Cognitive disorders are one of the relevant problems of modern clinical medicine. This is due to both their high frequency of occurrence and significant negative impact, which has a violation of higher cortical functions on the quality of life of patients due to the deterioration of their social communication, as well as reducing the effectiveness of professional and household functions. The main cause of cognitive disorders is Alzheimer’s disease. At the same time, according to statistical studies, a significant increase in the incidence of the number of persons in the human population as a whole suffering from this pathology is predicted. At the heart of Alzheimer’s disease is a complex of pathobiochemical changes leading to synaptic dysfunction, accompanied by the development of atrophic changes in certain areas of the brain, against which a specific clinical picture is formed. The earliest and most important manifestation of Alzheimer’s disease is memory impairment for current events, which are subsequently joined by a number of other symptoms. The literature describes certain risk factors that contribute to the development of the disease, among which a certain place is occupied by infectious pathology. However, this aspect remains largely outside the traditional study of the pathogenesis of Alzheimer’s disease. In the review the analysis of the results of modern studies confirm the possible involvement of infections in the development of dementia of Alzheimer’s type.

The Aсanthamoeba keratitis is a rare, but very dangerous disease of cornea; its development is connected with contact lens wearing, and corneal microtraumas with contamination of particles of the soil or water. The disease has no pronounced distinguishing clinical signs therefore it is difficult to distinguish them from herpetic or fungal keratitis. Nevertheless, it can be suspected on the basis of anamnestic data (use of contact lenses, corneal injury with contamination by the soil or water), uneven strong pain syndrome, ring-shaped infiltration of cornea, absence of effect of traditional therapy. Isolation of Acanthamoeba by bioculture method, morphological research of corneal bioptat (by light and luminescent microscopy), gene diagnostics, in – vivo confocal microscopy of the cornea can give additional help in the diagnosis. Also perspective diagnostic methods of Acanthamoeba keratitis are given. Nevertheless, so far there is no conventional technique of diagnosis of this disease.

The etiology of autism spectrum disorders still remains unclear. Recently a number of research have emerged linking the increment of vaccination in population and the increased frequency of autism spectrum disorders. In this review we analyzed the most representational studies on this issue. The main hypotheses linking autism spectrum disorders and vaccination were identified: association of vaccination against measles and enteropathy caused by the components of the measles virus vaccine strain which indirectly affects the brain; the onset of autism symptoms as a result of postvaccine encephalitis due to the use of various vaccines: the Measles, Mumps, Rubella vaccine, Diphtheria, Pertussis, Tetanus vaccine; the effect of multivaccine on the development of autism spectrum disorders; the effect of individual components of vaccines, particularly thimerosal, on the development of childhood autism and similar conditions. The data of epidemiological studies that refute these hypotheses were presented. Large samples in these studies provide a level of statistical significance sufficient enough to reveal even rare statistical associations. These results actually disproved the notion that vaccines cause autism.

Currently, the leading cause of social disadaptations and disability of patients at advanced stages of HIV infection, as well as adverse outcomes, is the presence of severe comorbid variants of the course of HIV infection: HIV and co-infection of chronic viral hepatitis, tuberculosis, HIV and malignant tumors, and HIV-associated neurological diseases. In pediatric practice, the combination of HIV-induced and perinatal CNS lesions is the most relevant. The differential diagnosis of these conditions is complicated due to the polymorphism of clinical manifestations and the possibility of combining several pathological conditions simultaneously in patients. Neuroimaging data does not always have clear criteria for determining the exact cause of cerebral damage. The article presents data of own clinical neuroimaging observations of two patients with perinatal and parenteral HIV infection. The nervous system damage was polyetiological in nature and was presented in one case by a combination of HIV-encephalitis, cerebral toxoplasmosis and CNS lymphoma, in the second by the presence of Bourneville-Pringle disease (tuberous sclerosis) with the formation of giant-cell astrocytoma and HIV-induced brain damage. It should be noted that the optimization of the antiretroviral therapy regimen in the case of a combination of B-cell lymphoma and cerebral toxoplasmosis in a child with perinatal HIV infection led to clinical and laboratory remission

The aim of the study was to assess the possibilities of noninvasive diagnosis of liver fibrosis (FIB-4 and APRI indices) in patients with CHC and abdominal obesity.

Materials and methods. 52 men with CHC were examined. Genotype 1 was determined in 24 patients, genotype 3 in 19 patients and genotype 2 in 9 patients. According to the severity of fibrosis, patients with CHC were divided: without fibrosis (F0) - 12 patients, with weak fibrosis (F1) - 17 patients, with moderate fibrosis (F2) - 10 patients, with severe fibrosis (F3) - 8 patients, cirrhosis of the liver (F4) was detected in 5 patients. According to a liver biopsy, steatosis was found in 18 patients with CHC. Abdominal obesity was found in 34 patients with CHC. Non-invasive diagnosis of liver fibrosis was assessed using routine FIB-4 and APRI indices. The interval of values of FIB-4 and APRI, not related to the criteria for assessing the stage of fibrosis F3 and F4, we have conventionally designated as the «gray zone». The presence of insulin resistance was evaluated at HOMA-IR> 2.

Results. Key values of the FIB-4 index in patients with CHC and abdominal obesity were found significantly more often than when calculating the APRI index. Insulin resistance in patients with CHC and abdominal obesity was statistically significantly more frequent than in patients with CHC and without abdominal obesity. At stages F3-F4 in patients with CHC, abdominal obesity and insulin resistance, APRI values were recorded more often in the «gray zone»than FIB-4 values.

Conclusion. The FIB-4, APRI, HOMA-IR indices can be used in patients with CHC and abdominal obesity during the follow-up and dynamic monitoring of patients with CHC to highlight risk groups. FIB-4 was significantly more informative for determining the stage of fibrosis than APRI in patients with CHC and abdominal obesity with insulin resistance (HOMA-IR> 2).

The aim of the work: Using the data of genome-wide sequencing of tick-borne encephalitis virus strains of the Far Eastern population, reveal the peculiarities of the moleculargenetic characteristics and their relationship with the pathogenicity of the agent.

Materials and methods. A full-genomic characteristic of 63 TBEV strains isolated in the Far East and registered in GeneBank wos given. A pathohistological study of the central nervous system of monkeys infected with the highly virulent strains Sofjin and Khabarovsk-17 TBEV was conducted.

Results. All strains are assigned to the Far Eastern subtype of TBEV and are located in three clusters, the territorial attachment of individual strains groups is noted. In the cluster of Sofjin-like strains, independent groups were identified, isolated in the territories of Primorsky Krai only, and separate groups – only in northern focal territories (Khabarovsk Krai). The cluster Senzhang-like strains are represented by strains of different clusters, isolated in China and throughout the Far East. The Oshima-like cluster of strains, except for strains from Japan, consists of strains isolated only in the south of the Far East (in Primorsky Krai). The incubation period of the disease in experimental animals was shorter when infected with the Sofjin strain (3–5 days) than when infected with the Khabarovsk-17 strain (7 days or more). The strain-specific differences in the severity of morphological changes in the central nervous system were revealed. For primorsky TBEV strains, a higher degree of neuroinvasiveness was characteristed with a more rapid development of severe manifestations of neuroinfection, compared to khabarovsky strains.

Findings: 1) based on full-genome sequencing and phylogenetic analysis of 63 TBEV strains, three main clusters were distinguished: Sofjin-, Senzhang- and Oshima-like; 2) in these clusters, territorial attachment of TBEV strains groups with a certain molecular genetic characteristic was established; 3) in primorsky TBEV strains, genetically determined advantages in the degree of neuroinvasiveness have been revealed, which provide them with the ability to more quickly overcome the blood-brain barrier compared to khabarovsky strains.

The aim of the study was to obtain new biochemical data on the pathogenesis of respiratory syncytial viral infection (RSVI) in children.

Object and methods: 60 children aged 1 month to 5 years, treated in the clinic of Pediatric Research and Clinical Center for Infectious Diseases, from which in 50 patients RNA RSV was isolated in smears from the oropharynx. The comparison group consisted of 10 children who failed to verify RSVI by laboratory methods. All children at admission and before discharge from the hospital (after-7-9 days) underwent a clinical blood test a Sysmex XP-300 hematology analyzer (Japan). Alpha-1-antitrypsin and alpha-2-macroglobulin were determined in blood serum by quantitative immunoturbidimetry on a biochemical analyzer CLIMA-15 (Spain) using Sentinel test systems (Italy). Determination of the amount of total protein, albumin and C-reactive protein in serum was carried out on an automatic analyzer Taurus (Instrumentation Laboratory, Italy) using reagents of the company «Vector-best» (Russia). The study of protein fractions in blood serum was carried out by capillary electrophoresis on the device Minicap company Sebia (France) with the help of test systems «Minicap Protein(e) 6» of the same manufacturer. The levels of cytokines (IL-6, IL-10) in serum were determined by ELISA on ELISA analyzer «INFINITI» (TECAN, Austria) using reagents firm «Vector-best» (Russia).

Results: RSVI occurs with lesions of the lower respiratory tract in 42% of cases, with the development of complications in 44% of sick children. The study revealed a prolonged increase in serum alpha-2 fraction of globulins, immunoregulatory cytokines with pro-inflammatory (IL-6) and anti-inflammatory (IL-10) action and, which may indicate the presence of subacute inflammatory process associated with the persistence of RS-virus. Lower levels of gamma-globulin fraction, including the main specific and nonspecific immunoglobulins, in children with PCR-proven RSVI, both in the acute period and in the period of convalescence, probably can cause repeated RSV-diseases, as well as an increase in the risk of atopic diseases.

Conclusion. The long-term increase in the level of subacute inflammation markers, established in the course of the study, even against the relieve of clinical picture of the disease, makes the question of developing an etiopathogenetic treatment of respiratory syncytial viral infection with the use of drugs with antiviral and anti-inflammatory action relevant.

Objective. Develop an algorithm for determining tactics and parameters of their treatment to improve treatment outcomes.

Methodology. Material and research methods. A statistical analysis of the treatment results of 90 HIV-infected patients aged from 23 to 54 years with extra-articular fractures of long bones of the extremities was carried out. When determining the tactics and method of treatment, the peculiarities of the effect of HIV infection, antiretroviral drugs, and opportunistic diseases on the patient’s body were not taken into account.

Results. Non-infectious complications are characteristic of HIV-infected patients: sides of the postoperative wound (seromas, hematomas, discrepancy of wound edges, delayed crushing), aseptic loosening and migration of fixatives, delayed consolidation of fractures. The presence of a statistically significant relationship between the objective factors characterizing the course of HIV infection: the stage of the disease, the number of CD lymphocytes, the ratio of CD4 / CD8 lymphocytes, viral load and the risk of postoperative complications was revealed.

Conclusion. The application of the developed algorithm allows you to objectify the procedure and provide an individual approach in determining the tactics and method of treatment for HIV-infected patients with extraarticular fractures of long bones of the extremities

Aim of investigation: The aim of the present study was to evaluate the possibility using of indirect liver fibrosis markers for the estimation of fibrosis severity and timely prescribing of antiviral therapy in patients with chronic hepatitis B.

Materials and methods: We examined 130 patients with chronic hepatitis B (mean age 41,8±13,5 years, 70% of men) having known liver fibrosis stage based on fibroelastography or liver biopsy. The age of patients, 9 parameters of biochemical blood analysis, complete blood count and coagulogram along with 7 indices calculated on their base were considered. Their prognostic values were estimated by means of ROC analysis.

Results: According to increase of liver fibrosis stage albumin, prothrombin index, platelet count, cholesterol reduce and aspartate aminotransferase, international normalized ratio, gamma-glutamyl transpeptidase, alanine aminotransferase, alkaline phosphatase levels rise (p<0,01). All of the laboratory parameters and indices were significantly different (p<0,01) in patients with minimal (F0–F1) and advanced (F2–F4) fibrosis. For patients with chronic hepatitis B the most significant predictors of advanced liver fibrosis (F2–F4) were: GUCI and King’s score indices as well as eLIFT scale. Index GUCI had the best diagnostic performance (area under the receiver operating characteristic curve 0,866) with 89,5% sensitivity and 78,0% specificity at cut off ≥0,7/

Conclusion: The assessment of indirect liver fibrosis markers in patients with chronic hepatitis B can be easily performed at any stage of medical care; they are quite informative and can be used for the estimation of fibrosis severity and timely conducting antiviral therapy.

Objective: to examine the state of the immunity to measles in different age groups.

Materials and methods: In 2018, 4444 people were examined at the Diagnostic Center (virological). Among them, 3783 people were examined using the passive haemagglutination test for measles (manufactured by Pasteur Research Institute of Epidemiology and Microbiology, Russia). In the remaining 661 cases, the IgG to measles were detected using the enzyme-linked immunosorbent assay (ELISA) by VektoMeaseles IgG test (manufactured by Vector-Best, Russia). The correlation between the measles IgG level (ELISA) and the age was examined in 518 patients.

Results: In this study, the immunity to measles was shown to be insufficient in all groups of observed people. Even among medical staff, nearly 10% had no protective level of measles antibodies. We have shown that the correlation between the measles IgG level and the age is statistically significant, so that the number of seronegative persons in different age groups differs significantly.

Conclusion: The highest ratio of seronegative individuals was found in the age group between 18 and 25 years (52,33%), which can lead to serious measles outbreaks. Hence, this study confirms a strong need for additional immunization in all groups and especially in young population.

Dynamics of proinflammatory (IL-1, TNF), immunoregulatory (IL-4) and anti-inflammatory (IL-10) cytokine levels was studied in 35 and 6 patients with abdominal fever with outcome of the disease in recovery and acute bacterial carriage, respectively. Level of cytokines in peripheric blood was studied at the height of the disease (the second week) and at the stages of early (the fourth week) and late (before hospital discharge) convalescence. Control group included 24 healthy individuals. At the height of the disease IL-1 and TNF levels were significantly higher in patients with disease recovery compared to patients with acute bacterial carriage. Dynamics of indices of anti-inflammatory cytokines IL-4 and IL-10 in patients with acute abdominal fever with outome in recovery and acute bacterial carriage was similar: the indices were increased at the height of the disease, at the stages of early and late convalescence the stable tendency to further increase was observed. Dynamics of proinflammatory (IL-1 and TNF) cytokines demonstrates that chronization of infectious process in abdominal fever/development of acute bacterial carriage is specified by insufficient increase of proinflammatory cytokines.

Objective: clinical and laboratory characteristics of HCV infection in patients with oncohematological malignancies.

Materials and Methods: The study included 106 patients with a positive serum HCV antibody (anti-HCV) test result, who were examined or treated in 5 specialized oncohematological units of different hospitals in Saint Petersburg in 2018–2019.

Laboratory tests included: ALT and AST activity, qualitative (with sensitivity of 60 IU/ml) and quantitative determination of HCV RNA, as well as HCV genotyping by real-time PCR. The presence and the grade of liver fibrosis according to the METAVIR scale were evaluated by indirect elastography on Fibroscan.

Results: Men were predominant (62,2%), and most of patients (67%) were of young and middle age (18-59 years old). HCV infection was confirmed in 68% patients, and in 41.7% of them HCV genotype 3 was detected. HCV RNA was not detected in 32% cases, suggesting the spontaneous clearance of the virus. Severe liver fibrosis (F3) or cirrhosis (F4) were found in 40% patients with confirmed viremia. In most patients, the normal ALT activity level was registered. 86% patients diagnosed with HCV infection were followed up by an infectious disease specialist until the present study. 19% patients received antiviral therapy for HCV infection.

Conclusion: A significant proportion of patients with advanced liver fibrosis and HCV 3 genotype, causing the greatest difficulties in antiviral treatment for HCV infection, was revealed. Prescription of direct-acting antiviral agents in the early terms after establishment of the diagnosis is reasonable.

During  last  years  the  frequency  of  invasive  pulmonary aspergillosis  (IPA)  in  immunocompetent  patients  has  increased. Clinical case report of successful treatment invasive aspergillosis  with  influenza  A(H1N1)  presented  in  the  article. We analyzed the special literature of patients with IPA following influenza infection. The timely identification and treatment of these patients are necessary.

The case of chronic hepatitis C 1b genotype with grade 3 fibrosis according to Metavir, complicated by the development  of mixed  type  III  cryoglobulinemia,  cryoglobulinemic vasculitis with damage to the skin vessels of the skin (hemorrhagic vasculitis), and the liver (alternatively proliferative vasculitis) is demonstrated. The introduction of daclatasvir + asunaprevir was virologically unsuccessful: mutations D168E and L31V were detected against  the background of a  virological breakthrough. A repeated course of antiviral therapy with the combination of Grazoprevir + Elbasvir in combination with sofosbuvir led to a stable virologic response, partial immunological and clinical remission.

The article presents current data on the high epidemiological and social significance of meningococcal infection caused by Neisseria meningitidis W in the Russian Federation and abroad. The article contains a review of the literature on the clinical features of the course of generalized forms of meningococcal infection caused by serogroup W. The clinical observation of a rare variant of generalized meningococcal infection with the development of acute epiphyseal osteomyelitis of the distal epiphysis of the right tibia, arthritis of the right ankle joint, right wrist joint, joints of 1-st right toe in an early childhood is described.