No 5 (2015)

Objective. To study the epidemiological and clinical features of hemorrhagic fever with renal syndrome (HFRS) in the Kirov Region at the present stage. Subjects and methods. The course of HFRS was analyzed in 81 patients aged 16 to 65 years who had been treated at the Kirov Infectious Diseases Hospital in 2010-2014. Results. The major clinical manifestations of the disease were represented by intoxication-inflammatory, catarrhal, and hemorrhagic syndromes, renal dysfunction, and lung injury. Conclusion. Men are more frequently ill; their contamination occurs to a greater extent when going to the forest or fishing. HFRS in the Kirov Region versus this infection in other endemic regions runs a benign course.

Objective. To estimate infection rates for main TORCH agents, such as T. gondii, cytomegalovirus (CMV), rubella virus, and herpes simplex virus types 1 and 2 (HSV-1 and HSV-2), in certain population groups from the Samara, Kaluga, and Lipetsk Regions of Russia. Materials and methods. Epidemiological analysis of 564 364 studies applying ELISA to detect specific IgM and IgG antibodies in blood samples with reagent kits (ZAO «EKOlab») approved for use in Russia. Results. Different standards were established to examine the population in the regions of the Russian Federation. The detection of specific IgG antibodies could determine high infection rates in Russia’s population for HSV-1 (89.3%), rubella virus (85.8%), CMV(77.1%) and average values for T. gondii (41.7%) and HSV-2 (16.1%). Regional differences were found. There were specific IgM antibodies to T. gondii (2.4%), rubella virus (0.55%), CMV (2.5%), HSV-1 and HSV-2 (7.6%). In 24.6% of the cases, the blood level of IgG antibodies to rubella virus was below the protective level (25 IU/ml). Conclusion. The epidemiological surveillance system for the spread of TORCH infections in the Russian Federation needs to optimize and standardize the scope of a serological survey of the population, by identifying the markers of humoral immunity.

Objectivе. To investigate changes in the hemostastic system and blood rheology during the progression of the infection process in patients with lower-limb and facial erysipelas and to provide a rationale for the expediency of replacement and/or antithrombotic therapy. Subjects and methods. Sixty patients with erysipelas were examined in terms of the extrinsic (prothrombin time, international normalized ratio) and intrinsic (activated partial thromboplastin time) pathways of coagulation; the degree of dysfibrinogenemia (thrombin time, functional fibrinogen activity, and D-dimer level); the count and functional activity of platelets (aggregation to ADP) and erythrocytes (aggregation to lanthanoids and protamine sulfate). Endothelial dysfunction was also estimated from the decreased athrombogenicity of the vascular wall endothelium (antithrombin III and protein C) and the increased adhesive properties of the endothelium (von Willebrand factor). The comparison groups comprised healthy volunteers (n = 32) and patients with an inflammation focus localized on the face (n = 24) and lower limbs (n = 36) in the course of the disease (on days 1-3, 4-6, 7-10 and 11-15), who were treated at Infectious Diseases Hospital Two, Moscow. Results. The proposition that lower-leg erysipelas is 3.9 times more frequently complicated by hemorrhagic manifestations than facial erysipelas has been confirmed by laboratory findings. In particular, a significant decrease in protein C levels was noted in the patients with an erysipelatous inflammatory focus on the legs and concomitant chronic venous insufficiency. There were increased D-dimer and decreased a 2-macroglobulin levels, suggesting the potent activation of proteolytic enzymes (plasmin, matrix metalloproteinases, neutrophil elastase), which can be one of the causes of bullae, erosions, and ulcerations in the erysipelatous focus on the lower extremities. Conclusion. There were signs of intravascular (latent) hemolysis, such as lower haptoglobin concentrations and higher indirect bilirubin and LDH levels in the blood; a change in the rheological properties of red blood cells - their increased deformability (aggregation with lanthanum chloride) and decreased elasticity (aggregation with protamine sulfate) as one of the main causes of DIC-like syndrome in erysipelas.

Objective. To evaluate the impact of different dosage regimens of VM-1500 in combination with drugs used for standard antiretroviral therapy (ART) versus a combination containing efavirenz (EFV) and standard ART (2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs/HtRTs)) on the efficiency of treatment in view of a reduction in viral load to an undetectable level (< 50 copies/ml) at 24 weeks in previously untreated HIV-1-infectedpatients. Subjects and methods. Study Stage 1 included 90 HIV-1-infected patients who had not previously received ART and were randomized into 3 groups at a 1:1:1 ratio: 1) VM-150 20 mg daily; 2) VM-150 40 mg daily; 3) EFV 600 mg daily (a comparison group). All the patients also took TDF/FTC. At this study stage, an interim analysis of the efficiency and safety of therapy was performed after 12-week therapy. Results. The 12-week ART regimen including VM-1500 at doses of 20 and 40 mg in combination with TDF/FTC was as effective as the EFV + TDF/FTC regimen regardless of the baseline level of HIV RNA. The proportion of patients with a HIV RNA level of < 400 copies/ml was highest in Group 1 and amounted to 93.3%, which was 11.8% below that in Group 3 (MIIT analysis). In Group 1, the incidence of all moderate (26.7%) and severe (6.7%) adverse events (AEs) was lowest as compared to that in Group 3 (60.7 and 14.3%, respectively). AEs of special interest (impairments of the central nervous system and mental activity) were substantially rarer in Groups 1 and 2 than in Group 3 (57.1%). Conclusion. There is evidence for the comparable (equivalent) efficiency of both VM-1500 doses and EFV as a component of ART. The safety of 12-week ART regimens incorporating VM-1500 was higher than that of the regimen containing EFV. VM-1500 20 mg daily was chosen to be further investigated.

This article describes the multifaceted (social, scientific-and-practical, and pedagogical) activities of the distinguished Russian scientist Fedor Fedorovich Erisman. It discloses the epidemiological component of his activity.