the sensing of the viruses responsible of the subglottic clogging ague laryngitis in kids and the constitution of clinical-etiological and epidemiological correlativities. Material and method. There have been investigated 88 kids, between 3-36 months, during two back-to-back seasons ( 2004-2005 and 2005-2006 ) , prosecuting the designation of 8 viruses: influenza A and B, parainfluenza 1,2,3, adenovirus, rubeolas and respiratory syncytial virus. Results.The etiology has been identified for 79.54 % of the instances, most frequent being the parainfluenza 3 ( 27.14 % ) and rubeolas ( 21.42 % ) viruses, and the less noticeable grippe A ( 5.71 % ) and B ( 4.28 % ) viruses. There have been observed differences between the age groups, the patients ‘ birthplace environment and sing the distribution between genders. The rubeolas and parainfluenza 3 viruses have determined the most terrible signifiers of disease. Conclusions.Assessing viral etiology of laryngitis allows us to reason specific distinctive features between aetiologic, clinical and demographic spread.
INTRODUCTION The subglottic clogging ague laryngitis of the baby and little kid has an about entirely viral aetiology. They represent a consistent section of the respiratory pathology of the referential kids and are responsible for a big figure of hospitalizations.
OBJECTIVE Our aim is to place with truth the viral etiology of the laryngitis and to research the possibility of sketching clinical-etiological and epidemiological correlativities.
MATERIAL AND METHODS The survey has been performed upon 73 kids hospitalized in the Children ‘s Clinical Hospital “ Gavril Curteanu ” Oradea, for a clinical image of subglottic clogging ague laryngitis, and upon 15 patients infected with rubeolas, complicated with laryngitis, hospitalized in the Clinical Hospital of Infectious Diseases Oradea. The inclusion standards have been:
– age: 3 – 36 months ;
– kids without malformative pathology of laryngotracheobronchitis domain ;
– kids, hospitalized or place observed for a 14 yearss period after release, for a right rating of the studied stuff, severally the monitorization of the IgM antibody titer in kineticss.
The exclusion standards have been:
– the being of malfor mative syndromes of laryngotracheobronchitis domain ;
– other signifiers of clogging laryngitis ( spastic laryngitis, epiglottitis ) ;
– kids which, after release, could non be monitorized for reevaluation up to a sum of 14 yearss.
The design of the research: The selected patients have been clinically examined in the first twenty-four hours of hospitalization, set uping the diagnosing of subglottic clogging ague laryngitis and including them in a certain badness mark.
Therefore, there have been described 3 phases of badness:
– visible radiation, score 1: the kid has a good general status, accepts the nutrient, has no stridor in rest and no abjuration ;
– medium, score 2-7: the stridor is present and in rest, the abjuration is moderate, tachypnea, tachycardia, maintains involvement for people and the surrounding environment. If a kid with average obstructor becomes agitated or tired, it is a mark of patterned advance to the terrible signifier ;
– severe, mark & gt ; 7: stridor and ample abjuration, besides present in rest, cyanosis, tachycardia, paroxysm or obnubilation, loss of involvement for the people around, can non feed or hydrate, nowadayss fatigue, exhaustion. The respiratory hurt can be less marked than in the medium signifier due to exhaustion. The kids have been monitorized under the clinical development study and the response to intervention, besides observing the length of hospitalization. If the hospitalization period has been shorter than 14 yearss, those kids were monitorized ambulatory and were recalled on the fourteenth twenty-four hours at the ambulatory service of the infirmary, for the 2nd sampling of blood. The samples taken from the same patient ( in twenty-four hours 1 and 14 ) have been analyzed concomitantly, to corroborate the etiology. The trials for the virus diagnosing have been performed for the undermentioned aetiologic agents: the respiratory syncytial virus, the adenovirus, the grippe A virus, the grippe B virus, the parainfluenza 1 virus, the parainfluenza 2 virus, the parainfluenza 3 virus, the rubeolas virus. For designation there has been used the ELISA technique ( enzyme-linked immunosorbent check ) . For statistics informations at that place has been used the EPIINFO aplication, 6.0 version, a plan of The Center of Disease Control and Prevention – Atlanta, with the Student method ( prove T ) and I‡2.
Consequence Of the entire figure of 88 kids which were paraclinically analysed, the aetiology could be determined for 70 patients ( 79.54 % ) , as it consequences from fig. 1. From the entire 70 instances with established etiology, there has been determined a predomination of the parainfluenza 3 virus, which was detected at 19 people ( 27.14 % ) , followed by the rubeolas virus, which caused 15 instances within the two seasons ( 21.43 % ) . This facet is presented in table no. I. The lowest incidence have had the infections caused by the grippe B virus: 3 patients ( 4.29 % of the instances with declared aetiology ) and the grippe A virus: 4 patients ( 5.71 % of the instances with identified aetiology ) , in all, during the two seasons. In our survey group, the aetiology has been stated in 31 instances in the urban environment ( 44.29 % ) and 39 instances in the rural environment ( 55.71 % ) , the rural/urban study being of 1.3:1. Sing the relation aetiologic agent-origin environment of the patient, the state of affairs can be evaluated based on table no. II, ensuing a important difference between the urban and the rural ( p & lt ; 0.001 ) . Therefore, the VRS prevalence, the parainfluenza 1 and 2 viruses, is 2-2.9 times bigger in the urban country, and the prevalence of the grippe A and B viruses, the parainfluenza 3 and rubeolas viruses is significantly bigger in the rural environment. The distribution on groups of age was the undermentioned: 8 instances ( 11.43 % ) have had ages between 3-12 months, 39 instances ( 55.71 % ) between 13-24 months and 23 instances ( 32.86 % ) between 25-36 months. Mentioning to the groups of age, we have observed that: the age group 3-12 months nowadayss hazard of acute laryngitis with VRS ( RR=2.44 ) and adenovirus ( RR=1.94 ) , the age group 13-24 months holding laryngitis with rubeolas virus ( RR=3.18 ) and the age group 25-36 months holding acute laryngitis with parainfluenza1 and 2 virus ( RR=2.04 ) . We can non province that one of the age groups presents a higher hazard of acute laryngitis with parainfluenza 3 virus. In table IV is presented the distribution of the studied instances, doing the correlativity between the patients ‘ gender and aetiologic agent of the laryngitis. One may detect that more male patients have been hospitalized, that is 41 ( 58.57 % ) , compared to merely 29 female ( 41.42 % ) . We note that the VRS prelevance, of the grippe A and B viruses is significantly bigger with misss ( 1.4 -2.8 times bigger, p=0.044, 0 & lt ; 0.001 ) , and of the parainfluenza 1 virus with male childs ( p=0.021 ) ( fig. Fig. 5 shows that the most frequent signifiers of disease have been those with average badness ( 60.00 % ) and terrible ( 30.00 % ) . One of the really of import facets of this survey has been represented by the high spot of the correlativity between the badness mark and the aetiologic agent of the disease. Table Volt shows that for the parainfluenza 3 virus and the rubeolas virus have been encountered more terrible signifiers of disease ( 52.63 % , severally 73.33 % ) . There is a really tight correlativity between the badness mark and the figure of yearss of hospitalization. Therefore, the patients with subglottic clogging ague laryngitis given by the infection with the parainfluenza 3 and rubeolas viruses, which determined the terrible signifiers of disease, have needed a significantly longer period of hospitalization From the analysis of the mean figure of hospitalization yearss, are to be noticed 4 groups: the first one includes VRS and adenovirus, the 2nd the parainfluenza 1 and 2 viruses, the 3rd one the grippe A and B viruses, and the Forth one the parainfluenza 3 and rubeolas viruses. Within the groups there is no important difference sing the mean figure of hospitalization yearss, while between the four groups there are important differences ( p=0.042 between groups 1 and 2, p=0.037, between the groups 2 and 3, p=0.024 between the groups 3 and 4 and p & lt ; 0.01 between the groups 3 and 4 ) .
DISCUSSION Because the incidence of the subglottic ague laryngitis is conditioned chiefly by the season, the viral aetiology has been investigated merely in the interspace 1st of October- 30 of April ( autumn-winter- early spring ) . The aetiology identified for 79.54 % of the instances, presents a construction that is merely partly similar with the one presented in other published surveies. Still, we note that the high frequence of the infection with rubeolas virus explains through the fact that, in February 2005, in Bihor County started a rubeolas epidemic. Harmonizing to the informations published by the Public Health Authority of Bihor, the epidemics developed along the full twelvemonth, the descendant development taking topographic point merely in 2006, after the intercession in the anterooms represented by the less accessible communities, with infant population that was non registered in the household doc- tors ‘ lists and that was non vaccinated. The predomination of the parainfluenza 3 virus represents an ascertainment applicable to other referential plants. The survey performed by us indicated a predomination of the instances with beginnings in the rural environment, where certain conditions ( agglomeration, lodging, general and medical attention ) have made babies and kids more vulnerable in forepart of the referential viral infections. The ascertainment is correlated with the fact that the biggest figure of unvaccinated kids that were infected with rubeolas was in the rural environment. It has been observed the predomination of the rubeolas, grippe B and parainfluenza 3 type viruses, in the rural environment, compared to the urban environment. We found no observations in the professional literature that would analyze the two beginning environments in comparing, our work being a premiere in this respect.As other writers did, we signalized a upper limit of incidence in the 2nd twelvemonth of life and an obvious predomination in the male gender. We observed a predomination of the parainfluenza 3 and rubeolas viruses for the age groups 19-24 months and 13-18 months. Besides, there has been registered a significantly bigger prevalence of the respiratory syncytial virus and of the grippe A and B viruses in the female gender, and of the parainfluenza 1 virus in the male gender. The most terrible signifiers of subglottic laryngitis have been determined by the parainfluenza 3 virus and particularly by the rubeolas virus. The ascertainment is inconsistent with one of the studies, where the most terrible signifiers have been given by the grippe A virus. The longest hospitalization was registered with the instances of laryngitis holding as etiology the parainfluenza 3 and rubeolas viruses that besides generated the most alarming signifiers of disease.
CONCLUSIONS 1.The viral aetiology has been analysed for 88 kids with ages between 3-36 months, with subglottic clogging ague laryngitis during 2 seasons ( 2004-2005 and 2005-2006 ) , with the intent to place 8 serological confirmed viruses. 2. The aetiology could be established for 70 instances ( 79.54 % ) , most detected being the parainfluenza 3 ( 19 instances, 27.14 % ) and rubeolas ( 15 instances, 21.43 % ) viruses, and less identified were the grippe B and A viruses ( 3 instances, 4.29 % , severally 4 instances, 5.71 % ) . 3. The most terrible signifiers, that implied the biggest figure of hospitalization yearss, have been determined by the parainfluenza 3 and rubeolas viruses.
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