Vol 25, No 6 (2020)


The use of computer techniques to optimize the diagnosis of tuberculosis in HIV-infected patients at the secondary diseases stage

Umbetova K.T., Arutyunova D.D., Gerasimov A.N., Belaya O.F., Malov V.A., Pshenichnaya N.Y.


ВACKGROUND: The course of tuberculosis in HIV-infected patients has no significant clinical and diagnostic differences from damage to organs and systems of other etiology. The growth of new cases of HIV/TB co-infection necessitates a revision of diagnostic approaches, their improvement in order to increase the efficiency of examination and management of HIV-infected patients, depending on the stage and indicators of the immune status.

AIM: Of the study was to determine by the method of complex statistical processing the main clinical and laboratory-instrumental criteria for improving the diagnosis of tuberculosis in HIV-infected patients at the stage of secondary diseases.

MATERIALS AND METHODS: The study design was retrospective. The object of the research was the case histories of 113 patients with HIV infection at the stage of secondary diseases (classification by V.I. Pokrovsky), of parametric and nonparametric statistics, computer analysis of images with the gradient program proposed by Dr. Sci. A.N. Gerasimov, to assess the possibility of using micro- and macro-preparations of tissues and organs of patients with HIV infection.

RESULTS: Using the method of correlation adaptometry, it was found that there are no significant differences in the clinical course of HIV-infected patients with tuberculosis of various localization, and with lesions of the respiratory organs of other etiology. The use of multivariate probability models made it possible to identify significant diagnostic risk factors for lethal outcome ― 66.7% of patients with further lethal outcome complained of chest pain during breathing (p=0.004), and ESR was significantly accelerated in patients with a lethal outcome in the hospital ― 77±1.99 (p=0.019).

CONCLUSION: The multicomplex instrumental and laboratory examination makes it possible to diagnose tuberculosis of various localization at the initial stage of development. The use of computer techniques optimizes and unifies the diagnostic search in patients with HIV infection and determines the timely treatment tactics.

Epidemiology and Infectious Diseases. 2020;25(6):236-245
pages 236-245 views

Heterogeneity by antibiotic sensitivity and genotype of Vibrio Cholerae El Tor strains isolated from environmental objects in Russia

Selynskaya N., Levchenko D.A., Egiazarjan L., Pasyukova N.


BACKGROUND: Waterborne diseases kill 3.4 million people worldwide each year. Cholera is one such disease. Up to 4 million cases of this infection occur in the world every year, leading to more than 100,000 deaths. The plasticity of the genome of the causative agent of cholera, the mobility of genetic elements carrying factors of pathogenicity and antibiotic resistance, contribute to the variability and unpredictability of the spectrum of resistance, the formation of new pheno- and genotypes. A single Vibrio cholerae isolate can contain up to 40 different genes that can confer resistance to 22 antibiotics, representing nine different classes of antimicrobial drugs. The ability of Vibrio cholerae to long-term survival in aquatic ecosystems in which there is an active exchange of genetic information and new ecological lines may arise that have potential advantages in the adaptation of microorganisms to adverse conditions, emphasizes the complexity of the ways of transmission of this infection and the need for studies at the environmental level. Periodic deliveries of cholera to the territory of the Russian Federation with (without) the spread of the infectious agent, V. cholerae contamination of surface water bodies used as sources of water supply and for recreational water use, the possibility of implementing the main route for cholera (water) the pathway for the spread of the pathogen of the infection indicate the need for conducting annual monitoring of antimicrobial resistance as part of the epidemiological surveillance of cholera in order to obtain information on the distribution, nature and dynamics of resistance in a specific period of time in a given territory.

AIM: Analysis of the spectrum of antibiotic resistance of Vibrio cholerae O1 serogroup strains isolated from environmental objects in various territories of the Russian Federation in 2020.

MATERIALS AND METHODS: 25 strains V. cholerae О1 El Tor, isolated from environmental objects in the Russian Federation in 2020. The sensitivity / resistance of the studied strains to 13 antibacterial drugs was determined by the method of serial dilutions on a solid nutrient medium in accordance with guidelines. PCR-genotyping of strains V. cholerae El Tor was performed for 14 target genes, followed by cluster analysis.

RESULTS: The strains showed resistance markers to furazolidone, trimethoprim/sulfamethoxazole, ampicillin, nalidixic acid, ceftriaxone, which formed 5 phenotypes. PCR-genotyping genotyping of 14 target genes divided the strains into five genotypes (A1–A5), corresponding to certain territories. The antibiotic resistance profiles within the same genotype in V. cholerae О1 El Tor belonging to different territories were both the same and different.

CONCLUSION: The genotypic diversity of isolated strains was revealed, the variability of resistance markers even in one region, which indicates both changes in the V. cholerae population and the possibility of circulation of various geno- and phenotypes, which emphasizes the importance of constant monitoring of these pathogens.

Epidemiology and Infectious Diseases. 2020;25(6):246-252
pages 246-252 views

Epidemiological features of hepatitis B in the Russian Arctic

Fomicheva A.A., Pimenov N.N., Komarova S.V., Urtikov A.V., Paevskaya O.A., Tsapkova N.N., Chulanov V.P.


BACKGROUND: Hepatitis B is an urgent medical and social problem in Russia.

AIM: To determine the epidemiological features of the hepatitis B in the Russian Arctic.

MATERIALS AND METHODS: We carried out a retrospective analysis of the incidence of hepatitis B (acute and chronic forms) in 9 Russian Arctic regions, 3 subarctic regions (Khanty-Mansiysk Autonomous Okrug, Magadan Region, Kamchatka Territory) and Russian Federation in 1999–2019. We also studied the prevalence of chronic hepatitis B and vaccination data against hepatitis B in these territories.

RESULTS: From 1999 to 2019 the incidence of acute hepatitis B in three subarctic regions decreased 166 times (from 66.5 to 0.4 per 100 thousand population), in the Arctic zone of 74.5 times (from 29.8 to 0.4 per 100 thousand population) and 73 times in Russia (from 43.8 to 0.6). The incidence of chronic hepatitis forms in the same period in the Arctic zone decreased by 8.6 times (from 140.1 to 16.3), 5.8 times in the subarctic regions (from 116.6 to 20.0) and 5.7 times in Russia (from 96.3 to 16.8). In 2018, the results of the prevalence of chronic hepatitis B in the Arctic zone (697.3) was higher than in Russia by 98% (352.1) and higher in the subarctic regions by 67% (588.6). Timely coverage of hepatitis vaccination in children aged 12 months in the Russian Federation, the Arctic zone and the subarctic regions is maintained at a high level (more than 90%) from 2004 in 2019. Coverage of children by vaccination to 17 years inclusive and adults up to 35 years on these territories also exceeded 90%.

CONCLUSIONS: Vaccination against hepatitis B in the Russian Federation led to a significant decrease in the incidence of this infection in the Russian Arctic. High prevalence of infection indicates the need to continue the program of mass vaccination and the timely introduction of the first dose of vaccine newborns. To reduce the risk of cirrhosis and liver cancer, it is necessary to increase the availability of diagnosis of the disease and its possible outcomes in the Arctic regions and timely provision of antiviral treatment of all patients.

Epidemiology and Infectious Diseases. 2020;25(6):253-263
pages 253-263 views


Possibilities of modern methods of laboratory diagnostics in the study of viral hepatitis A

Volchkova E.V., Belaya O.F., Umbetova K.T., Pshenichnaya N.Y., Malov V.A., Konnova Y.A.


It is generally accepted that the course of viral hepatitis A is accompanied by short-term viremia, and the disease itself does not have serious consequences for the person who has recovered. The article describes a clinical case of a protracted course of viral hepatitis A with long-term persistence of the virus. Against the background of the therapy, the patient's condition improved, and by the time of discharge from the hospital on the 38th day of illness and later, with a retrospective examination on the 68th day from the onset of the disease by the method of reverse transcription PCR (RT-PCR in real time), the presence of RNA of the hepatitis A virus was confirmed in feces, which indicated a long persistence of the virus in the body. This observation indicates the need for long-term dispensary observation of patients who have undergone viral hepatitis A.

Epidemiology and Infectious Diseases. 2020;25(6):264-268
pages 264-268 views

Practical remarks on hydrophobia (Rabies): publication of Enegolm, Medical Doctor, State Counselor and Chevalier of Russian Empire

Volchkova E.V.


Rabies, an outdated name for hydrophobia, has been known since ancient times, and even than its occurrence was associated with the bites of dogs and wolves. The only way to prevent the development of this disease was considered to be cauterization of the wound to destroy the poison contained in the saliva of an animal stricken with rabies. The article of the doctor, the actual state councilor Enegolm "Practical remarks on hydrophobia" published in No. 1 of the General Journal of Medical Science for 1811, really contains a detailed description of all the approaches to the treatment of hydrophobia that existed then, although, as the author notes, without any benefit. Nevertheless, even today, in the 21st century, the article is of great interest to doctors, since in the most detailed way, very emotionally, with empathy for the patient, he describes day by day the development of the clinical picture of the disease, forgotten by many modern doctors. The article contains recommendations for preventing the spread of rabies both in urban and rural areas, which does not lose its relevance today, given the problems associated with the widespread growth of the population of stray animals, in particular dogs and cats.

Epidemiology and Infectious Diseases. 2020;25(6):269-278
pages 269-278 views

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