Acute lower respiratory tract infections are the leading cause of global morbidity and mortality in children under five years. Verification of the etiology of acute lower respiratory tract infections is necessary for definition of treatment and direction of prevention. Respiratory syncytial virus, influenza A and B, parainfluenza 1, 2, and 3 and adenovirus are considered the main reasons of acute lower respiratory tract infections. The importance of different viruses depends on countries, district, seasons and ages of children. Analysis of the results of studies from different regions of the world showed fluctuations in frequency of etiology definition of respiratory viruses from 25 to 90%. Respiratory syncytial virus is the main reason of acute lower respiratory tract infections, especially in the group of children up to 1 year.

Ixodes tick-borne borrelioses found both in Europe, Asia and in America. It has long been known that the disease is transferred ticks. It has been proven, and the assumption of transplacental transmission of Borrelia. But so far not proved the existence of congenital borreliosis. Numerous studies conducted in various countries have not been able to prove or disprove the possible impact of infection on prenatal development of the child. In spite of this, the world’s developed principles of chemoprophylaxis borreliosis in pregnant women after tick bites. Also developed an effective therapy borreliosis in pregnant women. Russia is a country with a high incidence of Lyme disease. Meanwhile, in the domestic literature is almost no descriptions of cases of suspected congenital Lyme. The results obtained in other countries, need to continue to explore the possible impact on the fetus borreliosis. Before domestic doctors and scientists continue to study the task, begun counterparts in other countries.

The review purpose – to analyse modern epidemiological and clinical laboratory data on the most actual diseases of respiratory organs at HIV-positive persons. Questions of distribution, features of a clinical course of tuberculosis of lungs, pnevmotsistny, toksoplazmozny, Cytomegaloviral, bacterial pneumonia and their combined options at HIVpositive patients are considered. According to domestic and foreign literature advantages and restrictions of methods of beam and nuclear diagnostics in identification of the most typical pathological changes in lungs of various genesis are established.

The modern data concerning questions of differential diagnostics at identification at the patient with HIV infection of a so-called “pulmonary syndrome” are presented in the review. The practicing therapists, infectiologists, phthisiatricians, doctors of other specialties have to know about this pathology in due time to suspect possible damage of lungs at HIV-positive patients, to conduct careful laboratory and tool examination, to choose adequate further tactics of maintaining the patient.

This paper comprises a review of up-to-date literature devoted to the problem of congenital cytomegalovirus infection, its epidemiology and pathogenesis. The paper includes one report on features and variants of clinical presentation of congenital cytomegalovirus infection and its sequelae, including late-onset complications. We pay attention to the problems related to timely diagnostics of congenital infections during pregnancy and suggest measures that can improve the quality of the survey. The basic aspects of laboratorial verification of cytomegalovirus infection in fetus and newborn are reviewed in the light of peculiarities of the features of the newborns’ immune system. In addition, significant points of etiotropic therapy are emphasized. Principal groups of antiviral drugs are delineated in this review, with proposal for their administration according to the clinical course and sequlae development. Furthermore, in this review we pay attention to the importance of preventive measures for reducing prevalence of cytomegalovirus in pregnant women. In view of its high prevalence among adult population and likelihood of recurrent clinical course in pregnant women, we specifically focus on necessity of further professional development of pediatricians and neonatogists. This necessity is determined by the prevalence of latent course of congenital cytomegalovirus infection, as its diagnostics is frequently retarded and, consequently, provokes development of severe complications. In this paper the indispensability of universal neonatal cytomegalovirus screening embedding is proven. Therefore, this review presents contemporary data about the problem of congenital cytomegalovirus infection and highlights general problems related to timely diagnostics and treatment of intrauterine infections.

The aim was to study the clinical and epidemiology of various forms of tick-borne encephalitis patients in the Kirov region.

We analyzed 384 medical records of patients with tickborne encephalitis in age from 18 to 78 years. The feverish form was recorded in 195 patients (50,8%), meningeal form – in 76 (19,8%), focal form – in 113 (29,4%).

Tick-borne encephalitis occurs more frequently in men (61,5%) of working age (37.5% of cases of the disease recorded in the age from 45 to 60 years). Persons older than 60 years were significantly more developed focal forms (p<0,05). Transmissible path noted in 76,3%, nutritional – 7,8%, «unspecified» – 15,9%. Statistically significant at the «unspecified» way more likely to develop focal forms than febrile (p <0,01) and meningeal form (p <0,01). It noted an acute onset of the disease with severe intoxication, inflammatory syndrome, which in focal forms was significantly more pronounced than at hectic (p <0,01) and meningeal (p<0,01). In clinical structure of focal forms of the following options allocated: polioencefalitic form – 33,6%, encephalitic form – 23,0%, poliomielitic form – 11,5%, and mixed versions: encefalitic-polioencefalitic rorm – 12,4%, polioencefaliticmielitic form – 8.0%, encefalitic-poliomielitic form – 4,4% encefalitic-polioencefalitic-mielitic form – 7,1%.

In 50,4% of patients were marked by the residual effects: asthenovegetative syndrome (32.0%), glaring peripheral mono and paraparesis of up and low extremities (24,3%), cerebellum ataxia – 5,8%, drooping head syndrome (4,9%), central hemiparesis (1,0%).

Thus, the tick-borne encephalitis is a disease relevant to the Kirov region. Further study of the epidemiological and clinical features of the disease will allow substantiating and developing a set of measures aimed at reducing the incidence of tick-borne encephalitis.

Literature analysis of published data on mechanisms of infection, disease progression and treatment of chronic hepatitis C, associated with systemic cryoglobulinemic vasculitis and kidney involvement is presented. A clinical case of effective treatment of cryoglobulinemic vasculitis associated with HCV infection is described. Female with HCV infection genotype 1b with liver fibrosis 1 grade Metavir developed clinical picture of essential mixed cryoglobulinemia II type with monoclonal IgM/kappa production. Cryoglobulinemia was presented with skin hemorrhagic vasculitis, proliferative vasculitis of small liver vessels, kidney involvement with III type membranoproliferative glomerulonephritis. Treatment with Dasabuvir;Оmbitasvir+Paritaprevir+Ritonavir without immunosuppressive medications or steroids resulted in persistent virologic response by 12 weeks after administration and also dramatic reduction of cryoglobulimenia from 27% to 8%, suppression of detectable IgM/kappa production, diminished skin vasculitis, restoration of glomerular filtration rate, proteinuria and decrease in erythrocyteuria.

The objective. To evaluate the efficacy, safety and tolerability of double (cepeginterferon alfa-2b and ribavirin) and triple (simeprevir, cepeginterferon alfa 2b and ribavirin) treatment regimens in chronic hepatitis C patients in everyday clinical practice of the Hepatology Center in Clinical Infectious Diseases Hospital in Moscow.

Materials and methods. From 2013 to 2015 a total of 289 patients with chronic hepatitis C received antiviral therapy with cepeginterferon alfa 2b. 267 patients received combination of cepeginterferon alfa 2b and ribavirin. 22 patients received triple antiviral therapy with simeprevir, cepeginterferon alfa 2b and ribavirin. Treatment efficacy was assessed by the rate of sustained virologic response on 12/24 week after completion of antiviral therapy (SVR 12/24). In safety analysis all 289 patients were included. All cases of deterioration of the patient’s condition and laboratory abnormalities were registered throughout the treatment period and follow up.

Results. 267 patients (74,5%, n=199, with 2/3 genotype, 25,5%, n = 68, with 1 genotype) received cepeginterferon alfa 2b 1,5 µg/kg/week and ribavirin 800-1400 daily (weight based). 22 patients with genotype 1 (the majority of them had advanced fibrosis (F3-F4) underwent triple therapy with simeprevir 150 mg once daily in combination with cepeginterferon alfa 2b 1,5 µg/kg/week and ribavirin 800-1400 mg daily (weight based) for 12 weeks, followed by cepeginterferon alfa 2b/ ribavirin therapy for 12-36 weeks. SVR was observed in 85,6% (n=113) of genotype 2/3 infected patients and in 64,6% (n=31) of genotype 1 infected patients. Among patients with mild or moderate fibrosis SVR rate was 90,7% in genotype 2/3 patients and 75% in genotype 1 patients. 21 patient completed the course of triple therapy. SVR was observed in 71,4% (n=15) of patients. Registered adverse reactions were common for interferon/ribavirin based therapy. In most cases adverse events were moderate and matched grade 1-2 of CTCAE.

Conclusion. The present experience confirms the efficacy and safety of double therapy including cepeginterferon alfa 2b and ribavirin in genotype 1 and 2/3 infected patients. The use of this regimen is reasonable in patients who don’t have negative predictive factors of response to interferon-based therapy. In patients with genotype 1 HCV and/or advanced fibrosis (F3-F4) adding of simeprevir to the cepeginterferon alfa/ribavirin combination reduces the duration of treatment, improves the efficacy, while maintaining a good safety profile.

The aim of this study was to determine the relationship between infection with “persistent” agents of children and the possibility of the development of inflammatory diseases of the respiratory tract such as community-acquired pneumonia and acute bronchitis on the basis of risk management concepts.

Materials and methods. 701 children in age from 15 days to 16 years were examined in Nizhny Novgorod and the Nizhny Novgorod region with clinically and radiologically confirmed diagnosis: community-acquired pneumonia, acute bronchitis. This study was performed in the period from 2005 to 2014. The control group consisted of 127 healthy children of different ages. The detection of M. pneumoniae, Сytomegalovirus, Herpes simplex I/II C. pneumoniae was performed by PCR. The concept of risk determination was based on the determination of the absolute risk in the exposed and the no exposed groups, attributable risk, relative risk, the population attributable risk, as well as determining the standard errors for each type of risk and confidence interval.

Results. Attributable risk, relative risk, population-attributable risk are statistically significant figures. Attributable risk of development of community-acquired pneumonia was 29,26%; 27,37%; 25,70%; 20,21% for the M. pneumoniae, C. pneumoniae, CMV, HSV I / II respectively. The relative risk was 1,43 for the M. pneumoniae; 1,38 – for C. pneumoniae and CMV; 1,28- for HSV I / II. The presence of persistent pathogens is resulting in increased incidence of communityacquired pneumonia throughout the population (population attributable risk): 4,75% for M. pneumoniae, 0,23% for C. pneumoniae, 5,59% for the CMV and 1,08% for the HSV I/II. Similar calculations were performed for patients with acute bronchitis. The statistical analysis allowed to exclude C. pneumoniae and HSV I / II of the risk factors for communityacquired pneumonia and acute bronchitis.

Conclusion. The findings suggest the influence of M. pneumoniae and CMV in the development of communityacquired pneumonia and acute bronchitis in children. C. pneumoniae, and HSV I / II do not play a statistically significant role in the overall landscape of etiologic agents of community-acquired pneumonia and acute bronchitis.

Aim: Study of the role of Coxsackieviruses B in the etiology of enterovirus infection and other forms of neurological pathology and also the frequency of isolation of enteroviruses excreted by children living on the territory of the Russian Federation.

Materials and methods: We investigated 1722 samples from children with acute flaccid paralysis, 19030 samples from patients with enterovirus infection and 100 samples from healthy children from institutions of preschool education. Isolation and identification of enteroviruses were conducted according to WHO recommendations.

Results: Coxsackieviruses B were detected in patients with acute flaccid paralysis and persons who had contacts with them. In the patients with enterovirus infection Coxsackieviruses B were isolated in 3, 6% of cases, mainly in sporadic cases of enterovirus meningitis. In the structure of all isolated enteroviruses the percentage of Coxsackieviruses B was rather high (26%) and it was only lower than those of enterovirus ECHO 30 (32, 2%) which caused the season’s peaks of enterovirus infection in 2007–2009 and 2013. Coxsackieviruses B were also detected in the samples from children from preschool institutions. These viruses prevailed in the structure of all isolated enteroviruses and they were isolated in the samples from some children in two preschool institutions which served as the proof of the virus propagation after their importation to the institution when children start attending the institutions after summer holidays.

Conclusion: Coxsackieviruses B constantly circulated on a great number of territories. They are the etiologic factor of mainly sporadic but also group cases of enterovirus meningitis. In the structure of all isolated enteroviruses these viruses occupied the leading position during almost all the years of 10 years of surveillance. The examination of the children without clinical symptoms of infection revealed that Coxsackieviruses B constituted the majority among isolated enteroviruses. That proves the possibility that healthy children are carriers of Coxsackieviruses B.

Objective of our work was to evaluate MEPs characteristics in children with acute inflammatory demyelinating polyneuropathy and evaluate usefulness of TMS as an additional diagnostic method in this disorder.

Methods. 20 healthy children (7–14 years old, average 12 years, 7 females, 13 males) without any signs of neurological disorders were enrolled as controls and 37 patients (8–13 years old, average 11 years, 19 females, 18 males) with AIDP were enrolled as the main group. EMG and TMS were performed on 3–7 day from the onset of the first symptoms. Cortical and lumbar MEP`s latencies, shapes and amplitudes and CMCT were averaged and analyzed.

Results. Significant differences between children with AIDP and controls on latencies of both cortical and lumbar MEPs were registered. Cortical MEPs shapes were disperse in 100% of the cases, and lumbar MEPs were disperse in 57% of the cases. Amplitudes changes for both lumbar and cortical MEPs were not significant.

Conclusions. Diagnostic transcranial magnetic stimulation on the early stage of the acute demyelinating polyneuropathy in children may be implemented as the additional tool. Main finding in this population is lengthening of the latency of cortical and lumbar motor evoked potentials. Disperse shape of the lumbar MEPs may also be used as the early sign of the acute demyelization of the peripheral nerves.

Aim: to analyze epidemiological and clinical features of tularemia cases diagnosed between 2010 and 2014 and to identify factors associated with complications.

Methods: We conducted retrospective cohort study including all patients hospitalized with tularemia between 2010 and 2014.

Results: Most of tularemia cases were diagnosed in July (20,8%) and August (57,1%) among adult females (63,6%). The most common forms were bubonic and ulcer-bubonic (89,6%). Buboes were commonly found in the upper femoral and groin regions (92,2%). Diagnostic errors were revealed in 54,1% of cases. The most frequent misdiagnoses were lymphadenitis and fever of unknown origin. Delay in effective antibiotic therapy was associated with an increased rate of complications.

Conclusion: Tularemia has a diversity of clinical presentations. Doctors need to memorize the most common clinical signs of tularemia (fever and lymphadenitis) to make timely diagnosis.

Aim. to assess galectin-3 level in the serum of HCV patients according to the biochemical activity of hepatitis, liver fibrosis, in view of insulin resistance and overweight.

Materials and methods: The content of serum galectin-3 was detected in 78 patients with chronic hepatitis C in age from 20 to 55 years with oligosymptomatic course of the disease and minimally expressed liver fibrosis in most cases. We evaluated the association between the content of galectin-3 in the blood and metabolic disorders, biochemical activity of hepatitis and fibrosis of the liver.

Results: In patients with normal ALT levels (42% of the patients), the average level of galectin was 3.17 (1.23; 5.94) ng / ml. Elevated levels of gammaglobulin in blood was noted in 21 patients, 15 of them also had elevated levels of galectin-3. Patients infected with genotype 1b, galectin-3 was higher than other genotypes. With a high viral load (> 500,000 IU / mL), the average level of galectin-3 was higher than the lowest. One-third of patients with overweight levels of galectin-3 was higher than normal. MI was diagnosed in the majority (61.5%) examinees, and in these patients, there was an increase level of galectin-3. When comparing the levels of galectin in patients with varying degrees of fibrosis, significant differences were found only when F0 – F2 (p = 0,033).

Conclusion: The galectin-3 serum level was elevated in most patients with chronic hepatitis C. The maximum increase in galectin-3 was observed in patients with severe liver fibrosis (F 3). The connection between the level of galectin-3 and the metabolic syndrome components such as body mass index, and insulin resistance was found.

In article the interconnected provisions of the federal legislation and regulations of federal executive authorities regulating a question of obligatory immunization of health workers against flu in aspect of legal consequences of refusal of her are considered. The analysis of the existing regulations and materials of jurisprudence concerning carrying out obligatory vaccination of health workers against flu is carried out. By results of the analysis it is shown that today a problematic issue is absence of the accurate standardly consolidated criteria of reference of these or those categories of medical personnel to group of the subjects of obligatory immunization performing works with sick infectious diseases and, respectively, against flu. It doesn’t allow the management of the medical organizations to differentiate specifically mentioned professions and positions owing to what the requirement about obligatory carrying out preventive inoculations against flu of those health workers whose obligatory vaccination isn’t provided actually is compulsion to vaccination. Therefore, the subsequent discharge from work in case of refusal it работни from carrying out an inoculation strikes at his rights (as in this case, for example, time of discharge isn’t subject to payment and inclusion in the length of service granting the right for the annual paid vacation) and is illegal.

It is offered to accept as such criterion the labor function fixed by the statutory act of authorized federal executive authority for concrete positions of employees of the medical organizations providing performance of work with sick infectious diseases. The recommendations to heads of the medical organizations concerning the publication of local acts on the organization of vaccinal prevention of flu and adoption of administrative decisions after written refusals of vaccination are provided.

The article presents an analysis of the first clinical cases of acute hepatitis E autochtonic on the territory of the Kirov region. HEV-infection was diagnosed in 76 year old male, not to travel outside the region and the country for a long time, eat a lot of fresh fruit. A feature of the disease in non-endemic region was: severe course of hepatitis E in the elderly, with the development of clinic of acute liver failure and encephalopathy, the presence of the expressed syndrome cytolysis, cholestasis, hepatic-cell failure.

Timely treatment of a patient for medical care, the lack of severe somatic diseases, chronic liver disease and adequate pathogenetic therapy helped to keep the patient’s life. In deciphering undifferentiated acute hepatitis in the elderly should be included in the scheme of examination and determination HEV RNA, a/HEV IgM and G.

Here is presented the clinical surveillance of course coinfection (and HIV / TB) process of a pregnant woman. In a retrospective discussion of medical tactics marked the main points of contention in the conduct of pregnant women with coinfection (HIV / TB), an analysis of the adequacy and the need for X-ray examination of the patient, the effectiveness of the treatment process coinfection process. The case demonstrates the ability of HIV-infected effectively treat tuberculosis and healthy baby female patient with active tuberculosis with timely and adequate combination therapy (antiretroviral and anti-tuberculosis).

The article describes the clinical case of meningococcal infections, complicated with the development of reactive arthritis. It highlights possible pathogenetic mechanisms of aseptic inflammation in combined meningococcal and herpesvirus infections. The role of herpesviruses as a co-factor in the formation of unfavorable course of meningococcal infection. The effectiveness of antiherpetic therapy in the complex treatment of meningococcal disease.

Белозеров Евгений Степанович – доктор медицинских наук (1975), профессор (1976), заслуженный деятель науки Республики Казахстан (1992).

СПб НОО «Центр изучения инфекций» ФГБУ «НИИ детских инфекций ФМБА России» РОО
«Врачи Санкт-Петербурга», г. Санкт-Петербург, 29 октября 2015 года.