Study aimed to compare the results of skin test with allergen tuberculosis recombinant (ATR), containing proteins ESAT-6 and CFP-10 and QuantiFERON test (QFT) in children with different forms of tuberculosis infection. The results of test with ATR and QFT coincided with 164 (82.4%) children. Both tests were positive in 140 (70.4%) patients, both tests were negative in 24 (12.0%). The opposite results were obtained in 35 (17.6%) children. The most common combination was ATR -positive/QFT-negative – 23 (11.6%), the less common type was ATR-negative/QFT-positive – 12 (6.0%). It was concluded that test with ATR has advantages in screening children for tuberculosis since it is simpler and cheaper. Additionally, the use of QFT is indicated in difficult diagnostic cases, with a recent infection, in young children, in the presence of immunodeficiency.
Представлен анализ сезонных подъемов заболеваемости энтеровирусной инфекции, клинического разнообразия, зависимости проявления форм и поражения нервной системы у детей Челябинской области от распространенных эпидемических вариантов энтеровирусов. The analysis of seasonal increases in the incidence of enterovirus infection, clinical diversity, dependence of the manifestation of forms, damage to the nervous system in children of the Chelyabinsk region on common epidemic variants of enteroviruses is presented.
In order to determine the frequency and nature of sonographic changes in abdominal organs in children with tuberculosis infection, 192 patients at the age of 6 months -14 years were examined on the basis of the tuberculosis department of City Children’s Infectious Hospital №3 for the period 2019-2021. 3 groups of patients were identified: group 1 - 92 children with active respiratory tuberculosis; group 2 – 52 children with residual post-tuberculosis changes; group 3 – 48 children with latent tuberculosis infection at risk of tuberculosis. Sonographic liver changes (reactive and/or intrahepatic cholestasis and/or hepatomegaly) were observed in children with active tuberculosis in 40.2±5.1% of cases, in children of group 3 - in 35.4±6.9% of cases and less often in children of group 2 - in 17.3±5.3% of cases (p<0.05). Changes of the gallbladder (violations of bile outflow and/or shape changes) were visualized in children with active tuberculosis in 73.9±4.6% of cases, in children of group 3 (60.4±7.1% of cases), less often in children of group 2 (55.8±6.7% of cases, p<0.05 for group 1). Changes of the pancreas were reactive and were more often observed in children of group 1 - in 14.1± 3.5% of cases than in children of group 2 (5.8±3.2% of cases, p<0.05) and group 3 (4.2± 2.9% of cases). Also, ultrasound changes of the spleen were more often detected in children with active tuberculosis - in 17.4±4.0% of cases than in children of group 2 (5.8±3.2% of cases, p<0.05) and group 3 (2.1±2.1% of cases, p<0.05).
С разработкой противовирусных препаратов прямого действия терапия хронического гепатита С (ХГС) у детей вышла на новый уровень этиотропной направленности – на элиминацию вируса. Хронический гепатит С – заболевание, вызываемое РНК-содержащим вирусом, с гемоконтактным механизмом передачи. При развитии инфекционного процесса вирус гепатита С (НСV) проникает в гепатоциты, где происходят его репликация и иммунопатологический процесс. Геном НСVкодирует структурные и неструктурные белки, к каждому из них вырабатываются антитела, которые не обладают вирус-нейтрализующим свойством. Особенность HСV заключается в способности к быстрой замене нуклеотидов, что приводит к образованию большого числа генотипов, субтипов и мутантных штаммов. Выделяют 7 генотипов вируса и более 90 субтипов НСV. Изменчивость генома вируса, строения антигенных детерминант определяют выработку специфических антител, не способных элиминировать возбудителя из организма и препятствующих созданию эффективной вакцины против гепатита С. В апреле 2019 года EMA было одобрено применение пангенотипного противовирусного препарата глекапревир/пибрентасвир в фиксированной дозе для подростков 12-17 лет, инфицированных HCV, на основе высокой частоты устойчивого вирусного ответа (100%; 47 из 47 пациентов) в исследовании Dora [1, 4, 25]. Целью назначения прововирусных препаратов прямого действия детям, по рекомендации ESPGHAN, является лечение инфекции для предотвращения потенциального прогрессирования заболевания печени, связанного с НСV, и его осложнений. Эффективностью терапии ХГС у детей является не обнаруживаемая с помощью чувствительного метода исследования (нижний порог чувствительности <15 МЕ/мл) РНК НСVв крови через 12 недель (устойчивый вирусный ответ – УВО12) после окончания лечения препаратами прямого противовирусного действия. With the development of direct-acting antiviral drugs, the therapy of chronic hepatitis C in children has reached a new level - an etiotropic focus on the elimination of the virus. Chronic viral hepatitis C is a disease caused by the RNA-containing hepatitis C virus (HCV), with a hemocontact transmission mechanism. With the development of the infectious process, HCV penetrates into hepatocytes, where its replication and immunopathological process occur. The HCV genome encodes structural and non-structural proteins, and antibodies are produced to each of them that do not have a virus-neutralizing property. The peculiarity of HCV is the ability to quickly replace nucleotides, which leads to the formation of a large number of genotypes, subtypes and mutant strains. There are 7 genotypes of the virus and more than 90 subtypes. The variability of the virus genome, the structure of antigenic determinants determine the production of specific antibodies that are unable to eliminate the virus from the body and prevent the creation of an effective vaccine against hepatitis C. In April 2019 EMA approved the use of the fixed-dose pan-genotypic antiviral drug glecaprevir-pibrentasvir for adolescents 12-17 years old infected with HCV, based on the high frequency of sustained viral response (100%; 47 out of 47 patients) in the Dora study [1,4,25]. The goal of therapy in children, according to the recommendation of ESPGHAN, is the treatment of HCV infection to prevent the potential progression of HCV-related liver disease and its complications. The effectiveness of therapy in children is not detectable by a sensitive method of investigation (lower threshold of sensitivity < 15 IU / ml) NSO RNA in the blood after 12 weeks (sustained viral response) after the end of treatment with direct antiviral drugs.
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