Features of course and treatment of necrotic epifascial phlegmona in children's chicken pox

Abstract

Introduction. The most life-threatening bacterial complication of chickenpox in children is necrotizing epifascial phlegmon. The incidence of this disease is 0.01-0.2%. Unsatisfactory results of treatment can be associated with late and erroneous diagnosis, as well as insufficient intensive therapy.The aim is to study the features of the course and treatment of necrotizing epifascial phlegmon with chickenpox in children.Material and methods. An analysis of the treatment of 20 children with necrotizing epifascial phlegmon with chickenpox was carried out. Microbiological and histological studies were performed from the lesion focus, the immune status and the state of hemostasis were studied, and a clinical assessment of the wound process was given on the basis of visual observation.Results. In the study, there were 12 boys and 8 girls among all patients. The most frequent localization of necrotizing epifascial phlegmon in chickenpox was the lower and upper extremities. Of the observed 20 patients with necrotizing epifascial phlegmon at the age from 1 to 7 years, there were 16 children. The development of this disease usually occurred on the 3-5th day of the course of chickenpox. The disease proceeded with a clearly pronounced staging, thrombosis in the vessels of the skin and subcutaneous tissue, followed by necrosis. The severity of the patient's condition depended on the area of skin and subcutaneous tissue lesions. Streptococcus pyogenes was the main causative agent in the inoculation of the lesion separatedfrom the focus. Changes in the immune status for the most part corresponded to those in acute purulent inflammation. Complex treatment with systemic antibacterial and intensive syndromic therapy, active intervention in the lesion focus and the use of modern technologies in the management of wounds and wound defects contributed to the healing of patients and a decrease in mortality.Conclusion. The likelihood of developing necrotic epifascial phlegmon in children with chickenpox is quite high when infected with Streptococcus pyogenes. The course of necrotic epifascial phlegmon with chickenpox in children has a certain sequence: a period of progressive course, a period of necrosis and wound defects, a period of repair. Active early complex treatment with targeted antibacterial and intensive post-syndrome therapy, the use of anticoagulants and antiplatelet agents, antibiotic-novocaine blockade and incisions in the lesion focus, the use of modern technologies in the management of wounds and wound defects contributed to the healing of patients and the prevention of deaths.