Clinical Infectious Hospital Research Articles

Evaluating the iatrogenic effects of polypharmacy and drug interactions in HIV-positive patients admitted to the intensive care unit: a single-center retrospective study

Background. Polypharmacy and drug interactions are of particular concern in people living with HIV/AIDS, especially those who receive antiretroviral therapy (ARVs). Polypharmacy and drug-drug interactions (DDIs) can impact the efficacy and toxicity of HIV treatment. ARVs used in HIV treatment are often prone to drug interactions if administered with other non-ARV drugs because many of them are metabolized through the cytochrome P450 system. The pharmacological management of HIV patients in the intensive care unit (ICU) is usually complex and typically involves the administration of several classes of drugs. This patient group may be at higher risk for potential DDIs due to polypharmacy in the ICU. The main objective of this study was to assess the iatrogenic effects of polypharmacy in HIV patients treated in the ICU and to describe the DDI profile between ARVs and other non-ARV medications prescribed in the ICU. Methods and materials. Between 2018 and 2020, we conducted a single-center, retrospective study evaluating the medical records of 59 HIV patients admitted to the ICU for more than 24 hours at the Infectious Disease Clinical Hospital No. 2, Moscow, Russia. We evaluated the impact of polypharmacy on renal, hepatic and haemopoietic function. The Liverpool HIV Drug Interaction database was used to identify DDIs in ART-treated HIV patients. Results. All patients received more than 5 different medications matching the definition of polypharmacy. The average number of concurrent medications prescribed was 156.713 (maximum 40, minimum 6). All drug interactions recorded were between ARVs and antibiotics: 30 cases of potential interactions in 65.5% patients who received ARV. Of such patients, 94% were exposed to at least two potential interactions. Tenofovir (TDF) and the antibiotic vancomycin underlaid the most common potential interaction (49.2%), followed by lopinavir ritonavir (LPV/RTV) and ciprofloxacin (30.3%). A significant difference in average creatinine levels was found in patients with TDF/vancomycin potential interactions (p 0.05). Conclusion. This study demonstrated that potential DDIs frequently occur in ICU patients in line with previous investigations. It is necessary to implement collaborations among clinical pharmacologists and infectious disease/HIV specialists, as well as frequent clinical and laboratory monitoring, aimed at developing effective and actionable strategies that could reduce potential DDIs in HIV patients in the ICU.

Comparative characteristics of clinical, laboratory and instrumental indicators in children with seasonal influenza depending on the virus strain

Introduction. According to the literature, it is known that clinical signs and symptoms of influenza may differ depending on age, the state of the human immune system, the serotype of the virus and its virulence. Intoxication, catarrhal and hyperthermia are main symptoms of influenza, but the disease does not always proceed classically, it may hide under the mask of other infections. The aim was to conduct a comparative analysis of clinical, laboratory and instrumental parameters in children with influenza A(H1N1) and A(H3N2). Materials and methods. A single-stage retrospective comparative study was carried out with the participation of 96 children from 1 month of age up to 13 years old with a diagnosis of influenza, who were hospitalized at the Irkutsk Regional Infectious Clinical Hospital from December 2018 to January 2019. Clinical and laboratory features of the course of influenza in children were determined depending on a viral strain. Results. The structure of morbidity: influenza A(H1N1) – 70 people (73 %), influenza A(H3N2) – 20 children (21 %), influenza A clinically unvaccinated – in 3 people (3 %), mixed viral infection influenza H1N1 + adenovirus infection – 2 cases (2 %), mixed viral infection H1N1 flu + RS-virus – 1 case (1 %). In the clinic of both strains of the virus, symptoms prevailed: runny nose, dry cough, fever, intoxication. Muscle pain and pharyngeal hyperemia were significantly more common in influenza A(H1N1), the duration of symptoms did not differ. Lymphocytosis was more often observed in influenza A(H1N1), monocytosis – in influenza A(H3N2) (р < 0.05). In 64 % of cases, patients with influenza A(H1N1) had a high leukocyte index of intoxication (odds ratio – 2.2). Conclusion. The symptoms of different influenza A viral strains virus in children are the same, however, muscle pain and hyperemia of the pharynx prevails in children with influenza A(H1N1).

Lesions of the nervous system in herpesvirus infections

Diseases caused by herpesviruses are among the socially significant ones, which is determined by their wide distribution, polymorphism of clinical manifestations and severity of the course up to the development of lethal outcomes.The article presents literature data on the importance of the problem of lesions of the nervous system in herpesvirus infections at the present stage and the results of our own observations of 60 patients hospitalized in the Infectious Clinical Hospital of Yaroslavl in the period from 2015 to 2021. The analysis of the main clinical and laboratory indicators was carried out and the features of the course of lesions of the nervous system in herpesvirus infections were established.

Characteristics of imported cases of Dengue fever and hemorrhagic Dengue fever in 2009-2019

In Russia, the approved morbidity statistics system is represented by the International Classification of Diseases of the 10th revision (ICD-10). This classification provides two forms of dengue fever (DF): dengue fever (A90) and hemorrhagic dengue (A91). Official statistics on the ratio of forms of DF is not published in open sources and this lack of information about the real ratio of the forms of DF makes it difficult to objectively assess the factors that determine the severity of this disease. compare the clinical and epidemiological features of dengue fever and hemorrhagic dengue fever in patients hospitalized in 2009-2019 to the City Infectious Clinical Hospital No. 1, Moscow. A retrospective cohort study. We analyzed the patient database and reviewed 391 medical records of patients with diagnosed dengue fever. We compared gender, age characteristics, travel geography including information about previous visits of patients to endemic regions and dengue virus serotype. To determine the primary and re-infection rate, an analysis of IgG for the dengue virus was carried out on days 1-5 of the disease. To compare indicators, 95% confidence intervals for proportions, medians, and interquartile ranges were calculated. The significance of differences between independent samples for assessing qualitative characteristics was carried out using the criteria χ2, the odds ratio. To assess the quantitative characteristics, the Mann-Whitney test was used. Differences were considered statistically significant at p ≤ 0.05. The proportion of patients with dengue fever was 14.9% of all hospitalized with febrile illnesses that developed after international travel. Hemorrhagic dengue fever (DHF) was diagnosed in 15.7% of patients with dengue fever. DHF developed significantly more often in women, as well as in those who had history of repeated visits to endemic regions. However, DHF was also diagnosed in 10.9% of first-time travelers to tropical countries. We did not find significant differences in the rates of DHF development depending on age and dengue virus serotype. In a number of patients who had not previously traveled to endemic regions, IgG to the dengue virus were detected, which may indicate a previous infection with related flaviviruses. It has been established that in the regions most visited by Russians, there is a circulation of all serotypes of the dengue virus with an annual change in the predominant serotype.

СРАВНЕНИЕ КЛИНИЧЕСКОЙ КАРТИНЫ ИКСОДОВОГО КЛЕЩЕВОГО БОРРЕЛИОЗА У ДЕТЕЙ И ВЗРОСЛЫХ В АМБУЛАТОРНЫХ УСЛОВИЯХ

The polymorphism of clinical manifestations of Lyme borreliosis (LB) creates significant problems in the study of this disease. In addition to the variability in classifications used in Russia and abroad, the spectrum and the frequency of symptoms in outpatient and hospitalized patients with LB differ significantly, which makes it difficult for a physician to understand the clinical picture of LB. The purpose of the study was to describe the clinical picture of LB in an outpatient infectologist appointment conditions according to the E. Asbrink, A. Hovmark classification of Lyme borreliosis in children compared with adults. Materials and methods of the research: a retrospective single-center cohort study was conducted based on the analysis of the data from 213 outpatient records of patients with confirmed LB diagnosis, consulted by infectologist at the Moscow Infectious Clinical Hospital No. 1 of the Moscow Department of Healthcare (Moscow, Russia) in Jan. 2018 - Sep. 2019. In order to compare the clinical features between children and adults the patients were divided into 2 groups by age: adults (18 years and older) and children (1 to 17 years old). The confirmation of the LB diagnosis was carried out according to the clinical and/or laboratory criteria using enzyme immunoassay and immune blotting. Results: in the group of children (n=52), the median age was 6 [3; 8] years old, the proportion of boys was 44% (n=23, 95% CI 30-57%), girls - 56% (n=29, 95% CI 43-70%). In the group of adults (n=161), the median age was 59 [49; 65] years old, the portion of males was 29.2% (n=47, 95% CI 22.2-36.0%), females - 70.8% (n=114, 95% CI 64.0-77.8 %). The most frequently diagnosed was LB at its early localized stage, both in children (n=44, 84.0%, 95% CI 74.0-93.0%) and adults (n=123, 76.4%, 95 % CI 69.7-82.6%). No statistically significant difference was found (p=0.248). Erythema migrans (EM) was the vast majority of early localized stage manifestations in children (95%, 95% CI 88-100%). The incidence of EM in adults was not statistically significantly different from that in children (94.3%, 95% CI 89.9-98.1%, p=1.000). EM in children was most often localized on the scalp (46%, 95% CI 31-60%), in adults the most common localizations were the skin of the trunk and lower extremities (total 92.9%, 95% CI 87.8-97.0; n=118). Differences in the typical localization of EM in children and adults were statistically significant (p<0.001). In the clinical picture of the early localized stage of LB the fever was rare in both children (7%, 95% CI 4-16%) and adults (8.9%, 95% CI 4.3-14.5%) (p=1.000). At the same time, the regional lymphadenitis was detected statistically significantly more often in adults than in children (50%, 95% CI 35-65% vs. 26.8%, 95% CI 19.3-34.5%, p=0.005). Both groups showed a lower incidence of regional lymphadenitis during examination by an infectologist if the patient was prescribed antibiotic therapy at the place of residence, while statistically significantly more often in the group of children (34%, 95% CI 23-46 vs. 15%, 95% CI 8-23, p=0.003). Conclusion: the authors have described the spectrum and frequency of the LB clinical manifestations according to the E. Asbrink, A. Hovmark classification in children vs. adults. The influence of research conditions and the previous antibiotic therapy on the spectrum and frequency of the LB clinical manifestations detected during the initial examination was demonstrated as well.

Features of the epidemiological history of patients with Lyme borreliosis

In the treatment of Lyme borreliosis (LB), early diagnosis is a key component. The epidemiological history of the patient plays one of the leading roles in suspected borreliosis and at the same time is an important criterion for clinical diagnosis.Purpose. Analysis of epidemiological history data in outpatient cases of LB in Moscow.Material and methods. We conducted a retrospective, non-randomized, single-center cohort study, based on the analysis of data from 660 outpatient records of patients, referred by local physician with tick bite or suspicion of LB, and consulted by an infectious disease specialist on the basis of the Infectious clinical hospital No.1 in Moscow. For further analysis, patients were divided by age and the presence or absence of LB. Confirmation of LB was based on clinical and/or laboratory criteria using methods of enzyme immunoassay and immune blot.Results. We have updated the epidemiological features of the LB for Moscow, such as: the relative number of cases in the administrative districts of Moscow, places and seasonality of tick bites. Among children, compared with adults, cases of a tick bite without the development of LB was predominant, which must be taken into account in order to avoid overdiagnosis of LB. In patients with LB, an indication of the fact of tick bite in the anamnesis was much less common than going to its habitats.Conclusion. Our data clarify the epidemiological features of LB for residents of Moscow. In the absence of a history of indications of tick bite, an informative sign for clinical diagnosis is a visit to its habitats, including not only trips to wooded areas, but also to suburban areas and parks.

Antibiotic-Associated Syndrome in Clinical Practice

Purpose of Research: Establishing clinical features of an antibiotic- associated diarrhea and extra-intestinal manifestations of an antibiotic- associated syndrome in children Patients and Methods: In 2017-2019 on the basis of GBUZ Infectious clinical hospital No. 2 DZ of Moscow a prospective clinical surveillance was carried out 200 patients aged 3 months to 13 years who were hospitalized with a diagnosis of acute pneumonia and received antibacterial therapy. All patients were evaluated for antibiotic-associated diarrhea (development of diarrhea, vomiting, dyspepsia, stomatitis) and manifestations of antibiotic-associated syndrome in children (condition of the skin and appendages of the skin, nervous system, development of inflammatory changes in the external genitals) within a month after antibiotic therapy. Comparative analysis of the effectiveness of probiotic prevention of antibiotic-associated syndrome was conducted in two groups: group 1 (23 children who received a drug containing Lactobacillus acidophilus, polysaccharide of kefir fungus in parallel with antibacterial therapy), group 2 (122 patients who received a medication containing Lactobacillus acidophilus, Bifidobacterium infantis, Enterococcus faecium). Results: 29% of patients had symptoms of antibiotic-associated syndrome. AAD symptoms were diagnosed in 13% of patients. Abdominal pain (32.8%), dyspepsia symptoms (22.4%), bad breath (17.2%), flatulence (17.2%), stomatitis (10.3%), and constipation (1.7%) associated with antibiotic therapy were found among the manifestations of antibiotic-associated gastrointestinal syndrome. Dry skin was observed in 15.5% of patients, diaper rash-3.4%, brittle nails-15.5%, peeling of the skin-3.4% of patients, increased irritability in 17.2%, inflammatory changes in the external genitals-in 1.7% of patients. Comparative analysis of various probiotic prophylaxis of AAD showed that 1 group patients were significantly more likely to have stomatitis (p<0.01) and dry skin (p<0.05) than patients in group 2. Summary: New term “ antibiotic-associated syndrome» implies the development of a wider range of clinical manifestations associated with the use of antibacterial agents than the development of antibiotic-associated diarrhea. The use of probiotic prophylaxis with a medication containing Lactobacillus acidophilus, Bifidobacterium infantis, Enterococcus faecium demonstrates high efficiency compared to the comparison group.

Assessment of Antimycobacterial Activity of Newly Synthesized Pyrimidine Derivatives Against Mycobacterium tuberculosis

Background. The current trend of growing antibiotic resistance among pathogenic microorganisms remains one of the urgent and significant problems of mankind. The constant spread of resistant strains of microorganisms requires the development of innovative methods and the search for medicinal compounds with a highly effective mechanism of action. One of these multi-resistant pathogens that are difficult to eradicate is the causative agent of tuberculosis — Mycobacterium tuberculosis. The aim is to study the effect of newly synthesized pyrimidine derivatives on the growth of Mycobacterium tuberculosis culture, as well as on the structural changes in cells.Material and methods. In order to assess the effect of a number of pyrimidine derivatives on the growth of Mycobacterium tuberculosis culture, 6 samples of 5-(arylmethylene) hexahydropyrimidine-2,4,6-triones (TAG1 — TAG6), 7 samples of 5-hetarylmethylidene-2,4,6-triones (TAG7 — TAG13), and 2 new samples of 3-(2-Benzyloxy-2-oxoethyl)quinazoline-4(3H)-one and 3-[2-(1-Naphthyl)-2-oxoethyl]quinazoline-4(3H)-one were screened under the laboratory ciphers VMA-13-03 and VMA-13-04 in the course of the study. M.tuberculosis H37RV strain was used as a test culture; it was provided by the bacteriological laboratory of the Regional Infectious Clinical Hospital named after A. M. Nichoga. A 4-week culture of M.tuberculosis, synchronized by cold (+4°C) for 72 hours, was used to prepare a suspension of mycobacteria. The number of mycobacteria in the suspension was determined using the McFarland 0.5 turbidity standard. 0.2 ml of M.tuberculosis working suspension was added to each tube of a series of successive dilutions of the studied substances, including the control. The study was carried out in 4 series of replicates. The minimum bactericidal concentration of the compounds, at which no colony growth was detected, as well as the minimum inhibitory concentration, at which mycobacterium growth was delayed by 50% compared to the control, were determined. Smears were prepared from the sediment for staining using theZiehl-Neelsen method to determine the presence of acid-resistant and non-acid-resistant forms of mycobacteria, as well as to study the effect of pyrimidines and a comparison drug on structural changes in M.tuberculosis cells.Results. In the course of the study, the TAG4, TAG6, and TAG8 compounds were found to have the closest antibacterial activity to the comparison drug isoniazid, according to the indicator of mycobacteria growth retardation. The greatest bactericidal activity against M.tuberculosis was observed in TAG4, TAG7, and VMA–13–04. The remaining compounds have shown minimal inhibitory effect on the growth of M.tuberculosis. Microscopic studies have shown that under the influence of TAG3, TAG4, TAG7, TAG12, VMA-13-03, and VMA-13-04, the main structural components of M.tuberculosis cells undergo fragmentation and morphological changes compared to mycobacterium cells without exposure.Conclusion. As a result, it was found that all the studied compounds possess antimycobacterial activity. Compounds under the laboratory ciphers TAG1, TAG4, TAG7, and TAG13 were comparable to isoniazid by the nature of the inhibitory effect on the growth of M.tuberculosis, and the TAG3 compound even slightly exceeded the effect of the comparison drug. Compounds under the laboratory codes VMA-13-03, and VMA-13-04 had the least pronounced anti-tuberculosis effect. Compounds under the laboratory codes TAG5, TAG6, TAG11, and TAG12 showed the least antimycobacterial activity.

Gene polymorphism in blood coagulation system and folate cycle affecting heart condition in patients with hemorrhagic fever and renal syndrome

One of the typical manifestations of hemorrhagic fever with renal syndrome (HFRS) is a damage to the cardiovascular system. The most promising direction of studying the causes of cardiac complications in HFRS should be considered the genetic patient characteristics, particularly taking into account the disease pathogenesis, study of polymorphism of the genes in the blood coagulation system and the folate cycle. The aim of the study was to find out an effect of polymorphism of the blood coagulation system and folate cycle genes on heart damage in hemorrhagic fever with renal syndrome. A case-control study was conducted by enrolling 19 patients in the 2019 summerautumn period at the Republican Clinical Infectious Hospital in the City of Izhevsk. The study of polymorphism of the blood coagulation system and folate cycle genes was performed by using a set of reagents RealBest-Genetics Hemostasis (12) on the CFX96 amplifier (Bio-Rad, USA). DNA was extracted from peripheral blood leukocytes with reagents RealBest Extraction 100. Transthoracic echocardiography was performed on a Vivid 7 Dimension ultrasound scanner (GE Healthcare, USA) with a matrix sector sensor M4S with a phased array at scanning frequency of 1.54.3 MHz. Statistical analysis was performed using Statistica 12, IBM SPSS 22. The group parameters were calculated and depicted as median and interquartile range (ME [Q25; Q75]). Comparison of such parameters was carried out by using the MannWhitney criterion. Comparison of the frequency distribution for genotypes and alleles in the study groups was carried out using the criterion 2. The association of alleles/genotypes with a predisposition to detectable changes was assessed by the risk ratio (OR) additionally calculating 95% confidence interval (CI). The p 0.05 was considered as statistically significant. During the study, 7 patients were found to have floating echoes on the aortic valve in the outlet of the left ventricle signs of thrombotic endocarditis. In the group of patients with signs of thrombotic endocarditis, there was revealed a higher frequency of the allele A for the F7:10976 G/A gene compared to patients lacking signs of thrombotic endocarditis (p = 0.0357). All study patients had a normal left ventricular ejection fraction (more than 50%), but during the speckle-tracking study assessing the index of averaged peak longitudinal contractility (GLPS AVG), 11 patients with impaired myocardial contractility were identified. In patients with decreased GLPS AVG, the genotype G/G of the FGB:-455 G/A gene was detected more often compared to patients with preserved myocardial contractility (p = 0.0397). In 8 patients, signs of grade 1 diastolic left ventricular dysfunction were revealed, the prognostic importance of the gene polymorphism related to the blood coagulation system and folate cycle in developing this complication has not been determined.

Clinical and laboratory features of the new coronavirus infection COVID-19 in patients with connective tissue dysplasia

Introduction. Connective tissue is ubiquitous in the human body, hereditary connective tissue disorders affect several systems and organs, undifferentiated connective tissue dysplasia is often not diagnosed, proceeds under the guise of another pathology, and the pathogenetic basis of COVID-19 is a systemic disease associated with vascular inflammation and endothelial damage. The goal is to study the clinical and laboratory features of a new coronavirus infection in patients with connective tissue dysplasia.Materials and methods. The study included 117 patients diagnosed with a new coronavirus infection COVID-19 aged 35 to 65 years, hospitalized in an infectious diseases hospital City Clinical Hospital No. 40 in Ekaterinburg. The patients were divided into 2 groups: the main group (n=90) people with the stigmas of connective tissue dysplasia and the comparison group: (n=27) people without signs of connective tissue dysplasia. Inclusion criteria: the presence of stigma of connective tissue dysplasia, the presence of a confirmed infection with COVID-19 (PCR of nasopharyngeal and oropharyngeal swabs for SARS-CoV-2). Exclusion criteria: age over 65, comorbidities: diseases of the musculoskeletal system, chronic kidney disease, pregnancy, HIV infection, oncohematological and lymphoproliferative diseases.Results. The course of a new coronavirus infection against the background of connective tissue dysplasia is characterized by: 1) fever in 100% of patients; 2) damage to the lungs of more than 50% of the lung tissue with signs of respiratory failure in 63%; 3) a pronounced systemic inflammatory response syndrome, manifested by a significant increase in C-reactive protein and creatine phosphokinase.Discussion. An analysis of the results showed that one of the predictors of the severity of the course of COVID-19 infection may be the presence of connective tissue markers of dysplasia (odds ratio 7.4, 95% CI 2.6-21.3).Conclusion. The new coronavirus infection COVID-19 proceeds against the background of connective tissue dysplasia more severely with a pronounced intoxication syndrome with an early and longer manifestation of acute respiratory failure.

Botulism in the Astrakhan region: a retrospective study

The average number of annually registered cases of botulism in the Russian Federation is 300. At the same time, there is an increase in the number of deaths to 26 per year.Materials and methods. The article presents the results of a clinical and epidemiological analysis of 47 cases of botulism in adults treated at the State Medical Institution «Regional Infectious Clinical Hospital named after A.M. Nichoga» in Astrakhan in the period from 2009 to 2019. The diagnosis of botulism was confirmed by a positive reaction of biological neutralization of the toxin in white mice.Results. It is established that the epidemic process of botulism in the Astrakhan region is characterized mainly by sporadic morbidity in adults of working age and the absence of cases of the disease in children. All patients had food botulism, which occurred typically in the form of moderate and severe forms of the disease, with a mortality rate of 4.2%. There is an increase in the share of fish and fish products, non-industrial preparation, as sources of infection. Laboratory confirmation of botulism occurred in 60% of patients.

Современные возможности диагностики лимфаденопатий у детей

В настоящее время вопросы дифференциальной диагностики лимфаденопатий у детей становятся особенно актуальными. Это обусловлено тенденцией к росту лимфаденопатий различной этиологии. Установлено, что дифференциальная диагностика лимфаденопатий основана на оценке клинико-анамнестических, гематологических, иммунологических, серологических, инструментальных (ультразвуковое исследование, компьютерная томография), гистологических и иммуногистологических данных биопсийного материала лимфоузлов. Проведенное исследование у 87 детей в возрасте от 4 до 18 лет, обратившихся в областную детскую инфекционную клиническую больницу, показало, что у 68 (78,7 %) больных лимфаденопатия была проявлением инфекционных или паразитарных заболеваний. Преобладали вирусные агенты, наиболее часто отмечались вирусная инфекция Эпштейна — Барр (19,8 %) и смешанная герпесвирусная инфекция (12,6 %). У 7 (8,04 %) больных увеличение лимфоузлов оказалось результатом онкологических заболеваний (4 — лимфома Ходжкина, 3 — неходжкинская лимфома). При лимфаденопатии неустановленной этиологии биопсия лимфоузла с последующим морфологическим или иммуногистологическим исследованием является решающей в постановке окончательного диагноза.

Герпесвирусные инфекции у детей: распространенность, заболеваемость, клинические формы и алгоритм ведения

Objective. To analyze the incidence, prevalence, and structure of various forms of herpesvirus infections (HVIs) among hospitalized children in Infectious Clinical Hospital No 1 in Moscow for the period 2010–2021. Patients and methods. The study included 6808 children of both sexes aged between 3 months (infants) and 17 years, hospitalized in Infectious Clinical Hospital No 1 with laboratory and clinical confirmed HVIs of moderate and severe course. Clinical, epidemiological, and statistical methods of data processing (Excel, Statistica 10) were used. Results. The most common nosological forms of HVIs, variants of mono-, mixed- and co-infections were analyzed and identified. The predominant diagnosis was infectious mononucleosis, which was detected in 83.40% (5678:6808) of pediatric patients in relation to the total number of children hospitalized with HVIs, and in 82.20% (5757:7003) of the identified HVI nosological forms. The second most frequent diagnosis was herpes simplex, which was detected at a rate of 7.31% among all hospitalized children and 7.11% (498:7003) among all HVI diagnoses, i.e., it occurred as a monoinfection. In third place with a comparable frequency was the diagnosis of CMV infection in 3.92% (275:7003) and sudden exanthema in 3.51% (246:7003). CMV infection was revealed in 2.44% (number of patients 166:6808) of patients, cases of both mono- and mixed infections were detected. Herpes zoster among hospitalized children was rare, in 0.42% of cases. In one case, a combination of HVI and HIV infection was observed. Key words: children, herpesviruses, herpesvirus infections, HSV-1, HSV-2, VZV, EBV, CMV, HHV-6, herpes simplex, varicella, herpes zoster, infectious mononucleosis, cytomegalovirus infection, sudden exanthema

СПЕКТР ВОЗБУДИТЕЛЕЙ БАКТЕРИЕМИЙ У ДЕТЕЙ

The analysis of the results of bacteriological examination of blood samples of patients aged from 1 month to 18 years was carried out. A retrospective analysis was carried out based on the results of the virus-bacteriological laboratory of the City Children's Infectious Clinical Hospital of Minsk for the period from 2009 to 2020. It was found that gram-positive bacteria predominate in the spectrum of bacteremia pathogens in patients (59.4%), among which coagulase-negative types of staphylococci dominate, which corresponds to numerous modern studies from other countries, according to which the most common pathogens of bacteremia are coagulase-negative staphylococci.

Human cytopenia variants at diverse HIV infection stages

Over decades, HIV infection and its complications have been one of the most debated problems in the world. The human immunodeficiency virus not only weaken the immune system, but also disrupts normal hematopoiesis manifested as cytopenia (anemia, thrombocytopenia and neutropenia). Materials and methods. A retrospective analysis of cases of combined HIV infection and inhibited hematopoiesis was carried out according to hemogram data of patients admitted for treatment at the Infectious Clinical Hospital No. 1 named after D. Dalmatov, Omsk. The inclusion criteria were cytopenia during hospitalization detected in detailed blood test (by calculating hemoglobin level, counts of erythrocytes, leukocytes, platelets). The age of the patients included in the study differed: from 20 to 29 years — 27 patients (24.6%), from 30 to 39 years — 69 patients (62.7%), from 40 to 49 years — 13 patients (11.8%), over 50 years old 1 patient (0.9%). All patients had suppression of at least one hematopoietic cell lineage. Anemia was considered as decreased hemoglobin level below than 130 g/l in men and 120 g/l in women. Erythrocytopenia was considered as decreased erythrocyte count below 4.76 × 1012/L. Leukopenia was defined as decreased total count of leukocytes below 4.0 × 109/L, while a decrease in the absolute count of neutrophils below 1000 cells/μL was considered as neutropenia. Thrombocytopenia was determined as decreased platelet count below 150 × 109/L. Results. All patients had suppression of at least one hematopoietic cell lineage. 6 patients with stage 2 had one-cell lineage cytopenias, 7 — two-cell lineages. While analyzing the data obtained, it can be concluded that in patients with stage 2 HIV, inhibition of erythroid and platelet cell lineage predominates, whereas thrombocytopenia reached grade IV. At stage 3 HIV, all 7 patients had inhibition of only one cell lineage. In this group, the inhibition of hematopoiesis had a lighter degree in all hematopoietic cell lineages. In 46 patients with stage 4, there were various oppression of one of the hematopoietic cell lineages, in 44 patients there were two-cell lineage cytopenias. For patients with a more advanced stage of HIV, a decrease in the number of all cellular elements of the blood in the hemogram is characteristic; these disorders are more severe and persistent.

Unspecified encephalitis in HIV-infected patients: clinical and postmortem evaluation

The search for an aetiology of central nervous system (CNS) lesions In HIV patients can be extremely challenging. To establish the nature and character of CNS lesion according to the data of pathological examination of deceased HIV-patients who had an antemortem clinical diagnosis of unspecified encephalitis. We analysed clinical and laboratory data of 225 HIV-patients admitted to the ICU at the Infectious Clinical Hospital №2 (Moscow, 2018). The principal diagnosis was unspecified encephalitis characterized by cerebral oedema. Had died 183 (67.9%) patients. We conducted pathological examination in 43 (23.5%). CNS lesions occurred in 331 patients (58.8% of 563 ICU). The antemortem diagnosis established were as follows: 12.1% toxoplasmosis; 6.6% HIV-encephalitis; 5.1% CNS lymphoma; 3.6% cryptococcal meningoencephalitis; 3.0% cytomegaloviral diseases; 2.1% progressive multifocal leukoencephalopathy. The cause of the pathology remained unidentified in 225 patients (68% with CNS lesions). Majority of patients were ART-naive. Post-mortem verification was conducted in 29 (67.4%) deceased patients, of which HIV-encephalitis 34.5%, toxoplasmosis 10.3%, progressive multifocal leukoencephalopathy 3.4%. The nature of brain damage in the remaining 20.7% cases was not established even after post-mortem investigation. Productive lepto-meningitis 8 (27.6%), indicating a prolonged duration of the inflammatory process. In the brain 48.1% patients with subacute and productive changes, had a pre-hospital time of more than 30 days, in contrast to 11.1% of patients who had acute pathological processes in the CNS (p0.05). Autopsy didnt reveal any inflammatory changes in the brain in 14 (32.6%) patients, though cerebral oedema 93.3%, haemorrhagic syndrome 60% cases. Accurate retrospective identification of the aetiology of CNS lesions combined with assessing in vivo characterisation of the pathological process plays an essential role in subsequent formation of diagnostic approaches in pathologies of the CNS in HIV-patients.

The course of labor in term patients with concomitant acute intestinal infections

BACKGROUND: Literature data on the course of labor in women with concomitant acute intestinal infections are very scarce. Individual works and articles are devoted to the coverage of this most important final stage of pregnancy. There are no developed specific tactics of labor management in patients with acute intestinal infections, therefore obstetricians and gynecologists have to use generally accepted standards of labor management in this group of patients, without having a clear idea of the frequency and nature of clinically relevant complications in childbirth. AIM: The aim of this study was to evaluate the course of labor in women with concomitant AIIs at full-term pregnancy. MATERIALS AND METHODS: We examined 120 patients aged 19 to 39 years, delivered in Clinical Infectious Disease Hospital named after S.P. Botkin, St. Petersburg in 2017-2019. The main group consisted of 60 women with concomitant acute intestinal infections who gave birth, and the comparison group comprised 60 conditionally healthy women. The spectrum of acute intestinal infection pathogens in pregnant women, the course of labor, complications during labor and the condition of newborns were evaluated. RESULTS: Women of the both study groups did not differ in the duration of labor and the anhydrous interval, the frequency of birth abnormalities, the volume of blood loss, and the frequency of maternal injury and complications in the postpartum period. The frequency of premature rupture of membranes, acute and chronic fetal hypoxia, and episiotomy was higher in patients of the main group. Asphyxia in the first minute after birth was also more common in newborns from women with concomitant acute intestinal infections. CONCLUSIONS: Acute intestinal infections may complicate the course of labor. Labor management in women with concomitant acute intestinal infections requires continuous monitoring of the condition of the fetus during labor and the provision of timely medical care to the newborn.

Monitoring of opportunistic microflora in secondary respiratory infections of HIV-infected patients

Objective: to evaluate the results of microbiological examination of sputum of HIV-infected patients with pneumonia clinic.Materials and methods. The analysis of microbiological results of sputum in 850 patients who were treated with pneumonia at the Infectious Clinical Hospital № 1 from 01.01.2012 to 01.01.2019.Results and its discussion. Gram-positive cocci were recorded in sputum in patients with HIV infection in 76,7±2,2% of cases. The growth of Staph. aureus noted in 20,1±2,0% of cases and was associated with the presence of sepsis and septic pneumonia. Staphylococcus epidermidis detected in sputum in 0,5±0,4% of HIV-positive patients with angiogenic sepsis. Streptococcus pyogenes was isolated in sputum in 2,3±0,8% of patients with severe community-acquired pneumonia. Str. pneumoniae was detected in 2,6±0,8% of cases. A common finding in the study of sputum in patients with HIV infection were viridans group Streptococci (50,3±2,6%). Gram-negative aerobic non-spore-forming bacterium Pseudomonas aeruginosa was found in 5,2±1,1%, Enterococcus faecalis in 3,1±0,9% of confirmed cases of pneumonia. Klebsiella pneumonia was confirmed in 11,5±1,6% of patients. Microbial association was noted in 24,1±1,7% of isolates; associations in combination with Staph. aureus were more common in 54,5±4,1% of HIV-infected patients with the clinic of community-acquired pneumonia.Conclusion. In patients with HIV infection with lung damage, it is necessary to collect biological material for microbiological examination, which will affect the further tactics of patient management.

СОВРЕМЕННЫЕ ОСОБЕННОСТИ МЕНИНГОКОККОВОГО СЕПСИСА (МЕНИНГОКОКЦЕМИИ) У ДЕТЕЙ

Meningococcal infection is a global health problem worldwide, which is caused by high mortality rates, difficulties in early diagnosis due to the nonspecific nature of the initial manifestations of the disease, and the unpredictability of the course. Invasive forms of infection are registered mainly in children of the first five years of life, which further actualizes this disease. In recent decades, the Republic of Belarus has seen a steady decline in morbidity rates, but given the epidemiological features of meningococcal infection (epidemiological ups and downs with a frequency of 10—20 years), experts are aware of the possible scale of the problem in the coming years. The article presents the results of the analysis (for the last 20 years) structures of invasive forms of meningococcal infection and clinical and laboratory features of meningococcal sepsis in children according to the data of the «City Children's Infectious Clinical Hospital» of Minsk.

Противовирусная терапия хронического гепатита С: многолетний опыт реальной клинической практики

Direct-acting antivirals (DAAs) have significantly changed the treatment of chronic hepatitis C (CHC) and the prognosis for patients since their introduction into clinical practice in 2014–2015. Objective. Study of the evolution and efficacy of antiviral therapy (AVT) for CHC based on the results of providing medical care to patients in Moscow in 2002–2020. Patients and methods. The study was conducted in the Center for the Treatment of Chronic Viral Hepatitis “Infectious Clinical Hospital No 1 of the Moscow City Health Department”. For quantitative variables, the mean and standard deviation were used, while for categorical variables, frequency and proportion were counted (%). Results. 69,745 patients were diagnosed with CHC among all the patients who were examined in the Center. The pooled SVR rate of various therapy regimens was as follows in the HCV genotype 1 (GT1) cohort: IFN + ribavirin – 41.7%; DAAs + PegIFN + ribavirin – 77.4%; IFN-free regimens – 94.0%. Age older than 40 years, diabetes mellitus (DM), history of AVT failure (retreatment), and liver cirrhosis (LC) adversely affected the achievement of SVR. In the patients with HCV GT2 and GT3, the IFN + ribavirin combination allowed SVR achievement in 68.5% of patients, while IFN-free regimens were effective in 95.2% of patients. The predictive factors for achieving SVR were similar to those in the GT1 subgroup, except that the effect of age and DM did not reach statistical significance. Conclusions. The efficacy of DAAs in real clinical practice significantly exceeds the efficacy of IFN-based regimens in patients with various HCV infection genotypes. Achievement of SVR as a result of AVT reduces the likelihood of LC and HCC development. Key words: viral hepatitis, chronic hepatitis, antiviral therapy, peginterferon, interferon-free, dual therapy, triple therapy