Vol 21, No 1 (2016)

The purpose of the study - the detection of clinical and epidemiological peculiarities of sepsis in patients admitting to the Infectious Diseases Unit on the base of the analysis of the hospital cohort. Patients and methods There was studied the Hospital cohort of the Krasnodar Specialized Infectious Disease Hospital for the period from 2010 to 2014, there were analyzed both the frequency of registration of sepsis and the structure of the mortality rate. The clinical course of sepsis and epidemiological records were considered in 81 patients. Results. The percentage of sepsis in the hospital cohort of the infectious clinic accountedfor 0.28%. In the structure of hospital lethal outcomes, the share of sepsis amounted for one fourth (24%). Among deceased patients in the clinic, the diagnosis of sepsis was predominant in 9% ofpatients; in the rest 15% cases sepsis complicated the course of the underlying disease. The mortality rate in patients with sepsis was 14%. Among the cases the males (73%) prevailed. The disease was detected at the age of 19 to 87 years. More than half ofpatients (60%) were 20-40years aged, with an average age of 41.3 ± 2.15 years. The most common of the directional diagnoses were: acute respiratory tract infection (37%), and unspecified fever (26%). Thereafter clinical diagnosis of severe sepsis was made in 94% of cases, subacute - in 3%, chronic - in 3% of cases. The disease was moderate in course in 62% of patients, severe course occurred in 38%. In all cases, the cryptogenic sepsis was diagnosed. In 2 patients sepsis developed on the background of HIV infection. 31% of patients were treated in the ICU unit. Complications of the severe course of sepsis were: infectious-toxic shock (19%), acute cardiovascular insufficiency (16%), acute hepatorenal failure (19%), ARDS, ARF (16%), DIC (9%), anemia (13%). The clinical diagnosis of sepsis has been confirmed by laboratory isolation of blood culture and a positive reaction with the autostrain in 40% of cases. In the etiological structure of sepsis staphylococcus dominated (85%), polyetiological nature of sepsis was confirmed in two patients (E.coli, St.aureus, S. pneumonae, fungi Candida). In rare cases, Str. Mitis, Kl. Pneumoniae were confirmed. Etiotropic therapy was performed with broad-spectrum antibiotics and antifungal drugs. Conclusion. In the practice of the infectious disease specialist predominantly there is made the diagnosis of cryptogenic staphylococcal sepsis as well as sepsis in the outcome of a particularly severe infectious disease. The disease was more frequently observed in young males at the age of d 20 to 40 years, it has an acute course and is manifested in moderate and, more rarely, in the severe form. The establishment of a diagnosis of sepsis in the clinic of infectious diseases is based on the following criteria: signs of SIRS, signs of organ-system failure (infectious-toxic shock , acute hepato-renal failure, acute cardio-vascular insfficiency, ARF, ARDS, DIC) in 2 or more systems; bacteremia (positive blood culture confirmed by the reaction with autostrain, positive PCR). The diagnosis is not in doubt in the presence of at least two of these signs

The purpose of the study is the investigation of etiological, clinical and epidemiological features of HFRS, caused by Sochi virus in the Krasnodar area, as well as a comparative analysis of the data with those of HFRS, caused by Kurkino virus in the Central Russian regions and Puumala virus in the areas of Volga region. Materials and methods For the identification of HFRS patients, sera from more than 800 acute febrile patients residing in Krasnodar area were examined for hantavirus antibody by IFA with Puumala, Hantaan, Seoul, Sochi, Kurkino and Dobrava viruses. For primary screening there was used the indirect immunofluorescence (ELISA) method with polyvalent cultural antigen as for serotyping of positive sera according to affiliation of antibodies to various Hantaviruses species, there were used ELISA method with monovalent cultural antigens and the neutralization reaction with Puumala, Hantaan, Seoul, Sochi, Kurkino and Dobrava viruses with the use of the method of Inhibition of Focus-Forming Units assay. Clinical and epidemiological studies have been performed on the base of history cases and records of the epidemiological examination. Results of the study. During 2000 - 2013 there were identified 64 patients suffered from HFRS caused by the Sochi virus. The patients resided in 36 settlements of 10 administrative districts of the Krasnodar area. A comparative analysis of clinical, laboratory and epidemiological data of patients with HFRS-Sochi, HFRS-Kurkino and HFRS-Puumala viruses allowed to reveal differences between the clinical (frequency of registration and severity of several symptoms, severity of the course and mortality rate) and epidemiological (prevalence in rural and urban residents, occupational pattern, the seasonality of the disease, conditions of contamination) manifestations. Conclusion There was established the etiological and epidemiological importance of Sochi virus. Sochi virus causes sporadic annual incidence of HFRS in the territory of Krasnodar area. Cases of HFRS caused by the Sochi virus are differ in more severe course of the disease and high lethality rate in comparison with the other two forms of HFRS caused by Puumala and Kurkino viruses in the territory of the European part of Russia.

Introduction The intoxication rate due to venomous snake bites in the population in the Republic of Guinea is 100-150 cases per 100 000 habitants with the mortality rate to 18% and represents a serious problem for public health services of the country. In the same time there is a big lack in antivenin sera supply. Nevertheless, the provision with antivenin serum against snake venom in the country is evidently not enough. Aim of research clinical trials of the efficiency and tolerance of a new polyvalent antivenin sera Inoserp® Panafricain against snake venom in comparison with the used previously serum Antivipmyn® Afrique. Methods There were treated 109 patients with pronounced symptoms of intoxication due to venomous snake bites. In the absence of hemolytic and neurologic symptoms they were intravenously administered the 1 dose (10 ml) of serum or 2 doses in the presence of mentioned symptoms. If situation so requires (in the absence of the positive effect, the occurrence of hemorrhage and neurological symptoms) this serum was re-administered 3, 6, 12 or 24 hours after the first injection. There was noted a status ofpatient and the presence of side effects after the application of this serum. Results All 109 patients have received an average of 1.1 doses (ampules) of serum. 108 patients (99%) recovered without consequences. No case of necrosis was observed. There was noted the 1 fatal case (0.9% of total patients). In 6 (5.5%) patients 10 minutes after administration of the serum there were noted side effects, but shortly they disappeared. The overall mortality rate in our experience was lower than in the testing of the similar serum Antivipmyn® Afrique, especially in patients who have not received antisera against the venom of snakes. Conclusion The efficacy and tolerability of the Inoserp® Panafricain serum were higher as mortality rate (0.9%) and side effects (5.5%) - lower in comparison with the serum Antivipmyn® Afrique. This experience has shown the perspectiveness of the use of serum Inoserp® Panafricain for the treatment of cases bitten by venomous snakes in Guinea.

Cases of arthropod dermatoses acquired by Russian tourists in tropical countries Brazil, Sri Lanka, Peru and Thailand are presented. These dermatoses were associated with trombiculidae mites infesting alligator, Hydrochaeris hydrochaeris, elephants and parrots. Because of widespread travel, trombiculiasis has become more common in European countries. Awareness of dermatoses associated with mites other than Sarcoptes for clinicians should be considered for a patient who has recently returned from endemic area. Misdiagnosis and mismanagement can occur owing to limited awareness of the condition outside endemic areas.

Therapy for viral hepatitis B at the present stage depends on the stage of the disease, activity of the viral process, the extent of liver tissue fibrosis and concomitant pathological processes. The high level of liver cells fibrosis in combination with viral processes are known to promote the formation of hepatocellular carcinoma. Under our supervision over 5 years there is the patient with HBV infection and high levels of fibrosis: from the acute period ofdiseases till now. Performing long-term antiviral therapy allowed to significantly reduce the level offibrosis, however, despite the prolonged use of modern antivirals, we have twice watched ”viral breakthrough”, that necessitated stopping treatment.