The article presents the current strategy of malaria treating. Unlike previous years, the new treatment is supplemented with artemisinin-based combination therapy – ACT, where two or more anti-malarial drug have multidirectional mechanism of action on P. falciparum. Previously recommended quinine related to alternative antimalarial agents and it is recommended only in case of absence or inability of artesunate (or artemether) using. At the same time, tropical malaria infection during the first trimester is treated by quinine in combination with clindamycin for 7 days. In the second and third trimester artesunate with clindamycin are usually appointed. Pathogenetic and symptomatic features of treatment of severe malaria are observed.

The aim of the current study was the investigation of the clinical features of ornithosis and respiratory mycoplasma infection during autumn outbreak in 2012 in 58 patients admitted to the Institute of influenza department of adult respiratory viral infections based at St Petersburg Botkin Infectious Diseases Hospital. It has been shown that the concomitant ornithosis and respiratory mycoplasma infection were registered more often in the group of young patients and the finding was statistically significant. Pulmonary form of the infection was registered more often in patients with respiratory mycoplasmosis. It was found that in patients with mycoplasma infection catarrhal and constitutional symptoms were longer in duration than in ornithosis or in concomitant ornithosis and mycoplasmosis and the findings were statistically significant. Macrolide antibiotics can be considered as the first-line medications in treatment of respiratory mycoplasmosis and ornithosis. According to our data, these antibiotics were more effective in ornithosis.

Aim of our study was to investigate central motor pathways involvement in children in early recovery period after the aseptic meningitis.

Materials and methods: 65 patients (40 children with average age 12 years with aseptic meningitis and 25 age matched controls) were enrolled. TMS (single-pulse protocol) with MEP shape, latency and amplitude and CMCT averaged and analyzed.

Results: In aseptic meningitis group in 69–73% of the patients diffuse TMS parameters changes were seen (MEPs amplitudes lowering). These changes may be interpreted as motoneurons diffuse functional activity lowering, but also as a signs of neurodegenerative process of a certain degree. Axonal lesions (MEPs latency lengthening) was registered in 12–15% of the patients of aseptic meningitis group.

Conclusion. When aseptic meningitis in most cases, signs of diffuse lesion of motoneurons

A clinical and epidemiological study for 14 years was conducted. Among TB patients, the percentage of persons with mixed infection (TB+HIV infection) increased during the observation period from 10 up to 64%. About one third of them had a pleura reaction with an accumulation of fluid between pleura’s petals. Pleuritis in patients with mixed infection were characterized by special features: pleurisy complicated another form of tuberculosis more often, in one-third of patients (29,8%) pleural liquid had hemorrhagic type, Mycobacterium tuberculosis in the pleural fluid was detected six times more often. The level of activity of adenosine deaminase and neopterin in the exudate of patients with tuberculosis and HIV infection remained significantly higher than in the control group of persons. These data can be useful in the diagnostics of specific diseases in HIV-infected patients.

The objective: to study a role peroxidation of lipids and antioxidative system at children at influenza А H1N1pdm09.

Materials and methods: research prooxidatic and antioxidatic activity of blood at 114 children with an uncomplicated current of influenza A H1N1pdm09 and at 87 children with a pneumonia associated with a virus of influenza A H1N1pdm09 is carried out.

Results of research: it is established, that uncomplicated forms of influenza A H1N1pdm09 at children’s age are accompanied by depression of antioxidatic protection and appreciable intensifying of processes peroxidations of lipids, depending on gravity of a clinical current of an infection. At the complicated current of influenza A H1N1pdm09 a pneumonia processes peroxidations of lipids proceed more intensively, especially at a serious current of pathological process.

Conclusion: development of oxidising stress with prevalence of oxidizers is one of key pathogenetic links of formation of the serious and complicated forms of influenza A H1N1pdm09 at children.

Tendency to chronization of infectious process is characteristic of a current the Ixodes tick-borne borreliosis. Early identification of laboratory signs of risk of development of a chronic process of disease will allow to correct in due time therapy and to prevent a disease failure.

Research objective: search of criteria for chronization in the retrospective analysis of the immune status of patients with various clinical forms of sharp ixodes tick-borne borreliosis.
Materials and methods: clinical trials are executed at 161 patients with a chronic current and 420 patients with a sharp process of disease. Results of the retrospective analysis of the immune status and cytokines taking into account recovery and disease chronization are given.

Results of research: predictive criteria of chronization of an erythema form of Ixodes tick-borne borreliosis were decrease in absolute quantity of lymphocytes, a phagocytic index, number of the phagocytic neutrophils, the raised level of the total IgM. Significant criteria of chronization of an illness after the ended non-erythema’s form of a disease were decrease in an expression of cytotoxic CD8+ of cells, decrease CD4+/CD8+ of cells and decrease in number the phagocytic neutrophils. For all clinical forms of a sharp process of Ixodes tick-borne borreliosis the increased synthesis interleukin-8 during the convalescence period at patients with the subsequent chronization of a disease was characteristic. Preservation of high level of interleukin-1β secretion and a neoplasm necrosis factor-α after the ended non-erythema’s form of an illness was predictive criterion of chronization of a disease. Characteristic of production cytokines at patients with the combined course of a borreliosis-encephalitis infection in the sharp period of a disease was high level of synthesis interleukin-4.

Conclusion: adverse predictive criteria of development of a chronic process of Ixodes tick-borne borreliosis are failure of a phagocytic link to immune system, decrease in an expression of cytotoxic CD8+ of the cells, the increased synthesis interleukin-8 and interleukin-4.

Diagnostics of urinary bladder tuberculosis bases on pathological verification. Standard histological staining (hematoxylin–eosin) reveals glaucomatous inflammation, but cannot estimate its etiology.
Aim of our study was to evaluate the role of complex immunohistochemical method in diagnostic of tuberculosis infection in bladder. Our study included 21 histological specimen of the resected bladder in case of nephrotuberculosis. Standard histological examination revealed specific changes in bladder tissue only in 2 cases, while immunohistochemical method with antibodies to Mycobacterium tuberculosis (MBT) demonstrated positive reaction at 5 patients. Investigation of lower urinary tract function in late postoperative period showed that patients with positive anti-MBT reaction had clinically significant chronic urinary retention, as well as their degree of urinary disorders assessed using a questionnaire IPSS-Qol was higher. Thus, the use of IHC method in combination with standard histological examination improves diagnostics of urinary bladder tuberculosis, and it may serve the predictor of long-term results of surgical treatment of microcystis.

Purpose: to evaluate the effect of additional vaccination of adult HBV- infection years 2007–2010 on the incidence of chronic hepatitis B and its outcomes on the example of the Kirov region.

Materials and Methods: the evaluation of epidemiological features process in patients with chronic HBV infection in adults, depending on the vaccination carried out on the basis of official data Rospotrebnadzora in Russia and Kirov region on incidence of infectious disease for the period 1999–2012. Diagnosis of chronic hepatitis B was based on clinical and biochemical, instrumental, virological data. Structure outcomes of chronic hepatitis B was studied in 295 patients aged 18–75 years who were hospitalized in the department of viral hepatitis Kirov infectious diseases hospital in 2006–2010.

Results: In the Kirov region tended to decrease the incidence of chronic hepatitis B in adults. Additional adult vaccination against hepatitis B has not led to the expected significant decrease of the number of patients with chronic forms. One reason for this is the low (20,3–64%) of the adult population immunization coverage. Chronic HBV- monoinfected was observed in 17.1% , cirrhosis in the outcome of chronic hepatitis B in 5,4% of cases, in hospital mortality from complications of HBV- cirrhosis was 0,7%. Association virus C and D have increased the total cohort, compared to a mono- infection by 3,8% and 0,5% lethality.

Conclusion: Additional adult vaccination against hepatitis B in the area has led to a slight decrease in the overall incidence of chronic hepatitis B, but has not reduced the incidence of adverse events – cirrhosis and liver- mediated lethality.

The aim: is to investigate pro- and anti-inflammatory cytokines in the cerebrospinal fluid of children with meningitis of different aetiology in the dynamics of the disease.

Materials and methods: there were examined 93 children: 29 of them had bacterial purulent meningitis, 42 ones – serous meningitis, and 22 – an acute respiratory viral infection of meningeal symptomatology (control group). The design of the investigation is an open comparative research. The concentration of proinflammatory (IL-1β, IL-6, IL-8) and anti-inflammatory (IL-4, IL-10) cytokines was defined by the solid-phase immune-enzyme assay. The results were processed statistically by computer standard programs Excel and Statistica 7.

Results and discussion: different levels of the cytokine concentration increase were detected in the acute period of the disease, the maximal one – in the case of bacterial purulent meningitis, IL-6 and IL-10 in particular. The concentration of IL-1β, IL-6, IL-4, IL-10 was significantly increased to compare with serous meningitis. The decrease of cytokine level was detected in the period of reconvalescence.

Conclusion: the cytokine concentration increase in the cerebrospinal fluid in the acute stage of bacterial purulent and serous meningitis indicates both the presence of common patterns of neuroinfectious process and the features caused by the agent, and their increase in the stage of reconvalescense demonstrates the remaining intrathecal inflammation.

Viral intestinal infections play an important role in infectious diseases in children of different ages.

Aim of this study was to investigate the etiological structure and characteristics of viral diarrhea in hospitalized children in 2009–2013.

Materials and Methods: 5535 children’s medical histories were analyzed, in which algorithm survey polymerase chain reaction using primers production «AmpliSens ® Rotavirus / Norovirus / Astrovirus-FL» or «OCI screen AmpliSens ® -FL», «AmpliSens ® Enterovirus-FL» production «InterLabService» (Moscow) was included.

Results: we found that with using the polymerase chain reaction etiologic diagnosis was deciphered in 3241 cases (59,8%) and the part of diarrhea of viral genesis of decrypted acute intestinal infections was 77,35 %. Results have shown that the virus diarrhea predominantly affects children under 3 years old (45%). Revealed the prevalence of rotavirus infection (40,44%) also a high proportion of norovirus gastroenteritis (21,18%) have been founded. We found that rotavirus have the first place in importance in the age group of children up to 6 years (56%); however in patients of school age the first place was the norovirus (45,2%). The incidence of rotavirus infection remained high throughout the study period (44,6-58,9%), incidence of norovirus gastroenteritis increased from 24 % in 2010 to 32% in 2012 . In most cases (82%) of viral gastroenteritis was moderate, major complication was dehydration syndrome of 1–2 stage.

Conclusion: results have proved that using of modern methods of diagnosis help to decrypt at least 60% of cases of infectious diarrhea, and the main etiological agents are rotaviruses and noroviruses . Our results are fully consistent with the data on the epidemiology in foreign sources of acute intestinal infections in children prior to mass vaccination rotavirus.

The incidence of chronic hepatitis C in St. Petersburg is 124.4 per 100 000 population. The number of patients with liver cirrhosis is significant.

Aim of this study: to examine the demographic, clinical and epidemiological characteristics of patients with cirrhosis in the results of chronic hepatitis C.

Materials and methods: 100 patients with cirrhosis due to chronic hepatitis C in age 31–70 years were included. Patients with infection hepatitis viruses A and B, HIV, alcohol abuse, drug addicts, previously received antiviral therapy were excluded. Liver cirrhosis was diagnosed on the basis clinical, laboratory and instrumental investigations.

Results: most patients (86,2% male and 81,7% female) are socially adapted. In 23,2% of patients antibodies to hepatitis C virus were first detected simultaneously with the diagnosis of cirrhosis. Medical procedures were the most common route of infection (25,6% male and 57,1% female). Genotype 1 was dominant (65.7%). Viral load over 800 000 IU/ml was detected in 36,7% of patients. ALT activity was normal or not more than 2 upper limit of normal in 59% of patients, AST – 47%. Normal levels of total bilirubin were recorded in 37% of cases.

Conclusions: the first detection of antibodies to hepatitis C virus at the stage of cirrhosis, absence of jaundice, normal or low cytolytic activity once again confirms the need for screening for markers of hepatitis C virus. Dominance of genotype 1 is probably due on the one hand with features routes of transmission, and the other – with the speed of transformation chronic hepatitis to cirrhosis.

Costs of HIV-infection treatment in Russian Federation are a considerable burden on national resources.

Study objective: calculation of one year costs for first line antiretroviral therapy (ART) according to Recommendations (clinical guidelines) of Russian Federal/National Research and Methodology Centre of AIDS Prevention and Treatment, with assessment of patient access within a fixed budget.

Materials and methods: Cost calculation for acquisition of one year of ART is based on Emergency Drug List (EDL) registered prices by Ministry of Health including the VAT and 10% trade surplus. Comparisons are performed within treatment categories recommended by Russian clinical guidelines. ART selections within categories are assumed to be of similar efficacy and tolerability, according to Russian guidelines.

Results and discussion: annual cost of first line ART per patient vary from 44 to 286 thousand RUR. The choice of ART is primarily based on clinical situation and co-morbidity. Among ART regimens in the same treatment category, assuming similar clinical efficacy and tolerability profiles, the less costly are preferable.

Conclusions: comparison of alternative antiretroviral first line treatment regimens with comparable clinical efficacy and tolerability profiles demonstrates that cost minimization based on drug prices can grant access to treatment to maximum number of patients. Lopinavir/ritonavir is the less costly option in several guideline-recommended categories of first line regimens.

The manuscript provides comparative cost assessment of HIV PMTCT and family planning program among HIV infected women.

Materials and Methods: calculation is based on the state healthcare system costs of complex/combined 3-stage perinatal HIV prophylaxis, follow up antiretroviral therapy and social costs related to rehabilitation and education HIV infected children. Cost benefit analysis is conducted on utility per 1 RUB of budget investment.

Results and discussion: HIV PMTCT cost benefit is 3,33 per 1 RUB of investment in long-term perspective. Analysis stated average family planning expenditure will be 3,69 K RUB despite 21,72 K RUB per patient without family planning service. As result cost benefit family planning program among HIV infected women is 4,89 RUB per 1 RUB of investment.

Conclusion. Broad access to reproductive health service is key milestone of quality of life among HIV infected patients and it would be positioning as economically reasonable HIV prevention and cost containment measure.

A retrospective epidemiological analysis of the incidence of acute intestinal infections in 2008–2012 in Sumy region. Indicators of the incidence ranged from 172,8 to 181,7 per 100 thousand of the population. Absolute growth of acute diarrheal infections was +5,2%. In 29,8% of the samples retrieved from the feces of children and 7.5% of adults with acute intestinal infections, viruses isolated. In the structure of the viral landscape dominated by rota-, adeno- and noroviruses. The results of studies on detection of virus in samples of faeces methods of analysis immunoassay, enzyme immunoassay analysis and polymerase chain reaction were not significantly different (p >0,05).