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CHAPTER 8. THE CONCLUSION (DISCUSSION OF THE RECEIVED RESULTS)

According to many authors, frequency of references to the doctor concerning DS increases. However not only high frequency of appealability behind medical aid defines an urgency of this problem. Complexity also that the spectrum of diseases at which the long subfebrile condition is one of leading symptoms, is wide enough.

Now the majority of authors the point of view about polietiologichnosti adhere to long rise in temperature, including both the infectious factor, and a pathology of endocrine, nervous and immune systems [13, 81, 82]. Today has appeared more bases to suspect a role of viruses of family of herpes in formation of a long subfebrile condition at children. Persistent gerpeticheskie infections, in modern conditions, are surveyed as one of interaction forms macro-and a microorganism at the cellular level, allowing the originator not only long time to be in a human body in a latent condition, but also activly to be reproduced, cause formation of secondary immunodeficiencies, an autoimmune pathology, to possess oncogenous action, to lead to failures of mechanisms of adaptation, breaking thereby the organism homeostasis, one of which components is a thermoregulation [16].

In connection with above stated there was a necessity of carrying out of the present research, the purpose kotorogojavilos, studying of frequency of occurrence gerpesvirusnyh infections at patients with a long subfebrile condition. Otsenkaih clinical and pathogenetic value in formation DS and obosnovanieprintsipov etiopatogeneticheskoj therapies. Problems of our research was: to make syndrome definition «a long subfebrile condition»; to tap forms gerpesvirusnyh infections at children with a long subfebrile condition; to define the etiological
Structure active primary and reaktivirovannoj gerpesvirusnoj infections at children with a long subfebrile condition; to investigate variants of a current and clinical features active primary, reaktivirovannoj and latent gerpesvirusnoj infections at children with a long subfebrile condition; pathogenetically to prove application etiotropic and immunokorregirujushchej therapies.

Under our observation there were 127 children at the age from 6 months till 15 years, with duration of a subfebrile condition from 3 weeks to 4 h years. In group of surveyed children of boys was in 2 times more than girls (66 % and 34 % accordingly). Most often long subfebrile condition meets at children till 3 years of a life (33 %), in other age groups it becomes perceptible about identical distribution of children (22,2 % and 23 % accordingly).

From 127 children who have arrived in a hospital, there is more than half of children (58 %), are hospitalised with the diagnosis: «the Fever of an obscure genesis» and «the Long subfebrile condition of an unstated aetiology», and also. «The postinfectious subfebrile condition». Other children arrived with diagnoses "ORVI" or «ORVI with complications» (an obstructive bronchitis, a pneumonia, a purulent otitis, gerpetichesky a keratitis, an island appeditsit, lacunar quinsy) (27 %). «Recurring gerpeticheskaja an infection» (2,4 %), «the Syndrome of vegetative dysfunction» (2,4 %), «Immunodefitsitnoe a condition» (1,6 %), «Cephalalgias of an obscure aetiology» (1,6 %), «Limfoproliferativnoe disease» (0,8 %). These data confirm difficulties clinical diagnosti at a pre-hospital stage.

Occurrence DS at (34,6 %) children became perceptible after the transferred infection. Including, in half of cases (54,5 %) after ORVI and ORVI with complications: a pneumonia (11,4 %), a purulent otitis (11,4 %), after transferred by IT (11,4 %), after a chicken pox (9 %), after rotavirusnoj infections (4,5 %).

Diagnostics gerpesvirusnoj infections was based on a complex estimation of a clinical picture of disease and results of laboratory researches.

On set of the found out markers and clinical implications у112 (88,2 %) from 127 children the infection in various forms has been diagnosed gerpesvirusnaja: at 15 (13,4 %) from 112 the infection, at 34 (30,3 %) — reaktivirovannaja, at 63 (56,3 %) — the latent form of an infection has been diagnosed active gerpesvirusnaja.

At 15 (11,8 %) — markers GVI have not been found out.

At the analysis etiological strukturygerpesvirusov at DS at children it has been established, that admixed forms GV were more often taped. So, EBV and TSMV in various combinations met boleechem at half of children that has made 57,4 % and 50 %, accordingly. More than at 1/3 children was vyjavlenvgch 6 types in various combinations of 37,8 %. Most less often met VPG 1 type — in 28,3 % of cases.

Clinical observation of patients included studying of the anamnesis of disease, revealing of clinical diagnostic criteria.

It has been established, that expression of clinical implications gerpesvirrusnoj varies infections from bright demonstrative forms to subclinical and depends on form GVI.

At active GVI, at all children to development of a syndrome of a long subfebrile condition preceded ORVI, against spent therapy of full recover from a respiratory infection did not come, the subfebrile condition 37,4-37,8 °s, within 28-58 days remained, and then, a condition of the child again there was a febrile fever, symptoms of an intoxication and clinic of complications, as served as an occasion to hospitalisation. Analyzing received clinico-datas of laboratory, we have established following osobenosti primary active gerpesvirusnoj infections at children with long субфебрилитетом:в the majority of cases disease proceeds under the scenario serious ORVI, sochetannoj the virus
Bacteriemic aetiology, with joining of secondary bacteriemic complications (which the expressed symptoms of an intoxication and change in a haemogram cause), and as symptoms acute GVI.

At primary active VGCH 6, TSMVI and EBVI, and also at combination TSMVI and EBVI, the polymorphic semiology was observed: a febrile fever, no more than 5 days, against a subfebrile condition (100 %), a hyperadenosis (100 %), difficulty of nasal breath (86,6 %), a moderate hepatomegalia (86,6 %), a splenomegaly (66,6 %). From other symptoms were observed: tussis (80 %) — at children with an obstructive bronchitis, an abdominal pain (80 %), quinsy (40 %) pastoznost persons (40 %), an exanthema (40 %), a rhinorrhea, osiplost voices, vomiting, osiplost voices (26,6 %), puffiness and an ecdysis of palms and feet (20 %), an arthritis of a knee joint (6,6 %),

At the majority of children (86,6 %) with a long subfebrile condition, at the height of primary active GVI in the general analysis of blood indicators of red blood remained within norm, more than at half of children the moderate leukocytosis, with limfomonotsitozom, acceleration SOEv of 71,5 % of cases became perceptible. Atypical mononukleary were taped at 13,3 % of children. The disease beginning could be accompanied at the majority of children by a neutrocytosis, in 20 % of cases with formula shift to the left.

It is established what to differentiate primary acute GVI TSMV, EBV or VGCH 6 — to clinico-laboratory signs, and also on character of a temperature curve, it is not obviously possible to an aetiology. However revealing of DNA TSMV (100 %), EBV (75 %) or VGCH 6 in blood (100 %), along with detektsiej antigens TSMV (60 %), EBV (40 %) and ВГЧ6 (100 %) in blood leucocytes, presence of antibodies of class IgM (100 %) to the specified viruses, allow to diagnose primary acute GVI. Therefore at cupping of acute bacteriemic complications, despite clinical improvement of a condition, current GVI that causes a remaining subfebrile condition remains.

Reaktivirovanaja gerpesvirusnaja the infection was at 34 (30,3 %) children with a long subfebrile condition. Among the diseased children of early and younger age whom was in 2,4 times more than senior pupils (24 and 10 accordingly) prevailed. Boys was more than girls (21 and 13 accordingly).

At 28 (82,3 %) from 34 premorbidal condition have been burdened by a various infectious and somatic pathology, that we explain longer period of a becoming infected gerpesvirusami, in comparison with active primary GVI. The carried out research has shown, that at reactivation GVI, longer current of a subfebrile condition is observed, than at primary acute GVI (from 3х months till 1 year and from 3х weeks to 2х months accordingly). And at primary acute GVI and at a reactivation, the manifestation of syndrome DS is is more often noted after transferred ORVI. It is possible to believe, that disease ORVI reactivates latentno persistent GVI and, thus, clinical implications can be caused a virusno-virus mikst-infection [8].

At children with reaktivirovannoj GVI variability of clinical implications became perceptible: along with a long subfebrile condition, delicacy, a sweating, giddiness, emotional lability, cramps, plentiful regurgitations, vomiting, ikterichnost skins which we have not met at patients with primary acute GVI.Vjalost were observed, the malaise, appetite depression, a headache are noted almost at vsehbolnyh.

From features of temperature curves at children with DS at reaktivirovannoj GVI, it is necessary to note, also as well as at active, daily evening liftings of a body temperature to 37,7-37,90С. Febrile temperature otmechenalish in 20,5 % of cases.

Generalising the above-stated, it is possible to tell, that the most typical clinical symptoms reaktivirovannoj GVI at children with a long subfebrile condition are: a combination of an astheno-vegetative syndrome with
Lymphadenopathy (6 %), with gastrointerstitsialnymi disorders (55,8 %) which we have not met at primary acute GVI, a hepatomegalia (64,7 %) and moderate augmentation of a lien in (20,5 %) cases. In blood serum moderate rising of transaminases in 1,5-3 times above norm in 9 % of cases became perceptible.

At the analysis of frequency of changes of laboratory indicators at reaktivirovannoj GVI a various aetiology, at third of children the anaemia and a neutropenia that we did not observe at active GVI have been taped. It is important to underline, that atypical mononuklearov in OAK it becomes perceptible only in 11,7 % of cases. The basic hematological changes in OAK at reactivation GVI are: an early moderate leukocytosis in 1/4 cases, on the first week moderate acceleration of an ESR is frequent nejtrofilnogo character, limfomonotsitoz in height of illness, and.

Thus, at children with active primary GVI, against an antigenic load the system of immune adaptation that is expressed in more short-term current of a subfebrile condition (at all children duration of a subfebrile condition works did not exceed 3 months). At patients the clinic mononukleozopodobnogo a syndrome, reactive changes in a haemogram was observed.

Reaktivirovannaja GVI proceeded against the lowered immunologic reactance to what presence in this group of considerable quantity CHBD testifies, at the majority of children the burdened premorbidal condition, (a delay of psychomotor development, oligotrophy I-II of degree), an accompanying somatic pathology, and also, longer current of the subfebrile condition, a primary current in the form of the admixed forms becomes perceptible.

At observation over children with latent GVI it has been established, that it in 50 % is registered at teenagers, in 1,4 times more often at boys, than at girls. In etiological structure, also as well as at other forms
Infectious process prevails admixed GVI, and the augmentation of etiological importance VGCH 6 types becomes perceptible.

Characterising temperature curves at latent GVI, it is necessary to note, chtodlja it most typical: a monotonous temperature curve, and, the low and high subfebrile condition was registered equally often. The number of children with morning and evening liftings of a body temperature to subfebrile digits was, practically, identical. At an estimation of temperature curves of statistically significant differences in features of temperature curves, depending on duration of a subfebrile condition, at latent GVI it is not received. However, analyzing features of temperature reactions, depending on the form of infectious process, authentically more often the febrile fever was registered at children with primary acute GVI (100 %), than at reactivation GVI (20,5 %) and at persistentsii GVI (15,2 %), (r

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Scientific source Lebedeva Tatyana Mihajlovna. Clinico-pathogenetic value gerpesvirusov at long subfebrile conditions at children. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

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Other medical related information CHAPTER 8. THE CONCLUSION (DISCUSSION OF THE RECEIVED RESULTS):

  1. THE TABLE OF CONTENTS
  2. the Table of contents
  3. THE TABLE OF CONTENTS
  4. the Maintenance:
  5. CHAPTER 8. THE CONCLUSION (DISCUSSION OF THE RECEIVED RESULTS)
  6. INTRODUCTION
  7. CHAPTER №5 DISCUSSION
  8. the Table of contents
  9. Chapter 7 DISCUSSION of RESULTS of RESEARCH
  10. THE TABLE OF CONTENTS
  11. CHAPTER 4. THE CONCLUSION (DISCUSSION OF THE RECEIVED RESULTS)
  12. Chapter 7 DISCUSSION of RESULTS of RESEARCH
  13. the MAINTENANCE
  14. the Chapter VI. DISCUSSION of the RECEIVED DATA
  15. INTRODUCTION
  16. THE TABLE OF CONTENTS