No 5 (2013)

The basis for the concept of the pathogenesis of infectious disease is the theory of the portal of entry of infection, a tropic organ, and variability. The course of disease and immediate and long-term outcomes are determined by the portal of entry through inoculation. If infection occurs naturally through the oropharynx, airways, gastrointestinal tract or skin, there is an adequate immune response and the disease manifests as typical clinical symptoms, shows a cyclic pattern, and usually results in recovery to confer complete sterile immunity. If the pathogen enters hematogenously (parenterally), including perinatally, there is no portal of entry so no adequate immune response forms and the disease has a chronic course involving the viscera due to the actuation of a mechanism of affinity evolution and to the emergence of new tropicity substrates in other organs. Full sanogenesis requires that the germ or its mediators should be present in the primary focus of infection. It is suggested, that HIV, HCV, hepatitis B virus, tetanus, rabies and other infections involving the viscera, as well as all slow infections should be interpreted as hematogenous infectious diseases that run due to the affinity evolution mechanism that gives rise to new tropicity substrates in the viscera. The theory of the portal of entry, tropicity, and the emergence of tropical substrates in the visceral organs should form the basis for modern infectology.

Objective. To study the epidemiological manifestations of ascariasis for the substantiation of groups of the examined patients and to evaluate the efficiency of polymerase chain reaction (PCR) versus conventional microscopy. Subjects and methods. 209 patients with the intestinal phase of ascariasis and 80 healthy individuals were examined in 2009-2012 to estimate the informative value of the above methods. Results. Children aged 1 to 6 years were found to be a major group at risk for ascariasis. This group of patients showed the most adequate results proving that PCR had higher sensitivity, specificity, and diagnostic efficiency than microscopy. Conclusion. When helminthiases are diagnosed, molecular genetic studies should be widely introduced into practical public health to optimize the diagnostic subsystem for epidemiological surveillance of ascariasis invasion.

Objective. To study a role of infective endotoxicosis in the pathogenesis of recurrent herpes infection, by determining the level of malondialdehyde and the proinflammatory cytokine tumor necrosis factor-a in relation to its stage, severity, and comorbidity. Subjects and methods. Eighty-nine patients with recurrent herpes infection were followed up. The blood levels of malondialdehyde and tumor necrosis factor-a were determined during the height of the disease, alleviation of clinical symptoms, early and, in some patients, late convalescence. Results. These indicators were found to be higher in relation to the period of the disease, its severity, and comorbidity. Conclusion. The found changes characterize the development of intoxication syndrome in herpes infection and may be used to evaluate disease severity and recovery completeness.

Objectives. To develop the methodological approach for epidemiological zoning and to conduct the zoning of the Stavropol Territory according to the activity of the natural focus of Crimean-Congo hemorrhagic fever (CCHF). Materials and methods. The data on CCHF incidence, minimal infection rate of Ixodidae ticks by CCHF virus and CCHF infection rate in rodents were collected by the Stavropol Plague Control Institute during the surveillance of CCHF in 1999-2011. Results. Administrative districts of the Territory were three times classified by Hierarchical Cluster Analysis using three above-mentioned indices. The clusters were ranked from lowest to highest values of related indices. Then the sum of three separate ranks was calculated for each district. According to the sum of ranks, that is the integral risk index, four, eleven, ten and two districts were included in the groups of minimal, reduced, raised and maximal risk, respectively. The integrated risk estimate for a district depended on a landscape and was increased significantly in a succession from forest-steppe area to prairie and then to semi-desert area. The algorithm for direct zoning without preliminary clustering of districts was formulated by Classification Trees procedure. This algorithm used only the values of CCHF incidence and minimal infection rate of ticks. Conclusion. The developed approach may be used for the zoning of the Russian Federation in accordance with the epidemic situation for CCHF and other natural focal infections.

The paper gives data on Escherichia coli infections in children in comparative evolutionary aspects: it terms of etiological spectrum, epidemiology, and clinical manifestations. It presents information on the prevalence of Escherichia coli infections in modern day clinical practice and shows the leading role of molecular genetic studies in the diagnosis of the disease.

Objective. To make a clinicoeconomic estimate of maraviroc versus raltegravir, darunavir, etravirine, and enfuvirtide used as part of reserve treatment regimens for HIV infection in patients who had previously received antiretroviral therapy (ART). Materials and methods. The results of randomized controlled trials were used to make an indirect comparison of the clinical efficacy and safety of the test drugs applied in combination with optimized basic therapy. Relying on the comparison, the authors made a cost minimization analysis, in which a Microsoft Excel-based model was used to estimate the costs of the antiretroviral drugs (maraviroc, raltegravir, darunavir, and enfuvirtide) and averaged basic therapy (regimens containing medicines from the groups of nucleoside reverse transcriptase inhibitors and protease inhibitors), and a follow-up of HIV-infected patients. Comparison of maraviroc with etravirine as part of reserve ART regimens, by taking into account the indirect comparison data on the higher efficacy of the former, required the use of a cost-effectiveness analysis, but the latter was not done in this study. The impact of incorporation of maraviroc into the standard of primary health care for HIV-induced disease on the health care budget was additionally analyzed. Calculations were based on the manufacturers’ registered maximum release prices of drugs from the list of vital and essential medicines and on the standards of f inancial costs in the health system of the Russian Federation. Results. The comparable efficacy, safety, and less cost of maraviroc versus those of raltegravir, darunavir, and enfuvirtide as part of reserve AR T regimens can substantially reduce the cost of treatment. The cost saving for maraviroc per patient versus that of raltegravir will average 177764.16 rubles during 48 weeks of therapy and 340714.64 rubles during 96 weeks; versus that of darunavir was 59929.92 and 114865.68 rubles, respectively; that of enfuvirtide was 462295.92 and 886067.18 rubles, respectively. The incorporation of maraviroc with 2% frequency into the standard of primary health care for HIV infection into the section «Other antiviral drugs» (JO5AX) will be able to lower federal expenditures by an average of 6933.98 rubles per patient yearly, which will, in terms of the number of patients receiving ART, amount to 808307916.56 rubles (according to the data as of October, 2013).

The paper deals with the epidemiology of surgical wound infection. The author shares her experience in making an epidemiological investigation of cases of postoperative pyoseptic complications in the abdominal surgery units, by using the data of a retrospective epidemiological analysis, including case history examinations, microbiological monitoring, the minutes of the health care meetings of infection prevention commissions, and various report forms. The author reveals the possible causes of sporadic cases of disease and gives recommendations for goal-oriented preventive and antiepidemic measures in the specific units.