Vol 12, No 2 (2022)

The data accumulated during a long follow-up period could determine the rate, trends, and structure of morbidity, mortality, and death in invasive meningococcal disease (IMD) in the Russian Federation (RF). Objective. To analyze the epidemiological features of IMD in the RF during a 10-year follow-up period. Materials and methods. The personalized information on 10,119 cases of IMD, which had been obtained by the Russian Reference Center for Monitoring Bacterial Meningitis (RCMBM) in 2010-2019, was retrospectively analyzed. Results. The incidence of IMD in the RF tends to decrease. However, since 2016 there has been a rise in the incidence of IMD with an average annual increase of 10.4% and an absolute increase of 0.15 per 100,000population; the involvement of adolescents and young adults in the epidemic process (a rise in the 2016-2019 incidence by 2.4 and 2.6 times, respectively); a 5.5-fold increase in the number of cases caused by serogroup A meningococcal strains. The highest morbidity and mortality rates were found among the children, but the role of adults was significant in the structure of morbidity and mortality for IMD. Conclusion. The investigation has established the precursors of epidemiological troubles in relation to IMD, indicating a possible threat of the next periodic rise in its incidence. The findings could optimize MD vaccination in the RF and increase its coverage among the population

Objective. lo investigate the pathogenetic features of the development and progression of heart damage in COVID-19, by estimating the pretest probability of coronary heart disease CHD) in patients at 3 months after the illness. Subjects and methods. Clinical and laboratory parameters were analyzed in 180 patients who had received inpatient treatment for diagnosed and confirmed moderate novel coronavirus disease (COVID-19) and had no history of cardiac disease. In addition to the standard laboratory examination, the levels of biochemical, immunological, and cardiac markers, such as IFN-а, IL-6, IL-17, macrophage inflammatory protein (MIP-1P), brain natriuretic peptide (NT-proBNP), troponin I, fatty acid binding protein, and C-reactive protein were studied over time. Results. On days 7 to 10 after illness onset, the patients with moderate COVID-19 were found to have elevated levels of the markers of myocardial damage [troponin I (53.3%), fatty acid binding protein (8.8%)] and myocardial dysfunction [NT-proBNP (45%)]. By the 2nd week of hospitalization, the number of patients with the elevated level of troponin I increased up to 68.3% and that of NT-proBNP decreased to 26.7%. There was a direct correlation between the increase in the above markers with the levels of IL-6 and IL-17, as well as with the concentration of MIP-1P and there was an inverse correlation with the level of IFN-а. ECG revealed signs of myocardial ischemia, cardiac hypertrophy and overload, and arrhythmia. At 3 months after recovery, 20% of the examinees complained of heart area pains that were not recorded before COVID-19, of whom 58.3% of patients were noted to have a pretest probability of 15-85% for CHD, which justifies the need for additional cardiac imaging tests after COVID-19 infection. Conclusion. Comprehensive analysis of clinical complaints, biochemical and immunological parameters, and ECG and echocardiography data in patients with moderate COVID-19 could diagnose the development of acute myocardial damage in 43.8%, exertional angina pectoris in 11.2%, arrhythmia in 27%, and heart failure in 14.7%.

Herpes viruses are considered as a trigger factor for the development of a number of somatic diseases; however, no convincing relationship has ever been established between specific pathogens and a particular disease. Objective. To define the role of herpesvirus infections in the development of nervous system disorders and associated cerebrovascular diseases. Subjects and methods. The incidence of infectious mononucleosis, genital herpes, cytomegalovirus infection, nervous system disorders, and circulatory system diseases, including cerebrovascular ones, was analyzed in Russia in 2000-2020. Ninety-two blood donors and 84 neurology inpatients aged 18-65 years were examined for IgM and IgG antibodies to herpes simplex viruses (HSV-1 and HSV-2), Epstein-Barr virus (EBV), cytomegalovirus (CMV), and human herpesvirus 6 (HHV-6). Parametric and nonparametric methods were used for statistical processing. Results. A significant strong direct correlation was found between the incidence of infectious mononucleosis and circulatory system diseases (p = 0.89), cerebrovascular diseases (p = 0.92), genital herpes, and nervous system diseases (p = 0.70). The detection rate for HSV-1 and HSV-2 IgM, total IgEa and EBV IgM VCA in the patient group was significantly higher than that in the donors (p < 0.05). Dorsopathy is diagnosed significantly more often in active HSV-1 infection; cerebrovascular diseases are in EBV (p < 0.05). The presence of EBV IgM VCA and IgG Ea significantly (p < 0.05) increases the incidence of cerebrovascular disease (RR = 41.7; 95% CI 5.9-293.4). Conclusion. It has been shown for the first time that active EBV infection is a trigger factor for the development of cerebrovascular diseases.

There is currently a transformation of the clinical symptoms of Astrakhan spotted fever (ASF): cases of its severe course, complications, and death have become more common. Among the complications of ASF, acute renal failure (ARF) is most frequently diagnosed at the present stage. On hospital admission, no clinical and laboratory markers indicating the onset of the pathogenetic process in the kidneys have yet been detected; creatinine and urea remain within the normal range or are recorded at the upper reference values. Neutrophilic gelatinase-associated lipocalin (NGAL) that has shown its diagnostic and informational value is proposed to be studied as an early marker of the severe course of ASF and renal complications thereof. Objective. To assess the diagnostic and prognostic values of determining NGAL in patients with ASF. Subjects and methods. Solid-phase enzyme immunoassay was used to study the plasma concentration of lipocalin in patients with ASF depending on disease severity and (initial, peak) period. Forty-nine patients who were treated for ASF were followed up in the A.M. Nichoga Regional Infectious Diseases Clinical Hospital in Astrakhan. Most of the cases were rural residents (63%), individuals at the age of over 60 years (89.7%). Results. Just on hospital admission with the still normal values of creatinine and urea, the level of lipocalin increased statistically significantly compared to the control values in apparently healthy volunteers - 511.27+146.06 ng/ml (p < 0,001) for severe ASF and 173.95+40.1 ng/ml (p < 0.05) for moderate ASF. Conclusion. The paper has demonstrated the diagnostic value of studying the plasma level of lipocalin as an early informative marker to confirm the development of ARF and to determine its severity in ASF.

The paper reviews the results of foreign and Russian investigations of the clinical and pathogenetic features of longterm andpost-COVID syndrome in in- and outpatients with COVID-19.

COVID-19 is accompanied by an imbalance of the immune response with severe macrophage activation syndrome, which creates the possibility of using drugs that affect the regulation of macrophage functions. Objective. To estimate the efficacy of the immunomodulator aminodihydrophthalazinedione sodium (galavit) for the prevention and treatment of COVID-19. Subjects and methods. The investigation was conducted in 2 stages. At Stage 1, a total of 115 healthcare workers were followed up for 1 month. A study group (n = 68) took aminodihydrophthalazinedione sodium (galavit) as a prophylactic drug; a comparison group (n = 47) did not receive the drug. Weekly PCR assay of nasopharyngeal/ oropharyngeal swabs could determine the timing of SARS-CoV-2 infection, depending on the prophylactic cycle. At Stage 2, to evaluate the therapeutic efficacy of the drug, a follow-up was made in 76 healthcare workers who were on outpatient treatment with a laboratorially confirmed diagnosis of moderate COVID-19, of whom 46 patients (a study group) had Galavit in the combination therapy and 30 (a comparison group) received standard therapy. The serum levels of IL-1, IL-6, IL-10, TNF-а, and IFN-а in novel coronavirus infection (NCI) were studied. Results. During the follow-up period at Stage 1, there were 14 (20.5%) and 22 (46.8%) persons were infected in the study and comparison groups, respectively. The asymptomatic and mild courses of the infection were observed in 10 (71.4%) patients of the study group); its mild course was seen in 4 (18.1%) patients of the comparison group. At Stage 2 of the investigation, the study group patients with NCI were recorded to have a statistically significant (p < 0.01) stabilization of cytokines, normalization of laboratory inflammatory markers and complete blood cell counts, and a more obvious regression of lung damage, as evidenced by chest CT. Conclusion. The preventive therapy cycle with aminodihydrophthalazinedione sodium showed a pronounced effect of the drug in reducing the risk of infection and preventing severe NCI. Immunomodulatory therapy with aminodihydrophthalazinedione sodium that has anti-inflammatory, antioxidant, and immunomodulatory effects is accompanied by the early relief of clinical symptoms of NCI, normalization of laboratory data, and significant stabilization of cytokine system parameters.

Objective. To study risk factors for SARS- CoV-2 in patients with sarcoidosis (S) and the features of viral shedding in them during the development of COVID-19. Subjects and methods. Nineteen case histories of S patients who had fallen ill with COVID-19 were analyzed. The diagnosis of S was confirmed morphologically, whereas COVID-19 was confirmed mainly by positive PCR tests for SARS-CoV-2 RNA. Mediastinal, pulmonary-and-mediastinal, and pulmonary S were diagnosed in 11, 6, and 2 cases, respectively. Sixteen patients with S before COVID-19 had a stable clinical condition that required no medical support. In unstable S, 1 patient took azathioprine (100 mg/day) and two had metypred (8 mg/day). As a result of treatment, all the patients with S recovered from COVID-19. All the 19 patients underwent an epidemiological analysis that included an assessment of the likely sources of SARS-CoV-2. Results. The patients with S were found to have contacts for coronavirus: familial (n = 8), working (n = 6), nosocomial (n = 3), household (n = 1), and unidentified (n = 1) contacts. The mean duration of viral shedding was 10.6±2.8 days in the Spatients. Six patients with S had mild COVID-19; 13 had a moderate course with recovery. Conclusion. The main risk factors for SARS-CoV-2 infection in S are familial and working contacts: being in the same room with the source of infection and professional activities associated with numerous contacts with a large number of people. COVID-19 in Spatients was characterized by its mild and moderate clinical course. The mean duration of viral shedding in this case was 10.6±2.8 days.

The paper dealing with the 95th anniversary of the Children’s Research and Clinical Center for Infectious Diseases (formerly the Research Institute of Childhood Infections) describes its history and evolution of scientific activities. It shows the mission, strategy, and scientific directions of the activity of the institution that is an integral part of the National Biosafety System of the country. The paper depicts the major scientific achievements in the past 5 years, the introduction of which into the practical work of healthcare facilities in our country confirms the effective implementation of the institution’s mission to save the lives of children.