DIAGNOSIS AND TREATMENT OF BACTERIAL RESPIRATORY TRACT INFECTIONS

L. Namazova-Baranova

Scientific Research Institute of Prophylactic Pediatrics and Rehabilitation, Scientific Center of Children's Health, Russian Academy of Medical Sciences, Moscow, Russia

Respiratory tract infections are the most common diseases in young children? Among them viruses are the most important etiological agent and bacterial etiology is confirmed only in 6-8% of cases. Nevertheless, antibacterial therapy is administered ambulatory in 65-85% of all ARI cases, and in 98% cases in some hospitals. At the same time in case of proven bacterial etiology of infection or a high probability of bacterial infection it is important to promptly start antibiotic therapy in order to avoid severe system complications. In case of obvious infection focus (eg, sore throat, otitis) and related laboratory changes diagnosis is not difficult to confirm. Recovery of β-hemolytic group А Streptococcus from the pharynx is reliable diagnostic criterion of bacterial tonsillitis. Symptoms of otitis media include ear pain, febrile fever, often signs of intoxication, ear discharge. Otoscopy can confirm diagnosis. The most common etiological agent of otitis is Streptococcus - Pneumoniae, rarely - unencapsulated Haemophylus influenzae, or Moraxella catharralis. Purulent sinusitis is characterized by high fever, intoxication, cheek and periorbital edema, and is often caused by Streptococcus spp. Signs of lymphadenitis include lymph node (usually tonsillar) enlargement and tenderness with surrounding edema and fluctuation; usual etiology is Streptococcus spp, rarely - Staphylococcus spp. Acute bronchitis manifests by cough, dry and mixed moist rales in the absence of infiltrative or focal changes in lung tissue on the X-ray. In 5-15% cases of bronchitis in preschool and school age children, especially in autumn, disease is caused by Mycoplasma pneumoniae. Sings of mycoplasma bronchitis include abundance of asymmetrical, fine moist rales and conjunctivitis (without abundant effusion). Bronchitis in children under the age of 5 months may be caused by Chlamidia trachomatis, in adolescents-by Chlamidia pneumoniae. Prevalence of these bronchitis forms is unclear, but there is reason to believe that it is small. Bacterial bronchitis occurs in infants with the syndrome of frequent food aspiration, usually accompanied by aspiration pneumonia. Respiratory disorders of different severity and typical physical signs along with focal or infiltrative X-ray changes are indicative of pneumonia.

However, in the absence of clear focal changes, pediatrician should be guided by additional criteria that with high probability support the development of bacterial infection. They include: body temperature above 38°C over 3 days, dyspnea in the absence of airway obstruction (children under the age of 2 mo. >60 b/m, 3-12 mo. - > 50 b/m, 1-3 y. -> 40 b/m); chest retractions or grunting respiration in the absence of airway obstruction, marked toxemia, leukocytosis >15,000/mcL, neutrophilia with an increase in the number of young neutrophil forms, ESR > 20 mm/h, procalcitonin and CRP increase.

Thus, in order to determine the optimal strategy of patients with respiratory tract infections management we should determine disease etiology as early as possible, and administered antibacterial therapy if appropriate.