medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-19-29-34medsovet-7160Research ArticleБРОНХОПУЛЬМОНОЛОГИЯ, ОТОРИНОЛАРИНГОЛОГИЯBRONCHOPULMONOLOGY, OTORHINOLARYNGOLOGYОсобенности течения гриппа и его коинфекции у детей на современном этапеFeatures of the course of influenza and its co-infection in children at the present stagehttps://orcid.org/0000-0003-3880-8112НиколаеваС. В.NikolaevaS. V.

Николаева Светлана Викторовна, д.м.н., ведущий научный сотрудник клинического отдела инфекционной патологии

 111123, Россия, Москва, ул. Новогиреевская, д. 3а 

Svetlana V. Nikolaeva, Cand. Sci. (Med.), Leading Researcher of the Clinical Department of Infectious Pathology

3a, Novogireevskaya St., Moscow, 111123, Russia 

nikolaeva008@list.ruhttps://orcid.org/0000-0001-5232-7337УсенкоД. В.UsenkoD. V.

Усенко Денис Валерьевич, д.м.н., ведущий научный сотрудник клинического отдела инфекционной патологии

 111123, Россия, Москва, ул. Новогиреевская, д. 3а 

Denis V. Usenko, Dr. Sci. (Med.), Leading Researcher, Clinical Department of Infectious Pathology 

3a, Novogireevskaya St., Moscow, 111123, Russia 

dusenko@rambler.ruhttps://orcid.org/0000-0002-3346-1132ПогореловаО. О.PogorelovaO. O.

Погорелова Ольга Олеговна, к.м.н., научный сотрудник клинического отдела инфекционной патологии

 111123, Россия, Москва, ул. Новогиреевская, д. 3а 

Olga O. Pogorelova, Cand. Sci. (Med.), Researcher of the Clinical Department of Infectious Pathology 

3a, Novogireevskaya St., Moscow, 111123, Russia 

vickdok@rambler.ruhttps://orcid.org/0000-0002-3774-819XШабалинаС. В.ShabalinaS. V.

Шабалина Светлана Васильевна, д.м.н., профессор, ведущий научный сотрудник клинического отдела инфекционной патологии

 111123, Россия, Москва, ул. Новогиреевская, д. 3а 

Svetlana V. Shabalina, Dr. Sci. (Med.), Professor, Leading Researcher, Clinical Department of Infectious Pathology 

3a, Novogireevskaya St., Moscow, 111123, Russia 

svs2810@pcr.ruhttps://orcid.org/0000-0003-4821-676XХлыповкаЮ. Н.KhlypovkaYu. N.

Хлыповка Юлия Николаевна, к.м.н., научный сотрудник клинического отдела инфекционной патологии

 111123, Россия, Москва, ул. Новогиреевская, д. 3а 

Yuliya N. Khlypovka, Cand. Sci. (Med.), Researcher of the Clinical Department of Infectious Pathology 

3a, Novogireevskaya St., Moscow, 111123, Russia 

ve-stu@mail.ruhttps://orcid.org/0000-0003-2619-9110ШушаковаЕ. К.ShushakovaE. K.

Шушакова Екатерина Константиновна, младший научный сотрудник клинического отдела инфекционной патологии

 111123, Россия, Москва, ул. Новогиреевская, д. 3а 

Ekaterina K. Shushakova, Junior Researcher of the Clinical Department of Infectious Pathology 

3a, Novogireevskaya St., Moscow, 111123, Russia 

ketlu@bk.ruhttps://orcid.org/0000-0002-1524-2868РублеваО. В.RublevaO. V.

Рублева Ольга Васильевна, к.м.н., главный врач

142000, Россия, Московская область, Домодедово, ул. Курыжова, д. 18, корп. 1

Olga V. Rubleva, Cand. Sci. (Med.), Chief Physician

18, Bldg. 1, Kuryzhova St., Domodedovo, Moscow Region, 142000, Russia 

og@rcbd.orgЦентральный научно-исследовательский институт эпидемиологииРоссияCentral Research Institute of EpidemiologyRussian FederationООО «Биолаб-Р»РоссияBiolab-R LLCRussian Federation2022121120220192934Copyright © Николаева С.В., Усенко Д.В., Погорелова О.О., Шабалина С.В., Хлыповка Ю.Н., Шушакова Е.К., Рублева О.В., 20222022Николаева С.В., Усенко Д.В., Погорелова О.О., Шабалина С.В., Хлыповка Ю.Н., Шушакова Е.К., Рублева О.В.Nikolaeva S.V., Usenko D.V., Pogorelova O.O., Shabalina S.V., Khlypovka Y.N., Shushakova E.K., Rubleva O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7160

Грипп – острая респираторная инфекция, протекающая с преимущественным поражением дыхательных путей (чаще трахеи), характеризующаяся склонностью к быстрому развитию симптоматики и в большинстве случаев не требующая госпитализации. Характерна неспецифичность клинических проявлений, свойственная всем острым респираторным инфекциям: регистрируются симптомы интоксикации, катаральные явления (заложенность носа, ринорея, боль или дискоморт в горле), лихорадка, кашель. Совершенствование и широкое внедрение молекулярных методов идентификации респираторных патогенов привело к установлению большей частоты сочетанных форм инфекций. Представлен анализ данных литературы по частоте регистрации сочетанных форм гриппа. Описаны клинические случаи моногриппозной и сочетанной инфекции гриппа и респираторно-синцитиальной инфекции, в котором продемонстрирован антагонизм влияния двух вирусов на течение болезни. В первом случае пациентка, 1 год 1 мес., была госпитализирована с температурой 39 ºC в среднетяжелом состоянии. В мазке из носоглотки методом ПЦР выделена РНК вируса гриппа А, диагностирован грипп. Во втором случае пациент, 2 года, в начале заболевания предъявлял жалобы на повышение температуры тела до 38,7 ºC, кашель, затрудненное носовое дыхание. При поступлении состояние средней тяжести, температура тела 36,6 ºC, сознание ясное, самочувствие не нарушено. При аускультации в легких дыхание жесткое, хрипы единичные влажные, рассеянные с обеих сторон. В мазке из носоглотки методом ПЦР выделены РНК вируса гриппа А и респираторно-синцитиального вируса. Диагностирована вирусная острая респираторная инфекция сочетанной этиологии, острый бронхит. В третьем случае пациент, 14 лет, обратился с жалобами на лихорадку до 39 ºC, головную боль, слабость, боль в мышцах, сухой кашель. Состояние средней тяжести. Диагноз гриппа А подтвержден экспресс-тестом на грипп А/В/С. В лечении и профилактике как моноинфекции, так и сочетанных форм гриппа с вирусной инфекцией другой этиологии в данных клинических примерах показана эффективность применения препарата осельтамивир. Приведенные клинические примеры позволяют обозначить некоторые ключевые параметры: сочетанность респираторных инфекций изменяет типичную клиническую картину болезни, что делает затруднительной клиническую диагностику инфекции, выводя на первый план лабораторную диагностику, которая, в свою очередь, способствует быстрой верификации диагноза и своевременному назначению адекватной терапии.

Influenza is an acute respiratory infection, mainly affecting the respiratory tract (often the trachea), with a tendency to develop symptoms rapidly and in most cases not requiring hospitalization. All acute respiratory infections are non-specific, with symptoms of intoxication, catarrhal symptoms (nasal congestion, rhinorrhoea, sore throat or pharyngeal discomfort), fever and cough. Improvement and widespread implementation of molecular methods to identify respiratory pathogens has led to the establishment of a higher frequency of co-infections. A literature review of the frequency of influenza co-infections is presented. Clinical cases of monoinfluenza and co-infections of influenza and respiratory syncytial infection are described, demonstrating the antagonistic effect of the two viruses on the course of the disease. In the first case, the patient, 1 year 1 month old, was hospitalised with a fever of 39 ºC in a moderate condition. A nasopharyngeal swab showed RNA of influenza A virus by PCR and was diagnosed with influenza. In the second case, the patient, 2 years old, at the beginning of the disease complained of an increase in body temperature to 38.7 ºC, cough, and difficulty in nasal breathing. On admission, the patient was in moderate condition with a body temperature of 36.6 ºC, clear consciousness and well-being. On auscultation, breathing in the lungs was rigid, single moist rales, scattered on both sides. A nasopharyngeal swab showed RNA of influenza A virus and respiratory syncytial virus by PCR. A viral acute respiratory infection of combined etiology and acute bronchitis was diagnosed. In the third case, a 14-year-old patient presented with complaints of fever up to 39 ºC, headache, weakness, muscle pain, dry cough. The condition was of moderate severity. The diagnosis of influenza A was confirmed by a rapid test for influenza A/B/C. In the treatment and prevention of both monoinfection and co-infections of influenza and other viruses, these clinical examples demonstrate the effectiveness of oseltamivir. These clinical examples highlight some key parameters: respiratory co-infections change the typical clinical picture of the disease, making it difficult to clinically diagnose the infection, highlighting laboratory diagnosis, which in turn facilitates rapid verification of the diagnosis and timely prescription of adequate therapy.

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The authors declare that there are no conflicts of interest present.