[Spectrum, clinical features, diagnosis of opportunistic and comorbid pathology in HIV-infected patients admitted to infection hospital of Moscow].

AIM: To analyse structure, clinical features, diagnosis of opportunistic and concomitant diseases in patients with HIV infection admitted to infection hospital of Moscow. MATERIAL AND METHODS: A total of 4155 patients with HIV infection (1518 of them with AIDS) most of them (89%) at the age of 20-39 years were treated in Moscow AIDS hospital in 2006-2007. The examination included standard blood and urine tests, device diagnosis, immunological, bacteriological and molecular investigations of biological materials for detection of opportunistic infections. Cell-mediated immunity was also studied. HIV infection resulted in a lethal outcome in 255 (6.1%) inpatients. RESULTS: Leading causes of hospitalization of patients at early stages of HIV infection were bacterial bronchitis or pneumonia, hepatic pathology (chronic viral hepatitides, alcohol-associated diseases), sepsis. One-third of the inpatients were at AIDS stage characterized by tuberculosis (66.3%), visceral candidosis (12%), manifest cytomegalovirus infection (10.1%), cerebral toxoplasmosis (9.2%), pneumocystic pneumonia (5.5%). The number of HIV-infected persons with atypical mycobacteriosis, lymphoproliferative diseases, brain tumors increased. Chronic hepatitis C prevailed among liver damage cause in HIV infection, it also often caused hospitalization and death of patients. 60.3% patients having HIV infection who died without AIDS stage had hepatic cirrhosis. Tuberculosis was a leading cause of severe pulmonary pathology, most frequent opportunistic disease, main cause of death in patients with HIV infection. One-third of patients had generalized tuberculosis. Tuberculosis was diagnosed in more than 40% HIV-infected patients with pulmonary lesion, in 65% AIDS patients, 36% dead AIDS patients. CONCLUSION: To render effective anti-HIV treatment, infection hospital must be equipped with facilities providing device tests, molecular diagnosis, modern etiotropic and pathogenetic medication.

[Pulmonary diseases in patients with HIV infection].

AIM: To characterize the spectrum, incidence rate and features of pulmonary pathology in HIV-infected inpatients with reference to a fall in the count of CD4-lymphocytes. MATERIAL AND METHODS: A total of 2370 patients with HIV infection admitted to Moscow infectious hospital N 2 were examined. The protocol of examination included: standard diagnostic tests, bronchoscopy with examination of bronchoalveolar lavage and bronchial biopsies for genetic markers of basic pulmonary disease pathogens, assessment of external respiration function by spirometry. By the count of CD4-lymphocytes in the blood (> 500 cells/mcl; 500-200 cells/mcl and < 200 cells/mcl) the patients with pulmonary pathology were divided into groups 1, 2 and 3. RESULTS: Affection of the lower respiratory tract (LRT) was detected in 1209 (51%) patients. Incidence, etiological spectrum and severity of LRT lesions increased significantly with aggravation of immunological disorders. The patients of group 1 were affected more frequently with bacterial bronchitis, pneumonia (88.2%), group 2 patients - with bacterial pneumonia (67.1%) and pulmonary tuberculosis (28.1%), group 3 - with tuberculosis including generalized forms (53.9%), cytomegalovirus infection (11.2%), pneumocystosis (7.2%). Combined pulmonary pathology was diagnosed in 25% cases. CONCLUSION: Changes in external respiration function were most evident in pneumocystosis and tuberculosis, but they were most persistent in cytomegaloviral lesion of the lungs. Some tuberculosis and CMV infection patients exhibited ventilatory disorders prior to clinical and x-ray symptoms, this suggests prognostic significance of spirometry.

[Clinical and structural parallels in changes of the myocardial conduction system in diphtheria patients]. / Klinicheskie i strukturnye paralleli izmenenii provodiashcheisistemy serdtsa i miokarda u bol'nykh difteriei.

AIM: Comparison of the results of clinical device investigations of the heart with morphological autopsy evidence in diphtheria. MATERIAL AND METHODS: Hearts of 309 patients with diphtheria aged 25 to 80 years and 60 hearts of patients who died of diphtheria were investigated using ECG, echo-CG, doppler echo-CG, Holter ECG monitoring, biochemical tests of blood. Structural study of cardiac conduction included examination of the sinus-atrial node, atrioventricular node and bundle regarding the adjacent myocardium. RESULTS: Variants of structural-functional state of the myocardium and conduction system are explained by variability of the pathological processes which arose due to individual features of the conduction system structure and location, relationships with the myocardium. In acute diphtheria (day 1-10) dystrophic, necrobiotic and vascular disorders prevailed followed on days 11-30 by inflammation ending in myocardiosclerosis. Nodes and bundles of the conduction system are affected less frequently than the myocardium. CONCLUSION: A correlation exists between structural state of the cardiac conduction system and variants of clinical affection of the heart in diphtheria.

[Course and outcomes of infectious endocarditis in HIV-infected patients]. / Techenie i iskhody infektsionnogo éndokardita u VICh-infitsirovannykh bol'nykh.

39 patients with acute infectious endocarditis were observed; of these, 28 patients had HIV infection at different stages of the disease. The specific features of the course of acute infectious endocarditis in HIV-infected patients were established. The severe course of acute septic endocarditis was observed in those patients whose parameters of the cell-mediated immune system (cells CD4+) were in the state of compensation or subcompensation. At different stages of HIV infection different clinical syndromes of infectious endocarditis prevailed. In patients with HIV infection the combined lesions of the heart valve apparatus were observed and mixed microflora was isolated from the blood more frequently. The development of acute septic endocarditis negatively affected the course of HIV infection and was manifested by a rapid decrease in the amount of CD4 lymphocytes.

[Impaired cardiovascular system in patients with HIV-infection and manifested cytomegalovirus infection]. / Porazhenie serdechno-sosudistoi sistemy u bol'nykh VICh-infektsiei i klinicheski vyrazhennoi cytomegalovirusnoi infektsiei.

AIM: To assess the condition of the cardiovascular system in HIV-infected patients with manifest cytomegalovirus (CMV) infection. MATERIAL AND METHODS: The condition of the cardiovascular system was studied in 21 HIV-infected patients with manifest CMV infection using the following diagnostic methods: clinical, electrocardiographic, echocardiographic, histological ones, measurement of activity of cardiospecific enzymes. RESULTS: CMV infection the affects functional and morphometric parameters of the cardiac muscle evident as cavity dilatation, increased myocardial mass, low myocardial contractility. CMV is involved in development of dilated cardiomyopathy. Specific therapy with cimeven had a good effect on morphofunctional characteristics of the myocardium. CONCLUSION: Development of manifest CMV infection and affection of cardiovascular system are related.

[Central hemodynamics and portal-hepatic blood flow in patients with acute and chronic virus hepatitis]. / Tsentral'naia gemodinamika i portal'no-pechenochnyi krovotok u bol'nykh ostrymi i khronicheskimi virusnymi gepatitami.

AIM: To characterize central hemodynamics and portal-hepatic blood flow in patients with acute and chronic viral hepatitis. MATERIAL AND METHODS: Ultrasound investigation, tetrapolar rheography, hepatic scintigraphy were made in 149 patients with acute and chronic viral hepatitis B, C and B + C. RESULTS: The above patients had disturbances in central hemodynamics manifesting with developing myocardiodystrophy and hyperkinetic hemodynamics syndrome; decreased intensity and increased amplitude of respiratory fluctuations of volumic hepatic blood flow; impairment of peripheral blood flow. CONCLUSION: The above changes were most prominent in patients with chronic hepatitis B + C.

[Clinical and instrumental diagnosis of cardiac affection in patients with toxic diphtheria]. / Klinicheskaia i instrumental'naia diagnostika porazheniia serdtsa u bol'nykh toksicheskoi difteriei.

AIM: To specify myocardial affection in adult patients with toxic diphtheria (TD). MATERIALS AND METHODS: Along with routine clinical examination 150 patients with toxic diphtheria underwent ECG, echo-CG and biochemical tests. 22, 81, 26, 14 and 7 patients had subtoxic TD, toxic form of the first degree, second degree, third degree and hemorrhagic TD, respectively. RESULTS: Myocardial impairment in TD develops very early, but is diagnosed in different time depending on the diagnostic technique. Early signs of myocardial involvement are activation of cardiospecific enzymes and echo-CG changes. Poor myocardial prognosis in TD is predetermined by progressive cardiac failure (primarily right ventricular), marked conduction disorders, diminished contractility, hyper- or hypoactivity of cardiospecific enzymes. CONCLUSION: The knowledge of myocardial affection variants in TD enables the clinician not only to predict the disease course but to conduct more adequate therapy resultant in less numerous lethal outcomes of toxic TD.

[The first case of visceral leishmaniasis in a patient with HIV infection in Russia]. / Pervyi sluchai vistseral'nogo leishmanioza u bol'nogo s VICh-infektsiei v Rossii.

A case history of a 39-year-old male is reported. The patient was diagnosed to have visceral leishmaniasis and HIV infection in January 1997. HIV-infection manifested with advanced Kaposi's sarcoma, recurrent Candida and Herpes infection, a decrease of body mass by more than 10%. The diagnosis of visceral leishmaniasis was confirmed by detection of Leishmania in biopsy from the bone marrow. Glucantim treatment produced a good clinical effect.