Характеристика клінічного перебігу позалікарняної пневмонії залежно від ураження вірусом SARS-CoV-2 у дітей Північно-Східного регіону України

Pathology of the respiratory system continues to occupy a leading place among diseases of childhood, especially in economically poor countries. One of the most common respiratory diseases is community-acquired pneumonia (CAP). According to the WHO, one child dies every 43 seconds from pneumonia worldwide. Pneumonia affects the lung tissue with the development of respiratory failure, causing changes in metabolic processes in the body, including electrolyte imbalance. The disease has a diverse etiological picture, but in recent years, viral and combined forms of pathogens have prevailed, causing a long course and negative consequences for the child’s body. The objective: to establish the features of the clinical course of CAP in children in the North-Eastern region of Ukraine (Sumy) aged 6 years to 17 years, taking into account the detected SARS-CoV-2 virus infection. Materials and methods. The research was carried out on the basis of the Infectious Diseases Department of the MNPE “CCH of Saint Zinaida” Sumy City Council and MNPE “Central Primary Healthcare Centre No 1” of Sumy City Council. The total number of children who were examined was 166. Of them, 134 children are patients with CAP. The patients were divided into two groups depending on the SARS-CoV-2 virus infection. The control group consisted of 32 somatically healthy children. The patients had complete clinical, laboratory and instrumental examinations with a detailed medical history. Statistical processing was performed using Microsoft Excel 2013 software adapted for biomedical research. Reliability was determined using the two-sided independent Student’s t-test, with p-values < 0.05 considered reliable. Results. It was found that there was no sex difference in the incidence of pneumonia in children at the age of 6 to 17 years inclusive. In 64.1% of cases, the development of CAP occurred against the background of SARS-CoV-2 virus infection. The incidence of pneumonia increased in spring and in autumn. Most children with CAP, regardless of SARS-CoV-2 infection, were examined and treated by a family physician before hospital admission. The main clinical manifestations of CAP in both groups of children were: disturbance of general state, lack of or decreased appetite, dyspnea, cough, runny nose. In addition, children with pneumonia caused by SARS-CoV-2 virus had dyspeptic symptoms with fever. Objective examination at hospital admission showed that auscultatory and percussion changes were significantly more common in the group of patients without coronavirus. The majority of children with CAP and SARS-CoV-2 infection had bilateral interstitial lung lesions (80.2%). In patients with pneumonia and no evidence of SARS-CoV-2 virus, the pathological process was more often localized in the right lung and had a focal nature. Mean saturation levels during hospitalization were significantly lower in children with CAP and SARS-CoV-2 virus infection than in patients without coronavirus infection. The mean values of clinical blood tests in patients with pneumonia and SARS-CoV-2 virus infection were characterized by age-appropriate leukocyte counts and erythrocyte sedimentation rates. Children with CAP without SARS-CoV-2 virus infection had leukocytosis and accelerated erythrocyte sedimentation rate in the blood. Conclusions. This study describes the clinical course of CAP in children at the current stage, taking into account the characteristics of the region and coronavirus infection. The results show that children with SARS-CoV-2 virus infection have milder clinical manifestations at hospital admission compared with patients without coronavirus infection. However, the instrumental and laboratory studies show that children require special approach and monitoring of their condition during the period of illness.