term Definition «often ill children», structure of a case rate of often ill children.

According to the representations accepted in domestic pediatrics (Samsygina G. A, 2004), often ill children (CHBD) is «a designation of group of children inclined to more frequent, than at their contemporaries, to diseases of a respiratory tract» [2,3,21,23,64,88].

In 1986 leading pediatrists of our country have suggested to carry to group CHBD of children till 1 year if they were ill with acute respiratory diseases (ORZ) and diseases of ENTs-bodies of 4 and more times in a year, children from 1 till 3 years if they were ill 6 and more times a year, children from 3 till 5 years in case of diseases of 5 and more times in a year and children is more senior 5 years - at frequency of diseases 4 and more in a year [2,3,32,49,50,64]. And though by numerous epidemiological researches it is established, that each child within a year on the average transfers from 2 to 5 episodes of these diseases, group CHBD allocation quite obosnovanno from the point of view of studying of their features immune, endocrine, etc. systems [39,49,50].

In the Russian Federation each 4-5 child can be carried to group CHBD and on this group it is necessary more than 60 % of all diseases of children's age [23,38,47,52]. And according to [2,3,50] on share CHBD it is necessary from 25 to 50 % of all cases of diseases of children, and among children of preschool age CHBD makes 26 %, till 3th years - 42 %.

It is necessary to notice, that CHBD is not the nosological form and not the clinical diagnosis as wide variability of an aetiology and a pathogenesis of diseases of ENTs-bodies and respiratory system of nanosecond allow clinically obosnovanno to apply this term. Allocation of this category of children in practical pediatrics is caused by necessity of carrying out

The preventive actions having proved enough scientific preconditions.

Studying of the periodic scientific literature on problem CHBD has shown uniformity of basic representations after etiological structure and case rate CHBD, the basic pathogenetic links, and also treatment-and-prophylactic actions at this ipynnw sick children. It is shown, in particular, that the basic pathogenetic link in group CHBD is the changed reactance of immune system caused by such factors, as age of mother, toxicoses of pregnant women, a prematurity, is purulent-septic diseases, artificial feeding, social factors, and also an intensive antigenic load on a growing organism and individual combination theory of inherited genes immunnoju the answer (genes of the Ministry of Taxes and Tax Collection-komileksa) [38,43,78,91]. It is established, that in family trees at CHBD in 14,5 times chronic bronho-pulmonary diseases, in 20 „7 times more often - an adenoid disease, adenoid vegetations and an adenoiditis, in 4 times more often - malignant neoplasms, in 7,6 times more often - allergic diseases and almost in 10 times more often - ORZ at parents and close relatives from group CHBD in comparison with families of control group of seldom ill children [38,52,64] is more often become perceptible.

In struktu-re case rates at CHBD to 80 % occupy illnesses of organs of breath among which prevail acute respiratornoyovirusnye infections and a flu, then, on frequency of occurrence, illness of an ENT - of organs and infectious diseases [23,52]. For often ill child are characteristic long, often repeating within a year (irrespective of a season) diseases with the tendency to synchronisation and relapses.

Most typical the described picture for children till 3 years.

According to authors [10,38,88] at CHBD among chronic diseases the ENT-pathology is in the lead, taped in 24 % of cases (adenoides II-1II of degree, a hypertrophy of tonsils, an adenoid disease, tonsillar illness), follow further allergic diseases, - at 11 % of children (a bronchial asthma, atopichesky a dermatitis, an asthmatic bronchitis, a medicinal allergy), on the third place - gastoenteropatologija, taped at 9 % of children (a dyskinesia zhelchevyvodjashchih ways, chronic gastroduodenit, a reactive pancreatitis) and on the fourth place other chronic pathology taped at 3 % of children (a chronic pyelonephritis, a Werlhof's disease other).

Results of researches of other group of authors have taped the following structure of a case rate in group CHBD: an acute nasopharyngitis - at 72 % of children, an acute laryngotracheitis - at 10 %, an acute tonsillitis at 7 %, an acute bronchitis - at 4 %, an acute sinusitis - at 3 %, an acute pneumonia and an acute otitis - at 2 % [45J. It is necessary to notice, that in the given work the case rate during the acute period was considered. As to prevalence of a pathology of JAOR-BODIES at children on appealability (group CHBD) the pharynx pathology (33-35 %) is prevailing, illnesses of an ear (26-33 %), illnesses of a nose (20-33 %) [8].

Among etiological factors ORZ at CHBD the leading part play the viruses which specific gravity makes from 65 to 90 % of cases. Joining of a bacteriemic infection leads to increase of gravity of disease and rising of risk of development of complications (an otitis, a sinusitis, a tracheobronchitis, a pneumonia, etc.) [2,24,37].

As it has been told above, repeated infections of respiratory tracts - one of the most frequent reasons for visits to pediatrists and ENTs-doctors, and also hospitalisation in a hospital. These infections are presented, basically, following kinds: bacteria Haemophylus influencae (most often type b), Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, Moraxella catarrhalis, viruses (mainly respiratorno - sintsitialnym, viruses of a flu, a parainfluenza, adenoviruses), originators of family Chlamidia and Mycoplasma, especially Chlamidia pneumoniae and Mycoplasma pneumoniae [9,42, 55].

It is necessary to notice also, that according to a number of researches, development repeated ORZ promotes factors of the broken bionomics, delay of development of immune system, disturbance of components of local immunity, a sensibilization to bacteriemic allergens and the raised frequency of allergic diseases [45, 88].sereznuju the problem is represented by complications of chronic inflammatory diseases of a pharyngeal lymphoid ring, in particular, an adenoid disease and adenoidnta, so inherent to group CHBD. The number of such diseases reaches nearby 100 (47].

Among diseases of ENTs-bodies adenoid vegetations prevail. Persistent in an adenoid tissue pathogenic bacteria and viruses promote development of inflammatory processes in a nasal cavity and okolonosovyh sinuses, and also to infection diffusion on a middle ear. In the presence of adenoid vegetations there is "vicious circle": adenoides cause difficulty of nasal breath that interferes with cold treatment, and last causes the further augmentation of adenoid growths [48,62,103].

Frequent complication is tonzilogennaja the intoxication. It always exists at dekompensirovannyh forms of an adenoid disease and adsnoidita and is accompanied by reflex reactions from cardiovascular, neuroendocrinal, digestive and mochsvydslitelnoj systems. More and more essential value gets such implication tonzilogennoj intoxications, as a tonzillo-cardial syndrome. Influence of the chronic centres of an infection in a nasopharynx on development nejropegetatnvnoj dystonias [47,48,62] is established. Communication of chronic diseases of a pharyngeal lymphoid ring with disturbances of sexual development and genesial function at girls [5,176] Also becomes perceptible.

The role of the specified processes in a nasopharynx in rheumatic disease development is indisputable, including and rheumatic myocardites. Persistentsija in a nasopharynx of the R-Haemolitichesky streptococcus of group And, including nefritogennye strains, it is considered the main reason of a hypersensibilization of an organism and an induction of infectious-dependent autoimmune process. This process can cause development of a poststreptococcal glomerulonephritis, and also an IgA-dependent nephropathy at a corresponding genetic predisposition [48,62,76]. The role of chronic inflammatory diseases of a nasopharynx in development of a pathology of organs of breath is doubtless. Adsnotonzilljarnaja the hypertrophy can cause apnoe during a dream, a relapsing bronchitis [99,105,151]

Connection of the specified diseases with repeated average otites, depression of hearing, Werlhof's disease, hemorrhagic vasculitis, nodous polyarteritis, system lupus erythematosus, thyrotoxicosis, eczema, scleroderma and other diseases [47,62.176,195] is besides established.

The important factor of diseases of a lymphoid pharyngeal ring at CHBD is age features of immune system. It is known, that the period of formation of the immune system, coming to the end as a whole at the age of 17-19 years, it is accompanied by the changed reactance of immunity. Last circumstance causes growth in group CHBD of infectious diseases, adenoid diseases and adenoidites, the allergic and autoimmune diseases interfaced to a pathology of a lymphoid pharyngeal ring [22,152,189]

Thus, apparently from the presented data of the periodic literature, the structure of a case rate at CHBD is heterogeneous, respiratory system including infectious lesion, an ENT - of organs, allergic diseases, diseases of a gastroenteric tract, etc. However, the lesion of ENTs-bodies, in the form of clinically demonstrating rhinites, rinosinusitov, adenoid vegetations and adenoidites, an adenoid disease, otites, a laryngitis is prevailing.


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A source: Amirova Patimat Junuskadievna. The study of the immunomorphological clinical features of adenoid vegetations and palatine tonsils in frequently ill children. Thesis for the degree of candidate of medical sciences. Moscow –2006. 2006

More on topic term Definition «often ill children», structure of a case rate of often ill children.:

  1. value of a pathology of an ENT - of organs in structure of a case rate of group chaego ill children.
  2. the General characteristic of a problem of often ill children.
  3. features of a condition of immune system at often ill children.
  4. features of a condition of local immunity at often ill children
  5. 3.1. The morphological analysis of adenoid vegetations of tonsils at often ill children
  6. studying of a condition of system cellular immunity at often ill children with a pathology of ENTs-bodies.
  7. studying of local humoral immunity of adenoid vegetations and palatine tonsils at often ill children
  8. 3.2. Studying of local cellular immunity of adenoid vegetations and palatine tonsils at often ill children
  9. Studying of a condition of local cellular immunity at often ill children with a pathology of ENTs-bodies.
  10. Studying of a condition of local humoral immunity at often ill children with a pathology of ENTs-bodies.