Research clinical and subclinical characteristics of severe viral pneumonia in children under 5 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 5 years old.
1 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 3034% of cases. The cause of pneumonia accounts for 75% of deaths from respiratory diseases and 3035% of deaths among children. The prevalence of pneumonia virus in children is quite high, accounting for 6070% More than onethird of cases of coinfection 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, Realtime. PCR, multiprimer PCR Quantifying a number of factors such as hsCRP, Procalcitonin and Interleukin6 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 cobacterial 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 hsCRP, 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 Assess the relationship between hsCRP, Procalcitonin, Interleukin6 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 6070%. With the development of science, there are many methods such as Realtime PCR, multiprimed PCR with high sensitivity and specificity to accurately diagnose viral pneumonia, and markers such as hsCRP, Procalcitonin, Interleukin6 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 coinfected with bacteria and / or viruses. The thesis stated the correlation between hsCRP, PCT, IL6 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 Chapter 1 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 hsCRP, PCT and IL6 1.3.1.1. Reactive C protein (CRP) CRP is known as a marker of inflammation, the sensitivity of hs CRP 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 nonbacterial infection, thereby shortening the time of diagnosis, distinguishing bacterial or viral infections 1.3.1.3. Interleukin 6 Interleukin (IL6) 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 Pneumoniacausing viruses: influenza virus, subinfluenza 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 (71.9 67.7%) + 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 (24.222.6%) + 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