Measles is still an major public health problem in many countries. According to the World Health Organization, up to 3 million measles cases were recorded annually. Measles was one of the main causes of death among young children in the pre-vaccine period. More than 10 million children died of measles every year throughout the world. In 2014, on a global scale, there were 114 900 deaths from measles almost 314 deaths per day or 13 deaths per hour. The main cause of death from measles are complications from the respiratory tract (pneumonia), the central nervous system (meningitis, encephalitis, meningoencephalitis, encephalomyelitis), gastrointestinal tract (diarrhea). Between 2000 and 2014, mass measles vaccination reduced global measles mortality rate by 79%, and about 17.1 million children's lives were saved. However, measles still remains endemic and, one of the leading causes of childhood mortality in developing countries as a result of lack of immunization policies. Up to 98% of measles mortality are registered in developing countries, such India, Bangladesh, Nigeria, RDC, etc. If in the pre-vaccine period, measles affected predominantly children aged less than five years, the global immunization era led to a change in the measles-age-category pattern. The increase measles occurency in adults is due to the loss of protective antibodies, that last generally for 10 to 15 years after vaccination in only 36% of the vaccinees. Complications due to measles in adolescents and adults are most likely than in children. However, immunocompetent individuals may have repeated measles infections. The possibility of transplacental transmission of the disease: measles in pregnant women leads to a higher risk of premature birth, spontaneous abortion, congenital malformations, and with a woman at the end of pregnancy intrauterine infection and the birth of a child with signs of measles. In the absence of specific anti-measles antibodies in the mother, the child may become ill in theantenatal period. Differential diagnosis of measles is carried out with infections that occur with exanthema syndrome (parvovirus B19, sudden exanthema, etc.). Etiotropic therapy is carried out with preparations of recombinant interferon (viferon, etc.). Doses of drugs and the duration of treatment are determined by the severity of the disease. Pathogenetic and symptomatic therapy is strongly recommended.
ГБоУ ВПо «Санкт-Петербургский государственный педиатрический медицинский университет» минздрава России Резюме. В лекции представлены результаты многолетних собственных исследований и анализа данных литера-туры по клинический картине и терапии острого инфекционного мононуклеоза Эпштейн-Барр вирусной природы у детей. Дана подробная характеристика ведущим клиническим синдромам, таким как лихорадка, интоксикация, лимфопролиферативный, гепатолиенальный, синдром экзантемы. Разработаны клинико-лабораторные критерии оценки степени тяжести болезни. Принципы медикаментозной терапии представлены в соответствии с клинически-ми рекомендациями (протоколом лечения) и стандартами оказания медицинской помощи детям с инфекционным мононуклеозом. В комплексной терапии ведущее место занимают этиотропные и иммунотропые средства. В педиа-трической практике наиболее широко применяется комбинированный противовирусный и иммунотропный препарат виферон, который назначают по 150 000 МЕ -детям до 7 лет, по 500 000 МЕ -детям 7-12 лет и по 1 000 000 МЕ -детям старше 12 лет и взрослым 2 раза в сутки с интервалом 12 часов в течение 10 дней. После курса терапии вифе-роном отмечается достоверное сокращение сроков лихорадочного периода и интоксикации, затруднения носового дыхания и лимфопролиферативного синдрома, существенное уменьшение длительности пребывания пациентов в стационаре. Виферон оказывает также положительное влияние на скорость нормализации гемограммы и гемоста-зиологических показателей, таких как протромбиновое время и активированное парциальное (частичное) тромбо-пластиновое время. Индукторы синтеза эндогенного интерферона (анаферон детский, циклоферон, деринат) обу-словливают длительную циркуляцию в крови собственных интерферонов. Антибактериальная терапия проводится при паренхиматозном тонзиллите с учетом чувствительности выделенной микрофлоры. Симптоматическая терапия включает использование жаропонижающих, сосудосуживающих, антигистаминных средств. При развитии токсоко-аллергической сыпи применяют виферон-мазь, виферон-гель, аллергоферон.Ключевые слова: инфекционный мононуклеоз Эпштейн-Барр вирусной этиологии; клиническая картина; критерии оценки тяжести течения; современная диагностика; принципы современной терапии; Виферон. Abstract. The lecture presents the results of many years own research and analysis of the literature on the clinical presentation and therapy of acute infectious mononucleosis, Epstein-Barr viral nature of children. The detailed characterization of the leading clinical syndromes such as fever, intoxication, lymphoproliferative, gepatolienalny syndrome, exanthema. The clinical and laboratory criteria for evaluating the severity of the disease. Principles of drug therapy are presented in accordance with clinical guidelines (treatment protocol) and standards of care for children with infectious mononucleosis. In the treatment leading place etiotropic and immunotropye funds. In pediatric practice, the most widely used and combined antiviral drug viferon immunotropic who appoint 150 000 IU -children up to 7 years,...
The high frequency of severe and complicated forms of infectious diseases in young children, with the possibility of death, confirms the importance of timely specific protection of this age group. In order to identify the causes of violation of the terms of vaccination of young children, 469 histories of children from 0 to 12 months of life were studied. The analysis showed that only 77% of the observed children in the first year of life were vaccinated according to the immunization schedule, whereas in 23% of cases, violations of the vaccination status were found. In 45% of children, the time of immunization was violated already at the stage of the maternity hospital: only every fifth child was not vaccinated because of health reasons, while 79% of children did not receive prophylactic vaccinations due to the mother’s refusal. Medical abductions prevailed in the structure of violations of vaccination terms in the сhildren’s оutpatient: 39% of children were vaccinated with deviations from the schedule due to temporary contraindications, 22% were vaccinated later than terms due to unreasonable medical leads. In 39% of cases of violation of vaccine status is associated with a misunderstanding of the parents of the risk of infectious diseases and the effectiveness of the child’s protection through immunization. Of these, 22% of children were denied, 10% of children were vaccinated with a significant delay, 7% of children did not reach the сhildren’s оutpatient during the year without an explanation of the reasons. Thus, the analysis showed that the majority of the observed children (57%) did not receive timely protection against infectious diseases due to attitudes towards vaccinations of parents, 43% of children were not vaccinated due to medical abductions.
The objective of the study: evaluation of the effectiveness of clinico-epidemiological and laboratory diagnostics of HIV infection in pediatric practice. Materials and methods. Under the supervision of pediatricians of the Department of motherhood and childhood of the St. Petersburg AIDS Center, there were 388 HIV-infected children aged from one month to 17 years inclusive. Due to the reasons of late detection and HIV dissidence of parents, 18 children (4%) died cumulatively among the children observed in St. Petersburg center for AIDS. The object of the immunohistochemical study was randomly selected HIV-infected children who applied to the center for prevention and control of AIDS for return visits. Material for testing for the presence of HIV-1 P24 antigen was taken from the back wall of the nasopharynx. Results. When analyzing the ways of HIV infection in children registered at the maternity and childhood Department of the Saint Petersburg AIDS Center, it turned out that 363 children were infected perinatally (93,6%), 23 (5,9%) sexually infected and 2 children through injecting drugs (0.5%). The proposed method of immunocytochemistry for the diagnosis of HIV infection in children can find its application, especially for primary diagnostics, which may simplify and reduce the cost of laboratory diagnostics.
Currently, in medical practice, there is a high interest in diseases caused by herpes viruses, among them the Epstein-Barr virus (EBV) occupies the leading place. Almost 90% of the worlds population over the age of 40 are infected with VEB. In patients of the first two years, the proportion of asymptomatic carriage reaches 90%, and at the age of 2-10 30-50%. The article considers current data on the impact of EBV on cellular and humoral immunity, its connection with autoimmune and lymphoproliferative diseases. EBV has been shown to play a significant role in the onset of oncological diseases such as Hodgkins lymphoma, Burkitts lymphoma, nasopharyngeal carcinomas, as well as autoimmune diseases systemic lupus erythematosus, rheumatoid arthritis, Sjogrenʼs syndrome, autoimmune hepatitis, lymphoid interstitial hepatitis, lymphoid interstitial syndrome. The results of studies over the past 5 years of cases of activation of autoimmune processes associated with EBV infection, as well as predisposing factors underlying these manifestations, are presented. Due to the fact that the autoimmune effect of EBV infection is manifested in various organs and tissues, this problem is multidisciplinary, affecting such fields of medicine as pediatrics, infectious diseases, endocrinology, oncology, gynecology, ophthalmology, gastroenterology, etc.
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