No 4 (2015)

Objective. To analyze the present-day epidemiological features of hemorrhagic fever with renal syndrome (HFRS) in the Yaroslavl Region and prehospital clinical errors. Subjects and methods. The clinical and epidemiological data of 73 HFRS patients treated at Yaroslavl Infectious Diseases Hospital One in 2011-2014 were comparatively analyzed. Results. Upsurges of HFRS morbidity in the region are observed every 2-3 years and coincide with the enhanced epizootic activity of principal reservoir hosts. The red-backed mouse (Clethrionomys) is most commonly infected with hantaviruses. Humans are infected via contact, more frequently during autumn and winter months. Among the patients there is a preponderance of men (72.6%), mainly able-bodied ones (76.6%). Children are ill with HFRS more rarely. The disease is observed mainly in urban dwellers (81.9%); the contamination occurs when they go to the country into a feral focus. 58.9% of the patients are hospitalized in late periods (on day 7 or later). The diagnosis is made correctly and timely in only 26.8% of the patients with HFRS due to the polymorphism of its clinical picture. Conclusion. In the Yaroslavl Region, HFRS is high of the list of feral herd diseases, being second only to tick-borne infections.

Objective. To assess the role of the factors of innate and adaptive immunity to the pathogens S. pneumoniae and H. influenzae type b in newborn infants depending on their compromised maternal history of infections. Subjects and methods. A total of 140 infants born to mothers who had experienced various infectious and inflammatory diseases during pregnancy (Group 1) and 40 babies born to mothers with no history of infections (Group 2) were examined. After using 23-valent pneumococcal polysaccharide vaccine and polysaccharide conjugate vaccine to prevent infection caused by H. influenzae type b, the investigators determined the expression of TLR2 and TLR4 and the production of cytokines (IL-1β, IL-6, TNF-α) on umbilical cord blood mononuclear cells, as well as the serum level of IgG to the outer membrane proteins of S. pneumoniae and H. influenzae type b. Results. There were no differences in the expression of TLR2 and TLR4 after using the vaccines in the infants in both groups. There were significant differences in the functional activity of umbilical cord blood, assessed by the synthesis of proinflammatory cytokines in the cell culture supernatants. Thus, Group 1 showed a higher synthesis of the cytokines IL-1β and IL-6 than did Group 2 (p < 0.05). Lower values of IgG antibodies to S. рneumoniae and H. influenzae type b were ascertained in Group 1 infants (p < 0.05). Conclusion. The found differences in the functional indicators of innate and adaptive immunity as the high activity of proinflammatory cytokines along with the low level of antipneumococcal and antihaemophilus IgG antibodies in babies born to mothers with a compromised history of infections are likely to be of great pathogenetic and prognostic values, give grounds to assign newborn infants to a group at high risk for the infections, and may be used during personalized approaches to their vaccination.

Objective. To assess the possibilities of using the commercial test systems developed for the rapid identification of Group A streptococci (GAS) in the throat smears in soft tissue infections; to identify the emm types of isolated streptococci; to study their antibiotic sensitivity, and to determine the presence of the toxin genes in their genomes. Materials and methods. The rapid test-system «STREPTATEST» and the classical microbiological method were applied. The medical records of patients with soft tissue infections treated at the Purulent Surgical Department, Medsantrud Clinical Hospital Twenty-Three (Moscow) in 2008-2011 were analyzed. A total of 118 GAS strains isolated from patients with streptococcal infection of soft tissues were investigated. Molecular genetic methods were used to determine the emm type of GAS and the presence of the speA, speB and speC toxin genes. The microdilution antibiotic sensitivity testing was performed using cation-adjusted Mueller Hinton broth (BBL, USA) supplemented with lysed horse blood (5% final concentration). Results. The investigators determined 34 different GAS emm types belonging to 9 different emm clusters, out of which clusters D4, E2 and E4 proved to be most numerous. The emm-types 66, 88 and 169 (st1731) were most common (each had more than 10 strains). Twenty-one cultures that were resistant to more than one antibiotic belonged to 11 emm genotypes. The speA gene was detected in a small proportion of invasive strains. No false-positive and false-negative results were recorded in the investigation using the rapid test. Conclusion. A diversity of isolated GAS genotypes was established in the Moscow patients with soft tissue infections. At the same time, more than half of the emm types belong to the three clusters encompassing closely related M types. Identification of multidrug-resistant GAS strains underlines the need for monitoring the antibiotic sensitivity of isolates. The test system «STREPTATEST» has been shown to be promising in identifying GAS in patients with pyoinflammatory diseases of soft tissues during surgery.

Hepatitis C virus (HCV) is an etiological agent of an inflammatory process in the liver, which is characterized by the parenteral route of transmission. Transfusions of donor blood components are an integral part of therapy for blood system diseases and increase a risk for blood-borne transmissible infections, including hepatitis C. The virus genotype determines both the nature of the disease and a response to antiviral therapy. Objective. To analyze the profile of HCV subtypes in infected people, including in recipients of donor blood components. Subjects and methods. A total of 811 HCV infected patients, including 550 donor blood recipients (Group 1) and 261 transfusion-free patients (Group 2), were examined in 2004 to 2011. Commercial reagent kits (OOO «InterLabService», Russia) were applied. Results. There was a remaining prevalence of subtype 1b (n = 381 (47%)). Group 1 showed a significant increase in its proportion from 39.57 to 63.64% (p < 0.05). During the investigation, the proportion of untyped samples declined from 26.20 to 6.50% in Group 1 and from 22.20 to 2.99% in Group 2 (p < 0.05). Cases of subtypes 3 and 4 were codetected in Group 1. Conclusion. Subtype 1b remained prevalent. The improved quality of laboratory diagnosis could statistically significantly reduce the proportion of HCV-positive samples that could not be genotyped. There were cases of codetection of more than two HCV subtypes in the group of recipients of blood component transfusions, unlike blood transfusion-free patients.

Objective. To optimize treatment and to evaluate the therapeutic efficacy of the Russian intravenous immunoglobulin Gabriglobin in children with severe forms of viral meningitis. Subjects and methods. Clinical observations of 120 sick children aged 5 to 14 years with severe arboviral meningitis were the basis for the investigation. Serum cytokine levels were determined by enzyme immunoassay. Results. It was found that cytokine imbalance due to the hyperproduction of proinflammatory cytokines along with the suppressed elaboration of interferon-γ might underlie secondary immunodeficiencies in patients with arboviral meningitis. The intravenous immunoglobulin was shown to be effective in the combination therapy of viral meningitis in children. Conclusion. The use of intravenous immunoglobulins in combination therapy may be a promising area in treating children with severe viral meningitis.

There has been recently an increase in the number of HIV-infected people among pregnant women, which necessitates the optimization of approaches to chemoprevention (CP) of vertical HIV transmission. Objective. To evaluate the efficiency of different routes of vertical HIV transmission. Methods. A total of 1355 cases born to HIV-infected women registered in the Saratov Regional Center for AIDS Prevention and Control were retrospectively analyzed; and the women were divided into groups according to the mode of pregnancy management. Results. As compared to emergency CP and no prophylaxis, a three-stage CP procedure using a few agents, which ensures a significant reduction in the risk of vertical HIV transmission to 3.1%, is a priority. The findings are supported by the clinical examples of the efficiency of current prevention and treatment regimens in HIV-infected pregnant women. Conclusion. Pregnancy is an absolute indication for CP and continued antiretroviral therapy in HIV-positive women; however, it is necessary to weight the risks and benefits when choosing a specific regimen.