[The spectrum of primary drug resistance of Mycobacterium tuberculosis in patients with tuberculosis in relation to human immunodeficiency virus status]. / Spektr pervichnoi ustoichivosti Mycobacterium tuberculosis k lekarstvam u bol'nykh tuberkulezom v zavisimosti ot statusa po virusu immunodefitsita cheloveka.

AIM: To estimate the detection rate and spectrum of primary drug resistance of Mycobacterium tuberculosis (MBT) in patients with tuberculosis (TB) in relation to their human immunodeficiency virus (HIV) status in a region with high HIV infection rates (the Perm Territory) and to compare of drug-resistant MBT (DR-MBT) in patients with HIV/TB co-infection, by using phenotypic and molecular genetic testing (MGT) methods. SUBJECTS AND METHODS: The results of sputum bacteriological examination were analyzed in 178 HIV-infected patients and 354 non-HIV-infected individuals with a TB diagnosis made in the period July 1, 2014 to August 1, 2015. The diagnostic algorithm for all patients involved a duplicate sputum test for MBT by two techniques: fluorescence microscopy (FM) and inoculation into the Levenstein-Jensen dense culture medium. In patients with HIV/TB, the bacteriological examination was complemented with two more methods: detection of MBT DNA by a real-time polymerase chain reaction assay using the AmpliTube-RV system (Synthol, Russia); and inoculation into the Middlebrook liquid nutrient medium, by applying the automated BACTEC MGIT 960 system. RESULTS: In patients with HIV/TB, the sensitivity of FM proved to be lower than in those with TB (24.2 and 32.8%, respectively; p<0.05) and that of inoculations into the dense culture medium was comparable regardless of HIV status (60.7 and 57.1%, respectively; p>0.05). The primary drug resistance of MBT in patients with HIV-TB was higher than that in HIV-negative individuals (60.2 and 41.6%, respectively; p<0.05). The phenotypic method (inoculation into the Levenstein-Jensen culture medium) and MGT revealed their agreement for the resistance of MBT to rifampicin (the most clinically significant drug in the choice of treatment policy) in 88.5% of the patients with HIV/TB. CONCLUSION: In patients with HIV/TB, the sensitivity of FM for detecting acid-resistant mycobacteria was lower than in those with TB and that of inoculations into the dense medium was comparable regardless of HIV status.

[Comparative evaluation of the efficacy of uncoated and coated with silver silicone urethral catheters for prevention of urinary tract infections among patients of the intensive care unit].

The goal of the research is to compare and evaluate the efficiency of using silver - coated silicone urinary catheters and catheters without coating for prevention urinary tract infections. MATERIALS AND METHODS: The study included 57 adult patients of intensive care unit, which have silicone bladder catheters "Foley" without coating, and 57 patients were catheterized using catheters coated with silver. We revealed symptomatic and asymptomatic urinary tract infections in our research. RESULTS: During the 14-day bladder catheterization period the preventive effect of urethral silicone catheters coated with silver for prevention of manifest and subclinical urinary tract infections was determined.

[The frequency of detection of non-polio enteroviruses in foul and fecal waste waters, water and some food products].

In the Perm Territory from 2010 to 2014 155 samples offoul andfecal waste waters, 293 samples of surface water, 827 samples of supply net water, and 57 vegetable and fruit water-washes were examined for the RNA enterovirus agent with the use of polymerase chain reaction (PCR) method. In parallel 155 wastewater samples, 20 samples of surface water, and 4 samples of supply net water were examined for non-polio enterovirus agent with the use of virological methods. In the samples of foul waste waters the RNA enterovirus agent was detected in 74.8 ± 3.4%, and nonpolio enterovirus agent - in 65.1 ± 3.8%. In the samples of surface water the RNA enterovirus agent was detected in 2.3 ± 0.8%; in the area offoul and fecal waste waters the non-polio enterovirus agent was detected in 20.0 ± 4.4% in the process of virological investigation of RNA-positive water samples. In supply net water the RNA enterovirus agent was detected in 0.8 ± 0.3 %, on the surface of vegetables, fruits, and grapes - in 10.5 ± 3.9 %.

[MANIFESTATIONS OF EPIDEMIC PROCESS AND TRANSMISSION ROUTES OF CAUSATIVE AGENT OF ENTEROVIRUS SEROUS MENINGITIS].

AIM: Study the manifestations of epidemic process and leading transmission routes of causative agents of enterovirus serous meningitis (SM) by results of laboratory studies and epidemiologic examination of epidemic nidi. MATERIALS AND METHODS: During 2010 - 2014 a study for enterovirus was carried out in cerebrospinal fluid in 743 patients, hospitalized into medical organizations of Perm with primary diagnosis "serous meningitis", feces of 426 individuals, that had communicated with patients with SM of enterovirus etiology; 827 water samples from the distribution network, 295 water samples from open water and 57 washes from surface of vegetables and fruits. All the samples were studied in polymerase chain reaction, part--by a virological method. Epidemiologic examination of 350 epidemic nidi of SM was carried out. RESULTS: Enterovirus and (or) its RNA were detected in 62.0% of patients and 61.9% of individuals that had communicated with patients with enteroviris SM. ECHO 6 serotype enterovirus dominated among the causative agents. Maximum intensity of epidemic process of enterovirus SM, based on data from laboratory examination of patients, was detected in a group of organized pre-school and school age children during summer-autumn period. CONCLUSION: . Examination of epidemic nidi and laboratory control of environmental objects have shown that CV causative agent transmission factors are, in particular, unboiled water from decentralized sources (boreholes, wells, springs), water from open waters during bathing, as well as fresh vegetables, fruits, berries and meals produced from them. .

[Formation of Enterobacter cloacae resistance to disinfectants under the effect of bactericidal concentrations of quaternry ammonium compounds in the experiment].

AIM: Study the possibility of formation of induced resistance of purulent-septic infection (PSI) causative agents against disinfectants (DI) in bactericidal concentrations. MATERIALS AND METHODS: Daily exposure to bactericidal concentrations of preparations from the group of quaternary ammonium compounds (QAC) on Enterobacter cloacae strain that has incomplete sensitivity to the same disinfectants on the same test objects was carried out in experiments on test objects from wood and plastic. Exposure was carried out until the moment of transition from incomplete sensitivity to resistance. RESULTS: E. cloacae strain that initially had incomplete sensitivity to various disinfectants of the QAC group in antibacterial concentrations according to manuals acquires resistance on test objects from wood and plastic after 2 - 12 exposures to the preparations. CONCLUSION: The data obtained give evidence that the resistance of PSI causative agents to disinfectants can take place not only under the influence of low concentrations of the preparations but also during use of disinfectants at bactericidal concentrations.

[Sensitivity of nosocomial purulent-septic infection causative agents to disinfection agents and antibiotics].

AIM: Study the sensitivity of nosocomial purulent-septic infection (PSI) causative agents to disinfectants (DA) and antibiotics (AB). MATERIALS AND METHODS: Sensitivity to DA and AB of 209 PSI causative agent strains isolated from patients and the environment of 2 obstetric and 3 surgical hospitals was studied in 2009-2011. Sensitivity to DA of 94 strains and to AB of 189 strains of Pseudomonas aeruginosa isolated from patients with signs of PSI of reanimation and intensive therapy and surgical departments of a multi-field hospital was studied in 2012. Sensitivity to DA was determined on test-surfaces and in solution according to guidelines by V.V. Shkarin et al., 2010; sensitivity to AB - by disc-diffusion method. RESULTS: Among PSI causative agents resistant to DA the portion of poly-antibiotic resistant strains is higher than among microorganisms sensitive to DA, and among antibiotic resistant bacteria the number of strains resistant to DA is higher than among sensitive to antibiotics. The increase of resistance to DA and AB of P. aeruginosa strains is observed in parallel to the increase of volume of the antibacterial preparations used. CONCLUSION: The results obtained give evidence of the possibility of formation of combined (associated) resistance to DA and AB by nosocomial PSI causative agents against the background of increase of their consumption.

[The experimental evaluation of the possibility of the penetration of enteric viruses from the surface into the pulp of contaminated fruits and vegetables].

According to the results of complex microbiological examination of samples of vegetables, fruits and grapes there was established significant contamination of them with opportunistic bacteria, antigens of intestinal viruses and cysts of intestinal Protozoa, that confirms the epidemiological role of these products as factors in transmission of acute intestinal infections. There was revealed ribonucleic acid of enteric viruses in experimentally infected pulp from the surface of tomatoes and apples, that indicates to the possibility of penetration of these pathogens into the fruits and vegetables through intact (having no visible damages) surface.

[Is resistance to disinfectants a mandatory feature of a hospital strain of causative agents of nosocomial purulent-septic infections?].

AIM: Evaluate resistance to working solutions of disinfectants by Staphylococcus haemolyticus and Klebsiella pneumoniae isolated from newborns and hospital environment objects of obstetric hospital during registration of group purulent-septic infections (PSI). MATERIALS AND METHODS: Analysis of 2 epidemic situations on PSI morbidity of newborns caused by S. haemolyticus and K. pneumoniae was carried out. Sensitivity to antibiotics of S. haemolyticus and K. pneumoniae strains isolated from newborns and hospital environment was studied by disc-diffusion method and genotyping of K. pneumoniae--by using polymerase chain reaction with universal primer M 13 (RAPD-PCR). Sensitivity of S. haemolyticus and K. pneumoniae to working solutions of disinfectants was determined on test-surfaces (glass, metal, plastic, wood, oilcloth). RESULTS: The detected identity of antibiotic phenotype of S. haemolyticus and K. pneumoniae strains as well as genotype of K. pneumoniae strains combined with registration of group PSI morbidity among newborns confirms that the circulating strains (clones) of the causative agents were hospital. S. haemolyticus and K. pneumoniae strains in most cases were sensitive to working solutions of disinfectants. CONCLUSION: Resistance of causative agents of nosocomial PSI to disinfectants is not an unconditional feature of a hospital strain, and concurrence of resistance profile of microorganisms to disinfectant preparations--a mandatory feature of the presence of epidemiologic connection between the diseased.

[Food contamination by pathogens of acute intestinal infections and survival of microorganisms in them under some variants of thermal processing and storage].

The contamination of the surface of vegetables and fruits with conditionally pathogenic enterobacteria, intestinal protozoa and enteric viruses has been revealed. The experiment showed an opportunity of penetration of enteric viruses inside of vegetables and fruits with intact (without visible damages) surface. S. enteritidis survive on the shells of the eggs 4 months in the refrigerator, in the albumen and yolk--more than 5 months and in the long storage (more than one month) of chicken eggs in the refrigerator S. enteritidis could penetrate into the egg through the intact shell and multiply in the yolk. It was shown in the experiment on the condition laying of chicken eggs of room temperature in cold water and their subsequent cooking S. enteritidis full destruction of pathogens comes on the 5 minute of heat processing, when the temperature inside the eggs reaches more than 80 degrees C. In mayonnaise at the temperature of the refrigerator S. enteritidis reproduce, but remain viable for 13 days. In the egg powder at the room temperature noted smooth death of S. enteritidis, term viability of microorganisms is 5 months. Addition 10% acetic acid to egg powder in the ratio 1:2 provides for the death of S. enteritidis for a minute. In experimental conditions was established that the processing of chicken on the grill in the process of cooking "Shaverma" provides exemption meat from Salmonella only in the thickness of a piece of up to 2 centimeters. The deeper layers of meat and meat juice which accumulates on the pallet grill, throughout the duration of thermal processing may remain contaminated Salmonella.

[Microbiological evaluation of chicken meal "shaverma" as a factor for Salmonella transmission].

It has been established that the dish shawarma may be a factor for Salmonella transmission, by involving in sporadic and outbreak cases of Salmonella infection. Chicken fillet grilling when cooking the dish shawarma has been found to ensure its guaranteed freedom from Salmonella only in a piece less than 2 cm thick. Deeper layers of chicken and its juice that accumulates in the grill tray may remain be Salmonella-contaminated throughout the heat treatment. Obviously, for the epidemiological safety of the dish shawarma, it is necessary to cut a not more than 2-cm piece of fillet every time the latter is ready-made, i.e. a white color and a clear juice are produced. At the time one should not use the chicken juice as sauce to the ready-made fillet and to gather and crumble the latter in a separate container rather than in the tray.

[Influence of dairy food rotavirus contamination on morbidity].

The indirect hemagglutation test (IHT) indicated that rotaantigen infection of dairy foods (DF) selected at the milk processing shop in the year of high morbidity due to rotavirus infection (RVI) averaged 12.4%. Laboratory monitoring of DF sold in the year of relative low morbidity could establish that the rate of their rotaantigen contamination averaged 4.8%, as evidenced by IHT; polymerase chain reaction was positive in 19.3% of cases. Comparison of annual trends in the detection rate of rotaantigen in DF and RVI morbidity revealed that there was an increase in DF rotavirus contamination in the cold period of a year, following the seasonal activation of an epidemic process.

[Epidemiological survey of a single-case focus of acute enteric infections]. / Epidemiologicheskoe obsledovanie ochaga ostrykh kishechnykh infektsii s edinichnym zabolevaniem.

The aim, tasks and stages of the epidemiological survey of a single-cased focus of infection, taking into account present-day specific features of the epidemiology of acute enteric infections, have been formulated. The technical approaches to the detection of the source, routes, factors and conditions of the causative agent transmission are given. The patterns of the conclusion on the epidemiological survey of the focus are given.

[Characteristics and trends in the development of an epidemic process of Sonne and Flexner dysentery among preschool children]. / Kharakteristika i tendentsiia razvitiia épidemicheskogo protsessa dizentereii Zonne i Fleksnera sredi detei doshkol'nogo vozrasta.

The results of studies indicate that the morbidity rates of dysentery among children attending preschool institutions and children brought up at home converged in recent years. This phenomenon was most pronounced among children of the kindergarten age group. At the same time dysentery caused by Sh. sonnei and Sh. flexnery produced a higher morbidity rate among children attending nursery in comparison with that among children of the same age group brought up at home. Group infections in preschool institutions were caused by Sh. sonnei in 89.1% of cases and by Sh. flexneri in 10.9% of cases. Outbreaks due to the transfer of infection through everyday contacts were observed only in dysentery caused by Sh. sonnei, constituting 71.4% of the total number of dysentery outbreaks.

[Nature of the epidemic process in Sonne and Flexner dysenteries and the causes of its induction]. / O kharaktere épidemicheskogo protsessa dizenterii Zonne i dizenterii Fleksnera i prichinakh, obuslovlivaiushchikh ego.

A comparative study of the epidemic process in Sh. sonnei and Sh. flexneri dysentery in different regions of the USSR revealed that the morbidity level of Sh. sonnei dysentery changed simultaneously in the regions under study at intervals of 2-3 years. Sh. flexneri dysentery showed morbidity rises occurring at intervals 6-8 years, and their occurrence did not coincide with the periods of elevated morbidity in Sh. sonnei dysentery. The data obtained in the cohort analysis and in the study of recurrent morbidity suggest that Sh. flexneri dysentery produces more pronounced postinfection immunity than Sh. sonnei dysentery, and the immunological factor probably affects the dynamics of the epidemic of these Shigella infections.

[An evaluation of the scope of the circulation of Salmonella among the workers of commercial poultry- and meat-packing enterprises based on serological study data in the PHA test]. / Otsenka shiroty tsirkuliatsii sal'monell sredi rabotnikov predpriiatii promyshlennogo ptitsevodstva i miasokombinata po dannym serologicheskikh issledovanii v RPGA.

Serum samples from 641 workers of large poultry and meat-packing plants were studied in the passive hemagglutination test with the use of Salmonella complex and serogroup diagnostica. A specific increase in the level of anti-Salmonella antibodies in 60.7% of poultry plant workers and in 9.8% of meat-packing plant workers was established. Among the workers of the poultry plants the most pronounced immune shifts were detected in persons having contacts with sick poultry and pathological material and among the employees of the meat-packing plant, in those who ate raw sausage meat. A high level of antibodies in the professional groups under study was observed as early as in the first year of work at the plant and persisted over the whole period of this work. Under the conditions of constant contamination of the workers of poultry and meat-packing plants with small doses of salmonellae specific immunity to this infection was seemingly induced, which inhibited the development of the manifest forms of infection, but did not prevent the formation of chronic carrier state.

[An assessment of the connection between the annual population morbidity of salmonellosis due to Salmonella enteritidis and the dynamics of the epizootic process among chickens in commercial poultry plants]. / Otsenka sviazi vnutrigodovoi zabolevaemosti naseleniia sal'monellezom, obuslovlennym Salmonella enteritidis, s dinamikoi épizooticheskogo protsessa infektsii sredi kur promyshlennykh ptitsekompleksov.

The dynamics of annual morbidity in salmonellosis caused by S. enteritidis among the population of Perm during the period of 1987-1992 was analyzed. Blood sera taken from 4,689 practically healthy donors and from 6,997 hens at poultry breeding complexes were studied in the passive hemagglutination test with the use of complex Salmonella diagnosticum. The study revealed that seasonal rises in morbidity caused by S. enteritidis in winter and spring months, as well as in autumn months, were linked with the activation of the epizootic process of Salmonella infection among hens at poultry-breeding complexes during these periods of the year. A rise in the level of anti-Salmonella antibodies in poultry and human blood sera was found to be the precursor of the aggravation of the epidemic situation.

[Trends in the development of the epidemic process in salmonellosis caused by Salmonella typhimurium and Salmonella enteritidis]. / Tendentsii razvitiia épidemicheskogo protsessa sal'monellezov, obuslovlennykh Salmonella typhimurium i Salmonella enteritidis.

The dynamics and structure of the epidemic process of Salmonella infections among the population of Perm in 1983-1988 was studied and the results of evaluation of antibiotic resistance of the dominating Salmonella species analyzed. The study revealed that a decrease in salmonellosis morbidity caused by S. typhimurium was associated with a limited circulation of anthroponotic (antibiotic-resistant) variants of Salmonellae and a relative increase in the proportion of zoonotic (antibiotic-sensitive) strains. At the period of elevated morbidity this Salmonella infection affected mainly young children in cold months, whereas in recent years seasonal morbidity rises shifted to spring-summer and summer-autumn months, affecting older age groups of the population. The study also revealed that a rise in salmonellosis morbidity caused by S. enteritidis was due to increased circulation of zoonotic variants of Salmonellae. Changes in the epidemiological situation necessitate correction of the system of epidemiological surveillance on Salmonella infections with the emphasis on sanitation measures in stock-breeding farms with unfavorable epidemiological situation.

[An assessment of epidemic outbreaks of salmonellosis connected with poultry plant production]. / Otsenka épidemicheskikh vspyshek sal'monelleza, sviazannykh s produktsiei ptitsefabrik.

The causes of the simultaneous rise of salmonellosis morbidity induced by S. enteritidis among the population of three towns in the Perm region were studied. The study revealed the leading role of eggs and chicken meat as factors contributing to the transfer of this infection to the population of different territories, commonly supplied with the products of one poultry plant. The contamination of eggs and chickens with S. enteritidis occurred at the plant due to Salmonella infection of chickens, parallel with the use of nonbalanced mixed fodder, originally intended for feeding swine. Analysis of the epidemic and epizootic processes of Salmonella infection in this epidemic situation made it possible to reliably establish the factors contributing to the transfer of the infective agent and the site of contamination.

[The epidemiological patterns of rubella and the ways to improve epidemiological surveillance]. / Epidemiologicheskie zakonomernosti krasnukhi i puti sovershenstvovaniia épidemiologicheskogo nadzora.

The retrospective epidemiological analysis of rubella morbidity in Perm has revealed that the epidemic process of rubella is revived every 2-3 years in winter and spring. Children of preschool age in organized groups are mainly affected; 42.5% of these children have no specific antibodies. Among adults, the risk group consists mainly of women aged 20-29 years. The intensity of the epidemic process of rubella in organized groups of children has been found to depend on the general level of collective immunity. The hemagglutination inhibition test with the use of rubella antigenic diagnosticum may be recommended for practical use in the system of epidemiological surveillance for the differential diagnosis of rubella with a view to distinguish it from other infections, the determination of the scope of the virus circulation among different groups of the population and the timely diagnosis of rubella in pregnant women.

[Immunological control in the system of epidemiological surveillance over infections with different mechanisms of causative agent transmission]. / Immunologicheskii kontrol' v sisteme épidemiologicheskogo nadzora za infektsiiami s raznymi mekhanizmami peredachi vozbuditelia.

The results of immunological control of infections with different mechanisms of the transmission of their causative agents (diphtheria, measles, viral hepatitis, salmonellosis) for many years are summarized. About 25,000 serum samples taken from humans and more than 10,000 probes from agricultural animals have been studied in the passive hemagglutination test and more than 3,600 serum samples have been studied in the enzyme immunoassay for the presence viral hepatitis markers. Planned immunological control has ensured greater possibilities of the epidemiological diagnosis and prognostication of complications in the epidemic and epizootic situations. Urgent immunological control has made it possible to establish the proportion of non-manifest forms of diseases, to differentiate the foci of infection by transmission routes, to determine the degree of protection from infection and to substantiate the tactics of individual immunization.