MD667Z - Method for treatment of infectious mononucleosis in children - Google Patents

Abstract

The invention relates to medicine, in particular to infectious diseases and can be used for the treatment of infectious mononucleosis in children.According to the invention, the claimed method consists in that it is administered the antibiotic therapy, vitamin therapy, hepatoprotective, detoxifying and symptomatic therapy, and additionally is daily administered, per os, 30 minutes before a meal 5α-furostan-3β,22,26-triol-3-[O-β-D-glucopyranosyl(1→2)-β-D-glucopyranosyl(1→4)-β-D-galactopyranosyl]-26-O-β-D-glucopyranoside, 50 mg, twice a day, for 30 days.

Description

The invention relates to medicine, especially to infectious diseases and can be used for the treatment of infectious mononucleosis in children.

The method of treating infectious mononucleosis in children is known, which includes bed rest, avoiding physical exertion during the persistence of splenomegaly and changes in the electrocardiogram, diet No. 5 according to Pevzner, which takes care of the liver. The pathogenetic and symptomatic treatment is done with antipyretics (paracetamol, ibuprofen, etc.), antihistamines (suprastin, taveghil, etc.), ursodeoxycholic acid and hepatoprotectors in case of liver damage, diuretics, vitamins (C, B1, B6, B12), at the use of aciclovir or antiviral remedies is also known [1].

The disadvantages of this method consist in the low effectiveness of antiviral preparations that do not allow to obtain the expected results, at the same time they cause the development of adverse reactions, which limits the application of the known method in practice for most patients, especially those of young age.

The problem that the invention solves consists in the development of a method of treatment of infectious mononucleosis with liver syndrome in children, by administering the native preparation - Pacovirine, which significantly reduces the frequency of manifestations of the general toxic syndrome, polyadenopathy, digestive disorders and hepatomegaly, normalizes ALAT, AST indices and γGT, respectively contributing to the reduction of the length of hospitalization of patients.

According to the invention, the claimed method consists in the fact that antibiotic therapy, vitamin therapy, hepatoprotective, detoxification and symptomatic therapy are administered, and in addition, 5α-furostan-3β,22,26-triol- 3-[O-β-D-glucopyranosyl(1→2)-β-D-glucopyranosyl(1→4)-β-D-galactopyranosyl]-26-O-β-D-glucopyranoside, 50 mg each, of 2 times a day for 30 days.

The result obtained consists in the creation of a method of treatment of infectious mononucleosis in children based on the administration, simultaneously with the basic therapy, of Pacovirine, with an immunomodulatory, antioxidant, interferonogenic and antiviral effect.

For the approval of the claimed method of treatment of infectious mononucleosis with liver syndrome in children at the Municipal Clinical Hospital for Infectious Diseases for Children (IMSP SCMBCC) the following investigations were carried out:

1) clinics;

2) paraclinical (hemoleukogram with the determination of the level of leukocytosis, the presence of lymphocytosis with monocytosis and atypical lymphocytes; the biochemical examination with the assessment of the level of aminotransferases (ALT, AST), alkaline phosphatase, serum bilirubin and its fractions, as well as β-lipoproteins, gamma- glutamyl transferase, lactate dehydrogenase and thymol test;

3) immunological examinations (immunoenzymatic method (ELISA) for the determination of serological markers of Epstein-Barr virus infection (VCA IgM, VCA IgG, EA IgG, EBNA IgG) of viral hepatitis (HBsAg, anti-HBcor IgM and anti-HBcor sum, anti-HCV, anti-HCV IgM, anti-HDV summary and anti-HDV IgM);

4) ultrasound examination of the abdominal organs (if necessary).

The object of the study were 175 patients (84 patients - the experimental group and 91 - the control group) and their observation sheets (form 003/e), with a clinical diagnosis of infectious mononucleosis with the Epstein-Barr virus with liver syndrome, hospitalized in IMSP The Municipal Clinical Hospital for Children's Contagious Diseases, during the years 2009...2012.

All the patients in the study received pathogenic and symptomatic treatment, which included a hygienic-dietary regimen (salon regimen, diet no. 5 according to Pevzner), antibiotics (in the case of purulent tonsillitis), hepatoprotectors (silymarin, essential phospholipids, ursodeoxyholic acid), detoxification therapy in the presence of general intoxication syndrome (i/v administration of physiological solutions, glucose, etc.) and vitamins. The patients in the experimental group (n-84) were additionally administered Pacovirine (medicinal form - capsules). The duration of the cure was one month, in the dose corresponding to the age (2 times a day).

The results of the method of treatment of children with infectious mononucleosis with the Epstein-Barr virus with liver syndrome were analyzed at the end of the inpatient treatment and after one month of catamnesis.

The results obtained.

In both groups in the study, boys had the highest share: 1st group - 47 (55%), 2nd group - 57 (62.6%), and less girls: 1st group - 37 (44 .1%), the 2nd group - 34 (37.4%).

About 2/3 of the patients in the 1st study group (experimental) were children up to 7 years old - 66 (78.6%), including up to 3 years old - 34 (40.5%) and aged between 3...7 years - 32 (38.1%), and aged between 7...14 and 14...18 years - 14 (16.7%) and 4 (4.7%), respectively. Group II (control) also mainly consisted of preschoolers (children up to 7 years old) - 71 (78.0%), and between 7...14 years old - 18 (19.8%) and between 14 ...18 years - 2 (2.2%), all these data are presented in the figure, which represents the distribution of patients with infectious mononucleosis with liver syndrome, depending on age.

Approximately 1⁄2 (43...51.2%) of the children of the first group attended collectives (kindergartens, schools, high schools, etc.), and in the case of the second group, the frequency of those present in collectives was lower (45 - 43.4%) .

The onset of the disease was acute in most patients: in the 1st group - 80 (95.2%) children, in the 2nd group - 87 (95.6%). According to the criteria of the severity of the disease (signs of general intoxication, the level of fever, the intensity of polyadenopathy, hepatosplenomegaly, etc.) at the hospitalization department, the general condition was assessed as serious at 30 (23.8%) and of medium severity at 64 (76.2 %) children from the 1st group. In the children of group II, the general serious condition was established at 14...15.4%, and of medium severity at 77...84.6%.

At home, by the family doctor or other specialists, 35 (41.7%) and 40 (43.9%) children from the 1st and 2nd groups were consulted. The majority (I group - 32 (38.0%), II group - 33 (36.3%)) of them started outpatient antibiotic treatment, which did not improve the general condition. The most frequent antibiotic administered in group I was from gr. cephalosporins (in 19 patients). It should be mentioned that 8 children were prescribed augmentin or amoxicillin.

At the start of treatment, all patients, both in the experimental group and in the control group, presented specific symptoms (fever, difficult nasal breathing, angina with or without purulent deposits, polyadenopathy, hepatomegaly, splenomegaly and specific hematological signs) characteristic of Epstein-Barr virus infection (infectious mononucleosis) with liver syndrome.

Fever was assessed in 78 (92.8%) patients from group I, with the appearance in the first three days from the onset of the disease in 29 (34.5%). The maximum values of the fever, established between 38...39°C, were recorded in 34 patients (40.4%) and above 39°C - in 44 (52.4%) patients. The average duration of the fever was 7 days, including between 4...7 days - in 35 and between 8...14 days - in 34, and in 9 children it persisted for more than 14 days.

In more than 2/3 (62...73.8%) of the patients in group I and in 66 (72.5%) in group II, difficult nasal breathing, stuffy nose, nasal voice were observed. Facial puffiness with eyelid edema, in some cases with periganglionic edema was observed in 28 (33.3%) cases, pharyngitis in 67 (79.8%) cases, abdominal pain in 11 (13.1%).

Purulent tonsillitis, at the time of hospitalization, was detected in the majority of patients from both group I (72...85.7%) and group II (80...87.9%).

Polyadenopathy with enlargement of anterior and posterior cervical, submandibular, axillary, inguinal, ulnar lymph nodes was present in all (100%) patients.

Hepatomegaly, in group I, was determined in 82 (97.6%) patients, in group II in 89 (97.8%). In most of the children in group I, the liver exceeded the right costal edge by 4 cm, including by 2...3 cm in 39 (46.4%) and by 3...4 cm in 19 (22.6%). Pronounced hepatomegaly, where the liver exceeded the costal edge by 4...5 cm, was detected in 14 (16.7%) and over 5 cm in 10 (11.9%) patients.

Splenomegaly was observed in 63 (75.0%) patients from the 1st group, with 1 cm below the left costal edge in 16 (19.0%), with 1...2 cm in 14 (16.7%) and with 2... 3 cm in 15 (17.8%) patients. Obvious splenomegaly was observed in 18 patients (with 3...4 cm below the costal edge in 11 (13.1%), with 4...5 cm in 4 (4.8%) and over 5 cm in 3 (3.6% ) sick.

The characteristic clinical signs were equally present in the case of children from group II (tab. 1).

Table 1

Clinical signs present in MI patients with EBV in the study

Clinical signs Experimental group Control group Abs. % Abs. % Fever 78 92.8 85 93.4 Odynophagia 67 79.8 64 70.3 Abdominal pain 11 13.1 16 17.6 Difficult nasal breathing 62 73.8 66 72.5 Pharyngoatonsillitis 72 85.7 80 87.9 Lymphadenopathy generalized 84 100.0 91 100.0 Hepatomegaly 82 97.6 89 97.8 Splenomegaly 63 75.0 70 76.9

At the time of hospitalization, the blood counts were characterized by the presence of anemia, with a higher frequency in children from the experimental group (34...40.5%) than in children from the control group (28...30.8%).

Leukocytosis was present in both study groups with the same frequency (in group I at 58.3%, in group II at 50.0%). Lymphocytosis and monocytosis at the first investigation was detected with the same legitimacy as leukocytosis: in group I children in 58.3% of cases, in group II children in 50.5%. Atypical lymphocytes were visualized in 61.9% of the children in the first study group and in 59.2% of the second group. The level of atypical lymphocytes in most cases in group I children was 30...50% (41.6%), compared to group II children (26.6%). Accelerated erythrocyte sedimentation rate in both groups was recorded at the same level (group I at 76.2%, group II at 73.6% children).

Hypertransaminasemia, as a sign of liver cytolysis, with the increased level of ALT was determined in 100% of the children of both groups and of AST - in 83.3% of the I group and in 83.5% of the II group. ALAT values between 49...100 IU/hour were determined in 56 (66.7%) patients from the experimental group, between 101...150 IU/hour - in 14 (16.7%), between 151...250 IU/hour - in 9 (10.7%), over 250 IU/hour - in 5 (5.9%) children. The bilirubin level was within the normal range in all cases.

All children included in the study (both from the experimental group and from the control group) benefited from pathogenetic and symptomatic treatment, and if necessary, they were given antibiotics and detoxification treatment. In the acute phase of the disease, the following were indicated: bed rest, diet no. 5.

All patients were monitored, daily during the hospitalization and one month after diagnosis, by the attending physician, with the assessment of all the clinical parameters characteristic of infectious mononucleosis and possible adverse reactions to the administration of the preparation. The evolution of the disease in all patients was benign. At the time of discharge from the hospital, hepatomegaly was preserved in the experimental group in 50 (59.5%) children and in the control group in 55 (60.4%). Splenomegaly at the time of discharge was observed in 32 (38.0%) children from group I and 33 (36.3%) from group II.

The comparative evolution of basic clinical signs in children with infectious mononucleosis with the Epstein-Barr virus with liver syndrome who received treatment with Pacovirine and those who received pathogenetic treatment is presented in tab. 2.

Table 2

The comparative evolution of the main clinical signs in patients with EBV hepatitis (the experimental group that received treatment with Pacovirine and the control group that received treatment

baseline) up to one month after treatment

No. Clinical parameters/no. of patients Group I (experimental) (n=84) P Group II (control) (n=91) P Before treatment After treatment (1 month follow-up) Before treatment After treatment (1 month follow-up) Abs. M±m (%) Abs. M±m (%) Abs. M±m (%) Abs. M±m (%) 1 Acute onset (with fever, difficult nasal breathing, etc.) 80 95.2 ±2.4 0 0 P<0.001 87 95.6± 2.2 0 0 P<0.001 2 Purulent tonsillitis 72 85 .7±4.1 0 0 P<0.001 80 87.9± 3.6 0 0 P<0.001 3 Generalized polyadenopathy 84 100 67 79.8± 4.9 P<0.001 91 100 83 91.2± 3.1 P<0.001 4 Hepatomegaly 82 97.6±1.7 8 9.5±1 0.3 P<0.001 89 97.8± 2.2 29 31.9± 8.6 P<0.001 5 Splenomegaly 63 75.0 ±5.4 4 4.8±1 0.7 P<0.001 70 76.9± 5.0 14 15.4± 9.6 P<0.001

In patients from the experimental group, hepatomegaly and splenomegaly were significantly reduced one month after discharge from the hospital, compared to those in the control group. The dynamics of the general toxic syndrome, manifested by fever and general toxic signs (lack of appetite, drowsiness, general weakness), during the surveillance period did not differ significantly in patients from groups I and II.

The data obtained in the control group are more modest, however, a significant statistical difference was detected according to the clinical criteria monitored in the catamnesis. Hepatomegaly (one month after discharge) was present in 8 (9.5%) patients in group I, compared to group II - in 29 (31.9%). The presence of splenomegaly was determined in 4 (4.8%) children from group I and 14 (15.4%) from group II.

A faster positive dynamic was observed in the decrease of the level of ALT and AST in the serum (tab.3). ALAT values at the end of treatment were within the normal range in 56 (66.7%) patients from the experimental group, compared to 43 (47.2%) from the control group. The normal ASAT level at the time of discharge was assessed in 68 (80.9%) children from group I and 56 (61.5%) from group II. Hyperbilirubinemia was not determined in any child in the study group.

Table 3

Characteristics of biochemical indices in patients with infectious mononucleosis with liver syndrome (experimental group who received treatment with Pacovirine and control who received basic treatment) before and after treatment

Biochemical parameter/term of testing/number of patients Group I (patients, who benefited from treatment with Pacovirine) n=84 Group II (patients, who benefited from basic treatment) n=91 norm > norm norm > norm abs. % abs. % abs. % abs. % ALAT ill. (index) 0...49 mmol/l Before treatment 0 0 84 100 0 0 91 100 After treatment 56 66.7 28 33.3 43 47.2 48 52.8 P P<0.001 P<0.001 P<0.001 P<0.001 SO sick. (index) 0...46 mmol/l Before treatment 14 16.7 70 83.3 15 16.5 76 83.5 After treatment 68 80.9 16 19.1 56 61.5 35 38.5 P P<0.001 P <0.001 P<0.001 P<0.001 Increase in γGTP level (index) 35…100 Before treatment 78 92.8 6 7.2 89 97.8 2 2.2 After treatment 84 100 0 0 91 100 0 0 P P>0, 05 P>0.05 P>0.05 P>0.05

All patients at the time of initiation and completion of Pacovirine treatment were subjected to serological investigations with the determination of specific anti-EBV markers. Seroconversion of markers of EBV infection in catamnesis was detected more frequently (56...66.7%) in children who benefited from Pacovirine treatment, compared to those who received basic treatment (39...42.8%).

Thus, the results of the clinical study on a group of 84 patients allow us to state that the administration of the Pacovirine preparation had a positive effect on the manifestation of the main clinical signs of the general toxic syndrome, polyadenopathy, digestive disorders that disappeared in a significant number of patients. In the majority of the patients in the experimental group, the reduction of the size of the liver and spleen assessed by palpation was observed towards the end of the Pacovirine treatment course. In the experimental group, the positive dynamics of the paraclinical indices (ALAT, AST and γGTP level) was more obvious.

The administration of the Pacovirine preparation as an additional medicinal remedy to the basic treatment, in accordance with the claimed method, led to a faster and more intensive normalization of the clinical and paraclinical indices, favoring a more favorable evolution of the pathological process with a faster recovery of the patients , a more intensive normalization of biochemical indices with a significant reduction in the duration of manifestation of the main clinical signs in the experimental group, compared to the control group.

The claimed method is carried out in the following way: antibiotic therapy, vitamin therapy, hepatoprotective, detoxification and symptomatic therapy are administered, and in addition 5α-furostan-3β,22,26-triol-3 is administered daily, orally, 30 min before meals -[O-β-D-glucopyranosyl(1→2)-β-D-glucopyranosyl(1→4)-β-D-galactopyranosyl]-26-O-β-D-glucopyranoside, 50 mg each, 2 times per day for 30 days.

Example 1

Patient Ş., 2 years old, was hospitalized on the 9th day after the onset of the disease in the IMSP Municipal Clinical Hospital for Contagious Diseases for Children (IMSP SCMBCC) during the period 26.10.2012 - 06.11.2012 with the clinical diagnosis of: infectious mononucleosis caused by the Epstein-Barr virus (primary infection), medium severity. Hepatitis mononucleosis. Basal bronchopneumonia on the right S7...S10, the convalescence period.

At the hospitalization department, he presented complaints of: fever up to 39°C, odynophagia, difficult nasal breathing, wheezing, swelling of all lymph nodes, hyporexia, general weakness, fatigue.

According to the medical history, he fell ill a week ago (on 18.10.2012) with an acute onset (fever, rare dry cough, general weakness, fatigue). He is consulted by the family doctor who initiates the treatment with amoxicillin. On 21.10.2012, after a repeated consultation, in the absence of efficacy, the antibiotic was changed (to cefatoxime). Against the background of the administered therapy, the general condition does not improve, difficult nasal breathing with snoring occurs during sleep, polyadenopathy, pain in the abdomen. On 23.10.2012, he was admitted to the Municipal Clinical Hospital for Children no. 1, where the diagnosis of basal bronchopneumonia was established on the right S7...S10, the convalescence period and augmentin was administered simultaneously with metronidazole, intravenously. The persistence of fever and other characteristic clinical signs require the transfer of the patient on 26.10.2012 to IMSP SCMBCC.

At admission, the general condition of the child is assessed as being of medium severity. The clinical examination reveals: diffusely hyperemic pharyngeal isthmus with hypertrophied palatine tonsils of gr. II and purulent deposits in bilateral gaps; submandibular lymph nodes up to 1.8...2.5 cm, anterior cervical up to 1.5 cm, posterior cervical up to 1.0 cm, axillary up to 0.8 cm, inguinal up to 0.8 cm, painless. The liver being appreciated with +2.5; +3.0; +4.0 cm below the costal border, elastic, painless, and the spleen +1.0 cm below the costal border.

During the hospitalization, the following investigations were carried out:

1) Blood count

Date/values obtained 27.10.2012 05.11.2012 Units of measurement Hemoglobin 118 114 g/l Erythrocytes 4.1 3.9 *1012/l Color index 0.86 0.88 Platelets 241 313 *109/l Leukocytes 17.5 9.4 *109/l Unsegmented 0 0 % Segmented 23 15 % Eosinophils 1 0 % Basophils 0 0 % Lymphocytes 64 78 % Monocytes 12 7 % Atypical mononuclear cells 11 0 ESR 25 10 mm/hour

2) Urogram - normal.

3) Analysis of faecal masses for: helminth eggs - negative, protozoa - negative.

4) Biochemical blood analysis

Date/values obtained 27.10.2012 05.11.2012 Units of measurement Urea 2.9 - mmol/l Creatine 68.9 - mmol/l ALT 66.4 18.6 U/l AST 62.5 36.3 U/l Bilirubin total 9.9 10.8 mcmol/l Conjugated bilirubin 0 0 mcmol/l Free bilirubin 9.9 10.8 mcmol/l Thymol sample 3.1 - Un Glucose 4.3 - mmol/l Amylase 34.7 - U /l Alkaline phosphatase 639.3 373.5 U/l

5) Serological examination for EBV markers (27.12.2012) anti EBV VCA IgM - positive, EA IgG - negative, EBNA IgG - negative.

6) Thick drop in malaria (27.23.2012) - negative.

7) Blood culture (25.12.2012) N 232 - negative.

8) Uroculture (27.12.2012) N 637 - negative.

9) ECG (25.12.2012) Regular sinus rhythm. Vertical electrical axis. Signs of left ventricular repolarization changes.

10) Ultrasound of the abdomen determined moderate hepatosplenomegaly with diffuse changes in the parenchyma.

As a result of the treatment the general condition became satisfactory. The fever persisted for 10 days. The submandibular lymph nodes were estimated to be enlarged at discharge, with sizes up to 0.8 cm, anterior cervical up to 0.7 cm, posterior cervical up to 0.7 cm, axillary up to 0.5 cm, inguinal up to 0.5 cm, painful. Liver protrudes +2; +2.5; +2.5 cm below the costal edge, elastic, painless. The spleen is not palpable. During the hospitalization, the patient received: basic treatment, including the hygienic-dietary regimen, antibiotic therapy (ceftriaxone 600 mg 2 times a day, for 7 days, i/m) and hepatoprotective (ursofalc 150 mg per bone, for 10 days). He was administered Pacovirine per os 50 mg x 2 times a day, with the continuation of the treatment in outpatient conditions, for 1 month under the supervision of the family doctor and the infectious disease specialist. More than a month after starting treatment with Pacovirine, the level of leukocytes (5.6*109/l) and lymphocytes (in 45%) returned to normal. Aminotransferase values remained normal: ALAT - 23.2 U/l; SAT - 31.3 U/l. The dimensions of the liver, towards the end of the treatment, exceeded the costal border by 1.0; +1.5; +1.5 cm. No adverse reactions to Pacovirine were observed during the treatment.

Example 2

Patient C., 3 years old, was hospitalized on the 3rd day after the onset of the disease in IMSP SCMBCC ward no. 4 during the period 26.10.2012…06.11.2012 with the clinical diagnosis of: infectious mononucleosis caused by the Epstein-Barr virus (primary infection), medium severity. Hepatitis mononucleosis. Acute bilateral pyelonephritis. Toxic infectious cardiopathy.

At the hospitalization department, he presented complaints of: fever up to 38.2°C, odynophagia, difficult nasal breathing, wheezing, swelling of all lymph nodes, hyporexia, general weakness, fatigue.

The patient fell ill on 24.10.2012 with fever, odynophagia. After consultation with the family doctor, Zimax therapy was initiated, but the general condition did not improve, the fever persisted. On 26.10.2012, after consultation with the maxillofacial surgeon, who ruled out purulent cervical lymphadenitis, he was hospitalized in IMSP SCMBCC.

At admission, the general condition of the child is rated as medium serious. The clinical examination shows hyperemia of the pharyngeal isthmus with hypertrophied palantine tonsils of gr. III and purulent deposits in bilateral gaps; submandibular lymph nodes up to 2.5...2.8 cm, anterior cervical up to 1.9 cm, posterior cervical up to 1.5 cm, axillary up to 0.8 cm, inguinal up to 0.8 cm, in a chain , painful. The liver being appreciated +4.0+4.5+4.5 cm below the costal border, elastic, painless, and the spleen +4.0 cm below the costal border.

During the hospitalization, the following investigations were carried out

1) Blood count

Date/values obtained 27.10.2012 05.1.2012 Units of measurement Hemoglobin 110 116 g/l Erythrocytes 3.9 4.1 *1012/L Color index 0.85 0.85 Platelets 158 194 *109/l Leukocytes 15.6 13.5 *109/l Unsegmented 0 0 % Segmented 31 26 % Eosinophils 0 0 % Basophils 0 0 % Lymphocytes 51 64 % Monocytes 18 10 % Atypical mononuclear cells 15 0 ESR 37 18 mm/hour

2) Urogram

Date Dense. React. Trans. Prot. This. Epit. Leuc. Erith. Cylin. Mucus. I jump. 27.10 1010 Alcal Tran 0 0 1-3 6-8 0 0 0 0

3) Urine after Neciporenco

Date/values obtained 29.10.2012 Units of measurement Leukocytes 800 mm3 Erythrocytes 1000 mm3 Cylin. 0 mm3

4) Analysis of faecal masses for: helminth eggs - negative, protozoa - negative.

5) Biochemical blood analysis:

Date/values obtained 27.10.2012 05.11.2012 Units of measurement Urea 3.8 - mmol/l Creatine 88.2 - mmol/l ALAT 87.1 39.7 U/l SAT 96.4 36.5 U/l Bilirubin total 9.6 7.2 mcmol/l Conjugated bilirubin 0 0 mcmol/l Free bilirubin 9.6 7.2 mcmol/l Thymol sample 3.0 - One Glucose 10.2 3.18 mmol/l γGTP 28.9 15.5 U/l β lipoprotein 41.0 - Un Alkaline phosphatase 620.7 460.8 U/l

6) Serological examination for EBV markers (27.23.2012) anti EBV VCA IgM - positive, EA IgG - negative, EBNA IgG - positive.

7) ECG (25.12.2012) Irregular sinus rhythm. Vertical electrical axis. Overstrain of the myocardium of the ventricle. Signs of left ventricular repolarization changes.

8) Abdominal USG (01.11.2012) Hepatomegaly. Reactive pancreatitis. Suspicion of bilateral pyelonephritis S>D.

He is discharged in satisfactory condition. The sizes of submandibular lymph nodes up to 1.1 cm, anterior cervical up to 0.9 cm, posterior cervical up to 0.7 cm, axillary up to 0.5 cm, inguinal up to 0.5 cm, painless. The liver is palpated with +3.0; +3.5; +3.5 cm below the rib cage, elastic, painless, and the spleen +2.5 cm, elastic, painless.

Inpatient treatment included: salon regimen throughout the period, dietary regimen, antibiotics (cefotaxime 500 mg 2 times a day for 7 days, i/m), hormones (sol. Dexamethasone 4 mg/day, for 2 days , i/m), hepatoprotective (ursofalc 150 mg, per os, for 10 days). Pacovirin was indicated per os 50 mg x 2 times a day, the treatment being extended on an outpatient basis for 1 month under the supervision of the family doctor and the infectious disease specialist. One month after starting treatment with Pacovirine, the leukocyte values (7.9٭109/l) normalized, and the lymphocyte level was 47%, which corresponds to the physiological norm according to age. The level of ALT (18.6 U/l) and AST (21.5 U/l) being within the norm. The liver in catamanesis is appreciated with 1.0; +1.0; +1.5 cm below the costal edge. The spleen is not palpable. No adverse reactions to Pacovirine were observed during the treatment.

1. Rusu Galina, Galetchi Axenia, Popovici Parascovia. Infectious diseases in children. Chisinau, 2012, p. 131-138

Claims (1)

Method of treatment of infectious mononucleosis in children, which consists in the administration of antibiotic therapy, vitamin therapy, hepatoprotective, detoxification and symptomatic therapy, and additionally 5α-furostan-3b is administered daily, orally, 30 min before meals,22 ,26-triol-3-[O-β-D-glucopyranosyl(1→2)-β-D-glucopyranosyl(1→4)-β-D-galactopyranosyl]-26-O-β-D-glucopyranoside, how many 50 mg, 2 times a day, for 30 days.