Cutaneous vasculitis in newborns. Hemorrhagic vasculitis in children: causes, symptoms and treatment

Vasculitis is a pathological condition with the occurrence of an inflammatory process in the walls of blood vessels, which leads to their damage and gradual destruction. The disease affects capillaries, large veins and even arteries.

Developing, the disease affects adjacent tissues and internal organs. For this reason, they cannot function normally, unbalancing the work of the whole organism.

Description of the disease

Vasculitis is an inflammatory process of blood vessels, both small and large. Progressing, the disease can disrupt the normal functioning of the body due to circulatory failures. Its most unpleasant consequence is tissue necrosis. Due to the weak supply of arterial blood, the condition of the limbs worsens.

Treatment Methods

Treatment of allergic vasculitis aims to reduce inflammation. For this, drugs are prescribed. Treatment is complex. In addition to anti-inflammatory drugs, they use drugs that reduce the formation of blood clots (antiplatelet agents), increase vascular tone, and antihistamines that reduce allergic manifestations.

In case of recurrence of the disease, the use of previously used medications is prohibited. The body can develop resistance to them.

To exclude the influence of food allergic agents, enterosorbents are taken. They bind and remove toxins from the intestines, preventing them from entering the bloodstream.

You can not do without a strict diet. Foods that can trigger an immune response should be excluded from the diet.

Forecasts and prevention

The prognosis for children with vasculitis varies widely but is generally positive. Some patients manage to fully recover from the pathology without any treatment. Other children may be at risk of developing serious life-threatening diseases, as well as irreversible damage to vital organs.

Approximately 20% of children are forced to take medication all their lives, accumulating residues of toxic drugs. Fatal outcome is extremely rare, being a consequence of complications from the gastrointestinal tract (bleeding, intussusception, bowel infarction). It can also lead to acute renal failure or damage to the central nervous system.

After the transfer of the disease in question, the children are registered with the dispensary for five years. With kidney damage, this time is extended until adulthood. Regular blood and urine tests and timely sanitation of foci of chronic infection are required.

After the child has recovered, he should not be immunized with any type of vaccine. During the year, and sometimes longer, a hypoallergenic diet is recommended.

In the future, in order to prevent relapses, vaccination against tuberculosis is not carried out. Treatment with antibiotics in the presence of contraindications is carried out under the supervision of a physician. A child who has had a disease should be protected from hypothermia and strong physical exertion. If you follow all the recommendations of the doctor, the disease will recede forever.

Vasculitis in children does not occur very often. Interestingly, boys are more susceptible to this disease. The causes of this disease are still not very clear. However, it has been observed that the progressive development of the disease begins after an infectious disease, for example, acute pharyngitis, tonsillitis or tonsillitis. In addition, children with helminthiases are at risk.

In some cases, vasculitis in children appears after vaccination, the use of certain drugs, or after severe hypothermia. The disease is also associated with disorders in the immune system.

The so-called hemorrhagic triad disease manifests itself, which includes horse rash, transient arthritis and abdominal syndrome.

At the beginning of the disease, small eryrematous spots appear on the skin, which are associated with damage to small vessels. In most cases, they are localized on the extensor surfaces of the skin, and then spread to the limbs, buttocks, lower back and neck. In the future, the rash acquires a purple-red color, the bubbles merge with each other, forming large spots. Rashes are not accompanied by itching, but sometimes ulcers and foci of necrosis can form on the skin.

As the disease progresses, damage to large joints begins. Polyarthritis is accompanied by swelling, swelling and redness of the skin over diseased joints.

Each touch or pressing on the affected area responds with pain. In addition, children complain of discomfort and pain, which may resemble mild body aches, or severe spasms that interfere with movement. In most cases, arthritis resolves without any major damage to the joints.

Last of all, the so-called abdominal syndrome appears, which is accompanied by strong, sharp pains in the abdomen, which in most cases are localized around the navel. Acute pain may mimic the symptoms of appendicitis, pancreatitis, or cholecystitis.

In rare cases, kidney diseases are observed, which are associated with damage to small glomerular vessels. As a result, the appearance of nephritis and the development of renal failure are possible.

At the first symptoms of the disease (the appearance of a rash or pain in the joints), it is urgent to show the child to an experienced specialist. The treatment uses a lot of different drugs, including anticoagulants, antibiotics and vitamins. The child also needs strict bed rest and a hypoallergenic diet.

Vasculitis in children: treatment and symptoms

Angiitis or vasculitis in children is a primary or secondary inflammation of the walls of blood vessels. Primary systemic vasculitis is a group of diseases characterized by damage to the walls of vessels of various calibers (from the microvasculature to the aorta and its branches) according to the type of focal inflammation and necrosis, followed by the involvement of organs and tissues in the pathological process in the area of vascular damage. Secondary vasculitis develops in infectious, autoimmune, rheumatic, oncohematological and other diseases.

The prevalence of this group of diseases in children is unknown. Schoenlein-Genoch disease (hemorrhagic vasculitis), juvenile polyarteritis, Kawasaki disease, Takayasu's arteritis (nonspecific aortoarteritis) are observed mainly in childhood. Unlike adults, although systemic vasculitis in children develops less frequently, it differs in the severity of the course, vivid manifest symptoms and, at the same time, a more optimistic prognosis, provided early and adequate therapy.

Causes of the disease

The etiology of most primary vasculitis is unknown. It is believed that frequent acute infectious diseases, foci of chronic infection, drug allergies, hereditary predisposition to vascular or rheumatic diseases can contribute to their occurrence in a child. Bacterial or viral infections (streptococcal, herpesvirus, parvovirus, hepatitis B or C), on the one hand, allergies or a aggravated allergic history, on the other hand, according to experts, serve as two equal factors that form the background for hypersensitization of the body or act as trigger, provocative moments .

Of great importance in the development of vasculitis are the formation, circulation and deposition on the walls of blood vessels of immune complexes, antineutrophil cytoplasmic antibodies, immune proliferative-destructive inflammation of the walls of arteries of various calibers, damage to the vascular endothelium, increased vascular permeability, hypercoagulation with impaired blood flow, ischemia in the area of vascular damage.

Pathomorphology

Destructive proliferative vasculitis is systemic. If, as a result of fibrinoid necrosis of the arterial wall, the elastic skeleton ruptures, an aneurysm is formed. With predominantly proliferative segmental inflammation, stenosis and occlusion of the lumen of the artery develop. Changes in the area of the damaged part of the vessel are diverse - from ischemia to hemorrhage, necrosis, infarction. The degree of vascular disorders depends on the caliber of the affected arteries and the state of the collateral circulation.

Symptoms of vasculitis in children

In the initial period of vasculitis, common manifestations of a nonspecific inflammatory syndrome are observed: subfebrile or febrile fever, arthralgia, weight loss, symptoms of peripheral and visceral vascular disorders, moderate anemia, leukocytosis in the peripheral blood, an increase in ESR, signs of hypercoagulation, dysproteinemia, an increase in the level of C reactive protein, IgA, CEC and cryoglobulins. However, along with common signs, each disease has its own clinical syndromes (Table). The peculiarity of clinical manifestations is due to the localization of vasculitis, the caliber of the affected vessels, the prevalence of the pathological process, the characteristics of morphological changes (the predominance of destructive or proliferative processes), the degree of hemodynamic disorders and ischemia of organs and tissues.

Table. Clinical syndromes of juvenile forms of systemic vasculitis

Symptoms and treatment of vasculitis

Vasculitis is a disease that includes a group of diseases characterized by inflammation in the blood vessels. The disease can occur anywhere, but mostly affects several tissues or organs at once.

Depending on what and how provoked the disease, vasculitis is divided into primary and secondary. Primary ones arise as independent diseases that are not accompanied by other diseases, and secondary ones - as a result of other pathologies of the body.

There are a large number of varieties and classifications of vasculitis and differ from each other in the localization, severity and etiology of the process. For example, some vasculitis can affect only the surface of the skin, without affecting the internal organs. Others, on the contrary, can harm vital organs and even lead to death.

There are the following varieties:

Symptoms of the disease

Depending on the localization of vasculitis and concomitant disease, the symptoms that characterize it change. If the skin is damaged, a rash appears on its surface. If the nerves are affected, then the sensitivity of a person is lost, aggravated or completely disappears. When blood flow to the brain is interrupted, a stroke occurs. A heart attack occurs when the blood flow to the heart is interrupted. Renal vasculitis contributes to the development of renal failure.

Common symptoms of vasculitis:

lack of appetite;
weakness and fatigue;
pallor of the skin;
increase in body temperature.

Nodular vasculitis is characterized by muscle and abdominal pain, nausea and vomiting, weight loss, mental disorders. The defeat of the paranasal sinuses occurs with Wegener's granulomatosis, when bloody and purulent discharge comes out of the nose, sometimes a cough appears, shortness of breath is observed, and even kidney failure may develop. Symptoms of giant cell arteritis include fever, weakness, weight loss, and severe headache in the temples. Nonspecific aortoarteritis is characterized by pain and weakness in the arms and legs, blurred vision, fainting. Inflammation of the eyes, stomatitis and ulcers on the genitals makes itself felt Behçet's syndrome.

A disease such as rheumatoid vasculitis can develop in patients with chronic rheumatoid arthritis. One of the varieties of allergic vasculitis is necrotizing ulcerative vasculitis, which is based on thrombosis of inflamed blood vessels. As a result, there is a development of a heart attack of one or another area of the skin, which is manifested by necrosis.

Systemic vasculitis

In the case of damage to several organs or tissues at once, we are talking about systemic vasculitis. The skin, heart, joints, organs of vision, etc. are affected. The disease is diagnosed using laboratory tests, biopsy results and visceral angiography. Symptoms of systemic vasculitis are characterized by various general non-specific symptoms: fever, loss of appetite, asthenia, weight loss.

Unlike adults, vasculitis in children develop less frequently, but differ in their severity. Symptoms of vasculitis in children are more pronounced and pronounced. And, at the same time, the prognosis, subject to timely therapy, is more optimistic.

Causes of vasculitis

The etiology of this disease is not yet fully understood. Basically, the disease vasculitis is associated with various viral infections and diseases of the immune system. The most common causes of vasculitis are:

allergic reaction to medications;
as a result of complications of past infections (an abnormal reaction of the body, as a result of which the destruction of blood vessels occurs);
chronic autoimmune diseases (lupus erythematosus, thyroid disease, reactive arthritis).

Disease treatment and prognosis

Depending on the concomitant diseases and the degree of organ damage, a course of treatment and rehabilitation is prescribed. For example, primary allergic vasculitis mostly resolves on its own without requiring treatment. But in case of damage to vital organs, the patient needs intensive treatment.

In the treatment of vasculitis, corticosteroids are used, chemotherapy in small doses is possible. The goal of treatment is to suppress the regenerative function of the affected organs and suppress the reaction of the body's immune system, which destroys blood vessels and normal blood circulation in tissues and organs.

Depending on the type and degree of damage to organs and tissues, a course of treatment is prescribed. The chances of prolonging the life of a sick person increase due to properly adequate treatment. The main thing is to correctly diagnose and choose the right treatment.

Hemorrhagic vasculitis in children refers to systemic vasculitis, in which small vessels are affected with the development of an inflammatory reaction in them. The second name of the disease is Shenlein-Genoch purpura.(named after the authors who first described it). The main damaging factor in this pathology is class A immunoglobulins, which are formed against antigens of the inner wall of blood vessels. The main manifestations of hemorrhagic vasculitis affect the skin, joints, kidneys and intestines. Based on this, clinical diagnosis is carried out.

Schönlein-Henoch disease is the most common systemic vasculitis in children. Most often it develops before the age of 16, but in general, any age is susceptible to it, incl. and adults. The peak falls on the period from 4 to 6 years (90% of diagnosed cases).

The causes of hemorrhagic vasculitis are still not understood. This determines the presence of drug-resistant forms, when drug therapy is ineffective. The disease is characterized by seasonality - spring and autumn. That's why As the most likely predisposing factors, infections of the respiratory system are considered:

pharyngitis
tonsillitis
tracheitis
bronchitis.

After them, vasculitis may develop in 1-4 weeks. In this case, in the respiratory tract, microorganisms are most often found such as:

streptococcus, β-hemolytic
staphylococcus aureus
coli
tuberculosis mycobacteria
yersinia
Epstein-Barr virus
adenovirus
cytomegalovirus
measles virus and others.

With the development of bacterial infections of the respiratory system in children, timely administration of safe antibiotics is recommended. They cause the speedy death of microorganisms before the latter lead to allergization of the child's body.

Also, hemorrhoidal vasculitis in children can develop after:

the introduction of vaccines, especially against the background of an undiagnosed inflammatory process (a doctor should always examine a child before vaccination)
taking certain drugs that can change the state of the immune system (penicillins, non-steroids, erythromycin)
bites of some insects.

However, there are often cases when it is not possible to identify any causative factor. The disease develops gradually - against the background of complete health. All this once again emphasizes the low level of knowledge of the etiology of hemorrhagic vasculitis.

There is greater clarity among scientists regarding the damaging mechanisms in this pathology. But even here there are white spots that do not allow in all cases to achieve stable remission against the background of drug therapy. The first pathogenetic link is the formation of immune complexes consisting of an antigen and an antibody. The second is the development of an inflammatory reaction in the vascular wall. The third link is the defeat of the "favorite" organs (skin, kidneys, intestines, joints) with the development of various complications.

Diagnostic criteria

Diagnostic criteria for hemorrhagic vasculitis were formulated in 1990 by the American College of Rheumatology. They are easy to identify and allow you to easily and accurately establish the correct diagnosis. It is considered reliable if there is a main feature and 1 of the additional ones. The main symptom is skin purpura. It is a slightly raised skin rash that is not associated with low platelets.

Whenever hemorrhagic vasculitis is suspected, a blood test is performed to determine the level of platelets. If they are reduced, then this diagnosis is unlikely.

Additional criteria are:

diffuse pain in the abdomen, indicating intestinal ischemia. Such pain intensifies after eating, and quite often it is combined with the appearance of blood in loose stools.
joint pain, and various joints can be involved, regardless of their size
glomerulonephritis, which is characterized by the appearance of protein in the urine and / or red blood cells in large numbers
detection of class A immunoglobulins in the vascular wall (the material is obtained by biopsy).

Symptoms

Symptoms of vasculitis in children depending on the frequency of their occurrence, they are distributed as follows:

rash in the form of papules and red spots - 100% of cases
arthritis and joint pain - 82%
abdominal pain - 63%
kidney damage (glomerulonephritis) - 5-15%.

Most often, recovery occurs spontaneously. Therefore, the disease is relatively favorable in childhood, especially if the rules of nutrition are followed and the elimination of a possible causative factor has begun. After the inflammation subsides, the risk of recurrence is maximum in the first 3 months, but may be later.

After recovery, you should adhere to the principles of dietary nutrition throughout the year and avoid contact with allergens that enter through the respiratory tract.

Skin syndrome in the clinical picture of vasculitis is the leading one. It is characterized by the following features:

the appearance of a rash called purpura
its symmetry
purpura rises above the skin and is well palpable
at the same time, there may be red spots, pimples, vesicles, which are characterized by itching
primary rashes on the feet, later they spread to the thighs and buttocks
after a couple of days, the rashes turn from bright red to brown, and then turn pale and disappear
sometimes there may be pigmented foci that persist for a long time.

The development of glomerulonephritis usually occurs a month after the onset of the first symptoms of the disease. Kidney damage can occur with minimal manifestations or be prone to an aggressive course. Depending on this, the clinical and laboratory signs of glomerulonephritis are very diverse. They include:

pain in the lumbar region
redness of urine (gross hematuria) or only microscopically detectable presence of red blood cells in it (microhematuria)
protein in urine
edema, sometimes very pronounced as part of the nephrotic syndrome, in which the loss of protein in the urine can reach 3.5 g per day
transient increase in pressure.

Abdominal syndrome is a consequence of intestinal ischemia. In children, it is characterized by:

diffuse pain all over the abdomen like colic
pain gets worse after eating
nausea
vomit
the appearance of bloody streaks in the stool
loose stool.

The abdominal form of hemorrhagic vasculitis resembles an "acute abdomen", traditionally requiring surgical intervention. However, with this disease, it is contraindicated, because. due to vascular damage. Appropriate drug therapy is required.

Articular syndrome with hemorrhagic vasculitis, it has typical signs that distinguish it from articular syndrome in other diseases (osteoarthritis, rheumatoid arthritis, gout). These include:

symmetry of the lesion
no pain migration
no joint destruction
frequent damage to the ankle and knee joints.

In rare cases, hemorrhagic vasculitis may affect:

testicles (orchitis)
bladder
lungs
nervous system.

In the latter case, the clinical picture appears:

headache
seizures like epilepsy
desensitization
numbness of the limbs, etc.

To achieve relief of these symptoms is possible only with specific treatment aimed at eliminating immune inflammation in the vessels. Traditional neurological treatment is ineffective.

Diagnostic methods

In pediatrics, the diagnosis of hemorrhagic vasculitis is usually based on the clinical criteria above. However, in difficult cases, a biopsy (under anesthesia) may be required. For this, a small area of skin is taken at the site of the rash. If typical immunoglobulins A are found in the material during histological examination, then hemorrhagic vasculitis is diagnosed.

Other methods of additional research are necessary for early detection of possible complications and assessment of the degree of involvement of organs in the pathological process. That's why children with this diagnosis are carried out:

general clinical analysis of blood and urine
a biochemical blood test (primarily, they evaluate the levels of creatinine, protein and uric acid, indicating the functioning of the kidneys)
x-ray examination of the joints
dopplerography of intestinal vessels
colonoscopy to detect damage to the terminal sections of the intestine.

Treatment

Treatment of hemorrhagic vasculitis in children is aimed at suppressing the activity of immune inflammation. Moreover, there is still no unequivocal opinion among scientists regarding the effectiveness of various methods.

Currently, with a therapeutic purpose for this disease, the following can be used:

corticosteroids
cytostatics
aminoquinolines
non-steroids
apheresis procedures (removal of immune complexes that have a damaging effect from the blood).

Therapeutic Approaches with hemorrhagic vasculitis vary significantly. So, some researchers claim that this diagnosis is always a direct indication for the appointment of corticosteroid drugs, others hold a different point of view. They believe that corticosteroids are required only if there is severe damage to the skin or intestines. According to scientific publications, non-steroids should be preferred for severe articular syndrome and the absence of intestinal and renal manifestations. Other scholars suggest generally abandon these drugs, tk. they can provoke abdominal syndrome or significantly aggravate its course.

However, it is now known for sure that even the use of corticosteroid drugs is not able to prevent the development of glomerulonephritis or relapse of the disease. This is influenced by some other factors, the nature of which has not yet been established. Therefore, with minimal renal manifestations, medical immunosuppression is not indicated. It should be carried out only with severe kidney damage, given the poor prognosis. In this case, immunosuppressive therapy is carried out in several stages:

the first stage - corticosteroids in high doses and cytostatics
the second is a gradual reduction in the dose of corticosteroids and the continuation of cytostatics. They move on to this stage when a favorable effect is achieved.

Diet

A diet for vasculitis can speed up recovery. Its positive effect is explained by the fact that various allergens can enter the body with food, further perverting the normal reaction of the immune system. This exacerbates vascular damage. Therefore, children with this diagnosis must follow a diet until complete recovery. It lies in the fact that from the diet it is necessary to exclude products with a high allergenic potential. These include:

fatty fish, shrimp and other seafood
citrus
chocolate
nuts
mushrooms
Strawberry
raspberry
semolina and others.

You should also refuse to eat semi-finished products. They contain a large amount of preservatives and other chemicals that are foreign to the immune system. Therefore prohibited sausages, chips, sweets, etc.

Vasculitis is a group of pathological conditions. They are united by one common characteristic - an inflammatory process in the walls of blood vessels, leading to their damage and gradual destruction. Both large veins and arteries, and small capillaries can be at risk. Progressing, the disease affects adjacent tissues and internal organs, which disrupts their normal functioning and upsets the work of the whole organism.

Pathologies affect both men and women of all ages. Especially dangerous are those cases when vasculitis occurs in a child. A young unformed organism is not able to cope with the disease on its own. Timely seeking medical help will help to avoid complications.

Varieties of vasculitis

Vasculitis is divided according to a number of characteristics: the type and degree of damage to blood vessels (arteries, veins, capillaries), the localization of the focus, its size, etc. This makes their classification rather complicated, in addition, it is often revised. However, two large groups of vasculitis should be distinguished:

systemic - lead to damage to tissues and organs, due to a violation of their blood supply;
skin - appear in the form of specific rashes on the skin, rarely leading to complications.

Also, for the main reason for their occurrence, vasculitis is divided into the following groups:

Vasculitis in a child and an adult is subject to a single classification.

Why is vasculitis dangerous in children?

If a child develops vasculitis, then the risk of its generalized course increases, that is, spread throughout the body. An unformed children's body cannot cope with the pathological process itself, and the disease progresses rapidly. Therefore, the onset of the disease can proceed in an acute form. And after recovery, the likelihood of relapse increases.

Fever, deterioration in general condition, loss of appetite, a characteristic rash that causes discomfort and itching are signs by which vasculitis in children can be recognized (photo below).

The situation is complicated by the fact that the child begins to comb problem areas, which injures the skin, provokes the formation of scar tissue. An infection enters the blood through wounds, which further worsens the condition and slows down the healing process.

In the presence of complications, any vasculitis can flow into other more severe forms. Then not only skin vessels are affected, but also large and small arteries and veins of other areas of the body and internal organs. Muscles and joints that do not receive sufficient nutrition and blood supply gradually atrophy and lose their mobility. Such dangers entail vasculitis in a child. Treatment and qualified assistance must be timely.

The first evidence of the manifestation of the disease is hemorrhagic of varying degrees of intensity. Most often it is localized on the lower extremities, near the joints, folds. Very rarely, rashes appear on other parts of the body - palms, feet, neck, face. At this stage, the lesion spreads to small vessels of the skin. This is the main symptom by which hemorrhagic vasculitis is determined in children.

Symptoms characteristic of the disease may appear in parallel with the skin rash or at its later stages. This is a lesion of the joints, manifested in the form of pain, inflammation, swelling. It is possible to involve the digestive organs in the pathological process, which is accompanied by heaviness in the abdomen, colic, nausea, and vomiting.

On the 1st or 2nd year of life, the development of a fulminant form is possible, which greatly complicates hemorrhagic vasculitis in children. The causes of occurrence are the transfer of so-called childhood infections - scarlet fever, chickenpox, rubella, etc. The course of such a disease is always acute, characterized by an excessive manifestation of all symptoms and can be dangerous for an unformed child's body.

Clinical forms

For convenience in clinical practice, it is customary to subdivide into the following forms:

Simple form. Known as cutaneous purpura. It manifests itself in the form of a reddish rash - this is the most basic diagnostic sign and symptom. Most often affects the lower extremities, rarely rises higher.
Skin-articular purpura. A more severe form of the disease. In addition to skin rashes, joint damage occurs. This is accompanied by pain and swelling. The knee joints are especially affected, less often the elbow and wrist joints.
Abdominal purpura (syndrome). Accompanied by pain and pain in the abdomen, vomiting, nausea. In the presence of only this symptom, it is extremely difficult to diagnose hemorrhagic vasculitis in children. The causes of the disease are damage to the abdominal organs, namely the gastrointestinal tract.
renal syndrome. It often develops against the background of other signs of the disease.
mixed form. It can combine 3 signs at the same time or all.
Rare forms. Expressed in the defeat of the lungs, nervous system, genital organs. Meet in isolated cases.

Causes

Hemorrhagic vasculitis is classified as an immunocomplex disease. Immune complexes are involved in its occurrence and course - antigen-antibody compounds (AG - AT) circulating in the blood.

Usually, AT-AG complexes are destroyed by special blood cells - phagocytes. But sometimes they can accumulate in the bloodstream, “settle” in adjacent tissues and organs, and cause inflammation. In addition to the occurrence of AG - AT complexes, the permeability of the walls of blood vessels increases, activation occurs - proteins involved in the immune response. According to these parameters, laboratory diagnostics are carried out.

Diagnosis of the disease

Vasculitis in a child is diagnosed by the following signs:

The presence of a skin rash of lilac and red shades. Spots of small diameter, convex shape. They can occur on any part of the body, but most often on the lower extremities.
Abdominal (from lat. abdomen - stomach) pain. They can be intermittent, worse every time after eating.
A biopsy (examination of a tissue fragment) of the walls of venules or arterioles demonstrates an increase in the number of granulocytes.

Laboratory data are not diagnostically significant in this case. However, attention is paid to an increase in the amount of type A immunoglobulins in the blood serum. Also important indicators can be a high titer of AntiStreptoLysin-O (ASL-O) and erythrocyte sedimentation rate (ESR), which are used to diagnose vasculitis in children.

Forecasts may be favorable. In some cases, all symptoms disappear after about 30 days after the acute onset of the disease. However, there is a risk of developing kidney failure, complications from the gastrointestinal tract, or damage to the central nervous system.

Hemorrhagic vasculitis in children: treatment

Treatment of hemorrhagic vasculitis begins only after the final diagnosis by a specialist and the causes of the disease. Therapy will depend on the phase of the disease and the degree of its development.

In any case, limit physical activity. This is especially important during the acute course of the disease. Bed rest is prescribed until the stable disappearance of the skin rash. Its average duration is approximately 3-4 weeks. Violation of this condition can provoke repeated hemorrhagic rashes. In the event of complications and acute course of the disease, bed rest is extended.

Be sure to prescribe a diet with strict exclusion from the diet of allergenic and potentially. If the disease proceeds in the form, then diet No. 1 is prescribed. If the situation is complicated by severe nephritis - diet number 7 (exclude salt, meat, cottage cheese). Such nutrition will reduce the unpleasant manifestations that lead to hemorrhagic vasculitis in children.

Treatment, regardless of the form of the disease, includes taking antiplatelet agents - drugs that reduce blood clots, as well as fibrinolysis activators - substances involved in the "dissolution" of blood clots. The composition and quantity of medicines, their dose and duration of administration are approved by the attending physician.

Since the onset of the disease is associated with the launch of immune mechanisms, treatment consists in removing AG-AT complexes from the body. In case of a severe course of the disease and the absence of contraindications, mechanical blood purification is carried out - the procedure will remove not only immune complexes from the blood, but also pathogenic bacteria and toxins.

Allergic vasculitis in children

The cause of this disease is an allergic reaction. As a rule, this is an immune response to medicines, food, or an infection in the body. The result is inflammation and vascular damage, mainly in the skin. Most often it develops in children under 15 years of age after the transfer of infectious diseases or a course of drug treatment. Sometimes the cause of allergic vasculitis in children may not be clear. Then a thorough study of the medical history is necessary.

The main symptom is an extensive rash that causes itching. It has the appearance of spots and / or convex bumps of purple or red-lilac color on large areas of the skin. They mainly appear on the legs, thighs, buttocks. Perhaps the formation of blisters and ulcers, scarring of damaged vessels. Allergic vasculitis usually resolves on its own within a few weeks. However, complications are possible in the form of damage to internal organs due to a violation of their blood supply.

Varieties and forms

Depending on the diameter of the affected vessels, there are:

superficial (dermal) allergic vasculitis - affects the capillaries, arterioles and venules lying in the skin;
deep or dermo-hypodermal - occurs when medium-sized arteries and veins are involved in the pathological process.

Depending on the stage of development of a skin rash, there are several forms of the disease:

papular - rashes are convex, palpable, pigmented;
vesicular - vesicles (vesicles) with liquid contents are formed;
pustular - there are cavities filled with pus;
ulcerative - necrotic ulcers appear at the site of pustules;
cicatricial - accompanied by scarring of damaged skin.

Treatment of allergic vasculitis

It aims to reduce inflammation by taking medications. The complex therapy also includes taking drugs that reduce the formation of blood clots (antiplatelet agents), increase vascular tone, and antihistamines to reduce allergic manifestations. If the disease is recurrent in nature, you can not take the medicines used earlier, it is possible that the body has developed resistance to them.

To exclude the influence of food allergic agents, enterosorbents are prescribed. These drugs bind and remove toxins from the intestines, preventing them from entering the bloodstream. In addition, a strict diet is required with the exclusion of foods that can trigger an immune response. These are mandatory measures when vasculitis is diagnosed in children.

The causes of the disease can be varied. Sometimes, if the need arises, medicines and drugs that can lead to an allergic reaction are excluded. The duration of therapy depends on the nature of the course of the disease (wavy or recurrent).

What is important for parents to know?

Parents need to be very careful about any rashes on the child's skin. Even to those that seem insignificant at first glance. It is important for parents to understand that vasculitis in a child can occur in waves: periods of remission are replaced by relapses. Moreover, the symptoms of a newly appeared disease may differ from those that were previously. Timely seeking medical help will help to avoid unpleasant consequences.

It is not necessary to independently prescribe treatment for a child if vasculitis has been suspected. In children, the symptoms of the disease can be ambiguous. Diagnosis and treatment should be carried out by a qualified specialist. In particular, one should not show independence when choosing immunostimulating and immunomodulatory drugs. After all, the main reason for the appearance of any form of vasculitis is a violation of the mechanisms of the protective functions of the body.

To prevent the recurrence of the disease in a child, following simple measures will help:

limiting the number of stress factors;
ensuring a healthy diet, an active lifestyle;
the presence of light physical activity;
strengthening immunity.

It is important to understand that illnesses suffered by a child at an early age can adversely affect his physical and mental development.

The term "vasculitis" can be used to describe any disorder characterized by inflammation of the blood or lymph vessels. Vasculitis in children is not a distinguishing disease, but rather a symptom or characteristic of a number of different diseases, and can affect vessels of any type or size, including large arteries and veins, as well as arterioles, venules, and capillaries. The term "childhood vasculitis" is used to refer to a group of diseases that primarily affect children and adolescents. These disorders vary widely in severity as well as the types of blood vessels and organs affected. Some of the diseases are mild and go away without treatment, while others are potentially life-threatening. The most common vasculitis in children is Kawasaki syndrome (Kawasaki disease) and hemorrhagic vasculitis.

Vasculitis classification

The most widely used classification schemes for vasculitis divide the latter into types according to the size of the involved blood vessels:

Vasculitis of large vessels. This category includes two disorders, one of which, Takayasu's arteritis, occurs in children and adolescents.

Vasculitis of the middle vessels. This category includes polyarteritis nodosa and Kawasaki disease.

Vasculitis of small vessels. Disorders in this category include hemorrhagic vasculitis and Wegener's granulomatosis.

The danger of vasculitis

Vasculitis can damage blood vessels in two different ways. In some cases, the inflamed tissue weakens and stretches, forming a bulge in the vessel wall, known as an aneurysm. The aneurysm may eventually rupture, allowing blood to leak into nearby tissues. In other cases, the inflammation causes the blood vessels to narrow, sometimes to the point where blood can no longer flow through the vessel. In the case of large enough vessels that supply a specific organ or part of the body, the tissue dies.

Symptoms of vasculitis in children

Early symptoms of vasculitis often include fever, weakness, loss of appetite, weight loss, fatigue, muscle and joint pain, and swelling. Some of the childhood vasculitis affects the skin, causing rashes, sores, or reddish-purple patches known as purpura. Others affect the lungs, gastrointestinal tract, kidneys, liver, nervous system, eyes, or brain, resulting in symptoms such as abdominal pain, diarrhea, cough, high blood pressure, shortness of breath, blurred vision, headache, fainting , numbness in the limbs. The specific symptoms of the most common pediatric vasculitis will be described in more detail below.

Children's vasculitis

Some childhood vasculitis may be preceded by infectious diseases, but most are still relatively rare disorders.

Hemorrhagic vasculitis most often affects children between the ages of three and twelve. The disease occurs in North America between November and January; by some estimates, every fifteen children out of a hundred thousand. About half of the children with this condition had a diagnosis of strep throat or another upper respiratory infection two to three weeks before the onset of vasculitis.

Kawasaki disease affects one to three children out of every ten thousand every year. The disease is much more common in Japan, with eighty percent of cases occurring in children under the age of five.

Pediatric polyarteritis nodosa is a rare disease, and is sometimes described as a more severe variant of Kawasaki disease. Incidence is an uncertain factor, primarily due to disagreement among physicians over the classification of pediatric vasculitis. Polyarteritis nodosa is more common in children of Asian descent.

Arteritis Takayasu first described by a Japanese ophthalmologist in 1908, it is primarily a disease of adolescents and young adult women, although it occurs in children as young as six months of age. Takayasu's arteritis is a relatively rare disease that affects about three people in a million. In India, Takayasu's arteritis is more commonly associated with tuberculosis.

Wegener's granulomatosis - also a rare disease that is diagnosed in one to three people in every hundred thousand. It is, however, one of the most serious and dangerous vasculitis.

Causes of vasculitis in children

There is not a single pathological process that underlies all vasculitis in children. Various causes have been proposed for specific diseases.

Hemorrhagic vasculitis

Although the ultimate cause of this disease is unknown, it is usually preceded by acute upper respiratory infections in at least half of the children diagnosed. In other cases, hemorrhagic vasculitis appears to be caused by an immune complex reaction to certain vaccines (most commonly typhoid, measles, yellow fever, or cholera vaccines) or drugs (most commonly penicillin, erythromycin, quinidine, quinine). Children diagnosed with hemorrhagic vasculitis are characterized by higher levels of immunoglobulin A in the blood and its deposits on the walls of blood vessels.

Kawasaki disease

It is thought to be caused by infectious organisms, but no specific viruses or bacteria have been identified to date. Kawasaki disease has been associated with various agents, including parvovirus B19, HIV infection, measles, influenza viruses, rotaviruses, and adenoviruses. Some doctors believe that genetic and immunological factors are also involved in the disease.

Children's nodular polyarthritis

As with Kawasaki disease, various infectious organisms are thought to be the cause of the disease, including hepatitis B virus, Epstein-Barr virus, various retroviruses, and streptococci. None of these viruses or bacteria, however, have been found in all patients with infantile polyarthritis nodosa. Another theory is that the latter is indeed an immune complex disease, but its triggers have not been identified to date.

Arteritis Takayasu

The causes of the disease are unknown, but may include genetic factors, as Takayasu's areriitis has been reported in identical twins.

Wegener's granulomatosis

The cause of Wegener's granulomatosis is also unknown, but as with other vasculitis, it is thought to be caused by a variety of pathogens (including fungi, bacteria, and viruses). A genetic link has not been established.

Typical symptoms of vasculitis

Early symptoms of vasculitis in children are often difficult to distinguish from symptoms of other illnesses. The following are the symptoms that are characteristic of each individual disease.

Hemorrhagic vasculitis

Hemorrhagic vasculitis is an acute condition characterized by fever (about 38°C), purpura, joint pain (usually in the ankles and knees), abdominal pain, internal bleeding in the digestive tract, and inflammation of the kidneys. Boys with this condition often have testicular inflammation.

Kawasaki disease

Kawasaki disease has three stages: acute - lasting about ten days, which is characterized by high fever (over 40 ° C), inflammation of the tongue and cracked lips, conjunctivitis, problems with the liver, kidneys and gastrointestinal tract, and inflammation of the heart muscle; the subacute phase lasts about three weeks and is characterized by irritability, loss of appetite, peeling of the skin of the fingertips and the development (in about twenty percent of patients) of aneurysms in the coronary artery; the third phase is characterized by the expansion of the aneurysm and possible heart attack. Kawasaki disease is the leading cause of acquired heart problems in children in developed countries.

Children's nodular polyarthritis

Early symptoms of this disease are non-specific, usually fever, loss of appetite, weight loss, and abdominal pain. The disease affects the kidneys, heart and liver. Depending on the organ involved, aneurysms in the arteries supplying the kidneys, kidney failure, aneurysms in the coronary artery, congestive heart failure, massive bleeding in the gastrointestinal tract, aneurysms in the arteries supplying the brain, and stroke can develop. About half of children experience joint pain or skin rashes; boys often experience pain in the testicles.

Arteritis Takayasu

Takayasu's arteritis is a chronic inflammatory disease that affects the aorta and its major branches. Early symptoms include fever, weight loss, and a general feeling of tiredness. The disease may not be diagnosed for several months or even years. Inflammation of the aorta eventually leads to either the formation of an aneurysm or narrowing or complete blockage of the blood vessels. The patient may feel aching pains in those parts of the body that have suffered from insufficient blood supply, for example, in the legs when walking or cramping sensations in the abdomen after eating. In rare cases, there may be a heart attack or stroke. Takayasu's arteritis is sometimes called pulseless disease because the doctor does not detect a pulse on one side of the patient's body. Another diagnostic clue is a significant difference (more than 30 mm Hg) in blood pressure on the right and left sides of the body.

Wegener's granulomatosis

Wegener's granulomatosis most commonly affects the upper respiratory tract, eyes, ears, kidneys, and skin. The disease is characterized by the formation of granulomas, which are small lumps or nodules of inflammatory cells in the patient's tissue. The patient may have recurrent ear infections that heal slowly, inflammation of the tissues inside the eye, inflamed sinuses, epistaxis, coughing up blood, narrowing of the trachea and saddle of the nose as a result of deformity caused by cartilage breakdown. The child may also experience joint pain, loss of appetite, skin lesions, and fever. Wegener's vasculitis can lead to a heart attack. If left untreated, the disease will eventually progress to kidney failure and can lead to death.

When to See a Doctor

Parents should see a doctor if their child has the following symptoms:

malaise (general feeling of physical discomfort),
loss of appetite,
fever,
loss of energy
conspicuous purple,
tingling or other unusual sensations followed by numbness in certain parts of the body.

Diagnosis of vasculitis in children

Diagnosis of vasculitis is complicated by several factors. Many of the early symptoms of childhood vasculitis are not specific to these disorders and may have a wide range of other possible causes. In many cases, a physician may not be able to diagnose specific organs or organ systems. This excludes other possible diagnoses such as bacterial or viral infections, collagen vascular disease, allergic reactions, and malignant tumors.

Another factor that makes diagnosis difficult is that different pediatric vasculitis have overlapping symptom profiles. Although lists of diagnostic criteria have been developed for various diseases in this group, some patients do not meet the criteria for any one disorder.

The first step in diagnosis is to study the history of the disease. The doctor makes a diagnosis based on the patient's age, gender, ethnicity, and a history of recent vaccinations or upper respiratory tract infections. It is also important whether the child has a fever, abdominal cramps, diarrhea, or muscle and joint pain. The second step is a general physical examination. Some of the vasculitis affect circulation, eyes or skin. For example, Takayasu's arteritis affects the patient's pulse and blood pressure, and also produces small retinal hemorrhages, while Kawasaki's disease is characterized by conjunctivitis (inflammation of the tissues of the eyelids). The doctor examines the child's skin for purpura, other skin rashes or ulcers, redness, or swelling, looking for the location of these disorders. In most cases, the child is referred to a specialized specialist for further evaluation. This could be a rheumatologist, cardiologist, neurologist, or infectious disease specialist.

Laboratory research

Laboratory tests for vasculitis include blood and urine tests. Blood tests include a complete blood count, serum chemistry, ESR, rheumatoid factor and circulating immune complex tests, and antineutrophil cytoplasmic antibody tests. An assessment of kidney function is also done. The doctor may also order a biopsy of the skin, muscles, lungs, or sinuses.

Imaging studies that are used to diagnose various childhood vasculitis include chest X-ray or CT scan of the sinuses in Wegener's granulomatosis; Aortic CT, angiography, or ultrasound for Takayasu's arteritis; arteriography or echocardiography, chest x-ray for Kawasaki disease; chest x-ray, abdominal ultrasound, or gastrointestinal examination for hemorrhagic vasculitis.

Treatment of vasculitis in children

The treatment of children with one of these disorders is highly individualized; it is carried out taking into account the specific affected organs and the general condition of the child. Hemorrhagic vasculitis is usually treated without any specific therapy. The general goals of treating vasculitis are to reduce the inflammation of the affected blood vessels; maintaining adequate blood supply to vital organs and skin; and control of side effects of drugs prescribed for the treatment of vasculitis.

Medications

Most patients with vasculitis, if inflammation of the blood vessels is present, take corticosteroids to relieve joint pain. Other types of medicines recommended for vasculitis are immunosuppressants and anticoagulants. Immunosuppressants are prescribed to treat inflammation by reducing the body's response to allergens and other triggers, while anticoagulants prevent blood clots and blockage of blood vessels narrowed by inflammation. Children with muscle or joint pain may be prescribed non-steroidal anti-inflammatory drugs (NSAIDs). Antibiotics are indicated for patients with Wegener's granulomatosis.

Surgery

Patients with Takayasu's arteritis often require surgical repair of damaged arteries. The most common procedures in this area are balloon angioplasty or stenting. A stent is a small metal tube or wire that is inserted into an injured blood vessel. In severe cases, the damaged section of the artery may need to be completely removed and replaced with an artificial graft.

Nutrition for vasculitis in children

Children who develop high blood pressure from vasculitis are usually on a low-sodium diet.

Denial of responsibility: The information provided in this article about vasculitis in children is intended to inform the reader only. It cannot be a substitute for the advice of a health professional.