Topical issues concerning treatment of intracellular bacterial pathogens in children

M.S. Savenkova1,2, M.P. Savenkov1 1Pirogov Russian National Research Medical University, Moscow, Russian Federation 2Morozov Children’s City Clinical Hospital, Moscow, Russian Federation The article considers the issues of pharmacodynamics, clinical efficacy and safety of macrolide antibiotics. It also discusses the development of microorganisms resistance to macrolides. A number of studies in vivo and in vitro on various cellular and animal models have shown that macrolides have anti-inflammatory and immunomodulatory effects. The presence of these effects in macrolides may be especially relevant during the period of increasing incidence of influenza and the new COVID-19 coronavirus infection. It is known that the severity of viral infections is associated with the release of proinflammatory cytokines. Macrolides change the entire inflammatory response cascade by weakening the excess production of cytokines. Besides, macrolides can affect the activity of phagocytes, changing their function, including chemotaxis, phagocytosis, destroying bacteria and viruses. Earlier it was reported that macrolides (in particular, clarithromycin) can interfere with the replication cycle of the influenza virus, thus leading to its production inhibition by intracellular proteolysis of hemagglutinin. One of the commonly prescribed drugs in this group is clarithromycin. The article summarizes the literature data and presents the materials of our own clinical observations on the clarithromycin treatment of children with intracellular bacterial pathogens, the causative agents of which are Mycoplasma pneumoniae and Chlamydia pneumoniae. Keywords: macrolides, clarithromycin, intracellular bacterial pathogens, children, antibacterial therapy. For citation: Savenkova M.S., Savenkov M.P. Topical issues concerning treatment of intracellular bacterial pathogens in children. Russian Journal of Woman and Child Health. 2020;3(4):326–335. DOI: 10.32364/2618-8430-2020-3-4-326-335. </p

TREATMENT OF FREQUENTLY SICK CHILDREN WITH MIXED INFECTION

The article presents information on treatment of children with frequent mixed infections (herpes-viral and intracellular). Examination of frequently sick children included combination of diagnostic methods (microbiological, serological) for the selection of combined therapy. Inosine pranobex (Isoprinosine) used as a part of complex treatment of mixed infection in frequently sick children favored to decrease of the duration of main clinical symptoms and to elimination of antibodies to infectious agents in respiratory tract or to decrease of their titre in most frequently sick children. Good therapeutic effect was detected in children with herpes viral infection.Key words: frequently sick children, respiratory infections, herpes virus, inosine pranobex, treatment.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 83–88

TREATMENT OF FREQUENTLY SICK CHILDREN WITH MIXED INFECTION

The article presents information on treatment of children with frequent mixed infections (herpes-viral and intracellular). Examination of frequently sick children included combination of diagnostic methods (microbiological, serological) for the selection of combined therapy. Inosine pranobex (Isoprinosine) used as a part of complex treatment of mixed infection in frequently sick children favored to decrease of the duration of main clinical symptoms and to elimination of antibodies to infectious agents in respiratory tract or to decrease of their titre in most frequently sick children. Good therapeutic effect was detected in children with herpes viral infection.Key words: frequently sick children, respiratory infections, herpes virus, inosine pranobex, treatment.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (4): 83–88)</span

PROPHYLAXIS AND TREATMENT OF RESPIRATORY DISEASES AND FREQUENTLY AILING CHILDREN WITH TOPICAL BACTERIAL LYSATES

The share of acute respiratory infections is more than 90% of all diseases of upper airways. It mostly related with insufficiency of immunological defense, which elements are localized in different organs, including mucous tunic of upper airways. The article presents the data on high effectiveness of complex treatment of frequently ailing children with respiratory infection, including topical immunomodulator IRS 19 (bacterial lysates mixture). Its administration combined with antibiotics and antiviral medications allowed achieving more rapid fauces sanation. In particular, significant decreasing of pathogenic and conditionally pathogenic micro flora (neumococcus, neisseria, and Staphylococcus aureus) was marked in 3 months after the beginning of treatment.Key words: frequently ailing children, acute respiratory infections, etiotropic therapy, bacterial lysates mixture.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2009;8(6):92-96

PROPHYLAXIS AND TREATMENT OF RESPIRATORY DISEASES AND FREQUENTLY AILING CHILDREN WITH TOPICAL BACTERIAL LYSATES

The share of acute respiratory infections is more than 90% of all diseases of upper airways. It mostly related with insufficiency of immunological defense, which elements are localized in different organs, including mucous tunic of upper airways. The article presents the data on high effectiveness of complex treatment of frequently ailing children with respiratory infection, including topical immunomodulator IRS 19 (bacterial lysates mixture). Its administration combined with antibiotics and antiviral medications allowed achieving more rapid fauces sanation. In particular, significant decreasing of pathogenic and conditionally pathogenic micro flora (neumococcus, neisseria, and Staphylococcus aureus) was marked in 3 months after the beginning of treatment.Key words: frequently ailing children, acute respiratory infections, etiotropic therapy, bacterial lysates mixture.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2009;8(6):92-96)</span

Importance of herpes viruses in children with post-COVID conditions

M.S. Savenkova1,2, I.A. Sotnikov2, A.A. Afanasieva1,2, Ya.V. Afanasieva3, R.V. Dushkin4 1Pirogov Russian National Research Medical University, Moscow, Russian Federation 2Morozov Children's City Clinical Hospital, Moscow, Russian Federation 3All-Russian Public Organization “Russian Academy of Engineering”, Moscow, Russian Federation 4LLC “Agency of Artificial Intelligence,” Moscow, Russian Federation Aim: to assess the prevalence of detection of confirmed herpes virus infections (HVI) in children who had a previous COVID-19 infection, characterize specific clinical manifestations of the disease under the new conditions (post-COVID syndrome), and to provide a rationale for the administration of drug therapy. Patients and Methods: of 456 patients who received medical consultations from September 2021 to July 2022, the authors selected 72 (15.8%) children (42 boys and 30 girls) who had a previous SARS-CoV-2 infection confirmed by serological tests or polymerase chain reaction and in whom herpes viruses were found during serological evaluation. Results: most of the children (81.4%) visited the polyclinic within the first six months after the COVID-19 infection. Epstein-Barr virus (EBV) was the most prevalent finding among herpesviruses detected in children with post-COVID-19 sequela — it was detected in 44 (61.1%) cases. Human herpesvirus (HHV) 6 and cytomegalovirus (CMV) were less common in this group and found in 41 (56.9%) and 30 (41.7%) children, respectively. HHV-1 and HHV-2 were detected more rarely — in 11 (15.3%) children. Monoinfection was diagnosed in 41 (56.9%) cases and a combination of viruses was found in 31 children, in 22 (71.0%) of them it comprised two viruses, in 6 (19.3%) — three viruses, and in 3 (9.7%) — four viruses. The presence of herpesvirus infections underpinned the main reasons why parents of the ill children were seeking for outpatient care, in particular: a prolonged subfebrile condition (18.0%), fatigue and sleep disorders (27.7%), rashes (16.6%), lymphadenopathy (16.7%), ENT diseases (33.3%), more frequently occurring respiratory diseases (33.3%), and the increase in seizure activity in children with epilepsy (8.3%). In addition to herpes viruses, pathogenic agents were detected in 18% of patients, including intracellular pathogens, which were found in 13.9% of 72 children. Taking into consideration the obtained results and established clinical diagnoses, the authors conducted a review and provided a rationale for the administered drug therapy, including medications for herpes treatment. Conclusion: a prior COVID-19 infection induces immunosuppression and, as a result, the activation of herpesvirus infections as long-term effects of COVID-19 (post-COVID conditions). The presence of mixed viral and bacterial pathogens is an indication for administering antivirals, immunomodulators, antibacterial agents, and probiotics. Keywords: post-COVID conditions, herpesvirus infections, children, clinical symptoms, treatment. For citation: Savenkova M.S., Sotnikov I.A., Afanasieva A.A. et al. Importance of herpes viruses in children with post-COVID conditions. Russian Journal of Woman and Child Health. 2023;6(1):39–44 (in Russ.). DOI: 10.32364/2618-8430-2023-6-1-39-44. <br

Применение продленной аналгезии плечевого сплетения для ранней реабилитации детей с посттравматическими контрактурами локтевого сустава

Objective. Improvement of surgical treatment outcomes in children with post-traumatic elbow contractures. Materials and methods. The study is based on the diagnostic findings of 48 children with post-traumatic elbow contractures who were treated at the Turner Scientific and Research Institute for Childrens Orthopedics. All children underwent complex rehabilitation after reconstructive intra-articular surgery to work out passive motions in the elbow using ARTROMOT-E2 device. The patients of the study group started rehabilitation in the first days after reconstructive intra-articular surgery in the background of prolonged blockade of the brachial plexus. In the control group, the rehabilitation was carried out traditionally on the 6th day after surgery without regional anesthesia. The patients of the study group were supplied with Contiplex SU perinural catheters for prolonged blockade of the brachial plexus using ultrasound (Edge SonoSite) and neurostimulation (Stimuplex HNS12) before surgery. For perioperative blockade of the brachial plexus we used intermittent injection of 0.5% ropivacaine (2 mg / kg). The severity of pain at the stages of rehabilitation was assessed using 10-point grading scale (FPS-R). The range of active and passive motions in the joints was evaluated by measuring the range of motions with a fleximeter. Results. Intermittent injection of ropivacaine before rehabilitation allowed to correct post-traumatic elbow contractures in children in the first days after surgery associated with the minimum subjective pain level and stable hemodynamic parameteres, accompanied with a significant increase of the elbow motion range in comparison with the group of the patients who were not performed regional anesthesia . Conclusion. Prolonged blockade of the brachial plexus in rehabilitation treatment of children with post-traumatic contractures provides appropriate analgesic and myoneural block components from the 1st day after intra-articular reconstructive surgery. Early rehabilitation provides good results of the treatment and reduces rehabilitation period terms.Цель работы - улучшение результатов хирургического лечения у детей с посттравматическими контрактурами локтевого сустава. Материал и методы. Выполнен анализ результатов обследования 48 детей с посттравматическими контрактурами локтевого сустава, которые проходили лечение в ФГБУ Научно-исследовательский детский ортопедический институт им. Г.И. Турнера Минздрава России. Всем детям после реконструктивных внутрисуставных операций проводили комплекс реабилитационных мероприятий, направленных на разработку пассивных движений в локтевом суставе на аппарате ARTROMOT-E2. Пациентам основной группы разработку пассивных движений в локтевом суставе начинали на фоне продленных блокад плечевого сплетения в первые сутки после реконструктивных внутрисуставных операций. В контрольной группе комплекс реабилитационных мероприятий проводили традиционно - с 6-х суток после хирургического вмешательства без регионарной аналгезии. Пациентам основной группы катетеры для продленной блокады плечевого сплетения Contiplex SU устанавливали периневрально надключичным доступом под контролем ультразвука (Edge SonoSite) и нейростимуляции (Stimuplex HNS 12) после индукции в анестезию перед хирургическим вмешательством. Периоперационную блокаду плечевого сплетения обеспечивали интермиттирующим введением 0,5% раствора ропивакаина (2 мг/кг). Интенсивность боли на этапах реабилитации оценивали по 10-балльной лицевой шкале боли (FPS-R). Объем активных и пассивных движений в суставах оценивали измерением амплитуды движений с помощью угломера. Результаты. Интермиттирующее введение ропивакаина перед сеансом ЛФК позволило проводить эффективную разработку посттравматических контрактур локтевого сустава у детей в первые сутки после хирургического вмешательства при минимальном уровне боли и стабильных показателях гемодинамики, что способствовало увеличению амплитуды движений в суставе и сокращению сроков госпитализации. Заключение. Использование продленных блокад плечевого сплетения в структуре активного восстановительного лечения у детей с посттравматическими контрактурами обеспечивает адекватный аналгетический и миоплегический компонент во время проведения ЛФК с первых суток после реконструктивных внутрисуставных вмешательств. Раннее начало реабилитационных мероприятий положительно сказывается на результатах лечения и сроках реабилитации

ACUTE EPIGLOTTITIS IN CHILDREN (ETIOPATHOGENESIS, DIAGNOSIS, TREATMENT)

Acute epiglottitis (AE) must be considered as not a separate entdisease but as compound pathology with wide polymorphism, which can often need an intervention of different medical specialists: experts in resuscitation, infectiologists, immunologists, pulmonologists, and cardiologists. The increase of rate of AE and its septic complications and severe outcomes in last years forced us to consider this problem in detail on the basis of longstanding experience of Morozov children's city clinical hospital.Key words: children, acute epiglottitis, etiology, diagnosis, treatment