Напруженість популяційного імунітету проти дифтерії у Дніпропетровської області

Встановлено, що рівень протективного імунітету проти дифтерії становив 69,5%. Переконливий рівень імунологічного захисту серед дітей становив 70,9%, серед дорослих – 68,3%. Жодна з вікових груп не мала достатнього рівня антитоксичного імунітету, необхідного для припинення трансмісії збудника дифтерії. Відсоток захищених осіб знижувався зі збільшенням віку людей. Така ситуація може створювати передумови для спалахів дифтерії у Дніпропетровській області.Diphtheria is an infectious disease spread of which is limited by population post-vaccination immunity. In the system of epidemiological surveillance of diphtheria for objective assessment and prediction of epidemic situation in low intensity of epidemic process of this infection the serological control of immunity is crucial

A clinical case of a combination of secondary headache with recurrent genital rash in an immunocompetent woman

Headache is one of the most common pathological conditions worldwide, taking into account that 45 % of the adult population has ever reported severe or disabling cephalgia. This interdisciplinary problem often requires participation of many specialists to perform comprehensive differential diagnosis and to choose the effective management. The article investigates one of the causes of the headache such as infections due to persistent viruses. The article presents a detailed clinical case of recurrent episodes of severe disabling headache in an immunocompetent female, which were accompanied by genital rash. Performed laboratory survey is discussed. Methods and efficacy of therapeutic approach during exacerbation episodes and long-term follow-up are described. The article presents international classification of primary and secondary causes of headache disorders according to the International Headache Society (2013). The spectrum of etiological causes of headache, which should be included into differential diagnosis is discussed. Attention is given to differentiation of headache as a presentation of infectious diseases, both intracranial and systemic. Considering the presented clinical case of recurrent episodes of severe headache associated with signs of genital rash, etiology of herpes simplex virus 1 + 2 is suggested. According to clinicians’ opinion, Mollaret meningitis was diagnosed in the discussed case. The article presents historical background of this diagnosis, pathogenic features of this disorder, diagnostic criteria of Mollaret meningitis, its relation to the group of benign recurrent aseptic meningitis, as well as outline of other reasons of benign meningitis. Recommended management of Mollaret meningitis and its efficacy are provided in the study. Differential diagnosis of recurrent episodes of headache should include a long list of causes and often requires collaboration of different specialists. The combination of recurrent pain of any localization, such as cephalalgia with neurologic or somatic pathology, includes herpes simplex virus 1 + 2 infection in the clinical and laboratory differential diagnosis. When establishing the diagnosis of recurrent aseptic meningitis, such as Mollaret meningitis, first line etiotropic drugs are derivatives of acyclovir unless another cause of serous meningitis is confirmed. The use of acyclovir derivatives with recurrent aseptic meningitis, including Mollaret meningitis, can be justified on the basis of clinical signs in cases when exact etiotropic confirmation is complicated. This therapy should be performed as a long-term suppressive chemotherapy, duration and efficacy of which should be established during further clinical evaluation, considering absence of headache relapses and other clinical presentations. Резюме. У статті наведено детальний аналіз клінічного випадку рецидивуючих епізодів вираженого головного болю з появою висипання в ділянці зовнішніх статевих органів у імунокомпетентної жінки. Описано особливості перебігу цiєї патології, наведено результати лабораторного обстеження з обґрунтуванням вибору методів і оцінкою ефективності терапії. Наведено аналіз і класифікацію можливих інфекційних та неінфекційних етіологічних причин головного болю відповідно до Міжнародного товариства головного болю. Подано історичну довідку про менінгіт Молларе, діагностичні критерії цього діагнозу, описано терапію і прогноз. Також проведено диференціальну діагностику інших причин доброякісного рецидивуючого асептичного менінгіту. У результаті диференціального підходу в наведеному клінічному випадку був діагностований менінгіт Молларе. У статті описано особливості цієї патології і діагностичні критерії, обговорено можливі етіологічні причини і схеми терапії. Підкреслено необхідність і ефективність тривалої супресивної хіміотерапії для профілактики повторних епізодів клінічного загострення в терапії менінгіту Молларе

Напруженість популяційного імунітету проти дифтерії у Дніпропетровської області

Встановлено, що рівень протективного імунітету проти дифтерії становив 69,5%. Переконливий рівень імунологічного захисту серед дітей становив 70,9%, серед дорослих – 68,3%. Жодна з вікових груп не мала достатнього рівня антитоксичного імунітету, необхідного для припинення трансмісії збудника дифтерії. Відсоток захищених осіб знижувався зі збільшенням віку людей. Така ситуація може створювати передумови для спалахів дифтерії у Дніпропетровській області.Diphtheria is an infectious disease spread of which is limited by population post-vaccination immunity. In the system of epidemiological surveillance of diphtheria for objective assessment and prediction of epidemic situation in low intensity of epidemic process of this infection the serological control of immunity is crucial

Clinical case of recurrent parotitis in a child.Discussion of causes

Currently, with introduction of vaccination against epidemic parotitis, differential diagnosis of salivarygland involvement in children should include other viruses, such as cytomegalovirus, Coxsackie virus, herpes virustype 6, human T-lymphotropic virus, human immunodeficiency virus, etc., as well as autoimmune and oncologicdiseases. Comprehensive differential diagnosis is required before establishing the diagnosis of exclusion, such as juvenilerecurrent parotitis. It will ensure more effective therapeutic approach and avoiding the prescription of unnecessarymedicines and manipulations. The article presents detailed clinical case of recurrent parotitis in a fully vaccinated(according to national vaccination schedule) 6-year-old boy, who experienced several episodes of painlessswelling of the left parotid area without fever or with low-grade fever accompanied by redness in the left eye duringobservation. Performed laboratory survey and instrumental examination are given. Methods and efficacy of therapeuticapproach are described. The article presents etiological classification of salivary gland involvement, whichincludes inflammatory diseases, autoimmune and hypertrophic lesions, obstructive and traumatic conditions, developmentaldefects, tumors. Epidemiologic and etiologic features of parotitis in pediatric population are considered.Differential diagnosis also includes, for example, Sjogren’s syndrome, sarcoidosis, cat-scratch disease, Parinaudconjunctivitis, with description of diagnostic criteria of the mentioned conditions. According to clinicians, juvenilerecurrent parotitis was diagnosed in the presented case. The article presents epidemiological features of this pathology,diagnostic criteria, discussion of possible etiology, recommendations for the management. Necessity and safetyof vaccination against epidemic parotitis were accentuated, as well as importance of avoiding the prescription of unnecessarymedicines. Vaccination against epidemic parotitis is a prerequisite for the prevention of viral lesions of thesalivary glands. It also helps to narrow the differential diagnosis of parotitis causes. If diagnosis of epidemic parotitisis excluded in a child, comprehensive clinical, laboratory and instrumental examination is recommended. It is veryimportant to provide follow-up after the first episode of parotitis in order to exclude recurrent course of the disease.In the presence of recurrent parotitis and exclusion of other causes of damage to the parotid salivary gland, it shouldbe suggested that the child has juvenile recurrent parotitis, which is a diagnosis of exclusion, and can be made afterat least 12 months of follow-up. The drug management of juvenile recurrent parotitis should exclude unreasonableprescription of medicines, such as antibiotics, antiviral drugs and especially immunomodulators. Only symptomatictherapy is indicated, providing relief of symptoms. Systematic follow-up of patients with this pathology is required

The efficacy and safety of long-term systemic acyclovir therapy of neonatal herpes in immunocompetent children

Medical case histories of two male infants born naturally, in term, who developed neonatal Herpes simplex virus type 2 (HSV-2) infections are discussed. Mothers of both infants presented with signs of vesicular rash in the anogenital area at the time of parturitions. In both cases the presented HSV-2 infection had intranatal transmission route. Clinical course of infection was notable for recurrent vesicular rash with no signs of fever or systemic disorders. Both infants were prescribed continuous systemic acyclovir therapy from the early age for over a year. In both cases long-term course of acyclovir was well tolerated and led to longlasting control of the infection. Therefore such therapeutic regimen might be preferable to the intermittent short-term courses for exacerbations of HSV-1 and HSV-2 infections in infants. Assessment of efficacy and optimal duration of the treatment should be mainly determined by clinical indications

A case of infantile strongyloidiasis associated with Salmonella infection: diagnostic considerations

Background. Pediatric co-infections are an emerging clinical problem due to their increasing prevalence and tendency to transform a typical clinical presentation of particular diseases. Thereafter, it tangles the accurate estimation of etiology, complicates the management and negatively impacts the outcome. Given the climatic changes, significant migratory flows and international tourism, tropical helminthiases, previously not common in Ukraine, are a real threat to the public health, especially in combination with other pathogens. Materials and methods. We observed a case of strongyloidiasis and salmonellosis in a Ukrainian 5-month-old female infant who had no history of visiting any of the sub- or tropical territory of the globe. The girl came from a socially vulne­rable family and was abandoned by her homeless parents immediately after admission. The girl presented with severe toxic manifestations, diarrhea, developmental delay, moderate-to-severe malnutrition and dehydration, and maculopapular rash on the trunk and lower extremities. Direct light microscopy of feces revealed Str. stercoralis in the number of more than 10 mobile larvae per high-power field, at different stages of development. Bronchial lavage fluid contained no larvae of Str. stercoralis. Fecal culture revealed group D S. enteritidis. Chemotherapy with ceftriaxone IV and oral albendazole resulted in elimination of both pathogens. Conclusions. The given case of S. enteritidis and Str. stercoralis co-infection should be considered as a probable case of autochthonous Str. stercoralis infection, as it was not confirmed by more reliable diagnostic methods (e.g. PCR for Str. stercoralis DNA), and demonstrates a doubtful epidemiological history. Consequently, to improve the diagnosis of endemic parasitic infections, it is necessary to introduce such a verification as compulsory, and mandatory registration of relevant cases in the Ukrainian National System of Epidemiological Surveillance and Biosecurity is required

Guillain-Barré syndrome as an early complication of a new coronavirus infection SARS-CoV-2 (clinical case)

O. The new strain of coronavirus SARS CoV-2 can affect any organ and system of the body. The pathogenesis of these lesions is due to both direct damage to body cells by the virus and the development of immunopathological reactions that can lead to demyelinating diseases of the nervous system. The article presents a clinical case of the development of Guillain-Barré syndrome associated with coronavirus disease in a 71-year-old man who developed after infection with a new strain of SARS CoV-2 virus. The man was hospitalized on the seventh day of the disease with complaints of unproductive cough, weakness, fever in the range of 37.5-38.7°C, shortness of breath during exercise. The clinical diagnosis was confirmed by the presence of SARS CoV-2 RNA in the nasopharyngeal secretion. According to digital radiography, the presence of interstitial pneumonia was determined. Against the background of treatment, the condition gradually improved and on the 14th day after the onset of the disease, a negative PCR result (SARS CoV-2 (-) RNA) was obtained. However, on the 16th day of hospital stay (23-24th days of the disease) he was diagnosed with polyneuropathy (Guillain-Barré syndrome), severe tetraparesis. Despite the therapy, the condition gradually deteriorated due to the progression of polyneuropathy. On the 9th day after the onset of neurological symptoms (25th days of illness), on the background of severe neurological deficits, the signs of respiratory and cardiovascular insufficiency developed, which led to the death of the patient. It has been shown that the course of Guillain-Barré syndrome, which developed after infection with a new strain of SARS CoV2 virus, in this case has a severe course and lethal outcome of the disease. It is necessary to look for clinical predictors that would predict the occurrence of neurological complications in patients with coronavirus disease. Guillain-Barré syndrome as an early complication of a new coronavirus infection SARS-CoV-2 (clinical case). Lytvyn K.Yu., Mavrutenkov V.V., Yakunina О.M., Chykarenko Z.O., Bilokon O.O., Turchyn M.O

Guillain-Barré syndrome as an early complication of a new coronavirus infection SARS-COV-2 (clinical case)

The new strain of coronavirus SARS CoV-2 can affect any organ and system of the body. The pathogenesis of these lesions is due to both direct damage to body cells by the virus and the development of immunopathological reactions that can lead to demyelinating diseases of the nervous system. The article presents a clinical case of the development of Guillain-Barré syndrome associated with coronavirus disease in a 71-year-old man who developed after infection with a new strain of SARS CoV-2 virus. The man was hospitalized on the seventh day of the disease with complaints of unproductive cough, weakness, fever in the range of 37.5-38.7°C, shortness of breath during exercise. The clinical diagnosis was confirmed by the presence of SARS CoV-2 RNA in the nasopharyngeal secretion. According to digital radiography, the presence of interstitial pneumonia was determined. Against the background of treatment, the condition gradually improved and on the 14th day after the onset of the disease, a negative PCR result (SARS CoV-2 (-) RNA) was obtained. However, on the 16th day of hospital stay (23-24th days of the disease) he was diagnosed with polyneuropathy (Guillain-Barré syndrome), severe tetraparesis. Despite the therapy, the condition gradually deteriorated due to the progression of polyneuropathy. On the 9th day after the onset of neurological symptoms (25th days of illness), on the background of severe neurological deficits, the signs of respiratory and cardiovascular insufficiency developed, which led to the death of the patient. It has been shown that the course of Guillain-Barré syndrome, which developed after infection with a new strain of SARS CoV2 virus, in this case has a severe course and lethal outcome of the disease. It is necessary to look for clinical predictors that would predict the occurrence of neurological complications in patients with coronavirus diseas

Lyme disease. Pediatric Aspects (II Part)

Up to 25 % of all patients with Lyme borreliosis — children aged 5–9 years. In children also have three clinical and pathogenetic stages of Lyme disease. Typical sign of borreliosis — erythema ≥ 5 cm in diameter, developing at the site of mite biting in 1–32 days. Dissemination of Borrelia burgdorferi s.l. determines clinical polymorphism. Lyme borreliosis is not an obstetric infection. In spite of adequate antibiotic therapy, development of postborreliosis syndrome is possible