Vol 21, No 1 (2016)


Diagnosis of sepsis in the practice of the infectious disease doctor

Avdeeva M.G., Gorodin V.N., Blazhnaya L.P., Kulbuzheva M.I., Zotov S.V., Pronin M.G., Vaniukov A.A., Savitskaia I.M.


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
Epidemiology and Infectious Diseases. 2016;21(1):4-13
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Problems of vaccine prophylaxis of influenza in pregnant women

Maksakova V.L., Konshina O.S., Erofeeva M.K., Tokin I.I.


Pregnant women are at high risk for the adverse course of respiratory diseases, among which the influenza is the one of the leading infections, of ten finishing tragically for most pregnant and her offspring. Due to the disproportionately high morbidity, mortality and adverse outcomes of pregnancy after influenza virus infection, pregnant females are classified as a priority group for vaccination. Immunization with inactivated influenza vaccine is one of the most important strategy to prevent both of influenza infection, its severe complications, and mitigating of the effects of the epidemic of influenza. There was accumulated sufficient evidence demonstrating that the vaccine promotes the diminution of clinical manifestations of influenza infection in pregnant women, as well, has a positive effect on the health of the newborns due to the active transport of maternal antibodies. In the review there are presented data on the safety, high immunogenicity and clinical efficacy of vaccination against influenza as for pregnant women as well for infants.
Epidemiology and Infectious Diseases. 2016;21(1):14-21
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Etiologic and clinical epidemiological features of hemorrhagic fever with renal syndrome (HFRS) in the Krasnodar Krai

Tkachenko E.A., Morozov V.G., Dzagurova T.K., Yunicheva Y.V., Pilikova O.M., Zavora D.L., Ishmukhametov A.A., Gorodin V.N., Bakhtina V.A., Zagidullin I.M., Sotskova S.E.


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.
Epidemiology and Infectious Diseases. 2016;21(1):22-30
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Retrospective analysis of the incidence of viral hepatitis A in the republic of Crimea

Gorovenko M.V., Karimov I.Z., Penkovskaya N.A., Los-Yatsenko N.G., Midikari A.S., Tkachuk O.B.


Viral hepatitis A is the most widespread form of acute viral hepatitis in the world and one of the most important medico-social problems of public health care. The existing ecologic problems of the Crimea demand more careful studying of regularities of epidemic process of hepatitis A on the peninsula to provide epidemiological well-being of the population and visitors. Retrospective epidemiologic analysis of long-term and annual dynamic of viral hepatitis A incidence in Crimea Republic in 2005-2014 had been carried out on the basis of statistical data of Interregional Department of Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing of the Republic of Crimea and the city of Sevastopol. It is revealed that The prevalence of adults in structure ofpatients, leveling ofperiodicity and expressed tendency to reducing of morbidity were revealed to be features of hepatitis A on the peninsula.

Epidemiology and Infectious Diseases. 2016;21(1):31-36
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Trial of the new antivenin serum INSERP®PANAFRICAIN in the Republic of Guinea for the treatment of patients bitten by venomous snakes

Balde M.S., Buaro M.I., Konstantinov O.K., Diallo M.S., Millimono E., Kulibali M.


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.
Epidemiology and Infectious Diseases. 2016;21(1):36-40
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Whether soil-transmitted helminthiases elimination is feasible within framework of WHO 40 programme on neglected tropical diseases implementation

Litvinov S.K., Morozov E.N., Kuznetsova K.Y., Zhirenkina E.N.


The authors critically consider the feasibility of the elimination of soil-transmitted helminthiases as the public health problem within the framework of recently established WHO programme "Neglected tropical diseases". This objective proposed by the programme seems to be rather questionable due to practically complete lack of use so called sanitary and helmintological approach, which has been successfully and effectively utilized in our country in control of ascariasis and trichocephaliasis. The weakest link in achieving this ambitious goal is the almost complete disregard for health helminthology approaches, the importance and high effectiveness of which has been demonstrated in the our country in the processs of the ascariasis and trichuriasis control. The possibility of elimination of geohelminthiases without the use of these approaches seems to be very doubtful.
Epidemiology and Infectious Diseases. 2016;21(1):40-43
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Trombiculiasis in Russian tourists travelled to tropical countries

Bronshteyn A.M., Kochergin N.G., Malyshev N.A., Konstantinov O.K., Davydova I.V., Burova S.V.


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.
Epidemiology and Infectious Diseases. 2016;21(1):43-50
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Clinical and epidemiological characteristics of ebola at the present stage

Nikiforov V.V., Shakhmardanov M.Z.


The disease being caused by the Ebola virus (Ebola virus disease - EVD, Ebola haemorrhagic fever) referred to the genus Ebolaviruses - is a viral haemorrhagic fever in human and other primates subjects. There is a reason to consider frugivorous bats - the inhabitants of the tropics as the natural reservoir of the virus. The transmission from person to person by airborne droplets has not been proved. Signs and symptoms of the disease usually begin during the period from two days to three weeks after infection with fever virus, from sore throat, muscle pains and headaches. Then there are affiliated vomiting, diarrhea, rash, disorder of the function of liver and kidneys. In many patients there are adhered the external and internal bleeding. The mortality rate in this disease varies between 25 and 90 percent, in average about 50 percent. The cause of the lethal outcome in most cases is toxic shock and/or hypovolemic dehydration shock, which occurs usually after six to sixteen days from the onset of the disease. Therapy is limited to a complex ofpathogenetic therapeutic measures, as there is no specific treatment. EVD vaccines are at the final stages of the delivery.
Epidemiology and Infectious Diseases. 2016;21(1):51-57
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Long-term clinical observation. viral hepatitis B: from diagnosis to treatment selection in different periods of illness

Poluektova V.B., Volchkova E.V.


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.
Epidemiology and Infectious Diseases. 2016;21(1):58-63
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