Respiratory chlamydia in children

ICD-10 code

А74 Other diseases caused by chlamydia.

Epidemiology

Up to 15-20% of all pneumonias and 20-30% of conjunctivitis in newborns occurs due to infection during passage of the birth canal of women suffering from urogenital chlamydia. Children can also be infected through the hands of staff or mothers, household items, linens, toys, and also by airborne droplets.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]

Causes of respiratory chlamydia

Respiratory chlamydia in children cause Ch. Pneumoniae and many biovars Ch. Trachomatis (D, E, F, G, H, J, etc.). According to morphological, biological properties, these serovars are indistinguishable from other chlamydia.

[12], [13], [14], [15],

Symptoms of respiratory chlamydia

Respiratory chlamydia in children often proceeds according to the type of conjunctivitis, bronchitis and pneumonia.

Chlamydial conjunctivitis begins with the redness of both eyes and the appearance of a purulent discharge. On the conjunctiva, especially in the region of the lower transitional fold, large bright rows of red follicles are constantly found; possible pseudomembranous formations, epithelial point keratitis. The general condition suffers insignificantly. Parotid lymph nodes are often enlarged, sometimes they are painful on palpation. When sowing out of the eyes, the bacterial flora is usually not detected. The course of chlamydial conjunctivitis may be acute or chronic. In acute course of conjunctivitis in 2-4 weeks completely pass even without treatment. In chronic course, clinical manifestations show up for many months and even years.

Chlamydia bronchitis begins gradually, usually at normal body temperature. The first sign of the disease is a dry cough, often paroxysmal. The general condition is insignificant. Sleep and appetite are preserved. At auscultation, scattered, predominantly medium-bubbling rales are heard. Percutally, lung changes are usually not detected. After 5-7 days, the cough becomes wet, his attacks stop. Recovery occurs after 10-14 days.

Chlamydial pneumonia also begins gradually, with a dry, unproductive cough that gradually increases, becomes paroxysmal, accompanied by a general cyanosis, tachypnea, vomiting, but there are no reprises. The general condition suffers insignificantly. Gradually the dyspnea increases, the number of breaths reaches 50-70 per minute. Breathing is grunting, but respiratory failure is poorly expressed. By the end of the first and during the second week, a pattern of bilateral disseminated pneumonia forms in the lungs. When auscultation, these patients hear crepitating rales, mainly at the height of inspiration. On objective examination draws attention to the mismatch of clinically pronounced pneumonia (dyspnea, cyanosis, scattered crepitating rales over the entire surface of both lungs, etc.) and a relatively mild general condition with minimal symptoms of intoxication. At the height of clinical manifestations, many patients have enlarged liver and spleen, enterocolitis is possible.

X-ray examination reveals multiple fine-meshed infiltrative shadows up to 3 mm in diameter.

In the blood of patients with chlamydial pneumonia, pronounced leukocytosis is detected - up to 20x10 ⁹ / l, eosinophilia (up to 10-15%); ESR increased sharply (40-60 mm / h).

Diagnosis of respiratory chlamydia

Clinical suspicion of chlamydial infection is possible when the neonates consistently develop conjunctivitis (at the 2nd week of life) with a long persistent course, bronchitis (for 4-12 weeks of life) with bouts of painful cough and small-focal pneumonia, especially when eosinophilia and significant increased ESR with a relatively mild general condition.

For laboratory confirmation of respiratory chlamydiosis, the detection of chlamydial antigen in a biological material using the PCR method, the detection of specific anti-Chlamydia antibodies of classes G and M in ELISA, etc. Are used.

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

Differential diagnostics

Chlamydial conjunctivitis must be differentiated with conjunctivitis. Caused by gonococci and other pyogenic microorganisms (staphylococci, streptococci, gram-negative flora), as well as by various viruses (adenoviruses, enteroviruses, herpes simplex viruses). The results of a bacterioscopic and bacteriological study of the discharge from the eyes are important for differential diagnosis.

Pneumonia caused by staphylococci, pneumococci and other microorganisms. Accompanied by a high body temperature with a severe general condition with frequent formation in the lungs of large lesions, and chlamydial pneumonia is characterized by multiple small-spot infiltrates.

[21], [22], [23], [24]

Treatment of respiratory chlamydia

The international standard for the treatment of chlamydial infection is macrolide antibiotics (erythromycin, azithromycin, etc.). With conjunctivitis, antibacterial drugs are prescribed in the form of ointments, with pneumonia intramuscularly and intravenously. In severe cases, resort to combined treatment with two drugs or more. Typically, macrolides are combined with biseptol, another sulfanilamide preparation or furazolidone. Duration of treatment is about 10-14 days.

With a recurrent course, immunostimulating therapy (sodium nucleate, thymus preparations - tactivin), cycloferon, pentoxil, etc., probiotics (acipol, bifidumbacterin, etc.) is shown.

Prevention of respiratory chlamydia

Preventive measures should be directed to the source of infection, the transmission route and the susceptible organism. As children become infected with respiratory chlamydia in maternity hospitals, the main preventive measure should be the identification and treatment of sick women. To prevent postnatal infection, maximum isolation of newborns and strict adherence to hygiene in care are important. Active prophylaxis is not developed.