The pandemic of COVID-19, a novel respiratory infection, has become one of the most significant events in the history of infectious diseases over the past 100 years. The article reviews the main stages in the development of a pandemic and the fight against it, the most appealing issued faced by medical science, the successes and mistakes of healthcare systems and researchers, the current state of the problem and the nearest prospects.

Since March 2020, the first reports have appeared about the increasing, almost everywhere, number of children who have undergone a new coronovirus infection caused by SARS-Cov-2 with a symptom complex resembling the manifestations of Kawasaki disease. A special feature of the clinical manifestations of this syndrome, which is called “Pediatric multisystem inflammatory syndrome associated with COVID-19”, is the high incidence of life-threatening conditions caused by the sharp development of arterial hypotension against the background of cardiogenic or vasogenic shock.
In St. Petersburg, since the end of November 2020, there has been a sharp surge in admissions of children to the ICU of various hospitals with the clinic of Pediatric multisystem inflammatory syndrome, who have laboratory confirmation of the transferred COVID-19.
The purpose of this article is to attract the attention of doctors of various profiles, to combine efforts to study this pathology, to determine the criteria for verifying the diagnosis, optimal treatment regimens and dispensary monitoring of patients who have been ill.

This article provides an overview of the existing literature on the pharmacogenetic determinants of exposure and toxicity of antiretroviral drugs, as well as on genetic markers associated with the rate of disease progression. In addition, this article looks at current clinical opportunities as well as genetics in HIV drug development. Large-scale, integrated approaches to the genome are expected to significantly change the knowledge landscape in the future.

Whooping cough is still an urgent health problem in Russia, despite the vaccination that has been carried out for many decades. The group at high risk of severe whooping cough and death from it is children under 1 year old who have not received routine vaccination or are not vaccinated by age (the first months of life). The world health organization recognizes vaccination of pregnant women as the most effective method of preventing whooping cough in children before they receive three routine vaccinations. World experience in immunization programs for pregnant women against pertussis shows that up to 91% of children under 3 months of life are protected from pertussis as a result of transplacental transmission of antibodies formed in the mother after her vaccination (which corresponds to the timing of vaccination of children against pertussis in Russia: the first vaccination at the age of 3 months). The maximum preventive effect for a child was observed when a pregnant woman was immunized at 28–32 weeks of gestation. The safety of vaccination for both mother and child is shown. No serious adverse events related to vaccination have been reported. Coverage of pregnant women with vaccination in different countries reaches 51-70%. In order to increase adherence to vaccination of pregnant women, medical personnel should be regularly trained in the basics of vaccination, as well as conduct active health education among the population.

A retrospective analysis of the medical data of 12 patients with COVID-19 was performed. For the diagnosis of invasive aspergillosis the international criteria ECMM/ISHAM 2020 were used. We analyzed the scientific literature data on the diagnosis and treatment of invasive aspergillosis in patients with COVID-19.

Results. Among the 12 examined patients with a severe course of COVID-19, invasive aspergillosis was diagnosed in 5 patients. Four patients (80%) were treated in the ICU. Steroids or interleukin-6 inhibitors were used in 80% patients. Severe lymphocytopenia was in 80% patients, neutropenia 20%. A fever refractory to antibiotic therapy was noted in 80% patients, an increase in respiratory failure – 60%, acute respiratory distress syndrome – 60%. All patients showed negative dynamics of changes in the chest CT scan. Invasive aspergillosis was confirmed with a positive test for galactomannan in bronchoalveolar lavage and / or serum in 100% of cases. All patients received antifungal therapy with voriconazole and/or caspofungin. The overall 12-week survival rate was 80%.

Conclusion. In ICU patients with severe COVID-19 and progressive pulmonary symptoms invasive aspergillosis should be excluded. Examination of substrates from the lower respiratory tract (BAL, tracheal aspirate, or nonbronchoscopic lavage) is necessary. Laboratory examination should include microscopy, culture and test for galactomannan. Voriconazole and isavuconazole are drugs of choice for the treatment of invasive aspergillosis in patients with COVID-19.

Aim. To determine the number of children with chronic hepatitis C in the Russian Federation, including, who have received antiviral treatment, taking into account their age, the genotype of the virus, as well as the therapy regimens used.

Materials and methods. The analysis of specially developed statistical reporting forms was carried out, the filling of which was carried out in September 2020 by specialists from 268 medical organizations from 37 constituent entities of the Russian Federation, which are part of 8 federal districts.

Results. In September 2020, 2,160 children with chronic hepatitis C virus infection aged 0 to 17 years were under observation in 268 medical organizations, including 50.7% females and 49.3% of males. The number of children in the age group from 12 to 17 years was 42.9%, from 6 to 11 years – 34.5%, from 3 to 5 years – 16.2% and from 0 to 2 years – 6.4%. The genotype of the virus was determined in 1388 (64.3%) children. The proportion of children with genotype 1 was 58.6%, with genotype 3 – 37.2%, with genotype 2 – 4%. Only 141 (8.8%) children with chronic hepatitis C virus infection have been received antiviral therapy. 1465 (91.2%) children were not treated, but 153 (9.5%) of them received therapy earlier, without achieving a sustained virological response. Direct-acting antiviral agents treatment was carried out to 120 children (85.1%), of whom glecaprevir + pibrentasvir was received by 85 children (70.8%) in 20 regions, sofosbuvir + ledipasvir – 14 children (11.7%) in 6 regions, sofosbuvir – 14 children (11.7%) in 6 regions, daklatasvir – 7 children (5.8%) in 4 regions. Children are removed from dispensary observation after achieving a stable virological response in accordance with the current regulatory documents in 26 regions of the Russian Federation (70.3%).

Conclusion. In 2020, less than 10% of children under management received antiviral therapy for chronic hepatitis C virus infection in the Russian Federation. It is necessary to approve the state program for the treatment of viral hepatitis, one of the directions of which should be the provision of all children with chronic hepatitis C virus infection with modern highly effective antiviral drugs. It is also necessary to conduct clinical trials to assess the safety and efficacy of direct-acting antiviral agents for children with chronic hepatitis C virus infection in order to ensure the possibility of their earlier prescription.

Objective: to study the values of fibrosis indices and transient elastometry in patients with chronic HCV infection who received antiviral therapy.

Materials and methods: The study included 64 patients with chronic HCV infection who received antiviral therapy with direct-acting antiviral drugs or a combination of peginterferon and ribavirin.

The fibrosis indices AAR, APRI and FIB-4 were calculated before the start of therapy and 6 months after its completion. Values of AAR>1, APRI≥1,5, and FIB-4≥1,45 were considered indicators of severe fibrosis. We studied the dynamics of fibrosis indices and elastometry values depending on the treatment regimen, their correlation and the prognostic significance of fibrosis indices in relation to elastometry.

Results. Among patients treated with direct-acting antiviral drugs, a sustained virologic response was achieved in 100%, and peginterferon-containing regimen – in 85%. Elastometry and APRI and FIB-4 indices decreased in both groups. In patients without liver cirrhosis, the average elastometry after treatment decreased from 9,5±1,7 kPa to 6,7 ± 1.4 kPa (p = 0,0006). In patients with liver cirrhosis, the median of elastometry decreased from 20 to 11,7 kPa (p = 0,0006), the median of APRI decreased from 2,09 to 0,61 (p = 0,005), FIB-4 from 3,95 up to 2,22 (p = 0,022). The prognostic significance of FIB-4 in relation to elastometry before treatment was 81%, after – 82%.

Conclusion. Successful etiotropic therapy leads to an improvement in values of liver fibrosis indices and transient elastometry in patients with HCV infection, including liver cirrhosis, regardless of the treatment regimen. The FIB-4 index showed the highest sensitivity and prognostic significance in determining severe fibrosis.

Introduction. Chickenpox is one of the most common infectious diseases in childhood. It is considered a benign disease, but both children and adults can lead to the development of serious complications.

Purpose: to study the epidemiological and clinical features of chickenpox in children aged 0–17 years, hospitalized in the Krai government-owned publicy funded health care institution “City clinical hospital No. 11, Barnaul”, for the period 2008–2018.

Materials and methods. The materials of the study were data from statistical reporting forms No. 2 of the Federal state statistical observation “Information on infectious and parasitic diseases” in Barnaul for 2008–2018, and medical archive documentation of the children’s infectious diseases Department of the Krai government-owned publicy funded health care institution “City clinical hospital No. 11, Barnaul” for the same period. Data processing was performed using calculation of intensive and extensive indicators, calculation of the arithmetic mean (X) and standard error of the average (m). Calculations were made using the STATISTICA-10 program.

Results. The incidence of chickenpox is consistently high, and children aged 3 to 6 years dominated the structure of hospitalized patients with the diagnosis of «chickenpox». All patients were not vaccinated against this infection. Patients developed complications due to the layering of secondary bacterial flora. Summary. Chickenpox is an infectious disease that can be severe, especially in patients with a heavy premorbid background. There is a tendency to” grow up” the infection, which emphasizes the need to discuss specific prevention of the disease.

In conditions of increasing antibiotic resistance and widespread antibiotic-associated diarrhea caused by Clostridium difficile, it is necessary to choose a rational drug for the empirical treatment of escherichioses, which has a wide range of antibacterial activity and does not lead to the development of serious side effects and disruption of the gut microbiota.

The aim of the study is to assess the effectiveness and safety of the use of the drug “Nifuroxazid-ECO” in the integrated therapy of escherichioses in children.

Patients and methods: 50 patients aged 1 month to 18 years were selected for work by random sampling, hospitalized in the intestinal department of the Pediatric Research and Clinical Center for Infectious Diseases of Russia with non-severe clinical forms of escherichioses. All patients underwent routine clinical, biochemical, instrumental examination. DNA detection of the pathogen was carried out by molecular methods in fecal samples using a set of reagents to detect and differentiate the DNA of diaregenic E. coli in environmental objects and clinical material by polymerase chain reaction (PCR) with hybridization-fluorescent detection. Patients received the drug “Nifuroxazid-ECO”at age dosage, every 6–8 hours for 5–7 days.

Results: Against the background of the therapy, a significant majority of patients showed clinical improvement. The average duration of hospitalization was 4.8 days, the duration of preservation of diarrhoeal syndrome was 3.4 days. The drug showed good tolerability. There were no cases of antibiotic-associated diarrhea, re-hospitalization at an early date after treatment, serious adverse reactions.

Conclusion: Studies have shown that the drug “Nifuroxazid- ECO” is a safe and effective modern drug which can be successfully used in the therapy of non-severe escherichioses in children.

Dengue fever is a zooantroponotic, vector-borne viral disease. It is common among the population of tropical countries and is characterized by a tendency to expand to other countries as a result of infection drifts.

Objective: to identify epidemiological, clinical and laboratory features of imported dengue fever in St. Petersburg.

Materials and methods. The obtained data of official registration of cases of diseases in the Department of accounting and registration of infectious and parasitic diseases of the city of St. Petersburg and clinical case histories from the Сlinical Infectious diseases hospital named after S.P. Botkin for 2012–2018 were used as the basis for epidemiological analysis. 144 cases of dengue fever were identified on the basis of registration materials in the city during this period, of which 86 cases were studied on clinical histories. Standards methods of epidemiological diagnostics and statistics were used in the article.

Results and discussion. Epidemiological anamnesis has been seen in a wide variety of countries in which tourists stayed and became infected. The hemorrhagic form of dengue fever was diagnosed in only 18 (19,1%) out of 86 patients. This form usually develops with repeated encounters with the virus and is more severe than the classic version of the disease. Dengue fever remains a topical imported disease and is associated with an increase in tourists, often re-visiting disadvantaged tropical countries. Both sexes were equally exposed to the disease. The age characteristic of patients is represented by persons of 20–29 and 30–39 years of age. An increase in the number of patients over a 7-year period was noted in May and November. Such countries as Thailand (37%), Vietnam (13,9%) and India (9,3%) were the predominant tourist destinations. Besides, single infections occurred in 13 countries of the Asian, African and American regions. The primary diagnosis in 50,3% of patients referred to hospital were acute respiratory diseases, combined with diarrhea and other manifestations. Clinical manifestations fit into 5 syndromes, which pass with a variety of symptoms, complicating both clinical diagnosis and laboratory confirmation of the diagnosis. Imported dengue fever is characterized by combined infections caused by pathogens of acute intestinal diseases, cytomegalovirus, hemorrhagic fever with renal syndrome, West Nile fever, hepatitis A, Legionella and Plasmodium malaria. In General, combined infection was detected in 39.5% of patients.

The aim of this work is to study the etiological and epidemiological features of infectious hemocolites (IG) in hospitalized children of different ages.

Materials and methods of research. An analysis of the results of a survey of 3103 children admitted to hospital treatment for acute intestinal infections (AII) from January to December 2018, among which patients with IG were identified. The etiology of the disease was determined based on the results of the bacteriological method, PCR studies of faeces with Amplicens ® OKI screen-FL reagents, serological and immunological methods. Microscopic examination of faeces was performed to identify protozoa. Patients were divided into age groups: infant (n=78; 30%); early (n=74; 28,5%); preschool (n=63; 24,2%), school (n=45; 17,3%).

Results. The incidence of IG in hospitalized children with AII was 8,4%. Bacterial pathogens of IG were detected in 66,5% of children, IG of unspecified etiology was diagnosed in 24,2%. Viral and bacterial infections were rarely detected (9,2%). Among intestinal viruses, rotavirus (37,5%), norovirus (29,2%) and enterovirus (20,8%) were more frequently detected in hemocolitis of combined viral and bacterial etiology. In the IG age structure, infants (30%), young children (28,5%) and pre-school children (24,2%) made up the majority. The maximum number of IG patients was detected in the summer (10,9% of all cases of AII). Salmonellosis was more often detected in autumn (31,6%), campylobacteriosis – in summer (17.9%) and autumn (24,1%), escherichiosis and shigellosis – in summer (11,5% and 6,4%, respectively). The maximum detection of IG in infants was observed in June (14,1%) and October (12,8%), in young children – in July (17,6%), in preschoolers – in June (12,7%) and November (15,9%), in schoolchildren in May (13,3% of cases) and in October (15,6%).

Conclusion. The incidence of infectious hemocolites in hospitalized children with acute intestinal infections was 8,4%. The bacterial etiology of the disease was detected in 66,5% of children. The age structure of the IG was dominated by children of infant, early and preschool age. The maximum detection of patients with IG was observed in the summer.

The goals of the research are to determine the latent morbidity and financial losses of the Russian Ministry of Defense due to the dismissal of service members with HIV infection at symptomatic stages; to establish the supposed clinical and pharmacoeconomic effectiveness of the early detection and treatment of service members.

The materials compile 379 case histories of patients of the only specialized department for HIV-positive military personnel in the Armed Forces for 2017–2019, as well as various reporting forms. The study uses the following methods for the analysis: Markov chains are employed to calculate QALYs (Quality Adjusted Life Years), “cost-effectiveness”, and “willingness to pay”. The research compares two competitive models: “Current Situation” - without the introduction of algorithms for early detection and treatment of HIV infection, and “Prognosis” - with the introduction of these algorithms.

The following results are obtained: implementing a mandatory triennial screening for HIV-antibodies among military personnel allows to raise the detection of HIV-positive military personnel in the early stages of the disease by 55%. At the same time, early administered antiretroviral therapy prevents the progression of HIV infection, while the number of military personnel who have reached symptomatic stages of HIV infection and the number of deaths decreases by 35,6% and 80,2% (six-fold), respectively. The economic effectiveness of these measures includes a reduced cost of treatment and an increased length of military service. The sensitivity analysis of the method shows that the proposed measures remain pharmacoeconomically highly effective with a wide variability of the initial data.

Conclusion. The results of the study demonstrate that a significant improvement of the epidemiological situation in the field of HIV infection in the Armed Forces is achievable at very low economic costs. With the full implementation of the proposed measures, the cohort of military personnel of the Armed Forces is able to achieve the World Health Organization’s “90-90-90”criteria of in 3–5 years.

Purpose of the study: evaluation of the anthropometric parameters of newborns with realized perinatal transmission of HIV.

Materials and methods: The article presents the analysis of the main anthropometric parameters (length, weight, head and chest circumference) of 147 infants born to HIV-infected mothers who were divided into 2 groups of observation (with realized and unrealized transmission of HIV).

Results: These results demonstrate that a reduction in comparison with the normative parameters of anthropometric indicators such as body weight, head circumference and chest circumference at birth, is a distinctive feature, substantiating intrauterine infection with HIV. Indicators body length did not significantly deviate from the norm in both groups observation that, apparently, was associated with a short-term impact of HIV on the child body during pregnancy.

Aim: Analysis of enterovirus infection morbidity and characteristics of the etiological agents of this infection on some territories of Russia in 2017.

Materials and methods: We investigated 7858 samples of the biological material from the patients suffering from enterovirus infection. The isolation and identification of enteroviruses were conducted by virological and molecular methods.

Results: The epidemic process and the clinical picture of enterovirus infection on different territories had some peculiarities. On some territories enterovirus meningitis was the predominant form of infection, on other territories enterovirus infection with exanthema prevailed. In Saint-Petersburg, Archangel and Saratov regions the percentage of enterovirus infection cases with the clinical picture of enterovirus meningitis was significantly higher than the percentage of enterovirus infection with exanthema. In the Komi Republic, Leningrad and Murmansk regions the percentage of infection with exanthema was statistically higher than the enterovirus meningitis portion. Enteroviruses of 30 serotypes were detected in the samples of patients suffering from enterovirus infection. We determined the etiology of sporadic and epidemic cases of enterovirus infection represented by different clinical forms. On some territories the epidemic foci of enterovirus infection among children were revealed. The etiological agents of enterovirus meningitis foci in Saint-Petersburg, Murmansk and Saratov regions were Coxsackievirus B5, Coxsackievirus B4 and Echovirus 30. The foci of enterovirus infection with exanthema in Archangel, Leningrad, Murmansk and Novgorod regions were caused by Coxsackieviruses A10, A16 and A6.

Conclusion: The clinical forms of enterovirus infection on some territories were provoked by enteroviruses which dominated in the circulation on one or other territory. Enteroviruses of species B, mainly Echovirus 30, Echovirus 6 and Coxsackieviruses B1–6 were the etiological agents of enterovirus meningitis. The etiological factors of enterovirus infection with exanthema were Enteroviruses of species A, mainly Coxsackieviruses of different serotypes as well as Enterovirus 71.

2020 began with the most significant pandemic COVID-19 in the history of this century. The epidemiology indicators are growing every day. The spread of COVID-19 may affect an increase in the incidence of tuberculosis, despite a decrease in the incidence rate that is associated with objective difficulties in detecting tuberculosis against the background of COVID-19 and severe complications after the new coronavirus infection. Tuberculosis is one of the infectious diseases, and the problem of its spread continues to be relevant throughout the World. The effect of the SARS-CoV-2 virus can cause certain difficulties in the diagnosis and treatment of tuberculosis infection. The possibility of concomitant these infectious diseases can affect the clinical course of tuberculosis, an influence on mortality of the disease, but at the same time, there is a decrease in the number of cases that is not objective. The authors analyzed the currently published data on detecting tuberculosis in the conditions of the COVID-19 problem and presented difficulties in the diagnosis of COVID-19 and TB concomitant diseases with a description in the clinical case.

In the presented clinical case, the combination of two pathogens (enterovirus and streptococcus) caused a severe and atypical course of the hand-foot-mouth syndrome in a child of primary school age. EVI from the first days of the disease represented by the typical localization of the primary elements of the rash and the characteristic intoxication syndrome was confirmed by the detection of enterovirus RNA in the feces. The course of the disease was undulating. In the first wave, skin rashes accompanied by soreness and itching corresponded to the classical EVI in terms of the nature of the elements, their localization and were combined with lesions of the epithelium of the oral mucosa. Starting from the 5th day of the disease, against the background of an increase in the severity of intoxication syndrome, bullous elements appeared on the skin of the extremities, an excess of the permissible values of antistreptolysin-O was found 12 times, and when sowing material from cracks in the corner of the mouth, Streptococcus pyogenes 10⁶ KUO was isolated, which indicated a combination of the syndrome Hand-foot-mouth with streptococcal infection. Onychomadesis in the period of convalescence retrospectively testified to the dominant role of enterovirus in the presented clinical case.

Visceral leishmaniasis is a generalized infection of the reticuloendothelial system, it is fatal if left untreated in most cases. Early diagnosis and effective therapy can reduce the risk of disability and mortality. However, in non-endemic areas diagnosis may be delayed or missed. In the article we presented a case report of a child with imported visceral leishmaniasis. The gradual onset of the disease with irregular fever, growing weakness, fatigue, loss of appetite, anemia, cytopenic syndrome required differential diagnosis with oncological diseases. The diagnosis of leishmaniasis was made by microscopy of a bone marrow smear and the detection of leishmania. Recovery occurred after the prolonged course of amphotericin B and supportive treatment.