Vol 19, No 1 (2014)

The purpose of the study the improvement of early diagnostics of Lyme disease on the based of clinical and epidemiological analysis of the main clinical forms of the acute course of the disease in new natural foci in the Krasnodar Krai. Patients and methods. There was analyzed the clinical course of disease and epidemiological data for 207 patients in the early period of acute course of Lyme disease within the period from 2004 to 2013. Results. In the territory of the Krasnodar Krai and the Republic of Adygea there has formed a set of foci of tick-borne borreliosis (TB), i.e. Lyme disease (LD). The infection of cases is observed not only in the natural foci of disease, but also within the city limits. The disease is registered mainly in the erythematous form (74% of patients), non-erythematous form accounts for 26%. The average age of patients was 41,1±1,83, years, males 38%, females 62%. In the non-erythematous form initial clinical symptoms are recorded in average in 11,6 ± 2,20 days after tick suction; in the erythematous form in 6,4 ± 0,70 days ( p <0.05). The greatest difficulties are arised in the diagnosis of the non-erythematous form of TB running with prolonged fever and central nervous system involvement. Initial clinical manifestations of non-erythematous forms are symptoms of meningitis or meningoencephalitis of serous nature, and defeat of the third pair of cranial nerves. In the erythematous form of TB there are observed symptoms of peripheral nervous system damage in the form of radiculopathies. Regardless of the clinical form, in the first month of disease diffuse myocardial changes (55.3%) or conduction disorders of varying severity ( 7.1%) are recorded. Conclusion. In clinical diagnostics of TB distributed in the Krasnodar Krai, the early manifestation of signs of involvement of he nervous and cardiovascular systems must be considered. The formation of new natural foci of TB requires the in-depth clinical and epidemiological study, introduction of the different methods of serological diagnosis (indirect immunofluorescence test, ELISA) and PCR studies.

Phylogenetic analysis of nucleotide sequences of HIV-1 variants was applied in epidemiological investigation of the case of the group incidence of HIV infection for identification of the genetic relatedness and verification of clinical and epidemiological findings. The article also raises issues the solution of which will improve the quality of the performance of such investigations.

The Experience of investigation of pseudotuberculosis outbreak in the Tyumen region shows the need to improve epidemiological surveillance and control Yersinioses, within the frameworks of informational subsystem of which it is reasonable to take into account serotype land scape and genetic characterization of their pathogens, by means of introdiuction into practice the available methods of diagnosis and identification of Yersinia strains isolated from biomaterial and environmental objects with mand atory sending them to reference-centers for in-depth study with the use of molecular and genetic methods. The last is advisable for more qualitative investigation of foci of yersinioses and establishing epidemiological relationships that will increase the effectiveness of preventive measures.

Currently genotyping of microorganisms is widely used in the investigation of outbreaks of infectious diseases, the implementation of epidemiological surveillance of infections and phylogenetic analysis of bacterial pathogens. Development of methods for genotyping is particularly topical for pathogens of such highly dangerous infections as plague, cholera, anthrax, brucellosis, tularemia, glanders and melioidosis, due to their high pathogenicity and contagiousness. In this overview there is presented the characteristics of different genotyping methods together with an indication of their advantages and drawbacks. There has been analyzed the frequency of the use of genotyping methods on an annual basis and in terms of the type of the causative agents of especially dangerous infections.

Practical skills of clinical work before applying them to real patients, students should acquire in special centers, equipped with high-tech simulators and computerized mannequins, permitting to simulate the clinical situations. One of the important prerequisites to the implementation of this principle is the creation of modern simulation centers. In the article there are discussed the problems which must be sold for the successful and effective implementation of a simulation training in the medical education.