Клинико-эпидемиологическая характеристика завозной тропической лихорадки денге

Dengue fever is a zooantroponotic, vector-borne viral disease. It is common among the population of tropical countries and is characterized by a tendency to expand to other countries as a result of infection drifts.Objective: to identify epidemiological, clinical and laboratory features of imported dengue fever in St. Petersburg.Materials and methods. The obtained data of official registration of cases of diseases in the Department of accounting and registration of infectious and parasitic diseases of the city of St. Petersburg and clinical case histories from the Сlinical Infectious diseases hospital named after S.P. Botkin for 2012–2018 were used as the basis for epidemiological analysis. 144 cases of dengue fever were identified on the basis of registration materials in the city during this period, of which 86 cases were studied on clinical histories. Standards methods of epidemiological diagnostics and statistics were used in the article.Results and discussion. Epidemiological anamnesis has been seen in a wide variety of countries in which tourists stayed and became infected. The hemorrhagic form of dengue fever was diagnosed in only 18 (19,1%) out of 86 patients. This form usually develops with repeated encounters with the virus and is more severe than the classic version of the disease. Dengue fever remains a topical imported disease and is associated with an increase in tourists, often re-visiting disadvantaged tropical countries. Both sexes were equally exposed to the disease. The age characteristic of patients is represented by persons of 20–29 and 30–39 years of age. An increase in the number of patients over a 7-year period was noted in May and November. Such countries as Thailand (37%), Vietnam (13,9%) and India (9,3%) were the predominant tourist destinations. Besides, single infections occurred in 13 countries of the Asian, African and American regions. The primary diagnosis in 50,3% of patients referred to hospital were acute respiratory diseases, combined with diarrhea and other manifestations. Clinical manifestations fit into 5 syndromes, which pass with a variety of symptoms, complicating both clinical diagnosis and laboratory confirmation of the diagnosis. Imported dengue fever is characterized by combined infections caused by pathogens of acute intestinal diseases, cytomegalovirus, hemorrhagic fever with renal syndrome, West Nile fever, hepatitis A, Legionella and Plasmodium malaria. In General, combined infection was detected in 39.5% of patients.Лихорадка денге – зооантропонозное, вирусное трансмиссивное заболевание, распространенное среди населения стран тропического пояса, которое завозится в другие страны из эндемичных регионов мира.Цель: дать эпидемиологическую и клинико-лабораторную характеристику лихорадки денге завозного характера в Санкт-Петербурге.Материалы и методы. В основу эпидемиологического анализа положены данные официальной регистрации случаев заболеваний в 2011–2019 гг. в отделе учета и регистрации инфекционных и паразитарных заболеваний Санкт-Петербурга, изучения историй болезни Клинической инфекционной больницы им. С.П. Боткина за 2012–2018 гг. Всего по материалам регистрации за этот период в городе было выявлено 144 заболевания лихорадкой денге, из которых 86 изучены по историям болезни, 46 – по данным регистрации. Использованы стандартные методы эпидемиологической диагностики и статистики.Результаты и обсуждение. Эпидемиологический анализ статистических данных за 2012–2018 гг. показал, что заражение туристов лихорадкой денге произошло преимущественно в странах Азии. Из 86 больных у 18 (20,9%) пациентов диагностирована геморрагическая форма лихорадки денге, в 68 случаях (79,1%) – классический вариант заболевания. Лихорадка денге остается актуальной завозной болезнью и связана с увеличивающимся числом туристов, посещающих неблагополучные тропические страны. В половой структуре больных в равной степени были как мужчины (50,4%), так и женщины (49,6%). В возрастной структуре больных, как у мужчин, так и у женщин, превалировали лица 20–29 и 30–39 лет. Увеличение числа больных за 7-летний период отмечено в мае и ноябре. Превалирующими местами заражения туристов были Таиланд (37%), Вьетнам (13,9%) и Индия (9,3%); единичные заражения произошли еще в 13 странах Азиатского, Африканского и Американского регионов. Первичными диагнозами при направлении больных в стационар в 50,3% случаев были острые респираторные заболевания, сочетающиеся с диарейным синдромом и другими симптомами. Спектр клинических проявлений лихорадки денге укладывается в 6 синдромов, протекающих с разнообразной симптоматикой, затрудняющей как клиническую диагностику, так и лабораторное подтверждение диагноза. Для завозной лихорадки денге характерны сочетания с заболеваниями другой этиологии, включая возбудителей острых кишечных инфекций, цитомегаловирусной инфекции, геморрагической лихорадки с почечным синдромом, лихорадки Западного Нила, гепатита А, легионеллеза и малярии. В целом, сочетанная инфекция выявлена у 39,5% больных

Secondary hemophagocytic syndrome in adult patients. Study of 91 patients

Background. Secondary hemophagocytic lymphohystiocytosis (sHLH) is a hyperinflammatory reaction provoked by some trigger (cancer, autoimmune or infection). The majority of affected patients are at high risk of fatal multiple organ failure without getting immunsupressive treatment.Objective. Clinical and laboratory profile of sHLH patients.Materials and methods. Retrospective study included clinical, instrumental and lab data from the 91 patients followed between June 2009 and June 2019. Diagnosis sHLH had been based on HLH-2004 and H-Score criteria. The analyzed parameters had been fever chart, liver and spleen enlargement, changes in the bone marrow; values levels of glutamic pyruvic transaminase, serum glutamic oxaloacetic transaminase, alkaline phosphatase, bilirubin, triglycerides, total ferritin with percentage of glycosylation. All patients with rheumatic disorders or malignancies had received either immunosuppressive or cytotoxic therapy. Febrile patients received anti-infective treatment according to the local routine protocols.Results. The data from 91 patients (41 male and 50 female) had been analyzed. Median age was 58 (2–90) years. The sHLH trigger-diseases spectrum included leukemia/lymphoma (n = 52), infection diseases (n = 11), autoimmune disorders (n = 5), allogenic bone marrow transplantation (n = 13), unidentified (n = 10). A fever with an unknown origin and refractory to antibacterial treatment had been observed in 87 (96 %) patients. Morphological hemophagocytic evidences in the bone marrow had been found in 83 %. Breath shortening, liver failure, neurologic disturbances, systemic effusions, rash, heart failure had been registered in 83 % patients. Detected splenomegaly presented in 56 %. Laboratory changes, median were as following: serum glutamic-pyruvic transaminase (alanine aminotransferase, SGPT) – 92 (39.2–1060.8) IU/L; serum glutamic oxaloacetic transaminase (aspartate aminotransferase, SGOT) – 105 (40–4177) IU/L; alkaline phosphatase – 225 (120.9–989) IU/L; bilirubin – 50.5 (22–559) µmol/L; triglycerides – 3.2 (1.95–8.6) mmol/L; total ferritin – 10000 (597–255000) ng/mL with glycosylation percentage – 20.45 (0–37.8) %. 71 patients received various of HLH-directed therapy courses. The overall survival rate was 27 %, median follow-up – 540 days.Conclusion. The main clinical and instrumental findings in sHLH are fever, refractory to anti-infective treatment, elevation of transaminases, serum alkaline phosphatase, triglycerides, total ferritine with low glycosylated fraction. Early diagnosing and immunesupression are the main factors of survival