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Vol 10, No 2 (2020)

Articles

M.I. Epidemiological aspects of pneumococcal meningitis in the Russian Federation

Koroleva I.S., Beloshitsky G.V., Koroleva M.A., Gritsai M.I.

Abstract

Objective. To assess the relevance of the problem associated with pneumococcal meningitis (PCM) in the Russian Federation during the period 2010-2018 and to determine the serotypic characteristics of pneumococcal strains. Materials and methods. Data were collected in accordance with Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being (RFSSCRPHW) letter No. 01/9620-0-32 «On the interaction of territorial RFSSCRPHW bodies with the Reference Center for Bacterial Meningitis Monitoring» dated June 29, 2010. A total of 123pneumococcal strains isolated from the cerebrospinal fluid or blood of PCM patients were studied in 2014 to 2017. Results. The incidence of PCM tends to increase in the Russian Federation. The highest incidence rates were found in a group of children less than 5 years of age. The highest mortality rates in the study period were noted in a group of people over 45 years of age; the maximum (25%) rate was recorded among people aged over 65 years in 2018. The correspondence of invasive pneumococcal strains to the serotypes included in the PCV13 vaccine was 70%. Conclusion. It is necessary to continue a close epidemiological surveillance of PCM and to expand the coverage of immunization with conjugated pneumococcal vaccines in children and adults of the Russian Federation.
Epidemiology and Infectious Diseases. Current Items. 2020;10(2):6-10
pages 6-10 views

Features of the epidemic process of chronic hepatitis B in the Russian Federation and the Samara Region

Churbakova O.V., Akimkin V.G., Pechkurov D.V.

Abstract

Objective. To analyze the features of the epidemic process of chronic hepatitis B (CHB) in the Russian Federation and the Samara Region in the period 1997 to 2018. Materials and methods. Analysis was based on the data of official statistics, such as materials of the Federal Service for Supervision of Consumer Rights Protection and Human Well-Being and its Directorate for the Samara Region. Results. During the period 2002 to 2018, the rate of an increase in the incidence of CHB decreased in both the entire country and the Samara Region. There were positive results of the impact of hepatitis B immunoprophylaxis in the population of the Samara Region. Hepatitis B vaccination in children below the age of 18 years led to the fact that there was no new case of CHB infection among those in the region in the past 3 years.
Epidemiology and Infectious Diseases. Current Items. 2020;10(2):11-14
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Epidemiological evaluation of healthcare-associated infections found in a Khabarovsk obstetric hospital

Bondarenko A.P., Shmylenko V.A., Trotsenko O.E., Zaitseva T.A., Karavyanskaya T.N., Prisyazhnyuk E.N., Alekminskaya I.M., Trigorlova T.N., Ardasheva T.A., Astashkin E.I.

Abstract

Objective. To make an epidemiological assessment of pyoseptic infection (PSI) cases detected in a Khabarovsk obstetric hospital.Materials and methods. Twelve polyetiological PSI cases were recorded among newborn infants in the Khabarovsk maternity hospital in August-September 2017. The leading pathogen is K. pneumoniae. The strains were identified in a Vitec 2 bacteriological analyzer and a MALDI-TOF Biotyper. The drug resistance spectrum was determined by the disc method (EUCAST, 22 specimens). A molecular biological study of K. pneumoniae established the genotype (R APD typing), capsular types, and virulence factors.Results. Two groups of K. pneumoniae strains isolated from 5 newborn infants and 6 employees of the maternity hospital differed dramatically in the sign of drug resistance and molecular biological characteristics. The strains isolated from the newborn infants belonged to multidrug-resistant ESBL clones and to one genotype A. The strains from the personnel were sensitive to most antibiotics, belonged to different genotypes (B, C, D), capsular type K1, and had virulence factors and a hypermucoid phenotype. Conclusion. The results of the study of K. pneumoniae strains isolated from the newborn babies and staff in the maternity hospital during the PSI outbreak are suggestive of a difference between the two groups of strains and of the independent epidemic processes of Klebsiella infection, which have formed among the newborn infants of the obstetric hospital and among the carriers among its staff
Epidemiology and Infectious Diseases. Current Items. 2020;10(2):15-24
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Clinical, epidemiological, and diagnostic characteristics of measles during its outbreak in a vaccined population

Matievskaya N.V., Samoilovich E.O., Kuznetsova E.V., Vasilyev A.V., Semeiko G.V., Miklash L.V., Ostrovskaya O.V.

Abstract

Objective. To determine the clinical, epidemiological, and diagnostic characteristics of measles during its outbreak in the Grodno Region in 2019. Materials and methods. Case histories were retrospectively analyzed in 43 patients diagnosed with measles. The diagnosis was confirmed by laboratory tests identifying anti-measles virus IgM antibodies or by detection of viral RNA in urine and/or nasopharyngeal swab. IgM was determined using enzyme-linked immunosorbent assay systems manufactured by Euroimmun (Germany) and the JSC «Vector-Best» (Russia). Viral RNA was determined by a one-step diagnostic real-time RT-PCR assay and/or a one-step RT-PCR with electrophoretic detection of reaction products. A total of 450 C-terminal nucleotides of the N-gene of 11 measles viruses were sequenced for genotyping. Results. Among the measles cases, 83.7% were adults. Seven (16%) persons had not been vaccinated against measles. One (2%) and 28 (65%) patients received 1 and 2 doses of measles vaccine, respectively; there were no data about 7 (16%) patients. The vast majority (86.2%) of vaccinated cases had received the last dose of the vaccine 10 or more years earlier. There was no prodromal period or the latter reduced to 1-2 days in 88.4% of patients; Belsky- Filatov-Koplik spots were absent in 65.1%, and the staging of rash was in 48.8%. The unvaccinated individuals showed a higher and longer temperature response. Specif ic IgM antibodies were found in 36 (83.7%) patients; only molecular methods could confirm the diagnosis in 7%. 65.7% of patients formed 18 foci without subsequent disease transmission; 34.3% did 5 foci with cases of subsequent transmission. The detected measles viruses belonged to 2 genotypes: B3 and D8, the Gir Somnath genovariant. Conclusion. The measles outbreak involved individuals vaccinated 10 or more years earlier. Mild and moderate forms of the disease prevailed in vaccinated cases. Only the combined use of serological and molecular assays makes it possible to obtain reliable measles diagnostic results in a well-vaccinated population.
Epidemiology and Infectious Diseases. Current Items. 2020;10(2):25-31
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Comparative characteristics of the clinical and epidemiological features of Astrakhan rickettsial and Crimean hemorrhagic fevers

Galimzyanov K.M., Bedlinskaya N.R., Cherenova L.P., Mirekina E.V.

Abstract

Objective. To comparatively analyze the clinical and epidemiological features of Astrakhan rickettsial fever (ARF) and Crimean hemorrhagic fever (CHF). Subjects and methods. A total of177 cases of the moderate course of ARF (Group 1, n = 104) and CHF (Group 2, n = 73) underwent clinical and epidemiological analyses. Results. Patients with ARF or those with CHF were found to have signif icant differences in clinical manifestations: prolonged fever, chill, headache, myalgia, and arthralgia were observed in ARF; while symptoms, such as dizziness, dyspeptic disorders (loss of appetite, nausea, vomiting), scleroconjunctivitis, and hepatosplenomegaly, prevailed in CHF (p < 0.05). Conclusion. In CHF, unlike in ARF, hemorrhagic syndrome manifested not only by the appearance of hemorrhagic elements of a rash on the surface of the skin and mucous membranes, but also by the occurrence of non-cavitary and cavitary hemorrhage.
Epidemiology and Infectious Diseases. Current Items. 2020;10(2):32-36
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Chronic hepatitis B and C in patients with mental illnesses: clinical and epidemiological aspects

Baramzina S.V., Bondarenko A.L., Tokareva N.V.

Abstract

Objective. To study the clinical and epidemiological features of chronic hepatitides and cirrhosis of HBV and HCV etiology in patients with different mental illnesses. Subjects and methods. Examinations were made in seventy 18-70-year-old patients with mental illnesses and chronic hepatitis B (CHB) and C (CHC). Results. Middle-aged people suffered from CHB and CHC, whereas elderly people had viral cirrhosis. HBV infection occurred more frequently by sexual and artificial routes; HCV did by intravenous drug use or promiscuity. HBe-negative CHB constituted the highest proportion (45.7%) among hepatitides; CHC (41.4%) and CHB + CHC (5.7%) were less common. The clinical presentation in CHB was characterized by a preponderance of asthenia, dyspepsia, liver pain, minimal cytolysis, and cholestasis. Patients with CHB, CHC, or CHB + CHC were found to have grades 2 and 3 liver fibrosis (F2-F3) in 34.3, 48.3, and 25% of cases, respectively. In 7.2% of cases, the outcomes of chronic hepatitides were viral cirrhosis of HBV-, HCV-, and HBV + HCV etiologies with more clear-cut symptoms: severe asthenia, portal hypertension, encephalopathy, liver cell failure, hepatosplenomegaly, mild cytolysis, and severe cholestasis, which made it difficult to perform psychopharmacotherapy. There was a direct correlation of the activity of CHB, CHC, and viral cirrhosis with the severity of schizophrenia (p < 0.05). Conclusion. In patients with mental illnesses, CHB and CHC have an adverse effect on the course and severity of mental illness (schizophrenia). There were differences in the course of CHB, CHC, and CHB + CHC and viral cirrhosis in these patients.
Epidemiology and Infectious Diseases. Current Items. 2020;10(2):37-44
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Analysis of the needs of specialists for assistance in forming follow-up care and treatment adherence in HIV-infected patients

Belyaeva V.V., Kozyrina N.V., Sokolova E.V., Khokhlova O.N., Suvorova Z.K., Kulabukhova E.I.

Abstract

Objective. To investigate the actual needs of specialists for assistance in the formation of adherence to follow-up care and treatment for HIV infection. Subjects and methods. The paper presents the results of surveying 63 specialists who have experience in rendering care to HIV-infected patients. Group 1 consisted of 26 specialists from the Russian Federation; Group 2 included 37 specialists from Eastern Europe and Central Asia (EECA) countries, such as the Republics of Azerbaijan, Armenia, Uzbekistan, Tajikistan, Belarus, and the Kyrgyz Republic. The respondents were asked to answer the indicator question about their needs for forming patient adherence and to rate their abilities in this context. The results were assessed using the content analysis and the descriptive statistics. Results. The respondents’ most urgent needs that were common to both groups were related to organizational issues (39.3 and 58.2%, respectively), as well as to knowledge acquisition (28.6 and 25.4%). Group 1 respondents also stated that they needed to have support (17.8%) and to use effective drugs to treat HIV infection (14.3%). At the same time, half (50%) of the respondents rated their ability to form and maintain their adherence at 5 or less out of 10 scores. Group 2 respondents showed the expectations of patients to be ready for treatment (14.5%) and stated the need for material assistance (1.8%). 41.17% of the survey participants rated their ability to form and maintain adherence at 5 or less scores. Conclusion. The share of the content indicating the need to increase psychological competencies was 71.42% in Group 1 and 76.92% in Group 2. The findings should be taken into account when developing effective strategies to form adherence in HIV infection.
Epidemiology and Infectious Diseases. Current Items. 2020;10(2):45-49
pages 45-49 views

Mucosal changes in the upper gastrointestinal tract in patients with hemorrhagic fever with renal syndrome and leptospirosis

Klochkov I.N., Martynov V.A., Zhdanovich L.G., Karaseva E.A.

Abstract

Objective. To study the incidence of erosive and ulcerative diseases in the gastroduodenal mucosa in patients with hemorrhagic fever with renal syndrome (HFRS) and leptospirosis. Subjects and methods. Examinations were made in 126 men and women aged 15 to 78years who were divided into 3groups: 1) 65 patients with HFRS; 2) 29 patients with leptospirosis; 3) 32patients with urinary tract infection (UTI) of unspecified etiology. Results. There was a high rate of registration of erosions and ulcers in the gastrointestinal tract (GIT) mucosa, which were interrelated to leading laboratory parameters and the severity of the underlying disease, the basis for which is deep microcirculatory disorders. Two variants of the course of GIT diseases were identified in relation to dyspepsia syndrome. There was an association of erosive and ulcerative lesions with Helicobacter pylori infection. Conclusion. Patients with HFRS and leptospirosis show a high frequency of gastroduodenal erosions and ulcers that are more commonly recorded in the severe course of the disease on its days 2-17. Helicobacter pylori infection was detected in 39% of patients with gastroduodenal mucosal erosions and ulcers. Erosive-ulcerative diseases equally frequently occurred in the presence and absence of dyspepsia syndrome. Morphological changes were characterized by microcirculatory disorders due to microvascular changes.
Epidemiology and Infectious Diseases. Current Items. 2020;10(2):50-55
pages 50-55 views

The role of endothelial dysfunction in the pathogenesis of chronic hepatitis C and methods of its correction

Grushko I.P., Romanova E.B., Tverdokhlebova T.I.

Abstract

The paper presents the data available in Russian and foreign literature on the role of endothelial dysfunction in the mechanisms of progression of chronic HCV infection. Nitric oxide, endothelin-1, asymmetric dimethylarginine, and von Willebrand factor occupy a special place among the indicators of endothelial function. In chronic hepatitis C, nitric oxide deficiency is consistent with a simultaneous increase in the blood concentration of endothelin-1. The high level of von Willebrand factor is generally associated with destruction of the sinusoidal endothelium and disordered vascular platelet hemostasis. The markers of endothelial dysfunction have been ascertained to be associated with the severity of liver f ibrosis and inflammation. The paper discusses the involvement of endothelial factors in the development of impairments in portohepatic hemodynamics and hepatic vascular remodeling with the formation of collateral blood flow. It considers the possibilities of pharmacological correction of endothelial dysfunction as a promising area of pathogenetic therapy for chronic hepatitis C.
Epidemiology and Infectious Diseases. Current Items. 2020;10(2):56-61
pages 56-61 views

Role of disintoxication and antioxidant therapy for COVID-19: theory and practice

Khavkina D.A., Ruzhentsova T.A., Chukhlyaev P.V., Garbuzov A.A., Shushakova E.K.

Abstract

Literary sources containing information about the course, diagnosis, and therapy of COVID-19 do not mention detoxification and/or antioxidant therapy. Based on their own clinical experience, the authors supplement the data on the pathogenesis of COVID-19, which provide a rationale for the necessary use of detoxifiers, sorbents, and antioxidants to improve the course, prognosis and outcome of the disease. The developed model of COVID-19 pathogenesis is pathophysiologically substantiated; the positive impact of the proposed pathogenetic therapy is demonstrated using clinical examples.
Epidemiology and Infectious Diseases. Current Items. 2020;10(2):62-69
pages 62-69 views

Results of 144-week use of the combined drug rilpivirine/tenofovir/emtricitabine in HIV-infected patients in Saint Petersburg

Sizova N.V., Maiorova S.O., Bratkova V.V., Sotnkova A.L., Malkova A.V., Gusev D.A.

Abstract

Objective. To evaluate the efficacy, safety, and tolerance of the combined drug RPV/TDF/FTC (Еviplera) in HIV-infected patients who have received treatment for 144 weeks.Materials and methods. Medical records of 213 HIV-infected outpatients who had received RPV/TDF/FTC for 3 years were retrospectively analyzed. The main criterion for the effectiveness of the regimen was the proportion of patients having an undetectable viral load at week 144 of treatment. The additional criteria for evaluating the effectiveness and safety of the regimen were the time course of changes in the count of CD4+-lymphocytes and the frequency and nature of adverse events (AEs).Results. At week 144 of treatment, 91% of patients continued their RPV/TDF/FTC regimen. 98.4% of them had a viral load of < 50 copies/ml and 99.5% had that of <500 copies/ml in both the patients who had received ART for the first time and those who had experienced treatment. Only 5.8% of patients discontinued the drug due to AEs. In 2 (0.9%) patients, the regimen was replaced because of the development of HIV drug resistance. The mean CD4+-lymphocyte counts increased by 74 cells/μl at week 144 of treatment. Conclusion. The RPV/TDF/FTC regimen demonstrated its effectiveness and safety. AEs occurred in 20% of patients older than 50 years and in only 1.3% of those younger than 50 years old (p < 0.05). Before prescribing RPV/TDF/FTC to patients older than 50 years, it is necessary to thoroughly estimate glomerular filtration rate and to perform densitometry. It is advisable to prescribe RPV/TDF/FTC as a first-line regimen both to retain the patient on the therapy and to prevent dyslipidemia and a cardiovascular risk.
Epidemiology and Infectious Diseases. Current Items. 2020;10(2):70-75
pages 70-75 views

Experience with narlaprevir in the treatment of chronic hepatitis C

Ponezheva Z.B., Makashova V.V., Sannikova I.V., Titorenko M.V., Mannanova I.V., Patlusov E.P., Kambieva L.F., Ivanova M.R.

Abstract

Objective. To evaluate the efficacy and safety of the Russian NS3-protease inhibitor narlaprevir used with ritonavir (NVR/RTV) in combination with Peg-IFN and ribavirin (RBV) in patients with chronic hepatitis C (CHC), who were infected with HCV genotype 1b, as well as in combination with daclatasvir (DAC) in those with CHC who have not received antiviral therapy. Subjects and methods. The investigators analyzed the case records of 42 patients aged 18 to 70 years with CHC infected with CHVgenotype 1b, who were not found to have NS5A drug resistance-associated amino acid substitutions (Y93C/H/N/S and/or L31F/M/V/I). Two groups were formed according to the treatment regimen. Group 1 patients (n = 26) received triple therapy: NVR 200 mg once daily, RTV100 mg once daily in combination with Peg-IFN) and RBVfor 12 weeks with interferon therapy continuation for up to 24 weeks. Group 2 patients (n = 16) had 12-week interferon-free therapy: NVR 200 mg once daily, RTV100 mg once daily in combination with DAC 60 mg once daily. The proportion of patients who had achieved a sustained virologic response (SVR) was a main efficiency indicator. Results. SVR at 24 weeks after therapy (SVR24) could be achieved in 5 out of 6 patients who relapsed after the previous Peg-IFN + RBV treatment cycle. Primary patients who received NVR/RTV therapy achieved SVR24 in 93% of those who had the initial degree of liver fibrosis F0-F2 (according to the METAVIR scoring system). In Groups 1 and 2, SVR24 was recorded in 21 (81%) and 15 (94%) patients, respectively. Conclusion. A combination of NVR/RTV + DaC compared to that of NvT/rTv + Peg-IFN + RBV showed a higher eff iciency (94% vs. 81%) and safety, ease of use and good tolerability.
Epidemiology and Infectious Diseases. Current Items. 2020;10(2):76-83
pages 76-83 views

Malaria chemoprophylaxis during a long-term stay in an endemic area: experience with mefloquine and chloroquine

Solovyev A.I., Uskov A.N., Moskalev A.V.

Abstract

Objective. To study the dynamics of occurrence of side effects of mefloquine and chloroquine after starting their regular prophylactic administration and to determine the optimal duration of a continuous cycle of malaria chemoprophylaxis. Subjects and methods. The authors present the results of following up the armed forces personnel from the Russian aviation group of the United Nations peace-keeping mission in Angola in 1996-1997 and used malaria chemoprophylaxis with mefloquine (250 mg once a week) and chloroquine (300 mg once a week). The military servicemen aged 22 to 53 years were followed up for 6 to 12 months. Results. At 4 months after starting medication administration, the proportion of people with signs of the hypersensitivity of mefloquine and chloroquine was 29.7 and 8.3%, respectively. By the end of the 5th month, that was 35.1 and 10.7%, respectively. The persons sensitive to mefloquine had weakness, nausea, sleep disturbance, signs of depression, and a decline in visual acuity. Weakness, short-lasting headache, tinnitus, and decreased appetite were observed in those who took chloroquine. Conclusion. When choosing a malaria chemoprophylaxis scheme, it is necessary to take into account individual drug sensitivity and the length of stay in an endemic area. As a rule, a continuous cycle of chemoprophylaxis should be planned for a period of not more than 3- 4 months. The package of antimalarial measures should additionally include measures to reduce the risk of infection, to protect against vector attacks, and to ensure early detection and effective treatment in infected people.
Epidemiology and Infectious Diseases. Current Items. 2020;10(2):84-89
pages 84-89 views

A clinical and morphological case of COVID-19

Vorobyeva O.V., Lastochkin A.V.

Abstract

COVID-19 is an acute respiratory viral disease caused by the new coronavirus SARS-CoV-2. The common complication of COVID-19 is acute respiratory distress syndrome. Other recorded complications include acute kidney and myocardial injuries and multiple organ failure. The paper describes a case of severe COVID-19 in a 68-year-old female inpatient diagnosed with severe bilateral community-acquired systemic pneumonia. She was admitted to hospital with complaints of weakness, a feeling of chest congestion, dyspnea, and a fever of up to 38.0°C. The concomitant diseases were diabetes mellitus, hypertension, and coronary heart disease. Despite the treatment, her condition progressively worsened and she died. Autopsy study revealed the clinical presentation of hemorrhagic pneumonia with alveolar f ibrin areas, desquamation, necrotic alveolar epithelial areas, and edema with a hemorrhagic component. The image of the heart showed a picture of concentric hypertrophy: cardiomyocytes with large lobulated hyperchromatic nuclei were disconnected and isolated from each other by interstitial interlayers. The clinical presentations of diabetic microangiopathy, such as plasmorrhagia and vascular hyalinosis, were visualized. Necronephrosis was detected in the kidneys. Virological examination revealed viral RNA in COVID-19. In the described case, the lung clearly shows a tendency from the exudative to proliferative phase; however, hemorrhagic edema still prevailed due to a premorbid history (diabetes mellitus, hypertension, obesity, microangiopathy); this led to the development of acute pulmonary heart failure, lung and brain edema, and necronephrosis.
Epidemiology and Infectious Diseases. Current Items. 2020;10(2):90-93
pages 90-93 views

Natalia Mikhailovna Belyaeva

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Epidemiology and Infectious Diseases. Current Items. 2020;10(2):94-94
pages 94-94 views

Viktor Vasilyevich Maleev

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Epidemiology and Infectious Diseases. Current Items. 2020;10(2):95-95
pages 95-95 views

In memory of Arpik Ashotovna Asratyan

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Epidemiology and Infectious Diseases. Current Items. 2020;10(2):96-96
pages 96-96 views

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