Telemedicine is a modern field that utilizes three types of technologies: medical, information, and telecommunications; The primary goal of telemedicine is to ensure equitable access to medical services in the required volume and in a timely manner, regardless of the patient’s or medical professional’s location, thereby improving the quality and accessibility of healthcare; The application of telemedicine technologies is regulated by the federal legal framework; A review of scientific literature has identified key advantages of telemedicine in infectiology: the ability to control infections in conditions of geographical remoteness and limited resources, prevention of infectious complications in patients of various profiles, expanded access to drug therapy, increased treatment adherence, and economic feasibility. It has been proven that the effectiveness of telemedicine technologies is not inferior to traditional face-to-face interaction. Potential risks include clinically significant errors in diagnosis and treatment, technological and infrastructural failures, information security issues, and legislative restrictions. It is essential to continue active efforts to expand the use of telemedicine technologies while minimizing potential risks.

Infectious diseases that require exclusion when febrile catatonia is suspected include herpes encephalitis. Clinical differential diagnosis of these diseases is a challenge even when they present in a typical form. Laboratory and instrumental diagnostics also present a number of challenges. Laboratory and instrumental diagnostics are also difficult and require careful interpretation of the results. Each of these diseases is characterized by a high mortality rate and can cause severe disability. The aim of this study was to summarize the available literature on the clinical presentation and diagnosis of febrile catatonia and herpetic encephalitis. The review included 10 russian and 11 international articles in the public domain (covering a literature search depth of 25 years). The Clinical Guidelines of the Russian Society of Psychiatrists were also considered. This work resulted in a structured analysis of the clinical presentation and diagnosis of the disorders under consideration.

The steady increase in the incidence of the disease worldwide, the increase in the number of registered cases in the Russian Federation, the increase in the elderly and senile population, the possibility of over-the-counter and uncontrolled use of antibacterial drugs, the decreased alertness of physicians of various specialties regarding clostridial infection, the wide spectrum of clinical manifestations from asymptomatic carriage to severe course with life-threatening complications in the form of sepsis, septic shock, toxic megacolon, perforation, in most cases leading to death, places this disease among the most significant infectious diseases of our time.

Study Objective. To conduct a comparative analysis of anamnestic and clinical laboratory parameters in two groups of patients with Clostridium difficile-associated enterocolitis, depending on the disease outcome.

Materials and Methods. This was an observational, retrospective, case-control study. The medical records of 230 patients with Clostridium difficile infection were reviewed at the S.P. Botkin Clinical Infectious Diseases Hospital of St. Petersburg. The study was conducted from January to December 2025. Two groups were formed based on the disease outcome: patients with a favorable outcome (discharge from hospital) (n=188) and patients with a fatal outcome (n=42). A comparative analysis of age, hospital history, hospital stays, comorbidities, primary clinical manifestations, complications, clostridial toxins isolated in stool using ELISA, and other factors were conducted among the study subjects.

Conclusion. Older and advanced age, transfer from other healthcare facilities, the presence of concomitant cardiovascular and renal pathologies, and the simultaneous detection of two C. difficile toxins, A and B, in stool samples are the main predictors of fatal outcomes in Clostridium difficile infections.

Aim: To assess the level of awareness and the factors associated with pregnant women’s decision-making regarding pertussis vaccination.

Materials and Methods: A cross-sectional study was conducted using an online questionnaire to evaluate awareness, factors influencing willingness to receive vaccination during pregnancy, and the need for additional information to support decision-making. Differences in categorical variables were analyzed using Pearson’s chisquare test.

Results: A total of 101 pregnant women participated. Overall, 8,9% had experience of vaccination during pregnancy; among them, 42,1% were vaccinated following a physician’s recommendation. Among women who did not receive a recommendation, only 1,2% were vaccinated. More than half of the women vaccinated both in childhood and adulthood (53.8%) were willing to be vaccinated during pregnancy, compared with 19,1% among those vaccinated only in childhood. More than 60.0% of women who had previously received a physician’s recommendation expressed willingness to be vaccinated, whereas 69,5% of those without such a recommendation were unwilling. All women with prior vaccination during pregnancy (100,0%) were willing to be vaccinated again. Among those without such experience, the proportion of hesitant respondents was high (69,6%). Women who correctly identified the purpose of vaccination were twice as likely to express willingness to be vaccinated. Based on these factors, participants were categorized by a vaccination readiness index: 12,9% demonstrated low readiness, 72,2% moderate readiness, and 14,9% high readiness.

Conclusion: Willingness to vaccinate during pregnancy was associated with prior regular vaccination, physician recommendation, previous vaccination during pregnancy, and understanding of the purpose of immunization. A rapid screening tool was developed to evaluate the readiness index and support a differentiated counseling approach for pregnant women regarding pertussis vaccination.

Objective. To evaluate the clinical efficacy and safety of riamilovir in the treatment of acute respiratory viral infections in adolescents aged 15–17 years.

Materials and methods. A prospective, open-label, observational comparative study included 100 male adolescents aged 15–17 years with mild or moderate acute respiratory viral infections who were hospitalized within the first 72 hours after disease onset. The main group included 50 patients who received riamilovir 500 mg/day for 5 days; the comparison group included 50 patients who received standard symptomatic therapy without specific antiviral drugs. Clinical dynamics, parameters of the symptom severity scale, viral elimination, complications, and safety were assessed.

Results. By day 3 of treatment, body temperature normalization was registered in 46 of 50 (92.0%) patients in the riamilovir group and in 37 of 50 (74.0%) patients in the comparison group (p=0.031). Symptoms of intoxication had completely resolved by day 3 in 47 of 50 (94.0%) and 38 of 50 (76.0%) patients, respectively (p=0.023), and catarrhal symptoms in 42 of 50 (84.0%) and 25 of 50 (50.0%) patients (p=0.00056). The time to complete resolution of all symptoms according to the severity scale was shorter in the riamilovir group: 3.0 [2.0; 3.0] days versus 4.0 [3.0; 4.75] days (p=0.0012). Earlier sustained improvement was also observed in this group: 3.0 [2.0; 4.0] days versus 4.0 [3.0; 5.0] days (p=0.0013). Viral pathogen elimination by day 6 of follow-up was 88.9% and 73.1%, respectively (p=0.175). The incidence of complications was comparable: 12.0% and 10.0%, respectively (p=1.000). No adverse events associated with riamilovir administration were registered.

Conclusion. The use of riamilovir in adolescents with acute respiratory viral infections was associated with faster early clinical improvement after therapy initiation and demonstrated a favorable safety profile.

Introduction. Pertussis is an acute infectious disease characterized by paroxysmal cough, edematous syndrome, specific hematological changes, and the development of secondary immunodeficiency. The appearance of characteristic syndromes in pertussis is associated with the functioning of the kallikrein-kinin system and its key protein, C1-esterase inhibitor (C1-INH).

Objective. To clarify the role of C1-esterase inhibitor in the pathogenesis of pertussis by determining its serum levels in children with pertussis, stratified by disease severity and age.

Materials and Methods. The study enrolled 117 children. Patients were divided into 3 groups: 1) children with severe pertussis; 2) children with moderate pertussis; 3) children with acute respiratory infections (ARI). The age of the examined children ranged from 1 month to 17 years inclusive. Serum C1-INH levels were determined using enzyme-linked immunosorbent assay (ELISA).

Results. Children with severe pertussis exhibited higher mean C1-INH levels (30.8 ± 4.7 mg/dL) compared to those with moderate pertussis (24.3 ± 3.4 mg/dL) and significantly exceeded the levels in patients with ARI (14.6 ± 4.6 mg/ dL; p=0.04). Infants with pertussis under one year of age, regardless of disease severity, had significantly higher C1-INH levels compared to children from older age groups. Analysis of the relationship between age and serum C1-INH levels in children with pertussis revealed a statistically significant inverse correlation (r = -0.24, p=0.02): the younger the child with pertussis, the higher the C1-INH level. In contrast, no such age-related correlation was observed in the comparison group of children with ARI (r = -0.14, p=0.4).

Conclusion. Assessment of C1-INH levels in children, depending on age and severity of the disease, is important to clarify its role in the pathogenesis of whooping cough and to develop new treatment methods. Further research is warranted.

Purpose: to identify specific characteristics of the gut microbiota composition associated with high and low viral load in patients with chronic HCV infection, taking into account sex and age.

Materials and methods: a single-center, cross-sectional clinical study was conducted, including 124 patients with chronic HCV infection . The study determined the composition of gut microbial diversity using metagenomic sequencing of 16S rRNA. High-throughput sequencing was performed using the MiSeq genetic analyzer (Illumina, USA) using a protocol based on the analysis of variable regions of the 16S rRNA gene. Data were analyzed using Kraken2. The significance level was set at 0.05.

Results: the features of the gut microbiota in patients with chronic HCV infection , depending on the level of viral load, are described. In the group of patients with low viral load, there was an increase in the diversity of opportunistic bacteria, including representatives of the oral microbiota Prevotella (padj = 0.129) and Gemella (padj = 0.124), inflammatory markers Burkholderia (padj =0.035), Haemophilus (padj = 0.143) and Paraclostridium (padj = 0.035) and delayed motility Sarcina (padj = 0.035). In patients with high viral load, there was a relative increase in the presence of proinflammatory and potentially pathogenic taxa such as Stenotrophomonas (padj = 0.106) and Nitratidesulfovibrio (padj = 0.121).

Conclusions: the study demonstrates that the viral load in chronic HCV infection is associated with qualitatively different shifts in the gut microbiota. The data obtained suggest that at high viral load, changes in the gut microbiota are predominantly mediated by systemic inflammation, while at low viral load they more closely reflect structural changes in the liver.

The slowdown in the decline of tuberculosis (TB) incidence and mortality following the coronavirus (COVID-19) pandemic has become a problem of considerable medical and socioeconomic importance.

The aim of this study was to compare mortality among hospitalized patients with HIV-associated TB and those with TB without HIV infection during the post-pandemic period.

Materials and Methods. We analyzed medical records and pathological reports of patients who died with a confirmed diagnosis of TB in 2023 at the S.P. Botkin Clinical Infectious Diseases Hospital (St. Petersburg). The study included 73 fatal cases: 57 (78.1%) with both TB and stage 4B HIV infection (Group 1) and 16 (21.9%) with TB monoinfection (Group 2). We assessed gender, demographic characteristics, and comorbidities using the Charlson Comorbidity Index. For HIV-positive patients, additional data on infection duration, degree of immunosuppression, and opportunistic conditions were evaluated. Diagnostic methods for TB and clinical characteristics of disease progression were compared between groups.

Results and Discussion. Most deceased patients were young to middle-aged men with HIV-associated TB. Among HIV-positive individuals, TB was either the direct cause of death (61.4%) or served as a concurrent opportunistic infection (38.6%). In contrast, HIV-negative patients typically had severe systemic comorbidities, reflected by a Charlson index of 3.8. TB was the primary cause of death in 75% of individuals in Group 2. Only 29.8% of microbiological tests identified highly sensitive Mycobacterium tuberculosis strains; more than half (54.4%) revealed multidrug-resistant or extensively drug-resistant strains. Generalized TB was diagnosed significantly more often among HIV-positive patients (77.2%) compared with HIV-negative patients (37.5%). Central nervous system involvement occurred in a quarter of all cases, including one case in a patient without HIV infection.

Conclusion. Our findings demonstrate a worsening course of TB in the post-COVID period in both HIV-positive and HIV-negative patients.

Infectious diseases often disguise themselves as somatic pathologies, leading to delayed diagnosis and treatment.

Objective: To identify the frequency of infectious etiologies in the structure of chronic somatic diseases in children undergoing long-term follow-up by specialists in outpatient clinics.

Materials and Methods: Retrospective analysis of medical records (form 112/u), examination, and laboratory testing (as indicated) of 166 children aged 3-17 years referred to an infectious disease specialist in 2022-2024 by specialists after prolonged, ineffective treatment (3 to 8 months).

Results: ENT physicians referred 86 patients with lymphoid organ hyperplasia scheduled for adenectomy. During examination, 23 patients (26.7%) were diagnosed with EBVrelated infectious mononucleosis. Treatment was prescribed, resulting in adenoid regression in 19 cases (i.e., 82.6% of those treated), preventing the need for surgery.

Gastroenterologists referred 36 patients complaining of abdominal pain. After examination by an infectious disease specialist, infectious pathology was diagnosed in 15 children (41.7%): 5 (13.9%) with giardiasis, 7 (19.4%) with salmonellosis, and 3 (8.3%) with pseudotuberculosis. All patients experienced normalization after specific therapy.

Allergists referred 23 patients due to recurrent rashes and elevated blood eosinophil levels above 20%. Six patients (26.1%) were suspected of having toxocariasis and received treatment, which improved their condition.

Pulmonologists referred 21 patients for consultation; mycoplasma bronchitis was diagnosed in four patients (19.0%). The children received etiotropic therapy, which showed positive results.

Conclusion: In 28.9% of children observed and receiving long-term treatment by specialists, infectious and parasitic agents were the cause of their pathology (1.6 times more often for gastrointestinal symptoms than for other symptoms). A lack of timely diagnosis leads to inadequate long-term treatment. These data indicate that specialists have insufficient knowledge of infectious pathology and its manifestations in children.

Objective: based on the study of clinical manifestations of whooping cough in adults in a comparative aspect in 2024–2025, to identify the features of the clinical course and to evaluate the effectiveness of modern laboratory diagnostic methods – polymerase chain reaction (PCR) and enzymelinked immunosorbent assay (ELISA).

Material and methods. The study included 57 patients aged 18 to 73 years hospitalized in 2024–2025 at the Infectious Clinical Hospital No. 1 of the Moscow Health Department with suspected whooping cough. Clinical observation and analysis of medical records were performed. To confirm the diagnosis, the following methods were used: PCR with the reagent kit “AmpliSens® Bordetella pertussis/parapertussis-FL” (Central Research Institute of Epidemiology, Rospotrebnadzor, Russia) for detection of Bordetella pertussis DNA in oropharyngeal swabs; ELISA (Savyon Diagnostics Seropertussis test system, Israel) for detection of anti-pertussis antibodies IgM, IgA, IgG in blood serum. Examination for concomitant respiratory infections (viral, mycoplasma, chlamydial) was performed using multiplex PCR (AmpliSens® ARVI-screen-FL kit). Statistical analysis was performed using IBM SPSS Statistics 26.0 with calculation of arithmetic means (M), standard errors (m), relative values (%), and confidence intervals. Group comparison was performed using Pearson’s χ² test. Differences were considered statistically significant at p < 0.05. Morbidity data were obtained from the federal statistical observation form No. 2 “Information on Infectious and Parasitic Diseases.”

Results. The incidence of whooping cough decreased in all age groups starting from the second half of 2024 and in 2025. The proportion of hospitalized adults in 2025 (40.0±6.4%) was significantly higher than in 2023 (13.7±1.4%) and 2024 (13.3±1.9%) (p < 0.001). Among hospitalized patients, moderate forms predominated (93.0±3.4%). In outpatient settings in 2025, the proportion of mild forms (79.7±2.2%) was higher than in 2024 (61.9±1.4%) (p < 0.001). In 5 (12.2%) patients in 2024, “cough syncope” was registered. Mixed infections were detected in 26 (45.6%) patients, most commonly respiratory mycoplasmosis (26.3%). The diagnosis of whooping cough was confirmed by PCR in 21.7% of patients and by ELISA in 96.2%.

Conclusion. ELISA has significantly higher diagnostic efficacy compared to PCR starting from the 3rd week of illness. The obtained data confirm the need to optimize the vaccination strategy in adults.

Measles continues to cause periodic epidemic outbreaks at the present stage, affecting not only children but also the adult population, with the development of various complications, particularly in individuals with comorbid conditions. This necessitates a high level of awareness among healthcare professionals regarding this nosology and further scientific investigation in this field.

Aim: To provide a clinical-laboratory characterization of measles in adults and endothelial dysfunction .

Methods: A prospective study was conducted including 278 (100%) patients aged over 18 years diagnosed with measles and hospitalized in the Infectious Diseases Department of the multidisciplinary clinic of Tashkent State Medical University between March 2022 and December 2024. The presence of immunosuppression in this patient cohort was established, manifested by transient leukopenia in 62.9% of cases, lymphopenia in 47.5%, and thrombocytopenia in 45.3%.

Results: In adults, measles at the present stage was characterized not only by classical clinical manifestations but also by atypical features, including the absence of typical stage progression in 16.5% of patients. Gastrointestinal complications, primarily diarrhea, were observed in 37.8% of patients, leading to dehydration. Hepatomegaly was detected in 38.1% of cases and was associated with cytolytic syndrome. A statistically significant elevation of vascular endothelial growth factor A (VEGF-A) (423.6 ± 37.6 pg/mL) and Creactive protein (CRP) levels (62.7 ± 2.9 mg/L) was observed in severe measles compared to moderate disease (276.4 ± 20.3 pg/mL and 48.3 ± 3.1 mg/L, respectively), indicating pronounced endothelial dysfunction. A correlation was identified between increased interleukin-1 (IL-1) levels and elevated CRP and VEGF-A concentrations, which predisposed to the development of pneumonia in 82 (29.5%) patients. Among these, 2.7% demonstrated elevated procalcitonin levels, suggesting a bacterial etiology of pneumonia.

Conclusion: These findings indicate that marked endothelial dysfunction with the development of pathological angiogenesis represents one of the key pathogenetic mechanisms underlying pneumonia formation in adult patients with measles.

Objective: to analyze the post-vaccination immune response to hepatitis B virus in medical personnel to determine prognostic criteria and risk management.

Materials and methods: the results of serological screening of 1,380 employees of a multidisciplinary medical center for anti-HBsAg, HBsAg in 2024-2025 and their vaccination history data were analyzed. Laboratory tests were performed on the basis of the laboratory of the European Medical Center “UMMC-Health” by enzyme immunoassay using a set of reagents “Vecto HBsAg-antibodies”, JSC “Vector-Best”. The protective concentration of specific antibodies in the blood serum was considered to be 10 mIU/ml or more. Statistical processing was performed in Microsoft Office Excel 2016 and SPSS Statistics (v. 26).

Results: in 81.8% of the employees, the concentration of anti-HBsAg was more than 10 mIU/ml. When constructing a binary logistic regression model (p<0,001), it was found that increasing the age of employees by 1 year lowered the chances of a positive result by 1,052 times. An increase in the period since the last injection of the vaccine for each year reduced the chances of a positive result by 1,055 times. Administration of each additional dose of the vaccine increased the chances of a positive result by 2,036 times. The sensitivity of the model was 73.9%, and the specificity was 73.7%. The overall diagnostic significance of the model is 73.8%.

Conclusion: the results of the study indicate the need for further study of the feasibility of booster immunization of medical workers, taking into account a comprehensive assessment of humoral and cellular immunity, in order to effectively manage biological risks.

Introduction. Lyme disease is one of the most significant natural-focal infections in the Russian Federation. The Kaliningrad region belongs to the regions with a high level of Lyme disease incidence, which is due to climatic and geographical features, the presence of vast forests, and high recreational load. Seroepidemiological studies are an important component of epidemiological surveillance and allow for obtaining more objective information about the prevalence of Lyme disease among the population.

The aim of the study was to determine the seroprevalence levels of the practically healthy population of the Kaliningrad region to Borreliella burgdorferi sensu lato.

Materials and methods. 847 blood serum samples of donors were examined by ELISA for the presence of specific IgG antibodies to B. burgdorferi s.l. Statistical processing was performed using the R program.

Results. The overall seroprevalence rate was 4.13% [95% CI: 2.99–5.69]. There were significant variations in the rate across administrative territories: the highest rates were observed in Pionersky (8.99%), Svetlogorsky (6.74%), Chernyakhovsky (6.02%), and Bagrationovsky (5.71%) districts, while the lowest rates were observed in Zelenogradsky (0.76%) and Sovetsky (1.52%) districts. A statistically significant trend towards increasing seroprevalence with age was established (p=0.033): the lowest rates were found in children under 17 years of age (1.94%), and the highest rates were found in the 45–59 years of age group (6.45%) and in the 75+ years of age group (6.06%). No differences were found by gender (p=0.426).

Conclusion. The data obtained indicate the active circulation of B. burgdorferi s. l. in the Kaliningrad region and the uneven distribution of epidemic risk. Priority territories and age groups at risk have been identified, which justifies the need for a differentiated approach to planning preventive measures.

Human alveococcosis, caused by the larval stage of Echinococcus multilocularis, is a zoonotic parasitic disease characterized by a prolonged asymptomatic course and a high rate of diagnostic challenges. Diagnostic difficulties are particularly common in patients from non-endemic regions due to limited physician awareness and the similarity of clinical and radiological findings to malignant tumors and other focal liver lesions. The aim of this study was to analyze clinical cases of alveococcosis and evaluate the diagnostic value of molecular genetic methods for disease confirmation. We present three clinical cases of patients examined and treated at the Clinic of Infectious and Parasitic Diseases of the Rostov Research Institute of Microbiology and Parasitology, Rospotrebnadzor. In all cases, initial diagnoses included alternative pathological conditions such as cystic echinococcosis and malignant hepatic neoplasms. Definitive diagnosis was established based on histopathological findings and molecular genetic analysis using polymerase chain reaction, which confirmed the presence of E. multilocularis DNA. These clinical observations highlight the significant diagnostic value of molecular genetic techniques in improving diagnostic accuracy, reducing the risk of misdiagnosis during differential diagnosis, and facilitating the timely initiation of appropriate treatment.

Meningococcal infection remains one of the most dangerous infections with a high mortality potential. In recent years, the Russian Federation has seen instability in the epidemic process, changes in the dominant serogroups (activation of serogroups A and W), and an increase in the incidence of invasive meningococcal diseases.

Two clinical cases of invasive meningococcal diseases observed at the Saratov regional infectious clinical hospital named after N.R. Ivanov in 2022– 2023 are presented: Case 1 –a 12-year-old adolescent (fatal outcome), Case 2 – а 9-month -28 days-old infant (favorable outcome). In the first case, fulminant meningococcemia complicated by septic shock and Waterhouse-Friderichsen syndrome led to a fatal outcome despite resuscitation efforts. In the second case, despite a complicated epidemiological history (death of a sister from invasive meningococcal diseases) and late pre-hospital diagnosis, timely intensive therapy with extracorporeal hemocorrection saved the child. Both cases share the absence of specific vaccination. Data on the activation of serogroups A and W in the Russian Federation, the emergence of rare serogroups (X, Y), and vaccination with polyvalent conjugate vaccines for the prevention of meningococcal diseases.

The presented observations confirm that the lack of vaccination is a fatal risk factor. Expanding the serogroup coverage of vaccines to 5 (ACWYX) and 6 (ACWYX + B) components is a strategic direction in combating the «fluctuating epidemiology» of meningococcus.

Staphylococcal burnt skin syndrome (SSSS) is a severe toxin-mediated disease that is classically associated with young children (up to 5-6 years old). In adolescents and adults, the development of SSSSS is extremely rare and is usually associated with severe immunosuppression or severe comorbid pathology. In the available literature, isolated cases have been described in patients with chronic renal failure, which makes each such observation clinically significant.

A clinical case of successful diagnosis and treatment of SSSS in a 17-year-old adolescent with terminal chronic kidney disease (CKD stage 5) caused by congenital anomalies of the kidneys and urinary tract (CAKUT syndrome) is presented.

This article describes a rare case of spondylodiscitis caused by brucellosis infection complicated by destruction of the cervical C3-C4 vertebral bodies in patient Sh., 38 years old. This clinical presentation of acute brucellosis confirms the systemic nature of organ and tissue damage. Dynamic observation of patient Sh. included the calculation of hematological indices (NLR, LMR, PLR, SII). The probability of brucellosis progression, occurring against the background of a systemic inflammatory response, was assessed based on changes in the sum of these parameters. Brucellosis in patient Sh. was caused by infection with Brucella melitensis through food and contact transmission. A comprehensive clinical, laboratory, and instrumental examination of the patient, as well as the isolation of a pathogen culture from vertebral material obtained during surgery, allowed for increased treatment effectiveness during the surgical intervention and subsequent rehabilitation.

Hemorrhagic Fever with Renal Syndrome and Human Immunodeficiency Virus co-infection is a rare occurrence that warrants significant clinical and scientific attention. A comprehensive understanding of the immune-mediated mechanisms underlying the interaction between Hemorrhagic Fever with Renal Syndrome and HIV is essential for accurate prognostic modeling. This is particularly crucial because co-infection with these two pathogens often correlates with a severe clinical course, increased mortality rate, and significantly prolonged recovery period. This article presents two clinical case reports. The first involves a patient with virally suppressed HIV infection. The patient experienced a severe clinical course of Hemorrhagic Fever with Renal Syndrome despite strict adherence to antiretroviral therapy. After receiving intensive treatment, the patient showed clinical improvement and was discharged in stable condition. The second case highlights the progression of Hemorrhagic Fever with Renal Syndrome in a patient with profound immunosuppression. This one was characterized by a series of complications that resulted in a fatal outcome. The fundamental interaction between these two pathogens is not yet fully understood. This highlights the critical necessity for continued investigation.

Acute respiratory viral infections (ARVI) continue to be a major public health concern, ranking among the leading causes of medical consultations and accounting for up to 90–95% of all infectious disease morbidity. Although most cases are mild to moderate in severity, some patients may develop severe or even life-threatening conditions. The progression to severe disease is determined by viral virulence factors, host immune response characteristics, underlying comorbidities, and delayed initiation of appropriate therapy. The current approach to the rational management of acute respiratory infections is grounded in the principles of evidence-based medicine, including strict differentiation between viral and bacterial etiology, minimization of polypharmacy, and categorical avoidance of unjustified antibiotic prescription. An optimal therapeutic strategy requires a combination of systemic and local interventions: etiotropic and immunomodulatory agents, as well as topical preparations to control inflammation and relieve pain in the oropharynx. Inosine pranobex exhibits a dual mechanism of action — direct antiviral activity against a broad spectrum of respiratory viruses and a pronounced immunomodulatory effect. In ARVI involving the respiratory tract, catarrhal syndrome develops and is classified according to the anatomical level of inflammation. In pharyngitis, the use of direct-acting topical agents is justified to alleviate symptoms (pain relief and reduction of inflammation). Non-steroidal anti-inflammatory drugs, including benzydamine, are widely used for this purpose. Benzydamine provides marked local anti-inflammatory and analgesic effects in pharyngitis and tonsillitis of various etiologies. The timely and etiopathogenetically justified use of a systemic antiviral agent (inosine pranobex) in combination with topical symptomatic therapy (benzydamine) may contribute to more rapid symptom resolution and a shorter recovery period.