The article presents a case of an unusual course of chickenpox in a young child (1.5 months). The development of acute hepatitis against the background of the course of the disease is described.This clinical observation clearly demonstrates that the varicella zoster virus, like other viruses from the herpes family, is secondary hepatotropic and is capable of causing acute hepatitis. This experience allows us to recommend assessing liver function in patients with chickenpox, and, if abnormalities are found, supplement the standard therapy with the appointment of hepatoprotectors.

There is a close relationship between intestine and liver, so-called ‘gut liver’ axis, especially in patients suffered from chronic liver diseases with significant degree of fibrosis. Small intestinal bacterial overgrowth and disturbance in the microbiota composition lead to an increase in the permeability of the intestinal epithelium, the development of endotoxinemia, the activation of pro-inflammatory cytokines and, as a consequence, an additional damage to hepatocytes.Objective. To estimate the incidence of bacterial overgrowth syndrome (BOS) in the small intestine in adolescents with chronic hepatitis C (CHC), to identify the interaction between this syndrome and cytolytic activity, the degree of fibrosis.Materials and methods. There is a group of 33 patients aged 12—17 years old with CHC. All children underwent a hydrogen breath test with lactulose. The degree of fibrosis was assessed by the results of liver elastography (Fibroscan), cytolytic activity was determined by the level of alanine transaminase in serum.Results. The frequency of BOS was 81.8% in the study group. As a result of the correlation analysis, no relationship was found between the development of BOS and the degree of cytolytic activity of chronic hepatitis C (criterion χ2= 0.914, p > 0.05). Also, there was no correlation between excessive bacterial contamination and the degree of fibrosis in the liver tissue (criterion χ2= 0.914,p> 0.05).Conclusion. BOS in children with CHC occurs much more often than in adults. However, no relationship was found between this syndrome and the severity of cytolytic activity, the degree of fibrotic changes in the liver.

Введение. Хронический гепатит С (ХГС) занимает лидирующую позицию среди всех хронических гепатитов. Около 71 миллиона человек в мире инфицированы вирусом гепатита С (ВГС), среди них, по разным оценкам, от 2,1 до 5 млн составляют дети до 15 лет. В большинстве случаев заболевание в детском возрасте протекает бессимптомно, однако с возрастом повышается риск развития фиброза и связанных с ним осложнений, что требует динамического контроля и своевременного назначения противовирусной терапии. Цель исследования. Определить эпидемиологические особенности и характер течения вирусного гепатита С у детей, инфицированных в раннем возрасте; проанализировать эффективность новых схем терапии препаратами прямого противовирусного действия в сравнении с терапией препаратами интерферона. Материалы и методы. В группу наблюдательного исследования вошли 559 детей с установленным диагнозом ХГС. Диагноз был подтвержден серологически (методом ИФА) и молекулярно-генетически (методом полимеразной цепной реакции - ПЦР). Степень фиброза оценивалась по результатам эластографии печени (Fibroscan). Результаты. Преобладающее большинство детей были инфицированы ВГС в результате перинатального контакта. Спонтанный клиренс отмечался не более чем в 20% случаев. По полученным данным, девочки заражались чаще мальчиков, однако с большей частотой элиминировали вирус. ХГС в детском возрасте характеризовался гладким, малосимптомным течением, однако 12% пациентов имели начальную стадию фиброза. УВО при использовании интерфероновых (ИФН) схем был достигнут у 40-53% пациентов с 1-м генотипом, у 92-100% пациентов со 2-м и 3-м генотипами. Эффективность терапии α-ИФН с рибавирином (РВ) составила 72%, пег-ИФН с РВ - 81,8%, комбинацией пег-ИФН + РВ в сочетании с каскадной плазмофильтрацией - 89,2%. Применение препаратов интерферона сопровождалось развитием нежелательных явлений, наиболее тяжело переносили введение препарата подростки старше 12 лет. Среди побочных реакций чаще всего наблюдался гриппоподобный, астеновегетативный синдромы (до 97%), несколько реже отмечались диспептические расстройства, снижение массы тела, алопеция, нервно-психические расстройства. В единичных случаях был спровоцирован дебют аутоиммунных заболеваний. На базе нашего центра подтверждено влияние полиморфизма генов rs8099917 и rs12979860 IL28B на вероятность спонтанной элиминации вируса гепатита С, а также на эффективность ПВТ. С 2019 г. начата терапия препаратами прямого противовирусного действия (ПППД), которая показала 100% эффективность при развитии минимальных нежелательных явлений. Выводы. Заболеваемость ХГС в настоящее время остается на высоком уровне. Несмотря на малосимптомное течение заболевания у детей, с возрастом значительно повышается риск развития прогрессирующего фиброза печени, жизнеугрожающих осложнений. Применение препаратов прямого противовирусного действия у детей позволяет не только своевременно начать терапию ХГС, но также избежать серьезных нежелательных явлений, связанных с лечением препаратами интерферона. Introduction. Chronic hepatitis C (CHC) occupies a leading position among all chronic hepatitis. There are about 71 million people in the world infected with the hepatitis C virus (HCV). Among them there are 2.1-5 million children under 15 years of age according to various estimates. In most cases, the disease in childhood is asymptomatic, however, with age, the risk of fibrosis and associated complications increases, that`s why requires dynamic control and timely administration of antiviral therapy. Purpose of the study. To determine the epidemiological features and nature of the course of viral hepatitis C in children infected at an early age; to analyze the effectiveness of new regimens of therapy with direct antiviral drugs in comparison with interferon therapy. Materials and methods. There are 559 children with an established diagnosis of CHC included in the observational study group. The diagnosis was confirmed serologically (by ELISA) and molecular- genetically (by polymerase chain reaction - PCR). The degree of fibrosis was assessed by the results of liver elastography (Fibroscan). Results. The vast majority of children were infected with HCV as a result of perinatal contact. Spontaneous clearance was noted in no more than 20% of cases. According to the data obtained, girls became infected more often than boys, but eliminated the virus with a greater frequency. CHC in childhood was characterized by a smooth, low-symptom course, but 12% of patients had an initial stage of fibrosis. SVR after using interferon (IFN) regimens was achieved in 40-53% of patients with genotype 1, 92-100% in patients with genotypes 2 and 3. The effectiveness of therapy for a-IFN with ribavirin (RV) was 72%, peg-IFN with RV - 81.8%, the combination of peg-IFN + RV in combination with cascade plasma filtration - 89.2%. The use of interferon preparations was accompanied by the development of undesirable phenomena; adolescents over 12 years of age hardly tolerated the administration of the drug. More often observed adverse events were flu-like, asthenovegetative syndromes (up to 97%), dyspeptic disorders, weight loss, alopecia, and neuropsychiatric disorders were noted somewhat less frequently. In isolated cases, the debut of autoimmune diseases was provoked. On the basis of our center, the influence of the polymorphism of the rs8099917 and rs12979860 IL28B genes on the probability of spontaneous elimination of the hepatitis C virus, as well as on the effectiveness of the AVT, has been confirmed. Since 2019 therapy when direct antiviral therapy (DAA) was started, it showed 100% efficiency with minimal adverse events. Conclusions. The incidence of CHC currently remains at a high level. Despite the low-symptomatic course of the disease in children, the risk of developing progressive liver fibrosis and life-threatening complications increases significantly with age. The use of drugs with direct antiviral action in children allows not only to start therapy for CHC in a timely manner, but also to avoid serious adverse events associated with treatment with interferon drugs.

Hepatitis B, despite of being a controlled infection today, is one of the most common form of hepatitis in the world. According to the experts' evaluation there are about 3 million patients with chronic hepatitis B in our country. The global strategy of the World Health Organization includes the elimination of viral hepatitis by 2030.The program used in the North-West Federal District to eliminate acute hepatitis B has reduced the incidence rate due to the widespread vaccination coverage of children and the annual increase in adult immunization coverage.However, the relevance of HBV-infection in children still remains high which is associated with a high infection by hepatitis B virus in women of childbearing age and the possibility of the transmission of the infection from mother to her child. In case of perinatal infection the formation of chronic hepatitis B in children reaches up to 90%. The natural course of chronic hepatitis B is characterized by a change in pathogenetically determined phases, and HBsAg-negative infection, which is a latent (occult) form of hepatitis, was added to them in 2009. Occult hepatitis B is an epidemiological danger, for the child as well, if the mother suffers from this form of chronic hepatitis B. Monitoring of pregnant women is often limited to identifying only HBsAg, which is not enough to detect occult hepatitis B. Lately diagnosed occult HBV-infection can become a source of the infection for the baby, especially in cases when due to some reasons there are disorders in hepatitis B vaccination schedule after birth. The article presents an interesting clinical case of family hepatitis B.