Vol 23, No 3 (2018)

The aim of the work was to study the structure, level and dynamics of resistance to antimicrobial drugs of the most common types of microorganisms in patients with community-acquired pneumonia (CAP) in the Krasnodar Territory, on the example of patients treated in a regional specialized infectious hospital for the period 2015-2017. Materials and methods. The results of bacteriological tests of expectoration, including 523 positive strains of microorganisms, are analyzed. The analysis does not include strains with hospital multidrug resistance. A bacterioscopy with Gram stain and sputum seeding on plate-like artificial nutrient media were carried out. Identification of the pathogen was performed by mass spectrometry using MALDI-TOF technology (Microflex LT, Bruker, Germany), phenotypically identified resistance mechanisms were confirmed on the automatic analyzer Vitek II Compact (BioMérieux, France). The sensitivity to antimicrobials was determined by the disc-diffusion method in the Müller-Hinton medium, using the disks by Bio-Rad, France. The antibioticogram was analyzed on the apparatus “Adagio” (Bio-Rad, France). Results. In the etiologic structure of community-acquired pneumonia, Streptoccocus pneumonia prevails in patients hospitalized in an infectious hospital in the Krasnodar Territory, which is determined in 73.56% of confirmed cases, which is twice as high as an average in Russia. Staphylococcus aureus was determined in 9.04% of casesd, with fluctuations in different years from 3.8% to 12.1%. Klebsiella pneumoniae was found in 4.61%, with variations from 1.7% to 9.3%. Pseudomonas aeruginosa was registered in 4.6%, altered from 1.3% to 7.8%. Other microorganisms were represented with Enterobacteriaceae family, 8.2% of the cases. The resistance of wild strains of microorganisms isolated at CAP to a number of antimicrobial agents has been established. A number of negative trends were noted: the emergence of pneumococcal strains resistant to beta-lactam antimicrobial drugs (benzylpenicillin MIC < 2μg); an increase in the resistance of pneumococci to macrolides, tetracyclines, sulfonamides. There is a high percentage of Staphylococcus aureus (80%) producing penicillinase, and an increase in their resistance to macrolides. A high level of Pseudomonas aeruginosa resistance to 3-rd and 4-th generation cephalosporins is noted. Conclusion. The obtained data determine the need for further monitoring of regional resistance of microorganisms, which will allow both adequate start therapy and the possibility of its timely correction. In the practical work of a doctor, it is important not only to be guided by local data on the resistance of microorganisms to antimicrobial drugs, but also to analyze the possible causes of its occurrence with the establishment of individual risk factors.

The purpose of this study was to improve the diagnosis of influenza A (H1N1) in pregnant women and to determine the risk of developing various types of pathology in newborns, depending on the gestation period at which the infection influenza occured. Materials and methods. A total of 94 pregnant women, an average age of 28.7 ± 0.48, who were on treatment with influenza diagnosis in the Specialized Infectious Disease Clinical Hospital of the Ministry of Health of the Krasnodar Territory during the epidemic rise of influenza A (H1N1) from December 2015 to February 2016. The diagnosis of influenza A (H1N1) was confirmed in all cases by the isolation of RNA of influenza A (H1N1) virus by PCR in a nasopharyngeal scrap. Patients applied for medical care on average 2.74 ± 0.16 days of illness. Pregnancy at the gestational age corresponding to the first trimester was in 20 (21.3%), in the term of the second trimester - in 36 (38.3%), and in the third trimester - in 38 (40.4 %) of women. The results of the laboratory examination were evaluated. Pregnancy outcomes were traced in 94 women, a telephone questioning of women was conducted 3-6 months after childbirth, the state of children at birth was analyzed based on the results of a retrospective analysis of 91 neonatal card in the maternity hospital. Results. Highly pathogenic influenza A (H1N1) in pregnant women during early treatment and prescription of antiviral therapy was mainly in medium-heavy form (96.81%). In the first day of the disease, subfebrile fever predominated - 63.3%, febrile fever subsequently developed in 53.33%, headache, and other intoxication manifestations were less than in the case of epidemical influenza A. Catarrhal syndrome is not bright, often characterized by early joint cough. The main complication of influenza, determining the severity of the patient state, was pneumonia, developed in one third of patients. Early antibacterial and antiviral therapy in most cases prevented the formation of severe lung lesions and abortion. Pregnancy ended with urgent deliveries in 89 women (94.68%); in three cases, in women who had influenza at 6, 15 and 29 weeks of gestation, abortion with fetal death (3.19%) occurred. Premature delivery at 28 and 33 weeks of gestation with the birth of a viable child occurred in two cases (2.13%). The development of influenza in the first trimester resulted in complications in 42% of cases, increasing the risk of abortion and developmental anomalies, mainly from the cardiovascular system (26.31%). Infection of pregnant women with influenza in the second trimester led to a different pathology of newborns in 49% cases. Among them, acute intranatal asphyxia prevailed (14.29%), pathology of the nervous system (11.43%), less frequently developed intrauterine infection, pneumonia (5.71%). Special attention is required by women with influenza in the third trimester of pregnancy, in this group, the pathology of the newborns was noted in 54% of cases, mainly in the form of acute intranatal asphyxia (29.73%) against the background of intrauterine infection, pneumonia (16.22%), central nervous system pathology (8.11%). The conclusion. Despite the medium-heavy course, the woman’s influenza had an adverse effect on the formation of the fetus and the condition of the newborn at birth. On the background of influenza infection, the degree and nature of exposure depended on the gestation period.

The clinical observation of the development of acute diverticulitis of the sigmoid colon following a previous acute intestinal diarrhea infection of unknown etiology by a gastroenteric variant is considered. Brief characteristics of the course of the diverticular disease of the colon are given. The possible interrelation of the diverticular disease of the large intestine with synovial cysts is considered.

Febrile infection-related epilepsy syndrome (FIRES) is an acute disease provoked by the nonspecific febrile illness with the development of refractory status epilepticus. It frequently occurs in previously healthy children. The pathogenesis of this syndrome is still unknown. The leading initial symptoms include acute fever, seizures, consciousness disorders and imitate neuroinfection or autoimmune pathology of CNS. These features make diagnosis extremely difficult, and there are in addition some difficulties with the verification of the diagnosis. Interpretation of MRI results allows identifying involved parts of the brain. However, the EEG record pattern is not precise. We report a clinical case of FIRES occurred in a 14-year-old previously healthy boy. The disease began similarly to an acute neuroinfection disease with prolonged refractory status epilepticus