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СОВРЕМЕННЫЕ ЭТИОПАТОГЕНЕТИЧЕСКИЕ И КЛИНИЧЕСКИЕ ОСОБЕННОСТИ РОТАВИРУСНОЙ ИНФЕКЦИИ У ДЕТЕЙ
Гарас Н.Н.,
Высшее учебное заведение Украины «Буковинский государственный медицинский университет»,
г., Черновцы, Украина, доцент кафедры педиатрии и детских инфекционных болезней, кандидат
медицинских наук Марусык У.И.,
Высшее учебное заведение Украины «Буковинский государственный медицинский университет»,
г., Черновцы, Украина, доцент кафедры педиатрии и детских инфекционных болезней, кандидат
медицинских наук Бебык В.В.
Высшее учебное заведение Украины «Буковинский государственный медицинский университет», г., Черновцы, Украина, доцент кафедры иностранных языков, кандидат медицинских наук
MODERN ETIOPATHOGENETIC AND CLINICAL FEATURES OF ROTAVIRUS INFECTION IN
CHILDREN
Garas M.N.,
Higher education institution Ukraine "Bukovinan State Medical University", c. Chernivtsi City, Ukraine, Assistant professor, Department of pediatrics and children's infectious diseases, PhD
Marusyk U.I.,
Higher education institution Ukraine "Bukovinan State Medical University", c. Chernivtsi City, Ukraine, Assistant professor, Department of pediatrics and children's infectious diseases, PhD
Bebykh V. V.
Higher education institution Ukraine "Bukovinan State Medical University", c. Chernivtsi City, Ukraine,
Assistant professor, Department of Foreign Languages, PhD
Аннотация
В статье показано ведущую этиологическую роль ротавирусной инфекции среди причин острого гастроэнтерита и секреторной диареи в детском возрасте, описаны вклад ротавирусов в структуре нозоко-миальных кишечных инфекций. В условиях умеренного климата возбудителю присуща зимняя сезонность и определенная возрастная зависимость (больше всего - в раннем возрасте). Характерными клиническими особенностями ротавирусной инфекции является комбинация проявлений со стороны респираторного и желудочно-кишечного тракта в виде катара верхних дыхательных путей и острого гастроэнтерита. В последние годы приходится роль ротавируса в развитии внекишечных церебральных симптомов (менинго-энцефалиты, судороги, миозит и полиомиелитоподобного заболевания).
Abstract
The paper shows the leading etiological role of rotavirus infection among the causes of acute gastroenteritis and secretory diarrhea in childhood. It describes the contribution of rotavirus in the structure of nosocomial gastrointestinal infections. In a temperate climate, the pathogen is characterized by winter seasonality and by a certain age dependence (most notably at an early age). Characteristic clinical features of rotavirus infection are a combination of manifestations from the side of the respiratory and gastrointestinal tract in the form of catarrh of the upper respiratory tract and acute gastroenteritis. In recent years, the role of rotavirus in the development of extraintestinal cerebral symptoms (meningoencephalitis, seizures, myositis, and poliomyelitis-like illnesses) has been proved.
Ключевые слова: ротавирусная инфекция, гастроэнтерит, диарея, дети.
Keywords: rotavirus infection, gastroenteritis, diarrhea, children.
Acute gastrointestinal infection (AGI) continue to occupy an important place in infectious diseases of childhood. According to the World Health Organization (WHO), more than 1 billion people every year suffer from acute gastrointestinal infections, 65-70% of which are children under the age of 5 years [16].
Currently, rotavirus infection is considered to be the leading etiological factor of acute gastrointestinal infections in children in general, including secretory diarrhea of young children [6,10] and viral lesion of intestine in particular [14]. Every year in the world more
than 125 million cases of rotavirus gastroenteritis among children are registered, about 2 million children under 5 years old with rotavirus gastroenteritis need hospitalization, in Europe, acute viral gastroenteritis is the most common cause of hospitalization of children under the age of 3 years. Up to 5 years of age, 95% of children in the world are infected with rotavirus [28].
Rotavirus is the most common cause of acute gastroenteritis in children in all European countries. In different countries of Western Europe, the incidence of rotavirus infection ranged from 1,33 to 4,96 cases per 100
people annually. Indicators of hospitalization of patients with rotavirus gastroenteritis varied from 7% to 81% in different countries. Indicators of morbidity for rotavirus gastroenteritis in some years ranged from 0,94 to 3,18 per 100 thousand population. However, domestic researchers point out that the actual morbidity of ro-tavirus gastroenteritis significantly exceeds these rates due to limitations of virological diagnosis. In addition, it should be recognized that when identifying the etio-logical factors of mixed viral-bacterial infections, they are usually limited only to the definition of a bacterial pathogen [9, 17].
The timeliness of the study of theoretical and practical issues related to rotavirus infection is also explained by the fact that rotavirus is the most common cause of nosocomial infection, especially in young children. Up to 69% of nosocomial acute gastrointestinal infections (AGI) are associated with rotavirus. High levels of contagiousness and virulence of rotavirus in hospital conditions are due to the high resistance of the pathogen to ordinary disinfectants, the ease of transmission through contaminated hands, toys, medical instruments, low dose of the pathogen, which is necessary for infection. The infectiousness of children is also facilitated by the frequent transmission of virus carriers among medical personnel (up to 20% of the staff of children's medical institutions shed rotaviruses) and other children (25-50% of children under 24 months of age hospitalized with different pathologies, shed rota-viruses in the absence of disorders of gastrointestinal tract) [24, 25, 18].
The first outbreaks of rotavirus diarrhea were described in the nineteenth century, the pathogen was isolated by R. Bishop and G. Barnes during electron microscopic studies of ultrathin sections of duodenal biopsy from children suffering from acute gastroenteritis (1973). In a separate nosology, the rotavirus infection was approved by the WHO in 1979. Rotaviruses belong to the family Reoviridae, which have double-thread fragmented RNA. The genome contains 11 fragments that are surrounded by a clearly defined three-layer protein shell (capsid) and resembles a "wheel with a wide hub, short spokes and a sharply circumscribed encircling", which has led the virus to its name (Latin rota -"wheel"). The unique structure of the rotavirus genome ensures their extremely high variability, the emergence of new serotypes, circulation and widespread prevalence in nature. As part of the virus there are no lipids, and this fact determines the resistance to environmental factors [3].
According to antigenic properties, rotaviruses are divided into 9 serotypes. Other serotypes are isolated in animals, they are non-pathogenic for humans. All rota-viruses, in the presence of a type-specific antigen, are divided into 7 groups: A, B, C, D, E, F, G. Most numerous are group A, which includes most human rota-viruses. Human infection can also occur with rotavirus groups B and C [5].
Rotavirus infection in temperate climates is seasonal, reaching the maximum at the end of winter. The age peak for rotavirus infection ranges from 6 months to 2 years [20].
The main pathway of spreading is fecal-oral. Transmission occurs when exposed to contaminated surfaces of the environment. Rotavirus transmission is very effective due to several factors, in particular, the presence of a large number of virions in feces, low infective dose and prolonged asymptomatic virus release contribute to a high degree of contagious activity. Insignificant is the protective role of gastric juice, since for the development of the disease, only 10% of microorganisms penetrate into the intestine from the entire infectious dose is enough. There is also an assumption about the possibility of airborne transmission pathway, since the virus has been isolated from the respiratory tract. The indicated mechanism explained the development of in-hospital rotavirus infections, since strict hygiene of hands and isolation did not have impact on the effectiveness of preventive measures [3, 5].
The discovery of the rotavirus genome revealed that the rotavirus RNA consists of 2 strands and has 11 segments that encode 6 structural (VP) and nonstruc-tural (NSP) proteins. The main trigger, which induces the development of diarrhea and lactase deficiency during the course of RVI, is the protein NSP4 [30]. It was found that the NSP4 protein is specific to rotavirus en-terotoxin, which can cause secretory diarrhea, similar to cholera toxins. Reduction of disaccharidase activity in the lumen of the intestine during rotavirus gastroenteritis is not mainly caused by the destruction of enter-ocytes by viral replication or virusseducatory apopto-sis, but by blocking the work of individual transport proteins of the enterocyte brush rims by the enterotoxin of the rotavirus NSP4 [26, 30]. Thus, rotavirus suppresses the activity of dependent sympathy of Na + -D-glucose without the damage to enterocytes, resulting in reduced glucose uptake and water reabsorption. In addition to the above, enterotoxin NSP4 causes the destruction of dense cell contacts, which is accompanied by an increase in paracellular permeability and an increase in the outflow of water from the interstitial space to the lumen of the intestine [27]. In the early period of the disease, lactase insufficiency is due to inhibition of the activity of the release of lactase-florizine hydroly-zates from enterocytes by inhibition of the NSP4 protein [19, 29].
The incubation period for rotavirus gastroenteritis is on average no more than 1-2 days. The severity of clinical symptoms, including and asymptomatic course, is determined by the genotype of the virus. The disease begins acutely, the developed clinical picture of the disease is formed already on the first day of the disease and is manifested by an increase in body temperature to subfebrile and, more often, febrile numbers (the temperature reaction lasts several days), the appearance of symptoms of a general state disorder that are nonspecific (weakness, malaise, fatigue, fever, headache), which are initially associated with hyperthermia, and later with the development of dehydration and lack of electrolytemia [10]. Against the background of a general state disorder, a combination of manifestations of the respiratory and gastrointestinal tract in the form of catarrh of the upper respiratory tract and acute gastroenteritis, enteritis (repeated vomiting, flatulence, abdominal pain, frequent watery feces) are characteristic
of rotavirus infection [3, 7]. Quite rarely, the colon can be involved in the process, most often this occurs as a result of secondary infection with the development of necrotizing enterocolitis [13].
Acute gastroenteritis is defined as the dilution of the consistency of defecations and/or the increase in the frequency of excrement to 3 and more times per day, with or without fever or vomiting. At the same time, it is more characteristic to change the stool consistency, but not their frequency, especially for the children of the first months of life.
Diarrhea, as defined by the WHO, is a frequent (3 and more times) liquid feces (which take the form of the container to which they fall) that are observed for 24 hours or more, which is accompanied by excessive loss of water and electrolytes. In young children, diarrhea is considered to be the volume of feces exceeding 15 g/kg/day, at the age of 3 years - more than 200 g/day [1, 24].
The most typical manifestations of enteritis are diarrhea - feces are rare, watery, foamy, poorly colored, with no pathological impurities, or with insignificant amounts of mucus, with a pungent odor. Number of defecations 5-20 times a day. Characteristic imperative desire for stool, it occurs suddenly, accompanied by rumbling in the intestine, complete with loud passage of flatus and splashing feces, and after the bowel movement the patient becomes better. Due to the rapid loss of water and electrolytes there is a rapid dehydration of the organism [3, 5]. Dehydration in case of untimely access to medical care can lead to the death of a child. It is believed that rotavirus infection is inferior only to cholera in severity of exsicosis [10].
In most cases enteritis does not occur in isolation, but acquires the forms of gastroenteritis and is characterized by rumbling and discomfort in the abdomen, abdominal pain, loss of appetite, nausea, repeated vomiting. Vomiting is a frequent symptom and is noted in 80% of patients with rotavirus infection. Most often it occurs simultaneously with diluted feces. Vomiting is repeated, but short-term (1-2 days) [21].
In recent years, great attention has been paid to respiratory syndrome as an important differential diagnostic feature that is found in patients with rotavirus infection in acute period. In this case, in certain parts of children, catarrhal phenomena appear previously dyspeptic syndrome [8], and in most children they precede hyperthermia [2]. Patients tend to complain about runny nose, nasal congestion, sore throat, dry cough, and with objective examination, hyperemia and granularity of soft palate, anterior pillar of the fauces (arcus glossopalatinus), uvula, posterior throat wall appear. Cataracts are short-lived and disappear completely after 3-4 days. In addition to the above-mentioned symptoms, extracerebral abnormalities such as anorexia and irritability are characteristic [11, 12]. The indicated symptoms are noted in 90% of ill children and occur almost simultaneously, which allowed foreign researchers to characterize the rotavirus infection as a DFV syndrome (diarrhea-fever vomiting) [7, 13, 31].
In addition to the lesion of the gastrointestinal tract, lately there have been reports of damage to the
nervous system in rotavirus infection. Currently, the literature describes reliable cases of damage to the nervous system associated with rotavirus. The rotavirus RNA was found in cerebrospinal fluid of patients with rotavirus infection in children with spasm [31]. En-cephalopathies, meningoencephalitis, encephalic reactions, benign convulsions, myositis, and poliomyelitis paresis and paralysis are also described. Extraintestinal cerebral manifestations of rotavirus infection, although rare, but threatening [4, 22, 23].
Conclusions: 1. Acute gastrointestinal infections are an actual problem of modern pediatrics and infec-tology. Rotavirus infection is the leading etiological factor of secretory diarrhea in infants and toddlers. 2. The clinical picture of rotavirus infection is characterized by a combination of manifestations from the side of the respiratory and gastrointestinal tract in the form of catarrh of the upper respiratory tract and acute gastroenteritis, enteritis (repeated vomiting, flatulence, abdominal pain, frequent watery defecation). 3. The main life-threatening condition in rotavirus gastroenteritis is dehydration, however, in recent years there have been extraintestinal cerebral manifestations of rotavirus infection.
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FEATURES OF OVARIAN RESERVE IN PATIENTS WITH INFERTILITY AND OVARIAN
ENDOMETRIOSIS
Andriets A. V., Yuzko O.M.
The Higher State Educational Institution of Ukraine "Bukovinian State Medical University"
Abstract
The purpose of the study: - to study the peculiarities of the ovarian reserve of the patients with infertility and ovarian endometriosis on the basis of the investigated level of anti-Mullerian hormone in the blood and the echographic count of the number of antral follicles in the ovaries.
Materials and methods: An echographic number of antral follicles count(AFC) in the ovaries was performed among 100 patients (the main group) with infertility and ovarian endometriosis, 55 of them - the determination of
