[Chronic viral hepatitis in St.Petersburg].

Morbidity data on chronic viral hepatitis including cirrhotic stages of disease and lethality indexes in St. Petersburg are provided. The necessity of isolation in ICD- 10 and statistical accounting of chronic viral hepatitis diagnosis with outcome into cirrhosis (cirrhotic stage) is shown. During use of viral etiology liver cirrhosis diagnosis the disease is registered in the structure of liver diseases which does not allow to have data on unfavorable outcomes of chronic viral hepatitis and for complete morbidity accounting.

[The topical problems of morphological diagnosis and the pathomorphism of HIV infection].

The paper analyzes the frequency of admissions to the S. P. Botkin Clinical Infectious Hospital and the City AIDS Center among patients with HIV infection and the structure of fatal outcomes. It is concluded that there is a considerable increase in mortality and the number of patients needing hospitalization. The dead HIV-infected patients autopsied at the Unit of Morbid Anatomy, S. P. Botkin Hospital, in the past years are characterized in detail. The topical problems of HIV infection the solution of which require the participation of pathomorphologists are discussed.

[Comparative clinical and epidemiologic characteristic of HIV infection in women from discordant pairs].

Forty HIV-positive women living with HIV-infected sexual partner as well as 40 HIV-positive women from discordant pairs (HIV-positive wife and HIV-negative husband) were surveyed. Less than half of HIV-infected patients (40%) specified the use of condoms for sexual contacts. In the group of women living with HIV-infected partner more expressed immunosupression (CD4 count 427 cells/mcl versus 528 cells/mcl) was observed. Statistically significant increased viral load in the 1st group compared with the women from discordant pairs was revealed.

Evaluation of diphtheria convalescent patients to serve as donors for the production of anti-diphtheria immunoglobulin preparations.

AIMS: The study was conducted to evaluate the possibility of selecting convalescent diphtheria patients to serve in emergency situations as donors for the production of anti-diphtheria immunoglobulin. To select suitable donors, the criterion of an antitoxin titer >/=3.0 IU/ml was used. In addition, the effects of treatment and the effect of immunization with diphtheria toxoid on the level of anti-diphtheria toxin antibodies were evaluated. SCOPE: Three groups of diphtheria patients were included in the study. The first group (n = 23) consisted of patients who had a basic antibiotic treatment, with or without serotherapy using horse antitoxin and/or human immunoglobulin. The second group (n = 12) comprised patients examined immediately after the onset of disease. The immunological history of this group was not known. The third group (n = 20) included patients with a known immunization history, treated only with antibiotics but having received a booster immunization with diphtheria toxoid. Antitoxin titers were measured using the toxin binding inhibition (ToBI) assay. CONCLUSIONS: In the first group, 47.8% (11/23) of the patients had a diphtheria antibody titer >/=3.0 IU/ml. For most of them, however, the antibody titers could have resulted from treatment with exogenous antibodies from horse antitoxin or human immunoglobulin (18/23). Only two of the 11 high-titer subjects had received antibiotics only. Among the second group, only two (16.76%) of the patients had an antibody titer of >/=3.0 IU/ml. In the third group 50% (10/20) of the patients showed an antibody titer of >/=3.0 IU/ml prior to vaccination, and therefore could be directly considered as donors. Three weeks after booster vaccination, 70% (14/20) had an antibody titer of >/=3.0 IU/ml and 1 year after booster vaccination, 28.6% (2/7) of the subjects still had titers of >/=3.0 IU/ml. In 40% of these patients, a decrease was observed 3-4 weeks after the booster dose. It was concluded that convalescent diphtheria patients could be considered as donors in an emergency situation, since approximately half of them showed antitoxin titers of >/=3.0 IU/ml.

[Tuberculosis in HIV-infected and AIDS patients]. / Tuberkulëz u VICh-infitsirovannykh i bol'nykh SPIDom.

The course of the combined infection (tuberculosis plus HIV-infection) has been analysed in 41 patients. Of them, 24 patients developed tuberculosis in the presence of HIV-infection (group 1) and 17 were infected with HIV when they already had tuberculosis running up to 5 years. HIV-infection in group 1 ran a more severe course, the patients developed generalized, disseminated and complicated forms of tuberculosis with more frequent lethal outcome. 39 patients of both groups received specific antituberculous therapy including 1-5 drugs. A response to treatment was achieved in 23 (60%) patients (52 and 47.8% at early and late HIV-infection stages, respectively). Treatment failure was explained by development of severe opportunistic infections and secondary diseases (generalized cytomegalovirus infection, advanced candidiasis, toxoplasmosis), poor compliance, asocial life style, advanced tuberculosis process, late diagnosis, inadequate treatment. It is shown that in late HIV-infection positive results of treatment can be expected only in early detection of tuberculosis and active long-term treatment.

[The dynamics of the course of HIV infection in patients with concomitant sexually transmitted disease morbidity and viral hepatitides detected in Saint Petersburg in 1997-1998]. / Dinamika techeniia VICh-infektsii u patsientov s soputstvuiushchimi ZPPP i virusnymi gepatitami, vyiavlennye v Sankt-Peterburge v 1997--1998 gg.

During the recent 2 years growth in the number of cases of HIV infection, exceeding 1.2-fold the number of cases detected during the preceding 9 years, was registered in St. Petersburg. In the structure of patients with detected HIV infection injecting drug users prevailed. Among 124 patients with detected HIV infection 28.2% and 46.8% had, respectively, concomitant sexually transmitted diseases (STD) and virus hepatitides (VH). Due to preventive and antiepidemic measures the STD and VH morbidity decreased in all groups of HIV-infected patients under study.

Circulation of subtype A and gagA/envB recombinant HIV type 1 strains among injecting drug users in St. Petersburg, Russia, correlates with geographical origin of infections.

Countries of the former Soviet Union are experiencing an emerging HIV-1 epidemic due to a rapid expansion of HIV-1 among injecting drug users (IDUs). To study the molecular epidemiology of HIV-1 among IDUs in St. Petersburg, Russia, virus sequences were obtained from 22 individuals. Phylogenetic analysis of the env and gag regions revealed circulation of two major HIV-1 populations, one belonging to HIV-1 subtype A, and another being a recombinant of subtype A and B viruses (gagA/envB). Both virus populations were highly homogeneous, with a mean pairwise genetic distance of <2%, and similar to viruses obtained earlier from IDUs in other regions of the former Soviet Union. Distribution of the two major HIV-1 genotypes in St. Petersburg correlated with geographical origin of infections. In one individual, a virus type previously unseen among IDUs was found, which demonstrates the possibility that new viruses are entering this risk group.

[Clinical course of cryptococcosis in HIV infection]. / Klinicheskoe techenie kriptokokkoza pri BICh-infektsii.

Cryptococcosis was detected in 17% of examines with AIDS. The disease was caused by fungus Cryptococcus neoformans. Most frequently cryptococcosis affected CNS (meningitis and encephalitis). The symptoms were scare and nonspecific, e.g. positive meningitis indicators occurred only in 9% of the patients. Cryptococcosis tends to hematogenic spread with severe dissemination. The diagnosis was made primarily basing on the results of mycological investigations of the biosubstrates, i.e. discovery of Cryptococcus neoformans.

[The characteristics of the course of tuberculosis in HIV-infected patients and prophylactic measures]. / Osobennosti techeniia tuberkuleza u VICh-infitsirovannykh i mery ego profilaktiki.

Morbidity in HIV infection and tuberculosis in persons having these two infections in association was analyzed. According to the data for the end of the first quarter of 1997 the presence of association of HIV infection with tuberculosis was found in 91 patients. In 70.3% of cases HIV infection was contacted before the appearance of tuberculosis and in 18.7% of cases, after it; in 11% of cases the order of appearance of these two diseases could not be established. The study revealed that the markedness of the clinical picture of tuberculosis was determined by the progress of HIV infection.

[The clinical course of HIV infection in children who were parenterally infected]. / Klinicheskoe techenie VICh-infektsii u detei s parenteral'nym putem infitsirovaniia.

The data on the study of the clinical course of HIV infection in 127 children, 124 from these infected in nosocomial foci. The overwhelming majority of the children were infected at the period of their stay in hospitals of Elista, Volgograd, Rostov-on-Don, Shakhty (Rostov Province) and Stavropol'. At the end of 9-9.5 years elapsed since the appearance of the first documented cases of parenteral infection 33 children (26%) died. The study revealed that at the age under 1 year the course of HIV infection could rapidly progress into the stage of AIDS in the presence of aggravated premorbid background linked with the unfavorable course of pregnancy in the mother and a severe disease in the child prior to contacting HIV infection.

[Our experience with acycloguanosine treatment of herpes simplex]. / Opyt lecheniia prostogo gerpesa atsikloguanozinom.

A 5% ointment acycloguanosine was tried in the treatment of recurrent herpes simplex of the skin and genitalia in 48 patients. The treatment brought limitation of the process, relief of the symptoms, control of local manifestations and toxicity, accelerated epithelization, complete regression and disappearance of the eruption.

Fatal respiratory tract diphtheria apparently caused by nontoxigenic strains of Corynebacterium diphtheriae.

A major diphtheria epidemic affecting the whole population of St. Petersburg started in 1990. During the period of 1991 to 1995, 4600 patients with clinical respiratory tract diphtheria were treated in Botkin's Hospital. From 112 (2.4%) of these patients only a nontoxigenic strain of Corynebacterium diphtheriae was isolated. Three patients with this strain who were suffering from clinical disease consistent with classical toxic diphtheria died. All had myocarditis, two had asphyxia due to membrane formation in the lower respiratory tract, and one had severe polyneuritis. In two patients the causative agent was of the biotype mitis and in the third intermedius, whereas the prevailing epidemic strain was of the biotype gravis. As the clinical presentation of the disease in the three patients who died was typical of toxic diphtheria, it is considered likely that the immunodiffusion test for toxin production in vitro may fail to detect strains of Corynebacterium diphtheriae producing toxin in vivo.

[Treatment of Flexner's dysentery with ofloxacin]. / Lechenie dizenterii Fleksnera ofloksatsinom.

Twenty four patients with dysentery due to Shigella flexneri2a and 1 patient with mixed infection (acute dysentery due to Sh.flexneri 2a+group B salmonellosis) were treated with ofloxacin. The patients were divided into 4 groups. In group I ofloxacin was administered intravenously in a dose of 200 mg twice a day followed by its oral use in the form of tablets in a dose of 200 mg twice a day for 5 to 6 days. In group II ofloxacin was used orally in the form of tablets in a dose of 200 mg once a day in the morning for 5 to 7 days. In group III ofloxacin was used in the same dosage but in combination with some other antibiotics. In group IV the patients were treated with antibiotics except for ofloxacin. High efficacy of ofloxacin was observed with all the regimens. In the patients treated with ofloxacin rapid improvement of the patient state (normalization of the body temperature by the 2nd or 3rd day) and complete eradication of the pathogens were recorded. Ofloxacin was superior by the efficacy to the other antibiotics.

Diphtheria outbreak in St. Petersburg: clinical characteristics of 1860 adult patients.

An epidemic of respiratory tract diphtheria began in Russia in 1989. In 1994 more than 2,500 cases occurred in St. Petersburg alone. We describe clinical findings in the 1,860 adult patients treated in Botkin's Hospital. The study is based on a retrospective review of patient records. In 98% of the patients the diagnosis was confirmed by a positive throat culture growing a toxin producing strain of Corynebacterium diphtheriae. A catarrhal disease without membranes was present in 1,256 (67.5%) patients, 150 patients had membranes on tonsils only, 268 patients on tonsils, the uvula, soft palate and posterior pharynx and 35 patients on larynx or in the lower respiratory tract. 42 patients (2.3%) died. Among the deceased patients 26 were alcoholics, whereby the death rate for non-alcoholics was probably around 1%. 151 patients (8.1%) had a toxic form of the disease with swelling of the neck. This form of the disease carried a high mortality, 25.7%. In a subgroup of 1,045 patients the protective efficacy of vaccination could be evaluated. A 2.2-fold protection was found, but the study may underestimate the efficacy. We conclude, that if a wide diphtheria epidemic affects an industrialized country, it would probably not any more be the big killer that it was in Europe and in the United States in the 1950's and 1960's.