Problems of clinical diagnosis and treatment of P. falciparum malaria in Russian Federation.

AIM: To study the causes of falciparum malaria deaths in Russian Federation and to optimize therapy for severe forms of the disease. MATERIALS AND METHODS: The analysis of falciparum malaria cases with deaths recorded in Russian Federation from 2013 to 2017 was conducted. The results of optimization of pathogenetic therapy of severe forms of falciparum malaria for the prevention of adverse outcomes in the intensive care unit of the Infectious Clinical Hospital №2 of Moscow in 44 patients with severe course are presented. Treatment, clinical laboratory and instrumental investigations were carried out in accordance with our intensive care protocol, which took into account the current WHO recommendations. RESULTS: From 2013 to 2017 there were nine deaths from falciparum malaria reported in patients from African countries (6) and India (3). In Russia, due to the lack of effective drugs of artemisinin group, quinine with tetracycline or doxycycline is used for etiotropic therapy of patients with complicated form of falciparum malaria. In the management of such patients, the basis for treatment was the prevention of ischemic, reperfusion injuries of organs and hemorrhagic complications. In the infectious clinical hospital №2 of Moscow, since 2007, the intensive care unit has developed and tested a protocol for intensive therapy in patients with severe and complicated forms of falciparum malaria, including preventive methods of extracorporeal hemocorrection with prolonged veno-venous hemodiafiltration therapy and plasmapheresis, as a result of which the mortality rate decreased from 84 to 6.8. CONCLUSION: The country's lack of anti-malarial drugs, the insufficient awareness of the population about the risk of infection and measures to prevent malaria, late referral of cases for medical care and errors of clinical diagnosis and treatment annually lead to fatal outcomes. In such situation, the experience of optimizing the treatment of severe falciparum malaria is particularly useful, allowing decreasing the mortality.

[(HUMAN DIROFILARIASIS: CLINICAL DIAGNOSTIC FEATURES ASSOCIATED WITH DIFFERENT DEVELOPMENTAL STAGES OF THE PATHOGEN)].

To seek medical advice is due to the time when a person has become infected during the infection transmission season (July-August) and the duration of development of the pathogen Dirofilaria (N.) repens in his/her body Clinical manifes- tations occurred in 61% of the patients 6-10 months after infection, as confirmed by the maximum body sizes (125-160 mm) of removed females which have reached puberty. PCR-based diagnosis in conjunction with microscopic studies improves the efficiency of identifying the patients and the species of the pathogens D.repens and D.immitis. The use of these methods for the first time in 2016 could confirm D.immitis infestation in a 14-month-old infant living in the Solnechnogorsk District, Moscow Region.

[(TO UPDATE ENFORCEMENT PRACTICE IN ENSURING THE PARASITIC SAFETY OF ENVIRONMENTAL OBJECTS. LEGAL AND METHODOLOGICAL CONFLICTS: WAYS OF THEIR SOLUTION)].

The modern development of parasitological science and practice is integrated into the process of legal regulation of the protection of human rights and health and the environment. Russian Federation Government Enactment No. 761 dated September 28; 2009, determines a provision on examining the legal acts establishing the sanitary and epidemiological requirements for their compliance with the standards, recommendations, and other documents of international organiza- tions, including the World Health Organization [10]. The authors carried out a detailed analysis ofthe status of law enforce- ment practice in ensuring the safety of water to be free from parasites, the most studied and proven in international and national law. Factorization of national statutes on safe drinking water and water in the water sources identified legal in- consistencies in both different legal acts of the Russian Federation and their compliance with the WHO recommendations [12]. Ways to overcome legal and methodological conflicts and those to provide mechanisis of legal regulation in this area were defined. It is noted that the decision is a complex process that involves various levels of a structure of legislative initiatives and the professional public; however,,the end result is focused on the dynamic integration of national law in ensuring the parasitic safety of the environment in the unified field of international law.

[(INTRODUCTION OF RESEARCH RESULTS INTO THE TRAINING OF PHYSICIANS IN THE SPECIALTY OF PARASITOLOGY)].

The paper presents the results of theoretical and practical studies into parasitology, which were conducted at the E.I.Martsinovsky Institute of Medical Parasitology, Tropical and Vector-Borne Diseases and then used for the training of specialists with higher medical education at the Department of Tropical Medicine and Parasitic Diseases, I.M.Sechenov First Moscow State Medical University. The need to develop professional skills is related to the increasing learning require- ments due to socioeconomic conditions and the epidemiological situation in the country.

[(EXPERIENCE WITH GEOGRAPHIC INFORRMATION SYSTEMS USED IN EPIDEMIOLOGICAL STUDIES (AS AN EXAMPLE OF MALARIA AND DIROFILARIASIS)].

The effective application of GIS against parasitic diseases requires the patterns of spread of parasitic diseases in certain natural, climatic, and socioeconomic conditions of different regions where there are epidemically effective carriers. The epidemiological parameters defining a high risk of an epidemiological process after P.vivax importation into Russia were calculated using the developed HealthMapper controlled module with a database. Analysis of the average long-term air temperatures in the administrative territories of Russia over 78 years, namely July, the warmest month of the year when there are the largest numbers of all types of mosquito vectors and high levels of microfilaria in the peripheral blood of in- fected dogs (definitive hosts), has shown that the northern border of the maximum possible area of dirofilariasis in Russia is most fully described by the +14C July isotherm.

[(CHANGE IN THE DIAGNOSTIC CHARACTERISTICS OF ANTIBODIES TO CYSTICERCUS CELL ULOSAE IN THE SERUM SAMPLE COLLECTION IN RELATION TO THE PERIOD OF STORAGE DURING DEEP FREEZING)].

The paper gives the results of experimental studies determining the preservation of antibodies to C.cellulosae in the serum in relation to the period of their storage during deep freezing. These studies, as applied to parasitic pathology, have been conducted for the first time and are of practical medical value in determining optimal procedures and periods of serum storage without a loss of their diagnostic characteristics.

[(THE WORLD HEALTH ORGANIZATION NEW GLOBAL TECHNICAL STRATEGY FOR 2015-2030)].

The Global Technical Strategy for Malaria 2016-2030, which was approved by the World Health Assembly in 2015, over the next 15 years suggests that the number of patients with malaria will decline by 90%, that it will be eliminated in 35 countries where this infection remained endemic in 2015, and that the resurgence of malaria will be prevented in the previously eliminated areas. Taking into account the existing features of antimalarial programs in the endemic countries at both national and subnational levels, this strategy can and must serve as a basis for the development and formulation of really implementable national malaria control and elimination programs.

MALARIA: FROM CONTROL TO ELIMINATION IN THE WHO EUROPEAN REGION (1999-2014).

Malaria in the WHO European Region has gone from control to elimination thanks to the great efforts of health services in endemic countries. Locally transmitted malaria cases decreased from 90,000 late in the 20th century to 0 in 2015. Currently, there is a real threat to resurgence of malaria in the south of the European and Asian parts of the Region. Neglecting malaria prevention measures in the countries with high malariogenic potential areas where malaria elimination has been achieved may lead to consequences of imported malaria.

[EXPECTED CONSEQUENCES OF TARGETED HUMAN BEHAVIOR MODULATION UPON EXPOSURE TO TOXOPLASMA GONDII].

The paper shows that there are more seropositive people in a group of those who have experienced road accidents (RA) and who are responsible for the latter than in a control group. The investigations have indicated that chronic toxoplasmosis may be regarded as a potential increased risk factor of RA.

[Results of studies of human dirofilariasis in Russia].

Human dirofilariasis is a pressing health problem in Russia. By 2014, there have been as many as 850 Dirofilaria repens-infested people living in 42 subjects of the Russian Federation. One of the favorable factors for circulation and spread of invasion is a temperature of above +20-24 degrees C; when the latter is maintained during at least 20 days there may be 1.-1.5 circulations of invasion in the carrier and a 2.8-fold increase in transmission intensity. The border ofa dirofilariasis area with a temperate climate is southward to 58 degrees N in European Russia and West Siberia and southward to 50 degrees N in the Far East. The conditions in the human body have been found to be more favorable for the development of Dirofilaria than considered before and allow the helminth to achieve sexual maturity and to propagate. If man has microfilaremia, he may be a source of invasion. It is necessary to examine venous blood by the enrichment method and, if possible, polymerase chain reaction and enzyme immunoassay, which make it possible to establish a diagnosis in occult invasion and to identify a pathogen species.

[Entomological monitoring of an area to assess Dirofilaria transmission risk].

As the basis for entomological monitoring, the authors first propose to investigate the structure of a season of D. repens invasion transmission in the carrier in relation to the ambient temperature, such as onset of a transmission season, terminaton of mosquito infection, the number of invasion circulations. A calculating procedure has been developed. It is shown that there is a need for entomological monitoring of each specific area irrespective of the latitude to study a risk for local dirofilariasis cases.

[The first finding of invasive species Aedes (Finlaya) koreicus (Edwards, 1917) in European Russia].

For the first time mosquito Aedes koreicus were identified by morphology and molecular genetics in the south of European Russia (Sochi city) in 2013.

[Assessment of the risk of expansion of the habitats of the mosquitoes AEDES aegypti L. and Aedes albopictus Skus. in Russia].

Based on climatic characteristics, the authors show that an invasive Aedes albopictus species is likely to emerge in new areas of the Russian Federation.

[Distribution of aedes (stegomyia) aegypti l. and aedes (stegomyia) albopictus skus. mosquitoes on the Black Sea coast of the Caucasus].

There is evidence that in the Black Sea coastal area, Ae.albopictus mosquitoes are encountered everywhere from N. Afon to Dzhubga over a length of 250 km of the coast and Ae.aegypti ones are from N. Afon to Agoi, Tuapse District (215 km). The Ae.albopictus mosquitoes have extended 44 km in length and 600 m in height in the eastern part of the coast (Krasnaya Polyana).