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The literature review is devoted to the chromosomally integrating viruses, the integration property. These are revealed using modern diagnostic methods, including highthroughput sequencing. The review describes various types of viruses, such as retroviruses, adenoviruses, herpes viruses, papillomaviruses, hepatitis B, SARS-CoV-2 and others. These viruses have the ability to integrate their genomes into the host cell genomes and their prevalence. Modern information on the molecular mechanisms of viral integration and methods of differential diagnostics is presented. Each of these viruses has its own unique ways of interacting with the host cell genome to maintain a latent state, which determines the specifics of the infectious process and pathological consequences for the body due to the possibility of effective reactivation.

The heavy burden of meningococcal infection is associated not only with life-threatening complications in the acute period and high mortality in invasive forms of the disease, but also with severe consequences in survivors, who are not recorded in our country.The aim of study: to analyze clinical manifestations, complications of the acute period and outcomes of invasive forms of meningococcal disease in children in various regions of the Russian Federation.Materials and methods: an analysis of data from 1327 inpatient medical records of children with an invasive meningococcal infection from 14 regional centers of the Russian Federation for 2012-2021 was carried out (28.3% of cases of the disease in children in the represented federal districts).Results: it was found that young children predominated among the patients – the median was 27.4 (10.7-70.4) months. Complications of the acute period, often combined, were observed in 47.6% of cases. The development of septic shock was noted in 30.4%, Waterhouse-Friderichsen syndrome in 6.6%, carditis in 2.9%, cerebral edema in 15.7%, arthritis in 1.4% of cases; the formation of hydrocephalus, subdural effusion, sensorineural hearing loss in 1.8%, 0.6%, 1% of children, respectively. The presence of soft tissue necrosis requiring surgical intervention was noted in 3.5% of cases. Mortality rate was 10.1%. At the time of discharge from the hospital, 30% of children had complications associated with meningococcal infection: organ dysfunction/ failure in 13.2% of patients (severe in 1.3%), cerebral insufficiency in 19.6%; severe psycho-neurological deficits, sensorineural hearing loss, problems associated with the need for orthopedic/surgical interventions accounted for 0.7%, 0.6% and 0.8%, respectively.Conclusion. Considering the epidemiological features of meningococcal infection – the risk of a sharp increase in morbidity in short periods of time, the life-threatening nature of the disease itself, it is necessary to remain alert to these risks and take all possible measures to prevent the disease using all available means, the most effective of which is vaccine prevention.

The aim: to characterize the clinical and etiological features of facial palsy (FP) in children of different ages at the present stage and their correlation with the outcome and duration of the disease.Materials and methods: the data of 68 children with FP were obtained. The neurological examination with an assessment of the level of facial nerve damage and the severity of FP using the House-Brackmann scale (HB), the concomitant symptoms and the etiological verification of a possible infectious agent were performed to all children. Also, their correlation with the outcomes and duration of the disease were assessed.Results: in the etiological structure infectious FP are more common in children under 12 years of age, with a predominance of herpesviruses and enteroviruses, whereas, more than half of the cases in children over the age of 12 years are idiopathic (Bell’s palsy), less often herpesviruses. A longer course and the probability of an unfavorable are significantly more often observed in the group of children under 12 years of age. There was also a significant correlation between the severity of FP according to HB with the outcomes and duration of the disease.Conclusion: The results confirm the importance and necessity of laboratory confirmation of a possible etiological agent associated with the development of FP. The severity of FP doesn’t depend on the age of the child, but correlates with the outcome and duration of the disease, more less with the synkinesia. A promising direction for further research is to clarify the climatic factors affecting the incidence of FP.

Objective – to study the dynamics of the level of neuron-specific enolase (NSE) and S-100 protein in blood serum and cerebrospinal fluid in children with various features of viral encephalitis course and outcome and to define their role in diagnostics and prognosis.Material and methods. 48 children aged from 1 month to 15 years were examined. Analysis of the level of NSE and S-100 protein was performed by the method of hardphase immune-enzyme analysis.Results. A reliable increase of the level of S-100 protein in blood serum was identified in comparison with the control group in both acute and reconvalescence periods. During acute period higher values of NSE in blood serum were found in children with herpesvirus encephalitis of various etiologies in comparison with varicella zoster encephalitis, and during reconvalescence period – higher values of S-100 protein. In case of the most severe course of the disease the level of NSE in cerebrospinal fluid was reliably higher in comparison with patients in severe condition. Children with convulsive syndrome demonstrated higher concentration of NSE in cerebrospinal fluid than patients without convulsions. In case of formation of stable neurologic deficiency during the disease outcome there was identified an increase of NSE concentration in blood serum in comparison with the recovered patients. It was also identified that if the values of NSE were >7.0 ng/ml, it was possible to predict unfavourable outcome of viral encephalitis with sensitivity of 61.54% and specificity of 71.43%. The highest values of neuron-specific proteins in blood serum were found in the dead patient with herpes encephalitis.Conclusion. Analysis of NSE and S-100 protein in pediatric viral encephalitis is characterized by diagnostic and prognostic significance, demonstrates their role in pathogenesis and can be used for therapy correction.

Purpose: to assess the functional state of the brain in critically ill encephalopathy in children with infectious diseases.Materials and methods: 75 patients aged from 1 month to 17 years 11 months with infectious diseases, who were in the intensive care unit of the clinic, were examined, divided into two groups: the main group and the comparison group. Exclusion criteria: patients with cerebral palsy, organic lesions of the central nervous system, neuroinfections and epilepsy. Conducted daily clinical and neurological examination; study of the level of neurospecific proteins (NSE, protein S100) in blood serum; electroencephalography; study of evoked potentials of various modalities; ultrasound examination of the optic nerves, neuroimaging.Results: All patients had general infectious manifestations, the development of sepsis syndrome, cerebral systemic disorders with impaired consciousness, as well as convulsive syndrome. In the acute period of the disease in the main group, NSE values in 87.5% of children were within the upper limit of normal, S100 protein levels were many times higher than those in the comparison group. In dynamics, all patients showed an increase in the level of NSE, which correlated with persistent neurological symptoms in the form of irritability, weakness, and cognitive decline. In the comparison group, an increase in NSE occurred in 53% of children, an increase in S100 - in 83%. By the time of discharge, 47% of patients had an increase NSE and S100 protein. Visual evoked potentials in 84% of the children of the main group in the acute period, had a decrease the amplitude of the N2-P2 cortical response was revealed without significant dynamics in the future, which was accompanied by pronounced clinical manifestations, which made it possible to substantiate the expediency of dispensary observation of children who underwent a critical condition against the background of severe infectious pathology.Conclusion: in infectious diseases in children that are not accompanied by inflammatory processes in the nervous system, but proceed with the development of a critical condition, there is a neuropsychiatric deficit in the outcomes, which necessitates follow-up follow-up of such patients in the future.

Current insights into the close relationship between human health and the gut microbiota, as well as recent advances in molecular biology suggesting a significant role for gut viromas, have encouraged research into the therapeutic usefulness of bacteriophages.The purpose of this review is to consider the prospects for the use of bacteriophages for the correction of the gut microbiota and therapy of digestive system diseases.The review describes the basics of phage biology, peculiarities of bacteriophage virome of the intestine in gastroenterological pathology; it highlights modern methods of phage-based therapy and prevention, considers problems of phage therapy and ways to overcome them. It is shown that the use of phages can become a key personalized approach to the treatment and prevention of infectious and non-infectious gastroenterological diseases.

The article presents a clinical observation of severe acute hepatitis of unknown aetiology with liver transplantation in a 16-year-old child, which occurred in October 2021. Initial symptoms were abdominal pain, diarrhea. The general wellbeing of the girl did not suffer, there was no fever, no intoxication syndrome. Over the next days, she began to notice the appearance of edema on the legs, an increase in the size of the abdomen. From the 10-11th day of illness – darkening of urine, acholia of feces, jaundice were observed. She was examined by a pediatrician, a biochemical blood test was performed, according to the results the girl was hospitalized with a diagnosis of acute hepatitis. According to the severity of the condition, she was hospitalized in the ICU. On admission she complained of abdominal pain, jaundice, edema, and weakness. On examination: jaundice, scleral icterus, hemorrhagic rash at the site of the tourniquet, bleeding from injection sites, hepatomegaly, anasarca. In blood tests: progressive anemia, thrombocytopenia, increased AST (with a decrease in dynamics against the background of progression of liver failure), a decrease in total protein and albumin, fibrinogen, prothrombin according to Quick. Laboratory excluded viral hepatitis A-E. The only infectious agent diagnosed was group F adenovirus in feces. By the third day of hospitalization developed of multiple organ failure, DIC. On the 4th day of hospitalization, the child was transferred to a specialized hospital, where an emergency liver transplantation was performed. The operation was successful, the child was discharged in a stable condition.

Since the onset of the SARS-CoV-2 infection, there has been an increase in the number of reports of patients who have experienced the development of autoimmune neurological disorders. It is assumed that such an increase in the incidence rate may occur due to an abnormal immune-mediated response of the body to the pathogenic impact of SARS-CoV-2. This article discusses the possibility of the influence of SARS-CoV-2 on the onset and exacerbation of the course of autoimmune neurological disorders, possible pathogenetic factors and mechanisms, and analyzes the features of the clinical picture and therapy. The article includes foreign and Russian scientific data and clinical observations of cases of Guillain-Barré syndrome, multiple sclerosis, acute disseminated encephalomyelitis, myasthenia gravis and other autoimmune diseases that have changed their typical course on the background of COVID-19.

Herpesviruses are the most common etiological agents of encephalitis in children. The most pathogenic properties for humans are: Herpes Simplex virus type 1, type 2, Varicella Zoster virus, Human Herpes virus type 6 and Epstein-Barr virus, combined infection with which, along with the individual characteristics of the patient's immune status, can lead to a severe course and unpredictable outcome encephalitis.Materials and methods. Clinical and neurological monitoring, etiological verification of infectious agents in the blood and cerebrospinal fluid by PCR and ELISA methods were carried out in 85 children with encephalitis at the age of 10—18 years. In patients suffering from herpesvirus encephalitis, the levels of pro-inflammatory cytokines, interleukins, chemokines were determined in the blood during the acute period of the disease and after 10—14 days.Results. A decrease in the production of IFN-α and IFN-γ was revealed, which is an unfavorable factor prolonging the course of an active herpes virus infection. Conclusions. Cytokines should be considered as one of the prognostic factors for the course and outcomes of encephalitis in children, which will allow timely correction of patient management tactics in each specific case and improve the outcome of the disease.

The article reflects the history and evolution of the scientific activities of the research institute, now the Pediatric Research and Clinical Center for Infectious Diseases. The mission, strategy and current scientific directions are presented. The main achievements over the past five years are reflected, the introduction of which into the practical work of medical institutions in our country testifies to the effective implementation of the Mission of the institution to save the lives of children.

Development of various immune-mediated neurological complications after a viral infection is of particular interest to medical society during a pandemic of COVID-19. It was found that SARS-CoV-2 has the ability to cause hyperstimulation of the immune system, thereby initiating developing of autoimmune diseases. The article describes a clinical case of new onset of generalized myasthenia gravis with thymoma in a patient after previous COVID-19.

The problem of ixodic tick-borne borreliosis remains relevant due to its ubiquity, high incidence, especially in the Northwestern Federal District, a variety of clinical manifestations, as well as the possibility of chronization, including in children.Purpose: to describe our own clinical observations of Bannwart syndrome, which developed during the dissemination of the pathogen.Results. Bannwart syndrome is pathognomonic for borreliosis symptoms, including a triad of clinical manifestations: serous meningitis, single- or bilateral lesion of facial nerves, polyneuropathy. Timely clinical and adequate laboratory diagnostics determine the favorable course of the disease.

Currently, the most effective way to diagnose hereditary defects of the immune system is molecular genetic research, the results of which are evaluated in conjunction with the data of clinical and laboratory studies.Aims of the sudy: to evaluate the frequency and spectrum of rare genetic variants associated with the development of primary immunodeficiency (PID) in children with recurrent infections.Materials and methods: DNA samples from 113 children with recurrent infections were analyzed by targeted multigene sequencing of 338 PID-associated genes. Results: Pathogenic variants appropriate to the potential diagnosis of PID were identified in 8% of patients. Interestingly, 47.8% of children had variants associated with auto-inflammatory disorders.

The article, dedicated to the 30th anniversary of the founding of the Department of Infectious Diseases in Children of the Faculty of Postgraduate and Additional Professional Education of the St. Petersburg State Medical Pediatric University of the Ministry of Health of Russia, outlines the history of the creation and development of the department. The results of the comprehensive activities of the department are reflected: educational, research, organizational and methodological, treatment and diagnostic and advisory. The main directions and results of scientific work, their effectiveness when introduced into practical health care are described. The educational-methodical developments of the department, published in recent years, are presented, which are an important tool for improving the professional level of doctors. It is noted that by increasing the educational level of medical personnel, the department contributes to improving the quality of medical care for children, thereby not only taking part in improving the demographic situation in the country, but also in ensuring its national security.

Bacterial purulent meningitis is a life-threatening disease characterized by high mortality and severe consequences in survivors. Despite the modern possibilities of medicine, the disease continues to be a heavy burden on health care, the economy and society everywhere.Aim. To draw the attention of doctors to the problems associated with modern features of epidemiology, the consequences and possibilities of preventing bacterial purulent meningitis, especially in children, who constitute the main risk group for the development of this pathology.Literature review of Russian and foreign publications on the problem under consideration presented.Vaccination is recognized as one of the main tools for reducing morbidity and mortality from meningitis. Prophylactic vaccinations against N. meningitidis, Str.pneumoniae, H. influenzae, along with strict adherence to anti-epidemic measures in hospitals providing care to newborns, can help reduce the incidence of purulent meningitis in children and improve outcomes if they develop.

We present a review of the literature and our own data on the management and rehabilitation of impairment or persis‑tent loss of the olfactory function – hypo‑ and anosmia. Approaches for restoring impaired olfactory function can be divided into olfactory training, pharmacological and physiotherapy. Smell training is carried out according to a number of protocols that differ mainly in the used arsenal of smells, as well as in the frequency of their presentation. Pharma‑cologically, it is proposed to use steroids used both topically (intranasally) and systemically; there is no common view on the effectiveness of this approach. Physiotherapy involve electrical stimulation of the olfactory filaments in the area of their exit into the nasal cavity (lateral masses of the ethmoid bone). In our opinion the most rational approach is the use of training methods using different smells.

Invasive meningococcal infection is a significant cause of death, reaching 80% in septic shock. The Pediatric Research and Clinical Center for Infectious Diseases (PRCCID) has developed an algorithm for the treatment of children with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome, which includes basic drug therapy with polymyxin hemoperfusion in combination with extended methods of extracorporeal hemocorrection.Purpose: to evaluate the effectiveness of extracorporeal hemocorrection operations in children with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome.Materials and research methods: to the intensive care unit of the PRCCID for the analyzed period 2006—2020 34 children were hospitalized with invasive meningococcal infection with refractory septic shock and multiple organ failure syndrome. Two groups were formed: Group 1 — children admitted to the PRCCID in the period 2014—2020 (n = 23), who underwent polymyxin hemoperfusion simultaneously with extended methods of extracorporeal hemocorrection, group 2 — children hospitalized in 2006—201 3 (n = 1 1), methods of extracorporeal hemocorrection were not performed. The Mann-Whitney U-test and ANOVA were used to evaluate the results.Results and discussion: the use of extracorporeal hemocorrection operations in the complex therapy of invasive forms of meningococcal infection with refractory septic shock and multiple organ failure syndrome in children provides stabilization of central hemodynamics, reduces clinical and laboratory inflammatory reactions, helps to reduce the dose of vasopressor drugs and parameters of respiratory support, and also increases patient survival rate by 82.6%.

Since March 2020, the first reports have appeared about the increasing, almost everywhere, number of children who have undergone a new coronovirus infection caused by SARS-Cov-2 with a symptom complex resembling the manifestations of Kawasaki disease. A special feature of the clinical manifestations of this syndrome, which is called “Pediatric multisystem inflammatory syndrome associated with COVID-19”, is the high incidence of life-threatening conditions caused by the sharp development of arterial hypotension against the background of cardiogenic or vasogenic shock.In St. Petersburg, since the end of November 2020, there has been a sharp surge in admissions of children to the ICU of various hospitals with the clinic of Pediatric multisystem inflammatory syndrome, who have laboratory confirmation of the transferred COVID-19.The purpose of this article is to attract the attention of doctors of various profiles, to combine efforts to study this pathology, to determine the criteria for verifying the diagnosis, optimal treatment regimens and dispensary monitoring of patients who have been ill.

The review presents modern data on the genetics and etiopathogenetic features of Clostridium perfringens toxins, including the role of Clostridium perfringens enterotoxin, in the development of food poisoning and a number of intestinal diseases in humans, animals and birds.

Convulsive syndrome in children is manifested in the three forms: febrile convulsions in acute infections, symptomatic convulsions during acute neuroinfection, as well as onset of epilepsy requiring careful differentiation to prescribe adequate therapy. A threat of convulsive syndrome spreads beyond complications related to ongoing infection, because its development is associated with the risk of emerging symptomatic epilepsy in the future. Postencephalitic epilepsy developing in children within the first years after viral encephalitis has been specifically highlighted. A necessity to identify groups at risk of developing epilepsy gave a momentum to seek out for biomarkers of epileptogenesis reflecting the features of systemic and local inflammatory process in the central nervous system during the immune response to infection. Cytokines mainly mediating inflammation are currently examined being studied as candidate biomarkers of the risk of epilepsy. On the other hand, neuron-specific proteins known as inflammation biomarkers identified in various diseases of the central nervous system are being investigated to reveal brain cell injury in neuroinfections and epilepsy. Here we review publications assessing a potential to use inflammation biomarkers (cytokines and neuron-specific proteins) to diagnose and monitor pediatric neurological diseases associated with convulsive syndrome. The first part of the review describes the results of determining the inflammation biomarkers in the blood and cerebrospinal fluid during acute viral encephalitis/encephalopathy associated with various neurotropic viruses (herpes viruses, flaviviruses, enteroviruses). A significance of diverse biomarkers in predicting an outcome and long-term disease consequences are discussed.

Introduction. Nerve ultrasound continues to progress due to improved technical equipment and knowledge, but so far not enough research has been done to determine the normative values of the cross-sectional area in children, and the obtained results differ between laboratories and researchers.Aim of the study. To determine the normative values of peripheral nerves» cross-sectional area in children 5–18 years old.Materials and methods. High resolution nerve ultrasound of brachial plexus, median, ulnar, radial, femoral, sciatic, tibial and peroneal nerves was performed in 30 children in real time. Nerve trunks were visualized throughout the limb from both sides. The cross-sectional area of the nerves was measured by a manual tracing method with the rounding of the hypoechogenic contours of the nerve trunk. Nerves’ crosssectional area was measured at distal and proximal sites. The obtained data were statistically processed using Excel and Statistica 10.Results. No bilateral cross-sectional area’s differences were found in children. Boys had significantly thicker nerves compared to girls, older age group (13–17 years old) compared to younger ones. There was a significant correlation between cross-sectional area of the median nerve at the level of the wrist, sciatic nerve and children’ height and weight.Conclusions. The normal values of cross-sectional area in children can be used in the practical work of a neurologists, neurophysiologists and ultrasound technicians.

The onset of 2020 clearly demonstrated that infection agents pose a major threat to mankind. Current infectiology is shaped by resurrection of “old” seemingly forgotten infections, emergence of “new” infection agents, unusual combinations of known agents, evolving resistance of microorganisms to antibacterial drugs, transformation of human microbiome leading to distortions in herd immunity and, ultimately, emergence of healthcare-related infectious diseases, not letting alone threats of bioterror. Infection agents evolve together with mankind. Novel facets emerge in infectiology, alongside with trends in diagnosis, treatment and prevention of infectious diseases that become more diverse as the list of pathogens grows. Human and infection agent links extend beyond antagonistic relations towards symbiosis. Microorganisms adapt quickly in the new technogenic environment giving rise to novel pathogens and making it unlikely for the mankind to get free from infections any time soon.The total economic damage from infectious diseases increases by year, despite continuous improvement in therapy. Infectious mortality in children aged 0 to 14 years is the top fourth among other causes of death. The work assesses comparative dynamics of “common” childhood infections in the Russian Federation during 2018–2020. We analyse official statistics on paediatric infectious morbidity, comparative dynamics of main infectious diseases (acute respiratory diseases, intestinal infections of bacterial and viral nature, neuroinfections, anthropozoonotic infections, viral hepatitises), assess trends in morbidity of vaccine-preventable infections in children and adults in the Russian Federation, with greater detail towards selected regions, from January 2018 to April 2020.

Objective: to study the frequency, etiological, age, epidemiological features of combined acute intestinal infections in children.Materials and methods. In n the Department of intestinal infections of Pediatric Research and Clinical Center for Infectious Diseases within a year have observed 167 children with combined acute intestinal infections regardless of the severity of the disease. The etiology of the acute intestinal infections was verified by bacteriological, serological methods, PCR reagents “AmpliSens® AII screen-FL. Criteria for inclusion of patients in the study: no signs of nosocomial OKA. Statistical analysis of the results was performed using Excel 2007. Student’s criterion was used to estimate the difference of the studied data. Differences were considered significant at p

Purulent meningitis and viral encephalitis are the most common neuroinfections in children. The severity of the lesion, the frequency of disabling manifestations, as well as high mortality, determine the relevance of their study. Violations of hemostasis both in purulent meningitis and in viral encephalitis are some of the important pathogenetic mechanisms that determine the nature of the course and the similarity of the disease. The material for clinical, laboratory, and radiation studies was 100 children with purulent meningitis of various etiologies and viral encephalitis from the age of 1 month to 17 years 11 months. In addition to clinical monitoring, all patients underwent D-dimer and circulating endotheliocytes in the acute period and disease dynamics. The different nature of vascular damage has been proved: with the prevalence of endothelial damage in purulent meningitis, and a violation of its functional activity with vascular tone dysfunction — in case of viral encephalitis. Radiation markers of cerebral vascular damage in the acute period of neuroinfections are described. The pathogenetic significance of structural and functional disorders of the vascular wall and hemostasis in the genesis of purulent meningitis and viral encephalitis in children has been established.

In this review, magnetic resonance imaging (MRI) is presented as a tool for the differential diagnostics of the brainstem lesions in children. It has been shown that both the isolated brainstem lesions or those related to the supratentorial changes occur within a wide range of pathological conditions in acute stroke, dismetabolic disorders, inflammatory processes of both the infectious and non-infectious (autoimmune, paraneoplastic) etiology, neurodegenerative diseases, tumors. A small size of the brainstem, as well as a less clear distinction between the gray and white matter and certain limitations of visualization of the infratentorial structures with multiparametric MRI often lead to difficulties in the differential diagnosis. Sometimes the most important in the diagnostics is the topography of lesions and their signal intensity. Nevertheless, the clinical data, the results of epidemiological and laboratory studies are of primary importance for the differential diagnosis of brainstem lesions.

Aim: To investigate the features of allelic polymorphism, of several immune- and hemostasis-related genes in children with generalized, meningococcal infections and. to assess the usefulness of genotyping for prediction, of severe disseminated intravascular coagulation (DIC) and. multiple organ dysfunction, syndrome in these patients.Materials and methods: we studied. 20 children aged, from 8 months up to 17 years with generalized, meningococcal infections who developed DIC or/and multiple organ dysfunction syndrome. The control group consisted, of 200 blood, donors. Genomic DNA was isolated, from peripheral blood, leucocytes. Allelic variants of genes coding for plasma hemostatic factors (FI-A, FI-B, FXIII-A, PAI-1, ТРА) or pro-inflammatory cytokines (IL-6, IL-1B, TNF-A) were detected by PCR and. subsequent restriction, analysis. Allele and. genotype frequencies were calculated, by direct counting, and. their differences between the groups were assessed, by Fisher's exact test. For statistical analysis, the GraphPad. Prism, ver.4.0 software was used.Results: in the group of children with generalized, meningococcal infections, the frequency of heterozygotes for the IL-6 -174 G/C polymorphism, was 1.5-fold higher than in the controls (75.0% vs. 50.0%, respectively, OR=3.0; 95% CI: 1.1-8.6; p=0.037). Genotype TPA Del/Del was detected 4-fold more frequently in children who developed multiple organ dysfunction syndrome than in those with the more favorable disease course (45.4% vs. 11.1%, respectively, OR=6.7; 95% CI: 0.6-73.1; p=0.16). Moreover, among the patients having multiple organ dysfunction, syndrome, we observed, more frequently individuals who possessed, at least 2 unfavorable genetic variants (p=0.022).Conclusion: Simultaneous assessment of nucleotide variations in 8 studied genes could help to define the group of children with high, risk of multiple organ dysfunction, syn-drome.Genotype TPA Del/Del, associated, with decreased, production, of this factor, might serve as a marker of unfavorable DIC course and possible predictor of multiple organ dysfunction. syndrome in children with generalized, meningpcoc-cal infections.

The article presents a clinical case of a 14-year-old patient with viral meningoencephalitis complicated with cerebral edema and a brain coma caused by herpes simplex viruses. Comprehensive etiopathogenetic therapy was not sufficiently effective due to the late referral for medical help and the late start of treatment. It has been shown that the use of the L-lysine escinate preparation up to 10 intravenous injections in a single dose of 0.15 mg/kg twice a day, even in the later stages of encephalitis, which has an extremely severe course due to cerebral edema development, is highly effective due to its multifactorial actions.

PParry–Romberg syndrome, also known as progressive hemifacial atrophy, is a rare clinical entity of unknown origin with atrophy of skin and subcutaneous fat changes. A classic case of Parry–Romberg syndrome in a woman age 43 is presented. Initial facial changes appeared at the age of 20 years amid complete well-being and in the next 21 years a subcutaneous fat atrophy of the left half face developed, resulting in characteristic deformity changes. No other complaints and manifestations of the disease (epileptic seizures, headache, involvement of the other half of the face and/or extremities) were present at the timeof survey. The analysis of blink reflex, galvanic skin reflex, needle electromyography of the m. orbicularis oris from two sides, computed tomography of the skull bones revealed no pathological changes. The face infrared thermography confirmed asymmetric reduction of temperature on the ipsilateral side. Magnetic resonance scan showed hypotrophy of the left masticatory muscle, the left submandibular salivary gland, thinning of subcutaneous fat layer, changes in the white matter of the brain. Despite the typical clinical features the Parry - Romberg syndrome is a diagnostic challenge known and it is necessary to inform doctors about the latest achievements in the study of etiology, management and prognosis of the disorder.

We described a case of amyotrophic lateral sclerosis (ALS) with comorbid HIV infection. The diagnosis was confirmed by genetic tests. The difficulty of the differential diagnosis between amyotrophic lateral sclerosis and HIV-associated ALS syndrome is discussed.

Background. The similarity of the clinical manifestations of encephalitis (E), disseminated encephalomyelitis (DEM) and multiple sclerosis (MS) in children, the complexity of predicting the nature of the course and outcome of diseases determines the search for additional diagnostic and prognosis criteria.Objective: a comparative characteristic of laboratory indicators for E, DEM and RS in children to assess their diagnostic and prognostic value.Materials and methods. Fifty six children (14 children with E, 14 – with DEM, 28 – with MS) and 16 children of the control group (with acute respiratory virus infection) at the age from 10 to 17 years were examined. Laboratory methods included standard studies of cerebrospinal fluid (protein, cytosis), determination of concentrations of albumin and immunoglobulin G (IgG) in cerebrospinal fluid and serum with subsequent calculation of protein indices (albumin, immunoglobulin, intrathecal immunoglobulin G indexes).Results. With all nosological forms in the serum there were no significant differences between albumin and IgG from the control group, whereas in the cerebrospinal fluid an excess of the concentration of IgG was detected at a normal level of albumin. An increase in the albumin index was found only in E, whereas the immunoglobulin index was significantly higher than the norm in all groups of patients. A significant spread of the intrathecal IgG index (from 0.1 to 11.9) was found, which determined the analysis of clinical and laboratory parameters by subgroups, depending on its magnitude. The maximum incidence of increased intrathecal IgG synthesis was detected in children with MS (with exacerbation of MS – 74 %, in remission – 67 %), whereas in E and DEM, an increase was observed in about half of the patients surveyed and associated with a more favorable course of the disease.Conclusion. The data obtained make it possible to assert that, despite the commonness of some pathogenetic mechanisms, there are differences in the degree of impaired permeability of the blood brain barrier, the intensity of the systemic and intrathecal humoral immune response in E, DEM and RS, which may determine the features of their course and the outcome of the disease, including the transformation of the DEM in the RS.

The review article presents the scientific substantiation of the prospective direction of research of the intestinal microbiota and its role in the formation of various neurological pathologies. Reflected information about the enteral nervous system, which has direct relevance in the interaction between the brain and intestines. The study of the intestinal microbiota is currently carried out using modern methods of metagenomics, sequencing and bioinformation analysis. Data are presented on the formation of functional digestive disorders in children with altered intestinal microbiota and the ways of correction are determined.

Aim. The objective of the study was to substantiate the rationality of using monochromatic polarized incoherent optical radiation (photochromotherapy) on the abdomen as a supplement to the standard program for the treatment of acute intestinal infections in children.Material and methods. Twenty-six children with acute intestinal infections from 6 months to 12 years old were observed during inpatient treatment. In the comparison group (n = 11), children received standard therapy, including diet therapy, rehydration, sorbents, probiotics or prebiotics, as well as indications for etiotropic drugs. In the main group, patients (n = 15) in addition to standard therapy received photochromotherapy as an effect on the abdomen with monochromatic polarized incoherent optical radiation from the Bioptron apparatus with a blue filter at a distance of 5 cm labile along the bowel. The duration of photochromotherapy was 5 minutes, the course of treatment included 4-5 sessions 1 time per day. The effectiveness of the therapy regimens used in the groups was assessed by the duration of the disease, the length of inpatient treatment, the dynamics of changes in the clinical blood test at the time of discharge. Results. The advantage of the technique with the addition of standard treatment of acute intestinal infections by photochromotherapy was established. In the main group of patients, the duration of the disease was significantly shorter (9,1±0,8 days) compared to the comparison group (10,2±1,5 days, p=0,02) against the background of a significant decrease in the severity of inflammatory manifestations in the hemogram in form of a decrease in thrombocytosis. Conclusion. The obtained data make it possible to recommend the method of photochromotherapy in the complex therapy of intestinal infections of various etiologies in children older than 6 months.

Background. Unlike parameters of phrenic nerve conduction in healthy adults characterized by stability, in children variations with age are observed. The objective is to investigate the M-wave latency and amplitude in electroneurographic (ENG) examination of the phrenic nerve in healthy children of different ages for development of a normative database of neurophysiological data.Materials and methods. 48 healthy children (28 girls and 20 boys) were examined. Mean age was 9.19 ± 5.43 years (1–18 years). ENG examination of the phrenic nerve was performed with the modified standard procedure of stimulation at the level of the outer margin of the lower third of the sternocleidomastoid muscle with registration of M-wave from standard diaphragm point and parallel registration of the muscle activity from m.deltoideus and m.serratus anterior.Results. Mean values of the M-response latency were 5.64 ± 1.25 ms, amplitude – 0.66 ± 0.34 mV. For age-differentiated subgroups 1–2 years (n = 7), 3–5 years (n = 9), 6–12 years (n = 15), and 13–18 years (n = 17), the latency was 4.96 ± 1.94; 5.01 ± 1.13; 5.42 ± 0.84, and 6.44 ± 1.43 ms, respectively; the amplitude was 1.01 ± 0.37; 0.87 ± 0.31; 0.61 ± 0.24, and 0.45 ± 0.21 mV, respectively. The M-response amplitude values in children aged 1–2 years significantly differed from the values in children aged 6–12 and 13–18 years.Conclusion. ENG examination of the phrenic nerve is a technically uncomplicated procedure, and the obtained data is easy to interpret. During phrenic nerve ENG in children, it is necessary to take age variability of the M-wave latency and amplitude into account. The M-wave amplitude in healthy toddlers (1–2 years old) was significantly lower than in children aged 6–18 years.

In our review we present update on modern state of knowledge on instrumental methods of heart function evaluation. This methods are valuable and reliable additional tool in diagnostic process in patients with infectious diseases of different origins. Electrocardiography and heart ultrasound allows to perform noninvasive and highly informative investigation of heart’s condition on all stages of the disease. We review both literature and our own data on these matters. Heart MRI may further improve that diagnostic process and add it with valuable insights into the heart function and anatomy during the infectious diseases.

Background. The growing incidence of such central nervous system disorders as encephalitis (EP), acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) in pediatric population, similarity of their clinical manifestations at the onset, lack of universal diagnostic criteria and the risk of ADEM transformation into MS in the case of late diagnosis and inadequate treatment suggest the importance of this problem.Objective: to evaluate diagnostic and prognostic value of multimodal evoked potentials and transcranial magnetic stimulation (TCMS) in children with EP, ADEM and MS.Materials and methods. The study included 200 participants: 50 children with MS (mean age 14.0 ± 3.7 years), 50 children with ADEM (mean age 14.0 ± 3.5 years), 50 children with EP (mean age 12.0 ± 2.2 years) and 50 controls (mean age 14.0 ± 3.1 years). All patients underwent neurological examination, magnetic resonance imaging of the brain, diagnostic TCMS and assessment of visual evoked potentials, brainstem auditory evoked potentials, cognitive evoked potentials P300 to an auditory stimulus and somatosensory evoked potentials.Results. We found that the P37–N45 amplitude 124 msec) is a risk factor for ADEM transformation into MS. The P100 latency >132 msec and lack of cortical evoked motor response from the m. abductor hallucis at MS onset indicate a high risk of disease progression and further development of disabilityConclusion. TCMS and assessment of multimodal evoked potentials (with estimating response amplitudes) allow determining the nature and severity of brain lesions, detecting subclinical dysfunction of the central nervous system, monitoring of the recovery processes and predicting outcomes in children with EP, ADEM and MS.

Focal central nervous system damage can be a result of infectious process in brain or spinal cord, autoimmune or hypoxic-ischemic process and a relationship of these processes. Difficulties in differential diagnosis of variant pathogenic focuses in central nervous system are related with absence of specific clinical and laboratory data. In such cases brain biopsy can help to make right diagnosis. In this article we characterized diagnostical process in teenage girl with progressive case of acute disseminated encephalomyelitis and vegetative status as complication, though she got large doses of steroids and intravenous immunoglobulins at the disease onset, with positive dynamic as a result of prolonged antiviral therapy. The diagnosis was made only by brain biopsy – we found herpesviral brain damage, further the disease transformed in multiple sclerosis.

This review article presents the current data on vitamin D metabolism, «classical» and «nonclassical» functions which are most widely studied in recent years. Vitamin D inhibits cell proliferation and stimulates cell differentiation, inhibits adaptive immunity and promotes innate immunity. In recent years, proven the impact of vitamin D on the development and functioning of the nervous system, including the process of myelination. These effects can largely determine the role of vitamin D in the prevention and for a number of widespread diseases of modern man, including infectious pathology, autoimmune diseases, neuropsychiatric disorders, which explains the necessity of studying the therapeutic potential of vitamin D in a variety of human pathology.

Pediatric Research and Clinical Center of Infectious Diseases under the Federal Medical Biological Agency, Saint Petersburg, Russia Investigation of the role of cerebrospinal fluid components in the processes of patho- and sanogenesis of central nervous system diseases is a fundamental problem of medicine and biology. The work aim was to study immunomodulatory features of cerebrospinal fluid in case of bacterial purulent meningitis (BPM) in children by an in vitro experiment.There were studied immunomodulatory features of high-molecular and low-molecular fractions of cerebrospinal fluid of 33 children with bacterial purulent meningitis of different etiology and 12 children without meningitis by phytohemagglutinin (PHA)-stimulated reaction of leukocyte blast transformation. There was studied the influence of homogeneous cerebrospinal fluid samples of 8 children with bacterial purulent meningitis upon the production of immunoregulatory cytokines by blood cells. Concentration of cytokines (Interleukin (IL)-12, Tumor necrosis factor (TNF)-a, IL-8, IL-6, IL-10, IL-1b) in supernatants of 3-day old cultures of blood cells was detected by flow cytometry method.The effects of cerebrospinal fluid fractions directed on both stimulation and suppression of blast production were identified by phytohemagglutinin-stimulated reaction of leukocyte blast transformation (PHA-RLBT) test. The maximal frequency of stimulating effect of fractions was revealed in children with meningococcal meningitis. There was detected a link between the dynamics of blast forms production under the influence of cerebrospinal fluid fractions and severity of the disease course. The studied cerebrospinal fluid samples of children with bacterial purulent meningitis stimulated IL-6 proinflammatory cytokine production by blood cells as much as possible whereas the influence upon the synthesis of other immunoregulatory cytokines was ambiguous.

Convulsions in case of acute neuroinfections can both complicate the disease course and transfer to symptomatic epilepsy which is one of the most important medical and social problems. The review article presents the data on epidemiology of convulsive disorder and symptomatic epilepsy in case of neuroinfections in children. There are considered the current immune and biochemical aspects of epileptogenesis in case of infectious pathology. There is given the information on neurophysiological and radial features of symptomatic epilepsy developed in case of neuroinfections of different etiology. There is underlined the practical significance of timely complex etio-pathogenetic therapy for neuroinfections complicated by convulsion that allows to reduce the frequency of symptomatic epilepsy development. There are presented the data on the results of transcranial magnetic stimulation in case of refractory epilepsy.

The article describes some topical problems of neuroinfections in children and the ways of their solutions on the basis of the experience of a leading institution — Pediatric Research and Clinical Center for Infectious Diseases. There are introduced some innovation approaches of diagnostics and therapy of bacterial purulent meningitis tested at the institution. There are described diagnostic markers of meningitis in children, method of ultrasound evaluation monitoring of the condition of kidneys, renal blood flow, adrenal glands in the patients with a fulminant course of generalized form of meningococcal infection, and innovation therapeutic approach by recombinant interleukin-2 — roncoleukin introduction to the complex therapy. There is reflected an innovation method of differential diagnostics by the determination of acute-phase protein haptoglobin in cerebrospinal fluid. There are presented the tested methods to diagnose sensorineural deafness in children with bacterial purulent meningitis, critical condition polyneuropathy, and inflammatory polyneuropathy by the technique of rehabilitation potential evaluation.

In this review we discuss clinical significance of using evoked potentials in children with epilepsy and related disorders. This approach has been commonly adapted for practice in pediatric epileptology. In most cases, it serves a neuromonitoring tool to assess the effectiveness of a therapy program and / or its side-effects. In addition, the method of evoked potentials is helpful in testing the central inhibition and excitation balance in different forms of epilepsy. In this respect, we also take a look at the impact of epileptic activity on the function and development of brain regions. The method of evoked potentials may be used for localization of epileptic lesions in children suffering from focal epilepsy. Given the variety of existing modalities of evoked potentials, their safety, painlessness and neuromonitoring qualities, we recommend to expand the use of these techniques in pediatric patients with paroxysmal disorders.

Genetic characteristics of host organism may cause susceptibility to a variety of bacteria, viruses and fungi, as well as influence the course of infectious diseases. Multiple studies indicate the existence of alleles predisposing to infections. Furthermore, there are about 300 nosological entities of primary immunodeficiencies (PID), i.e., inherited defects of immunity. Timely diagnosis of such conditions is quite challenging; however, it is vital for improving quality of patient care. Modern methods of DNA analysis allow establishing genetic causes of vulnerability to certain infectious agents in many individuals

The article presents the basic aspects of the activity of the institution established for the benefit of children from the moment of its foundation in 1927. There are noted landmarks in history and the priority scientific research works carried out in different periods of the institution development. Some results of the current history, improvement of its material resources are presented. There are described scientific achievements and the institution discoveries and their social value.

Diagnostics, equally with prevention and treatment, is a basis of medical science and practice. For its history the medicine has accumulated a great variety of diagnostic methods for different diseases and pathologic conditions. Nevertheless, new tests, methods and tools are being developed and recommended to application nowadays. Such indicators as sensitivity and specificity which are defined on the basis of fourfold contingency tables construction or ROC-analysis method with ROC – curve modelling (Receiver operating characteristic) are used as the methods to estimate the diagnostic capability. Fourfold table is used with the purpose to estimate the method which confirms or denies the diagnosis, i.e. a quality indicator. ROC-curve, being a graph, allows making the estimation of model quality by subdivision of two classes on the basis of identifying the point of cutting off a continuous or discrete quantitative attribute.The method of logistic regression technique is introduced as a tool to develop some mathematical-statistical forecasting model of probability of the event the researcher is interested in if there are two possible variants of the outcome. The method of ROC-analysis is chosen and described in detail as a tool to estimate the model quality. The capabilities of the named methods are demonstrated by a real example of creation and efficiency estimation (sensitivity and specificity) of a forecasting model of probability of complication development in the form of pyodermatitis in children with atopic dermatitis.

Aim of our work was to evaluate the prognostic value of brainstem auditory evoked potentials (BAEPs) for the recovery period outcomes in children with acute bacterial meningitis.Methods. 65 patients with acute bacterial meningitis (average age 3 years, range 3 months-17 years) and 20 healthy controls of comparable age were evaluated with BAEPs. I-V and III-V intervals, amplitudes of the III and V peaks were registered and analyzed. During the recovery period prolonged neurologic observation was performed for the period of 1-6 years. Severe ataxia, pareses, symptomatic epilepsy, speech disturbances and intellectual impairments were regarded as signs of psycho neurologic deficit. ROC-analysis was performed to evaluate sensitivity and specificity of BAEPs parameters in predicting the occurrence of these signs.Results. There were statistically significant difference between the groups on the parameters of I-V interpeak interval and amplitudes of III and V peaks. ROC-analysis revealed that I-III, I-V interpeak intervals and amplitudes of III and V peaks were sensitive and specific in the predicting of the psycho neurologic deficit in the recovery period. Thus, these parameters may be used as a prognostic tool for predicting of such outcomes in acute meningitis in children.

The article describes the features of the course of generalized meningococcal infection caused by W135 serogroup meningococcus in children of various age groups. Taking into account the load of the disease course, especially in children of older age, vaccination by tetravalent (A, C, W, Y) conjugated vaccine is recommended not only for children of early age but also adolescents.

Objective of our work was to evaluate MEPs characteristics in children with acute inflammatory demyelinating polyneuropathy and evaluate usefulness of TMS as an additional diagnostic method in this disorder.Methods. 20 healthy children (7–14 years old, average 12 years, 7 females, 13 males) without any signs of neurological disorders were enrolled as controls and 37 patients (8–13 years old, average 11 years, 19 females, 18 males) with AIDP were enrolled as the main group. EMG and TMS were performed on 3–7 day from the onset of the first symptoms. Cortical and lumbar MEP`s latencies, shapes and amplitudes and CMCT were averaged and analyzed.Results. Significant differences between children with AIDP and controls on latencies of both cortical and lumbar MEPs were registered. Cortical MEPs shapes were disperse in 100% of the cases, and lumbar MEPs were disperse in 57% of the cases. Amplitudes changes for both lumbar and cortical MEPs were not significant.Conclusions. Diagnostic transcranial magnetic stimulation on the early stage of the acute demyelinating polyneuropathy in children may be implemented as the additional tool. Main finding in this population is lengthening of the latency of cortical and lumbar motor evoked potentials. Disperse shape of the lumbar MEPs may also be used as the early sign of the acute demyelization of the peripheral nerves.

The article describes the clinical case of meningococcal infections, complicated with the development of reactive arthritis. It highlights possible pathogenetic mechanisms of aseptic inflammation in combined meningococcal and herpesvirus infections. The role of herpesviruses as a co-factor in the formation of unfavorable course of meningococcal infection. The effectiveness of antiherpetic therapy in the complex treatment of meningococcal disease.