Catarrhal Symptoms Research Articles

Safe Comprehensive Therapy to Prevent Complications in Children with Catarrhal Symptoms Associated with Acute Viral Respiratory Infections: Series of Clinical Cases

Safe Comprehensive Therapy to Prevent Complications in Children with Catarrhal Symptoms Associated with Acute Viral Respiratory Infections: Series of Clinical Cases

Treatment of influenza and other acute respiratory viral infections in children: multicenter double-blind placebo-controlled randomized comparative clinical trial

The article presents the main results of a randomized clinical trial of the efficacy and safety of Panavir®, rectal suppositories 100 μg, in children with influenza and other acute respiratory viral infections (ARVI).Characteristics of children and research methods. The trial included 40 children from 12 to 17 years old, the children were randomized into 2 groups: 20 children were treated with Panavir®, 1 rectal suppository per day for 7days, 20 children received placebo according to Panavir® regimen on the background of standard symptomatic therapy. The scientists monitored the efficacy criteria: the primary criteria: recovery time and the number of patients with successful treatment (normalization of axillary body temperature no later than 48 hours of therapy); the main secondary criteria: the timing of the normalization of body temperature, the disappearance of intoxication and catarrhal symptoms and satisfaction with the results of treatment by the parents /adoptive parents of patients on the IMPSS scale.Results. In the Group of Panavir®, the authors registered shorter mean recovery periods (4.5 days versus 7.4 days in the Group of Placebo), normalization of body temperature (39.1 hours versus 76.1 hours) and regression of intoxication manifestations (2.9 days versus 4.3 days) and catarrhal (3.4 days versus 5.6 days) syndromes (with statistical significance of intergroup differences). The treatment success was achieved in 85% of cases in the Panavir® Group versus 30% of cases in the Placebo Group; according to this criterion Panavir® exceeded placebo by at least 24.7%. At the end of the therapy course, 80% of the parents /adoptive parents were satisfied with the treatment results in the Panavir® Group versus 25% of cases in the Placebo Group. The authors determined a comparable incidence of adverse events in the Panavir® and Placebo Groups. There were no adverse events associated with the administration of Panavir®.Conclusion. This study established the efficacy and safety of Panavir® in the treatment of children of 12-17 years old with influenza and other acute respiratory viral infections. This drug with a combined antiviral and immunomodulatory effect is promising for pediatric practice.

CLINICAL AND LABORATORY PREDICTORS OF LATENT HERPESVIRUS INFECTION IN CHILDREN WITH ROTAVIRUS GASTROENTERITIS

To achieve the aim there has been examined 104 children aged 1–3 years with moderate and severe forms of intestinal infection of rotavirus etiology, for which they received appropriate treatment in Kharkiv Regional Children's Infectious Diseases Clinical Hospital. Patients were divided into 2 groups: 1 group — 33 children with no concomitant herpesvirus, and 2 groups — 71 patients with rotavirus gastroenteritis and latent herpesvirus infection, caused by cytomegalovirus, Epstein-Barr virus or human herpes virus 6. Children in examined groups were comparable by gender, age, severity of main disease and other parameters.Prognosis of latent herpesvirus infection was made by means of multiple binomial regression. Independent predictors of concomitant herpesvirus infection included maximal daily number of vomiting, maximal increase of body temperature, time of onset of catarrhal symptoms since beginning of disease, level of ketone bodies in urine, amount of leukocytes, rod-shaped neutrophils and eosinophils in common blood count during acute phase of disease. As a reference group, we used respective clinical and paraclinical indices of patients with rotavirus infection only. Accuracy of model is 81.73 %.

Clinical Efficacy and Safety of Pentanedioic Acid Imidazolyl Ethanamide in Patients Aged 3 to 6 years with Influenza and other Acute Respiratory Viral Infections Based on the Results of Double-Blind Randomized Placebo-Controlled Multicenter Study

Study Goals.Assessment of the efficacy and safety of the Pentanedioic Acid Imidazolyl Ethanamide (IPA) in the treatment of influenza and other acute respiratory viral infections (ARVI) in children aged 3–6 years.Children Characteristics and Study Methods.The randomized double-blind placebo-controlled multicenter clinical study involving 190patients aged 3–6 years was carried out as follows: 95 patients received IPA at 30 mg/day dose once for 5 days and 95 patients – placebo using the same pattern. The therapy efficacy was assessed by the body temperature, dynamics of the individual symptoms of thedisease as per the Severity Scale for the patients with influenza and other acute respiratory viral infections (Scale) and the incidencerate of complications of the acute respiratory viral infections. The primary endpoint is the period of the score reduction on the Scale to 2points, providing that there is not more than 1 score on the individual subscales with the body temperature normalization from the startof treatment. The safety analysis was carried out using the assessment of the nature and incidence rate of the adverse events.Results.The IPA use at 30 mg/day dose significantly promotes the achievement of goals for the primary endpoint – the averagevalue in the IPA group is 91.79 h (95% confidence interval – CI from 87.45 to 96.13), in the placebo group – 100.12 h (95% CIfrom 96.73 to 103.51). In the IPA group, the body temperature returned to normal by 18.56 h faster in average compared with theplacebo. The regression of the catarrhal and intoxication symptoms was significantly promoted with the IPA use as follows: by the3rd day of the therapy, the average score on the Scale was 5.22 points for IPA, and it was statistically significantly lower than thatin the placebo group – 6.21 points. The comparative analysis of the incidence rate of adverse events did not reveal the statisticallysignificant differences between IPA and placebo. None of the adverse events recorded was clinically significant, and none caused thecancellation or change in the dosage of the study drug.Conclusions.IPA broad-spectrum antiviral drug at 30 mg/day dose has demonstrated the high efficacy in the treatment of the acute respiratory viral infections of various etiologies in children aged 3–6 years. The IPA use compared with the placebo causes the significant reduction of the fever period, accelerates the relief of the intoxication and catarrhal symptoms, and decreases the recoverytime. The IPA is characterized by high tolerability and high safety, which allows to recommend the drug for the treatment of influenzaand ARVI (acute respiratory viral infections) in children from 3 years of age.

Possibilities of therapeutic correction of ENT pathology associated with COVID-19 in children on an outpatient basis

To evaluate the therapeutic and preventive efficacy of the drug with antiviral and immunotropic activity Cytovir-3 in children with COVID-19 on an outpatient basis. A retrospective analysis the treatment of 52 pediatric patients aged 1 to 17 years with a confirmed new coronavirus infection SARS-CoV-2 with the drug Cytovir-3 was carried out. 28 people, contacts in the family, received the drug for prophylactic purposes. Clinical observation of patients was carried out with an assessment of the severity and duration of fever, the anosmia, catarrhal symptoms in the nasopharynx and analysis indicator of saturation. In the control group, there were 27 patients of the same age who received the medicine Umifenovir and 25 contact family members who did not receive the medicine for prophylactic purposes. The use of Cytovir-3 in the COVID-19 treatment in children led to a decrease in intoxication symptoms 3.2-3.4 days after taking the medicine, a significant reduction of anosmia period recovery time, and elimination of the pathogen according to PCR analysis. The patients receiving the drug did not have ENT- complications and did not require hospitalization. Prophylactic administration of the drug in contact family members statistically significantly reduced the likelihood of developing the disease 3.6 times. The clinical efficacy and feasibility of using Cytovir-3 in the treatment and prevention of new coronavirus infection in patients of different ages has been shown.

Особенности диагностики новой коронавирусной инфекции у детей, госпитализированных в многопрофильный стационар

The second decade of the 21st century started with the emergence of a new coronavirus SARS-CoV-2, affecting humans and causing COVID-19 infection. Children usually have mild disease with one-third of them being asymptomatic, which hinders diagnostics of this infection and does not prevent hospitalization of infected children with non-respiratory disorders to hospitals. Objective. To assess the incidence and specific characteristics of COVID-19 among children emergently admitted to a multidisciplinary hospital not intended for hospitalization of patients with COVID-19. Patients and methods. We performed retrospective analysis of medical records of children admitted to different departments of a multidisciplinary hospital in Moscow between 20.03.2020 and 20.07.2020 (9,779 were discharged during this period). Results. A total of 64 children aged 1 month to 17 years admitted to 10 different departments had positive PCR results for COVID-19 (nasal/oropharyngeal swabs) upon admission to hospital. Fifteen patients (23.4%) had asymptomatic coronavirus infection. These were primarily children of school age and less often of preschool age admitted to the Departments of Traumatology, Surgery with injuries, fractures, exacerbation of chronic nephrological or abdominal disorders. Twenty-four participants (37.5%) presented with mild or none catarrhal symptoms, whereas 12 children were diagnosed with pneumonia. The highest number of SARS-CoV-2-positive children (n = 30; 46.9%) were admitted to the Department of Infectious Diseases, as could be expected. Conclusion. Our findings suggest that, in general, the current situation reflects our knowledge about COVID-19. Children usually have mild or asymptomatic COVID-19 and play a significant role in virus transmission, contributing to the continuation of the pandemic. Our results have high clinical and epidemiological significance and require further investigations among children of different ages to accumulate the data. Key words: children, SARS-CoV-2

Топические этиотропные препараты в терапии инфекционно- воспалительных заболеваний глотки у детей дошкольного возраста. Результаты многоцентрового рандомизированного сравнительного клинического исследования

In accordance with modern clinical guidelines, systemic antibiotic therapy for infectious and inflammatory diseases of the throat is recommended only when beta-hemolytic group A streptococcus is detected. In other cases, it is advisable to use topical drugs of etiotropic, pathogenetic and symptomatic action. The combined preparation Grammidin® has a wide spectrum of etiotropic activity (antiviral, antibacterial and antifungal). Objective of the study: to assess the safety and efficacy of the use of Grammidin® for children (dosage form – metered spray) in the treatment of inflammatory diseases of the pharynx in preschool children. Materials and methods. An open comparative multicenter randomized study was carried out in two parallel groups with the participation of 160 patients aged 3–5 years with an infectious-inflammatory disease of the pharynx of nonstreptococcal etiology. The disease was established clinically by the presence of: a symptom of «sore throat» according to the Wong-Baker (WB) scale, as well as two or more local signs of acute inflammation of the oropharynx (hyperemia of the pharyngeal mucosa, edema of the pharyngeal mucosa, edema of the soft tissues of the posterior and lateral pharyngeal walls, an increase in lymphoid granules of the posterior pharyngeal wall and lateral columns, swelling of the uvula) according to pharyngoscopy. The randomized patients received Grammidin® for children or Hexoral® for 7 days according to the instructions for medical use. Safety was assessed by the incidence of adverse events (AEs) and by monitoring vital signs (body temperature, blood pressure, respiration and heart rate) with monitoring of blood and urine tests. Efficacy was assessed by the decrease in mean disease severity (modified TSS) at visit 2 from baseline – the primary endpoint. Changes were used as secondary endpoints: the severity of the disease (TSS scale), the severity of the sore throat symptom (WB scale), the severity of each of the catarrhal symptoms initially identified according to pharyngoscopy data, the proportion of patients with no sore throat (WB scale), the proportion of patients with the absence of all catarrhal phenomena (pharyngoscopy) at visits 2 and 3. Results. Primary efficacy endpoint: change in mean disease severity on the TSS scale at Visit 2 from baseline in Group 1 was –1,80 (95% CI –1,98 – –1.61) points and –1,31 (95 % CI –1,50 – –1,12) points - in group 2 (p = 0.003). Secondary performance endpoints. According to the analysis of variance in Group 1, there was a statistically significant predominance of the therapeutic effect throughout the treatment in relation to the severity of the disease on the Total Symptoms Score (TSS) scale (p = 0,006), the severity of sore throat on the WB scale (p = 0,006), as well as the severity of individual signsof the disease: «Hyperemia of the pharyngeal mucosa» (p = 0,036) and «edema of the pharynx» (p = 0,037). The rates of relief of symptoms: «the severity of lymphoid granules of the posterior pharyngeal wall and lateral columns» and «uvula edema» were similar in both groups. The proportion of children with no sore throat at visit 2 was statistically significantly different: 46 and 29% for Group 1 and Group 2, respectively (p = 0,022). Safety assessment. In the course of the study, 1 child was registered in each group who developed 1 AE of mild severity, had a doubtful connection with the study drugs, did not require their cancellation and additional therapy, and spontaneously ended without consequences by visit 3. Conclusions. The combined drug Grammidin® for children in the form of a metered spray was well tolerated by children aged 3–5 years and according to a number of main criteria of efficacy (total severity of symptoms of the disease, sore throat, hyperemia and swelling of the pharyngeal mucosa) showed a pronounced and statistically significant advantage in speed and severity effect over a monocomponent preparation containing hexetidine in the form of an aerosol.

ASSESSMENT OF THE DEPENDENCE OF THE CLINICAL MANIFESTATION OF ACUTE GASTROENTERITIS CAUSED BY ROTAVIRUS ON ITS GENOTYPES

The leading cause of acute gastroenteritis (AGE) in children is rotavirus. In different countries, different rotavirus genotypes prevail and are associated with different severity of disease. The purpose of our study was to identify the distribution of rotavirus genotypes in Kyiv, Ukraine, and to determine the correlation between the genotypes and course of disease. Materials and methods. 978 children under 5 years of age were examined with АGE symptoms and not vaccinated against rotavirus. Determination of rotavirus antigen and genotype were performed using the immunoenzymatic assay and real-time RT-PCR. We assessed the demographics, clinical manifestations of AGE, the Vesikari scale AGE severity. Results. The G4P[8] genotype prevailed in Ukraine during 2014-2018. The G1P[8] was the second most common. G9P8 was the third, the fourth place was shared by G2P[4] and G3P[8]. Fever, as a manifestation, was more pronounced in G1P[8] and G3P[9]. The highest number of vomiting episodes per day occurred in the G1P[8] and G4P[8]-related cases. Maximum of diarrhea episodes per day was observed in genotypes G1P[8], G3P[8], G4P[8] and G9P[8]. Mucus and blood in stool were found in genotypes G3P[8] (1/33.33 %), G4P[8] – blood (1/2.27 %). The children with genotypes G1P[8] and G4P[8] had catarrhal symptoms. More cases of moderate and severe dehydration, occurred in the G4P[8]. The Vesikari scale analysis showed that only G1P[8] led to mild cases(3.57 %). The most widespread genotypes, G1P[8] and G4P[8], led to a moderate illness in 14.29 % and 13.56 % cases, respectively, and to a severe illness in 82.14 % and 86.44 % cases, respectively. Conclusions. G4P[8] was associated with the most severe disease due to more frequent and prolonged vomiting, febrile fever and bloody diarrhea. G1P[8] and G4P[8] were associated with catarrh.

Случай развития переднего увеита на фоне острого лимфобластного лейкоза

A clinical case of the development of a rare form of ocular manifestation of acute lymphoblastic leukemia, one of the most common oncological diseases in childhood, is described. A seven-year-old child initially had weakness, decreased appetite, and a single episode of subfebrile condition for two days without catarrhal symptoms. Further, an increase in the cervical lymph nodes was noticed. Then a hemorrhagic rash appeared all over the body. In the complete blood count (CBC) test: erythrocytes (RBC) – 3.8 * 1012 / l, hemoglobin (HGB) – 115 g/L, leukocytes (WBC) – 121*109/L, platelets (PLT) – 22*109/L. The child was admitted to the regional children’s clinical hospital. On examination, 90% of blast cells were detected in the myelogram. Against the background of a confirmed remission of the oncological disease, iridocyclitis of the left eye was diagnosed. It could not be stopped by standard antibacterial and antiinflammatory therapy. After a while, the right eye was also involved in the pathological process. Hematologists confirmed the recurrence of acute lymphoblastic leukemia after bone marrow puncture. The presented clinical case demonstrates the fact that the treatment of ocular manifestations of acute lymphoblastic leukemia can be effective only in the treatment of the underlying disease.

The role of children and adults as a reservoir of pathogens during the seasonal rise in the incidence of upper respiratory tract infections

Infection caused by the Epstein-Barr virus (EBV) is more common in children and is transmitted through contact with saliva. The role of adults in the epidemic process has not been sufficiently studied. The goal is to study the role of children and adults with catarrhal phenomena in the spread of EBV during the seasonal epidemic rise in the incidence of upper respiratory tract infections (URTI). Materials and methods . In the epidemic season of 201 9—2020, 226 people with catarrhal symptoms (140 adults and 86 children) were examined by PCR for the presence of EBV and other URTI pathogens in their nasal and oropharyngeal smears. Results. Significant differences in the frequency of detection of pathogens in children and adults have not been established. In both groups, EBV was detected as a single pathogen and in combination with other pathogens. The presence of a runny nose, sneezing and coughing is unusual for EBV, but occurs when EBV is combined with other URTI pathogens. Discussion. The presence of EBV in the nasopharynx and oropharynx in children and adults plays an important role in the spread of the pathogen. The combination of EBV with other pathogens that cause runny nose, sneezing, and coughing contributes to the formation of a more concentrated infectious aerosol and its spread over long distances. Conclusions. During the seasonal epidemic upsurge, children and adults are equally involved in URTI epidemic process and are sources of EBV infection with a frequency of 3 1.39 and 37.14 per 1 00 examined and an average concentration of the virus in smears of 31 199 and 33 074 copies/ ml, respectively. In children and adults, EBV was detected in combination with other U RTI pathogens with a frequency of 1 6.28 and 1 8.57 per 1 00 subjects, respectively. The presence of EBV in the upper respiratory tract, together with other pathogens, contributes to the active transmission of EBV during the seasonal epidemic rise of upper respiratory tract infections.

Characteristics of CoVID-19 in children: the first experience in the hospital of st. Petersburg

Objective:to identify the clinical, laboratory and epidemiological features of the new coronavirus (CV) infection inthe provision of specialized medical care to children in themegalopolis of the Russian Federation.Methods:674 cases of hospitalization of patients frombirth to 17 years old inclusive with confirmed COVID-19 inthe period from March 26 to June 26, 2020 in a children’smultidisciplinary hospital in St. Petersburg. Diagnostics ofSARS-COV-2 in upper respiratory tract (URT) smears wascarried out by PCR (a set of reagents for detecting RNA ofcoronavirus 2019-nCoV by PCR with hybridization-fluorescence detection “Vector-PCRRV-2019-nCoV-RG”). Patientsunderwent 4 (3; 5) repeated examinations depending on thediagnosis of the referral, as well as the duration of the convalescent virus carriage. The analysis of the severity of thecourse of the disease, the main clinical manifestations andtheir relationship with the development of pneumonia, as wellas the epidemiological features of COVID-19 in children. Theduration of inpatient treatment, outcomes and the need forintensive care are described. Changes in a number of laboratory parameters on analyzers made in the USA were assessed:a clinical blood test on a hematological one - Coulter UniCel(Beckman Coulter), a biochemical blood test on a biochemical one - Uni Cel DxC (Beckman Coulter), a coagulogram ona hemostasis analyzer (Instrumentation Laboratory).Results:Overall, there was a favorable course ofCOVID-19 in children. Intensive therapy was required only in3.6% of cases with a total mortality rate of 0.15%, Kawasakilike syndrome was recorded in 0.3% of cases. In 1/3 of patients, prolonged viral shedding from the upper respiratorytract was detected. In children, intrafamilial infection fromadults was in the lead; schoolchildren accounted for half ofall hospitalizations. A distinctive feature of the new infectionwas mild clinical symptoms with fever and catarrhal symptoms up to 4/5 of cases, gastrointestinal symptoms - in every third patient. There were no significant differences in the severity of the disease by age. Pneumonia, diagnosed in ¾cases by computed tomography, complicated the course in13.1% of cases. The defeat of the lungs was accompanied byfever and dry cough, and in a more severe course: desaturation, chest pains, a feeling of insufficiency of inspiration. Theage peaks of the incidence of pneumonia were revealed: at4, 9, 12 years old and at the age of 17 years, the maximum(in 1/3 of cases). Laboratory changes were insignificant andquickly reversible.Conclusion:the course of COVID-19 in children in themegalopolis of Russia is comparable with foreign information. However, taking into account the experience of “Spanish ‘flu”, it is possible that in pediatric practice the numberof severe forms and unfavorable outcomes may change inthe near future, especially due to the difficulty of diagnosingKawasaki-like syndrome and the need for a multidisciplinaryapproach to the treatment of such patients. Currently, themost vulnerable to the new CV are children with severe oncological, neurological and cardiovascular pathology, whohave a rapid decompensation of the underlying diseaseagainst the background of COVID-19.

New COVID-19 coronavirus infection in the practice of a neonatologist and pediatrician

The article analyses the data published from January 2020 to April 25, 2020 in the print media or available on the official websites of peer-reviewed medical sources (pre print), international and national medical professional communities, and state regulatory authorities dedicated to the epidemiological and clinical laboratory features of the new coronavirus infection in newborns, infants and older children. The authors have concluded that currently there are no convincing data on vertical transmission of infection. At the same time, they have found that there is a risk of horizontal infection of a newborn child; therefore, there is the need for strict adherence to the recommended algorithms for monitoring children in the neonatal period born by the women with positive or presumably positive COVID-19 (Coronavirus disease 2019) status. The authors note that due to the limited quantity of observation cases, all existing recommendations are temporary and may be revised. The newborns from mothers with COVID-19 demonstrate the variability of clinical picture from asymptomatic course to severe respiratory failure. In the post-neonatal period children have asymptomatic or mild course of a new coronavirus infection. The authors note that some children with an asymptomatic course of the disease have pneumonia detectable during X-ray examination. Children with the manifest forms of COVID-19 do not have specific clinical symptoms; both children and adults have fever, cough and other catarrhal symptoms; tachypia, tachycardia and gastrointestinal symptoms are much less common. It has been found that children with COVID-19, unlike adults, are unlikely to develop severe pneumonia, as well as conditions requiring intensive care and mechanical ventilation. Changes in laboratory parameters in children also do not have a consistent pattern and they are less pronounced than in adults. The epidemiological data indicate that children are one of the main sources of the ongoing spread of infection in the human population. The authors present the first-ever data on the cases of 45 infants born from the mothers with positive COVID-19 status in Moscow.

Guidance for the management of adult patients with coronavirus disease 2019.

In December 2019, a novel coronavirus was identified in Wuhan City, Hubei Province, China and later the disease was named coronavirus disease 2019 (COVID-19). On March 11, 2020, the World Health Organization (WHO) officially announced that COVID-19 had reached global pandemic status. This article summarized the understanding of the etiology, pathogenesis, epidemiology, clinical characteristics, diagnosis, treatment, rehabilitation, and prevention and control measures of COVID-19 based on the available data and anti-epidemic experience in China.

Primary Observational Results on Children Who Have Been Exposed to COVID-19 in Moscow

Background. The number of people infected with SARS-CoV-2 causing COVID-19 is growing worldwide. It is necessary to study features of prevalence and clinical signs in pediatric population considering the fact that this disease is rather new.The aim of the study is to analyze the features of prevalence and clinical signs of pathologic process of COVID-19 in pediatric patients according to the results of practical experience of primary care medical facility (Children’s City Outpatients Clinic № 133) under the conditions of pandemia.Methods. Pediatricians of Children’s City Outpatient’s Clinic № 133 have examined certain categories of pediatric patients (especially who came from abroad or contacted with infection) for the presence of a new coronaviral infection in February 2020. Doctors have been examining children with catarrhal symptoms and hyperthermia since March 2020. The survey of children in February and March was carried out in accordance with algorithms (uniform for adults and children) approved by the Moscow City Health Department. Later, the survey was carried out in accordance with the guidelines for children prepared by the Ministry of Health of the Russian Federation. The throat and nose swabs on SARS-CoV-2 were performed for all patients on the 1st, 11th and 13th day of the disease.Results. 1,900 children (or 3.1% of total attached pediatric population) have been examined in our outpatient’s clinic with the polymerase chain reaction (PCR) method on the presence of the new coronavirus RNA since the beginning of the COVID-19 pandemic in Russia. The course of disease was analyzed in first 100 patients with the confirmed COVID-19 diagnosis: 58 (58%) boys and 42 (42%) girls. In 81% of cases we revealed the source of infection, in 19% – we did not. The disease was asymptomatic in 11 (11%) children examined after the contact with ill relatives; 89% had mild COVID-19 disease with light catarrhal signs. The most numerous group of patients who had COVID-19 consisted of children over 10 years of age (42%); in 20% of cases it was pupils from 7 to 10 years old. Smell disorders were reported in children over the age of 10 in 50% of all cases.Conclusion. New coronaviral infection COVID-19 in children is taking mild course, without complications, under the «mask» of common viral infection. Thus, it is unknown either those who have undergone COVID-19 asymptomatically remain healthy or they need special rehabilitation. The timely development of clear algorithm with step-by-step instructions for various situations for every health professional is crucial during these difficult times.

P1810INFECTION TRIGGERS AS A COMPLEMENT-ACTIVATING STATE IN ATYPICAL HEMOLYTIC-UREMIC SYNDROME IN CHILDREN

Abstract Background and Aims Atypical hemolytic-uremic syndrome (aHUS) is a rare life-threatening disease, which is based on the dysregulation of the complement system. Different complement-activating factors is known for aHUS, including infections, vaccination, concomitant diseases, pregnancy, surgical interventions, transplantation, etc. In 24% of cases, a connection with diarrheal prodrome is revealed, in 18% - with acute respiratory infections. The diagnosis of aHUS is established if other forms of thrombotic microangiopathy (TMA) are rejected: HUS associated with Stx-producing strains of E. Coli and Shigella dysenteriae (STEC / Stx - HUS), TTP. We analyze the etiology of trigger events in children with aHUS. Method An analysis of 165 case histories of children with aHUS was carried out for the period from 2000 to 2019. Of these, 70 are boys and 95 are girls. The average age was 4.83 ± 3.84 years (from 2.5 months to 17.8 years). The diagnosis of aHUS was established on the basis of microangiopathic hemolysis, thrombocytopenia, organ dysfunction and recurrent TMA activity. 66 patients were genetically screened, among which mutations in genes encoding complement proteins were detected in 23 (34.9%) children. Results The prodromal period of patients with aHUS was characterized by fever (53.9%), weakness (42.4%), decreased appetite (27.3%), catarrhal symptoms (20.6%), nausea (17.6%), and vomiting ( 63%), abdominal syndrome (26.7%), diarrhea (38.8%), hemocolitis (12.1%). Among the trigger events, acute intestinal infections accounted for 44.2% of cases, acute viral infections - 26.0% (with catarrhal syndrome - 20.6%, intestinal - 5.4%), herpetic infection (CMV, VEB, HSV 1 type) was found in 3% of cases. In 10.3% of children, the TMA symptom complex developed after vaccination with mainly live attenuated vaccines, in 4.2% against other rare conditions (trauma, taking an unknown drug, tonsillitis, etc.). In 12.1% of cases, the disease manifested itself without a complement-activating state. E.coli was confirmed in 16 observations (EHEC - 12, EagEC - 2, EPEC - 2), shigellosis (Shigella Flexner 6) was detected in 1 case. The nature of viral diarrhea was identified in 8 patients: rotovirus RNA - 4, adenovirus DNA - 2, norovirus RNA - 2, type 5 Coxsackie RNA - 1. In the case of TMA after E.coli and shigella, the initial diagnosis was STEC / STx - HUS, which was subsequently transformed into aHUS due to the recurrent TMA activity with persistent dialysis-dependent AKI, and the addition of extrarenal symptoms not associated with volume overload. Conclusion Infectious diseases are the most common complement-activating condition for the implementation of aHUS in children. Among them, in most cases, diarrheal prodrome is associated with acute intestinal infections, which differs from population data (44.2% vs 24%). With the development of TMA in children with escherichiosis/shigellosis, repeated episodes of hemolysis, platelet consumption, the appearance of extrarenal symptoms with normalization of hematological parameters, the detection of pathogenic mutations in complement genes and the positive effect of complement blocking therapy (eculizumab) confirms the diagnosis of aHUS in this category of patients. To exclude or confirm aHUS in these cases, monitoring of clinical and laboratory data is necessary.

Homeopathic medicines as a means of non-specific prophylaxis and therapy of influenza and acute respiratory diseases

Many years of experience in the use of homeopathic medicines in the treatment and prevention of respiratory diseases has been accumulated in Russia; it testifies to the effectiveness of their use in pediatrics. Materials and methods. The results of a multicenter open randomized observation on the effectiveness of the homeopathic medicine Oscillococcinum® in the treatment of influenza and other acute respiratory diseases in children aged 6 to 12 years are presented. Results. It was shown that short-term (within 4 days from the onset of the disease) administration of the drug according to the standard scheme leads to a persistent improvement in clinical symptoms already on the 4th day of illness in most children (88.66%). Symptoms of intoxication, such as weakness, headache, temperature reaction are recorded by the 14th day of the disease in only 2—4% of cases. Catarrhal symptoms stop by the end of the second week of the disease in most children. Only 1 adverse event was identified associated with the course of the underlying disease.

The role of group A β-hemolytic streptococcus in the etiology of acute inflammatory pathology of the pharynx in children and adolescents

Determine the incidence of GABHS in children with catarrhal symptoms (rhinorrhea, cough) and without them. 69 children with signs of acute tonsillopharyngitis (ATP) in the first 2 days of the disease were examined. Patients were divided into 2 groups depending on the presence or absence of rhinorrhea and cough. All patients underwent a comprehensive otorhinolaryngological examination and bacteriological examination of smears from the surface of the posterior pharyngeal wall and lacunae of the tonsils. Obtained data was processed by basic statistical methods. Incidence of GABHS in children with ATP without catarrhal symptoms was 9.5%, with rhinorrhea and cough - 3.7%. Median age for the detection of GABHS in patients with ATP was 5.6 years. A statistically significant symptom of GABHS-positive patients in our study was the enlargement of the anterior cervical lymph nodes; plaques on the tonsils were found only in 20% of cases. GABHS is predominant in patients with ATP without catarrhal phenomena, however, the presence of rhinorrhea and coughing in a patient does not exclude the possibility of the presence of GABHS infection, therefore, patients with ATP should undergo an objective examination for GABHS.

Влияние терапии комбинированным препаратом интерферона альфа-2b с витаминами Е и С на течение ОРВИ и гриппа в детском возрасте: результаты мета-анализа

Key words: viral shedding, influenza, children, interferon, interferon-alpha-2b, intoxication, catarrhal symptoms, fever, ARVI, complications, rhinitis, rhinorrhea

Рациональная терапия острых респираторных инфекций у детей раннего возраста препаратом рекомбинантного интерферона альфа-2b

Influenza and acute respiratory viral infections (ARVI) remain a global health problem worldwide, and therefore the search for effective means of prevention and treatment of these diseases is extremely urgent. Objective. To evaluate the therapeutic efficacy and safety of a drug form of recombinant human IFN alpha-2b in combination with a complex of antioxidants (Viferon®-suppositories) in children with ARVI. Patients and methods. Clinical and laboratory studies were conducted in 100 children (toddlers up to 3 years old), hospitalized in St. Olga's children hospital No 4 with a diagnosis of influenza or ARVI. The etiology of diseases was established using serological methods and immunofluorescence analysis; the immune and interferon status was determined. VIFERON®-suppositories were used rectally daily in age-related dosages. The effectiveness of therapy was evaluated by comparative analysis of disease symptoms, as well as laboratory indicators – immune and interferon status. Results. The use of VIFERON® – suppositories contributed to reducing intoxication and catarrhal symptoms, speeding up the recovery time of patients. After the treatment, the children's ability to produce IFN-α and – γ, as well, as sIgA content in nasal secretions, increased, but there was no marked enhancement in serum IL-1β, IL-8 levels, whereas the children in the control group and in 30% of cases occurred to change them. The use of the medicine did not cause any complaints in patients and staff. Conclusion. Data from clinical and laboratory studies of children hospitalized for ARVI, whose therapy included the VIFERON® – suppositories, indicate a significant therapeutic effect of this medicine and restoration of the immune and interferon defense systems of patients. Keywords: children, acute respiratory viral infections, recombinant interferon α-2b, immune status, interferon status, antiviral therapy, cytokines IL-1β, IL-8, IL-10, TNF-α

Use of azoximer bromide for treatment of children's inflammatory infections of respiratory system: a meta-analysis of controlled clinical studies

Objective. The aim of this meta-analysis is to summarize clinical efficacy of azoximer bromide for treatment of inflammatory respiratory infections in children and adolescents based on data from controlled clinical trials. Materials and. methods . In total 5 clinical studies with data from 542 patients aged. 3—18 years were selected, where effectiveness of therapy with addition of azoximer bromide to combination, therapy was compared, to standard, symptomatic treatment. Results. The results of the meta-analysis demonstrate that the addition of azoximer bromide from the first day to respiratory infections treatment in patients aged. 3-18 years helps to reduce temperature normalization, time [mean difference -1,92 day in favour of treatment with investigational drug (95% confidence interval 1,65; 1,15) according to the random effects model or -1,4 days (95% confidence interval 3,16; 0,67) according to fixed effects model]. Moreover azoximer bromide use in inflammatory respiratory infections treatment reduces the duration of fever and intoxication symptoms by 1,4 days in comparison with the control group (95% confidence interval 1,65; 1,15), headache by 0,53 days (95% confidence interval -0,91; -0,15), muscle and. joint pain by 1,59 days (95% confidence interval -2,1854; -1,0028) and catarrhal symptoms by 1,23 days (95% confidence interval 1,32; 1,14). Conclusion. Addition of azoximer bromide as nosotropic therapeutic agent to combination, therapy of respiratory diseases make possible to control intoxication, symptoms in a better way, reduces the morbidity of infectious and inflammatory process, has positive effect on immune mechanisms and causes almost no side effects.