The treatment for infectious mononucleosis in children
The invention relates to medicine and concerns of Pediatrics and treatment of infectious diseases, namely infectious mononucleosis in children. As a drug proposed Bifidumbacterin Forte. Monotherapy specified drug eliminates the need for the use of hormonal drugs and antibiotics in the treatment of infectious mononucleosis in children. 4 table.
The present invention relates to the treatment of pediatric infections, including such common diseases as infectious mononucleosis.
As is known, the most common method of treatment of infectious mononucleosis is symptomatic therapy - anti-inflammatory drugs (Panadol, paracetamol, brufen and others), desensibilizing (tavegil, claritin and others), upgrades to relieve local process vitamin. When there is marked clinical symptoms - high fever, common overlays on the tonsils, intoxication, and a significant increase in cervical lymph nodes used antibiotics and metronidazole as well as glucocorticoids (Manual on infectious diseases in children under the editorship of academician FRAMES the AI of the above drugs, thus attempting to increase the effectiveness of therapy of infectious mononucleosis, however, in all cases of severe forms of the disease in treatment there are antibiotics and glucocorticoid hormones (2000 Red Book: Report of the Committee on Infectious Diseases, 25-th ed.; American Academy of Pediatrics; 2000; p.238-240).
The aim of the present invention is to develop a method of treatment of infectious mononucleosis in children, eliminating the need to use hormones and antibiotics.
This goal is achieved by the fact that as a means for treatment of infectious mononucleosis applied medication Bifidumbacterin Forte.
Bifidumbacterin Forte is a drug previously used for correction of the intestinal microflora of the child with acute intestinal infections and intestinal dysbiosis (Desbiens intestine in children. Manual for doctors. Edited by Kushnir, S. M., Moscow 2002, page 49).
For the treatment of infectious mononucleosis in children the drug Bifidumbacterin Forte proposed by us for the first time.
The invention is illustrated by the following specific examples of its implementation.
Example 1. (history - contract N37)
D-VA Elizabeth, vom - follicular tonsillitis, sinusitis.
The clinical diagnosis of infectious mononucleosis. Acute bilateral catarrhal robotic.
General history. The girl from pregnancy occurring with toxemia, fetal hypoxia. Delivery is urgent, weight 2950, length - 49 see Discharged from the hospital on day 7. At birth the child is diagnosed with heart disease - the oval window, up to 1 year was observed by a neurologist regarding perinatal encephalopathy syndrome increased nervno-reflex excitability.
There is an ENT specialist about adenoids 3rd degree. Illness: acute respiratory viral infections.
Drug Allergy: skin rashes and diarrhoea on admission of eubacteria.
Medical history: about a week ago she got a stuffy nose without discharge. With 21.04 body temperature of 37.8°C, angina with overlays on the tonsils. In the following days - febrile fever, complaining of severe pain in the throat, breathing through the mouth. 21.04 received once Sumamed 250 mg Continued high fever (>39°C). At 16.00 22.04 hospitalized. Epidemiological history: mother eve was celebrated unexpressed pain in the throat.
When pasabot voice, notes sore throat, rhinitis. Conjunctiva hypermonogenic feverish glitter of eyes, mouth hyperemia, the tonsils are enlarged to 3 degrees, in the small gaps ostrovche overlay mucus for palatal curtain. Skin pale, pure, and puffiness of the face, the shadows under his eyes. Considerably enlarged tonsil, as well as front - and zadaszenia lymph nodes are visualized, sealed, sensitive to palpation. In the lungs, breathing hard, no wheezing. Heart sounds rhythmic, acadeny to 140 beats per minute. Systolic murmur at the apex of the heart. Lips dry, soft belly, stool and urine output is not broken. Language moderately covered. Liver +2 cm below the costal arch, spleen +2.5 cm below the costal arch. Neurological status without features, meningeal signs.
General analysis of blood from 23,04: leukocytes 21500, erythrocytes 530000, hemoglobin of 12.6 g/l, platelets 289000, neutrophils 48%, stab leukocytes 8%, lymphocytes 19%, monocytes 8%, atypical mononuclear cells 25%, ESR - 28 mm/h
General analysis of blood from to 26.04: leukocytes 11300, erythrocytes 680000, hemoglobin of 12.6 g/l, platelets 381000, neutrophils 18%, stab 4%, segmented 14%, lymphocytes 40%, monocytes 6%, atypical mononuc-3 in the field of view, leukocytes 3-5 in the field of view, the meager amount of cells of the transitional epithelium.
The study of blood serum from 23.04: IgM and IgG antibodies to Epstein-Barr virus is not detected.
The study of blood serum from 23.04: IgM and IgG antibodies to cytomegalovirus not found.
Analysis of feces from 23.04: protozoa and worms were not found.
Examination of the doctor-otolaryngologist from 23.04: acute bilateral catarrhal robotic, acute rhinopharyngitis, acute lacunar angina in the face of infectious mononucleosis, adenoids 3 degrees.
Re-examination of the doctor-otolaryngologist from 25.04: positive dynamics - reducing catarrhal phenomena on the mucous membranes of the nasopharynx and swelling of the mucous membranes of the nose.
Conclusion the diagnosis on the basis of medical history, clinical observations in the Department, characteristic changes in the total blood (moderate leukocytosis, the occurrence of atypical mononuclear cells from 25% to 36%, moderately elevated erythrocyte sedimentation rate - up to 28 mm/h), the data of the examination of the doctor-otolaryngologist girl diagnosed with infectious mononucleosis, acute bilateral catarrhal robotic.
Treatment. The mode box, Desk, age, abundant vitamin drink, bi the nose drops, demetallization ointment in nose; in the auditory passages - parallelnavi alcohol on turunda, processing tonsils solution of hydrogen peroxide and a solution of borax in the glycerin during the child's stay in the Department.
The dynamics of the disease. During his stay in the Department of the girl's condition has improved considerably: the body temperature returned to normal on day 5 of illness, clinical symptoms of intoxication disappeared by the 6th day of illness. At the same time disappeared overlay on the tonsils and cervical adenopathy and hepatosplenomegaly was significantly reduced to 8 days from the onset of the disease.
Table 1 presents a graph of the duration in days of the main clinical symptoms of infectious mononucleosis patient of Dr. howl E.(the history of Dr. No. 37), receiving Bifidumbacterin Forte and symptomatic therapy.
Conclusion. When applying Bifidumbacterin Forte on the background of symptomatic therapy in the child marked a very small duration (4-8 days) main clinical symptoms of infectious mononucleosis, which is substantially less than the average duration of the main symptoms of this disease.
General history. Early psychophysical development according to age. Immunizations according to age schedule.
Illness: acute respiratory viral infections 3-4 times a year, whooping cough.
There is physician rheumatologist diagnosed with mitral valve prolapse, bradyarrhythmia.
Drug Allergy: at an early age rash on erythromycin.
The history of the disease. The disease began 08.09.02 with the appearance of the neck enlarged painful lymph node; the next day the body temperature has risen to 38.5°C, deteriorated health, the girl began to complain of a sore throat, have a runny nose, increased in size lymph nodes for almost all groups. Ambulatory received treatment Sumamed 3 days and symptomatic treatment, but health was deteriorating, body temperature remained elevated (up to 39°C). For further treatment, she was hospitalized.
Upon receipt. A state of moderate severity. Body temperature 38,8°C. Complains of headache, sore throat, appetite SNIIM in diameter, plotnovato sensitive to palpation; cervical - 1.5 cm, BTE - up to 0, 7 cm, occipital - up to 1 cm, axillary and inguinal up to 1 cm in diameter. Lymph nodes are sealed, sensitive to palpation. Lips dry, tongue coated white bloom. Breathing through the nose is moderately difficult, from the nasal passages - mucous discharge. On the back wall of the pharynx flows muddy slime. Fauces - tonsil gipertrofirovannyy up to the 3rd degree, in the gaps melkooptovaya, yellowish-gray overlay, more in the left amygdala. Percutere above the light lung sound auscultation-vesicular respiration, wheezing no. Heart tones are rhythmic, loud systolic murmur along the left sternal border and a 5 point heart. The abdomen is soft, bezbolezneno palpation in all departments. The liver is palpable 1 cm below the edge of the costal arch, spleen not palpated. Dysuric phenomena not. Meningeal signs are missing.
The results of the surveys.
General analysis of blood from 13.09.02: leukocytes 21500, erythrocytes 4720000, hemoglobin 14.2 g/l, platelets 134000, neutrophils 9, stab leucocytes 5, Segmentgalerie 3,5, lymphocytes 20, monocytes 1,5, atypical mononuclear cells 69, erythrocyte sedimentation rate 5 mm/h
General analysis of blood from 19.09.02: leukocytes 9800, erythrocytes y 1, basophils 1, lymphocytes 34, monocytes 7, atypical mononuclear cells 41, erythrocyte sedimentation rate of 7 mm/h
Serum from 24.09.02: detected IgM antibodies to Epstein-Barr virus.
General analysis of urine from 13.09.02.: protein - no, leukocytes 1-2 in sight, erythrocytes 4-6 in the field of view. Bacteria in large quantities. Salt not found. Mucus in large quantities.
General analysis of urine from 19.09.02: without deviation from the norm.
A swab from the throat quantitative method from 13.09.02: non-haemolytic Streptococcus 108, pneumococcus 107the fungus Candida 102.
ECG from 13.09.02: sinus bradycardia. The vertical position of the electrical axis of the heart. Process changes of ventricular repolarization.
ECG from 16.09.02: moderate sinusova aetiology. The vertical position of the electrical axis of the heart. Violations of intraventricular conduction. Increasing the electrical activity of the left ventricle.
The study of feces from 14.09: protozoa and worms were not found.
Conclusion the diagnosis. Based on these clinical and laboratory data specific for this disease laboratory data (atypical mononuclear cells in the total blood from 13.09 - 69% and in General an the operating mononucleosis.
Treatment. In the separation mode box, Desk, age, vitamin drink, a course of treatment Bifidumbacterin Forte 40 doses three times a day for 5 days, got tavegil in the nasal passages drops of 0.01% solution of naphazoline, 3% solution of the colloid in the nasal passages laid hydrocortisoneodoquinol ointment, rinsed my mouth with a solution octenisept.
The dynamics of the disease. On the background of therapy the girl's condition improved significantly. Intoxication disappeared on the 7th day of illness, the body temperature returned to normal on day 8, the overlay on the tonsils and hepatomegaly disappeared on the 6th and cervical lymphadenitis - 10 day from the onset of the disease. Discharged 20.09.02.
Table 2 presents a graph of the duration in days of the main clinical symptoms of infectious mononucleosis patient C-howl, 14 years old, history - economic agreements) receiving Bifidumbacterin Forte and symptomatic therapy.
Conclusion. When applying Bifidumbacterin Forte on the background of symptomatic therapy for a sick child was observed fast inverse dynamics and extinction of the main clinical symptoms of the disease, the duration of which does not exceed 5-10 days.
Example 3. (history - host the 8.11.02 on the 3rd day of illness with a diagnosis of infectious mononucleosis, chickenpox.
Clinical diagnosis: infectious mononucleosis, typical, moderate to severe form of chickenpox, the period of convalescence.
General history: the Early development without features, immunizations according to age schedule. Illness: frequent acute respiratory viral infections, bronchitis, acute intestinal infection. Drug and food allergies have been noted.
The history of the disease. With 23.11.02. on the skin of the trunk, arms and legs appeared elements vetrennay rash. Were symptomatic therapy. 26.11.02 complaints of nasal congestion, increase in cervical lymph nodes, sore throat, was appointed Amoxiclav, the state of the child within the next two days continued to deteriorate, the body temperature of more than 38,5°C remained sore throat, and cervical lymphadenitis, and due to the ineffectiveness of treatment, the girl was sent to the hospital.
Admission: state of moderate severity, sluggish, to the examination is negative. The body temperature of 38.3°C. Complains of pain in the throat when swallowing. The skin is clean, pale. Cervical lymph nodes up to 1.5-2 cm with perifocal edema, other groups of lymph nodes are small. Breathing through the nose difficult, nose sparse dense I krupnogolovchaty tinged gray-yellow color. Vesicular breathing in lungs, is carried out in all departments, wheezing is not heard, percutane-pulmonary sound. Heart sounds sonorous, rhythmic, boundaries within the age norm. The abdomen is soft, painless on palpation. The liver is palpated 3 cm below the costal arch, elastic, spleen acts from under the left rib for 4 cm elastic. Chair decorated, dysuric disorders no. Meningeal symptoms are absent.
The results of the surveys.
General analysis of blood from 29.11.02: leukocytes 10800, erythrocytes 3990000, hemoglobin of 10.9 g/l, platelets 278000, neutrophils 44, stab leukocytes 15, lymphocytes 16, monocytes 2, atypical mononuclear cells 38%, erythrocyte sedimentation rate, 33 mm/h
Slide test for infectious mononucleosis from 29.11.02 - positive swab from the throat from 29.11.02: detected Staphylococcus aureus, viridans Streptococcus and saprophytic of Neisseria.
A swab from the throat and nose on Bacillus Lefler (BL) from 28.11.02-negative. The analysis of a feces on eggs a worm 29.11.02 - negative.
Consultation of the doctor otolaryngologist from 29.11.02: lacunar tonsillitis.
Conclusion the diagnosis. Based on these anamnestic, clinical and laboratory data (38% of atypical mononuclear cells in the total Ana is penziony mononucleosis typical, the intermediate form, chickenpox, the period of convalescence.
Treatment. The mode box, Desk, age, Bifidumbacterin Forte 40 doses three times a day for 4 days, then within 4 days once for 40 doses daily; acyclovir 200 mg 5 times a day for 5 days, tavegil 1/3 tablets 2 times a day, nasal drops of a solution of colloid and 0.01% solution of naphazoline.
The dynamics of the disease: on the background of the application in complex therapy of Bifidumbacterin Forte the child, despite combined with chickenpox course, was fast inverse dynamics of the main symptoms of infectious mononucleosis. Thus, the temperature normalized and intoxication disappeared from the 8th day of the disease, the overlay on the tonsils disappeared on the 7th day of illness, and the effects of cervical lymphadenitis and hepatomegaly decreased significantly to 8 days from the onset of infectious mononucleosis. Discharged 06.12.02.
Table 3 presents a graph of the duration in days of the main clinical symptoms of infectious mononucleosis patient E-s, 4 years, receiving Bifidumbacterin Forte and symptomatic therapy.
Conclusion: the use of Bifidumbacterin in this patient turned out to be all the C).
Just in our clinic on the proposed method of treatment carried out on 20 patients. The results are presented in table 4.
From the table it follows that the duration in days of such symptoms of infectious mononucleosis as fever, intoxication, an overlay on the tonsils and cervical lymphadenitis, significantly less in the group of patients treated in the adjuvant therapy of Bifidumbacterin Forte. These data confirm the clinical efficacy of Bifidumbacterin Forte in the treatment of children with infectious mononucleosis.
The obviousness of the proposed method of treatment of infectious mononucleosis in children for professionals working in this field stems from the firm belief that this pathology in children with moderate and severe forms of this disease requires the appointment of such drugs as antibiotics, prednisone and zovirax avoid the serious consequences of this vyakaranam patients.
In order to assign a child with a high fever, intoxication, severe cervical lymphadenitis, common overlays on the tonsils and hepatosplenomegaly only bitcontrol status of the child, as well as the systematic monitoring of all clinical and laboratory parameters of the patient in the hospital.
Obtaining a positive clinical outcome is not followed the instructions and practice the application of Bifidumbacterin Forte, previously used when dysbiosis and intestinal infections. Recommended dosage for treatment of infectious mononucleosis in children not exceed those used in gastrointestinal pathology at the present time.
The drug of Bifidumbacterin Forte as a means of treatment of infectious mononucleosis in children.
FIELD: biotechnology, microbiology, medicine.
SUBSTANCE: invention relates to the strain Lactobacillus paracasei CNCM I-2116 used for diarrhea prophylaxis causing by pathogenic microorganisms. Supernatant of this strain culture elicits ability to prevent colonization of intestine with pathogenic microorganisms causing diarrhea also and this strain is designated for preparing agent used for prophylaxis and/or treatment of disorders associated with diarrhea. Agent for oral administration represents therapeutically effective dose of the strain L. paracasei CNCM I-2116 or supernatant of its culture and acceptable foodstuff. Invention provides the enhanced viability of the strain in its applying and effectiveness in prophylaxis of adhesion to intestine cells and invasion to intestine cells of pathogenic microorganisms causing diarrhea.
EFFECT: valuable medicinal properties of strain.
5 cl, 8 dwg, 10 ex