Regional Lymphadenitis Research Articles

Clinical experience in managing patients with lymphogranuloma venereum.

The article presents two clinical cases of lymphogranuloma venereum with classic manifestations of the disease. In the first case, the stages of lymphogranuloma venereum can be traced: the appearance of a primary affect (ulcer on the penis), the development after a few weeks of regional (inguinal) lymphadenitis and proctitis (anorectal syndrome). On the background of prescribed antibiotic therapy according to the regimen: doxycycline at a dose of 100 mg twice a day for 21 days, the clinical manifestations completely resolved. The second case is interesting in the development of the clinical picture of lymphogranuloma venereum from the second stage of the disease (inguinal syndrome) and the ineffectiveness of treatment with doxycycline, which subsequently required surgical intervention. In addition, in this case, Chlamydia trachomatis DNA was initially detected in a urethral scraping without evidence of urethral inflammation, which is rare for this disease. To treat a patient with “groin syndrome” as a clinical manifestation of lymphogranuloma venereum, a fluoroquinolone antibiotic, levofloxacin, was successfully used according to the regimen: 500 mg twice a day for 28 days.

Regional Lymphadenitis Related to Bacille Calmette–Guerin Vaccination: A Case Series from a Tertiary Care Childrens’ Hospital

Background: Immunization with Bacille Calmette–Guerin (BCG) vaccine, used worldwide for years, for the prevention of tuberculosis, rarely leads to complications like regional lymphadenitis. There is controversy regarding the management of BCG lymphadenitis. We share our experience regarding the management and course of this rare complication in nine infants. Clinical Description: Over a period of 24 months, 9 infants, who had received BCG vaccination after birth, presented to us between 1 and 3 months of age, with left-sided supraclavicular swellings. The infants were otherwise thriving well, with no constitutional symptoms. On examination, the infants were stable with normal systemic examination. Local examination revealed all the swellings to be supraclavicular lymphadenopathies, two of them being suppurative. Thus, the infants fulfilled the clinical criteria for BCG regional lymphadenitis. Management and Outcome: Fine-needle aspiration cytology from the swellings of all infants was consistent with BCG lymphadenitis. Two of the smears were positive for acid-fast bacilli. Besides percutaneous pus aspiration in two infants, no other intervention was done in any of the infants, and no antibiotics nor antitubercular treatment was administered. With observation and regular follow-up, the lymphadenopathies resolved over time in all the infants. Conclusion: This case series creates awareness regarding the benign, self-resolving nature of BCG regional lymphadenitis, which may be followed conservatively without any medical or surgical intervention.

Clinical efficiency and stability of surface-modified implants: acid modification versus photoactivation.

. Aim: To study the stability of surface-modified dental implants, with the usage of sandblasting/acid modification vs. photoactivation. Materials and Methods: In the observation were included 164 patients with dental defects. All patients had digital impressions taken by scanning the oral cavity with an intraoral scanner 3Shape TRIOSR. Group A (80 subjects) included implants whose surface was modified with a combination of sandblasting and acid. Group B (84 subjects) - implants after modification with photoactivation. The implant stability quotient was recorded using an Osstell MentorTM device. Results: The reliable effectiveness of the photoactivation method in complex treatment of the surface of dental implants in improving the stability of fixed dentures in the short and long-term periods of observation was proven. When assessing immediate clinical outcomes, there was no significant difference in the frequency of hyperemia, algesia, hyperthermia, soft tissue edema, regional lymphadenitis, depending on the classical method of treating the implant surface and the complex method with photoactivation. Of the long-term clinical outcomes with classical surface treatment, the absolute risk of implant failure was 1.2%, relative risk - 0,99 [CI%0,96-1,0]. The average value of the implant stability coefficient (ISQ) and the data of the Periotest study at the time of surgery probably did not differ in the observation groups, after 3 months, a higher index was proven in the treatment of the surface by the method of photoactivation and greater stability of the mandibular implants. At the time of implantation, there were no statistically significant differences in implant fixation between the groups, however, during prospective observation in group A, secondary stability indicators based on periotestometry results were significantly lower. Conclusions: It was proved the reliable effectiveness of the photoactivation-method for surface modification in the short and long-term periods of observation for improving the results of orthodontically treatment.

Rubella and pregnancy: what should a general practitioner do?

Along with toxoplasmosis, cytomegalovirus, and herpes, rubella belongs to TORCH infections, i.e. the diseases that can have a detrimental effect on the fetus if infected during pregnancy. The disease is caused by a virus, the only known source and carrier of which is a person. The disease affects mainly children and young people, who tolerate the disease quite easily. As for the clinical symptoms, the appearance of a rash, a slight increase in temperature, regional lymphadenitis, and sometimes conjunctivitis should be noted. In adults, inflammation of the joints, the duration of which is usually 3-7 days, can also be noted. The rubella virus poses the greatest danger during the primary infection of a woman during pregnancy, especially in the first trimester. The probability of intrauterine infection of the fetus in this situation is 90%, resulting in its death or the development of congenital rubella syndrome (CRS). As a result, children with congenital rubella syndrome may suffer from developmental disorders, hearing and vision disorders, diabetes mellitus, and thyroid pathology. To prevent intrauterine infection of the fetus, vaccination against rubella is carried out, leading to the development of stable immunity. To date, rubella vaccination is carried out in 168 countries of the world, which makes it possible to cover about 70% of women with immunization. The countries of the African continent and South-East Asia are the least covered by rubella vaccination, resulting in about 4 cases of birth of children infected with the virus in utero per 1,000 bir ths.

Typical time courses and appearance of skin reactions at the site of Bacillus Calmette-Guérin vaccination for infants inoculated at 5-8 months of age.

Taiwan increased the Bacillus Calmette-Guerin (BCG) vaccination age from 24h after birth to 5-8months of age to lower BCG-related osteitis/osteomyelitis in 2016. However, the sequences of skin changes at the injection site and in the corresponding lymph nodes are unknown for infants vaccinated at an older age. We prospectively collected the photographs of skin reactions within 6months after vaccination. The type, size, onset time, and duration of the skin reactions were recorded and analyzed. We enrolled 532 infants. The types and median times at onset of skin reactions were as follows: erythema at week 1, induration at week 3, ecchymosis at week 4, and ulceration at week 6. The peak skin responses were at week 6, with average sizes of 8.4mm, 7.4mm, and 8.2mm for erythema, induration, and ecchymosis, respectively. The duration of induration was long, with 57.6% and 23% of the infants still having a response at week 12 and 24, respectively. The rate of induration size≥20mm was 1.7% (95% confidence interval: 0.8%-3.2%). Overall, 46.4% of the infants experienced ulcerative change, with most occurring at week 6 (34.1%), and 9.5% and 4.1% of the infants still had ulceration at week 12 and 16, respectively. Twelve infants (2.3%) had spontaneous resolution of regional lymphadenitis, with the onset time ranging from week 1 to 12. All infants had developed a scar at the end of follow-up. Our study demonstrates the typical appearance and time courses of skin reactions in infants who received the BCG vaccination at older than 5months of age. Infants vaccinated at this age may have a more potent skin response with longer induration and ulceration than those vaccinated at birth.

Algorithms for the diagnosis and treatment of chronic tonsillitis

Introduction. Features of the course of chronic tonsillitis may vary depending on the age of the patient, his comorbid status and the severity of the disease. One of the characteristic manifestations of the disease are local signs of chronic tonsillitis and manifestations of a systemic inflammatory response. The article considers the issue of increasing the effectiveness of treatment of patients with chronic tonsillitis at the stage of clinical examination by using bioregulatory therapy drugs in complex conservative treatment. Aim. Evaluation of the effectiveness of bioregulatory therapy (Traumeel ® S) in the dynamic monitoring of patients with chronic tonsillitis. Materials and methods. A randomized controlled trial was conducted in patients with newly established and confirmed diagnosis of chronic tonsillitis, decompensated form. The severity of subjective and objective symptoms was assessed using a visual analogue scale, as well as pharyngoscopy data, supplemented by the results of ultrasound examination of the palatine tonsils. Results. In the group of patients who took bioregulatory therapy, positive dynamics was observed already on the 2 nd day and related to the reduction of bad breath and sore throat. Comparative analysis in the groups made it possible to note a more significant and faster dynamics in relation to changes in the palatine arches, elasticity of the palatine tonsils and the phenomena of retromaxillary regional lymphadenitis. The monitoring of the condition of the treated patients over the course of 6 months made it possible to identify more rare recurrences of chronic tonsillitis among patients in the complex treatment of which the bioregulatory medicine was used, the frequency of which was 2.8 times lower compared to the control group. Discussion. The conducted study showed that the use of bioregulatory therapy has a positive effect on the symptoms of the inflammatory process. This is confirmed by an improvement in the general condition of patients in dynamics, a decrease in pain according to visual analogue scale, and an objective assessment of changes in the structure of the palatine tonsils using ultrasonography. Conclusions. Вioregulatory therapy as of a complex application (oral and parenteral forms) increases the effectiveness of treatment in patients of the dispensary group with a newly diagnosed chronic tonsillitis, decompensated form. Drug can significantly reduce the duration of therapy and reduce the number of relapses after complete recovery within 6 months.

СРАВНЕНИЕ КЛИНИЧЕСКОЙ КАРТИНЫ ИКСОДОВОГО КЛЕЩЕВОГО БОРРЕЛИОЗА У ДЕТЕЙ И ВЗРОСЛЫХ В АМБУЛАТОРНЫХ УСЛОВИЯХ

The polymorphism of clinical manifestations of Lyme borreliosis (LB) creates significant problems in the study of this disease. In addition to the variability in classifications used in Russia and abroad, the spectrum and the frequency of symptoms in outpatient and hospitalized patients with LB differ significantly, which makes it difficult for a physician to understand the clinical picture of LB. The purpose of the study was to describe the clinical picture of LB in an outpatient infectologist appointment conditions according to the E. Asbrink, A. Hovmark classification of Lyme borreliosis in children compared with adults. Materials and methods of the research: a retrospective single-center cohort study was conducted based on the analysis of the data from 213 outpatient records of patients with confirmed LB diagnosis, consulted by infectologist at the Moscow Infectious Clinical Hospital No. 1 of the Moscow Department of Healthcare (Moscow, Russia) in Jan. 2018 - Sep. 2019. In order to compare the clinical features between children and adults the patients were divided into 2 groups by age: adults (18 years and older) and children (1 to 17 years old). The confirmation of the LB diagnosis was carried out according to the clinical and/or laboratory criteria using enzyme immunoassay and immune blotting. Results: in the group of children (n=52), the median age was 6 [3; 8] years old, the proportion of boys was 44% (n=23, 95% CI 30-57%), girls - 56% (n=29, 95% CI 43-70%). In the group of adults (n=161), the median age was 59 [49; 65] years old, the portion of males was 29.2% (n=47, 95% CI 22.2-36.0%), females - 70.8% (n=114, 95% CI 64.0-77.8 %). The most frequently diagnosed was LB at its early localized stage, both in children (n=44, 84.0%, 95% CI 74.0-93.0%) and adults (n=123, 76.4%, 95 % CI 69.7-82.6%). No statistically significant difference was found (p=0.248). Erythema migrans (EM) was the vast majority of early localized stage manifestations in children (95%, 95% CI 88-100%). The incidence of EM in adults was not statistically significantly different from that in children (94.3%, 95% CI 89.9-98.1%, p=1.000). EM in children was most often localized on the scalp (46%, 95% CI 31-60%), in adults the most common localizations were the skin of the trunk and lower extremities (total 92.9%, 95% CI 87.8-97.0; n=118). Differences in the typical localization of EM in children and adults were statistically significant (p<0.001). In the clinical picture of the early localized stage of LB the fever was rare in both children (7%, 95% CI 4-16%) and adults (8.9%, 95% CI 4.3-14.5%) (p=1.000). At the same time, the regional lymphadenitis was detected statistically significantly more often in adults than in children (50%, 95% CI 35-65% vs. 26.8%, 95% CI 19.3-34.5%, p=0.005). Both groups showed a lower incidence of regional lymphadenitis during examination by an infectologist if the patient was prescribed antibiotic therapy at the place of residence, while statistically significantly more often in the group of children (34%, 95% CI 23-46 vs. 15%, 95% CI 8-23, p=0.003). Conclusion: the authors have described the spectrum and frequency of the LB clinical manifestations according to the E. Asbrink, A. Hovmark classification in children vs. adults. The influence of research conditions and the previous antibiotic therapy on the spectrum and frequency of the LB clinical manifestations detected during the initial examination was demonstrated as well.

Clinical variants of the non-erythema form of ixodid tick-borne borreliosis

The patients with the nonerythematous form of borreliosis (83 persons) were observed in the epidemic seasons of 19971999. The organ pathology often develops on the background of the general infections syndrome. The clinical variants of the early period are described: arthromyalgic, similar to influenza, regional lymphadenitis, neurologic, cardiovascular, hepatitis, mixed.

Bacillus Calmette-Guerin Vaccine-Associated Lymphadenitis in Children

Background: Tuberculosis (TB) is one of the most important infectious diseases worldwide. Bacillus Calmette-Guerin (BCG) is a live attenuated vaccine, entered into the childhood immunization program by the World Health Organization (WHO) in 1974 to prevent TB. One of the relatively common complications of BCG vaccination is regional lymphadenitis. Objectives: This study aimed to determine the lymphadenitis incidence in BCG-vaccinated children in southwest Iran. Methods: In a prospective descriptive study, infants born from March to June 2017 were evaluated for BCG vaccine complications at two, four, six, nine, and 12 months of age in Ahvaz, southwestern Iran. Results: The study enrolled 1,506 infants (794 males and 712 females). Among the vaccinated infants, four (0.26%) had injection site reactions, and 106 (7.03%) presented lymphadenitis (66 males and 40 females). The lymphadenitis rate was significantly higher in males than in females (P = 0.024). The mean age at presentation was 4.28 ± 0.79 months. Suppurative lymphadenitis was seen in 53 (50%) cases and nonsuppurative lymphadenitis in 53 (50%) cases. About 80% of nonsuppurative lymphadenitis resolved entirely or partially after a one-year follow-up. Of 53 cases with suppurative lymphadenitis, 46 (43.4%) developed spontaneous drainage, and seven (6.6%) were drained by needle aspiration. No significant relationship was found between the BCG inoculation site and lymphadenitis rate. No other complications such as osteomyelitis or disseminated BCG infection were observed after one year of follow-up. Conclusions: The relatively high incidence of BCG lymphadenitis in this study may be due to the vaccine strain, young vaccinees, and improper vaccination techniques. In most cases, nonsuppurative lymphadenitis regressed spontaneously, and suppurative lymphadenitis was drained spontaneously or by needle aspiration.

Erizipel nakon ujeda mačke izazvan bakterijom "Pasteurella multocida" - prikaz slučaja

Introduction: Erysipelas is a characteristic form of acute superficial streptococcal cellulitis, usually treated in outpatient service, primarily with penicillin, or erythromycin, in cases where the patient is allergic to penicillin. We are reporting the case of a patient who was preventively treated with erythromycin, after a cat bite, but during treatment developed erysipelas, which, after a swab sample from the wound was analyzed, proved to be caused by Pasteurella multocida, resistant to erythromycin. Case report: A 53-year-old woman came to the outpatient clinic with clinical signs of erysipelas cruris. Seven days before, she had been bitten by her own cat. The wound was surgically treated, and erythromycin, 500 mg qid, was prescribed as prophylaxis of wound infection. There were no signs of infection. On the 5th day following the bite, the patient was running a very high fever (39.2°C), but she was without other symptoms, thus the fever was considered to be a symptom of the flu. On the following day, prominent erythematous swelling appeared around the site of the wound, with localized lymphangitis and regional lymphadenitis, and discharge from the wound. The diagnosis of erysipelas was made. The peripheral blood test results were as follows: WBC = 13.9 x 109 /l; NE = 82%, CRP = 43 IU. A swab sample was collected from the wound and the patient was started on penicillin. On the 7th day of penicillin administration, there were no signs of inflammation, while the blood test results were as follows: WBC = 5.1 x 109 /l; NE = 52%; CRP = 24 IU. Pasteurella multocida, resistant to erythromycin but sensitive to penicillin was isolated from the swab sample. Conclusion: Erysipelas, although an easily recognized clinical entity, can be caused by other microorganisms, besides streptococcus. It is very important to consider this in order to make an accurate diagnosis and prescribe the appropriate therapy.

How to suspect tularemia in a child outside the endemic focus

Tularemia is an acute zoonotic natural focal disease caused by Francisella tularensis, with a variety of pathogen transmission mechanisms. A person becomes infected in various ways, mainly through insect bites (mosquitoes, ticks), through direct contact with infected animals, and also by inhalation. The disease is characterized by high fever, intoxication, inflammatory changes in the area of the entrance gate, regional lymphadenitis. It is often difficult to suspect tularemia in the early stages due to the lack of specificity of clinical manifestations (fever, intoxication, regional lymphadenitis). Even in endemic regions, in most cases, acute respiratory viral infection, lymphadenitis, fever of unknown origin are diagnosed, which leads to a late start of etiotropic treatment. There is a clinical case of tularemia in a 13-year-old child who was misdiagnosed in the early stages of the disease. And only a careful collection of an epidemiological history (stay in an endemic area, a mosquito bite), as well as a competent assessment of clinical and laboratory data, allowed tularemia to be included in the differential diagnosis on the 18th day of the disease and confirmed by the detection of the highest titers of anti-tularemia antibodies in blood serum. Thus, against the background of low morbidity, especially in childhood, there is no alertness among doctors of all specialties, which leads to late diagnosis and, as a consequence, late started specific treatment. All children with prolonged fever in the presence of lymphadenitis of unknown genesis, who have been in a territory unfavorable for tularemia, need to undergo a specific examination to identify mild and erased forms of the disease.

Cervical osteomyelitis and an epidural abscess: an unusual form of cat-scratch disease in one case

BackgroundThe association of cervical osteomyelitis with epidural abscess is extremely rare; atypical symptomatology is what makes diagnosing and management challenging. This case is the sixth case reported in the literature. The objective of our study is to describe the clinical manifestation and treatment approach.Case presentationA 71-year-old male with no medical history, who was admitted to the emergency room for C7-T1 spinal cord compression caused by Bartonella henselae, marked improvement after decompression by evacuating the empyema and antibiotic course.ConclusionCat-scratch disease or subacute regional lymphadenitis is a bacterial infection caused by Bartonella henselae; children and adolescents are mostly infected. Systemic complications are rare; the prevalence of bone damage is estimated at 0.1 to 0.3%. Our case allows a literature review of and put in focus on our diagnostic and therapeutic attitude.

The role of surgical management of BCG vaccine-induced regional suppurative lymphadenitis in children: a 7\xa0years' experience from one medical center

BackgroundThe management strategy of Bacille Calmette-Guérin (BCG) vaccine-induced regional suppurative lymphadenitis in children is still controversial and more clinical studies are needed. We therefore present a surgical case series to explore the role of surgical management for this dilemma.MethodsFrom January 2013 to June 2020, data from 65 patients diagnosed with BCG vaccine-induced regional suppurative lymphadenitis were retrospectively reviewed. Clinical characteristics, ultrasonographic findings, surgical procedures, perioperative management, and outcome were analyzed. The association between postoperative seroma and symptom duration, skin involvement, and postoperative hospital stay were compared using Yates's corrected Chi-square test and Student's t-test for statistical analysis. The follow-up period ranged from three to six months.ResultsOf the 65 cases, the median age at presentation was 3.4 months. All patients were full-term with normal range of birth weight and received a BCG vaccination in the first 24 h of life. All patients underwent surgical excision of the abscess with the involved lymph node(s). Postoperative seroma formation was found in 20 patients and fine needle aspiration was needed. There was no significant association between postoperative seroma formation with symptom duration, skin involvement, and postoperative hospital stay. No oral anti-tubercular agents were given postoperatively. The mean length of postoperative hospital stay was 6.02 ± 1.62 days. Sixty-four cases (98.46%) received only one procedure and recovered. One patient required a second procedure due to postoperative sinus.ConclusionsThe present study showed that surgical excision of the abscess with involved lymph node(s) is one of the choices for BCG vaccine-induced suppurative lymphadenitis, but special attention should be paid to controlling the surgical indications. Intraoperative meticulous manipulation and postoperative care are crucial to achieve a good outcome.

Management of Bacille Calmette-Guérin Lymphadenitis and Abscess in Immunocompetent Children: A Systematic Review.

There is no consensus on managing common adverse reactions to Bacille Calmette-Guérin (BCG) vaccination. We systematically reviewed the management of BCG-associated regional lymphadenitis and injection site abscess in immunocompetent individuals. Searches of Medline, Embase and PubMed were done until November 2020. Randomized controlled trials (RCTs) and cohort studies that compared management strategies for complications of intradermal BCG vaccination were included. Of 1338 individual articles, 15 met inclusion criteria. Six RCTs, 4 prospective and 4 retrospective cohort studies compared management in 1022 children with BCG-associated lymphadenitis. For nonsuppurative lymphadenitis, no antimicrobial was found to significantly impact on time to resolution or prevention of suppuration. For suppurative lymphadenitis, there was some evidence that needle aspiration shortens time to resolution and prevents sinus tract formation. Surgical excision (mainly offered for persistent suppurative lymphadenitis) generally had favorable outcome. Two cohort studies (including 1 aforementioned) compared management strategies in up to 36 children with BCG injection site abscess; one showed no difference in outcome in children treated with antibiotics and the other reported complete resolution without treatment. Evidence does not support a role for antimicrobial therapy in the management of localized reactions to BCG vaccination in immunocompetent children. Needle aspiration may shorten the recovery period for BCG-associated suppurative lymphadenitis. BCG injection site abscess usually heals without treatment. However, studies are limited and cases are not well defined. Growing research into novel BCG applications provides opportunities to investigate optimal management strategies for adverse reactions in a prospective manner using active safety surveillance.

Atypical presentation of bartonellosis with hepatolienal lesions

Cat scratch disease is caused by the gram-negative intracellular bacterium Bartonella henselae (B. henselae). Human infection occurs mainly through cat scratches and bites. In typical cases, the clinical course is presented by a primary affect on the skin and regional lymphadenitis. The atypical presentation of infection can occur with fever, abdominal, ocular and neurological manifestations. A special feature of the abdominal form is the presence of solitary or multiple hypo/anechoic foci of different size and shape in the liver and spleen. B. henselae infection is one of the most common mimics of malignant lymphoma, when the spleen is involved in combination with B symptoms (weight loss, night sweats and prolonged fever). A history of recent contact with cats and diagnostic IgG titers to B. henselae indicate infection. There is no consensus on the choice of antimicrobial drug and the duration of therapy for systemic forms. The article presents its own experience in the diagnosis and treatment of such patients. The patient's parents agreed to use the information, including the child's photo, in scientific research and publications.

Rubella — what is the danger of this disease?

Rubella, along with toxoplasmosis, cytomegalovirus and herpes, belongs to TORCH infections, diseases that can have a detrimental effect on the fetus if infected during pregnancy. The disease is caused by a virus, the only known source and carrier of which is human. Mostly children and young people are susceptible to the disease; they tolerate the disease quite easily. Of the clinical symptoms, it should be noted the appearance of a rash, a slight increase in temperature, regional lymphadenitis, and sometimes conjunctivitis. In adults, joint inflammation can also occur, which usually lasts 3–7 days. The rubella virus is most dangerous when a woman first becomes infected during pregnancy, especially in the first trimester. The probability of intrauterine infection of the fetus in this situation is 90 %, as a result of which it may die or develop congenital rubella syndrome (CRS). As a result, children with congenital rubella syndrome can suffer from developmental defects, hearing and visual impairments, diabetes mellitus and thyroid disorders. To prevent intrauterine infection of the fetus, vaccination against rubella is carried out, which leads to the development of stable immunity. Today rubella vaccination is carried out in 168 countries of the world, which allows immunization coverage of about 70 % of women. The countries of the African continent and Southeast Asia are the least affected by rubella vaccination, as a result of which there are about 4 cases of births of children in utero infected with the virus per 1000 births.

Применение ультразвукового исследования в диагностике хронического лимфопролиферативного синдрома ЛОР-органов у детей младшего возраста

The aim of study was to assess the diagnostic value of ultrasound diagnostics of chronic lymphoproliferative syndrome in the young children. 88 children aged 2–3 years with pathology of the lymphadenoid ring of the pharynx, accompanied by regional cervical lymphadenitis, needing surgery were examined. Endoscopy of the nasopharynx, otomicroscopy, impedance, ultrasound examination of cervical and submandibular lymph nodes, abdominal organs, complete blood count with a manual differential, ELISA to determine specific IgM, IgG to cytomegalovirus (CMV) antigens, to human herpes virus type 6 (HCV-6) antigens, to nuclear, viral capsid and early antigens complex Epstein – Barr virus (EBV), PCR in scrapes from the oropharyngeal mucosa and blood were performed. The patients were divided into two groups: group I with pronounced lymphadenopathy (lymph nodes conglomerates 31×13 mm in size or multiple) (n = 32), group II with moderate lymphadenopathy (single symmetrical painless lymph nodes less than 16 mm in size) (n = 56). In the group I, the following were statistically significant more frequent: snore and sleep apnea (Fisher's exact test, p < 0,001, odds ratio (OR) 13,00, 95% confidence interval (CI) 4,439–38,07); manifestations of asthenic vegetative and intoxication syndromes (p < 0,001, OR 7,80, CI 2,248–27,06); ultrasound signs of hepatic splenic syndrome (p < 0,001, OR 34,71, CI 7,185–167,7); serological markers of contamination and active stages EBV infection (p < 0,001, OR 16,71, CI 4,673–55,27); markers of mixt EBV + CMV + HHV-6 infections (p < 0,001, OR 16,20, CI 3,327–78,87), compared to the group II. Regional cervical lymphadenitis with lymph nodes diameter more than 16 mm on ultrasound was a sign of pronounced chronic lymphoproliferative syndrome in the young children, in which half were found to have markers of the EBV infection active stage. The development of pronounced cervical lymphadenitis is associated with hepatic splenic syndrome, usually caused by the herpesvirus infections reactivation.

Diseases of the upper respiratory tract in pregnant women

Inflammatory diseases of the upper respiratory tract are extremely common, 6-15% of healthy people get sick every year. Pregnant women, due to physiological changes in the upper respiratory tract and a special immune state, get sick even more often.The purpose of the article is to provide doctors with basic information about the features of the course and treatment of the most common diseases of the upper respiratory tract during pregnancy.Prerequisite for the development of nasal congestion syndrome during pregnancy is an imbalance in the autonomic regulation of vasoconstriction and vasodilation of the vessels of the nasal mucosa and secretion of the nasal glands, the predominance of parasympathetic influences. The most common nosological causes of nasal breathing disorders are allergic rhinitis, gestational (hormonal) rhinitis and acute rhinosinusitis.The pathogenetic mechanism of gestational rhinitis is estrogen-mediated inhibition of cholinesterase, resulting in cholinergic vasodilation and increased secretion of mucous glands. The increase in circulating plasma volume and extravasal transudation, which is also due to the effects of estrogen on the vascular wall, contribute to pregnancy. Treatment is symptomatic (local decongestants, herbal secretolytics, sea water).Allergic rhinitis is based on IgE-mediated inflammatory process of the mucous membrane of the nasal cavity and paranasal sinuses. The most common causative allergens are plant pollen, spores of lower fungi, insect particles, animal epidermis, house dust mites. Treatment includes topical and systemic agents (glucocorticosteroids with low bioavailability, H1-histamine receptor blockers).Acute rhinosinusitis is an inflammation of the nasal mucosa and paranasal sinuses that lasts up to 12 weeks. In pregnant women, the development of the disease and its prolonged course is facilitated by frequent swelling of the nasal mucosa. The main causative agent of GDS are viruses (approximately 80% of cases). Evidence-based treatment includes irrigation therapy (symptomatic treatment of all forms of GDS), modern phytonutrient therapy using standardized BNO 1016 extract (for viral and post-viral MS, safe during pregnancy), mometasone furoate (nasal spray), anesthesia . Antibacterial drugs are indicated only for the treatment of bacterial rhinosinusitis.Acute tonsillitis is an inflammation of the tonsils with clinical symptoms that occur suddenly. Specific manifestations are sore throat (without acute shortness of breath), redness and swelling of the tonsils, often with layers, regional lymphadenitis; non-specific – fever, general weakness, malaise and pain in the joints and lower back. The clinical picture in pregnant women does not differ significantly. The severity of the disease and the probability of bacterial etiology is assessed on a special scale. Be sure to determine the presence of β-hemolytic group A streptococcus in the throat, depending on which antibacterial treatment is prescribed.

Inoculation Age of Bacillus Calmette-Guérin Tokyo-172 Strain and Vaccine-related Adverse Reactions in Taiwan Birth Cohort of 2012-2017.

In 2016 in Taiwan, inoculation with the Bacillus Calmette-Guérin (BCG) Tokyo-172 vaccine was postponed from 24 hours after birth to 5-8 months of age. We reviewed BCG-induced adverse reactions reported to the Vaccine Injury Compensation Program (VICP) to identify differences between early and delayed BCG inoculation. Clinical presentations of BCG-related adverse reactions reported to VICP for the 2012-2017 birth cohort were reviewed until the end of 2019. The correlations between inoculation age and complications were evaluated. We analyzed 233 BCG adverse reactions, including regional lymphadenitis (33.9%), injection site reactions (35.2%), osteitis/osteomyelitis (27.9%), and distant soft tissue infections (3.0%). The incidence of osteitis/osteomyelitis was lower when vaccination was done after 5 months of age (relative risk [RR], 0.32; 95% confidence interval [CI], .16-.64). Injection site reactions (RR, 8.82; 95% CI, 5.04-15.44) and lymphadenitis (RR, 2.24; 95% CI, 1.44-3.45) were significantly more common in vaccinees older than 5 months. Shorter onset durations of mild adverse reactions (lymphadenitis and injection site reactions) were reported in vaccinees older than 5 months, while no statistical significance was found regarding osteitis/osteomyelitis. Osteomyelitis and distant soft tissue infection may occur less frequently when BCG inoculation occurs after 5 months of age, although mild adverse reactions can be more frequent, symptom onset times can be shortened. As few severe reactions might occur more than 2 years after BCG inoculation and the policy of delayed BCG inoculation was implemented in 2016, a longer observational period is needed to clarify the exact severe complications decrement.

FEATURES OF THE COURSE OF TONSILLITIS IN CHILDREN INFECTED WITH THE HERPES VIRUS

The article presents the features of the clinical course of tonsillitis caused by hemolytic streptococcus in children infected with human herpes simplex virus type 6 (HHV 6). It was revealed that tonsillitis in children with background infection with HHV 6 is characterized by a prolonged course, prolonged maintenance of fever, impaired general condition, the presence of signs of hepatomegaly and regional lymphadenitis, and as a result, a longer stay of such patients in the hospital. The characteristic clinical and laboratory features of tonsillitis in children infected with HHV 6 include the presence in the debut of the disease subfebrile body temperature, regional lymphadenopathy, hepatomegaly, thrombocytopenia, signs of a parenchymal reaction of the liver and mesadenitis. Latent HHV 6 infection in children affects the frequency of registration and the duration of certain symptoms of tonsillitis.