Vol 25, No 4 (2020)

ORIGINAL STUDIES

Epidemiological risks and lessons from the first wave of new coronavirus infection (COVID-19) in medical organizations

Sisin Y.I., Golubkova A.A., Kozlova I.I., Ostapenko N.A.

Abstract

BACKGROUNDHealth workers, who have been at the forefront of efforts to counter the COVID-19 pandemic, have become one of the main risk groups for SARS-CoV-2 infection. The study of the incidence of a new coronavirus infection of medical workers and the development of measures to protect them is an urgent task.

AIMS: Study of epidemiological risks and features of the incidence of COVID-19 in medical organizations for the development of proposals for the adjustment of preventive and anti-epidemic measures in the context of a new wave of coronavirus infection.

MATERIALS AND METHODSWe examined reporting forms “an overview of cases with positive COVID-19” (138 items), “an overview of cases of community-acquired pneumonia with positive COVID-19” (138 units), the card of epidemiological investigation of the disease COVID-19 health workers (386 units of information), copies of “Acts of epidemiological investigation of infectious (parasitic) diseases, establishing causal relationships” (47 units of information), copies of extraordinary reports about the emergency situation of sanitary-and-epidemiologic nature (47 items).

RESULTS: The incidence of COVID-19 among healthcare workers (40.1‰) correlated with the same indicator in the adult population and was 2.6 times higher. The incidence of pneumonia and COVID-19 deaths in health care workers and adults did not differ. The complete set of personal protective equipment was observed in contact with the sick from 100.0 to 62.5% in various departments. More than half of the affected employees had a source of infection in the immediate environment, in 63.2% of cases it was colleagues. The most likely places of infection were places of work (66.8%) and places of residence (30.3%).

CONCLUSIONSThe epidemic process of coronavirus infection among employees of medical organizations correlated with the incidence of adult population had a higher incidence rate than among them, without differing in severity and outcomes of COVID-19. The prevalence of morbidity in medical organizations was the predominance among the affected employees of medical organizations. Conditions that contribute to infection were various violations of preventive and anti-epidemic measures, including the use of personal protective equipment.

Epidemiology and Infectious Diseases. 2020;25(4):156-166
pages 156-166 views

Physiciansʼ awareness level assessment of the epidemiology and diagnosis features of nosocomial infection caused by Clostridium difficile in a multidisciplinary hospitals

Khasanova G.R., Yakupova G.R., Kondratieva K.A., Lokotkova A., Bulycheva I.A., Shaikhrazieva N.D.

Abstract

BACKGROUND: Clostridium difficile has an important place among healthcare associated infections pathogens, mainly due to the widespread and inappropriate antibiotics use. Over the past 10 years an incidence of this infection has increased in the USA and European countries. Unfortunately, C. difficile infection cases in the Russian Federation are almost not register, probably due to the lack of physicians awareness and underestimation of the pathogen role in the etiology of nosocomial infections.

AIM: Is to study the different specialties physicians awareness of C. difficile infection development in multidisciplinary hospitals.

MATERIALS AND METHODS: A questionnaire survey of 115 physicians of two multidisciplinary hospitals in Kazan was carried out. The questionnaire included 15 questions related to etiology, transmission mechanism, risk factors, clinical presentation, diagnosis and prevention of C. difficile infection. Statistical data processing was carried out in MS Excel. We used Fisher’s exact test for comparisons questionnaire responses indicators. P-values below 0.05 were considered statistically significant.

RESULTS: A low level of physicians awareness on this issue was revealed. 92.2% of physicians did not have any C. difficile infection cases in their practice. 31.3% of respondents underestimate the role of antibiotic use as the main risk factor for the development of the disease; at the same time, there are frequent cases of unreasonable prescription of antibiotics. 32.2% of the respondents are poorly informed about diagnosis methods of clostridiosis. 20% of physicians deny the role of bacteria carriers as a source of infection. 77.4% of respondents indicated the alimentary route as the main route of infection transmission. Only 38.2% of respondents noted the hospital environment objects as a possible factor in the transmission of C. difficile.

CONCLUSIONS: There is no alertness regarding antibiotic-associated diarrhea caused by C. difficile infection among multidisciplinary hospital physicians. Insufficient knowledge of epidemiology, clinical manifestations, laboratory diagnostics of C. difficile infection are factors that determine the low frequency of its detection and, accordingly, impede the implementation of required anti-epidemic measures. There is a need to include C. difficile infection issues in professional development programs for medical workers. It is advisable to develop and implement C. difficile infection control.

Epidemiology and Infectious Diseases. 2020;25(4):167-173
pages 167-173 views

CASE REPORTS

Toxic epidermal necrolysis (Lyell’s syndrome) in a patient with HIV infection

Popova D., Voznesensky S.L., Soboleva Z.A.

Abstract

Lyell’s syndrome, or toxic epidermal necrolysis, is a skin disorder characterized by extensive exfoliation of the epidermis. The prognosis for this disease is poor due to damage to the visceral organs, electrolyte disturbances and the risk of infection. The article describes a clinical case of Lyell’s syndrome in an HIV-infected patient who was first prescribed ART in combination with valganciclovir. The diagnosis was made on the basis of characteristic clinical manifestations and the exclusion of another similar pathology. On the background of the therapy, the rash regressed, the areas of damaged skin became epithelialized, and the body temperature returned to normal. A differential diagnosis was made with measles, Stevens-Johnson syndrome, staphylococcal infection. Against the background of the therapy, the patient’s condition was positive.

Epidemiology and Infectious Diseases. 2020;25(4):174-182
pages 174-182 views

‘Semi-third-day fever’ according to special observations and experiments carried out in the southern countries of Russian Empire. Described by Dr. Iog Mart Minderer in 1770–1772

Volchkova E.V.

Abstract

The article “Semi-third-day fever” is based on personal experience obtained during the hostilities in the southern regions of the Russian Empire in 1770–1772 by Doctor Ioannes Mart Minderer, Active State Councilor and companion, correspondent of various scientific societies, and member of the Imperial Medical and Surgical Academy. At first glance, the “semi-third-day” fever described by the author looks completely mysterious, but an attentive reader can solve this puzzle based on a detailed description of the course of the disease by days, clinical symptoms, course options, and most importantly, the climatic and geographical characteristics of the area, which is characterized by the spread of this disease, as well as based on own clinical experience and contemporary literature. The logical chain created by the author is of particular note, as it linked together the clinical presentation, geographical, climatic, and social conditions under which the disease considered develops, which is essentially a prelude to the formation of understanding of the role of environmental factors in the development and spread of various infections. Despite the archaic language of presentation, the article is percepted with great interest and is an example of a deep and comprehensive approach to the material analyzed.

Epidemiology and Infectious Diseases. 2020;25(4):183-191
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LETTERS TO THE EDITOR

Semi-third-day fever in view of modern medicine

Avdeeva M.G.

Abstract

It is difficult for a modern doctor who relies on a wide range of laboratory diagnostic capabilities to imagine the path of mistakes, insights and delusions traveled by doctors of the past. How exactly through clinical observation the disease was observed. The archival article “Half-tree-day fever” published in the journal is an example of a clinical and epidemic description of an outbreak of an acute infectious disease, the etiology of which remains unknown. The more interesting are the distinguishing issues of differential diagnostics.

Epidemiology and Infectious Diseases. 2020;25(4):192-194
pages 192-194 views


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