[Emergence of tick-borne spotted fever group rickettsiosis in Moscow].

AIM: Analysis of clinical cases of tick-borne spotted fever (TSF) group rickettsiosis in 2005 - 2010. MATERIALS AND METHODS: General clinical, biochemical and serological parameters were determined in 10 tick-borne spotted fever group rickettsiosis patients who had visited various geographical regions of the World. RESULTS: TSF group rickettsiosis diagnostic criteria, optimal serological diagnostics timing were determined. Possible diagnostic errors, features of serological diagnostics and antibacterial therapy of this nosologic form are discussed. CONCLUSION: Indication for TSF examination are primarily epidemiologic including tick attachment indication and clinical data. Serological studies are positive only in 3 - 4 weeks after the onset of the infection and thus can not be used for early diagnostics.

[Outcomes of severe pandemic influenza A/H1N1/2009].

AIM: To study the outcomes of severe pandemic influenza A/H1N1/2009. SUBJECTS AND METHODS: The study enrolled 24 patients, including 8 males and 16 females (10 of whom were pregnant), aged 17 to 58 years, with a laboratorily verified diagnosis of pandemic influenza A/H1N1/2009, treated at the intensive care unit for the significant symptoms of acute respiratory failure (RF). Real-time RT-PCR was used to verify the diagnosis. Organs and tissues from deceased patients were histologically studied; chest computed tomography, body plethysmography, fibrobronchoscopy, breath test, and 6-minute walk test were performed in the late period. RESULTS: Within the first 30 days, a fatal outcome caused by therapy-resistant progressive RF was observed in 33% of the patients with pandemic influenza treated at the intensive care unit. Diffuse alveolar damage caused by influenza virus, which gives rise to hyaline membranes, underlies RF. Lung tissue fibrosis formed in recovered patients. CONCLUSION: The severity of pandemic influenza A/H1N1/2009 was determined by massive bilateral pneumonia, interstitial (alveolar) pulmonary edema, formation of diffuse bilateral lung fibrosis at the outcome of severe virus pneumonia (acute respiratory distress syndrome) with a decrease in vital and diffusing capacities, thereby generating a need to follow up this patient category and, possibly, to elaborate special rehabilitation programs.

[Acute hepatitis of unspecified etiology: etiological structure and clinical-laboratory characteristics].

The straight line nucleic acids detection method of viruses and wide spectrum of virus antigens immunodiagnostics in acute hepatitis of unknown etiology patients has allowed verifying the diagnosis at 19% cases (a viral hepatitis A, C or E). Results of research do not allow to consider hepatotropic viruses HGV, TTV, PV B19, EBV, CMV, HHV 1, 2, 6 and 8 type, NV-F as etiological agents at the majority of patients of investigated group, and the data of the anamnesis and a clinical and laboratory picture of a current of disease does not allow to exclude at 29.4% of patients a drug-induced hepatitis. Despite detailed molecular-biological and immunological inspection of patients, at 37.9% of acute hepatitis of unknown etiology patients it was not possible to establish a connection with hepatitis and defined etiological factor (the infectious agent).

[Viral hepatitis type A as an important all-clinical problem].

The article contains present-day data on type A viral hepatitis, whose incidence in Russia has increased significantly in the recent years. The authors consider the pathogenesis of type A hepatitis, taking into account the peculiarities of immune response to the virus. Clinical manifestations of various variants, including anicteric one and combinations of type A hepatitis with hepatites of other etiologies, are described. The authors stress the diagnostical significance of anti-HAV IgM detection, the aspects of differential diagnosis, treatment, as well as specific and non-specific prophylaxis of type A viral hepatitis.

[Nervous system involvement in hemorrhagic fever with renal syndrome].

The authors of the article describe two cases of hemorrhagic fever with renal syndrome (HFRS) with prevalence of signs of nervous system involvement. The first case was a 40-year-old woman with moderate HFRS, who developed Guillain-Barre syndrome of axonal-demyelinating polyneuropathy. An important observation was the absence of hemorrhagic or renal syndrome; combined therapy including plasmapheresis was successful. The second case demonstrated polymorphism of HFRS clinical manifestations with prevalence of neurological symptoms, which consisted in encephalopathy and no renal failure signs; hemorrhagic syndrome was moderate. In both cases the diagnosis was confirmed by elevated titer of antibodies to HFRS virus, belonging to the group of hantaviruses.

[Food poisoning in patients with diabetes mellitus]. / Pishchevye toksikoinfektsii u bol'nykh sakharnym diabetom.

The clinical picture of food toxoinfections in patients with diabetes mellitus is characterized by a more severe and protracted course. On the other hand, food toxoinfections promote diabetes mellitus decompensation and the development of diabetic ketoacidosis. Since diabetes mellitus and food toxoinfections have a number of symptoms in common the authors suggest the diagnostic working schedule. Grave and medium-grave food toxoinfections in patients with diabetes mellitus mandate refusing the intake of oral antidiabetic drugs and long-acting insulins. It is recommended that insulin may be administered in divided doses.

[Thrombosis of the mesenteric vessels as a complication of food toxicoinfection]. / Tromboz mezenteral'nykh sosudov kak oslozhnenie pishchevykh toksikoinfektsii.

The authors have observed 189 patients with thromboses of the mesenteric vessels. In 85.7% of the cases thrombosis developed in the mesenteric major vessels (mainly in the upper mesenteric artery), in 14.3% in the microcirculation system as a complication of food poisoning. Differential-diagnostic signs for both groups and clinical illustrations are presented. The importance of efficient rehydration therapy in food poisoning for the correction of rheological and homeostatic disorders in the microcirculation system is emphasized.

[Prostaglandins and cyclic nucleotides in the gastrointestinal form of yersiniosis]. / Prostaglandiny i tsiklicheskie nukleotidy pri gastrointestinal'noi forme iersinioza.

In spite of the resemblance of the clinical picture of gastrointestinal yersiniosis and acute dysentery, material differences underlie the pathogenesis of these diseases. Yersiniosis is marked by the predominance of an increase in the content of PGF2 alpha, whereas acute dysentery by an increase in the content of PGE, which may be accounted for by greater intensity of the allergic manifestations in yersiniosis patients as compared with dysentery. Shigellosis runs its course in the presence of the prevailing influence of the guanylate cyclase system, whereas yersiniosis in that of the adenylate cyclase. This is likely to be related to graver destructive lesions in the colonic mucosa in acute dysentery.

[The clinical manifestations and differential diagnosis of Yersinia hepatitis and viral hepatitis A and B]. / Klinicheskie proiavleniia i differentsial'naia diagnostika iersinioznykh i virusnykh gepatitov A i B.

Hepatic involvement in yersiniosis is associated with clinical symptoms of hepatitis, sometimes dominant in the clinical picture. Such cases need differentiation of yersiniosis with viral hepatitides A and B. Clinical and biochemical findings were compared for matched patients with yersiniosis-induced hepatic lesions, viral hepatitis A and viral hepatitis B verified at specific laboratory examination. This permitted introduction of differential diagnostic signs able to recognize one disease from the other.

[Acute fatty gestational hepatosis in infectious and obstetrical clinic]. / Ostryi zhirovoi gepatoz beremennykh v infektsionnoi i akusherskoi klinike.

Moscow infection hospital N 1 admitted in 1970-2000 fifty seven pregnant women with acute fatty gestational hepatosis (AFGH). 10 women died. AFGH is a severe complication of pregnancy. It occurs rather rarely, has clinical variants, can be mistaken for infectious diseases, primarily for viral hepatitides. When AFGH diagnosis is verified, the patient must immediately deliver otherwise the prognosis is poor.

[Clinical and prognostic significance of disturbed global and regional contractility of left ventricle in diphtheria myocarditis]. / Klinicheskoe i prognosticheskoe znachenie narushenii global'noi i regional'noi sokratimosti levogo zheludochka pri difteriinykh miokarditakh.

Examination of 159 diphtheria patients diagnosed myocarditis in 64 of them. The latter were divided into 3 groups: with mild, moderate and severe myocarditis. The patients with and without diphtheria have undergone two-dimensional echocardiography with estimation of the asinergia index (AI) and left ventricular (LV) ejection fraction. Pronounced systolic dysfunction was revealed only in severe diphtheric myocarditis (DM). AI rose in moderate and severe DM. By the degree of AI elevation it can be judged about myocarditis severity and the disease prognosis. Regional LV contractility and LV systolic dysfunction were correlated. A group of patients with severe DM was identified who had a high risk of death in akinesia of LV segments (IA > 2) and lowering of LV ejection fraction below 35%.

[What surgeon must know about rabies and its treatment]. / Chto dolzhen znat' khirurg o beshenstve i ego lechenii.

From 1991 to 2002 10 patients with rabies were treated, all the patients died. Epidemiology, clinical picture, specific symptoms are described, rarity of this severe disease is noted. The necessity of urgent preventive vaccination immediately after bites is emphasized.