Інфекційні захворювання у дітей в амбулаторній практиці лікаря. Інфекційні захворювання у дітей в амбулаторній практиці лікаря
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АББРЕВИАТУРЫ Th1 – Т-хелперы Иг – иммуноглобулины ДК – дендритные клетки ГКГС – главный комплекс гистосовместимости CD – поверхностный лейкоцитарный антиген соответствующего дифференцированного кластера ИФН – интерферон NF-kB – нуклеарный фактор kB TLR – toll-подобные рецепторы БАЛТ – лимфоидная ткань, ассоциированная с бронхами ГАЛТ – лимфоидная ткань, ассоциированную со слизистой ЖКТ НАЛТ – лимфоидная ткань, ассоциированную со слизистой носоглотки САЛТ – лимфоидная ткани, ассоциированной со слизистыми оболочками ВЭВ – венулы с высоким эндотелием АПК – антиген представляющие клетки pIgR- поли Иг – рецепторы ИЭЛ- интраэпителиальные лимфоциты * ОМ-85 – запатентованное название орального бактериального лизата восьми наиболее распространенных возбудителей бактериальных инфекций дыхательных путей. Литература 1. Kiyono H, Fukuyama S. NALT- versus Peyer’s-patch-mediated mucosal immunity. Nat Rev Immunol. 2004 Sep;4(9):699–710. 2. Kunisawa J, Fukuyama S, Kiyono H. 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OM85-BV induced the productions of IL-1β, IL-6, and TNF-α via TLR4- and TLR2- mediated ERK1/2/NF-κB pathway in RAW264.7 cells. J Interferon Cytokine Res. 2014 Jul;34(7):526–36. 33. Coviello S, Wimmenauer V, Polack FP, Irusta PM. Bacterial lysates improve the protective antibody response against respiratory viruses through Toll-like receptor 4. Hum Vaccin Immunother. 2014;10(10):2896–902. 34. Kim SH, Jang YS. Antigen targeting to M cells for enhancing the efficacy of mucosal vaccines. Exp Mol Med. 2014 Mar 14;46: e85. 35. Roth M, Pasquali C, Stolz D, Tamm M. Broncho Vaxom (OM-85) modulates rhinovirus docking proteins on human airway epithelial cells via Erk1/2 mitogen activated protein kinase and cAMP. PLoS One. 2017 Nov 28;12(11): e0188010. 36. Esposito S, Soto-Martinez M.E., Feleszko W., Jones M. H., Shen K. L., Schaad U. B. 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The PARI–IS Study Steering Committee and Research Group. Prevention of Acute Respiratory Infection by an Immunostimulant. Am J Respir Crit Care Med. 1997 Dec;156(6):1719–24. 81. Li J, Zheng JP, Yuan JP, Zeng GQ, Zhong NS, Lin CY. Protective effect of a bacterial extract against acute exacerbation in patients with chronic bronchitis accompanied by chronic obstructive pulmonary disease. Chin Med J (Engl). 2004 Jun;117(6):828–34. 82. Solèr M, Mütterlein R, Cozma G; Swiss-German OM-85 Study Group Double-blind study of OM-85 in patients with chronic bronchitis or mild chronic obstructive pulmonary disease. Respiration. 2007;74(1):26–32. Epub 2006 Jun 12. 136 Інфекційні захворювання у дітей в амбулаторній практиці лікаря 137 Парвовірусна інфекція Особливості у дітей раннього віку Найбільш характерним проявом парвовірусної інфекції у цьому віці є інфекцій- на еритема. Для захворювання зазвичай не характерний розвиток симптомів інтоксикації і високої температури, як правило, протікає легко. Катаральні сим- птоми виражені помірно. У той же час у дітей раннього віку відносно частіше захворювання маніфестує з ураженням нервової системи (судомний синдром, менінгоенцефаліт, нейропатія). Для дітей, на відміну від пацієнтів старшого віку, менш характерна висип у вигляді «рукавичок і шкарпеток», розвиток артритів. Діагностика Клінічні критерії: Інкубаційний період – 4–28 днів. Продромальний період: – тривалість – 2–5 днів; – підвищення температури до 38–39 °C; – симптоми порушення загального стану (слабкість, млявість, головний біль); – катаральні явища (нежить, кашель, біль у горлі); Період висипання: – тривалість в середньому 7–10 днів; – на обох щоках з’являються яскраво-червоні висипання, при цьому навколо рота шкіра бліда, що схоже на сліди від ляпасів. В наступні дні на тулубі і кінцівках з’являється вторинний еритематозний плямисто-папульозний висип. Потім він зазнає зворотного розвитку, утворюючи «мереживний» сітчастий малюнок. Майже зниклий висип може знову проявлятися під дією світла або тепла. |