Vol 19, No 4 (2014)

Aim: to identify features of the clinical course of hepatitis A (HA) caused by viruses of different subtypes. Patients and methods: In the study there were included 195 patients with hepatitis A (130 males and 65 females) at the age from 15 to 72 years residing in the territories with various manifestations of the epidemic process of HA (Moscow, the Khabarovsk region, the Republic of Sakha (Yakutia), the Republic of Tajikistan and Ukraine). All patients were examined for the presence of Hepatitis A virus (HAV) RNA in blood, with following determination of the genotype of the virus by PCR. Biochemical blood tests (concentration of total and direct bilirubin, ALT activity) were performed from 2 to 9 times depending on the duration of hospital stay and severity of infection. The dynamics of biochemical indices was evaluated in accordance with the period of the disease: the first period -from the 1 st to 10 th day, the second -from 11 th to 20 th day, the third -from the 21 st day and later. Results: A direct moderate correlation (The Spearman correlation coefficient r = 0,3; p = 0,002) between the duration of jaundice and patients ’ age has been revealed. A significant relationship was observed in the group ofpatients with subtype IIIA (r = 0,4; p = 0,003) and was absent in patients with subtype IA. There were no statistically significant differences between the groups of patients with subtypes IA and IIIA, in dependence on the duration of hospitalization, the variant of the course ofprejaundice period, severity of the course disease, duration of the persistent jaundice and symptoms of intoxication. Absolute values and the dynamics of the reduction of total and direct bilirubin, as well as the dynamics of decrease of ALT activity in groups of patients with various subtypes were not differed significantly. Cholestatic forms of HA were observed only in patients with HAV isolates belonging to subtype IIIA. Conclusion: HAV subtype has no effect on the severity of the course of the disease neither major clinical symptoms and laboratory indices in patients from different age groups. A direct correlationship between the duration ofjaundice syndrome and age in patients with subtype IIIA may indicate a trend towards the formation of cholestatic forms of HA in patients with this subtype of the virus in older age groups.

The purpose of research - the study of clinical and pathogenetical features of cryptococcal meningoencephalitis (CME) in patients with HIV infection for the improvement of the efficiency of diagnosis and treatment. Materials and Methods. There are presented the results of the study of 67 cases of cryptococcal meningoencephalitis in patients with HIV infection. There was performed an assessment of the clinical picture and the cerebrospinal fluid (CSF), which was consisted of direct microscopy, cultural method and PCR. Also pathomorphological data of deceased patients have been analyzed. Results of the study. The clinical picture of CME was mildly pronounced and not constant. Dominant complaint is constant headache diffuse in character. Meningeal symptoms are uncertain or absent. CSF changes are not specific, most informative methods are PCR and mycological study of CSF. The fatality was causedfirst ofall by the development of edema-brain swelling and the dislocation of stem structures. Conclusion. The clinical picture of cryptococcal meningoencephalitis is caused first of all by destructive processes in brain tissue and progression of the development of edema-brain swelling. The clinical picture is poorly pronounced and is not constant, therefore to all patients with HIV infection in the presence of long-term headache the CSF examination is indicated even in the absence of meningeal symptoms.

In the Yaroslavl region (Central Federal District of Russia), endemic of tick-borne encephalitis (TBE), the features of epidemiology of this infection were studied during 1992-2012. Cyclical fluctuations in the incidence of TBE, the lack of the trend to decrease of the incidence were observed, the average annual incidence was 1,6 ± 0,32 per 100 thousand ofpopulation. The prevalence offebrile forms of disease was 62,2%, meningeal forms - 16,3%, the total percentage offocal forms was 13,9%. Manifestations of evolution of TBE were: the increase of the epidemiological significance of anthropogenically transformed natural foci, anthropurgical foci of TBE, until 81% of TBE cases were unvaccinated citizens, the high lethality of 4% and the high frequency of cases of alimentary infection of TBE of 7,8% with lethality of 10,8%. The aethiological agent of 10 lethal cases was Siberian subtype of TBE virus.

The problem of epidemiology, laboratory diagnosis and specific prophylaxis of pertussis remains to be relevant because the level of the morbidity rate of this infection ‘managed’ by vaccination is rising, despite the wide coverage of immunization of the child population. Knowledge of the distribution and the course ofpertussis infection, Bordetella pertussis strains circulating in modern conditions, factors of pathogenicity of the causative agent and mechanisms of pathogenesis of the disease is important as wellfor medical students as for physicians ofvarious specialties - not only pediatricians, but also therapeutists, pulmonologists, microbiologists, epidemiologists and etc. It is worth to consider principles of laboratory diagnosis of pertussis and difficulties to which the laboratory service is faced at this as well as the comparative characteristics of traditional and express methods for diagnosing of pertussis infection - possible and regulated for implementation by basic bacteriological labotories in the territory of Russian Federation. Fundamentals of pertussis vaccination as the only effective means for prevention of mass outbreaks of this disease are also considered in the framework of the proposed lecture.