Long-term fever in a child: what is the reason, how to examine, treat or not treat?

Long unclear fever in children of different ages remains one of the difficult and topical issues in the paediatric practice. Despite up-to-date techniques of laboratory and instrumental examination, verification of prolonged fever causes remains difficult; it cannot be deciphered in 10% of cases. It is especially important to differentiate fever from hyperthermia in paediatric practice. The article provides an overview of the status update on the issue. The mechanisms of fever and hyperthermia are described, criteria for fever of unknown origin are given. It is stated that infectious diseases under the guise of fever of unknown origin develop in 60–70% of children. Systemic connective tissue disease and vasculitis are detected in 20% of cases, hemato-oncological – in 5%, auto-inflammatory – in 5%, the cause of fever remains unknown in 10% of cases. The article provides clinical observations of children with diseases debuting as fever of unknown origin with the following diagnoses: juvenile rheumatoid arthritis (JRA), a systemic variant with high activity (DAS index 28 = 5.1 at the rate of < 2.6); mucocutaneous lymphonodular syndrome (Kawasaki syndrome), damages of cardiovascular system (small coronary artery aneurysms), bacterial-viral infection; auto-inflammatory syndrome – mevalonate kinase deficiency syndrome (hyper-IgD syndrome). Diagnostic approaches to the verification of febrile condition are outlined. It is noted that treatment should not be started in a stable condition of the patient without establishing the cause of the fever, and it is advisable to use only an antipyretic agent with central and peripheral effects, pronounced antipyretic effect, analgesic and anti-inflammatory effects

Lysosomal lipid storage diseases in children. Modern diagnostic and treatment methods

One of the causes of hepatomegaly in children are rare (orphan) diseases associated with congential metabolic disorders. Starting from 2008, the last day of February is Rare Disease Day. As a rule, knowing that the child has a congenital metabolism disorder does not inspire pediatrician's optimism because of poor prognosis and ineffective therapy. However today, new drugs are emerging that can improve the quality of life of patients with orphan diseases. The main target of the pediatrician is timely diagnosis which allows to prescribe replacement enzyme therapy

ACUTE OBSTRUCTIVE LARYNGITIS IN CHILDREN: EMERGENCY PRE-HOSPITAL MANAGEMENT (IN A TABULAR AND DIAGRAM FORM)

Acute obstructive laryngitis is a life-threatening upper respiratory tract disease of various aetiologies that is characterized by laryngostenosis and manifests itself by barking cough, dysphonia and inspiratory dyspnoea [8]. A child showing these clinical symptoms needs urgent medical care. Delay in emergency treatment of a child with acute obstructive laryngitis may lead to serious complications and even to an unfavourable outcome [1–15]

A teenager with a severe form of COVID-19

In most cases children have a light form of new coronavirus infection COVID-19 as compared to adult patients; however, some children may develop severe forms of the disease. Children account for 1—11% of the confirmed patients, less than 1% of the patients have severe and extremely severe forms. The article describes a clinical case of a teenager with a severe course of COVID-19, characterized by the mismatch of physical data and a large degree of lung tissue damage, the development of hemorrhagic syndrome, low effectiveness of antibacterial and antiviral therapy, requiring Tocilizumab

Treatment of acute respiratory viral infections and influenza in children: the minimal sufficiency principle

Acute respiratory viral infections (ARVI) occupy a special place in pediatric practice. This is due to several factors including high incidence, increased morbidity, frequently severe course and risk of complications especially in children with premorbidities, as well as a significant economic and social burden [1]. It should be specifically noted that ARVI in children is the main reason for seeking medical care on an outpatient basis, accounting for more than 90% of all doctor visits during the epidemic outbreak of the disease [2]

SELECTION PRINCIPLES OF INITIAL ETIOTROPIC THERAPY FOR ACUTE UPPER RESPIRATORY TRACT INFECTIONS IN CHILDREN

Acute upper respiratory tract infections maintain leadership in the overall morbidity patterns of the Russian Federation population. The highest prevalence of acute respiratory infections is reported in the pediatric population. For example, if in 2016 there were 21,703.38 cases of acute upper respiratory tract infections per 100,000 population nationwide, the incidence rate in children aged 0–14 years was 4.1 times higher and amounted to 88,621.04 per 100,000 [1]

ТЕРАПИЯ ОСТРЫХ РЕСПИРАТОРНЫХ ИНФЕКЦИЙ У ДЕТЕЙ: ЧТО НОВОГО?

The article is dedicated to acute respiratory infections — the most frequent cause of visits to doctors all around the world, especially among children under 5 years of age. The authors cite data on clinical ARI course variants in small children, present data of virologic analysis and immune status peculiarities, list the main methods of ARI prevention in children and assess efficacy of using bacterial lysates in children with acute and recurrent acute respiratory diseases. Статья посвящена острым респираторным инфекциям (ОРИ) — наиболее частой причине обращения к врачу во всем мире, особенно среди детей до 5 лет. Приводятся сведения о клинических вариантах течения ОРИ у детей раннего возраста, представлены данные вирусологического исследования особенностей иммунного статуса; приведены основные методы профилактики ОРИ у детей; дана оценка эффективности использования бактериальных лизатов у детей с острыми и рекуррентными острыми респираторными заболеваниями

Moyamoya disease in the practice of a pediatric-infectiologist

Moyamoya disease is a rare chronic cerebrovascular disorder characterized by gradually progressive luminal stenosis of the intracranial segments of the internal carotid artery and the initial segments of the anterior and middle cerebral arteries, thus forming a network of minor vascular anastomoses. Impaired blood supply in the above vessels due to occlusion leads to the development of ischemic and hemorrhagic strokes in the respective beds, causing a variety of neurological and visual disorders.Activation of herpesvirus infection in a 2-year-old infant provoked the onset of moyamoya disease. An abnormal posterior right eye segment (bindweed syndrome) detected by an ophthalmic examination, which is commonly concurrent with various cerebrovascular disorders, allowed cliniciansto adequately interpret mild transient neurologicalsymptoms and to rapidly diagnose moyamoya disease, by applying radiodiagnostic methods.The treatment involved antibiotic and antiviral therapy, infusion of glucose-salt solutions and encephabol. The infant’s status improved; seizures were stopped; right muscle tone fully recovered; and right hand tone remained reduced. Revascularization of  the middle and anterior cerebral arteries were further performed