Recurrent respiratory tract infection is a common clinical disease in pediatrics, with an incidence of about 20%.It refers to the respiratory tract infection with frequent upper respiratory tract infection or lower respiratory tract infection within one year, which exceeds a certain range.The diagnostic criteria for different ages are different. Repeated upper respiratory tract infections are more than 7 times/year for infants under 2 years old, more than 6 times/year for children between 3 and 5 years old, and more than 5 times/year for children over 6 years old;Repeated lower respiratory tract infection can be diagnosed by more than 3 times/year for infants under 2 years old, more than 2 times/year for children aged 3 to 5 years old, and more than 2 times/year for children over 6 years old.
TCM disease name
Repeated respiratory tract infection
Foreign name
RRTI
alias
Repeated respiratory tract infection
Multiple population
The highest incidence rate is in children under 2 years old
Common causes
Congenital factors or low immune function or deficiency of trace elements and vitamins
Science popularization in China
Committed to authoritative science communication
The certification expert of this term is
Meng Yanni|Deputy chief physician
Department of Respiratory Medicine, Hunan Children's Hospitalto examine
The highest incidence rate is in children under 2 years old
Common causes
Congenital factors or low immune function or deficiency of trace elements and vitamins
pathogeny
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The factors of recurrent respiratory tract infection are complex.Most of them are the result of congenital factors or low immune function of the body or lack of trace elements and vitamins, or improper feeding methods, as well as multiple factors such as heredity, nursing and living environment.Children's immune function is relatively low, and they are prone to respiratory diseases.In addition, children who have a long-term preference for food, are picky eaters, and have poor cold tolerance are prone to respiratory infections, and air pollution also has an impact on susceptibility to respiratory diseases.
clinical manifestation
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Respiratory tract infection is a common disease in children. The onset of the disease is often anxious. It can include fever, runny nose, nasal congestion, sneezing and mild cough.Some may have vomiting, diarrhea, etc.The symptoms vary with age.In addition to suffering from several times more respiratory diseases than healthy children, those susceptible to recurrent respiratory infections often have poor appetite, night sweats, weight loss, sallow complexion, etc.Improper treatment will lead to asthma, myocarditis, nephritis and other diseases, seriously affecting the growth and health of children.
inspect
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1. Blood examination
The total number of white blood cells, the percentage of neutrophils and lymphocytes can help determine whether the respiratory tract infection is caused by bacteria or viruses.In general, the total number of white blood cells and the percentage of neutrophils will increase in bacterial infection;In viral infection, the number of white blood cells is normal or low, and the proportion of lymphocytes is high.
2. Pharyngeal swab culture
For children suspected of causing recurrent respiratory tract infection by bacteria, throat swab culture, that is, throat secretion culture and drug sensitivity test, should be conducted to understand which bacteria cause the infection and which antibiotics are effective.The specific methods are:;In the morning, when fasting, drinking, and brushing and gargling are not allowed, gently apply the disinfectant cotton swab to the pharynx for several times, and then put it into the bacterial culture solution. It should also be noted that it is better to do this inspection before taking antibiotics, because taking antibiotics will inhibit or kill bacteria, which is difficult to obtain satisfactory culture results.
3. Radiological examination
Children with recurrent pneumonia must be examined by X-ray fluoroscopy or radiography. Because of the length of illness, severity of illness and infection of pathogenic microorganisms, the radiological manifestations will be different.This change of image is of great significance in guiding the diagnosis and treatment of children.
4. Inspection of immune function
For children with recurrent respiratory tract infection, if possible, this test should be performed to observe whether the immune function is normal.Because the most important symptom of children with congenital immunodeficiency disease is recurrent respiratory tract infection, and the immune function of these children is obviously abnormal, the examination of immune function can distinguish these children, which is conducive to guiding treatment.Immune function examination includes two aspects:
(1) Humoral immune functionIt is closely related to the human body's resistance to bacterial infection.It mainly detects serum immunoglobulins (IgG, IgA, IgM, IgD and IgE).If this test is not available, plasma protein quantification and serum protein electrophoresis can also be detected to preliminarily determine the humoral immune status of the child.The serum IgG or IgA of some children with recurrent respiratory tract infection can be lower than the level that normal people should have, but can not reach the level of diagnosis of immunodeficiency disease.
(2) Cellular immune functionIt mainly refers to the human body's resistance to virus invasion.It includes T cell subclass (CD cell classification) and delayed hypersensitivity skin test (PPD, PHA skin test).Some children, especially those with malnutrition, often show a decrease in the number of peripheral blood helper T cells (CD4 cells) and a low response to skin tests.The mild abnormality of the above immune function may be due to the repeated stimulation of the immune system by microorganisms such as bacteria or viruses, which makes the immune active cells in a state of fatigue and causes the immune function to be low.
As the parents of children with recurrent respiratory tract infection, they must pay attention to that children must undergo immune function tests to determine whether recurrent respiratory tract infection is caused by immune deficiency disease, because the treatment and prognosis of the two are different.
diagnosis
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It can be diagnosed according to clinical manifestations and examination results.
treatment
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The purpose of clinical treatment is to reduce the number of respiratory tract infections.
1. Etiological treatment
The most common pathogenic factor during the infection period of children's recurrent upper respiratory tract infection is the invasion of pathogens, most commonly viruses, bacteria and atypical pathogenic microorganisms.Anti infection treatment for etiology is routine treatment.
2. Immunomodulator treatment
The use of immunomodulators can enhance the immune function of the respiratory tract, effectively reduce the frequency of recurrent respiratory tract infections and the use of antibiotics.
3. TCM treatment
Traditional Chinese medicine (TCM) has unique advantages in improving symptoms, eliminating pathogenic factors, strengthening the foundation, regulating the constitution, and controlling recurrent attacks.
prevention
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There are not many prevention and treatment measures for children's recurrent respiratory tract infection in modern medicine, and the long-term effect remains to be observed. In addition, recurrent respiratory tract infection is closely related to children's defense ability, nutritional status, and environmental factors, and is related to the anatomical characteristics of children's respiratory tract.The preventive measures must first start with increasing the children's physical resistance and preventing the invasion of pathogens. For example, children's physique can be strengthened through appropriate outdoor activities, more sun exposure, physical exercise and nutrition supplement.During the flu season, children should not be taken to public places, and children should not be exposed to infected children and adults.In the changing weather season, strengthen the care. The children should wear clothes that are warm and cold, and the indoor air should be ventilated.Children who are really weak can take medicine to strengthen their immunity.
