Regional Clinical Infectious Hospital Research Articles

Features of the clinical course of measles infection during the measles outbreak in 2018-2019 in Ukraine

Measles is an infectious disease characterized by an acute onset, a short prodromal period, presence of febrile, catarrhal and intoxication syndromes, as well as the development of typical enanthema and exanthema. Despite the active work of WHO to eliminate measles and the introduction of a vaccination program in developing countries, measles remains an urgent problem and the cause of high mortality rates among both children and adults. One of the dangerous complications of measles infection is the respiratory tract involvement in yhe form of out-of-hospital pneumonia, which occurs in 10-34% of patients. The out-of-hospital pneumonia was one of the main complications among the patients with measles who were treated in the Kharkiv regional clinical hospital and was registered both in patients with severe and moderate disease. That is why it was interesting to study the clinical and laboratory features of the course of measles infection in the adult population at the present stage. Objective: to determine features of the clinical course of measles infection and the factors that are prerequisites for the development of complications. Materials and methods. The study included 65 patients who were treated in the Kharkiv regional clinical infectious hospital in 2018-2019. Based on the clinical course of the disease, the severity and the presence of complications, the patients included in the study were divided into 4 groups. The control group consisted of 20 healthy voluntary donors who did not have exclusion criteria. On the day of admission to the hospital and on the 10th day of stay in the hospital, based on the data of a clinical blood test, we calculated the cellular reactivity leukocyte indices (CRLI) – the white blood cell shift index (WBCSI), the white blood cell index (WBCI) and the D. A. Ivanov immunoreactivity index (IRI). Results and discussion. The study shows that the patients from groups 1 and 2 on the 10th day of hospitalization showed a complete clinical recovery and was discharged from the hospital, whereas patients from groups 3 and 4 on the 10th day showed a clinical improvement and were transferred for further treatment to the general department. When assessing the CRLI on the day of admission to the hospital, an increase in the WBCSI in patients from groups 2, 3 and 4 was found, with the greatest increase observed in patients from group 4. In patients from group 1, on the contrary, a decrease in the WBCSI and and an increase in WBCI were determined, which indicates the activation of the lymphocytic link of the immune response. Conclusions. The development of measles infection in the adult population is characterized by changes in the leukocyte indices of cellular reactivity, which are markers of the functional activity of the immune system. The moderate course of the disease is accompanied by a tendency to normalization of the indices that characterize the activity of the inflammatory process, while its severe course is characterized by an increase in the values of these indices and a decrease in the activity of the lymphocytic link of the immune response. Assessment of changes in the parameters of leukocyte indices in dynamics makes it possible to predict the clinical course of the disease and the risk of complications, to assess the adequacy of the therapy, as well as to identify the need for immune correction therapy.

Clinical significance of laboratory diagnostics of coxyellosis in children.

The urgency of the problem of coxyellosis in children is determined by the endemic nature of this pathology for a number of regions of Russia. The purpose of the study: to evaluate the results of diagnosis of coxyellosis in children using the methods of complement binding reaction (RSC), enzyme immunoassay (ELISA), and polymerase chain reaction (PCR). Retrospective analysis of the survey on Coxiella in 3 groups of children aged 7 to 17 years: group 1 (n=30) method RSK; group 2 (n=34) - by ELISA; group 3 (n=35) - PCR, were hospitalized in GBUZ «Regional clinical infectious hospital named. A. M. Nicholi» Astrakhan in the period from January 2010 to January 2020. The most informative methods of diagnosis of coxyellosis in children during the first 7 days from the onset of the disease is the PCR reaction (specificity-94%, sensitivity-91%), after the 7th day of the disease ELISA (specificity -91%, sensitivity - 94%).The sensitivity of the RSC method is 70%, the specificity is 87%.

Clinicopathogenetic features of cardiovascular system affection in influenza patients with hypertensive reaction revealed for the first time

Aim. To study the state of central hemodynamics, oxygen metabolism and tissue blood flow in patients with influenza who suffered from hypertensive reaction detected for the first time, in dynamics of infectious process.
 Materials and methods. At Perm Regional Clinical Infectious Hospital, 65 patients with influenza underwent a deepened study of cardiovascular system: central hemodynamics and local blood flow.
 Results. While studying the central hemodynamics, there was detected the increased general peripheric vascular resistance without normalization during the follow-up period. Investigation of gas exchange showed decrease in tissue oxygenation, vasodilatation and tissue blood flow.
 Conclusions. Among patients with influenza, the oxygen transport system functions in a tense regime. In dynamics of infectious process and after the disease, the following is observed: development of tissue hypoxia, decrease in local blood flow tempo and elevation of general peripheric vascular resistance.

Immunodiagnostics of cerebral toxoplasmosis depending on permeability of blood-brain barrier

The aim of the work was to detect a diagnostic value of CNSToxoIndex - index of correlation between albumin concentration and anti-toxoplasma antibodies, which reflects local production of anti-toxoplasma IgG in CNS compared with their level in blood. Materials and methods: 30 HIV-infected persons with the IV clinical stage (16 man and 14 women) aged from 25 to 49 years with clinical and instrumental signs of cerebral toxoplasmosis were selected from the general array of the patients treated in the Regional Clinical Infectious Hospital. A retrospective parallel detection of IgG T. gondii was performed in serum and CSF in patients, whose results of ELISA or PCR on T. gondii were positive. Blood serum and CSF were obtained from patients at the same time. All samples for analysis were stored at -20 °C and then tested on the RT-2100C Rayto Life and Analytical Sciences Co., Ltd (China) immunoassay analyser for quantitative detection of the level of specific anti-Toxicoplasma IgG. Detection of albumin concentration in serum and CSF was performed on the Chemray-120 Automated Biochemical Analyzer Rayto Life and Analytical Sciences Co., Ltd (China) using the Liquick Cor-ALBUMIN Diagnostic Kit. Results: Specific IgG to T. gondii in blood plasma was found in 27 patients (90%) while in CSF only in 7 (23 %). The results of the research in this group of patients were represented by the following parameters: patient 1 (blood antiToxo IgG - 200 IU/ml, blood albumin - 36 g/l, CSF antiToxo IgG - 10 IU/ml, CSF albumin - 0.8 g/l, CNSToxolndex - 2.3); patient 2 (150 / 40 / 90 / 0.7 / 34.3, respectively); patient 3 (90 / 35 / 64 / 0.25 / 99.6); patient 4 (140 / 39/ 10/ 0.19/ 14.7); patient 5 (88 / 52 / 48 / 0.21 / 135.1); patient 6 (160 / 48 / 50 /0.15 / 100.0); patient 7 (122 / 42 / 15 / 0.17 / 30.4). Consequently, taking into consideration the diagnostic marker CNSToxolndex more than 10.0, cerebral toxoplasmosis was diagnosed only in six patients from seven, in whom anti-toxoplasma antibodies in CSF were detected. Patient 1, despite clinical symptoms similar to cerebral toxoplasmosis, and substitute signs of cerebral toxoplasmosis detected with the help of neuroimaging methods (volumetric formation of the right frontal lobe with a ring-shaped enhancement), availability of specific anti-toxoplasma antibodies in blood serum and CSF, diagnosis of cerebral toxoplasmosis has not been confirmed. M. tuberculosis DNA was found in CSF by PCR. Conclusions: CNSToxoIndex allows evaluating the local production of anti-toxoplasmic IgG in CNS and their diffusion from blood as a result of the blood-brain barrier damageand it is a powerful method of cerebral toxoplasmosis diagnostics in HIV-positive people as well.

A/H1N1 INFLUENZA CLINICAL CASE, COMPLICATED BY RAY SYNDROME

The flu problem is becoming more urgent, as the incidence in Ukraine over the last decade is 7-8 million people annually, of which about 30% are children. Hospitalization of children under 5 years 120-123 per 100 thousand population per year and average bed-day is 6.5 days. Influenza complications are a major threat to the lives of children. According to the Public Health Center of the Ministry of Health of Ukraine, 5.4 million people were infected with influenza and SARS during the 2018/2019 epidemic, 65.3% of whom were children. The flu claimed the lives of 64 Ukrainians, including 12 children, under the age of 17. None of the dead were vaccinated for the flu, 11 people did not seek medical help at all, and one of five people sought help with a critical deterioration in health on the 6 day or later. Among 2927 laboratory-tested influenza patients, 30% had positive results, with the predominance of type A influenza virus. For the purpose of the publication, the authors set out to focus on the circumstances of the occurrence of Ray syndrome with the analysis of a clinical case of a 2 years child, who was in the regional clinical infectious hospital, in the intensive care unit. The condition of the child was found to be severe and a fatal incident was noted on the 5th day of stay in the department of the intensive care unit in the regional infectious hospital. The final clinical diagnosis after a detailed laboratory and instrumental examination was made at an expanded council of doctors of the regional clinical infectious hospital in Poltava and the above mentioned narrow specialists: Flu A / H1N1, toxic form, severe course. Toxic encephalopathy. Brain edema, dislocation of its structures. Toxic hepatitis. Ascites. Erosive gastritis. Gastrointestinal bleeding. Acute kidney damage. Gastrointestinal bleeding. Anuria. Acute renal failure. ICE Syndrome. Non-rheumatic carditis (pancarditis, pericarditis). Heart failure 3 degree. Polyseritis. Deficiency anemia. Ray syndrome.

Informative value of McIsaac scale for diagnosis of pediatric scarlatina

Aim. To estimate the statistical indices of informative value of clinical McIsaac scale at the example of scarlatina in children.
 Materials and methods. Retrospective cliniсostatistical analysis was carried out on the basis of 30 medical cards of children, hospitalized to children’s unit of Perm Regional Clinical Infectious Hospital in 2017 with diagnosis of scarlatina. The control group consisted of 25 children with moderately severe tonsillopharyngitis.
 Results. Clinical peculiar features of scarlatina were studied in 30 children, hospitalized to children’s infectious unit in 2017. Nowadays, scarlatina was revealed to have a typical course with characteristic clinical symptoms, including punctate rash, intoxication with increased temperature up to 38–39, acute tonsillitis, absence of cough in the acute period, moderate regional lymphadenitis. At the hospital stage, there predominate moderately severe forms of this disease. Bacteriological verification of Streptococcus pyogenes (at admittance to the hospital) in the investigated group was 74 %. Typical punctate rash remains the basic clinical symptom of scarlatina. Informative value of McIsaac scale for diagnosis of BHSA-tonsillitis with scarlatina infection was assessed. Specificity of assessment was 92 %.
 Conclusions. Clinicodiagnostic McIsaac scale is highly informative for diagnosis of BHSA-tonsillitis among children.

Nutritive status changes, studied in hiv-positive patients with pneumonias, caused by Streptococcus pneumoniae

Aim. To study the changes in nutritive status of HIV-positive patients, hospitalized with community-acquired pneumonias, caused by Streptococcus pneumoniae.
 Materials and methods. During 2014–2017, clinicolaboratory examination of 676 HIV-positive patients was carried out on the basis of Perm Regional Clinical Infectious Hospital. There were formed the groups of “observation”, including patients with pneumonias, caused by Streptococcus pneumoniae with lethal outcomes, and groups of “comparison”, including patients, discharged from hospital in satisfactory status.
 Results. Negative dynamics of nutritive status, caused by progression of the main disease and addition of bacterial agent was revealed. The moderately severe and severe changes were registered in patients with lethal outcomes already at the moment of hospitalization.
 Conclusions. Direct correlation between the protein-energy insufficiency and the number of life-threatening complications was determined.

ON AGE PECULIARITIES OF INFECTIOUS MONONUCLEOSIS

Aim. To determine the age peculiarities of infectious mononucleosis (IM), caused by Epstein-Barr virus, in hospitalized children. Materials and methods. On the basis of case histories of 50 children with infectious mononucleosis, caused by Epstein-Barr virus, who were hospitalized to children’s unit of Perm Regional Clinical Infectious Hospital in 2015, retrospective clinicostatistical analysis was carried out. Results. By means of mathematical prognostic modeling of age peculiarities of infectious mononucleosis, induced by Epstein-Barr virus, direct correlation dependence between children’ age and development of hepatitis with cytolysis syndrome was stated. To assess the probability of risk, a logistic classification model was developed. It was indicated that children over 3, despite moderately severe disease, are usually hospitalized reliably later, than younger children that can have unfavorable consequences due to late therapy of hepatitis. Conclusions. The created logistic classification model for assessment of age-dependent probability of risk for the development of hepatitis with cytolysis syndrome in Epstein-Barr infection indicated its growth by 1.5 times in children, reaching the age of 5.5 years.

CLINICAL PECULIARITIES OF COMMUNITY-ACQUIRED PNEUMONIA COURSE INDUCED BY STREPTOCOCCUS PNEUMONIA AND STAPHYLOCOCCUS AUREUS IN HIV-INFECTED PATIENTS

Aim. To reveal the clinical peculiarities of the course of community-acquired pneumonias caused by S.pneumoniae and S. aureus . Materials and methods. Over the period of 2006-20015, clinicolaboratory examination of 676 HIV-positive patients with community-acquired pneumonia was performed on the basis of Perm Regional Clinical Infectious Hospital. Results. It was established that the leading positions of etiological agents of nontuberculous etiology belong to S. pneumonia (30,1 %) and S. aureus (21,8 %). Conclusions. The clinical course of staphylococcal pneumonia in HIV-positive patients has a great number of complications and unfavorable outcomes.

CLINICOPATHOGENETIC PECULIARITIES AND PREVENTION OF TICK-BORNE BORRELIOSES

Aim. The aim of the study was to analyze the clinicopathogenetic peculiarities of tick-borne borrelioses (TBB) course in Perm Krai and their prevention. Materials and methods. During the period from 1991 to 2015, a complex clinicolaboratory and instrumental examination of 1878 patients with borrelioses was carried out at Regional Clinical Infectious Hospital of the city of Perm. Results. The disease is manifested in two forms: erythemal (77,5 %) and erythema-free (22,5 %). The organ pathology includes the damage of nervous and cardiovascular systems, locomotor system and liver. Reliable increase in the total peripheral resistance was detected while studying the hemodynamic structure. Decrease in tissue oxygenation, capillary-tissue oxygen diffusion, tissue metabolism and blood flow was revealed when determining the state of tissue gaseous metabolism. While studying the parameters of hemostasis, changes in the form of raised SFMC level, fall in Pt and APTT were found ( p < 0,05). Platelet serotonin neuromediator level analyzed in borrelioses patients indicated significant reduction in this index versus the control values. Conclusions. The peculiar feature of acute borreliosis course consists in the damage of different organs and systems that should be taken into consideration in diagnosis of this disease. New pathogenetic mechanisms in the form of structural and functional vascular changes, disturbed hemostasis in the form of development of latent syndrome of disseminated intravascular clotting were stated. Decrease in activity of cerebral serotoninergic structures in case of acute borreliosis course was established and need for correction of this status was shown. To prevent TBB development, it is necessary to carry out an antibacterial preventive course, which is of great efficiency, and results in a 10-12 fold reduction of morbidity.

PECULIARITIES OF PNEUMOCOCCAL PNEUMONIA COURSE IN MEDICAL PERSONNEL

Аim. To detect the clinical peculiarities of pneumococcal pneumonia course among medical personnel. Materials and methods. Over the period of 2001 to 2014, 49 patients diagnosed community-acquired pneumococcal pneumonia were examined on the basis of Perm Regional Clinical Infectious Hospital. Results. Analysis of the clinical course of S. pneumonia -induced community-acquired pneumococcal pneumonia in the group of medical personnel permitted to establish a number of peculiarities, which should be taken into account for diagnosis of these diseases. The disease was characterized by moderate and severe course with extensive pulmonary-tissue damage, clear complains and late response to bacterial inflammation in blood tests. Frequency of antibiotic-resistant S. pneumonia strains causing pulmonary-tissue damage was 16,3 % that exceeds the analogous index in the group of patients who do not belong to medical personnel. Conclusions. Peculiar features including difficulties in diagnosis of S. pneumonia -induced community-acquired pneumococcal pneumonia, severe course, significant number of cephalosporin and fluoroquinolone-resistant pneumococcal strains prove the need for specific prevention of medical personnel from pneumococcal infection.

OPPORTUNISTIC INVASIVE MYCOSES IN HIV-INFECTED PATIENTS

Aim. To study the peculiarities of the clinical course of invasive mycosis in HIV-infected patients so as to improve early diagnosis and timely adequate antimycotic therapy. Materials and methods. Over the period of 2007-2014. 62 patients including 34 patients with cryptococcosis, 28 - with invasive candidosis were observed at Perm Regional Clinical Infectious Hospital. Life-time diagnosis of invasive mycosis was fixed in 55 patients, postmortem - in 7 patients on the basis of complex clinicolaboratory, instrumental and mycologic methods including isolation and identification of fungous cultures. Results. Invasive fungous infections in HIV-infected patients are characterized by severe course with affection of central nervous system, development of multisystem insufficiency and high lethality (cryptococcosis - 50 %, candidosis - 36 %). Clinical manifestations of cryptococcal meningoencephalitis and invasive candidosis are nonspecific and similar to identical diseases of other etiology. The risk factors are the following: immunodeficiency (CD4 lower than 200 kl/mkl), lack of antiretroviral therapy and presence of superficial candidosis foci. Conclusions. Thus, so as to administer a timely and adequate antimycotic therapy, diagnosis of invasive fungous infections in HIV-infected patients should be complex including clinicoinstrumental studies and obligatory mycologic analysis of blood, liquor and other biological materials.

916 Clinical Paraclinical Characteristic of Measles in the Children in the Endemic Region

Backgraund and aimsIn this article we showed features of duration Measles in children from endemic region.MethodsWe investiganed 69 children with Measles in age from 3 to 15 months which used...