The aim: to confirm the optimal forecast of typhus elimination.

The research method: searching and analytical.

Results: characteristics of rickettsiosis prowazekii in Russia and neighboring countries after the second world war are presented. The incidence has stopped, the immune population in Russia and Ukraine has decreased from 15,0–23,6% in the 1950–1960s down to 1,4–0,78% at the end of XXth and at the beginning of XXIth c. (until the complete disappearance). The recurrency coefficient (RC) was calculated, and its increase (1:1,000 – 1:1,500 in the first 10–15 years after primary form of the disease up to 1:52 000 after 60 years) further from the time of primary form of the disease was shown. Possibility of the return of the epidemic form is negated, the need for containment of R. prowazekii strains is stressed.

More than 60 original articles and reviews were analyzed in order to study the current state of the epidemiology and prevention of acute intestinal infections (AII) of viral etiology in the world. Interest in a problem of viral AII is determined by their widest prevalence and huge costs associated with the elimination of their consequences. There are at least eight families of viruses that are the cause of acute gastroenteritis. The expansion of the ideas on the epidemiology of viral gastroenteritis has made a significant contribution to increasing the availability of modern diagnostic methods. Leading positions in the etiological diagnosis of viral diarrhea belong to the polymerase chain reaction. The structure of the viral AII in Russia is comparable with the average global rate. The most important frequency agents are rotaviruses and noroviruses. The article reflects the current trends in the epidemiology of acute viral diarrheal diseases: particularly dominant circulating serotypes of rotavirus and rare serotypes in various regions; seasonal changes of dominant strains of rotaviruses; increased frequency of norovirus gastroenteritis in the structure of the AII and increase mortality of children from norovirus infection. Presents data on the phylogenetic diversity of noroviruses and features of GI and GII circulation of genotypes. After the introduction of mass vaccination against rotaviruses in developed countries increases the share of astroviral and adenoviral infection in the structure of the AII. High frequency of astroviral infection is noticed in people with immunodeficiency. Much attention in article is paid to the increase in incidence and mortality of noroviruses, rise in detection rate of mixed viral and viral-bacterial associations and often registration of rare viruses and animal viruses in children. Presents data on the effectiveness of vaccination against rotaviruses in different regions of the world, the development of new vaccines for the prevention of norovirus gastroenteritis. New knowledge about the epidemiology of viral gastroenteritis will contribute to the development of effective  measures of specific preventive maintenance, based on the introduction of vaccination against the most common serogroups of pathogens and application of vaccines with high immunogenicity.

Objective. To study the peculiarities of trichinosis on the material of the group flashes.

Materials and methods. Described and analyzed outbreak of trichinosis in 14 adolescents aged 13 to 18 years, were hospitalized in pediatric infectious ward of the city of Samara.

Results. The source of infection – infected meat badger. The severity of illness depend on the amount of meat eaten, that is, the infectious dose of the pathogen. In severe cases, the incubation period of trichinosis was minimal (7 days), and if less severe – the maximum (from 19,5 to 21 days). Mild course also contributed to the early administration of antiparasitic therapy. Most of the children the disease begins with fever and dyspepsia, half recorded rash.
At the height of the disease is predominant myalgias, half of cases – swelling. The peculiarity of the current severe trichinosis were pronounced toxic-allergic syndrome, generalized edema, myalgia and myasthenia gravis, up to a full adinamii, organ destruction: infectious-toxic kidney, cardiomyopathy, fulminant hepatitis, polyserositis with ascites, hydrothorax 3 week
disease. The temperature in most of the patients wore a doublewavelength character with rises in the disease onset and disease for 2–3 weeks. It noted the duration of the clinical symptoms. The longest was myalgic, half of the patients remained at the time of discharge from the hospital. The features of laboratory parameters (leukocytosis, eosinophilia, ALT, AST, CRP) in various forms of the disease. The diagnosis was confirmed by serology (IgM, Ig G to Trichinella spiralis) in different phases of the disease. All patients received a specific antiparasitic therapy albendazolom secondary therapeutic dosage for 10 days, as well as detoxication, allergen and symptomatic therapy is indicated.

Conclusion. Thus, health education among the population and will be a true prevention of trichinosis.

The purpose of the research – to characterize of the factors that influence the effectiveness of the starting highly activе antiretroviral therapy in children with HIV infection.

Materials and methods. A total of 67 children with HIV infection
at the age from 24 to 36 months who have not received antiretroviral treatment. Patients received highly activе antiretroviral therapy on clinical, immunological and laboratory indications. Regimen consisted of two HIV nucleoside reverse transcriptase inhibitors (zidovudine and lamivudine) in combination with a nonnucleoside reverse transcriptase inhibitor or viral protease inhibitor. Аs the third component of the scheme in 22 patients (32,8%) used nevirapine, in 24 (35,8%) – lopinavir/ritonavir, in 21 children (31,3%) – nelfinavir. In the future, the effectiveness of treatment was assessed by clinical parameters, the number of CD4 lymphocytes in the blood and HIV blood viral load. Data on the duration of the effectiveness of conservation regimens examined using Cox proportional hazard model.

Results. Duration of highly activу antiretroviral therapy was 12–79 months (median 28 months, interquartile range 13–60 months). In 55,2% patients, achieved sustained viral suppression (viral load levels below the level of test system sensitivity), improving the immune status (increase number of CD4 lymphocytes), the positive dynamics of clinical symptoms. In 37,3% patients, initial regimen was modified because of its inefficiency, which is often due to the inability to completely suppress viral replication (37,5%) and improve immune status (8,9%). Side effects occurred in 28,4% children, but only in 7,5% patients they were the cause of change therapies. When testing the clinical and laboratory parameters prior to treatment in the Cox model revealed that an independent factor increasing the duration of the effectiveness
of homepage conservation regimen was the appointment of lopinavir/ritonavir.

Conclusion. The results will contribute to the effectiveness of highly activе antiretroviral therapy of HIV infection in children with her long-term use.

Introduction. Biological properties of virus, such as susceptibility to antivirals, the clinical course of chronic hepatitis B (CHB), the probability of developing cirrhosis and hepatocellular carcinoma are determined by genotype and mutations in the genome of the hepatitis B virus (HBV).

The aim of the study was evaluating of HBV genetic variants in patients with CHB from St. Petersburg hospitals.

Material and methods. A total of 1414 CHB patients with positive polymerase chain reaction HBV genome in blood and/or liver tissue were observed. Genotype was determined in 298 patients, sequencing of the polymerase gene fragment was performed in 80 patients.

Results. Viral DNA was detected in 323 (55.8%) patients with CHB. Genotype D was determined in 238 (80,1%), genotype A – in 49 (16,5%), C genotype – in 2 (0,7%) and mixed A+D – in 8 (2,7%) patients. Substitutions in YMDD-motif of the polymerase protein (M204I/V) as well as other primary and secondary resistance mutations to nucleotide analogues (lamivudine, telbivudine, entecavir) were found in four patients. Mutations in the reverse transcriptase (rt) region of polymerase gene were shown to affect the structure of surface protein. The substitution rtA181T in three patients resulted in formation of stop codon (sW172*) and premature termination of surface protein synthesis. The absence of HBeAg and the degree of fibrosis increase in 7 patients may be the result of mutations identified in core gene (G1896A, A1762T, G1764A).

Conclusion. Study of the geographical distribution of HBV genotypes and identification of amino acid substitutions leading to decrease in serum markers concentration and emergence of resistance antivirals mutations is of great practical importance for predicting severity of the disease and effectiveness of antiviral therapy.

Contemporary problems of hemorrhagic fever with renal syndrome (HFRS), being one of hantaviral infection nozoforms and wide-spread on Euro Asiatic continent are considered. Annual increase morbidity with of natural foci expansion, often severe course and a high mortality rate determine the importance of HFRS for health of many countries and in particular the Russia. This article presents of long standing results obtained during the study of epidemiologic, clinical and laboratory diagnostic, immunopathogenesis, treatment trials in Primorsky region of Russian Federation, being the endemic area of co-circulation of several pathogenic hantaviruses.

Objective. Study of clinical and epidemiological characteristics
of hepatitis A in children.

Materials and methods. The paper presents the epidemiological situation of this issue in the Krasnoyarsk Territory, as well as the results of clinical observations of 104 children with hepatitis A in age from 1 to 14 years.

Results. It was found that at the present time is marked deterioration of the epidemiological situation of hepatitis A with involvement in the epidemiological process of young children. In this severe hepatitis A, often occurring with the phenomena of cholestasis, significantly more frequent among children aged 7–14 years. Despite the apparent beneficial for the infection at discharge on the part of school-age children has been a recovery with residual effects that require continued monitoring and corrective therapy appointment.

Introduction. Acute kidney injury is a frequent complication of hemorrhagic fever with renal syndrome. The objective evaluation of аcute kidney injury severity degree is significant in determining the amount of medical actions at hemorrhagic fever with renal syndrome.

Objective. Тhe shifts of acute kidney injury biomarkers’ levels (urine neutrophil gelatinase-associated lipocalin, serum cystatin C and serum creatinine) at different periods of hemorrhagic fever with renal syndrome were evaluated.

Methods. Depending to hemorrhagic fever with renal syndrome severity the patients were divided into groups with severe (n=16) and moderate form of hemorrhagic fever with renal syndrome (n=10); the control group included 10 healthy individuals. The levels of biomarkers were measured by ELISA.

Results. Тhe serum concentration of creatinine and cystatin C – markers of glomerular pathology – increased significantly in hemorrhagic fever with renal syndrome, peaking at oligouric period; while changes of cystatin C were more rapid. Urine neutrophil gelatinase-associated lipocalin level – marker of renal tubular damage – increased 30 to 96 times compared to the control group in fever period of hemorrhagic fever with renal syndrome and gradually decreased thereafter.

Conclusion. Тhe use of modern biochemical markers of renal pathology (sCystatin C, urine neutrophil gelatinaseassociated lipocalin) in hemorrhagic fever with renal syndrome, along with traditional indicators, allows a more differentiated approach to the assessment of renal pathology and gives additional evidence to highlight stage and severity of the disease.

The aim. To analyse the epidemiological situation on the ixodidae tick-borne infections in Kemerovo Region and to determine their clinical and epidemiological peculiarities in Novokuznetsk.

The materials and methods. There have been analysed the official statistical data on the tick-borne infections, morbidity in the course of 10 years. There have been observed 240 patients: 106 cases of the tick-borne encephalitis, 118 cases of the Ixodidae tick-borne borreliosis, 13 cases of the tick-borne typhus, 3 cases accompanied with the tick-born infection.The antibodies to the tick-borne encephalitic virus, to Borreliae, to Erlichiae in the patients, serum and the antigene of the tick-borne encephalitic virus in the ticks were tested by the method of the immunoenzymatic analysis, the antibodies to Rickettsiae were tested by the method of the complement-fixation reaction.

The results. The activity of the diseases, carriers is from 95 to 105 days in the course of different years. The maximum rate of morbidity cases is at the end of May and June. About 80% of residents of towns and cities suffer from these diseases. The encephalitic virus contagiousness of the ticks is 1,5–5,4 on different parts of the area. In the course of 10 years the rate of the tick-borne viral encephalitis morbidity in the regionhas decreased from 6,7 to 2,96, which 2 or 3 times exceeds Russia, average rate. Novokuznetsk rate is lower as compared with Kemerovo region, rate, varying from 5,3 to 2,1, without clear tendency to lowering of the rate; the meningeal and feverish forms being mainly registered. The Ixodidae tick-borne borreliosis morbidity in the region has increased and makes 3,9–10,1, which is higher than its level in Russia. In Novokuznetsk this rate is lower than in the region and in Russia (2,0–6,3), the erythematic and non-erythematic forms being registered with equal rate. About 2–3 cases of the tick-borne typhus have been registered every year. The cases of the monocytic erlichiosis of man are not registered. Tick-borne infections accompanying other diseases are diagnosed very rarely.

The conclusion. In the etiological structure of the tickborne infections on the territory under investigation the leading importance have the tick-borne viral encephalitis (the morbidity rate has decreased) and Ixodidae tick-borne borreliosis (the morbidity rate has increased).

Aim. To analyze the concentration of HIV RNA in the cerebrospinal fluid and to evaluate its significance in the pathology of the central nervous system among HIV infected persons.

Materials: We examined 36 patients with HIV infection with signs of pathology of the central nervous system. All patients was done completed a standard investigation of cerebrospinal fluid, cytological examination and detection viral load of HIV in the cerebrospinal fluid and serum.

Results. A different of opportunistic and HIV-related disease was diagnosed in 29 patients. The most frequent pathology of the nervous system (12 cases) is a diffuse HIV-associated brain damage occurring in 7 patients in the form of aseptic non purulent meningitis and in 5 patients in the form of encephalitis. The average value of the absolute and relative count of CD4-lymphocytes in patients amounted 147,0 cells/μl (40,0; 408,75) and 10.0% (4,00; 18,50). Pathological changes in cellular composition and protein concentration of cerebrospinal fluid detected in 19 cases. Replication of HIV in the cerebrospinal fluid are detected in 31 of 32 patients not receiving antiretroviral therapy, including 17 patients with normal values of cerebrospinal fluid. The average HIV viral load in the cerebrospinal fluid was 15 133,0 copies/ml (2501,0; 30624,0) or 4,18 (3,35; 4,48) lg HIV RNA, average HIV viral load in serum – 62 784,0 copies/ml (6027,5; 173869,0) or 4,80 4,80 (3,7; 5,2) lg HIV RNA. The concentration of HIV in the cerebrospinal fluid was significantly lower than in serum (4,18 and 4,80 lg HIV RNA, p=0.027). 4 patients with severe, multietiology damage of the central nervous system viral, microbial and fungal etiology, there was an inverse relationship between the concentration of HIV in the cerebrospinal fluid and in serum, the concentrations of HIV was higher in the cerebrospinal fluid.

Conclusion: Among the majority of HIV-infected patients with signs of the central nervous system pathology HIV replication in the cerebrospinal fluid was detected. Observed in some patients HIV replication in the cerebrospinal fluid in the absence of morphological and laboratory changes in the composition of cerebrospinal fluid may reflect indirect effects of HIV the brain, manifested in the form of functional disorders of the central nervous system.

The aim of organizational aspects of preventing the transmission of hepatitis C virus with donor blood and its components.

Materials and methods. An activity of the blood service establishments in Russia for the prevention of HCV infection through transfusion of blood and its components on the basis of the analysis of sectoral statistical surveys was studied.

Results. The frequency of detection of antibodies to hepatitis C virus in blood donors and its components during 2009–2013 decreased by more than 1,5 times. The percentage of donors who have identified markers of hepatitis C virus was significantly different in different regions: from 0,51% to 1,36%. The activity of the blood service implemented method of plasma quarantine resulting annually rejected from 0,32% to 0,23% as a result of the identified markers of HCV. Pathogen inactivated plasma volume increased in 3 times, the platelet concentrate in 3,2 times.

Conclusion. To ensure the safety of donated blood and its components in the blood service effectively the modern technology use for to prevention transmission of the HCV: quarantine of plasma, donor selection and development, inactivation of pathogens. The degree of implementation in practice of nonpaid voluntary blood transfusions significantly increased and is characterized by regional features in recent years .

Evaluation of susceptibility of systemic antifungal agents against Candida spp. in recent years has been standardized and refined based on species-specific characteristics of Candida. In addition to new values clinical breakpoints were introduced epidemiological cutoff value. This value can serve as a sensitive marker of reduced susceptibility to the systemic antifungal agents. In our study was tested the resistance of fluconazole, voriconazole, posaconazole, anidulafungin, caspofungin, micafungin for 294 clinical strains of Candida spp. (2012–2014) from specimens of cancer patients. Definition of MIC was performed by epsilometric method (Е-test). The resistance to azoles in the average observed in 47.4%, to echinocandins – in 4.2%.

The absence of an adequate experimental animal model makes difficult study of immunity against whooping cough and its pathogenesis. Experimental whooping cough reported by us earlier in pubescent non-human primates of the Old World was accompanied by specific clinical and laboratory marks in the absence of cough. The possibility of pertussis modelling while experimental whooping cough in impuberal hamadryad baboons was investigated. In the process of selection of monkeys for the further studies for perfecting of experimental model for pertussis research unexpectedly were detected specific pertussis antibodies in impuberal hamadryad baboons.

The aim of the study: revealing of source of infection and transmission of pertussis to hamadryad baboons and investigation of response of antibody-positive impuberal hamadryad baboons to secondary contagion by B. pertussis bacteria while experimental infection.

Results. 18 veterinary checked, somatically healthy hamadryad baboons of various gender managed in two neighboring cages. Specific pertussis IgM and IgG antibodies were found in blood serum of all the animals and one of the monkey keepers. By real-time PCR in nasopharyngeal swabs of the monkey keeper and three 7- and 9-month-old hamadryad baboons were registered single B. pertussis genom equivalents. Seropositive impuberal hamadryad baboons were experimentally challenged by virulent B. pertussis 475 strain. Quantity of B. pertussis genom equivalents and percentage of IgM and IgG antibodies in impuberal hamadryad baboons after experimental infection were detected. These results were comparable with such received after secondary experimental challenge of monkeys by B. pertussis. Humoral immuneresponse was characterized by booster effect and rapid B. pertussis elimination.

Conclusion. The case of transmission of B.pertussis bacteria to hamadryad baboons by natural contagion and epizootic focus of pertussis in apery conditions were registered. In dynamics of immune response and level of bacterial load in experimentally infected impuberal and pubescent hamadryad baboons were not revealed significant differences. The possibility of asymptomatic B.pertussis transmission from man to monkey and from monkey to man without definitive spasmodic cough was reviewed. Pertussis research perspectives using experimental model of non-human primates of the Old World were marked.

Objectives. The goal of the study was to isolate group A, С, and G streptococci from children and characterize them by the methods of molecular epidemiology.

Materials and methods. Group A, С, and G streptococci were isolated from tonsils and back wall of pharynx of Vietnamese children during 2012–2014. сpn60 gene based PCR approach and rnpB gene sequencing were used to identify streptococcal species belonging to group С and G streptococci. The presence of scpA, lmb, nga, slo virulence genes was analyzed in S. anginosus and S. dysgalactiae subsp. equisimilis strainS. emm-typing of S. pyogenes was done as published (http://www.cdc.gov/ncidod/biotech/strep/MProteinGene_typing.htm). Antibiotic resistance of the strains was tested by the disk diffusion method.

Results. A total of 1359 children were examined. Group A streptococci (S. pyogenes) were isolated from 49 children, group C streptococci – from 8 children (4 stains – S. anginosus, 1 strain – S. dysgalactiae subsp. equisimilis, 1 strain – S. parasanguinis, 1 strain – S. gordonii, 1 strain – S. constellatus), and group G streptococci – from 75 children (55 stains – S. anginosus, 8 stains – S. dysgalactiae subsp. equisimilis, 4 stains – S. sanguinis, 3 stains – S. parasanguinis, 2 stains – S. australis, 2 stains – S. constellatus, 1 stain – S. mitis). emm-typing of 47 S. pyogenes strains revealed 15 different emm-subtypes belonging to 11 different emm-typeS. The subtypes emm104.0 and emm109.1 were found to be predominant. S. anginosus strains under study were genetically heterogeneous for the presence of virulence genes. All tested strains were susceptible to cephalosporins and vancomycin, and resistant to amikacine. A total of 70% and 52,5% of S. pyogenes were resistant to tetracycline and erythromycin, respectively.

Studied the epidemiological features of the delta as a coinfection of hepatitis B in Saint-Petersburg for 14-year period (2002–2014). Clinical and laboratory data of 232 patients admitted to Botkin CIB them during this period. Revealed a 2-fold increase in performance of co-infection (Br + + IOP HIV) by 2014. In 49,6% of patients (group 1) were diagnosed less often chronic and acute forms of HBV in combination with delta infection. In 24,5% of cases (group 2) delta infection is associated with chronic hepatitis B and C. In the remaining 25,9% of the cases (B group) occurred multiple infection
(HBV + HCV + HIV + IOP). Based on the clinical and epidemiological and laboratory data in 75,8% of patients defined delta superinfection, at 24,2% – co-infection. The marked increase in co-delta infection in recent years due to the accumulation of the potential epidemic of chronic hepatitis B in the population and the increase in the number of imported cases from 8,8% to 37,2% of migrants in the city. Cytolytic components, characterized by higher rates of ALT activity was most pronounced in the first group and the third group is minimal. However, the mean activity values for patients of the 3rd group were higher than in the first. ACAT groups had the same tendency as AlAt. Patients third group was a higher mortality, compared with other groups.

Combination of TB and HIV-infection is still the most nowadays important problem, and it connects not only with steady growth of HIV infection, but with difficulties in TB diagnosis. X-ray lung studies often have unusual nature, clinical symptomatology appears when process are hard and spread. At the same time in global practice IGRAtests applying, to which they belong to SPOT.TB test and QuantiFERON®-TB Gold test, they pay great attention to it, particularly among patients with HIV- infection. In study there were data when 41 patients with lung TB were examined, 56 HIV-positive patients with lung TB and 58 healthy donors. When active TB IGRA-test and test with Diaskin test show comparable same results. Against the backdrop of HIV skin tests (Mantoux test with 2 TE and tests with Diaskin test) it was demonstrated direct dependence of level immunosuppression in contrast to IGRA – tests, that allows to carry out these researches in conditions when standard skin tests do not work.