Vol 10, No 1 (2020)

Objective. To analyze the incidence of tick-borne infections (TBI) in the south of Russia in 2014 to 2018 and the features of manifestations of the epidemic process. Materials and methods. The investigators used data from the epidemiological examination schedules for an infectious disease focus and from the feral nidal infectious disease reports submitted by the Departments of the Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being and the Centers of Hygiene and Epidemiology in the subjects of the Southern and North Caucasian Federal Districts. Results. Six nosological entities of TBIs are registered in the south of Russia every year; two of them (Crimean hemorrhagic fever and tick-borne encephalitis virus infection) have a viral etiology. Four other infections (Ixodes tick-borne borreliosis, Astrakhan spotted fever, Q fever, rickettsial tick-borne spotted fever from the Mediterranean spotted fever group) have a bacterial etiology. Conclusion. It has been noted that there is a wider range of pathogens of TBI and an annual rise in its incidence, by involving people of all age groups, including young children, in the epidemic process. There is a substantial increase in the duration of the epidemic season for most TBIs due to favorable weather and climate conditions for tick activity.

Postpartum infectious and inflammatory diseases are one of the main causes of maternal morbidity and mortality. Due to the higher frequency of operative delivery, the incidence of pyoseptic diseases in puerperas has increased up to 30-35%. Caesarean section remains a risk factor for postpartum infections, the most common disease of which is considered to be endometritis. The incidence of endometritis after spontaneous birth and cesarean section is 3-5 and 10-20%, respectively. Objective. To provide the clinical and epidemiological characteristics of risk factors for postoperative endometritis in puerperas at the present stage of obstetric care. Materials and methods. The investigators used official registration data on healthcare-associated infections (HAI) in puerperas, as well as additional reporting forms designed by the authors to account and register HAI cases in the healthcare facilities of the Sverdlovsk Region. The follow-up period was 28 years (from 1991 to 2018). A total of 16,413 cases of postpartum infections were analyzed in puerperas, including 3,194 cases of postoperative endometritis. The study was conducted in the perinatal center, by using 168 operative delivery histories, including 82 histories with a postpartum physiological course and 86 ones with the development of endometritis. Epidemiological and statistical methods were applied. Results. The proportion of postoperative endometritis in the structure of postpartum infections of the uterine cavity was found to increase substantially from 26.6% in the 1990s to 40.8% at the present time (фemp = 7.908; р < 001). Operative delivery was noted to increase the risk of severe septic endometritis by 1.8 times (RR = 1.825; 95% CI, 1.732-1.924) and postpartum sepsis by 14 times (RR = 12.109; 95% CI, 6.331-23.157), which determines the importance of the problem. The clinical manifestations of postoperative endometritis are typical and in most cases develop during hospital stay in the postpartum unit. In 60% of the female patients, the diagnosis of postoperative endometritis was confirmed bacteriologically, by isolating monocultures and microbial associations in 77 and 23%, respectively. Conclusion. The risk factors of postoperative endometritis are pelvic diseases during pregnancy (OR = 7.1), a longterm membrane rupture to delivery interval (OR = 2.4), frequent vaginal examinations (more than once during childbirth) (OR = 3.4), and open fetal bladder surgery (OR=2.4).

Objective. To identify the clinical characteristics of seborrheic dermatitis (SD) in HIV-infected patients according to HIV infection stage, immune status, and viral load. Subjects and methods. A total of 401 patients with SD were followed up. A study group included 198 (49.4%) HIV-infected patients; a comparison group consisted of 203 (50.6%) HIV-negative patients. The dermatology index (Perioral Dermatitis Severity Index (PODSI)/ITPOD) was determined to assess the severity of SD symptoms. In addition to conventional studies, the investigators determined HIV RNA levels by PCR on an iCycler (Austria), by using the AmpliSens HIV-Monitor test system (Central Research Institute of Epidemiology of Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Russia) and estimated the counts of CD3+, CD4+, and CD8+ lymphocyte subpopulations on a FACS Calibur flow cytometer (Becton Dickinson, USA). Results. The onset or exacerbation of skin disease was observed in 372 (92.7%) patients within 6 months to 3 years before their inclusion in the study. The progression/exacerbation of SD at the stage of secondary diseases was noted in 140 (76.5%) patients of the study group. The process was sluggish and continuously recurring in 33.5% of cases. The concurrence of the two skin pathologies was observed in 46.1% of patients in both groups, while the compatibility was 73.2% in the study group. At the beginning of the study, obvious immunodeficiency was seen in patients at the stage of secondary diseases (the CD4+ lymphocyte counts was less than 350 cells/ml in 101 patients), while the viral load was more than 103 copies for HIV RNA; 71 patients were noted to have moderate-to-severe and severe SD requiring continuous drug therapy. Conclusion. Taking into account the correlation of the intensity of cutaneous manifestations of SD with the clinical stage of HIV infection, viral load, and CD4+ lymphocyte counts, the quantitative and qualitative assessment of the recording of morphological alterations of the skin can serve as a prognostic criterion for the course of HIV infection.

Objective. To analyze the clinical and pathogenetic features of generalized meningococcal infection (GMI) caused by N. meningitidis serogroup W. Subjects and methods. The clinical presentation of the disease was studied using the case histories of 92 patients (90 adults and 2 children, whose age was 3 to 62 years) with GMI caused by N. meningitidis serogroup W, who were hospitalized in Moscow Infectious Diseases Clinical Hospital Two in 2011-2018. Clinical examples are given. The findings were statistically processed using the generally accepted parametric methods for variation statistics. Results. The data of Moscow Infectious Diseases Clinical Hospital Two show that there has been an increase in the incidence of GMI caused by N. meningitidis serogroup W in the past 8 years from 1% in 2011 to 34.1% in 2018. Moreover, pneumonia is frequently diagnosed as an independent disease entity. Its development and generalized infection are often preceded by catarrhal laryngitis. In GMI caused by serogroup W meningococcus, pneumonia develops until a rash and meningeal syndrome appear. The disease is characterized by a severe course and high mortality rates and requires a longer inpatient treatment than infection caused by N. meningitidis serogroups A, B, and C.

Objective. To study the genotypic characteristics of Plasmodium falciparum that causes tropical malaria complicated by hemolytic anemia. Materials and methods. Two tropical malaria cases identified in Saint Petersburg hospitals in 2018 served as a material for clinical observations. In one case, the disease was severe and accompanied by the development of severe anemia; in the other case, it was uncomplicated. A polymerase chain reaction (PCR) assay was used for the investigation. The investigators used primers for the marker nucleotide sequences of the major virulence factor in P. falciparum (Plasmodium falciparum erythrocyte membrane protein 1 (PFEMP1)), encoding the structure of DBLla, DBLfi, CIDRla domains. Results. It was shown that in severe tropical malaria accompanied by the development of hemolytic anemia, the genetic markers of PFEMP1, which corresponded to the DBLla and DBLfi domains, were identified in the patient’s blood. In uncomplicated tropical malaria, these genetic markers were absent. It was suggested that there might be a relationship between the features of the P. falciparum genome and the clinical course of tropical malaria. The specific nucleotide sequences of the P. falciparum genome encoding the DBL1a and DBLfi domains of PFEMP1 are early predictors for the severe course of the disease. Conclusion. Detection of appropriate genetic markers in the blood of patients can be used in clinical practice to predict the development of tropical malaria.

Currently, there are more and more cases of the development of antibiotic-associated diarrhea in patients, which means at least three unformed stools for two or more consecutive days while taking antibiotics. The paper presents the clinical features, diagnosis, and differential diagnosis of antibiotic-associated infection and describes a clinical case of the development of enterocolitis caused by Cl. diff icile toxins A and B in an immunosuppressed patient using antibiotics.

The review presents the existing biological and mathematical models of the infectious disease process caused by Epstein-Barr virus (EBV). The existence of EBV in the host can be presented by a cycle consisting of 6 consecutive stages, each of which has its own independent variant of immune regulation. The phenomenon of virus shedding into the biological fluids, into the saliva in particular, which has been modeled with differential equations, is described. The mathematical modeling makes it possible to supplement the existing knowledge about the pathogenesis of the infectious disease process caused by Epstein-Barr virus, as well as to determine the threshold levels of virus shedding into the nonsterile environments for the diagnosis of active infections.