Matvienko S. Features of the course of community-acquired pneumonia in children on the background of intracellular infection: diagnosis, differential diagnosis, prognosis. – Qualification scientific work on the rights of a manuscript

The thesis is devoted to improving the efficiency of diagnosis and treatment of community-acquired pneumonia in children, which occurs on the background of intracellular infection by developing diagnostic algorithms, differential diagnosis and prediction of treatment efficacy. Community-acquired pneumonia on the background of intracellular infection is more likely to occur: in boys, children under 6 years old, children with birth weight ≤ 2500 g, burdened by the neonatal period, breastfeeding duration ≥ 11 months, with a history of acute acute bronchitis, acute obstructive bronchitis, acute otitis and sinusitis. Children with community-acquired pneumonia against the background of intracellular infection show a higher activity of the inflammatory process, which manifests itself as III degree of severity of pneumonia, its focal-confluent, segmental form, the presence of respiratory failure, longer duration of course, leukocytosis, neutrophilia, lymphocytopenia, development of adverse adaptive reactions according to L. Kh. Garkavi, two or more antibacterial replacements. For infection with Mycoplasma pneumoniae, Chlamydophila pneumoniae was significantly more often determined: body temperature ≥ 39,1℃; aggravation of the neonatal period, diffusion of the inflammatory process and focal-confluent nature of its manifestation, leukocytosis, adverse adaptation reactions of the body, slight or moderate e increase in the level of IL-4, a very high level of IL-18, a longer ( ≥ 11-per day) antibiotic therapy, as well as a large number of replacements of the antibacterial agent. The duration of antibiotic treatment for community-acquired pneumonia is significantly affected by a complex of factors: birth weight ≤ 2500 g, burden of pregnancy and childbirth, burden of the neonatal period, past infectious diseases (acute respiratory infections, acute tonsillitis), pneumonia debut clinic, severity of pneumonia, the size and intensity of the center of darkening in the lungs, the degree of severity of the inflammatory process according to the clinical analysis of blood and the level of ferritin, reduction of resistance of the body a (adaptive reactions according to L. Kh. Garkavi), the degree of infection with intracellular pathogens, the adequacy of the starting antibacterial agent.