No 5 (2016)

Objective. To establish the manifestations of the epidemic process of parvovirus infection in Belarus in the period 2005-2014 on the basis of the laboratory-verified cases of exanthematous form of the disease. Materials and methods. A total of 821 cases were analyzed. The long-term trend in the incidence of the disease was determined by the method of least squares using a first-order parabola. The annual dynamics was estimated from typical and group curves. The age structure of the cases was studied in the age groups: less than 3, 4-6, 7-10, 11-14, 15-19, 20-29, 30-39, 40-49 and 50-64 years. Results. One epidemic cycle lasting 9 years was revealed in the long-term dynamics. The annual seasonal dynamics was characterized by prevalence in winter, spring, and summer with 7- and 4-month seasonal peaks in ill-being and well-being years, respectively. The seasonal increment in morbidity rates in the ill-being and well-being years was 65.8 and 12.55%, respectively. The influence of seasonal factors in the ill-being years was 21.6 times higher than in the well-being years. Cases of the disease were confirmed in all age groups. The incidence rates in the children aged 4-6 and 7-10 years (6.76 and 5.34 per 100,000 children of this age, respectively) was 5 or more times higher than in the other age groups. Conclusion. The analysis of laboratory-verified parvovirus infection cases notified in the Republic of Belarus within a 10-year follow-up could establish long-term and annual morbidity trends, as well as the age structure of the cases.

Objective. To study the microbiological and epidemiological efficacy of streptococcal, staphylococcal, and polyvalent bacteriophages and bicillin-5 for the prevention of bacterial respiratory diseases in an organized group in the period of seasonal rise of their incidence. Materials and methods. Before and after using the bacteriophages and bicillin-5, their efficacy was evaluated from changes in the microflora and in morbidity rates and structure. The study enrolled 510 healthy military people (men) who were divided into 4 subgroups receiving different types of bacteriophages and bicillin-5, as well as a control group. Results. All the bacteriophages were ascertained to have a high ability of phage lysates to isolate pure cultures. The use of bacteriophages could significantly reduce the incidence of bacterial respiratory diseases in the organized groups by 1.8 to 9.0 times. Conclusion. The bacteriophages administered to prevent catarrhal diseases have a sanitation effect on the organized military collective. The use of bacteriophages is a current area in the prevention of streptococcal infections in the organized military groups.

Objective. To analyze the prevalence, etiological pattern, and profile of antibiotic resistance in pathogens of healthcare-associated infections (HAI) in surgical and intensive care units at Saint Ioasaf Belgorod Regional Clinical Hospital over time in 2014-2015. Materials and methods. The study material was the results of a clinical observation of pyoinflammatory infections and bacterial complications in patients over the last two years. Conventional microbiological methods were used to isolate the causative agent in the pure culture and to determine its antibiotic susceptibility by the disk diffusion method, as well as with a WalkAway bacteriological analyzer. A BACTEC Becton Dickinson analyzer was applied to examine blood cultures. The study used the data of a qLIS laboratory information system containing data on the causative agents of HAI over time in 2014-2015. Results. S. aureus (15.6%), S. epidermidis MRS (9%), S. epidermidis (13.7%), K. pneumoniae (11.3%), and Ent. aerogenes (3.5%) were dominant causative agents in the etiological pattern of catheter-related blood stream infections. Str. species (31.6%), S. aureus (7%), P. aeruginoza (6.5%), K. pneumoniae (6.3%), and Candida fungi (8.8%) were leading microorganisms in the microflora in respiratory tract and lung infections. The problem pathogens in the etiology of skin and soft tissue infections were P. aeruginoza (11.7%), E. coli (6.6%), K. pneumoniae (3.9%), S. aureus (20.7%), and S. epidermidis (8.8%). Urinary tract infections were mainly caused by E. coli (28.5%), K. pneumoniae (9.1%), E. aerogenes (7.5%), E. faecalis (7%), and E. faecium (11%). Those in the etiology of intraabdominal infections were P. aeruginoza (10.7%), E. coli (6.9%), K. pneumoniae (4.9%), and S. aureus (17%), and S. epidermidis (8.6%). All cases of nosocomial CNS infections were caused by E. aerogenes (33.3%), K. pneumoniae (16.7%), A. baumannii (16.7%), S. epidermidis (16.7%), and S. haemolyticus (16.7%). The isolated microbial strains were characterized by multidrug resistance to most antimicrobial agents used at hospital. Conclusions. To elaborate reasonable treatment algorithms for each specific hospital remains a rather relevant problem. If microbiological monitoring is absent, there are considerable difficulties in predicting the efficiency of HAI treatment. Investigation of trends in the spread of epidemically significant types of causative agents allows the prediction of the intensity and nature of contamination. The antibiotic resistance of HAI pathogens is the most important parameter for reasonable empirical and further etiotropic treatment and the mainstay for the prevention of pyoinflammatory infections in critically ill patients.

Bacterial meningitis in childhood poses a real threat to life and may lead to severe disabling sequels. In the absence of mandatory vaccination against Haemophilus influenza, its type b remains one of the most common causes of bacterial purulent meningitis in children. Objective. To study the clinical and epidemiological features of Haemophilus meningitis in Saint Petersburg children. Materials and methods. The case histories were retrospectively studied in 73 children treated at the Research Institute of Childhood Infections, Federal Biomedical Agency of Russia (Saint Petersburg) in 2010-2014. Results. Children of the first five years of life with different compromised premorbid conditions constitute a major proportion (98.7%) of cases. In the acute period of the disease, the severity of the condition was due to the obvious manifestations of systemic inflammatory response syndrome in all the patients; cerebral edema developed in 50.6%; septic shock in 2.6%; subdural effusion in 15%, empyema in 1.3%; and sensorineural hearing loss in 6.8%. The outcomes were as follows: complete recovery (53.4%); the development of symptomatic epilepsy (4.1%), sensorineural hearing loss (3.1%), compensated communicating hydrocephalus (8.2%), and various manifestations of encephalopathy (17.8%). Movement disorders were most frequently manifested by long-term (up to 6 months) frontal-cerebellar ataxia varying in severity (26.0%), there were no deaths. Conclusion. Despite the fact that there are no deaths from Haemophilus meningitis in the period under consideration, the disease is characterized by a severe course and high frequencies of complications. The most effective measure that can prevent the development of both the condition itself and its complications is vaccination against Haemophilus infection.

Objective. To provide comparative characteristics of hemostatic system indicators in patients with Child-Pugh Class B alcoholic liver cirrhosis (ALC) and mixed alcoholic liver cirrhosis (MALC) (hepatitis C + alcohol). Subjects and methods. Twenty-six patients with liver cirrhosis (LC) of different etiologies, whose hemostatic system was evaluated over time, were examined. Results. International normalized ratio (INR) and thrombin time were estimated to be significantly above normal throughout the treatment only for MALC. The activity of von Willebrand factor (vWF) was observed to be significantly above normal throughout the hospital stay and did not depend on the etiology of LC. In the outcome of ALC and MALC, the values of erythrocyte aggregation (EA) and platelet aggregation (PA) were noted to be significantly below the control ones throughout the treatment. The initial level of D-dimers in MALC was recorded to be significantly higher than both the control values and parameters in patients with ALC. Conclusion. In the patients with Child-Pugh class B liver cirrhosis, INR, thrombin time, and vWF activity were significantly higher in MALC than those in ALC, which is suggestive of an earlier and notable impairment in the hemostatic system in MALC due to the presence of two damaging factors.

The article presents the results of a HIV-VM1500-04 study after 24-48 weeks of treatment. Subjects and methods. The study included 120 adult HIV-infected patients randomized into 2 groups equally: 1) TDF/FTC +Elpivirine (VM-1500, Elpida®) (a study group), and 2) TDF/FTC + EFV(a control group). Treatment has been completed or is being continued by 91.7 and 80% in Groups 1 and 2, respectively. Results. Following 24-48 weeks of treatment, the antiretroviral therapy (ART) regimen including Elpivirint 20 mg/ day in combination with TDF/FTC was no less effective than the EFV + TDF/FTC regimen, regardless of the baseline viral load level. After 24 weeks of ART, in the study group the proportion of patients with HIV-RNA <50 copies/ml was substantially higher than that in the control group: 84.5 and 66.7% (MITT analysis; p = 0.031). At 24-48 weeks of treatment, the safety of the ART regimen including Epivirtm was higher than that containing EFV. The development of adverse events of special interest (impairments in the central nervous system and mental activity) was significantly less frequently detected in the study group (30%) than in the control one (62.1; p < 0.001). The study is expected to be completed in November 2016.