[Oral health as a factor of primary prevention of postinfectious complications]. / Zdorov'e organov rta kak faktor pervichnoi profilaktiki postinfektsionnykh oslozhnenii.

OBJECTIVE: The purpose of the study is to substantiate the need and importance of early diagnosis and treatment of oral lesions in infectious diseases (ID) by dentists. MATERIAL AND METHODS: A retrospective analysis of the provision of dental care in multi-specialty hospitals to 780 patients with infectious pathology: herpetic infections (HI) - 320 people (41.03%); ARVI - 160 people (20.51%); acute enteric infections (AEI) - 300 people (38.46%). The diagnosis of the disease was established by infectious diseases doctors. The etiology of ID was confirmed using PCR and IFA. RESULTS: The prevalence of caries is 98.5%, the CPEs index is 10.26±0.04. In 84.1% of patient's oral hygiene was unsatisfactory. In the acute period of ID in HI, ARVI and AEI oral mucosa (OM) lesions were detected in 75.89% of cases: stomatitis (81.75%), gingivitis (69.76%), glossitis (35.98%), cheilitis (23.31%). Incidence of OM lesions in ID: catarrhal stomatitis - HI - 52.8%, ARVI - 64.1%, AEI - 67.9%; catarrhal gingivitis: in patients with HI, it is 1.7 times less frequent than in patients with AEI (p<0.001), and in ARVI - 1.6 times more often than in patients with HI (p<0.001). Cheilitis: HI - 25.9%, ARVI - 18.3%, AEI - 23.7%; catarrhal glossitis: AEI - 65.1%, ARVI - 23.2%, HI - 17.0%; candidiasis of the oral mucosal and tongue: HI - 11.1%, ARVI - 27.5%, AEI - 26.9%. A direct relationship between the lesions of OM and the severity of the course of HI, ARVI and AEI was established. CONCLUSION: Thus, dental pathology in infectious patients is pathogenetically determined by combined and interrelated disorders of the functional state of each organ of the oral cavity, the dental system and the body as a whole. Due to the relatively short duration of inpatient treatment for acute ID, priority should be given to the prevention of postinfectious complications of oral mucosal diseases.

[Postmortem forensic medical diagnostics of fulminant sepsis caused by Gram-negative bacterium (Capnocitophaga canimorsus) following a dog bite].

This article provides the example of postmortem forensic medical diagnostics of fulminant sepsis caused by Gram-negative bacterium (Capnocitophaga canimorsus) following a dog bite. In order to identify the etiological factor of fulminant sepsis, the expert carried out the study of the autopsy materials with the use of polymerase chain reaction (PCR). This method has only recently been introduced into postmortem diagnostics of fulminant sepsis in this country; it has no analogs abroad and can be employed for the purpose of forensic medical expertise and pathological anatomic studies.

[Syphilis in a patient with the primary diagnosis of infectious mononucleosis, cytomegalovirus and herpes infection].

The paper reports a case of fresh secondary syphilis affecting oral cavity and lips in a 25 year old woman. The primary diagnosis of infectious mononucleosis, cytomegalovirus and herpes infection proved erroneous. Retrospective differential diagnostics of infectious mononucleosis, cytomegalovirus and herpes infection from fresh secondary syphilis was performed This case suggests the absence of vigilance with respect to venereal diseases in the medical personnel.

[HIV infection in a patient with a referral diagnosis of sore throat].

HIV infection was documented in a patient with hairy leukoplakia and oral candidiasis who had the wrong referral diagnosis of sore throat in the absence of dental complaints. Dental treatment at an infectious hospital led to regression of oral mucosa lesions, but failed to arrest the progress of severe pneumonia presumably caused by a specific pathogen.

[The state of oral cavity in patients with hepatitis A].

The aim of the study was to estimate oral cavity condition in 42 patients aged 25-58 years with hepatitis A. Forty patients without hepatic pathology served as controls. Hepatitis A is known to be associated with inflammation of oral mucosa with stomatitis occurring in 78.5% of the patients, glossitis in 71.4%, cheilitis in 64.3%, marginal periodontal inflammation in 85.7%. Oral mucosal lesions confound the clinical picture of hepatitis. The prevalence of caries and its complications in patients with hepatitis A amounts to 95.2%. Results of our studies confirm the necessity of early stomatological examination of such patients.

[Salmonellosis and concomitant yersiniosis].

Clinical description of salmonellosis and concomitant yersiniosis in 6 women aged 26-50 years infected from a common source is presented. They were members of a group of 65 women suffering alimentary intoxication the source of which was supposed to be either light-salted salmon or vegetable salad. The incubation period varied from 4 to 12 hours. The disease started as an acute infection with a rise in temperature to 38.5-40 degrees C, repeated vomiting, mucous-watery diarrhea and pain in the right half of the abdomen (largely in the ileocecal region). These symptoms provided a basis for differential diagnosis from yersiniosis and appendicitis. The patients presented with leukopenia and moderate leukocytasis with the prevalence of rod-nuclear cells (up to 9-56%). Diagnosis of mixed infection was confirmed by detection of group D1 S. enteriditis in feces and positive serological reactions with O3 intestinal-yersiniosis diagnosticum. Fever, diarrhea, and abdominal pain persisted for 5-6 days, The patients were treated by rehydration, symptomatic and antibacterial therapy (ciprofloxacin, cifran).

[Comparative efficiency and side effects of combined antiviral therapy of chronic hepatitis C].

The study included 100 patients with chronic hepatitis C previously untreated by interferon preparations. Patients of group I (n=53) were given pegylated interferon alpha-2b (PEG IFN) and rebetol, patients of group 2 (n=47) PEG IFN and copegus. The overall efficiency of therapy regardless of hepatitis C virus genotype in the two groups was estimated at 83 and 79% respectively. It was 65% in patients with virus genotype 1b in group 1 and 69% in group 2 In patients with virus genotypes 2 and 3, the efficiency was estimated at 100 and 91% in groups 1 and 2 respectively. The efficiency of therapy depended on the duration of the period during which the virological response was obtained. Side effects in the form of disturbed sleep, musculo-articular pain, and anorexia occurred in group 1 more frequently than in group 2 The reverse was true of scalp reactions and psycho-emotional distress.

[Concerning changes of oral cavity mucous tunic in acute enteric infection].

The authors represented the results of oral cavity stomatological examination in 171 patients with acute enteric infection (AEI): shigellosis, salmonellosis etc in dynamics of disease. These patients had first diagnosed inflammatory changes of oral cavity mucous tunic: catarrhal gingivitis, catarrhal and benign migratory glossitis, aphthous stomatitis with submandibular lymphadenitis. These changes were accompanied by aggravation of herpetic infection or its debut, candidosis. Lesions of oral cavity mucous tunic in patients with AEI are particular manifestation of infectious process. In acute period patients with AEI have to be examined by stomatologist.

[Anaerobic gas-producing clostridial endogenic infection in patient with salmonellosis].

Anaerobic gas-producing clostridial infection is one of most severe complications of mainly gunshot wound of war period, in peace time occurs very seldom. The rare clinical case of anaerobic gas-producing clostridial endogenic infection with fulminant course in patient with salmonellosis produced by group B salmonella typhimurium. The disease was finished with fatal outcome in 8.5 hours after appearance of pain syndrome in right thigh with consequent fulminant development of gas gangrene with arterial hypotension on 4th day after onset of gastroenteric form of medium severity salmonellosis. Clinical, microbiological and postmortem data are represented.

[Fever as a very important symptom of infectious and some non-infectious diseases].

Fever is a protective and adaptive reaction, an early and obligatory symptom of infectious diseases in the first place. Historically, this term has been used in the names of more than 20 infectious diseases. Fever may also be a manifestation of other diseases accompanied by aseptic inflammation and neurohumoral disturbances. The growth rate of fever and the character of its circadian fluctuations at the beginning of the disease, as well as its total duration, the height and type of temperature curve, and time of onset of organic lesions should be taken into consideration when performing differential diagnostics of fevers of different origins. The authors developed an algorithm of differential diagnostics of febrile conditions. When an infectious process is excluded reasonably, the patient should undergo further examination for early detection of other diseases accompanied by fever.

[Acute myocarditis caused by ECHO virus].

Enteroviral infection is characterized by clinical polymorphism. One of its clinical manifestation is myocarditis, which is usually caused by Coxsackie virus. ECHO viruses cause the disease mostly in childhood. The article presents a case of enteroviral (ECHO) infection complicated by pneumonia and focal myocarditis in a 41-year-old patient, hospitalized during a season of influenza and acute respiratory infections. Acute myocarditis was moderate and the patient recovered by day 23.

[Serologic shifts in food poisoning by 1 and 2 infectious agents]. / Serologicheskie sdvigi pri pishchevykh toksikoinfektsiiakh, vyzvannykh odnim i dvumia vozbuditeliami.

Features of serological shifts in patients with alimentary toxicoinfections (ATI) caused by one infective agent (E. coli, staphilococci, Proteus, enterococci) and by two infective agents in various combinations have been studied. The suppression of immunogenesis has been found to be most pronounced in patients having ATI mixed according to agglutinin titers to the autostrains of infective agents. The features of serological shifts in mixed ATI should be taken into consideration in evaluating the diagnostic significance of this reaction in the time course of the disease.

[Isolation of the L forms of Acinetobacter calcoaceticus var. Lwoffii in infectious endocarditis]. / Vydelenie L-form Acinetobacter calcoaceticus, var. Lwoffii pri infektsionnom éndokardite.

In the bacteriological study of blood samples taken from a patient with infectious endocarditis the hemoculture of the L-forms of A. calcoaceticus, var. lwoffii, was isolated. This hemoculture reverted into the bacterial form in the process of subculturing on solid media. The species of the isolated L-forms was established on the basis of the data obtained in the study of the biological properties of the revertants. To ensure the effectiveness of bacteriological investigations, a special search for atypical cultures is recommended in those cases when the inoculation of blood samples yields negative results.

[Microcirculation and hemostasis in influenza and acute viral respiratory infections complicated with pneumonia]. / Sostoianie mikrotsirkuliatsii i gemostaza pri grippe i ostrykh respiratornykh virusnykh infektsiiakh, oslozhnennykh pnevmoniei.

AIM: To study microcirculation (MC), hemostasis and blood viscosity (BV) in influenza and acute respiratory viral infections (ARVI) complicated by pneumonia. MATERIAL AND METHODS: Conjunctival biomicroscopy, hemostasis and BV were studied in 232 patients with influenza and ARVI. In 91 of them the disease complicated with acute pneumonia (AP), in 87--with obstructive bronchitis. RESULTS: Irrespectively of the disease course, patients with influenza and ARVI showed intravascular changes in MC system, hypercoagulation, deterioration of fibrinolysis. In convalescence platelet aggregation increased, fibrinolytic blood activity enhanced. In influenza and ARVI complicated with AP intravascular changes and hypercoagulation were most pronounced. In uncomplicated influenza and ARVI accompanied by bronchitis such changes are less severe. BV was the highest in development of AP. CONCLUSION: MC and hemostatic disorders arising in influenza and ARVI seem to be essential pathogenetic links provoking development of AP. In intravascular aggregation of platelets and red cells, activation of plasmic hemostasis differentiated treatment with desaggregants and anticoagulants are indicated.

[Comparative efficacy of combined treatment with intron A and pegintron in combination with ribavirin of patients with chronic hepatitis C]. / Sravnitel'naia otsenka kombinirovannoi terapii intronom A i pegintronom v sochetanii s ribavirinom bol'nykh kgronicheskim gepatitom C.

AIM: To investigate the efficacy of combined therapy of patients with chronic hepatitis C (CHC) including intron A, pegintron (preparations of alpha-2b interferon) and ribavirin, and evaluation of the above treatment side effects. MATERIAL AND METHODS: 47 CHC patients (38 males and 9 females) were divided into two groups. 22 patients of group 1 received intron A and ribavirin, 25 patients of group 2 were given pegintron and ribavirin for 6-12 months. The examination made before the treatment, during the treatment and after it included clinical, biochemical, virusological blood tests, tests for autoantibodies, thyroid hormones, ultrasound investigation. RESULTS: The response in group 1 was 55%, in group 2--72.7%. In group 2, CNS and skin side effects occurred more frequently. After the treatment side effects regressed in 95.8% patients. CONCLUSION: The pilot experience in Russia confirmed the findings of the foreign investigators on higher efficacy of combined treatment with pegylized interferons (pegintron) and ribavirin vs combination of intron A with ribavirin. It is shown that side effects of the above treatment can be corrected in outpatient medication.

[Diagnostic difficulties in herpes zoster]. / O trudnostiakh v diagnostike opoiasyvaiushchego gerpesa.

The authors have analysed the clinical and laboratory findings in 170 patients with herpes zoster (HZ). Of these, 21 patients (12.3%) had been erroneously diagnosed before the appearance of herpetic eruption as having other diseases (erysipelas, renal colic, acute pancreatitis, acute abdomen, and so forth). The authors point to the difficulties encountered in making the diagnosis at the initial disease period with emphasis on the great importance for early diagnosis of HZ of the analysis of the clinical findings, prodromal period and hemogram data.

[Herpes zoster in cancer patients]. / Opoiasyvaiushchii gerpes u onkologicheskikh bol'nykh.

In cancer patients, the development of herpes zoster (HZ) is accompanied by protracted period of skin rash exudation and by slower scab rejection. Unlike hematological patients, no unfavourable outcomes with infection generalization are observed. The disease is associated with the rise of the content of total IgM, IgA (to a lesser degree) and with the normal level of IgG. There is a tendency towards the reduction of the count of T and B lymphocytes. The cases of primary diagnosis of a malignant tumor in HZ patients are more frequent (2 out of 36).

[Clinical course of herpes zoster in middle-aged and elderly persons]. / Klinicheskoe techenie opoiasyvaiushchego gerpesa u lits pozhilogo i starcheskogo vozrasta.

The clinical progress of herpes zoster (HZ) was studied in 216 patients under 60 years and in elderly and senile persons. A clear relationship was revealed between the gravity of the clinical progress of HZ and the patients' age. The number of patients with grave HZ patterns and with HZ of medium gravity was found to be increasing in elderly and senile persons. It was also established that HZ took a graver course in patients aggravated with concomitant pathology. The concomitant diseases are demonstrated to have a multifactorial aggravating effect on the progress of HZ.