Criteria of diagnostics of intraccellular infection in children with community-acquired pneumonia

• Main Author: Sergey Matvienko
• Format: Article
• Language: English
• Published: PC Technology Center 2018-12-01
• Series: ScienceRise: Medical Science
• Subjects: позалікарняна пневмонія; внутрішньоклітинні патогени; внутрішньоклітинна інфекція; критерії діагностики; алгоритм діагностики
• Online Access: http://journals.uran.ua/sr_med/article/view/149295

Community-acquired pneumonia is the largest group of pneumonia, which the doctor has to meet daily in outpatient practice and in the hospital. The interest in this problem is due to the fact that no final response has been received regarding the prevalence of intracellular pathogens with this disease, the role of herpes viruses, mixed associations, the entire spectrum of immuno-pathological changes caused by persistence of infection in the child’s body. Undetermined criteria for the diagnosis of pneumonia on the background of intracellular infection with herpes virus persistence, which are based on clinical, anamnestic and paraclinical indicators. The aim of the study was to determine the criteria for the diagnosis of intracellular infection in children with community-acquired pneumonia with the development of a diagnostic algorithm for this cohort. Methods. A comprehensive survey of 120 children hospitalized for community-acquired pneumonia was conducted. The average age of patients was 6.9 ± 0.2 years. Verification of the diagnosis was carried out on the basis of a complex of clinical and anamnestic, laboratory and radiological data. The determination of pathogens was established on the basis of: bacteriological culture of material from the pharynx, nose on the flora with an antibiogram, bacteriological culture of sputum on the flora with an antibiogram. The presence of Streptococcus pneumoniae, Haemophilus influenzae in smears from the pharynx, nose, sputum was determined by real-time polymerase chain reaction. The method of immunoassay was determined immunoglobulin classes M and G to Ch. pneumoniae, M. pneumoniae, the presence of antibodies to herpes viruses (human herpes virus 6th type, cytomegalovirus, Epstein-Barr virus). According to the results of the polymerase chain reaction in real-time determined the presence of DNA Ch. pneumoniae, M. pneumoniae, herpes viruses. Using heterogeneous sequential Wald-Genkin procedures, diagnostic factors (DF) and diagnostic informativity (I) of symptoms were determined with the formation of generalized and reduced algorithms for diagnosing intracellular infection with herpesvirus persistence in children with community-acquired pneumonia. As a result of the study, community-acquired pneumonia was diagnosed in 38.3 % of patients against intracellular infection with herpes virus persistence (Mycoplasma pneumoniae, Chlamydophila pneumoniae, cytomegalovirus, Epstein-Barr virus, human herpes virus 6th type). Considering that all types of examination of patients differ in significant diagnostic information, this made it possible to form an algorithm for diagnosing intracellular infection with herpes virus persistence in children with community-acquired pneumonia. The obtained properties of the algorithms have a positive significance for clinical practice, since it is better to overestimate the unfavorable clinical situation than to admit the absence of a proper assessment. Conclusions. The highest diagnostic information in the diagnosis of intracellular infection of children with community-acquired pneumonia are: the contents of monocytes (Ι = 1.84); the number of replacements of ABT (Ι = 1.65); the nature of the adaptation reactions of the body (Ι = 1.39); severity of pneumonia (Ι = 1.34); dimensions of the main area of darkening in the lungs (Ι = 1.31); conducting infusion therapy (Ι = 1.27); body temperature (Ι = 1.12) and the form of pneumonia (Ι = 1.12). The high diagnostic reliability of the proposed algorithm allows recommending it for clinical use