virusebis roli axalsobilebsi sistemuri infeqciis ... · pdf filemiekutvneba sisxlis saerto...

virusebis roli axalSobilebSisistemuri infeqciis ganviTarebasa da

gamosavalSi

marika koWlamazaSvili MD, MPH

Tbilisis saxelmwifo samedicino universiteti,

saerTaSoriso jandacvis skola

MAmarti 1 , 2010

Tbilisi, saqarTvelo

marika koWlamazaSvili

virusebis roli axalSobilebSi sistemuri infeqciebis ganviTarebasa da gamosavalSi 2

neonataluri da perinataluri sikvdiloba

Cvil bavSvTa sikvdiloba kvlav rCeba sazogadoebrivi janmrTelobis

erT-erT mniSvnelovan problemad. es maCvenebeli farTod gamoiyeneba

qveyanaSi da qveynebs Soris mosaxleobis janmrTelobis da keTildReobis

Sesadareblad. aTaswleulis ganviTarebis miznebidan meoTxe mizani swored

bavSvTa sikvdilobis Semcirebaa, romlis amocanasac warmoadgens 1990-2015

w.w. periodSi xuT wlamde asakis bavSvTa sikvdilobis ori mesamediT

Semcireba [1].

jandacvis msoflio organizaciis (janmo) monacemebis Tanaxmad

yovelwliurad 13 milioni bavSvi ibadeba, romelTagan 4 milioni

axalSobili iRupeba dabadebidan 4 kviris ganmavlobaSi (neonataluri

periodi- 28 dRe). neonataluri sikvdilobis 75% modis pirvel kviraze, xolo

25%-45% pirvel ocdaoTx saaTze. mkvdradSobadoba ki Seadgens 3,3 milions.

janmos SefasebiT, ganviTarebad qveynebze neonataluri sikvdilobis 98% da

mkvdradSobadobis 97% modis. amavdroulad am qveynebSi Sobadobisa da

sikvdilobis monacemebi yovelTvis ar aris registrirebuli [2].

msoflioSi 5 wlamde asakis baSvTa sikdilobis ZiriTadi mizezebia

Tandayolili dazianebebi, pnevmonia, malaria, wiTela, diarea, aiv/Sidsi,

neonataluri sikvdiloba da ucnobi etiologiis sikvdiloba. amaTgan 36%

modis neonatalur sikvdilobaze, romlis ZiriTadi mizezebia :

dRenakloba (27%), asfiqsia (23%), Tandayolili daavadebebi (7%),

araidentificirebuli (7%) da infeqciuri daaavadebebi (36%). ganviTarebad

qveynebSi neonataluri infeqciebi warmoadgens 1.6 milioni bavSvis

sikvdilobis mizezs, maT Soris wamyvani adgili sefsiss ukavia (26%) [3].

Sesavali



ukanaskneli aTi wlis ganmavlobaSi saqarTveloSi ganviTarebulma

movlenebma bavSvTa avadobaze mniSvnelovani gavlena iqonia. Cvil bavSvTa

sikvdilianobis maCvenebeli qveyanaSi Zalian maRalia da Seadgens 19.7

SemTxvevas yovel 1000 cocxalSobilze [4,5] . 2008 w. 0-5 wlamde asakis bavSvTa

sikvdilianobis maCveneblebSi (16.0) , 0-1 wlamde bavSvTa sikvdilobas (14.3)

mnivnelovani adgili uWiravs. Cvil bavSvTa gardacvalebis maRal maCvenebels

ki ganapirobebs neonataluri da gansakuTrebiT adreuli neonataluri

sikvdiloba (sikvdilianobis maCvenebeli – 9.2) [6].

saqarTvelos daavadebaTa kontrolis da samedicino statistikis

erovnuli centris monacemebiT 2003-2008 ww. 0 - 1 wlamde asakis bavSvTa

sikvdilianoba 1000 cocxalSobilze 18.5-dan 14.3-mde Semcirda. aseve Semcirda

adreuli neonataluri sikvdilianobis (12,3-dan 9.2-mde) da mkvdradSobadobis

(16.0-dan 12.6-mde) maCveneblebi 1000 cocxalSobilze. 0-1 wlamde asakis bavSvTa

sikvdilobis 92.4% perinatalur periodSi warmoqmnili calkeuli

mdgomareobebiTaa ganpirobebuli, 5.5% - Tandayolili anomaliebiT.

perinataluri sikvdilianobis maCvenebeli 1000 dabadebulze 2003 - 2008 ww.

Semcirda 28.1-dan 21.7-mde [4].

saqarTvelos daavadebaTa kontrolis centris monacemTa Tanaxmad,

axalSobilTa avadobisa da sikvdilobis maCvenebelTa Soris hemoragiuli

sindromis Semdeg neonataluri sefsisi da perinataluri infeqciebi yvelaze

maRali fataluri gamosavliT xasiaTdeba (83.3% da 52.2%). [cxrili #1 ]

saqarTveloSi axalSobilTa sikvdilobis erT-erT umniSvnelovanes

mizezs warmoadgens infeqciebi. SemTxvevaTa did nawilSi gamomwvevi mizezi

daudgeneli rCeba. generalizebuli infeqciis mqone bavSvebSi, romelTac aqvT

mravlobiTi araspecifiuri simptomebi, rogoricaa: hiper- an hipoTermia,

siyviTle, koagulopaTiasTan asocirebuli sisxldena, sunTqvis ukmarisoba,

hepatomegalia, splenomegalia, ismeba “axalSobilTa sefsisis” diagnozi

gamomwvevi faqtoris gansazRvris gareSe da iniSneba mkurnaloba farTo

speqtris antibiotikebiT. miuxedavad aseTi “empiriuli” mkurnalobisa, aseT

axalSobilTa sikvdilobis maCvenebeli Zalian maRalia, daaxloebiT 65%.



garda amisa, “axalSobilTa sefsisi” xSirad asocirebulia centraluri

nervuli sistemis infeqciebTan – meningiti da encefaliti, rac prognozs

kidev ufro amZimebs [7].

saqarTveloSi generalizebuli infeqciis mqone axalSobilebSi

etiologiuri agentis dadgena xSirad ar xdeba. ar arsebobs zusti

monacemebi axalSobilTa avadobaSi virusuli infeqciebis rolis Sesaxeb.

amJamad pediatriul pacientebSi virusul infeqciebze kvleva xdeba mxolod

serologiuri meTodiT, rac eqims mxolod SezRudul informacias aZlevs,

ismeba “axalSobilTa sefsisis” diagnozi da iniSneba mkurnaloba farTo

speqtris antibiotikebiT. generalizebuli infeqciebis mqone axalSobilTa

mniSvnelovan nawils aReniSneba virusuli infeqciebi, romelTa garkveuli

procenti gankurnebadi virusuli infeqciebia. prevencias daqvemdebarebuli

da gankurnebadi virusuli infeqciebis adreuli diagnostika mogvcems

saSualebas SevamciroT sikvdiloba am populaciur jgufSi.

Cvens qveyanaSi sefsisismagvar sindromSi virusuli paTogenebis rolis

Sesaxeb monacemebis simwire am kvlevis mniSvnelobas aSkaras xdis.

0-1 wlamde asakis bavSvTa ganviTarebis

etapebi

pediatriaSi gamoyofen bavSvTa zrda-ganviTarebis gansazRvrul etapebs

maTi morfologiuri, fiziologiuri da fsiqologiuri maxasiaTeblebis

mixedviT. adamianuri ontogenezis procesSi mniSvnelovania perinataluri da

postnataluri periodi.

postnataluri periodi iwyeba neonataluri periodiT anu

axalSobilobis periodიT, romelic Tavis mxriv iyofa adreul da gvian

periodad. adreuli neonataluri periodi aris dabadebidan Svidi dRe

(mTlianad 168 saaTi). axalSobilis dabadebis pirvelive dReebSi xSiria

Cirqovan septikuri daavadebebi, piodermia, kuW-nawlavisa da sasunTqi gzebis



zogierTi mZime baqteriuli da virusuli daavadebebi. Cvil bavSvTa advilad

inficirebis mizezebia organizmis aramyari damcvelobiTi unaris, agreTve

sekretoruli imunoglobulin A-s ar arseboba da M jgufis antisxeulebis

dabali koncentracia. gviani neonataluri periodi moicavs 21 dRes

(axalSobilis dabadebis me-8 dRidan 28 dRis CaTvliT). am periodSi Tavs

iCens sxvadasaxva daavadebebis gamovlinebebi, romelic iwvevs ganviTarebidan

gadaxras da dakavSirebulia perinataluri periodisa da adreuli

neonataluri periodis paTologiebTan. gviani neonataluri periodis dros

bavSvTa organizmis rezistentoba dabalia da swored am periodisTvis

damaxasiaTebelia sefsisis klinikuri gamovlineba. bavSvTa ganviTarebis

ocdamecxre dRidan iwyeba ZuZuTi kvebis postnataluri periodi , romelic

grZeldeba erT wlamde [8].

5 wlamde asakis bavSvTa sikvdilobidan 38% swored neonatalur

sikvdilobaze modis. neonatalur periodSi sikvdilobis dRiuri maCvenebeli

30-jer maRalia postneonatalur periodTan SedarebiT. sikvdiloba

gansakuTrebiT maRalia dabadebidan pirveli 24 saaTis ganmavlobaSi

(neonataluri sikvdilobis 25-45% modis). zogadad, neonataluri sikvdilobis

3/4 dabadebidan pirveli kviris ganmavlobaSi viTardeba.

axalSobilTa sefsisi

axalSobilTa sefsisi kvlav rCeba seriozul problemad, vinaidan igi

potenciurad fataluri mdgomareobaa da misi diagnostireba sakmaod rTulia.

klinikuri gamovlineba bundovania da araspecifikuri, swored amitom ar

arsebobs daavadebis sando da standartizebuli markerebi. mozrdilebisaTvis

miRebuli sefsisis klasifikacia, romelic SedarebiT standartizebulia,

axalSobilebSi ar gamoiyeneba. sefsisis mqone aranamkurnalevi axalSobilis

mdgomareoba SemTxvevaTa umetesobaSi mZimdeba da xSirad letaluri

gamosavliT mTavrdeba. amitom zedmeti sifrTxilis gamo bevri axalSobilis



mkurnaloba mimdinareobs “sefsisze saeWvo” mdgomareobis diagnoziT, rac

umravles SemTxvevaSi realobas ar Seesabameba. sefsisis gavrceleba da

masTan dakavSirebuli sikvdiloba mniSvnelovnad meryeobs sxvadasxva

qveynebSi da didad aris damokidebuli socialur-ekonomikur faqtorebze. igi

warmoadgens ganviTarebad qveynebSi axalSobilTa sikvdilobis 30-50%-is

mizezs [9;10]. saqarTveloSi daavadebTa kontrolisa da sazogadoebrivi

janmrTelobis erovnuli centris monacemebis Tanaxmad 2008w. axalSobilTa

sefsisis incidentoba 1000 cocxladSobilze Seadgens 1.6 [4].

Tandayolili sefsisis klinikuri gamovlinebebi umravlesad

aRiniSneba sicocxlis pirvel kviras. nayofis inficireba xdeba aRmavali

gziT an samSobiaro gzebSi gavlisas. nayofis inficirebis risk-faqtorebs

miekuTvneba dedis saSarde gzebis infeqcia, dRenakloba, orsulisaTvis

Catarebuli zogierTi invaziuri manipulacia, qorioamnioniti da sxv.

neonataluri sefsisi ZiriTadi maxasiaTeblis mixedviT iyofa or

kategoriad: adreuli sefsisi (romelic vlindeba dabadebidan 72 saaTis

ganmavlobaSi pnevmoniiTa da sasunTqi sistemis distres sindromiT), romlis

gamomwvevebia streptokoki da Esherichia coli da mogvianebiT gamovlenili

sefsisi, romelic viTardeba 72 saaTis Semdeg. warmodgenilia sefticemiiTa

da pnevmoniiT. gamomwvevTa Soris dominirebs Klebsiella, Staphylococcus epidermidis,

Pseudomonas aerugenosa [11;12].

rogorc aRvniSneT, klinikuri gamovlinebis mixedviT sefsisi

xasiaTdeba araspecifikuri mimdinareobiT da moicavs sxvadasxva sistemur

infeqciebs rogoricaa sefticemia, meningiti, pnevmonia, arTriti,

osteomieliti da Sardsasqeso sistemis infeqciebi. infeqciebis zedapiruli

gamovlinebebi, rogoricaa konuqtiviti da stomatiti, yovelTvis ar aris

damaxasiaTebeli neonataluri sefsisisTvis. neonataluri sefsisi saWiroebs

droul diagnostirebas, romelic SeiZleba daisvas mxolod laboratoriuli

gamokvlevebis gaTvaliswinebiT. aucilebel laboratoriul kvlevebs

miekuTvneba sisxlis saerTo analizi, sisxlis kultivireba da C reaqtiuli

cilis gansazRvra. meningitze saeWvo SemTxvevebSi am testebs emateba



Tavzurgtvinis siTxis gamokvleva. daavadebis maRali letalobis gamo

nebismier saeWvo SemTxvevaSi an dedis seriozuli risk-faqtorebis

arsebobisas am gamokvlevebis Catareba aucilebelia [13].

sisxlis kultivireba iTvleba oqros standartad sefsisis

diagnostirebaSi, romlis nakli mdgomareobs imaSi, rom gamokvlevis Sedegi

dayovnebulia 48-72 saaTi. am xnis ganmavlobaSi bavSvi aucilebelad

saWiroebs intensiur mkurnalobas. zogjer gamokvlevis Sedegis molodinSi

axalSobils utardeba arasaWiro mkurnaloba intravenuri antibiotikebiT.

Tanamedrove neonatologiaSi yuradReba maxvildeba aseve mTel rig

damatebiT markerebze, romelTa kompleqsuri ganxilva diagnozis dasmas

aadvilebs. aseTi markerebia IL6, IL1beta, CD11b, TNFa, prokalcitonini, CD14 da

sxv.

herpes virusebis roli axalSobilTa

avadobaSi

virusul infeqciebs Soris herpesvirusebis ojaxis warmomadgenlebs

mniSvnelovani adgili uWiravs axalSobilTa sistemuri infeqciebis

ganviTarebaSi. zogadad, herpesvirusebis warmomadgenelTa Soris adamianis

avadobisa da sikvdilobis gamowveva SeuZlia rva viruss: martivi herpesis

virusi (I da II tipi), Cutyvavila-zosteris virusi, citomegalovirusi, epStein-

baris virusi, herpes virusebi 6, 7 da 8 [14]. herpesvirusTa yvela saxeoba

morfologiurad identuria. isini warmoadgenen ormagad gadajaWvuli dnm

genomis Semcvel virusebs. virioni Sedgeba ikosaedris (ocgverda) birTvuli

membranisagan , romelsac gars ertymis lipidebis ormagi Sre. membranasa da

lipidur Sres Soris moTavsebulia amorfuli cilebis Sre, romelic

cnobilia safarvelis saxelwodebiT. herpesvirusTa saerTo maxasiaTebelia

is, rom pirveladi inficirebisas virusi warmoSobs latentur infeqcias

maspinZel organizmSi, romlis reaqtivacia SeiZleba moxdes sicocxlis



nebismier safexurze. reaqtivacia aris xSiri, magram yovelTvis ar iZleva am

daavadebisTvis damaxasiaTebel klinikur suraTs. arsebuli virusebi

SeiZleba iyos mizezi bavSvTa dRenaklobis, nayofis mcire wonis,

ganviTarebis anomaliebis, Tandayolili daavadebebisa da persistentuli

infeqciebisa. [15]

axalSobilTa herpesuli infeqcia xSirad xasiaTdeba mwvave

mimdinareobiT. axalSobilebs aqvT susti ujreduli imuniteti da HSV-1 anN2

rig SemTxvevebSi neonataluri herpesis ganviTarebis mizezi xdeba. kvlevebis

Tanaxmad qveynebis umravlesobaSi genitaluri herpesis ganviTarebis ZiriTadi

mizezi HSV-2-ia da masze modis SemTxvevaTa 85%. swored amitom HSV-2 aris

herpesTa jgufis is warmomadgeneli , romelzec modis 70% neonataluri

herpesebis ganviTarebisa [16;17].

gadacema dedidan bavSvze ZiriTadad xdeba mSobiarobis dros (85%-Si)

dedis genitaluri herpesis SemTxvevaSi. iSviaTad SeiZleba moxdes herpesis

virusis transplacenturi gadacemac, gansakuTrebiT es xdeba dedis

pirveladi infeqciis dros. SesaZlebelia aseve axalSobili dainficirdes

postnatalurad. dedis genitaluri herpesis arsebobis SemTxvevaSi

axalSobilebSi herpes virusis gamovlena xdeba dabadebidan pirveli sami

kviris ganmavlobaSi, gansakuTrebiT mexuTe - meTerTmete dRes. SeZenili

postnataluri herpesi viTardeba HSV-1 virusiT da dakavSirebulia ojaxis

wevrebTan an saavadmofos personalTan urTierTobasTan, romlebic arian

HSV-1-is mtarebelni [16].

mucladyofnisa da dabadebis Semdeg SeZenili axalSobilTa herpesuli

infeqciebi klinikuri gamovlinebebis mixedviT SeiZleba daiyos:

kanis, Tvalis (vezikuluri konuqtiviti) da/an piris Rrus

(stomatiti) forma , romelic xasiaTdeba buStukovani gamonayariT

Sesabamis midamoebSi.

centraluri nervuli sistemis (cns) dazianebiT mimdinare forma.

klinikuri simptomebi moicavs gamonayars, meningits, gulyrebs,

encefalitsa da leTargias.



diseminirebuli herpesuli daavadeba sxvadasxva organoTa sistemebis

dazianebiT, romlis klinikuri gamovlinebaa gamonayari, centraluri

nervuli sistemis dazianeba, organoTa mravlobiTi dazianebebi

(hepatiti, pnevmonia, qorioretiniti) [18;19].

neonataluri herpesis kanis, Tvalis da piris Rrus forma (kTp)

vlindeba daaxloebiT dabadebidan meaTe-meTerTmete dRes. axalSobilebs,

romlebsac aqvT herpes virusTa am formiT gamovlineba 30%-40%-Si

uviTardebaT nevrologiuri dazianebebi antivirusuli mkurnalobis

Cautareblobis SemTxvevaSi. ufro metic, 75% Cvilebisa, romelsac

aReniSnebaT kTp forma mkurnalobis gareSe uviTardebaT centraluri

nervuli sistemis an diseminirebuli herpesuli daavadebebi [20;21].

neonataluri herpesis inkubaciuri periodia 4-21 dRe. simptomebi

xSirad araspecifiuria da moicavs mxolod cxelebas, sunTqvis ukmarisobas,

cianozs da sxv. xSirad mkurnaloben rogorc baqteriul sefsiss da amitom

antivirusuli mkurnaloba yovndeba.

Cvil bavSvebSi sxva gamovlinebebTan erTad, herpesvirusebs SeuZlia

gamoiwvios sistemuri infeqcia da meningoencefaliti. neonataluri herpesebis

gamovlinebebs Soris centraluri nervuli sistemis damoukidebeli

daavadebebi gvxvdeba herpesiT dainficirebul axalSobilTa 35%-Si.

antivirusuli mkurnalobis gareSe sikvdilobis maCvenebeli Seadgens 50% da

ZiriTadad dakavSirebulia tvinis Reros dazianebasTan. daavadebis klinikuri

Taviseburebebi, iseve rogorc simZime da prognozi, mniSvnelovnad aris

damokidebuli herpesvirusebis tipze da qvetipze. es faqtori miuTiTebs am

virusebis tipirebis mniSvnelobaze [20;14].

neonataluri herpesis yvelaze rTuli mimdinareoba da gamosavali

damaxasiaTebelia diseminirebuli daavadebebisaTvis. diseminirebuli

daavadebebis mqone axalSobilebi arian xSirad cxridan TerTmet dRemde

asakobriv jgufSi. diseminireba xdeba neonataluri herpesis SemTxvevaTa

daaxloebiT 22%-Si da mkurnalobis gareSe sikvdiloba maRalia (Seadgens

daaxloebiT 85%). diseminirebuli daavadebis mqone axalSobilebSi adeqvaturi



mkurnalobis kursis Catarebis SemTxvevaSi sikvdilobis maCvenebeli

mniSvnelovnad iklebs [22].

enterovirusebi

kidev erTi jgufi virusebisa, romelTac SeuZliaT gamoiwvion

sistemuri infeqciebi Cvil bavSvebSi, aris enterovirusebi. rnm-is Semcveli

erT-jaWviani enterovirusebi, romlebic miekuTvnebian Picornaviridae ojaxs

tradiciulad iyofa sam jgufad: 3 poliovirusi, 29 koqsakvirusi da 31

exovirusi. koqsakvirusebi Tavis mxriv iyofa or jgufad A(23 tipi) da B(6

tipi) [23].

enterovirusebis sxvadasxva stereotipiT gamowveuli neonataluri

infeqciebis klinikuri niSnebi erTmaneTisagan Znelad gasarCevia. Tu ar

CavTvliT poliovirusebs, romelic warmoadgens ganivi mielitis

ganviTarebis mizezs. mwvave neonataluri infeqciebis didi nawili modis

exovirusis 11 serotipsa da koqsakvirus B jgufze.

enterovirusebi kuWis mJavis pH- mimarT gamZlea. inarCunebs

sicocxlisunarianobas oTaxis temperaturaze ramodenime dRis ganmavlobaSi.

enterovirusul daavadebebs ZiriTadad ar axasiaTebs sezonuroba.

enterovirusuli infeqciebis gamovlinebaTa axali SemTxvevebi piks aRwevs

zafxulsa da Semodgomaze.

roCesterSi, niu-iorki, CatarebuliPprospeqtuli epidemiologiuri

kvlevis Tanaxmad, sxvadasxva biologiuri masalis (xorxis da fekaluri

masebis) kultivirebiT axalSobilTa 12.8%-s aRmoaCnda enterovirusi.

miuxedavad aseTi maRali gavrcelebisa 79% infeqciis mimdinareobda

asimptomurad. B jgufis streptokokTan da herpes virusebTan asocirebul

hospitalizaciis maCveneblebTan SedarebiT enterovirusebTan asocirebuli

hospitalizaciis ricxvi gacilebiT maRalia. sxva kvlevebis Tanaxmad,

enterovirusebi aReniSneba 26-dan 50-mde axalSobils 100,000 dabadebulze [24].



virusebis gadacema xdeba adamianidan adamianze fekalur – oraluri

gziT, romelic SeiZleba gagrZeldes inficirebidan ramodenime kviris

ganmavlobaSi. enterovirusuli daavadebebis paTogenezi mimdinareobs

Semdegnairad: oraluri an respiratoruli epiTeliumidan SeWris Semdeg,

replikacia xdeba limfur ujredebSi, romlis gavrceldeba xdeba sisxlis

saSualebiT da gvaZlevs mravalferovan klinikur suraTs inkubaciuri

periodis(2 dRidan 10 dRemde) Semdeg. virusi aseve gadaecema dedidan

bavSvze. aRwerilia infeqciis nozokomialuri gadacema postnatalurad.

kvlevebis Tanaxmad 11%-dan 22%-mde enterovirusebisa gadadis

transplacenturad, ris dastursac warmoadgens daavadebis gamovlineba

dabadebidan pirveli-ori dRis ganmavlobaSi, aseve amnionur siTxesa da

Wiplaris sisxlSi virusis aRmoCena. enterovirusebi xangrZlivad inarCuneben

sicocxlisunarianobas garemoSi.

enterovirusiT avadobis maRali procenti modis neonataluri asakis

mqone bavSvebze, romlis gamomwvevic umravles SemTxvevaSi koqsakvirus B da

exovirusebis serotipi 11-ia. aseve xSiria dabal socialur-ekonomiur

jgufebSi da dabali sanitaruli pirobebis mqone garemoSi. [25;26].

axalSobilebi, romelTac simptomebi uviTardebaT dabadebidan 7 dRis

ganmavlobaSi, ufro mZime klinikuri gamovlinebebiT xasiaTdebian da

savaraudod inficirebulni arian vertikaluri gziT mSobiarobis dros

dedis fekaluri masebidan an genitaluri sekretidan, zogjer ki

transplacenturadac. vertikalurad gadacemuli enterovirusuli infeqciis

dros letaloba maRalia da Tu ganviTarda RviZlis nekrozic, sikvdilobis

maCvenebeli 80% udris [27].

rig SemTxvevebSi perinataluri exovirusuli infeqciis mqone bavSvebs

sicocxlis me-3-me-5 dRes ewyebaT "sefsisi" progresirebadi fulminanturi

hepatitiT, RviZlis ukmarisobiT da diseminirebuli sisxlZarRvSida

koagulaciiT. enterovirusebi axalSobilTa meningitis yvelaze xSiri mizezia

[28].



ar arsebobs monacemebi saqarTveloSi sistemuri infeqciebis mqone

axalSobilebSi virusuli infeqciebis gavrcelebis Sesaxeb. sxva qveynebSi

Catarebuli kvlevebi am mimarTulebiT cxadyofs infeqciaTa maRal

gavrcelebas neonataluri asakis populaciur jgufSi. iegeris mier

Catarebulma kvlevam 51 dRenakl axalSobilze, romlebic moTavsebuli iyvnen

axalSobilTa reanimaciaSi, gamoavlina herpesis jgufis erT-erTi virusis -

citomegalovirusis arseboba 16 (31,4%) axalSobilSi, romelTac

aReniSnebodaT sunTqvis gaZneleba, hepatosplenomegalia da atipuri

limfocitozi [29].

kvlevis mizans warmoadgenda dagvedgina virusuli infeqciebisa da sxva

risk-faqtorebis roli septiuri axalSobilebisa da Cvilebis sikvdilobaSi.

kvlevis amocanebs warmoadgens Semdegi:

1) generalizebuli infeqciebis mqone axalSobilebSi herpesis jgufis

virusebis da enterovirusebis gavrcelebis Seswavla

2) axalSobilebis klinikuri statusis daxasiaTeba infeqciis tipis

mixedviT

3) infeqciis gamosavlis asociaciis Seswavla infeqciis tipsa da

klinikur statusTan

kvlevis amocanebi

kvlevis mizani



kvlevis dizaini da sakvlevi jgufi

kvleva Catarda jvaredin-seqciuri meTodiT.

sakvlev kontigents Seadgenda saqarTveloSi generalizebuli infeqciis

simptomebis mqone 187 axalSobili, romlebic 2005 - 2006 wlebSi

hospitalizebulni iyvnen Tbilisis saxelmwifo samedicino universitetis

pediatriuli klinikis axalSobilTa reanimaciis ganyofilebaSi. kvlevaSi

CarTvamde sakvlevi pirebis dedebi detalurad ecnobodnen kvlevis miznebs

da amocanebs da maTi Tanxmobis SemTxvevaSi xels awerdnen Tanxmobis formas.

kvlevaSi CarTvis kriteriumi iyo:

asaki naklebi 8 kviraze

kvlevaSi CarTvis momentisaTvis ucnobi etiologiis

generalizebuli infeqciis arseboba, romlis klinikur

gamoxatulebad iTvleboda: hepatosplenomegalia, siyviTle,

adenopaTia, pnevmonia, kanisa da lorwovanis paTologiebi (peteqia,

purpura, vezikulebi an makulopapuluri egzanTema), nervuli

sistemis dazianeba (meningoencefaliti, mikrocefalia,

hidrocefalia) da Tvalis dazianebani (keratokoniunqtiviti,

qorioretiniti, retinopaTia)

Tavzurgtvinis siTxeSi virusuli infeqciebisaTvis damaxasiaTebeli

cvlilebebis arseboba.

romelime dadasturebuli baqteriuli infeqciis ar arseboba.

kvleva damtkicebulia reabilitaciis centris eTikuri komisiis mier

(eTikuri komisia registrirebulia aSS jandacvis nacionalur institutebSi).

meTodologia



monacemTa Segroveba

dasamuSavebeli monacemebi Segrovda kvlevis farglebSi

virusologiuri gamokvlevebis Sedegebisa da avadmyofobis istoriidan

amonawerebis safuZvelze, romelic Tan axlda Tavzurgtvinis siTxis da

sisxlis sakvlev nimuSs. imisaTvis, rom daculi yofiliyo

konfidencialuroba, sakvlevi pirebis identificireba xdeboda mxolod

kodirebulad (erTi da igive kodi eniWeboda sinjaras da istoriidan

amonawers) da pacientebis saxeli da gvari ar ewereboda. Segrovebuli

informacia da pacientTa identificirebis dokumenti inaxeboda qalTa da

bavSvTa dacvis kavSirSi, mTavari mkvlevaris ofisSi da xelmisawvdomi iyo

mxolod misTvis. klinikuri monacemebis Segroveba xdeboda axalSobilTa

avadmyofobis istoriebidan.

es informacia moicavda Semdegs:

axalSobilTa demografiul maxasiaTeblebi: asaki, sqesi,

stacionarSi Semosvlis TariRi, gaweris TariRi, mudmivi

sacxovrebeli adgili.

klinikuri informacia, romelic moicavs axalSobilTa

maxasiaTeblebs: gestaciuri (orsulobis) asaki; wona, apgaris

skalis monacemebi, mSobiarobis tipi, mSobiarobis garTulebebi,

axalSobilTa reanimaciaSi momarTvis TariRi da saidan iyo

gamogzavnili; klinikuri statusi Semosvlis dros (kanis, kanqveSa

cximovani qsovilis, sasunTqi sistemis, gul-sisZarRvTa sistemis,

saWmlis momnelebeli sistemis, nervuli sistemis das Sard-sasqeso

sistemis mdgomareobis mixedviT); generalizebuli infeqciis tipi

(adreuli an gviani sefsisi); daavadebis progresireba, mkurnalobis

sqema, reanimaciaSi mkurnalobis xangrZlivoba, klinikuri

gamosavali.



laboratoriuli gamokvlevis Sedegebi (sisxlis da SardissaerTo

analizi, bioqimiuri maCveneblebi, Tandayolil infeqciebze

gamokvlevis Sedegebi, liqvoris saerTo analizi, rentgenografiuli

da eleqtrokardiografiuli monacemebi da sxva);

monacemebi mSobelTa Sesaxeb: dedis demografiuli maxasiaTeblebi:

dedis asaki mSobiarobis dros, sacxovrebel adgili (sofeli Tu

qalaqi; ganaTlebis done; bavSvebis raodenoba, aRniSnuli pacienti

meramdene bavSvi iyo. dedis klinikuri informacia: prenataluri

vizitebis arseboba, mSobiarobis anamnezi, mSobiarobis garTulebebi

(sanayofe wylebis adreuli daRvra).

aRniSnuli monacemebi Segrovebul iqna mxolod erTi mkvlevaris mier

da gadamowmda Sesabamisi randomizebuli wesiT monacemebis Segrovebis

sizustis dasadgenad.

sisxlis sinjebi da laboratoriuli

gamokvlevebi

TiToeul axalSobils, romelic xvdeboda axalSobilTa reanimaciaSi,

pirvelive dRes uRebdnen 5 ml venur sisxls da 3 ml Tavzurgtvinis siTxes,

romelic igzavneboda virusologiur laboratoriaSi gamosakvlevad. sinjebis

transportirebisaTvis iyenebdnen civ yuTs (40C). aRebuli masala iyofoda 3

nawilad ELISA, PCR da RT-PCR meTodebiT analizisaTvis. PCR -saTvis

gamoyenebul iqna iseTi praimerebi, romlebic Seesabameboda 5"

aramakodirebel konservirebul regions, romlebic saerToa yvela

enterovirusis genomisaTvis. aseTi midgoma Semowmebulia enterovirusebis 65

serotipisaTvis rogorc referens-sinjebze, ise klinikuri sinjebze

gamoyenebis SemTxvevebSi [39]. Catarebul inqa sinjebis skriningi

enterovirusebis romelime serotipis arsebobaze maTi Semdgomi



identifikaciis gareSe. amplifikaciis produqtebi Senaxul iqna maTi

Semdgomi kvlevisaTvis.

sisxlis rutinuli analizi bioqimiuri analizis CaTvliT Cautardeba

praqtikulad yvela axalSobils, romelic mkurnalobda axalSobilTa

reanimaciaSi.

monacemebis Seyvana, verifikacia, marTva da statistikuri analizi

ganxorcieldeba statistikuri paketis SPSS me-16 versiis saSualebiT.

univariaciuli analizi Catarda demografiuli da klinikuri

maxasiaTeblebis sixSiris (procentulobis) gamosaTvlelad. aseve

gamoyenebul iqna bivariaciuli analizi, raTa Segvefasebina visurusuli

infeqciis (eqspozicia) prognostuli mniSvneloba letalobisTvis

(gamosavali) , riskTa Tanafardobis (Risk Ratio(RR)) 95 procentiani

sarwmunoebis intervalis gamoyenebiT. χ2 (Chi-square) testi an Fisher`s exact testi

iqna gamoyenebul xarisxobriv faqtorTa Soris arsebuli asociaciis

statistikuri sarwmunoebis dasadgenad, xolo stiudentis t test saSualebiT

gamoTvlil iqna uwyvet cvladebs Soris arsebuli asociaciis statistikuri

sarwmunoeba. multivariaciuli analizi ganxorcielda puasonis regresiuli

analizis meTodiT, romelsac gaaCnia garkveuli upiratesobebi sxva

multivariaciul meTodebTan SedarebiT, rodesac daavadebis prevalentoba

aWarbebs 10%-s.

erTwliani kvlevis pirobebSi Tbilisis saxelmwifo samedicino

universitetis pediatriuli klinikis axalSobilTa reanimaciis

statistikuri analizi

Sedegebi



ganyofilebaSi gamokvleul iqna 187 ucnobi etiologiis generalizebuli

infeqciiს mqone axalSobili, romelTagan 98 (52.4%) iyo mamrobiTi da 89

(47.6%) iyo mdedrobiTi sqesis. momarTvisas 98 (51.3%) axalSobili

miekuTvneboda adreul neonatalur asaks, xolo 91 (48.7%) gvian neonatalur,

anu 7 dRidan 28-dRemde asaks.

stacionarSi Semosul bavSvTaASoris 140 (74.9%) bavSvi 2500 gramze meti

woniT daibada. daavadebul bavSvTa mxolod erTi meoTxedi, anu 42

axalSobili (25.1%) dabali wonis iyo (2500 gramze naklebi). axalSobilTa

mdgomareobis diagnostirebis TvalsazrisiT gamoyenebul iqna apgaris skala.

monacemTa mixedviT 63 (33.7%) axalSobils miniWebuli hqonda 6-ze naklebi

qula. 124 (66.3%) bavSvi ki 6-ze maRali quliT iyo Sefasebuli. bavSvTa

umravlesoba (65.2%) iyo vaginaluri gziT, xolo 34.8% - sakeisro kveTiT

dabadebuli.

aRniSnuli kvlevis Sedegad ganisazRvra herpesvirusebisa da

enterovirusebis gavrceleba generalizebuli infeqciis mqone bavSvebSi.

kvlevaSi CarTul bavSvebs Soris 66 axalSobils (35.3%) aReniSneboda

enterovirusiT infeqciis SemTxveva, romelTagan 3 (7.3%) gardaicvala. 68

axalSobils (36.4%) daudginda romelime herpesvirusiT infeqcia. 53 (28.3%)

axalSobilSi ki daisva ucnobi etiologiis virusuli infeqciis diagnozi.

sakvlev jgufSi antibiotikebiT mkurnaloba Cautarda 171 (91,4%)

bavSvs. mkurnalobis sqemaSi antivirusuli medikamentebi CarTuli iqna

mxolod 33 SemTxvevaSi (17.6%). (ix. cxrili # 2)

cxrili #3 gvaZlevs informacias 179 axalSobilis dedis

demografiuli da klinikuri monacemebis Sesaxeb. dedaTa umravlesoba (84.5%)

iyo 19 welze ufrosi asakis, 114 (61.0%) cxovrobda qalaqSi da 150 (80.2%)

hqonda umaRlesi ganaTleba. 179 dedidan mxolod 43 (23%) dedisTvis iyo

kvlevaSi CarTuli bavSvi pirveli Svili. mniSvnelovnad maRali (89.3%) iyo im

dedebis procenti, romelTac Catarebuli hqondaT prenataluri vizitebi.

sanayofe wylebis adreuli daRvra aRiniSneboda 25 (13.4%) SemTxvevaSi.



kvlevis ganmavlobaSi reanimaciul ganyofilebaSi Semosul bavSvTa

Soris gardaicvala 41 (63.4%) axalSobili. maT Soris enterovirusebi

aRmoaCnda 3 (7.3%), herpesvirusebi 16 (36.4%) da gamomwvevi virusi ver dadginda

22 (28.3%) SemTxvevaSi. etiologiuri faqtorebis mixedviT axalSobilTa

letalobis maCveneblebi mniSvnelovnad gansxvavdeba erTmaneTisagan. kerZod,

herpesvirusebis infeqciis jgufSi arsebuli letaloba 1.75-jer aRemateba

enterovirusebis jgufSi letalobas (RR = 0.57, 95% CI 0.33,0.97). magram, aqve

unda aRiniSnos, rom bavSvebSi, romelTa Soris ver moxda etiologiuri

agentis identificireba (53.7%) letalobis maCvenebeli ufro maRalia, vidre

enterovirusebiT da herpesvirusebiT gamowveuli bavSvTa letaloba (RR = 0.11

, 95% CI 0.33,0.97).

gamovlinda sarwmuno asociacia axalSobilTa letalobasa da

hospitalizaciis asaks Soris. kerZod, gardacvlilTa Soris 0-7 dRemde

asakis axalSobilebis ricxvi orjer metia gviani neonataluri asakis

axalSobilebTan SedarebiT (RR =2.04 , 95% CI 1.13,3.69, p=0.013). aseve, mamrobiTi

sqesis sakvlev pirTa letaloba Warbobs mdedrobiTi sqesisas, TumcaRa

axalSobilTa letalobasa da sqess Soris statistikuri sarwmunoeba ar

gamovlinda (RR =1.57, 95% CI0.89,2.78, p = .11 ). pacientTa Soris, romlebic

dabali wonis kategorias miekuTvnebodnen (2500 gramze naklebi) letalobis

maCvenebeli gacilebiT dabali iyo im pacientebTan SedarebiT, romlebic

iwonidnen 2500 gramze mets. Tumca es asociacia ar aris statistikurad

sarwmuno (p =.15). (ix. cxrili #5.) da bolos, gamovlinda sarwmuno asociacia

apgaris qulasa da letalobas Soris. kerZod, axalSobilebSi, romlebic

apgaris skalis mixedviT Sefasebul iyvnen 6-ze naklebi quliT, maRalia

letalobis maCvenebeli im pacientebTan SedarebiT , romlebic 6-ze meti

quliT iyvnen Sefasebuli ( RR =2.07, 95% CI 1.21,3.52 , p = .007) .

dedaTa demografiuli da klinikuri maCveneblebis asociacia

axalSobilTa letalobasTan naCvenebia cxrili # 6. dedaTa demografiuli

da klinikuri maCveneblebidan axalSobilTa letalobasTan statistikurad

sarwmunod asocirebuli cvladebia:



dedis asaki - 18 welze umcrosi asakis dedebs riski ufro maRali

aqvT (RR =2.0, 95% CI 1.13,3.52, p = 0.02)

sacxovrebeli adgili – bavSvTa letaloba soflad macxovrebeli

dedebSi ufro maRalia, vidre qalaqSi macxovreblebisa (RR =1.81,

95% CI 1.05,3.10, p = 0.02)

prenataluri vizitebi - dedebi, romelTac Catarebuli ar hqondaT

prenataluri vizitebi riski ufro maRalia prenataluri vizitebis

mqone dedebTan SedarebiT (RR =2.02, 95% CI 1.09,3.75, p = 0.039).

axalSobilTa dRenakloba – dRenaklul axalSobilTa letalobis

riski aRemateba droulebisas (RR =2.20, 95% CI 1.17,4.42, p = 0.027).

mSobiarobis tipi – vaginalurad dabadebul bavSvTa letalobis

riski maRalia sakeisro kveTiT dabadebulebTan SedarebiT (RR =2.20,

95% CI 1.08,4.48, p = 0.02).

axalSobilTa letalobis asociacia Semdeg cvladebTan ar iyo

statistikurad sarwmuno:

ganaTleba - saSualo ganaTlebis mqone dedebis riski ufro

maRalia, vidre umaRlesi ganaTlebis mqone dedebisa (RR =0.69 , 95%

CI 0.60,2.18, p = 0.69).

pirveli Svili - dedebi, romelTaTvisac sakvlevi pirebi pirveli

Svilebi arian, riski maRalia (RR =1.23, 95% CI 0.67,2.24, p = 0.51).

sanayofo wylebis naadrevi daRvra – dedebs, romelTac

aReniSneboda adreuli sanayofe wylebis daRvra riski maRalia,

vidre vadamitanil orsulebSi, romlebac mSobiarobis dawyebamde

daRvares sanayofe siTxe ( RR =1.11, 95% CI 0.52,2.37, p = 0.78). (ix.

cxrili #7).

vinaidan, Cveni kvlevis mizans warmoadgens virusuli infeqciebisa da

sxva risk-faqtorebis rolis gansazRvra septiuri bavSvebis sikvdilobaSi,

erT-erTi mniSvnelovani da saintereso faqtoria mkurnalobis reJimi,

rogorc axalSobilTa letalobis potenciuri prediqtori. axalSobilebSi,



romelTac CautardaT antibiotikoTerapia, letalobis maCvenebeli 1.16-jer

metia im neonataluri asakis bavSvebTan SedarebiT, romlebsac ar miuRiaT

antibiotikebi. aqve unda avRniSnoT, antivurusuli mkurnalobasa da

axalSobilTa letalobas Soris asociacia. im pacientebSi, romlebsac ar

CautardaT antivirusuli mkurnaloba( 85.4%) letalobis maCvenebeli

gacilebiT maRalia im CvilbavSvebTan SedarebiT, romlebsac daeniSnaT

antivirusuli (14.6%) mkurnaloba. miuxedavad aseTi Sedegisa, Tu zogadad

vimsjelebT axalSobilTa letalobasa da antibiotikoTerapiasa da

antivirusuli mkurnalobis rejims Soris asociaciaze , Cveni kvlevis

Tanaxmad statistikurad sarwmunod asociacia ar dadginda ( p = .48 da p = .61)

(ix. cxrili # 8).

multivariaciuli analizis Sedegad dadginda, rom etiologiuri

faqtori (virusis tipi), apgaris skalis maCvenebeli, mSobiarobis tipi

(vaginaluri / sakeisro kveTa) da sacxovrebeli adgili (sofeli / qalaqi)

warmoadgens damoukidebel risk-faqtorebs septiuri bavSvebis sikvdilobaSi.

ganviTarebad qveynebSi bavSvTa sikvdilobis 1.6 milioni SemTxveva

neonatalur infeqciebze modis, romelTagan wamyvani mizezi sefsisia. mwiri

resursebis mqone qveynebSi, maT Soris saqarTveloSi, pediatriul pacientebSi

sefsisis etiologiuri faqtorebi da gamosavlebi kargad ar aris

gansazRvruli.

Cveni kvlevis Tanaxmad septikuri bavSvebis letaloba

ganpirobebulia sxvadasxva risk-faqtorebiT, maT Soris wamvani adgili

virusul agentebs eniWebaT. kerZod, enterovirusebsa da herpesvirusebs.

neonataluri enterovirusebis klinikuri manifestacia

mravalxrivia, romelic iwvevs sxvadasxva xarisxis mwvave daavadebebs.

diskusia



neonataluri asakis jgufSi, enterovirusebiT gamowveuli daavadebebi

zogjer mTavrdeba fataluri, sefsisis msgavsi gamosavliT. miuxedavad imisa,

rom saqarTvelo ganviTarebadi qveyanaa, Cven QqveyanaSi Catarebuli kvlevis

Sedegebi TiTqmis ar gansxvavdeba ganviTarebul qveynebSi Catarebuli

kvlevebis Sedegebisgan. Cveni kvlevis Sedegad dadginda, rom saqarTveloSi

enterovirusebis roli neonataluri asakis septiuri bavSvebis letalobaSi

arc Tu ise maRalia (RR = 0.19, 95% CI 0.06,0.63, p = 0.0016). Tu SevadarebT sxva

kvlevebs, 1993 -2003ww. amerikaSi Catarebuli enterovirusebis erovnuli

kvlevis Tanaxmad, romelic sazRvravda asociacias enterovirusis serotipsa

da neonataluri infeqciebis gamosavals Soris , dadginda, rom 26,737

gamovlenili SemTxvevidan neonataluri asakis iyo 2544, romelTagan

fatalurad dasrulda 3.3%. neonataluri asakis bavSvebSi enterovirusiT

ganpirobebuli letaloba erT Tveze meti asakis bavSvebTan SedarebiT

xuTjer maRali iyo (11.5% vs. 2.5%; odds ratio [OR] = 5.1; 95% CI 3.3, 7.8). amasve

adasturebs verbun-makiolekis holandiaSi neonatalur intensiur

ganyofilebaSi Catarebuli 12 wliani kvleva, romelic gvaZlevs monacemebs

virusuli infeqciebis klinikuri da epidemiologiuri maxasiaTeblebis

Sesaxeb. kvlevis safuZvelze dadginda, rom 5396 pacients Soris virusuli

infeqcia aRmoaCnda 51.

serologiuri kvleva ar aris sarwmuno testi axalSobilebSi

herpesvirusebis diagnostikisTvis. IgM antisxeulebis warmoqmna xSirad

mogvianebiT xdeba [31]. IgG antisxeulebis gansazRvra mxolod retrospeqtuli

diagnostikisTvis xdeba. axalSobilebSi xSirad IgG antisxeulebis warmoqmna

ar xdeba da titris oTxjeradi matebis dafiqsireba SeuZlebelia [32].

amitom gamomwvevi agentis pirdapiri gansazRvra aseT SemTxvevebSi Zalian

mniSvnelovan diagnostikur Rirebulebas iZens. diagnostikis klasikuri

meTodebi, rogorebicaa eleqtronuli mikroskopia, imunofluorescentuli

mikroskopia da virusis kultivireba SedarebiT ufro damuSavebulia HSV-1,

HSV-2, VZV, CMV virusebisaTvis, maSin rodesac, EBV, HHV-6, HHV-7, HHV-8-is

kvleva aRniSnuli meTodebiT dResdReobiT kvlav uamrav siZnelesTanaa



dakavSirebuli, gansakuTrebiT klinikur pirobebSi. polimerizaciis jaWvur

reaqciaze (pjr) dafuZnebuli meTodebi ganixileba umniSvnelovanes midgomad

aRniSnuli agentebis laboratoriuli deteqciisaTvis [33]. iseTi virusis

SemTxvevaSic ki, rogoricaa martivi herpesis virusi (HSV), romelic

SedarebiT advilad SeiZleba kultivirdes, mainc pjr diagnostika sadReisod

"oqros standartad" iqca zogierTi daavadebis, maT Soris herpesuli

encefalitis diagnostikisaTvis [34].

imis gamo, rom herpesvirusebis jgufis ramdenime warmomadgenelma

SeiZleba ganapirobos msgavsi simptomebis ganviTareba, aseve daavadebis

CamoyalibebaSi SeiZleba ori an ramdenime herpesvirusi erTdroulad iRebdes

monawileobas, dRis wesrigSi dadga iseTi pjr testebis SemuSaveba, romelTa

saSualebiTac SesaZlebelia moxdes ramdenime herpesvirusis erTdrouli

deteqcia. dReisaTvis aseT meTodebs ganekuTvneba paraleluri pjr,

multipleqs pjr ramdenime praimeriT, aseve konsensus pjr praimerTa iseTi

wyviliT, romlebic Seesabameba konservirebul genomur ubans, saerTos

herpesvirusebis jgufis erTdroulad ramdenime warmomadgenlisaTvis.

meTodebs, romlebic gamiznulia aRniSnuli skrininguli meTodiT

gamovlenili virusis Semdgomi konfirmaciisa da tipirebisaTvis, miekuTvneba

hibridizacia saxeoba-specifikuri zondebis gamoyenebiT, budobrivi pjr

saxeoba-specifikuri praimerebis gamoyenebiT, restriqtuli fermentuli

analizi [35-37]. kvlevaSi gamoyenebul iqna konsensus praimerTa ori wyvili

pjr-saTvis, xolo amplifikaciis produqtebis identifikaciisaTvis

gamoyenebul iqna fermentebi BamHI da BstUI [34]. aseTi midgomis sizuste da

sandooba Semowmebulia yvela 8 herpesvirusis amplifikaciisa da

identifikaciisaTvis da dadasturebulia misi dadebiTi mxareebi,

rogorebicaa siswrafe, simartive da xarj-efeqturoba klinikuri

laboratoriuli diagnostikis pirobebSi [34].

enterovirusebis deteqciisaTvis serologiuri kvleva Cveulebriv ar

aris efeqturi serotipebis simravlis gamo [28]. am mizezis gamo pjr-ze

dafuZnebuli swrafi meTodis gamoyeneba enterovirusebis sxvadasxva



serotipis erTdrouli diagnostikisaTvis, Zlier mniSvnelovani iyo klinikur

pirobebSi aRniSnuli virusebis aRmoCenisaTvis. sxvadasxva avtoris mier

mowodebulia ramdenime aseTi meTodi [38].

Tu gaviTvaliswinebT herpes virusebis seriozul da fatalur

gamosavlebs, igi warmoadgens sazogadoebrivi jandacvisTvis seriozul

problemas saqarTveloSi da mTels msoflioSi. Cveni kvlevis Sedegad

generalizebuli infeqciis mqone axalSobilTa sikvdilobis 39% (16/41) herpes

virusebiT iyo gamowveuli (p = 0.039). miuxedavad imisa, rom saqarTveloSi ar

arsebobs monacemebi herpesvirusebis incidentobis Sesaxeb 100,000

cocxalSobilze ris gamoc sxva qveynebis monacemebTan pirdapiri Sedareba

SeuZlebelia, Cvens mier miRebuli Sedegebis safuZvelze arapirdapir

SegviZlia vimsjeloT, rom incidentoba mniSvnelovnad unda aRematebodes

ganviTarebuli qveynebis maCveneblebs. did britaneTSi herpesvirusebis

incidentoba Seadgens 2/200,000 cocxalSobilze. amerikis monacemebis Tanaxmad

herpesvirusebis incidentoba Seadgens 20-50/100,000 cocxalSobilze, sadac 75%

neonataluri infeqciebis modis herpesvirus 1-sa da herpesvirus 2-ze.

herpesvirusebis prevalentoba aseve dabalia avstraliaSi (1/10 000),

holandiaSi (1/14 000-20 000), daniaSi (1/22 000) , iaponiaSi (1/14 000-20 000),

SvedeTsa(1/15 000) da norvegiaSi (1/25 000) [46].

literaturuli monacemebis Tanaxmad, herpesis virusebis gadacema

dedidan bavSvze transplacenturi gziT arc Tu ise xSiria. gadacema xdeba im

SemTxvevaSi, roca orsulobis mesame trimestrSi dedebs aqvT genitaluri

herpesi klinikuri gamovlinebis an misi gamovlenis gareSe. am dros

axalSobilis inficireba xdeba dedis samSobiaro traqtTan pirdapiri

kontaqtiT, amis gamo sakeisro kveTiT dabadebul bavSvebze genitaluri

herpesis gadacemis riski minimumamde dadis. SesaZlebelia, rom orsulobis

periodSi usimptomod mimdinare genitaluri herpesis arseboba ar iyos

cnobili dedisTvis, Sesabamisad, fiziologiuri mSobiarobis SemTxvevaSi

dedidan bavSvze gadacemis riski didia. Cveni kvlevis Tanaxmad, letaloba im

bavSvebSi, romlebic fiziologiuri mSobiarobiT iyvnen dabadebulni (80.5%)



metia im pacientebTan SedarebiT, romlebic sakeisro kveTiT daibadnen (19.5%)

(RR =2.20, 95% CI 1.08,4.48, p =0.02) . arsebobs erT-erTi prospeqtuli kvlevis

Sedegebi, romelSic CarTuli iyo 58 000 qali. am kvlevis farglebSi 202

qalSi genitaliebis sekretidan aRmoCenil iqna herpesvirusi, romelTa Soris

117(58%) qalma imSobiara fiziologiuri mSobiarobiT, xolo 85 (42%) daeniSna

sakeisro kveTa. herpesvirusebis mniSvnelovnad dabali SemTxvevebi

dafiqsirda sakeisro kveTiT gaCenil bavSvebs Soris vaginalurad gaCenil

bavSvebTan SedarebiT ( 1.2%(1/85) vs. 7.7(9/117) OR = 0.14, 95% CI 0.02,1.08; p = .047).

kaliforniis StatSi Catarebuli kvleva gviCvenebs, rom mas Semdeg, rac

genitaluri herpesis mqone qalebSi fiziologiuri mSobiarobis ricxvma imata

(8%-dan 35%-mde), Sesabamisad orjer gaizarda neonataluri herpesvirusebis

ricxvic.

Tumca amasTan dakavSirebiT kvlevebis sruliad gansxvavebuli

Sedegebic arsebobs: neonataluri herpesvirusebis incidentoba ar gazrdila

didi britaneTis erT saavadmyofoSi, sadac sakeisro kveTiT mSobiarobis

ricxvi Semcirda 37%-iT genitaluri herpesis mqone qalebSi, TumcaRa

neonataluri herpesvirusebis ricxvi mainc ar gazrdila. anu, sakeisro kveTis

dadebiTi efeqtis Sesaxeb sakmaod urTierTgamomricxavi monacemebi arsebobs.

Cveni kvlevis Sedegebi miekuTvneba im jgufs, romelic sakeisro kveTis damcav

efeqts adasturebs dedidan bavSvze herpesis virusis gadacemis mxriv.

miuxedavad amisa, sadReisod amerikis daavadebaTa kontrolis centris

rekomendaciiT sakeisro kveTa amcirebs axalSobilebze virusuli infeqciebis

gadacemis risks da Tu sakeisro kveTa samSobiaro wylebis adreul

daRvramde iqna Catarebuli, es TiTqmis gamoricxavs axalSobilze virusis

gadacemis risks.

aqve unda aRiniSnos, rom rogorc Cveni kvlevis Sedegad gamovlinda,

maRalia araidentificirebuli virusuli agentiT gamowveuli sikvdiloba,

rac ufro arTulebs mkurnalobisa da gamosavlis gaumjobesebis process.

rodesac vmsjelobT mSobiarobis tipis asociaciaze axalSobilTa

letalobasTan, yuradReba unda gavamaxviloT samSobiaro wylebis adreul



daRvraze. sxvadasxva qveyanaSi mSobiarobis marTvis taqtika erTmaneTisgan

gansxvavebulia. sanayofe wylebis adreuli daRvra aris garTuleba, romelic

gvxvdeba orsulobis 3%-Si da aris naadrevi mSobiarobis mizezi, igi aseve

warmoadgens perinataluri sikvdilobisa da neonataluri garTulebebis

mizezs, kerZod neonataluri sefsisis, placentis aSrevebisa da

respiratoruli distres sindromis. samSobiaro wylebis adreuli daRvriT

ganpirobebuli axalSobilTa sikvdiloba damokidebulia gestaciur asakze.

orsulobis 24 kviraze samSobiaro wylebis adreuli daRvris SemTxvevaSi

neonataluri sikvdiloba maRalia. Cvens kvlevaSi ganxilul iyo sanayofe

wylebis adreuli daRvris efeqti axalSobilTa letalobaze. monacemebis

Tanaxmad, gamovlinda, rom axalSobilebis letalobis ricxvi, romlebic

sanayofe wylebis adreuli daRvriT iyo gamowveuli maRalia, vidre

vadamitanil orsulobisas mSobiarobis dawyebamde sanayofe wylebis daRvris

SemTxvevaSi. ar iqna miRebuli sarwmuno mtkicebulebebi neonataluri

sikvdilianobis Sesaxeb (RR =1.11, 95% CI 0.52,2.37, p = 0.78). Tu SevadarebT sxva

qveynis monacemebs, amerikaSi naadrevi mSobiaroba Seadgens 11%, romelTagan

3% sanayofe siTxis adreuli daRvriT aris ganpirobebuli. xolo

axalSobilTa sikvdiloba maRalia ZiriTadad orsulobis 24 kviraze sanayofe

siTxis adreuli daRvris SemTxvevaSi. vinaidan sanayofe siTxis

mSobiarobamdeli daRvra orsulobis adreul etapze warmoadgens dedisa da

axalSobilis inficirebis xSir mizezs, mimoxilvis Tanaxmad, romelSic

Sevida 19 kvleva,sadac CarTuli iyo 6000 qali, dadginda antibiotikebis

gamoyenebis sargeblianoba, romelic amcirebs neonatalur infeqciebs (RR =

0.88, 95% CI 0.81,0.96).

U Cveni kvlevis Tanaxmad dedaTa demografiuli da klinikuri

maCveneblebi , kerZod dedis asaki da sacxovrebeli adgili axalSobilTa

sikvdilobis erT-erTi mniSvnelovani prediqtoria. axalSobilTa sikvdiloba

im dedebSi, romelTa asaki < 18 welze da soflad cxovrobdnen aRemateboda

19 welze ufrosi asakisa da qalaqad macxovrebel dedebis maCveneblebs.

axalSobilTa Soris maRali sikvdiloba soflad macxovreblebSi SeiZleba



aixsnas sxvadasxva faqtoriT, rogoricaa axalSobilTa intensiuri

samkurnalo ganyofilebebis gaumarTaoba, Tanamedrove samkurnalo meTodebis

ar arseboba da dabali socialur-ekonomikuri pirobebi. dedaTa asakisa da

sacxovrebeli adgilis asociacia neonataluri asakis sikvdilobasTan

naCvenebia mraval kvlevaSi [44,45]. kerZod, 1973-1989ww. stokholmi, SvedeTSi,

Catarebuli kvlevis Tanaxmad, romlebic adgendnen axalSobilTa

sikvdilobaze dedis asakis gavlenas, gviCvena, rom axalSobilTa sikvdilobis

maRali ricxvi Tineijer dedebSi dakavSirebulia dedebis fizikuri da

reproduqciuli ganviTarebis xarisxTan. am kvlevis monacemebiT,

neonataluri sikvdilobis risksa da dedis asakobriv jgufebis Soris

kavSiri aSkaraa : axalSobilTa sikvdiloba 20-24 wlis asakis dedebTan

SedarebiT 13-15 wlis (OR = 2.7) da 16-17 wlis (OR = 1.4) dedebSi gacilebiT

maRalia.

mniSvnelovania aseve Cvens kvlevaSi bavSvTa sikvdilobis SemTxvevebis

kavSiri dRenaklobasTan. daaxloebiT 17.1% gardacvlili bavSvebisa iyvnen

dRenaklebi (RR =2.20, 95% CI 1.17,4.41, p = .027) da 52.1% bavSvebisa, romlebic

Sefasebul iyvnen ≤ 6 quliT apgaris skalis mixedviT, fataluri gamosavliT

dasrulda. sxva kvlevis Tanaxmad, romelic nepalSi Catarda da miznad

isaxavda gaerkvia neonataluri sikvdilobis risk-faqotrebi, aseve dadginda,

rom dRenaklobasa da axalSobilTa letalur gamosavals Soris aris

mniSvenelovani asociacia (OR=4.27, 95% CI 3.06, 5.97;) [47].

rac Seexeba herpesvirusebis dauyovnebliv mkurnalobis dawyebas,

mravali faqtori unda inqes gaTvaliswinebuli. kerZod, herpesvirusebis

gamovlenasa da hospitalicias Soris saSualo dro 4 dRea, romelsac kidev

sxva mravali faqtori aferxebs. situacia kidev ufro rTuldeba dabadebisas

simptomebis ar arsebobis SemTxvevaSi, rodesac axalSobili gadayvanilia

binaze. inficirebuli dedis mier vaginalurad dabadebuli axalSobilebi

gamokvleul unda iyvnen 24-48 saaTis ganmavlobaSi. cnobilia antivirusuli

mkurnalobis adreuli Carevis roli neonataluri herpesvirusebis xelsayrel

gamosavalze. antivirusuli mkurnalobis usafrTxoeba da efeqturoba



virusuli infeqciebis mkurnalobaSi cnobilia bolo aTwleulis manZilze.

antivirusuli mkurnaloba dawyebuli unda iqnes daavadebis rac SeiZleba

adreul etapze. naklebad savaraudoa daavadebis sasurveli gamosavlis

miRweva, Tu simptomebis gamovlenasa da mkurnalobis dawyebas Soris

intervalebi ar iqna Semcirebuli. Cveni kvlevis Tanaxmad, gardaclilTa

Soris (n = 41) antivirusuli mkurnaloba acikloviriT CautardaT 85.6%.

antivirusuli mkurnalobis Sedegad gardacvlil axalSobilTa ricxvi(14.6%)

gacilebiT dabali iyo antibiotikebiT Catarebuli mkurnalobis Sedegad

gardacvlil bavSvTa ricxvze (90.2%). mixedavad amisa, Cveni kvlevis Tanaxmad

antimikrobuli mkurnalobisa da antivirusuli mkurnalobis asociacia

axalSobilTa letalobasTan TiTqmis erTnairia (RR= 1.6 vs. RR= 122, p= 0.48 vs.

p=0.61).

TumcaRa, sxva kvlevebis Tanaxmad, acikloviri ar unda iqnes

daniSnuli rutinulad standartuli antibiotikebis mkurnalobis msgavsad

neonataluri sefsisis dros.

praqtikaSi acikloviri gamoiyeneba misi usafrTxo profilisa da

moxerxebuli rejimis gamo [41]. bolo periodSi Catarebulia kvlevebi,

romlebmac gamoikvlies acikloviris maRali doziTa da xangrZlivi periodis

ganmavlobaSi herpesvirusebis mkurnalobis reJimi[42]., rogorc acikloviris

supresirebuli Terapiis kursi [43]. axalSobilTa sikvdilobisa da

daavadebianobis Semcirebis gaumjobeseba SesaZlebelia mkurnalobis kursis

gaxangrZlivebiT 10 dRidan 14-21 dRemde, romelic Tavis mxriv dakavSirebulia

daavadebis klinikasTan. axalSobilebis samkurnalod neonataluri herpesis

dadgenili an saeWvo infeqciis SemTxvevaSi gamoyenebul unda iqnes

intravenuri acikloviris maRali doza (60 mg/kg dReSi gayofili sam dozad),

8 saaTSi erTxel 21 dRis ganmavlobaSi diseminirebuli formisa da

centraluri nervuli sistemis dros, xolo kanisa da lorwovanis membranis

darRvevis SemTxvevaSi igive doziT 14 dRe.



arsebobs rigi naklovanebebisa, romelic aqvs Cven kvlevas da saWiroa

gaTvaliswinebul iqnes Sedegebis gaxilvis dros. pirvel rigSi, ZiriTad

naklovanebas warmoadgens sakvlevi jgufis raodenobis simcire, radgan

dabali statistikuri Zala aZnelebs gamovavlinoT statistikurad sarwmuno

asociciacia jgufebs Soris, romlebic Zalian umniSvnelod gansxvavdebian

erTmaneTisgan. aseve, Cveni kvlevis farglebSi axalSobilebi reanimaciul

ganyofilebaSi gadmogzavnil iyvnen mxolod samSobiaro saxlebidan da

poliklinikebidan. SesaZlebelia bavSvebi, romlebsac mkurnaloba

utardebodaT mxolod sakuTari ojaxis eqimis an poliklinikis pediatris

meTvalyureobis qveS, ver moxvedriliyvnen Cvens kvlevaSi. garda amisa,

idealuri iqneboda dedebis klinikur maxasiTeblebze damatebiTi

monacemebis arseboba, kerZod orsulobis dros dedebis virusologiuri

gamokvlevis Sedegebi. es SeiZleba miCneul iqnes kvlevis naklovanebad, Tumca

umravles SemTxvevaSi dedebs orsulobis dros virusologiuri kvlevebi

Catarebuli saerTod ar hqondaT. da bolos, vinaidan Cveni kvlevis mizans

warmoadgenda dagvedgina virusuli infeqciebisa da sxva risk-faqtorebis

roli septiuri bavSvebis sikvdilobaSi, gaweris Semdeg gadarCenil bavSvTa

saboloo gamosavali mniSvnelovani informacia iqneboda, Tumca es monacemebi

CvenTvis ucnobia.

kvlevis naklovanebebi

daskvna



Cvens mier Catarebuli kvleva sakmaod mniSvnelovan informacias

gvawvdis generalizebuli infeqciis mqone axalSobilebSi virusuli

paTogenebis rolze. kvlevis Sedegad SeiZleba davaskvnaT, rom septikuri

bavSvebis sikvdilobaSi virusul agentebs sakmaod mniSvnelovani adgili

eniWebaT, kerZod, enterovirusebsa da herpesvirusebs. Cveni kvlevis Sedegad

aseve gamovlinda, rom maRalia araidentificirebuli virusuli agentiT

gamowveuli sikvdiloba, rac arTulebs mkurnalobisa da gamosavlis

gaumjobesebis process. kvlevis Sedegebi gasaTvaliswinebelia am jgufis

pacientTa marTvaSi, rac SesaZlebels gaxdis minimumamde Semcirdes

antibiotikebis xSirad aramiznobrivi gamoyeneba da moxdes mizanmimarTuli

antivirusuli mkurnalobis drouli daniSvna, rac am axalSobilTa

keTilsaimedo prognozis Sanss mniSvnelovnad gazrdis.



cxrili # 1. neonataluri sikvdiloba saqarTveloSi

daavadebebis mixedviT (2003-2005) (dk&sjec)

maxasiaTeblebi SemTxvevebisraodenoba

avadoba / 1000cocxalSobilze

sikvdilobaadreulneonatalur

fataloba

1 sul 5489 116.7 583 10.6

2qalasSidahemoragia

54 1.1 50 92.6

3neonatalurisefsisi

120 2.6 100 83.3

4perinataluriinfeqciebi

203 4.3 106 52.2

5respiratorulidistres sindromi

522 11.1 146.1 28.0

6sxvarespiratorulidarRvevebi

2797 59.9 452 16.2

7qalasSida tramvamSobiarobis dros

231 4.9 36 15.6

8simaxinjeebi 329 7.0 49 14.9



cxrili # 2. septiuri bavSvebis demografiuli da klinikuri

maxasiTeblebi.

maxasiaTeblebi bavSvTa

raod.(No.*)

procentebi

1 etiologiuri faqtorebi

enterovirusebi

herpesvirusebi

araidentificirebuli

66

68

53

33.5

36.4

28.3

2 mkurnaloba antibiotikebiT

ki

ara

16

177

8.6

91.4

3 antivirusuli mkurnaloba

Kki

ara

158

33

84.5

17.6

4 sqesi

mdedrobiTi

mamrobiTi

89

98

47.6

52.4

5 asaki hospitalizaciisas

< 7 dRe

≤ 7 dRe

96

91

51.3

48.7

6 wona dabadebisas

≤ 2500

> 2500

47

140

25.1

74.9

7 apgaris skala

≤ 6

> 6

63

124

33.7

66.3



8 dRenakloba

ki

ara

16

171

8.6

91.4

* Number – bavSvTa saerTo raodenoba

cxrili #3. dedaTa demografiuli da klinikuri monacemebi.

maxasiaTeblebi bavSvTa

raod.(No.*)

procentebi

1 dedis asaki

≤18

> 19

29

158

15.5

84.5

2 sacxovrebeli adgili

sofeli

qalaqi

73

114

39.0

61.0

3 ganaTleba

saSualo

umaRlesi

37

150

19.8

80.2

4 pirveli bavSvi

ki

ara

43

144

23.0

77.0

5 prenataluri vizitebi

ki

ara

167

20

89.3

10.7

6 sanayofe wylebis adreuli daRvra

ki

ara

25

162

13.4

86.6

7 mSobiarobis tipi

vaginaluri

sakeisro kveTa

122

65

65.2

34.8



* Number – bavSvTa saerTo raodenoba

cxrili #4. sikvdilianobis maCveneblebi etiologiuri

faqtorebis mixedviT.

maxasiaTeblebi gard* gadarC. †

RR‡ 95% CI §Chi-squareTest #

p value**No. % No. %

etiologiuri

faqtorebi

enterovirusebi

herpesvirusebi

araidentificerbuli

3

6

2

3

9.0

3.7

3 43.2

2 35.6

1 21.2

0.19

0.57

0.11

0.06,0.63

0.33,0.97

0.03,0.35

9.92

4.47

24.20

0.0016

0.034

0.0000009

sul 1 100 46 100 23.62 0.000007

* gardacvlilTa raodenoba, Number - saerTo raodenoba, procenti† gadarCenilTa raodenoba‡ Risk ratio - riskTa Tanafardoba§ Confidence Interval - sarwmunoebis intervali

# Chi-square Test - xi-kvadrat testi**or mxriani statistikuri testi, p value < 0.05 aris statistikurad sarwmuno



naxazi 1. letalobis procentuli maCveneblebi etiologiuri

faqtorebis mixedviT.

ჰერპესვირუსებიარაიდენტიფიცირ

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

sikvdil

oba %

ენტეროვირუსები

ჰერპესვირუსები

არაიდენტიფიცირ

*

*

* statistikurad sarwmuno



cxrili #5. axalSobilis demografiuli da klinikuri

maCveneblebis asociacia sikvdilobasTan.

maxasiaTeblebi gard* gadarC. † RR‡ 95% CI § Chi-squareTest #

p value**

No. % No. %

sqesi

mdedrobiTi

mamrobiTi

26

15

63.4

36.6

72

74

9.3

50.7

1.57 0.89,2.78 2.55 0.11

asaki

hospitalizaciisas

≤18

>19

11

30

26

73.2.8

18

128

12.3

87.7

2.0 1.13, 3.52 5.14 0.02

apgaris skala

≤ 6

> 6

21 51.7 42 28.8 2.07 1.21,3.52 7.22 0.007

20 48.8 104 71.2

wona dabadebisas

≤ 2500

> 2500

13 31.7 34 23.3 0.15 0.93,1.65 2.03 0.15

28 68.3 112 76.7





cxrili #6. dedaTa demografiuli da klinikuri

maCveneblebis asociacia axalSobilTa

sikvdilobasTan.

maxasiaTeblebi gard* gadarC. † RR‡ 95% CI § Chi-squareTest #

p value**

No. % No. %

dedis asaki

≤ 18

>19

11

30

26.8

73.2

18

128

12.3

87.7

2.0 1.13,3.52 5.14 0.02

sacxovrebeli

adgili

sofeli

qalaqi

22

19

53.7

46.3

51

95

34.9

65.1

1.81 1.05,3.10 4.72 0.02

ganaTleba

saSualo

umaRlesi

9 22.0 28 19.2 1.14 0.60,2.18 0.16 0.69

32 78.0 118 80.8

pirveli bavSvi

ki

ara

11 26.8 32 21.9 1.23 0.67,2.24 0.44 0.51

30 73.2 114 78.1

prenataluri

vizitebi

ki

ara

8 19.5 12 8.2 2.02 1.09,3.75 4.27 0.039

33 80.5 134 91.8

* gardacvlilTa raodenoba, Number - saerTo raodenoba, procenti† gadarCenilTa raodenoba



‡ Risk ratio - riskTa Tanafardoba§ Confidence Interval - sarwmunoebis intervali


cxrili #7. mSobiarobis Taviseburebebis asociacia

axalSobilis sikvdilobasTan. 2005-2006ww.


RR‡ 95% CI § Chi-squareTest #


dRenakloba

ki

ara

7

34

17.1

82.9

9

137

6.2

93.8

2.20 1.17,4.414 4.87 0.027

membranis adreuli

darRvevebi

ki

ara

6 14.6 19 13.0 1.11 0.52,2.37 0.07 0.78

35 85.4 127 87.0

mSobiarobis tipi

vaginaluri

sakeisro kveTa

33 80.5 89 61.0 2.20 1.08,4.48 5.38 0.02

8 19.5 57 29.0





cxrili # 8. mkurnalobis rejimis asociacia

axalSobilTa sikvdilobasTan


RR‡ 95% CI §Chi-squareTest #


mkurnaloba

antiobiotikebiT

ara

ki

4 9.8 12 8.2

37 90.2 13.4 91.8

1.6 0.47,2.83 Fisher's

exact

0.48

antivirusuli

mkurnaloba

ara

ki

35 85.4 12.3 84.2

6 14.6 27 18.5

1.22 0.56,2.66 0.26 0.61





1. United Nation. Road map towards the implementation of the United Nations Millennium

Declaration. General assembly resolution A/56/326.

2. World Health Organization.Newborns: reducing mortality.Retrieved January 10, 2010 from

http://www.who.int/mediacentre/factsheets/fs333/en/index.html

3. World Health Organization. Issues in adolescent health and development. WHO; Geneva: 2004.

[April 10, 2007]. Adolescent pregnancy. http://www.who.int/child-adolescent-

health/New_Publications/ADH/ISBN_92_4_159145_5.pdf.

4. European Health for All database (HFA-DB). Retrieved January 10, 2010 from

http://www.euro.who.int/hfadb

5. Ministry of Labour, Health and Social Affairs of Georgia et al.Health Care in Georgia compared

with the European region countries. Retrieved January 11,2009 from

http://www.ncdc.ge/Eng/Health/Georgia%20vs%20International.pdf

6. National Center for Disease Control and Public Health. Maternal and Child Health. Health and

health care, Georgia, 2008.

7. Report on the maternal and child health in Georgia, Tbilisi 2001: 9.

8. Mazurina AV.,Vorontsov IM.Pediatric Propedevdic.Medicina, 1986.

9. Gotoff SP. Neonatal Sepsis and meningitis: in:Nelson textbook of Paediatrics. (15th Edition).Eds

Behraman RE, Kleigman RM, Arbin AM.Philadelphia, WB saunders company 1996:PP:528-

537.

10. Agrawal R, Sarkar N, Deorary AK and Paul VK.Sepsis in newborn. Ind. J. Paediatric Dec

2001:68 : 1143-1147.

11. Jain NK, Jain VM, Maheshwari S. Clinical Profile of Neonatal Sepsis. Kathmandu University

Medical Journal (2003) Vol. 1, No. 2, 117-120

gamoyenebuli literatura:



12. Sankar MJ, Agarwal R, Deorari AK, Paul VK. Sepsis in the Newborn. AIIMS- NICU protocols

2008

13. Gladstone IM,Ehrenkranz RA,Edberg SC, et al.A ten-year review of neonatal sepsis and

comparison with the previous fifty-year experience.Pediatric Infectious Disease

Journal;9:819,1990.

14. Marshall G. Epidemiology and clinical manifestations of herpesvirus infections in infants and

children. Sem Pediatr Infect Dis 1997; 8(3): 151-160.

15. Nahmians AJ., Alford CA.,Korones SM. (1970)Infection of the infant with herpesvirus hominis.

Advancesin Pediatrics, 17, 185.

16. Kimberlin D. Herpes Simplex Virus, Meningitis and Encephalitis in Neonates. HERPES 11

Supplement 2 2004

17. Tookey P, Peckham CS.Neonatal herpes simplex virus infection in the British Isles. Paediatr

Perinat Epidemiol 1996; 10: 432–442.

18. Whitley R. Herpes Simplex Virus Infection. Philadelphia: WB Saunders, 1990.

19. Prober CG, Corey L, Brown ZA, Hensleigh PA, Frenkel LM, Bryson YJ et al. The management

of pregnancies complicated by genital infections with herpes simplex virus. Clin Infect Dis

1992;15:1031–1038.

20. Kimberlin DW, Lin CY, Jacobs RF, Powell DA, Frenkel LM, Gruber WC et al. Natural history

of neonatal herpes simplex virus infections in the acyclovir era. Pediatrics 2001; 108: 223–229.

21. Rudinick CM., Hoekzema GS. Neonatal Herpes Simplex Virus Infections. American Family

Physician. Volume 65, Number 6 / March 15, 2002

22. Knezevic A. et al. Disseminated Neonatal Herpes Caused by Herpes Simplex Virus Types 1 and

2. Emerging Infectious Diseases. Vol. 13, No. 2, February 2007

23. Tebruegge M.Curtis N. Enterovirus infections in neonates. Volume 14, Issue 4, Pages 222-227

(August 2009)

24. Caddle S. Adam HM. Enteroviruses.Pediatrics in Review Vol.24 No.10 October 2003

25. Hawkes TM, Vaudry W. Nonpolio enterovirus infection in the neonate and young infant.

Paediatr Child Health 2005;10(7):383-388.

26. Jenista JA, Powell KR, Menegus MA. Epidemiology of neonatal enterovirus infection. J Pediatr

1984;104:685-90.



27. Modlin JF. Perinatal echovirus infection: Insights from a literature review of 61 cases of serious

infection and 16 outbreaks in nurseries. Rev Infect Dis 1986;8:918-26

28. Isaacs D, Moxton ER. Handbook of neonatal infections. Saunders 1999, 509p.

29. Yeager AS, Hafleigh MT, Arvin AM et al. Prevention of transfusion-acquired cytomegalovirus

infection in newborn infants. J Pediatr 1981; 98: 281-7.

30. Aschengrau A., Seage GR.Essentials of Epidemiology in Public Health. Jones and Barlett

Publishers. 2008 , Sudbury,Massachusetts.

31. Sullender WM, Miller JL, Yasukawa LL, et al. Humoral and cell-mediated immunity in neonates

with herpes simplex virus infection. J Infect Dis 1987; 155: 28-37.

32. Kahlon J, Whitley RJ. Antibody response of the newborn after herpes simplex virus infection. J

Infect Dis 1988; 158: 925-33.

33. Johnson G, Nelson S, Petric M, Tellier R. Comprehensive PCR-based assay for detection and

species identification of human herpesviruses. J Clin Miocrobiol 2000; 38(9): 3274-9.

34. Atkins JT. HSV PCR for CNS infections: pearls and pitfalls. Pediatr Infect Dis 1999; 18: 823-4.

35. VanDevanter DR, Warrener P, Bennett L, et al. Detection and analysis of diverse herpesviral

species by consensus primer PCR. J Clin Microbiol 1996; 34 (7): 1666-71.

36. Pozo F, Tenorio A. Detection and typing of lymphotropic herpesviruses by multiplex

polymerase chain reaction. J Virol Meth 1999; 79: 9-19.

37. Minjolle S, Michelet C, Jusselin I, et al. Amplification of the six major human herpesvirus from

cerebrospinal fluid by a single PCR. J Clin Microbiol 1999; 37: 950-953.

38. Zoll GJ, Melchers MJ, Kopecka H, et al. General primer-mediated polymerase chain reaction for

detection of enteroviruses: application for diagnostic routine and persistent infections. J Clin

Microbiol 1992; 30:160-165.

39. Rotbart HA, Sawyer MH, Fast S, et al. Diagnosis of enteroviral meningitis by using PCR with a

colorimetric microwell detection assay. J Clin Microbiol 1994; 32:2590-2592.

40. Khetsuriani N, LaMonte A, Oberste S, Pallansch M. Neonatal Enterovirus Infections Reported to

the National Enterovirus Surveillance System in the United States, 1983-2003. The Pediatric

Infectious Disease Journal 2006; 25;10 :889-893.

41. Whitley R, Arvin A, Prober C,Burchett S, Corey L, Powell D et al. A controlled trial comparing

vidarabine with acyclovir in neonatal herpes simplex virus infection. Infectious Diseases

Collaborative Antiviral Study Group. N Engl J Med 1991; 324:444–449



42. Kimberlin DW, Lin CY, Jacobs RF, Powell DA, Corey L, Gruber WC et al. Safety and efficacy

of high-dose intravenous acyclovir in the management of neonatal herpes simplex virus

infections. Pediatrics 2001; 108:230–238.

43. Kimberlin D, Powell D,Gruber W, Diaz P, Arvin A,Kumar M et al.Administration of oral

acyclovir suppressive therapy after neonatal herpes simplex virus disease limited to the skin,

eyes and mouth: results of a phase I/II trial. Pediatr Infect Dis J1996;15:247–254.

44. Ketterlinus RD, Henderson SH, Lamb ME. Maternal age, sociodemographics, prenatal health

and behavior: influences on neonatal risk status. J Adolesc Health Care. 1990 Sep;11(5):423-31.

45. Olausson PO, Cnattingius S, Haglund B. Teenage pregnancies and risk of late fetal death and

infant mortality. Br J Obstet Gynaecol. 1999 Feb;106(2):116-21.

46. Brown Z. Preventing Herpes simplex virus transmission to neonate. HERPES.2004; Supplument

3.

47. Sharma V et al. Young Maternal Age and the Risk of Neonatal Mortality in Rural Nepal. Pediatr

Adolesc Med. 2008 September; 162(9): 828–835.

virusebis roli axalsobilebsi sistemuri infeqciis ... · pdf filemiekutvneba sisxlis saerto...

Documents