Optimizing the Intensive Care Treatment of Severe and Complicated Plasmodium falciparum Malaria in Nonimmune Patients.

This study analyses the intensive care treatment of 48 patients admitted to the Intensive Care Unit (ICU) at the Infectious Diseases Clinical Hospital No. 2, Moscow, Russia, between 2007 and 2019, with a severe and complicated form of P. falciparum malaria (B50.8 ICD 10). Objective. The aim of this study was to improve the intensive care treatment for severe and complicated P. falciparum malaria. The treatment strategy implemented was aimed at preventing ischaemia-reperfusion injury to organs, as well as haemorrhagic complications. The ICU Case Management Protocol set up indications for transferring patients to the ICU which provide preventive (prior to the development of renal failure) application of extracorporeal hemocorrection methods (continuous venous-venous hemodiafiltration and plasmapheresis in a plasma exchange mode) and mechanical ventilation under a medically induced coma, given impaired consciousness as the initial symptom of patients. Results. Successful treatment outcome in a majority of the patients (93.8%), shorter ICU length of stay (6.67 ± 1.9 days as compared to 94 ± 1.6 before introduction of the protocol), a median parasite clearance time of 37.50 hours (95% CI 36.21-38.18), and a reduced mortality rate from 29.1% to 6.25% support the efficacy of the ICU protocol in managing severe and complicated P. falciparum malaria.

[Epidemiological and clinical aspects of diagnosis, treatment and prophylaxis of imported malaria cases in Russian Federation].

Actually one of the main tasks of health workers in the field of the tropical diseases prevention (malaria) is early detection of malaria imported cases and efficacious treatment. In order to prevent the re-establishment of local malaria transmission by Anopheles mosquitoes from imported malaria cases, and fatal cases of disease there is develop and implement the Case Management Protocol of malaria diagnosis and treatment (2014, 2019) based on long-term experience of epidemiologists and clinicians, taking into account recommendations of WHO (2013, 2015). In this article the main principles of diagnosis and treatment of different malaria species Plasmodium falciparumand Plasmodium vivax-malaria, prophylaxis measures of autochthonous cases from imported cases of the word endemic region are discussed.

[Current view on Blastocystis species: clinical forms, diagnosis and treatment].

The symptomatic form of Blastocystis spp. infection not only with mild diarrhea or dysentery-like syndrome, but also with the development of severe ulcerative necrotic lesions of the intestine. Meanwhile, the pathogenicity of these microorganisms should not be exaggerated, due to majority asymptomatic cases or infection transmission with minor impaired bowel function.

[Human babesiosis: clinical cases in the european part of the Russian Federation].

The article describes four clinical observations of patients with babesiosis detected in the European part of the Russian Federation, two of whom were under the direct supervision of the authors. The analysis of epidemiological data, clinical picture, results of laboratory studies in the dynamics of the disease. Differential diagnosis and treatment are discussed.

[THE CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF MALARIA CONCURRENT WITH OTHER INFECTIONS AND INVASIONS].

The present review considers malaria infection concurrent with different species of helminths, bacterial and viral infections, as well as mixed malaria pathogens in the subtropical and tropical countries of the world, causing the clinical picture and epidemiological situation to be different. Malaria co-infections with different pathogenic micro-organisms, such as HIV, tuberculosis, viral hepatitides, and others, affect almost one third of the planet's population. It is known that people who are at risk for malaria may be also at risk for other parasitic and infectious diseases, most commonly helminthisms.

ON THE EPIDEMIOLOGY OF COMPLICATED VIVAX MALRIA.

A larger number of publications on cases of. complicated vivax malaria in the world literature can be. explained by a set of diffeetit faciors'. There has been unification of the definition of complicated tertian malaria allowing ihe clinical nianagement of a patient and the reporting of complicated cases of P.vivax to be improved. The, epidemiological characteristics of complicated vivax malaria are determined by a diversity of geographical, races, variants, gentyies and phenotypes of tertian malaia due to intensive internal and external migration. Chloroquine resistance and primaquine refractoriness contribute to increased local malaria transmission due to a rise in cases of reinfection during-epidemics of vivax malaria. From an epidemiological point of view, the increasing number of complicated vivax malaria cases indicates the untimely detection and treatment of malaria patients, the low level of medical personnel training and a negative attitude of the local population towards the recommendations of national malaria programs for prevention measures. Unsolved problems can substantially retard the time to achieve malaria elimination.

[South African tick bite fever in a group of Russian tourists].

The paper describes a clinical case of South African tick bite fever in a group of Russian tourists. The group of 5 people who had been ill with this disease after a tourist trip to the South African Republic (the Kruger National Park in the north-eastern province of Mpumalanga) were followed up. During their trip, all of them were bitten by different insects many times. The disease exhibited different clinical presentations; however, all the patients were noted to have a fever with slight intoxication and a maculopapular rash at different sites of the body; 3 had lymphadenopathy and one had a primary effect at the site of tick sticking. The diagnosis was verified by indirect immunofluorescence for the detection of high titers to Rickettsia conorii. The course of the disease was favorable in all the patients treated with antibiotics (doxycycline or ceftriaxone).

[Methodological features of DNA isolation for nested PCR for the differential diagnosis of malaria].

Current PCR assays for the differential diagnosis of malaria need to be further developed and certified in the Russian Federation. PCR may serve as a control diagnostic method. These investigations have demonstrated that an erythrocytic clot may be used as an adjunct to microscopy and the described procedure can be employed to isolate DNA for PRC in an inpatient setting.

[Human babesiasis].

The paper describes a case of imported babesiasis caused by Babesia microti. This is an account of the second case of babesiasis in the Russian-language medical literature. Its clinical picture and laboratory data in the course of the disease are depicted and analyzed. Its clinical differential diagnosis with malaria and an update on the diagnosis and treatment of babesiasis are discussed.

[The specific features of imported Plasmodium vivax malaria, Chesson strain type].

The details of imported case of Chesson strain of P. vivax malaria to Russian Federation (Moscow) from border areas between Myanmar and Thailand is given. It might further confirm the expansion of this strain from its original place in the Western Pacific towards other territories in the World, described in various publications.

[Role of cytokines in the clinical course of tropical malaria in children].

The paper gives data on impaired cytokine status in children with tropical malaria. There have been heterodirectional changes in the level ofcytokines during the infectious process and in relation to the severity of the pathological process, which allow prediction of the course of tropical malaria. Correlations were found between the clinical and laboratory parameters and the level of proinflammatory cytokines, which provide evidence for an important role of inflammatory mediators in the clinical course of the disease. The findings suggest that it is expedient to correct immune disorders in the early stages of tropical malaria.

[Current course of pneumocystic pneumonia in HIV-infected patients].

AIM: To describe clinical and laboratory characteristics of pneumocystic pneumonia (PP) in patients with HIV-infection for improvement of diagnosis quality. MATERIAL AND METHODS: Detailed examination was performed in 111 HIV-infected patients with suggested diagnosis of PP. The following investigations were made: clinical, x-ray examinations, total count and biochemical blood tests, enzyme immunoassay, indirect immunofluorescence reaction (II-FR) for Pneumocystis jiroveci antigens in bronchoalveolar lavage fluid (BALF) or induced sputum. For diagnosis of other secondary diseases PCR was used for investigation of BALF and bronchial biopsy to detect DNA of Mycobacterium tuberculosis complex, Candida albicans, Cytomegalovirus, Toxoplasma gondii, Mycoplasma spa., Herpes simplex I, II. DNA of cytomegalovirus in blood was detected with PCR. Microscopic tests of the sputum were conducted for detection of acid-resistant mycobacteria. RESULTS: PP was associated with other secondary diseases in 59% patients (pulmonary tuberculosis ---16%, CMV pneumonia--31%, combination of all the lesions--5%). PP diagnosis was cancelled and pulmonary tuberculosis was diagnosed in 12 patients. In combination of PP with other pathology dominant were symptoms observed in PP monoinfection and only effective anti-pneumocystic treatment revealed signs of comorbid pathology. Tuberculosis patients had weaker signs of respiratory failure, symmetric bilateral interstitial or small-focal alterations were detected less frequently. CONCLUSION: Current PP course characteristics in HIV infection are identified. In clinical diagnosis of PP special attention should be paid to data complex especially to increasing respiratory failure, high ESR, elevated lactate dehydrogenase, low blood pO2, fast response to ex juvantibus therapy. The most effective method of the diagnosis verification--BALF IIFR.

[Monitoring delagil (chloroquine) efficacy against imported Plasmodium vivax strains].

The efficiency of P. vivax malaria treatment with delagil (chloroquine) was evaluated in 122 patients, including 82 cases in Moscow and the Moscow region. The origin of the cases was malaria endemic areas in Asia, Africa, the Pacific Region, South America, and Transcaucasia. Forty other cases were imported malaria cases (secondary to imported ones), detected in Moscow and the Moscow region. Standard treatment with delagil (2.5 g) resulted in clinical improvement during 3 days in the majority of cases. Initial signs of degradation of asexual stages of P. vivax--kernels of nucleus, refinement of cytoplasm and its vacuolization, aggregation of pigment in isolated instances, its pushing out from cytoplasm--were observed after 1-2 hours after administration of delagil. Thereafter, parasite degradation was increasing, and it disappeared within 48 hours. Disappearance of fever slowed down in a few cases. However, degradation of parasites occurred during the same period among the rest of cases. It can not be excluded that fever was determined by the pyrogenic effect of remnants of degraded parasites and by the products of destroyed infected erythrocytes. It is probable that the findings of gametocytes, not completely degraded after disappearance of asexual forms in conjunction with prolonged fever, could result in a wrong conclusion of drug resistance. Negative results of microscopy and nested PCR on the last day of treatment, as well as in the following 10 days and absence of complains during 45 days, suggest the absence of resistance to delagil in P. vivax strains imported from different regions of the world. It is also probable that the literature on P. vivax resistance to chloroquine is limited to sporadic cases.

[Time course of cytochemical changes in the microbicidal system of neutrophilic granulocytes in children with tropical malaria].

The functional metabolic activity of neutrophilic leukocytes underwent clinical laboratory assessment in tropical malaria. A significant inhibited activity of myeloperoxidase and decreased levels of cationic protein, glycogen, and lipids were revealed while the activities of alkaline and acid phosphatase were increased. The degree of changes in the enzymatic activity of leukocytes and the level of intraleukocytic components depended on both the stage of the disease and the degree of the pathological process and the presence of mixed infections. The maximum changes in the content of all components of the neutrophilic microbicidal system were noted in patients with tropic malaria concurrent with typhoid fever. The values of the peripheral neutrophilic microbicidal system may be used as additional criteria for evaluating the severity and prognosis of tropical malaria.

[Decline of antibodies to hepatitis C virus during antiviral therapy].

The goal of this study was to investigate interrelationship between changes in anti-hepatitis C virus antibody and response to antiviral therapy. The comparative quantitative analysis of antibodies to individual structural and nonstructural viral proteins was done during two years in three patient groups: initial responders, non-responders and a reference group (without therapy). All patients in the treated groups exhibited decrease in the analyzed antibodies to HCV proteins, but with different patterns. The first statistically significant difference in the decrease of virus-specific antibody between initial responders and non-responders was observed within the first three months of therapy beginning. Some treated patients demonstrated decrease in antibody levels to HCV proteins after the end of therapy.

[Humoral response to hepatitis C virus antigens in coinfection with human immunodeficiency virus type 1].

A humoral immune response to individual hepatitis C virus (HCV) antigens was studied in 49 patients at the subclinical stage of HIV-1 infection. These patients, as compared with a group comprising 50 patients with chronic hepatitis C, showed statistically significant higher levels of HCV-specific immunoglobulins G to nucleocapsid protein and the antigens NS3, NS4ab, NS5a. The group of patients with coinfection did not differ from those with chronic HCV monoinfection in detection rates and anti-HCV IgM.