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Vol 28, No 1 (2023)

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Work experience and development of interaction between specialists of medical organizations in conducting dynamic monitoring of pregnant women in contact with HIV-infected sexual partners in the Saratov region

Danilov A.N., Gridneva T.B., Abramyan T.L.


BACKGROUND: In HIV-discordant couples, questions often arise about the possibility of having a child. Under current conditions, with the availability of antiretroviral therapy, such couples can have healthy children, subject to specific requirements. No approved algorithm exists for examining and monitoring of pregnant women in contact with HIV infection.

AIM: This study uses a team approach that comprises specialists from medical organizations to monitor discordant couples in which the man is HIV positive, and the woman is HIV negative at any stage of pregnancy.

MATERIALS AND METHODS: A retrospective study was conducted from 2018 to 2021 from medical records of 158 discordant couples in which the man is HIV positive and the woman is HIV negative. The detection results of HIV infection were evaluated by detecting HIV antibodies, HIV DNA/RNA in healthy pregnant women and CD4 lymphocytes, and HIV RNA in HIV-infected sexual partners. Safety measures were observed for medical personnel and the patient during medical interventions.

RESULTS: Discordant couples under observation were divided into 2 groups and totaled 158 couples. They included 69 (43.3%) couples who were observed at the Center for AIDS and were planning a pregnancy and 89 couples (52.9%) who first applied to the medical organization about a pregnancy that had already occurred. In the first group, sexual partners were on antiretroviral treatment until the wife became pregnant, and the viral load was undetectable. In 100% of cases, there was no HIV transmission to a woman in this group during pregnancy. In the second group, 52 (58.4%) HIV-infected sexual partners and 37 (42.5%) couples not receiving antiretroviral therapy received antiretroviral therapy. In the second group of discordant couples, HIV transmission was 1.1% (1 woman).

CONCLUSIONS: It is necessary to develop, approve, and implement an algorithm that includes monitoring discordant couples from the moment they are registered, examining the sexual partners of pregnant women in 100% of cases, and developing a team approach to monitor pregnant women.

Epidemiology and Infectious Diseases. 2023;28(1):5-14
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Express method for determining the sensitivity of pathogens of bacterial complications in COVID-19 to bacteriophages

Kraeva L.A., Konkova L.S., Burgasova O.A., Dolinny S.V.


BACKGROUND: In recent years, there has been a catastrophic increase in the resistance of bacterial strains to antibacterial drugs. The spread of the novel coronavirus disease (COVID-19) pandemic has led to the overuse of antibiotics, which has led to an even greater spread of resistant strains in hospitals. Given the accumulated positive experience in using bacteriophages, it is advisable to use them in patients after determining the sensitivity of each strain of isolated bacteria to bacteriophages. Since Klebsiella pneumoniae was the most frequently isolated bacteria in complicated forms of COVID-19, it became necessary to determine the sensitivity of these and other gram-negative bacteria to the corresponding bacteriophages.

AIM: This study aims to reduce the time for determining the sensitivity of an isolated microorganism culture to bacteriophages by developing an express method.

MATERIALS AND METHODS: The study used 30 strains of pan-resistant Gram-negative microorganisms from the collection of the Museum of the Laboratory of Medical Bacteriology of the Pasteur Research Institute of Epidemiology and Microbiology in St. Petersburg: Klebsiella pneumoniae (n=10), Escherichia coli (n=10), Pseudomonas aeruginosa (n=10), and also preparations of bacteriophages manufactured by JSC “NPO Microgen:” Bacteriophage Klebsiella polyvalent purified; Bacteriophage coliproteus; Pseudomonas aeruginosa bacteriophage.

RESULTS: Of the strains studied, 4 out of 10 studied K. pneumoniae strains, 6 out of 10 E. coli strains, and 7 out of 10 P. aeruginosa strains were susceptible to polyvalent bacteriophage preparations. Reliable results were obtained 3 hours after the sensitivity of isolated cultures to bacteriophages was established, which is undoubtedly the most important finding of the study.

CONCLUSION: The developed method for determining the sensitivity of gram-negative bacteria to bacteriophages enables reducing the study time by 6 times (up to 3 hours), which affects the timing of etiotropic therapy selection with bacteriophages for each patient.

Epidemiology and Infectious Diseases. 2023;28(1):15-22
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The epidemic process of a new coronavirus infection among medical workers in the context of V.D. Belyakov’s theory of self-regulation of parasitic systems

Sisin E.I., Golubkova A. ., Kozlova I.I., Ostapenko N.A., Ezhova O.A., Marapov D.I., Platonova T.A.


BACKGROUND: The epidemic process of COVID-19, during the analyzed time interval (2020–2022), like any parasitic system, had a cyclic course, which corresponded to the main provisions of the theory of V.D. Belyakov on the self-regulation of parasitic systems. At the same time, cyclic changes in the clinical and epidemiological characteristics of the infection occurred in the general population and among its cohorts, including employees of medical organizations. The study of the clinical and epidemiological features of COVID-19 in medical workers at various stages of the pandemic is an important area of scientific research that allows the quick adjustment of preventive and antiepidemic measures for reducing the impact of biological factors on the epidemic process.

AIM: This study determines the clinical and epidemiological features of COVID-19 in medical workers, considering the phase transformations of the pathogen, and assesses the effectiveness of individual antiepidemic measures at different stages of the pandemic.

MATERIALS AND METHODS: The reporting forms “General information about patients with positive COVID-19,” “General information about patients with community-acquired pneumonia with positive COVID-19” (497 units of information), 2176 cards of epidemiological investigation of COVID-19 cases among employees of 3 municipalities were analyzed. Epidemiological and statistical research methods were used.

RESULTS: When studying the epidemic process of a new coronavirus infection among medical workers, there was a decrease in the incidence of COVID-19 and the proportion of severe clinical forms of infection and foci during the pathogen reservation phase that corresponded to the appearance of a new genetic variant. During the epidemic spread phase of the pathogen, the largest number of recurrent disease cases was recorded, and disease cases were among those previously vaccinated against this infection. The coefficient and index of focality and the average duration of the existence of the focus in this phase were higher than in the previous one. Among the factors that negatively affected the epidemic were shortcomings in implementing antiepidemic measures, violations in the flow of technological processes, crowding, and lack of working space. As the number of vaccinated and recovered COVID-19 medical workers increased, the nature of the clinical manifestations of the infection changed regarding an increase in the proportion of mild (erased) forms, and a number of characteristics of the epidemic process also changed regarding the frequency of foci formation with multiple diseases.

CONCLUSIONS: The conducted analytical epidemiological study confirms the universal nature of the main provisions of the theory of V.D. Belyakov about the self-regulation of parasitic systems at the population level. It also allows us to explain the individual characteristics of the epidemic process among specific cohorts, in particular medical workers, considering the phasic nature of the epidemic, the influence of pathogen and host population transformations, and social and natural factors.

Epidemiology and Infectious Diseases. 2023;28(1):23-33
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Atypical chronic active herpesvirus infections: Etiological structure, frequency of occurrence, clinical syndromes associated with them

Khalturina E.O., Mironov A.Y., Suranova T.G.


BACKGROUND: Every year, a steady, progressive increase in the number of atypical chronic, active forms of infections caused by herpesviruses is recorded. Diagnosing and selecting adequate therapeutic strategies for treating these infections present significant difficulties for physicians due to the polysyndromicity and many clinical manifestations.

AIMS: This study determines the prevalence of atypical chronic, active infections caused by herpesviruses among patients infected with herpesvirus infections and studies the etiological structural features and clinical manifestations/criteria and signs of atypically occurring chronic forms of herpes viral infections.

MATERIALS AND METHODS: Under our supervision at the Clinical and Diagnostic Center “Medsi in Belorusskaya” (Moscow), 98 patients of both sexes aged 23 to 60 years suffering from atypical chronic, active forms of infections caused by herpesviruses comprised the herpesviruses group. The comparison group consisted of 30 conditionally healthy subjects comparable in sex and age to patients. In addition to traditional methods (history collection, physical examination, general blood test, and others), serodiagnostic methods with ELISA were used to detect herpesvirus infections. ELISA was also used for detecting the genome of viruses in biomaterials. The study was approved by the ethics committee, and all patients received informed consent to participate in the study. Statistical analysis was performed using adequate methods.

RESULTS: The study of the etiological structure of herpesvirus infections in patients with atypical chronic, active forms of infections caused by herpesviruses, mixed herpesvirus infections were shown to occur in 83.4% of patients, and mono herpesvirus infections in 16.6% of cases. It was shown that the Epstein–Barr virus was the dominant virus among patients with mono and mixed herpesvirus infections. A high rate of Epstein–Barr virus DNA detection was demonstrated in saliva (84.2%), posterior pharyngeal wall scrapings (73.5%), tonsils (42.9%), urine (12.6%), and blood (8.3%) is a marker of the high replicative activity of the virus. The primary clinical syndromes associated with mono and mixed atypical chronic and active forms of infections caused by herpesviruses were identified.

CONCLUSIONS: This study identified and quantitatively assessed the viral load associated with the severity of the course and clinical manifestations of atypical chronic, active forms of infections caused by herpesviruses. Clarifying the features of clinical manifestations and syndromes in patients suffering from various mono and mixed herpesvirus infections will allow us to outline the goals for the further development of an adequate diagnostic algorithm for these atypical forms of herpesvirus infections and the concept of targeted, personalized etio- and immunopathogenetic therapy.

Epidemiology and Infectious Diseases. 2023;28(1):34-43
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Antimicrobial properties of oxygen-active disinfectants

Gerasimov V.N., Kharseeva G.G., Gaitrafimova A.R., Bystrova E.V., Fedorova L.S.


Oxygen-active disinfectants are widely used for the nonspecific prevention of infectious diseases: hydrogen peroxide, chlorine dioxide, potassium fluoride peroxyhydrate, perborates, persulfates, perphosphates, and percarbonates. These compounds have a broad spectrum of antimicrobial activity against bacteria (including Mycobacterium tuberculosis), viruses, fungi, and spores of bacilli.

The primary exposure “targets” exposure for oxygen-containing disinfectants are proteins and lipids in the cytoplasmic membranes of bacterial cells and the spore membranes of bacterial spores. When a bacterial cell is exposed to hydrogen peroxide at the stage of contact with the cytoplasmic membrane, hydrogen peroxide decomposes into highly reactive hydroxyl radicals, which have a destructive effect on the membranes. Hydroxyl radicals are powerful oxidizing agents, have a short existence and interact with lipids, proteins, and nucleic acids. Lipid oxidation, mainly unsaturated fatty acids, leads to increased membrane permeability. During the membrane protein oxidation consisting of amino acids with disulfide bonds, the latter are converted into –SH-radicals, forming cross-links at amino groups and resulting in protein-lipid complexes. The proteins are oxidized and denatured, leading to cell death. Hydroxyl radicals and other intermediate decomposition products of hydrogen peroxide, such as hydronium cation (Н3О+) and perhydroxylanion (НО2-), have damaging effects.

This article analyzes scientific papers on the mechanism of action of oxygen-active disinfectants on vegetative cells and bacterial spores.

Epidemiology and Infectious Diseases. 2023;28(1):44-52
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Mixed infection with COVID-19 and tropical malaria (case report)

Efremov D.O., Khuramshin A.R., Кozlov S.S., Gulyaev N.I.


This article describes a clinical case of mixed infection with COVID-19 and tropical malaria. Patient Z., 37 years old, arrived from the Central African Republic with a diagnosis of “New coronavirus infection COVID-19, confirmed (PCR RNA SARS-CoV-2‘+’ from January 27, 2022) mild form.” During an objective examination, the subictericity of the sclera and skin integument attracted attention. During thermometry, an increase in body temperature to 39.0°C was found. Consciousness at the level of somnolence was observed. Hemodynamics was unstable, with episodes of arterial hypotension; heart rate was 96 beats per minute. Respiratory rate was 24 breaths in 1 minute, SpO2 95%, and with inspiratory dyspnea. According to the patient’s laboratory study results, severe thrombocytopenia, apparent signs of hepatic and renal insufficiency, hyperbilirubinemia, increased concentrations of C-reactive protein, and procalcitonin were revealed. A differential diagnostic search was performed between acute viral hepatitis and malaria. Blood microscopy revealed young trophozoites of Plasmodium falciparum (++++) using the thick drop method. Antimalarial therapy with Malacur was prescribed, which was then replaced with parenteral Quinine followed by mefloquine. In parallel, extracorporeal detoxification operations were performed. The patient’s condition was stabilized against adequate etiotropic therapy and complex intensive care measures. On the 40th day, the patient was discharged restored health.

The purpose of demonstrating a clinical case is to attract increased attention to the problem of imported cases of malaria, which, when combined with COVID-19 infection, may remain unrecognized for a long time, especially in cases where the diagnosis of COVID-19 receives rapid laboratory confirmation.

Adequate and timely antimalarial therapy, including a complex of intensive care measures supplemented with extracorporeal detoxification methods, is the basis for a successful outcome in patients with severe malaria with the development of severe complications.

Epidemiology and Infectious Diseases. 2023;28(1):53-62
pages 53-62 views

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