Respiratory chlamydia in children

ICD-10 code

A74 Other diseases caused by chlamydia.

Epidemiology

Up to 15-20% of all pneumonias and 20-30% of conjunctivitis in newborns occur due to infection during passage through the birth canal of women suffering from urogenital chlamydia. Children can also become infected through the hands of staff or mothers, household items, underwear, toys, and also by airborne droplets.

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Causes of respiratory chlamydia

Respiratory chlamydia in children is caused by Ch. pneumoniae and many biovars of Ch. Trachomatis (D, E, F, G, H, J, etc.). In terms of morphological and biological properties, these serovars are indistinguishable from other chlamydia.

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Symptoms of respiratory chlamydia

Respiratory chlamydia in children most often occurs as conjunctivitis, bronchitis and pneumonia.

Chlamydial conjunctivitis begins with reddening of both eyes and the appearance of purulent discharge. Large, bright red follicles arranged in rows are constantly found on the conjunctiva, especially in the area of the lower transitional fold; pseudomembranous formations and epithelial punctate keratitis are possible. The general condition suffers slightly. The parotid lymph nodes are often enlarged, sometimes they are painful on palpation. When sowing discharge from the eyes, bacterial flora is usually not detected. The course of chlamydial conjunctivitis can be acute or chronic. In the acute course, the symptoms of conjunctivitis completely disappear in 2-4 weeks even without treatment. In the chronic course, clinical manifestations are detected for many months and even years.

Chlamydial bronchitis begins gradually, usually at normal body temperature. The first sign of the disease is a dry cough, often paroxysmal. The general condition suffers insignificantly. Sleep and appetite are preserved. Scattered, mainly medium-bubble rales are heard on auscultation. Percussion of the lungs usually does not reveal changes. After 5-7 days, the cough becomes wet, its attacks stop. Recovery occurs in 10-14 days.

Chlamydial pneumonia also begins gradually, with a dry unproductive cough that gradually intensifies, becomes paroxysmal, accompanied by general cyanosis, tachypnea, vomiting, but there are no reprises. The general condition suffers slightly. Dyspnea gradually increases, the number of breaths reaches 50-70 per minute. Breathing is grunting, but respiratory failure is weakly expressed. By the end of the first and during the second week, a picture of bilateral disseminated pneumonia is formed in the lungs. During auscultation, crepitant wheezing is heard in these patients, mainly at the height of inspiration. During an objective examination, attention is drawn to the discrepancy between clinically expressed pneumonia (dyspnea, cyanosis, scattered crepitant wheezing over the entire surface of both lungs, etc.) and a relatively mild general condition with minimally expressed symptoms of intoxication. At the height of clinical manifestations, many patients have enlarged liver and spleen, and enterocolitis is possible.

X-ray examination reveals multiple fine-mesh infiltrative shadows with a diameter of up to 3 mm.

In the blood of patients with chlamydial pneumonia, pronounced leukocytosis is detected - up to 20x10 ⁹ /l, eosinophilia (up to 10-15%); ESR is sharply increased (40-60 mm/h).

Diagnosis of respiratory chlamydia

Clinically, chlamydial infection can be suspected when a newborn consistently develops conjunctivitis (in the 2nd week of life) with a long, persistent course, bronchitis (in the 4th-12th week of life) with attacks of painful cough and small-focal pneumonia, especially when eosinophilia and a significant increase in ESR are detected with a relatively mild general condition.

For laboratory confirmation of respiratory chlamydia, the detection of chlamydial antigen in biological material using the PCR method, determination of specific anti-chlamydial antibodies of classes G and M in ELISA, etc. are used.

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Differential diagnostics

Chlamydial conjunctivitis must be differentiated from conjunctivitis caused by gonococci and other pyogenic microorganisms (staphylococci, streptococci, gram-negative flora), as well as various viruses (adenoviruses, enteroviruses, herpes simplex viruses). The results of bacterioscopic and bacteriological examination of eye discharge are important for differential diagnosis.

Pneumonia caused by staphylococci, pneumococci and other microorganisms is accompanied by high body temperature with a severe general condition with frequent formation of large lesions in the lungs, and chlamydial pneumonia is characterized by multiple small-spotted infiltrates.

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Treatment of respiratory chlamydia

The international standard for treating chlamydial infection is macrolide antibiotics (erythromycin, azithromycin, etc.). For conjunctivitis, antibacterial drugs are prescribed in the form of an ointment, for pneumonia - intramuscularly and intravenously. In severe cases, combined treatment with two or more drugs is used. Macrolides are usually combined with biseptol, another sulfanilamide drug, or furazolidone. The duration of treatment is about 10-14 days.

In case of recurrent course, immunostimulating therapy (sodium nucleinate, thymus preparations - taktivin), cycloferon, pentoxyl, etc., probiotics (acipole, bifidumbacterin, etc.) are indicated.

Prevention of respiratory chlamydia

Preventive measures should be aimed at the source of infection, transmission routes and the susceptible organism. Since children become infected with respiratory chlamydia in maternity hospitals, the main preventive measure should be the identification and treatment of sick women. To prevent postnatal infection, maximum isolation of newborns and strict adherence to hygiene rules during care are important. Active prevention has not been developed.