Aim. To assess the current situation on streptococcal (group A) infection in Russia, to study the molecular properties and antimicrobial susceptibility of group A streptococcus isolated from patients with soft tissue infection.

Materials and methods. We performed a descriptive epidemiological study using official statistics. A total of 97 cases of soft tissue infection caused by group A streptococci were investigated for emm-types, the presence of genes of bacteriophage toxins and integrases by PCR and sequencing. We tested 91 strains for antimicrobial susceptibility by the micro dilution methods.

Results. From 2009 through 2017, 2.8 million cases (563 thousand primary cases) of group A streptococcal disease were reported. There was a decrease in the incidence of scarlet fever in Russia (31.5 per 100 000 population). In 2009–2017 the incidence of rheumatic fever and rheumatic heart diseases increase slightly but the prevalence of this forms group A streptococcal disease are decrease. Annually 2600 people die from the rheumatic fever and rheumatic heart diseases. Of the 97 cultures of group A streptococci, 33 were associated with invasive infection. We identified 33 different emm-type. All cultures contained speB gene. Some strains contained speA, and others speC genes. We did not find any correlation between the presence of bacteriophage toxin genes and the invasive properties of streptococci. Tetracycline and macrolides are ineffective in patients with of soft tissue infection

Conclusion. Streptococcal (group A) infection continues to be of significant social and economic importance for Russia. The streptococcus cultures isolated from patients with invasive forms were heterogeneous in molecular and biological properties and remained sensitive to penicillin antibiotics.

Goal. Evaluation of duration and frequency of Bordetella pertussis DNA detection in contact persons in family foci of whooping-cough.
Materials and methods. 116 persons from 59 family foci of pertussis were examined in contact with sick young children. The DNA of B. pertussis bacteria in nasopharyngeal swabs was detected by real-time PCR (PCR-RV) using a test system developed at Gamaleya Research Institute of Epidemiology and Microbiology (Moscow). The bacterial load and the duration of the release of genomic equivalents (GE) of B. pertussis DNA were determined in dynamics at 1, 3 and 6 months.
Results. Among the contact persons in family foci, adults accounted for 59,48%, adolescents and schoolchildren – 10,35% and 12,07% respectively. Cough was absent in 35,34% of contact persons, 20,69% had a rare dry cough, 24,14% had a dry compulsive cough and 19,83% had a typical cough. None of the contact family members were diagnosed with whooping cough, although 64.66% of the patients had clinical signs of the disease, mainly its atypical form (44.83%). Among the carriers of B. pertussis adults accounted for 82.92%, among patients with atypical forms of whooping cough – 51.92%. In the study of nasopharyngeal swabs using the PCR-RV method, it was found that 86.10% of the contact persons detected DNA of B. pertussis. After 3 months in 90% of the contacts, the DNA of pertussis causative agent was detected in a minimum amount of 101-102GE/ml in the sample. After 6 months, B. pertussis was sanitized in 50% of the examined patients. 12.5% of the samples identified avirulent forms of the causative agent of pertussis, formed as a result of movement of IS481 in operon bvgAS.
The conclusion. In 86.1% of contact persons in family foci for a long time (from 3 to 6 months), detection of genetic markers of the causative agent of pertussis from the nasopharynx was noted, including 35.34% of those examined in the absence of cough. This, along with the reported genetic mutation in operon bvgAS in 12.5% of cases, can characterize the presence of persistence of B. pertussis, explaining its preservation in circulation in the conditions of mass vaccine prevention.

Purpose: To study an epidemiological features and evolution of clinical presentation of typhoid fever in modern megapolis
Materials and methods: A study of 115 patient’s medical records was performed. All patients were hospitalized in Clinical Infectious Diseases Hospital named after S.P. Botkin, Saint-Petersburg, Russia during 2005–2017 with confirmed diag№sis of typhoid fever. We have conducted a comparison of epidemiological and clinical features between 59 patients hospitalized in 2005–2009 and 56 hospitalized in 2010–2017.
Results: There was increase proportion of Central Asia’ countries citizens among study group during recent years. Social status of affected patients had also changed recently due to decrease fraction of homeless people along with decreased number of patients with accompanied infectious diseases. Atypical clinical presentation had become more common №wadays with most of a patients presented with moderate severity form of disease.
Conclusion: Clinical presentation and epidemiology of typhoid fever are prone to changes over time. New data on epidemiology and predominance of atypical form of disease need to be considered to ensure prompt diag№sis of a disease.

The aim of the study was to assess the efficacy and safety of ART regimens that included different doses of the drug 6НР with the reception of QD, in comparison with the scheme of ART, containing, PhAZT, to select the daily dose 6НР in conducting phase III clinical trials.
Patients and methods. 125 patients were randomized to 25 people in 4 groups, depending on the daily dose of the drug 6НР (600, 800, 1000, 1200 mg), and in the comparison group (phosphazide). For a daily dose of the drug 6НР the study was blind. All patients, in addition to the studied drugs were receiving 3TC and EFV. The effectiveness of ART regimens was assessed by the proportion of patients with HIV RNA <50 copies/ml and CD4+lymphocyte increase after 24 weeks of therapy.
Results. The use of ART scheme, which included 6НР + 3TС + EFV, was highly effective regardless of the daily dose of the drug 6НР, and is comparable to the effectiveness of the comparison mode (PhAZT+3TC+EFV). More than 95.5% of patients receiving 600 mg and 800 mg of the drug 6НР QD, after 24 weeks of therapy, the level of HIV RNA was < 50 copies/ml (in the comparison group – 87.5%). In patients of all groups there was a significant increase in the median CD4+lymphocytes. The maximum result of increasing the median CD4 + lymphocyte count (164 cells/µl) was observed in patients receiving the drug 6НР – 600 mg/day. All the studied modes was safe because of the 24-week study made up 94% of the patients receiving 6НР, and 96% of receiving PhAZT. Only 1 patient (1%) receiving the maximum daily dose 6НР (1200 mg), marked AES possibly related to study medication, and which led to the cancellation of the treatment.
Conclusions. The effectiveness and safety of all modes of ART did not depend on the daily dose of the drug 6НР and was comparable to the comparison scheme, which included PhAZT. The maximum virological and immunological response after 24 weeks of therapy was achieved in patients receiving the drug 6НР at a dose of 600 mg QD in the ART scheme. The drug 6HP is recommended for phase III study in a daily dose of 600 mg in the ART.

Aim of work – to analyze the etiological structure, epidemiological structure, social-demographic features and the nature of the development of complications of the central nervous system in aseptic meningitis in children in Khmelnitskyi region for the period 2004-2017.
Materials and methods. It was conducted a prospective analysis of 208 cases of aseptic meningitis in children of whom 138 people were boys and 70 people were girls. The etiology of the disease was determined by studying cerebrospinal fluid using PCR method. Complications of the central nervous system were diagnosed on the basis of the clinical picture and CT or MRI scans. The analytical method was used to conduct the analysis of the received data.
Results. The highest seasonal increase of the incidence was from August to October and it was 65.6% with its peak in September (24.0%). The clinical picture was characterized by a moderate trend in 71.2% of cases and in 28.8% by a severe course. In 100% of cases the disease began with a fever, headache (83.6%), vomiting (76.9%), abdominal pain with diarrhea (6.2%), epileptic seizures (0.9%). The average level of cytosis was 269.4±196.7 cells/mm3with a predominance of lymphocytes and the average protein level in cerebrospinal fluid was 73 ± 36 mg/dl. The etiological factor was established in 18 (8.6%) patients.
Conclusions. Enterovirus remains to be the main pathogen which was determined in 72.2% of cases. The second place was taken by herpes viruses (22.2% of cases), the third place was given to the mumps virus (5.6% of cases) (in etiologically verified cases). In most cases the disease ended in complete recovery but in 47 (22.6%) patients the complications were observed. The prevalence of aseptic meningitis among children in Khmelnitskyi region was 6.2 per 100,000 children, and males outnumbered females by a 2:1 ratio.

The aim of this study was to characterize the situation of HIV infection among pregnant women in the Republic of Bashkortostan in 2013-2017 on the basis of a comprehensive retrospective analysis of indicators.

A comprehensive retrospective analysis of statistical data on 2734 cases of pregnancies of HIV-infected women who were on dispensary observation at the Republican center for prevention and control of AIDS and infectious diseases in the period from 2013 to 2017 was carried out. The prevalence of HIV infection in pregnant women during the study period tended to increase annually from 656.4 to 857.8 per 100 thousand pregnancies. The prevalence of HIV infection among pregnant women who have completed pregnancy by childbirth increased from 650.7 to 795.0 per 100 thousand women who gave birth. The incidence of HIV infection among pregnant women, reflecting the first identified cases, increased from 248.4 to 267.1 per 100 thousand pregnancies. The proportion of newly diagnosed HIV infections among pregnant women in the structure of the overall HIV incidence has decreased from 7.92% to 6.03%. The main route of HIV infection of pregnant women was sexual, the average for the period of its specific weight was 92.6±4.0%, the parenteral pathway accounted for 7.4±4.0%. There is a steady change in the age structure of HIV-infected pregnant women with first time established diagnosis, towards the age group of 21-30 years. If in 2013, the structure was dominated by pregnant women aged 31-40 years (60.2%), in 2017 the first place was the age group of 21-30 years (47.9%). On average, 24.7±2.3% of HIV-infected women were admitted to the study period under observation up to 12 weeks of pregnancy. The rate of vertical transmission of HIV infection averaged 2.9±1.0% over the period. Determination of the main trends of HIV infection among pregnant women, allows to assess the effectiveness of the implemented therapeutic and preventive measures, to develop and implement new methods of organization of medical care of this category of population, aimed at reducing the spread of the disease.

Objective: to characterize the clinical and laboratory parameters of patients with HIV infection with newly diagnosed Kaposi’s sarcoma.

Materials and methods. The analysis of clinical and laboratory data of 25 HIV-infected patients with newly diagnosed Kaposi’s sarcoma who were treated in the in-patient department of St. Petersburg Center for the Prevention and Control of AIDS and Infectious Diseases in 2009-2017

Results. Ninety-two (n=23) patients were men. The median age at detecting HIV infection is 36 years. The manifestation age of Kaposi’s sarcoma is a median of 37 years. Elements of Kaposi’s sarcoma were located mainly on the skin of the lower and upper extremities, trunk, face and oral mucosa. Manifest CMV infection was registered in one patient, candidiasis of various localizations was found in 19 patients (76%), 2 of them also had one case of tuberculosis and toxoplasmosis. The viral load of HIV in the serum of patients upon admission to the hospital ranged from 26 159 to 2 755,549 copies/ml. The number of CD4 lymphocytes in the serum of patients is from 4 to 674 cells/μl. First-line antiretroviral drugs were prescribed to 20 (80%) patients, while the positive dynamics of sarcoma was observed in 8 patients. Four (16%) patients received antitumor treatment. The duration of hospitalization of patients ranged from 8 to 85 days (median 29). Twenty-one patients were discharged from the hospital, death was registered in 4 patients (16%).

Conclusion. Characteristics of patients with HIV infection with newly diagnosed Kaposi’s sarcoma are: the predominance of males aged 30-39 years; skin lesions of the limbs and trunk in the debut of the clinical picture of sarcoma; laboratory signs of pronounced immunodeficiency (in 75% of patients, CD4 lymphocytes in the serum are less than 200 cells/μl); high viral load of HIV in serum (in 88% of patients more than 100 000 copies/ml); frequent combination with other opportunistic diseases.

Antibiotic resistance threatens the effective prevention and treatment of healthcare associated infections which are the most frequent adverse event in health-care settings worldwide. There is an urgent need to investigate alterative preventive and treatment options while there are still a few antibiotics left. Bacteriophage (phage) therapy has been championed as a promising alternative to antibiotics.
The aim of this study was to evaluate the efficacy of a therapeutic bacteriophages to control of Staphylococcus aureus and Klebsiella pneumonia outbreaks in newborn intensive care units.
Materials and methods. Commercial bacteriophage cocktails targeting these paphogens was orally and locally given over 5 days to patients of neonatal intensive care units in Saint-Petersburg, Russia.
Results. Bacteriophages were used as antimicrobial agents for control of three S.aureus outbreaks and one K.pneumonia outbreak. S.aureus infection incidence during the three outbreaks were 22.2%, 54.5% and 50.0% accordingly, and K.pneumoniae outbreak – 19.0%. After application of the phage cocktails among newborns, the incidence of infections caused by S.aureus and K. pneumoniae decreased to zero. All treatments were well tolerated. No adverse events were reported.
Conclusion. Presented results clearly demonstrate high efficiency of bacteriophages. Phages have several features that make them potentially attractive antibacterial agents. Bacteriopahges are highly specific and very effective in destroying targeted bacteria, have only minimally impact on health-protecting normal flora bacteria, safe and rapidly modifiable to combat the emergence of newly arising bacterial threats.

Objective: to study the clinical and epidemiological features of influenza in children in the Stavropol Territory.
Materials and methods: influenza prevalence is analyzed from 2015 to 2017 the paper used the data from the Territorial Rospotrebnadzor in the Stavropol Territory. We used the following methods: bibliographic, monographic description, epidemiological, analytical, statistical methods.
Results: Among the deciphered acute respiratory viral infections, the specific gravity of influenza A (H1N1) 09 in 2016 reached 78%, and in 2017 influenza B prevailed – in 57,4% of children, and influenza A (H3N2) – in 42,6% of cases. In 2016 68,5% of children under 6 years of age, of all admitted, were hospitalized, and in 2017 – 83,86%. We presented the peculiarities of the course of influenza in different epidemic seasons.
Conclusion: Unvaccinated children up to 6 years of age have the disease mainly in severe forms and with complications. The epidemic period began to increase in 2015–2016 at week 52, and in 2016–2017 from week 48, ended at week 13 and at week 17. At the epidemic of 2015–2016, intoxication syndrome with chills, microcirculation disturbance, catarrhal syndrome, ARDS prevailed in the clinical picture. The epidemic season of 2016–2017 was characterized by intoxication syndrome, encephalic reaction, hemorrhagic and myalgic syndromes.

We describe the human acute opisthorchiasis outbreaks in Moscow region acquired from eating raw Leuciscus idus, Abramis brama and Aspius aspius in 10 patiens: 5 delivered fish from Tyumen and Sverdlovsk regions and 5 – from fish during their travelling to Tomsk and Astrakhan regions. Although, 18 people had identical history of consumption raw fish 10 had clinical symptoms of which the most frequent one was febrile eosinophilic syndrome. Other 8 people had no clinical symptoms. Eggs of O.felineus were found in 10 patients. Due to risk of cholangiocarcinoma in patients infected with O.felineus we recommend one day of praziquantel 25 mg/kg TID. Although opisthorchiasis is not frequently reported in Moscow region, it should be considered in cases of unexplained acute febrile eosinophilic syndrome with cholestasis, especially when patients confirm the ingestion of raw fish.

The goal of the study was the identification of epidemiological features of whooping cough and assessment of economic losses due to this disease in Moscow.
Materials and methods. The retrospective descriptive epidemiological research is conducted. The statistical data on incidence of whooping cough in the Russian Federation and in Moscow from 2009 to June, 2018, the reports on registration of whooping cough cases as well as the results of laboratory testing on whooping cough in Moscow in 2017 have been studied. The general losses from whooping cough in Moscow in 2017 have been calculated.
Results. The whooping cough incidence in Moscow considerably influences a situation on this infection in the country in general as more than 20% of all cases of whooping cough in Russia are registered in the capital, where the incidence exceed by 1.5–2.5 times the average country level. The incidence of whooping cough among children of 7–14 years and the share of this group of population in the structure of the whooping cough cases have increased in Moscow, and outbreaks of pertussis at schools are observed. In Moscow the general losses due to whooping cough in children of 7–14 years in 2017 were estimated as 19.72 million rubles. High performance of vaccinal prevention of whooping cough is confirmed: in Moscow in 2017 the coefficient of epidemiological efficiency of vaccination among children of 6-12 months was 97.7%, among children at the age of 1 year – 82.6%, 2 years -79.9%, 3 years – 74.9%. Weighted average of direct loss from a case of whooping cough was estimated as 31182.2 rubles. The general losses due to whooping cough in Moscow in 2017 were 67.88 million rubles.
Conclusion. It is necessary to take additional measures for vaccinal prevention of whooping cough at children of school age and to support the high level of coverage by timely immunization of children of the first year of life. For assessment of economic feasibility of vaccinal prevention of whooping cough it is necessary to consider the size of economic losses due to this disease.

According to requirements of WHO, the trivalent influenza vaccines (TIV) have to contain antigens of two influenza A strains (A/H1N1, A/H3N2) and one influenza B strain which can be presented by antigens of a virus of lineages Yamagata or Victoria. In a season of 2017/2018 the discrepancy of the vaccinal and circulating influenza B strains was noted that caused decrease in effectiveness of vaccination, especially at children’s age when the frequency of detection of influenza B is higher, than in other age groups. Now in the Russian Federation it is registered, in addition to TIV, quadrivalent vaccine (QIV) manufactured in the Russian Federation and including antigens of influenza B viruses of the two lineages.
The purpose of work was assessment of the cost-effectiveness of QIV in comparison with TIV at children of preschool age on the basis of epidemiological data on the Russian Federation for a season of 2017/2018.
Material and methods. The analysis was carried out by a modeling method from a health care system and societal perspective taking into account epidemiological data on the Russian Federation and the European data on effectiveness of TIV at citizens of various age. Indirect effect of vaccination was not considered. The cost of the TIV and QIV (Grippol plus and Grippol quadrivalent, respectively) corresponded to the registered price including VAT.
Results. The analysis showed that use QIV instead of TIV for children of preschool age in an epidemiological season of 2017/2018 would allow to increase quantity of the prevented influenza cases by 17.1%. The prevented indirect costs exceed the prevented direct medical costs. The incremental cost-effectiveness ratio (ICER) is 1042.65-1093.7 thousand rubles/QALY in the analysis from the health care system perspective and 124.50-267.91 thousand rubles/QALY in the analysis from the societal perspective.
Conclusions. Vaccination against influenza of children of preschool age in the Russian Federation in a season of 2017/2018 with quadrivalent vaccine would allow to increase significantly the number of the prevented cases of disease and could be considered as economically highly effective intervention. Reduction of vaccine price less, than for 5% in comparison with the registered price would allow to avoid completely additional budget burden.

A clinical case of development of secondary hemophagocytic syndrome is presented on the background of sepsis caused by Serratia proteamaculans, in a child of monthly age, culminating in recovery. Hemophagocytic syndrome in the child developed on the 32nd day of life and was accompanied by fever, hepatosplenomegaly, anemia, thrombocytopenia, elevated blood levels of triglycerides and ferritin. Blood culture was positive for Serratia proteamaculans. Isolate of Serratia proteamaculans was resistant to aminopenicillins (including protected ones), 1–4 generations of cephalosporins and aminoglycosides but sensitive to ciprofloxacin and moderately sensitive to imipenem and meropenem. The duration of fever in the child was seven days, thrombocytopenia, hyperfertritinemia and hypertriglyceridemia – 28 days. The normalization of the indices of ferritin, triglycerides and platelets coincided with the reduction of bacteremia and high values of the C-reactive protein. The duration of bacteremia was three weeks: the isolation of Serratia proteamaculans from the blood occurred three times. Elevated levels of C-reactive protein in the blood were noted for 30 days. Reduced hemoglobin and red blood cells counts were noted for eight weeks. Positive dynamics of the hemophagocytic syndrome occurred as a result of measures aimed at treating sepsis – antibiotic therapy with imipenem in combination with ciprofloxacin, appointed by the decision of the medical commission on the basis of the sensitivity of Serratia proteamaculans to antibiotics, intravenous immunoglobulin, and infusion therapy. Glucocorticosteroids and cytotoxic agents (etoposide, cyclosporin A) have not been used in this case.

Infectious diarrheas are a current problem of children’s age. Despite prevalence in structure of acute intestinal infections at children of a viral gastroenteritis dysentery keeps the relevance owing to development of severe forms of a disease and serious complications. The choice of drug for etiotropic treatment of bacterial diarrheas at children’s age taking into account the existing international and Russian recommendations is difficult and ambiguous. The efficiency of many modern antibacterial drugs which are traditionally used for treatment of a shigellosis and others infectious diarrheas decreases because of high prevalence of polyresistant strains. It is known that so far, at infectious diarrheas unreasonably long antibacterial therapy with change of 3–4 medicines is carried out, repeated courses of germicides at a reconvalescents bacterioexcretion of activators of infectious diarrheas are widely appointed, unfairly short antimicrobial therapy takes place less often. Despite existence modern diagnostic the test of systems antibiotic-associated diarrheas are often late diagnosed that lead to development of severe forms of a disease or complications. The negative C. difficile toxins test does not allow to exclude the antibiotic-associated nature of diarrhea completely. The clinical case of dysentery of Fleksneri at the child caused by a strain with a multiple antimicrobial resistance and which led to development of antibioticassociated colitis and dynamic intestinal impassability is given as an example in article. Therefore, when choosing antimicrobial drug means for treatment of infectious diarrheas it is necessary to consider regional features of the circulating activator strains.