Chronic hepatitis C remains one of the most important socially significant infections for world health. The use of modern highly effective drugs with direct antiviral action allows to achieve a sustained virological response in patients. At the same time, in a significant number of cases after elimination of HCV infection, the progression of fibrosis continues with the development of its terminal stages and an unfavorable outcome for patients. The article focuses on comorbid pathology, which is a leading factor in this process in patients with chronic hepatitis C who have achieved a sustained virological response and presenting a serious challenge to modern hepatology.

The goal of study was the epidemiological substantiation of optimization measures of a vaccinal prevention of whooping cough in the Russian Federation.
Materials and methods. The retrospective descriptive epidemiological research has been conducted by analysis of the official statistical data on the whooping cough case rate (form No. 2) in 2005–2017 in the Russian Federation, as well as the data about preventive whooping cough inoculations (forms No. 5, No. 6) in 2005–2017 and about epidemic outbreakes in 2017 (form No. 23-17). The assessment of an economic damage from whooping cough in 2005-2017 has been carried out.
Results. The following adverse characteristics of a modern epidemiological situation on whooping cough in Russia are shown: long-term recurrence of epidemic process, tendency of rising of a case rate of children of 0-2 years; high percentage of children of preschool and school age among whooping cough cases; prevalence among the patients with whooping cough of the children who have been vaccinated against this infection previously, epidemic outbreakes in children’s collectives, the stability of a case rate of teenagers and adults with prevalence of the mild and the erased clinical forms of this infection. The risks due to weaknesses of the whooping cough vaccinal prevention are noted: the insufficient immunization coverage owing to falce contraindications and refusals of parents of vaccinations of children, noncompliance with terms and intervals between inoculations, lack of domestic vaccine for revaccination of children at the age of 5 years and older.
Conclusion. It is necessary to introduce in the national vaccination schedule a preschool booster dose for children at the age of 6 and adolescents at 14 years with the combined reduced antigen content tetanus–diphtheria and acellular pertussis vaccines as well as the inoculations of this vaccine according to epidemiological indications to health workers, employees of educational institutions. A revaccination against whooping cough is recommended as “cocoon” for the persons contacting to not vaccinated child under 1 year of age.

This article describes the results of own observations of viral placentitis caused by parvovirus, human immunodeficiency virus, respiratory syncytial virus and Herpesviridae family viruses – herpes simplex virus types 1 and 2, cytomegalovirus and Epstein–Barr virus), describing the morphological features of typical changes and immunohistochemical verification their etiology.

Aim. To determine the prevalence of amino acid substitutions in hepatitis C virus NS5a and core proteins which are associated with resistance to direct-acting antivirals and interferon in genotype 1b (HCV-1b) strains circulating in Russia.
Materials and methods. Nucleotide sequences of NS5a (n=93) and core (n=30) of HCV-1b were obtained using direct sequencing of respective amplified genome fragments. The search for resistance associated substitutions was performed for amino acid positions 28, 29, 30, 31, 32, 58, 62, 92, 93 of NS5a, and 70 and 91 amino acid positions of core proteins, respectively.
Results. The total proportion of HCV-1b strains carrying resistance associated substitutions in NS5a was 22,6% (21/93). The total detection rate of L31M and Y93H substitutions that are associated with resistance to the majority of NS5a inhibitors was 10,8%. Less clinically significant substitutions L28M, R30Q, P58S/T, A92T were detected too. The proportion of infections caused by HCV-1b strains that are potentially resistant both to interferon and NS5a inhibitors was 10% (10/30).
Conclusion. Testing of HCV-1b infected patients for background resistance profile could be a useful tool to prevent the choosing of initially ineffective treatment regimen.

The aim of the study was to compare the efficacy and safety of ART regimens, which included TDF or PhAZT, in patients with HIV infection who had not received treatment previously.
Patients. The study included 85 adult patients with HIV infection. Group 1 consisted of 60 patients who received TDF/FTC + EFV. The second group included 25 patients who received PhAZT + 3TC + EFV. The study was not randomized, comparative, patient groups were similar in terms of the main indicators. The efficacy and safety of the treatment was assessed during the first 24 weeks of therapy.
Results. After 24 weeks of therapy, 74,5% of patients in Group 1 and 87,5% of patients in Group 2 had less than 50 copies/ml of HIV RNA (MITT analysis). The increase in the median CD4 + lymphocytes after 24 weeks of treatment was 143 and 135 cells/μl, respectively. Most of the AE (including all AE that caused change or cancellation of the treatment regimen) were associated with the use of EFV. In 22,4% of patients receiving TDF, transient proteinuria was noted, and in 17,2% – deviation of blood creatinine level deviation of mild severity. The safest drugs included PhAZT, FTC and 3TC. The most frequent AE associated with the use of PhAZT, there was a slight decrease in hemoglobin and red blood cell count.
Conclusion. The study conducted in the conditions close to real clinical practice showed that both first-line ART regimens, including TDF or Phosphazide in addition to 3TC (FTC) and EFV antiretroviral drugs, were highly effective and safe during the first 24 weeks of treatment. PhAZT is a drug of choice in the schemes of ART of the first line in the presence of contraindications to the prescription of TDF and/or ABC.

Goal. Paritrapeprir / ritonavir / ombitasvir / dasabuvir on the clinical and laboratory parameters, including the subpopulation composition of lymphocytes, in patients with compensated cirrhosis in the outcome of chronic hepatitis C.
Materials and methods. The study included patients with compensated liver cirrhosis class A (no more than 6 on the Child – Turcotte – Pugh scale), in the outcome of chronic hepatitis C, genotype 1b (group 1, n = 28). The comparison group (group 2, n = 25) consisted of patients comparable in terms of gender and main study parameters, not receiving antiviral therapy.
Results. A stable virologic response was 96,8%. There were no serious adverse events requiring treatment reversal. As a result of treatment, there was a disappearance or a significant decrease in the severity of asthenovegetative and dyspeptic syndromes, a reduction in liver size, an improvement in liver functional parameters (biochemical response), and normalization of the balance of the cellular immunity by increasing CD3 +, CD4 +, CD8 + – CD16 + lymphocyte counts.
The conclusion. Etiotropic therapy with paritrapeprir /ritonavir / ombitasvir / dasabuvir is well tolerated by patients with compensated cirrhosis in the outcome of chronic hepatitis C, has high efficacy, positively influences the dynamics of clinical manifestations, and also helps reduce the imbalance of the cellular immunity.

Purpose: to estimate the content of platelets and sP-selectin in patients with different severity of Hemorrhagic Fever with Renal Syndrome.
Materials and methods: we have conducted the clinical and laboratory examination of 220 patients with Hemorrhagic Fever with Renal Syndrome, including mild (52), moderate (112) and severe (56) forms. The quantitative content of sPselectin in blood serum was determined by enzyme immunoassay in 90 patients (30 people from each group).
Results: during first days of admission to the hospital thrombocytopenia in patients with mild form of HFRS was moderate. For moderate and severe forms of HFRS during the initial period the average value of the platelet was less than 100u109/l; correlation analysis between platelet count and creatinine level revealed an inverse relationship between the platelet count during the initial period and the level of creatinine during the oliguric period (r=-0,526; p=0,029). The difference in the content of sP-selectin are statistically significant not only with the control group, but also between groups of patients depending on the severity of the disease, a correlation between the content of platelets and sP-selectin was revealed in all groups of patients.
Conclusion: the activity of sP-selectin and the degree of thrombocytopenia are closely interrelated and characterize the severity of the disease.

The aim of the study was to evaluate clinical, immunologic and anti-viral efficacy of antiviral therapy (АVT) with drugs of the direct antiviral action (DAA) of the chronic hepatitis C (CHC) complicated with secondary mixed cryoglobulinemia in small cohort of patients.
Patients and methods: The cohort consisted of 12 patients with CHC (without signs of a coinfection of HIV, a hepatitis B virus) complicated with mixed cryoglobulinemia (criocrit more than 5% and presence of cryoglobulinemia-related symptoms). Standard DAA based therapy was indicated in all patients: 2 cases daclatasvir and asunaprevir, 3 cases daclatasvir and sofosbuvir and 7 cases Dasabuvir;Ombitasvir+Paritaprevir+Ritonavir.
Results: Anti-viral response at 12 and 24 weeks was found in 91,6% (11/12) treated patients. In one case (on the daclatasvir and asunaprevir) resistance to both drugs developed. Clinical response was confirmed in 83% – 10/12 (25% – the complete response, 58% – the partial response). Despite of anti-viral response kidney damage persisted in 2 patients without apparent improvement. There was one lethal outcome at 25th week since the beginning of treatment because of bilateral pneumonia and thromboembolism in patient with kidney involvement treated with steroids and cytostatics.
In 25% of patients total elimination of cryoglobulins was confirmed by the end of AVT and in 75% dramatic decrease of criocrit was found. Conclusion: We confirmed good virologic, clinical and immunologic response and safety of AVT with DDA in patients with HCV induced crioglobulinemia, especially when using schemes with a high genetic barrier (daclatasvir and sofosbuvir, Dasabuvir;Ombitasvir+Paritaprevir+Ritonavir).

Introduction. To assess the severity of acute gastroenteritis in children, two scales of gravity are used: a 20-point Vesicari scale and a 24-point Clark scale. However, there are significant differences between these scales and there are practically no studies comparing their effectiveness in one representative group of patients.
Material and methods: Complex clinical and laboratory examination of 143 children aged 1 to 7 with intestinal viral intestinal infections caused by rotavirus and norovirus was carried out. The severity of the patients’ condition was assessed using both Clark and Vesicary scale. Convalescences continued to be monitored for 12 months to open adverse outcomes.
Results: In assessing the severity of viral intestinal infections using Clark and Vesicari scales, there were significant
differences in children. The Vesicari scale significantly more accurately estimates the severity of intestinal infection in the acute period of the disease. At the same time, the use of the Clark scale contributes to the refinement of the prognosis for the development of post-infection gastroenterological pathology and its timely prevention.
Conclusion: There is a need to create a new scale of universal assessment of the severity of viral intestinal infections that combines the advantages of both scales.

The artical presents data of a clinical-neuroimaging survey of patients with perinatal infection. In order to study the peculiarities of cerebral complications, an analysis of the data of 96 children aged from 3 to 17 years was carried out.
Patients underwent a clinical and laboratory examination, neuroimaging (MRI), electrophysiological studies (EEG, ENMG). The data of own clinical observations of children with HIV-vasculopathy, complicated by acute disorders of cerebral circulation, are given. The results of dynamic observation of two patients with occlusive vasculopathy are presented. According to the study, cerebrovascular pathology was detected in 48 patients (50%).

The article describes two clinical cases of yersiniosis accompanied by Hepatitis A and E. In patients with a clinical picture of icteric form of acute viral hepatitis, there was a symptomatic gastrointestinal form of yersiniosis. Patients were discharged on day 22,5±3,5 of the disease with moderate cytolysis. In the enzyme immunoassay at the time of discharge IgM and IgG were detected to Y. Enterocolitica, indicating a tendency in the progradient case of yersiniosis.

Objective: to study the efficacy and safety of antiviral therapy for influenza and acute respiratory viral infection with Kagocel in children in a hospital.
Materials and methods: in the observational study included 80 children aged 3 to 11 years, hospitalized with symptoms of influenza and acute respiratory viral infection. The etiological confirmation of the diagnosis was carried out by the PCR method based onthe study of nasal swabs.The drug Kagocel was administered according to the instructions for use during the first 24 hours of hospitalization.The analysis of the virus release after the course of therapy with Kagocel (at 5–6 days from the beginning of treatment) was carried out only in patients with verified influenza and acute respiratory viral infection.
Results: the dominant influence of viruses in the development of acute respiratory infections in children aged 3 to 11 years in the period of rising morbidity in St. Petersburg from September 2015 to May 2016. At the same time, 25% of the total number of patients were sick with influenza A and/or B. There was a significant decrease in fever to the third day (p <0,001) and normalization of body temperature from the fourth day after the beginning of therapy with Kagocel in the general group and in patients with confirmed influenza diagnosis. The intoxication syndrome, most pronounced with the flu, was mostly stopped by the fourth day(р<0,001). Catarrhal syndrome, prevalent in the general group of acute respiratory viral infection, had longer periods of clinical manifestation and against the background of the therapy completely eliminated to the third or seventh day of therapy.Negative PCR results after the course of Kagocel therapy were established in 57,1% of the total group of patients. Among all detected viruses, the most typical is the absence of repeated isolation of influenza B and A viruses, PC virus (86% and 53,8%, 71,4%, respectively), the elimination of rhinoviruses was less frequent (33,3%).
Conclusion: according to the results of the study, the effectiveness of therapy with the inclusion of the drug Kagocel in relieving fever by 3–4 days of treatment, as well as intoxication syndrome by 5–6 days in patients with acute respiratory viral infections, including patients with influenza, has been established. Negative results of PCR at the time of completion of therapy occurred mainly in patients with influenza A and B, PC infection. No adverse events were noted.

Introduction. Human immunodeficiency virus (HIV) infection is a risk factor for tuberculosis (TB), increasing the likelihood of its development in 20–37 times. The purpose of the study was to evaluate an influence of HIV infection on a spectrum of extrapulmonary tuberculosis (EPTB).
Material and methods. Statistical reports of dispensaries on tuberculosis in Siberia and Far East were analyzed for 2016–2017 years. Of total 1227 patients with isolated EPTB (without pulmonary TB) who have the status of HIV infection were enrolled in the study. пациентов с изолированными формами ВЛТ, у которых определен статус ВИЧинфицирования.
Results. In the overall spectrum of the incidence of EPTB in Siberia and the Far East, estimated independently from HIV infection, the leading form with a large predominance was the bone and joints TB (41,0%). The second-third place was divided by urogenital tuberculosis and tuberculosis of the central nervous system (19,4% and 18,7% respectively). The spectrum of the incidence of EPTB changed dramatically depending on HIV infection. If in HIV-infected patients most common form was TB of the central nervous system (43.8%), followed by the second – the bone and joints TB (34.5%), and TB of peripheral lymph node TB (11.7%). The proportion of urogenital tuberculosis in HIV-infected was negligible (1.9%). In the analyzed period, significant changes in the proportions of extrapulmonary tuberculosis localization in both HIV-infected and immunocompetent patients were not found.
Conclusion. HIV infection dramatically changes the spectrum of the incidence of EPTB. We recommend making changes in the system of recording patients with EPTB, allocating HIV-infected to a separate group.

Brucellosis is characterized by nonspecific clinical manifestations, the possibility of subclinical flow, the development of relapses and chronic course. Currently, there are no laboratory criteria to assess the activity of inflammation in brucellosis, the effectiveness of the therapy, predict the outcome of the disease and the risks of recurrence. Available in clinical practice, laboratory tests to assess inflammation, in particular, erythrocyte sedimentation rate, C-reactive protein, leukocyte level, with brucellosis infection are almost not informative. An important role in the development of the cellular immune response against brucella is played by interferon-γ, lipopolysaccharide-binding protein and neopterin. The aim of the study was to determine the level of lipopolysaccharide-binding protein, neopterin and interferon-γ, in the serum of patients with acute form of brucellosis before and after antibacterial treatment. When studying the blood of patients with acute brucellosis before and after therapy, the indices of neopterin, lipopolysaccharide-binding protein and interferon-γ were significantly higher than normal values. The obtained results testify to the persisting active inflammation and the formation of a chronic brucellosis. Determination of the level of lipopolysaccharide-binding protein, neopterin and interferon-γ in the blood of patients with brucellosis can be used as markers of inflammation and in monitoring the effectiveness of antibacterial therapy.

The most important direction in the system of anti-epidemic protection of the population and military personnel from dangerous infectious and natural focal diseases is epidemiological monitoring with the obligatory use of laboratory methods of detection of pathogens and their markers. On separate territories of placement of the military units which are a part of the southern military district, there are centers of natural and focal infections of dangerous infectious diseases (plague, tularemia, cholera). The article presents the results of laboratory studies during epidemiological monitoring of natural focal and dangerous infectious diseases, which can be used by the military medical service as an information basis for decision-making on the organization of anti-epidemic protection of troops in the event of emergency situations of biological and social nature in these areas.

Aim: Characteristics of enterovirus infection morbidity and study of peculiarities of enterovirus circulation on some territories of Russia in 2017.
Materials and methods: We investigated more than 5000 samples from the patients with enterovirus infection. The isolation and identification of enteroviruses were conducted by virological method and by partial sequencing of the genome region VP1. Phylogenic trees were constructed according to the method of Bayesian Monte Carlo Markov Chain.
Results: Epidemic process and clinical picture of enterovirus infection were not the same on different territories. Peculiarities of the circulation of different types of enteroviruses on the territories were also different. In Saratov region 65% of cases were represented by enterovirus meningitis. In Murmansk region and in the Komi Republic enterovirus infection with exanthema prevailed, 95% and 60% correspondingly. In Saratov region enterovirus ECHO18 was the etiological agent of enterovirus meningitis. In Murmansk region and in the Komi Republic the cases were connected mainly with Coxsackieviruses A6. The strains of enterovirus ECHO18 were distributed to three clusters. The strains which provoked enterovirus meningitis in Saratov region belonged to cluster 3, they were formed separately from other strains of this enterovirus type and differed from the stains of ECHO18 which circulated in the North-West of Russia. The strains of Coxsackieviruses A6 identified in the North-West of Russia belonged to three sub-genotypes 5, 6, 8 of pandemic genotype of CoxsackievirusesA6. The majority of the strains belonged to sub-genotypes 6 and 8 which in 2017 dominated in the structure of Coxsackieviruses A6 in the North-West of Russia and in Russia.
Conclusion: Epidemic peaks of enterovirus infection represented by different clinical forms of the disease were provoked by different types of enteroviruses. Enterovirus ECHO18 was the etiological agent of enterovirus meningitis. The main etiological factors of enterovirus infection with exanthema were Coxsackieviruses A6 of different sub-genotypes.

The clinical features of the onset and dynamics of ecthyma gangrenosum caused by Pseudomonas aeruginosa with the development of sepsis are observed in an eight-monthold child. The article incudes a detailed description and corresponding photo images of skin manifestations of the disease in the form of solid hemorrhagic fast-growing papules with a cyanotic halo and developing necrosis in the centre of the elements followed by the formation of ulcers or blisters. The diagnosis was made on basis of clinical manifestations and Pseudomonas aeruginosa culture from the contents of the blisters and blood. In spite of being treated intensely and being given antibacterial preparations possessing anti-Pseudomonad activity, the girl died on the 17th day after hospitalization.

We described a case of amyotrophic lateral sclerosis (ALS) with comorbid HIV infection. The diagnosis was confirmed by genetic tests. The difficulty of the differential diagnosis between amyotrophic lateral sclerosis and HIV-associated ALS syndrome is discussed.

Disease case has been analyzed at 59 years old female patient, living in rural area. The disease progressed with long-time and high fever accompanied with liver damage including formation of abscesses. Anamnesis showed that raw milk was consumed. During 1.5 months, high steady fever, weakness, sweating and anorexia were observed, with further moderate pain in a right abdominal wing. The whole period of disease was noted with hepatomegaly, worsening leukocytosis, ESR 60 mm/hr, and moderate hyperenzymenia. SCT findings showed an inhomogene hypoechoic formation in a right hepatic lobe in segment’s projection 7, with sharp margins, dimension 3,0 2,2 cm, with 4 nearby liquor formations up to 1.2 cm in diameter. The percutaneous puncture biopsy, liquor formation aspiration and automatic trepanobiopsy of the tissue pattern of the formation under consideration. Cytological study revealed a non-specific inflammation with pus. Atypical cells not found. Histological findings: biopsy material from liver does contain a fibrous tissue with granulomatous inflammation. Complex detoxicating, metabolic and desensibilizing therapy was performed in combination with Ofloxacin, Meropenem (14 days), and Doxycycline (20 days). Diagnosed coxiellosis was confirmed with ELISA in titer 1:400/ ОD 0,587 – ОD/0,726. The patient is fully recovered.