The opportunity of persistent viral infection in clinical and immunological manifestation of community-acquired pneumonia

Abstract

Introduction: Pneumonia is the cause of death of more then 2 mln children every year, which represents approximately 20% from all deaths. In RM the prevalence is 140-150 at 1000 of children. According to WHO, the mortality caused by herpetic infection is placed on 2nd place (15.8%) in group of viral infections, followed by H. influenzae. Death rate in CM V infection is evaluated at 30 %, and 80% -100% of the survivors will develop such sequelaes as: progressive deafness, mental retardation, microcephaly. Affectation of respiratory system at children with CMV infection is estimated at 49%, clinical manifested by respiratory distress syndrome and pneumonia. Objectives: To highlight the risk factors and determine the clinical and immunological particularities of CAP associated with persistent viral infection. Materials and Methods: 1. Examination of medical cards. 2. Paraclinical Examination (hemoleucogram, biochemical examination, immunological examination using the Mancini’s method - IgA, IgG, IgM; anti - CMV serological examination, anti - CMV - IgA; 3. Screening methods: chest X-ray, internal organs Eco; 4. Consultation of Infectionist, gastroenterologist, psycho-neurologist, allergist, etc.; 5. The obtained investigations results were statistically processed by using variational and descriptive analysis in Microsoft Excel statistic programs. In each group we had the follow age structure: 1-6 months, 6-12 month, 1-3 years, and 3-5 years. The distribution in study groups was the similar as in the control one. Results: From 106 children with CAP: 1st lot: Anti-CMV IgM positive, Anti-CMV Ig G positive - 31; 2nd lot: Anti-CMV IgM negative; Anti-CMV Ig positive - 44; 3rd lot: Anti-CMV IgM negative; Anti-CMV IgG negative - 31; 1. Risk factors that determine the severe evolution of CAP at infants with positive herpetic IgM or IgG are herpetic family history 61.3%, in special with MV 43.07 %. 2. Clinical diagnostic markers in suspicion of persistent viral infection - family persistent viral history, congenital pneumonia, prolonged neonatal jaundice, toxic hepatitis. 3. The association of CAP with IgM positive herpetic infection, appreciate the severity of disease (35.48±1.4%, p<005), its duration (more than 1 month, 2 week of hospitalization) and the presence of complications (83.8±2.35%, p<0,005) and comorbidities at this children. Conclusions: The herpetic infection is an important risk factor that needs to be evaluated and be very seriously studied. Persistent herpetic viral infection can be qualified as a medico-social problem, because of its clinical and immunological manifestation, distribution, amplitude and comorbidities and we must take an attitude behind this problem, as soon as possible.