Diathesis – the constitutional feature causing predisposition of a children's organism to development of certain diseases or pathological reactions. Depending on a type of diathesis at children tendency to allergic reactions, violation of exchange processes, a diffusion giperplaziya of lymphoid fabric, infectious incidence etc. can be noted. Various children's experts take part in diagnosis of diathesis, laboratory and tool methods of a research are used. Medical tactics at diathesis provides observance of a diet and mode, medicinal therapy taking into account individual manifestations, massage, gymnastics.
Diathesis (anomaly of the constitution) – the hereditary feature of an organism of the child causing specifics of his adaptive reactions and predisposition to certain diseases. The term "diathesis" was entered into pediatrics in to. XIX - the head of the 20th century for designation of hereditary predisposition to something as the level of development of science of that time did not give exact ideas of molecular and genetic mechanisms of many diseases. Today, thanks to development of molecular biology and genetics, the doctrine about diathesis is of rather historical interest though it is still used in domestic pediatrics.
Thus, diathesis is not an independent disease or a syndrome, and designates the feature of the constitution of the person connected with hereditary, age, environmental factors and defining reactivity of an organism. Presence of this or that diathesis (a background, borderline) at the child at adverse confluence of exogenous and endogenous influences is risk factor of development of certain diseases. It is considered that to 90% of chronic diseases of adult age develops against the background of diathesis.
Reasons of development of diathesis
At the heart of anomalies of the constitution or diathesis disorder of neuroendocrine regulation of metabolic and immunological processes lies that leads to development of inadequate, pathological reactions to usual irritants.
Risk factor of development of diathesis in the child is the adverse course of pregnancy: toxicoses, infectious diseases of mother, pharmacological loading during pregnancy, violation of the food mode by future mother, addictions; a sweat hypoxia, asphyxia in labor.
The children with the burdened heredity, perinatal pathology of TsNS, the low or increased body weight at the birth who are on artificial feeding, having an intestinal dysbiosis are subject to diathesis. Communication between diathesis and early infection of the child respiratory a virus is proved. Diathesis at the child can demonstrate at non-compliance with a day regimen, irrational food, defects of leaving, chronic infections, vaccination, an emotional distress, etc.
Classification of diathesis
In medicine there are over 20 types of diathesis; at the same time their various combination and individual options inherent in the specific person is possible. Carry to specifically anomalies of the constitution of children's age ekssudativno-catarrhal, limfatiko-hypoplastic and neuro diathesis.
Ekssudativno-kataralnye (allergic, atopic) diathesis includes various tranzitorny allergic manifestations at children of early age who can be transformed further to chronic allergic and infectious and inflammatory diseases. Limfatiko-gipoplastichesky (lymphatic) diathesis unites group of primary immunodeficiency causing a giperplaziya of lymphoid fabric and a timus. neuro diathesis is presented by various violations of exchange of uric acid and purin. Distinguish from seldom found forms psikhastenichesky, vegetodistonichesky, atherosclerotic, etc. diathesis.
Symptoms of ekssudativno-catarrhal diathesis
Ekssudativno-kataralny diathesis makes 40-70% of cases among various forms of diathesis at children of the first year of life. At rational correction of display of diathesis disappear by 2-3 years. Sometimes as a part of ekssudativno-catarrhal diathesis mark out the allergic (atopic) anomaly of the constitution connected with genetically determined hyperproduction of IgE and which is found in families with hereditary allergic diseases.
At the child of the first month of life gneiss (seboreyny dermatitis) – grease scales which in the form of an armor cover a hairy part of the head in the field of the top and a darkness can be display of ekssudativno-catarrhal diathesis. Gneiss usually has a favorable current, however at a part of children it can be transformed to the seboreyny eczema which is characterized by reddening, puffiness, moknutiy, formation of crusts on skin of a forehead, cheeks, auricles. A frequent symptom of ekssudativno-catarrhal diathesis at children of the first year of life is the dairy scab – reddening, puffiness and a peeling, an itch of skin of cheeks.
The remaining intertrigo in skin folds and on buttocks is characteristic of ekssudativno-catarrhal diathesis with firmness. At a part of pastose, corpulent children of an intertrigo can proceed with moknutiy and maceration of skin, stratification of infectious damages of skin (piodermiy). The heaviest display of ekssudativno-catarrhal diathesis is children's eczema which can pass into neurodermatitis with age.
The paratrofiya, unstable increase of body weight (excess weight easily is replaced by insufficient), pallor and puffiness of the person, pastosity, geographical language, meteorizm, abdominal syndrome is typical for children with this anomaly of the constitution. Children with ekssudativno-catarrhal diathesis are predisposed to frequent and long pneumonia, rhinitises, sinusitis, pharyngitises, tonsillitis, bronchitis, atopic dermatitis. The differential diagnosis at various displays of ekssudativno-catarrhal diathesis should be carried out with dermatitis, eritrodermiya, psoriasis, etc.
Symptoms of limfatiko-hypoplastic diathesis
The share of limfatiko-hypoplastic diathesis among anomalies of the constitution makes 10-12%. Limfatiko-gipoplastichesky diathesis at children is formed by 2-3 years and at favorable development disappears by the pubertatny period. At individuals signs of the timiko-lymphatic status remain all life.
Development of limfatiko-hypoplastic diathesis is connected with hypofunction of adrenal glands and dysfunction of simpatoadrenalovy system, resistant compensatory giperplaziy lymphoid fabric, decrease in function of the central body of immune system - a thymus, violation of humoral and cellular immunity.
Children with limfatiko-hypoplastic diathesis have a disproportional constitution (rather short trunk at slightly extended extremities), pale marble skin, poorly developed muscles, pastosity and the lowered turgor of fabrics. Such children usually sluggish, adynamic, quickly get tired, are inclined to arterial hypotonia. They have frequent SARS which proceed with a hyperthermia, violation of microcirculation and the phenomena of neurotoxicosis.
Increase in all groups of peripheral lymph nodes, giperplaziya of adenoides and almonds, timomegaliya, gepato-and a splenomegaliya is found in children with limfatiko-hypoplastic diathesis. After removal of adenoides they have tendency to repeated growth. At this type of anomaly of the constitution other anomalies of development – a hypoplasia of heart, kidneys, glands, external genitals can come to light. It is considered that the syndrome of sudden death meets among children with limfatiko-hypoplastic diathesis more often. At limfatiko-hypoplastic diathesis it is necessary to exclude , HIV infection.
Symptoms neuro diathesis
neuro diathesis meets less than ekssudativno-catarrhal and limfatiko-hypoplastic – at 2-5% of children. Is its cornerstone the caused metabolic disorder (mainly uric acid) and decrease in the utilizing ability of a liver is hereditary that is shown neurotic, metabolic, spastic and skin by syndromes. At adult age at persons with neuro diathesis obesity, nephrite, an urolithic disease, a chronic renal failure, diabetes, atherosclerosis, gout, ZhKB quite often develops.
The neurotic syndrome at neuro diathesis is observed in 80% of cases. At children of the first year of life it is characterized by excessive excitement, concern, fearfulness, a sleep disorder. At early and preschool age such children early seize oral speech and reading, show interest and inquisitiveness in surrounding, have good memory. However along with safe mental and emotional development, at them emotional lability, SDVG, headaches, persistent anorexia, stutter, enuresis can be noted.
The syndrome of exchange violations accompanying a current neuro diathesis is shown by passing artralgiya, dizurichesky frustration, a saluriya (existence of urat, oxalates, phosphates in the general analysis of urine). Owing to the low acetylating ability of a liver at children the atsetonemichesky syndrome can develop. In the period of atsetonemichesky crisis there is unrestrained vomiting, dehydration, intoxication, a hyperthermia.
As manifestations of a spastic syndrome at diathesis serve the bronkhokonstriktion, migrenepodobny headaches, kardialgiya, arterial hypertension, intestinal and renal gripes, locks, spastic colitis. At such children asthmatic bronchitis which can be transformed to atopic bronchial asthma often comes to light.
The skin syndrome at neuro diathesis can proceed in the form of a small tortoiseshell, Quincke's hypostasis, a pochesukha, neurodermatitis, eczema. At children with neuro diathesis test to Mant often happens positive that demands carrying out a diffdiagnostika with a tubinfitsirovaniye. Also in the course of observation of the child it is necessary to exclude existence at it of neurosis, diabetes, rheumatism.
Diagnosis of diathesis
As diathesis is not an independent disease and the diagnosis, children with various manifestations of anomalies of the constitution can be patients of the pediatrician, the children's dermatologist, the children's endocrinologist, the children's nephrologist, the children's allergist-immunologist, the children's rheumatologist, the children's neurologist, the children's otolaryngologist, the children's homeopathist, etc.
From methods of laboratory diagnostics at diathesis are used the general analysis of urine and blood; biochemical analysis of urine; definition in blood of level of glucose, cholesterol, phospholipids, uric acid, catecholamines; immunological researches (definition of IgA, IgG, T - and V-lymphocytes, the CEC), a research a calla on dysbacteriosis, etc.
Treatment of diathesis
Non-drug methods of treatment of diathesis at children include a dietotherapy, the organization of careful leaving and a rational day regimen, physiotherapeutic influence. Breastfeeding, at more advanced age – observance of the eliminative diet excluding the causal and significant agent is recommended to children with ekssudativno-catarrhal and allergic diathesis. From medicines reception antihistaminic (, ) and sedative (valerian) medicines, group B vitamins is shown; if against the background of diathesis dysbacteriosis is diagnosed, a probiotics is appointed (bifidum-and lactobacilli).
Local therapy at ekssudativno-catarrhal diathesis includes bathtubs with bran, a camomile, a train, oak bark; putting non-hormonal anti-inflammatory ointments on affected areas of skin. Courses of the general ultra-violet radiation give good effect. Carrying out a specific hyposensitization small doses of anti-genes under control of the allergist-immunologist is possible. Therapy of limfatiko-hypoplastic diathesis joins regular courses of reception of vegetable and synthetic adaptogens (an eleuterokokk, a pentoksil), vitamins; massage, hardening, gymnastics. At emergence of nadpochechnikovy insufficiency glucocorticoids are appointed.
In a diet of children with neuro diathesis restriction of the products rich with purina (chocolate, cocoa, a liver, a herring, peas, spinach), greasy food is necessary. Complex therapy joins sedative and bile-expelling means, B6 and B12 vitamins, gymnastics. At development of atsetonemichesky vomiting carrying out an oral or parenteral regidratation, washing of a stomach, statement of a cleaning enema is necessary.
Prevention and forecast of diathesis
Antenatalny prevention of diathesis at children includes hypoallergenic food of the pregnant woman, the prevention of gestoz and ekstragenitalny diseases. In the post-natal period the important role belongs to breastfeeding of the child, an exception of food of allergiziruyushchy products, performing preventive massage, the tempering procedures, gymnastics, sanitation of the centers of a chronic infection. Vaccination to children with diathesis has to be carried out according to the individual schedule, only during remission and after special preparation.
At observance of the treatment-and-prophylactic mode the forecast of diathesis at children favorable: in most cases its manifestations disappear to awkward age. At limfatiko-hypoplastic diathesis and a timomegaliya the lethality at children of the first year of life makes 10%. Development at young age of allergic, autoimmune, cardiovascular, exchange diseases is considered also adverse.