Clinical Infectious Diseases Hospital Research Articles

THE IMPACT OF VACCINATION STATUS ON THE CLINICAL CHARACTERISTICS OF MEASLES COURSE

Measles is a dangerous and highly contagious viral disease with a tendency to spread rapidly. The incidence of measles is cyclical with outbreaks occurring every 5-6 years and is directly related to the level of vaccination against the disease. Measles can become severe clinical course and have serious, sometimes fatal consequences. The purpose of the study is to compare the clinical course of measles depending on the vaccination status of patients. We analysed medical records of 218 patients aged 18 to 55 years who were inpatients with a diagnosis of measles at the Poltava Regional Clinical Infectious Diseases Hospital. The clinical features of measles were compared based on vaccine status using descriptive statistics methods in accordance with the analysis requirements. Comparison of the clinical course of the disease depending on vaccination status did not reveal a statistically significant difference in clinical symptoms between the groups of vaccinated and unvaccinated individuals. However, in the group of unvaccinated patients, a severe course of measles was significantly more often observed compared to those who were vaccinated (p = 0.003). The incidence of complications was studied and found to be lower in vaccinated individuals than in non-immune patients (p = 0.051), specifically pneumonia (p = 0.006). No cases of complications such as measles encephalitis and enterocolitis were recorded among vaccinated individuals. Thus, the course of the disease was characterised by typical clinical signs with a predominance of intoxication syndrome, the appearance of a typical rash, its stages, the presence of catarrhal and, less often, intestinal syndromes. It was found that vaccinated individuals had significantly less frequent severe measles, and the incidence of complications, including pneumonia, was was significantly lower than in unvaccinated patients.

Flu in children: Clinical, laboratory indicators and cytokine profile parameters

Introduction. Respiratory diseases occupy a leading place in the structure of pathology of childhood. The proportion of influenza and acute respiratory viral infections among all infectious diseases is 90 %. The literature describes gender differences in the immune response to respiratory infections in children, but there is a gap in the description of the cytokine profile in children with influenza depending on gender and age.The aim. To analyze clinical and laboratory parameters as well as cytokine profile parameters in children with influenza.Materials and methods. A single-stage descriptive study was conducted with the participation of 50 children from 1 to 11 years of age with a diagnosis of influenza who were on inpatient treatment at the Irkutsk Regional Infectious Diseases Clinical Hospital from December 2018 to January 2019. The clinical and laboratory features of the course of influenza in children, the duration of treatment were determined. The concentration of cytokines interleukin (IL) 1β, IL-4, IL-6, IL-8, tumor necrosis factor alpha (TNF-α), interferon alpha and gamma (INF-α, INF-γ) in blood plasma was determined by enzyme-linked immunosorbent assay (ELISA) using diagnostic test systems manufactured by Vector-Best (Novosibirsk, Russian Federation) on the analyzer Multiscan EX (Thermo Electron, Germany).The control group consisted of practically healthy children without signs of acute respiratory viral infection (n = 50; mean age 5.3 ± 2.6 years).Results. When comparing clinical and laboratory data and cytokine profile parameters in children with influenza, no gender differences were found. There was a statistically significant increase in the level of pro-inflammatory cytokines IL-1β, IL-6, IL-8, TNF-α, INF-α, as well as CRP, anti-inflammatory cytokine IL-4 in influenza in all age categories, in contrast to the control group (p < 0.05).Conclusion. Influenza in children of different sexes proceeds classically without a statistical difference in clinical and laboratory parameters and in the level of cytokines.

Кандидозный эзофагит у пациентов с COVID-19

The purpose is to examine the incidence and clinical characteristics of сandidiasis esophagitis in COVID-19 patients. Material and methods. We conducted a retrospective observational study by analyzing the medical records of 68 patients with COVID-19 and esophageal candidiasis. All of the patients received in-patient treatment at the Republic Clinical Infectious Diseases Hospital in Kazan from 2020 to 2022. Results. From 2020 to 2022, 1177 fibrogastroduodenoscopies (FGDS) were performed on patients with COVID-19 at the Republic Clinical Infectious Diseases Hospital in Kazan. Esophageal candidiasis was diagnosed in 68 (5.8%) of the examined patients, Mostly often, elderly patients with chronic pathology of the gastrointestinal tract (65%) and diabetes mellitus (29%). Esophageal candidiasis developed in patients with different severity of COVID-19, including mild forms of infection. According to the Kodsi scale, grade I of esophageal damage was diagnosed in 63.3%, grade II in 27.9%, grade III in 4.4%, grade IV in 4.4% of patients. Patients complained of epigastric pain (34.6%), chest pain (7.7%), dysphagia (7.7%), nausea and vomiting (13.4%), heartburn (1.9%), hiccups (1.9%). 41.5% of patients had no “esophageal” complaints. Antimycotic therapy for candidal esophagitis was carried out with fluconazole at a daily dose of 400 mg, then 200 mg for 14 days. 92.5% of patients were discharged with improvement or clinical recovery. Death occurred in 5 (7.5%) patients. The cause of death was COVID-19 complications (ARDS, PE, multiple organ failure syndrome, acute kidney failure, etc.). Conclusion. The development of esophageal candidiasis is possible in patients with any severity of COVID-19. Esophageal candidiasis can be asymptomatic. The severity of fungal infection of the esophagus correlates with the severity of coronavirus infection. Patients with severe forms of COVID-19 may develop grades III and IV of esophageal damage. If esophageal candidiasis is detected in a patient with COVID-19, a mycological test of blood, urine and bronchoalveolar lavage should be performed to identify other localizations of invasive candidiasis.

Этиологическая структура и антибиотикорезистентность возбудителей сепсиса у больных COVID-19

The purpose — to study the etiological structure and antibiotic resistance of sepsis pathogens in patients with COVID-19. Material and methods. A retrospective observational, uncontrolled study was conducted. We analyzed the results of an examination survey of 584 patients with severe and extremely severe forms of COVID-19 hospitalized at the Republic Clinical Infectious Diseases Hospital in Kazan from April 1, 2020 to October 1, 2022. Identification of the pathogen in blood and other biological materials was carried out using a Microflex LT Bruker mass spectrometer. The antibiotic sensitivity of the isolated bacterial strains was determined by the disk diffusion method using an ADAGIO analyzer (France). Results. Various types of bacteria were isolated from the blood of 76 (13%) patients with severe and critical forms of COVID-19, including: A. baumannii (23.7%), K. pneumoniae (19.7%), S. haemolyticus (19.7%), S. aureus (7.9%), E. faecium (11.8%), E. faecalis (7.9%), E. coli (3.9%), R. planticola (2.6%), P. aeruginosa (2.6%), S. pneumoniae (2.6%), S. maltophilia (1.3%), and B. cereus (1.3%). In 15 patients (19.7%) associations of 2–3 types of bacteria were isolated from the blood. A. baumannii isolates were resistant to carbapenems (94.5%), fluoroquinolones and aminoglycosides (100%), and trimethoprim-sulfamethoxazole (83.3%) strains. K. рneumoniae strains were resistant to carbapenems (60%), cephalosporins (cefixime, ceftazidime) (73.3%), fluoroquinolones (ciprofloxacin) (80%), aminoglycosides (60%), and semisynthetic penicillins (100%). 33.3% of S. aureus strains were resistant to trimethoprim-sulfamethoxazole, 16.7% — to oxacillin, erythromycin and gentamicin. Resistance of S. haemolyticus to trimethoprim-sulfamethoxazole was detected in 86.7%, to erythromycin — in 80%, to norfloxacin — in 50% of strains. 93.3% of S. haemolyticus strains were methicillin-resistant. 88.9% of E. faecium strains were resistant to ampicillin, 22.2% to tigecycline, 11.1% to linezolid. 50% of E. faecalis strains were resistant to norfloxacin, 16.7% of strains were resistant to amoxicillin, ampicillin and piperacillin. P. aeruginosa 50% of strains were resistant to levofloxacin. R. planticola was resistant to all antibiotics tested. S. maltophilia demonstrated sensitivity to co-trimoxazole only with increased exposure. Conclusion. Bacterial sepsis was diagnosed in 13% of severe and extremely severe patients with COVID-19. The etiological structure of sepsis includes a wide range of pathogens with a predominance of multi-resistant bacteria from the group of ESKAPE pathogens. Data on the etiological structure and antibiotic resistance of isolated pathogens should be taken into account for the rational use of antimicrobial drugs in the treatment of sepsis in patients with COVID-19.

Эндотелиальная дисфункция у пациентов с коронавирусной инфекцией COVID-19

Endothelial dysfunction is the main cause of thrombotic complications and unfavorable disease outcome in COVID-19. The study of markers of endothelial dysfunction in patients with COVID-19 will help to determine additional directions for the treatment of hemostatic disorders. The purpose — to evaluate the diagnostic significance of endothelial dysfunction markers in moderate and severe forms of COVID-19. Material and methods. The study was carried out in 28 patients with COVID-19 hospitalized at the Republic Clinical Infectious Diseases Hospital (Kazan) from 02.16.2023 to 03.07.2023. The median age of patients was 66.5 years. The control group consisted of 20 healthy people of the same age. Results. It was found that moderate and severe forms of COVID-19 are accompanied by increased values of D-dimer and VWF in the blood, the medians of which were 2.6 and 1.9 times higher than control values, respectively. No significant differences in the values of P-selectin and thrombomodulin were detected in the compared groups. A moderate correlation was established between the level of P-selectin and the absolute number of neutrophils in the blood. It was found that the values of D-dimer and thrombomodulin were significantly higher in patients with COVID-19 who had two or more comorbid diseases. The high likelihood ratios of FFB and D-dimer positivity (LR+ = 8.4) allow considering them as reliable parameters for assessing endothelial dysfunction in patients with COVID-19. Conclusion. Endothelial dysfunction in COVID-19 disease is manifested by increased levels of D-dimer and VWF in the blood. The identified changes indicate the possibility of using medications that neutralize VWF in addition to anticoagulant drugs.

Coronavirus infection and systemic inflammatory reaction syndrome.

Aim: The purpose of this study was a clinical approbation of the Kometad drug (international non-proprietary name sodium colistimethate), an antibiotic from the polymyxin group in patients with severe course of confirmed сoronavirus infection in the intensive care unit of the Branch of the I. Zhekenova Municipal Clinical Infectious Diseases Hospital.. Materials and Methods: The methodology is based on both theoretical and empirical methods of scientific cognition. During the study, the features of the Coronavirus infection and the inflammatory reaction syndrome were considered, which became quite a big problem during the pandemic. Results: The main indications for the tested drug and the consequences of its use for one age group were also determined. Conclusions: The conclusion was made about the positive dynamics of the patients' health status, and recommendations were given for further research in this area. The practical significance of this study lies in the first clinical approbation of the Kometad drug, which can be used in medicine to reduce the severity of the systemic inflammatory reaction syndrome and improve the patient's health as a result of the disease of Coronavirus infection, after further clinical trials of the drug with different age groups of patients.

Investigation of SARS-CoV-2 antibody levels after COVID-19 vaccine in chronic hepatitis Bpatients.

The aim was to compare SARS-CoV-2 IgG antibody levels in chronic hepatitis Bpatients and healthcare personnel selected as the control group and to determine factors such as age, gender, vaccine type, and number of vaccines that may affect the antibody levels. 87 chronic hepatitis B(CHB) patients followed in Ankara Training and Research Hospital Infectious Diseases Clinic and Mamak State Hospital Infectious Diseases outpatient clinic and 89healthcare personnel selected as the control group were included in the study.SARS-CoV-2 IgG antibody levels in the serum samples of patients and healthcare personnel who received the COVID-19 vaccine were studied with the ELISA method in the Microbiology Laboratory of Ankara Training and Research Hospital, using acommercial ELISA kit (Abbott, USA) in line with the recommendations of the manufacturer. In the study, SARS-CoV-2 IgG levels were compared in CHB patients and healthcare personnel. In addition, the relationship between SARS-CoV-2 antibody level, gender, average age, natural history of the disease, number of vaccinations, vaccine type (Coronavac TM vaccine alone, BNT162b2 vaccine alone or Coronavac TM and BNT162b2 vaccine (heterologous vaccination)), treatment duration of CHB was investigated. Statistical analyses were made in the SPSS program. Avalue of p≤ 0.05 was considered statistically significant. Atotal of 167 people, including 87 CKD patients and 80 healthcare personnel as the control group, were included in the study. SARS-CoV-2 IgG antibody levels were detected above the cut-off level in the entire study group, regardless of the vaccine type. No difference was detected in SARS-CoV-2 IgG titers after COVID-19 vaccination between CHB patients and healthcare personnel. There was astatistically significant difference in SARS-CoV-2 IgG antibody levels among individuals participating in the study according to vaccine types. Compared to those who received Coronavac TM vaccine alone, the average SARS-CoV-2 IgG level was found to be statistically significantly higher in those who received BNT162b2 vaccine alone or heterologous vaccination with Coronavac TM + BNT162b2 vaccine. There was no difference between the groups in terms of age, gender, number of vaccinations, natural transmission of the disease, and duration of antiviral therapy in the CHD patient group. As aresult, SARS-CoV-2 IgG antibody levels above the cut-off value were achieved with Coronavac TM and BNT162b2 vaccines in both CHD patients and healthy control groups. however, both CHD patients and healthcare personnel had higher antibody levels than those who received BNT162b2 alone or those who received heterologous vaccination had higher antibody levels than those with Coronavac TM alone. Therefore, if there are no contraindications, BNT162b2 vaccine may be preferred in CHB and health personnel (Tab. 2, Ref. 14).

The nature of lesions of the central nervous system in infections, caused by <i>Varicella Zoster</i> virus

Varicella Zoster virus can cause damage to the nervous system, more often in the form of meningitis and meningoencephalitis.Purpose: to identify the nature of damage to the central nervous system during infections caused by the Varicella Zoster virus. Materials and methods. The article presents the literature data and the results of own observations of 47 patients treated at the Infectious Diseases Clinical Hospital of Yaroslavl in the period from 2015 to 2021. There were 20 children (42.6%) aged from 18 days to 12 years with chickenpox. There were 27 (57.4%) patients with Herpes Zoster, of which 20 (74.1%) were adults aged 24 to 82 years, 7 (25.9%) were children aged 4 to 14 years. Results. The main clinical and laboratory indicators were analyzed, the features of central nervous system lesions caused by the Varicella Zoster virus were revealed, and the medical and social significance of this problem was confirmed. Among the patients, patients with Herpes Zoster predominated — 27 (57.4%). Meningitis (45.0%), meningoencephalitis (30.0%) and encephalitis (25.0%) were recorded in children with chickenpox. In children with Herpes Zoster, meningoencephalitis predominated (71.4%), while in adults - meningitis (65.0%); there were no encephalitis. There were no deaths, 14.9% of patients were transferred to the neurological department, 85.1% were discharged as outpatients.

2020–2021 rhinovirus genetic diversity in Saint Petersburg

Introduction. Rhinoviruses represent one of the most common respiratory viruses and belong to the Picornoviridae family, genus Enterovirus, being divided into three types: A, B, C, which account for 169 types. Rhinoviruses predominate in autumn and spring periods, although they circulate throughout almost entire epidemic season. The rhinovirus genome is represented by a single-stranded 7.2 thousand base-long +RNA. According to the publications, the most common rhinovirus species is rhinovirus A (HRV-A), followed by rhinoviruses C (HRV-C) and finally rhinovirus B (HRV-B). The aim of our study was to define rhinovirus genetic diversity in Saint Petersburg . Materials and methods. The study was conducted at the Laboratory of Molecular Virology, Smorodintsev Research Institute of Influenza. Samples (smears from the nasopharynx and oropharynx) were delivered from the S.P. Botkin Clinical Infectious Diseases Hospital, St. Olga’s Children's City Hospital, N.F. Filatov Children's City Clinical Hospital No. 5. Outpatient samples were used as well. Samples received from December 2020 to October 2021 were analyzed. Detection of rhinoviruses was carried out by real-time PCR, typing — by Sanger sequencing, with primers developed by da Costa Souza L. et al. (2021). Results. According to total specimen testing, rhinoviruses comprise 3.2% total number of specimens tested. Of these, 71 rhinoviruses were typed, representing 17.03% total number of rhinovirus-positive specimens. The most common was HRV-A (55%), among which 21 types were found (the most common HRV-A46 is 13%, n = 5). HRV-B and HRV-C were found in equal numbers — 23% (n = 16) of each species out of total number of typed rhinoviruses. Among HRV-B, 8 types were found; the most common HRV-B06 comprised 33% (n = 5). Among HRV-C, 7 types were found (the most common types are HRV-C42, HRV-C32 and HRV-C15 — 19% each, n = 3). HRV-A was detected mainly in patients aged 18 to 65 years (57.5%, n = 23). HRV-B was detected only in adult patients (100%, n = 16). HRV-C was detected in children under 2 years of age (43.75%, n = 7) and adults aged 18–65 years (31.25%, n = 5). In some cases, HRV-A and HRV-C were associated with various respiratory tract syndromes such as acute nasopharyngitis, laryngotracheitis, obstructive bronchitis, and pneumonia. HRV-B was related to clinical manifestations of pneumonia in seven cases. Conclusion. Rhinovirus type A prevails in Saint Petersburg . Rhinoviruses can be associated with diverse respiratory tract syndromes.

A case of West Nile fever in the Kursk region of Russia

Aim: to analyze the features of the clinical course of a case of West Nile fever (WNF) first detected in the Kursk region. Materials and methods. The article presents the first case of WNF detected in the Kursk region, confirmed by detection of pathogen RNA in the PCR test. Results. Patient Ch., 68 years old, was hospitalized to the intensive care unit of the Regional Clinical Infectious Diseases Hospital with severe intoxication, fever up to 39°C, positive meningeal symptoms of Kernig, Brudzinsky, severe neck stiffness. Upon admission, the analysis of peripheral blood showed leukocytosis up to 13.6×109, lymphopenia up to 5%, ESR acceleration up to 20 mm/h. Biochemical analysis revealed a significant increase in CRP, an increase in transaminase activity. In the cerebrospinal fluid, cytosis was noted up to 71 cells per mm3, an increase in protein up to 872 mg/l, the number of neutrophils up to 60%, lymphocytes - up to 40%, and the loss of a delicate plaque. The results of the study revealed high titers of Ig M and Ig G to the antigens of the virus, as well as the detection of WNF virus RNA in the blood and cerebrospinal fluid by PCR. Taking into account the data of the epidemiological anamnesis, clinical symptoms, positive results of ELISA and PCR of blood and cerebrospinal fluid for the causative agent of WNF, the diagnosis was made: West Nile fever with CNS damage, meningeal form (serous meningitis), severe course. Dyscirculatory encephalopathy of complex (dyscirculatory, dysmetabolic) genesis with scattered microsymptomatics. Conclusion. The described clinical case indicates that the WNF causative agent circulates in the Kursk region, which justifies the need for blood and cerebrospinal fluid testing in all patients with hyperthermia of unknown origin, combined with neurological symptoms for the WNF virus.

Comparative Evaluation of the Clinical Severity of COVID-19 of Vaccinated and Unvaccinated Patients in Southeastern Romania in the First 6 Months of 2022, during the Omicron Wave.

(1) Background: The pandemic wave produced by SARS-CoV-2 Omicron was characterized by milder clinical forms and high contagiousness. The vaccination rate against COVID-19 in Romania was approximately 42%. (2) Objectives: Comparison of the clinical severity in vaccinated patients compared to unvaccinated ones. (3) Methods: A retrospective cohort study was conducted on a group of 699 adult patients confirmed with COVID-19 who presented in the "Sf. Cuvioasa Parascheva" Infectious Diseases Clinical Hospital of Galati, Romania, between 1 January 2022 and 30 June 2022. The study compared the need for hospitalization, reinfections, demographic and comorbidity data, clinical and paraclinical parameters from the initial evaluation, and the ratio of unfavorable developments on subgroups chosen according to the vaccination status. (4) Results and Conclusions: Our study reveals that unvaccinated patients required hospitalization in 54.68% of cases, while fully vaccinated patients had a hospitalization rate of 40.72%, which was significantly lower than that of the unvaccinated group (p = 0.01); patients who received a booster dose had a hospitalization rate of 27.84% (p < 0.01, significantly lower than unvaccinated individuals; p = 0.01, significantly lower than fully vaccinated individuals); and among the four patients who received four doses, none required hospitalization. From the analysis of the two subgroups of hospitalized patients, we observed a significantly higher prevalence of radiological lesions, such as pulmonary opacities in the group of unvaccinated patients and a higher average duration of hospitalization, and serum values of D-dimers and blood-sugar at admission were significantly higher in unvaccinated patients. The higher presence of these parameters, which are indicators of severe progression in clinical studies, in the group of unvaccinated patients suggests the need to include them in the initial evaluation of the unvaccinated patients with COVID-19.The cumulative share of deaths and transfers in the ICU was higher in the group of unvaccinated patients, but the difference between the groups had no statistical significance. This study draws attention to the possibility of severe clinical forms among both vaccinated and unvaccinated populations, especially in the elderly and in patients with multiple comorbidities.

Determinants of manifestations of the epidemic process of epidemic hemorrhagic fever in Primorsky Krai

BACKGROUND: The contribution of random and regular factors in the process of epidemic hemorrhagic fever is unknown, which necessitates the search for the reasons for the formation of severe and fatal cases.&#x0D; AIM: Based on the incidence of epidemic hemorrhagic fever in Primorsky Krai over a long period, we aimed to establish the role of the main determinants of the epidemic process and to demonstrate the causality of local manifestations in epidemic foci in patients with epidemic hemorrhagic fever.&#x0D; MATERIALS AND METHODS: In this comprehensive descriptive epidemiological and clinical study, we undertook the epidemiological analysis of the incidence of epidemic hemorrhagic fever and data from examinations of the foci of infection. We performed a clinical observation (case study) of a case of epidemic hemorrhagic fever with a fatal outcome at the Regional Clinical Infectious Diseases Hospital in March 2022. The object of the study is statistical data on officially registered cases of epidemic hemorrhagic fever in Primorsky Krai from 1995 to 2021.&#x0D; RESULTS: The proportion of random factors in the epidemic process of epidemic hemorrhagic fever in the period under review was 28.7% of the incidence, which formed deviations from the typical curve, but did not participate in the formation of cyclicity in the long-term dynamics. Variable factors that formed cyclicity and random deviations together determined 53.4% of the incidence. They were fully related to seasonal morbidity (67.8%). Moreover, the remaining 14.4% of seasonality was formed by constant factors for each month. Factors constant for all months of the year form a year-round form, that is, 32.2% of the incidence.&#x0D; In the clinical and epidemiological observation of a lethal case of epidemic hemorrhagic fever, infection was noted under conditions of dust formation, such as when restoring order in a closed room at a negative temperature (sweeping) and high titers of specific antibodies resulting from repeated encounters with the pathogen in residential and occupational types of morbidity and the accompanying illnesses.&#x0D; CONCLUSIONS: The study of the incidence of epidemic hemorrhagic fever demonstrated a high resolution of epidemiological analysis by using a binary method in zoonoses. The patterns and features of human morbidity were controlled by natural and social factors more strictly than by biological ones. The determinants of the socio-ecological system in epidemic hemorrhagic fever in Primorsky Krai make it possible to specify the tactics and strategy for the implementation of epidemiological surveillance.

КЛИНИКО-ЛАБОРАТОРНАЯ ХАРАКТЕРИСТИКА ПОРАЖЕНИЙ ПЕЧЕНИ ПРИ COVID-19

Background. Having its multisystemic effect СOVID-19 leads to liver disfunction. Objective. To assess the functional state of the liver in patients with COVID-19 during the periods of circulation of different SARS-CoV 2 strains. Material and methods. The object of the study was 180 patients with COVID-19 who were hospitalized at Grodno Regional Infectious Diseases Clinical Hospital. The patients were divided into two groups: the 1st group (n=51) - those examined during the circulation of the Omicron strain (2022), the 2nd (n=129) – the patients who were treated over 2020-2021 (during the circulation of previous strains). The laboratory analysis included the assessment of biochemical and sonographic parameters. Results. In the first group, dyspeptic syndrome, hyperbilirubinemia and hypoalbuminemia were more often recorded. The patients of the second group had more pronounced manifestations of severe respiratory failure alongside with significantly more pronounced hyperenzymemia according to aspartate aminotransferase (AST) level. Conclusions. Hyperbilirubinemia and hypoalbuminemia, being significantly more common during the circulation of the Omicron strain, may be regarded as a manifestation of acute mixed-etiology reactive hepatitis. The predominance of hyperenzymemia due to AST during the circulation of other strains may be accounted for by the cytopathic effect of the virus and drug-induced liver damage.

Labor in women with the new coronavirus infection (COVID-19) and HIV infection

BACKGROUND:HIV and COVID-19 remain some of global health problems today. Complications of these diseases, pregnancy and labor, as well as the perinatal condition of newborns can make a significant contribution to the deterioration of the demographic situation in this country. Summarizing the foreign and domestic literature, one may assess the impact of each individual pathogen on the condition of the pregnant woman and the fetus. However, we have not found data on the associative or antagonistic form of symbiosis of these pathogens, as well as on the joint effect on the pregnancy, labor and the condition of newborns in the available literature.&#x0D; AIM:The aim of this work was to analyze the outcomes of labor in women with the new coronavirus infection (COVID-19) and HIV infection.&#x0D; MATERIALS AND METHODS:We performed a retrospective analysis of birth histories of 63 women who were delivered in S.P. Botkin Clinical Infectious Diseases Hospital (Saint Petersburg, Russia) in the period from April 2020 to March 2022. Of these, 26 birth histories are of women with a combination of HIV infection and COVID-19, and 37 birth histories of women with HIV infection alone. We assessed the severity of COVID-19 in pregnant women with HIV infection, the course of labor, complications during childbirth and the condition of newborns.&#x0D; RESULTS:The groups did not differ in the duration of labor, the frequency of labor abnormalities, the volume of blood loss during delivery, the frequency of postpartum complications and the condition of newborns after one and five minutes on the Apgar scale. The duration of the anhydrous interval was significantly longer in women with HIV infection who did not suffer from COVID-19. The frequency of cesarean section was significantly higher in pregnant women with HIV infection and COVID-19. According to pathological examination, inflammatory changes in the placenta and signs characteristic of viral infection occurred more often in the group of women with HIV infection and COVID-19.&#x0D; CONCLUSIONS:The presence of COVID-19 affects the course of labor in patients with HIV infection. However, the frequency of caesarean section in the group of patients with HIV infection and COVID-19 was significantly higher due to obstetric reasons, and was not related to the severity of the mothers condition and the prenatal state of the fetus due to the infectious process. Inflammatory changes in the placenta and signs of a viral infection are more common in patients with COVID-19 and HIV infection. These data suggest that the combined course of these diseases may have a greater negative impact on the fetus than in women with HIV infection who do not suffer from COVID-19.

ЭТИОЛОГИЧЕСКАЯ СТРУКТУРА САЛЬМОНЕЛЛЕЗА И ЧУВСТВИТЕЛЬНОСТЬ МИКРООРГАНИЗМОВ К АНТИБАКТЕРИАЛЬНЫМ ПРЕПАРАТАМ

Salmonellosis is one of the most common acute intestinal diseases, often occurring in the form of group outbreaks with food transmission factor. Among infections of bacterial etiology, it has the highest incidence rates. Infection is registered in all countries and is an pressing medical problem, including the Russian Federation. Also, the public health problem is the resistance of the pathogen to antimicrobial drugs, there is a constant need to determine sensitivity for the correction of therapy. The purpose of our study was to determine the etiological structure of salmonellosis and sensitivity of individual salmonella isolates to antibacterial drugs in the Republic of Mordovia in various years of observation. The material of this study was the case histories of 500 patients hospitalized in Republican Infectious Diseases Clinical Hospital. For this purpose, a retrospective analysis of medical records was carried out. We have identified that in the territory of the Republic of Mordovia, the incidence of salmonellosis for many years exceeded the average incidence in Russia. At the same time, its decline was noted during the pandemic of the new coronavirus infection (as well as in Russia as a whole). The article reflects the results of the analysis of the etiological structure, provides data on the dynamic monitoring of the sensitivity of salmonella to antibacterial drugs in the republic. We noted that the appearance of new serological variants of the pathogen is often recorded. At the same time, S. Enteritidis remains predominant. Enteritidis, Munchen, Newport, and Glostrup were highly sensitive to fluoroquinolones, betalactams, cephalosporins, carbapenems, and monobactams. However, there is a growing trend in the resistance of salmonella to antibacterial drugs, sometimes simultaneously to five and six. Low sensitivity was revealed to ampicillin, gentamicin, tetracycline (more often in S. Enteritidis and S. Glostrup). The information obtained can be used to assess the epidemiological situation, to monitor antimicrobial resistance within the framework of epidemiological surveillance, to optimize antibacterial therapy, as well as in the educational process and clinical practice.

Genetic polymorphism of some genes of toll-like receptors in patients with influenza A (H3N2)

Background.Among all infectious diseases that occur in the human population, only acute respiratory viral infections, including influenza, lead to massive outbreaks, often taking on the character of epidemics and pandemics. Polymorphism of cytokine genes can be both a factor of predisposition and resistance to infection, the development of the disease, and a long, complicated course of influenza.&#x0D; Aim.Study of the genetic polymorphism of the genes of toll-like receptorsrs5743708 (Arg753Gln, G2258A),TLR3 rs3775291 (Phe412Leu, C1234T),TLR4 rs4986790 (Asp299Gly, A896G),TLR4 rs4986791 (Thr399Ile, C1196T)in healthy individuals and in patients with influenzaA(H3N2).&#x0D; Material and methods.The study, using the continuous sampling method, included patients with influenzaA (H3N2; 89people) who were treated at the Regional Clinical Infectious Diseases Hospital in Chita during the epidemic seasons of 20162017 and 20172018. The control group consisted of 96practically healthy donors. To analyze the polymorphism of theTLR2 rs5743708 (Arg753Gln, G2258A), TLR3 rs3775291 (Phe412Leu, C1234T), TLR4 rs4986790 (Asp299Gly, A896G),andTLR4 rs4986791 (Thr399Ile, C1196T)genes the method of polymerase chain reaction with electrophoretic detection using standard kits from Scientific and Production Company Litekh (Moscow) was applied.Statistical analysis was carried out in accordance with the principles of the International Committee of Medical Journal Editors and the Statistical Analysis and Methods in the Published Literature recommendations. Pearson's 2test was used for comparative evaluation of qualitative nominal data.&#x0D; Results.Patients with influenzaA (H3N2) more often had heterozygousTLR2 753Arg/Glnvariants [2=8.26, p=0.02; odds ratio (OR) 3.00; 95% confidence interval (CI) 1.336.73], homozygousTLR3 412Leu/Leuvariants (2=11.68, p=0.003; OR=2.39; 95% CI 1.043.61), heterozygous variants ofTLR4 299Asp/Gly(2=6.97; p=0.03; OR=2.15; 95% CI 1.024.70) and399Thr/Ile(2=8.39; p= 0.01; OR=2.30; 95% CI 1.064.88) compared with a group of healthy donors.&#x0D; Conclusion.The genotypes753Arg/Glnof theTLR2gene,412Leu/Leuof theTLR3gene,299Asp/Glyof theTLR4gene,Thr399Ileof theTLR4gene predispose to the development of influenzaA (H3N2); carriage of genotypes753Arg/Argof theTLR2gene,412Phe/Pheof theTLR3gene,299Asp/Aspof theTLR4gene,399Thr/Throf theTLR4gene reduces the likelihood of the influenzaA(H3N2) development.

Combination of new coronavirus infection and HIV infection

Objective. Evaluation of different options for the formulation of a pathoanatomical diagnosis in the combined course of HIV infection and a new coronavirus infection COVID19Materials and methods. The study included the protocols of clinical autopsies performed at the S. P. Botkin Clinical Infectious Diseases Hospital from March 2020 to September 2021, with the simultaneous diagnosis of HIV infection and the new coronavirus infection COVID19.Results and discussion. Among the secondary diseases in HIV infection in combination with a new coronavirus infection, no significant difference was found in comparison with HIV monoinfection. On the part of the new coronavirus infection, no relationship was found between the course of the infection and the manifestations of secondary diseases in HIV infection. In cases with a protracted new coronavirus infection against the background of a mild HIV infection, the dominant disease in thanatogenesis is COVID-19. In the presence of severe secondary diseases of HIV infection, it acts as the main infection. In cases of the presence of other competing diseases in PAD, they play a leading role in thanatogenesis, or have a significant impact on the course of the disease.Conclusion. Based on the analysis of autopsy protocols with the simultaneous diagnosis of HIV infection and the new coronavirus infection COVID19, various options for the formulation of pathoanatomical diagnosis and encryption of observations are justified

Bacterium with Leuconostoc pseudomesenteroides

Introduction. Leukonostoc pseudomesenteroides, widespread in nature (soil, plants, milk, etc.), until recently was classified as a commensal microorganism, but from 1985 until now several sporadic cases of infection with this pathogen have been described in humans. Bacteremia with Leuconostoc spp. are increasingly reported. Unique cases of infection of other sites have also been described: in soft, lung, urinary, Central Nervous System tissues, etc. Most often, these cases have been reported in patients with cancer, and are often considered opportunistic for acquired immunodeficiencies. However, several cases have also been reported in immunocompetent patients, including in those previously treated with vancomycin, Leuconostoc spp. having a natural resistance to this antibiotic. &#x0D; Material and methods. An analysis of the literature and the clinical case are presented here: the child of an 11-month-old with congenital malformation - rabbit lip, who underwent maxillofacial operation twice and had pneumonia 2 months before his admission to the Toma Ciorba Infectious Diseases Clinical Hospital. &#x0D; Results. Meningococcemia and meningitis were clinically established upon admission. The blood culture result was received a few days later, and Leuconostoc pseudomesenteroides was identified. The etiological treatment was corrected, after which the sterile result of the blood culture was obtained. The child was released in a satisfactory condition. &#x0D; Conclusions: The clinical case presented is the first case of infection with Leuconstoc spp. described in the Republic of Moldova. The correct choice of the etiological treatment allows the eradication of this pathogen, with a satisfactory clinical result.

Клинико-эпидемиологическая и лабораторная характеристика пищевой вспышки сальмонеллеза

Among bacterial intestinal infections, salmonellosis occupies one of the leading places. The purpose to study the clinical, epidemiological and laboratory features of a food outbreak of salmonellosis. Material and methods. A retrospective analysis of 29 medical records of patients from a food outbreak of salmonellosis hospitalized in the Republican Clinical Infectious Diseases Hospital of Kazan in September 2021. Results. The likely transmission factors for Salmonellosis were poached egg and/or lightly salted salmon. Young females predominated (83%) among patients. The disease proceeded according to the gastroenteric variant (69%) of moderate severity (96.6%) with a favorable outcome (100%). The incidence of colitis syndrome was 31%. Among the biochemical parameters, high levels of CRP (161.97 (108.54) mg/l) attracted attention, reaching values characteristic of a severe bacterial infection. In bacteriological examination of faeces and/or vomit, Salmonella enteritidis was isolated from all patients. The isolated strains of S. enteritidis were sensitive to ampicillin, cefepime, ceftriaxone, chloramphenicol, salmonella bacteriophage, 80% of the isolates were resistant to pefloxacin and 40% to co-trimoxazole. Conclusions. A persistent increase in CRP can be used at the initial stage of differential diagnosis of etiologically different types of diarrheas to decide on the tactics of treating patients with infectious diarrhea. In order to maximize the effectiveness of antimicrobial treatment of salmonellosis, it is necessary to focus on regional antibiotic susceptibility profiles.

Значение исследования напряжения кислорода в моче в характеристике острого повреждения почек у больных коронавирусной инфекцией COVID-19

Objective. To evaluate the diagnostic capabilities of the method of studying the voltage (partial pressure) of oxygen (pO2) in urine to characterize the state of the kidneys in COVID-19 infection. Patients and methods. The study is based on the results of continuous prospective (cohort) study organized in 2020-21 on the basis of the Republican Clinical Infectious Diseases Hospital in Izhevsk. The included patients were divided into 3 groups: I – 14 patients with signs of acute kidney injury (AKI), which resolved within the next 7 days (group of patients with AKI), II – 12 people whom AKI was not stopped within 7 days (group of patients with acute kidney disease (AKD)), III – 17 patients of the comparison group (patients without clinical and laboratory signs of AKI). Clinical and laboratory examination of patients, including the study of pO2 in urine, was carried out for 7 days daily. Results. With the development of AKI in COVID-19, a significant (p &lt; 0.001) decrease in pO2 in urine to 47.1 mmHg is observed. Increasing of pO2 in urine by 20% of the minimum value with 95% probability (p &lt; 0.05) may be the predictor of subsequent decreasing in urea and creatinine levels within 72 hours and with the probability of 72% (p &lt; 0.05) – a predictor of AKI resolution. Conclusion. The revealed correlations between the indicators of pO2 in urine with the parameters of the functional state of the kidneys indicate the possibility of their using in the diagnosis, assessment of the severity and dynamics of the condition of patients with AKI during COVID-19. Key words: COVID-19, oxygen tension in urine, acute kidney injury