No 4 (2010)

The characteristics of exacerbations of chronic obstructive pulmonary disease (COPD) are presented. It is emphasized that the exacerbation of COPD can develop by two ways; first way is characterized by increasing inflammatory syndrome, and the second - by progressive dyspnea and increased extrapulmonary manifestations of COPD. Among the factors contributing to the exacerbation of COPD, the leading role belongs to the effects of bacterial and/or viral infection of bronchial tree, primarily Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis (10-30%). In addition to infectious agents, the cause of COPD exacerbations in about half the cases may be non-infectious factors, among which the leading role belongs to atmospheric pollutants. In patients with COPD, CAD, bronchial asthma and gastroesophageal reflux disease are frequent comorbidities affecting course of disease, including exacerbations. Physicians in the treatment of exacerbation must take into account all the peculiarities of manifestations, the nature and severity, because acute exacerbation of COPD is associated with high mortality.

The present article is concerned with modern aspects of infection caused by Clostridium difficile. The main forms of its course are antibiotic-associated diarrhea and pseudomembranous colitis. Risk factors for infection C. difficile, its clinical manifestations, and diagnostic and treatment issues are considered in detail. It is stated that drugs of choice in the treatment of infections C. difficile are metronidazole and vancomycin. It is emphasized that the uncontrolled use of antibacterial drugs contributes the growth of infection C. difficile.

This article presents data for the etiology of pneumonia and exacerbations of chronic bronchitis/chronic obstructive pulmonary disease. The spectrum of respiratory fluoroquinolones (levofloxacin, moxifloxacin), indications for their use, treatment regimens and dosage regimens are considered. The author presents own data for the long-term use of levofloxacin in the treatment of lower respiratory tract infections. Various schemes of levofloxacin use, including step-down therapy are expressed. The effectiveness of levofloxacin alone and in combination with carbapenems in the treatment of critically severe pneumonia is presented.

The present article is concerned with modern clinical aspects of erysipelas as streptococcal infection. From 1981 till 2009, 44 172 patients with erysipelas were under observation. The disease was frequently observed in women (63.2% of cases). The modern features of the clinical course of erysipelas are the prevalence of disease in older and elderly people (65.3% of patients aged 50 years and older), predominant localization of the inflammatory focus in the lower extremities (69.6%), the dominating development of hemorrhagic forms. The modern schemes of antibacterial therapy and preventive measures are presented.

The authors have conducted clinical and laboratory examination of 273 patients with acute intestinal infections (AII) of different etiology with moderate course of disease, and diagnosis was bacteriologicaly confirmed in 14.7% of cases only. S. sonnei O-antigens, S. flexneri 1-6, S. dysenteriae 1, Salmonella В, С1, С2, D, E serogroups, Y. pseudotuberculosis I and III, Y. enterocolitica О3, О7,8, О9, О4,33, О6,30, Campylobacter (C. jejuni, C. coli, C. lari), V. sholerae 01, as well as markers of Shiga toxin, C. difficile toxins A and B, C. perfringens enterotoxin type A, and cholera enterotoxin were identified in coprofiltrates by coagglutination. Simultaneous identification of 2 to 5 toxin markers was observed in 66.7% of patients (often - a combination of C. perfringens enterotoxin A with C. difficile toxin A/B or Shiga toxin). By the time of discharge from the hospital markers toxins remained in the fecal masses in 12.5% of patients. Levels of markers and frequency of these toxins occurrence in the CIC of blood serum were identified. Increase of toxigenic strain (the number of toxins in the fecal masses) lead to decrease of levels of markers of Shiga toxin and the Clostridium diffitsile toxin A in the CIC of blood serum. There is a trend to increase of level of a marker of Shiga toxin in the circulating immune complexes (CIC) of blood against the background of ciprofloxacin use in the treatment of AII. In contrast, the treatment without the use of ciprofloxacin leads to decrease of level of marker of Shiga toxin. A complete cessation of identification of O-antigen and toxins in coprofiltrates can serve as indicator of high treatment efficiency. For the purpose to verify the diagnosis of AII, identification of bacterial mixed-infections and difficult diagnosable yersiniosis, campylobacteriosis, clostridiosis, the use of wide range of diagnostic test kits for detection of markers of exotoxins and specific O-antigens is reasonable.

We have evaluated efficacy of Stomatidin (hexetidine) and Lizobakt in the treatment of acute respiratory infections in frequently ill children and children with chronic ENT pathology. It was found that the inclusion of Stomatidin in complex therapy within the first days of the disease provides a reduction of terms of relief of major symptoms of the disease (intoxication, local manifestations of oropharyngeal lesions). Late in the early convalescence period, the Lizobakt administration promotes the normalization of the immune homeostasis of the oral cavity and, indirectly, the correction of the microflora of this epitope, and increase of colonization resistance.

The article presents history of Rauhfuss-Grocco symptom - percussion sign of massive exudative pleurisy. In Russia, this symptom was first described by K.A. Rauhfuss, largest clinician and organizer of the pediatric care in St. Petersburg. The learned works of K.A. Rauhfuss are focused mainly on diseases of the larynx, trachea and lungs in children, as well as childhood infectious diseases, including diphtheria. He was one of the organizers of the first clinical studies evaluating the efficacy and safety of antidiphtheritic serum. P. Grocco - spectacular Italian physician known for his scientific work in the diagnosis of internal and nervous diseases.