Clinical and laboratory characteristics of haemophilus influenza type b Infection with central nervous system Involvement in young children

Introduction. Invasive Haemophilus influenza type b (Hib) infection often manifests as severe and complicated forms of purulent meningitis in children from birth to 6 years of age. Hib meningitis is the most commonly diagnosed invasive form, with a severe course. There is no generally accepted clinical classification of Hib infection. Along with meningitis, the infection is often manifested with purulent inflammatory foci of different localization.The objective was to characterize the course of purulent Hib meningitis, including in combination with purulent foci, in young children.Methods and materials. We analyzed 45 case histories of children (under the age of 3 years) who had an invasive Haemophilus infection with purulent meningitis. Hib meningitis (Group-1) was diagnosed in 17 patients and meningitis in combination with specific purulent foci was diagnosed in 28 patients (Group-2). The diagnosis in all patients was confirmed bacteriologically or serologically (Latex Agglutination Test).Results. The combination of meningitis with purulent foci of Hib infection was characterized by late hospitalization (36 %), longer recovery of cerebrospinal fluid, longer duration of the disease, and the prevalence of severe and complicated disease, and often required surgical treatment (46.4 %). A burdened premorbid background is traditionally considered a condition for the development of invasive Hib infection. According to our data, only 40 % of children had a burdened premorbid background, which is confirmed by clinical cases.Conclusion. Since Hib infection in young children is often combined with meningitis with purulent foci, is characterized by a severe and complicated course, and often requires surgical treatment, it is advisable to consider this form of infection separately

Diagnostic markers of hepatic steatosis in patients with chronic viral hepatitis C

Objective was to conduct a comparative analysis of routine clinical and laboratory parameters in two groups of patients with chronic viral hepatitis C (CHC) depending on the presence or absence of hepatic steatosis.Methods and materials. The observational retrospective cross-sectional study included 411 patients with CHC, of which 43.80 % were those with hepatic steatosis. The studied parameters were routine clinical and laboratory parameters, the viral genotype, as well as formalized results of a liver biopsy and ultrasound examination of the abdominal organs. To assess the differences between the two groups, the following were calculated: Pearson’s test, two-tailed Fisher’s test, Wilcoxon rank sum test, Spearman’s correlation coefficient, and partial correlation coefficient.Results. It was found that CHC patients with hepatic steatosis were older and had a higher body mass index (BMI) than patients without hepatic steatosis (p<0.01). Among patients with hepatic steatosis, the 3a genotype of the virus (p<0.001) and advanced stages of liver fibrosis (p<0.01) were more often detected, higher concentrations of hepatic transaminase (p£0.001) and iron (p<0 .01) in blood serum were observed, as well as higher liver (p<0.001) and pancreas (p<0.001) sizes on ultrasound than among patients without hepatic steatosis.Conclusion. Age, BMI, viral genotype, stage of liver fibrosis, ALT, AST, GGT, and iron levels, as well as liver and pancreas size are potential predictors of the presence of hepatic steatosis in CHC patients

The causes of death of HIV-Infected subjects in Lomonosov district of the Leningrad region, Russia, in 1999–2011

Aim – to analyze causes of death of HIV infected subjects died in Lomonosov District of the Leningrad Region, Russia, in 1999-2011. Materials and Methods. A retrospective analysis of 118 autopsy results of all HIV-infected patients who died in hospitals of Lomonosov district of the Leningrad region, as well as those delivered to the autopsy department from homes or streets in 1999–2011. Results. Males were 76%, the middle age – 32,1±4,3 years. The HIV-infection was the cause of death in 53 subjects (49%). Tuberculosis was the major postmortem diagnosis in this group of patients (85%). Due to other diseases or have died a violent death 29 (27%) and 27 (24%) individuals correspondingly. From 62 patients deceased in hospitals 18% subjects died at first day of staying at hospitals, and 42% during first three days. Antiretroviral treatment was prescribed to 9 patients. All of the were nonadherent to treatment and follow-up. Other study subjects were nonadherent to follow-up or never on follow-up. Conclusion. In almost half of subjects the death was due to progression of HIV-disease. All HIV-infected patients had poor adherence to follow-up and/or antiretroviral treatment. The results confirm the critical importance of timely and early detection of HIV-infected persons, regular follow-up and improving adherence to antiretroviral therapy among HIVinfected patients

EVALUATION OF EFFECTIVENESS OF ANTIVIRAL THERAPY FOR CHRONIC HEPATITIS C, CAUSED BY HCV GENOTYPE 6

Objectives: Evaluating the effectiveness of 2 therapeutic schemes for chronic hepatitis C (genotype 6) which combined sofosbuvir and ribavirin, one of them also included pegylated interferon. Materials and methods: The study included 110 patients with chronic hepatitis C (genotype 6), who have undergone antiviral therapy (HTP) in Hepatology Clinic inHo Chi Minh City,Vietnamfrom November 2015 to July 2016. 24 patients were treated by Pegylated interferon alfa-2a, ribavirin and sofosbuvir for 12 weeks, 86 patients – by sofosbuvir and ribavirin for 24 weeks. Non-interferon regimen was administered primarily to patients with contraindications to the use of interferon. To monitor the effectiveness of antiviral therapy, quantification of HCV RNA in serum was performed by PCR prior to treatment, at 4th, 12th or 24th week (depending on the observation group) from the starting of treatment and at 12th, 24th week after completion of treatment. Results: All patients, who were treated with pegylated interferon, ribavirin and sofosbuvir, completed the full course of treatment and 100% of them are registered with sustained virological response at 12th and 24th week after the end of antiviral therapy (SVR-12 and SVR-24, respectively). In the group of patients, who treated with ribavirin and sofosbuvir, 97,7% of patients completed full course of treatment (SVR-12 was registered in 93% of patients, and SVR-24 – in 91,9% of patients). Of 75 patients without a history of HCC, SVR24 was registered in 74 people (98,7%), of 11 patients with HCC – in 5 patients (45,5%). SVR-24 was registered in 98% of patients with cirrhosis (F4) without HCC. Conclusion: The results can serve as a justification for the use of these schemes of antiviral therapy for special groups of patients and/or conditions when it is impossible to follow the latest recommendations, which will help to expand the access of patients to effective antiviral therapy for chronic hepatitis C

Случай геморрагической лихорадки, вызванный вирусом денге

.

Быть или не быть: прогноз развития эпидемии COVID-19 в России

Currently, the intensity of COVID-19 epidemic in Russia is declining. Most of the country’s regions are at the first stage of lifting restrictions; some regions have moved to the second and third phases. At the same time, the development of the COVID-19 pandemic in Southern hemisphere indicates the continuous circulation of SARS-CoV-2 in the world. The article provides statements arguing for the development of the «second wave» of the COVID-19 epidemic in Russia, as well as practical recommendations aimed at preparing for the autumn-winter epidemic season 2020–2021.В настоящее время эпидемия COVID-19 в России идет на спад. Большая часть регионов страны находятся на первом этапе снятия ограничений, некоторые регионы перешли ко второй и третьей фазе. Вместе с тем, развитие пандемии COVID-19 в странах Южного полушария свидетельствует о непрекращающейся циркуляции SARS-CoV-2 в мире. В статье приведены аргументы, свидетельствующие в пользу развития «второй волны» эпидемии COVID-19 в России, а также даны практические рекомендации, направленные на подготовку к осенне-зимнему эпидемическому сезону 2020–2021 гг

ЛЕЧЕНИЕ ХРОНИЧЕСКОГО ГЕПАТИТА С (ГЕНОТИПА 6) У БОЛЬНЫХ, ИМЕЮЩИХ ПРОТИВОПОКАЗАНИЯ К ПРИМЕНЕНИЮ ИНТЕРФЕРОНА-α

.

Prediction of the course of antibiotic-associated diarrhea caused by <i>Clostridioides difficile</i> based on clinical and laboratory characteristics of the disease

Background. The most severe complications of antibiotic use are clostridial infection (CDI) and pseudomembranous colitis (PMC). There is a need for further study of these conditions and identification of their triggers. Aim. To identify risk factors for severe forms of antibiotic-associated diarrhea caused by Clostridioides difficile. Materials and methods. A clinical and laboratory examination of 440 patients with CDI who were treated at Botkin Clinical Infectious Diseases Hospital was conducted. CDI was confirmed by detection of toxins A and B of C. difficile in feces using enzyme-linked immunosorbent assay and immunochromatography. Metronidazole (2 g/day, in patients without comorbid pathology) and vancomycin (0.5–2 g/day) were used as a starting drug for up to 14 days. Statistical processing of the obtained data was performed using the Statistica for Windows, v.10 (StatSoft, USA) program. Results. CDI was confirmed by enzyme-linked immunosorbent assay in 202 (45.91%) patients, immunochromatography – in 149 (33.86%), endoscopically – in 203 (46.14%). CDI was most frequently recorded in 2 age groups of patients: 18–30 years old – in 137 (31.14%); over 60 years old – in 205 (46.59%). CDI was characterized by a combination of colitic and intoxication syndromes. In 43 (9.77%) patients the disease resulted in death. The diagnosis of PMС was established in 61 (13.86%) people. The risks of developing PMC when prescribing antibacterial drugs decreased in the following order: fluoroquinolones, cephalosporins, macrolides, penicillins, nitrofurans and chloramphenicol. Probiotic drugs reduced the risk of developing PMC (relative risk 0.5 [0.3; 0.7]; p=0.002). Conclusion. PMC was characterized by a combination of diarrhea, intoxication and abdominal pain. The formation of PMC was preceded by courses of antibacterial drugs of the fluoroquinolone and cephalosporin groups, eradication therapy for Helicobacter infection, the use of high doses of glucocorticosteroids, as well as intestinal superinfection in patients with previous episodes of CDI

An impact of CMV and HHV-6 reactivation on the course of early period after hematopoietic stem cell transplantation in patients with hematologic malignancies

Objective. To assess the impact of CMV and HHV-6 reactivation on the course of early post-transplant period in patients with hematologic malignancies.   Materials. Retrospective analysis of medical records of 339 patients with hematologic malignancies who received hematopoietic stem cell transplantation (HSCT) was performed, and markers of CMV and HHV-6 infections were detected (specific IgG, EIA). Blood and other materials from HSCT recipients were tested (PCR) for viral DNA in early post-transplant period (up to Day 100).   Results. Reactivation of viral infections after HSCT was discovered in 177 patients (52,2 %): CMV-infection was detected in 23 %, HHV-6 in 17,4 %, CMV+HHV-6 in 11,6 % of HSCT recipients. CMV DNA was predominantly identified in blood, while HHV-6 DNA was more frequently discovered in GIT mucosa and bone marrow. 40 % of 99 patients with HHV-6 reactivation had concomitant CMV+HHV-6 reactivation. In this group, the clinical manifestation of infections was registered significantly more frequently. Febrile neutropenia was more frequent in HSCT recipients with CMV reactivation, sepsis and graft hypofunction were diagnosed more frequently in presence of HHV-6 and predominantly HHV-6+CMV infections. The direct correlation (using Spearman’s method) between CMV and HHV-6 reactivation and terms of leukopoiesis recovery, engraftment terms, and transplant hypofunction was revealed. An impact of herpetic infections reactivation on the graft hypofunction and late recovery of leukopoiesis was confirmed using the logistic regression; its impact on the chimerism was revealed. In 72 % of cases, the graft failure in early post-transplant period occurred in patients with herpetic infections reactivation.   Conclusion. HHV-6 and CMV reactivation in the early period after HSCT correlates with terms of leukopoiesis recovery, contributes to development of complications, and is an additional factor aggravating the course of the post-transplant period