Оптимизация лечения Эпштейна-Барр вирусного инфекционного мононуклеоза у детей В. Б. КОТЛОВА, С. П. КОКОРЕВА, А. В. ТРУШКИНА ГБОУ ВПО «Воронежская государственная медицинская академия имени Н. Н. Бурденко» Министерства здравоохранения Российской Федерации, БУЗ Воронежской области «Областная детская клиническая больница № 2», Воронеж, РФ В работе представлены результаты наблюдения за 103 детьми в возрасте от 10 месяцев до 15 лет с ВЭБ-ассоциированным инфекционным мононуклеозом (ИМ), обусловленным в 32% острой первичной Эпштейна-Барр вирусной инфекцией (ОЭБВИ) и в 68% случаев реактивацией хронической (ХЭБВИ). Выявлены клинико-лабораторные особенности течения ИМ в зависимости от формы инфекции. В исходе ИМ при первичном инфицировании в 5,8 раза чаще, чем при ХЭБВИ, через год после перенесенного заболевания формируется латентная инфекция. Показана высокая эффективность монотерапии рекомбинантными интерферонами при первичной инфекции и обоснована целесообразность комбинированной этиотропной терапии при лечении ХЭБВИ. Ключевые слова: Эпштейна-Барр вирусная инфекция, дети, рекомбинантные интерфероны, индукторы эндогенного интерферона The paper presents the results of observation of 103 children aged from 10 months to 15 years with EBV-associated infectious mononucleosis (IM), determined in 32% by acute primary Epstein-Barr virus infection (AEBVI) and in 68% of cases by reactivation of chronic Epstein-Barr virus infection (CEBVI). Clinical and laboratory characteristics of the course, depending on the form of infection, were investigated. As a clinical outcome of infectious mononucleosis in patients with primary infection latent infection after a year is formed 5.8 times more often than in patients with chronic Epstein-Barr virus infection (CEBVI). The high efficiency of recombinant interferon monotherapy in patients with primary acute infection was recorded and the expediency of combined etiotropic therapy in the treatment of chronic Epstein-Barr virus infection was found out.

In recent years, enterovirus infection (EVI) retains its cyclical nature with an increase in the incidence rate in the Russian Federation in 2000, 2006, 2009, 2013 and 2017. Observation of 41 patients with laboratory-confirmed enteroviral meningitis (EVM) in 2000, 54 children in 2013, and 56 patients in 2018 revealed the clinical and laboratory features of this clinical form of the disease, mainly concerning changes in hemo- and liquorogram parameters, which allowed to trace the evolutionary changes during this infection in children.

The relevance of respiratory syncytial virus infection is due to its widespread, severity of the course in young children with a predominant lesion of the lower respiratory tract with acute respiratory failure and absence of etiotropic therapy with proven efficacy. The risk group for severe course and mortality is made up of premature babies, children with bronchopulmonary dysplasia, hemodynamically significant congenital heart disease. In addition, according to individual indications, by the decision of the council, specific prophylaxis is carried out for newborns and premature infants with severe neuromuscular pathology, CNS injury with impaired respiratory function, patients with congenital anomalies and genetic pathology of the respiratory system, as well as congenital immunodeficiency. The article presents a description and analysis of the severe course of respiratory syncytial infection with the development of obstructive bronchitis with respiratory failure of the 2nd degree in a child aged 1 year 4 months with Charge syndrome – a severe genetic pathology, including combined congenital heart disease, choanal artesia, protein-energy malnutrition, congenital immunodeficiency. The child had bronchopulmonary dysplasia, chronic paralytic laryngeal stenosis. The disease required oxygen support and the patient's stay in the intensive care unit. The described clinical example demonstrates a severe course of respiratory syncytial virus infection with the damage of the lower respiratory tract in a child over one year old from the risk group. Key words: respiratory syncytial virus infection, children, obstructive bronchitis, bronchiolitis

In the following days the condition remained grave. According to CT (from 19.06.2017)

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