PROTOKOL
DIAGNOSIS AND TREATMENT IN CHILDREN MEASLES
Measles - an acute infectious disease caused Morbillivirus, (belongs to the
family paramiksovirusiv) is characterized by a violation of general condition,
inflammation of the upper respiratory tract, oral mucosa, Eyes and maculopapular
skin rash.
DIAGNOSTIC CRITERIA:
CLINICAL:
The incubation period - the day 9-17-21;
Catarrhal PERIOD
- Lasts 4-5 days;
- Top of the acute illness;
- Increased body temperature to 38-39 grad.;
- Violations of symptoms of general condition;
- Catarrhal phenomena: Abundant cold, stubborn cough, hoarse voice;
- Cognac conjunctivitis, scleritis, photophobia, blepharospasm;
- The mucous membrane is soft and hard palate - patchy enanthema.
- The mucosa against cheeks of small indigenous teeth on gums and other oral
mucous membranes are determined by small white spots - a Filatov- BielskoKoplika’s symptom;
- Humped nature of the temperature curve.
PERIOD rash:
- General condition deteriorated;
- Body temperature again rises to 39-40 degrees. and remained high during the
whole rash;
- Catarrhal phenomena grow;
- Spot-papular rash, the first elements to appear behind the ears, face. Typical
phasing appearance of rash: 1 day - face, 2-day - body and 3-day - limbs.
Profuse rash, may drain, located on unchanged skin.
PERIOD pigmentation:
- Develops in the sequence, and rash;
- In place of rash appear pigmentation.
- Improving health;
- Normal body temperature;
- Catarrhal phenomena disappear.
The diagnosis of measles can be put, relying only on clinical diagnostic
criteria. In cases of difficult clinical diagnosis using additional tests.
Laboratory research:
1. Total blood - leukopenia, lymphocytosis, eosinopenia, thrombocytopenia;
1. Cytological studies (cytoskopia) smears, imprints of fauces - identify
typical multi measles giant cells;
2. Antibody method (RTHA and RPHA) - increase in antibody titer in the
dynamics of 4 and more times;
3. ELISA (ELISA) - the detection of antibodies to measles virus class Ig M
(acute period), increase class Ig G titer 4 times or more (transferred disease).
TREATMENT
patients with measles are mainly at home. Hospital patients are subject to:
- The first year of life;
- With severe measles;
- With complications;
- At epidemic rates.
Uncomplicated easy, intermediate and atypical forms of measles, measles
does not require medication. Patients appointed:
- Bed rest during the whole period of fever;
- Safety measures for oral cavity and eyes;
- Frequent airing of the premises;
- When cold - vasoconstrictor drugs;
- Cough - mucolitic preparations;
- Ascorbic acid, vitamin A.
COMPLICATIONS:
(under appropriate treatment protocols)
1. laryngitis,
2. acute stenosis larynhotraheobronchitis (viral croup)
3. pneumonia,
4. encephalitis,
5. meningitis
6. otitis.
PROTOKOL
DIAGNOSIS AND TREATMENT IN CHILDREN RUBELLA
DIAGNOSTIC CRITERIA:
CLINICAL CRITERIA take the form of measles:
- Top of the acute illness;
- Fever to 37,5-38 C;
- Mercurial, weakly pronounced catarrhal changes on the mucous membranes,
conjunctiva;
- Roseola enanthema solid taste;
- Increase back on the neck pain and neck lymph nodes;
- May be prodromal period that lasts several hours;
- A rash of "is the first day of illness;
- Rash roseola and small spots - papular. Elements of a rash does not merge,
appear simultaneously throughout the body. Most localization - extensor
surface of the extremities, back, buttocks, thighs, outer surface.
- Rash disappears within 1-3 days without pigmentation or the formation of
exfoliation.
CLINICAL CRITERIA innate Rubella:
- Classic triad: Cataracts, heart defects (cleft ductus arteriosus, aortic valve
defects, aortic stenosis, coarctation of the aorta, the defect between ventricle
partitions and pulmonary artery stenosis, interatrial wall defect, transposition
of the aorta and pulmonary artery), deafness;
- "Advanced" innate rubella syndrome: Besides the above, microcephaly,
mikroftalm, retinopathy, corneal clouding, glaucoma, split palate, interstitial
pneumonia, hepatitis, myocarditis, meningoencephalitis, the vestibular
apparatus lesions, defects of the urogenital system, dermatitis,
thrombocytopenia, hemolytic anemia, hypogammaglobulinemia reduced birth
weight, secondary immunodeficiency (hypogammaglobulinemia).
Laboratory research:
TO ACQUIRED RUBELLA:
1. Total blood (leukopenia, neutropenia, limfocytosis, plasma cells, normal
ESR);
2. Antibody method (RN, RTHA, RZK, RIF) - increase of antibody level in
the dynamics of 4 or more times;
3. ELISA (ELISA): identification of specific Ig M class antibodies in the
acute period of disease and Ig G adjourned after infection in the blood, spinal
fluid, if necessary.
4. PCR of blood, urine, saliva, spinal fluid, if necessary - the selection of
RNA virus.
TO CONGENITAL RUBELLA:
1. ELISA (ELISA): Detection of specific antibodies of class Ig M;
2. Antibody method (RPHA): strong positive result;
3. Detection of RNA virus (blood, urine, saliva, feces, intraspinal brain fluid)
using PCR.
TREATMENT
patients with uncomplicated course of acquired rubella spend at home:
1. Bed rest during the acute period;
2. General hygienic measures;
3. Frequent airing of the premises;
4. Symptomatic therapy: antipyretic in fever (paracetamol, ibuprofen) and
others.
Treatment of patients with congenital rubella - depending on the nature of
basic clinical syndromes in specialized hospital in the isolated ward.
COMPLICATIONS:
(under appropriate treatment protocols)
1. Arthritis;
2. Synovitis;
3. Serous meningitis;
4. Encephalitis.
PROTOKOL
DIAGNOSIS AND TREATMENT IN CHILDREN CHICKENPOX
Chickenpox - this acute infectious disease caused by a virus herpes 3 type
(the virus Varicella-Zoster), from breezing through the transmission, characterized
by a sort of maculopapular rash, vesicles and characterized by skin lesions and
mucous membranes.
DIAGNOSTIC CRITERIA:
CLINICAL:
Typical forms of varicella zoster
- The disease begins with acute fever (height is determined by disease
severity) and the appearance of skin rash.
- Sometimes for 1-5 days before the appearance of rash observed prodrome as
subfebrile temperature, doze, lack of appetite and the appearance of "NESrash (Scarlatiniform, erythematous, similar to measles).
- chicken pox rash appears simultaneously with increasing temperature or
several hours later. Originally formed small spots that quickly turn into
papules and vesicles. Vesicles are usually unilocular. Rash - maculopapularchicken pox.
- Skin rash located on the trunk, face, limbs, scalp and sometimes on the
mouth mucous membranes, respiratory tract, eyes, external genitalia.
- Rash may be accompanied by itching.
- The mucous membrane elements rash quickly maceration with the formation
of surface erosion, which hide within 1-2 days.
- The skin bubbles gradually subside, dry out and covered crust. After
desquamation crusts in their place a long time kept light pigmentation, in rare
cases - scar.
- The process of eruption occurs shocks, at intervals of 1-2 days, within 2-4
days, in rare cases up to 7 days or more. Therefore, there is a false
polymorphism rash.
Atypical form of varicella zoster
- Rudimentary form develops in children with inherited passive immunity or
after entering the period of incubation of antibodies, plasma, blood. They
appear slim papular rash, single small bubbles on the background of normal
body temperature.
- Pustular form typical for the formation of bubbles in pustule with
suppurative content. The disease is accompanied by high levels of
intoxication. After falling away crusts often left scars.
- With bullous form along with the typical vesicles appear large in diameter to
2-3 cm at low pressure from blister lid and turbid contents. Blister may burst
with the formation of major erosion surfaces. After epithelial past often
remains brown pigmentation.
- Haemorrhagic form is immunocompromised children. In them a 2-3 day
illness content of bubbles becomes hemorrhagic, crusrs are black. Possible
bleeding in the skin, mucous membranes, internal organs, brain, nasal
bleeding.
- Gangrenous form is immunocompromised children in poor care. In this form
of the disease along with the typical rash appears bubbles with hemorrhagic
content and significant inflammatory reaction around the. The next formed
blood (black) sores, which appear after the rejection of the deep, rounded
necrotic ulcer with a dirty bottom and dig edges.
- Generalized (visceral) form sometimes occurs in newborns or older children
with immunodeficiency conditions or are receiving long Glucocorticosteroids.
Thus there is a specific destruction of internal organs.
Diagnosis of varicella zoster can be put, relying only on clinical diagnostic
criteria. In cases of complex clinical diagnostic use more testing.
Laboratory research:
1. Blood: leukopenia, relative limfocytosis, normal ESR performance.
2. During microscopy, smears of the elements show multi-cell rash of
eosinophilic inclusions in the nucleus. Typical infection caused by VZV
(approximate method).
3. Cultivation of the virus in skin fibroblasts, muscle and epithelial cells of
human embryos used only in specific virological laboratories).
4. XRD can detect antigen of the virus (VZV) in smears - prints contents of
vesicles.
5. For serologically using paired sera. Diagnostic titer rise is at 4 or more
times within 10-14 days. Research conducted by RZK, RNHA, ELISA, RIA.
6. Determination of specific anti-VZV immunoglobulin class of Ig M.
7. Detection of virus antigen in the blood cell rash using PCR method.
TREATMENT
1. In mild and moderate forms of varicella zoster in immunocompetent
patients therapy aimed at preventing secondary bacterial complications, and
includes careful hygiene care. This daily change clothes, bedding, lubricates
vesicles 1% solution of brilliant green or 1-2% solution of potassium
permanganate, washed his mouth after eating antiseptic solutions. If necessary topically for skin rash treatment using antiviral ointments and emulsions
(acyclovir).
2. Medium causal treatment varicella zoster is acyclovir.
Indications are acyclovir:
- Patients with haematological diseases;
- Recipients of organs, bone marrow;
- Patients who receive corticosteroid preparations;
- Children with congenital immunodeficiency;
- Children with HIV infection;
- Congenital varicella;
- Chicken pox, which complicated diseases of the nervous system, hepatitis,
thrombocytopenia, Pneumonia;
- Severe forms of varicella zoster.
In addition to acyclovir in varicella are effective antiviral drugs such as
valacyclovir, famtsyklovir, hantsyklovir.
Antiviral therapy appoint the first day of illness. Acyclovir intravenously at a
rate of 10 mg / kg body weight (single dose) 3 times a day. The course lasts for 7
days or even 48 hours after onset of rash of recent items. Immunocompetent
children older than 2 years and adolescents with severe forms of disease can be
assigned into acyclovir at a dose of 80 mg / kg the day. Average duration 5-7 days.
In children under 2 years acyclovir dose is 40 mg / kg / day.
3. In severe, generalized forms of varicella zoster, especially in infants and
children the first year of life, can use specific varicella zoster immunoglobulindose 0.2 ml / kg body weight, or donor immunoglobulin.
COMPLICATIONS:
(under appropriate treatment protocols)
1. Encephalitis; cerebellar (ataxia) encephalitis;
2. Myelitis;
3. Encephalomyelitis;
4. Polyneuropathy;
5. Neuritis of the optic nerve;
6. Serous meningitis;
7. Severe thrombocytopenia;
8. Hemorrhages in the adrenal glands;
9. Acute adrenal insufficiency;
10. False croup;
11. Acute respiratory failure;
12. Pneumonia;
13. Bacterial complications (phlegmon, abscess, impetigo, bullous
streptodermia, erysipelas, abscess, purulent conjunctivitis, keratitis,
stomatitis);
14. Sepsis;
15. Arthritis;
16. Osteomyelitis;
17. Nephritis;
18. Myocarditis;
19. Bleeding;
20. Ray Syndrome.
PROTOKOL
DIAGNOSIS AND TREATMENT IN CHILDREN SCARLET FEVER
Scarlet fever - an acute infectious disease caused by β-haemolytic
streptococci group A and is characterized by symptoms of general intoxication,
sore throat and skin rash.
DIAGNOSTIC CRITERIA:
CLINICAL:
- Incubation period - from a few hours (minimum - 1 day) for 7 days,
maximum -12 days;
- Top of the acute illness;
- Intoxication syndrome: Fever, malaise, headache, drowsiness, vomiting;
- Rash appears on 1-2 days of illness;
- Punctulata rash for congested skin background;
- The vast space localization rash: Bending the surface of the extremities,
front and side of the neck, side surface of the trunk, abdomen, thighs, inner
surface, the natural skin folds;
- No rash in the area of noso-labial triangle (symptom Filatov, Filatov mask);
- Symptom Pastia - accumulation in places rash of natural and artificial skin
folds and the appearance here of linear elements of haemorrhagic rash;
- Positive symptom "pinch” - the emergence of new items rash, petechiae after
physical activity on the skin;
- Possible hemorrhagic rash, small spots with cyanosis shade;
- Dry skin;
- White dermographism;
- Sore throat;
- Angina: Catarrhal, follicular, lacunar or necrotic;
- Distanced hyperemia of the soft palate ( "burning mouth");
- Enanthema of soft palate;
- Tongue furred white bloom, which is from 2 to 4-5 days gradually cleared of
plaque, acquires a bright crimson color, show through enlarged papillae (
"raspberry" tongue Papillary" tongue);
- Regionary inframaxillary or cervical lymphadenitis;
- Peeling skin from the end of first week: on the face, neck - defurfuration on
the trunk, limbs - small plates on hand and foot - large plate;
- Modified phases autonomic nervous system: During the first 3-4 days
tachycardia, increased blood pressure, from 4-5 day bradycardia, reduction in
blood pressure.
The criteria of severity:
FAQ form: body temperature increased to 38 degrees., Moderately
pronounced symptoms of intoxication, general condition, catarrhal angina,
minor skin rash, clinical symptoms lasting 3-5 days.
Intermediate form: body temperature increased to 39 - 40 degrees., Length 5 7 days, headache, repeated vomiting, bright, intense skin rash, follicular,
lacunar tonsillitis, enanthema on soft palate, the development of
complications.
Severe:
Toxic: more pronounced intoxication syndrome, the body temperature to 40
degrees and above, possible meningeal signs, seizures, mental blankness, a
rash of cyanosis shade, hemorrhagic rash, the development of complications.
Bacterial form: characterized by necrotic angina, necrotic nasopharyngitis,
development of septic complications.
Laboratory research:
1. Total blood (leukocytosis, neutrocytosis, left shift formula, eosinophilia,
increased ESR);
2. Bacteriological study of mucus from the fauces (the allocation of hemolytic streptococcus group A);
3. Antibody (Increase titles antistreptolisin O dynamics).
TREATMENT
patients with scarlet fever is carried out mainly at home.
Hospital patients are subject to:
- With severe scarlet fever;
- Complications;
- Impressions of the epidemic.
1. Bed rest during the acute period;
2. Causal treatment: Antibiotics - penicillin with benign or macrolide, with
moderate - penicillin, while difficult - and cephalosporin-II generation,
clindamycin, vancomycin. Antibiotics - to 10-day benign, moderate and
severe 10 -14 days, by introducing - in light form - orally, to moderate internally, "the muscle, while difficult - intravenously.
3. Detoxification therapy: When benign - a significant amount of drinking,
with moderate and severe forms - infusion of glucose-salt solutions;
4. Antihistamine.
5. Drugs that enhance the vascular wall (askorutyn, halaskorbin);
6. Pyretic drugs (paracetamol, ibuprofen);
7. Means of local sanitation: Rinse the throat disinfectant solutions tube quartz, etc..
COMPLICATIONS:
(under appropriate treatment protocols)
Toxic: encephalopathy, myocarditis, nephritis, hepatitis, ITSH;
Bacterial: Synuity (sinusitis - antritis, Frontitis, etmoyidyt) otitis; mastoyidyt;
lymphadenitis; phlegmonous adenitis neck arthritis; synoviyit, pyelonephritis,
sepsis, osteomyelitis, purulent meningitis;
Allergic: myocarditis, glomerulonephritis, rheumatism, arthritis, synoviyit.
PROTOKOL
DIAGNOSIS AND TREATMENT IN CHILDREN
PSEUDOTUBERCULOSIS
Pseudotuberculosis (Scarlatiniform fever) - acute infectious disease caused
by Yersinia pseudotuberculosis and is characterized by pronounced polymorphism
of clinical symptoms with predominance of toxic-allergic syndrome scarlatiniform
rash, lesion of the gastrointestinal tract and liver, often has a protracted course of
recurrent.
Clinical form pseudotuberculosis:
Typical form:
- Scarlatiniform;
- Abdominal;
- Artralgic;
- Icteric;
- Combined;
- Generalized (typhoidform, mononucleosisform);
- Septic.
Atypical form:
- Catarrhal;
- Removed;
- Subclinical.
DIAGNOSTIC CRITERIA:
CLINICAL:
- Incubation period of 3 to 18 days;
- Top acute;
- Body temperature - febrile, wavy, the average duration of 7.11 days;
- Intoxication syndrome;
- Enteritis, at least - gastroenteritis, enterocolitis;
- Exanthema - punctulata (Scarlatiniform), large maculopapular, petechiaehaemorrhagic, nodal Erythema.
- Rash of `is for 2-4 days, is located on flushed background, located on the
face (including the nasolabial triangle), trunk, face extensor limbs around the
joints;
- A symptom of "gloves", "socks Hood";
- "Raspberry" tongue;
- White dermographism;
- Lamellated peeling on the palms and soles;
- Increase the size of the liver;
- Increasing the size of spleen;
- Hyperemia of the conjunctiva and sclera vascular injection;
- Joint pain - migratory arthralgia, primarily affects the radial-carpal joint,
cubital and knee joints interphalangeal, Swollen and painful joints;
- Muscle aches;
- Slight catarrhal manifestations;
- Acute tonsillitis;
- May be the development of hepatitis;
- May be abdominal syndrome;
- Possible development myocarditis;
- May be symptoms of irritation peritoneum;
- Possible development of "infectious-toxic kidneys;
- 16 - 22% of patients may developrelapse in a worsening of symptoms,
occurrence of allergic and articular symptoms, nodular erythema.
The criteria of severity:
Mild form:
A) The symptoms of intoxication weakly expressed;
B) body temperature subfebrile;
B) rash small, localized in the folds of skin around the joints;
D) liver increased slightly.
Moderate form:
A) body temperature febrile;
B) expressed symptoms of intoxication;
B) expressed pain in the abdomen;
D) enteritis or enterocolitis;
D) liver performs at 3-5 cm, painful to palpation;
E) rash is intense, may be hemorrhagic nature.
Severe form:
A) pronounced symptoms of intoxication;
B) high body temperature;
B) may be meningeal syndrome;
D) hepatitis;
D) polymorphic rash, profuse;
E) lesions of the gastrointestinal tract, pseudoapendicular form;
F) polyarthritis;
Z) sepsis
Laboratory research:
1. Total blood - leukocytosis, neutrocytosis with stab shift, eosinophilia,
accelerated ESR.
2. Bacteriological method - identification of the causative agent in faeces and
other physiological media body (urine, blood specimens, the contents of
abscesses).
3. Antibody method - agglutination test and indirect hemahlyutynatsiyi - for
3-4 weeks and in the dynamics of the disease. Diagnostic titer is 1:200 or
higher.
4. ELISA (if possible) - the definition of class IgM antibodies in the acute
phase.
TREATMENT
Milder forms of disease can be treated at home symptomatic, without the use
of antibacterial drugs.
Required hospitalization are:
- Children with medium-severe;
- Children with severe;
1. Mode - in the form of light - half bed rest, with moderate - half bed rest; In
severe - strict bed rest;
2. Diet: when expressed affection hepatobiliary system - table number 5 on
Pevzner, with predominantly intestinal disorders - table number 4 on Pevzner,
when all other forms - table number 15 on Pevzner;
3. Causal treatment:
Antibacterial therapy: antibiotic choice - Levomycetin; antibiotics Reserve cephalosporin III - IV generation. In severe forms of the disease a possible
combination of these antibiotics with aminoglycosides. Average course
duration 14 days, appoint parenteral antibiotics.
4. Detoxification therapy - in the form of light - a significant amount of
alkaline drinking in moderate and severe forms - by the glucose-salt solutions.
5. When expressed joint disease - non-steroid anti-inflammatory drugs.
COMPLICATIONS:
(under appropriate treatment protocols)
 Carditis;
 Dyskinesia;
 Infection dyskinesia;
 Acute renal failure;
 Acute liver failure;
 DIC - syndrome.