Non-specific Infection Research Articles

Смешанные неспецифические инфекционные заболевания влагалища: опыт локальной терапии

Aim: to describe the experience with the topical treatment for mixed non-specific vaginal infections. Patients and Methods: this prospective study included 72 women (mean age 26.3±5.5 years) with mixed non-specific vaginal infections who received a vaginal capsule containing metronidazole and miconazole (at night for 10 days) followed by a probiotic containing L. casei rhamnosus Doderleini (intravaginally for 14 days). Vaginal microbiota was assessed by real-time PCR. The ratios of Lactobacillus spp. and anaerobic microbe concentrations and the total amount of opportunistic microflora were calculated. In addition, vaginal pH, Hay/Ison criteria, and the sensitivity of Candida spp. to antimycotics (NCCLS standards) were evaluated. When analyzing cellular composition, white blood cell count, epithelial cell count, total cell count, and cytological coefficient were measured. The efficacy was assessed 10 days and 1 month after the treatment. Results: the treatment resulted in the significant reduction in the clinical (both subjective and objective) symptoms of mixed non-specific vaginal infections, the improvement of vaginal discharge pH and the cellular composition of vaginal discharge and vaginal microbiocenosis. Microscopy with Hay/Ison criteria assessment demonstrated the normalization of Lactobacillus count and the reduction in the threshold of opportunistic microflora and Candida spp. Conclusions: our experience with the topical treatment for mixed non-specific vaginal infections using a drug containing metronidazole and miconazole has demonstrated high clinical (96%) and microbiological (97.4%) efficacy and safety as well as good treatment compliance. KEYWORDS: mixed non-specific vaginal infection, decontamination, metronidazole, miconazole, vaginal microbiocenosis, bacterial dysbiosis. FOR CITATION: Borovikov I.O., Kutsenko I.I., Bulgakova V.P. et al. Mixed non-specific vaginal infections: the experience with topical therapy. Russian Journal of Woman and Child Health. 2020;3(4):221–227. DOI: 10.32364/2618-8430-2020-3-4-221-227.

The occurrence of hemotropic Mycoplasma ovis-like species in horses

Hemotropic mycoplasmas (haemoplasmas) are wall-less bacteria, which may lead to anemia and, even, mortality in mammals. The present study was aimed to characterize the causative agent(s) of haemoplasma infection in blood samples taken from horses (n = 133) in south of Iran. Microscopic examination of blood smears and PCR assay were performed for the detection of hemotropic Mycoplasma and equine piroplasma (Babesia caballi and Theileria equi). For the purpose of molecular characterization, 16S rDNA and 18S rDNA markers were used for hemotropic Mycoplasma and piroplasma pathogens, respectively. The PCR-positive samples were sequenced for haemoplasma and further phylogenetic analysis was performed for the obtained haemoplasma sequences. Nine out of 133 (6.77 %, 95 % CI: 2.5–11.04 %) horses were positive for Mycoplasma sp. by PCR. Furthermore, three of these animals were co-infected with T. equi. Interestingly, the phylogenetic and molecular analysis of the haemoplasma sequences derived from the PCR amplicons in the equine positive cases showed 100 % identity with 16S rDNA in Mycoplasma ovis, an HM member mainly found in sheep and goats. In addition, the hematological analysis showed that PCR positive horses for M. ovis-like species had a lower hematocrit (Hct), hemoglobin (Hb) concentration, and red blood cell (RBC) count compared to the PCR negative ones (P ≤ 0.05). Mild anemia was also developed in the haemoplasma-positive horses. These findings represent the first molecular evidence of M. ovis-like species in horses. Further experimental studies are needed to examine the importance of this nonspecific host infection and evaluate its pathogenicity in equine and other species.

Management of Spontaneous Spinal Discitis and Spondylodiscitis in Older People

Introduction: Spontaneous spinal infection is an uncommon disease, although the incidence is increasing in the last years. Absence of specific symptoms, and delayed diagnosis result in high morbidity, and mortality. Aim of the Study: To assess the clinical status of the patients, laboratory markers of inflammation, radiological findings, causative organisms, methods of management and their outcome. Patients and Method: Prospective study of 14 patients having spontaneous spinal infection from April 2017 to June 2019. Results and outcome: The study included eight males and six females with mean age of 43.1 years. On Denis pain score, six patients were P5 and eight patients were P4. Fever was found in nine patients. As regards ASIA score, seven patients were ASIA score E (normal motor, and sensory function), six patients were ASIA score D and one patient ASIA score C. Nine patients were found to be diabetic. Laboratory markers of inflammation were elevated in all patients. Two patients were managed conservatively (14.3%) (two cases were TB infection). Twelve patients were managed surgically (85.7%), six of them were TB infection (50%), three were nonspecific infection (25%), one patient was Staph aureus, one streptococci, and one brucella contributing to (8.3%) for each. There was improvement of neurological condition as eleven patients became ASIA score E, and three D and pain had also improved in all patients, ten patients became Denis P1, and four P2. Conclusions: Early diagnosis of spontaneous spinal infection depends on clinical sense to detect patients with back or cervical pain associated with fever and elevated laboratory markers of inflammation. A diagnosis was proved by MRI. Not all cases of Spinal infection need surgery. The indication of surgery is the presence of neurological deficit, spinal instability and failure of medical treatment in case of severe pain. Tuberculosis was the commonest organism as it is endemic in Egypt.

Peptide arrays of three collections of human sera from patients infected with mosquito-borne viruses.

Background: Global outbreaks caused by emerging or re-emerging arthropod-borne viruses (arboviruses) are becoming increasingly more common. These pathogens include the mosquito-borne viruses belonging to the Flavivirus and Alphavirus genera. These viruses often cause non-specific or asymptomatic infection, which can confound viral prevalence studies. In addition, many acute phase diagnostic tests rely on the detection of viral components such as RNA or antigen. Standard serological tests are often not reliable for diagnosis after seroconversion and convalescence due to cross-reactivity among flaviviruses. Methods: In order to contribute to development efforts for mosquito-borne serodiagnostics, we incubated 137 human sera on individual custom peptide arrays that consisted of over 866 unique peptides in quadruplicate. Our bioinformatics workflow to analyze these data incorporated machine learning, statistics, and B-cell epitope prediction. Results: Here we report the results of our peptide array data analysis, which revealed sets of peptides that have diagnostic potential for detecting past exposure to a subset of the tested human pathogens including Zika virus. These peptides were then confirmed using the well-established ELISA method. Conclusions: These array data, and the resulting peptides can be useful in diverse efforts including the development of new pan-flavivirus antibodies, more accurate epitope mapping, and vaccine development against these viral pathogens.

Repurposing an HIV Drug for Zika Virus Therapy.

Repurposing an HIV Drug for Zika Virus Therapy.

Severe fungal infections following blunt traumatic injuries: A 5-year multicenter descriptive study

IntroductionThe aggressive and timely treatment of post-traumatic fungal infections is the most efficacious way to reduce morbidity and mortality. Compared to the military trauma population, studies reporting on fungal infections in civilian trauma are not well described. The purpose of this study was to describe characteristics of civilian trauma patients who developed fungal infections and to identify common risk factors and report any delays between injury and treatment. MethodsThis was a five-year (1/1/2013–3/1/2018) retrospective, descriptive study across six level 1 trauma centers. All consecutively admitted trauma patients (≥18 years) with laboratory-confirmed fungal wound infections were included. Patients with solely candida wound isolates were excluded. Patient demographics, clinical wound and infection characteristics, organisms cultured, treatment modalities, length of stay, in-hospital mortality, and any diagnostic or treatment delays were described. ResultsOf the 54,521 trauma patients screened for fungal infection, 12 were identified. All patients suffered major injuries after blunt trauma (abbreviated injury score 3–5) and sustained wound contamination, and in nine patients, the cause of injury was motor vehicle. Six had open wounds/fractures on admission. The geographical region with the highest rate of fungal infection was Texas (n = 7), followed by Kansas (N = 3), then Missouri (N = 2). First symptoms of infection (leukocytosis or fever (n = 10)) presented a median of 6.3 (4.1–9.8) days after injury. Wound management entailed a combination of debridements (n = 8), negative pressure wound therapy (n = 9), amputation (n = 6), and antifungal treatment (n = 10). All fungal isolates identified from the wound site were hyphomycetes. A median of 2.1 (1.8–4.0) days passed from diagnosis to first antifungal treatment, and 3 patients died. ConclusionsOur study shows the challenges surrounding diagnosis and treatment of fungal infections secondary to trauma. Non-specific fungal infection symptoms, such as leukocytosis and fever, typically presented a week after injury. Vigilance for investigating risk factors and infection symptoms may help clinicians with more timely management of trauma patients with a severe fungal infection.

A Novel Magnetic Resonance Imaging Scoring System in Making Specific Diagnosis of Tubercular Spondylitis in Advanced Infection

Objective: The diagnosis of tuberculous spondylitis by microbiological and histopathological analysis is time consuming. Non-invasive methods such as magnetic resonance imaging (MRI) are useful for early diagnosis of infective spondylitis; however, the usefulness of MRI in accurate prediction of tuberculosis rather than non-specific infections is still not elucidated. There is a lacuna in the literature with regard to this. Non-invasive identification of tubercular etiology help in initiation of appropriate treatment and thus a better therapeutic response. We intend to devise a novel MRI score in making a confident diagnosis of tubercular spondylitis rather than non-specific infective spondylitis. Materials and Methods: A retrospective observational analysis was performed on 125 biopsy-proven infective spondylitis patients which included 70 tubercular (Group A) and 55 pyogenic (Group B) patients. Tubercular spondylitis was confirmed by either positive result of tissue gene expert test, histopathology or culture results. Eight MRI findings described in literature to be favorable for tubercular spondylitis were selected and analyzed for their predictive value, and a scoring system is derived based on the observations. Results: Statistically significant differentiation was noted in six out of selected eight MRI parameters, namely, (1) involvement of more than two contiguous vertebrae, (2) presence of para or intraosseous abscess, (3) subligamentous spread, (4) vertebral collapse, (5) large collection with thin abscess wall, and (6) presence of hypointense debris/wall on T2WI. Positive predictive value for tubercular spondylitis was obtained for the following MRI parameters by multivariate regression analysis: (1) Sub-ligamentous spread, (2) vertebral collapse, (3) large collection with thin abscess wall, and (4) presence of T2 hypointense debris. These MRI parameters having an independent prediction of tuberculosis were given two points score for each. Less significant MRI findings of more than two contiguous vertebral involvement and presence of intraosseous abscess were given a score of one for each. A total score of 10 was formulated and scoring for both groups was tabulated and analyzed. Contrary to that available in literature, no significant statistical correlation for differentiation was observed in our group for the presence of skip lesions and absence of intervertebral disc involvement. Hence, these were not included in our scoring system. Distribution of scores among the subjects aged 53.4 ± 17 years showed P < 0.001 (t-test and Mann–Whitney U-test) with mean of 7.4 for tubercular and 2.9 for pyogenic group (SD of 1.9). A score of 6 or above suggested tuberculosis and score below 6 suggested pyogenic infection (Chi-square value of 87.67 and P < 0.00001). Conclusion: MRI can thus be used for accurate diagnosis of spinal tuberculosis, and our novel MRI scoring system can be applied to exclude non-specific spondylodiscitis, help in reducing the burden of additional invasive investigations, expenditure and the time delay for initiating antitubercular treatment.

Mediastinal Lymphadenopathy in Children With Histoplasmosis

BackgroundMediastinal lymphadenopathy (ML) in children can arise from malignancy, infection, or rheumatic illness among others, and may be found incidentally on imaging or during workup for a variety of symptoms. Our aim was to describe the clinical presentation and natural history of histoplasmosis in children who present to a tertiary care center with ML in an endemic area of the country. MethodsAfter institutional review board approval, a retrospective study of all children (aged < 21 y) presenting with proven (positive serologies) or suspected histoplasmosis (negative serologies, negative tuberculosis testing, and benign outcomes in follow-up) over a 5-y period was done. Seventy-four patients were tested; those with another diagnosis (n = 6) or without ML (n = 26) were excluded, for a total cohort of 44 patients. Demographics, clinical presentation, symptoms, laboratory data, treatment course, radiography studies, and inpatient and outpatient visits were examined. ResultsOf the 44 patients with ML, 27 had proven histoplasmosis, and 19 had suspected histoplasmosis. The median follow-up by imaging or clinical examination was 6.9 mo (0.3-73.2 mo). Sixteen patients received antifungal therapy with itraconazole, and 15 patients received at least one course of steroids, nearly all for respiratory symptoms; 11 patients (24%) received both. There was no difference in readmission rate (n = 5 versus 2, P = 0.7) or recurrence of symptoms (n = 2 versus 5, P = 0.4) between patients who received an antifungal and those that did not. Receiving steroid therapy was associated with airway narrowing and a higher readmission rate (n =6 versus 2 who were not treated with steroids, P = 0.04), but not with symptom recurrence. Nine lymph node or mass biopsies were performed; however, the pathology only confirmed nonspecific infection in three and was nondiagnostic in the remaining six patients. Twenty-seven patients had at least one confirmatory laboratory test positive for histoplasmosis. Thirty-nine of the 44 patients (84%) with a diagnosis of histoplasmosis (proven or suspected) were asymptomatic by 1-2 mo follow up, with the remainder having intermittent chest pain or reactive airway disease. ConclusionsML because of proven or suspected histoplasmosis is usually a self-limiting disease that can be managed with treatment of the child's symptoms. Antifungals and steroids are of unclear benefit and may not alter the natural course of the disease. Biopsies are rarely diagnostic in the setting of ML, and invasive procedures should be avoided.

Traditional Chinese medicine on treating epididymitis: A systematic review and meta-analysis protocol.

Background:Epididymitis is a common disease in nonspecific infections of the male reproductive system according to the clinical incidence of acute epididymitis and chronic epididymitis. Many clinical trials have proven that Chinese medicine has a significant effect in the treatment of epididymitis. In this systematic review, we aim to evaluate the effectiveness and safety of traditional Chinese medicine (TCM) for epididymitis.Methods:We will search for PubMed, Cochrane Library, AMED, Embase, WorldSciNet, Nature, Science online, China Journal Full-text Database (CNKI), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials included in the China Resources Database. The time is limited from the construction of the library to November 2018. We will use the criteria provided by Cochrane 5.1.0 for quality assessment and risk assessment of the included studies, and use the Revman 5.3 and Stata13.0 software for meta-analysis of the effectiveness, recurrence rate, and symptom scores of epididymitis.Ethics and dissemination:This systematic review will evaluate the efficacy and safety of TCM for treating epididymitis. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process.Registration number: PROSPERO CRD42019130569

FISTULOTOMY FOR THE SURGICAL TREATMENT OF PERIANAL FISTULA OF CRYPTOGLANDULAR ORIGIN

Perianal fistula usually results from a non-specific infection of the cryptic glands located at the anal dentate line. Identification of the exact course of a perianal fistula and the extent of anal sphincteric complex involvement are of paramount importance, in order to design the therapeutic and interventional approach and achieve the best results without impairment of the anorectal function. Several interventional methods are in use for the surgical treatment of CPF, including fistulotomy, insertion of cutting “seton”, core fistulectomy, ligation of the intersphincteric fistulous track (LIFT), rectal advancement flap, injection of fibrin glue at the fistulous track, insertion of fistulous plug, and obliteration of the fistulous track with the use of Laser. In clinical practice a combination of the aforementioned methods can be used, in particular for the complex-high or recurrent fistulae.

Bacteriology of the anterior genitalia of the domestic house cat: aetiology of non-specific infection.

The bacteriology of the anterior genitalia of the domestic house cat was determined using vaginal swabs collected from sixty apparently healthy female domestic cats (20 kittens, 20 pregnant and 20 non-pregnant adults). The swabs were streaked on blood agar, Mac Conkey agar and eosin methylene blue agar plates which were all incubated at 37 o C for 24 – 48 hours. Biochemical tests were also used to determine the bacterial isolates. The species of bacteria isolated were; coagulase negative Staphylococci 31 (25.2%); α-haemolytic Streptococci 21 (17.1%); Actinomyces pyogenes 21 (17.1%); E. coli 16 (13.0%); Bacillus species 12 (9.7%); β-haemolytic Streptococci 9 (7.3%); Proteus species 8 (6.5%) and Staphylococcus aureus 5 (4.1%). These organisms could therefore be regarded as part of the normal aerobic vaginal flora of domestic cats found in the semi-arid region of north -eastern Nigeria. Keywords: Domestic cats, Aerobic bacteria, Anterior genitalia, Semi-arid region, Nigeria.

Abdominal pain is a common and recurring problem in paediatric emergency departments.

Abdominal pain is a frequent reason for paediatric emergency department visits, but specific research is lacking. Our aim was to obtain information on the diagnosis of abdominal pain and what healthcare services children with this condition need. This retrospective study focused on patients visiting the emergency department of the Children's Hospital Iceland in 2010 with abdominal pain and any subsequent visits up to 1 January 2015. There were 11340 visits to the emergency department in 2010 and 1118 children made 1414 (12%) visits due to abdominal pain. The majority (58%) with abdominal pain were girls (p<0.001) and they were older than the boys, with an average age of 12 versus 10years (p<0.001). The most common diagnoses were non-specific abdominal pain (40%), constipation (22%) and viral infections (13%). During the follow-up period, 423/1118 children (38%) visited the emergency department 883 times, 58% were girls and the most common diagnosis was non-specific abdominal pain (37%). Of the 436 children initially diagnosed with non-specific abdominal pain, 154 (35%) revisited the emergency department during the follow-up period. Abdominal pain was a common reason for visits to the paediatric emergency room and a third paid more than one visit.

Diet and disease in Tomar, Portugal: Comparing stable carbon and nitrogen isotope ratios between skeletons with and without signs of infectious disease

ObjectivesThis study explored the correspondence between stable isotope ratios and indicators of non-specific (periostitis and/or osteomyelitis) and specific (venereal syphilis) disease in a sample of human skeletons from a Portuguese archaeological collection. Additionally, this study examined stable carbon (δ13C) and nitrogen (δ15N) isotope ratios between individuals at different disease stages. Materials and methodsδ13C and δ15N data from previously analysed skeletons without signs of infectious disease or physiological stress (n = 32) were compared to new data from skeletons with active (n = 6), healed (n = 7) or a combination of both lesions (n = 10). Skeletons with lesions (n = 23) were also grouped as having only healed tibial periostitis (n = 7), generalised non-specific (n = 5) and generalised specific infections (n = 2). The skeletons with lesions that did not fit into these groups (n = 9) were not used in this analysis. ResultsThe δ15N from skeletons with non-specific generalised infections in several bones differed significantly when compared to skeletons that had either only healed tibial periostitis or were without lesions. Skeletons with venereal syphilis had similar mean δ13C and δ15N to either skeletons without signs of disease or those with only healed tibial periostitis. DiscussionThese results suggest different diets may be linked into an individual's susceptibility to these pathogens. Diet influences resistance to infectious disease, while infections decrease nutrient availability, increase malabsorption and resting energy expenditure. Potentially therefore, combining isotopic evidence of diet with pathology may contribute to a new understanding of health and lifestyle in the past.

Minimally invasive surgery for the treatment of thoraco lumbar pyogenic spondylodiscitis: indications and outcomes.

Pyogenic spondylodiscitis (PS) is a non-specific infection affecting intervertebral disks and adjacent vertebral bodies. Once considered a rare condition in developed countries, the incidence of PS has been increasing alarmingly and still represents a challenge for clinicians and orthopedic surgeons. New minimally invasive techniques have been proposed but the proper indications for these different approaches remain controversial. The aim of this study was to describe the available minimally invasive surgical techniques and to evaluate their proper indications through a review of recent literature. Over 30 articles of recent scientific literature have been reviewed and analyzed. Studies were searched through the PubMed database using the key words: spondylodiscitis, minimally invasive, and surgical treatment. The most interesting and valid techniques and results have been reported. Despite the exclusion of case reports, all the available studies have been conducted on small groups of patients. Indications for each technique have been reported according to a clinical-radiological classification of PS. Six of the most widely used minimally invasive surgical techniques have been described. High success rates have been reported in terms of preventing the progression of spondylodiscitis into more destructive forms, reduction of time and operative hospitalization, faster pain relief, early mobilization, and achievement of microbiological diagnosis. The role of minimally invasive surgery in the treatment of PS is rapidly expanding. Reducing surgery-related morbidity in these frail patients is possible and often necessary. However, while more and more new techniques are being proposed, still few clinical data are available. Clinical comparison studies with open traditional surgery should be encouraged, and more attention should be paid to long-term outcomes. For the present, the indications for minimally invasive procedures should, therefore, be evaluated on a case by case basis and on clinical and radiological findings.

Detection of ureaplasma urealyticum by polymerase chain reaction examination in nonspecific genital infection patients

Non specific genital infection (NSGI) is a condition affecting females which causes inflammation of the endocervix or anterior urethra that is not caused by Neisseria gonorrhoeae. The causative sexually transmitted organisms include Chlamydia trachomatis (Groups D to K) and Ureaplasma urealyticum. Infection caused by Ureaplasma urealyticum is often asymptomatic even though many studies have pronounced that Ureaplasma urealyticum can contribute not only to lower genitourinary infection but also to infertility. Ureaplasma urealyticum cannot be stained by Gram stain due to the lack of a cell wall of the organism. This research aims to evaluate the prevalence of Ureaplasma urealyticum in NSGI patients by using the polymerase chain reaction (PCR) method targeted in the ureaplasma gene structure 429 bp area. The samples were extracted from eighteen DNA NSGI patients. Eleven out of eighteen (61.11%) DNA NSGI samples tested positive for Ureaplasma urealyticum. Most patients (44.44%) with Ureaplasma urealyticum were unemployed, and 27.78% were complaining of recurrent vaginal discharge. The high incidence of Ureaplasma urealyticum in this study needs further attention since doxycycline remains the drug of choice of NSGI. Moxifloxacin should be considered for patients who are making no clinical progress with doxycycline.

Polymerase chain reaction chlamydia trachomatis examination in nonspecific genital infection patients

Introduction: Nonspecific genital infection (NSGI) is an inflammation of urethra, rectum, or cervix that caused by nonspecific bacteria. Chlamydia trachomatis is known as the most causal organism of NSGI, usually mild (mucopurulent discharge) or asymptomatic, and if untreated it can cause serious complication such as pelvic inflammatory disease that leads to infertility in women. The diagnosis of Chlamydia trachomatis needs an advanced method, such as polymerase chain reaction (PCR). PCR has high sensitivity and specificity, and endocervical swab is specimen of choice that also has high sensitivity and specificity to diagnose Chlamydia trachomatis. Method: This research aims to evaluate if Chlamydia trachomatis is the most causal organism of NSGI by PCR Chlamydia trachomatis using 201bp primers. Results: Eighteen NSGI married patients who came to outpatient clinic were evaluated from endocervical swab. The result demonstrated that 16,67% from eighteen NSGI patient positive Chlamydia trachomatis. Conclusion: The low incidence of Chlamydia trachomatis in low risk population such in this study need further study, the cause of NSGI needs to be known certainly so the exact treatment can be given.

Adeno Associated Virus (AAV) as a Tool for Clinical and Experimental Delivery of Target Genes into the Mammalian Retina.

With an increasing number of identified causative genes, the widespread use of gene therapy is quickly becoming feasible. Once a target gene is selected, it is important to have a cell delivery method that is both specific and efficient. Cell type specificity and high efficiency is particularly important for the treatment of retinal degeneration, since viruses are efficient gene delivery vehicles for the nervous system, but often bring with them non-specific infections. In this review, we focus on adeno-associated virus (AAV). Over the last few decades, AAV has become a leading choice for safe gene delivery, in part due to its replication deficiency in cells without a helper virus. Here, we summarize the tropism of recombinant AAV (rAAV) for various types of mammalian retinal neurons in relation to capsid serotype and administration method. We also include our recent findings on an AAV serotype that AAV was specifically infected mouse cone photoreceptors when delivered by subretinal administration.

Pertussis: The Identify, Isolate, Inform Tool Applied to a Re-emerging Respiratory Illness.

Pertussis, commonly referred to as “whooping cough,” is a highly contagious acute respiratory infection that has exhibited cyclical outbreaks throughout the last century. Although vaccines have provided some immunity, many populations, including infants and pregnant women, remain at risk for serious illness. Through the use of the novel “Identify, Isolate, Inform” (3I) tool, emergency department (ED) providers can readily recognize key symptoms of the disease and risk factors for exposure, thus curbing its transmission through early initiation of antimicrobial therapy and post-exposure prophylaxis. The three classic stages of pertussis include an initial catarrhal stage, characterized by nonspecific upper respiratory infection symptoms, which may advance to the paroxysmal stage, revealing the distinctive “whooping cough.” This cough can persist for weeks to months leading into the convalescent stage. Household contacts of patients with suspected pertussis or other asymptomatic, high-risk populations (infants, pregnant women in their third trimester, and childcare workers) may benefit from post-exposure prophylactic therapy. The Pertussis 3I tool can also alert healthcare professionals to the proper respiratory droplet precautions during contact with a symptomatic patient, as well as isolation practices until antimicrobial treatment is in progress. ED personnel should then inform local public health departments of any suspected cases. All of these actions will ultimately aid public health in controlling the incidence of pertussis cases, thus ensuring the protection of the general public from this re-emerging respiratory illness.

Diagnosis of pulmonary tuberculosis in a pulmonology hospital

A clinical case of 23-year old female with pulmonary tuberculosis is described in this article. The patient was admitted to a hospital with preliminary diagnosis of community-acquired pneumonia and negative TB test. Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia is often difficult and could be more difficult in patients with co-existing specific (Mycobacterium tuberculosis) and non-specific infection in the lungs.

ОПЫТ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ТУБЕРКУЛЕЗНОГО И НЕСПЕЦИФИЧЕСКОГО АРТРИТА МЕТОДОМ ДВУХЭТАПНОЙ АРТРОПЛАСТИКИ С ИСПОЛЬЗОВАНИЕМ АРТИКУЛИРУЮЩИХ ЦЕМЕНТНЫХ СПЕЙСЕРОВ, НАСЫЩЕННЫХ АНТИБИОТИКАМИ

The objective : to analyze the results of surgical treatment of tuberculosis and non-specific arthritis of large joints of extremities by two-stage endoprosthesis replacement using cement articulating spacers saturated with antibiotics. Subjects and methods . The prospective single-center cohort trial included 36 clinical cases in 35 patients with purulent destructive arthritis of the hip, knee, and shoulder joints, who underwent two-stage surgery from 2010 to 2018. This method implied using cement articulating spacers at the first stage of surgery followed by replacement with a prosthetic implant. Joint tuberculosis was diagnosed in 7 (20.0%) patients, all other cases were non-specific arthritis. Results . In all 36 cases, patients underwent a full cycle of two-stage endoprosthesis replacement of joints affected by tuberculosis or non-specific infection resulting in pronounced destructive changes. In 33 clinical cases of the patients (91.67%), a positive outcome was observed with restoration of joint and extremity function in general with persistent eradication of the infection. An unfavorable outcome was obtained in 3 patients due to development of periprosthetic infection and loosening of the implant, 2 of them had tuberculous arthritis.