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Vol 26, No 2 (2021)

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An integrated approach to the differential diagnosis of COVID-19 syndromes and symptoms

Orlova N.V., Nikiforov V.V.


COVID-19 is characterized by a variety of symptoms that are not pathognomonic (hyper-/hypothermia; acute intoxication syndrome; cough; sore throat; enlargement of submandibular lymph nodes; shortness of breath; dyspeptic syndrome; neurological symptoms; ageusia and anosmia, etc.), which determines the need for differential diagnosis. COVID-19 refers to acute respiratory infections, has common transmission routes and similar symptoms, simultaneous infection with other respiratory viruses is possible.

Symptoms of intoxication require differential diagnosis with other infections, cough and shortness of breath may be manifestations of cardiovascular diseases, ageusia and anosmia occur in respiratory viral infections and neurological diseases, skin manifestations are also not specific. Laboratory and radiation diagnostics in COVID-19 reveals frequent changes, which, however, are also not pathognomonic. The article discusses diseases that have similar manifestations to COVID-19.

The greatest difficulties in differential diagnosis are caused by combined conditions ― the development of COVID-19 in patients with cardiovascular diseases, cancer patients, with chronic diseases of the respiratory system and others. Crucial in the differential diagnosis is the conduct of a specific examination ― the determination of the SARS-CoV-2 antigen in smears from the nasopharynx and oropharynx by immunochemical methods.

Epidemiology and Infectious Diseases. 2021;26(2):44-56
pages 44-56 views


Analysis of risk factors of developing infections associated with medical care among maternity and newborn babies

Aliyeva A.I., Ibnumashudova P.M., Shulaev A.V., Mironov A.Y., Mitrokhin S.D., Suranova T.G.


BACKGROUND: In modern conditions of the development of healthcare and humanity as a whole, the prevention of healthcare associated infections is one of the global world problems.

Identification of risk factors for the development of infections associated with the provision of medical care in patients in various types of medical organizations is an integral part of epidemiological surveillance.

To determine the “health index” of a nation, it is enough to indicate the level of infectious morbidity, in the formation of which healthcare associated infections plays an important role. Currently, the attention of medical workers of various specialties is attracted to this problem: hygienists, health care organizers, microbiologists, epidemiologists, and heads of nursing staff.

AIM of this study was to identify possible risk factors for the development of healthcare associated infections in puerperas and newborns in the perinatal center in Makhachkala.

MATERIALS AND METHODS: The retrospective, observational, single-center, continuous study was conducted based on the data of birth histories and individual maps of the development of newborns. The main group consisted of 125 puerperas and newborns with signs of HL. The diagnosis was confirmed by positive results of bacteriological examination of puerperas and newborns. The sanitary and hygienic background of the hospital was determined by samples of swabs from the surfaces of equipment, inventory, medical products, underwear and bed linen, dishes, hands of staff and puerperas.

RESULTS: It has been established that possible risk factors for the development of infections associated with the provision of medical care in newborns and maternity hospitals include the carrying of hospital ecovars of microorganisms in workers of all categories; contamination by conditionally pathogenic microorganisms of various surfaces of the hospital environment, equipment, tools, inventory; invasive medical and diagnostic interventions (vascular catheterization, urinary tract, endoscopic studies, transfusions, punctures, injections), artificial lung ventilation, artificial feeding, etc. The multiplicity and duration of procedures are important.

CONCLUSIONS: Strengthening control over the epidemiological safety of medical care using the risk assessment of hospital infections, as well as strengthening microbiological monitoring of circulating strains of topical pathogens are leading in the prevention of infections associated with the provision of medical care.

Epidemiology and Infectious Diseases. 2021;26(2):57-66
pages 57-66 views

Current epidemiological aspects of acute viral hepatitis in Russia

Butskaya M.Y., Bushmanova A.D., Priyma E.N., Ogurtsova S.V., Novak K.E., Esaulenko E.V.


BACKGROUND: According to the World Health Organization, viral hepatitis is one of the leading causes of death in the world. Mortality in hepatitis A varies from 0.1 to 2.1%, in hepatitis E from 0.1 to 4%, reaching 30% in pregnant women in the third trimester. From the outcomes and complications of hepatitis B and C, up to 1.4 million people die in the world every year.

AIMS: Determine the current aspects of the epidemic process of acute viral hepatitis: in the conditions of polyethylene friendliness, the influence of socio-economic changes taking place in the Russian Federation and measures of specific immunoprophylaxis of hepatitis B and A.

MATERIALS AND METHODS: The analysis of the data of the state statistical reporting of acute viral hepatitis in the Russian Federation (Form No. 2 “Information on infectious and parasitic diseases”) was carried out, the analytical tables developed by the Pasteur Research Institute of Epidemiology and Microbiology and the Reference Center for Monitoring Viral Hepatitis of the FBSI Central were analyzed. Research Institute of Epidemiology of Rospotrebnadzor. To establish the occurrence of polyetiology, a serological study was carried out by ELISA of 275 blood samples obtained from patients hospitalized in an infectious diseases hospital with a laboratory-confirmed diagnosis of hepatitis A (HAVAb IgM) for the presence of hepatitis B markers (HBsAg, HBsAb, HBcAb) and hepatitis С (HCVAb).

RESULTS: The incidence of acute viral hepatitis has reached the elimination rate in children and adults. In 2009 the incidence of acute hepatitis C was 2.2 per 100 thousand of the population, in children under 14 years old ― 0.6 per 100 thousand of the population, and in 2020 the rate decreased to 0.66 per 100 thousand of the population in the whole country up to 0.1 in children. A characteristic feature of the modern epidemic process of hepatitis А is the shift in incidence to age groups 20–39 years. The most common variants of polyetiology are hepatitis A + hepatitis B (74%). The incidence of parenteral hepatitis has been decreasing in the Russian Federation over the past decade due to ongoing anti-epidemic and preventive measures.

CONCLUSION: The current trend in the epidemiology of acute viral hepatitis is a steady decrease in the incidence. The number of new cases of registration of both vaccine-controlled and non-managed acute viral hepatitis has been steadily declining in both children and adults. The most common variants of polyetiology are hepatitis A + hepatitis B (74%).Vaccinal prophylaxis of hepatitis A and hepatitis B remains a necessary measure to combat various variants of the course of mixed infections.

Epidemiology and Infectious Diseases. 2021;26(2):67-74
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Epidemiological characteristics of sexually transmitted infections in children in the Republic of Tatarstan

Minullin I.K., Bilduk E.V., Vafina G.G., Platonova O.V., Bogdanova E.V., Salyahova L.S., Eremeeva Z.G., Iskandarov I.R.


BACKGROUND: Sexually transmitted infections are classified as a group of socially significant diseases, causing infertility, premature birth, congenital pathology, fetal abnormalities, oncological diseases, affecting reproductive health.

AIM: Epidemiological characteristics of the morbidity of children of the Republic of Tatarstan with sexually transmitted infections.

MATERIALS AND METHODS: A retrospective analysis of the incidence of sexually transmitted infections in children in the Republic of Tatarstan was carried out according to statistical form No. 9 “Information on STI diseases and infectious skin diseases” for 2011–2020. The data is processed in Microsoft Excel.

RESULTS: In 2011–2020, there is a statistically significant tendency to decrease the incidence of sexually transmitted infections in children in the Republic of Tatarstan, with the stabilization of the incidence of sexually transmitted infections in boys 0–14 years old. For 2011–2020 among children with sexually transmitted infections, a large proportion are girls aged 15–17 (83%). In the nosological structure of sexually transmitted infections in children aged 0–17 and 15–17 years, including girls, anogenital warts (42; 43; 45; 46%), chlamydia (18; 19; 19; 20%), trichomoniasis (18; 18; 20; 20%); in boys of these ages: gonorrhea (32%; 37%), anogenital warts (31%; 28%), chlamydia (14%; 16%). In children 0–14 years of age, the structure of sexually transmitted infections includes anogenital warts (38% in all, 34% of girls, 49% of boys), syphilis (21; 17; 32% respectively), trichomoniasis (13% of all, 17% of girls, 3% of boys), gonorrhea (13; 15; 8% respectively).

CONCLUSIONS: The registration of all forms of sexually transmitted infections in children causes socio-epidemiological anxiety and is a reason for a detailed analysis of the epidemiological situation. The study of the incidence of sexually transmitted infections among children and adolescents in different regions, the identification of epidemiological features will provide a more accurate description of the problem and develop recommendations for the prevention of infection in this socially vulnerable population group.

Epidemiology and Infectious Diseases. 2021;26(2):75-83
pages 75-83 views


Malignant course of invasive pulmonary aspergillosis in the new coronavirus infection COVID-19

Avdeeva M.G., Mozgaleva N.V., Parkhomenko Y.G.


Respiratory infections caused by fungal pathogens are the main cause of death in immunocompromised patients. During the COVID-19 pandemic, the registration of respiratory fungal pathology, especially pulmonary aspergillosis, has increased significantly.

We present a histopathologically confirmed case of fatal invasive pulmonary aspergillosis complicating COVID-19. A 65-year-old patient with long-term diabetes backgrounded with a severe course of COVID-19 (the virus was identified ICD-10 code U07.1) described. During the illness bilateral polysegmental pneumonia of fungal-bacterial (Klebsiella pneumoniae) etiology with necrosis and sequestration of the affected tissue the lower lobe of the right lung with the formation of a “fungal ball” and the development of a right-sided pneumothorax was developed. In other parts of both lungs, focal destruction of the interalveolar septa was determined with the formation of small cavities filled with detritus and accumulations of segmented neutrophils, with the proliferation of fungal mycelium, positively stained in the PAS reaction. Fungal hyphae and conidial heads were also found in the lumens of individual bronchi and vessels with invasion of their walls. Long-term (more than one month) course of the disease, clinical and radiological dynamics, and detection of a forming connective tissue capsule along the periphery of the necrosis zone during microscopy testifies in favor of the subacute nature of the infection.

The presented clinical case, as well as a review of current publications and meta-analyses on invasive pulmonary aspergillosis, point to diagnostic problems and poor outcomes of invasive pulmonary aspergillosis in patients with COVID-19.

Pulmonary aspergillosis associated with COVID-19 is a serious and potentially life ― threatening complication in patients with severe COVID-19 receiving immunosuppressive treatment. Early diagnosis of fungal infections is crucial to ensure the survival of such patients. Targeted biopsy examination with microscopy and/or seeding of a lung biopsy allows not only to establish the diagnosis of aspergillosis, but also to determine the presence of tissue invasion.

Further research should include approaches aimed at developing an effective diagnosis of fungal tissue invasion and respiratory tract damage, determining the patient’s immune status in order to conduct personalized immunotherapy.

Epidemiology and Infectious Diseases. 2021;26(2):84-91
pages 84-91 views

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