RATIONALE 1. The necessary of thesis According to a World Health Organization (WHO) report, in 1997, 3.9 million people worldwide died from acute lower respiratory infections and 394 million new cases. In Vietnam, on average, each child can contract acute respiratory infections 3 to 5 times, pneumonia accounts for 30-34% of cases. The cause of pneumonia accounts for 75% of deaths from respiratory diseases and 30-35% of deaths among children. The prevalence of pneumonia virus in children is quite high, accounting for 60-70%. More than one-third of cases of co-infection with viruses and bacteria will worsen the condition. Advanced virus diagnostic techniques is able to find out the causes quickly and to identify virus types accurately such as rapid test for virus antigen, Real-time. PCR, multi-primer PCR. Quantifying a number of factors such as hs-CRP, Procalcitonin and Interleukin-6 helps to assess the severity of the disease, diagnosis, prognosis and appropriate treatment in order to avoid the spread of antibiotic use. In Vietnam, there have been separate studies on pneumonia caused by each virus as well as some factors reflecting inflammation in viral pneumonia. However, there has not been a full review of the severe or co-bacterial viral pneumonia and the association between viral pneumonia and a number of factors that reflect childhood inflammation. Therefore, we conducted the topic "Research clinical, subclinical characteristics and hs-CRP, Procalcitonin, Interleukin 6 in severe viral pneumonia in children under 5 years old" with two objectives: 1. Research clinical and subclinical characteristics of severe viral pneumonia in children under 5 years old from 2/2015 to 2/2017. 2. Assess the relationship between hs-CRP, Procalcitonin, Interleukin-6 and clinical, subclinical, treatment results, viral etiology in severe viral pneumonia in children under 5 years old. 2. Practical significance and new contributions of the thesis Bronchitis is a common disease in children, a leading cause of morbidity and mortality, especially in children under 5. The cause of viral pneumonia accounts for 60-70%. With the development of science, there are many methods such as Real-time PCR, multi-primed PCR with high sensitivity and specificity to accurately diagnose viral pneumonia, and markers such as hs-CRP, Procalcitonin, Interleukin-6 to assess the condtion of patient for better treatment and prognosis. The study identifies the viral etiology model in both single and multiple infections with 73.8% of children infected with a single virus, including RSV infection (36.1%), influenza A (24.3%), Adenovirus (19.8%), influenza B (6.9%) and 53 children (26.2%) were co-infected with bacteria and / or viruses. The thesis stated the correlation between hs-CRP, PCT, IL-6 inflammation index and the difference of some clinical and subclinical signs with these inflammatory markers. The research is believed to be reliable because of being conducted at the largest pediatric center in Vietnam. Therefore the thesis is very practical, thesisal and scientific. 3. The thesis structure The thesis is presented in 124 pages including: Introduction (2 pages), overview (38 pages), subjects and methods (16 pages), results (39 pages), discussion (26 pages), conclusions (2 pages) and recommendations (1 page). The thesis consists of 47 tables, 6 charts, 4 illustrative figures. The thesis has 135 references, including 38 Vietnamese, 97 English.
1 RATIONALE The necessary of thesis According to a World Health Organization (WHO) report, in 1997, 3.9 million people worldwide died from acute lower respiratory infections and 394 million new cases In Vietnam, on average, each child can contract acute respiratory infections to times, pneumonia accounts for 30-34% of cases The cause of pneumonia accounts for 75% of deaths from respiratory diseases and 30-35% of deaths among children The prevalence of pneumonia virus in children is quite high, accounting for 60-70% More than one-third of cases of co-infection with viruses and bacteria will worsen the condition Advanced virus diagnostic techniques is able to find out the causes quickly and to identify virus types accurately such as rapid test for virus antigen, Real-time PCR, multi-primer PCR Quantifying a number of factors such as hs-CRP, Procalcitonin and Interleukin-6 helps to assess the severity of the disease, diagnosis, prognosis and appropriate treatment in order to avoid the spread of antibiotic use In Vietnam, there have been separate studies on pneumonia caused by each virus as well as some factors reflecting inflammation in viral pneumonia However, there has not been a full review of the severe or co-bacterial viral pneumonia and the association between viral pneumonia and a number of factors that reflect childhood inflammation Therefore, we conducted the topic "Research clinical, subclinical characteristics and hs-CRP, Procalcitonin, Interleukin in severe viral pneumonia in children under years old" with two objectives: Research clinical and subclinical characteristics of severe viral pneumonia in children under years old from 2/2015 to 2/2017 Assess the relationship between hs-CRP, Procalcitonin, Interleukin-6 and clinical, subclinical, treatment results, viral etiology in severe viral pneumonia in children under years old Practical significance and new contributions of the thesis Bronchitis is a common disease in children, a leading cause of morbidity and mortality, especially in children under The cause of viral pneumonia accounts for 60-70% With the development of science, there are many methods such as Real-time PCR, multi-primed PCR with high sensitivity and specificity to accurately diagnose viral pneumonia, and markers such as hs-CRP, Procalcitonin, Interleukin-6 to assess the condtion of patient for better treatment and prognosis The study identifies the viral etiology model in both single and multiple infections with 73.8% of children infected with a single virus, including RSV infection (36.1%), influenza A (24.3%), Adenovirus (19.8%), influenza B (6.9%) and 53 children (26.2%) were co-infected with bacteria and / or viruses The thesis stated the correlation between hs-CRP, PCT, IL-6 inflammation index and the difference of some clinical and subclinical signs with these inflammatory markers The research is believed to be reliable because of being conducted at the largest pediatric center in Vietnam Therefore the thesis is very practical, thesisal and scientific The thesis structure The thesis is presented in 124 pages including: Introduction (2 pages), overview (38 pages), subjects and methods (16 pages), results (39 pages), discussion (26 pages), conclusions (2 pages) and recommendations (1 page) The thesis consists of 47 tables, charts, illustrative figures The thesis has 135 references, including 38 Vietnamese, 97 English Chapter OVERVIEW 1.1 Definition 1.1.1 Definition of Pneumonia According to WHO: Pneumonia is a disease usually caused by viruses or bacteria Pneumonia is divided into two types: pneumonia severe and not severe depending on the clinical Antibiotics are often used in pneumonia and severe pneumonia Severe pneumonia requires special care such as oxygen breathing and hospitalization 1.1.2 Definition of viral pneumonia - Viral pneumonia: is a pneumonia caused by a viral infection in the lower respiratory tract The disease usually occurs in the winter and spring The invasive virus causes irritation, swelling, epithelial desquamation and airway obstruction The typical lesions in pneumonia are alveoli and small air passages filled with fluid, mucus or pus reducing or lose gas exchange function that results in respiratory failure 1.1.3 The definition of hs-CRP, PCT and IL-6 1.3.1.1 Reactive C protein (CRP) CRP is known as a marker of inflammation, the sensitivity of hsCRP has higher than that of CRP, especially in low concentration samples, so it has better diagnostic value of inflammation 1.3.1.2 Procalcitonin (PCT) PCT is a specific marker for bacterial and septicemia PCT helps distinguish between infected and non-bacterial infection, thereby shortening the time of diagnosis, distinguishing bacterial or viral infections 1.3.1.3 Interleukin Interleukin (IL-6) is an interleukin that acts as an important inflammatory cytokine during the acute inflammatory phase 1.2 Reasons 1.2.1 Causes of pneumonia 1.2.2 Causes of viral pneumonia - Pneumonia-causing viruses: influenza virus, sub-influenza virus, respiratory syncytial virus, Adenovirus - Virus rarely causes pneumonia: Rhinovirus, Coronavirus - The virus causes systemic illness, pneumonia complications: Herpes, chicken pox, measles, Cytomegalovirus… 1.3 Mechanism of pathogenesis of viral pneumonia 1.3.1 Infiltration of virus at airway 1.3.2 Cell destruction and inflammatory response 1.3.3 Recovery after viral infection 1.4 Symptoms of viral pneumonia 1.4.1 Epidemiological factors - Living in an infected area - Contact with other children or adults infected with the virus 1.4.2 Clinical symptoms + Fever: high fever fluctuates or reduces body temperature in young children, fatigue, crying, dry lips (66.9 - 87%) + Cough: dry cough or cough with a lot of mucus secretion (71.967.7%) + Wheezing (41.1%) + Runny nose (61.6%) + Rapid breathing with age (92%) + Dyspnea, thoracic recess (73%), nasal fluttering, head nodding with breathing, intercostal muscle contraction, receding concave (53.1%) + Breathing Oxygen support (56.12%) + Ventilator support (3.06%) + Vomiting (24.2-22.6%) + Diarrhea (15.7 - 4.3%) + Skin rash (4.3%) + Other symptoms: Fatigue, poor appetite, sweating, muscle and joint aches (57.1%) + The most common bacterial pneumonia is Streptococcus pneumonia 1.4.3 Subclinical symptoms - Blood formula: when being infected pneumonia, the number of white blood cells