area, as a result of which croup syndrome often occurs.

[16], [17], [18], [19], [20], [21]

Symptoms of the parainfluenza

The incubation period is 2-7 days, an average of 3-4 days. The parainfluenza disease in most patients begins acutely with a rise in body temperature, the appearance of mild symptoms of intoxication and catarrhal phenomena. Usually the temperature reaches a maximum on the 2-3rd day of the disease, less often on the 1st day. The general condition of the child at the height of the disease is broken moderately. Children complain of weakness, loss of appetite; disturbed sleep. There is a headache, single vomiting. In some patients, the body temperature can reach 40 ° C, but no pronounced symptoms of intoxication are observed.

The symptoms of parainfluenza begin with catarrhal phenomena, which are quite pronounced already from the 1st day of illness. Noted resistant, rough , dry cough,, sore throat, runny nose, nasal congestion. Nasal discharge, first mucous membranes, may later become mucopurulent. On examination of the oropharynx note swelling, moderate hyperemia mucosa, handles, soft palate, the back wall pharynx, sometimes purulent pleural effusion detected in the gaps.

Often the first manifestation of parainfluenza infection is croup syndrome, mainly in children aged 2 to 5 years. In these cases, among the full health of the child suddenly wakes up at night from rough, barking cough. Quickly Joining hoarseness, noisy breathing and laryngeal stenosis develops. However, with parainfluenza the stenosis rarely reaches II and even less often - III degree.

Para-flu croup quickly disappears as the acute symptoms of para-flu are eliminated. If secondary microbial flora is attached, the course of croup is more prolonged.

[22], [23], [24]

Forms

There are light, moderate and severe forms of parainfluenza. In milder forms, the body temperature is usually normal or subfebrile. Parainfluenza disease is manifested by catarrhal phenomena, nasal congestion, and slight indisposition. With moderate forms of body temperature reaches 38-39 ° C, moderate symptoms of intoxication. Severe forms are rare.

Symptoms of parainfluenza are slightly dependent on the parainfluenza serovar virus. However, croup syndrome occurs more often with the disease caused by type 1 and 2 viruses, and pneumonia - with type 3 viruses.

[25], [26], [27], [28]

Diagnostics of the parainfluenza

Suspicion of parainfluenza may occur when a child develops an acute febrile illness with catarrhal symptoms and croup syndrome. Early age and correct assessment of epidemiological data are important for diagnosis.

Isolation of parainfluenza virus from nasopharyngeal swabs is not of practical importance due to the difficulty and insufficient sensitivity of cultivation methods.

For serological diagnostics use RSK, RTGA and PH. The increase in the titer of specific antibodies in the dynamics of the disease by 4 times or more indicates parainfluenza. As an express diagnosis, an immunofluorescent test method is used with labeled sera against parainfluenza viruses of all types.

[29], [30], [31]

Differential diagnosis

Paragripp differentiate with acute respiratory viral diseases of a different etiology:

1. flu,
2. adenoviral diseases,
3. respiratory syncytial infection, etc.

Croup syndrome at the onset of the disease with an increase in body temperature with mild symptoms of intoxication suggests a parainfluenza. However, it is possible to definitively establish the etiology of the disease after a laboratory examination, since the same symptoms can occur with influenza and with acute respiratory diseases of another viral etiology.

[32], [33], [34], [35], [36]

Treatment of the parainfluenza

Symptomatic treatment of parainfluenza is carried out at home. Only children with croup syndrome and severe bacterial complications are hospitalized. Assign bed rest and symptomatic agents. Food should be complete, easily digestible, without significant restrictions on food ingredients. Give food in the form of heat.

Prevention

Specific prevention of parainfluenza is not developed. General prophylactic measures are the same as with flu.

[37], [38], [39], [40], [41]

Forecast

Parainfluenza in children has a favorable prognosis. Lethal outcomes are possible only when severe bacterial complications occur (pneumonia, purulent necrotic laryngotracheobronchitis, etc.).

[42], [43], [44]