Vol 24, No 5-6 (2019)

Outbreaks of infectious diseases in healthcare facilities: Issues of epidemiological diagnostics and preanalytical stage
Smirnova S.S., Yuzhanina T.S., Vyatkina L.G., Golubkova A.A., Alimov A.V.

Background. The issue of outbreaks of infectious diseases in healthcare facilities is not often discussed in the scientific community. Several years ago, the primary etiological agents of outbreaks in hospitals were bacteria, whereas in most cases under modern conditions, outbreak incidence is caused by viruses.

Aim. Based on the analysis of research materials on outbreaks of infectious diseases in healthcare facilities of Ural and Siberian Federal Districts, this work aimed to characterize infectious diseases under contemporary conditions and identify problematic issues of the preanalytical stage of epidemiological diagnostics and the organization of preventive and anti-epidemic measures.

Methods. The data of federal statistical monitoring form No. 23 “Information on outbreaks of infectious diseases” (18 units of information) and the copy of the “Acts of an epidemiological investigation of foci of infectious (parasitic) diseases with the establishment of a causal relationship” (14 units of information) were analyzed. The work used epidemiological and statistical methods of information processing. The significance of differences between the indices of independent samples was evaluated using Fisher’s exact test.

Results. In 2018, 14 outbreaks of infectious diseases were recorded in healthcare facilities in 7 out of 18 subjects in Ural and Siberian Federal Districts. The total number of victims was 183 people (97 (53.0%) children and 86 (47.0%) adults). Most of the outbreaks (12 of 14; 85.7%) were of viral etiology. One outbreak was of bacterial, and one was of fungal origin.

Discussion. Viruses played a key role in the formation of foci with multiple diseases in the healthcare facilities of Ural and Siberian Federal Districts in 2018. Most of the foci of infection with an aerogenic transmission mechanism were caused by varicella-zoster virus, and those with fecal–oral transmission mechanism were etiologically associated with Norwalk virus. Children were the most vulnerable contingents in outbreaks in the healthcare facilities. In all the situations analyzed, the prerequisites for an outbreak include the untimely isolation of the source of infection, hospital overload, and inadequate financial and logistical support. Anti-epidemic measures were conducted to the fullest extent during outbreaks of acute intestinal infections in comparison with outbreaks of a different etiology.

Conclusion. Most outbreaks registered in the hospitals could be prevented by vaccination of the related population.

Epidemiology and Infectious Diseases. 2019;24(5-6):204-212
Anthrax in Dagestan: clinical and epidemiological characteristics, risks, and prognosis of a group outbreak in 2019
Shakhmardanov M.Z., Abusuevа A.S., Nikiforov V.V., Tomilin Y.N., Burova S.V.

Anthrax continues to pose a serious problem for the healthcare and agricultural industries of Russia. Since 1900, over 70,000 outbreaks of human and animal infection have been recorded in Russia. Despite ongoing anti-epidemic measures, epizootics and epidemic foci of anthrax are recorded annually. Over the past 10 years, 23 anthrax outbreaks among people have been recorded in the Russian Federation with a morbidity rate of 90 people, and three fatal outcomes were observed. The Caucasus region ranks first in the Russian Federation in the incidence of anthrax in people and animals. The Republic of Dagestan is a region that is highly prone to anthrax. The spread is aggravated by landscape and environmental conditions that are favorable to the formation and long-term existence of anthrax foci. In most cases, the disease arises in areas previously considered safe for this infection, which indicates the presence of unregistered animal burial sites and the lack of proper control over sanitary condition. People become infected with anthrax due to the uncontrolled and forced farm slaughter of sick animals resulting from the lack of facilities for sanitary slaughter. Human infection occurs mainly during the slaughter of sick cattle, carving, and contact with animal raw materials. This article illustrates a group of anthrax outbreaks that occurred as a result of contact with a sick animal during slaughter and carving. Four local residents of one village fell ill, and in all of them, anthrax manifested in the form of a moderate skin course. The last case of anthrax in cattle in the said locality was recorded in 1958. This fact highlights the importance of compliance with anti-epidemic measures, including the so-called settlements that are safe for anthrax.

Epidemiology and Infectious Diseases. 2019;24(5-6):213-219
Clinical and epidemiological characteristics of hepatic cirrhosis of hepatitis C virus etiology in the early stages of its formation
Avdeeva M.G., Kulbuzheva M.I., Ganzha A.А., Zapashnaya O.V., Chernikova N.V., Kolodko E.I., Stolyrova L.P., Dobriev H.A., Dobriev H.A.

Background. Currently, the incidence of viral cirrhosis of the liver increases significantly, presenting an essential medical and social problem. This study aimed to clarify the clinical and epidemiological characteristics of hepatic cirrhosis of hepatitis C virus (HCV) etiology in the early stages of formation to improve the quality of diagnosis using a sample of patients from the regional hepatological center in Krasnodar (Specialized Clinical Infectious Diseases Hospital).

Methods. In 2018, 1,307 patients with liver diseases of viral etiology were examined and treated at the hepatological center. A retrospective analysis of the monitoring results of 153 patients with hepatic cirrhosis of viral C etiology with HCV replication was performed; patients with mixed etiology of cirrhosis were excluded from the study. The enrolled participants included 89 women (58.2%) and 64 men (41.8%). The average age of the patients was 53.5 ± 0.93 years. In accordance with the Child–Pugh classification of hepatic cirrhosis, class A (I) was diagnosed in 92 (60.1%) patients, and class B (II) was revealed in 53 (34.6%) patients.

Results. In 59.5% of cases, viral liver damage was first detected at the stage of outcome to cirrhosis. In 1/3 (32.5%) of the patients, the diagnosis of hepatic cirrhosis was established in the year of visit, and in another 27%, it was established during the first three years from the date of detection of hepatitis C markers. In less than in 1/5 (18.3%) of the patients, 9–24 years have passed from the discovery of hepatitis C markers to the establishment of hepatic cirrhosis. During the three-year follow-up period, the progression of cirrhosis with the transition to the next stage occurred in 6.5% of cases. In residents of Krasnodar Territory, among the leading epidemiological factors, including a monofactor epidemiological history and multifactorial nature with almost the same frequency, the alleged cause of infection was surgery (43%–45%). Prosthetics, dental sanitation, and blood transfusion were indicated as possible infection factors with high incidence. Factors, such as drug addiction, childbirth, tattoos, occupational injuries in medical personnel, and abortions, were recorded in isolated cases. In the early diagnostics of compensated class A cirrhosis, the increased contents of alanine and aspartate aminotransferases showed diagnostic value. Mild increases in the levels of alpha-fetoprotein and direct bilirubin, moderate decreases in prothrombin index and platelets, dilation in the diameter of the portal (v. portae) and splenic (v. lienalis) veins to borderline values with an upper limit of norm with an increased size of the spleen, and esophageal varices, and development of the initial stage of hepatic encephalopathy were also noted. The presence of extrahepatic manifestations in 12% of the patients should be considered.

Conclusion. Despite the high infection rate of the population with hepatitis C virus, late diagnostics of liver damage often occurred, and this finding is partly due to the late action of patients in seeking medical help. On the other hand, the widespread introduction of mandatory medical examination led to the active identification of sick people. For timely diagnosis, the presence of a history of risk factors for hepatitis infection must be considered, and attention must be focused on the abnormalities of blood biochemical parameters, ultrasound, and fibrogastroduodenoscopy data.

Epidemiology and Infectious Diseases. 2019;24(5-6):220-228
Clinical manifestations of parvoviral infection in Uzbekistan
Lokteva L.M., Pulatova R.Z., Aliyeva L.E., Musabaev E.I.

Parvoviral infection (PV B19) is an important but underinvestigated problem. Parvovirus B19 is being studied for the first time in Uzbekistan, and its clinical manifestations are not well known, thus requiring differential diagnosis with other viral infections and noncommunicable diseases. Available literature reported the possible relation of PV B19 in children to a number of pathological conditions, such as allergies, severe anemia, arthralgia, periarteritis nodosa, systemic lupus erythematosus, myocarditis, and hepatitis.

Epidemiology and Infectious Diseases. 2019;24(5-6):229-233
Detection of Coxiella burnetii in ticks collected from cattle in several provinces of the Republic of Guinea
Panferova Y.A., Freylikhman O.A., Tokarevich N.K., Naydenova E.V., Zakharov K.S., Senichkina A.M., Agafonov D.A., Nassour A.A., Konstantinov O.K., Sanaba B., Boiro M.

Background. Q fever, or coxiellosis, is a natural focal disease characterized by polymorphism of clinical signs and can affect not only humans but also many species of animals. This infection is spread almost all over the world. On the African continent, the foci of coxiellosis infection endanger the local population and people arriving for temporary stay. Given that sick agricultural animals and their ectoparasites are markers of the presence of infection in the region, a study of the latter may be relevant to identify the potential foci of Q fever.

This work aimed to identify Coxiella burnetii DNA from ixodic ticks collected from cattle in several provinces of Republic of Guinea and to type isolates using genetic markers (plasmid type) to enable their comparison with strains of different geographical origin.

Methods. Using amplification technologies, we investigated the ticks obtained from cattle in the provinces of Boke and Kindia to detect Coxiella DNA.

Results. The genetic material of the Q fever causative agent was detected in no more than 5% of the total number of samples studied. For positive samples, typing was performed using plasmid analysis. The isolates with the plasmid type QpH1 circulate in the Republic of Guinea.

Conclusion. The findings were analyzed along with data from other researchers on the spread of Q fever in subequatorial Africa. The differences in the levels of prevalence of Coxiella in ticks in the territories of not only different countries but also within the same state can be determined by the prevalence among the hosts within herds. The risk of contamination with Q fever in endemic regions should be considered.

Epidemiology and Infectious Diseases. 2019;24(5-6):234-239
Role of opportunistic infections in the formation of complex comorbidity
Shkarin V.V., Saperkin N.V., Kovalishena O.V.

This review presents critical insights into the clinical and epidemiological aspects of participation of various causative agents of opportunistic infections in the formation of complex comorbidity in humans. Clinical and epidemiological aspects are important components of complex comorbidity due to wide occurrence, causing negative impact on human health and population reproduction. The data on the relative incidence of mono- and concurrent-infections are heterogeneous. The causative agents of opportunistic infections can persist in the human body, cause latent endogenous infections, and engage in intracellular parasitism. A high level of circulation of opportunistic infections pathogens creates the conditions for atypical forms of multisystemic pathology. Broad clinical polymorphism and low specificity cause untimely diagnosis. Low tension of anti-infection immunity is associated with the low protective activity of pathogens and mosaicism of antigens. Examples of complex comorbidity with the involvement of herpes viruses can be a combination of Epstein–Barr virus and Corynebacterium diphtheriae, cytomegalovirus and infectious mononucleosis and a combination with Streptococcus pneumoniae, Haemophilus influenzae type b. The combination of cytomegalovirus infection can occur with either one infectious disease or multiple ones (for example, metapneumovirus infection, S. pneumoniae, Bordetella pertussis, and H. influenzae). Mycoplasmosis can have a course of specific polyetiological infections in combination with viruses, bacteria, fungi, and protozoa. The authors also paid attention to the manifestation forms of pneumocystosis in the impairment of the immune status of the body (combination with toxoplasmosis, blastocystosis, etc.). The possibility of association of blastocysts with Staphylococcus spp., Klebsiella pneumoniae, and Lamblia intestinalis has been shown, and the roles of anisacidosis and chlamydial infection in the formation of complex comorbidity are also discussed. Complex comorbidity requires increased attention to diagnosis, assessment of epidemiological determinants, and the organization of epidemiological studies for its analysis.

Epidemiology and Infectious Diseases. 2019;24(5-6):240-248

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