Vol 23, No 6 (2018)

The aim of the work is a comparative evaluation of the epidemic process manifestations and the leading factors of serous meningitis (SM) pathogens and enteroviral etiologyherpetic angina (HA) transmission. Materials and methods. Manifestations of the epidemic process of SM and HA were studied according to the official registration of the incidence of the population of Perm for the 2010-2016. 1464 water samples of the distribution network, 178 samples of water from decentralized sources of water system, 293 samples of surface water, 117 samples of bottled water, and 57 wipe samples from the surface of vegetables and fruits were studied usingpolymerase chain reaction (PCR)for the presence of markers of non-polyemic enteroviruses (NEV). In conditions of analytical “case-control” method the epidemiological survey of 350 epidemiological focuses of SM and 142 focuses of GA were conducted. Results. The findingsclearly demonstratethat it is similarity betweenepidemic process manifestations of SM and enteroviral etiologyHA. In both clinical variants of enteroviral infection, the priority role is the water way of transmission of the pathogen by drinking water from centralized and decentralized sources of water system, as well as swimming in surface water. The water transmission way is activated in the summer-autumn period of the year due to the increase in the number of emergency situations on the water supply networks, as well as due to the swimming factor. The role of bottled water as well as vegetables and fruits as factors of transmission of enteroviral infection has been revealed.

In 2012-2018, 243 samples of blood, serum, urine and saliva of patients with acute febrile diseases hospitalized in medical institutions of Astrakhan, Astrakhan Region and Infectious Diseases Hospital №1 of Moscow were examined in experiments on intracerebral inoculation of newborn white mice. As a result, 8 strains of dengue 1 virus were isolated from patients infected in Thailand (7 strains) and Vietnam (1 strain); eight strains of dengue 2 virus from patients infected in Thailand (5 strains), Indonesia (2 strains) and the Maldives (1 strain); one strain of dengue 3 and one strain of Chikungunya virus (Asian genotype) from patients hospitalized after returning to Moscow from trips to the Philippines; 2 strains of Zika virus (Asian genotype) from patients visiting the Dominican Republic; 6 strains of Crimean-Congo hemorrhagic fever virus genotype Europe 1 and one West Nile virus strain of genotype 1a from patients of the Astrakhan region.

The issues of etiotropic therapy of infectious diarrhea require a differentiated approach not only depending on the etiological factor, but also on the type of diarrhea caused by the location of the pathological process. Infectious diarrhea occur in the form of three main types: secretory, osmotic, inflammatory (invasive). Secretory and osmotic type of diarrhea are found in infectious gastroenteritis. In the mechanisms of elimination of infectious gastroenteritis pathogens, the following factors play a leading role: the destructive effect on pathogens in the lumen of the small intestine of trypsin, chemotrypsin and acid duodenal content entering the small intestine; the «killer» action of interepithelial large granular lymphocytes (M-cells) on pathogens; the increase in resistance of the small intestine epithelium under the influence of M-cell cytokines; the difficulty of intercellular distribution of pathogens due to faster than in the gut, small intestine epithelial cell renewal; microbial antagonism of representatives of normal intestinal microflora. The appointment of etiotropic agents in cases of infectious gastroenteritis, at least, suppresses the manifestations of microbial antagonism on the part of representatives of the normal intestinal microflora, creating prerequisites for the delay of the pathogen in the body. The inflammatory type of diarrhoea occurs when invasion of pathogens to the mucosal lining of the colon, with subsequent development of the destructive changes and the possibility of further translocation. Obstacles to adhesion, penetration and intercellular spread of invasive pathogens in the colon mucosa is much less than in the small intestine. Pathogens of the same genera, species and serological variants (e.g. Salmonella, Campylobacter) can cause both secretory and invasive types of diarrhea. However, the appointment of antibacterial therapy will depend on the location of the pathological process. When gastroenteritis etiotropic therapy in most cases is impractical. In the presence of clinical manifestations of colitis, involving the implementation of invasive properties of the causative agent, the appointment of etiotropic treatment is justified.