This article presents the main historical stages of Russia's first department of infectious diseases, has made a huge contribution to the science of infectious diseases and the establishment of effective treatment and prevention of these diseases.

This review summarizes recent advances in the study of the efficacy and safety of antiviral therapy in patients with chronic hepatitis B. Describe the modern concept of monitoring and treatment of these patients. Particular attention is given to determine the prognostic significance of the level of control HBsAg phases of treatment. Present new algorithms of interferon treatment and approaches nukleos(t)ide analogues therapy. Proposed start initial therapy in patients with chronichepatitis B with pegylated interferon. In the absence of favorable prognostic criteria or sustainable immune control, as well as the presence of contraindications tointerferon therapy and the development of adverse events requiring its withdrawal, patients should be translatedinto treatment nukleos(t)ide analogues.

The modern detailed data about different aspects of parvovirus infection presented in this review. Based on the analysis of literature, the ethiology epidemiology, clinical manifestations of this disease described. The special attention pays to mechanisms of virus’s pathologic impact to fetus. The authors widely take up the possibilities to estimate risks of congenital parvovirus infection, antenatal diagnostics measures, interpretation of the lab and instrumental results. Therapeutic approaches in different clinical situations described, possibilities of prophylaxis discussed.

This review presents recent data on the energy metabolism of Trichomonas vaginalis and ways the activation of metronidazole. The sensitivity of microorganisms to the 5-nitroimidazole by the presence of their enzyme systems, generating and transporting electrons, which can then transfer them to the nitro group of the drug. In T.vaginalis these are pyruvate ferredoxin-oxydoreductase, thioredoxin reductase and flavin reductase. The development of resistance T.vaginalis to metronidazole preparations of this multistep process, based on the gradual reduction (up to a loss) activity hydrogenosomal enzymes and / or violation of the flavindependent metabolic pathways.

The aim of this study is to estimate parvovirus B19 (PV B19) infection (infectious erythema) prevalence in North-West Russia. In 2009-2011 anti-IgM antibodies against PV B19 among 12,5% of patients with exanthematous disease was detected in 9 (from 11) administrative territories of N-W region. Prevalence of anti-IgG antibodies in pregnant females (risk group) vary from 37,5 to 83,3%% in various age groups. Sufficient that most reproductively active females age group (18–35 yo) belongs to the group of risk: 49,2% (in St-Petersburg) and 40,5% (in Vologda) were anti-IgG PV B19 negative. Rational clinical laboratory diagnostics and modern surveilliance of PV B19 and other exanthematous diseases were discussed.

The authors conducted clinicopathologic analysis of 33 cases of lethal influenza caused mainly by influenza virus H1N1/California in northwest regions of Russia. Five types of structural changes in lungs were outlined: 1) massive serous-hemorrhagic edema (9% of studied cases); 2) serous and desquamative viral pneumonia (6%); 3) viral pneumonia with acute phase of diffuse alveolar damage (DAD) (18%); 4)viral pneumonia with prevalence of regenerative and hyperplastic changes (27%); 5) mixed viral and bacterial pneumonia (36%). The authors also made morphological description of two types of virus-induced cytopathic changes (two types of «influenza»-cells).

Based on the survey results in 1322 patients found that patients with hronic viral hepatitis (CVH) blastocysts are found more often than in the group of individuals without concomitant pathology of the hepatic-biliary system (28.8% vs. 5.5%, respectively). In healthy individuals the blastocyst revealed more often in the summer, peaking in July and August, while in patients with CVH Blastocystis most frequently observed in winter. The high incidence of Blastocystis sp. CVH patients suggests that the pathology of the hepatic-biliary system fosters a supportive environment in the gastrointestinal tract for the colonization of its blastocyst. Molecular biological methods of investigation revealed that the subtype antroponozny blastocysts met in this population, 5.3 times less likely than those without concomitant liver disease.

The goal was to clarify the pathogenesis of the formation of frequent respiratory infections in children with Epstein-Barr virus and cytomegalovirus infection on the basis of studying the microbial landscape of anti-infective and mucous membranes of the oropharynx resistance. The results of clinical and laboratory examination of 47 frequently and chronically ill children aged 6 months to 7 years with active Epstein-Barr virus and / or cytomegalovirus infection are presented. 19 children (40,4%) had mono-CMV infection, 6 patients (12,8%) – Mono-Epstein – Barr virus nfection, 22 children (46,8%) – mixed herpesvirus infections. The carrier state of S. рneumoniae was revealed in 70,0% of cases, the carrier state of S. aureus – in 40,5% of cases against the background of decrease normal mouth microflora. Deficiency of nonspecific secretory immunoglobulin class A was established in 98% of cases, destructive changes of epiteliotsits on a mucous membrane of an oral cavity children was established in 93,9 % of cases. The presence of eosinophils in the mucosa of the oropharynx was reported in 29,8% of patients, in 78,7% of patients – the presence of polymorphonuclear leukocytes of more than 5 cells in a field of view. A scheme of the pathogenesis of recurrent respiratory diseases in often long-term ill children is desined.

We have performed primary examination of 50 children with neonatal hepatitis. Prevalence of herpes infection as the etiologic agent (40,0%) has been found, as well as parenteral hepatitis, both as an isolated (26,0%) and mixed infections. We conducted a comparative analysis of clinical and laboratory data at initial examination and determined the outcomes of neonatal hepatitis to 12 months of life depending on the etiology. Congenital CMV- etiology hepatitis characterized by more cytolysis, mainly due to aspartate aminotransferase and cholestasis, which is 33,3% of cases combined by acholia and urobiliya. In 50,0% of patients with CMV-hepatitis was detected fibrosis with a mean value of liver elastography 9,9 kPa, which is ІІІ degrees of fibrosis METAVIR scale, whereas in children with primary chronic hepatitis C and concomitant HCV + DNA-virus infection fibrosis was not registered. Despite on the large number of modern non-invasive techniques for determining the degree of hepatic fibrosis, the use of its in children during the first months of life is limited and does not allow to predict disease outcome.

Pneumococcal infection prevention in children of the first 5 years of life in Russia is of high importance due to high morbidity and mortality. The goal of the study is pharmacoeconomic assessment of first year of life infants vaccination program by 13-valent conjugate pneumococcal vaccine (PCV13) for both routine vaccination by 3 doses and for selected vaccination of premature (born before 32 week of pregnancy) children by 4 doses. Modeling based on clinical trials and epidemiology data results has been established. The costs of Medical care have been obtained from the 2011 State Insurance tariff in St.Petersburg. Analysis has been done from the position of the Health Care system (only direct medical costs) and from the social perspective (analysis of direct medical and indirect costs) with 10 and 20 years horizon and for the full length of life. In routine vaccination scenario and in case of investing to the Health Care system for 10 years cost effectiveness of PCV13 in general population of children including herd effect is 44,2K rubles/1 additional life year gained for direct medical costs only. In direct and indirect costs estimating vaccination is dominating – so, not only decreasing the incidence and morbidity but cost-saving for 2,1K rubles per patient. Study horizon extension (prolongation of the period when the State is ready to wait for the return of investment) is leading to the vaccination cost-effectiveness increase: without herd effect the cost/effectiveness is 505,1K rubles per 1 additional life year gained in 10 years horizon and 100,6K rubles in analysis for the full length of life. Selected vaccination of premature children is also cost effective as these children are at real high risk for Pneumococcal Infection – efficiency in 10 years horizon for direct medical costs is 131,2K rubles per 1 additional life year gained and for indirect and direct costs is 48,3K rubles per 1 additional life year gained. But it is important to mention that routine vaccination of all children during the first year of life is more efficient due to herd effect starting from the third year of the routine immunization start. According to the WHO recommendations efficiency of medical interventions can be assessed by comparison with the NDP – in Russia in 2012 this has been 316K rubles per citizen. Therefore, PCV13 can be recommended for inclusion and addition to the Russian National Immunization Calendar due  to the high clinical effectiveness with appropriate cost-effectiveness even its’ implementation needs significant increase of budget investment to vaccination. Routine vaccination is economically more preferable and efficient in comparison to selected groups’ vaccination and will provide the return of investment and budget cost savings in 10 years period from the start.

We examined 1824 patients with diphtheria treated in Clinical Infectious Diseases Hospital Botkin (St. Petersburg) in 1993 – 1994, and more than 500 patients referred to the clinic with a diagnosis of «angina». Based on published data and our own research observations investigated the etiology of acute tonsillitis. Bacterial tonsillitis should be treated with antibiotics, and this is important aetiological interpretation of these diseases. Streptococcal tonsillitis should always be a sore throat syndrome as a diagnostic sign of support. For other forms of lymphoma lesion of the tonsils should not be defined as «angina», and called «tonsillitis». Аngina as β-hemolytic streptococcus group A infection is recognized as the leader in the development of rheumatic fever. On the basis of a large clinical material briefly analyzed the clinical manifestations of various forms of diphtheria with membranous tonsillitis. Also presented with a syndrome of infectious diseases as tonsillitis, therapeutic and surgical «mask» of infectious diseases.

The aim of this study was to reveal features of chronic viral esophagitis in children. 102 patients from 3 till 17 years with histologically confirmed chronic esophagitis (CE) are surveyed. Immunohistochemically viruses have been found in esophageal mucosa in 65 (64 %) children (1 group). 37 children (2 group) have CE of other causes. In 50 (77 %) children of 1 group HV have been revealed, in 22 (34 %) - CMV, in 19 (29 %) - VEB, in 22 (34 %) a combination of 2 or 3 viruses. Clinical manifestation of viral esophagitis was similar to reflux-esophagitis. Endoscopical signs of CE have been found in 55 % of children of 1 group and in 40,5% of 2 group, erosions were only in 1 group (15 %). The inflammatory index in 1 group was significantly higher, diskeratosis (14 %), parakeratosis (6 %) and balloon dystrophy (32 %) of esophageal epithelium were also revealed in it, but columnar metaplasia was not found. Thus, we have revealed high frequency of chronic virus infection as the cause of CE in immunocompetent patients. Erosions, higher degree of inflammatory changes morphologically and more manifest clinical symptoms are typical for a chronic virus esophagitis.

In order to estimate the frequency of detection of bacterial overgrowth syndrome in patients with chronic hepatitis C, find a possible relationship between development dysbiotic changes in the small intestine and over chronic hepatitis C were examined 80 patients (68 males and 12 females). In addition to standard laboratory tests for all patients was performed hydrogen breath test with a load of lactulose and fibrogastroduodenoscopy and hepatic biopsy with subsequent histological examination of biopsy. It was found that bacterial overgrowth syndrome, according to the hydrogen breath test detected 40% of patients with chronic hepatitis C, and the severity of it increases with the progression of the pathological process in the liver tissue. urthermore, in patients with endoscopic signs of catarrhal duodenitis according fibrogastroduodenoscopy, the level of molecular hydrogen when the hydrogen breath test at the appropriate stages of measurement was significantly lower, which may be due to the lack of saccharolytic and / or the predominance of proteolytic flora in the development of bacterial overgrowth syndrome.

Streptococcus pneumonia – one of the reasons for the appearance of complications from influenza and acute respiratory diseases, occurring with a lesion of ENT organs and respiratory system. In this regard, there is a substantial need for the use of additional methods of laboratory testing for verification of pathogen. Diagnostics of complications from respiratory diseases caused by pneumococcal flora has been carried out by immunochromatographic assay. Microbiological examination revealed the pneumococcal etiology of complications only in 14,0% of cases, but verification of diagnosis by detection of Streptococcus pneumonia antigen in the urine in 29,8%.

The aim of the study was to investigate the clinical course of acute Epstein-Barr virus infection in children with the syndrome undifferentiated connective tissue dysplasia. We examined 127 patients aged 6 months to 15 years acute Epstein-Barr virus infection. The study was an open-controlled, parallel-group. Syndrome undifferentiated connective tissue dysplasia verified in 69% of children: mild dysplasia of the connective tissue is installed in 46 patients (36.2%), moderate – in 41 children (32.3%), severe degree is not diagnosed. A total of 40 (31.5%) of children surveyed had no phenotypic features of connective tissue dysplasia. The peculiarities of the clinical course of acute Epstein-Barr virus infection in patients with undifferentiated connective tissue dysplasia include an increase severity of infection by increasing the duration of fever, severity and persistence polylimphoadenopathii, frequent development of parenchymal Epstein-Barr virus associated hepatitis. Active proliferation of virus-infected Epstein-Barr virus lymphocytes occurs in all organs, with lymphoid tissue and is accompanied by infiltration and histologic changes in lymph nodes, liver, spleen, etc. In combination with the weakness of connective tissue structures that causes the symptoms of acute polymorphic Epstein-Barr virus infection and nature of the complications. We examined patients revealed changes in the indicators of collagen metabolism, indicating their partial degradation. The severity of these changes varies depending on the severity of the syndrome of connective tissue dysplasia and paired with the severity of virus-infected Epstein-Barr. When verification of the second degree of connective tissue dysplasia in patients with acute Epstein-Barr virus infection with high probability we can predict the development of severe infection that occurs in liver in the form of the Epstein-Barr virus
associated hepatitis. 

The data of current vaccination process of cellular, humoral immunity and specific antibody formation in 41 children with Down syndrome at the age of 1 year to 6 years old is observed. To prevent easles used measles vaccine (n=12), divaccine -measles-mumps (n=21) and or Priorix vaccine (n=8). The comparison group consisted of 63 children without Down syndrome. The post-vaccination period in 97,6% of children with Down syndrome cases are asymptomatic, only 2,4% of children mentioned layering of intercurrent diseases. The immunological status in children with Down syndrome is characterized by a significant decrease in the  umber leucocytes, lymphocytes, CD3+, CD4+, CD8+ and absolute number of CD20+, but functional activity of the cells is preserved. By 30 days after immunization they have increased leucocytes, lymphocytes, CD 95+cells. The number of antibodies significantly increased (6,63±0,33 compared to 5,79±0,32 log2, р < 0,05).

The purpose of this research is the study of the dynamics of platelet count in blood of patients with chronic hepatitis C on the background of the combined antiviral therapy with standard or pegylated interferon-α in combination with ribavirin. Prior to treatment, as well as at different stages of combined antiviral therapy were studied absolute numbers of blood platelets in patients with chronic hepatitis C. We determined the relationship between platelet counts at different stages of antiviral therapy and baseline clinical and laboratory parameters (age, sex, body mass index, genotype, level of viremia, ALT, fibrosis), as well as alternative combination therapy. It is established that the significant decrease in platelet count in patients with chronic hepatitis C were observed as during treatment with pegylated or standard interferon-α in combination with ribavirin (38,5% and 16,0%, respectively, p < 0,05). Therapy with pegylated interferon-α treatment as compared with standard interferon-α was accompanied by a more pronounced decrease in platelets, peaking at 8 weeks of treatment (188,4±3,9×109/l). In addition, we observed a direct correlation between the level of blood platelets and rate of sustained virologic response. The study identified prognostic criteria, indicating the possible development of thrombocytopenia on the background of antiviral therapy: BMI < 20kg/m2, age over 45 years.