Lead article
Relevance of the problem of a new COVID-19 coronavirus infection is obvious. Among its most important aspects that require special study, are pathogenesis and morphological changes in severe forms of the disease.
Material and methods. The analysis of 18 autopsy observations was carried out. Along with routine assessment of macro – and microscopic changes, immunohistochemical studies of lungs and other organs were performed using sera against antigens CD2,3,4,5,7, 20,31,34, 56,57,69; the presence of Fe2+ and Fe3+ was detected in the lungs and liver.
Results. Structural changes in the lungs may be associated with cytopathic and cytoproliferative effects of the virus with damage to both the ciliary and alveolar epithelium, as well as the formation of hyaline membranes. Cellular infiltration is mainly represented by suppressor populations of T-lymphocytes and macrophages. Endothelial damage, vascular thrombosis of vessels of different calibers, and hemorrhages were detected. Many organs (lymph nodes, spleen, intestines, brain, adrenal glands) show changes that may indicate generalization of viral infection, and infiltration
of CD8+ lymphocytes in the kidneys, liver, adrenal glands, pericardium,and intestines indicates a probable autoimmune component of pathogenesis. In the liver and lungs deceased from COVID-19 only small clusters of Fe3+ and Fe2+ granules were detected, which can be associated (including in our control observation) with liver damage in malaria.
Review
The literature review highlights the feasibility of accurate etiological and invasive diagnosis of lung lesions in different clinical settings, as well as the need to designate various options of empirical antimicrobial therapy. The features of antimicrobial therapy and, in particular, the use of fluoroquinolones during the differential diagnosis of pulmonary lesions in HIV infection are discussed. The difficulties of verifying of HIV-associated lung diseases indicate the need of unified therapeutic and diagnostic approaches for use by various physicians (general practitioners, pulmonologists and
phthisiologists).
practice.
Original Research
The objective: to study the clinical course of rickettsialpox at the current stage in the Donetsk city.
Materials and methods. 43 patients (men – 26, women – 17) aged 17–42 years (M ± 29) years were examined. Verification of the diagnosis was based on the results of ELISA (IgM) with R.Akari in titer 1: 160 in 9, 1: 320 in 15 patients.
Results. The observed cases of rickettsialpox were sporadic. All patients were residents of Donetsk city. The presence of rodents in places of living or work was indicated by 39,5% of patients. The clear seasonality of rickettsialpox drew attention: 59% of patients were hospitalized in June, 7% in August. Uniform distribution of hospitalization in July, September and October was observed (14%, 14%, 12%, respectively). Acute onset of the disease was noted in 53,5% of patients. 16,3% revealed a large papule under the crust
during initial examination, which is defined as the primary element. Fever accompanied by chills was observed in 93.0% of patients from the first day of the disease. The duration of the fever was (11,4 ± 1,2) days. The rash appeared in the first four days of the disease, papulo-vesicular elements predominated (60.5%). Leukopenia (3,9 ± 0,9×109 G/L) was observed in the blood with a shift to the left (14,8 ± 1,3)% and lymphocytosis (49,3 ± 1,6)%, ESR – (21 ± 0,9) mm/h. Medium-severe course was observed in 55.8%, severe – 39,5%, mild – in 4,7% of patients. Doxycycline was prescribed as
etiotropic therapy.
Conclusion. Rickettsialpox is an endemic disease for the Donetsk city. Data on the true spread of the disease are not available. Undetectable primary affect and regional lymphadenitis in most patients is the reason for the unjustified exclusion of the disease. Laboratory diagnosis questions seem relevant for studying the problem of rickettsialpox.
The purpose of the research: To investigate clinical and epidemiological features, clinical course and outcomes of pneumococcal meningoencephalitis in children, Streptococcus pneumoniae serotype distribution and their compliance with antigenic composition of existing pneumococcal vaccines, as well as antimicrobial resistance of the pathogen.
Research tasks: 1. To characterize the clinical features of pneumococcal meningitis; 2. To study the serotypes and antimicrobial resistance of S. pneumoniae strains isolated from patients with pneumococcal meningitis; 3. To detect the genotypes (ST-types) of S. pneumoniae strains.
Materials and Methods: There were 17 patients aged 2-15 years with pneumococcal meningitis under the supervision. DNA isolation of S. pneumoniae was done by «AmpliSens DNA-sorb B» kits (InterLabServise, Russia). Multiplex PCR was used for serotype deduction. S. pneumoniae antimicrobial resistance was investigated by Etest (bioMerieux, France). Statistical analysis was conducted by Microsoft Excel, and included the determination of percentages, averages, and mean deviations.
Results: Pneumococci can cause not only meningeal lesions itself, but brain substance damage; it results to secondary severe meningoencephalitis with complicated course (cerebral edema, cerebral coma, and ventriculitis). S. pneumoniae serotypes identified (14, 19F, 3, 7F, 6AB) are common, most often causing meningitis in children and adults. All these serotypes are vaccine-preventable. More than half of isolates revealed penicillin-resistance.
Conclusion: Due to complete accordance of S. pneumoniae serotypes detected to those included in widely used 13-valent pneumococcal conjugated vaccine (PCV13), the vaccination should be considered as effective preventive measure. The features of pneumococcal sensitivity to antimicrobials must be considered when prescribing antibiotics.
Relevance. The growth of pertussis is observed in all countries of the world. The main reasons for this are: decreased level of vaccination, loss of antibodies after vaccination, new methods of examination, changes in the antigenic structure of the pathogen. Solution: vaccination of pregnant women, increasing the level of vaccination, age-related revaccinations. The prospect is to create new vaccines.
Purpose. Determine the frequency of untimely vaccination against whooping cough in children of the first years of life, the duration of immunity preservation after the completed set of vaccinations, and the rationale for the catch-up immunization scheme.
Results. The timeliness of vaccination was evaluated in 675 children according to vaccination certificates and form112/y. It turned out that 9,21% of children received the first vaccination after a first year old, the second – already 24,10%, the third more than 34%. 49,75% of children included in the analysis had revaccination by the 2 year old. Antibody titers were evaluated after vaccination and 1 revaccination in 114 children with informed parental consent. Through the year after whole cell vaccine did not have protective titers of 17 of the 58 children (29,3%), the grafted acellular – 15
of 56 (26.8 percent). After 3 years was examined 39 children (25 – grafted acellular vaccine and the whole-cell 14). 44,0% (11 children) and 50,0% (7 children) did not have protective titers, respectively. The data coincided with the results of serological monitoring of Rospotrebnadzor in St. Petersburg. The need for catch-up immunization and the introduction of age-related revaccinations against pertussis was confirmed. Catch-up immunization schemes have been developed.
Conclusions. Almost half of children are vaccinated with a violation of the calendar, the primary complex of vaccinations, both whole-cell and acellular vaccines, does not provide long-term protection. It is necessary to introduce catchup immunization and age-related revaccinations.
The article presents the experience of the mobile team as an integral component of palliative care for patients with HIV infection.
Objective: To analyze the effectiveness of the mobile team as a key component of palliative care for patients with advanced stages of HIV infection and comorbid conditions.
Materials and methods: In 2018, a joint project of the St. Petersburg AIDS Center and the BF (charity foundation) «Humanitarian Action» created a mobile team to provide onsite medical and social assistance to patients with HIV infection. The article presents the results of the project for 2018–2019. We studied the composition of patients, their needs for various types of support, as well as assessing the problems in providing this type of service to patients with HIV infection. The analysis of the work of the mobile team for 2018–2019. The composition of patients in need of medical and social assistance was studied.
Results. In the supervision of the mobile team were 79 patients with HIV. The main tasks of the mobile team were to identify patients with HIV infection who suffered from severe opportunistic diseases, for various reasons they could not come to the doctor’s center for antiretroviral therapy, and also monitor the effectiveness of treatment and psychological support for sedentary and hard-to-reach groups of patients.
Conclusion: Given the increase in the number of patients with advanced HIV infection and comorbid conditions, the creation of mobile teams that are part of palliative care is an essential part of comprehensive medical and social care.
Objective: comparative open-label randomized study of the safety and efficacy of the drugs Alpha-glutamyl-tryptophan + Ascorbic acid + Bendazole («Cytovir-3«) and Umifenovir for prophylactic influenza and acute respiratory viral infectionsin children aged over 6 in organized groups.
Materials and methods. 207 healthy children ≥6 years old of organized educational groups. According to study protocol they were divided into 2 groups: 102 children were randomizes to receive Alpha-glutamyl-tryptophan + Ascorbic acid + Bendazole (Сytovir-3, Group 1), capsules (JSC MBSPC «Cytomed«, Russia) while 105 children were randomizes to receive Umifenovir 100 mg (Group 2) capsules (Pharmstandart Leksredstva, Russia). The frequency of adverse reactions on drugs and adverse events was assessed while taking drugs and within 3 weeks after. Efficiency was assessed by calculate value of prophylactic efficiency index in comparison groups. Efficacy was analyzed on the basis of the comparative incidence of children included in the study with a total incidence in Saint-Petersburg.
Results: the studied drugs showed a high safety profile and match preventive clinical efficacy against influenza and acute respiratory viral infections. Both drugs during prophylactic administration stimulated the production of secretory IgA. A tendency to a decrease in the incidence of acute respiratory viral infections in groups of children taking the studied drugs was revealed and compared with general indicators reflecting the integrated epidemic situation of influenza and other acute respiratory viral infections in Saint-Petersburg during the study. The data obtained allow us to recommend the use of the drug Alpha-glutamyl-tryptophan + Ascorbic acid + Bendazole («Сytovir-3«) (dosage form – capsules) for the prevention of respiratory diseases in organized children’s
groups during the period of seasonal increase in the incidence of influenza and acute respiratory viral infectionsin.
With the increase in period of time from the beginning of vaccination against hepatitis B the relevance of the question about the duration of post-vaccination immunity increases.
The study has aimed to evaluate post-vaccination humoral immunity to hepatitis b virus 3–9 and 10–17 years after vaccination.
Materials and methods. The level of antibodies to HBsAg was studied in 25 children aged 3–4 years and 104 adolescents aged 16–17 years who were vaccinated in the first year of life, as well as 79 adults who were vaccinated at different times over 17 years. Vaccination was carried out according to the scheme: 0-1-6 months with different recombinant vaccines. The test systems “Vectonvsad-antibodies” produced by JSC “Vector-best” were used for the study.
Results. Antibody titers below 10 IU / l were found in 49,0±4,9% of adolescents and 50,0±8,6% of adults vaccinated over 10–17 years, 56,4±8,0% of adults vaccinated over 3–9 years, and 60,0±9,8% of children vaccinated over 3–4 years prior to the study. Antibodies in titers above 10 mIU/ml were detected only in isolated cases. No cases of hepatitis b virus infection or transmission were registered
among the surveyed individuals.
The low level of anti-HBs was not associated with specific names of vaccines and their storage conditions, with longer intervals between vaccinations. There was a slight decrease in the immune response in people over 40 years of age. The significant proportion of people who do not have a protective level of anti-HBs among those who have been vaccinated three times, identified in our and a number of other published studies, requires further study. In General, among the population of the Republic, the incidence of all forms of infection in the last decade against the background of mass vaccination has had a pronounced downward trend.
Wide incidence and high rate of poor outcomes of viral hepatitis C makes this issue very important. In majority of cases viral hepatitis C develops chronic form of the disease resulting in fibrosis, cirrhosis and hepatocellular carcinoma in longstanding period of time. The specificity of clinical presentation and particular aspects of pathogenesis complicates making the prognosis of its course significantly.
Objective. Estimation of clinical and immunomorphological factors that influence the process of fibrogenesis in chronic hepatitis C.
Material and methods. The object of our research was 64 liver biopsy samples from adults with natural course of chronic hepatitis C. Using immunohistochemistry and morphometric method intrahepatic CD3+, CD8+Т-lymphocites, CD68+-macrophages, alfa-SMA+-stellate cells were counted. Then the connection between this markers and histological activity index (HAI), stage of fibrosis, ALT elevation, viral load and viral genotype were evaluated.
Results. It was established, that increasing amount of intrahepatic CD8+-lymphocytes implicates augmentation of histological activity and ALT level: CD8 abs./HAI – r=0,56; CD8 abs/ALT – r=0,45; HAI/ALT – r=0,58 (p<0,05), and also raising of CD68+-macrophages in mild and moderate HAI: СD8 абс./СD68 абс. – r=0,58 и 0,54 accordingly (p<0,05), and alfa-SMA+-stellate cells. Histological activity was prone to raise with the stage of fibrosis. Also the higher number of intrahepatic CD8+-lymphocytes, HAI and ALT elevation was identified in cases with viral genotype 3.
Conclusion. As a result, unfavorable implication of cellrelated immune lesion and viral genotype 3 in fibrosis progression was demonstrated. The role of viral load was ambiguous.
The purpose of this paper is to evaluate the spreading of HIV-1 resistant to antiretroviral drugs among Tomsk Oblast population with newly diagnosed HIV-infection.
Materials and methods. It was collected 122 clinical samples of peripheral blood of HIV-infected patients from Tomsk Oblast who did not take antiretroviral drugs. In HIV-1 isolated from clinical samples we studied nucleotide sequence of genome fragments encoding virus protease and reverse transcriptase. Complex analyses of epidemiologic data from patients and the presence in genome HIV-1 mutations associated with resistance development to protease inhibitors and virus reverse transcriptase were carried out.
Results. Analysis of HIV-1 isolated from Tomsk Oblast naïve HIV-infected population made it possible to detect HIV-1 mutations associated with a decrease of virus sensitivity to antiretroviral drugs in 9,8% of cases. Among described mutations 50% were associated with resistance to virus protease inhibitors; 33,3% were resistance mutations to nonnuclease inhibitors of reverse transcriptase, and 16.7% were resistance mutations to nucleoside inhibitors of virus reverse transcriptase. Out of 9,8% of resistant viruses 7,3% of cases
included mutations associated with the development of potentially low level of reduction of HIV-1 sensitivity to drugs. Main HIV-1 resistance mutations of high and average levels were registered only in 2,5% of genotyped HIV-1 isolated from people who inject drugs.
Conclusion. Current study detected considerably low sampling rate of HIV-1 carrying mutations associated with resistance to antiretroviral drugs among Tomsk Oblast naïve HIV-infected population. It is believed to be caused by a relatively short period of extensive application of antiretroviral therapy in that territory. Analysis of epidemiologic data resulted in detection of factors negatively affecting prediction of further development of HIV-infection epidemic in the region including prevalence of risk behavior practice contributing to resistant HIV-1 transmission both among patients via heterosexual contacts and among people who inject drugs.
The aim of the work is to determine the clinical and pidemiological features and indicators of the cytokine profile in patients with viral diarrhea in the adult population, to establish the influence of inflammatory mediators on the course of the disease.
Materials and methods-we analyzed the patient’s hospital records, as well as the blood serum of patients diagnosed with viral diarrhea. The experimental group consisted of 29 patients aged 23,2 ±8,4, with an equal distribution among men and women. The 1 experimental group included 22 patients with norovirus infection, the 2 comparison group consisted of 7 people with rotavirus gastroenteritis. The control group consisted of 20 somatically healthy people of the appropriate age (23,3±1,4). The concentration of proinflammatory and anti-inflammatory cytokines in blood serum was determined by ELISA using reagents from Vector-best LLC
(Novosibirsk). Statistical processing of the obtained data was carried out using electronic programs Microsoft Excel 2010, Statistica 6.0, with the determination of the statistical significance of differences at the achieved significance level p≤0.05 using the Mann – Whitney test (U-test). When calculating correlations, we used Spearman’s coefficient, r = -1+1 (r=0-0, 3 – weak connection, r= 0,3–0,7 – medium strength connection, r= 0,7–1 – strong connection; «+» – direct connection, «–» – feedback). The distribution of features was evaluated using the Shapiro – Wilkes W test.
Results: in the course of work, the prevalence of norovirus infection among adult patients with viral diarrhea was established. Among the ways of infection, the food and water routes predominated, contact and household was noted, mainly, when caring for children with intestinal infection. In the clinical picture, all patients had a moderate intoxication syndrome. With rotavirus infection, catarrhal and pronounced gastroenteritis syndromes were determined, while for norovirus gastroenteritis, catarrhal syndrome was not characteristic, and patients also had a tendency to constipation. When assessing the cytokine status, an increase in the concentration of IL-2, IL-6, TNF-α, IL-10 was found, regardless of the etiological factor, at normal levels of IL-1β and low IL-4, as well as a strong direct dependence of the severity of feverish intoxication syndrome on the level of IL-2, IL-1β and IL-4. The effect of Pro-inflammatory and anti-inflammatory cytokine production on the duration of individual syndromes and on the duration of the disease as a whole has not been established.
Conclusion – norovirus infection, in contrast to rotavirus infection, occurs without an obvious respiratory catarrhal syndrome, with the predominance of intoxication over gastroenteritis, while in rotavirus infection, the syndrome of intoxication and gastroenteritis are expressed equally. In viral diarrhea, there is an increase in IL-2, IL-6, TNF-a, and IL-10, which play an important role in the development of feverintoxication syndrome and the formation of antiviral protection.
Purpose of the study. To study the view of the Irkutsk physicians of different specialities on the vaccination.
Materials and methods. We assessed the degree of awareness of 324 physicians of different specialities on the preventive vaccination based on the data of cross-sectional descriptive multicenter research. All the respondents were divided into three groups: group 1 (n = 218) – physicians prescribing vaccination for children (pediatricians, neonatologists); group 2 (n = 54) – physicians prescribing vaccination for adults (general practitioners, obstetricians-gynecologists); group 3 (n = 52) – physicians who can consult on the problems of vaccinations (neurologists and other physicians). Statistical analysis of the research results was carried out using Statistica 6.0. Critical level of statistical significance
p assumed equal 0,05.
Results. Physicians aged 21 to 50 years old prevailed (251/324 – 77,5%). Pediatricians (89/159 – 56%; χ2 = 5,94; df = 1; p < 0,05) and neurologists (19/27– 70,4%; χ2 = 4,46; p < 0,05) state their «sufficient» level of awareness on the vaccination. Obstetricians-gynecologists (28/42 – 66,6%; χ2 = 4,78; p < 0,05) state their «insufficient» level of awareness on the vaccination. Physicians of group 1 more often inform patients about the importance of vaccination (χ2 = 7,9, p < 0.01 and χ2 = 6,3, p < 0,05, respectively) and consider it necessary to vaccinate children additionally from current infections, unlike physicians of group 2 (χ2 = 27,6; df = 1; p < 0,0001). Most of the respondents (211/324 – 65,1%) agree with the necessity of introduction of a law on parental responsibility in case of vaccine-controlled disease for his child.
Conclusion. Monitoring the adherence of physicians to immunologic prophylaxis for themselves and their patients will allow timely identification and elimination of emerging contradictions and problems, as well as to maintain a high level of confidence in vaccination among the population.
Objective: to study the frequency, etiological, age, epidemiological features of combined acute intestinal infections in children.
Materials and methods. In n the Department of intestinal infections of Pediatric Research and Clinical Center for Infectious Diseases within a year have observed 167 children with combined acute intestinal infections regardless of the severity of the disease. The etiology of the acute intestinal infections was verified by bacteriological, serological methods, PCR reagents “AmpliSens® AII screen-FL. Criteria for inclusion of patients in the study: no signs of nosocomial OKA. Statistical analysis of the results was performed using Excel 2007. Student’s criterion was used to estimate the difference of the studied data. Differences were considered significant at p<0.05.
Results. Combined acute intestinal infections were diagnosed in 5,6% of 2968 patients, among whom children under 1 year were 21,6%, from 1 to 3 years – 48,4%, from 4 to 7 years – 18%, from 8 to 14 years – 9%, from 14 to 18 years – 3%. The combination of bacterial pathogens was noted in 12% of patients; viral – in 37,1%; viral and bacterial – in 50,9%. Viral-bacterial AII had rises in the frequency of diagnosis in spring, summer, autumn; viral-viral acute intestinal infections – in spring and autumn, bacterial-bacterial acute intestinal infections – in autumn. Infants in the structure of patients with viral-viral acute intestinal infections were 23,3%, viral-bacterial acute intestinal infections – 29,6%, bacterial-bacterial acute intestinal infections – 5%; young age – 45%; 47,%; 40%; preschool age– 25%; 23,3%; 15,5%; school age – 30%; 8.3%; 7% respectively. Among of associates the bacterial-bacterial acute intestinal infections, diarrheal Escherichia (60%), Salmonella (50%) and Campylobacters (40%) dominated. Among of associates of the viral-viral acute intestinal infections noroviruses (74,2%) and rotaviruses (at 69,4%) dominated. Among of viral associates of viral-bacterial acute intestinal infections more prevalent were rotaviruses (52,9%) and noroviruses (27,1%); among bacterial associates were diarrheal Escherichia (at 51,8%).
The results of the study allowed establish etiological, seasonal, age patterns of formation of the epidemiological process of intestinal infections of combined etiology in children.
Purpose. Analyze the dynamics of clinical and laboratory parameters, the outcomes of the disease on various treatment regimens. To identify the main markers of unfavorable outcome or protracted course of the disease.
Materials and methods. The study included 70 patients with HIV and mycobacteriosis who received complex therapy (antiretroviral and specific antibacterial drugs). Depending on the outcome of the disease, two groups were distinguished: clinical cure (n = 38) and lethal outcome (n = 32). The clinical manifestations of pathology, laboratory indicators at different stages of treatment, the scheme and terms of the therapy being carried out were analyzed on the basis of data from medical histories and ambulatory patient records.
A statistical analysis was performed, the efficacy of therapy was evaluated using the Kaplan-Meier method, the macrolide in the first line of antibacterial therapy used was taken as the basis.
Results. All patients who died developed a disseminated form of the process. In cases when MAI developed within the unmasking immune restoration syndrome patients were prognostically more favorable (p <0,05). In the clinical cure group, a significantly higher level of CD4 lymphocytes was recorded before treatment (33,3 ± 7,1 versus 9,9 ± 3,2 cells / μl, p <0,05). A significant difference in the level of CD4 persisted after a month of complex therapy (79,0 ± 13,4 versus 32,2 ± 9,1, p <0.05). In addition to higher immunity values, the first group also had a higher hemoglobin level after a month of treatment (108,3 ± 3,2 g / l versus 76,7 ± 5,2 g / l, p <0,05).
The regression of intoxication and fever was observed earlier in the cure group. When studying the used macrolide basis for the treatment of mycobacteriosis, it was found that survival term was significantly higher among patients who received clarithromycin in the first line (Kaplan – Meier, p <0,05 Breslow, Tarone-Ware). According to this sample, the introduction of aminoglycoside to the treatment regimen did not make significant changes in the timing and prognosis of treatment.
Conclusion. Prolonged persistence of the symptoms of the disease, persisting deep immunodeficiency and anemia of moderate or severe degree are associated with an unfavorable outcome. According to this sample, clarithromycin should be considered the drug of choice for the treatment of mycobacteriosis in HIV.
Objective: to conduct a comparative assessment of the effectiveness of immunomodulatory drugs in infectious mononucleosis of mixed etiology (EBV and CMV) in children, using the principles of evidence-based medicine.
Materials and methods: a comprehensive comparative assessment of the effectiveness of immunomodulatory drugs in children with infectious mononucleosis EBV+CMV-etiology in 3 groups: group I-20 patients receiving recombinant interferon α-2β, group II-20 children receiving interferon – meglumin inducer acridonacetate and group III-20 children treated with a synthetic immunomodulator-inosin pranobex. The comparison group (IV) consisted of 20 children who received basic therapy.
Results: Analysis of key intervention indicators for the outcome «fever Duration less than 5 days» showed the highest effectiveness of recombinant interferon α-2β, less effective were meglumina acridonacetate and inosine pranobex. According to the outcomes «Reduction of lymph nodes by 2 or more times» and «Reduction of the liver and spleen by 2 or more times», data on the advantage of meglumin acridonacetate were obtained. The recombinant interferon α-2β was the second most effective. All the studied drugs do not
significantly affect the severity of the hematological syndrome. The expediency of using immunomodulatory therapy in infectious mononucleosis of EBV+CMV-etiology is shown, the deviation from the norm of the integral outcome indicator is significantly higher in the group of children who were on symptomatic therapy. The overall effectiveness of the studied immunomodulatory drugs with all clinical outcomes does not have statistically significant differences.
Conclusion: the obtained data allow us to rationally approach the choice of immunomodulatory therapy, taking into account the effectiveness of clinical outcomes and the overall effectiveness of the drug.
Purpose of the study. Analysis of clinical and laboratory features of the course of HIV infection and antiviral therapy in children at different stages of the disease.
Materials and methods. Under supervision in the department of motherhood and childhood there were 90 children with HIV infection, which were divided into 3 groups: 1st group – 35 people. with a diagnosis of HIV infection in the first 2 months of life, group 2 – 25 people. with a diagnosis at the age of 6-12 months and the 3rd group (30 people) with a diagnosis of HIV infection over the age of 2 years. Statistical processing of the research results was carried out using the software package Statistica for Windows (version 8.0).
Research results. Early detection of HIV infection and the beginning of antiretroviral therapy (ARVT) led to the absence of clinical manifestations of the disease, low levels of HIV RNA in the blood and normal levels of CD4 lymphocytes, which persisted for 3 years of observation. The detection of HIV infection and the start of ART in the first 6–12 months of life of children was characterized by clinical symptoms up to CNS damage, high levels of HIV RNA in the blood, moderate decrease in CD4 lymphocytes, with normalization after 3–6 months of treatment and after 3 years of observation.
Late diagnosis of HIV infection in children – over 2 years of age is characterized by severe forms of the disease with secondary manifestations – AIDS in 20,0% of cases, low rates of CD4 lymphocytes, damage to the central nervous system with the formation of spastic diplegia, and slow recovery of immunity. The use of the drug Viferon, rectal suppositories in the combined treatment of EBV-mononucleosis and a generalized form of CMV infection allows the early treatment of the main symptoms of herpes virus infections and normalization of laboratory parameters.
Conclusion Our prospective study showed that mother-tochild transmission of HIV was realized due to the absence of the first stage of chemoprophylaxis (during pregnancy), and was also aggravated in 9 cases (10,0%) by breastfeeding. The severity of the clinical manifestations of HIV infection, the levels of CD4-lymphocytes and HIV RNA in the blood directly depend on the period of detection and the initiation of ART in children. The inclusion of human recombinant interferon alpha-2b with antioxidants (Viferon rectal suppositories) in the etiopathogenetic therapy of comorbid herpes virus diseases (EBV-mononucleosis, a generalized form of CMV infection) is effective and safe.
Epidemiology
Introduction. Despite the fact that since 2012 the necessary level of vaccination coverage (>95%) has been achieved and maintained in the Russian Federation, there has been a steady increase in the incidence of pertussis over the past five years. Meanwhile, one third of pediatric patients with pertussis infection had received a complete course of the pertissis vaccine. Pertussis incidence rates are high in all groups of pediatric population, which is a serious healthcare problem.
Materials and methods. The factors analyzed in the study included changes in the incidence rates of pertussis over time (over years and within a year) in different age groups, history of immunization in patients with pertussis infection and laboratory test methods used to make this diagnosis. A correlation analysis of the relationship between the timeliness of vaccination coverage and the incidence of pertussis was carried out by calculating the Pearson’s correlation coefficient. The significance of differences in the incidence rates was determined by estimating the confidence intervals and calculating the t-test.
Results. In the Russian Federation and the city of Moscow, the highest incidence rates are observed in infants, and are still high in children 1 to 6 years of age that are subject to vaccination. 30–40% of all reported cases of whooping cough are observed in children from 7 to 14 years of age. In this group, every second child has a history of immunization, while in adolescents 15–17 years of age the proportion of immunized patients with pertussis infection is over 60%. This suggests a reduction in the specific immune response over time and the need for introduction of booster immunization
with pertussis vaccine into the National Immunization Calendar of the Russian Federation in order to improve the immunization effectiveness.
Conclusions. The study allowed to make a conclusionthat high incidence rates in preschool children and increased incidence rates in school children, adolescents and adults are related to short-time duration of immune response after immunization or pertussis infection. In order to reduce the incidence of pertussis, it is necessary to keep the vaccination coverage at the level of not less than 95%, to carry out regular re-vaccinations in children aged 6–7 years, adolescents aged 14 years as well as to use decennial booster doses in adults.
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