В статье проводится подробный анализ современных публикаций, посвящённых результатам исследования астровирусной кишечной инфекции. На основании собственного обследования 3470 детей с ОКИ в возрасте от 1 месяца до 18 лет, проходивших лечение в клинике ФГБУ ДНКЦИБ ФМБА России в период с мая 2017 по июль 2018 гг., дается подробное описание характерных эпидемиологических, клинических и лабораторных особенностей заболевания. Выявлено, что астровирусы являются одними из значимых возбудителей ОКИ у детей, составляя 1,36% всех случаев заболеваний. Среди сочетанных форм астровирусной инфекции наиболее часто встречаются ассоциации с ротавирусами, норовирусами и кампилобактериями. Установлено, что заболевание чаще отмечается у мальчиков в возрасте от 1 до 3 лет, в клинической картине астровирусной инфекции у детей преобладает острое или постепенное начало с повторной рвоты, проявлениями умеренной интоксикации и симптомами гастроэнтерита. В связи с отсутствием патогномоничных клинико-лабораторных особенностей течения астровирусного гастроэнтерита, необходима диагностика с помощью лабораторных, в том числе молекулярно-генетических методов исследования.

Due to measures to optimize the healthcare system, the role of the primary care specialist is constantly increasing. The professional standard of a primary care pediatrician clearly defines his/her job functions, but a significant number of pediatricians do not always follow the regulatory documents on the provision of medical care to patients. Nevertheless, in case of any conflicts and in case of assessing the quality of medical care within the framework of various types of examinations, first of all, the compliance of the provided medical care with the current regulatory documents is assessed. The standard of medical care is not intended to make any decisions on the treatment of a particular patient, it is an economic tool. Amendments to the law №323-FZ "On the Fundamentals of Healthcare in the Russian Federation", adopted in 2018, gave clinical guidelines the status of mandatory for implementation along with standards, regulations, and procedures for providing medical care. Thus, clinical guidelines in our country are the basis for medical care, prepared by professional medical communities taking into account domestic and foreign meta-analyses and randomized clinical trials, and are aimed at protecting the rights of patients and medical workers. In the article on the example of clinical guidelines for salmonellosis in children the therapy option in the form of probiotics, the validity of their use in various clinical situations is analyzed.

The article presents a clinical observation of severe acute hepatitis of unknown aetiology with liver transplantation in a 16-year-old child, which occurred in October 2021. Initial symptoms were abdominal pain, diarrhea. The general wellbeing of the girl did not suffer, there was no fever, no intoxication syndrome. Over the next days, she began to notice the appearance of edema on the legs, an increase in the size of the abdomen. From the 10-11th day of illness – darkening of urine, acholia of feces, jaundice were observed. She was examined by a pediatrician, a biochemical blood test was performed, according to the results the girl was hospitalized with a diagnosis of acute hepatitis. According to the severity of the condition, she was hospitalized in the ICU. On admission she complained of abdominal pain, jaundice, edema, and weakness. On examination: jaundice, scleral icterus, hemorrhagic rash at the site of the tourniquet, bleeding from injection sites, hepatomegaly, anasarca. In blood tests: progressive anemia, thrombocytopenia, increased AST (with a decrease in dynamics against the background of progression of liver failure), a decrease in total protein and albumin, fibrinogen, prothrombin according to Quick. Laboratory excluded viral hepatitis A-E. The only infectious agent diagnosed was group F adenovirus in feces. By the third day of hospitalization developed of multiple organ failure, DIC. On the 4th day of hospitalization, the child was transferred to a specialized hospital, where an emergency liver transplantation was performed. The operation was successful, the child was discharged in a stable condition.