Hemorrhagic vasculitis, or Shenlein-Genoch disease, is associated with damage to small blood vessels - arterioles, venules, capillaries - which are located in the skin, gastrointestinal tract, joints, kidneys. The disease affects children at any age, but, according to statistics, is most common in the period from 4 to 12 years. Moreover, it was found that boys are almost twice as sick as girls. Further in the article, we consider the causes of its occurrence, characteristic signs and what is the treatment of hemorrhagic vasculitis in children.
Disease Description
With hemorrhagic vasculitis, the inflammatory process of microvessels and thrombosis occurs in them. As a result of inflammation of the vascular wall, they become brittle. Often there is a defeat of the capillaries of the skin, kidneys and digestive organs. Many blood clots form in microvessels, blood circulation is disturbed, and the body ceases to cope with its functions. Significant vascular damage causes hemorrhagic syndrome, which is manifested by small hemorrhages in the tissue. In the digestive tract, edema and damage to the mucous membranes occur; in the kidneys, vascular patency is impaired. ICD-10 hemorrhagic vasculitis in children has the code D69.0 and is characterized by symptoms of allergic purpura.
Classification of hemorrhagic vasculitis
According to the clinical course, the disease is divided into the following degrees:
- Easy - the patient is in a satisfactory condition: small rashes on the skin and mild pain in the joints.
- Medium - there is a profuse rash on the body, pain in the joints intensifies, discomfort in the abdomen is felt, an admixture of blood appears in the urine.
- Severe - multiple skin rashes with necrotic areas on the skin, possible Quincke's edema, protein-lipid metabolism is disturbed due to kidney damage, which may cease to function, blood is present in the urine, bleeding is observed in the digestive tract.
The course of the disease is:
- acute - lasts up to two months;
- protracted - about six months;
- chronically relapsing - lasts for years.
Hemorrhagic vasculitis in children, the clinical forms of which depend on the affected organ, can be of the following types:
- Cutaneous - only integuments suffer. The disease is often hereditary. The rash appears on the buttocks, abdomen, and articular folds.
- Renal - characterized by kidney damage: poor appetite, weakness, nausea, the presence of protein and red blood cells in a urinalysis. Skin rashes are absent.
- Cutaneous-articular - swelling of the joints of the upper and lower extremities is observed, a rash appears on the skin.
- Cutaneous abdominal - cramping pains in the abdomen and a rash on the skin are noted.
Causes of the disease
The exact causes of hemorrhagic vasculitis in children (a photo of the manifestations of the disease can be found on specialized sources) to date have not been identified. It is believed that the disease develops as a result of a malfunction of the immune system when antibodies that destroy the walls of small vessels begin to be produced. As a result, they become friable, their permeability is violated, and point hemorrhages appear. Factors that provoke the occurrence of an autoimmune process are often:
- infectious diseases;
- allergies to food or drugs;
- chronic infection
- injuries or operations;
- vaccination;
- helminthic infestations;
- hypothermia.
An important role is played by the hereditary factor.
Pathogenesis of the disease
In the pathogenesis of hemorrhagic vasculitis in children , the overproduction of immune complexes, which increases the permeability and damage to the vascular endothelium, is of particular importance. Basically, there is damage to the smallest vessels, as a result of which the structure of the wall tissues is disturbed and microthrombosis occurs. The vessels of the dermis are damaged, and hemorrhages reach the epidermis. With gastrointestinal lesions, edema and submucosal hemorrhages occur, as well as erosion and ulcers on the mucous membrane. In the kidneys, segmental glomerular dysfunction occurs. Capillaries become clogged with fibrinoid masses. As a result of this, inflammation occurs in microvessels, the walls are destroyed, and therefore their permeability increases. The blood coagulation system exhibits increased activity, there is a risk of blood clots, and this is a dangerous phenomenon.
Symptoms of the disease
Hemorrhagic vasculitis in children, the clinical onset of which is accompanied by a sharp rise in temperature, often occurs due to an acute respiratory viral infection. After this, a rash appears and other symptoms appear that depend on the form of the disease. They can be:
- general malaise;
- nausea and vomiting;
- pain in the abdomen;
- swelling of the joints;
- redness of the skin;
- failure in the digestive system - diarrhea, loss of appetite;
- fever;
- the presence of blood in urine or feces.
With hemorrhagic vasculitis in children, the syndrome in the form of a characteristic rash does not appear in certain forms of the disease, which makes diagnosis very difficult. Moreover, sometimes the disease suddenly disappears after 2-3 weeks, and then a new relapse appears.
Diagnostics
To make a diagnosis, the attending physician listens to complaints, conducts a visual examination, examines the patient’s medical history, and then prescribes the following measures:
- general analysis of blood and urine;
- a stool coprogram and analysis for eggs;
- ECG;
- Ultrasound of the kidneys and abdomen;
- roentgenography;
- tests to determine the state of immunity;
- rash biopsy.
For the diagnosis of hemorrhagic vasculitis in children, most likely, specialist consultations and, perhaps, additional examinations and tests will be required. After an accurate diagnosis is made, the doctor prescribes the necessary therapy.
Diet for children
All children with vasculitis are recommended a special diet, consisting of 5-6 meals a day. Foods rich in vitamins A, K, C, B are needed, and salt intake should be limited. To supplement the lack of calcium, it is advised to use low-fat dairy products. With the renal form of the disease, foods containing potassium should not be consumed. The general diet for hemorrhagic vasculitis in children includes the following products:
- Steamed, steamed, boiled or baked vegetables and meat.
- Use dairy and mashed soups.
- Water-cooked cereals.
- Sweet fruits.
- Freshly squeezed juices, decoctions of rose hips, green tea.
At the same time, fatty and spicy foods are not included in the diet.
Excluded from use:
- citrus;
- coffee;
- chocolate;
- cocoa;
- red fruits, berries and vegetables:
- chicken eggs.
After treatment of hemorrhagic vasculitis in children is recommended, it is recommended to adhere to an anti-allergenic diet for twelve months, gradually including prohibited foods in the diet. During the period of remission, the doctor individually for each patient selects the necessary products and diet, taking into account the characteristics of the body and the form of the disease.
Regimen for the patient
A child with hemorrhagic vasculitis is necessarily placed in a hospital, where his treatment is carried out. Bed rest is a prerequisite for recovery. Moreover, it is necessary to observe it until the skin rashes completely disappear, because any motor activity leads to an increase in purpura. In addition, during the treatment period it is very important to observe a hypoallergenic diet, to exclude contacts with household allergens.
Treatment methods
The basis for the treatment of hemorrhagic vasculitis in children, according to clinical recommendations, is the following:
- Bed rest - for a period of skin rashes and two weeks after the appearance of the last papule.
- Hypoallergenic diet - exclude all products that can cause allergies.
- Enterosorption - Enterosorbents are prescribed for one week, the active substances of which remove metabolites and toxins from the body.
- Drug therapy - is carried out in three stages.
A typical course of the disease is treated for about a month, and undulating, when remission is replaced by an exacerbation, up to three.
The first stage of drug therapy
In the treatment of hemorrhagic vasculitis in children, they seek to eliminate the active effect of antigens, temperature changes and load on the legs. For therapy, the following drugs are used:
- Improving microcirculation of blood - contribute to the expansion of blood vessels and increase blood supply to organs and tissues: "Niacin", "Eufillin", "Dibazol."
- Anti-inflammatory non-steroids - reduce inflammatory processes: “Ibuprofen”, “Voltaren”.
- Glucocorticoids - suppress the immune system and have an anti-inflammatory effect: Prednisolone.
For contraindications to hormones, anti-inflammatory drugs are used: Plaquenil, Ortofen.
- Vitamins A and E.
- Antiallergic drugs.
The second stage of therapy in children
In the presence of abdominal syndrome, impaired renal function and frequently recurring relapses of skin rashes for the treatment of hemorrhagic vasculitis in children, according to clinical recommendations, “Heparin” is used to achieve normal blood coagulation. Together with Heparin, antiplatelet agents are prescribed that prevent blood clots and improve its properties: Curantil, Trental, Tiklopidin.
In case of pain, a glucose-novocaine mixture is used. If treatment is ineffective, the baby undergoes plasmapheresis - a procedure for purifying blood plasma from protein molecules containing toxic substances.
The third stage of therapy
In the absence of results from previous therapy carried out in the first two stages of treatment, the child is prescribed cytostatics. These drugs have good efficacy, but also have a number of side effects. Therefore, before the appointment, the doctor evaluates the beneficial and harmful effects of the drugs on the body and only after that they conduct a course of therapy or refuse it. For the treatment of hemorrhagic vasculitis in children with cytostatics use: Cyclophosphamide and Azathioprine.
The maximum dose of drugs is used up to two months, then they switch to maintenance therapy for 30 days. The treatment of the disease is carried out under the strict supervision of a physician. Parents need to monitor compliance with the behavior and nutrition of the child. In most cases, the prognosis of the disease is favorable. After the illness, children are exempted from visiting preschool and school institutions for a period of one year. For three years, they are given a break from preventive immunization and spa treatment is not recommended.
Hemorrhagic vasculitis in children: consequences and complications
With adequate and timely therapy, the child is fully recovering. Sometimes a spontaneous recovery is possible 2-3 weeks after the onset of the pathological process. If only the skin is affected, the disease passes in a mild form and sparing drugs are used for treatment. If the kidneys and gastrointestinal tract are affected, the patient's condition becomes severe: the temperature rises, weakness and pain are observed, and the central and peripheral systems are affected. But the most dangerous is the rapid (lightning-fast) development of the disease in most cases leading to death. Currently, methods for its treatment have been developed, and they give positive results, but serious complications often arise:
- Glomerulonephritis with subsequent renal failure, turning into a chronic form.
- Intestinal invagination, when one part of the intestine enters the lumen of another, causing obstruction.
- Damage to the intestinal wall and penetration of contents into the peritoneum.
- Bleeding in the digestive tract.
- A sharp drop in hemoglobin due to large blood loss.
Such consequences occur with a chronic or protracted form of the disease. Especially dangerous are severe kidney damage, leading to irreversible processes, when they refuse to work and hemodialysis is indispensable in this case.
Hemorrhagic vasculitis in children: recommendations
After the child is discharged from the hospital, parents need to carefully monitor his condition. Doctors recommend:
- Clinical observation of the child for at least five years, given that the kidneys are not damaged. Otherwise, the control remains for life.
- Twice a year visiting a pediatrician, in the absence of exacerbations.
- Examination by a dentist and otolaryngologist three times a year.
- Exemption from physical education for one year, after which the transition to the preparatory group.
- Withdrawal from routine vaccination for two years, then with the permission of the attending physician with the mandatory use of antihistamines.
- Continuous monitoring of urine and feces.
- Mandatory adherence to an antiallergenic diet.
When visiting the attending physician, parents receive advice on the treatment of the diseases that have arisen, diet, behavior of the child at home and at school. With strict adherence to all recommendations, hemorrhagic vasculitis in children never gives relapse.
Reviews about hemorrhagic vasculitis
Many parents whose children have had hemorrhagic vasculitis share their experience with newcomers. Here are a few of them:
- Mom is often interested in the question about diet. For example, when should you give sweets after an illness? It is advised to do this gradually, starting with sweetened cereals.
- Some are very concerned about the fact that the disease is constantly returning, although the diet is strictly adhered to and no new drugs are being taken. The doctor will answer the questions. He advises not to seek help from people whose children have had the same illness. Everyone has a different organism and its own characteristics. You need to consult only in person with a doctor who treats hemorrhagic vasculitis in children.
- The opinions on whether it is possible to send a child to kindergarten after an illness are also different: some parents say that it is possible, but only so that he does not eat there, others advise to keep the child at home for a year and only then try to take him to kindergarten. Well, the third opinion is to transfer the baby to home education.
- Moms whose children have had hemorrhagic vasculitis recommend not to despair, strictly follow all the doctor’s recommendations: diet, be careful about taking medications, do not change your permanent place of residence, strengthen your immune system and everything will improve over time.
Recovery after treatment
Children who have had hemorrhagic vasculitis need a long recovery period. Parents of children need to completely change his lifestyle: daily routine, diet, habits and behavior. It is very important to be able to prevent the development of infectious diseases. Exclude the use of antibacterial and other drugs that can cause allergic reactions during treatment. Every day you need to work on strengthening immunity. To do this, take daily walks in the fresh air, take vitamin complexes, and use products with immunomodulating properties. The child must be protected from contact with infected people. The apartment is constantly doing wet cleaning and systematic ventilation. The child must know about his condition in order to behave correctly. It is very important to find a suitable occupation for him that would limit active actions, but at the same time be fascinating and interesting.
Conclusion
When treating Shenlein-Genoch disease in children, it is very important that parents strictly adhere to the antiallergic diet recommended by the doctor and bed rest. In addition, you can not use a number of drugs that can provoke a new attack of the disease. The mildest form of the disease is skin hemorrhagic vasculitis in children, when only the skin is affected, and the kidney is one of the most severe forms. With timely diagnosis and correctly prescribed treatment, the prognosis of the disease is favorable. But despite this, even after a complete cure, it is advisable for them to observe the guard regime for life.