научно-исследовательский центр эпидемиологии и микробиологии им. Н.Ф. Гамалеи» Минздрава России, 2 ГБУЗ «Инфекционная клиническая больница №2 Департамента здравоохранения города Москвы», 3 ГБОУ ВПО Первый МГМУ им. И.М. Сеченова Минздрава России, 4 ГБОУ ВПО РНИМУ им. Н.И. Пирогова Минздрава России, Москва Статья посвящена изучению этиологической роли герпесвирусов в инфекционной и соматической патологии детей (n = 770) с использованием комплекса методов лабораторной диагностики. Определена ведущая этиологическая роль ВПГ у детей с нейроинфекциями (12,7%) при первичном инфицировании и у детей с внутриутробной инфекцией (29,0%) при ее реактивации. Показано, что в 50,9% случаев диагноз «инфекционный мононуклеоз» подтвержден обнаружением маркеров острой ВЭБИ, а 20,0% он был заменен на мононуклеозоподобный синдром, так были обнаружены маркеры острой ЦМВИ и в 18,1%-маркеры острой ВГЧИ-6. Роль ВГЧ-6 как основного этиологического агента заболевания установлена у 36,3% детей, поступивших с судорожным синдромом на фоне фебрилитета, у 29,1%-с внезапной экзантемой и у 25,5%-с лихорадкой неясного генеза. Ключевые слова: герпесвирусные инфекции, маркеры острой инфекции, реактивация инфекции, латентная инфекция
Objective. The aim of the study is to investigate the peculiarities of changes in the immune status of individuals with active and latent forms of herpesvirus infections. Herpesvirus infections are an urgent problem of modern health care. Materials and methods. The prospective longitudinal cohort study included 92 permanent blood donors who were examined twice at 6-month intervals for the presence of specific IgM and IgG antibodies and antigens of herpes simplex viruses 1, 2, Epstein-Barr, cytomegalovirus, human herpesvirus type 6, as well as humoral immunity indicators. Results. In the period from October to April, 68.5 % of blood and its components donors were found to have markers of active herpesvirus infection caused by HSV 1, 2, EBV, CMV, and HHV6. The combination of the detected markers in the absence of clinical manifestations and changes in General and biochemical blood tests indicated asymptomatic reactivation of latent infection. The frequency of reactivations in the autumn and spring months is the same. The absence of IgG production after asymptomatic reactivation of HSV-2 and HHV-6 infections and an increase in IgG concentrations to HSV-1, EBV, and CMV were revealed. EBV infection is the most common among the studied nosologies (98.91 %) and is characterized by statistically significantly higher levels of specific IgG. The effect of asymptomatic reactivation of herpesvirus infections on the levels of total IDA, IgM, IgG, IDE, and CEC was not established. Conclusions. Asymptomatic reactivation of herpesvirus infections does not significantly affect the changes in immune status indicators, and the absence of clinical manifestations, and significant changes in General and biochemical blood tests cause epidemiological risks associated with difficulties in identifying the sources of infection.
The study showed a high prevalence of markers of herpesvirus infections among mothers — from 71% to 98% of HSV, EBV and CMV infections and from 29% to 58% of HHV-6 infection. HSV remains the most common etiological agent of intrauterine infections among herpesviruses — markers of active infection caused by this virus were found in 28.3% samples. The difficulty of determining the source of infection in the absence of data in the early stages of pregnancy is presented on 4 out of 10 cases of active HHV-6 infection. Markers of active pneumocystic infection were detected only in mothers: in the group with children under the age of 21 days — in 21—27% of cases, with children aged 22 to 28 days — in 15—21%. In addition to non-specific multiple organ failure during intrauterine infections (26.3%), only one organ system was observed: hypoxic-hemorrhagic lesions of the central nervous system were diagnosed more often — 17%, as well as meningitis/encephalitis, or hepatitis, or pneumonia, or disorders of hematopoiesis, or rash. In 17.5% of children from the comparison group, i.e. without any clinical manifestations of intrauterine infections, markers of active herpes virus infections were detected.
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