The review presents information on epidemiology, clinical, laboratory and radiological manifestations of infectious and malignant respiratory diseases in HIV-infected patients.

The data on the most common infections (communityacquired pneumonia, tuberculosis, Pneumocystis jiroveci pneumonia) and malignant diseases (Kaposhi’s sarcoma, lymphomas) as well as less frequent diseases (CMV-infection, MAC-infection, fungal pneumonias) are presented.

The article contains facts about the incidence of pulmonary diseases according to the severity of HIV-associated immunodeficiency. This review also presents current information on the diagnostic criteria, treatment regimens and secondary prophylaxis for HIV-associated respiratory infections and malignancies. The specialties of ART initiation in definite cases of opportunistic infections and ART assignment during the diagnostic period are highlighted.

The growing number of HIV-infected patients and the wide spectrum of possible pulmonary diseases argue the need for optimal clinical approach to HIV-infected patients with respiratory lesions for various physicians (general practitioners, pulmonologists and phthisiatricians). 

Purpose. Rhinovirus infection has in the past been perceived as a disease capable of causing mild respiratory symptoms in most cases in children. Modern clinical and epidemiological studies have shown that rhinovirus infection in adults and children and has a moderate and severe course. The aim of this study was to conduct a clinical and laboratory analysis of cases of rhinovirus infection in adult hospitalized patients and evaluate the etiological role of rinoviruses in the epidemic season of 2017/18.

Materials and methods. 1013 case histories of patients admitted to the hospital with a diagnosis of SARS were studied. These patients were taken nasopharyngeal swabs were investigated by PCR for the detection of respiratory pathogens. A positive result was obtained with rhinovirus infection of 51 patients.

Results. Of the examined patients, 41,6% had influenza, 45,8% had no viruses and 12,6% had other viral infections, of which 40% were due to rhinovirus infection. Among them, young patients prevailed: the median age for men was 31,0 years, for women-27,5 years. The disease occurred in a moderate form – 78,8%, severe course was observed in 5,3% of patients and was accompanied by infectious and toxic shock. Most often the disease occurred with complications acute bronchitis – 22,1%, pneumonia joined in 15,7% of cases.

Conclusion. rhinovirus infection ranks first (40%) among non-influenza causes of viral respiratory tract infection in the examined patients. It was registered mainly in young people. In most cases, it proceeded in a moderate form and had a complicated course, including pneumonia.

The purpose is to clarify the immunopathogenetic significance of immunocompetent cells activation and apoptosis in children with HIV-infection.

Materials and methods. A clinical and immunological examination of 92 children aged 1 to 5 years old with HIVinfection in latent stage 3 (25), in the stage of secondary diseases 4A (21), 4B (22) and 4V (24) was conducted.

Results. During the clinical examination, the consistent appearance of HIV-associated symptoms, opportunistic infections, and tumors was noted. Changes in the immune status included abnormalities in the T-cell component – a decrease in the number of CD4-, CD3-, increase of CD8-lymphocytes, inversion of the CD4/CD8 ratio, in the B-cell component – hyperimmunoglobulinemia, increase in the content of circulating immune complexes, in the part of innate immunity factors – a decrease in the intensity of the oxygen-dependent neutrophil metabolism and its reserve capabilities. Identified impaired positive activation of lymphocytes – a decrease in the number of CD25- and an increase in HLADR-cells. An increase in the expression of CD95-receptors on the lymphocyte membrane, an increase in the number of lymphocytes in the early (AnV) and late stages of apoptosis (AnV/Pr) was found. With the progression of HIV infection, there was a deepening of these shifts in immunological parameters, especially during the transition to the stage of secondary diseases 4V (AIDS).

Conclusion. An immunological examination and correlation analysis showed that an important immunopathogenetic mechanism for reducing the number of CD4 lymphocytes in children with HIV infection is the activation of apoptosis involving the receptor and mitochondrial mechanisms. One of the reasons for the formation of depressed cellular immunity was the hyperactivation of immunocompetent cells. The findings provide a rationale for the timely prescription of antiretroviral therapy for children with HIV-infection, which will prevent hyperactivation and apoptosis of immune system cells. 

Aim: to investigate the safety of acellular pertussis vaccines for adolescents.

Materials and methods. The clinical tolerability of revaccination against pertussis (cell-free component), diphtheria and tetanus was analyzed in 107 children aged 13,5–14 years. Group 1 consisted of children revaccinated with DTacP-IPV combined vaccine (Tetraxim), group 2 – vaccinated with Td and group 3 – children who received Tdap vaccine (Adacel).

Results. Statistically significant differences in the frequency of local reactions between the group that received Tdap and the other two (DTacP-IPV and Td) were detected (p = 0.001and p = 0.04, respectively). Analysis of the structure of local reactions revealed a difference only in the occurrence of the hyperemia at the site of injection, with the most frequent registration in the groups of children vaccinated with DTacPIPV (29,4%) and Td (14,7%), whereas in patients vaccinated with Tdap – only in 5,9% (χ2 = 6,8 p = 0,03). Systemic reactions occurred with the same frequency in all studied groups and did not require medical correction, as well as local reactions. Thus, revaccination against pertussis, diphtheria and tetanus of adolescents using Tdap, containing the acellular pertussis component, does not exceed the frequency of systemic reactions and the number of local reactions is significantly lower in comparison with the vaccine with a reduced content of diphtheria and tetanus toxoids (Td) that is used in practice for a long time.

The aim of the study: to analyze the pathogenetic structure of ventriculitis, their relationship with age, risk factors, study the etiological characteristics, clinical and diagnostic features, evaluate outcomes of ventriculitis and features of mortality.

Materials and methods: a retrospective analysis of inpatient medical charts of 72 children with ventriculitis received treatment in the neurosurgery department of Filatov Children hospital №5, St-Petersburg, from January 2008 to December 2017 was carried out.

Results: Most cases of ventriculitis occurred in infants (up to 1 year) and young children (1-3 years old). The largest group among pathogenetic variants of ventriculitis was shunt infection – 50 (69.44%) cases. Other groups were: ventriculostomy-associated ventriculitis – 12 (16,67%) cases; ventriculitis following a neurosurgical procedure without external ventricular drainage – 6 (8,33%) cases; ventriculitis complicated meningitis in patients without prior neurosurgery – 4 (5,56%) cases. The presence of such risk factors for ventriculitis as cerebrospinal fluid leakage (18,06%), intraventricular blood prior to the development of ventriculitis (22,22%), and other systemic infections (59,72%) were noted. The crucial role in the diagnosis of ventriculitis is played by the inflammatory changes in the ventricular cerebrospinal fluid on the background of specific clinical findings and indicative anamnesis. The commonest organism causing ventriculitis in the study was Staphylococcus epidermidis – 24 (33,33%) patients. Ventriculitis mortality rate was 8,33% (6 cases). Analysis of adverse outcomes revealed that aggressive health-care-associated multidrug resistant organisms are more dangerous for life, especially in patients with severe central nervous system pathology prior to ventriculitis.

Cytomegalovirus uveitis is one of the AIDS marker diseases, develops with severe immunodeficiency and is the main cause of blindness in HIV-infected patients.

The aim of our work is to study the course and outcomes of CMV uveitis in patients with HIV infection over the past 10 years.

Materials and methods. The study was conducted at the St. Petersburg Center for the Prevention and Control of AIDS and Infectious Diseases and at the Department of Ophthalmology of North-Western State Medical University named after I.I. Mechnikov. The analysis of statistical data of HIV Newsletters in St. Petersburg for 2009-2019 was carried out, as well as the Journal of Ophthalmologist Examination of the AIDS Center to assess the long-term dynamics of detection of CMV uveitis, CMV associated retinal detachment, and cases of vision loss.

Results. On average, CMV eye damage occurred in 1.65% of patients. In most cases, the involvement of the retina was predominantly peripheral (50-89%). Neuritis, panuveitis, cystic macular edema and retinal detachment were also registered. A positive strong linear relationship was found between the number of new cases of HIV infection already detected in the AIDS stage and new cases of cytomegalovirus damage to the organ of vision. There is a very strong inverse linear relationship between the frequency of detection of CMV uveitis and the amount of antiretroviral therapy provided.

Conclusion. Conducting antiretroviral therapy and providing it to an increasing number of patients helps to reduce the incidence of HIV infection in St. Petersburg and probably secondary CMV infection with damage to the organ of vision. 

Objective: to assess the presence and degree of bronchial hyperreactivity in convalescents of whooping cough based on the results of bronchial provocation tests.

Materials and methods. Using bronchial provocative samples with a 0,02/0,33% histamine solution and 0,33% methacholine solution on a PROVOTEST-2 apparatus from PARI, bronchial hyperreactivity was studied in 12 pertussis convalescents aged 7 to 17 years. The level of endogenous nitrogen monoxide in exhaled air (FeNO) was measured using a portable NObreath electrochemical analyzer (from Bedfont Scientific Ltd.).

The results. According to the results of BPP, 6 of 12 convalescents of whooping cough were found to have bronchial hyperreactivity of varying degrees. When conducting a breath test with a histamine solution, bronchial hyperreactivity was recorded in three children, in a sample with methacholine, in five. In 3 out of 6 children with revealed signs of bronchial hyperreactivity, the history of atopy was not burdened, which suggests a connection between the pertussis and the development of bronchial hyperreactivity. A significant increase in the level of endogenous nitric monoxide (above 16 ppb) was observed in 2 out of 10 patients. Follow-up observation showed that the duration of cough with whooping cough ranged from 3 to 6 months, and in patients with positive results of several tests it was maximum. Two out of three children with bronchial asthma showed elevated levels of FeNO and samples with methacholine. Follow-up observation showed that whooping cough aggravated bronchial asthma and demanded correction therapy.

Conclusion. A pilot study on the evaluation of bronchial provocative tests suggests that the formation of bronchial hyperreactivity in convalescents of whooping cough is probable, including without a history of atopy, which increases the risk of developing bronchial asthma, however, additional studies are required for a final conclusion.

Objective: to evaluate the intensity of measles immunity in students of I–VI courses of the pediatric faculty of St. Petersburg State Medical University.

Materials and methods: titers of antibodies to measles virus were determined in 986 students of I–VI courses in May –June 2019. The level of measles antibodies was determined by enzyme-linked immunosorbent assay.

Results: positive (protective) titres of measles antibodies were detected in 555 people. (56.4%), the absence of measles immunity was found in 431 people. (43.6%), including 57 people. (5.8%) specific antibodies were not detected. The relationship between the level of collective immunity and the duration of the period after the last vaccination against measles was revealed.

Conclusions: in the majority of examined students (96.2%), protective titers of measles antibodies remained for 10 years after the last vaccination. Subsequently, a significant decrease in the level of measles antibodies was noted. All students who do not have a protective IgG titer are shown measles vaccination with live measles vaccine in accordance with the instructions for use. 

Objective: to analyze the epidemiological and clinical features of acute respiratory infections occurring during the St. Petersburg 2017–2018 and 2018–2019 epidemic seasons.

Materials and methods: the study included 457 patients, treated in St. Petersburg clinics from 2017–2019, displaying symptoms of acute respiratory infection (ARI), including evaluation of their clinical histories. Pathogen types were determined by polymerase chain reaction (PCR). Data analysis was carried out using mathematical statistics methods using the Statistica 10 software package (StatSoft Inc.).

Results: in this study, we examined the epidemiological and clinical features of acute respiratory infections in St. Petersburg occurring during two epidemic seasons, 2017–2018 and 2018–2019. The 2017–2018 season was characterized by a prevalence of infections caused by influenza B viruses and influenza A subtype H3N2 viruses. In the 2018–2019 season, there was a greater number of acute respiratory viral infections (ARVIs) and infections caused by influenza A subtype H1N1pdm; influenza B virus was detected only in isolated cases. In the 2017–2018 sore throats and muscle aches were a characteristic symptom of influenza A H1N1pdm infections, of bacterial infections – only sore throats. It was shown that throat pain and vasodilation of the scleral and soft palate vessels were significantly more frequent in the 2017–2018 season, compared to the 2018–2019 season. Cough and redness of the posterior pharyngeal wall were hallmark signs of ARVIs in the 2018–2019 season.

Conclusion: according to the data, each epidemic season is characterized not only by its own type-specific acute respiratory infection frequencies, but also by different clinical manifestation frequencies. For global monitoring, treatment effectiveness evaluation, and refined study of acute respiratory infection clinical features, it is advisable to use approaches which incorporate accurate, specific, and rapid molecular biological methods capable of identifying a broad range of pathogens. 

The aim of the work is the clinical characteristics of all known cases of combined visceral leishmaniasis (VL) and HIV infection in the Russian Federation.

Results. The article contains information on the problem of the combined course of HIV infection and leishmaniasis: a number of statistical and overview data in the world. A brief description of known cases of high blood pressure in patients with HIV infection in the Russian Federation, as well as a detailed description of the last patient diagnosed with VL in 2019 in Moscow. In all cases, the diagnosis of VL was difficult, which was due to clinical features and the lack of alertness of physicians in relation to VL. All but one of the patients contracted VL during their stay in Crimea.

Conclusion. The authors point to the need for the formation of diagnostic alertness among doctors on this pathology, especially since with the expansion of tourist routes abroad in endemic countries, as well as in the Crimea, the relevance of this problem increases.

Objective: to determine the incidence of liver damage with measles, the specificity of these changes, to identify risk groups, to assess the dynamics of the development of hyperfermentemia in various stages of the disease.

Materials and methods: a retrospective cohort study of medical records of patients hospitalized with measles (n = 101), divided into 4 groups: children (n = 23), men (n = 32), women (n = 24) and pregnant women (n = 22). Patients with laboratory-confirmed influenza (n = 61) were taken as a comparison group. The analysis of the frequency of detecting changes in biochemical parameters, average values, standard error and confidence intervals.

Results: An increase in ALT in measles patients was observed in 56 (55.4%), above 5 norms – in 15 patients (14.8%), an increase in AST was detected in 80 (79.2%) patients, above 5 norms – in 10 (9.9%). These changes are specific for measles, which was established by comparing the indicators of patients with measles and influenza. The greatest frequency and severity of the observed changes was observed in men. Determination of bilirubin concentration was carried out in 95 patients. An increase in total bilirubin above 20 μmol / L was observed in 10 (10.5%), direct above 5 μmol / L – in 13 (13.6%) patients.

Conclusion: given the frequency of occurrence of the identified changes, it is advisable to conduct a biochemical blood test for measles patients. Therapeutic tactics should be determined taking into account the possible development of hepatitis with measles. 

The article sets out the views on the causes of the incidence of various categories of military personnel with acute respiratory infections of the upper respiratory tract (hereinafter – ARI URT), as having the greatest military and epidemiological significance for almost all military contingents.

According to the results of a study of literature data, two groups of reasons for the formation of the incidence of acute respiratory infections of the airborne diseases are identified: external (associated with the exposure of military personnel to specific factors of military service) and internal (associated with the characteristics of individual susceptibility to this group of infections).

Based on the results of a retrospective epidemiological analysis of the incidence of military servicemen on conscription, the development features of the epidemic process of ARI URT in military units and compounds are shown.

According to the results of a retrospective epidemiological analysis of the incidence rate of cadets at the S.M. Kirov Military Medical Academy for 2011-2017 and a comparative analysis of the reversal rate for completed cases, the presence and relatively stable proportion of military personnel exposed to frequent ARI diseases of the airborne diseases throughout the entire 6-year period has been shown period of study.

The results of a combined socio-psychological study in groups of often and rarely ill cadets are shown, showing individual signs and psychological characteristics, according to which individual military personnel can be assigned to the risk contingents of increased susceptibility to ARI URT for the purpose of organizing personalized sanitary-antipyretic (preventive) measures.

The literature provides conflicting data on the presence of seasonality of infection caused by the Epstein-Barr virus (EBV). The aim of the work was to assess the annual dynamics of the incidence of infectious mononucleosis in Moscow. Materials and methods. The analysis was carried out according to the official statistics and the results of laboratory studies (IgM VCA, IgG EA, EBV DNA in blood and saliva), conducted in the branches of LLC “Independent laboratory INVITRO” for the period 2014-2018. Were used conventional statistical methods. Results. Identified: seasonal rise in the incidence of infectious mononucleosis in the cold season with two peaks in autumn and spring; the presence of a strong direct correlation between the annual incidence and the frequency of detection of EBV DNA in the blood, IgM VCA, IgG EA per 100 thousand population; the distribution of detectability of markers per 100 examined from the maximum to the minimum (EBV DNA in saliva, IgG EA, IgM VCA, EBV DNA in the blood); a significant excess of detectability IgG EA, IgM VCA and EBV DNA in blood per 100 examined in the warm season; the presence in the annual dynamics of the frequency of detection of EBV DNA in saliva per 100 thousand population seasonal rise from October to June, reflecting the presence of sources of infection in the population. Conclusion. The use of indicators of the frequency of detection of markers of acute EBV infection allowed with a high probability to determine the presence of two seasonal wave rise in morbidity, which did not allow making official statistics that do not take into account the results of laboratory studies.

Based on archival materials, the activity of the Yakutsk infectious diseases’ hospital and its employees during the years of World War II are reviewed. Besides fulfilling their professional duties, medical workers carried out active educational work among the population and acted in measures to clean up the city and improve the infectious diseases hospital. The work also contains biographical information about V.M. Anaskin, the first chief physician of the hospital, who made an invaluable contribution to the work of this medical institution.

The five years old boy with recurrent respiratory tract infections was under observation of infectiologist due to high levels of human herpes virus type 6 (HHV-6), found in patient’s blood and saliva during a few years. The patient got the medicines against the HHV-6, without any effect. We investigated the patient’s and his mom’s nails and found the HHV-6 type B, so it was inherited chromosomal integrated HHV-6. Thus, to avoid the unnecessary treatment, in case of repeated high level of HHV-6, we need to exclude chromosomal integrated HHV-6.

Parvovirus infection is a widespread disease with a high risk of transplacental transmission among infected pregnant women, which leads to fetal death or the development of severe congenital disease in the newborn. Modern approaches to the diagnosis and treatment of parvovirus infection in pregnant women provide the opportunity for a favorable outcome of the disease, preserving the life and health of the child. A clinical case of antenatal diagnosis and treatment of congenital parvovirus infection with the development of severe anemia in the fetus and the results of postnatal observation are presented.

On the basis of literary sources, modern ideas about Marshall syndrome in children are given, as well as the main clinical and laboratory criteria for the diagnosis of this syndrome. A clinical case of Marshall syndrome in a boy 3 years 6 months infected with human herpes virus type 6 is described. Differential diagnostic criteria of Marshall syndrome and active herpesvirus infections in children are presented on the example of a clinical case.