Частота выявляемости маркеров цитомегаловирусной инфекции у детей с рекуррентными респираторными заболеваниями, у больных с шига-токсин-ассоциированным гемолитико-уремическим синдромом (STEC-ГУС)

The paper presents data on the detection and role of cytomegalovirus infection (CMVI) in 146 children of certain groups aged from 3 months to 15 years who were hospitalized — frequently ill children with respiratory pathology, patients with shiga-toxin-associated hemolytic uremic syndrome (STEC-HUS) and schoolchildren with somatic diseases during rehabilitation in a sanatorium.The aim of the study was to determine the frequency of detection of CMVI in the presented groups, the originality of the main clinical manifestations in correlation with the markers of activity of herpesvirus type V infection. Clinical monitoring was carried out, oropharyngeal swabs, saliva,blood samples (serum and blood cells) were studied using a set of laboratory diagnostic methods:RCM (rapid culture method) on Vero- and M-19 cells, IIR (reaction of indirect immunofluorescence), ELISA to detect specific antigens and antibodies (IgM, IgG).The detection rate of CMV IgG in diagnostic values ranged from 6.4% in the group of frequently ill children with respiratory pathology to 31.7% in schoolchildren of the sanatorium, the acute course of infection was detected in3.2% and 6.4%, respectively, based on markers of acute infection (CMV IgM and cytomegalovirus antigen). In patients with STEC-HUS CMV IgG in diagnostic titers were recorded with the highest frequency — in 74.4% of patients. Представлены данные по выявлению и роли цитомегаловируснойинфекции (ЦМВИ) у 146 детей отдельных групп в возрасте от 3 мес. до 15 лет, находившихся на стационарном лечении — часто болеющие дети (ЧБД) с респираторной патологией, пациенты с шига-токсин-ассоциированным гемолитико-уремическим синдромом (STEC-ГУС) и школьники с соматическими заболеваниями при реабилитации в санатории.Целью исследования явилось определение частоты выявления ЦМВИ в представленных группах, своеобразия основных клинических проявлений в корреляции с маркерами активности герпесвирусной инфекции V типа. Проводилось клиническое мониторирование, исследовались ротоглоточные мазки, слюна, образцы крови (сыворотка и клетки крови) с применением комплекса лабораторных методов диагностики: БКМ на клетках Verо- и M-19, НРИФ, ИФА для выявления специфических антигенов и ан-тител (IgM, IgG).Частота обнаружения ЦМВ IgG в диагностических значениях колебалась от 6,4% в группе ЧБД с респираторной патологией до 31,7% — у школьников санатория, острое течение инфекции выявлено в 3,2% и 6,4% соответственно на основании марке-ров острой инфекции (ЦМВ IgM и АГ цитомегаловируса). У больных STEC-ГУС ЦМВ IgG в диагностических титрах регистрировались с наибольшей частотой — у 74,4% больных

РОЛЬ ОППОРТУНИСТИЧЕСКИХ ИНФЕКЦИЙ В ВОЗНИКНОВЕНИИ ОСЛОЖНЕНИЙ У ДЕТЕЙ

The article highlights problems in the diagnosis of opportunistic infections (OI), shows the frequency of detection of acute infections in children with immunodeficiency and without marked disturbances in the immune system. The mothers and their ailing children were surveyed, The children were diagnosed with immune neutropenia. High presence of opportunistic infection pathogens was revealed both in mothers and in children. 4,5% of cases proved the mother to be the source of infection. The article discusses the role of causative agents of OI in the etiology of obstructive bronchitis and prolonged subfebrility in children. В статье освещены вопросы диагностики оппортунистических инфекций (ОИ), показана частота выявления острых форм инфекции у детей с иммунодефицитом и без выраженных нарушений в иммунной системе. Проведены наблюдения за парами мать — ребенок, где ребенок болен иммунной нейтропенией и была показана высокая инфицированность как матерей, так и детей возбудителями ОИ. В 4,5% случаев была доказана роль матери как источника инфекции. Определена роль возбудителей ОИ в этиологии обструктивных бронхитов и длительных субфебрилитетов у детей.

ЛАБОРАТОРНАЯ ДИАГНОСТИКА ОППОРТУНИСТИЧЕСКИХ ИНФЕКЦИЙ ПРИ ДЛИТЕЛЬНЫХ СУБФЕБРИЛИТЕТАХ И ОБСТРУКТИВНЫХ БРОНХИТАХ У ДЕТЕЙ ПРИ МИКСТ ИНФЕКЦИЯХ

The article discusses the role of agents of opportunistic infections (OI) in the etiology of children’s infectious diseases illustrated by the long-subfebrilites and obstructivebronchitis. When children without expressed immunity disorders are infected with mixed infections OI have more pronounced manifestations, which requires appropriate treatment. At the same time, the similarity of the clinical manifestations does not mean that an etiological diagnosis can be determined without laboratory diagnostic methods. The importance of routine pediatrics monitoring of children with latent forms of OI is emphasized.Показана роль возбудителей оппортунистических инфекций (ОИ) в этиологии инфекционных заболеваний детей на примере длительных субфебрилитетов и обструктивных бронхитов. У детей без выраженных нарушений иммунитета при смешанном инфицировании ОИ протекают более манифестно, что требует назначения соответствующего лечения. В то же время схожесть клинических проявлений не позволяет установить этиологический диагноз заболевания без использования лабораторных методов диагностики. Показана необходимость систематического наблюдения педиатрами за детьми с латентными формами ОИ

Are functional gastrointestinal disorders a clinically significant comorbid factor for acute respiratory infection in children?

Rationale: Functional gastrointestinal disorders (FGID) are highly prevalent in children worldwide. Current concept of FGID pathophysiology implies contributions from various mechanisms. Information in the role of acute respiratory infections in the development of FGID in children is lacking.Aim: To determine the prevalence of FGID in children hospitalized to the department of infectious diseases with acute respiratory tract infections (ARTI) and their association with demographic, medical biological factors and clinical manifestations.Materials and methods: We performed observational and cross-sectional study with continuous patient sampling. The study included 180 ARTI patients, whose mothers agreed to fill in the proposed questionnaire of 41 items. The diagnosis of FGID during in-hospital stay was made based on clinical data in accordance with the Rome criteria IV (2016) and by standard collection of the information from the parents. The stool characteristics were assessed with the Bristol scale. The rate of recurrent ARTI was assessed by the resistance index of above 0.5. We considered clinical symptoms of ARTI at the admittance, the rates of bacterial complications and the need in antibacterial treatment.Results: The prevalence of FGID in hospitalized children with ARTI below 4 years of age (n = 134) was 35.1% (95% confidence interval [CI]) 27.0– 43.9); they had higher rates of functional diarrhea (14.9%, 95% CI 9.4–22.1) and constipation (14.2%, 95% CI 8.8–21.3). Among those above 4 years of age (n = 46), FGID were diagnosed in 50% (95% CI 34.9–65.1) of the cases; with most frequent symptoms being abdominal pain (39.1%, 95% CI 25.1–54.6) and irritable bowel syndrome (10.8%). Irrespective of their age, the children with FGID had higher rates of ARTI recurrence (by 34.0%, 95% CI 20.0–48.1; relative risk 1.98, 95% CI 1.47–2.69; odds ratio 4.13, 95% CI 2.18–7.85) and intestinal infections in their past history, compared to those without any gastrointestinal symptoms during the index hospitalization. In children with FGID, ARTI were more frequently complicated by otitis and they had higher requirement in antibiotics. The mothers of the infants and toddlers with FGID had lower educational level (smaller proportion of those with high school education) and were less satisfied with their home and living conditions, whereas their fathers were older and more frequently employed in vehicle operations and less frequently were occupied in communication-related professions.Conclusion: Acute respiratory infections, especially recurring, may plaу a significant role in the development and maintenance of FGID in children. Further studies are necessary, which may result in useful information for the development of tailored strategies to treatment and prevention

Invasive streptococcal group A infection in children: а review of the literature and a clinical case of the toxic shock syndrome and complicated community-acquired pneumonia in a child with lung malformation

Streptococcal group A  infection (SGAI) remains an important cause of morbidity and mortality in children. In the recent years, the spread of new highly virulent strains of Streptococcus pyogenes, capable of producing cytolysins and pyrogenic exotoxins (superantigens) has led to an increase in the number of severe forms of diseases with high mortality rates. Invasive infection can occur as necrotizing fasciitis, myositis, sepsis, toxic shock syndrome, scarlet fever, meningitis, myocarditis, and pneumonia. A variety of symptoms in patients with tonsillitis without purulent depositions or after a blunt trauma of soft tissues, such as vomiting, diarrhea, and abdominal pain, can mimic other diseases. The toxic shock syndrome with circulatory collapse, hypotension, acute renal failure, and coagulopathy may develop rapidly and be fatal if not recognized on time or if treated inadequately. Time-sensitive combined antimicrobial therapy and adequate fluid administration, before the bacteriological results are obtained, are important components of any successful treatment. The review describes the current epidemiological situation, diagnostic criteria and treatment strategies for invasive SGAI with an emphasis on the toxic shock syndrome. We present our own observation of SGAI in a 5-year-old child with tonsillitis without purulent depositions, with abdominal pain, typical erythematous rash with desquamation at typical time intervals, and a toxic shock syndrome and pneumonia complicated by pleuritis and pneumohydorotorax. The complications and duration of pneumonia were related to lung malformation (adenomatous cystic type 1 malformation of the lungs), which was newly detected at the time of the disease.Conclusion: Due to global spread of SGAI, doctors should be alert to its severe manifestations

Mycoplasma pneumoniae, Chlamydophila pneumoniae, Pneumocystis jirovecii and herpes infection in children with recurrent respiratory diseases

Rationale: Acute respiratory disorders (ARD) have the highest proportion among infectious disease in children. Despite the fact that serological diagnostics of Mycoplasma pneumoniae, Chlamydophila pneumoniae, Pneumocystis jirovecii, herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2), Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus type 6 (HHV-6) has been available for many years, up to now some objective limitations exist that hinder reliable differentiation between the viral carriage, past or current infection. There are no widely accepted guidelines that would suggest unified strategies for diagnosis and what is of utmost importance, for therapeutic intervention on a  case-to-case basis. The rationale for this study was based on underestimation of the burden of these infections in children with prolonged periods of cough and recurrent ARDs, as well as the necessity to further develop diagnostic and management strategies.Aim: To determine causative role of M. pneumoniae, P. jirovecii, C. pneumoniae, HSV-1, -2, EBV, CMV, HHV-6 in children with recurrent ARDs hospitalized to an in-patient unit.Materials and methods: We examined 50 children with recurrent ARDs aged from 1 to 7 years who were hospitalized with an acute respiratory infection. Laboratory assessments included determination of the markers of infections caused by M. pneumoniae, P. jirovecii, C. pneumoniae, HSV- 1, -2, EBV, CMV, HHV-6 by means of polymerase chain reaction, immunoenzyme analysis, and indirect immunofluorescence reaction.Results: Markers of mycoplasma, chlamydial, pneumocystic infection, as well as HSV-1, -2, EBV, CMV, HHV-6 were found in 84% (42 / 50) cases. Active infection (acute or active persistent) was found in 38% (19 / 50) patients. The most prevalent was pneumocystic infection diagnosed in 12 (24%) patients; one fifth of all patients had mycoplasma (in 10 (20%) of cases), whereas herpetic and chlamydial infections were less frequent (4 (8%) and 1 (2%) of cases, respectively). Twelve (24%) patients had a single infection, while the others had mixed infections.Conclusion: We were able to confirm the possibility of combined M. pneumonia / P. jirovecii infection (8%) in children with recurrent ARDs and history of longstanding cough; this is important for an assessment of efficacy of causative treatment. Measurement of serum titers of specific immunoglobulins M and G along with DNA/antigens of potential causative organisms can be sufficient to choose specific antibacterial treatment of obstructive bronchitis and pneumonia in children with the history of longstanding cough and recurrent bronchial obstruction

LABORATORY DIAGNOSIS OF OPPORTUNISTIC INFECTIONS AT LONG-SUBFEBRILITES AND OBSTRUCTIVE BRONCHITIS IN CHILDREN WITH MIXED INFECTION

The article discusses the role of agents of opportunistic infections (OI) in the etiology of children’s infectious diseases illustrated by the long-subfebrilites and obstructivebronchitis. When children without expressed immunity disorders are infected with mixed infections OI have more pronounced manifestations, which requires appropriate treatment. At the same time, the similarity of the clinical manifestations does not mean that an etiological diagnosis can be determined without laboratory diagnostic methods. The importance of routine pediatrics monitoring of children with latent forms of OI is emphasized

THE ROLE OF OPPORTUNISTIC INFECTIONS IN COMPLICATIONS IN CHILDREN

The article highlights problems in the diagnosis of opportunistic infections (OI), shows the frequency of detection of acute infections in children with immunodeficiency and without marked disturbances in the immune system. The mothers and their ailing children were surveyed, The children were diagnosed with immune neutropenia. High presence of opportunistic infection pathogens was revealed both in mothers and in children. 4,5% of cases proved the mother to be the source of infection. The article discusses the role of causative agents of OI in the etiology of obstructive bronchitis and prolonged subfebrility in children

РОЛЬ ОППОРТУНИСТИЧЕСКИХ ИНФЕКЦИЙ В ВОЗНИКНОВЕНИИ ОСЛОЖНЕНИЙ У ДЕТЕЙ

The article highlights problems in the diagnosis of opportunistic infections (OI), shows the frequency of detection of acute infections in children with immunodeficiency and without marked disturbances in the immune system. The mothers and their ailing children were surveyed, The children were diagnosed with immune neutropenia. High presence of opportunistic infection pathogens was revealed both in mothers and in children. 4,5% of cases proved the mother to be the source of infection. The article discusses the role of causative agents of OI in the etiology of obstructive bronchitis and prolonged subfebrility in children. В статье освещены вопросы диагностики оппортунистических инфекций (ОИ), показана частота выявления острых форм инфекции у детей с иммунодефицитом и без выраженных нарушений в иммунной системе. Проведены наблюдения за парами мать — ребенок, где ребенок болен иммунной нейтропенией и была показана высокая инфицированность как матерей, так и детей возбудителями ОИ. В 4,5% случаев была доказана роль матери как источника инфекции. Определена роль возбудителей ОИ в этиологии обструктивных бронхитов и длительных субфебрилитетов у детей. </p

ЛАБОРАТОРНАЯ ДИАГНОСТИКА ОППОРТУНИСТИЧЕСКИХ ИНФЕКЦИЙ ПРИ ДЛИТЕЛЬНЫХ СУБФЕБРИЛИТЕТАХ И ОБСТРУКТИВНЫХ БРОНХИТАХ У ДЕТЕЙ ПРИ МИКСТ ИНФЕКЦИЯХ

The article discusses the role of agents of opportunistic infections (OI) in the etiology of children’s infectious diseases illustrated by the long-subfebrilites and obstructivebronchitis. When children without expressed immunity disorders are infected with mixed infections OI have more pronounced manifestations, which requires appropriate treatment. At the same time, the similarity of the clinical manifestations does not mean that an etiological diagnosis can be determined without laboratory diagnostic methods. The importance of routine pediatrics monitoring of children with latent forms of OI is emphasized.Показана роль возбудителей оппортунистических инфекций (ОИ) в этиологии инфекционных заболеваний детей на примере длительных субфебрилитетов и обструктивных бронхитов. У детей без выраженных нарушений иммунитета при смешанном инфицировании ОИ протекают более манифестно, что требует назначения соответствующего лечения. В то же время схожесть клинических проявлений не позволяет установить этиологический диагноз заболевания без использования лабораторных методов диагностики. Показана необходимость систематического наблюдения педиатрами за детьми с латентными формами ОИ.</p