['Masks' of acute neuroinfections and markers of differencial diagnosis]. / 'Maski' ostrykh neiroinfektsii i markery differentsial'noi diagnostiki.

AIM: To compare thе medical history, clinical features, composition of cerebrospinal fluid (CSF), results of laboratory and instrumental examinations of patients with acute neuroinfections and differentiable diseases including a pseudoinflammatory variant of the acute stage of uncomplicated subarachnoid hemorrhage (SAH), consequences of traumatic brain injury (traumatic SAH, SAN combination with secondary purulent meningitis, posttraumatic nasal liquorrhea, intracerebral hematomas), abscesses and tumors of the brain, lymphoma with proven CNS. These diagnoses were mistakenly made to patients admitted to an infectious department. MATERIAL AND METHODS: Forty-six patients, aged from 18 to 83 years, hospitalized in the Department of neuroinfections and intensive care in 2010-2016 were examined. Conventional clinical neurological, laboratory, instrumental (including MRI) examinations of patients, comprehensive examination of CSF samples, the study of markers of inflammation (C - reactive protein, CSF lactate), immunophenotyping of CSF cells were performed. RESULTS AND CONCLUSION: The misdiagnosis can be explained by the overestimation of such symptoms as the acute (in most cases) onset of the disease with increased body temperature to febrile levels, presence of meningeal syndrome, disorders of consciousness and focal symptoms of varying severity. The authors showed the errors and difficulties in the diagnosis, the role and importance of an integrated, interdisciplinary approach taking into account history, clinical data, results of CSF study, conventional and special methods of laboratory and instrumental examination of patients.

[Cerebrospinal fluid in clinical aspects of tuberculosis of the central nervous system].

OBJECTIVE: To identify clinical features of tuberculosis of the meninges and central nervous system (TM) with detailed characterization of changes in the composition of cerebrospinal fluid (CSF) in the initial period of the disease. MATERIAL AND METHODS: We analyzed the results of the examination of 42 patients, aged from 17 to 49 years, who were hospitalized in 2005-2014. RESULTS AND CONCLUSION: Most of the patients were admitted in the hospital in early acute disease onset. Along with the description of inflectional and cerebral symptoms, meningeal signs, disorders of consciousness and focal symptoms, we presented cell count values, protein and glucose concentrations at initial examination of CSF as well as the results of additional examination and specific therapy issues. The importance of combining treatment standards and individualization of therapy of TM patients is emphasized.

[Rare forms of segmental exanthema in patients with Herpes zoster].

OBJECTIVE: To describe rare clinical cases of Herpes zoster with a rash appeared simultaneously in different segmental zones (zoster duplex unilateralis and zoster duplex bilateralis). MATERIAL AND METHODS: Brief details of medical histories of 3 patients are presented. RESULTS AND CONCLUSION: A very rare possibility of the complete fusion of bilateral exanthema on the same topographic level with the development of an entire zoster that confirm a historical name of the disease has been demonstrated. A mistaken translation of disease name into Russian as "lishai" is emphasized. Recommendations on the complex, stage-by-stage treatment of patients, including psychotherapeutic treatment of the pain syndrome, are presented.

[Comparative evaluation of effectiveness of traditional serologic and modified methods of herpes zoster laboratory diagnostics].

AIM: Comparative evaluation of effectiveness of traditional serologic and modified diagnostic methods of disease arising due to varicella and herpes zoster virus (VZV) reactivation. MATERIALS AND METHODS: 2 groups of patients were examined. The main group consisted of 39 patients with manifest form of herpes zoster (HZ), control--20 healthy donors. Sex composition of the groups did not differ. Traditional method of serologic diagnostics included determination of anti-gE VZV IgG and anti-VZV IgG and anti-IgM in patient and donor blood sera by using EIA. Modified methods consisted of isolation in density gradient and cultivation for 48 hours of peripheral blood mononuclears (PBMC) in RPMI-1640 complete culture medium containing 10% of fetal bovine serum, 4 mM L-glutamin and gentamycin. Concentrations ofanti-VZV IgG and IgM were then determined in culture medium by using EIA. RESULTS: In all the examined HZ patients and healthy donors anti-VZV IgG were detected in blood. Only in 26 (67%) of 39 HZ patients anti-gE VZV IgG and anti-VZV IgM were determined in blood sera. Among donors false positive results for these markers were detected in 10% and 5% of cases, respectively. During simultaneous determination of anti-gE VZV IgG and anti-VZV IgM the specificity of the method increased to 100%, sensitivity of the diagnostic method based on simultaneous determination of anti-gE VZV IgG and anti-VZV IgM was 59%. During analysis of spontaneous production of anti-VZV antibodies by PBMC in 38 (97.4%) of 39 patients anti-VZV IgG were determined in PBMC culture, anti-VZV IgM production was observed only in 4 patients. In control group false positive results of anti-VZV IgG and IgM production by PBMC was not detected by the modified method (100% specificity). At equal specificity level sensitivity of the modified method based on determination of spontaneous anti-VZV IgG production by PBMC culture was significantly higher than effectiveness of the traditional serologic diagnostics (97.4% and 59%, p < 0.0001). CONCLUSION: The data obtained allow to recommend during diagnostics of manifest and atypical VZV infection forms arising due to endogenous virus reactivation the new modified method of laboratory diagnostics of the disease as having higher sensitivity compared with traditional serologic method.

[A rare form of eczema in a patient with herpes zoster].

A rare clinical condition, herpes Zoster duplex bilateralis, is described. Because the erroneous definition of the disease as a lichen is widespread even in the system of advanced medical training, the importance of differentiation between the notions of herpes and lichen is emphasized.