The role and structure of infectious pathogens in the development of chronic somatic pathology in children observed by specialist doctors in outpatient clinics

Infectious diseases often disguise themselves as somatic pathologies, leading to delayed diagnosis and treatment.

Objective: To identify the frequency of infectious etiologies in the structure of chronic somatic diseases in children undergoing long-term follow-up by specialists in outpatient clinics.

Materials and Methods: Retrospective analysis of medical records (form 112/u), examination, and laboratory testing (as indicated) of 166 children aged 3-17 years referred to an infectious disease specialist in 2022-2024 by specialists after prolonged, ineffective treatment (3 to 8 months).

Results: ENT physicians referred 86 patients with lymphoid organ hyperplasia scheduled for adenectomy. During examination, 23 patients (26.7%) were diagnosed with EBVrelated infectious mononucleosis. Treatment was prescribed, resulting in adenoid regression in 19 cases (i.e., 82.6% of those treated), preventing the need for surgery.

Gastroenterologists referred 36 patients complaining of abdominal pain. After examination by an infectious disease specialist, infectious pathology was diagnosed in 15 children (41.7%): 5 (13.9%) with giardiasis, 7 (19.4%) with salmonellosis, and 3 (8.3%) with pseudotuberculosis. All patients experienced normalization after specific therapy.

Allergists referred 23 patients due to recurrent rashes and elevated blood eosinophil levels above 20%. Six patients (26.1%) were suspected of having toxocariasis and received treatment, which improved their condition.

Pulmonologists referred 21 patients for consultation; mycoplasma bronchitis was diagnosed in four patients (19.0%). The children received etiotropic therapy, which showed positive results.

Conclusion: In 28.9% of children observed and receiving long-term treatment by specialists, infectious and parasitic agents were the cause of their pathology (1.6 times more often for gastrointestinal symptoms than for other symptoms). A lack of timely diagnosis leads to inadequate long-term treatment. These data indicate that specialists have insufficient knowledge of infectious pathology and its manifestations in children.

1. Dreval` A.V., Nechaeva O.A., Dreval` O.A., Gabrie`lyan A.R. RMZh. 2024 g. – №2. S. 20-24 (in Russian).

2. Newman-Toker D.E., Schaffer A.C., Winnie Yu-Moe C., Nassery N., Saber Tehran A.S., Clemens G.D., Wang Zh., Zhu Y., Fanai M., Siegal D. Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers. Diagnosis 2019; 6(3): 227–240.

3. Berner E.S. & Graber, M.L. Overconfidence as a cause of diagnostic error in medicine // Am.J.Med. Vol. 121(5 Suppl). P. 2–23.

4. Shojania K. G., Burton E. C., McDonald K. M. & Goldman L. (2003). Changes in rates of autopsy-detected diagnostic errors over time: a systematic review. JAMA, 2003. Jun. 4, 289(21), 2849–2856.

5. Nii-Trebi Т.I. Emerging and Neglected Infectious Diseases: Insights, Advances, and Challenges. BioMed Research International. 2017:2017:5425021.

6. Klinicheskie rekomendacii. Gipertrofiya adenoidov. Gipertrofiya nebny`x mindalin. Nacional`naya medicinskaya associaciya otorinolaringologov. 2024 g. S. 44. (https://cr.minzdrav.gov.ru/view-cr/662_2, data obrashheniya 15.01.2026 g.) (in Russian).

7. Klinicheskie rekomendacii (protokol lecheniya) okazaniya medicinskoj pomoshhi detyam, bol`ny`m infekcionny`m mononukleozom. 2013 g. S. 70. http://niidi.ru/dotAsset/a6816d03-b0d9-4d37-9b09-540f48e3ed43.pdf6 (in Russian).

8. Klinicheskie rekomendacii. Lyamblioz u detej i vzrosly`x. Nacional`naya associaciya specialistov po infekcionny`m boleznyam imeni akademika V.I. Pokrovskogo. 2024 g. S. 50 (https://cr.minzdrav.gov.ru/view-cr/893_1, data obrashheniya 15.01.2026 g.) (in Russian).

9. Klinicheskie rekomendacii. Sal`monellez u detej. Razrabotchiki: Mezhdunarodnaya obshhestvennaya organizaciya «Evro-Aziatskoe obshhestvo po infekcionny`m boleznyam», Mezhregional`naya obshhestvennaya organizaciya «Associaciya vrachej-infekcionistov Sankt-Peterburga i Leningradskoj oblasti». 2024 g. S. 47. https://cr.minzdrav.gov.ru/previewu3-cr/703_2, data obrashheniya 15.01.2026 g.) (in Russian).

10. Chernova T.M. Medicinskij sovet. 2015 g. №14. S. 7376 (in Russian).

11. Brambilla I., Pusateri A., Pagella F. at all. Adenoids in Children: Advances in Immunology, Diagnosis, and Surgery. Clinical Anatomy 27:346–352 (2014).

12. Kryukova D.A., Beloshangin A.S. Vestnik soveta molody`x ucheny`x i specialistov Chelyabinskoj oblasti. 2017 g. №2 (17). T. 2. S. 117-125 (in Russian).

13. Medvedeva E.A., Xavkin A.I. RMZh. Mat` i ditya. 2023; 6(2):175-183 (in Russian).

14. Chernova T.M., Ivanov D.O., Veduta O.I., Timchenko V.N., Barakina E.V., Pavlova E.B., Bazunova I.Yu., Zherebczova A.A. Detskie infekcii. 2024; 23(1):29-34 (in Russian).

15. Farrell P., Farrell L., Farrell M.K. The Approach to the Management of a Child with Chronic Abdominal Pain. Current Treatment Options in Pediatrics (2024) 10:64–78.

16. Romanovskix A.G., Belocerkovskaya Yu.G., Smirnov I.P., Klyachkina I.L. Farmateka. 2024 g. №1. S. 113-119 (in Russian).

17. Geppe N.A., Snegoczkaya M.N., Penkina M.V. Farmateka. 2014 g. №1 (274) (in Russian).

18. Gilmullina F.S. Prakticheskaya medicina. 2019. Tom 17, № 8, S. 58-61 (in Russian).

19. Marchant J.M., Newcombe P.A., Juniper E.F., Sheffield J.K., Stathis S.L., Chang A.B. What is the burden of chronic cough for families? Chest. 2008;134:303-309.

20. Cetinkaya P.G., Soyak Aytekin E., Esenboga S., Cagdas D., Sahiner U.M. at all. Eosinophilia in children: characteristics, etiology and diagnostic algorithm. European Journal of Pediatrics. ,T. 182, №6, p. 2833-2842.

21. Jesenak M., Diamant Z., Simon D., Tufvesson E., Seys S.F. at all. Eosinophils– from cradle to grave. Allergy. 2023; 78:3077–3102.