EARLY PROGNOSTIC MARKERS OF SEVERE ASTRAKHAN SPOTTED FEVER

There is currently a transformation of the clinical symptoms of Astrakhan spotted fever (ASF): cases of its severe course, complications, and death have become more common. Among the complications of ASF, acute renal failure (ARF) is most frequently diagnosed at the present stage. On hospital admission, no clinical and laboratory markers indicating the onset of the pathogenetic process in the kidneys have yet been detected; creatinine and urea remain within the normal range or are recorded at the upper reference values. Neutrophilic gelatinase-associated lipocalin (NGAL) that has shown its diagnostic and informational value is proposed to be studied as an early marker of the severe course of ASF and renal complications thereof. Objective. To assess the diagnostic and prognostic values of determining NGAL in patients with ASF. Subjects and methods. Solid-phase enzyme immunoassay was used to study the plasma concentration of lipocalin in patients with ASF depending on disease severity and (initial, peak) period. Forty-nine patients who were treated for ASF were followed up in the A.M. Nichoga Regional Infectious Diseases Clinical Hospital in Astrakhan. Most of the cases were rural residents (63%), individuals at the age of over 60 years (89.7%). Results. Just on hospital admission with the still normal values of creatinine and urea, the level of lipocalin increased statistically significantly compared to the control values in apparently healthy volunteers - 511.27+146.06 ng/ml (p < 0,001) for severe ASF and 173.95+40.1 ng/ml (p < 0.05) for moderate ASF. Conclusion. The paper has demonstrated the diagnostic value of studying the plasma level of lipocalin as an early informative marker to confirm the development of ARF and to determine its severity in ASF.

Astrakhan spotted fever, lipocalin, acute renal failure, complications