Filoviruses are known as causative agents of severe haemorrhagic fevers with a high mortality rate in humans. Zaire ebolavirus and Marburgvirus, the most known of them, are associated with the occurrence of sporadic cases and outbreaks of hemorrhagic fevers in some parts of Africa. Isolation of Reston ebolavirus in 1989 in the United States from samples of dead cynomolgus monkeys imported from the Philippines was the first evidence on the existence of filoviruses outside the Africa. Due to the development of new diagnostic methods, Reston ebolavirus or its markers (RNA, antibodies) were found in different animals in the Philippines, China and some other countries of Southeast Asia. These events significantly changed the concept of the geography of filoviruses at present time. Novel filoviruses have been identified in bats in China using of molecular genetic methods. Detection of filovirus RNA (the Lloviu virus) in samples from dead common bent-winged bats in Spain (2002) and in Hungary (2016) indicates the possibility of circulation of filoviruses with unknown pathogenicity potential for humans and animals among bats of temperate latitudes. This review summarizes data on findings of filovirus markers in animals in Southeast Asia, China and Europe.

A new approach in understanding the mechanisms of immune response in viral hepatitis is the discovery of a unique type of immune cells – plasmocytoid dendritic cells (pDCs). Plasmocytoid dendritic cells (pDCs) are cells of lymphoid origin and morphologically resemble plasma cells. Functionally, they are professional IFN-a-producing cells that play an important role in antiviral immune response. Data on the mechanisms of PDCs participation in hepatitis B virus infection are few and contradictory. In chronic HBV infection, the role of pDCs remains mysterious and poorly understood with conflicting circulating blood pDCs results that show differently that they are not affected or reduced. However, functional disorders of pDCs were observed in patients with chronic HBV infection. The establishment of these mechanisms, as well as the search for the cause of hepatitis B virus latency and the formation of chronic infection remains one of the important and promising areas of scientific activities today.

Epidemiology of cutaneous leismaniasis is considered, CL morbidity remains rather high and it is increasing in Uzbekistan. The main medicines in leishmaniasis treatment are pentavalent antimonials which are characterized by toxicity and resistance development, and amphotericin B. Amphotericin B is toxic too and has a lot of contraindications and side effects. Medicines with reparative and antioxidant properties are assumed to positively influence the CL course, not only leishmanicidal preparations. Protective immunity in CL mediated by Th1 response is analyzed. Expediency of examination of patients with CL for helminthiases inducing opposite Th2-response as well as studies of concomitant helminthiases influence on the CL course are discussed.

Invasive aspergillosis (IA) is a serious disease, with mortality rate up to 80%. A. fumigatus is an angiovasive pathogen, fragments of its hyphae can detach and circulate in the bloodstream. Platelets are activated by surface structures, metabolites and soluble fungal complexes, resulting in adhesion to conidia and fungal hyphae. The melanin and hydrophobin contained in the conidia, as well as the galactosaminogalactan contained in the hyphae and the glyphotoxin secreted by the hyphae, suppress phagocytic cells, but activate the platelets. Activated platelets show direct antifungal activity by releasing microbicidal proteins and serotonin. In addition to direct antifungal effect, platelets form an interactive network with cellular components of the immune system and a complement system, increasing the response of neutrophils and monocytes. In the presence of platelets, the efficacy of antimycotics is greatly enhanced. The adverse effects of platelet activation in IA are associated with clinical conditions such as hemoptysis, pulmonary hemorrhage and infarctions of various organs. Another danger associated with IA is the development of thrombocytopenia. Thrombocytopenia is defined as an independent risk factor of mortality in IA in oncohematological patients after allogeneic transplantation of hematopoietic stem cells. Numerous evidences of the important role of platelets in protection from A. fumigatus suggest that the study of the number and functional state of platelets will provide a new data, which will help develop new methods for prediction and treatment of IA.

The aim is to develop a method of early prediction of the severity of hemorrhagic fever with renal syndrome on the basis of clinical and laboratory data.

A comprehensive clinical and laboratory examination of 144 patients with hemorrhagic fever with renal syndrome was carried out in the period of 2–5 days from the onset of the disease. Based on the discriminant analysis of the data obtained, a discriminant model for predicting the severity of hemorrhagic fever with renal syndrome was developed. The index of accuracy of prognosis of clinical forms of the disease on the basis of the developed discriminant model is 97.4%.

Purpose of the study. To study the characteristics of acute HIV infection in adults in the Novosibirsk region in 2017– 2018.

Materials and methods. 200 patients with acute HIV infection, residents of the Novosibirsk region, aged 15 to 74 years, hospitalized in 2017–2018, 104 men and 96 women were examined. The diagnosis was verified by detecting antibodies to HIV in ELISA with a negative or doubtful result of the immunoblot, as well as by determining the quantitative content of HIV RNA in the blood by PCR. The hemogram, the content of CD4 + lymphocytes in the blood were determined. In addition, HIV-1 was studied in 71 patients for belonging to a genetic group.

Results. Patients of 20–40 years old prevailed – 70.5%. The sexual way was dominant in women (69.0%), injecting psychoactive substances was more often in men (32.2%). Frequent symptoms were fever (99%), exanthema (65.5%), polylimfoadenopathy (54.0%). Less common were diarrhea (36.0%), pharyngotonsillitis (23.0%), aphthous stomatitis (6.5%), hepatomegaly or hepatosplenomegaly (8.5%). Secondary diseases were revealed in 26.5% of patients. Leukopenia was recorded in 63.0%, thrombocytopenia in 62.5%, lymphocytosis and atypical cells of the lymphoid series in 14.0%. All patients had a high “viral load” – from 23,000 to 10,000,000 or more copies / ml, a decrease in the number of CD4 + less than 350 cells – in 38.0%. From among 71 patients, 19.7% had HIV-1 subtype A, and 76.0% had recombinant HIV-1 CRF63_02A. In the latter, “viral load” of more than 10,000,000 copies / ml was more often recorded (67.8% vs. 33.4%, p = 0.004).

Conclusion. A significant number of cases of acute HIV infection were reported in the Novosibirsk region in 2017– 2018. Its detection is possible by examination of all febrile patients who apply to medical institutions. Early initiation of antiretroviral therapy with the appointment of well-tolerated regimens contributes to the formation of a high commitment to therapy.

Purpose. To reveal and estimate prevalence of B. holmesii among the patients hospitalized with suspicion pertussis and pertussis-like illnesses.

Materials and methods. 424 clinical samples received from patients with of pertussis and pertussis-like illnesses in GBUZ IKB № 1 DZM in 2017–2018 are investigated. Identification of fragments of a genome of Bordetella was carried out in PCR-RT with “Amplisens® Bordetella multi-FL”. For identification of fragments of a genome of B. holmesii used PCR-RT with primers of IS481, IS1001 and hIS1001.

Results. The research included 424 patients, from them 56,1% of children aged till 1 year, 41,3% of children – are more senior than 1 year and 2,6% of adults. When using test system 60,4% of the samples containing DNA of B. pertussis are revealed; 1,9% of samples – DNA of B. parapertussis; in 34,9% of samples it is received negative and in 2,8% – doubtful results. The research of 424 samples in PCR-RT by means of IS481, IS1001 and hIS1001 primers showed that 61,1% of samples contained DNA of B. pertussis; 0,7% of samples – DNA of B. parapertussis and 3,8% of samples – DNA of B. holmesii. In 143 samples the result was negative. From 16 DNA of B. holmesii – positive samples, 9 samples were negative in test system earlier, in 2 samples – the doubtful result, 1 sample was earlier identified as DNA of B. parapertussis and in 4 samples DNA of B. pertussis and B. holmesii are found.

Conclusion. The research demonstrates circulation of B. holmesii in the territory of Russia that is confirmed by identification of positive samples in 3,8% of cases among the sick children and adults hospitalized in a hospital with suspicion of pertussis and pertussis-like illnesses. For increase in efficiency of laboratory confirmation of the clinical diagnosis of pertussis and pertussis-like illnesses the genodiagnostic of a pertussis is recommended to improve taking into account identification DNA of B. holmesii.

Objective. Identification of laboratory parameters that are used in routine practice and can serve as diagnostic and prognostic criteria for the development of sepsis and its outcomes in patients with purulent-inflammatory diseases of soft tissues.

Materials and methods. The study included 48 patients with purulent-inflammatory diseases of soft tissues. Recorded the occurrence of such clinical events as the development of sepsis or septic shock, intensive therapy, death or recovery and discharge from the hospital. For the diagnosis of sepsis, a SOFA (Sepsis-related organ failure assessment score) ³ 2 points was used. Patients were divided into subgroups according to the number of points according to the SOFA scale, intensive care and depending on the outcome of the disease: Subgroup 1 – 26 patients with sepsis (SOFA ³ 2 points) and 22 patients with systemic inflammatory response syndrome (SIRS) and SOFA <2 points; 2nd subgroup – 12 people who underwent intensive therapy and 36 people without it; 3rd subgroup – 7 patients with a fatal outcome and 41 patients with a favorable outcome.

Results. In patients with sepsis, albumin concentration was 24,07 g / l in median versus 34,65 g / l in the control group of patients with SOFA <2 points (p <0,01); glucose -7,82 mmol / l and 5,15 mmol / l (p <0,01); sodium concentration of 133 mmol / li 139 mmol / l (p <0,01). The values of the international normalized ratio (INR) amounted to a median of 1,29 and 1,04 (p <0,01); activated partial thromboplastin time -36,20 seconds and 31,50 seconds (p <0,01). In the subgroup of patients for whom intensive therapy was required, the concentration of albumin was 22,34 g / l by median versus 30,10 g / l (p <0,01); urea – 15,50 mmol / l versus 6,00 mmol / l (p <0,05), glucose – 9,61 mmol / l against 5,80 mmol / l (p <0,05), lactate dehydrogenase-644,00 U / l and 426,00 U / l (p <0,05); INR – 1,35 against 1,05 (p <0,05). The aver-age total protein concentration is 47,80 g / l versus 57,90 g / l (p <0,01). The average albumin is 22,34 g / l versus 28,50 g / l (p <0,05). The glucose concentration among patients with a fatal outcome was 12,00 mmol / l in median versus 5,95 mmol / l (p <0,01); urea – 23,22 mmol / l versus 6,00 mmol / l (p <0,01). The incidence of lethal disease was statistically significantly higher in patients with a total protein level of less than 52 g / l 5,96 times (RR = 5,96, 95% CI 1,32 – 26,89), glucose more than 11 mmol / l – 7,00 times (OR = 7,00, 95% CI 1,25 – 39,15), urea more than 20 mmol / l – 7,05 times (RR = 7,05, 95% CI 2,00 – 24,85).

Conclusion. Routine laboratory indicators as the level of total protein, albumin, glucose, sodium and urea, as well as indicators of the blood coagulation system (INR and APTT), can serve as diagnostic and prognostic criteria for the development of sepsis and its outcomes in patients with purulentinflammatory diseases. soft tissue.

Background and aims: to estimate concentration of sMadCAM-1 in peripheral blood at patients with chronic hepatitis C with excess body weight.

Materials and methods: The research included 88 patients (67 men, 21 women 41.4±3.2 years of age) with chronic hepatitis C (CHC) and excess body weight (the index of body mass is ³25 kg/m2, and abdominal circumference more than 94 cm in men, and 80 cm in women) with various morfofunktsionalny changes in a liver and a small bowel. From them men there were 67 people, women – 21, middle age was 41.4±3.2 years.

To all the patients complex clinical, biochemical, virologic, morphological trial was carried out. The functional condition of intestines was estimated by identification of a small intestinal bacterial overgrowth (SIBO) when carrying out the hydrogen respiratory test (HRT) with lactulose and existence of endoscopic signs of inflammation of a mucous membrane of intestines at a fibroezofagogastroduodenoskopiya. The quantitative assessment of a mucosal addressin cell adhesion molecule -1 was carried out by the definition concentration of its soluble form (sMadCAM-1) in a blood plasma by enzyme immunoassay method.

Results: the sMadCAM-1 level of peripheral blood at the patients with excess body weight increased in process of progressing of a stage of chronic hepatitis C (F0 – 349.10 (324.27-373.92) ng/ml; F1/2 – 439.69 (406.43-472.94) ng/ml; F3/4 – 1057.82 (593.38-1522.26) ng/ml; p˂0.05), existence of a syndrome of excess bacterial growth and endoscopic signsof a duodenitis. Besides, patients had its concentration more with the biochemical signs characterizing cytolytic (at ALT˃N: 502.54 (432.04-573.03) ng/ml against 381.04(345.49-416.58) at the ALT normal values), cholestatic (at GGTP˃N: 550.59 (453.31-647.88) ng/ml against 400.86(365.13-436.59) atnormal GGTP, p values 0.05; at ALP N: 572.2 (353.7-790.8) ng/ml against 468.7 (408.5-528.9) ng/ml at normal ALP, p values 0.05) and metabolic syndromes (at glucose of blood, TG, VLDL N: 562.93 (369.59-756.27) ng/ml, 681.15 (387.81-974.49) ng/ml, 809.65(124.04-1495.28) against (438.34(391.36-485.31) ng/ml), (421.69(379.41-463.97) ng/ml), 434.47(389.45-479.48), p values 0.05 at normal values of these indicators respectively).

Conclusion: Progressing of fibrosis and functional disturbances in intestines are interconnected with increase in concentration of MadCAM-1 in blood that allows to consider pathological changes in intestines of various genesis as the accessory factor promoting progressing of СHC at patients with excess body weight. Besides, definition of concentration of sMadCAM-1 in peripheral blood can be used as one of markers of noninvasive diagnostics of a stage of fibrosis at the patients with СHC and excess body weight.

Congenital heart defects account for about 30% of all anomaly of development in children. Cytomegalovirus infection suffered by a woman during pregnancy claims one of the leading places among teratogenic factors.

Aim: to study clinical and pathogenetic features of congenital heart diseases in children with active cytomegalovirus infection.

Materials and methods: the survey included 240 children with congenital heart defects under 1 years old. The diagnosis was verified by enzyme immunoassay with detection of immunoglobulins of classes M and G to cytomegalovirus and by polymerase chain reaction, the material for which was blood and urine.

Results. For congenital heart defects with the active forms of cytomegalovirus infection is characterized by a higher frequency of combined defects and the development of critical states. Children with cytomegalovirus infection in 40% suffered intrauterine myocarditis of cytomegalovirus etiology, which weighed the course of the underlying disease. The features characteristic of IUI was determined much more often (in the analysis of the noncardiac symptoms). Specific therapy of active forms of cytomegalovirus infection in children before surgery for correction of congenital heart defects has reduced the likelihood of postoperative complications.

Summary. Cytomegalovirus infection has a direct teratogenic effect and can provoke the development of congenital heart defects. In addition, the virus has a cardiotropic and immune-mediated effect on the myocardium. This leads to the development of intrauterine myocarditis, which aggravates the course of the disease. The specific treatment of active forms of cytomegalovirus infection in children before surgery for the correction of congenital heart defects, reduces the likelihood of postoperative complications.

The aim of this research was to analyze and compare CRIPSR loci and cas-proteins of Yersinia pseudotuberculosis strains isolated in different territories from patients with various clinical manifestations of pseudotuberculosis.

Materials and Methods. Complete genomes of Y. pseudotuberculosis IP329353 (NC_006155) and IP31758 (NC_009708) were obtained from NCBI Nucleotide Database. Strains were isolated from patients with gastroenteritis and systemic infection respectively. Search, identification, and analysis of CRISPR systems were carried out by onlinetools CRISPROne, CRISPRDetect, and CRISPRTarget.

Results. Analyzed strains have CRISPR-Cas systems that include one set of cas-genes and arrays situated at the long distances from each other. We defined three CRISPR arrays in Y. pseudotuberculosis IP32953: array YP1 located near cas-genes, arrays YP2 and YP3. CRISPR-Cas system of Y. pseudotuberculosis IP31758 includes two arrays – YP1 and YP3. CRISPR systems do not share similar spacers.

Conclusion. CRISPR systems of the analyzed strains differ in CRISPR loci and cas-protein structures that can be used as specific molecular marks of analyzed strains during the study of intra-species variability and evolution of Y. pseudotuberculosis.

The aim of the study was to present clinical, epidemiological and laboratory characteristics of modern pertussis in hospitalized children, as well as to assess the frequency of pertussis infection as an etiological factor of long – term cough in children and adolescents.

Materials and methods: medical records of 545 patients hospitalized in Children’s city clinical hospital №5 named after N.F. Filatov (Saint-Petersburg) in the period 2015–2017 were analyzed. Detailed clinical and laboratory analysis with subsequent follow-up of patients was carried out in 80 patients with pertussis aged 1 month to 18 years. The DNA of the causative agents of pertussis infection was identified by PCR using a commercial kit “AmpliSens Bordetella multi-FL” (Moscow); parallel was determined the bacterial load by quantitative PCRRT (real time) using test systems production, Gamaleya Research Institute of Epidemiology and Microbiology (Moscow), allowing to detect a single genome-equivalents (GE) of B. pertussis in smears from the nasopharynx. Pertussis convalescents were examined 1, 3 and 6 months after discharge.

Results. Among hospitalized children dominated the first 2 years of life (70.8%), 78% were unvaccinated children. The sources of infection for children of the first two years of life were family members in 77% of cases, for preschoolers-in 67%, for schoolchildren-in 14%. Patients of moderate severity were 81.1%, severe – 10.3%; mild – 7%. Of the specific complications, respiratory rhythm disturbances were notedin 11.6%, including respiratory arrest-in 2.8%; pneumonia of mixed etiology was recorded in 6.2% of cases. Introduction of PCR method allows to increase laboratory confirmation up to 87.2%. In 63.6% of cases pertussis of pertussis were detected by PCR genome-equivalents of DNA in 6 months from hospital discharge. In patients with long – term cough, pertussis wand DNA was detected in preschool children in 11.14% of cases, in patients 7–12 years – in 25.93%, in adolescents-in 20% of cases.

Conclusion. Whooping cough is a common infection among schoolchildren and adolescents, despite the high coverage of young children with preventive vaccinations. Pertussis convalescents can release the DNA of the pathogen for a long time, which may have epidemiological significance for unvaccinated and those children and adults, who have lost postvaccinal immunity, in the foci of infection.

Objective: to analyze the adequacy of the scheme of empirical antibiotic therapy in patients with complicated forms of HIV infection in a specialized hospital and propose a set of measures for its optimization.

Materials and methods: Clinical and demographic characteristics, results of bacteriological studies, risk factors of infection with resistant and multiresistant pathogens were studied in patients with HIV infection at the stage of progression with infectious complications of bacterial etiology, and the adequacy of empirical antibiotic therapy was evaluated.

Results: The analysis of bacterial infectious complications in 21 HIV-infected patients with advanced stages of the disease was carried out. It was established that the profiles of the starting ABT only in 47% of cases coincide with the results of the antibiogram. To increase the effectiveness of empirical antibacterial therapy, stratification of risk groups for the detection of multiresistant bacterial pathogens has been developed. The basis of stratification: the severity of immunodeficiency, the presence of previously conducted antibacterial therapy, the period and place of detection of infectious complications, the localization of the infectious process.

Conclusion: the use in clinical practice of a differentiated approach to the appointment of antibacterial drugs for starting empirical therapy in patients with HIV infection can improve the quality of treatment of infectious complications in patients with immunosuppression.

Aim of the study: To determine clinical course of Burkholderia cenocepacia bacteremia and outcomes in patients receiving cancer therapy.

Materials and methods: We indentified 10 adult patients with culture-verified catheter-related Burkholderia cenocepacia bacteremia. Pathogens were identified with protein mass spectrometry of bacteria cells. Testing for the «Microscan WalkAway 40/96 Plus» (Germany) did antibiotic sensitivity or «VITEK 2» (France).

Results: In the majority of cases course of bacteremia was indolent; this fact precluded its rapid identification with standard procedures for diagnosing bloodstream infection. All patients developed fever but we revealed neither leukocytosis nor leucopenia which could be attributed to active infection. However, antibiotic treatment was initiated during the 24 h after the first signs of infection in all cases. In one patient bacteremia was complicated with septic shock. We revealed that Burkholderia cenocepacia was able to form biofilms and persist in implanted venous port systems after treatment and in order to eradicate the pathogen venous catheters had to be removed despite effective antibacterial treatment. Initial treatment was prescribed empirically and further antibacterial treatment was adjusted based on sensitivity testing results in 7 patients. Burkholderia cenocepacia eradication rate was 100% and all patients were cured and were able to continue prescribed cancer therapy afterwards.

Conclusion: given to the low frequency of Burkholderia cenocepacia sporadic infections, clinicians must be aware of the possibility of drugs and medical supplies contamination with this pathogen. If one reveals ≥1 case of Burkholderia cenocepacia-associated infection the internal investigation must be initiated. Empiric antimicrobial therapy widely prescribed to treat febrile neutropenia in cancer patients is effective in these cases. However, it cannot eradicate the pathogen from inner lumen of implanted venous catheters. Identification of the possible pathogen in blood cultures and antibiotics sensitivity testing using microbiological analyzers prompts the diagnosis of bacteremia and prescription of most effective therapy

The purpose of the study is to analyze morbidity and to determine etiology of community-acquired pneumonia of conscripts, to examine the epidemiological effectiveness of pneumococcal conjugate and non-conjugate polysaccharide vaccines for the prevention of community-acquired pneumonia in soldiers.

Materials and methods. The incidence of communityacquired pneumonia of conscripts in the period from 2008 to 2017 was examined. PCR diagnosis of samples sputum and smears from the pharynx of 694 patients with pneumonia of conscripts was carried out to detect fragments of DNA/RNA of 14 different pathogens. Epidemiologic efficacy of conjugated and non-conjugated pneumococcal vaccine was studied in groups from a total population of 1727 soldiers.

Results. It is established that over the past 8 years, the incidence of community-acquired pneumonia of military conscripts decreased by 2.7 times. However, the level of morbidity achieved in 2017 (25.7 ‰) is still very high compared to the incidence of contract soldiers (5.3 ‰) and the population (4.2 ‰).

When determining the etiology of pneumonias in military conscripts by means of PCR diagnosis, the prevalence of S. pneumoniae and adenoviruses was established, the genetic material of which was detected in 56.3% and 35.9% of the examined samples, respectively. 56.1% of pneumonia had mixed, mainly viral-bacterial etiology.

Among those who were vaccinated with pneumococcal conjugate vaccine, the incidence of community-acquired pneumonia was 4.5 times lower in the 5 – month follow – up period than in the comparison group (p < 0.001) (effectiveness was 77.7%), and among those who were vaccinated with non-conjugate polysaccharide vaccines it was 2.8 times lower (p < 0.001) (effectiveness was 64.3%).

It was found that the use of pneumococcal conjugate vaccine in military teams formed a collective immunity that prevents the circulation of pneumococci and the development of diseases not only in vaccinated persons, but also in unvaccinated persons.

Conclusion. Both types of pneumococcal vaccines – conjugate, first used in the military, and usually used non-conjugate polysaccharide vaccine, have shown high epidemiological effectiveness in the prevention of community-acquired pneumonia and can equally be recommended for vaccination of recruits a month before the call to military service and of young soldiers, not vaccinated before the call.

Аim: Give an epidemiological description of the incidence of acute respiratory viral infection and influenza in the Russian Federation and Moscow.

Materials and methods: The form of the federal state statistical observation № 2 “Information on infectious and parasitic diseases” for 2007–2017. When analyzing the etiological structure of the agents of ARVI and influenza in Moscow, protocols were used for weekly laboratory tests of agents of ARVI and influenza conducted by the Center for Hygiene and Epidemiology in Moscow.

Results: The epidemic process of ARVI in Russia is characterized by a stabilization of morbidity with an average annual growth rate of 0,4%, and Moscow has a moderate tendency to reduce morbidity with an average annual rate of decline of 2,3%. The highest incidence of ARVI is observed among children under 1 year, 1–2 years and 3–6 years. The greatest proportion in the structure of the incidence of ARVI is children under 17 years. Both for Russia and for Moscow, there is a pronounced tendency to reduce the incidence of influenza. In contrast to ARVI, the largest proportion of people with influenza in Russia and in Moscow are adults, but the highest incidence rates are registered among the children. The epidemic rise of the incidence of ARVI and influenza in Moscow starts 10–12 weeks earlier than in the Russia as a whole.

Conclusion: For the epidemic of ARVI in Moscow and in Russia it is typical to involve children under 1 year, 1–2 years and 3–6 years. In Moscow in 2016 and 2017 there is a significant increase in the incidence of influenza among children under 1 year and 1–2 years. In contrast to the Russian Federation for Moscow among the causative agents of non-influenza etiology, dominated parainfluenza viruses (1–3 types) and adenoviruses.

The article describes in detail the clinical case of a severe course of a combined viral disease (Varicella-Zoster, Hantaan Hemorrhagic Fever), complicated by bilateral interstitial pneumonia, cerebral edema, and disseminated vascular coagulation syndrome, developed in an immunocompromised patient during the treatment period of exacerbation of a background disease (plaque psoriasis, progressive stage) with a cytostatic drug. The role of the main and associated diseases (pathogenetic mechanisms of comorbidity), specificly, hantavirus infection and psoriasis, as co-factors in the formation of an unfavourable course of varicella-zoster in an adult, is discussed. An example of an individual approach to the patient, a comprehensive diagnosis and rational treatment that contributed to a favorable outcome of the disease is given.