The aim. of the work was to evaluate the cost-effectiveness of vaccination with the 13-vaIent pneumococcal conjugate vaccine (PCV13) and its combination with the 23-valent pneumococcal polysaccharide vaccine (PPV23) of immunocompetent adult patients with different levels of risk of pneumococcal infection.

Material and methods. Cost-effectiveness analysis was carried out by a modeling method, with a horizon of 15 years from the position of the healthcare system, and. taking into account the social perspective. The analysis was performed, for 20, 40, and 60 year oId patients with 1, 2, and 3 risk factors. In accordance with national recommendations, the vaccination. regimen included, the introduction, of PC 1 dose of PPV23 one year later. In addition, the analysis was performed, for vaccination, with 1 dose of PCV13.

The efficacy of PCV13 and PPV23 in different age groups corresponded, to the results of foreign studies, taking into account the data of a Russian study of the serotypic landscape of pneumococci with community-acquired, pneumonia, which required, hospitalization.

The cost of treating pneumococcal infections was calculated. on the basis of the mandatory medical insurance rates in St. Petersburg for 2019. The cost of vaccination, for federal programs was calculated, on the basis of the PCV13 price of 1199 rubles per dose, and. for regional programs — 1518.63 rubles per dose. The cost of PPV23 in both, cases corresponded. to the weighted average price of auctions for 2019 (1639 rubles per dose).

Indirect costs were calculated, on the basis of data on average wages in the Russian Federation, and. employment of citizens of various age groups.

Costs and. life expectancy were discounted, at 3.5% per year.

Results. The number of cases of infection prevented, and. the amount of costs averted, increase with increasing risk level. Moreover, with age, the number of deaths caused, by these diseases increases significantly. The volume of prevented, direct medical and. general costs per 1 vaccinated, patient varies from 0.41-2.95 thousand, rubles and. 1.00-6.82 thousand, rubles, respectively. Vaccination, of patients with 3 risk factors is most cost-effective.

Conclusion. When analyzed, from the perspective of the healthcare system., vaccination, against pneumococcal infection with PCV13+PPV23 in 60-year-old. patients with at least 1 risk factor and. patients of any age with at least 2 risk factors can be considered as cost-effective. Vaccination with 1 dose of PCV13 of patients of any age with at least 1 risk factor in the analysis from the perspective of the healthcare system, can be considered, as a cost-effective intervention.

Successful implementation of lytic virulent bacteriophages in clinical practice requires convincing evidence of its safety and efficacy.

Design: We searched in CENTRAL, MEDLINE, Embase, and Russian-language literature databases in May 2018. Original articles must fulfill the following eligibility criteria: randomized, controlled trials investigating the effects of phage therapy in people with bacterial infections; at least one patient outcome was reported. Three review authors independently selected, studies, extracted, data, and. assessed, risk of bias. We used, random-effects models for meta-analysis.

Participants: adults and. children of both, sexes with bacterial infection, including multi-drug resistant variants, or individuals at risk of infection.

Outcomes: recovery or resolution of infection; clinical improvement; change in number of exacerbations; recurrence of infection; quality of life; elimination or load, reduction of a pathogen in an anatomical compartment.

Results: We included 13 trials (issued in 1965-2018) including 9 treatment studies and. 4 prevention studies. Overall, eight randomized, trials involved, adults. Five studies addressed skin and soft tissues infections, six studies concerned intestinal infections, one study addressed respiratory tract infection and. one study — ear infection. Across bias domains, 35-90% of trials scored, low risk of bias. Meta-analysis for adverse events attributable to phages and. for wound, healing provided us with pooled relative risks of 0.74 (95% CI 0.68;1.2) and 0.91 (95% CI0.68;1.2) respectively.

Conclusions: Beneficial effect of bacteriophages can be demonstrated, and. not refuted. However, our study led. to tentative conclusions. The conduct of well-designed and sufficiently powered, trials would, facilitate registration and. wide accepting of bacteriophage treatment.

Objective. The aim of this meta-analysis is to summarize clinical efficacy of azoximer bromide for treatment of inflammatory respiratory infections in children and adolescents based on data from controlled clinical trials.

Materials and. methods. In total 5 clinical studies with data from 542 patients aged. 3—18 years were selected, where effectiveness of therapy with addition of azoximer bromide to combination, therapy was compared, to standard, symptomatic treatment.

Results. The results of the meta-analysis demonstrate that the addition of azoximer bromide from the first day to respiratory infections treatment in patients aged. 3-18 years helps to reduce temperature normalization, time [mean difference -1,92 day in favour of treatment with investigational drug (95% confidence interval 1,65; 1,15) according to the random effects model or -1,4 days (95% confidence interval 3,16; 0,67) according to fixed effects model]. Moreover azoximer bromide use in inflammatory respiratory infections treatment reduces the duration of fever and intoxication symptoms by 1,4 days in comparison with the control group (95% confidence interval 1,65; 1,15), headache by 0,53 days (95% confidence interval -0,91; -0,15), muscle and. joint pain by 1,59 days (95% confidence interval -2,1854; -1,0028) and catarrhal symptoms by 1,23 days (95% confidence interval 1,32; 1,14).

Conclusion. Addition of azoximer bromide as nosotropic therapeutic agent to combination, therapy of respiratory diseases make possible to control intoxication, symptoms in a better way, reduces the morbidity of infectious and inflammatory process, has positive effect on immune mechanisms and causes almost no side effects.

The aim. is to develop a method, for predicting the development of lipid, distress syndrome in patients with a sustained, response to antiviral therapy of chronic viral hepatitis C on the basis of clinical and laboratory data.

Materials and. methods. The outcomes of lipid, distress syndrome were studied in 235 patients with a sustained vi-rological response to antiviral therapy of chronic hepatitis C during the follow-up period, from 1 to 10 years.

Results. On the basis of discriminant analysis of the data of complex examination of 135 patients, a discriminant model of predicting the development of lipid distress syndrome in patients with a sustained response to antiviral therapy of chronic hepatitis C. On the basis of the data of the survey of other 100 patients, cross-checking the accuracy of the prediction. was carried out.

Conclusion. Developed, diskriminantnaja model allows by identifying 5 of biochemical and. immunological parameters of blood (low-density lipoproteins cholesterol, homocysteine, interleukin. 4 and. 10, TNF) to predict the development of lipid distress syndrome in patients with sustained response to antiviral therapy for chronic hepatitis С. The sensitivity, specificity, predictive value of positive and. negative results of forecasting and precision index developed forecasting model of Fisher discriminant lipid, distress syndrome equal 100%. The proposed, method, should, be used, in clinical practice to predict development of lipid, distress syndrome in patients with sustained, response to antiviral therapy for chronic hepatitis C.

Nowadays infectious diseases of brain, despite the great possibilities of modern medicine, remain an important and still unsolved, problem, in neurosurgery. Among such diseases, ventriculitis takes a specific place due to appearance of a life-threatening condition that requires emergency, intensive and long-term treatment, as well as resistance to therapy, high frequency of generalization of infectious process and. relapsing course.

Objective: to evaluate the results of treatment of children with ventriculitis, depending on age, pathogenetic type of ventriculitis and applied approaches in treatment, to develop an optimal management for patients with ventriculitis.

Methods. The results of examination and. treatment of all patients with ventriculitis admitted, to “N.F. Filatov Children hospital N5", St. Petersburg, from January 2008 to December 2017 were analyzed. A total of 72 patients with ventriculitis aged, from 1 month, to 17 years were treated, during the study period.

Results. All patients with ventriculitis received, combined, systemic antibiotic therapy. The intraventricular route of antibiotic administration, was additionally used, in 81.9% of cases. In most cases, patients underwent external ventricular drainage to relieve acute hydrocephalus. In management of children with shunt infection, complete or partial removal of infected, shunt system, was performed, along with external drainage. In some cases, neuroendoscopic surgery were required, such, as endoscopic examination of the ventricular system, with removing pus and. debris, followed, by external drainage, septostomy, fenestration of cysts, removal of the lateral ventricle foreign body, endoscopic third, ventriculostomy.

Conclusions. Presently the main tools in the treatment of children with ventriculitis are antibacterial therapy and. external ventricular drainage. Given the problem, of low ability of antibiotics to penetrate the blood-brain barrier, even those recommended, for use in cerebral infections, it is necessary to consider the issue of addition intravenous antibiotic therapy with intraventricular administration, promptly. In case of ventriculitis appearance the implanted, devices (valve shunting systems, external ventricular drains) shall be removed, early and. completely with further placing a new external ventricular drainage, which is necessary. Neuroendoscopic surgery in treatment of children with ventriculitis can be used, depending on specific causes and objectives, and. can be indispensable in cases of protracted, ventriculitis.

Objective: to develop a new antigenic relevance influenza B virus suitable for modeling influenza infection in mice to assess of in vivo and in vitro therapeutic and preventive efficacy of antiviral drugs.

Materials and methods: was carried out an adaptation of influenza B virus in BALB/c mice. Was performed, comparative assessment of in vivo and in vitro pathogenicity of the parenta! virus and. adapted, influenza B virus. Was assessed, inhibition of neuraminidase with antiviral drugs (oseltamivir ethoxyacrylate and. Tamiflu) in relation to the adapted, influenza B virus.

Results: adapted  influenza B virus (B/Novosibirsk/40/2017-MA strain) models non-lethal influenza infection with pronounced, clinical signs of the disease in experimental animals. Were described the destructive changes in lungs and. brain that increases during infection. Analysis of internal organs (lungs, brain, liver, heart, kidneys, spleen) were revealed viral load only in the lungs. Were evaluated, in vivo and in vitro efficacy of antiviral drugs (oseltamivir ethoxysuccinate and Tamiflu®) on the model of influenza infection. Were proved, the high, efficiency of the innovative drug — oseltamivir ethoxysuccinate.

Conclusion: the antigen-relevant adapted, influenza B virus (B/Novosibirsk/40/2017-MA strain) can be used, to assess the drug effectiveness against influenza, as well as an additional tool for predicting the effectiveness of the vaccine against drifting strains.

Objective: to analyze the efficacy and safety of using direct antiviral action drug narlaprevir/ritonavir in combination with the prolonged alpha-interferon and ribavirin drugs in the conditions of day-time hospitals of St. Petersburg and. Novgorod.

Materials and methods: The study included. 35 patients with CHC of the 1st genotype. For treating these patients, a three-component regimen was used, which included the use of narlaprevir/ritonavir in combination, with peg-interferon and ribavirin.

Results: among all patients included, in the study, a sustained, virological response was noted, in 85,7%. Early virological response was observed, in 91,3% cases. The recurrence rate was observed, in 10% patients. In 3 patients, therapy was interrupted, for the following reasons: due to inefficiency, the development of serious adverse events, and on its own initiative.

Conclusion: the data obtained, demonstrate high, virological and. clinical efficacy and. safety of narlaprevir in combination with peg-interferon and ribavirin, in the treatment of chronic viral hepatitis C.

Aim: To investigate the features of allelic polymorphism, of several immune- and hemostasis-related genes in children with generalized, meningococcal infections and. to assess the usefulness of genotyping for prediction, of severe disseminated intravascular coagulation (DIC) and. multiple organ dysfunction, syndrome in these patients.

Materials and methods: we studied. 20 children aged, from 8 months up to 17 years with generalized, meningococcal infections who developed DIC or/and multiple organ dysfunction syndrome. The control group consisted, of 200 blood, donors. Genomic DNA was isolated, from peripheral blood, leucocytes. Allelic variants of genes coding for plasma hemostatic factors (FI-A, FI-B, FXIII-A, PAI-1, ТРА) or pro-inflammatory cytokines (IL-6, IL-1B, TNF-A) were detected by PCR and. subsequent restriction, analysis. Allele and. genotype frequencies were calculated, by direct counting, and. their differences between the groups were assessed, by Fisher's exact test. For statistical analysis, the GraphPad. Prism, ver.4.0 software was used.

Results: in the group of children with generalized, meningococcal infections, the frequency of heterozygotes for the IL-6 -174 G/C polymorphism, was 1.5-fold higher than in the controls (75.0% vs. 50.0%, respectively, OR=3.0; 95% CI: 1.1-8.6; p=0.037). Genotype TPA Del/Del was detected 4-fold more frequently in children who developed multiple organ dysfunction syndrome than in those with the more favorable disease course (45.4% vs. 11.1%, respectively, OR=6.7; 95% CI: 0.6-73.1; p=0.16). Moreover, among the patients having multiple organ dysfunction, syndrome, we observed, more frequently individuals who possessed, at least 2 unfavorable genetic variants (p=0.022).

Conclusion: Simultaneous assessment of nucleotide variations in 8 studied genes could help to define the group of children with high, risk of multiple organ dysfunction, syn-drome.Genotype TPA Del/Del, associated, with decreased, production, of this factor, might serve as a marker of unfavorable DIC course and possible predictor of multiple organ dysfunction. syndrome in children with generalized, meningpcoc-cal infections.

Study objective: identification of risk factors for the formation of cirrhosis and PLC in patients with chronic hepatitis B, C and D to develop a personalized, approach in treatment and prevention, of complications.

Materials and. methods. The materials of the official statistics of the Office of Rospotrebnadzor in the Republic of Sakha (Yakutia), the infectious disease department for treating patients with viral hepatitis of the Yakutsk Clinical Hospital were studied. Complex clinical, serological, and. molecular biological studies with the genotyping of hepatitis B, C, and D viruses were conducted (n = 354).

The results of the study. The prevalence of CVH B, C and. D in the territory of Yakutia is the primary cause of high, complications (such, as cirrhosis and. PLC) rate.

The most significant risk factors for the formation of cirrhosis and. PLC in CVH among the population, living in various geographical areas of the republic are identified. Large-scale vaccination, against hepatitis B will not only significantly reduce the amount of deaths caused, by HBV infection, but also generally have a positive effect on the epidemiological situation in the region. The organizational model for assisting CVH patients in the Republic of Sakha (Yakutia) has been developed.

Findings. Regions with the highest prevalence of hepatitis B, C and. D with the progressive course of the disease are identified. Risk factors for PLC in hepatitis B, C and. D are isolated.

Objectives: to find out and. analyze the problems of HIV-infected. patients which require additional attention of specialists during counseling before the start of antiretroviral therapy as well as to assess patients' needs in psychological help.

Materials and methods: the data are collected, by the questionnaire and. psychometrical screening using The Somatic Symptom. Disorder — B Criteria Scale from 365 HIV-infected. patients, including 155 (42,5%) females who took part in the group psychological counseling for preparing to the start of antiretroviral therapy from July 2017 to July 2018. The average age was 37.2 years old.

Results: the difficulties due to HIV-infection, which, are mentioned, by patients before the therapy start, are ranged, by the frequency of their answers as follows: 1) ««need, to conceal HIV diagnosis» — 27,1% answers, 2) ««lack of time for visiting the doctor» — 26,6%; 3) ««depression and/or anxiety» — 26,0%; 4) ««need, to use condom» — 19,5%; 5) ««restrictions in employment» — 10,1%; 6) ««disclosure of HIV diagnosis to the partner» — 8,5%. Less common are ««difficulties to interact with the doctor» (4,4%), ««impossibility to work in the specialty» (4,4%) and. ««the rejection from significant others» (4,1%). The monitoring of HIV treatment adherence showed, that 31,8% of patients were not ready to start taking medications right after the doctor's recommendations, and. 13,4% postpone the start of treatment for more than half a year.

Conclusion: in preparation for the start of antiretroviral therapy a patient needs the assistance in time scheduling required. for treatment. The discussion, with patients about their attitudes towards condom use and their self-efficacy to use condom, helps patients to overcome their fear of HIV diagnosis disclosure and. therefore reduces their risky sexual behavior. Psychological screening helps revealing psychological tension and allows offering the consultation of psychiatrist or psychologist with the purpose to correct mental state as well as to facilitate patient's efforts to develop adherence to continual treatment.

The aim. of the study is to optimize the Iaboratory diagnosis of cytomegaIovirus infection in chiIdren by finding cIinicaI and Iaboratory predictors corresponding to the acute stage of infection.

MateriaIs and methods. The resuIts of 65 chiIdren age from 1 to 3 years outpatient of with cytomegaIovirus mono-nucIeosis are presented. Markers of herpes virus infections (CMV, EBV, HHV-6 type) were determined by PCR-reaI time (bIood, saIiva) and seroIogicaIIy (IgM, IgG).

ResuIts. It has been estabIished. that acute cytomegaIovirus infection can occur both, in the form of infectious mononu-cIeosis and. be atypicaI accompanied, by proIonged fever and. severe Iymphadenopathy in most cases. Indirect Iaboratory markers of acute cytomegaIovirus infection are neutropenia and. hypoimmunogIobuIinemia IgA and. IgG. Acute cytomeg-aIovirus infection is accompanied by the virus shedding in both bIood and saIiva in aImost aII patients and the median vaIues of the viraI Ioad are different: 3,9 Ig DNA copies / mI for bIood, 4,9 Ig DNA copies / ml for saIiva. Using mathemati-caI modeIing, the “cut off" vaIue of viraI Ioad. for saIiva was determined, to be 4,1 Ig DNA copies / mI corresponding to 65.0% of the probabiIity of deveIoping acute CMV infection.

ConcIusion. The study made it possibIe to substantiate the aIgorithm. for diagnosing acute cytomegaIovirus infection. in young chiIdren which. incIudes the most significant cIinicaI Iaboratory predictors, as weII as the caIcuIated. “cut off" vaIue of viraI Ioad. for saIiva equaI to 4,1 Ig DNA copies / mI. Determining the viraI Ioad in the saIiva of patients can be used, as an additionaI diagnostic criterion for the atypicaI form of acute cytomegaIovirus infection.

Introduction: Respiratory syncytia! viral (RSV) bronchiolitis is a severe respiratory lesion, which is often found among premature infants, but has not been sufficiently studied, in this group of newborns.

The aim. of the study was to analyze clinical and. laboratory features of the course of RSV infection in premature infants.

Materials and methods. Clinical, laboratory and. x-ray examination of 40 pre mature infants with RSV-bronchiolitis verified by immunofluorescence reaction and polymerase chain reaction was carried out.

Research, result. Among patients with RSV-bronchiolitis, children with gestational age of 29—32 and 33—35 weeks and. body weight of 1000—1499 and. 1500—2499 grams predominate significantly. In patients, the disease was often accompanied by a lack of temperature, symptoms of bronchial obstruction, crepitation, development of respiratory failure II-IIICT in 77,5% of cases, severe need for oxygen therapy (80%), hospitalization, in ORNT (50%).

Conclusion. Premature infants constitute a risk group for the development of RSV bronchiolitis.

Objective: To evaluate the effectiveness and clinical significance of an accelerated, method, for the identification of microorganisms in blood, cultures in children using real-time multiplex PCR.

Materials and methods: A total of 72 blood, samples were obtained, from 62 children aged. 3 months to 16 years. The identification of the isolated cultures, according to the proposed, method, was carried out in real-time PCR and. also using classical culture microbiological methods.

Results: Based, on the frequency of detection and. the clinical significance of pathogens isolated from children, a panel of test systems was formed to identify them, by means of real-time PCR. It was shown that the effectiveness of the developed, method, for identification, of bacteria and. micromycetes by real-time PCR was 86,7% as compared, with the microbiological method. A significant reduction in the time of identification, of pathogens (from 48 hours to 5—7 hours) was demonstrated. In addition, the use of this method, allows, at the same time, to identify a number of antibiotic resistance genes (in particular, the genes of acquired, carbapenemases and. methicillin-resistant staphylococci).

Conclusion: The developed, method, with real-time PCR for detecting and identifying microorganisms in the blood has shown its effectiveness, clinical significance and. the possibility of using it for pediatric patients. Its use significantly shortens the time frame for obtaining results and, thus, allows timely initiation, of etiotropic therapy.

Objective: To study molecular and epidemiological aspects bocaparvovirus infection at the hospitalized, children in Republic of Belarus.

Materials and methods: the studies were as part of a sentinel surveillance of influenza and. other agents of acute respiratory viral infections (ARVI) in the period. 2010 — 2018. Investigated, nasopharyngeal swabs (3907), serum. (149) hospitalized. children from 0 to 18 years with symptoms of ARVI, as well as lymphoepithelial tissue of adenoids by real-time PCR (Rotor Gene 6000, Corbett research, Australia) for the presence of respiratory DNA/RNA viruses: influenza, respiratory syncytial virus, parainfluenza virus, rhinovirus, adenovirus, metapneumovirus, bocaparvovirus, and. coronavi-ruses. The full genomic DNA sequencing of the bocaparvovirus was performed, using the commercial kit «Genome Lab DTCS Quick Start Kit» (Beckman Coulter, USA). Electrophoresis and. analysis of the reaction products were performed, on a Beckman Coulter CEQ 8000 automated, capillary DNA analyzer (Beckman Coulter, USA).

Results: the genetic material of respiratory viruses was detected, in 2781 cases (71,2%). Bocaparvovirus was detected in 337 (12,1%,) patients. Bocaparvovirus infection showed, an increase in the incidence rate in the autumn period. The most susceptible to this infection are children aged. 2 years to 4 years. The duration of viremia in these patients ranged, from 6 to 15 days. Phylogenetic analysis, the Belarusian, viruses HBoV1BLR/Mogilev/241/14, HBoV1BLR/Minsk/10/14, HBoV1BLR/Minsk/11/14, HBoV1BLR/Gomel/285/15 were combined into a separate group and showed genetic similarity with the ST2 virus. Analysis of the primary structure of the Belarusian bocaparvoviruses showed the presence of amino acid substitutions.

Conclusion: Bocaparvovirus became the fourth, virus in frequency of occurrence along with other respiratory viruses. Bocaparvovirus infection may have a severe course. All amino acid, substitutions were located, in functionally significant regions of the virus genome.

MRSA is the polyphyletic group into Staphylococcus aureus species. In accordance to the hostal preference, this group is divided, to three subgroups, i.e hospital-associated. MRSA, HA-MRSA, which, includes nosocomial staphylococci variants, community-associated MRSA, CA-MRSA, that is related to human environment and livestock-associated MRSA, LA-MRSA, that has zoonotic origin and commonly is associated with livestock. LA-MRSA is widespread in most countries. The serious problem, is the spread, of LA-MRSA carriage in humans that work in closely contact with livestock. Interaction between populations of CA-MRSA and LA-MRSA leads to acquisition, of human pathogenicity-associated, genes in zoonotic MRSA. The variants of LA-MRSA, that can spread between human arises as the result of this process. These staphylococci may be the cause of human diseases, including hospital-acquired, infections. Intensification of animal husbandry determined massive and uncontrollable antibiotic usage and resulted to development and ubiquitous spread of LA-MRSA, that is, in contrast to CA-MRSA, is characterized, by multiple drug resistance. This circumstance make practically impossible to eliminate LA-MRSA in human and livestock environment. In such considerations, monitoring of ecologic, epizootic and epidemiologic situation in human and. livestock becomes one of the main ways to control the spread of MRSA and diseases, associated with it.

In 2015—2017, a cohort study of 72 cases of infectious spondylitis (is) with severe sepsis was conducted, which amounted, to 5,8% of all operated, patients. The study showed, that Gram. (+) bacteria -52 (55,9%) prevailed, in crops from all media. Gram. (-) bacteria were detected, in 1\3 cases 37(39.8%), and Candida infection in 4 (4,3%).

The main traced, sources of NI in patients with is where bedsores (13\18,1%), infection with surgical intervention, fistula (14\19,4), uroinfection (22\30,6%), subclavian catheters (7\55.5%). Gram. (+) bacteria was 26,8% (15 cases) and was mainly found, in wounds and. catheters. Gram. (-) bacteria more prevalent in ulcers in the urine culture (56,4 per cent). In 10 cases (17,8%) the crops were sterile. An increase in the role of S. epidermitis and. K. pneumoniae in the etiology of sepsis was found, in bacteriological typing of media. High resistance of nosocomial strains of Staphylococcus spp is noted. Gram. (-) bacteria to fluoroquin.alon.es and. cephalosporins 3—4 generations, which excludes the possibility of their empirical use in the treatment of severe sepsis in patients with is.

The article presents the features of the terminology of the main concepts on the problem, of sepsis from ancient times to the present. The contribution of Professor M. I. Lytkin to the development of the doctrine of surgical sepsis as the author of isolation and justification, of its independent form — angiogenic sepsis and the first national monograph “Septic shock" is shown. The special role in further improvement of definitions of the problem, of surgical sepsis in close integration, of clinicians, morphologists, microbiologists and researchers in the field of fundamental Sciences is emphasized.

Herpes viruses are widespread in the human population, they are able to infect almost all organs and systems of the body. Currently, 8 serotypes of herpesviruses pathogenic for humans are known: herpes simplex viruses of the 1st and 2nd. type, chickenpox — herpes zoster, cytomegalovirus, Epstein-Barr virus, 6th, 7th and 8th human herpes viruses. Primary infection with herpes viruses in 60—90% of cases occurs in early childhood, and, as a rule, is not accompanied, by typical clinical manifestations. Due to the lack of mandatory registration of the incidence of herpes virus infections in our country, the true number of patients is unknown. It is believed that about 20 million people are infected, every year in Russia and. the CIS countries. Herpes viruses, to a greater or lesser extent, can be considered, hepatotropic. A large number of studies are devoted, to the problem, of cytomegalovirus infection, one of the manifestations of which, is hepatitis. Most often, cytomegalovirus hepatitis occurs in immunocompromised. individuals or in patients receiving immunosuppressive therapy, cases of cytomegalovirus hepatitis and in immunocompetent individuals are also described. With liver transplantation without antiviral therapy, cytomegalovirus infection manifests itself in 11-28,5% of recipients and. can lead, to the development of liver failure, loss of transplant and. death, of the recipient. Performing diagnostic studies using both, serological and. molecular biological methods at different periods after liver transplantation, allows to detect cytomegalovirus infection timely and. initiate treatment, thereby avoiding graft rejection and. the death, of the recipient.

Giant cell hepatitis is characterized, by inflammation and large multinucleated. hepatocytes in hepatic parenchyma It is an unusual hepatocytes response to various noxious stimuli, characterized, by presence of multinucleated cells in liver with generally dismal clinical outcome. Giant cell hepatitis is commonly reported, in neonatal and. infantile liver diseases but rarely in adults (postinfantile giant cell hepatitis). Giant cell hepatitis is associated, with many diseases, including drugs toxicity, viral and. autoimmune liver diseases, with autoimmune hepatitis being the most prevalent. We report some clinical cases of giant cell hepatitis with review of literature regarding various etiological agents and their respective prognostic outcome.

A rare variant of pathology associated, with combined, herpetic infection, involving in the joint process and the formation of reactive arthritis, is considered. A clinical case of reactive arthritis associated, with combined, herpetic infection in a child. 1 year and. 9 months is demonstrated. The indicators of the main laboratory markers of herpesvirus activity are given, the changes in the patient's complaints and. the patient's condition are tracked. The changes in the patient's complaints and. the patient's condition are monitored. Laboratory research is subject to instrumental research methods. Possible therapeutic approaches are discussed, with the use of antiviral drugs, glucocorticosteroids, nonsteroidal antiinflammatory drugs.