Prolonged subfebrile condition (PSC) is a complex diagnostic and therapeutic problem caused by a wide variety of reasons, which often require a wide and expensive examination, consultations of various specialists, and repeated hospitalizations. Most often, PSC is associated with infections, some non-infectious diseases (predominantly connective tissue) and growths. To infectious causes of DS include: acute respiratory viral infections, herpes virus infections, toxoplasmosis, chlamydia, borreliosis, bartonellosis, etc. Separately, “psychogenic fevers”, subfebrile condition associated with taking drugs, and artifical subfebrile condition are distinguished. The condition of the children, as a rule, is benign and in most cases goes away on their own within 6-24 months.

The article describes the characteristics and classification of adverse events after immunization (AEFI) according to the latest WHO recommendations. The registration systems for AEFI in the USA and in Russia are described. Particular attention is paid to the interpretation of the convulsive syndrome that developed after vaccination. Four clinical cases of the development of convulsive syndrome in children hospitalized at the Pediatric Research and Clinical Center for Infectious Diseases of Russia (St. Petersburg) in the postvaccination period are presented. The criteria for differential diagnosis of the described diseases are indicated. Only a search for the etiology of the disease allows us to assess the relationship with vaccination, timely conduct adequate therapy and generate objective information on the safety of vaccines. There is a need to register all episodes of seizures after vaccination and introduce new methods for registering PPI, as well as creating a system of statistical accounting of background health conditions (convulsions, allergies) of the population of the Russian Federation of various age groups.

Objective: investigate epidemiology of infectious complications, intensity of antibacterial therapy, and features of the systemic inflammatory response in patients with prolonged disorders of consciousness.

Materials and methods: retrospective case histories analysis of 102 patients with prolonged disorders of consciousness who were treated in the department of anesthesiology and intensive care of Polenov Neurosurgical Institute from 2010 to 2019.

Results: during hospitalization all patients (100%) had signs of tracheobronchitis, 86 patients (84,3%) had urinary tract infection, 34 (33,3%) pneumonia, 10 patients (9,8%) meningoventriculitis, and in 9 (8,8%) cases sepsis was diagnosed. Identified bacterial complications required systemic antibacterial therapy. With an average length of hospital stay of 51±42 days, duration of antibiotic therapy was 37±41 days. One-component therapy was applied in half of the cases (54%), slightly less often (43,2%) treatment consisted of two antibiotics, in some cases patient’s condition required prescription of three antibiotics (2,8%). Even in the absence of a focus of infection, temperature and laboratory markers of inflammation in blood samples of patients with prolonged disorders of consciousness were higher than the reference values. CRP was increased with addition of any bacterial complications. Count of white blood cells significantly increased only in case of pneumonia and sepsis. Procalcitonin test was positive in 16,6% observations of urinary tract infection, 30,4% of pneumonia, and 28% of meningoventriculitis.

Conclusion: most informative proinflammatory marker of bacterial complications in patients with prolonged disorders of consciousness was CRP. Mild leukocyte response can be explained by immunosuppression in long-term ill patients. Limited value of procalcitonin test may be due to the insufficiency of the semi-quantitative method sensitivity with a threshold level of 0,5 ng/ml, as well as reduced proinflammatory response to local infection in patients with prolonged disorders of consciousness as a result of massive antibacterial therapy, colonization of opportunistic microflora and presence of sympathicotonia (non-infectious systemic inflammatory reaction). 

The aim of the study: to analyze the prevalence of resistance mutations to elsulfavirine and to evaluate the effectiveness of it among HIV-infected treatment-naïve patients in real clinical practice.

Materials and methods. The study included 578 patients with HIV infection, which divided into 3 groups. The first group is 354 HIV-infected treatment-naïve patients for whom HIV-1 nucleotide sequences were obtained as part of routine drug resistance testing. The second study group included 111 HIV-infected treatment-naïve patients, tested for drug resistance before the antiretroviral therapy containing elsulfavirine. The third study group included 113 HIV-infected treatment-naïve patients, each of whom was assigned a treatment regimen containing elsulfavirine without prior drug resistance testing. The observation period for patients of the second and third groups who received treatment was 24 weeks. To assess the effectiveness of antiretroviral therapy in patients, viral load, CD4+ T-cell counts, and adherence to therapy were assessed. HIV-1 subtypes and drug resistance mutations were determined using the Stanford HIV Resistance Database (v. 8.9-1). To clarify the results of subtyping, phylogenetic analysis of nucleotide sequences was carried out using the MEGA program (v. 6.0).

Results. The prevalence of mutations associated with decreased susceptibility to elsulfavirine among HIV-infected treatment-naïve patients was 1.7% and 4.5% for the first and second groups of patients, respectively. All of the patients have only single resistance mutations which, according to the results of preclinical studies, cannot cause drug resistance. The use of elsulfavirine in real clinical practice among treatment-naïve patients has demonstrated good virological and immunological efficacy of the drug. As a result of 24 weeks of therapy in patients of the second group, no treatment ineffectiveness, and the development of drug resistance were observed. Among the patients of the third group, 6 patients (5.3%) have the virological failure of therapy associated with the resistance to the used drugs. All patients with virological failure had a resistance mutation profile associated with a high level of drug resistance to one of the drugs in the treatment regimen, lamivudine. Additionally, 1 patient had a combination of mutations that reduce susceptibility to elsulfavirine, and 4 patients had mutations that can reduce susceptibility to elsulfavirine in combination with other mutations.

Conclusion. The low prevalence of mutations associated with a decrease in susceptibility to elsulfavirine and the absence of combinations of mutations make it possible to predict the successful use of this drug for Russian treatment-naïve patients. Reported cases of virological failure of antiretroviral therapy are difficult to interpret in the context of elsulfavirine due to the lack of an exact list of mutations and their combinations, and associations with the degree of resistance to it. This study describes for the first time the mutation profiles in patients with virological failure of therapy containing elsulfavirine and demonstrates the necessity of the further study of drug resistance profile to drug in vitro and in vivo.

Objective: To assess diagnostic importance of iron metabolism markers in the progression of anemia of inflammation (AI) in children with chronic HBV infection.

Materials and methods: Among 148 examined children with chronic HBV infection 140 had AI, 60.7% of them with refractory (RA) and 39.3% with non-refractory (nRA) progression variant. Complete blood count was performed using hematologic automatic analyzer. Virologic verification of HBV was done by ELISA and PCR. ELISA was used to determine 25-hepcidin, serum iron, ferritin, trasferrin, sTfR, IL-1, IL-6. The index sTfR/log10Ft was calculated.

Results: Performing the examination of children with chronic HBV infection we determined high prevalence of AI, equal to 94.6%, which was characterized by normocyte normochromic progression, thrombocytopenia, thrombocrit decrease in case of RA, and microcyte hypochromic progression with erythrocyte anisocytosis in case of nRA. Despite the high inflammatory index induced by HBV viral replication, children with RA had characteristic decrease in 25-hepcidin and transferrin parameters with background high values of ferritin, while nRA was characterized by rise of 25-hepcidin and transferrin spectrum with low values of serum iron and ferritin.

Conclusions. In the genesis of AI in chronic HBV cases two pathogenic variants were determined: true iron deficiency with ferromarkers in the type of IDA characteristic for nRA and redistribution iron deficiency compliant to hemosiderosis characteristic for RA. Priority in the differential diagnosis of AI variants is given to the comparison of sTfR/log10Ft index parameters (RA<1.0; nRA>2.0) with reference level of 25-hepcidin<28,68ng/ml in case of RA, and >56,37ng/ml in case of nRA.

Introduction. In children with rheumatic diseases, severe fungal infections (invasive mycoses – IM) are not well understood.

Objectives. To analyze risk factors, disease course of IM in children with systemic rheumatic diseases.

Materials and methods. For diagnosis of IM were used criteria EORTC/MSGERC, 2019. We reviewed the literature over the past 15 years on IM in children with rheumatic diseases from the international databases Pubmed and Web of Science.

Results. In retrospective multicenter study were included 8 children with IM and systemic rheumatic diseases: ANCA-associated vasculitis (n=4), systemic lupus erythematosus (n=3), juvenile rheumatoid arthritis (n=1). Median age was 13,5 (8-17) y., boys – 67%. Invasive aspergillosis was diagnosed in 5 patients and invasive candidiasis – 3. The risk factors of invasive mycoses were high rheumatic disease activity (100%), corticosteroids (prednisolone ≥ 0,3 mg/kg/d) use for ≥21 d (87,5%), immunosuppressive therapy (87,5%), recent (≤ 2 weeks) pulse steroid therapy (75%), hemophagocytic lymphohistiocytosis (62,5%), prolonged (≥ 10 days) severe neutropenia (≤ 0,5х109/l) (62,5%), and prolonged (≥10 days lymphopenia (≤ 1,0х109/l) (37,5%). In patients with invasive aspergillosis the involved organ was the lung, in patients with invasive candidiasis a candidemia was diagnoses. All patients received antifungal therapy. The overall 30 days survival rate was 37,5%.

Сonclusions. Children with high rheumatic diseases activity and intensive treatment with immunosuppressive agents should be considered as patients with a high risk of invasive mycoses with a high mortality. 

Introduction: Rotavirus infection (RVI) is one of the most common childhood illnesses in countries where routine vaccination against the disease isn`t introduced. The incidence of RVI in Russia remains at a consistently high level, leading to a huge socio-economic damage. In addition, in children who have undergone severe forms of the disease, have high risk of post-infectious functional disorders of the gastrointestinal tract (FD), leading to a decrease in the quality of life and prolonged persistence of dyspeptic phenomena. The pathogenetic mechanisms and factors predisposing to FD in RVI convalescents remain insufficiently studied.

The aim of the study was to establish the possible role of intestinal microbiocenosis disorders and immune response in the formation of gastroenterological pathology in children, convalescents of RVI.

Material and methods: The work was performed in 2014- 2019. in Pediatric Research and Clinical Center for Infectious Diseases. In the course of the implementation, a comprehensive clinical and laboratory examination was carried out for 60 children aged 1 to 7 years who had suffered RVI in a severe or moderate form, since the onset of infection followed by a three-year follow-up observation. Particular attention was paid to the assessment of intestinal microbiocenosis and immune response in the study group of patients. The interpretation of dyspeptic symptoms in the follow-up period was carried out on the basis of the Rome IV revision criteria. The structure of gastrointestinal tract disorders after rotavirus infection has been established.

Results: It was shown that with RVI, persistent changes in the intestinal microbiota are observed, characterized by a decrease in the number of symbiotic Bacteroides thetaiataomicron, Lactobacillus spp. and Faecalibacterium prausnitzii and overgrowth of semipathogenius microorganisms, including Bacteroides fragilis.

Conclusion: A close relationship of a number of factors (a decrease in the level of virus-induced production of IFNγ and serum IgA, overgrowth of Proteus spp., Bacteroides fragilis and a decrease in the level of Faecalibacterium prausnitzii and Bacteroides thetaiotaomicron) with the formation of FD in the follow-up period was revealed.

Introduction. The COVID-19 pandemic was announced by WHO in February 2020. In the Kaliningrad region, the first case (imported) was registered in early March 2020, the beginning of the epidemic increase fell on the 14th week. 2020, and the peak incidence was reached in the 22nd week of the year, after which there was a steady decrease in the number of cases. The study of population immunity was carried out at the 32nd week during the period of the lowest level of intensity of the epidemic process.

Purpose of the study. Assessment of the assessment of the level of population immunity to the SARS-CoV-2 virus among the population of the Kaliningrad region during the period of the epidemic incidence of the population of COVID-19.

Materials and methods. The study was carried out as part of the first stage of the Rospotrebnadzor program to assess population immunity to SARS-CoV-2 among the population of the Russian Federation. The selection of volunteers for the study was carried out by a questionnaire survey and subsequent randomization. The analysis includes the results of a survey of 2675 people. The number of volunteers in age groups ranged from 314 to 493 people. The results obtained were processed by the methods of variation statistics.

Results. The results obtained showed that the average seroprevalence in the population was 50.2%, while the highest seroprevalence was found in the child age group 1-17 years (66.9%) and among persons aged 18-29 (57.0). No significant gender differences were found (men – 48,3 ± 1,6%, women – 51,1 ± 1,1%). The distribution of the proportion of seropositive people in the settlements of the region varied from 33,9% to 59.6%. The largest share of seroprevalence in the representative samples was found among people engaged in art / creativity (55,3%), the smallest – among educational workers (42,0%). Among COVID-19 convalescents, the level of humoral immunity reached 94,6%. Most of the seropositive volunteers (95,2%) did not have any symptoms of COVID-19, that is, they belonged to the category of asymptomatic carriers.

Output. The results of a survey of a representative cohort of volunteers in the Kaliningrad region showed that they are characterized by a high level of population immunity, which makes it possible to expect a decrease in.

Introduction. Infants younger than 3 months old are at high risk of severe pertussis, complications and pertussis-associated mortality. Newborns receive protection against pertussis from maternal antibodies transferred predominantly during late pregnancy. Neither disease, nor vaccination provides lifelong immunity against pertussis. So most of women have low antibody concentrations, leaving their newborn infant at a higher risk for disease in the first months of life.

The aim of this study was to assess the concentration of antibodies against Вordetella pertussis among mother-baby dyads.

Methods. We performed a cross-sectional study including 119 mother-baby dyads. Maternal antibodies were measured in venous blood specimens during the last trimester of pregnancy for women and in cord blood for newborn infants.

Results. The median age was 30 (25; 34) years. The half of participants had unknown vaccination status (49,6%). Only 12,6% had a protective level (>18 U/mL) of anti-pertussis antibodies, 74,8% of participants had a nonprotective (<14 U/mL) level and 12,6% had an equivocal (14–18 U/mL) antibody concentrations. All newborns of seropositive women and 11,5% infants of women with an equivocal titers receive protection against pertussis. Transplacental transport ratio of antibodies against pertussis was higher in newborns of seropositive women.

Conclusion. We revealed a huge proportion of pregnant women (87,4%) and newborns (77,3%) susceptible to pertussis. Maternal antibody level against pertussis was the major predictor of the antibody level in the infant.

Diagnostic morphometric criteria for splenomegaly in children with infectious mononucleosis are established using ultrasound. The study included 29 children with infectious mononucleosis. The average age is 11.7 ± 3.5 years. A morphometric measurement of the length, width and thickness of the spleen, elastometry (EM), and lymph nodes were evaluated. The spleen mass was determined by method of O.V. Vozgoment, coefficients: the ratio of spleen mass to body mass (KMS, Km), body length (KI), body surface area (Ks). The average CCM value was 6,47 ± 2,8, the absolute value of the indicator varied from 1,9 to 14,2. According to the CCM, patients are divided into 3 groups: group A – 6 (20,7%), group B – 11 (38%), group C – 12 (41,3%). The average mass of the spleen was 332,5 ± 119.6 g, the CMS – from 7,7 to 14,2, the average value of the indicator – 8,6 ± 1,9. In group B the mass of the spleen, compared with group C is 1,2 times less. In group C the spleen mass is statistically significantly greater compared with groups A and B. In group C, spleen rigidity was increased in 42,9% of cases. The average EM value is 15,8 ± 4,8 kPa. A negative correlation between the average strength between EM and age (r = – 0,65, p = 0,01) was revealed. A direct relationship was found between the mass of the spleen and the CMS, and lymphadenopathy of various localization, often periportal lymph nodes.

Study Objective: to assess the impact of herpesviruses infections reactivation and concomitant chronic hepatitis C infection (CHC) on complications and one-year survival after hemopoietic stem cell transplantation (HSCT) in patients with hematologic malignancies.

Materials and Methods: medical records of HSCT recipients with PCR-confirmed viral infections (CMV, HHV-6, EBV, HSV-1,2, HCV) from Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation of Pavlov First St.Petersburg State Medical University were analyzed retrospectively. The following groups were composed: patients with herpesviruses infections reactivation (PCR+) without clinical manifestation (n=37), patients with clinically manifest herpesviruses infections (n=21), and patients with CHC (n=28). Control groups were selected using matched samples method from patients with negative test results. HSCT complications rate and one-year survival were compared. Statistical analysis was carried out using SPSS Statistics 22 software.

Results: Herpesviruses infections reactivation was revealed in 61,2% of 343 patients. The complications rate across the groups did not differ significantly. One-year survival (Kaplan-Meier) was significantly lower in the groups with herpesviruses infections (PCR+) without clinical manifestation (52,1% vs 73,5%), manifest herpesviruses infections (38,1% vs 75,0%), and CHC (64,3% vs 92,9%) than in the respective control groups. There were no significant differences between the group with reactivation of herpesviruses infections without clinical manifestation and the group with manifest herpesviruses infections.

Conclusion: Significant impact of herpesviruses infections, including those without clinical manifestation, and HCH with minor symptoms and normal liver functions on one-year survival in patients with hematologic malignancies justifies wider use of antiviral therapy in patients requiring HSCT.

Aim. To evaluate the antifibrotic effect of bicyclol with promising clinical effects on diffuse parenchymal liver diseases.

Materials and methods: We have included 40 adult male Wistar rats (weight, 180 to 200g) with experimentally inducted toxic F3 stage liver fibrosis. Control group consisted of 16 rats that received standart chow, experimental group of 24 rats also received 30-day bicyclol supply. To evaluate the results we used histological, biochemical, molecular genetic and statistical methods.

Results. In experimental group interlobular fibrosis was maintained in 4,16% (p<0,001) of cases after the end of the therapy, stromal fibrosis of portal tracts was observed in 62,5% (p<0,001) of cases. Periportal fibrosis detection rate in experimental group was 66,7% (p<0,001). Rats from experimental group showed regression of liver fibrosis to F1- F2 stage in 16,6% (METAVIR) whereas control group had F3 stage liver fibrosis in 62,5% (p <0,05). Statistically significant increase in ALT activity and decreased total protein levels in control group were observed. No changes in gut microbiome profile in experimental animals were found.

Conclusion. Use of bicyclol led to pronounced suppression of liver fibrotic changes in laboratory animals and temporary decreased serum ALT level. Our study showed no link between therapeutic effects of the drug and gut microbiome status.

Objective: The goal of this study was to examine the prevalence of anti-core+1 in “naive” patients with chronic hepatitis C and different stages of liver fibrosis infected by HCV subtypes 1b and 3a.

Materials and methods: A total of 86 “naive” patients (37 men and 49 women) with CHC observed in the Botkin infectious disease hospital in 2017, were included in this study. The average age was 50,7±2,7. Laboratory tests included ALT and bilirubin. In 53 patients, the fibrosis stage in the liver tissue was evaluated by the TE method using Fibroscan (Echosens, France). The presence of antibodies to the core+1 protein in blood serum samples was determined by the “inhouse” indirect ELISA method using synthetic peptides F10 and F13, which amino acid sequences correspond to the antigenic determinants of core+1 protein of the HCV subtypes 1b and 3a, respectively.

Results: In total, anti-core + 1 were detected in 27 (31,4%) subjects. It has been shown that the detection rate of anticore+1 does not depend on the HCV subtype. The study has indicated no statistically significant dependence between the presence of anti-core+1 and biochemical activity es of the infectious process (ALT, bilirubin). Anti-core+1 were detected in patients with all stages of fibrosis, however, the detection rate of anti-core+1 was statistically higher in patients with stage F4 fibrosis than in patients without liver fibrosis.

Conclusion: The obtained results suggest a possible role of the core+1 protein in the development of fibrosis. In the natural course of HCV infection, the detection of anti-core+1 can be considered as a prognostic marker for the progression of fibrosis in the liver tissue.

Purpose: to evaluate the importance of increasing cardioenzymes in the diagnosis of infectious heart lesions.

Object and methods: Under observation were 71 children aged 3 to 17 years (average age – 6.6 ± 0.4 years) who received treatment at the clinic of Pediatric Research and Clinical Center for Infectious Diseases. All children in the acute period of illness and 49 patients with follow-up history were identified with levels of creatine phosphokinase (CPK), MВ fractions of creatine phosphokinase (CPK-MВ), lactate dehydrogenase (LDH), C-reactive protein (CRP), aspartate aminotransferase (AST). Follow-up observation and examination of patients was performed after 1 month and after 1 year. All children were examined for a wide range of pathogens of acute respiratory viral infections, active herpes virus infections (EBV, CMV, HHV-6 type), B19 parvovirus, Chlamydophila pneumoniae, Mycoplasma pneumonia, enteroviruses and bacterial respiratory pathogens. All examined patients underwent electrocardiography and echocardiography.

The results of the study. In the examined patients with an increased level of “cardioenzymes” (CPK-MВ, LDH, AST) against the background of acute respiratory infection (ARI), a wide range of diseases was established with damage to both the upper respiratory tract and lower (bronchitis, bronchiolitis, pneumonia), and also other infectious nosologies, including respiratory syndrome (infectious mononucleosis, enterovirus and parvovirus infection). The etiological structure was dominated by a group of herpesvirus (53%) and bacterial infections (25%), as well as their combinations. An analysis of the dynamics of the main biochemical and hematological parameters characterizing the severity of the systemic inflammation syndrome (leukocytes, SRE, CRP, CPK), as well as reflecting myocardial injuries and used in cardiology practice (CPK- MВ, LDH, AST), revealed a long-term (within 1 year observations) the preservation of a moderately elevated level of CPK-MВ, unlike other indicators that returned to normal within 1 month. An increase in CPK-MВ was recorded in 79% of patients with drip infections, while the average level of CPK-MВ in the total sample exceeded the normal values by 1.8-2.4 times.

Conclusion. It was found that elevated levels of CPK-MВ and LDH can be used as criteria for the formation of dynamic observation groups and early rehabilitation.

Objective: to study the activity of HSV 1,2, EBV, CMV, HHV6, HHV7 in children of different age groups, to determine the frequency of various symptoms and syndromes in the examined children depending on hhv7 monoinfection and combined herpetic infection in the age aspect.

Materials and methods: 56 children aged 2 to 18 years were examined at the state MEDICAL research Institute named after Prof. A. F. Agafonov in Kazan, at the BIOMED medical and diagnostic center in Kazan and at the LUCH children’s clinic in Naberezhnye Chelny (boys accounted for 62.5% of cases, girls-37.5%). Verification of the diagnosis and evaluation of the dynamics of etiological markers of the infectious process in all observed children was performed by PCR. Blood and saliva were examined to detect markers of human herpes virus type 7 (in qualitative PCR), and blood, oropharyngeal flushing, and urine were examined in semiquantitative PCR to determine other viruses from the herpes family (HHV6, CMV, EBV). In enzyme immunoassay is determined At the same time, we studied options for combining laboratory markers of herpesvirus activity and changes in the main laboratory parameters used in routine practice. We studied the dynamics of the observed parameters against the background of complex antiviral therapy for the next 3 months after the initial examination. The frequency of occurrence of various symptoms and syndromes was determined depending on the activity of various representatives of the herpes family, their combination, and the age of the subjects.

Results of the study: HHV7-monoinfection is more typical for the age group of 7-14 years. The significance of mixed HHV6+HHV7 infection decreased with age. The combination of activity of 4 herpesviruses was more often registered in the age categories 2-7 years and 14-18 years. More often, patients had tonsillitis, generalized cervical lymphadenopathy, periodic temperature rise to subfebrile or febrile numbers, pharyngitis, recurrent ARI, rhinitis, which allows us to consider them as the main manifestations of HHV7 infection.

Conclusion: HHV7 infection is significant in the modern pathology of the child. The presence of such syndromes as recurrent tonsillitis, cervical lymphadenopathy or isolated enlargement of submandibular lymph nodes, periodic fever, pharyngitis, recurrent ARI in combination with hepato - and/ or splenomegaly, fatigue, and headache is often associated with HHV7. HHV7-viremia is relatively rare, despite obvious clinical and laboratory signs of inflammation indicating the presence of a viral disease, which, apparently, and is the cause of underdiagnosis and lack of proper attention to this infection. 

Outcomes of severe variants of acute infectious diarrhea in children with acute renal injury/failure (ARI/ARF) remain unsatisfactory, and mortality reaches 70% and more. ARI/ ARF therapy requires high material costs, which represent significant burden on health financing systems. It makes us consider AFR as one of the most important medical and social problems.

The aim of our study was to investigate predisposing factors contributing to the development of renal dysfunction in acute infectious diarrhea associated with hemocolitis (AIDH), as well as to study the relationship of the developed renal dysfunction with the severity of endogenous intoxication, damage of vascular endothelium and hemostasis system.

We examined 60 sick children with AIDH, divided into two groups: with ARF and without kidney pathology.

Susceptibility to ARI/ARF in severe forms of AIDH is mediated by early childhood (up to 3 years in 89,5% of patients), artificial and mixed feeding (in 52,6% and 36,8% of children respectively), pathology of pregnancy in the first trimester, mother diseases during pregnancy (84,2%) and the late admission to hospital (89,5%) on the 4,9±0,2 day of the disease, i/m administration of furosemide without volume circulating blood restoration, i/m administration of nephrotoxic antibacterial medicines. Shigella spp. and Escherichia coli as etiologic factors of diarrhea in 42,1% and 47,4% of cases respectively. Thus due these parameters we can predict the loss of kidneys adaptation ability in diseases with severe course including acute infectious diarrheas.

Interrelationships between elevation of the number of antigen binding lymphocytes to tissue antigens of vascular endothelium up to 8,1±0,6% in children with ARF and development of hemorrhagic syndrome (decrease of PTI to 72,5%) and intensity of endogenic intoxication (average molecular peptides up to 9,7±0,6 g/l) and worsening of AFR signs were established.

Thus, it was found that AKI most often develops when rehydration therapy is started late or inferiorly performed, when nephrotoxic antibiotics and loop diuretics are prescribed without circulating blood volume (CBV) compensation and is accompanied by an increase in the degree of endogenous intoxication and vascular endothelial damage. 

The objective is to compare clinical symptoms, lipid peroxidation indicators, the state of the antioxidant system and assess their impact on the severity and progression of pseudotuberculosis in children.

Materials and methods. We examined 125 children with pseudotuberculosis divided into 4 groups according to the severity and nature of the disease progression and 45 healthy children. The material for the study was red blood cells and blood plasma of patients received in the dynamics – the acute period (during hospitalization); 3-4 weeks later – the phase of early convalescence with a non-smooth progression and moderate and heavy severity; the recovery period with a smooth progression and mild and moderate severity; 5-6 weeks later – the recovery period with a non-smooth progression and moderate and heavy severity. The spectrophotometric method was used to study lipid peroxidation (the concentration of diene conjugates, TBA-reactive substances) in the blood plasma and components of the antioxidant support system (the content of reduced glutathione; the activity of glutathione reductase, glutathione peroxidase, and catalase) in red blood cells.

Results. It was determined that moderate and heavy pseudotuberculosis forms prevail in hospitalized children, the disease progression in 35.2% of them was non-smooth; lipid peroxidation products accumulate in the blood plasma and the concentration of reduced glutathione decreases in red blood cells during the acute period of pseudotuberculosis in all children relative to the parameters in the control group. In the period of early convalescence an imbalance in the functioning of antioxidant enzymes of red blood cells, as well as the accumulation of TBA-reactive substances and a decrease in the content of reduced glutathione were observed in patients with moderate and heavy pseudotuberculosis.

Conclusion. The impact of the imbalance of pro-/antioxidants on the formation of predominantly moderate and heavy pseudotuberculosis in children is shown. Prognostic criteria for the development of a non-smooth progression of pseudotuberculosis are a high level of lipid peroxidation products in the blood plasma, no normalization in values of glutathione system components and the activity of erythrocyte catalase during early convalescence. 

Purpose of the study. To conduct typing of toxigenic strains of Clostridium difficile, obtained from oncological patients who are in hospital.

Material and Methods. The study included 130 patients with Clostridium difficile – associated diarrhea. First, the presence of toxins A+B+ in the feces was determined by enzyme immunoassay on an automatic miniVidas analyzer from BioMieux SA (France). For screening using real-time PCR, 26 toxigenic Clostridium difficile were selected. For the study used the system GeneXpert company «Cepheid» (Sweden).

Results. Of the 1287 patients with diarrhea who were treated in an oncologic hospital, 130 (10,1%) tested positive for toxin A+B+ Clostridium difficile. For the study using real-time PCR, 26 samples were taken. The average age of patients is 57 years. 10 (38,5%) toxigenic strains were identified as hypervirulent ribotype. 7/10 strains were isolated for 3 consecutive month. The average age of patients with hypervirulent strains was 45 years. Patients participating in the study, in most cases were from the surgical departments – 61,5%, from the therapeutic – 34,7%.

Conclusion. The study showed that the prevalence of Clostridium difficile infection in our clinic is lower than in other countries. Although hypervirulent strains accounted for 1/3 of all typed Clostridium difficile, special attention should be paid to them. Delayed diagnosis, delay in the onset of specific therapy in cancer patients can lead to a deterioration in the quality of life and in some cases be fatal. PCR diagnostics can determine the hypervirulent ribotype and carry out epidemiological measures aimed at preventing local outbreaks in the hospital.

Objective is to reduce the risk of infection of people with plague in the territory of a natural focus on the basis of the targeted public health educational work with risk groups.

Materials and methods. In 2017, 30 visits were made by epidemiological groups to livestock farms in the epizootic zone to inform the population about the existing risks of plague infection and to conduct interviews to assess the level of alertness regarding the risk of the disease. Work was carried out with risk contingents with coverage of 1652 people (81% of the total number of people living in livestock camps).

Results. It was found that 64% of the respondents knew about the danger of plague infection in the region. 91% are aware of the role of marmots in infecting people with plague. 96.3% of respondents are aware of the ban on hunting groundhogs, while 39% continue to prey upon the grey (Altai) groundhog. The identified gaps in the population’s alertness regarding the risk of plague infection were eliminated through active sanitary and educational work with the population.

Conclusion. Direct work with the population, anti-epidemic groups, significantly affected the provision of epidemiological welfare as regards plague, which is confirmed by the absence of human plague cases in the natural focus in 2017-2019. 

In Russia, Hemorrhagic Fever with Renal Syndrome (HFRS) takes the leading place among all natural focal infections, the incidence rate in 2018 was 3,99 per 100 thousand population. In the Northwestern Federal District of the Russian Federation, HFRS occurs much less frequently – 1,46 cases per 100 thousand population. The disease is more susceptible to men aged 16–50 years, children rarely get sick. In 2019, 73 cases of HFRS (1,36 per 100 thousand population) were registered in St. Petersburg, among them only 2 episodes – in children under 18 years of age. A clinical case of HFRS in a child aged 1 year and 8 months is presented. The diagnosis was established on the basis of clinical and epidemiological data (acute onset of the disease, the presence of fever, thrombohemorrhagic syndrome, oliguria, anuria, information on cases of HFRS at the place of residence of the child) and laboratory data (detection of specific IgM antibodies to the Hantaan virus) in the later stages of the disease. The described case should alert pediatricians regarding possible natural focal diseases, including HFRS. A thorough analysis of the anamnestic, epidemiological and clinical data of the patient will help in the early stages of the disease to suggest a diagnosis, conduct laboratory diagnostics and prescribe appropriate therapy.