Vol 27, No 6 (2022)

BACKGROUND: Acute ixodid tick-borne borreliosis tends to turn into a protracted and chronic course. This suggests studying the causes of the violation of the immune status of a sick person. The central structural unit of immunity is the lymphocyte. It is known that the formation of specific T-lymphocyte subpopulations is based on the central role of IL-2, leading to the restructuring of cellular metabolic pathways. The regulation of signaling pathways and lymphocyte metabolism primarily determines disease outcomes.

AIM: This study determines the pathogenetic mechanisms of the infectious and inflammatory processes in the erythemal form of acute ixodid tick-borne borreliosis based on the study of the lymphocytic lysosomal enzyme activity, the level of IL-2, and the clinical disease manifestations.

MATERIALS AND METHODS: The main group is represented by 609 patients hospitalized at the Krasnodar City Clinical Hospital from 2010 to 2019. The study group comprised 45 patients with an erythemal form of acute ixodid tick-borne borreliosis. In the dynamics of the disease, the level of IL-2 and the cytochemical activity of acid phosphatase and non-specific alpha naphthyl esterase of lymphocytes were determined.

RESULTS: During the height of ixodid tick-borne borreliosis, a decrease in the cytochemical activity of hydrolytic enzymes of lymphocytes was noted compared with the control group. IL-2 levels had a high dispersion and were associated with clinical disease manifestations. A low level of IL-2 correlated with a decrease in the activity of alpha-naphthyl esterase lymphocytes. During the period of convalescence, there was a restoration of lymphocytic enzymatic activity and an increase in the number of cells with a pronounced activity of alpha-naphthyl esterase, typical of T-lymphocytes with killer activity.

CONCLUSION: The hydrolytic enzymes of the lysosomes of acid phosphatase and alpha-naphthyl esterase lymphocytes enable judging the intensity of intracellular metabolic processes and, combined with clinical disease symptoms and IL-2 activity, are indicators of the state of the immune process, supplementing the results of traditional immunological studies in patients with the erythema form of acute ixodid tick-borne borreliosis. The predominance of enzymatically inactive forms of T-lymphocytes in the acute period of the disease reflects a specific deficiency of T-cell immunity.

BACKGROUND: Reducing population immunity to vaccine-controlled infections because of low vaccination coverage at any moment could destabilize earlier epidemiological well-being against vaccine-controlled infections in the context of the COVID-19 pandemic.

AIM: This study comprehensively assessed the completeness and timeliness of TB vaccination of young children in a maternity hospital-polyclinic stages and identified resources to improve their immunization.

MATERIALS AND METHODS: Form 063/in patients born from January 1, 2020, to December 31, 2021, (3613), Registers of newborns under the supervision of the Children’s City Polyclinic (DPP) from 2020 to 2021 were obtained (3). This article uses epidemiological (descriptive-estimative and analytical) and statistical methods of analysis using the online service StatTech. Electronic discharges from the EMIAS system were used to examine the timeliness and completeness of vaccination coverage.

RESULTS: In 2020 and 2021, because of the early discharge of newborns from the maternity hospital, a significant proportion of them were not vaccinated against tuberculosis within the timeframe prescribed by the National Immunization Prevention Calendar. In 2020, 24.8% of the causes of not contracting tuberculosis in a maternity hospital were discharged early, whereas, in 2021, it was 9.6% (p <0.05). In 2020, the chances of not vaccinating against BCG because of early withdrawal were 3.12 times higher than in 2021 (95% of confidence interval 2.09–4.7). In the structure of the causes of the lack of development, the largest proportion was medical withdrawals from BCG and parental refusals, 40.7% and 40.9%, respectively. In 2020 and 2021 their number was relatively stable, and for each of the analyzed items, more than 40%. Later on, only 32.8% of those not disabled in the maternity hospital were vaccinated against tuberculosis up to the age of 2 months. The cumulative coverage of tuberculosis vaccination for children registered with DHS was 82% by the first 12 months of life, which was not in line with the WHO target of 95% immunization coverage. The reasons for this failure were parents’ refusal to be vaccinated (48.5%), their low social responsibility (39.2%), and medical defenses (12.3%). The interruption of vaccination schedules at the maternity ward during the COVID-19 pandemic due to the early discharge of newborns resulted in a delay in scheduling subsequent vaccinations. As a result, children were born in 2020 and 2021. By 12 months, 17%, whooping cough, diphtheria, and tetanus, 20.6%, polio 20.5%, pneumococcal infection 30.2%, had not been vaccinated.

CONCLUSION: Given the high incidence of morbidity among children up to the age of two and the increase in the number of home-based cases of tuberculosis, the ambiguity of the situation makes vaccination against tuberculosis a priority in the current version of the National Immunization Service. It requires control of the regulated order of the Ministry of Health of Russia from December 6, 2021. 1122h “On approval of the national calendar of preventive vaccinations, the calendar of preventive vaccinations according to epidemic indications and the order of preventive vaccinations” calendar.

Botulinum neurotoxin is the most potent poison known worldwide. Over the past two centuries, its structure and functions have been studied in detail, and obtained in its pure form. Knowledge of the mechanisms of action of botulinum neurotoxin has determined two directions of its possible use: negative, as a biological (toxin) weapon, and positive, as an agent that eliminates pathological muscle hypertonicity and neuropathic pain and can be used for aesthetic purposes (beauty injections).

The lecture presents the chronological development of both directions and provides a detailed analysis of the various uses of botulinum neurotoxin as a medical and cosmetic treatment. Particular attention is paid to the side effects of botulinum therapy and ways to overcome them.

This case describes a rare case of food botulism F in a 42-year-old man, which developed after he ate dried fish. The disease proceeded in a severe form with the development of ophthalmoplegia, tetraparesis, and respiratory failure. Monovalent antitoxic serums against botulinum toxins A, B, and E were administered to the patient. However, on the third day of the disease, he developed fulminant toxic myocarditis with asystole. Despite successful resuscitation, the patient developed a post-resuscitation disease and anoxic encephalopathy. The disease was complicated by severe aspiration pneumonia caused by Klebsiella pneumoniae (ESBL+). The duration of mechanical ventilation was 12 days. His hemodynamics stabilized on the eighth day of illness, and on the 19th day of illness, physical activity and a state of minimal consciousness appeared. The patient was transferred to the rehabilitation department on the 22nd day of the illness.

Doctors should be informed about the possibility of the development and severity of botulism caused by botulinum toxin type F. It is necessary to introduce polyvalent antibotulinic serum into clinical practice, including antitoxins against rare types of botulinum toxin.