[The clinical laboratory characteristic of primary acute cytomegalovirus infection in non-immunocompromised adult patients].

The purpose of study is the clinical laboratory characteristic of acquired acute cytomegalovirus infection in nonimmunocompromised adult patients. The sampling included 75 patients with acquired acute cytomegalovirus infection admitted to the specialized clinical infection hospital of the Minzdrav of the Krasnodar kraii. The verifcation of diagnosis was implemented using serological tests and polymerase chain reaction. It is demonstrated that males of younger age are most often infected with acute cytomegalovirus infection in the Krasnodar kraii. The disease takes its course in a generalized form. In clinical picture symptoms of intoxication (long-term temperature increasing, weakness), hepatomegaly with increasing of activity of hepatic enzymes, splenomegaly, monolymphocytosis prevail. In most of patients, manifestation of affection of upper respiratory tracts are observed and less frequently - community-acquired pneumonia. The alteration of immune status of patients in dynamics of disease was typical for acute faze of viral infection process with transition to a latent one. At the same time, certain percentage of patients preserved inhibition of neutrophil chain of immunity during re-convalescent period, hence developing menace of bacterial complications. The complex treatment with inclusion of etiotropic anti-viral pharmaceutical Gancyclovir with duration of 8,4±0,4 days resulted in normalization of fever, relief of organic affections and also disappearance of viral DNA from blood. The rate of wrong preliminary diagnoses (85.3%) at referral of patient to hospital testifes complicacy of clinical diagnostic of acute cytomegalovirus infection, conditioned by absence of pathognomonic symptoms under this disease. The last circumstance determines expediency of inclusion into algorithm of examination of patients with unidentifed genesis of fever, hepatosplenomegaly, lymphadenopathy, monolymphocytosis, increasing of activity of hepatic enzymes the analysis of antibodies to antigens of cytomegalovirus (IgM CMV, IgG CMV, avidity of IgG CMV) using enzyme-linked immunosorbent assay and also detection of DNA CMV in blood and urine using polymerase chain reaction technique. The alterations of immune status during re-convalescent period observed in one third of patients determine necessity of their dispensary observation.

[CLINICAL-EPIDEMIOLOGICAL CHARACTERISTIC OF WEST NILE FEVER IN KRASNODAR REGION].

AIM: Clinical-epidemiological characteristic of West Nile fever on the territory of Krasnodar Region in multi-year dynamics. MATERIALS AND METHODS: Manifestations of epidemic process and clinical symptoms of West Nile fever (WNF) on the territory of Krasnodar Region were analyzed retrospectively from 1988 to 2013. Results of epidemiologic observations wiih inclusion of monitoring of arbovirus circulation, carried out by Prichernomorskaya Station of Plague Control and Centre of Hygiene and Epidemiology in Krasnodar Region were used. Clinical course of verified WNFwas studied in 62 patients, treated in the Specialized Clinical Infectious Hospital ofKrasnodar in 1999-2012. RESULTS: Clinical-epidemiologic characteristic of cases of West Nile fever morbidity on the territory of Krasnodar Region is presented. The presence of acting foci of arbovirus infections was noted. Clinical signs of the disease are established, patients allocated into groups that require examination for West Nile fever. CONCLUSION: Complex of entomologic-virologic monitoring, prophylactic and counter-epidemic measures was determined, that allow to prevent emergence of dangerous epidemiologic manifestations of foci of the disease in the future.

[Enterovirus non-poliomyelitis infections in Krasnodar region].

AIM: Evaluation of epidemic situation by non-poliomyelitis enterovirus infections in Krasnodar region in multi-year dynamics and characterization of clinical course of enterovirus serous meningitis in hospitalize patients. MATERIALS AND METHODS: Retrospective analysis of non-poliomyelitis enterovirus infection epidemi process manifestations during 2002-2012 in Krasnodar region territory based on data of Center of Hygien and Epidemiology in Krasnodar Region. RESULTS: Clinical-epidemiologic characteristics of enterovirus infections in Krasnodar region are presented. Landscape ofenteroviruses isolated from the environment of some territories of the region and from the biological material of patients with various diseases is demonstrated. Clinical features ofenterovirus meningitis course are characterized. CONCLUSION: Enterovirus transmission b contact route was established to be the most frequent. A lack of pathognomonic symptoms and awareness o physicians of various specialties regarding diagnostics of this infection are the clinical problems of non-po liomyelitis enterovirus diseases.

[Post-vaccination complications during administration of BCG and BCG-M in children of Krasnodar].

AIM: Analysis of frequency and reasons of complications after BCG vaccination in 2008 - 2012 in Krasnodar Region for improvement of prevention measures. MATERIALS AND METHODS: Data on frequency and structure of post-vaccination complications during vaccination against tuberculosis of Centre of Hygiene and Epidemiology in Krasnodar Region and Regional Tuberculosis Hospital in 2008 - 2012 were used. Reasons of the complications were analyzed. RESULTS: During the observation period 16 complications related to immunization with tuberculosis vaccine were noted with frequency index of 5.1 - 40.4 per 100 000 immunized newborns and a tendency of decrease from 2008 to 2012. In the structure of complications cold abscesses (37.5%), lymphadenitis (31.25%) and ostitis (31.25%) occurred at a similar frequency. CONCLUSION: Predominance of cold abscesses in the structure of post-vaccination complications indicates violations in vaccination technologies in maternity hospitals and children's clinics in Krasnodar city, and late periods of post-vaccination ostitis diagnostics - a decrease of epidemiologic awareness of general medical network physicians regarding BCG-vaccination complications, that requires enhancement of immunization control and requalification of personnel carrying it out.

[The acquired overt cytomegalovirus infection (primary form and reactivation) in adult immune safety patients].

The analysis was applied to clinical course of disease in 102 patients with acquired overt cytomegalovirus infection (75 patients with primary form, 27 patients with reactivation). The primary form of acquired overt cytomegalovirus infection was identified on the basis of detection in enzymoimmunoassay of CMV-lgM under negative CMV-IgG or CMV-IgM and CMV-IgG with avidity less that 50%. The reactivation was diagnosed under identification of CMV-IgG with avidity 50% and more with low indicators of CMV-IgM. The acquired overt cytomegalovirus infection occurs more often in males of young age and proceeds mainly in generalized medium severe form with fever, intoxication and hepatosplenomegaly. The clinical differences are limited by higher rate of generalized forms of disease, febrile fever, weakness, hepatomegaly with increasing of activity of aminotransferase of blood serum, manifestation of signs of affection of respiratory tracts and increase of number of atypical mononuclear leukocytes of peripheral blood in patients with primary form of acquired overt cytomegalovirus infection as compared with reactivated infection.

[Time course of changes in serum cytokine levels and the erysipelas clinical pattern].

The time course of changes in the values of proinflammatory tumor necrosis factor-alpha (TNF-alpha) and IL-8 and the anti-inflammatory cytokine IL-4 has been studied in 78 patients with erysipelas of different frequencies and pathomorphological forms of the disease. In erysipelas and its erythematous form, there is an increase in the levels of TNF-alpha and IL-8 in early phase of the disease, a decrease in these indices during convalescence, and a rise in the content of the cytokine IL-4, which are typical of an acute cyclic infectious process with a good outcome. In recurrent erysipelas and its most severe bullous-hemorrhagic form, there is imbalance in the production of cytokines that are suggestive of that there might be a disease recurrence. In erysipelas patients with a TNF-alpha value of 2.5 pg/ml or less at the onset of the disease, the relative risk for prolonged signs of systemic and local inflammatory reactions increases as compared with those who have a TNF-alpha level of more than 2.5 pg/ml.

[Pathomorphogenesis of the liver, kidneys, and lungs in patients with icteric leptospirosis]. / Patomorfogenez pecheni, pochek i legkikh u bol'ntkh zheltushnym leptospirozom.

Postmortem and biopsies pathomorphological studies of the liver, kidneys and lungs of patients with leptospirosis were carried out. The content of myoglobin in these organs, blood and urine was investigated. Dystrophy and infiltration of the liver in leptospirosis are moderate and do not correlate with the intensity of icterus. In pathogenesis of hepatorenal and respiratory disturbances in leptospirosis the important role in leptospirosis belongs to rhabdomyolysis resulting in accumulation of blood myoglobin. Its elimination occurs through the liver, kidneys and lungs and this promotes development of such complications as shock, acute renal failure, respiratory distress syndrome. The inclusion in pathogenetic therapy of efferent methods of detoxication effectively eliminates endotoxicosis and hypermyoglobinemia and solves the problem of complications.

[Clinical and pathogenic evaluation of acid-base, gas and electrolyte homeostasis in patient with leptospirosis and acute renal insufficiency]. / Kliniko-patogeneticheskaia otsenka kislotno-osnovnogo, gazovogo i élektrolitnogo gomeostaza u bol'nykh leptospirozom s ostroi pochechnoi nedostatochnost'iu.

With the purpose of further perfecting the pathogenetic therapy, indices for the acid-base status were studied together with those for the electrolyte exchange in the time-related course of the disease in patients with grave leptospiral jaundice presenting with acute renal failure (ARF). Patients with leptospirosis running a grave course and ARF display changes in the acid-base status and gas composition of the blood. Patients presenting with oligoanuric ARF and fatal outcome develop uncompensated metabolic acidosis (11.8%), in case of favourable outcome--metabolic acidosis with compensation by respiratory alkalosis (29.4%). The polyuric ARF stage is characterized by a mixed metabolic and respiratory alkalosis (58.8%). Results of studies made warrant use of indices for the acid-base, gas, and electrolyte balance to assess severity and prognosis of leptospirosis, to determine the stage of ARF, and to develop rational pathogenetic therapies.

[Clinical aspects of leptospirosis in carriers of viral hepatitis markers]. / Klinicheskie aspekty leptospiroza u nositelei markerov virusnykh gepatitov.

Comparative clinical, laboratory, and instrumental studies were conducted in 370 leptospirosis patients having positive (14.32%) and negative (85.68%) viral hepatitis markers. There were differences in the symptoms of hepatobiliary lesions, which were regarded as phenomena of either chronic viral hepatitis or secondary reactive hepatitis in 84.9% HV-positive and 14.8% HV-negative patients with leptospirosis. The findings suggest that it is necessary for physicians to examine such patients for viral hepatitis markers and, if the latter are found, to define the pattern of hepatic damage, and to make an early pathogenetic correction of the disorders found. The viral etiology of chronic hepatic inflammation should be borne in mind at follow-ups of HV-positive reconvalescents.

[Hepatobiliary alternations in leptospirosis convalescents]. / Porazheniia gepatobiliarnoi sistemy u bol'nykh, perenesshikh leptospiroz.

AIM: To study hepatic function in leptospirosis convalescents. MATERIALS AND METHODS: Clinical laboratory and device examinations were performed in 121 leptospirosis convalescents. RESULTS: The majority of the examinees retained biochemical signs of cholestatic, mesenchymal-inflammatory and moderate cytolytic syndromes secondary to hepatic impairment. Ultrasound and radionuclide investigations detected biliary disorders and secondary chronic hepatitis in many of leptospirosis convalescents. CONCLUSION: It is shown that leptospirosis rehabilitation must be targeted. Reasons of development of chronic hepatic and biliary lesions in population of the north Caucus and Kuban in the absence of viral hepatitis markers are suggested.

[The albumin-binding capacity of the blood serum in diphtheria patients]. / Sviazyvaiushchaia sposobnost' al'bumina syvorotki krovi u bol'nykh difteriei.

Total and effective concentrations of blood serum albumins were measured in 45 patients with various clinical forms of diphtheria. Both parameters were decreased in patients with toxic forms of the disease in comparison with the norm and with those in patients during the period when specific complications develop and in patients with all clinical forms of diphtheria at the beginning of the illness.

[The clinical and pathogenetic role of erythrocyte catalase activity in diphtheria patients]. / Klinicheskaia i patogeneticheskaia rol' katalaznoi aktivnost' éritrotsitov u bol'nykh difteriei.

Cataleptic activity of erythrocytes was studied in 31 diphtheria and 10 quinsy patients versus 10 healthy controls. Inhibition of cataleptic activity in diphtheria directly correlated with growing severity of the disease. Such relationship was not found in quinsy.

[The results of a trial in the Socialist Republic of Vietnam of clothing providing mechanical protection against the bites of blood-sucking Diptera]. / Rezul'taty ispytaniia v SRV kostiumov, obespechivaiushchikh mekhanicheskuiu zashchitu ot ukusov krovososushchikh dvukrylykh.

The tested overalls for protection in hot climate may be recommended only for the protection of people engaged in work involving little movement (fishermen, watchmen, etc.). For wider use of such overalls in hot regions the design should be changed, the alterations are described in the paper. Further trials of the overalls should be carried out with its modified design; this costume provides adequate mechanical protection from the bites of mosquitoes and other blood-sucking Diptera and it will be widely used in the tropics, where blood-sucking Diptera contribute much to infection transmission.