Peer-rewieved medical journal for rheumatology
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Multidrug-Resistance of HIV-1 in Adult Patients in Russia in 2024–2025
The purpose. To assess the prevalence of HIV-1 drug resistance and multidrug resistance to antiretroviral drugs in adult patients with and without treatment experience in Russia in 2024–2025. Materials and Methods. A total of 1888 plasma samples from adult HIV-infected patients from 21 regions of Russia were analyzed. The average age of the patients was 42,08 years; 60,86% were men and 39,14% were women. 77,65% of patients had information about treatment experience; 28,04% of these patients were treatment-naive and 71,96% were treatment-experienced. Consensus nucleotide sequences of the pol gene, encoding HIV-1 protease, reverse transcriptase, and integrase, were obtained using next-generation sequencing. HIV-1 drug resistance analysis was conducted using the Stanford University HIVdb database. Results. The most common HIV-1 surveillance mutations were substitutions in the reverse transcriptase – M184V and K103N. In treatment-experienced patients, high levels of HIV-1 resistance were observed to NNRTIs (efavirenz) and NRTIs (lamivudine, abacavir), and in treatment-naive patients – to NNRTIs (efavirenz, nevirapine, rilpivirine). Low levels of HIV-1 resistance were observed to protease and integrase inhibitors, including dolutegravir. The most common combinations of surveillance mutations in treatment-experienced patients were G190S + K101E, G190S + M184V, K65R + M184V, K103N + M184V and G190S + K65R + Y181C. The most common combination of HIV-1 multidrug resistance was NRTI + NNRTI resistance. Conclusion. Early detection of drug resistance mutations using next-generation sequencing (NGS) followed by quasispecies analysis can significantly change the approach to choosing first- and subsequent-line etiotropic treatment regimens and improve the clinical and cost-effectiveness of HIV-1 treatment.
Viral pneumonia in children. Literature review
Modern research confirms that viruses can cause the development of 15-55% of all community-acquired pneumonia, which is about 200 million cases per year, and about half of them occur in the pediatric population. The main causative agents of viral pneumonia in children are: respiratory syncytial virus (7-44% of all cases of community-acquired pneumonia in children), influenza virus (5–20%), adenovirus (3– 18%), parainfluenza virus (2.5–25%), etc. The pathogenesis of viral pneumonia is complex: the sequential introduction of the pathogen into the lower respiratory tract, penetration into the cells of interstitial tissue, bronchial and alveolar epithelium, activation of the processes of infiltration and proliferation. This leads to swelling of the interalveolar septa and the appearance of exudate in the alveoli, which leads to a disorder of the ventilation-perfusion relationship and arterial hypoxemia. The clinical picture of viral pneumonia in children is nonspecific: gradual onset, upper respiratory tract lesion, fever, tachycardia and/or tachypnea, absence of purulent sputum, concomitant gastrointestinal symptoms. In children, the signs of respiratory failure are often the leading ones, prevailing over the severity of fever and intoxication. Auscultation data – diffuse bilateral wheezing. Instrumental and laboratory diagnostics of viral pneumonia has a rather low specificity and is not always available. The “gold standard” includes computed tomography and methods of nucleic acid amplification. Experts recommend prescribing antibacterial therapy to all patients with signs of pneumonia, since today there are no highly sensitive and specific methods necessary to exclude the bacterial nature of the disease.
Non-specific effects of pneumococcal conjugate vaccines: clinical significance and molecular mechanisms
Pneumococcal conjugate vaccines (PCVs) are widely used to prevent infections caused by Streptococcus pneumoniae, but evidence shows that they also exert clinically relevant nonspecific effects. This review summarizes current data on the impact of PCVs on non-pneumococcal respiratory infections and outlines possible underlying mechanisms. We analyzed studies published between 2011 and 2025 describing clinical outcomes, immunological responses, and molecular pathways associated with PCV use. PCVs were found to reduce influenza-related hospitalizations, respiratory syncytial virus infections, and non-pneumococcal pneumonia. These effects may result from reduced pneumococcal carriage, modulation of respiratory microbiota, and trained innate immunity. Further research is required to clarify populationlevel implications of next-generation PCVs.
Peculiarities of genetic regulation of human susceptibility to viral infections
The functioning of the human genome plays a role in protecting the body from viral invasion. The body’s susceptibility to various viral diseases is determined not only by the functioning of the innate and adaptive immune systems but also by individual genomic differences. Mutations in the FUT2 gene region can exert a protective effect against norovirus gastroenteritis, but also increase the risk of developing and complicating other diseases. The molecular mechanism of interaction between OAS family genes and the innate immune system, as well as the characteristics of normal genomic polymorphism, influence the development and favorable outcome of viral diseases. An analysis of information sources on the relationship between genomic processes and the course and outcome of viral diseases, as well as individual aspects of the influence of disease characteristics on these processes, was conducted as of July 2025. The following keywords were used in key electronic databases, including PubMed, Scopus, eLIBRARY, and Google Scholar: FUT, OAS, HDAC, epigenetics, immune resistance, viral diseases, and host immunity. Several mechanisms of the influence of epigenetic processes on the course of diseases, as well as the possibilities for their therapeutic correction, are presented. Research into the fundamental aspects of the influence of genetic control mechanisms on susceptibility to viral infections will allow for new understanding of risk groups and mechanisms for disease prevention and treatment.
Non-specific prevention of acute respiratory viral infections in naval personnel
Acute respiratory viral infections (ARVIs) consistently maintain a leading position in the structure of infectious diseases in the Russian Federation. The main causative agents of the disease are viruses capable of causing diverse clinical forms – from mild symptoms to severe pneumonia. For military personnel of the Navy, especially during long voyages, the risk of contracting ARVIs becomes particularly high, as confined spaces and close contact between people contribute to the rapid spread of diseases, necessitating the development of new methods of prevention and control. Objective. To evaluate the effectiveness of various approaches to the non-specific prevention and treatment of acute respiratory viral infections during long voyages among Navy military personnel. Materials and Methods. An observational study involved military personnel of the Russian Navy (150 individuals, mean age 29.77±6.3 years) in 2024. The incidence and health status during the voyage were assessed against the background of using intranasal human recombinant interferon alfa-2b. Participants in Group 1 (75 individuals) received intranasal interferon alfa-2b twice daily for one month before and after the voyage. The control group (Group 2) also consisted of 75 individuals. Questionnaires utilizing self-rated health tests and analysis of outpatient medical data were applied. Statistical processing of the obtained results was performed on Windows 10 operating systems using Statistica-8 and SPSSv.20 software. Results and Discussion. In the first month of the study, ARVIs were detected in 11% of military personnel in Group 1, who used intranasal interferon alfa-2b, and in 72% of military personnel in Group 2 (p<0.05). In Group 1, all disease cases were mild, and the interferon dosage was increased to 15,000-18,000 IU. The illness lasted on average 3±1.1 days and was not accompanied by complications. In Group 2, 17% of military personnel experienced a moderate severity of illness with febrile fever and catarrhal symptoms, requiring antibacterial therapy. During the voyage, no ARVI cases were recorded in Group 1, while in Group 2, such cases were diagnosed in 8% of individuals, with re-infections in 7%. One month after the voyage, 28% of military personnel from Group 1 contracted ARVIs, but the disease was mild and lasted up to 4 days, without complications or the use of antibacterial drugs. In Group 2, ARVIs were registered in 72% of individuals, with a mean duration of 14 days; 38% of them required antibacterial drugs due to the development of bacterial complications, and 7% were hospitalized. Conclusions. The study demonstrated the effectiveness of additional measures of non-specific pharmacological prevention of ARVIs in closed communities. Continuous epidemiological monitoring and improvement of prevention methods are important for maintaining the combat readiness of the army
Invincible pertussis: clinical and epidemiological features of pertussis in children at the present stage (based on materials from the Komi Republic)
Objective: to analyze the clinical and epidemiological features of the course of pertussis infection in children of various age groups taking into account vaccination status. The work is aimed at raising the vigilance of primary care pediatricians, as well as updating approaches to prevention and revaccination. Materials and Methods: The work presents data of a retrospective analysis of archival medical documentation of children from 0 to 18 years old, hospitalized at the Republican Infectious Diseases Hospital of Syktyvkar, with a confirmed diagnosis of pertussis for the period 2019–23. The diagnosis was verified using a bacteriological method, serological study, and polymerase chain reaction. Mathematical analysis of the obtained data was carried out using the BioStat version 6 statistical software package (Analyst Soft Inc, USA). For comparison of mean values, the Wilcoxon test was used. Results. Over the past two decades in the Komi Republic, a stable trend of increasing pertussis incidence has been noted. The greatest epidemiological vulnerability, the highest level of incidence, was demonstrated by children in the first year of life. Age-related incidence peaks were identified among vaccinated children (at ages under 1 year, 6–7 and 11–13 years), which may be associated with waning postvaccination immunity and insufficient vaccination coverage. Conclusion. The epidemiological reality of the current stage is the trend toward an increase in pertussis incidence even in countries with high vaccination coverage and modern diagnostic methods. The importance of cocoon vaccination against pertussis during pregnancy is substantiated, and the updating of the regional immunization schedule with revaccination against pertussis at 6 and 14 years is actualized.
Association of rs 9939609 polymorphism of the FTO gene with the development of obesity and type 2 diabetes mellitus in patients with chronic hepatitis C
Currently, an urgent problem in clinical medicine is the comorbid course of diseases. Their prevention and treatment are designated by WHO as a priority project of the 21st century. Comorbidity among patients with HCV infection is of particular interest. Its frequency is about 63% and one of the reasons for the development of comorbid pathology is genetic. Оbjective To identify the role of rs9939609 FTO gene polymorphism in the development of obesity and type 2 diabetes mellitus in patients with chronic hepatitis C. Materials and methods. 201 patients participated in the study. During the study, the patients were divided into two groups: the main group consisted of 101 patients with chronic hepatitis C, obesity (BMI ≥ 30 kg/m2), and type 2 diabetes; the comparison group consisted of 100 patients with chronic hepatitis C without obesity (BMI <30 kg/m2) and type 2 diabetes. The diagnosis of chronic HCV infection was based on the identification of specific markers. A genetic analysis of the DNA of patients living in Yaroslavl was carried out. Genomic DNA was isolated from venous blood. The polymorphism of the FTO (A23525T) gene was tested using real-time PCR on an iCycler iQ5 (BioRad) device with a set of SNP-express-RV reagents. Results. When analyzing the frequency distribution of alleles and genotypes of the FTO gene in patients with chronic hepatitis C and in the comparison group (patients with HCV without MS), statistically significant differences were found. It has been found that the carriage of the T allele, TT and AT genotypes of the FTO gene is more common in individuals with chronic hepatitis C and type 2 diabetes mellitus, and obesity (RR=1.06; 1.19; 0.05, respectively, p<0.05). Carriage of TT genotypes of the FTO gene is significantly associated with the development of type 2 diabetes mellitus in individuals with chronic hepatitis C (RR=3.1; p <0.05). Conclusion. Thus, a study in patients with chronic hepatitis C revealed an association of the rs9939609 polymorphism of the FTO gene with obesity and type 2 diabetes mellitus. According to the results obtained, a link has been established with homozygous TT and heterozygous AT genotype in the development of concomitant comorbid pathology.
Prediction of unfavorable outcome of sepsis in children
Sepsis remains a serious problem leading to high morbidity and mortality in children. Early detection and treatment are of primary importance for successful treatment of sepsis. Comprehensive treatment of sepsis based on the implementation of protocols, use of available resources and advanced technologies is the key to reducing mortality. The aim of our study was to find predictors of unfavorable course of sepsis in children with subsequent creation of a prediction model. Materials and methods: we analyzed 178 cases of sepsis with septic shock in children with an assessment of hematological, biochemical parameters and the severity of multiple organ failure (according to the Prism, Pelod-2, pSofa and Phoenix scales) in order to identify significant indicators that correlate with the development of an unfavorable outcome. Results: models were compiled that included indicators that correlated with the lethal outcome of sepsis and, based on the assessment of the performance parameters of the models, the best one was selected, subsequently a nomogram was developed to determine the probability of an unfavorable (lethal) outcome in pediatric patients with sepsis.
Influenza remains the most significant acute respiratory viral infection due to its high incidence rate, potential for severe disease progression, and complications. Chronic cardiovascular diseases, which are associated with endothelial dysfunction, represent risk factors for severe influenza outcomes and poor prognosis. Given the important role of hemostatic disorders in the development of cardiovascular pathology during severe infectious diseases, studying hemostasis in influenza appears highly relevant. Research Objective: To evaluate hemostatic parameters in adult patients with complicated and uncomplicated influenza. Materials and Methods. We analyzed medical records of 64 influenza patients aged 19 to 90 years hospitalized at the Professor A.F. Agafonov Republican Clinical Infectious Diseases Hospital (GAUZ “RKIB”) between December 1, 2023, and March 1, 2024. The median patient age was 65 years. Influenza A was diagnosed in 61 patients (95%), predominantly caused by A/H1N1 (50 cases) and A/H3N2 (11 cases). Three patients (5%) had influenza B. Pneumonia, confirmed by chest CT, complicated influenza in 32 patients (50%). Chronic cardiovascular diseases were present in 45 patients (70%). Hemostasis was assessed through platelet count, Ddimer level, prothrombin time (PT), prothrombin index (PTI), INR, and aPTT. Results. The acute phase of influenza was associated with elevated D-dimer levels, which were significantly higher than in the control group (p=0.000). The median D-dimer in influenza patients was 4.9 times higher than controls. Patients with pre-existing cardiovascular disease had 2.5-fold higher D-dimer levels compared to those without (p=0.02). Influenza patients with pneumonia showed 3.8-fold higher median D-dimer levels versus those without pneumonia (p=0.0009). Non-survivors had 2.8-fold higher admission D-dimer levels than survivors (p=0.003). A D-dimer level >3000 ng/mL in influenza-associated pneumonia correlated with high mortality risk (p<0.05). Conclusion. Patients with influenza complicated by pneumonia exhibit elevated D-dimer levels, creating a prothrombotic state that predisposes to thrombotic complications.
Genotypic diversity of HIV-1 and hepatitis C virus among persons with newly diagnosed HIV infection in Uzbekistan
Objective: To study the molecular genetic features of HIV-1 and HCV coinfection in antiretroviral-naive patients, assessing the distribution of genotypes of both viruses. Materials and methods: a total of 288 blood plasma samples collected in 2024 at the Republican AIDS Center from all regions of Uzbekistan were analyzed. Results: the obtained study data demonstrated a high prevalence of active replication of the hepatitis C virus among patients with newly diagnosed HIV infection who are not receiving antiretroviral therapy. Genetic diversity was established both among HIV-1 strains (subtypes A6 and CRF_02AG were identified) and among HCV genotypes (dominance of genotypes 3a and 1b), which reflects the characteristics of the epidemic process in the region. Conclusion: The results of the study highlight the need for routine molecular testing and genotyping of both viruses before starting ART for timely diagnosis, selection of optimal therapy and effective epidemiological surveillance.
Biochemical markers of liver damage in children with measles: a retrospective study
Liver damage in patients with measles isn’t traditionally considered a “classic” symptom. There are rare descriptions of measles-related hepatitis in the literature, but the frequency of its occurrence is unclear. The aim of the study was to investigate the incidence and characteristics of cytolysis syndrome in children with measles. The study examined 87 children with measles who were hospitalized in FRCCID from January 2023 to December 2024. Elevated ALT levels were recorded in 35,6% of patients, and elevated AST levels were found in 60,3%. The frequency of elevated ALT levels ranged from 10.0% in infants to 70,0% in teenagers. The median ALT level was 130,0 U/ml in the high-school age group and 24,0–38,0 U/ml in other age groups. The median AST level was 121,5 U/ml in the highschool age group and 49,5–57,0 U/ml in other age groups. Cholestasis was more common in children with more severe cytolysis syndrome. None of the children developed acute liver failure, impaired synthetic function, hypocoagulation, or hepatic encephalopathy. Therefore, the frequency of cytolysis syndrome was high among children with measles. Cytolysis syndrome was more common and more pronounced in teenagers. Reactive hepatitis proceeded without clinical manifestations and had a self-limiting course.
PostCOVID: cardiac rhythm and conduction disorders in children. Interim results of a longitudinal study
Goal. To study the long-term effect of the SARS-CoV-2 virus on the cardiovascular system in children of the Smolensk region. Materials and methods. Holter ECG monitoring for children aged 1 month to 18 years who suffered from mild or moderate COVID-19 within 3 to 12 months after discharge. Results. Sinus tachycardia unrelated to physical activity was recorded in 35%, sinus bradycardia - 25,9%. Non-sinus rhythm was observed in 19 children. 125 children had atrial extrasystoles. Ventricular extrasystoles were registered in 35% (single – 18,7%, by type of bigeminia – 17,9%, trigeminia – 9,4% and quadrigeminia – 1,8%). Among the cardiac conduction disorders, the leading position was occupied by atrioventricular blockages of 1–3 degrees, conduction disorders along the right and left legs of the Gis bundle, as well as their complete and incomplete blockages. Rhythm pauses were observed in 4,1% of cases, very low HRV was observed in 9,7% and QTc prolongation was observed in 40.2% of children, respectively. Conclusion. Cardiovascular lesions are one of the most central problems of post-covid. Various cardiac arrhythmias and conduction disorders have been recorded, and their frequency has been shown in pediatric patients aged 1 month to 18 months.
Population immunity to measles, rubella, and mumps viruses
In the post-pandemic period, in 2023–2024, high incidences of measles were recorded in all regions and countries worldwide, and there was a marked increase in cases of rubella and mumps. It is believed that double vaccination and high vaccination rates guarantee the elimination of measles and rubella. However, the true state of population immunity is determined by the results of immunological (serological) monitoring. The aim of the study was to assess the strength of humoral immunity to measles, mumps, and rubella in adults depending on age and previous vaccinations. Materials and methods. The study involved 3,617 informed participants from three regions within the Federal Medical and Biological Agency (FMBA) system, divided into five age groups (I – 18–27, II – 28–37, III – 38–47, IV – 48–57, V – 58 and above). All participants had their health status (presence of chronic diseases) and vaccination history against measles, rubella, and mumps analyzed. Their blood serum was tested for IgG antibodies to these viruses using the ELISA test systems VectoMeasles-IgG, VectoRubella-IgG, and VectoParotitis-IgG (Vector-Best). Antibody levels were defined as non-protective, low, moderate, and high. Results. Of the 3,617 subjects examined, 27.8% did not have a protective antibody titer to measles, 13,3% to mumps, and 3,9% to rubella (P < 0,001). A significant increase in the number of people unprotected against measles was revealed among young people: 47.1% in the 18–27 age group, 41,9% in groups II, 35,5% in III, and 21,6% in IV, which creates conditions for disease outbreaks. Only in people over 58 years of age did unprotected titers have 3,2%, and in this group there was the highest number of people with high antibody titers – 11,2%, in contrast to the other groups (p < 0,05). The highest proportion of people unprotected against mumps was in the 28–37 age group – 19,3% and 38–47 years – 20,1%. The situation with rubella remains epidemically stable. Conclusion. The obtained data confirm the feasibility of the planned introduction of additional immunization against measles and mumps for people aged 18–47 years and the expansion of seromonitoring of all three infections in adults aged 18–47 years.
Epidemiological situation of norovirus infection in armenia over the last decade
Objective: to analyze the epidemiological situation of acute intestinal infections of norovirus etiology in Armenia for 2016–2024. Materials and methods: The analysis is based on the data of an epidemiological study of 1154 cases of norovirus infection, emergency notifications about which were received by the National Center for Disease Control and Prevention of the Ministry of Health of Armenia. Descriptive epidemiological methods were used. Statistical and correlation analysis of a number of data was also conducted. Results: Noroviruses have caused 3,1–22,7% of all acute intestinal infections of viral etiology. During the analyzed period, an increase in the incidence of norovirus infection among the population of Armenia is recorded. A predominance of younger age groups in the structure of cases was revealed. In all cases, the diagnosis was established based on the PCR results. An analysis of the distribution of cases by region revealed a concentration of cases in the capital and nearby regions, which may be due to the insufficient capacity for laboratory diagnostics of acute intestinal infections of viral etiology in remote regions. Conclusion: Our study showed an increasing burden of acute intestinal infections of norovirus etiology in Armenia. The incidence rate in younger age groups is several times higher than among adults. In the absence of vaccination against this disease, the healthcare system should actively educate the population about methods of preventing acute intestinal infections, including norovirus.
Species diversity of spotted fever group rickettsia in the territory of northwestern Russia and the baltic region countries
The spotted fever group rickettsia is a group of obligate intracellular, Gram-negative bacteria belonging to the genus Rickettsia. They are widely distributed and capable of causing disease in a large number of vertebrate species, including humans, primarily transmitted through tick bites. The study’s objective was to identify the species diversity of spotted fever group rickettsia circulating in the territory of northwestern Russia and the countries of the Baltic region by analyzing scientific literature. Materials and methods. Data for this review were obtained from articles published in journals indexed in scientometric databases such as PubMed and Google Scholar, covering the period from January 1, 1979, to January 31, 2025. Results. The analysis revealed seven pathogenic species of spotted fever group rickettsia detected in ixodid ticks collected from vegetation in northwestern Russia and the Baltic region: R. helvetica, Candidatus R. tarasevichiae, R. raoultii, R. slovaca, R. monacensis, R. aeschlimannii and R. tamurae. The primary reservoirs of these rickettsia species in natural foci are ticks of the genus: Ixodes, Haemaphysalis, Hyalomma, Dermacentor, Rhipicephalus and Amblyomma. The clinical picture of these forms of tick-borne rickettsioses includes several symptom groups: dermatological (skin rash, necrotic eschar at the tick bite site); flu-like (fever, headache, fatigue, malaise, chills, cough and dizziness); musculoskeletal (myalgia, arthralgia); gastrointestinal (nausea, vomiting, diarrhea, anorexia) and other symptoms (lymphadenopathy, conjunctivitis, edema, meningitis). Conclusion. The findings confirm the existence of natural foci of tick-borne rickettsioses in northwestern Russia and the Baltic region, highlight the significant species diversity of spotted fever group rickettsia in these areas, and justify the need for ongoing monitoring of tick prevalence of these pathogens.
Modelling the economic effects of HPV-vaccination for adolescents of both sexes
Human Papillomavirus (HPV) is the most common sexually transmitted infection that can lead to a range of diseases. Globally, the burden of HPV-related malignant neoplasms is significant. Moscow Region is a leading region in Russia for HPV vaccine prevention with considerable accumulated experience. There is a need to consider the economic aspects, particularly the impact on the regional budget and reduction of socio-economic burden through HPV-associated diseases, taking into account regional characteristics and current epidemiological data. Objective: To conduct a pharmacoeconomic evaluation of gender-neutral HPV vaccination among 12-year-old adolescents using a quadrivalent vaccine in Moscow Region. Materials and Methods: The study was conducted from societal and governmental perspectives (considering direct and indirect costs) using Markov modeling for 100,000 12-year-old girls and boys. Two scenarios were considered – without vaccination and with two-dose quadrivalent HPV vaccination – followed by comparative analysis of the resulting healthcare system expenditures. The Markov cycle duration was 1 year. The analysis covered the life expectancy period of 12-year-old adolescents of both genders. The modeling considered the following conditions: cervical cancer, anal cancer, vulvar and vaginal cancer, and anogenital warts. Age-specific incidence and mortality rates corresponded to published Russian and international data. Analysis was performed without discounting. Results: For Moscow Region, modeling of 100,000 12-year-old girls and boys over their lifetime under the current scenario (without vaccination) showed that the total number of HPV-associated diseases would be 1,648 malignant neoplasms and 2,043 anogenital warts, with 509 deaths from HPV-associated malignant neoplasms. Vaccination would prevent 1,008 new cases of HPV-associated malignant neoplasms and 303 related deaths, as well as 1,907 new cases of anogenital warts. Analysis of gender-neutral HPV vaccination showed that 330 12-year-old adolescents need to be vaccinated to prevent one death from HPV-associated malignant neoplasms. Vaccination costs to prevent one death from HPV-associated malignant neoplasms would be 5.8 million rubles. Comparative analysis results, considering only direct medical costs, show that the difference between current and modeled practices amounts to 228.9 million rubles or 67.0% at the Moscow Region level. Conclusion: Implementation of HPV vaccination among 12-year-old adolescents using a gender-neutral approach is an economically viable strategy for Moscow Region.
The course of hemorrhagic fever with renal syndrome on the background of traumatic illness and acute appendicitis (clinical case)
The article describes a clinical case of hemorrhagic fever with renal syndrome against the background of traumatic disease and acute appendicitis. Patient K., 22 years old, was admitted to the surgical department on 08.08.2025 with the diagnosis of “Combined wound of the chest, pelvis, limbs from 30.07.2025”. On 12.08.2025, during examination, complaints of pain in the epigastric region and lower abdomen, an increase in body temperature. The abdomen is soft, sharply painful on palpation in the right sections, symptoms of peritoneal irritation are positive. Laboratory tests revealed leukocytosis, neutrophilia with a band shift to the left, thrombocytopenia, signs of acute kidney injury, and proteinuria. Diagnostic laparoscopy was performed, followed by appendectomy, sanitation and drainage of the abdominal cavity. 13.08.2025, ongoing intra-abdominal bleeding was suspected, in connection with which laparotomy, sanitation and drainage of the abdominal cavity were performed. Acute surgical pathology of the abdominal organs and the nature of the wound did not explain the cause of laboratory changes, diffuse intra-abdominal hemorrhagic changes. In addition, the differential diagnostic search was aimed at identifying infectious diseases. Immunoglobulins of class M to hantaviruses were detected on 15.08.2025. Against the background of complex treatment, the patient’s condition stabilized, on the 35th day the patient was discharged with restoration of health.
Measles in an HIV-infected adolescent: a clinical case
Measles is one of the most highly contagious infections. The measles virus spreads effectively not only when an infected person coughs or sneezes, but even when breathing or talking. Infection can cause serious illness, complications, and even death. Most often, complications develop in unvaccinated children under 5 years of age and in adults over 20 years of age. However, an important fact is that measles can also cause “delayed mortality”, especially in children under 2 years of age, immune system amnesia, Crohn’s disease, Paget’s disease, lupus erythematosus and subacute sclerosing panencephalitis. Timely diagnosis and initiation of treatment can reduce mortality. The article presents a clinical case of a patient with HIV infection stage 4B who was in St. Petersburg State Medical Institution “Clinical Infectious Diseases Hospital named after S.P. Botkin” with a diagnosis of measles erased form.
A clinical case of peripheral T-cell lymphoma in a patient with HIV infection
Lymphoma is the most common malignant disease in patients with HIV infection in the advanced stages of the disease. The incidence of T-cell lymphomas in the presence of HIV infection is 12–15%, and, unlike B-cell lymphomas, they are usually associated with a worse treatment outcome. This paper presents a case of cutaneous T-cell lymphoma (mycosis fungoides) in an HIV-infected man. Lymphoproliferative diseases can be hidden under the mask of diseases such as atopic dermatitis, psoriasis, parapsoriasis, eczema, mycosis of the skin, which are difficult to respond to the recommended type of therapy. In order to prevent misdiagnosis in such cases, it is necessary to carry out a histological examination of the skin flap, on the basis of which it is possible to establish the exact nature of the lesion.
A case of Malassezia furfur infection in a newborn
We report a clinicopathologically confirmed case of disseminated Malassezia furfur infection in a neonate with severe surgical pathology and a fatal outcome. Early isolation of M. furfur from non-sterile sites was underestimated, whereas subsequent cultural and histopathological examination of autopsy material confirmed an invasive infection. Yeast cells were detected within and along vessel walls, accompanied by vasculitis, septic “target-like” thrombi, and ischemic and necrotic changes in the lungs, liver, kidneys and heart. Fungal growth was obtained on modified Leeming–Notman agar, and species identification was confirmed by MALDI-TOF MS. Antifungal susceptibility testing revealed high minimal inhibitory concentrations for echinocandins and fluconazole, while amphotericin B, itraconazole, and posaconazole retained activity, which correlated with the lack of clinical response to micafungin and fluconazole. This case emphasizes the potential of M. furfur to cause true invasive disease in neonates and highlights the need for early recognition of Malassezia isolates in high-risk patients. Accurate identification using lipid-supplemented media or molecular techniques and appropriate antifungal selection based on species-specific susceptibility are crucial for optimal management.
Implementation of clinical metagenomics for pathogen identification in intra-abdominal sepsis: A case report
Clinical metagenomics methods significantly expand diagnostic capabilities, especially in cases where pathogens cannot be identified using traditional methods. This study describes a clinical case of acute gangrenous-perforated appendicitis complicated by severe sepsis and multiple organ failure. Blood cultures were negative throughout hospitalization, which served as the basis for metagenomic sequencing of whole blood and plasma obtained from the patient on the first and seventh days of illness. Two sequencing platforms were used: MGI and Oxford Nanopore (ONT). A total of 28.2 million to 58.6 million paired reads were obtained on the MGI platform, and 0.54 to 5.1 million reads on the ONT platform. The ratio of Homo sapiens DNA fragments to microbial DNA fragments was 99% and <1%, respectively. Cell-free DNA (cfDNA) fragments of anaerobes Bacteroides thetaiotaomicron, Phocaeicola vulgatus, and Barnesiella intestinihominis, which are part of the human intestinal microbiota but can cause severe sepsis with high mortality, were detected in blood plasma samples. Many DNA fragments of the herpes virus Roseolovirus human beta 6a were detected in all samples, likely indicating its reactivation and possible role in the severity of the infection. Information on potential pathogens obtained through metagenomic sequencing methods can be used to inform etiotropic treatment strategies.
Yuri Vladimirovich Lobzin – 75 years old.
Problems and opportunities for complex treatment of ARVI and other viral infections in children in outpatient practice. Assessing the value of antiviral and local therapy (Resolution of the interdisciplinary Council of Experts)
In September 2025, a meeting of experts was convened to discuss the problems of modern viral diseases, which are widespread and economically significant. Pathogens capable of causing respiratory tract damage belong to various taxonomic groups and manifest not only with the primary syndrome (respiratory inflammatory syndrome) but also with other diverse lesions of human systems and organs. The council was held in an interdisciplinary format and featured leading experts in pediatrics, infectious diseases, allergology, immunology, dermatology, and pharmacology. Given the significance of viral infections in children and adolescents, several key issues related to improving medical care for this category of patients were discussed. The purpose of the Expert Council was to systematize the available data on the treatment of viral infections affecting the respiratory tract and to exchange clinical experience in the management of pediatric patients (antiviral and immunomodulatory). The use of the drug inosine pranobex by the council members for various viral diseases and the relief of syndromes caused by the lymphoproliferative capabilities of viruses has made it possible to shorten the duration of the disease, its chronicity, reduce the need for antibiotic therapy and the development of complications. Among the effective medications with antiviral and immunostimulatory activity, inosine pranobex is a popular choice. Its active ingredient is inosine pranobex. Its pharmacotherapeutic group is immunostimulant. Its primary pharmacological actions are immunostimulatory and antiviral. Its mechanism of action is primarily the suppression of viral DNA and RNA replication. Respiratory viral infections remain a significant public health threat, especially to pediatric patients, requiring optimized diagnostic, treatment, and prevention efforts. Prescribing inosine pranobex reduces the recurrence rate of respiratory infections, herpesvirus infections, and other viral diseases, shortens the intensity and duration of acute respiratory viral infections, and improves overall patient well-being.
Международный совет экспертов по разработке Единых клинических рекомендаций/протоколов по лечению ОРВИ и гриппа у детей и взрослых в странах Евразийского региона
XVI Всероссийский ежегодный конгресс «Инфекционные болезни у детей и взрослых: диагностика, лечение и профилактика»