Lead article
Given that COVID-19 is a global public health problem and that almost all countries in the world have been severely affected by the COVID-19 pandemic, research is being actively pursued to better understand the effects of the virus on human cells. However, it is not clear what changes are observed in the cells of the main gate of infection – the mucosa of the mouth and the nose at different clinical forms and at different periods of disease. Understanding the ultra-structural cell changes of SARS-CoV-2 targets may help clarify the pathogenic aspects of infection in the lower respiratory tract. In this study, the elements of the life cycle of SARS-CoV-2 virus in the cells of the respiratory epithelium of the nose in patients with COVID-19 were evaluated using electron microscopy for the purpose of detecting the peculiarities of viral activity depending on the form and period of disease. Bioptats of the nasal mucous membrane were taken from COVID-19 patients and subsequently examined by electron microscopy. The severity of structural changes in tissue samples, presence of SARSCoV-2 virus in cells were determined, then bioptats were grouped according to the clinical form of the infection process (inapparent, acute upper respiratory tract infections, viral lung disease) and period of disease. It has been established that the most characteristic changes in the mucous membrane of the nose were observed in the first week of infection caused by SARS-CoV-2 and occurring in the form of acute respiratory disease, while viral lung infections have had the highest virus density in vesicles within cells, the formation of smooth virus-free vesicles is most common in inapparent forms. The data obtained may indicate that the formation of classical virus-induced changes in the respiratory epithelium of the nose mucous (vesicles with viral particles and signs of their release from the cell) is characteristic of localized forms of infection caused by SARS-CoV-2 (respiratory infection of the upper respiratory tract) and in cases of generalized infection (viral infection of the lungs and probably other organs and systems) accumulation of the infectious agent in high concentrations in vesicles.
Review
The prevalence of invasive candidiasis (IC) in pediatric hospitals is from 4,3 to 15,2 per 10,000 hospitalized, in ICU – from 3,5 to 7 cases per 1,000, with HSCT – 2,9%. The average length of stay of a patient in the hospital before the development of IC varies from 21 to 56 days, in the ICU – more than 15 days. Knowledge of risk factors (ICU stay for ≥15 days, use of antibacterial drugs and parenteral nutrition, active malignant neoplasm, etc.) makes it possible to identify patients with a high (10-46%) risk of developing IC. Candida albicans remains the leading causative agent of IC in children, but infections with non-albicans Candida spp. have increased and an increase in the resistance of IC pathogens to azole antimycotics was noted. The main clinical variant of IC in children is candidemia, other forms include the central nervous system, abdominal organs, eyes, heart, bones and joints, kidneys, skin and subcutaneous tissue involvement, as well as chronic disseminated (hepatolienal) candidiasis. Blood culture, the main method of laboratory diagnostics of IC, is characterized by low sensitivity and requires a long time. Methods of noncultural diagnostics of IC (1,3-β-D-glucan, mannan and antimannan antibodies, T2 Candida etc) in children have not been sufficiently studied. The main drugs for the treatment of IC in children are echinocandins (anidulafungin, etc.), and CVC removal/replacement is necessary. The overall mortality rate in pediatric patients within 30 days after the diagnosis of IC is 37% to 44%.
Hepatitis B is most common among young people, which is explained by the ways of infection – parenteral, sexual and vertical. Mother-to-child transmission is the main route of infection for children in areas where the hepatitis B virus (HBV) is endemic.
The available current data on the course and outcomes of chronic viral hepatitis B are contradictory in pregnant women. Some authors argue that the exacerbation of chronic hepatitis B is more common in the first and third trimesters in pregnant women, and with an increase in gestation, there is a deterioration in liver function and an increased risk of fulminant liver failure. Other researchers note a more severe course in the second half of pregnancy or in the first months after delivery.
High replication of the virus increases the frequency of gestational diabetes mellitus, hemostatic disorders, the threat of termination of pregnancy, gestosis, fetoplacental insufficiency, risk of bleeding in childbirth, premature birth, untimely discharge of amniotic fluid, and the birth of premature babies.
Children become chronic carriers of HBsAd in neonatal hepatitis. These findings suggest that transplacental infection before birth may be a mechanism contributing to higher rates of failed prevention in newborns born to women with a high viral load.
We could not find data on the features of the course and outcomes of viral hepatitis D in pregnant women in the available sources,. At the same time, it is known that mixed infection is more severe.
Polymorphisms of genes associated with the regulation of the state of the vascular wall can have a significant impact on the course of infection.
The high prevalence of hepatitis D infection in different parts of the world indicates the need for a comprehensive study of this disease, followed by the development of special programs for the prevention, early diagnosis and treatment of hepatitis B and D in pregnant women.
Original Research
The aim of this work was to attempt to analyze the demographic structure, clinical and radiological forms of tuberculosis and COVID-19, as well as the course and outcome of the disease in patients with this coinfection in the light of a new and still poorly understood problem of the mutual influence of tuberculosis and COVID-19.
Material and methods. Examination and treatment were carried out in the infectious-tuberculosis departments of the Botkin Clinical Infectious Disease Hospital. We examined 63 patients identified in the first seven months of the epidemic in the multimillion city of St. Petersburg (Russia). Tuberculosis, confirmed by conventional bacteriological and molecular genetic methods, had an active phase in all of them. The new coronavirus infection was verified by a positive polymerase chain reaction test for SARS-CoV-2.
Results. Tuberculosis in 43 patients was detected simultaneously with COVID-19, in 20 people it preceded coronavirus infection. Disseminated forms of tuberculosis prevailed - 50.8%; in 36.5%, two or more organs and systems were affected, which is associated with a high proportion (54.0%) of HIV-positive patients with an advanced stage of the disease. Lung damage with COVID-19 was noted in 36.5%. Fatal outcomes ended in 20.6% of cases of coinfection, the structure of the causes of death is given.
Conclusion. An assumption was made about the possibility of an aggravating effect of tuberculosis on COVID-19 in the case of severe or widespread forms of these diseases. The negative influence of HIV infection on the outcome of the disease has also been shown. Further follow-up is required to identify more reliable associations between tuberculosis and COVID-19.
Introduction. The issue of protection against vaccinepreventable diseases has acquired new urgency in connection with the decrease in the vaccination rate established by WHO against the background of the COVID-19 pandemic. This creates the conditions for outbreaks and puts patients with immunopathological diseases at particular risk, who are most often not vaccinated from the moment of diagnosis Purpose of the study – to assess the safety of specific antibodies to measles, mumps, rubella and diphtheria in children with JIA, depending on the duration of vaccination, the duration of the disease and the therapy received.
Materials and methods. The vaccination rate of 171 children with juvenile idiopathic arthritis (JIA) aged (11,31±0,31 years) with the duration of the disease at the time of examination was 4,69±0,29 years, who had previously received 1-2 vaccinations against measles, mumps, rubella and 3-6 vaccinations against diphtheria. Antibodies to these infections were determined by ELISA.
Results. 42.1% of children had no protective titers of antibodies to measles, 19,9% – to mumps, 9,4% – to rubella and 16,4% – to diphtheria. Among 93 vaccinated and revaccinated patients, there were no protective titers of antibodies to measles – 40,9% (38 children), mumps – 13,9% (13 people), rubella – 5,4% (5 children), and among 78 vaccinated once, respectively: measles – 43.6% (34 children), mumps – 25.6% (20 children), rubella – 14,1% (11). The level of protection against diphtheria was comparable for those who received 3-5 vaccinations. Depending on the therapy, 3 groups were identified: group 1-71 children received metatrexate and glucocorticosteroids, 2-82 children received modifying anti-rheumatic drugs (DMARD) and 18 children without this therapy (Group 3). Children of the 2nd group were on average older (12,48±0,42 years) than in the 1st and 3rd groups (10,04±0,48 and 10,96±0,96 years, respectively), they had significantly more frequent systemic variant and polyarthritis (64,6% compared to 36,6% and 16,7%, px2<0,001). The number of vaccine doses received by children in all groups before the onset of the disease did not significantly differ. >˂0,001). The number of vaccine doses received by children in all groups before the onset of the disease did not significantly differ. The average level of antibodies to measles in children of group 2 (0,32±0,07 IU/ml) was 2,8 times less than in group 3 and significantly less than in group 1 (0,78±0,16, Pt=0.009), the average value of antibodies to rubella was also significantly less in group 2 (84,48±7,34 IU/ml) than in group 1 (109,73±8,09, Pt=0,022) and in group 3 (120,01±15,42, Pt=0,042). The analysis showed that the safety of antibodies to antigens of live vaccines, especially against measles, is negatively affected by the duration of the disease and the nature of therapy. Children who received combined therapy with anti-TNF, anti-IL-6 and anti-CD-80 drugs had a longer duration of the disease (7,5±0,97 years)=0,00082 compared to those who received only anti-IL-6 (2,9±0,7 years) and antiTNF therapy (6,1±0,5 years) and with a comparable number of vaccine doses received, significantly lower average values of antibodies and a larger number of unprotected ones.
Conclusions. The duration of the disease, the lack of timely age-related revaccinations, as well as the presence of combination therapy aimed at suppressing various mechanisms of the immune response in children with JIA are factors that lead to an increase in the number of unprotected from controlled infections. Immunity to measles suffers the most – 40.9% of revaccinated people are unprotected.
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.
Purpose. Analyze and identify the features of the course of the new coronavirus infection (COVID-19) in HIV-infected patients.
Materials and methods. An analysis of the course of coronavirus infection (COVID-19) was carried out in 16 patients with HIV infection who were hospitalized at the St. Petersburg State Budgetary Healthcare Institution Center for the Prevention and Control of AIDS and Infectious Diseases from April to October 2020. All patients underwent a study of biological material from the oropharynx and nasopharynx for COVID-19 and diagnosed based on a positive PCR result.
Results. In HIV-infected patients with diagnosed coronavirus infection caused by COVID-19, signs of progression of HIV infection, clinical, immunological, virological (75%), opportunistic diseases and comorbidities (chronic viral hepatitis in the cirrhotic decompensated stage, cardiovascular diseases and others) (94%). A small sample of patients did not allow to determine with reliable accuracy the mutual influence of existing diseases and pathologies, but, of course, multiple comorbid pathologies play a role in the development of severe conditions and unfavorable outcomes. A clinical case is presented.
Conclusion. The provoking factors have been identified that play a role in the development of infection and more severe forms of coronavirus infection caused by COVID-19 in HIV-infected patients (injecting drug use, alcohol abuse, late stage of HIV infection (4B, 4C) and progression of earlier stages (4A ), a low number of CD4 lymphocytes (less than 200 cells / μl), multiple comorbid pathology (HIV infection, opportunistic diseases, comorbidities, especially chronic liver damage in the stage of decompensated cirrhosis), absence, interrupted antiretroviral therapy, multiple changes of regimens, absence prevention of opportunistic diseases). A patient with HIV infection at ART. 4B with multiple comorbidity, the possibility of long-term persistence of the COVID-19 virus coronavirus with positive and negative results for more than 2 months and later development of lung damage caused by COVID-19 was established.
Positive results have been achieved during the implementation of the measles elimination program in the Russian Federation and in the Northwestern Federal District (NWFD). However, measles remains an urgent problem for some regions due to the peculiarities of this infection.
Purpose of the work: to characterize the clinical, epidemiological and molecular genetic characteristics of measles in adults during the period of increasing incidence in St. Petersburg.
Materials and methods: the incidence of measles in the Northwestern Federal District was analyzed in 2006–2020, and the data of 30 patients of S.P. Botkin clinical infectious diseases hospital over 18 years old (2018). The diagnosis of measles is confirmed by enzyme immunoassay. Molecular genetic studies (PCR, sequencing) were carried out at the National Scientific and Methodological Center for the Surveillance of Measles and Rubella of G.N. Gabrichevsky Moscow Scientific Research Institute of Epidemiology and Microbiology, biological material was used (nasopharyngeal washings, urine).
Results: there was an increase in morbidity in some regions of the Northwestern Federal District in conditions of high coverage of the population with measles vaccinations. In the age structure in 2018–2019 the proportion of adults was 65%. 74% of patients were not vaccinated against measles. A moderate-severe course (100%) was noted, regardless of the genotypes of the virus. Clinical manifestations were characterized by febrile, catarrhal and exanthema syndrome. Diarrhea was found in 36,7% of patients, hepatomegaly in 43.4%, and an increase in transaminases in 87%. 66,7% of patients traveled outside St. Petersburg. The genotypes of the virus were identified: B3 Kabul and B3 Dublin of African origin, D8 Girsomnath of Indian origin.
Conclusions: measles remains an urgent problem, in recent years, adults prevail among patients, both local and imported cases are recorded. The clinical course of the disease may be accompanied by intestinal complications and other symptoms that make it difficult to diagnose at the prehospital stage. The use of molecular genetic methods makes it possible to identify the pathogen, assess the identity of viral isolates, and improve the epidemiological surveillance of the infection.
The maximum incidence of pertussis in young children confirms the importance of their timely immunization.
The goal is – to study the timeliness of vaccination against whooping cough, causes of violation of the vaccination schedule in young children, the effect of recombinant interferon-a on the post-vaccination period.
Materials and methods: the vaccination history and data on the course of the post-vaccination period after immunization with DPT and DaPT vaccines of 469 children at the age of 3–24 months were studied.
Results. The analysis showed that 14,9% of the observed children were not vaccinated against whooping cough in a timely manner. Of these: 34,3% had a written refusal to vaccinate (5.1% of the total number of observed children), in 32,8% of cases, the vaccination schedule was violated due to late arrival of parents, 32,9% of children by the start of immunization had medical challenges, and only half of them had justified contraindications. Non-serious side effects associated with immunization were observed in 11.3% of cases, statistically more often with DTP (22,0%) compared with DaPT (5.,5%). General and local reactions, in general, were recorded on DPT (6,9% and 15,1%, respectively) and less often developed with the use of DaPT (1,0% and 4,5%, respectively). Within 1 month after immunization, 16,2% of the observed children had an acute respiratory viral infection of varying severity. Those who did not receive antiviral therapy more often carried the disease in a moderate and severe form, which in all cases led to the postponement of the administration of the second and third doses of the vaccine.
Conclusion. To increase the timeliness of vaccination of children against whooping cough, medical professionals should persistently remind parents about the timing of turnout for the next vaccination, when making medical withdrawals, be guided by modern methodological documents and instructions for vaccines. The use of antiviral and immunomodulatory effects of IFN-alpha drugs allows us to comply with the recommended schedule for vaccination of children with a high risk of SARS in the post-vaccination period.
Тhe aim: to analyze the cases of complications of BCGvaccination in children, potential risk factors, patient management tactics.
Materials and methods: The statistical data on local complications of BCG-M vaccination in Saint Petersburg (Russia) from 2012 to 2019 was studied. To verify the diagnosis of post-vaccinal complication the Mantoux test, diaskintest or QuantiFERON-TB, X-ray examination, morphological and bacteriological examination were used in cases of indication. Observations of 22 children aged from 1,5 months to 1,5 years with complications after vaccination with BCG-M were analyzed.
Results. Since 2010, the sparing BCG-M vaccine has been used in St. Petersburg for primary immunization. The incidence of local complications over the past 8 years was 0,002% – 0,012% of the number of vaccinated children. A cold abscess was diagnosed in 11 (50,0%), BCG-lymphadenitis in 9 (40,9%), an ulcer in 2 (9,1%) children. In 14 (63,6%) of 22 children complications of vaccination were detected in the phase of abscess formation. Fore children underwent surgery with diagnoses of nonspecific lymphadenitis (3), soft tissue abscess (1). In these cases, diagnoses of BCG-M complications was established only after morphological examination of the surgical material. In children with complications while the results of Mantoux test were positive, results of diaskintest and QuantiFERON-TB were negative. The detection of Mycobacterium bovis BCG was possible in 5 patients by culture and polymerase chain reaction methods. 2 clinical cases are given.
Conclusion: It is necessary to increase the knowledge of pediatricians, pediatric surgeons, nurses of BCG vaccination techniques, diagnosis and treatment of post-vaccination complication, indications for dispensary observation.
Vertical transmission of viral hepatitis B (HBV) is one of the main transmission ways in endemic regions. There is a relationship between structural changes in the placenta and the clinical course of HBV infection. The risk of vertical transmission of hepatitis B depends on the condition of the placenta.
The goal of this work was to study the relationship between HBsAg and / or HBcorAg expression in placenta on the one hand, and clinical parameters of mothers and newborns on the other hand.
The study included 19 patients with CHB who gave birth at the Botkins infectious disease hospital in 2019. The first group included patients with markers of HBV infection (HBsAg and / or HBcorAg) detectable via immunohistochemical examination in at least one of the layers of the placenta. In patients from the second group, no markers of HBV infection were detected in any layer of the placenta. Inflammatory changes in placenta were detected in all women from the first group and in 9 (64%) women from the second group. HBsAg in umbilical cord blood was detected in 3 (16%) newborns. In two patients, whose children had HBsAg in the umbilical cord blood, no markers of HBV infection were detected in placenta. In the first group, only one newborn had HBsAg in umbilical cord blood. In two patients receiving an antiviral treatment during pregnancy, markers of HBV infection were identified in the placenta. Markers of HBV infection in placenta were also detected in women with undetectable viral load.
Conclusions
- Markers of HBV infection can be found in placenta at low maternal viral load.
- HBsAg in umbilical cord blood can be detected even in patients with no markers of HBV infection in placenta.
- Antiviral treatment during pregnancy does not prevent the possibility of placenta’s infection with HBV.
Objective: to study the circulation and prevalence of phage-resistant strains among opportunistic enterobacteria, isolated from children with disorders of intestinal microflora, in relation to domestic preparations of bacteriophages.
Materials and methods. A bacteriological study of the fecal microflora of the colon in 970 young children for dysbiosis was carried out. The sensitivity of 720 antibiotic-resistant strains of opportunistic enterobacteriaceae (S. aureus, K. pneumoniae, P. mirabilis and P. vulgaris, P. aeruginosa, E. coli, coagulase-negative staphylococci) isolated from children to domestic mono- and polyvalent drugs was studied (coliprotein, staphylococcal, Pseudomonas aeruginosa, purified Klebsiella pneumonia bacteriophage, “Sextafag”, Intesta bacteriophage). Determination of sensitivity to bacteriophages was carried out by the “sterile spot” method. Antibiotic sensitivity was determined by the disk diffusion method. Statistical processing of the results was carried out using the Microsoft Office Excel 2007 software package.
Results. A large percentage of phage-resistant strains with low sensitivity to bacteriophages was revealed among opportunistic bacteria, amounting to 54,2%, with the highest circulation among coagulase-negative staphylococci, Proteus, Klebsiella (more than 50%). A significant spread of intestinal dysbiosis was established in young children (87,5%), characterized by a low content of bifidobacteria and a high level of allocation of opportunistic enterobacteria, including in associations.
Conclusion. As a result of the studies, a significant prevalence of phage-resistant strains in children with dysbiosis was revealed, which indicates the need for preliminary determination of their sensitivity to bacteriophages in order to resolve the issue of their possible inclusion in the intestinal microflora correction system.
Purpose: to establish the frequency and clinical significance of mutant variations of the HFE gene polymorphism in chronic hepatitis B (CHB) in children with iron overload syndrome (IOS).
Materials and methods: 60 children with chronic hepatitis B with iron overload syndrome (IOS) were examined. When distributing children into groups, we took into account the criteria we developed for assessing the degree of life expectancy in children with CHB: CST>0.5 – mild degree of life expectancy (43,3% of children), CST˃0.5 – mild degree of life expectancy (43,3% of children), CST˂0,5 – moderate severity of life expectancy (31,7% of children) and CST˂0,2 – severe degree of SPL (25,0%). Virological verification of HBV was performed by ELISA and PCR. Using PCR Real Time and molecular genetic analysis, HFE gene C282Y, H63D, S65C mutations were detected from amplified DNA using the PRONTO Hemochromatosis reagent kit (Israel). The transferrin saturation coefficient (CST) was calculated using the formula CST = sTfR / log10.Ft. Results:
Results: The study of the hemochromatosis gene HFE showed that the overwhelming majority (84,0%) of children with CHB with IOS were carriers of heterozygous, phenotypically different, mutant types. And only 16,0% of sick children were homozites of the wild (normal) HFE gene. Analysis of the phenotypic polymorphism of the hemochromatosis gene HFE revealed the presence of three point heterozygous mutations: H63D, S65C and combined variations in H63D / S65C, the latter of which is associated with severe forms of CHB and severe IOS.
Conclusion. Children with CHB with IOS are characterized by a high incidence of heterozygous mutations in the HFE gene, the phenotypic manifestations of which were S65C, H63D, H63D / S65C. The comparability of the heterozygous combined mutation H63D / S65C with severe forms of CHB and a severe degree of IOS gives grounds to consider this phenotype of the HFE gene as a factor in the progression of the disease.
Epidemiology
Aim: to assess the incidence, prevalence of HIV infection and population dynamics in populations with negative, zero and positive natural increase.
Materials and Methods: Computer probabilistic modeling by the Monte Carlo method of the epidemic process of HIV infection in populations with different natural population growths was carried out. The parameters that are minimally necessary for such a description are used – population, birth rate, mortality, HIV prevalence, probability of HIV transmission.
Results and discussion: When modeling the epidemic process, two main scenarios of the spread of HIV infection in a population without diagnostic, therapeutic and preventive effects were established. With a negative or zero population growth and a random distribution of healthy and infected individuals in the simulated space, the population density gradually decreases. At some point, the probability of contact of the infected and healthy person becomes less than the probability of an infected person to live up to this event. Under such conditions, the complete elimination of the virus from the population is theoretically possible. With a positive natural increase, it is possible to form a stable state in which the periods of increase in population size, incidence and prevalence of HIV infection change in a cyclical decline. HIV prevalence in countries such as Swaziland, Botswana and Lesotho has been at the level of 25–30% for many years. In this case, the population steadily grows. Based on the conducted simulation studies, it can be assumed that in these territories an evolutionarily stable balance was formed between the share of healthy and HIV-infected people in which the prevalence does not occur above 30%.
Conclusions. The development of the epidemic process of HIV infection is determined by the dynamics of natural population growth. With a negative or zero natural growth and a random distribution of individuals in the simulated space, a complete elimination of the virus from the population is theoretically possible. With a positive natural increase, it is possible to form an evolutionarily stable cyclic balance between the proportion of healthy and HIV-infected people.
The goal is to identify the epidemiological, territorial-epidemiological, environmental, clinical and features of hemorrhagic fever with renal syndrome in order to improve epidemiological surveillance in a large metropolis of the Northwestern Federal District.
Materials and methods. An epidemiological analysis of cases of hemorrhagic fever with renal syndrome in St. Petersburg for 2005–2019 was carried out and the clinical and epidemiological characteristics of 135 patients hospitalized in the S.P. Botkin Clinical Infectious Disease Hospital were studied. 70 patients identified combined HFRS diseases associated with other pathogens of viral and bacterial nature. An epidemiological analysis of cases of hemorrhagic fever with renal syndrome in St. Petersburg for 2005–2018 and long-term monitoring of the zoological, epizootological state of small mammals in several districts of St. Petersburg and its suburbs were carried out. The clinical and epidemiological characteristics of 135 patients were studied, of which 70 patients identified combined hemorrhagic fever with renal syndrome diseases associated with other pathogens of a viral and bacterial nature. To assess the epizootological situation, trapped rodents were examined for the presence of viral antigen and antibodies using the method of indirect immunofluorescence with the Xantagnost diagnosticum and enzymelinked immunosorbent assay.
Results. The long-term dynamics of the incidence rate in St. Petersburg had a fluctuant rising character with two peaks. The proportion of diseases during the first rise was 11,5%, the second – 44,2% of the long-term incidence. Men prevailed in the age groups of 20-49 years without changes in periods. The proportion of women 20–49 years old was 20,7%, increased to 52,8 % in age groups over 50 years old. When distributed by month in a period of high incidence, the seasonal rise began in September with a peak in October. Infection with hemorrhagic fever with renal syndrome patients – residents of the city occurred mainly (with 35.5%), in the nearby territories of the Northwestern Federal District with 8.9% - in remote areas and with 5,9% in the countries of near and far abroad. The epidemiological situation in places of temporary residence and infection of people was characterized by an increase in the number of small mammals (redbacked voles) and, in particular, infection from 2,9 to 4,4%. Hemorrhagic fever with renal syndrome diseases occurred in the form of moderate severity in 94,4% cases. Severe forms were found in only 5,6% of cases. In the structure of combined infection in 25,9–22,3%, there was a combination of hemorrhagic fever with renal syndrome with gastroenterocolitis and influenza, serologically confirmed. In 17,6% of cases, hemorrhagic fever with renal syndrome was combined with other zoonoses (Lyme disease, tick-borne encephalitis, pseudotuberculosis, leptospirosis, tularemia), in 17,6% with of various etiologies. The presence of combinations of hemorrhagic fever with renal syndrome with other infections complicates the clinical diagnosis.
Clinical Case
Toxoplasmosis is a widespread ubiquatorial disease. A distinctive feature of this parasitosis is the predominance of latent forms. As a rule, in people with intact immune systems, the disease is asymptomatic. Severe cases of toxoplasmosis are usually associated with immunodeficiencies. At the same time, in cases of a manifest course in immunocompetent persons, toxoplasmosis is characterized by a polymorphism of clinical manifestations with damage to almost all organs and systems. In addition to the widely reported lesions of the eyes, brain, and intrauterine infection (IUI) associated with T. gondii, there are reports of damage to the liver, heart, lungs, and even multisystem cases of visceral toxoplasmosis. The article describes a clinical observation of toxoplasma hepatitis in a child with chronic viral hepatitis C. This clinical observation demonstrates the possibility of liver damage in the structure of toxoplasmosis and confirms the significance of this parasitosis among the population of patients with liver diseases.
The article presents clinical data and the results of a detailed pathology changes in a 2-month-old infant who died from a coronavirus infection, confirmed by the results of in vivo PCR and morphological examination, which included the detection of the SARS-Cov-2 spike antigen. Histological examination in the lungs, as well as in the brain revealed cytoproliferative and cytopathic changes similar to those described in coronavirus infection in adults, while other characteristic for them lesions were not determined. The unfavorable course of COVID-19 was facilitated by an activated intrauterine infection, mycoplasmosis or chlamydiosis according to morphological data.
A case of whooping cough in a moderate form in a child of the first month of life is described in the presented clinical observation. The moderate form was manifested by the duration of the preconvulsive period up to 5 days, the appearance of cyanosis of the face when coughing in the early stages of the disease (1 week), an increase in the number of coughing attacks. The difficulties of treating pertussis in young children are demonstrated by our observation of the course of the disease. There is no vaccination against pertussis in children in the family due to the refusal of parents and children with prolonged coughing were not examined at the outpatient stage. As a result, chemoprophylaxis was not performed on time and the newborn was discharged from the hospital to the center of pertussis infection. The solution to the problem of reducing the incidence in children in the first months of life should be vaccination of pregnant women in the last stages, and vaccination of the environment, including agerelated revaccinations.
Parvovirus infection is one of the most widespread infectious diseases in the world. Parvovirus В19 can cause a wide range of clinical manifestations with possible long-term viral persistence. Infectious erythema, arthropathy, fetal infection, and blood cell aplasia are the most common manifestations of parvovirus infection. A case of diagnosis and treatment of a rare variant of parvovirus B19 infection that occurred as acute hepatitis is presented.
The article describes the clinical observation of an HIVinfected patient heterozygous for the mutant allele of the CCR5 del 32 chemokine receptor, who is not receiving antiretroviral therapy. The follow-up showed the course of the disease over 20 years of follow-up, without receiving antiretroviral therapy, with a gradual decrease in the number of CD4-lymphocytes and an increase in viral load.