Causes, symptoms, diagnosis and treatment of hemorrhagic vasculitis in children

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

Hemorrhagic vasculitis, or Henoch-Schonlein 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, it is most common between 4 and 12 years of age. Moreover, it was found that boys are almost twice as likely to get sick as girls. Further in the article, we will consider the causes of its occurrence, characteristic signs and what is the treatment of hemorrhagic vasculitis in children.

Description of the disease

In hemorrhagic vasculitis, an inflammatory process of microvessels and thrombus formation occurs in them. As a result of inflammation of the walls of blood vessels, they become brittle. Often there is damage to 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 damagehemorrhagic syndrome, which is manifested by small hemorrhages in the tissue. Edema and mucosal damage occur in the gastrointestinal tract, and vascular patency is impaired in the kidneys. ICD-10 hemorrhagic vasculitis in children is code D69.0 and has symptoms of allergic purpura.

Classification of hemorrhagic vasculitis

According to the clinical course, the disease is divided into the following degrees:

• Mild - the patient has a satisfactory condition: slight skin rashes and mild pain in the joints.
• Medium - there is a profuse rash on the body, painful sensations in the joints increase, discomfort is felt in the abdomen, an admixture of blood appears in the urine.
• Severe - multiple rashes with necrotic areas on the skin, Quincke's edema is possible, protein-lipid metabolism is disturbed due to damage to the kidneys, which may cease to function, blood is present in the urine, bleeding is observed in the digestive tract.

Downstream the disease happens:

• acute - lasts up to two months;
• protracted - about six months;
• Chronic-relapsing - lasts for years.

Hemorrhagic vasculitis in children, the clinical forms of which depend on the affected organ, can be of the following types:

• Dermal - only the skin is affected. 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 inurine analysis. No skin rash.
• Dermo-articular - there is swelling of the joints of the upper and lower extremities, a rash appears on the skin.
• Dermo-abdominal - there are cramping pains in the abdomen and a rash on the skin.

Causes of disease

The exact causes of hemorrhagic vasculitis in children (photos of the manifestations of the disease can be found on specialized sources) have not been identified to this day. It is believed that the disease develops as a result of a malfunction of the immune system, when antibodies begin to be produced that destroy the walls of small vessels. As a result, they become loose, their permeability is disturbed and petechial hemorrhages appear. The factors provoking the occurrence of an autoimmune process are often:

• past infectious diseases;
• allergic to food or drugs;
• chronic infection;
• injuries or surgeries;
• vaccination;
• worm infestations;
• hypothermia.

An important role is played by the hereditary factor.

Pathogenesis of disease

In the pathogenesis of hemorrhagic vasculitis in children, hyperproduction of immune complexes, which increases the permeability and damage to the vascular endothelium, is of particular importance. Basically, the smallest vessels are damaged, 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 damage to the gastrointestinal tract, edema and submucosalhemorrhages, as well as erosions and sores on the mucous membrane. In the kidneys, segmental dysfunction of the glomeruli occurs. The capillaries become clogged with fibrinoid masses. As a result, inflammation occurs in the microvessels, the walls are destroyed, in connection with this, their permeability increases. The blood coagulation system is overactive, there is a risk of blood clots, and this is a dangerous phenomenon.

Disease symptoms

Hemorrhagic vasculitis in children, the clinical onset of which is accompanied by a sharp rise in temperature, often occurs as a result of ARVI. After that, a rash appears and other symptoms appear, which depend on the form of the disease. They can be:

• general malaise;
• nausea and vomiting;
• stomach pain;
• swelling of the joints;
• reddening of the skin;
• failure in the digestive system - diarrhea, loss of appetite;
• fever;
• 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. At the same time, sometimes the disease suddenly disappears after 2–3 weeks, and then a new relapse appears.

Diagnosis

To make a diagnosis, the attending physician listens to complaints, conducts a visual examination, studies the patient's medical history, and then prescribes the following measures:

• general blood and urine tests;
• coprogramstool and worm egg test;
• ECG;
• Ultrasound of the kidneys and abdomen;
• radiography;
• tests to determine the state of immunity;
• rash biopsy.

For the diagnosis of hemorrhagic vasculitis in children, most likely, consultations of narrow specialists and, perhaps, additional examinations and tests will be required. After an accurate diagnosis is made, the doctor prescribes the necessary therapy.

Diet for kids

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 s alt intake should be limited. To compensate for the lack of calcium, it is advised to use low-fat dairy products. In the renal form of the disease, you can not eat foods containing potassium. The general diet for hemorrhagic vasculitis in children includes the following foods:

• Steamed, steamed, boiled or baked vegetables and meat.
• Use milk and pureed soups.
• Poor-boiled porridge.
• Sweet fruits.
• Fresh juices, rosehip decoctions, green tea.

At the same time, fatty and spicy foods are not included in the diet.

Deprecated:

• citrus;
• coffee;
• chocolate;
• cocoa;
• fruits, berries and red vegetables:
• chicken eggs.

After the end of the treatment of hemorrhagic vasculitis in children, it is recommended to adhere to anti-allergic medicine for twelve monthsdiets, 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 organism and the form of the disease.

Sick Mode

A child with hemorrhagic vasculitis is necessarily placed in a hospital, where he is treated. Bed rest is a prerequisite for recovery. Moreover, it is necessary to observe it until the skin rashes completely disappear, because any physical activity leads to an increase in purpura. In addition, during the treatment period it is very important to follow a hypoallergenic diet, to exclude contact with household allergens.

Treatment methods

The basis of the treatment of hemorrhagic vasculitis in children, according to clinical recommendations, includes the following activities:

• Bed rest - for the period of skin rashes and two weeks after the appearance of the last papule.
• Hypoallergenic diet - exclude all foods 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 - carried out in three stages.

Typical course of the disease is treated for about a month, and undulating, when remission is replaced by exacerbation, up to three.

First stage drug therapy

In the treatment of hemorrhagic vasculitis in children, they seek to eliminate the active effects of antigens, temperature changes and stress on the legs. For Therapythe following medicines are used:

• Improving blood microcirculation - contribute to the expansion of blood vessels and increase blood supply to organs and tissues: "Nicotinic acid", "Eufillin", "Dibazol".
• Anti-inflammatory non-steroids - reduce inflammation: Ibuprofen, Voltaren.
• Glucocorticoids - suppress the immune system and have an anti-inflammatory effect: "Prednisolone".

In case of 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, disturbances in the functioning of the kidneys and frequently recurring 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 the formation of blood clots and improve its properties: Curantil, Trental, Ticlopidin.

In case of pain, a glucose-novocaine mixture is used. If the treatment is ineffective, the baby undergoes plasmapheresis - a procedure for cleansing the blood plasma from protein molecules containing toxic substances.

Third stage of therapy

In the absence of results from the previous therapy carried out at the first two stages of treatment, the child is prescribed cytostatics. Thesedrugs have good efficacy, but have a number of side effects. Therefore, before prescribing, the doctor evaluates the beneficial and harmful effects of drugs on the body and only after that conducts a course of therapy with them or refuses it. For the treatment of hemorrhagic vasculitis in children, cytostatics are used: Cyclophosphamide and Azathioprine.

The maximum dose of drugs is used up to two months, then they switch to maintenance therapy for 30 days. Treatment of the disease is carried out under the strict supervision of a doctor. Parents need to monitor compliance with the behavior and nutrition of the child. In most cases, the prognosis of the disease is favorable. After an illness, children are exempted from attending preschool and school institutions for a period of one year. For three years, they are given a deduction from preventive immunization and are not recommended spa treatment.

Hemorrhagic vasculitis in children: consequences and complications

With adequate and timely therapy, the child recovers completely. Sometimes spontaneous recovery is possible 2-3 weeks after the onset of the pathological process. When only the skin is affected, the disease passes in a non-severe 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, the central and peripheral systems are affected. But the most dangerous is the rapid (lightning-fast) development of the disease in most cases leading tolethal outcome. At present, methods of its treatment have been developed, and they give positive results, but serious complications often occur:

• Glomerulonephritis followed by chronic renal failure.
• Invagination of the intestine, when one part of the intestine enters the lumen of the other, causing an obstruction.
• Injury to the intestinal wall and penetration of contents into the peritoneum.
• Bleeding in the digestive tract.
• Sharp drop in hemoglobin due to massive blood loss.

Such consequences also occur with a chronic or protracted form of the disease. Severe kidney damage is especially dangerous, leading to irreversible processes, when they refuse to work, and in this case, hemodialysis is indispensable.

Hemorrhagic vasculitis in children: recommendations

After the discharge of the child from the hospital, parents should carefully monitor his condition. Doctors recommend:

• Dispensary observation of a child for at least five years, given that the kidneys are not damaged. Otherwise, control remains for life.
• Twice a year visits to the pediatrician, in the absence of exacerbations.
• Examination by a dentist and an 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 obligatory intake of antihistamines.
• Continuous monitoring of urine and stool results.
• Compulsory adherence to an anti-allergenic diet.

Visiting the attending physician, parents receive advice on the treatment of emerging diseases, diet, behavior of the child at home and at school. With strict adherence to all recommendations, hemorrhagic vasculitis in children never relapses.

Reviews about hemorrhagic vasculitis

Many parents who have had children with hemorrhagic vasculitis share their experience with newcomers. Here are a few:

• Moms often wonder about diet. For example, when should sweets be given after an illness? It is advised to do this gradually, starting with sweetened cereals.
• Some people are very worried that the disease is constantly returning, although the diet is strictly observed and no new drugs are taken. The doctor will answer questions. He advises not to seek help from people whose children have been ill with the same disease. Everyone has a different body and their own characteristics. It is only necessary to consult in person with a doctor who treats hemorrhagic vasculitis in children.
• Reviews on whether it is possible to send a child to a kindergarten after an illness are also different: some parents say that it is possible, but only that he does not eat there, others advise keeping 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 been ill with hemorrhagic vasculitis recommend not to despair, strictly follow all the doctor's recommendations: diet,be careful about taking medicines, do not change your permanent place of residence, strengthen your immune system and everything will get better with time.

Recovery after treatment

Children with hemorrhagic vasculitis need a long recovery period. Parents of children need to completely change their lifestyle: daily routine, nutrition, habits and behavior. It is very important to be able to prevent the development of infectious diseases. During treatment, exclude the use of antibacterial and other drugs that can cause allergic reactions. Every day you need to work on strengthening immunity. To do this, take daily walks in the fresh air, take vitamin complexes, use products with immunomodulatory properties. The child must be protected from contact with infected people. In the apartment constantly do wet cleaning and systematic airing. The child must be aware of his condition in order to behave correctly. It is very important to find a suitable activity for him that would limit active actions, but at the same time be exciting and interesting.

Conclusion

In the treatment of Henoch-Schonlein disease in children, it is very important that parents strictly follow the anti-allergic diet and bed rest recommended by the doctor. 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 cutaneous hemorrhagic vasculitis in children, when only the skin is affected, and the renal one is one of the most severe.forms. With timely diagnosis and properly prescribed treatment, the prognosis of the disease is favorable. But despite this, even after a complete cure, it is advisable for them to observe security mode for life.