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CHILDREN INFECTIONS

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Vol 18, No 4 (2019)
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https://doi.org/10.22627/2072-8107-2019-18-4

ORIGINAL ARTICLES

5-11 815
Abstract

The study is devoted to the clinical examination of frequently ill children in the North-Eastern regions of Russia and the laboratory detection of markers of herpesvirus infections, as well as pneumocystosis and the establishment of the relationship with their immune status.

62 children aged 8—15 years were examined. Samples of serum and blood cells, sputum on markers of herpesvirus infections and pneumocystosis by ELISA, indirect immunofluorescence reaction and rapid culture method were studied. Assessment of humoral immunity and determination of circulating immune complexes was performed by solid-phase enzyme immunoassay and immune turbodimetric analysis.

The study shows the etiological role of herpesviruses. Active infection (acute, reactivation) was caused in 9.7% of cases of HSV-1,2, 12.9% — EBV, 6.5% — CMV, 19.4% — HHV-6. This is indicated by a large number of convalescents: with EBVI — 40.3%, HSVI — 27.4%, HHVI-6 — 8.1%, CMVI — 4.8%. Also, a significant number of children were found and latent form. The formation of the circulating immune complexes (CIC) is a physiological mechanism of protection of the body, and their excessive accumulation indicates the development of inflammatory processes and autoimmune diseases. In the increase in CIC observed mainly in individuals with latent infection: HSVI — 29.4%; HHVI-6 — 20.8%; CMVI — 16.7%, EBVI — 11.9%. It is important to note that in almost half of the cases the increase in CIC level occurred simultaneously with the increase in the concentration of total IgE. A survey of children on Pneumocystis showed that among them, dominated native — 11.3%, in which the sputum was identified pnevmotsisty. It should be noted that one child was found mixed infection with reactivated CMVI. Acute infection was diagnosed only in 6.4% of the patients.

12-18 1216
Abstract

Objective: to study the clinical and laboratory manifestations of acute intestinal infections of bacterial etiology in hospitalized children, depending on the etiology, age, topic of the lesion, and complications.

A cohort clinical study of 570 children hospitalized from January to October 2019 in the infectious wards of Children's Clinical Hospital No.9 in Moscow was conducted. Studies included routine laboratory methods, bacteriological analysis of feces, Latex test, ELISA, PCR to detect pathogens, serological reactions to detect specific antibodies in blood serum. Two groups of patients were specially formed to compare the features of the course of bacterial diarrhea without hemorrhagic colitis (n = 111) and with hemorrhagic colitis (n = 125).

Among 33.2% of cases of deciphered etiology of bacterial diarrhea, Salmonella was isolated in 14.6%, Campylobacter — in 4.7%, Shigella — in 3%, in other cases — conditionally pathogenic flora. Salmonellosis and Сampylobacteriosis with the same frequency are recorded in children in the age groups of 1—3 and 3—7 years, in half of the patients proceed as enterocolitis (58 and 52%, respectively). Shigellosis is diagnosed in children older than 1 year of life with the same frequency in age groups 1—3, 3—7 and older than 7 years, a third of patients (35%) develop severe forms.

In most cases (83.2%), a complicated course of bacterial diarrhea was detected, more often dehydration 1 and 2 degrees (36.5%), acute respiratory viral infections (19.6%), mesadenitis (11.2%), community-acquired pneumonia (4.6%).

Enterocolitis is the topic of lesion in half of the children, and every 5th patient develops hemorrhagic colitis (21.9%). In 44% of cases of established etiology of hemorrhagic colitis, Salmonella was confirmed. Hemocolitis also develops more often with shigellosis, campylobacteriosis and clostridiosis. In the group of bacterial diarrhea with hemorrhagic colitis, significant differences were revealed compared with the group without hemocolitis: by the frequency of development in children under 3 years of age; by the duration of treatment in a hospital; by the frequency of mesadenitis; by the content of stab neutrophils in the hemogram, reflecting a more pronounced inflammation in hemorrhagic colitis.

Thus, bacterial diarrhea in children remains relevant due to the severity of inflammation, the incidence of complicated course and hemorrhagic colitis, which requires hospitalization.

19-24 682
Abstract

The aim of the study: to assess the incidence, prevalence, structure by sex and transmission routes of HIV infection among the child population of the Republic of Bashkortostan.

A study of data on HIV infection among children 0—17 years in the republic for 2014—2018 was conducted.

Results: the average incidence of HIV infection for 2014—2018 in the age group 0—14 years was 3.4 ± 0.4, 15—17 years — 8.7 ± 1.1, 0—17 years — 4.1 ± 0.4 per 100,000 child population of the corresponding age, the average prevalence of HIV infection at the age of 0—14 years — 26.6 ± 1.1, 15—17 years — 17.2 ± 3.1, 0—17 years — 25.2 ± 1.3 per 100,000 child population of the corresponding age. In 2018 compared to 2014 the incidence of HIV infection in the age group 0—14 years increased by 35.3%, 15—17 years — by 45.0%, 0—17 years — by 36.8%, the prevalence — in the age group 0—14 years increased by 27.4%, 15—17 years — 2.6 times, 0—17 years — by 38.3%. In 96.8% of HIV infections in children aged 0—14 years occurred as a result of perinatal transmission of the virus. Among children 0—14 years of age, 55.8% of cases were diagnosed with HIV infection at the age of 0—1 years. In 29.4% of children 0—14 years with perinatal transmission of HIV infection, the disease was detected at the age of 2 years and older. At the age of 15—17 years, sexual transmission of HIV infection prevailed — 90.9%, female adolescents accounted for 78.2%. In 21.8% of cases, HIV infection was detected in adolescents of the female sex during pregnancy follow-up, in 9.1% in the examination in connection with the consumption of drugs.

25-31 2084
Abstract

Acute respiratory infections (ARI) are the most common diseases of children, the main reasons for which are the age-related characteristics of the immune response, exacerbated by adverse perinatal factors, allergies, and increased contact with potential pathogens (the beginning of visits to preschool institutions, etc.).

Objective: to evaluate the effectiveness of the use of the drug recombinant interferon α-2b to reduce the incidence of acute respiratory infections in preschool children.

Throughout the year, there were 50 children under observation (average age 29.2 ± 0.97 months) attending preschool institutions. Recombinant interferon α-2b, ointment — VIFERON® 2500 IU 2 times a day for 14 days, in the next 4 weeks — 2500 IU 2 times a day 3 times a week was used for 25 children of the main group for the prevention of ARI in the pre-epidemic period.

Results: The use of recombinant interferon α-2b in children of the main group showed a statistically significant decrease in the incidence of ARI, pneumonia, otitis, and the disappearance of pathological symptoms in the nasopharynx. An increase in the level of antiviral cytokines (IFN-α, p = 0.0088, IFN-γ, p = 0.0014) and a decrease in the concentration of pro-inflammatory (IL-1β, p = 0.0072) were recorded. Carriage of S. aureus, S. epidermidis, Candida albicans decreased by 2 times. Decrease in titer of antibodies to Str. pyogenes (p = 0.0251), Str. pneumoniae (p = 0.0491), Branchamella catarrhalis (p = 0.0369), Haemophilus influenzae (p = 0.0251) indicates a decrease in the sensitization of the child's organism to microbial antigens.

VACCINATION

32-37 1114
Abstract

Voluntary anonymous questioning of groups of parents (n = 120), students of junior and senior courses of medical faculty (n = 250), оutpatient doctors (n = 45) concerning vaccination is carried out.

Parents showed a generally positive (60%) attitude to vaccination, high anxiety (90%) in connection with the possible development of post-vaccination complications, as well as lack of awareness and inertia in acquiring knowledge about vaccination. The positive trend in knowledge among students from junior to senior courses is adjacent to the lack of practical orientation on vaccination. Outpatient doctors are cautious about vaccination, especially for children with chronic illnesses.

TO HELP OF PRACTICAL PEDIATRICS

38-42 676
Abstract

Assessment of health-related quality of life in patients with chronic hepatitis C, as a technique for determining the tolerability of complex antiviral therapy.

Methods: а comprehensive examination of 106 patients with a diagnosis of chronic hepatitis C was performed before and after the end of the combination antiviral therapy.

Results of the study: after therapy on all scales of the physical component of health, higher rates were observed in men. Significantly differences (p < 0.05) were obtained in the following areas: physical functioning (PF), role-based functioning due to physical condition (RP) and general health status (GH). According to the scales of the mental component of health, the indicators of quality of life in men also exceed the obtained values in women, however, significant differences (p < 0.05) are established only on the scale of role-based functioning due to the emotional state (RE).

43-48 808
Abstract

In recent years, enterovirus infection (EVI) retains its cyclical nature with an increase in the incidence rate in the Russian Federation in 2000, 2006, 2009, 2013 and 2017. Observation of 41 patients with laboratory-confirmed enteroviral meningitis (EVM) in 2000, 54 children in 2013, and 56 patients in 2018 revealed the clinical and laboratory features of this clinical form of the disease, mainly concerning changes in hemo- and liquorogram parameters, which allowed to trace the evolutionary changes during this infection in children.

49-52 993
Abstract

In recent years, there has been an increase in the incidence of salmonellosis in children, including in the Yaroslavl region by 52.7%.

In order to study salmonellosis in children at the present stage, we observed 185 patients aged from 1 month to 18 years who were hospitalized in the Infectious Clinical Hospital of the city of Yaroslavl from 2015 to 2017. The analysis of the main clinical, epidemiological and laboratory parameters was carried out and the peculiarities of the course of salmonellosis in children were established.

Results: Salmonella enteritidis remains the dominant pathogen. The children of the first 3 years of life prevailed — 65.4%, of which under the age of 1 year — 18.9%, unorganized in preschool institutions — 49.2%. Alimentary infection was found in 49.7% of cases. In 71.4% of patients, the disease developed against a background of concomitant pathology. In most cases (74.1%), damage to the gastrointestinal tract was manifested by gastroenterocolitis or enterocolitis. In 38.9% of cases, salmonellosis occurred in combination with bacterial and viral pathogens, especially with rota and noroviruses (81.9%), which aggravated the course of the infection. Severe forms accounted for 24.9% and were due to the development of dehydration, mainly in patients with mixed infections.

53-55 823
Abstract

This paper presents materials on the incidence of children with ixodiс tick-borne borreliosis in the Ulyanovsk region for the period 1996—2017.

28 cases of tick-borne borreliosis among children were recorded. Tick suction in April-May was observed in 6 (21.4%) children, in June—August — in 12 (42.9%), in September—November — in 10 (35.7%). Migratory erythema was detected in 15 patients (53.6%). In half of the cases, moderate intoxication symptoms were observed (57.1%). Borreliosis was confirmed laboratory early in 75% of cases.

Thus, a feature of ixodiс tick-borne borreliosis in children in the Ulyanovsk region is: detection of the disease during the period of tick activity, that is, in the early stages; equal ratio of erythema and non-erythhema forms; the prevalence in the clinic of mild symptoms of intoxication; laboratory confirmation in 75% of cases in the early stages. The presence of migratory erythema in the patient gives reason for the diagnosis of ixodiс tick-borne borreliosis even in the absence of positive results of a serological examination.

REVIEW OF THE LITERATURE

56-63 15002
Abstract

A literature review of the works of foreign and domestic authors is devoted to modern approaches to the diagnosis, treatment and prevention of congenital cytomegalovirus infection (cCMV). The data of international consensuses are presented: «Congenital Cytomegalovirus: A European Expert Consensus Statement on Diagnosis and Management» adopted by the cCMV group from the European society for pediatric infectious diseases (ESPID) in Leipzig, Germany in 2015, and «Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy» by an informal International Congenital Cytomegalovirus Recommendations Group (ICCRG), established in Brisbane, Australia in 2015 as part of the 5th International cCMV Conference about evidence-based treatment cCMV using antiviral drugs and immunotherapy. Particular attention is paid to the prevention of cCMV in both pregnant and newborns, as well as data from international studies on the cytomegalovirus vaccination.

CASE FROM PRACTICAL

64-66 1752
Abstract

The article considers a case from clinical practice: mixed infection of viral hepatitis E and infectious mononucleosis caused by Epstein-Barr virus in a boy of 15 years. The patient was long observed by a pediatrician with a diagnosis of lacunar tonsillitis, hospitalized on the 10th day of the disease in an infectious diseases hospital with a preliminary diagnosis of infectious mononucleosis. Objectively, in addition to acute tonsillitis, detected polylithionite, hepatosplenomegaly. The biochemical analysis of blood revealed a pronounced cytolysis syndrome, a study on the markers of viral hepatitis (revealed anti-HEV IgM). Discharged on the 28th day of the disease with residual effects.

67-69 2488
Abstract

Anti-NMDA receptor encephalitis is an autoimmune disease of the central nervous system caused by autoantibodies to the NR1 and NR2 subunits of the glutamate NMDA receptor, with the possibility of both death and rapid remission. The binding of these antibodies blocks receptors and causes slowly developing psychiatric disorders, motor disorders and seizures.

Presented clinical observation in a 9-year-old patient. The disease debuted with prodromal flu-like symptoms, fever, headache and general weakness, after which neuropsychiatric symptoms, impaired memory and speech developed, further progression of the disease, convulsive status, and coma with a fatal outcome were noted. The final diagnosis of autoimmune encephalitis was made after identification of antibodies to the N-methyl-D-aspartate (NMDA) receptor in the blood.

70-72 905
Abstract

The sporadic incidence of tetanus, the identity of symptoms with the clinical picture of a number of common neuroinfections, the high frequency of various background pathologies create difficulties in disease diagnosing in children. On the case history example of a 3 years 9 months old child with two diseases (tetanus, enterovirus infection) that developed against the background of the active form of herpesvirus infection, an algorithm of diagnostic and therapeutic measures is presented.

A differential diagnosis was made between the generalized form of tetanus and meningoencephalitis of enteroviral etiology. Lack of vaccination, living in rural areas, violation of the integrity of the skin and soil contamination testified in favor of tetanus. The clinical symptoms of tetanus were revealed: a triad of symptoms (trismus, «sardonic smile», dysphagia), tetanic cramps against a background of clear consciousness, muscle hypertonicity in the interictal period. The patient received complex treatment; 100 thousand IU of anti-tetanus serum and tetanus anatoxin were introduced. Discharged on the 23rd day of illness with recovery.



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ISSN 2072-8107 (Print)
ISSN 2618-8139 (Online)