Respiratory infections of combined etiology in the clinical practice of the pediatrician
https://doi.org/10.21518/2079-701X-2021-1-78-82
Abstract
Acute respiratory infections hold the leading position in the structure of infectious pathology in children and are one of the main reasons for visits to the doctor. Most often causative agents of acute respiratory infections are viruses. In recent years, respiratory infections of combined etiology are becoming an increasingly significant problem, the proportion of which is increasing.
In co-infections, clinical diagnosis is difficult, which once again emphasizes the importance of the widespread introduction of highly sensitive etiological diagnostic methods, in particular polymerase chain reaction. Data on the tendency to a more severe course of co-infections compared to mono-infections are ambiguous, which seems to depend on the specific causative agent and the level of viral load. Another urgent problem of acute respiratory infections in children is the frequent registration of concomitant respiratory viral and herpes virus infections. The clinical picture of acute respiratory tract infections is not very diverse: fever, intoxication symptoms, cough, nasal congestion, rhinorrhea, sore throat, etc. At the same time, pathognomonic symptoms can be identified in some monoinfections, but in coinfections such clinical diagnosis is difficult, suggesting the importance of etiological diagnosis, especially polymerase chain reaction (PCR).
All of the above, as well as age and clinical manifestations largely determine the rational selection of antiviral therapy simultaneously effective against both respiratory viruses and herpes viruses. One such drug is Cycloferon, which has not only a broad antiviral spectrum, but also a high level of safety.
Inclusion of an interferon inducer in the treatment of acute respiratory infections will reduce the need to prescribe other drugs, including antibiotics, and reduce the medication load on the body.
About the Authors
Svetlana V. NikolaevaRussian Federation
Svetlana V. Nikolaeva, Cand. of Sci. (Med.), Senior Researcher of the Clinical Department of Infectious Pathology
3a, Novogireevskaya St., Moscow, 111123
Denis V. Usenko
Russian Federation
Denis V. Usenko, Dr. of Sci. (Med.), Leading Researcher of the Clinical Department of Infectious Pathology
3a, Novogireevskaya St., Moscow, 111123
Yuliya N. Khlypovka
Russian Federation
Yuliya N. Khlypovka, Cand. of Sci. (Med.), Junior Researcher of the Clinical Department of Infectious Pathology
3a, Novogireevskaya St., Moscow, 111123
Svetlana V. Shabalina
Russian Federation
Svetlana V. Shabalina, Dr. of Sci. (Med.), Professor, Leading Researcher of the Clinical Department of Infectious Pathology
3a, Novogireevskaya St., Moscow, 111123
Aleksandr V. Gorelov
Russian Federation
Aleksandr V. Gorelov, Corresponding Member of the RAS, Professor, Dr. of Sci. (Med.), Deputy Director for Scientific Work, Professor of the Department of Childhood Diseases
3a, Novogireevskaya St., Moscow, 111123
8, Bldg. 2, Trubetskaya St., Moscow, 119991
References
1. De Conto F., Conversano F., Medici M.C., Ferraglia F., Pinardi F., Arcangeletti M.C. et al. Epidemiology of human respiratory viruses in children with acute respiratory tract infection in a 3-year hospital-based survey in Northern Italy. Diagn Microbiol Infect Dis. 2019;94(3):260–267. doi: 10.1016/j.diagmicrobio.2019.01.008.
2. Fillatre A., François C., Segard C., Duverlie G., Hecquet D., Pannier C. et al. Epidemiology and seasonality of acute respiratory infections in hospitalized children over four consecutive years (2012–2016). J Clin Virol. 2018;102:27–31. doi: 10.1016/j.jcv.2018.02.010.
3. Canela L.N.P., de Magalhães-Barbosa M.C., Raymundo C.E., Carney S., Siqueira M.M., Prata-Barbosa A., da Cunha A.J.L.A. Viral detection profile in children with severe acute respiratory infection. Braz J Infect Dis. 2018;22(5):402–411. doi: 10.1016/j.bjid.2018.09.001.
4. Góes L.G.B., Zerbinati R.M., Tateno A.F., de Souza A.V., Ebach F., Corman V.M. et al. Typical epidemiology of respiratory virus infections in a Brazilian slum. J Med Virol. 2020;92(8):1316–1321. doi: 10.1002/jmv.25636.
5. Wong-Chew R.M., García-León M.L., Noyola D.E., Gonzalez L.F.P., Meza J.G., Vilaseñor-Sierra A. et al. Respiratory viruses detected in Mexican children younger than 5 years old with community-acquired pneumonia: a national multicenter study. Int J Infect Dis. 2017;62:32–38. doi: 10.1016/j.ijid.2017.06.020.
6. Yen C.Y., Wu W.T., Chang C.Y., Wong Y.C., Lai C.C., Chan Y.J. et al. Viral etiologies of acute respiratory tract infections among hospitalized children – A comparison between single and multiple viral infections. J Microbiol Immunol Infect. 2019;52(6):902–910. doi: 10.1016/j.jmii.2019.08.013.
7. Chen J., Hu P., Zhou T., Zheng T., Zhou L., Jiang C., Pei X. Epidemiology and clinical characteristics of acute respiratory tract infections among hospitalized infants and young children in Chengdu, West China, 2009–2014. BMC Pediatr.2018;18:216. doi: 10.1186/s12887-018-1203-y.
8. Goka E.A., Vallely P.J., Mutton K.J., Klapper P.E. Single, dual and multiple respiratory virus infections and risk of hospitalization and mortality. Epidemiol Infect. 2015;143:37–47. doi: 10.1017/S0950268814000302.
9. Appak Ö., Duman M., Belet N., Sayiner A.A. Viral respiratory infections diagnosed by multiplex polymerase chain reaction in pediatric patients. J Med Virol. 2019;91(5):731–737. doi: 10.1002/jmv.25379.
10. Antalis E., Oikonomopoulou Z., Kottaridi C., Kossyvakis A., Spathis A., Magkana M. et al. Mixed viral infections of the respiratory tract; an epidemiological study during consecutive winter seasons. J Med Virol. 2018;90(4):663–670. doi: 10.1002/jmv.25006.
11. Martin E.T., Kuypers J., Wald A., Englund J.A. Multiple versus single virus respiratory infections: viral load and clinical disease severity in hospitalized children. Influenza Other Respir Viruses. 2012;6(1):71–77. doi: 10.1111/j.1750-2659.2011.00265.x.
12. Bonzel L., Tenenbaum T., Schroten H., Schildgen O., Schweitzer-Krantz S., Adams O. Frequent detection of viral coinfection in children hospitalized with acute respiratory tract infection using a real-time polymerase chain reaction. Pediat Infect Dis J. 2008;27(7):589–594. doi: 10.1097/INF.0b013e3181694fb9.
13. Kurskaya O., Ryabichenko T., Leonova N., Shi W., Bi H., Sharshov K. et al. Viral etiology of acute respiratory infections in hospitalized children in Novosibirsk City, Russia (2013–2017). PLoS One. 2018;13(9):e0200117. doi: 10.1371/journal.pone.0200117.
14. Asner S.A., Science M.E., Tran D., Smieja M., Merglen A., Mertz D. Clinical disease severity of respiratory viral co-infection versus single viral infection: a systematic review and meta-analysis. PLoS One. 2014;9(6):e99392. doi: 10.1371/journal.pone.0099392.
15. Franz A., Adams O., Willems R., Bonzel L., Neuhausen N. Schweizer-Krantz S. et al. Correlation of viral load of respiratory pathogens and co-infections with disease severity in children hospitalized for lower respiratory tract infection. J Clin Virol. 2010;48(4):239–245. doi: 10.1016/j.jcv.2010.05.007.
16. Harada Y., Kinoshita F., Yoshida L.M., Minh le N., Suzuki M., Morimoto K. et al. Does respiratory virus coinfection increases the clinical severity of acute respiratory infection among children infected with respiratory syncytial virus? Pediatr Infect Dis J. 2013;32(5):441–445. doi: 10.1097/INF.0b013e31828ba08c.
17. Pinky L., Dobrovolny H.M. Coinfections of the Respiratory Tract: Viral Competition for Resources. PLoS One. 2016;11(5):e0155589. doi: 10.1371/journal.pone.0155589.
18. Melekhina E.V., Petukhova E.V., Chugunova O.L., Gorelov A.V. A rational approach to therapy of children with arvi against the background of active forms of herpes virus infections. Voprosy prakticheskoy pediatrii = Clinical Practice in Pediatrics. 2016;11(6):36–44. (In Russ.) doi: 10.20953/1817-7646-2016-6-36-44.
19. Sukhinin V.P., Zarubaev V.V., Platonov V.G., Kovalenko A.L., Ershov F.I. Protective effect of Cycloferon in experimental influenza infection. Voprosy Virusologii = Problems of Virology. 2000;(5):26–30. (In Russ.).
20. Romantsov M.G., Sologub T.V., Petrov A.Yu., Kovalenko A.L. Cycloferon in the treatment and emergency prevention of respiratory viral infections and influenza. Retsept = Recipe.2011;(6):59–65. (In Russ.) Available at: https://elibrary.ru/item.asp?id=17242316.
21. Romantsov M.G., Melnikova I.Yu., Smagina A.N., Shuldyakov A.A. Efficacy of cycloferon and evaluation of its safety in respiratory viral infections in children. Fundamentalnye issledovaniya = Fundamental Research. 2012;(2):208–214. Available at: https://fundamental-research.ru/ru/article/view?id=29429.
22. Isakov V.A., Romantsov M.G., Kabolova I.V., Erofeeva M.K., Vodeyko L.P., Smagina A.N. Efficacy of Cycloferon® in the treatment and prevention of influenza and ARI. RMZh = RMJ. 2011;(23):1420–1425. (In Russ.) Available at: https://rmj.ru/articles/bolezni_dykhatelnykh_putey/Effektivnosty_Cikloferona_v_terapii_i_profilaktike_grippa_i_ORZ/.
23. Romantsov M.G., Goryacheva L.G., Bekhtereva M.K., Sologub T.V., Kovalenko A.L. Cycloferon Efficacy in Viral and Bacterial Diseases of Children (Clinical Review). Antibiotiki i khimioterapiya= Antibiotics and Chemotherapy. 2010;55(11–12):39–51. (In Russ.) Available at: https://antibiotics-chemotherapy.ru/jour/article/view/344.
24. Romantsov M.G., Goryacheva L.G., Kovalenko A.L. Tsikloferon - the experience of usage in children. Detskie infektsii = Children Infections. 2008;7(4):62–68. (In Russ.) Available at: https://elibrary.ru/item.asp?id=11667212
Review
For citations:
Nikolaeva SV, Usenko DV, Khlypovka YN, Shabalina SV, Gorelov AV. Respiratory infections of combined etiology in the clinical practice of the pediatrician. Meditsinskiy sovet = Medical Council. 2021;(1):78-82. (In Russ.) https://doi.org/10.21518/2079-701X-2021-1-78-82