Этиологическая структура инфекционного мононуклеоза у детей и оптимизация его терапии

Abstract

На основании современных методов диагностики с использованием ИФА и ПЦР при обследовании 213 детей в возрасте от 10 мес. до 13 лет установлено, что инфекционный мононуклеоз является полиэтиологическим заболеванием и может вызваться вирусами герпеса IV, V и VI типов. Клинико-лабораторные особенности заболевания зависят от типа вируса. Оценена эффективность комплексной терапии заболевания с использованием препарата "Витаферон" у 35 детей. Лечение "Витафероном" способствует сокращению сроков лечения на 6,1±1,3 дня.

The aim of this paper is to study the etiological structure and clinical properties of infectious mononucleosis using PCR and IFA as well as improvement of therapy in this disease. Materials and Methods. There were 213 children patients from 10 months to 13 years of age. All these patients have been tested for IgM and IgG as to the VCA and EA antigens EBV, IgG to EBNA EBV as well as IgM and IgG CMV. The DNA of EBV, CMV and HHV-6 have been determined by the PCR method in blood serum and in saliva. All the patients have also been tested for the presence of viral hepatitis markers and HIV antibodies. Results and Discussion. Among the patients 122 (57.4 %) EBV-mononucleosis has been detected. In 19 (3.9 %) the CMV-mononucleosis has been found, and in 3 cases (1.4 %) had HHV-6- mononucleosis. In some cases we have observed a combined virus infection brought about by EBN+CMV and CMV+HHV-6 which amounted to 62 cases (29.1%) and 7 cases (3.2%) respectively. In cases with EBV-mononucleosis in the clinical symptoms we have observed febrile fever, difficult nasal breath, edematous face, enlarged anterior and posterior cervical and submaxillar lymphatic nodes up to 2-4 cm in diameter, tonsillitis with film covering tonsils. Hemogram had changes characteristic for leukocytosis, high level of lymphomonocytes, presence of atypical mononuclear cells, lever and spleen enlargement and high transaminase activity. In CMV-mononucleosis there was subfebrile fever, pharingitis symptoms, average enlagement of cervical lymphatic nodes (up to 1-1.5 cm in diameter). On third of the patients had enlarged liver with a mildly higher transaminase content and atypical mononuclear cell in the blood count. In HHV-6 mononucleosis a long subfebrile fever has been observed, insignificant enlagement of lymphatic nodes and appearance of allergic rash. There were no typical mononuclear cells in blood. In the therapy of EBV-mononucleosis Vitaferon® preparation has been used as it includes recombinant -interferon- 2b in combination with ascorbic acid. Vitaferon® has been prescribed to 35 patients from 1 to 5 yrs with the dosage of 250 000 IU twice daily with time interval of 12 hrs during 10 days. Alongside with Vitaferon® these children were taking basic therapy using macrolid antibiotics, desensibilizing and detoxication therapy. The control group receiving only basic therapy. The group receiving Vitaferon® has a better control of temperature and the main symptoms have vanished quicker and recovery time has been observed 6.1±1.3 days earlier than the control group. Results. Infectious mononucleosis is a polyetiological disease and can be evoked by herpes virus IV, V, VI. Fever, tonsillitis and prominent lymphoproliferative syndrome are most obvious in mononucleosis with EBV in children younger than 3 yrs of age. In mononucleosis of other etiology (CMV, HHV-6) the typical symptoms are usually absent and the diagnosis leans upon the presence of specific markers of the infection. The use Vitaferon® in the therapy leads to earlier normalization of body temperature, reverse dynamics of disease clinical symptoms and of the blood biochemical data.

На підставі сучасних методів діагностики з використанням ІФА і ПЛР при обстеженні 213 дітей у віці від 10 міс до 13 років встановлено, що інфекційний мононуклеоз є поліетіологічним захворюванням і його збудниками можуть бути віруси герпесу IV, V і VI типів. Клініко-лабораторні особливості захворювання залежали від типу збудника. Дана оцінка ефективності комплексної терапії інфеуційного мононуклеозу з використанням вітчизняного препарату "Вітаферон" у 35 дітей. Лікування "Вітафероном" сприяло скороченню строків лікування на 6,1 ± 1,3 доби.