Acute Respiratory Viral Infections Research Articles

CHANGES IN INDICATORS OF ENAMEL RESISTANCE IN CHILDREN WITH DIFFERENT FREQUENCY OF ACUTE RESPIRATORY VIRAL INFECTIONS

Dental caries is one of the most prevalent diseases affecting hard dental tissues. Dental caries is also known as multifactorial polyetiological disease. Out of 400 possible causes of caries, the decrease in the resistance of tooth enamel to the influence of organic acids produced by microorganisms is known as a leading cause. The occurrence of the demineralization process depends on a significant number of both general and local factors.
 The aim of the work was to study the parameters of the enamel resistance test and the clinical determination of the enamel remineralisation rate in children who often suffer from SARS in 5 year follow-up period after their receiving preventive measures.
 Subjects and methods. The study involved 80 children aged from 11 to 12 years who were under our observation 5 years ago who then were examined and divided into 4 groups.
 Results. Following the first TER test in children of groups 2, 3 and 4, we have determined that the structural and functional resistance of dental enamel is within 3 points that points out a slightly worse result than in healthy children, who has 1.85 ± 0.15 points. Further studies demonstrate the same situation, and the children of group 4 show the best result among those who are especially susceptible to acute respiratory viral infections. Clinical assessment of the enamel remineralisation rate reveals the same trend as the previous indicator.
 The results obtained after 2 and 5 years demonstrate no significant difference, because the children no longer had such control from our side. Children of group 2, who follow the prescribed only oral hygiene practice, demonstrate the worst results: 3.25±0.23 days (after 2 years) and 3.24±0.21 days (after 5 years), the best result among the children especially susceptible to the respiratory infections is in group 4, in which the speed of enamel remineralisation increased over time 2.53±0.21 days (after 2 years) and 2.73±0.22 days (after 5 years).
 The examination in 5 years has demonstrated that the lack of regular dental check-ups, hygiene control and the use of the treatment and prevention complexes we recommended lead to initial results that corresponded to a low value.
 Conclusion. Strong adherence to dentist’s advice, keeping on the preventive practice and the use of calcium-containing medicines improves the mineralizing properties of oral fluid that leads to an increase in enamel resistance in children of groups 3 and 4. This is especially noticeable in the 4th group of children during the second examination that enables us to recommend this complex in order to increase the resistance of the hard dental tissues

Pleuropulmonary blastoma: case report in a child 8 years old

Pleuropulmonary blastoma is a very rare primary fetal tumor of the lung and pleura in young children and is associated with a mutation in the DICER1 gene. Based on the histological picture, three types of this tumor are distinguished: cystic (type I), solid cystic (II), solid (type III). Treatment is surgical followed by polychemotherapy. The prognosis is unfavorable.
 The authors bring to the attention of colleagues a description of a clinical case of pleuropulmonary blastoma in an 8-year-old child, diagnosed against the background of an acute respiratory viral infection. He fell ill acutely with a rise in temperature and an unproductive cough. The condition was regarded as a course of an acute respiratory viral infection, symptomatic therapy was carried out. After 8 days from the onset of respiratory viral infection, there is a sharp deterioration in the condition in the form of shortness of breath, refusal to eat and drink, and weakness. The child is hospitalized in a Central District Hospital, differential diagnosis with pneumonia is carried out. According to the examination (plain radiograph and CT scan of the chest), a large volumetric formation with even contours is visualized in the right lung. The patient is transferred to a specialized hospital in St. Petersburg. After an MRI of the chest organs with contrast, taking a biopsy material and performing a histological examination, the patient was diagnosed with a tumor of the right lung pleuropulmonary blastoma type II.
 This clinical case of a rare malignant tumor in an 8-year-old child with congenital heart disease and cerebral palsy may demonstrate a severe variant of systemic connective tissue dysplasia and gene mutation.

Diagnosis and treatment of influenza: a literature review

Alisa Pozniak1 1Vilnius University, Faculty of Medicine, Vilnius, Lithuania Abstract Background. Influenza is an acute viral respiratory infection. Influenza viruses spread through respiratory droplets and are characterized by frequent mutations that lead to antigenicity changes. According to the World Health Organization, seasonal influenza epidemics cause approximately 4 million cases of severe illness and 250,000 to 500,000 deaths each year globally. Aim: to review the diagnosis and treatment of influenza. Methodology: literature sources were selected from PubMed database following dates from 2017 to 2022 using keywords and their combinations: influenza, rapid antigen test, neuraminidase inhibitors, favipiravir, baloxavir. Results. Influenza should be suspected in patients who develop acute respiratory symptoms during the influenza season. Diagnostic tests available for influenza include rapid antigen and molecular tests, polymerase chain reaction tests, virological culture. Antiviral therapy should be initiated in patients who are at increased risk of complications from influenza. The neuraminidase inhibitors zanamivir and oseltamivir are used for specific antiviral therapy. New antivirals such as peramivir, favipiravir, laninamivir and baloxavir have emerged as a promising new treatment approach. Conclusions. Influenza is a serious infectious disease that can lead to life-threatening complications. Virological diagnosis is based on specific epidemiological data, clinical symptoms and laboratory tests. Neuraminidase inhibitors are recommended for early treatment. Several cases of zanamivir and oseltamivir-resistant virus have been reported. That is the reason why different approaches for antiviral treatment are being investigated. Keywords: influenza, rapid antigen test, neuraminidase inhibitors, favipiravir, baloxavir.

Respiratory viral infections and their role in human cardiovascular diseases

Acute respiratory viral infections are the most common human diseases. Symptoms of the infection vary from a slight cold to critical condition requiring artificial lung ventilation and support of cardiovascular system. Main risk factors of severe disease include high viral load, co-infection with other pathogens, age from 0 to 2 years and older than 65 years, and immunodeficiency. Cardiac manifestations of the infection are usually caused by indirect effects due to inflammatory reaction resulting in systemic increase in proinflammatory cytokines, so called cytokine storm. However, there have been reports on the identification of respiratory viruses isolated directly from the myocardial tissue, or testing of viral RNA in the myocardium using real-time polymerase chain reaction. This review discusses the direct and indirect effects of respiratory viral infections on causing cardiovascular complications. The authors discuss the similarities and differences of the immunopathogenic mechanisms associated with COVID-19, influenza infection, as well as diseases caused by enteroviruses, respiratory syncytial viruses, metapneumoviruses, and parainfluenza viruses.

Respiratory viral infections and their role in human cardiovascular diseases

Acute respiratory viral infections are the most common human diseases. Symptoms of the infection vary from a slight cold to critical condition requiring artificial lung ventilation and support of cardiovascular system. Main risk factors of severe disease include high viral load, co-infection with other pathogens, age from 0 to 2 years and older than 65 years, and immunodeficiency. Cardiac manifestations of the infection are usually caused by indirect effects due to inflammatory reaction resulting in systemic increase in proinflammatory cytokines, so called cytokine storm. However, there have been reports on the identification of respiratory viruses isolated directly from the myocardial tissue, or testing of viral RNA in the myocardium using real-time polymerase chain reaction. This review discusses the direct and indirect effects of respiratory viral infections on causing cardiovascular complications. The authors discuss the similarities and differences of the immunopathogenic mechanisms associated with COVID-19, influenza infection, as well as diseases caused by enteroviruses, respiratory syncytial viruses, metapneumoviruses, and parainfluenza viruses.

Next Generation Sequencing Approaches to Characterize the Respiratory Tract Virome.

The COVID-19 pandemic and heightened perception of the risk of emerging viral infections have boosted the efforts to better understand the virome or complete repertoire of viruses in health and disease, with a focus on infectious respiratory diseases. Next-generation sequencing (NGS) is widely used to study microorganisms, allowing the elucidation of bacteria and viruses inhabiting different body systems and identifying new pathogens. However, NGS studies suffer from a lack of standardization, in particular, due to various methodological approaches and no single format for processing the results. Here, we review the main methodological approaches and key stages for studies of the human virome, with an emphasis on virome changes during acute respiratory viral infection, with applications for clinical diagnostics and epidemiologic analyses.

Rhino- and RS-viruses in the COVID-19 pandemic

Acute respiratory viral infections are distributed across the globe and are the most numerous human diseases caused by several hundreds of diverse viruses. Human rhinovirus is one of the most common respiratory pathogens worldwide, causing more than half of all acute respiratory viral infection cases. Seasonal human coronaviruses account for 1015% of common cold cases; respiratory syncytial (RS) virus is the most common cause of respiratory hospitalization in infants; influenza viruses, adenoviruses, human parainfluenza virus, metapneumoviruses, and some other pathogens are also widespread. It is believed that viral common colds are mostly self-limited, causing mild infections that usually resolve within 810 days. However, the role of common seasonal respiratory viruses in total respiratory morbidity should not be underestimated. It turned out that during extraordinary conditions of pandemics, they behave differently. This was clearly demonstrated in the last 2009 influenza pandemic. Whereas some viruses lost relevance under the burden of a new aggressive pandemic strain, others, e.g., rhinovirus, continued to fight for existence and not only circulated along with the pandemic pathogen, but delayed its spread in some cases. For instance, the data from some European countries pointed out that the circulation of the H1N1pdm09 influenza A pandemic virus was interrupted by the annual rhinovirus outbreak. Ten years after the H1N1pdm09 influenza pandemic, a new virus outbreak emerged the COVID-19 pandemic has begun. This pandemic, caused by the SARS-CoV-2 virus, has disrupted well-established pathogenetic and epidemiological relationships. The level of circulation of many respiratory pathogens has changed dramatically. For instance, global influenza activity has been at a much lower level than expected for the second year from now. In many regions of the world, the flu season has not been started yet. But what is interesting is that rhinoviruses together with RS-virus again showed their unique ability to compete with highly pathogenic and aggressive pathogens. Along with profoundly reduced circulation of many other seasonal respiratory viruses, rhinovirus, and RS-virus are the most frequently detected viruses. In this review, we have brought together the main biological characteristics of such genetically distinct viruses such as rhinovirus, influenza A virus, RS-virus, and SARS-CoV-2. We focused on their main similarities and discrepancies in the attempt to understand why they behave so differently in extreme pandemic conditions as well as what allows rhinoviruses and RS-viruses to coexist with SARS-CoV-2, which in turn almost fully replaced the influenza virus.

New treatment options for acute respiratory viral infections

The treatment of acute respiratory viral infection remains an urgent public health problem. There are currently a limited number of drugs used for the treatment and prevention of this pathology with proven efficacy and safety. According to current views in the field of immunology, the most important role in immune protection against both viruses and bacteria is played by molecules and receptors that form the so-called “immune synapse”, understood as a contact of cells involved in the detection of an antigen and triggering the subsequent chain of reactions to destroy it. A complex antiviral drug that has the ability to modulate rather than block the activity of its target molecules is a product containing technologically treated antibodies to interferon gamma, CD4 and domains of the main histocompatibility complex. The combined action of its components helps to reduce the infection load on the body, reduce the severity of symptoms of SARS during the first days, reduce the duration of the infectious disease. The pharmacological effect of the drug is achieved by acting on the key molecules and receptors involved in the recognition of pathogens of both viral and bacterial origin by the immune system. In addition, the product has a direct effect on IFN-γ, which results in stopping the multiplication of viruses and protecting healthy cells from infection. The use of the antibody-based drug reduces the risk of complications and helps to increase the body’s resistance to the main pathogens of viral and bacterial infections of the respiratory tract. According to the results of clinical trials, this drug has shown high efficacy and safety in the treatment of acute respiratory viral infections (ARI) in adults. The use of antibody-based medicine in paediatric acute respiratory infections and COVID-19 treatment in an outpatient setting is currently being investigated in multicentre, double-blind, placebo-controlled randomised trials.

Pathophysiological and pharmacological concepts in the treatment of bronchopulmonary diseases

Bronchopulmonary diseases are an urgent problem for practical health care, as they are a frequent complication of acute respiratory viral infections (ARVI), which have a very high incidence in all age groups of the population, and especially among children. The novel coronavirus infection (COVID-19) pandemic, which the world faced in 2019, convincingly confirmed these facts. Therefore, effective pathophysiological treatment of patients with bronchopulmonary diseases is the most important task of modern pharmacotherapy. The 2 most important highly effective mechanisms for protecting the respiratory tract from pathogenic agents that provide the drainage function of the respiratory tract are described: mucociliary transport and cough. When pathological processes occur in the tracheobronchial tree (various bronchopulmonary diseases), the rheological properties of the bronchial secretion, structural and functional characteristics of the mucous membrane and submucosal layer of the airways change. This leads to mucostasis, a violation in the system of mucociliary transport – a key mechanism for protecting the respiratory tract from pathogenic agents, which significantly complicates the course and treatment of bronchopulmonary diseases, because mucostasis contributes to the violation of bronchial patency and the occurrence of atelectasis. Multfactorial is a distinctive feature of changes in mucociliary transport in bronchopulmonary diseases and requires a complex pharmacological action aimed at its normalization. Therefore, pathogenetic therapy aimed at restoring all the key factors of mucociliary transport is targeted in the treatment of various bronchopulmonary diseases. Mucoactive drugs that belong to different pharmacological groups, the use of which is aimed at restoring mucociliary transport, are considered. The necessity of using combined mucoactive drugs for the treatment of patients with bronchopulmonary diseases has been substantiated.

Improving the clinical effectiveness of the treatment of acute inflammatory diseases of the upper respiratory tract in children with the use of silver-based medicines

Introduction. Acute respiratory viral infection (ARVI) is the most common reason for visits to the physician by both children and adults.The aim of the study was to analyse the features of the course of ARVIs in patients with different immune status, to evaluate the effectiveness of standard therapy for these groups of patients, as well as the use of silver-based medicines in the combination therapy of patients.Materials and methods. For the period from July to September 2022, 26 children (Group 1) without immunodeficiency conditions and 26 immunocompromised children (Group 2) were identified, all of them had symptoms of acute respiratory viral infections. In Group 1, 69.2% of children (n = 18) were classified as frequently ill children with ARVI rate of more than 8 times per year, 38.4% (n = 10) had allergic rhinitis, 7.7% (n = 2) had a concomitant bronchial asthma. In Group 2, the distribution of underlying immunocompromised disease was as follows: primary immunodeficiency – 7.7% (n = 2), Hurler syndrome after bone marrow transplantation – 11.5% (n = 3), acute lymphoblastic leukemia during specific therapy – 26.9% (n = 7), with graft versus host disease – 30.7% (n = 8) and currently in remission – 23% (n = 6). Among patients in this Group, only 7.7% of children (n = 2) had a history of allergic rhinitis.Results. The criterion for recovery in Group 1 was reversal of all clinical symptoms, in Group 2 – clinical improvement, normalization or significant decrease in C-reactive protein levels, improvement of paranasal sinuses pneumatization.Conclusion. During ARVI, post-viral rhinosinusitis often occurs, the ability of the mucosa to regenerate becomes disturbed, which makes it more vulnerable to adhesion of viruses, bacteria, and fungi. In this case, especially effective is the intranasal use of a silver-based medicine to form a protective protein film on the injured mucosa. The use of silver-based medicines in the combination therapy of patients with inflammatory pathologies of the nose, nasopharynx and paranasal sinuses can greatly increase the effectiveness of treatment, while shortening the duration of therapy and being safe.

Features of the course of influenza and its co-infection in children at the present stage

Influenza is an acute respiratory infection, mainly affecting the respiratory tract (often the trachea), with a tendency to develop symptoms rapidly and in most cases not requiring hospitalization. All acute respiratory infections are non-specific, with symptoms of intoxication, catarrhal symptoms (nasal congestion, rhinorrhoea, sore throat or pharyngeal discomfort), fever and cough. Improvement and widespread implementation of molecular methods to identify respiratory pathogens has led to the establishment of a higher frequency of co-infections. A literature review of the frequency of influenza co-infections is presented. Clinical cases of monoinfluenza and co-infections of influenza and respiratory syncytial infection are described, demonstrating the antagonistic effect of the two viruses on the course of the disease. In the first case, the patient, 1 year 1 month old, was hospitalised with a fever of 39 ºC in a moderate condition. A nasopharyngeal swab showed RNA of influenza A virus by PCR and was diagnosed with influenza. In the second case, the patient, 2 years old, at the beginning of the disease complained of an increase in body temperature to 38.7 ºC, cough, and difficulty in nasal breathing. On admission, the patient was in moderate condition with a body temperature of 36.6 ºC, clear consciousness and well-being. On auscultation, breathing in the lungs was rigid, single moist rales, scattered on both sides. A nasopharyngeal swab showed RNA of influenza A virus and respiratory syncytial virus by PCR. A viral acute respiratory infection of combined etiology and acute bronchitis was diagnosed. In the third case, a 14-year-old patient presented with complaints of fever up to 39 ºC, headache, weakness, muscle pain, dry cough. The condition was of moderate severity. The diagnosis of influenza A was confirmed by a rapid test for influenza A/B/C. In the treatment and prevention of both monoinfection and co-infections of influenza and other viruses, these clinical examples demonstrate the effectiveness of oseltamivir. These clinical examples highlight some key parameters: respiratory co-infections change the typical clinical picture of the disease, making it difficult to clinically diagnose the infection, highlighting laboratory diagnosis, which in turn facilitates rapid verification of the diagnosis and timely prescription of adequate therapy.

Application of herbal medicinal raw material in complex treatment COVID-19

COVID-19 is an acute respiratory viral infection caused by the coronavirus SARS-CoV-2 (2019-nCoV). Currently, approaches to coronavirus infusion are mostly confined to pathogenetic and symptomatic therapy. New treatment strategies include research to find new molecul candidates for COVID-19 treatment, as well as the repositioning of existing medicinal products. Recently, medicinal plants have been actively studied as potential candidates for COVID-19 treatment, showing high levels of antiviral activity and anti-inflammatory activity. This review focuses on medicinal plants whose biologically active substances are used or can be used for the treatment and the supportive therapy for a new coronavirus infection.

Clinical and Anamnestic Characteristics, Cardiovascular Pharmacotherapy and Long-term Outcomes in Multimorbid Patients after COVID-19

Aim. To study the clinical and anamnestic characteristics, pharmacotherapy of cardiovascular diseases (CVD) and long-term outcomes in post-COVID-19 patients with cardiovascular multimorbidity (CVMM), enrolled in the prospective hospital registry.Material and methods. In patients with confirmed COVID-19 included in the TARGET-VIP registry, the CVMM criterion was the presence of two or more CVDs: arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF), atrial fibrillation (AF). There were 163 patients in the CVMM group and 382 – in the group without CVD. The information was obtained initially from hospital history sheet, and afterwards – from a telephone survey of patients after 30-60 days, 6 and 12 months, from electronic databases. The follow-up period was 13.0±1.5 months.Results. The age of post-COVID patients with CVMM was 73.7±9.6 years, without CVD – 49.4±12.4 years (p<0.001), the proportion of men was 53.9% and 58.4% (p=0.34). In the group with CVMM the majority of patients had AH (92.3-93.3%), CHD (90.4-91.4%), and minority – CHF (42.7-46.0%) and AF (42.9-43.4%). The combination of 3-4 CVDs prevailed (58.9-60.3%). The proportion of cases of chronic non-cardiac pathologies was higher in the CVMM group (80.9%) compared to the group without CVD (36.7%; p<0.001). The frequency of proper cardiovascular pharmacotherapy during the follow-up period decreased from 56.8% to 51.3% (p for trend = 0.18). The frequency of anticoagulant therapy in AF decreased significantly: from 89.1% at the discharge from the hospital to 56.4% after 30-60 days (p=0.001), 57.1% and 53.6% after 6 and 12 months of monitoring (p for a trend <0.001). There were no other significant changes in the frequency of other kinds of the proper cardiovascular pharmacotherapy (p>0.05). There were higher rate of all-cause mortality among patients with CMMM (12.9% vs 2.9%, p<0.001) as well as rates of hospitalization (34.7% and 9.9%, p<0.001) and non-fatal myocardial infarction (MI) – 2.5% vs 0.5% (p=0.048). The proportion of new cases of CVD in the groups with CVMM and without CVD was 5.5% and 3.7% (p=0.33). The incidence of acute respiratory viral infection (ARVI)/influenza was higher in the group without CVD – 28.3% vs 19.0% (p=0.02). The proportion of cases of recurrent COVID-19 in groups with CVMM and without CVD was 3.7 % and 1.8% (p=0.19).Conclusion. Post COVID-19 patients with CVMM were older and had the bigger number of chronic non-cardiac diseases than patients without CVD. The quality of cardiovascular pharmacotherapy in patients with CVMM was insufficient at the discharge from the hospital with following non-significant decrease during 12 months of follow-up. The frequency of anticoagulant therapy in AF decreased by 1.6 times after 30-60 days and by 1.7 times during the year of follow-up. The proportion of new cases of CVD was 5.5% and 3.7% with no significant differences between compared groups. The rate of all-cause mortality, hospitalizations and non-fatal MI was significantly higher in patients with CVMM, but the frequency of ARVI/influenza was significantly higher in patients without CVD. Recurrent COVID-19 was registered in 3.7% and 1.8% of cases, there were no significant differences between compared groups.

Comparative analysis of three multiplex platforms for the detection of respiratory viral pathogens.

Acute viral respiratory infections are a major health burden in children worldwide. In recent years, rapid and sensitive multiplex nucleic acid amplification tests (NAATs) have replaced conventional methods for routine virus detection in the clinical laboratory. We compared BioFire® FilmArray® Respiratory Panel (FilmArray V1.7), Luminex NxTag® Respiratory Pathogen Panel (NxTag RPP) and Applied Biosystems TaqMan Array Card (TAC) for the detection of eight viruses in pediatric respiratory specimens. Results from the three platforms were analyzed with a single-plex real-time RT-PCR (rRT-PCR) assay for each virus. Of the 170/210 single-plex virus-positive samples, FilmArray detected a virus in 166 (97.6%), TAC in 163 (95.8%) and NxTag RPP in 160 (94.1%) samples. The Positive Percent Agreement (PPA) of FilmArray, NxTag RPP and TAC was highest for influenza B (100%, 100% and 95.2% respectively) and lowest for seasonal coronaviruses on both FilmArray (90.2%) and NxTag RPP (81.8%), and for parainfluenza viruses 1- 4 on TAC (84%). The Negative Percent Agreement (NPA) was lowest for rhinovirus/enterovirus (92.9%, 96.7% and 97.3%) on FilmArray, NxTag RPP and TAC respectively. NPA for all three platforms was highest (100%) for both parainfluenza viruses 1- 4 and influenza A and B, and 100% for human metapneumovirus with TAC as well. All three multiplex platforms displayed high overall agreement (>90%) and high NPA (>90%), while PPA was pathogen dependent and varied among platforms; high PPA (>90%) was observed for FilmArray for all eight viruses, TAC for six viruses and NxTag RPP for 4 viruses.

A systematic review and meta‑analysis of Arbidol therapy for acute respiratory viral infections: A potential treatment for COVID‑19.

Arbidol (ARB) is efficacious for the treatment of influenza, and has been recommended for COVID-19. The present systematic review was performed to assess the existing knowledge on ARB therapy for acute respiratory viral infections, especially COVID-19. Subsequently, six databases were searched for publications reporting clinical outcomes of ARB therapy, and registered clinical trials up to May 6, 2022. The available literature was rigorously appraised. Based on the inclusion and exclusion criteria, 20 articles were identified for the final review. The result of meta-analysis showed that there was no significant difference in the negative rate of PCR day 7 [risk ratio (RR), 1.1; 95% CI, 0.87-1.40], negative rate of PCR day 14 (RR, 1.24; 95% CI, 0.92-1.67), PCR negative conversion time [mean difference (MD), -0.26; 95% CI, -1.41-0.90], time of clinical improvement (MD, 1.11; 95% CI, 0.01-2.22), hospital stay (MD, 0.16; 95% CI, -1.62-1.93), rate of improvement on chest computed tomography (CT) (RR, 1.19; 95% CI, 0.74-1.91), duration of CT absorption (MD, -1.43; 95% CI, -10.28-7.42), disease progression (RR, 1.05; 95% CI, 0.64-1.71) and mortality (RR, 0.68; 95% CI, 0.42-1.11). ARB demonstrated significant difference in the rate of clinical improvement (RR, 0.81; 95% CI, 0.67-0.97), duration of fever (MD, -0.38; 95% CI, -0.74- -0.02) and adverse events (RR, 0.65; 95% CI, 0.45-0.94). Although past clinical studies indicates notable results of ARB on influenza, there is no consensus on the drug for therapeutic and prophylaxis of COVID-19. The safety of ARB should be carefully monitored. High quality randomized controlled studies are urgently needed to thoroughly evaluate the efficacy and safety of ARB in patients with acute respiratory viral infections, especially COVID-19.

Cytokine profile in community-acquired pneumonia in children

Community-acquired pneumonia (CAP) is one of the most common acute infectious diseases. To date, the incidence of CAP among children was decreased significantly worldwide, mainly due to increasing use of effective preventive measures. Nevertheless, CAP remains a common cause of childhood morbidity and mortality. Pneumonia may develop at any age, but most often it occurs in young children, who are more likely to have a more severe course of pneumonia. Currently, early diagnosis and prognosis of the disease severity in children is an urgent issue. It was found that, in most cases, a panel of conventional biomarkers, including the number of leukocytes, procalcitonin, CRP is not sufficient for the diagnosis of pediatric CAP. There is a demand for new biological markers which, along with clinical evaluation, may significantly improve diagnostics and management of CAP in children, thus reducing the risk of adverse outcomes associated with this disease. Such markers could be found among the cytokines, which are active participants in the CAP pathogenesis. The aim of this study was to determine the level of several cytokines in blood serum of children with CAP and to assess changes in the cytokine profile depending on the patient’s age and severity of the disease. The study included 117 children aged 1 to 18 years with a diagnosis of CAP confirmed by X-ray examination. The comparison group included 28 healthy children who did not have CAP or other signs of acute respiratory viral infection at the time of examination, being free of any chronic pathology requiring outpatient observation. A number of cytokines were determined quantitatively in blood serum, i.e., IL-1β, IFNγ, IL-2, IL-4, IL-6, IL-10, TNFα, IFNλ2 (IL-28A), IFNλ3 (IL-28B), IL-8, MCP-1, IL-17AF, GM-CSF using test systems based on the “sandwich” method of solid-phase ELISA using peroxidase labeling. As a result, it was found that the content of IL-6, IL-17AF, IL-1β, IFNγ, MCP-1, IFNλ2 (IL-28A), IFNλ3 (IL-28B), GM-CSF was significantly higher in the group of children with severe community-acquired pneumonia. The levels of certain cytokines, e.g., IL-6, IFNλ2 (IL-28A), IFNλ3 (IL-28B), GM-CSF varied depending on the age of patients, thus, probably, reflecting the degree of immune system activation in the children of different age groups.

Place of Immunostimulating Drugs in the Treatment of Respiratory Infections

Every year, influenza and other acute respiratory viral infections (ARVI) cause significant morbidity and mortality worldwide. Most people infected with respiratory viruses have an asymptomatic and uncomplicated course of the disease. ARVI is the most common infectious disease affecting all age groups. Among the causes of temporary loss of working capacity, they occupy the first place – even in the inter-epidemic period, 1/6 of the planet’s population is sick because of them. The objective: to analyse the efficacy of immunostimulating agent in treatment of ARVI on outpatient level. Materials and methods. 322 patients from 18 to 65 years old with symptoms of acute respiratory disease participated in the study. Patients were divided into two groups: 250 people who received symptomatic treatment were included in the control group, 72 patients who received symptomatic treatment and immunostimulating drug – in the experimental group. Results. The study showed that in the experimental group the average time for temperature normalization was 5.0 days, while in the control group it was 7.47 days (p<0.05); disappearance of headache occurs in 5.57 and 7.4 days respectively (p<0.05), disappearance of muscle pain – in 5.0 and 7.4 days (p<0.05). Conclusions. Non-specific drugs with wide spectrum of action are increasingly used in treatment of acute viral respiratory diseases, in particular, – remedies for stimulation of the immune response in the early stages of the disease, which can significantly shorten the period of fever and improve the general patients wellbeing. Timely treatment with immunostimulants can alleviate the severity and duration of clinical symptoms, help to avoid hospitalization and development of complications, reduce the burden on the outpatient department and use of antibiotics.

Antiviral activity of aminocaproic acid against SARS-CoV-2: review of the literature and results of the first experimental study

BACKGROUND. The SARS-CoV-2 pandemic has a significant impact on the global health care system, so effective treatments for coronavirus disease (COVID-19) are urgently needed. Nowadays, drug repurposing is widely considered for COVID-19 therapy; significant attention is paid to inhibitors of transmembrane serine proteases (TMPRSS2), which ensure the penetration of SARS-CoV-2 into the human cells and contribute to their infection. ε-aminocaproic acid (ACA), which has been used worldwide for many years to correct blood loss as a fibrinolysis inhibitor, is also known for its ability to block TMPRRS2. It is approved by the Ministry of Health of Ukraine for the treatment of influenza and acute respiratory viral infections.
 OBJECTIVE. The aim of our study was to evaluate the antiviral effect of ACA in vitro by staining of SARS-CoV-2 viral antigen (spike protein) and by visual scoring of cytopathogenic effect (CPE).
 RESULTS AND DISCUSSION. Using immunohistochemistry assay it was found that the mean value of EC50 for ACA on Caco-2 cells was 2.5 mg/ml and on Calu-3 cells – 17.3 mg/ml. Using CPE assay it was identified that the mean value of EC50 for ACA on Caco-2 cells was 6.4 mg/ml and on Calu-3 cells – 8.7 mg/ml. Additional analysis was shown that ACA has low cytotoxicity with CC50 values of >50 mg/ml on Caco-2 cells after 24h and 48h incubation and 37,57 and 41,29 mg/ml on Calu-3 cells after 24h and 48h incubation, respectively. Antiviral activity of ACA was detected when using non-toxic concentrations of the drug and did not depend on the time of introduction of ACA (before the introduction of the virus simultaneously with the pathogen after 1-hour incubation). ACA can be recommended for further in vivo studies on laboratory animals.

Complex therapy recovered after infectious diseases

Introduction. At the present time, the incidence of acute respiratory viral infections (ARVI) remains at a high level. Some patients who have undergone ARVI and COVID-19 have been disturbed by astheno-neurotic syndrome and chronic fatigue syndrome for quite a long time.Aim. To study the efficacy and safety dietary supplement treatment in the rehabilitation of patients recovered after acute respiratory viral infections.Materials and methods. We have examined 50 patients diagnosed with acute respiratory viral infections (38 people) and COVID-19 (12 people). Age of patients: from 25 years to 60 years old, average age 35 ± 11.84 years old. All patients were randomized into two study groups: the first group (25 people) received a biologically active food supplement and the second group (25 people) did not receive such complex. Сomplex was prescribed to the participants of the first group in amount of two capsules once a day. The course of therapy was 14 days. Before and after taking, all patients were assessed for shortness of breath on the MRC scale, depression on the Beck scale, chronic fatigue syndrome on the FAS scale, and the level of C-reactive protein (CRP) was assessed as well.Results. In the course of the observation, no significant difference between the groups was recorded in the dynamics of the state of assessment for dyspnea, depression and hemoglobin level. The average level of CRP before taking in the first group was 4.4 mg/l (from 0 to 22 mg/l), in the second – 3.8 mg/l (from 0 to 14 mg/l). When comparing the dynamics in the first group, there was more pronounced decrease in the level of CRP. In the first group, decrease in manifestations of pathological fatigue was revealed, characterized by decrease in FAS scores compared to the control group, where the number of scores, on the contrary, increased.Conclusions. Сomplex has a corrective effect on astheno-neurotic symptoms after suffering from acute respiratory viral infections or post-COVID syndrome.

Neuromedin U Induces Pulmonary ILC2 Activation via the NMUR1 Pathway during Acute Respiratory Syncytial Virus Infection.

Activated group 2 innate lymphoid cells (ILC2s) play a crucial role in respiratory syncytial virus (RSV)-induced airway inflammation and allergy-like symptoms because of their ability to secrete large quantities of type 2 cytokines. Cytokines such as IL-33, IL-25, and thymic stromal lymphopoietin are activators of ILC2s. Besides, a regulatory effect of neurotransmitters on ILC2 activation has been reported recently. However, whether and how RSV infection induces neurotransmitter production in the lungs and regulates pulmonary ILC2 activation remains unclear. In this study, using a murine model established by intranasal infection with RSV, we found that acute RSV infection induced the production of a neurotransmitter, neuromedin U (NMU), in the lungs of RSV-infected mice and upregulated the expression of NMUR1 (neuromedin U receptor 1) on ILC2s. Moreover, invivo administration of NMU exacerbated RSV-induced airway inflammation by promoting the proliferation and activation of pulmonary ILC2s via the NMUR1 pathway, which involved PI3K, mitogen-activated protein kinase kinase, and NFAT signaling proteins. Furthermore, pulmonary neurons responded to the stimulation of RSV infection and secreted NMU in a Toll-like receptor 4- and Toll-like receptor 7-dependent manner. Collectively, our data suggest that NMU is a powerful neuropeptide to activate ILC2s, highlighting the critical regulatory effects of neurotransmitters on antiviral, inflammatory, and tissue homeostasis at the mucosal barrier during a viral respiratory infection.