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Fever is a common complaint in children with lymphadenopathy. Reactive lymphadenopathy is defined as the presence of one or more lymph nodes with a diameter of more than 1.5-2.0 cm. A thorough diagnosis of lymphadenitis accompanied by hyperthermic syndrome is necessary. Purpose - is to determine the diagnostic algorithm of actions based on the example of a clinical case of fever of unclear origin. Clinical case. The peculiarity of this case is a prolonged hyperthermic syndrome with lymphadenitis against the background of helminthic invasion (toxocarosis). During her stay in the hospital, the girl’s condition was serious due to hyperthermic syndrome and lymphadenopathy. The diagnostic algorithm for this condition in children is proposed. During the examination, a diagnosis of Reactive cervical lymphadenopathy of infectious-allergic genesis; concomitant - «Parasitic invasion is mixed (toxocariasis, ascariasis). Fever» was established. The child’s condition upon admission was severe, due to intoxication and hyperthermic syndrome. The treatment was effective, the patient’s condition improved during the hospitalization. But establishing a diagnosis required the cooperation of doctors of many specialties and a large number of additional examinations. Conclusions. Therefore, it is necessary to form the alertness of pediatricians to toxocarosis and increase the level of knowledge about the correct diagnostic algorithm in such cases. Informing health care professionals about such lymphadenopathy and helminthic infestation in children should help practitioners distinguish them from febrile reactions or other conditions and improve treatment outcomes. The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child’s parents was obtained for the research. No conflict of interests was declared by the authors.

The COVID-19 pandemic has posed many challenges to the medical community, a number of which will remain in the near future. Analysis of clinical cases helps to identify problems, to plan future research, which can change the understanding of the consequences of the disease. As the first year of the pandemic progresses, there is a better understanding of the pathophysiology of the virus and the varied results of imaging COVID-19 in affected organs, which is crucial for improving the treatment of this complex disease and improving health outcomes. It is described a clinical case of exanthema in an 11-year-old patient after COVID-19. Clinical and immunological methods of investigation are used. The child’s condition was of the moderate severity, caused by skin and asthenovegetative syndromes. The child was diagnosed with COVID-19; fatigue syndrome after a viral illness; post COVID-19 exanthema infection crustal ichthyosis of the legs. A particular feature of this case is the occurrence of exanthema on the skin of the child after COVID-19. In these cases, the awareness of pediatricians should be raised to increase the level of knowledge of the correct diagnostic algorithm. No conflict of interests was declared by the authors.

Predisposition to venous thromboembolism is characteristic of SARS-CoV-2 infection, as thromboinflammation is one of the leading parts in the pathogenesis of COVID-19 and the cause of life-threatening conditions and death. We presented a clinical case of hepatic vein thrombosis in a 1-year-9-month-old girl with COVID-19 who met the MIS-C criteria. The girl was admitted to the hospital on the first day of the disease with complaints of repeated vomiting, fever up to 38.5-390C, severe weakness, refusal to eat and drink, a slight cough. The severity of the patient’s condition was due to fever and intoxication syndrome. There were manifestations of acute pharyngitis. In the first days we observed leukocytosis with neutrophilia, moderate lymphopenia, elevated levels of C-reactive protein, hypoalbuminemia, accelerated ESR. On admissiona rapid antigen test and PCR for SARS-CoV-2 were negative. Abdominal ultrasound revealed microthrombosis of the hepatic veins with inflammatory changes in the vessels, a small amount of free fluid in the abdominal cavity. Echocardiography detected the presence of fluid in the pericardial cavity. The level of D-dimer was increased to 943 ng/ml. Subsequently, COVID-19 was confirmed by serological testing. Conclusions. Thus, thrombosis of the veins of the internal organs, despite their rarity in childhood, can occur in COVID-19 and MIS-C and indicate thromboinflammation, which requires caution about their possible development and the correct diagnostic algorithm. Determination of the level of D-dimer and Doppler ultrasound examination of the abdominal cavity allows the diagnosis of thrombotic events in splanchnic organs in patients with COVID-19 and provide adequate treatment. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: COVID-19, hepatic vein thrombosis, thromboinflammation, multisystem inflammatory syndrome (MIS-C).

Currently the majority of malaria cases in Europe are imported by international travellers and immigrants. Typical clinical signs of malaria are recurrent fever, hepatosplenomegaly and haemolytic anaemia. Abdominal pain is not a specific clinical sign of malaria. We present a clinical case of three-day malaria in a 17-year-old Indian citizen who was admitted to the Ternopil Regional Children’s Hospital with fever and severe abdominal pain. The peculiarity of this case was the presence of fever and severe abdominal pain at the onset of the disease, which led to admission of the patient to surgical department and delayed correct diagnosis. Careful, thoro- ugh case history is one of the key points on the way to the accurate diagnosis. There is a need to increase the physicians’ awareness of malaria in patients with abdominal pain who have come from malaria endemic countries.

The aim of research is to estimate the number of LB-infected ticks and to evaluate their LB pathogen's genotype in children with clinical suspicion of Lyme borreliosis in the Ternopil region, Ukraine. In our first part of the study we conducted survey of 795 patients with clinical suspicion of Lyme borreliosis. In our second study we did laboratory analysis of the 795 ticks and 109 blood samples from children that were bitten by a tick. Real-time Polymerase Chain Reaction (PCR) using Vector-Best production test systems were used to detect infected ticks and evaluate pathogen's genotype. Only 267 (33.5%) children from the total number were bitten by infected ticks. The following forms of the lesion were noted:-skin - erythema form in 83 (76.1%) children, nervous system in 20 (18.3%), arthritis in 13 (11.9%) and heart in 1 (0.9%). The remaining (59.2.%) of children at the time of the study had no external manifestations and other clinical signs of the disease. LB was caused by one or a combination of the few pathogens: B.burgdorferi s.l., A.phagocytophilum, and B . miyamotoi. The DNA of several infectious pathogens B.burgdorferi s.l., A. phagocytophilum, B. Miyamotoi simultaneously were diagnosed in (12.3 %). We identify antibodies to the Borrelia burgdorferi sensu lato in 57.7.% of the examined children. The types of pathogens influence on Lyme borreliosis clinical symptoms and therefore on the timing of the diagnosing.

ObjectivesThe objective of this article was to present the clinical peculiarity of the Jarisch-Herxheimer reaction (JHR) during antibiotic treatment of Lyme arthritis.Material and methodsCase study presentation as a basis for discussion, literature search of PubMed database particularly in the subject of combination of the JHR and Lyme borreliosis using the combination of words “Jarisch-Herxheimer reaction” and “Lyme borreliosis”, “Lyme arthritis”, “antibiotic treatment”, “generalized inflammation”, “cytokine production”, “children”, “increasing awareness”; discussion of the problem based on a clinical case and cited articles.ResultsThe authors present a case of Lyme arthritis in a 13-year-old boy, as well as a discussion of clinical features of this complication of Lyme disease treatment as the Jarisch-Herxheimer reaction. On the 7th day of doxycycline treatment the patient’s condition deteriorated: a low-grade fever occurred, and severe arthralgias with intense hip, ankle and cervical spine pain and myalgias developed. Erythrocyte sedimentation rate and C-reactive protein were elevated. The Jarisch-Herxheimer reaction was diagnosed. This complication was characterized by severity, long duration and marked signs of inflammation.ConclusionsIn the reviewed literature the Jarisch-Herxheimer reaction in patients with Lyme borreliosis is described more often in adults, with mild course and short duration of the disease. Based on the presented clinical picture this severe complication may also be associated with long duration and marked signs of inflammation. The authors suggest that informing health professionals about occurrence of the Jarisch-Herxheimer reaction should help physicians to distinguish it from allergic reactions or other conditions and improve treatment outcomes.