Common Acute Infectious Disease Research Articles

Practice guideline of influenza vaccination and antiviral drugs use in children(2024 editon)

Influenza is the most common acute respiratory infectious diseases among children in China. The annual seasonal influenza outbreak has a significant impact on children's health, poses a significant disease and socioeconomic burden, and arouses a wide public concern. In recent years, a number of new influenza vaccines and influenza antivirals have been approved for use in children, expanding the choices for prevention and treatment of influenza. Pediatric Infection Group, Chinese Society of Infectious Diseases of Chinese Medical Association and Infection Group, Pediatric Expert Committee of National Health Commission Capacity Building and Continuing Education, and China Clinical Practice Guidelines Alliance Methodology Committee organized a multidisciplinary guideline development group (GDG) consisting of experts in pediatrics, infectious diseases,epidemiologists,health policy,and guideline methodology proposed eight key issues concerning influenza vaccination and antiviral use from a practice perspective. Through research question construction, evidence retrieval and synthesis, evidence appraisal and evidence-to-decision discussion, recommendations and implementation suggestions were formulated. This guideline is intended to provide guidance for pediatricians at different facility levels and healthcare providers engaged in vaccination services,and institutional professionals dealing with prevention and control of infectious diseases.

RELATED FACTORS TO THE SEVERITY OF HAND, FOOT AND MOUTH DISEASE IN CHILDREN TREATED AT CAN THO CHILDREN’S HOSPITAL 2022-2023

Background: Hand, foot, and mouth disease (HFMD) is an acute infectious disease caused by an intestinal virus with typical clinical manifestations: bullous rash on the hands, feet, buttocks, or mouth ulcers. The disease can spread very quickly from one child to another through two fecaloral and respiratory routes. Hand, foot, and mouth disease is one of the most common acute infectious diseases in Vietnam. Most cases of the disease are mild. However, the disease can become severe and cause dangerous complications leading to death if not detected early and treated promptly. Objectives: 1) To describe the clinical and paraclinical characteristics of hand, foot, and mouth disease in children treated at the Infection Department of Can Tho Children's Hospital. 2) To analyze factors related to the severity of hand, foot, and mouth disease in children treated at the Infection Department of Can Tho Children's Hospital. Materials and methods: A cross-sectional descriptive study with analysis. Results: General characteristics for men (60.5%), age group 12-24 months 43.5%, the reason for hospitalization is fever (95.5%), mouth ulcers (66.5%), rash, acne water (39%). The severity of hand, foot, and mouth disease is statistically significantly related to white blood cell count >=16x1G/l (p=0.0001) and platelet count >=400x109/l (p=0.0001). There is no relationship between hand, foot, and mouth severity with gender characteristics (p=0.980), age group (p=0.259), diet in the first 6 months (p=0.566), and education level (p=0.293), place of residence (p=0.948), number of days of onset before admission (p=0.171) and initial management (p=0.701). Conclusion: Factors such as white blood cell count (p = 0.001) and platelet count (p = 0.001) were statistically significant in the severity of hand, foot, and mouth disease (p < 0.05). There is no relationship between age group, gender, diet, education level, number of days of onset, and initial treatment with the severity of HFMD.

IJCM_103A: Cost Benefit Analysis Related to Community Acquired Pneumonia inpatients among Geriatric Age Group-A Study Conducted in A Tertiary Care Hospital

Background: Community-acquired pneumonia (CAP) is a common acute infectious disease among elderly people, and is associated with high rates of hospital admission and mortality. Old Age and male sex are known risk factors for CAP among adults and many comorbidity are also risk factors for CAP, such as chronic obstructive pulmonary disease (COPD), diabetes, cancer, dementia, congestive heart failure, and liver function failure. Objective: This study aimed to estimate the economic burden of community- acquired pneumonia (CAP) among elderly patients in Berhampur, Odisha. In addition, the study evaluated the relationship between total treatment cost and CAP risk factors. Methodology: A cross-sectional study was conducted in the IPD of MKCG MKCG Medical College of Berhampur in the period of September-November 2023. Purposive sampling was used and data was collected using semi structured questionnaire and analyzed by MS Excel 2017 Results: Among 348 are inpatient CAP episodes the mean ages were 63±8 years in outpatient group and 70±4 yrs in inpatient groups respectively. The Median treatment cost is Rs.3000/-INR per outpatient episode and Rs 10060/-INR per inpatient episode.Old patient, Male sex, Diabetes, Chronic obstructive Pulmonary Disease, liver dysfunction were associated with increased treatment cost. Conclusion: The economic burden of CAP might be decreased by reducing the number of hospitalizations for mild CAP and the incidence of severe CAP. Therefore, preventative care (e.g. oral hygiene or pneumococcus vaccination) is recommended for patients with related risk factors, such as male sex, older age, diabetes, chronic obstructive pulmonary disease.

Epstein - Barr Virus Salivary Shedding in Patients with Acute Infectious Diseases: A Pilot Study.

Epstein-Barr virus (EBV) is a widely disseminated herpesvirus for which antibodies have been demonstrated in over 90% of adults worldwide. After subclinical primary EBV infections, as well as after infectious mononucleosis, the virus can be shed in saliva for a prolonged period of time. Diseases and disorders that can induce EBV salivary shedding include mental disorders and sex, connective tissue disease, multiple sclerosis, systemic lupus erythematosus, malaria and HIV infection. Since the occurrence of EBV in saliva during acute infectious diseases has not yet been systematically researched, we aimed to investigate the possible relationship between acute infectious diseases and salivary shedding of EBV. This pilot cross-sectional study included consenting adults hospitalized for acute infectious conditions and their peers free of acute infectious diseases. A total of 40 patients with acute infectious diseases were enrolled, along with 41 adults free of acute infections. Peripheral venous blood samples for serodiagnosis and saliva samples for EBV PCR testing were collected from both groups. We fitted logit and general linear models to proportions and to ln (viral copy counts) to generate adjusted proportions and geometric mean values in the two groups of subjects. We used SAS for Windows 9.4. The most common acute infectious disease was COVID-19 pneumonia, followed by hemorrhagic fever with renal syndrome. Crude proportions of people with positive serological test results and those with saliva viral shedding were similar in the two groups. The presented preliminary data do not indicate acute infectious conditions as a marked "contributor" in increasing salivary EBV shedding.

Association between Acute and Chronic Inflammatory States: A Case-Control Study.

Fever is the hallmark of efficient acute inflammatory response, which may be disrupted in chronic inflammatory conditions. The "continuum theory" proposes that the return of acute inflammatory states with high fever predicts improvement in chronic diseases during treatment. Our objective was to investigate the observation made, during classical homeopathic treatment, that such an association exists between chronic inflammation and efficient acute inflammation. In a case-control study, the reports of patients diagnosed with chronic inflammatory conditions with at least 6 months of follow-up under homeopathic treatment were retrospectively sampled from homeopathic medical practices from Greece, India, Romania and Russia. Twenty patients who improved under homeopathic treatment and 20 age-matched controls of those who did not improve were selected. The occurrence of common acute infectious diseases with fever during the follow-up period was investigated. The average age of the cases and controls was 28.4 (SD: 16.64) and 27.9 (SD: 17.19) years respectively. 18/20 cases and 4/20 controls developed common infectious diseases with fever. Cramer's V co-efficient value was found to be 0.551 (p < 0.01), indicating that improvement was more in patients with fever than without. Odds ratio of improving with respect to development of acute infectious diseases was 36.0 (95% CI: 5.8 to 223.5). The binary logistic regression model indicated significant contribution of occurrence of acute infections with fever as a predictor for improvement in chronic inflammatory disease. Classical homeopathic clinical observations indicate an association between chronic inflammatory status in the body and the ability to mount efficient acute inflammation. In this case-control study, the occurrence of common infections with fever during treatment heralded improvement in chronic inflammatory disease. Further powered studies are necessary to substantiate this finding.

Preclinical safety evaluation of a bivalent inactivated EV71-CA16 vaccine in mice immunized intradermally

ABSTRACT Hand, foot and mouth disease is a common acute viral infectious disease that poses a serious threat to the life and health of young children. With the development of an effective inactivated EV71 vaccine, CA16 has become the main pathogen causing HFMD. Effective and safe vaccines against this disease are urgently needed. In our previous study, a bivalent inactivated vaccine was shown to have good immunogenicity and to induce neutralizing antibodies in mice and monkeys. Repeated administration toxicity is a critical safety test in the preclinical evaluation of vaccines. In this study, BALB/c mice were used to evaluate the toxicity of the bivalent vaccine after multiple intradermal administrations. Clinical observation was performed daily, and body weight, food intake, hematological characteristics, serum biochemical parameters, antinuclear antibodies, CD4+/CD8a+ T-cell proportions, bone marrow smear results and pathology results were recorded. The results showed that there was no significant change at the injection site and no adverse reactions related to the vaccine. The bivalent inactivated EV71-CA16 vaccine exhibits good safety in mice, and these results provide a sufficient basis for further clinical trials.

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.

Management of community-acquired pneumonia in adults with type 2 diabetes mellitus in a multidisciplinary hospital

Community-acquired pneumonia (CAP) is a common acute infectious disease in adults. Diabetes mellitus (DM) increases the incidence of CAP and worsens the prognosis. In this regard, the assessment of the current practice of CAP management in patients with concomitant DM and its compliance with clinical guidelines is of great interest.Purpose. To study the current practice of CAP treatment in adult patients with concomitant type 2 DM in a multidisciplinary hospital and evaluate its compliance with the national clinical guidelines.Methods. A cross-sectional observational study was carried out in a pulmonology department of a republican clinical hospital. The study recruited adult patients with a confirmed diagnosis of CAP and previously diagnosed type 2 DM. For each case, demographic characteristics, the severity of CAP, the presence and nature of complications, systemic antibiotic therapy (ABT) and compliance with 16 quality indicators (QI) were recorded. The quality indicators described the adequacy of examination, treatment and secondary prevention of CAP in the presence of concomitant DM. QIs were chosen based on the national clinical guidelines for CAP and algorithms for specialized medical care for patients with DM.Results. Altogether, 48 patients with the average age of 63.9 ± 10.5 years were enrolled. 81% of patients had mild CAP. The severity criteria were assessed in 60% of the patients, prognosis – in 17% of the patients. X-ray examination, pulse oximetry and complete blood count were performed on time in 100% of the cases. A total of 19% of patients had a culture of respiratory specimens. A blood culture was performed in 11,11% of the cases of severe CAP (SCAP). Rapid urine tests for pneumococcal and legionella antigens have not been used. Glycemia was monitored daily in 27% of the patients. ABT was initiated on time in 100% of the patients.Conclusion. Low adherence to many QIs, insufficient control of glycemia and correction of sugar-lowering therapy in the treatment of hospitalized patients with CAP and concomitant type 2 DM were observed, which can worsen clinical outcomes.

Federal guidelines on diagnosis and treatment of community-acquired pneumonia

Community-acquired pneumonia is one of the most common acute infectious diseases that has a significant share in the structure of mortality from respiratory diseases. It is extremely important to select rational antibiotic therapy which ensures optimal clinical efficacy, improved outcome, reduced rate of antibiotic resistance selection, and minimization of side effects.Methods. The target audience of these clinical recommendations are therapists, general practitioners, pulmonologists, anesthesiologist-resuscitators, and clinical pharmacologists. Each thesis-recommendation about diagnostic and therapeutic procedures has been scored according to the scale of classes of recommendations from 1 to 5 and A, B, C scale of the levels of evidence. The clinical recommendations also contain comments and explanations to these theses, algorithms for the diagnosis and treatment, and reference materials on the use of antibacterial drugs and microbiological (culture) tests.Conclusion. The presented clinical guidelines cover current information about the etiology, clinical manifestations, diagnosis and treatment tactics for community-acquired pneumonia. The presented clinical guidelines have been approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation in 2021.

Epidemiological investigation on drug resistance of Salmonella isolates from duck breeding farms in Shandong Province and surrounding areas, China

Duck salmonellosis is a common acute septic infectious disease that spreads rapidly, with serious harm to the duck breeding industry and public health. To date, there are few reports about the epidemiological characteristics of drug resistance in Salmonella from ducks. In this study, an epidemiological investigation was conducted on drug resistance of 110 Salmonella strains isolated from multiple duck farms in Shandong Province and surrounding areas, China. The multidrug-resistant (MDR) rate for 110 Salmonella strains was up to 71.82% (79/110), and 12 types of drug resistance genes were detected in all isolates, including β-lactams, aminoglycosides, tetracycline, macrolides, and quinolones resistance genes. Using the multilocus sequence typing (MLST) based on 7 housekeeping genes, 13 various ST types were identified among all strains, and ST19 (32/110, 29.09%) was the primary type. As the dominant serotypes, S. Kottbus and S. Typhimurium were divided into multiple ST types. A total of 6 kinds of plasmid incompatibility groups were carried in the Salmonella strains, of which IncFIIs (29/110, 26.36%) was most prevalent, and the class I integrons were detected in 78.18% (86/110) of strains. Furthermore, we found that some drug resistance genes, plasmid incompatibility groups, and class I integrons coexist in the same strain. This phenomenon indicates that class I integrons and plasmids are important ways for the spread of drug resistance genes. Therefore, the spread of antibiotic resistance in Salmonella had been facilitated, especially erythromycin (108/110, 98.18%), streptomycin (93/110, 84.54%), and tetracycline (53/110, 48.18%). The above research results broadened ideas and provided directions for the transmission mechanism of Salmonella resistance.

Correlation between acute and chronic inflammatory states, a case control study

Abstract Objective Suppression of efficient acute inflammation may be one of the mechanisms behind the onset of chronic low-grade inflammation. Efficient acute inflammatory response to pathogenic stimulus may not be possible in the presence of chronic inflammation. We investigated if a correlation exists between chronic and efficient acute inflammation. Methods Design Case control study. Setting Homeopathic medical practices in 4 countries Patients with definite improvement in chronic inflammatory conditions with at least 6 months of follow up were selected as cases. Age matched controls involved those who did not improve. Event of interest Occurrence of common acute infectious diseases with fever during the follow up period. Statistical analysis Odds Ratio of improvement in the chronic condition, with development of acute infectious diseases with fever was calculated. Graphs were plotted to study this correlation in individual cases. Results 20 cases and 20 age matched controls were selected. Average age was 28.4 and 27.9 years respectively. 18/20 cases and 4/20 controls developed common infectious diseases with fever during the follow up period. Odds Ratio of the chronic condition improving, with development of acute infectious diseases with fever was 36 (95 %, CI: 5.7973 to 223.5513), z statistic: 3.846 and significance level was p = 0.0001. Graphs of individual cases showed distinct patterns confirming the same. Conclusions In this case control study, appearance of common acute infectious diseases with fever during treatment was strongly associated with improvement in the chronic inflammatory conditions. Larger studies are needed to further establish the correlation. Supported by Nil

Clinical Characteristics and the Risk Factors of Hepatic Injury in 221 Children With Infectious Mononucleosis.

Background: Infectious mononucleosis caused by Epstein-Barr Virus infection is a common acute infectious disease in children. About 40–80% of children with infectious mononucleosis have hepatic injury, and hepatic failure is one of the main causes of death in patients with fatal infectious mononucleosis. Identifying the demographics, presenting clinical characteristics and the risk factors of hepatic injury in infectious mononucleosis children are helpful to remind clinicians which patients are prone to have hepatic damage.Methods: A descriptive, cross-sectional study with a 31-month retrospective review was performed on all infectious mononucleosis children hospitalized in the pediatric department of Fuyang People's Hospital. Demographic data, presenting features, radiology imaging, clinical and laboratory parameters, and clinical outcomes of infectious mononucleosis children were collected.Results: Two-hundred twenty-one infectious mononucleosis inpatients were enrolled, and 43.9% (97/221) patients were considered to have a hepatic injury (defined as alanine amino transaminase > 40 U/L). Compared with patients without hepatic injury, hepatic injury patients were marked with a significantly higher percentage of hepatomegaly (31 vs. 49%), splenomegaly (58 vs. 81%) and palpebral edema (47 vs. 63%), higher age (3.05 ± 2.12 vs. 3.84 ± 2.44), hospitalization days (6.85 ± 2.64 vs. 8.08 ± 2.83), leukocyte (14.24 ± 5.32 vs. 18.53 ± 8.63), lymphocytes (9.48 ± 4.49 vs. 13.80 ± 7.47), the proportion of atypical lymphocytes (0.12 ± 0.07 vs. 0.15 ± 0.08) and aspartate aminotransferase (33.71 ± 10.94 vs. 107.82 ± 93.52). The results of correlation analysis and multiple linear regression analysis indicated that age (OR = 1.185; 95% CI = 1.035–1.357, p = 0.014), female (OR = 2.002, 95% CI: 0.261–0.955, p = 0.036) and splenomegaly (OR = 2.171, 95% CI: 1.018–4.628, p = 0.045) were independent risk factors of hepatic injury.Conclusions: In this study, the hepatic injury was associated with gender, age, and splenomegaly, which improved our understanding of risk factors about hepatic injury among infectious mononucleosis children.

Inhibition of NF-κB/IL-33/ST2 Axis Ameliorates Acute Bronchiolitis Induced by Respiratory Syncytial Virus.

Background/Aim Bronchiolitis is a common acute lower respiratory tract infectious disease in infants. Respiratory syncytial virus (RSV) infection is one of the main causes. Bronchiolitis can lead to a significant increase in the incidence of asthma in young children, but the mechanism of bronchiolitis transforming into asthma is still unclear. The study was aimed at investigating the role of NF-κB/IL-33/ST2 axis on RSV-induced acute bronchiolitis. Methods A total of 40 infants diagnosed with acute bronchiolitis infected by RSV, and 20 normal infants were included in this study. BALB/c mice (6-8 weeks old, 20 ± 1.1 g) were used as study models. Enzyme-linked immunosorbent assay (ELISA), quantitative real time PCR, western blot analysis, immunohistochemical staining, and flow cytometry analysis were performed to examine relevant indicators. Results IL-33 level was significantly elevated, and Th1/Th2 ratio is imbalance after in infants with acute bronchiolitis. In vivo study, we found that NF-κB/IL-33/ST2 axis is mediated the Th2 cytokine levels and BAL cell number induced by RSV. Acute bronchiolitis induced by RSV in a mouse model is attenuated after inhibition of NF-κB/IL-33/ST2 pathway. Moreover, we also confirmed that macrophages are important sources of IL-33 and are regulated by NF-κB pathway in RSV-induced mice. Conclusion We confirmed that inhibition of NF-κB/IL-33/ST2 axis could attenuate acute bronchiolitis by RSV infected. Our findings not only demonstrate the potential role of IL-33 antibody in attenuating RSV-induced lung damage but also provide a new insight into better prevention of RSV-induced asthma by mediating NF-κB/IL-33/ST2 axis.

Shenling Baizhu Powder Inhibits RV-SA11-Induced Inflammation and Rotavirus Enteritis via TLR4/MyD88/NF-κB Signaling Pathway.

Rotavirus enteritis (RVE) is a common acute intestinal infectious disease caused by rotavirus infection. It is an important cause of death in children younger than 5 years worldwide. Shenling baizhu powder (SBP), a classic traditional Chinese formulation, is one of the most popularly prescribed medicines for digestive diseases. Clinical studies have revealed the protective effects of SBP on RVE. However, the potential mechanism is still unclear. In this study, we aimed to evaluate the anti-rotavirus effect of SBP and its mechanism, focusing on the TLR4/MyD88/NF-κB signaling pathway. Our results demonstrated that, based on the inhibition of the virus-induced cytopathic effect in Caco-2 cells, the concentration for 50% of maximal effect (EC50) and selectivity index (SI) of SBP for RV-SA11 in the serum were 5.911% and 11.63, respectively. A total of 219 active compounds with oral bioavailability ≥30% and drug-likeness ≥ 0.18 were selected from the 10 ingredients present in the formulation of SBP, which acted on 471 potential targets. A total of 226 target genes of RVE were obtained from the GeneCards database. The protein-protein interaction (PPI) network showed that there was a close interaction between 44 common targets of SBP and RVE. The results of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis showed that SBP acted on RVE through various inflammatory pathways and the intestinal immune network. Subsequently, we investigated the effect of SBP on TLR4/MyD88/NF-κB signaling pathway in vitro. After infection with RV- SA11, the expression of TLR4, MyD88, and NF-κB mRNA and protein increased significantly, which could be abolished by SBP treatment. In addition, the IL-1β, TNF-α, IL-6, and IFN-β levels increased markedly in Caco-2 cells infected with RV-SV11. Treatment with SBP partly reversed the changes of IL-1β, TNF-α, and IL-6, while further increased the level of IFN-β. In conclusion, our study revealed that SBP can significantly inhibit rotavirus replication and proliferation in vitro. The antiviral effect may be related to the regulation of the TLR4/MyD88/NF-κB signaling pathway, followed by the down regulation of inflammatory cytokines and up regulation of IFN-β induced by rotavirus.

Amino acid substitutions in VP2, VP1, and 2C attenuate a Coxsackievirus A16 in mice

Coxsackievirus A16 (CVA16) is one of the major etiological agents of hand, foot and mouth disease (HFMD), a common acute infectious disease affecting infants and young children. Severe symptoms of the central nervous system may develop and even lead to death. Here, a plaque-purified CVA16 strain, L731-P1 (P1), was serially passaged in Vero cells for six times and passage 6 (P6) stock became highly attenuated in newborn mice. Genomic sequencing of the P1 and P6 revealed seven nucleotide substitutions at positions 1434 (C to U), 2744 (A to G), 2747 (A to G), 3161 (G to A), 3182 (A to G), 4968 (C to U), and 6064 (C to U). Six of these substitutions resulted in amino acid changes at VP2-T161 M, VP1–N102D, VP1-T103A, VP1-E241K, VP1-T248A, and 2C–S297F, respectively. P1-based infectious cDNA was generated to further investigate these virulent determinants. Independent reverse transcription-polymerase chain reaction (RT-PCR) amplifications for mutant constructions and plaque-purification of the P6 for isolation of variants were performed to determine dominant mutations and strains more related to attenuation. The virulent P1, attenuated P6, as well as a plaque purified strain (PP) and other four recombinant mutants, were inoculated into one-day-old BALB/c mice and the 50% lethal dose of each strain was determined. Comparison of virulence among these strains indicated that amino acid changes of VP1–N102D, VP1-E241K and 2C–S297F might be associated more closely with a high level attenuation of CVA16-L731-P6 than other mutations. Identification of novel residues associated with virulence may contribute to understanding of molecular basis of virulence of CVA16 and other enteroviruses.

Educational differences in acute infectious diseases in the Netherlands: results from a nationwide health survey.

It is unclear to what extent socioeconomic inequalities exist in common infectious diseases in high-income countries. We aimed to explore educational differences in five common acute infectious diseases in adults in the Netherlands. As part of a year-round repeated cross-sectional health survey, adults aged 25 and older were asked if they had experienced acute upper or lower respiratory tract infections, acute otitis media, urinary tract infections or gastro-enteritis in the two previous months. If so, participants were asked whether they had consulted their general practitioner and if they had been unable to perform their normal daily activities. These outcomes were analyzed per highest attained level of education. Data of 18 629 survey respondents were used in the analyses. People with a low educational level had lower odds of upper respiratory tract infections (OR 0.88, 95% CI 0.81-0.95), but higher odds of lower respiratory tract infections (OR 1.57, 95% CI 1.16-2.11). After adjustment for several covariates, the differences in upper respiratory tract infections remained statistically significant (aOR 0.84, 95% CI 0.77-0.91). The educational differences in lower respiratory tract infections were mitigated by adjusting for chronic diseases and health behaviours. For all infectious diseases, the likelihood of general practitioner consultation was highest for the lower educated group. Inability to work or perform normal daily activities due to an infectious disease was similar across all levels of education. This study shows that educational differences in incidence and care seeking behaviours exist for common acute infectious diseases in the Netherlands.

Diagnosis, treatment and nursing of influenza

Influenza is a common acute respiratory infectious disease. In recent years, the number of epidemic outbreak cases is high. It is the peak season of the outbreak of influenza when winter turns to spring from 2017 to 2018. This article reviews the current situation of the diagnosis, treatment and nursing of influenza. Key words: Influenza, human; Diagnosis; Treatment; Nursing care

Progress in severe hand, foot and mouth disease of children

Hand, foot and mouth disease(HFMD)is a common acute infectious disease in children caused by intestinal viruses.The severe HFMD, mostly caused by enterovirus 71, can lead to meningitis, encephalitis, encephalomyelitis, pulmonaryedema, irculation disorder and high fatality.To investigate the research progress of pathogenesis, hysiopathology, immunoassay and diagnosis of severe HFMD can provide references to the clinical prevention and treatment. Key words: Hand, foot and mouth disease, Severe; Children; Enterovirus

Rational strategy of pharmacotherapy of patients with community-acquired pneumonia at elderly and senil eage

Introduction. Nonhospital pneumonia is the most common acute infectious infections disease of the lower respiratory tract. The incidence of the community-acquired pneumonia in Ukraine is 3 - 11 cases per 1,000 in adults per year and is the highest among the elderly and old patients. According to the foreign epidemiological studies, the incidence of nonhospital pneumonia in persons of young and middle-aged adults (&gt; 18 years) is 1 - 11,6 %; in the older age groups - 25 - 44 %. Mortality from nonhospital pneumonia without concomitant diseases is also the lowest (1-3 %) in those young and middle age. In patients over 60 years of age, if there is a serious comorbidity and in cases of severe nonhospital pneumonia, this figure reaches 15-30 %. To improve treatment outcome in nonhospital pneumonia and cost optimization in recent years a number of international and national recommendations were proposed. This help doctor to choose the most rational strategy for the management of patients in a specific clinical situation.The aim of the study. Retrospective analysis of case histories of patients older than 60 years with nonhospital pneumonia treated in the therapeutic department during the period from September 2010 to May 2013. Assessment of the quality of medical care and the practice of the appointment systemic antibacterial therapy in accordance with modern standards and quality indicators.Material and methods. Were selected 66 case histories of patients with nonhospital pneumonia, men were 41 people (62.1%), and women - 25 (37,9%), the average age was 69,5 ± 8.1 years. Based on the goal of the research objectives were: to assess the quality of medical aid for patients with nonhospital pneumonia and frequency of antibacterial therapy for patients with nonhospital pneumonia in a particular situation.; explore the features of administration of antibiotics at the start of therapy of the community-acquired pneumonia and compliance choice of antibiotic therapy to the national guidelines. Statistical data processing was carried out in the system of the SPT Statistica, version 8.0.Results and discussion. All hospitalized patients received systemic antibiotic therapy. Frequency assignments AMP patients at the outpatient stage was 21 %. Quick antibacterial therapy was in 15.1 % (n=10) cases, mainly in patients from 60 to 68 years, with no complications. Starting antibiotic therapy in most cases was chosen according to the national treatment guidelines. High efficiency of the combined antibacterial therapy compared with mono - antibacterial therapy was noted.Conclusions:The most effective antibacterial treatment was expected from the triple combination of antibacterial drugs: cephalosporins 3rd generation + fluoroquinolones + macrolides.The study has also noted the high relevance of the ongoing antibiotic therapy with existing national guidelines for management of patients with nonhospital pneumonia (89,9 %), which is comparable with the commitment to comply with the recommendations in the clinics of Europe and the USA.

Return to play after acute infectious disease in football players

Acute infectious diseases are common in athletes and can impair their ability to train and to compete. Furthermore, continuing exercise during infectious diseases may lead to prolongation or aggravation of illness with severe acute or chronic organ manifestations. Therefore, even simple infectious diseases require a sufficient period of convalescence and recovery, during which exercise may be not allowed. Nowadays, especially in professional football with high pressures on players, staff and clubs due to broad public interests as well as financial constraints, the return-to-play decision is of utmost significance. Based on previous suggestions and our own experience within amateur and professional athletes and football players, this article aims to give a short overview on return-to-play decisions after common acute infectious diseases in football players.