Summary thesis of Medical Doctor: Research clinical, subclinical characteristics and hs-CRP, Procalcitonin, Interleukin 6 in severe viral pneumonia in children under 5 years old

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