Vol 20, No 1 (2015)

Rationale The relevance of ventilator-associated respiratory tract infections in severe injury patients (SIP) is associated with both features of causative pathogens and the initial severity of the state of patients. Among causative pathogens nosocomial flora is dominant. Purpose - to perform an analysis of the microbiological monitoring of ventilator-associated respiratory tract infections in SIP. The analysis was based on the results of a prospective epidemiological, clinical, and instrumental study of 100 SIP with ventilator-associated respiratory tract infections, stayed in the surgical intensive care unit. The proportion of ventilator-associated respiratory infections in the structure of nosocomial infections in these patients is between 90 - 95%, at that there was revealed the prevalence of nosocomial pneumonia (61%). Ventilator-associated respiratory tract infection most commonly occurs during the first 10 days of mechanical ventilation. The prevailing flora was represented by Gram negative Acinetobacter baumamnnii (40.3 ± 2.1%) and Pseudomonas aeruginosa (38.4% ± 3.2%). Isolated microorganisms possessed multiple antibiotic resistance, with the greatest extent to aminoglycosides - 69.5%, fluoroquinolones - 40.3%, penicillin - 37.6%; cephalosporins (third generation) - 33.8%. There is noted marked preponderance of microbial associations compared with monocultures 57.1 ± 5.3%.

With the use of the ELISA method to detect an antigen, reverse transcription with quantitative real-time PCR with subtype-specific fluorescent probes, phylogenetic analysis of E and NS1 gene nucleotide sequences, bioassays with suckling mice, hemagglutination and neuroinvasiveness tests there was made a comparison of the tick-borne encephalitis virus (TBEV) infection of ixodid ticks Ixodes persulcatus P.Schulze and Ixodes pavlovskyi Pomerantsev 1946 in the area of sympatria of their natural habitats in the Novosibirsk region during growth period of their populations with the replacement ofprevailing species of monodominant type of the ixodid population structure. The ratio of 2 tick species didn’t depend on biotopes ofpine or birch forest but rather on the distance from the Novosibirsk Scientific Center: the lower anthropogenic pressure the smaller I.pavlovskyi proportion. The TBEV rate (including both pathogenic and apathogenic for laboratory mice virus), spectra of the TBEV3 main genetic types, neurovirulence and hemagglutination activity were similarfor both I.persulcatus and I.pavlovskyi. However, the proportion ofpathogenic for laboratory mice virus and the TBEV Far Eastern subtype, as well as viral loads of Siberian and European types for the TBEV from I.pavlovskyi were significantly higher than those from I.persulcatus.

Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever is severe acute infectious diseases accompanied by the development of severe systemic inflammatory response followed by the addition of disseminated intravascular coagulation and multiple organ failure. Since 1976 in Africa regularly observed disease outbreaks among humans caused by different types of Ebola virus. Modern epidemic in West Africa began in Guinea in February 2014 and is still going on, coming out of the country and distributed in Liberia, Sierra Leone and Nigeria. According to the World Health Organization (WHO) on December 14, 2014 recorded 18,603 cases of them confirmed EVD 11807, fatal 6915. From July 2014 to currently registered sporadic cases EVD among health care workers caring for patients, as well as among tourists returning from countries affected by the epidemic is already outside of West Africa. Due to the limited use of specific antiviral therapy with special attention to the management ofpatients with EVD should be paid to the intensive and timely pathogenetic therapy. Today, the only way to reduce morbidity and mortality among people from EVD is awareness on the risk factors of infection and the use ofpersonal protective measures.

There arc described four cases of infection of the lungs and pleura with Dirofilaria in patients infected in the Moscow region and Moscow, with clinical manifestations of recurrent exudative pleurisy, tumor-like formations in the pleura and the lungs. Non-specific clinical symptoms and clinical simulation of common known diseases render difficult the clinical and instrumental diagnosis of pleuropulmonary dirofilariasis. Currently, the best method of diagnosis and treatment of heartworm lungs and pleura is Videothoracoscopy. There are analyzed factors that contribute to the pleuropulmonary infection with Dirofilaria. There is mentioned the possibility of strain differences between Dirofilaria repens, distributed in various regions of Russia and abroad, and there are discussed the problems of treatment.

Lethal cases of tick-borne encephalitis in previously vaccinated patients have not been described. Modern inactivated vaccines against Tick-borne encephalitis (TBE) are high effective. The TBE cases, preference unfocal forms, are developed in persons with incomplete irregular vaccination. First case of lethal TBE after plural vaccination was described in the Kurgan region, the second case - in the Chelyabinsk region. These very rare unusual cases were studied. Being dominant the Siberian subtype of TBE virus is related with lethal TBE cases in the Chelyabinsk region. Unusual TBE case was developed in patient who had been vaccinated 8 limes with vaccines produced from strains of Far-Eastern TBE subtype («Virion», Tomsk, Chumakov institute, Moscow) and European TBE subtype (Encepur; FSME-Immun). Two years after the last vaccination a focal form of TBE was developed with lethal outcome at 9 th day. Specific antibodies IgM and IgG seroconversion were detected. The TBE virus antigen was detected in brain neurons by immunofluorescent test. Destructed neurons and gliocyles were shown by hystological study in cerebral hemispheres and cerebellum. The Purkinje cells were destructed. Possible reasons of surmounting vaccinal immunity including a genetic difference of vaccine and infection virus strains are discussed.