INTRODUCTION

Problem urgency

In connection with high frequency of occurrence and importance of the problems solved in practice, it is possible to consider a problem of a long subfebrile condition actual in pediatrics.

According to many domestic clinicians, in structure of all references in a children's out-patient department the number of children with a syndrome of a long subfebrile condition tends to growth and makes not less than 15 % among all references in an out-patient department and about 6 % among hospitalised in hospitals [13,35,67,74]. Treatment of such patients often leads unreasonable polipragmazii, to application of anti-infectives, including long and repeated courses, to occurrence disbioza, to growth of toksiko-allergic conditions and can be the reason of depression of a state of health and komplaentnosti lives.

The nature of a long subfebrile condition remains not studied. The majority of authors adheres to the point of view about polietiologichnosti a long fervescence, surveying as the reason a pathology of endocrine, nervous, immune systems [6,47,83].

On a course of research of this problem repeatedly there were bases to think io roles infectious patogenov (viruses Koksaki And, In, ECHO, adenoviruses, streptococcuses, staphilococcuses), but numerous researches in different years in this direction have not crowned full success [13,62].

Data on a role of viruses of family Herpesviridae in formation of a syndrome of a long subfebrile condition at children practically are not present now.

And meanwhile, persistent gerpesvirusnaja the infection (GVI) in modern conditions is surveyed, as one of interaction forms macro-and a microorganism at cellular level; such form allows
To the originator not only long time to be in an organism in a latent condition, but also activly to be reproduced, lead to failures of mechanisms of adaptation, breaking, thereby, the organism homeostasis, one of which basic components is a thermoregulation, to cause formation of secondary immunodeficiencies, an autoimmune pathology, to possess oncogenous action [16,47].

In connection with izlozhenym, there was a necessity of carrying out of the present research devoted to revealing of a role gerpesvirusnoj of an infection in formation of a syndrome of a long subfebrile condition.

Research objective:

To establish frequency of occurrence gerpesvirusnyh infections at patients with a long subfebrile condition. To estimate their clinical and pathogenetic value and to prove principles of treatment on the basis of use etiotropic and immunokorregirujushchih agents.

Research problems:

1) to make syndrome definition «a long subfebrile condition».

2) to Tap forms gerpesvirusnyh infections at children with a long subfebrile condition.

3) to Define etiological structure active primary and reaktivirovannoj gerpesvirusnoj infections at children with a long subfebrile condition.

4) to Investigate variants of a current and clinical features active primary, reaktivirovannoj and latent gerpesvirusnoj infections at children with a long subfebrile condition.

5) Pathogenetically to prove application etiotropic and immunokorregirujushchej therapies.

Scientific novelty

For the first time the scientific data are presented, allowing to survey a long subfebrile condition a variant of an infectious disease,
Proceeding in shape both active, and a latent infection on an example gerpesvirusnyh infections.

Specific gravity primary active (13,3 %), reaktivirovannyh (30,4 %), and latent forms (56,3 %) infections, more often proceeding as multi-infections (75 %), are more rare as a mono-infection (25 %) is defined.

Clinical features, including character of temperature curves are taped, at primary active, reaktivirovannoj and latent gerpesvirusnoj infections at children with a long subfebrile condition.

The interrelation of revealing of antigens gerpesvirusov in leucocytes of blood at children with a long subfebrile condition, with formation of an accompanying somatic pathology (a tserebro-asthenic syndrome — at 30 %, a pathology GASTROINTESTINAL TRACT — at 50 %, cardiovascular system — у50 %) is established.

Necessity etiopatogeneticheskoj therapies at children with a long subfebrile condition is pathogenetically proved. Clinical efficiency etiotropic and immunokorregirujushchej is shown therapy at a long subfebrile condition at patients with active gerpesvirusnoj an infection.

The practical importance

Features of clinico-laboratory implications GVI on which it is possible to assume are defined, whether is GVI the etiological factor of syndrome DS. Practical result of the carried out research were references on improvement of diagnostics GVI at children with syndrome DS, its etiological decoding by complex inspection of patients with DS on markers active replikatsii VPG I, EBV, TSMV and ВГЧ-6: virus antigens in blood leucocytes, DNA of viruses in blood, a saliva and urine, antibodies to viruses of classes ІдМи IgG, for the proof of presence at a sick active virus. It is shown, that it is important to elicit not the fact of presence GV in an organism to what indirectly testify AT to a virus of class IgG in blood, and essentially to tap its markers active replikatsii: antigens in
Leucocytes of blood which are early markers GVI and-or virus DNA in blood. Increase of level AT of class IgG in blood above diagnostic value in 4 times matters as also detection of DNA GVI in urine and a saliva, antibodies to a virus of class IgM, and.

The offered scheme complex etiopatogeneticheskoj to therapy GVIu of children with DS will promote reduction of terms of clinical implications, including subfebrile condition that promotes reduction of kojko-day for patients and to stay reduction by the sick-list of mothers who are looking after the sick child.

Introduction in practice

Results of the dissertation are introduced in practice of work of the Morozovsky children's city hospital and Central Hospital UPD the Russian Federation. Work substantive provisions are used at carrying out of employment and lecturing to students on chair of children's infectious diseases of pediatric faculty with a course of vaccinal prevention FUV GOU VPO of Russian state medical university Roszdrava, and also included in methodical grants for students, interns, interns and doctors.

Dissertation approbation

Dissertation materials have been reported on XII congress of pediatrists - infektsionistov Russia (Moscow, 2012); HSH the congress of pediatrists - infektsionistov Russia (Moscow, 2013); on V All-Russia nauchnoyoprakticheskoj conferences «Infectious aspects of a somatic pathology at children» (Moscow, 2012); on IV All-Russia congress on infectious diseases (2014), on section of pediatrists-infektsionistov (2014г.), at joint session of joint scientifically-practical conference of employees of chair infectious bolezneju children of pediatric faculty with a course of vaccinal prevention GOU VPO RNIMU № 1 and № 2, employees of laboratory epidemiologii opportunistic infektsiinii
Epidemiologii and microbiology of N.F.Gamalei and doctors of the Morozovsky children's city hospital (Moscow, 2013,2014).

Structure and dissertation volume

The dissertation consists of introduction, the review of the literature, heads of own researches, the conclusion, conclusions, practical references and the list of the literature including 82 domestic and 134 foreign sources. The dissertation is stated on 145 pages of the typewritten text, contains 4 extracts from case histories, 21 table, 12 drawings.