G.Z. GALEEVA^1,2, A.N. SAMOYLOV² V.A. ANOKHIN²,  A.Yu. RASCHESKOV¹, A.Yu. MEFODJEVA²

¹Сhildren’s Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, 140 Orenburgskiy tract, Kazan, Russian Federation, 420138

² Kazan State Medical University, 49 Butlerov Str., Kazan, Russian Federation, 420012

Contact details:

Galeeva G.Z. — Cand. Med. Sc, Assistant of the Department of Ophthalmology, Ophthalmologist of the ophthalmology division, tel.  (843) 237-30-19, e-mail: guzel-@list.ru

Samoylov A.N. — D. Med. Sc., Professor, Head of the Department of Ophthalmology, tel. (843) 528-09-14, e-mail: samoilovan16@gmail.com

Anokhin V.A. — D. Med. Sc., Professor, Head of the Department of children’s infections, tel. (843) 267-80-00, e-mail: anokhin56@mail.ru

Rascheskov A.Yu. — Cand. Med. Sc., Head of the ophthalmology division, tel.  (843) 237-30-19, e-mail: raslex@list.ru

Mefodjeva A.Yu. — student, tel. (929) 724-65-45, e-mail: albina_mefodeva@mail.ru

Received: March 30, 2018, accepted for printing: April 9, 2018.

The article summarizes the experience of examination and treatment of children with protracted keratitis with the duration of the disease from 4 months to 4 years and the duration of the last recrudescence from 1 to 9 months. The described forms of a protracted course of keratitis have not previously been recorded, but observed by us in recent years. Considering the long ineffective outpatient treatment according to the standard scheme, an extensive examination of patients was conducted to determine the etiology. The examination included both routine ophthalmic methods and blood tests for antibodies to herpes simplex viruses, general IgE, smear from the conjunctiva for the determination of microflora and sensitivity to antibacterial drugs, cell composition of the conjunctiva scraping, tests for excluding tubinfication, chronic otolaryngology and somatic pathology. Of all the examinations, only tests for chronic viral infections of the herpes group were positive, revealing, as a rule, a mixed-herpes infection (HSV, CMV, VEB in various combinations). Inclusion of complex therapy ganciclovir and human immunoglobulin against cytomegalovirus made it possible to achieve persistent remission in this group of patients. In the prolonged course of keratitis in children resistant to standard therapy, in our opinion, it is necessary to examine patients for chronic viral infections of the herpes group and to resort to etiotropic therapy.

Key words: keratitis, herpesviruses, cytomegalovirus, Epstein-Barr virus, ganciclovir.

(For citation: Galeeva G.Z., Samoylov A.N., Anokhin V.A., Rascheskov A.Yu., Mefodieva A.Yu. Treatment of protracted keratitis associated with mixed-herpes infection in children. Practical medicine. 2018 , No.2(113))

REFERENCES

1. Guseva L.N., Rogova L.A., Egorova N.YU., Balashova T.B., Cytomegalovirus infection (CMVI): classification, variants of the course. Detskie infekcii, 2003, no. 1, pp. 57-61. (In Russ.).
2. Kisteneva L.B., Martynova K.A., Hizhnyakova T.M., Cytomegalovirus infection in pregnant women. Diagnosis, interpretation of the results of the survey. Voprosy virusologii, 2003, no. 6, pp. 4-6. (In Russ.).
3. Kul’min V.N., Diagnosis, treatment and prevention of cytomegalovirus infection in pregnant women. Lechashchij vrach, 2002, no. 11. pp. 22-25.
4. Bissinger A.L., Singer C., Kaiserling E. Human cytomegalovirus as a direct pathogen correlation of multiorgan involvement and cell distribution with clinical findings in a case of  congenital inclusion diseases. J. Med. Viral, 2002, no. 67(2), pp. 200-206.
5. Revello M.G., Gerna G. Diagnosis and management of the human CMV in the mother, fetus аnd newborn infant. Clin. Microbiol. Rev, 2002, vol. 15, no. 4, pp. 680-705.
6. Levkova E.A., Savinov S.Z., Herpes-induced immunodeficiency diseases of children (by the example of 4 type of herpes). Sovremennye problemy nauki i obrazovaniya, 2016, no. 5, pp. 24-34. (In Russ.).
7. Rossihina E.V., Smirnova A.M., Kolevatyh E.P., Laboratory diagnosis of cytomegalovirus infection. Vyatskij medicinskij vestnik, 2010, no. 3, pp. 45-50. (In Russ.).
8. Federal clinical guidelines for ophthalmology 2016-2017. Gerpeticheskie zabolevaniya glaz: ehlektronnoe izdanie. (In Russ.).
9. Smirnova A.I., Rossihina E.V., Cytomegalovirus is the causative agent of opportunistic infections. Vyatskij medicinskij vestnik, 2011, no. 1, pp. 36-44. (In Russ.).
10. Galeeva G.Z., Rascheskov A. Yu. Keratitis of cytomegalovirus etiology in a child (case from practice). Prakticheskaya medicina. Oftal`mologiya, 2016, no. 2 [94], pp. 128-130. (In Russ.).