Vol 45, No 1 (2017)

Background: Community-acquired pneumonia can be caused by both bacterial and viral pathogens. The differential diagnosis based only on clinical data is not always feasible. The use of C-reactive protein (CRP) and procalcitonin might give some additional information for treatment decision-making.

Aim: To evaluate the structure and rates of viral isolation in community-acquired pneumonia in hospitalized infants and changes in CRP and procalcitonin levels.

Materials and methods: Seventy five infants at the age of up to 11 months and 29 days, who were hospitalized with community-acquired pneumonia confirmed by chest X-ray from March 2015 till February 2016, were included into the study. CRP and procalcitonin levels were measured. Detection of viruses in nasopharyngeal swabs was performed by a  real-time polymerase chain reaction.

Results: Nucleic acids of respiratory viruses were isolated in 72% (54/75) of infants. The most common were respiratory syncytial virus (in 70.4%, 38/54) and human rhinovirus (in 16.6%, 9/54). Median of white blood cell count in pneumonia associated with respiratory viruses was 10.95 (9; 14.1)×10⁹/L, CRP level, 1.95 (0.5; 7) mg/L, procalcitonin level, 0.087 (0.067; 0.17) ng/mL.

Conclusion: The study showed a high prevalence of respiratory viruses in community-acquired pneumonia in infants. There was no increase in CRP and procalcitonin levels in pneumonia associated with respiratory viruses.

Background: Despite the fact that the prevalence of the femoral head osteochondropathy is 2.9% of all bone and muscle disorders and 25% of the disorders of the hip joint, this problem demands special attention, while late diagnosis could lead to disability of the patient.

Aim: To compare and clarify X-ray symptomatology of Legg-Calvé-Perthes disease found by standard digital radiography and by tomosynthesis.

Materials and methods: Eighty six patients aged from 5 to 12 years with the femoral head osteochondropathy were allocated into two groups: 43  patients from the group  1 were assessed by standard two-plane digital radiography (frontal and Lauenstein projections), whereas 43  patients from the group  2 were assessed by direct plane tomosynthesis only. The investigations were performed with the X-ray machine FDR AcSelerate  200 (Fujifilm, Japan) with the function of tomosynthesis. Radiographic symptoms of the disease were assessed in the subgroups that were identified depending on the disease stage: 24 patients had stage I, 20 – stage II, 20 – stage III, and 22 – stages IV and V.

Results: Standard radiography could not detect any bone abnormalities in any patient with stage I of Legg-Calvé-Perthes disease (n₁ = 12, 100%); however, by means of tomosynthesis, all patients from this subgroup (n₂ = 12, 100%) had minimally increased density on the affected side. In 9  (75%) patients, tomosynthesis showed cystiform remodeling of trabecular structure in subchondral parts of the femoral head of the affected hip, and in 2 (17%) patients, flattening of the inner epiphysis pole was visualized. At stage II of the disease standard radiography showed femoral head compression with widening of the joint space in 8 (80%) patients, absence of subchondral lucency in 6 (60%), and increased density of the femoral head in 4 (40%). In all these patients (n₂ = 10, 100%) tomosynthesis showed signs of intra-articular effusion, in 6 (60%) cases there were areas of osteonecrosis, and in 8 (80%) cases, non-congruent edge of the femoral head and acetabulum. At stage III of the disease, all patients in whom standard radiography was performed (n₁ = 10, 100%) had homogeneous blurring of the femoral head with loss of its bony structure, and with the femoral neck shortening in 6 (60%) of them. With the use of tomosynthesis, all these patients (n₂ = 10, 100%) displayed synovial effusion, in 9  (90%) of cases, head fragmentation, and 7  (70%) patients had shortening and thickening of the femoral neck. Patients with stages IV and V had similar number of symptoms, excluding lateral subluxation of the femoral head (in  63.6% by standard radiography and in 81.8% by tomosynthesis). Accuracy, sensitivity and specificity of standard radiography were 73.3, 70.3, and 71.2%, whereas those of tomosynthesis 91.8, 92.4, and 93.1%.

Conclusion: Tomosynthesis is more accurate, sensitive, and specific and has better positive and negative prognostic values, compared to standard digital radiography. Tomosynthesis can be recommended as a method of choice for diagnosis of the femoral head osteochondropathy.

Rationale: As clinical efficacy of probiotics and prebiotics is determined by their joint effects both on the mechanism of immune tolerance, gut inflammation and intestinal wall permeability, one of the objective methods to assess efficacy of probiotic strain-containing agents could be based on measurement of fecal calprotectin levels.

Aim: To evaluate changes in fecal calprotectin as an efficacy parameter of treatment with the Lactobacillus rhamnosus GG  – fructooligosacсharide complex for prevention of atopic dermatitis in infants.

Materials and methods: Sixty healthy newborns from the risk group for allergic disorders were randomized (envelope randomization) into two groups: the infants from the control group (n = 31) were given widely used recommendations to prevent atopic dermatitis, whereas the infants from the study group (n = 29) were additionally administered a synbiotic containing Lactobacillus rhamnosus GG with fructooligosaccharides. The efficacy of the synbiotic therapy was assessed by measurement of fecal calprotectin levels at 3 and 6  months of the follow-up.

Results: The first measurement of fecal calprotectin levels at 3 months showed its significant increase in all infants (mean 276.9 ± 128.8  mcg/G), compared to the normal range (below 50  mcg/G). The second measurement at 6  months demonstrated a  decrease in fecal calprotectin in infants from both groups (mean 75.8 ± 55.3 mcg/G). However, mean levels of fecal calprotectin in the infants from the study group who had been administered the synbiotic, was significantly lower than that in the control group (48.6 ± 38.5 and 99.7 ± 57.4  mcg/G, respectively; р < 0.05).

Conclusion: The observed changes in fecal calprotectin levels support the positive role of synbiotics and lyophilized complex of Lactobacillus rhamnosus GG with fructooligosaccharides in the growth of gut microbiota in infants and in the reduction of inflammation, all of this being an important prerequisite for development of the oral tolerance mechanisms.

The review presents the data on the most important causative factors of acute gastroenteritis in children and on relatively new pathogens, such as bocavirus (HBoV), considering modern potential for verification of viral disorders. Human HBoV, belonging to Parvoviridae family, has been isolated from nasopharyngeal discharge in children with acute respiratory viral infection in 2005. Later on it was registered as a respiratory pathogen. Despite symptoms of an acute respiratory disease, HBoVinfected patients frequently present with acute gastroenteritis. In various regions of the world, fecal HBoV DNA has been found in children with acute intestinal infection by means of the polymerase chain reaction and subsequent sequencing. Molecular genetic studies showed the presence of 4 genetically different viral types. HBoV genotype 1 is more frequently found in nasopharyngeal smears from children with acute respiratory viral infection, whereas HBoV genotypes 2, 3, and 4 are isolated from feces in those with acute gastroenteritis. If HBoV is an intestinal pathogen, remain an unresolved issue. There is a  high rate of HBoV co-infection (up to 60% and more) with other intestinal viruses in children with acute gastroenteritis. High fecal DNA titers found in the studies in children with acute gastroenteritis have shown that HBoV is not only present in the bowel, but also is replicating there. The importance of studies on characteristics of molecular evolution of bocavirus is undoubted, while there are gaps in knowledge on its life cycle, mechanisms of genome replication; there is neither cultivation technique for this virus, nor animal models for disorders it may cause. The assay for anti-HBoV detection in human serum has been studied only in acute respiratory disease; high rates of HBoV seropositive patients and high antibody titers have been found in children correlating with a high viral load. It could be relevant to study prevalence and genetic variance of HВoV associated with acute gastroenteritis in various territories of the Russian Federation, because the international database GenBank does not have any genomic sequences of bocavirus isolated found in Russia. Investigation of molecular epidemiological and clinical characteristics of bocaviral infection in children with acute intestinal infection seems promising.

Proteus syndrome is an extremely rare genetic disorder with problematic genetic identification. It has been hypothesized that it is related to a lethal dominant somatic mutation occurring at a post-zygotic stage of embryonic development. Clinical presentation of the disease has much in common with a  number of hereditary disorders and is frequently associated with malignancies. We present a clinical case of Proteus syndrome in a child aged 14 years and 11 months, in whom late diagnosis and late administration of specific treatment resulted in disease progression with the development of the end stage chronic renal disease. Only correct and early diagnosis allows for timely referral of a  patient to a specialized hospital for adequate care.

We analyze a clinical case of the patient at the age of 6 years and 11 months with a cavernous hemangioma of the bladder. The disease manifested with isolated macrohaematuria. During the diagnostic assessment by 3D-ultrasound examination of the urinary tract with tight bladder filling, a mass with tuberous shape and echonegative areas inside was visualized on the left bladder wall close to its anterior surface, while external bladder contours were unchanged. Color Doppler mapping showed some vessels in the projection of the mass sprouting from the muscular layer of the bladder. The neoplasm was confirmed by abdominopelvic magnetic resonance imaging (with and without contrast enhancement) and by cystoscopy. Taking into account familial cancer history of the patient (oncological disorders in the maternal and paternal lines) and high degree of vascularization of the mass, a malignancy (rhabdomyosarcoma) was deemed highly probable. At 2 months after the disease manifestation, transurethral endoscopic surgery was performed with coagulation and a resection of an exophytic mass of 1 cm in diameter, with a wide base, irregular tuberous shape, brown colored, with a cystic component. The mucous layer on the lateral bladder wall was abnormal with some hemorrhages. Histological examination of the tissue sample showed a  cavernous hemangioma, that was the final diagnosis in this patient. During subsequent 2-year follow up, there was no recurrence of the disease. The described case is of clinical interest because bladder hemangiomas are rare in children; therefore, this disease should be on the list for differential diagnosis in children with macrohaematuria.

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