concept of a long subfebrile condition, prevalence of a long subfebrile condition at children.

The syndrome of a long subfebrile condition of a different aetiology among children meets often. To fluctuations of a body temperature children, both healthy, and patients are subject in larger degree, than adults [6].

There are divergences in understanding of norm of temperature: the majority of clinicians holds the opinion, that the normal temperature measured in an axillary hollow, makes 36,6°С± (0,2 0,3) °s [5]. According to P. B. Beeson [90], in the afternoon the temperature should not make more 37,0°C. According to I.S.Vajnberg [14], A.A.Baranova [5], at the overwhelming majority of people the normal temperature fluctuates from 36,0 to 37,0°C; at 7,5 % — in limits 35,0-36,0°C; at 2,5 % — in limits 36,5­37,5°C.

However indicators depend on age, a place and a way of measurement. So, temperature, izmerennajav oral cavities, an axillary hollow, in external acoustical passage and rectal can differ considerably from each other [162]. Thus it is important to consider and features of methods of measurement: for example, at an average otitis the temperature measured in external acoustical passage on the party of a lesion, it will be appreciable above real because of inflammatory process in a drum-type cavity; temperature measurement should pass in a mouth at the closed mouth and is strict under tongue. It is considered, that children till 3th years of the most exact will have a rectal temperature; at children from 5 years probably use of measurement in a mouth, and at children from 3 till 5 years — in an axillary hollow [162].

In the domestic literature it is accepted to name a long subfebrile condition rise in temperature to 38°С within two-three weeks and
More, quite often long subfebrile condition is present within several months or years and is the unique complaint of the patient [6,12,33,35].

In the foreign literature for subfebrile condition definition use a number of terms — «lowgradefever», «subfebriletemperature», «prolongedfever», etc. as which understand a body temperature in an axillary hollow 37,5­38,3°C [83].

The term «behavioural rise in temperature» which treat as rise in temperature no more, than to 38,3°C, with disturbance of a rhythm of heart [141] is close to these concepts. In work D. C. Knockaert et al. [155] it is shown, that among patients with long subfebrile conditions behavioural rise in temperature meets frequency of 2,5 % [155]. In a number of works influence of stress on development of a subfebrile condition [157,182] is shown. So, T. Okaetal. [183] have resulted a clinical example, where the patient with a syndrome of chronic weariness against physiological stress prodemonstirovala a fervescence with 37,2 to 38,2°С, measured in an axillary hollow. E. Briese [99] in the work carried out monitoring of the temperature measured in a mouth at students of 18-27 years before examination and after it next day. By the author it has been shown, that on the average before examination the temperature was above on 0,18°С, than after it.

The term «prolongedfever» — a long fever which is defined as a fervescence above 37,5 With within 14 days [109]. According to A. Bourrillon [97], prolongedfever it is defined as a fever within 5 days in the absence of the taped etiological factor, in opinion M. L. Milleretal. [167], the given term is applicable at a fever no more than two weeks in the absence of the diagnosis.

G. S. Marshal (2014 [162] observed patients with long rising temperaturyu which at careful inquiry, survey, as a result of application of tool and laboratory methods it was possible to establish the diagnosis. Usually rechshla about often meeting diseases with an atypical current (for example, a pneumonia in the absence of tussis, a sinusitis
Without typical vydeleny from a nose) or about typical implications of seldom meeting diseases (illness of Kawasaki, a subacute bacteriemic endocarditis, tumours, etc.) [153,162]. In works of foreign authors it is underlined, that it is necessary to estimate carefully complaints of the patient, since. In some cases actually can and not to be pathological liftings of temperature, and the temperature changes registered by patients can be bound to food intake, exercise stresses or an ovulation (at adults); also it is necessary to consider a way and a place of measurement of temperature [153,162].

The huge number of works is devoted such problem, as a fever of an obscure genesis («feverofunknownorigin», «unexplainedpyrexia»). At the given condition the big number of definitions such, as a fervescence from above 38,1 °s within 14 days [144], presence zadokumentirovannoj fevers within 7-10 days and absence of the diagnosis after one week of inspection of the patient [84], rise in temperature from above 38,3 °s some times within more than three weeks without the established reason [93,128,191]. P.O. Dienye, P.K. Gbeneol [114] in the work make similar definition of the given condition, however specify, that from above 38,3 °s should be rectal temperature.

The given literatures show, that frequency of references to the doctor concerning a long subfebrile condition increases. Authentic data on frequency of subfebrile conditions at children of various age and a floor are not present, nonaibolee often long subfebrile condition meets at children till 1 year of a life and at the age from 8 till 14 years [13], also is established, that the long subfebrile condition of an obscure aetiology meets at boys, than at girls is twice more often, that authors bind to features of endokrinno-humoral and metabolic processes in an organism of boys [47,61].

O. Coguluetal. [109] have analysed 17490 histories of illnesses of children and have taped a long fever in 80 cases that has made 0,46 %; from them boys there were 55 %, girls — 45 %. The majority of children (55 %) was in
Age 1 mes-2 year, at the age of 3-6 years — 26,25 %, from 7 till 10 years — 8,75 %, are more senior 10 years — 10 %. Duration of the raised temperature made 15­30 days at 57,5 % of children, from 31 till 60 days — at 22,5 % and more than 60 days — at 20 %. The fever within 37,5-37,9 °s was registered in 1,25 % of cases, 38 38,9 °s — in 36,25 %, 39-39,9 °s — in 50 % and from above 39,9 °s — in 12,5 % cases. The diagnosis managed to be established in 87,5 % of cases, from them infections in 58,75 % of cases (including an infectious mononucleosis in 2,5 % of cases), diseases of immune system — in 7,5 %, collagenic illnesses — in 6,25 %, tumours — in 2,5 %, other — in 12,5 %.

According to S.L. Ingarfieldetal. [142], frequency of revealing of a fever of an obscure genesis at children in skoropomoshchnom establishment makes 1,5 %. O. Mouradetal. [171] have carried out the regular analysis of publications,

Devoted to a fever and subfebrilitetunejasnogo a genesis with 1966 for 2000, authors specify, that prevalence of the given pathology makes 2,9 %. Frequency of a long feverish condition makes 0,5-3 % [107].

Thus in most cases, when the diagnosis «Long fever of an obscure genesis» is made, this genesis is known. So, according to different authors at 22-47,4 % of children the reason of a long fever is the infection, from them at 25,3-41,6 % — a virus aetiology (including. EBV, TSMV). There are collagenic and vascular diseases (6-16,7 %), neoplasms (2-12 %) Less often. The reason does not manage to be found out in 13-67 % of cases [91,160,166,186,187,201].

S. Pasicetal. [185] cites the given inspections of 185 children with a fever of an obscure genesis, among which 85 boys, 100 girls at the age from 6 months till 18 years (middle age of 6 years). In 70 % of cases it was possible to establish the diagnosis, from them in 37,8 % the infection, in 12,9 % — autoimunnye diseases, in 6,4 % — illness of Kawasaki, in 6,4 % — tumours, in 8,1 % — other reasons was the etiological factor. It is important to notice, that among infectious diseases most often there was an infectious mononucleosis (22,9 %); tsitomegalovirusnaja the infection has been registered in 1,4 % of cases.

In many works are specified gerpesvirusy (basically TSMV and EBV) as possible etiological factors of occurrence of a long fervescence (prolongedfever) [84, 109, 185, 207], however works of foreign authors where communication of a subfebrile condition would be studied and gerpesvirusov us to find it was not possible. We have spent search of the foreign literature in PubMed since 1950 on 2014 Results of search in terms «subfebriletemperature», «subfebrilefever», «subfebrilecondition» individual foreign articles [12, 129, 143, 148], dated till 1980, and the publication of domestic authors were.


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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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