Etiological Structure Research Articles

ACINETOBACTER BAUMANNII: РАСПРОСТРАНЕННОСТЬ, СПЕКТР И ДИНАМИКА АНТИБИОТИКОРЕЗИСТЕНТНОСТИ, ЧУВСТВИТЕЛЬНОСТЬ К КОМБИНАЦИЯМ АНТИБИОТИКОВ

Objective. To study the spectrum and dynamics of antimicrobial resistance to Acinetobacter baumannii, to assess the resistance mechanisms to carbapenems and antibiotic combinations susceptibility. Material and Methods. The antibiotic susceptibility of 305 A.baumannii clinical isolates was determined by an automated method. Carbapenemase genes detection was performed by real-time PCR method. Multiple combination bactericidal testing method is used for determination of antibiotic combinations susceptibility. Conclusions. The proportion of A.baumannii in the etiological structure of infectious pathology is increased. An increase in antimicrobial resistance was noted. The presence of OXA-40 carbapenemase genes was detected. No isolates resistant to colistin were found. Meropenem-colistin, amikacin-colistin and levofloxacin-colistin combinations were bactericidal for 100% of the isolates.

ETIOLOGICAL STRUCTURE OF NONGLAUCOMATOUS OPTIC NEUROPATHIES

Purpose: to study the etiological structure and incidence rate of various genesis optical neuropathies (ON) according to the own observation data. Material and methods. The study is based on the data analysis from a survey of 658 patients (982 eyes) with ON. The results of routine physical examination of all patients were analyzed to determine the genesis of ON. Results. The most common cases of ON were ischemic ON (31.2 % of all cases), as well as optic neuritis (18.3 % of cases). The anterior optic pathway tumor or infiltrative lesions were detected in 9.9 %, dysthyroid ON was found in 7.2 %. Acute and chronic ON with the optic nerve drusen accounted for 12.4 % of all cases of ON, was found in 60.5 % of all patients with the optic nerve drusen. Hereditary ON was found in 10 % of all cases of ON, toxic - in 4,3 % as a result of acute and chronic alcohol intoxication, chronic narcotic poisoning, drug poisoning. Traumatic ON was found in 6.7 % of all cases of ON. Conclusions. The causes of ON are diverse, vary from innate changes to diseases of the optic nerve as a result of serious therapeutic and neurosurgical pathology, which threaten not only the ophthalmologic, but also the life prediction. The patient thorough clinical study is required to determine the disease genesis at the time of ON symptoms identifying.

Etiological structure of intrauterine infections in pregnant and newborns with a complicated course of the early neonatal period

Aim of research – the study of the etiological structure of intrauterine infection in pregnant and estimation of their influence on the early neonatal period.Materials and methods. The material for the study was venous blood of pregnant, umbilical blood, breast maternal milk, mother’s saliva, newborn’s saliva of 114 pairs “mother-newborn”, divided in two groups – control one of physiological course of pregnancy, childbirth and early neonatal period and the main one with clinical symptoms of IUI. The diagnosis was proved by laboratory serological examinations for determining concentrations of IgM to Mycoplasma hominis, Chlamydia trahomatis, Ureaplasma urealyticum, to the herpes simplex virus and concentration and avidity index of specific IgG to HSV, to the virus of 6 type herpes, to the cytomegalovirus. The cytoscopic method was used together with serological ones to diagnose the cytomegaloviral infection.Research results. The increased concentration of IgM antibodies to M. hominis was revealed in the biological material (venous and umbilical blood) of pairs “woman-newborn) with the complicated course of the neonatal period in 9,1 % of examined persons, in 45,4 % of pairs – IgM to U. urealyticum, and in 81,8 % -to Ch. Trahomatis. IgM to the virus of herpes simplex virus (HVS) were revealed in 19,35 % of samples of venous blood, in 9,67 % of saliva samples and in 6,45 % of samples of breast milk of women; and IgM concentrations to HVS were (0,342±0,06) IU/ml, (0,117±0,04) IU/ml) and (0,438±0,001) IU/ml, respectively. Most samples of the biomaterial included low-avid IgG antibodies to the herpes simplex virus, 76 % of samples of women’s venous blood, 64 % of samples of breast milk and 38,7 % contained low-avid IgG to 6 type herpes virus. The cytomegaloviral infection in this group was diagnosed in 24 % of women and 32 % of newborns. The associated bacterial and viral infection were revealed in 65 % of examined pairs “mother-newborn” with the complicated course of the neonatal period, the triple infection with chlamydias, herpes simplex virus and cytomegalovirus was noted in 14 %; the association of herpes simplex virus, cytomegalovirus and ureaplasma was detected in 5 %. The double chamydia and herpes viral infection of 6 type were observed in 15 % of examined persons, at that these infections were added with ureoplasma in 7 %, with mycoplasma – in 5 %. The mix-infection of urogenital agents – chlamydias and ureaplasma was associated with the cytomegalovirus in 4 % of cases.Conclusions1. As a result of the realized study, the diagnosis was confirmed in all newborns with a suspected intrauterine infection.2. Mix-infections – Chlamydia, associated with viruses of the herpetic group occupy the leading place in the etiological structure of IUI agents, and the neonatal period is most complicated in children with double or triple infection.3. The leading clinical symptoms in children with IUI are the intrauterine development delay, intrauterine pneumonia, conjugated icterus, conjunctivitis

Regional monitoring of the urinary tract infections etiological spectrum pathogens in the child population in Chernivtsi region: dynamic changes, age, gender, administrative and territorial characteristics

Microbiological monitoring of the uropathogens is an effective «tool» for urinary tract infectious and inflammatory diseases treatment quality improvement. The aim of the article is to determine the range of the urinary tract infectious-inflammatory diseases etiological spectrum groups of pathogens in the child population in Chernivtsi region. Materials and methods. The etiologic spectrum of uropathogens identified in the urine samples of 657 patients who were provided with a specialized medical care in the Nephrology Department of the «Municipal Children’s Clinical Hospital», Chernivtsi (2014–2015) was analyzed in order to dynamically control the possible changes of the «urinary tract infections» (UTI) regional etiological structure and antibiotic resistance of pathogens; identification of age and gender differences of urine microbial diversity in the child population in Chernivtsi region (2014–2015) compared with the monitoring data for the 2009–2013 period. Results. A significant difference has been found in the etiological structure of the urine microbial diversity in children with infectious and inflammatory diseases of the urinary tract (Gram-positive cocci – p < 0.05; Enterobacteria – p < 0.01; resident microflora – p < 0.01) in comparison with uropathogens extracted in children with urinary tract noninfectious diseases. Administrative and territorial differences have been registered in etiological structure of the urine microbial diversity in children living in the urban areas (p < 0.01) from their peers living in the rural areas. Conclusions. The regional monitoring data showed changes of the urine resident microflora (p < 0.01) without significant changes of etiological spectrum of the UTI pathogens in examined children (0–18 years old) with urinary tract infectious and inflammatory diseases during 2009–2015 in Chernivtsi region. At the same time it as a matter of concern a significant increase in the proportion of «negative results» (no growth) in the urine bacteriological analysis (p < 0.01), which might indirectly indicate the «uncontrolled» use of antibiotics among children in the region.

The etiological structure, biological properties of causative agents of peri-implant mucositis

The purpose was to examine the peri-implant mucositis microflora and sensitivity of dominant pathogens to antibiotics and antiseptics. Materials and methods. The study involved 43 patients with peri-implant mucositis. During the study 162 clinical strains of microorganisms were isolated and identified. Cultivation of clinical isolates was performed by the standard method, final identification was carried out with using bacteriological automatic analyzer Vitec – 2compact bioMerieux (France). Determination of sensitivity to antibiotics of pathogens was carried with disc-diffusion method; the study of sensitivity to antiseptics was carried by means of double serial dilutions method by the standard procedure approved by the Order № 167 of the Ministry of Public Health of Ukraine on “On Approval of Training Guidance “Assessment of the sensitivity of microorganisms to antibiotics”, dated by April, 5, 2007. Results. It is The microflora of peri-implant area of patients with mucositis was revealed to consist of opportunistic species. Representatives of Streptococcus spp . and Staphylococcus spp . were dominating among them, although Kocuria spp., Enterobacter spp. and yeast-like fungi Candida spp. were detected quite common. Investigated clinical strains of microorganisms had different sensitivity to antibiotics. All cultures were sensitive to fluoroquinolones, but very significant number of them showed resistance to penicillins, macrolides and lincosamides. In turn, horosten, dekasan and chlorhexidine had powerful antimicrobial effect on dominant pathogens of periimplant mucositis in patients. Moreover, the effect of decametoxine-based antiseptics on some of them significantly exceeded the activity of chlorhexidine. Conclusions. Microflora from peri-implant area of patients with peri-implant mucositis consists mainly of aerobic and facultative anaerobic microorganisms, belonging to normal oral microflora. Most of pathogens of mucositis obtaine resistance to antibiotics (penicillins, macrolides, lincosamides). Modern antiseptics horosten, decasan and chlorhexidine provide a strong antimicrobial activity against etiological pathogens of mucositis, that makes them promising for use in dental implantology.

Classical Fever of Unknown Origin: Retrospective Study in Infectious Clinical Hospital №2

BackgroundDespite the recent advances in medicine, fever of unknown origin (FUO) remains a diagnostic and therapeutic challenge even to expert physicians. The etiological structure of FUO is determined by many factors, including the one where a person lived and where has been hospitalized. The aim of this study is to investigate the etiology and clinical characteristics of adult classical FUO with more diagnostics available and to analyze the factors for certain disease categories.MethodsThe clinical data were retrospectively analyzed from 80 patients with cFUO hospitalized at the Infectious Clinical Hospital №2 between October 2015 and October 2016 the patients who met the D.Durack criteria (1) An axillary temperature of >38.0 which corresponds oral temperature of >38.3; (2) illness duration is more than 3 weeks; (3) there is no definite diagnosis after three outpatient visits or 3 days in the hospital with intensive investigations; (4) the fever is not related to FUO of other groups: nosocomial FUO, FUO in patients with AIDS, neutropenia were included.ResultsOf the 80 FUO cases, 70 were positively diagnosed with a diagnosis rate of 87,5%. Infectious diseases were still the primary causes of FUO 63% (n = 50). Among them the most frequent diagnoses were bacterial infection of unspecified site 12.5% (n = 10), infective endocarditis 11% (n = 9), as well as pneumonia 7.5% (n = 6) and viral infections of unspecified site 7.5% (n=6). Connective tissue diseases and other noninfectious inflammatory diseases accounted for 17.5% of the FUO cases among which SLE and autoimmune thyroiditis were the most common etiologies and made up 5% (n = 4) and 3,75% (n = 3), respectively. Neoplasms were 8% (n = 6) in our sample. Also ten patients (12,5%) could not be confirmed until they were discharged from hospital.ConclusionInfectious diseases are the major causes of FUO, and the most common cause is bacterial infection of unspecified site. To determine the etiology was difficult due to the limited conditions of the clinical hospital. Infectious endocarditis was found on the second place. The most common causative agents of infective endocarditis were MRSA (3/9) и streptococcus viridans (4/9). The frequency of undiagnosed cases was increasing, but in most FUO cases the causes can be diagnosed eventually after careful analysis of clinical data.Disclosures All authors: No reported disclosures.

Clinical and Etiological Structure of Nosocomial Infections in Bulgaria for the Period 2011-2016

Abstract Despite their partial diagnosis and registration, nosocomial infections are widespread in Bulgaria and they are of great healthcare, social and economic importance for the society. Statistical processing of official information for the period 2011-2016 shows that the incidence of registered NI among hospitalized patients in Bulgaria is below 1%. In the clinical structure of NI in the above mentioned period, the infections of the surgical site are leading with a prevailing share of 20.67%. S. aureus (19.74%) and E. coli (19.33%) have the highest incidence in the etiological deciphering of infections of the surgical site. Leading etiological agents of lower respiratory tract infections (including pneumonia) in Bulgaria are Acinetobacter spp. (24.12%) and Pseudomonas spp. (20.18%). Urinary tract infections have a relative share of 15.08% in the clinical structure of NI. They are primarily caused by E. coli (28.95%). In bloodstream infection, coagulase-negative staphylococci (S. epidermidis prevailing) are isolated in 30.58% of the cases.

Genetic Factors Explain the Association Between Pain Catastrophizing and Chronic Widespread Pain.

Results suggest a shared genetic etiological structure between CWP and PC with no shared influence of environmental factors. Clinicians should be aware of this biological link within the context of clinical management of pain and pain coping.

The state of natural leptospirosis cells activity and functioning in the dry steppe zone of the Northwest Black Sea region

The territory of arid steppe terrain in climate and landscape social conditions largely determines the capacity and activity of local cells of leptospirosis.The features of enzootic functioning of cells in different landscape areas have the key meaning in the epidemic estimation of the territory that requires detailed knowledge of ecological, landscape and biocenotical geographical specificity of circulation circles of pathogen leptospirosis. On the basis of serological control of rodents and reporting data of laboratories SES about the results of analytical studies was made the analysis of eco-social nature of epizootic manifestations of natural infection in the region and established that a key role belongs to economic and socio-economic factors, the effect of which covers the entire research area and changes spatial, structure and etiological structure of natural cells of leptospirosis

ЗМІНИ ЕТІОЛОГІЧНОЇ СТРУКТУРИ ГНІЙНО-ЗАПАЛЬНИХ ЗАХВОРЮВАНЬ ЛОР-ОРГАНІВ ЗА П’ЯТЬ РОКІВ

Було обстежено 236 хворих на інфекційні захворювання ЛОР-органів у 2010 р. і 347 хворих у 2015. Мікробіологічне дослідження складалося з виділення збудників, ідентифікації їх за морфологічними, культуральними і біохімічними властивостями.У ході дослідження виявлено, що у період з 2010 до 2015 рр. спостерігалася чітка тенденція зростання питомої частки Candida spp. в етіологічній структурі інфекційних захворювань ЛОР-органів. Незмінною залишалася значуща роль S. aureus і S. epidermidis та стрептококів групи viridans, а зменшення їх відносної частки було обумовлене розширенням спектру збудників за рахунок інших опортуністичних мікроорганізмів (ентерококів, ентеробактеру, протея, коринебактерій, кишкової та синьогнійної паличок). S. aureus був представлений значною мірою у всіх ЛОР-органах, стрептококи групи viridans переважали у носоглотці, а S. epidermidis частіше за всіх виділяли з носа. Захворювання були обумовлені у більшості випадків грибково-бактерійними асоціаціями. Частка грибів роду Candida становила 22,9 %, причому 85,8 % штамів, виділених із слизової оболонки зіва (далі – із зіва), і 81,8 % штамів, виділених із зовнішнього вуха, були представлені в асоціаціях із бактеріями.Отримані дані свідчать про необхідність визначення етіологічно значимої флори, яка спричинює захворювання ЛОР-органів і органів дихання, її моніторингу як на рівні конкретного хворого, так і на регіональному і на рівні країни.

Taxonomic composition of microbiota of colon in breastfed infants with acute colienteritis

Introduction: In recent years, paradoxical situation has been created, that testifies adverse evolution of modern acute intestinal infections, especially in infants and vital prognosis for patients by measure of deep study of this disease in patients, which number is significant and continues to grow, and the prognosis is getting worse. Aim: To define the etiology of colienteritis in infants (1–6 months old), the taxonomic composition of pathogenic and conditionally pathogenic microorganisms. Materials and methods: Content of colon of 48 children (one to six months old) with colienteritis underwent bacterial and mycological examination (control group – 35 samples of colon content of practically healthy infants). Results: Etiological structure was determined in 28 (58,33 %) of investigations. Consistency index, frequency of occurrence, Margalef species richness, Whittaker species diversity, Simpson and Berger–Parker species dominance indices of bacteria of genera Bifidobacterium, Lactobacillus, Bacteroides and Escherichia did not differ in patients and healthy children. These indices grow in Peptostreptococci : constancy index – by 78,26 %, frequency of occurrence – by 60,00 %, Margalef species richness index – by 2 times, Whittaker species diversity index – by 97,32 %, Simpson species dominance index – by 3 times and Berger - Parker index – by 65,31 %. These indices also grew in conditionally pathogenic Enterobacteria ( Proteus ) by 82,24 %, by 2 times, by 2,03 times, by 68,18 % respectively. Study of taxonomic composition of colon microbiota in children with acute colienteritis showed widespread contamination of biotope (cavity) by pathogenic ( E. coli Hly + , enteropathogenic E. coli ) and conditionally pathogenic ( C. diversus, Proteus ssp. ) Enterobacteria , Staphylococci , Peptococcus . This is accompanied with elimination of bacteria of genus Eubacterium from colon cavity. Conclusions: Acute colienteritis in one to six months old breastfed children developed on the background of reducing value of Bifidobacterium and Lactobacillus and the contamination of colon with E. coli Hly+ , enteropathogenic Escherichia and C. diversus , Proteus , Peptococi , Staphylococci and Peptostreptococci , on the background of strengthening of value of Bacteroides and Escherichia .

CHARACTERISTICS OF THE EPIDEMICAL PROCESS OF ACUTE RESPIRATORY INFECTIONS IN THE REPUBLIC OF KARELIA IN THE MODERN PERIOD

Acute respiratory viral infections remain the most common group of diseases causing significant social and economic damage to society. Objective: to study the epidemiological characteristics of respiratory disease influenza and other etiology in the modern period in the Republic of Karelia – one of the most disadvantaged of this group of diseases regions of the country. Materials and methods: On the basis of statistical data and publications is analysed and compared with the performance of the country a long-term dynamics and of etiological structure of acute respiratory viral infections over the years 1980–2016, seasonality of morbidity in separate age and social groups of the population in the years 2013–2016, etiological structure allocated from sore viruses. On the basis of outpatient clinic investigated the clinical characteristics of acute respiratory viral infections in adult outpatients during the period of seasonal rise of morbidity. Results: it was found a marked reduction in the incidence of flu, partly due to clinical underdiagnosis of the infection, its rejuvenation, the prevalence of mild forms of influenza in adults; the increase in the incidence of infections influenza is not the etiology, mainly due to rhinovirus infection, forming a pronounced autumn rises, the lack of differences between the incidence of viral respiratory infections «organized» and «disorganized» children. Conclusions: in the modern period the epidemic process of acute respiratory viral infections has gained some new features, important from the point of view of the organization of preventive and curative interventions.

ETIOLOGICAL STRUCTURE AND DIFFERENTIAL DIAGNOSTICS OF SALMONELLOSIS OF BIRDS

The article presents the results of a study of the etiological structure and differential diag-nostic signs of avian salmonellosis. When identifying bacteria isolated from 128 blood samples of chickens with the use of rapid test "Salmonella latex kit" established the dominance of cultures of the microorganisms Salmonella spp. - of 10.94% (14 samples); 10 strains (71,43%) were attributed to Salmonella gallinarum, 4 (of 28.57%) to Salmonella pullorum. The overall level of resistance of Salmonella to ampicillin - 57,58%; tetracycline - 60,61%; streptomycin - 66,67%; had to 57,58%; 60,61% and 66,67% are sensitivity to norfloxacin amounted to 69,70%, to ceftazidime - 78,79%, enrofloxacin - 57,58%, ciprofloxacin - 69,70% of the tested strains. At postmortem examination the most frequently detected signs of pericarditis, hemorrhagic pneumonia, aeroscout, catarrhal-hemorrhagic enteritis, perihepatitis, hyperplasia of the spleen. The most frequently detected signs of pericarditis, aeroscout, catarrhal-hemorrhagic gastroenterocolitis, perihepatitis, inflam-mation of the ovaries, hyperplasia of the spleen. Revealed signs of congestive hyperemia, macrophage reaction, hyperplasia and plasmocytomas of lymphocyte transformation, increase the permeability of microcirculatory vessels, lymphoid-cellular infil-tration of loose fibrous connective tissue, perivascular oedema, disseminated thrombosis, proliferation of lymphocytes from lymph nodes, spleen, liver, and pancreas. In violation of the porosity of the blood vessels of serous membranes of organs were observed extensive serous oedema, the output of the formed elements of blood and the loss of fibrinogen.

CHANGING ETIOLOGICAL STRUCTURE AND OUTCOMES OF BACTERIEMIA IN SURGICAL PATIENTS AS A RESULT OF MONITORING AND MANAGEMENT OF ANTIBIOTIC RESISTANCE IN MULTIDISCIPLINARY HOSPITAL

Objective . Evaluate the change of etiological structure and clinical outcomes of bacteremia in surgical patients after the implementation the system of monitoring and control antibiotic resistance in a multidisciplinary hospital. Materials and methods . Interventional study with historical controls. The intervention: antibiotic stewardship program, including a group of experts on antimicrobial therapy, antimicrobial therapy and prophylaxis protocols, infection control, improving hospital bacteriological laboratory, educational programs, internal audit. Study onset: June 2013. Analysis of pre-intervention (Jan. 2011-June 2013) and intervention (July 2013-Dec. 2015) periods was carried out. We assessed incidence of bacteremia caused by methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococci (VRE), ESBL-producing Enterobacteriaceae, MDR Gram-negative nonfermenting bacteria (MDR-NFGB), incidence of candidemia, hospital length of stay (LOS) and mortality of surgical patients with bacteremia. Results. In the intervention period a significant decrease in the incidence of bacteremia caused by MDR-NFGB from 50 (14,8%) to 16 (4,7%), р<0,0001, VRE from 10 (3,0%) to 0, р=0,0008 and incidence of candidemia from 29 (8,6%) to 13 (2,8%), р=0,011, was detected. The frequency of bacteremia caused by ESBL-producing Enterobacteriae did not significantly change [103 (30,6%) vs. 86 (25,1%), р=0,124]. Number of MRSA bacteremias remained low [5 (1,5%) vs. 1 (0,3%), р=0,121]. There was a significant reduction of mortality from 36,8% до 22,3%, р<0,007 in the group of surgical patients with bacteremia. The LOS did not change significantly [34 (IQI 21-64) days и 34 (IQI 17,25-60,75) days, р=0,415]. Conclusion . Implementation of system monitoring and control antimicrobial resistance in multidisciplinary hospital allows to significantly reduce mortality in surgical patients with bloodstream infections due to changes in etiological structure of bacteremia, reduction of the incidence of candidemia and bacteremia caused by MDR-NFGNB and VRE, which may be the result of improving the quality of antimicrobial therapy of severe infections.

CAKUT-SYNDROME IN THE ETIOLOGICAL STRUCTURE OF CHRONIC KIDNEY DISEASE IN CHILDREN AND ADOLESCENTS

THE AIM. To evaluate CAKUT-syndrome frequency in the etiological structure of chronic kidney disease (СKD) in children and adolescents. PATIENTS AND METHODS. 80 children with CKD: 39 boys and 41 girls. 50 patients with predialysis stage, 30 dialysis patients, 21 of them on hemodialysis (HD), 9 peritoneal dialysis (PD). CKD diagnosis was established according to the recommendations K/DOQI (2006), Кidney Disease Improving Global Оutcomes (2012), NCGC(2015). Stages of CKD is classified in accordance with the recommendations K/DOQI (2006), NICE (2011); KDIGO (2012). Smirnov A.V., Shilov E.M., Dobronravov D.F. et al. (2012). RESULTS. In the CKD etiological structure from 80 patients in 60 (75%) revealed congenital and hereditary diseases of kidneys among which CAKUT syndrome – in 34 (56, 5%). CONCLUSION. It is established that in the etiological structure of CKD in children and adolescents is dominated by congenital and hereditary kidney diseases (75 %), among which prevails CAKUT-syndrome.

Etiological structure and features of clinical manifestations of neonatal infections in children born by cesarean section

The etiological structure and clinical manifestations of neonatal infections in 194 newborns hospitalized in an infectious hospital were studied. 44 children were born by cesarean section (CS), 150 children – by vaginal delivery (VD). Children born by cesarean section were significantly more often hospitalized for mixed infections of the respiratory, gastrointestinal tract and pyoinflammatory skin diseases (CS-20.5% and VD-3.3%, p<0.01). In children born by the operative route, infectious diarrhea (CS-66% and VD-39%, p<0.01), bronchiolitis (CS-20.8% and VD-6. 25%, р<0. 05), pyodermia caused by S. aureus (CS-23% and VD-15.9%, р<0.05), severe acute respiratory viral infections (CS-20.8% and VD-6.25%, р<0.05) were diagnosed more often than in children born by the vaginal delivery. The revealed features of the course of neonatal infections in children born by cesarean section dictate the need for in-depth studies on this topic.

The etiological structure of diseases in frequently ill children depending on age

The urgency of the problem of frequently ill children is associated with a significant number of patients who can be assigned to this category. Objective: to present the nosological and etiological structure of diseases in frequently ill children depending on age. Subjects and methods. 243 children aged 1 to 17 years with recurrent respiratory infections were followed up. The children were examined using routine clinical, laboratory, and instrumental examinations. The etiological diagnosisincluded bacteriological examination of the upperrespiratory tract microflora; determination of IgM and IgG antibodies against Chlamydophila pneumoniae, Mycoplasma pneumoniae, Epstein–Barr virus(EBV), and cytomegalovirus(CMV) in blood by enzyme immunoassay and that of Chlamydia and Mycoplasma DNA in pharyngealswabs and that of CMV, EBV and human herpesvirustype 6 DNA in blood by polymerase chain reaction. Results. Recurrentrespiratory diseases were found to be associated with herpesvirusinfection in 75% of the children aged 1 to 6 years, with Streptococcus, Mycoplasma, and Chlamydia infections in 16, 10, and 4% of those aged 3 to 6 years, respectively, and to be accompanied by abnormal lymphoid tissue proliferation in 84% of the children aged 3 to 6 years, with the abundant growth of bacterial opportunistic pathogensin one half of the patients. Despite the continuing importance of infectious agents(herpesviruses and streptococci in 29 and 20%, respectively), the chronically ill school-aged children displayed a high incidence of somatic diseases: chronic tonsillitis (43%) and chronic sinusitis (14%) in children aged older than 12 years and allergic rhinitis (23%) in those aged 7 to 17 years. The symptoms of autonomic vascular dystonia were observed in 21% of the patients; cardiac arrhythmias were diagnosed in 14%.

CHARACTERISTICS OF ACUTE INTESTINAL INFECTIONS IN CHILDREN HOSPITALIZED IN THE CLINIC IN MOSCOW

The article presents the results of the study of the etiological structure and clinical features of acute intestinal infections of viral, bacterial and mixed etiology in children hospitalized in a specialized department of Children's Clinical Hospital №9 named G. N. Speransky, city of Moscow in 2008—2016. It was found that during 9 years of follow-up, the number of hospitalized patients with acute intestinal infections does not have an obvious tendency to decrease. More than half of hos-pitalized patients are children 1—7 years old. Among the reasons for acute intestinal infections of established etiology, viral agents (rotaviruses and noroviruses) prevail. Among bacterial intestinal infections, the most urgent are salmonellosis, campylobacteriosis and staphylococcal infection.

Adenovirus gastroenteritides in children

Objective: to determine the proportion of adenovirus gastroenteritides in the structure of acute enteric infections of uncertain etiology among the children of Baku. Subjects and methods. A total of 155 children aged less than 14 years with acute enteric infections of uncertain etiology who had been admitted to the Clinic of Infectious Diseases, V. Akhundov National Research Institute of Medical Prevention, in 2014–2015, were examined. The etiological diagnosis of adenovirus gastroenteritis was made by immunochromatographic assay. To rule out the bacterial etiology of acute enteric infection, all the children underwent fecal bacteriological examination. The examinees included babies under 6 months (17,4%), infants aged 7 months to 1 year (6,4%), those 1–2 years of age (29,6%), and children aged 2–14 years (46,4%). Adenoviruses in conjunction with rotavirus were detected in 7 (4,5%) patients. Adenovirus monoinfection was seen in 23 (15%) children. The contribution of adenoviruses in the etiological structure of acute enteric infections in children was 19,3%. There was no significant difference in the frequency of adenoviruses depending on gender. Adenovirus monoinfection wasregistered in the children all year round. Adenovirus monoinfection occurred as moderate diarrhea whereas mixed adenovirus-rotavirus infection was characterized by the severe course of diarrheal syndrome and catarrhal manifestations.

Characteristics of hepatitis A on the background of chronic hepatitis B

Aim. To characterize clinical presentation of hepatitis A on the background of chronic hepatitis B. &#x0D; Methods. The study was conducted in 2012-2015 in Saint Petersburg Clinical infectious diseases hospital n.a. S.P. Botkin. Retrospective analysis of 259 medical records of in-patients diagnosed with hepatitis A was conducted on random samples. Etiology of the disease was confirmed with ELISA test for serological markers of hepatitis A, B and C. &#x0D; Results. Etiological structure of hepatitis A-mixed: combination of hepatitis A + chronic hepatitis B - 74.0%, hepatitis A + chronic hepatitis B + chronic hepatitis C - 11.0%, hepatitis A + chronic hepatitis C - 8.0%, hepatitis A + chronic hepatitis of unknown etiology - 7.0%. Age differences in the groups of patients with hepatitis A were revealed: mono- and mixed infections (35.5±11.74 and 40.7±13.72 years, respectively; р=0.026). Hepatitis A had moderate course regardless of infection with other hepatotropic viruses but in 1 patient with chronic hepatitis B resulting in cirrhosis severe course of the disease lead to death. Clinical presentation of hepatitis A as mono- and mixed infection was characterized by typical symptoms. Changes in blood chemistry in mixed infection were characterized by higher cytolytic activity, hypoalbuminemia, lesser decrease of urea level. &#x0D; Conclusion. In the etiological structure of mixed hepatitis combination of hepatitis A and chronic hepatitis B was predominant; in most cases hepatitis A had moderate course but in superinfection more severe course of the disease can be observed - up to lethal outcome.