ACUTE KIDNEY DAMAGE AS A COMPLICATION OF MALARIA CAUSED BY PL. MALARIA AND PL. FALCIPARUM: CLINICAL CASES.

We have described two clinical cases of severe malaria caused by different pathogens: Pl. falciparum and Pl. malaria, common to which there was a severe course, complicated by acute renal failure and hemolytic anemia. In a detailed analysis of both clinical cases, Patient 1 had acute kidney damage arose after the increase of anemia and thrombocytopenia, in combination with hemoglobinuria. This shows that the leading mechanism of kidney injure in this case is acute tubular necrosis, due to the toxic effects of free hemoglobin and sequestration in the capillaries of the glomerulus. A Patient 2 had a significant increase of anemia after appears of acute kidney damage; there was no hemoglobinuria, however, significant leukocytosis was observed. It seems, that the leading mechanism in this case is immune-mediated kidney injure or due to hypoperfusion of kidney tubules with the development of acute interstitial nephritis or immune complex glomerular injure with the development of glomerulonephritis, or a combination of them. A detailed analysis of the described two clinical cases of severe malaria caused by Pl. falciparum and Pl. malaria, respectively, and complicated by acute renal failure and hemolytic anemia, suggests that the pathogenetic mechanisms and severity of kidney damage depend on the type of malaria.

EFFICACY OF SPECIFIC PREVENTION OF INFLUENZA IN INDIVIDUALS WITH POLYMORPHISMS ARG753GLN OF TLR-2, LEU412PHE OF TLR-3, ASP299GLY OF TLR-4 GENES.

OBJECTIVE: The aim: Is to study the efficacy of influenza vaccination for individuals with polymorphism Arg753Gln of TLR-2 gene, Leu412Phe of TLR-3 gene, and Asp299Gly of TLR-4 gene. PATIENTS AND METHODS: Materials and methods: 66 people with mutant genotypes and normal distribution of alleles of TLR-2, TLR-3, TLR-4 genes, aged 18-63, were inoculated with anti-influenza vaccine. The genotyping of Arg753Gln polymorphic site of TLR-2, Asp299Gly of TLR-4, and Leu412Phe of TLR-3 gene was carried out by polymerase chain reaction with oligonucleotide primers usage. The immunological efficacy of vaccination was evaluated by seroconversion, seroprotection, and dynamics of mean geometric titers of antibodies. RESULTS: Results: It has been established that individuals with mutant genotypes Arg/Gln of TLR-2, Leu/Phe, Phe/Phe of TLR-3, Asp/Gly of TLR-4 genes have a vaccinal response to administering anti-influenza vaccine at the level of subjects with normal distribution of TLR alleles, as evidenced by the growth in dynamics of mean geometric titers of antibodies to vaccine strains, the level of seroprotection and seroconversion. Clinical and epidemiological efficacy of vaccination in this category of people is characterized by: reduction of ARI cases in the postvaccinal period by 2,0-3,0 times; prevention of pneumonia in all vaccinated subjects; decrease in the frequency of bronchitis by 2,5-3,8 times. CONCLUSION: Conclusions: Effectiveness of influenza vaccination in individuals with Arg573Gln polymorphism of TLR-2, Leu412Phe of TLR-3, Asp299Gly of TLR-4 genes by immune and clinical epidemiological parameters is determined at the level of vaccinated subjects with normal distribution of TLR-2, TLR-3, TLR-4 alleles. Specific influenza immunization of people with polymorphic modified genotypes of TLR-2, TLR-3, TLR-4 genes can prevent the development of pneumonia and reduce the incidence of bronchitis.

Some clinical and epidemiological features of influenza-associated pneumonia depending on the etiological agent.

OBJECTIVE: The aim: To analyze the epidemiological data and clinical course of pneumonia as a complication of influenza in the Poltava region, depending on the etiological agent. PATIENTS AND METHODS: Materials and methods: We have analysed the data of the official reporting documentation provided by the State Institution "Poltava Regional Laboratory Center of the Ministry of Health of Ukraine" and the chart of patients with a laboratory confirmed diagnosis of influenza who were in inpatient treatment at the Poltava Regional Clinical Infectious Hospital (PRCIH) in 2016-2018 years. In more detail, we examined 95 patients with pneumonia, which complicated the course of the flu. There were 43 (45.26%) female patients, - 52 (54.74%) male patients, aged 18 to 80 years. RESULTS: Results: Studies have shown that despite a decrease in the incidence of influenza in recent years, the incidence of pneumonia, which complicated the course of the flu, remained consistently high (19.7% - 20.8%) with bacteriological isolation of S.pneumoniae (22.11%), S.aureus (13.68%), Haemophilus influenza (4.21%) and E.coli (3.16%). Severe course of pneumonia with bloody sputum, evident shortness of breath, bilateral lung damage, and need for oxygen support were significantly more frequently reported in patients with isolated S.pneumoniae and S.aureus. However, the severe course of the disease with the formation of abscesses in the lungs was observed only in the group S.aureus despite the relatively young age of such patients and significantly fewer risk factors for severe influenza and comorbidities. CONCLUSION: Conclusions: The study showed a consistently high incidence of pneumonia, which complicated the flu and caused by S.pneumoniae, S.aureus, Haemophilus influenza and E.coli. Pneumonia caused by S.pneumoniae and S.aureus, were characterizedthe most severe course; however, a severe course with the formation of abscesses in the lung tissue was observed only in the group of S.aureus.

Genetic polymorphism ARG753GLN of TLR-2, LEU412PHE of TLR-3, ASP299GLY of TLR-4 in patients with influenza and influenza-associated pneumonia.

OBJECTIVE: The aim of the research is to study the prevalence and to determine the prognostic significance of polymorphism ARG753GLN of the TLR-2 gene, Leu412Phe of TLR-3, Asp299Gly of TLR-4 in influenza. PATIENTS AND METHODS: Materials and methods: 112 patients with influenza were examined (63 patients with uncomplicated course and 49 with influenza-associated pneumonia). The genotyping of the polymorphic site of ARG753GLN of the TLR-2 gene, Asp299Gly of the TLR-4 gene, and Leu412Phe of the TLR-3 gene was carried out by polymerase chain reaction using oligonucleotide primers. RESULTS: Results: It has found that the prevalence of the mutant allele 299Gly of TLR-4 in patients with uncomplicated influenza is 6.4 %, with influenza- associated pneumonia - 7.1 %, which exceeds the population control indicators by 3.8-4.3 times (1.7 %, p<0.05). Mutant allele 412Phe of TLR-3 is significantly more common in patients with influenzaassociated pneumonia (42.9%), as compared with uncomplicated influenza (24.6%, p<0.01) and healthy people (30.0%, p<0.05). The increased risk of influenza development is associated with the Asp/Gly genotype of TLR-4 (OR=4.22) and combination of mutant genotypes Leu/Phe and Phe/Phe of TLR-3 with Asp/Gly of TLR-4 and Arg/Gln of TLR-2 (OR=15.0); influenza-associated pneumonia - with genotype Phe/Phe of TLR-3 (OR=4.5). CONCLUSION: Conclusions: It has been found out that among patients with influenza and influenza-associated pneumonia, the mutant allele 299Gly of TLR-4 and combinations of polymorphisms Arg753Gln of TLR-2, Leu412Phe of TLR-3, Asp299Gly of TLR-4 are detected reliably more often. The frequency of the mutant allele 412Phe of TLR-3 is higher among patients with influenza-associated pneumonia. Markers of increased risk of influenza are 299Gly allele and genotype Asp/Gly of TLR-4 and the combination of mutant genotypes Leu/Phe and Phe/Phe of TLR-3 with Asp/Gly of TLR-4 and Arg/Gln of TLR-2; for influenza-associated pneumonia - allele 412Phe and genotype Phe/Phe of TLR-3.

Opisthorchiasis and viral hepatitis b: clinical cases.

OBJECTIVE: Introduction: Among the cases of biohelminthosis, which are registered in Ukraine, opisthorchiasis is the most common and constitutes the second largest centre in Europe. Due to the growth of migration processes and global tourism, opisthorchiasis is becoming increasingly relevant for the countries of the European Union and the United States. Under modern conditions, the clinical course of many infectious and parasitic diseases has changed. The aim: The present paper discusses and analyzes the cases of opisthorchiasis and hepatitis B virus which are challenging in terms of diagnostics and choice of treatment tactics. CONCLUSION: Conclusion: The course of acute infections, the formation of results and the effectiveness of treatment are influenced by a number of factors, among which mixed infections are of particular interest.