vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v12i1.560vsp-371Research ArticleНЕПРЕРЫВНОЕ ПРОФЕССИОНАЛЬНОЕ ОБРАЗОВАНИЕPROFESSIONAL DEVELOPMENTЧАСТО БОЛЕЮЩИЕ ДЕТИ: ЧТО ЕЩЕ КРОМЕ ИНФЕКЦИЙ?FREQUENTLY ILL CHILDREN: WHAT ELSE BESIDES INFECTIONS?ОвсянниковД. Ю.OvsyannikovD. Yu.

Ovsyannikov Dmitriy Yuryevich, PhD, Head of Chair of Pediatrics, Federal State Budget Educational Institution of High Professional Education “People’s Friendship University of Russia” Address: 117198, Moscow, Miklukho-Maklaya str., 6, Tel.: (499) 154-44-59, e-mail: mdovsyannikov@yahoo.com

mdovsyannikov@yahoo.comИлларионоваТ. Ю.IllarionovaT. Yu.mdovsyannikov@yahoo.comПушкоЛ. В.PushkoL. V.mdovsyannikov@yahoo.comКузьменкоЛ. Г.Kuz'menkoL. G.mdovsyannikov@yahoo.comРоссийский университет дружбы народов, МоскваРоссияPeoples’ Friendship University of Russia, MoscowRussian FederationРоссийский университет дружбы народов, Москва,РоссияPeoples’ Friendship University of Russia, Moscow,Russian Federation201303022013121Вопросы современной педиатрии7486Copyright © Овсянников Д.Ю., Илларионова Т.Ю., Пушко Л.В., Кузьменко Л.Г., 20132013Овсянников Д.Ю., Илларионова Т.Ю., Пушко Л.В., Кузьменко Л.Г.Ovsyannikov D.Y., Illarionova T.Y., Pushko L.V., Kuz'menko L.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/371

В обзоре данных литературы и собственных клинических наблюдений представлена оригинальная концепция дифференциальной диагностики состояний, объединяемых практическими врачами в понятие «часто болеющие дети». Группа диспансерного наблюдения «часто болеющие дети» определена как гетерогенная на основании сведений о высокой (20–40%) частоте атопических (аллергический ринит, бронхиальная астма) заболеваний и вариабельной частоты первичных иммунодефицитов. Предложены простые дифференциально-диагностические признаки и схема сбора анамнеза у часто болеющих детей, позволяющие своевременно установить диагноз аллергического заболевания, первичного иммунодефицита. Дана характеристика рецидивирующих респираторных инфекций. Детально описаны онтогенетические и конституциональные предпосылки и механизмы развития рецидивирующих респираторных инфекций в детском возрасте. Лечебные и профилактические вмешательства обоснованы с учетом группы часто болеющих детей и гетерогенности причин рецидивирующих респираторных инфекций.

 

An original concept of differential diagnostics of various conditions, referred by practitioners as «frequently ill children», is shown in this article, which represents a literature review and the authors’ own data. The followed-up «frequently ill children» are referred as heterogeneous group of patients according to the high rate (20–40%) of atopic diseases (allergic rhinitis, bronchial asthma) and variable frequency of primary immunodeficiency. The authors offered simple criteria for differential diagnostics and a scheme of history collection of frequently ill children, which contribute to timely diagnostics of allergic disorder or immunodeficiency. The article contains description of recurrent respiratory tract infections. The ontogenetic and constitutional prerequisites and mechanisms of development of recurrent respiratory infections in children are given in detail. Treatment and prophylactic measures are explained according to the group of frequently ill children and heterogeneity of recurrent respiratory infections causes.

 

часто болеющие детирецидивирующие респираторные инфекциибронхиальная астмапервичные иммунодефицитыfrequently ill childrenrecurrent respiratory infectionsbronchial asthmaprimary immunodeficiencyReferencesBredy M. Respiratory viral infections. Infectious diseases. Edited by D. Marry. Moscow: Praktika. 2006. Pp. 604–630.Bredy M. Respiratory viral infections. Infectious diseases. Edited by D. Marry. Moscow: Praktika. 2006. Pp. 604–630.Acute respiratory diseases in children: treatment and prophylaxis. Textbook for doctors. Moscow: Publishing house of Union of Pediatricians of Russia. 2002. 73 pp.Acute respiratory diseases in children: treatment and prophylaxis. Textbook for doctors. Moscow: Publishing house of Union of Pediatricians of Russia. 2002. 73 pp.Samsygina G. A. Frequently ailing children: problems of pathogenesis, diagnostics and treatment. Consilium medicum. 2004; 6 (2): pp. 3–8.Samsygina G. A. Frequently ailing children: problems of pathogenesis, diagnostics and treatment. Consilium medicum. 2004; 6 (2): pp. 3–8.Bartlett J. G. Management of respiratory tract infection. 3rd Ed. Philadelphia. 2001. Р. 178–182.Bartlett J. G. Management of respiratory tract infection. 3rd Ed. Philadelphia. 2001. Р. 178–182.Albitskiy V.Yu., Baranov A. A., Kamayev I. A. Frequently ailing children. Nizhniy Novgorod: Publishing house NizhGMA. 2003. 174 pp.Albitskiy V.Yu., Baranov A. A., Kamayev I. A. Frequently ailing children. Nizhniy Novgorod: Publishing house NizhGMA. 2003. 174 pp.Romagani S. Th1/Th2 paradigm. Immunology Today. 1997; 18 (6): 263–266.Romagani S. Th1/Th2 paradigm. Immunology Today. 1997; 18 (6): 263–266.Martinez F. D. Role of viral infections in the inception of astma and allergies during childhood: could they be protective? Thorax. 1994; 49: 1189.Martinez F. D. Role of viral infections in the inception of astma and allergies during childhood: could they be protective? Thorax. 1994; 49: 1189.von Mutius E., Martinez F. D., Fritzch C. et al. Prevalence of asthma and atopy in two areas of West and East Germany. Am. J. Respir. Crit. Care Med. 1994; 149: 358.von Mutius E., Martinez F. D., Fritzch C. et al. Prevalence of asthma and atopy in two areas of West and East Germany. Am. J. Respir. Crit. Care Med. 1994; 149: 358.Strachan D. P. Hay fever, hygiene, and household size. BMJ. 1989; 299 (6710): 1259–1260.Strachan D. P. Hay fever, hygiene, and household size. BMJ. 1989; 299 (6710): 1259–1260.Lauener R. P. Allergien: Genetisch determiniertes Schicksal oder durch Umwelteinflusse bestimmte Krankheit? Die Ontogenese der Immun-Kompetenz und Allergie-Entstehung. Monatsschrft Kinderheilkunde. 2003; 1: 63–67.Lauener R. P. Allergien: Genetisch determiniertes Schicksal oder durch Umwelteinflusse bestimmte Krankheit? Die Ontogenese der Immun-Kompetenz und Allergie-Entstehung. Monatsschrft Kinderheilkunde. 2003; 1: 63–67.Veraksa A., Del Campo M., Mc Ginnis W. Developmental patterning genes and their conserved functions: from model organisms to humans. Mol. Genet. Metab. 2000; 69: 85–100.Veraksa A., Del Campo M., Mc Ginnis W. Developmental patterning genes and their conserved functions: from model organisms to humans. Mol. Genet. Metab. 2000; 69: 85–100.Zaplatnikov A. L., Korovina N. A., Girina A. A. et al. Prophylaxis of recurrent respiratory diseases in frequently ailing children. Questions of practical Pediatrics. 2010; 5 (6): pp. 55–60.Zaplatnikov A. L., Korovina N. A., Girina A. A. et al. Prophylaxis of recurrent respiratory diseases in frequently ailing children. Questions of practical Pediatrics. 2010; 5 (6): pp. 55–60.Zinovyeva N. V., Davydova N. V., Shcherbina A.Yu. et al. Frequently ailing children: mythes and reality. Allergology and immunology in Pediatrics. 2005; 1 (4): pp. 26–30.Zinovyeva N. V., Davydova N. V., Shcherbina A.Yu. et al. Frequently ailing children: mythes and reality. Allergology and immunology in Pediatrics. 2005; 1 (4): pp. 26–30.Sokolova T. S. Bronchial asthma in children. Particular allergology. Edited by A. D. Ado. Moscow: Medicine. 1976. Pp. 261–290.Sokolova T. S. Bronchial asthma in children. Particular allergology. Edited by A. D. Ado. Moscow: Medicine. 1976. Pp. 261–290.Wright A. L., Taussing L. M., Ray C. G. et al. The Tucson Children’s Respiratory Study II: Lower respiratory tract illness in the first year of life. Am. J. Epidemiol. 1989; 129: 1232.Wright A. L., Taussing L. M., Ray C. G. et al. The Tucson Children’s Respiratory Study II: Lower respiratory tract illness in the first year of life. Am. J. Epidemiol. 1989; 129: 1232.Milne A. A. Sneezles. Now we are six. N.-Y: E. P. Dutton and Co. 1927.Milne A. A. Sneezles. Now we are six. N.-Y: E. P. Dutton and Co. 1927.Yakovleva N. V. Respiratory viruses. Mechanisms of inflammation in bronches and lungs ad anti-inflammatory treatment. Edited by G. B. Fedoseyev. St.-Petersburg.: Normed-Izdat. 1998. Pp. 25–66.Yakovleva N. V. Respiratory viruses. Mechanisms of inflammation in bronches and lungs ad anti-inflammatory treatment. Edited by G. B. Fedoseyev. St.-Petersburg.: Normed-Izdat. 1998. Pp. 25–66.Smolenov I. V. Asthma and sibilant rales induced by viral infection. Consilium Medicum. Appendix. “Bronchial asthma, allergic rhinitis and conjunctivitis”. Clinical recommendations. Edited by Chuchalin A. G. 2001. Pp. 9–14.Smolenov I. V. Asthma and sibilant rales induced by viral infection. Consilium Medicum. Appendix. “Bronchial asthma, allergic rhinitis and conjunctivitis”. Clinical recommendations. Edited by Chuchalin A. G. 2001. Pp. 9–14.Soldatov D. G. Virus-induced bronchial asthma. Bronchial asthma. Vol. 2. Edited by A. G. Chuchalin. Moscow: Agar. Pp. 118–125.Soldatov D. G. Virus-induced bronchial asthma. Bronchial asthma. Vol. 2. Edited by A. G. Chuchalin. Moscow: Agar. Pp. 118–125.Busse W. W., Godard P., Howarth P. et al. Role and contribution of viral respiratory infections to asthma. Eur. J. Allergy Clin. Immunol. 1993; 48 (17): 57–61.Busse W. W., Godard P., Howarth P. et al. Role and contribution of viral respiratory infections to asthma. Eur. J. Allergy Clin. Immunol. 1993; 48 (17): 57–61.Weiss E. B., Stein M. Bronchial Asthma. 3rd Ed. N.-Y.: Little, Brown and Co. 1993. 1259 p.Weiss E. B., Stein M. Bronchial Asthma. 3rd Ed. N.-Y.: Little, Brown and Co. 1993. 1259 p.Johnston S. L., Pattemore P. K., Sanderson G. et al. Community study of role of viral infections in exacerbations of asthma in 9–11 year old children. BMJ. 1995; 10: 1225–1229.Johnston S. L., Pattemore P. K., Sanderson G. et al. Community study of role of viral infections in exacerbations of asthma in 9–11 year old children. BMJ. 1995; 10: 1225–1229.Geppe N. A., Revyakina V. A. New international recommendation on bronchial asthma in children PRACTALL. Pulmonology and allergology. Moscow: Atmosfera. 2008; 1: pp. 60–68.Geppe N. A., Revyakina V. A. New international recommendation on bronchial asthma in children PRACTALL. Pulmonology and allergology. Moscow: Atmosfera. 2008; 1: pp. 60–68.Global Strategy of treatment and prophylaxis of bronchial asthma (review 2009). Edited by Chuchalin A. G. Moscow: Atmosfera. 2011. 103 pp.Global Strategy of treatment and prophylaxis of bronchial asthma (review 2009). Edited by Chuchalin A. G. Moscow: Atmosfera. 2011. 103 pp.Allergic rhinitis and its impact on asthma (ARIA), 2008 г. Russian allergological journal (appendix). 2010: p. 215.Allergic rhinitis and its impact on asthma (ARIA), 2008 г. Russian allergological journal (appendix). 2010: p. 215.Fever in children. Edited by Saib El-Radkhi A., Kerrol J., Klein N. Moscow: GEOTAR-Media. 2013. Pp. 125–129.Fever in children. Edited by Saib El-Radkhi A., Kerrol J., Klein N. Moscow: GEOTAR-Media. 2013. Pp. 125–129.El-Radhi A. S., Hogg C. L., Bungre G. K. et al. Effect of oral glucocorticoid treatment on serum inflammatory markers in acute asthma. Arch. Dis. Child. 2000; 83: 158–162.El-Radhi A. S., Hogg C. L., Bungre G. K. et al. Effect of oral glucocorticoid treatment on serum inflammatory markers in acute asthma. Arch. Dis. Child. 2000; 83: 158–162.Kulichenko T. V. Montelukast (Singulair) in treatment of chronic diseases in children. Pediatricheskaja farmakologija — Pediatric pharmacology. 2006; 2: pp. 46–54.Kulichenko T. V. Montelukast (Singulair) in treatment of chronic diseases in children. Pediatricheskaja farmakologija — Pediatric pharmacology. 2006; 2: pp. 46–54.Knorr B., Franchi L. M., Bisgaard H. et al. Montelukast, a leukotriene receptor antagonist, for the treatment of persistent asthma in children aged 2 to 5 years. Pediatrics. 2001; 108: 1–10.Knorr B., Franchi L. M., Bisgaard H. et al. Montelukast, a leukotriene receptor antagonist, for the treatment of persistent asthma in children aged 2 to 5 years. Pediatrics. 2001; 108: 1–10.Bisgaard H., Zielen S., Garcia-Garcia M. L. et al. Montelukast reduces asthma exacerbations in 2-to 5-year-old children with intermittent asthma. Am. J. Respir. Crit. Care Med. 2005; 171: 315–322.Bisgaard H., Zielen S., Garcia-Garcia M. L. et al. Montelukast reduces asthma exacerbations in 2-to 5-year-old children with intermittent asthma. Am. J. Respir. Crit. Care Med. 2005; 171: 315–322.L. G. Kuzmenko. To the discussion on human’s constitution, constitutional types and diathesis. Pediatriya. Zhurnal imeni G. N. Speranskogo — Pediatrics. 2005; 5: pp.76–86.L. G. Kuzmenko. To the discussion on human’s constitution, constitutional types and diathesis. Pediatriya. Zhurnal imeni G. N. Speranskogo — Pediatrics. 2005; 5: pp.76–86.Syndrome of enlarged thymus in children. Edited by Martynova M. I., Kuzmenko L. G., Tyrin N. A. Moscow: Publishing house PFRU. 1993. 203 pp.Syndrome of enlarged thymus in children. Edited by Martynova M. I., Kuzmenko L. G., Tyrin N. A. Moscow: Publishing house PFRU. 1993. 203 pp.Ivanovskaya T. E., Zayratyanz O. V., Leonova L. V., Voloshchuk I. N. Pathology of thymus in children. St.-Petersburg: SOTIS. 1996. 272 pp.Ivanovskaya T. E., Zayratyanz O. V., Leonova L. V., Voloshchuk I. N. Pathology of thymus in children. St.-Petersburg: SOTIS. 1996. 272 pp.Novikov V. S., Bulavin D. V., Malinin V. V., Simonenkova V. A. Apoptosis of immune system cells. Programmed cell death. Edited by V. S. Novikov. St.-Petersburg: Schience. 1996. Pp. 104–119.Novikov V. S., Bulavin D. V., Malinin V. V., Simonenkova V. A. Apoptosis of immune system cells. Programmed cell death. Edited by V. S. Novikov. St.-Petersburg: Schience. 1996. Pp. 104–119.King L. B., Vacchio M. S., Ashwell J. D. To be or not to be: mutually antagonistic death signals regulate thymocyte apoptosis. Intern. Arch. Allergy. Immunol. 1994; 105: 355–358.King L. B., Vacchio M. S., Ashwell J. D. To be or not to be: mutually antagonistic death signals regulate thymocyte apoptosis. Intern. Arch. Allergy. Immunol. 1994; 105: 355–358.Vaganov P. D., Martynova M. I., Arion V.Ya. et al. Clinicalimmunological characteristics of children with enlarged thymus syndrome and their correction. Russian bulletin of perinatology and Pediatrics. 2001; 46 (3): pp. 59–60.Vaganov P. D., Martynova M. I., Arion V.Ya. et al. Clinicalimmunological characteristics of children with enlarged thymus syndrome and their correction. Russian bulletin of perinatology and Pediatrics. 2001; 46 (3): pp. 59–60.Barcia P., Nelson T. Hyperplasia of the thymus and thymic neoplasm in children. Milit. Med. 1979; 144: 799–801.Barcia P., Nelson T. Hyperplasia of the thymus and thymic neoplasm in children. Milit. Med. 1979; 144: 799–801.Matkovskaya T. V. Enlargement of thymus in children. Tomsk: Publishing house of Tomsk University. 1991. 152 pp.Matkovskaya T. V. Enlargement of thymus in children. Tomsk: Publishing house of Tomsk University. 1991. 152 pp.Maslov M. S. Diatheses. Multivolume guideline on Pediatrics. Vol. 1. Moscow: Medgiz. 1951. Pp. 505–513.Maslov M. S. Diatheses. Multivolume guideline on Pediatrics. Vol. 1. Moscow: Medgiz. 1951. Pp. 505–513.Nesterova I. V., Starchenko A. A., Ivanova S. A., Simbirtsev A. S. Immunotherapy and immunotropic drugs. Handbook of immunotherapy for practice medicine. Edited by Simbirtsev A. S. St.-Petersburg: Dialog. 2002. Pp. 88–99.Nesterova I. V., Starchenko A. A., Ivanova S. A., Simbirtsev A. S. Immunotherapy and immunotropic drugs. Handbook of immunotherapy for practice medicine. Edited by Simbirtsev A. S. St.-Petersburg: Dialog. 2002. Pp. 88–99.Kvetnoy I. M., Yarilin A. A., Polyakova V. O., Knyazkin I. V. Neuroimmunoendocrinology of thymus. St.-Petersburg.: DEAN. 2005. 160 pp.Kvetnoy I. M., Yarilin A. A., Polyakova V. O., Knyazkin I. V. Neuroimmunoendocrinology of thymus. St.-Petersburg.: DEAN. 2005. 160 pp.Morozov V. G., Khavinson V.Kh., Malinin V. V. Peptide thymomimetics. St.-Petersburg. Science. 2000. 158 pp.Morozov V. G., Khavinson V.Kh., Malinin V. V. Peptide thymomimetics. St.-Petersburg. Science. 2000. 158 pp.Kuzmenko L. G. Treatment and prophylactic service in children with enlarged thymus. Pediatriya. Zhurnal imeni G. N. Speranskogo — Pediatrics. 1996; 4: pp. 63–67.Kuzmenko L. G. Treatment and prophylactic service in children with enlarged thymus. Pediatriya. Zhurnal imeni G. N. Speranskogo — Pediatrics. 1996; 4: pp. 63–67.Vaganov P. D., Arion V.Ya., Mikheyeva I. G. Prophylactic and health-improving tactics of children with thymomegalia syndrome management. Pediatriya. Zhurnal imeni G. N. Speranskogo — Pediatrics. 2005; 6: pp. 11–16.Vaganov P. D., Arion V.Ya., Mikheyeva I. G. Prophylactic and health-improving tactics of children with thymomegalia syndrome management. Pediatriya. Zhurnal imeni G. N. Speranskogo — Pediatrics. 2005; 6: pp. 11–16.Anlehnung an Wann V., von Bermuth H. Diagnostisches Vorgehen beim Verdacht auf einem primaren Immundefekt. J. Lab. Med. 2009; 33 (4): 179–187.Anlehnung an Wann V., von Bermuth H. Diagnostisches Vorgehen beim Verdacht auf einem primaren Immundefekt. J. Lab. Med. 2009; 33 (4): 179–187.Yartsev M. N., Yakovleva K. P., Plakhtiyenko M. V. Immune insuffi ciency and frequently ailing children. Russian allergological journal. Appendix. Collection of thematic articles on a problem “Frequently ailing children”. 2006: pp. 3–31.Yartsev M. N., Yakovleva K. P., Plakhtiyenko M. V. Immune insuffi ciency and frequently ailing children. Russian allergological journal. Appendix. Collection of thematic articles on a problem “Frequently ailing children”. 2006: pp. 3–31.Allergology and immunology. Edited by Baranov A. A., Khaitov R. M. Moscow: Publishing house of Union of Pediatricians of Russia. 2010. Pp. 169–210.Allergology and immunology. Edited by Baranov A. A., Khaitov R. M. Moscow: Publishing house of Union of Pediatricians of Russia. 2010. Pp. 169–210.Polyanin D. V., Kartseva O. A., Popova M. A. Clinical and morphological comparison in initial immunodegiciencies in children. Bulletin of PFRU. 2006; 2 (49): pp. 300.Polyanin D. V., Kartseva O. A., Popova M. A. Clinical and morphological comparison in initial immunodegiciencies in children. Bulletin of PFRU. 2006; 2 (49): pp. 300.Nesterova I. V., Malinovskaya V. V., Tarakanov V. A. et al. Therapy with interferon and immunotherapy in frequently and long-ailing children and adults treatment practice. Capricorn Publishing Inc. 2004. 160 pp.Nesterova I. V., Malinovskaya V. V., Tarakanov V. A. et al. Therapy with interferon and immunotherapy in frequently and long-ailing children and adults treatment practice. Capricorn Publishing Inc. 2004. 160 pp.Bossuyt X., Moens L., van Hoeyveld E. et al. Coexistence of (partial) immune defects and risk of reccurent respiratory infections. Clin. Chem. 2007; 53: 124–130.Bossuyt X., Moens L., van Hoeyveld E. et al. Coexistence of (partial) immune defects and risk of reccurent respiratory infections. Clin. Chem. 2007; 53: 124–130.Ribosomal immunocorrection in pediatrician’s practice. Edited by Korovina N. A. Moscow. 2006. 232 pp.Ribosomal immunocorrection in pediatrician’s practice. Edited by Korovina N. A. Moscow. 2006. 232 pp.Tatochenko V. K., Dorokhova N. F., Shmakova S. G. Ecological phactors and diseases of respiratory organs in children. Ecology and children’s health. Edited by Studenikin M.Ya., Yefimova A. A. Moscow: Medicine. 1998. Pp. 247–272.Tatochenko V. K., Dorokhova N. F., Shmakova S. G. Ecological phactors and diseases of respiratory organs in children. Ecology and children’s health. Edited by Studenikin M.Ya., Yefimova A. A. Moscow: Medicine. 1998. Pp. 247–272.Tatochenko V. K. Diseases of respiratory organs in children. Moscow: Pediatrician. 2012. Pp. 285–286.Tatochenko V. K. Diseases of respiratory organs in children. Moscow: Pediatrician. 2012. Pp. 285–286.Gavalov S. M. Acute pneumonias in children. Selected questions. Novosibirsk: Publishing house of Novosibirsk University. 1990. 276 pp.Gavalov S. M. Acute pneumonias in children. Selected questions. Novosibirsk: Publishing house of Novosibirsk University. 1990. 276 pp.Vavilova V. P., Perevoshchikova N. I. Educational program for pediatricians and general practitioners “Modern approaches to the management of frequently ailing children”. Kemerovo. 2007. 36 pp.Vavilova V. P., Perevoshchikova N. I. Educational program for pediatricians and general practitioners “Modern approaches to the management of frequently ailing children”. Kemerovo. 2007. 36 pp.Kovalevskiy V. A. Peculiarities of emotional and volitional development of frequently ailing senior pre-schoolchild. Bulletin of V. P. Astafyev Krasnoyarsk Pedagogical University. 2012; 3: pp. 77–82.Kovalevskiy V. A. Peculiarities of emotional and volitional development of frequently ailing senior pre-schoolchild. Bulletin of V. P. Astafyev Krasnoyarsk Pedagogical University. 2012; 3: pp. 77–82.Stefani D. V., Veltishchev Yu. E. Clinical immunology of children’s age. Moscow: Medicine. 1996. Pp. 7–Stefani D. V., Veltishchev Yu. E. Clinical immunology of children’s age. Moscow: Medicine. 1996. Pp. 7–

The authors declare that there are no conflicts of interest present.