Mycoplasma pneumoniae (M. pn.), which is a well-known pathogen to cause atypical pneumonia, in 25% of cases can lead to a wide range of extra-pulmonary symptoms, reflecting damage to almost any organ or organ system (skin and mucous membranes, nervous, cardiovascular, gastrointestinal, urinary system etc.). Aspecific syndrome Mycoplasma pneumoniae-induced rash and mucositis (MIRM) has been identified recently. Among the CNS manifestations associated with M. pn., acute postinfectious cerebellar ataxia is worth mentioning. In this article we present clinical cases of a 14-year-old boy and a 6-year-old girl with extrapulmonary manifestations of M. pn. infection. This article considers etiological, pathogenetic and clinical features of mycoplasma infection in children with an emphasis on extra-respiratory manifestations.

Organizing pneumonia (OP) is an interstitial lung disease (ILD), which is characterized by the proliferation of granulation tissue in the bronchioles and alveoli, and diagnosed on the basis of clinical history, morphological data, CT changes and response to glucocorticoid (GC) therapy. Information about OP in children is limited due to the insufficient number of cases described and observed. The purpose of this research was to establish the epidemiological characteristics, etiological structure, clinical and CT semiotics of OP in children, to characterize its comorbidity and therapy. Materials and methods used: 20 children aged 4 months to 17 years old with OP were observed in 2009-2023. The diagnosis was set based on the clinical and anamnestic data, the presence of specific CT patterns, positive clinical and radiological dynamics during GC therapy, and (in 2 cases) according to histological examination results. Results: the ratio of boys to girls was 1.8:1, most often OP was diagnosed in infants (40%) and young children (30%) with various comorbid diseases with a frequency of 0.012‰ in the structure of all hospitalized patients of a multidisciplinary hospital in Moscow (Russia) in 2014-2022 The reasons for the acute (80%) and subacute (20%) OP were respiratory infections (40%), aspiration (30%), diffuse connective tissue diseases (DCTD) (10%), in a single case the OP had developed as part of lung injury associated with vaping and electronic cigarettes (EVALI), 15% of patients had an idiopathic version of OP (cryptogenic OP). The clinical picture of OP was characterized by shortness of breath (100%), cough (90%), fever, rales/crepitus (65%), wheezing (45%); the chest CT scan (n=19) showed zones of consolidation (100%), including subpleural localization (84%), trapezoidal shadowing (27%), zones of “ground glass” (68%), reversed halo sign (32%). Therapy included GC (95%), azithromycin (40%), mechanical ventilation (40%), oxygen therapy (60%). Clinical and radiological improvement occurred in 18 (90%) children, and death occurred in 2 (10%) children. Conclusion: OP is a rare variant of ILD whose reasons in children can be respiratory infections, aspiration, DCTD, EVALI. The effectiveness of GC in the presence of characteristic symptoms and CT images confirms the diagnosis.

Neuroendocrine cell hyperplasia of infancy (NEHI) is an interstitial lung disease of unknown etiology that develops in the first year of life and manifests itself as persistent tachypnea syndrome. The aim of the study was to determine the diagnostic value of the clinical scale for the diagnosis of NEHI in comparison with computed tomography (CT) data of the chest organs and for differential diagnosis with acute bronchiolitis (AB)/community-acquired pneumonia (CAP). Materials and methods of research: a multicenter case-control study of children aged 21 days of life to 12 months was carried out: – 83 children with NEHI and 83 infants with AB or CAP. To determine the sensitivity and specificity of this scale for differential diagnosis with AB/CAP, the results of the assessment according to the proposed scale were compared in patients with NEHI (study group) and patients with AB/CAP (control group) on the day of treatment and after 3 weeks. Results: the sensitivity of the clinical scale for the diagnosis of NEHI when compared with the CT data of the chest organs was 85.5%. In the differential diagnosis of NEHI with AB/CAP on the day of treatment, the sensitivity of the clinical scale for the diagnosis of NEHI was 85.5%, the specificity was 80.7%; when re-evaluated after 3 weeks, the accuracy of the scale increased from 83.1% to 91.6%, the specificity – from 80.7% to 97.6%. Diagnosis on a scale after 3 weeks reduced the possibility of overdiagnosis of NEHI from 19.3% to 2.4%. Conclusions: the clinical scale for the diagnosis of NEHI has a high diagnostic value in comparison with the results of CT scan of the chest organs and for differential diagnosis with AB/CAP, especially when re-evaluating.

Дегтярёва Е.А., Жданова О.И., Павлова Е.С., Кантемирова М.Г., Овсянников Д.Ю., Закревский А.С., Коровина О.В. Инфекционный эндокардит у детей: сложности диагностики, особенности течения. Детские болезни сердца и сосудов. 2022; 19 (2): 92–9. DOI: 10.24022/1810-0686-2022-19-2-92-99 HTML

Coronavirus disease 2019 (COVID-19) in children in most cases is asymptomatic or mild, and its most severe late complication is multisystem inflammatory syndrome in children (MIS-C). The aim of the study is to find clinical, laboratory and instrumental characteristics, description of therapeutic tactics, including determination of the profile of patients requiring Tocilizumab prescription and the outcomes of MIS-C associated with COVID-19. Materials and methods of research: 245 children aged 3 months – 17 years old were included in the pilot prospective multicenter open-label comparative study with MIS-C associated with COVID-19, verified based on CDC criteria (2020). Results: the median age of patients was 8 [5; 10] years, boys predominated among the patients (57.1%); MIS-C manifested itself as a combination of the symptom complex of Kawasaki disease (KD, 53.1% of patients), more often of atypical form, cardiovascular (66.1%), gastrointestinal (61.2%), neurological (27.3%) symptoms and signs of detection of the urinary (29.4%) and respiratory (19.6%) systems; macrophage activation syndrome (MAS) was diagnosed in 19.5% of patients. Therapy included glucocorticosteroids (97.6%), antibiotics (95.5%), anticoagulants (93.9%), intravenous immunoglobulin (34.7%), vasoactive/vasopressor support (31.8%), Tocilizumab (15.1%), mechanical ventilation (2.4%), extracorporeal membrane oxygenation (0.4%). Patients receiving Tocilizumab, statistically significantly more often compared with patients without this therapy, were in the intensive care unit (ICU, 86.5% versus 40.9%, p<0.001), more often required vasopressor therapy (70.3% versus 25%, p<0.001), had statistically significantly higher markers of laboratory inflammatory activity. Treatment in 47.8% of cases was carried out in an ICU; one child has died. In 4.1%, according to echocardiography, coronaritis, ectasia of the coronary arteries without the formation of persistent aneurysms were detected. Conclusion: MIS-C associated with COVID-19 has clinical signs of KD, often of the incomplete form, accompanied by arterial hypotension/shock, MAS, which requires intensive therapy, and the prescription of Tocilizumab.

The most severe manifestation of the new coronavirus infection COVID-19 in children is the multisystem inflammatory syndrome in children (MIS-C). A systematic review of foreign publications as of July 25, 2020 contains an analysis of the disease course in 662 children with this syndrome and is used for comparison with the data obtained. Objective of the research: to characterize clinical manifestation, results of laboratory and instrumental studies, therapy, outcomes and consequences of the COVID-19- associated MIS-C, based on the observation of patients hospitalized to Morozov Children's City Clinical Hospital and Children’s clinical hospital of infectious diseases № 6 from May 1 to September 15, 2020. Materials and methods: the pilot study included 32 children aged 9 months – 15 years with COVID-19-associated MIS-C, verified based on WHO criteria (2020), including symptoms of Kawasaki disease (KD), arterial hypotension/shock, laboratory and instrumental signs of heart damage, signs of coagulopathy, gastrointestinal symptoms, increased inflammation markers, COVID-19 markers. Results: the median age of patients was 6 years, boys predominated among the patients (66%), all patients had antibodies to SARS-CoV-2 (31 children of the IgG class); MIS-C manifested itself as a combination of KD symptom complex (75% of patients) with arterial hypotension/shock (28%), neurological (50%), respiratory (41%), gastrointestinal (59%) symptoms; macrophage activation syndrome (MAS) was verified in 16% of patients. Therapy included intravenous immunoglobulin (75%), systemic glucocorticosteroids (88%), anticoagulants (91%), vasoactive/vasopressor support (31%). In 38% of cases treatment was performed in intensive care unit; one child died. According to echocardiography, 16% of patients had coronariitis, ectasia, and coronary arteries aneurysms. Conclusion: COVID-19-associated MIS-C is characterized by a severe course, cross-features with KD, shock syndrome with KD, MAS which requires intensive therapy and can cause acquired pathology of the cardiovascular system in children.

Aim. To summarize the existing literature data and to optimize protocols of anticoagulant therapy for Kawasaki syndrome. Methods. A review of treatment results in 10 patients with Kawasaki syndrome, where an individual approach to anticoagulation led to a positive result, and surgical treatment was not required, is presented. Results. In 5 of 6 patients with timely diagnosis and treatment according to the protocol, transient ectasia of coronary arteries with further normalization of their size within 4-7 months of follow up was detected. In one child on the 12th day of the disease small aneurysms of the right and left coronary arteries were identified. They disappeared after 7 months from the debut of the disease. In 3 patients, diagnosis and treatment have been delayed. In this group, a giant aneurysm of the proximal left anterior descending branch of the left coronary artery with the signs of thrombosis was discovered in a child aged 9 months on the 45th day of the disease. Anticoagulation with heparin with further switching to dalteparin sodium (Fragmin) was accompanied by adequate anticoagulation to the 3rd day of treatment. Aneurysms decreased to 2-4 mm without signs of thrombosis after 24 months of treatment with warfarin in combination with acetylsalicylic acid (Aspirin). In a girl of 1 year and 4 months of age, on the 20th day of the disease, it was complicated by exudative pericarditis with high risk for tamponade, which required a pericardial puncture and catheterization, and a giant aneurysm of the right coronary artery with the signs of thrombosis was found on the 45th day of the disease. Adequate anticoagulation was reached on the 3rd day of treatment with dalteparin sodium (Fragmin). Long-term use of warfarin in combination with acetylsalicylic acid (Aspirin) was continued. At follow-up at 4 months aneurysm of the right coronary artery has not decreased, but the size and the density of the blood clot reduced significantly. A year later, the aneurysm decreased to 5-6 mm without signs of thrombosis. At the next case of a 3 year old child, who was treated according to the treatment standards, ectasia of the right and left coronary arteries was revealed on the 14th day of treatment, disappearing after of long-term use of acetylsalicylic acid (Aspirin). Conclusion. At further development of standards and following up antithrombotic treatment in patients with the complicated forms of Kawasaki disease, the possibility of individual treatment adjustment based on the detection of thrombophilia genetic markers, which increase the risk for thrombotic complications, should be considered.

Aim. Development of informative differential diagnostic criteria of inflammatory myocardial involvement in young athletes. Methods. A total of 163 athletes (swimmers, football players and sailing athletes) aged 9 to 24 years (mean age 14.74±0,23 years, SD=3.03) were examined. Complete clinical and functional examination was performed. Remodeling of the left ventricle was studied in accordance with R. Devereux (1992) and B. Maron (2005) echocardiographic criteria. Myocardial morphometry results were compared with immunobiochemical markers of myocardial damage and titer of antimyocardial antibodies to the endothelium, cardiac conduction system, cardiomyocytes, and smooth muscle. Results. In 10 out of 40 athletes with echocardiographic signs of pathological remodeling of the left ventricle, the indicators of myocardial damage used as immunobiochemical screening tests, were increased, high titers of antimyocardial antibodies (more than 1:160), arrhythmias, sever conduction disorders, and high concentrations of infectious risk factors were revealed, allowing to diagnose subacute myocarditis. Conclusion. Subacute myocarditis should be excluded in athletes with echocardiographic signs of left ventricular myocardial remodeling and a high concentration of «infectious» risk factors based on immunobiochemical markers of myocardial damage and antimyocardial antibodies titer.

A multicenter trial involving 30 newborns with post-hypoxic myocardial lesions associated with I-II degree cerebral ischemia has revealed that the inclusion of cytoflavin infusions into the complex standard treatment leads, besides the improvement of general clinical status, to significantly more rapid, as compared to the control group, positive dynamics of pump and contractile myocardial functions, elimination of hyperenzymemia, hypoxia and electrical instability of the myocardium, decrease in energetic deficit, and repolarization changes within the first 5 days of in-hospital therapy as well as during the follow-up from 1 to 6 months of life.

Статья обобщает материалы исследований последних лет, включая собственные исследования, по проблеме формирования патологической трансформации спортивного сердца. Рассматривается значение профессионально-спортивных, инфекционных и иммунных аспектов ремоделирования миокарда, своевременная диагностика которых необходима для адекватной протекции.Article generalises materials of researches of last years, including own researches, on a problem of formation of pathological transformation of sports heart. Value of is professional-sports, infectious and immune aspects remodeling of a myocardium which timely diagnostics is necessary for the adequate patronage is considered.