Vol 82, No 11 (2010)

Articles
Vaccine prophylaxis of adult infectious diseases
Pokrovskiy V.I., Mikheeva I.V., Pokrovsky V.I., Mikheyeva I.V.
Abstract
The paper reviews the main problems of vaccine prophylaxis of adult infectious diseases, including the organization of adult vaccination within the national calendar of immunization and that as indicated by epidemics. It gives data on vaccine-controlled adult infectious morbidity. The problems of the training of medical workers serving the adult population in vaccine prophylaxis and those of the financing of adult immunization are discussed.
Terapevticheskii arkhiv. 2010;82(11):5-10
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Pandemic influenza A/H1N1 (sw2009) in Russia: epidemiology, diagnosis, clinical picture, and treatment
Yatsyshina S.B., Minenko A.N., Kushakova T.E., Praded M.N., Kudryavtseva A.V., Shipulin G.A., Maleev V.V., Pokrovskiy V.I., Yatsyshina S.B., Minenko A.N., Kushakova T.E., Praded M.N., Kudryavtseva A.V., Shipulin G.A., Maleyev V.V., Pokrovsky V.I.
Abstract
Aim. To study the epidemiological and clinical features of the 2009-2010 pandemic influenza in Russia. Subjects and methods. Materials from 874 patients, including postmortem samples from 287 subjects, were examined applying the AmpliSens Influenza virus A/H1-swine-FL PCR kit designed and produced by the Central Research Institute of Epidemiology. The clinical and postmortem characteristics of 68 patients who had died from influenza A/H1N1 (sw2009) were analyzed in detail. Results. The cause of deaths was primary virus pneumonia in most cases. The major manifestation of viral pathogenicity was impaired microcirculation leading to hemorrhage. No mutations conferring resistance to oseltamivir and arbidol were found. All A/H1N1swl viruses had genetic markers of remantadin resistance. Conclusion. The reagent kits developed by the Central Research Institute of Epidemiology proved to be effective. It is necessary to set up PCR laboratories that differentially diagnose influenza and acute respiratory viral infections in health care facilities in order to make early laboratory diagnosis of influenza and to timely perform its specific therapy.
Terapevticheskii arkhiv. 2010;82(11):10-14
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Outcomes of severe pandemic influenza A/H1N1/2009
Klimova E.A., Yushchuk N.D., Karetkina G.N., Boytsov P.V., Serobyan A.G., Kelli E.I., Malyshev N.A., Golokhvastova N.O., Esaulova M.R., Karchevskaya N.A., Avdeev S.N., Klimova E.A., Yushchuk N.D., Karetkina G.N., Boitsov P.V., Serobyan A.G., Kelli E.I., Malyshev N.A., Golokhvastova N.O., Esaulova M.R., Karchevskaya N.A., Avdeyev S.N.
Abstract
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.
Terapevticheskii arkhiv. 2010;82(11):15-18
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Clinical efficacy of reamberine in therapy for influenza
Isakov V.A., Vodeyko L.P., Kabolova I.V., Turkin V.V., Isakov V.A., Vodeiko L.P., Kabolova I.V., Turkin V.V.
Abstract
Aim. To evaluate the tolerance and therapeutic effectiveness of 1.5% reamberine (RB) solution infusions in complex therapy for pneumonia-complicated pneumonia and acute respiratory diseases (ARD). Subjects and methods. 133 patients aged 18 to 60 years with pneumonia-complicated influenza and ARD were examined. The investigators measured the dynamic serum levels of metalloproteins (MP), such as transferrin, lactoferrin, and ceruloplasmin, and the activity of superoxide dismutase. They also studied the concentration of secondary lipid peroxidation products (malondialdehyde) by the so-called thiobarbituric acid test. Results. Dropwise intravenous RB infusions exerted a modifying effect on MP content, contributed to more pronounced stabilization of a serum antioxidant potential (versus olifen, vitamin E, and basic therapy) and to enhanced nonspecific protection, which was accompanied by a significant clinical improvement. Conclusion. The study revealed the high clinical efficacy of 1.5% RB solution infusions (300 ml for 4-5 days) in the treatment of 74 patients with pneumonia-complicated influenza, stabilized serum antioxidant potential, and the body's enhanced nonspecific resistance.
Terapevticheskii arkhiv. 2010;82(11):19-22
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The pattern of central nervous system lesion in HIV-infected patients in the specialized unit of an infectious diseases hospital
Peregudova A.B., Shakhgil'dyan V.I., Tsvetkova O.O., Ermak T.N., Gruzdev B.M., Yuditskiy M.V., Tishkevich O.A., Shipulina O.Y., Al'vares Figeroa M.V., Safonova A.P., Dolgova E.A., Goncharov D.B., Peregudova A.B., Shakhgildyan V.I., Tsvetkova O.O., Yermak T.N., Gruzdev B.M., Yuditsky M.V., Tishkevich O.A., Shipulina O.Y., Alvares Figeroa M.V., Safonova A.P., Dolgova E.A., Goncharov D.B.
Abstract
Aim. To define the incidence and features of brain lesion (BL) in HIV-infected inpatients. Subjects and methods. Four hundred and fifty-eight patients with Stage 4B HIV infection (AIDS) and central nervous system (CNS) lesion admitted to Infectious Diseases Hospital Two, Moscow, were followed up in 2003-2009. The authors used cerebrospinal fluid (CSF) microscopic and bacteriological assays for DNA of T. gondii, M. tuberculosis, herpes simplex virus (HSV) types 1 and 2, cytomegalovirus (CMV), HSV type 6, and varicella-zoster virus, Cr. neoformans, C. albicans, C. glabrata, and C. krusei. Blood and CSF were tested for IgM and IgG T. gondii antibodies; brain magnetic resonance imaging was carried out. Results. In patients with late-stage HIV infection, the principal cause of neurological diseases was cerebral toxoplasmosis (34.7% of BL cases) and a generalized process involving the brain, lung, heart, liver, and eyes in 11.5%. There was commonly cerebral toxoplasmosis concurrent with CMV infection with clinical manifestations. 16-32% of the inpatients developed tuberculosis meningoencephalitis that was a manifestation of hematogenous disseminated tuberculosis involving the lung. There was a rise in the incidence of cancers (brain lymphomas, astrocytomas) running with CNS lesion. Mental disorders progressing to dementia were a distinctive property of CMV ventriculoencephalitis, one of the leading factors in the development of AIDS dementia complex. Molecular diagnostic techniques are needed to ascertain the etiology of BL in HIV infection. Conclusion. The CSF test for DNA of causative agents is a specific and most sensitive method for diagnosing a relevant CNS lesion.
Terapevticheskii arkhiv. 2010;82(11):22-27
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Raltegravir is the first HIV integrase inhibitor as part of antiretroviral treatment regimens
Kravchenko A.V., Kravchenko A.V.
Abstract
The paper gives the results of the largest international studies demonstrating the efficacy and safety of Raltegravir as part of antiretroviral treatment (ARVT) regimens in both patients starting therapy (STARTMRK study) and those pretreated with antiretroviral drugs (BENCHMRK study). The advantage of Raltegravir over Efavirens is the lower incidence of adverse central nervous system reactions. Based on the results of published investigations, specialists from the USA and European Union have incorporated the first HIV integrase inhibitor Raltegravir into a first-line ARTV regimen. Raltegravir is the drug of choice and should be used in special categories of patients, such as those with chronic hepatitis C or fat metabolic disturbances.
Terapevticheskii arkhiv. 2010;82(11):27-32
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The course and treatment of chronic hepatitis B in HIV-infected patients
Maksimov S.L., Tsarenko S.P., Kravchenko A.V., Yushchuk N.D., Maksimov S.L., Tsarenko S.P., Kravchenko A.V., Yushchuk N.D.
Abstract
The paper reviews the data available in the literature on patients with mixed hepatitis B virus (HBV) and HIV infection, its course and outcomes. The unity of the mechanisms of contamination with HBV and HIV increases the likelihood of these infections in patients. About 70% of HIV-infected patients are carriers of the markers, the presence of which is indicative of current or previous HBV infection. An average of 7.6% of HIV-infected patients were diagnosed as having chronic hepatitis B (CHB) in West Europe and North America. The notification rate of CHB in adult HIV-infected patients was 5-7% in the Russian Federation. Most specialists report that HIV-infected patients have a severer course of HBV. Mixed HBV and HIV infection, and low CD4+ lymphocyte count in particular, increase the risk for death from hepatic diseases and there is evident hepatotoxicity during antiretroviral therapy. The management of patients with mixed HBV and HIV infection is determined by indications for therapy for both HIV infection and CHV infection, by the availability of double-action antiviral drugs (that suppress either HIV or HBV replication), by the development of their resistance in one or both viruses. Indications and preferable variants of using various treatment regimens are given.
Terapevticheskii arkhiv. 2010;82(11):32-37
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Myonecrosis in injection drug users (a clinical case)
Shestakova I.V., Yushchuk N.D., Tishkevich O.A., Shestakova I.V., Yushchuk N.D., Tishkevich O.L.
Abstract
Myonecrosis remains one of the severest manifestations of skin and soft tissue infections. Clostridia (C. perfringens, C. novyi, C. septicum, C. sordellii, C. histolyticum) are dominant and Staphylococcus aureus, Streptococcus pyogenes, Bacillus cereus, and Bacteriodes fragilis are much less in the etiology of myonecrosis. Cases of gas gangrene have recently become more frequent among injection drug users all over the world. Russia has become the largest opiate market in Europe and consumption of these narcotic drugs is annually growing. In the Russian Federation, a larger number of injection drug users uniquely results in a rise of cases of Clostridium- and mixed flora-induced myonecrosis. Gas gangrene in HIV-positive drug abusers seems to rapidly progress to multiple organ failure and to show high death rates, rather than to develop a localized form. The analyzed case of mixed flora-induced gas gangrene is of interest to physicians of any specialties who can encounter this wound infection in HIV-positive patients.
Terapevticheskii arkhiv. 2010;82(11):37-40
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Quality of life indices in patients with chronic viral hepatitis
Beloborodova E.I., Lambrova E.G., Beloborodova E.V., Ostanko V.L., Alekseeva A.S., Kalacheva T.P., Livshits I.K., Chvyrina D.V., Beloborodova E.I., Lambrova E.G., Beloborodova E.V., Ostanko V.L., Alekseyeva A.S., Kalacheva T.P., Chvyrina D.V.
Abstract
Aim: to estimate quality of life (QL) indices in patients with chronic viral hepatitis (CVH) and their relationships to the clinical characteristics of the disease. Subjects and methods. One hundred and ten patients with chronic viral hepatitis (CVH), including 58 patients with chronic hepatitis C (CHC), 27 with chronic hepatitis B, and 25 with CHC + HBCor, were examined. The personality psychological profile, reaction and personality anxiety were evaluated; the Beck inventory was used to identify borderline mental disorders. The test developed by the Karelian Research Center, Russian Academy of Medical Sciences, modified by Ya. M. Rutgaizer, and the Nottingham Health Profile were applied to estimate QL indices. Results. Parameters characterizing the social and personality indices of life, such as qualitative performance of paid work, participation in social life, impossibility of adequate rest, and sexual life are most frequently influenced. The main indicators of worse QL were diminished vitality (vital energy), sleep disorders, and emergence of emotional reactions. This was largely seen in patients with active CVH infection and in those who had isolated HBcor antibodies. Conclusion. QL is directly related to the duration of viral infection.
Terapevticheskii arkhiv. 2010;82(11):41-45
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The etiological pattern of diseases in pregnant women with enhanced blood AlAT and AsAT activities, admitted to the obstetric unit of an infectious diseases hospital
Dudina K.R., Znoyko O.O., Trubitsyna Y.G., Shut'ko S.A., Kuz'min V.N., Serobyan A.G., Revazyan N.R., Petrova N.P., Blokhina N.P., Yushchuk N.D., Dudina K.R., Znoiko O.O., Trubitsyna Y.G., Shutko S.A., Kuzmin V.N., Serobyan A.G., Revazyan N.R., Petrova T.V., Blokhina N.P., Yushchuk N.D.
Abstract
Aim: to define a role of hepatotropic (HAV, HBV, HCV, and HDV) and opportunistic hepatotropic (HGV, CMV, EBV, HHV types 1, 2, and 6) viruses in the etiological pattern of diseases accompanied by enhanced blood AlAT and AsAT activities in pregnant women. Subjects and methods. Two hundred and eleven pregnant women, including 123 patients with chronic viral hepatitis, 74 with enhanced blood AlAT activity and no markers of viral hepatitis (EAlAT-NMVH), and 14 with acute viral hepatitis were examined. Results. Most pregnant women with chronic HBV and HCV infections were found to have HBV DNA and HCV RNA in the blood in the presence of normal and enhanced activities of transaminases. In the EAlAT-NMVH group, there was none of the opportunistic hepatotropic viruses in more than 7% of cases. No genetic material of HAV, HBV, HCV, HDV, HGV, CMV, EBV, HHV types 1, 2, and 6 was found in the blood of all 10 patients with hepatitis of unspecified etiology. Conclusion. In the absence of serologic data supporting the presence of infectious pathology, blood testing using the polymerase chain reaction is of low informative value in detecting opportunistic hepatotropic viruses in pregnant women with hepatitis of unspecified etiology. However, by keeping in mind that the spectrum of opportunistic hepatotropic viruses is not confined to those included in this study, it is expedient to examine additionally pregnant women with enhanced blood AlAT and AsAT activity in order to identify TTV, B19V, HHV-8, SEN and NV-F in the blood.
Terapevticheskii arkhiv. 2010;82(11):45-48
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Use of cyclopheron in the treatment of patients with pulmonary tuberculosis with mild clinical manifestations
Filippova T.P., Vasil'eva L.S., Kochkin A.V., Filippova T.P., Vasilyeva L.S., Kochkin A.V.
Abstract
Aim: to evaluate the efficacy of cyclopheron used in patients with mild clinical manifestations of focal and infiltrative pulmonary tuberculosis (PT). Subjects and methods. Thirty first detected patients with PT, in whom a complex of their etiotropic therapy comprised cyclopheron, and 32 similar patients who received etiotropic agents and placebo were examined. Tuberculosis process activity was confirmed by clinical, X-ray, bacteriological, and immunological studies. The hypothalamic-pituitary-adrenal system was determined from serum cortisol concentration. The sympathoadrenal system was assessed from cardiac rhythm parameters (autonomic balance index). Results. Incorporation of cyclopheron into the combined therapy of patients with PT led to increased blood cortisol concentration, higher autonomic balance index, elevated T-lymphocyte count, enhanced phagocytic activity, and lower levels of circulating immune complexes, resulting in earlier decay cavity closure and sputum negativation. Conclusion. Extrastress status of adaptation systems and the absence of their activating impact on immunity and inflammation are detectable in first detected patients with mild clinical manifestations of PT running in significant lung tissue fibrosis. Therapy with cyclopheron that stimulates the production of stress-induced cytokines gives rise to a stress reaction, activates immune processes, and enhances therapeutic effectiveness in this group of patients.
Terapevticheskii arkhiv. 2010;82(11):49-53
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To the differential diagnosis of arthritides of pseudotuberculous and chlamydial etiology
Burgasova O.A., Yushchuk N.D., Pogorel'skaya L.V., Tseneva G.Y., Kulyashova L.B., Voskresenskaya E.A., Fedunyak I.P., Burgasova O.A., Yushchuk N.D., Pogorelskaya L.V., Tseneva G.Y., Kulyashova L.B., Voskresenskaya Y.A., Fedunyak I.P.
Abstract
Aim: to define main differential diagnostic criteria for arthritides of chlamydial and pseudotuberculous etiology and to improve patient examination tactics. Subjects and methods. Forty-six patients with pseudotuberculosis and 41 patients with chronic urogenital chlamydial infection with articular involvement were examined. A bacteriological method of polymerase chain reaction (PCR), agglutination test, enzyme immunoassay (EIA) (IgA, IgG, IgM), indirect hemagglutination (IHA) test were used to diagnose pseudotuberculosis. Diagnostic techniques for chlamydiasis involved cultural, direct immunofluorescence (DIF), real-time PCR, and EIA (IgM, IgG, IgA). Results. Patients with pseudotuberculosis developed polyarthritis and oligoarthritis in 56 and 39%, respectively. The development of arthritides was accompanied by fever in 89%, exanthema in 57%, gastrointestinal lesion in 56%, hepatomegalia in 78%. The pseudotuberculous etiology of the disease was confirmed by the agglutination test in 71% of the patients and by IHA in 7%. EIA revealed IgG in 78% of the patients, IgA in 11%, and IgM in 29%. PCR of synovial fluid (SF), synovial shell, and other biological substrates revealed Yersinia pseudotuberculosis DNA in 43%. Chlamydiasis and polyarthritis developed in 71 and 19%, respectively. The diagnosis of chlamydiasis was verified by EIA detection of IgG and IgA in 76 and 27% of cases, respectively. DIF, PCR, and culture studies of urethral scrapes found Chlamydia in 9, 32, and 29% of cases, respectively. Examination of SF and synovial shells revealed Chlamydia trachomatis in 24% of the patients and culture studies detected the pathogen in 21%. Conclusion. Asymmetrical polyarthritides mainly involving the knee joints are the most common arthritides of pseudotuberculous etiology. EIA detection of serum IgG and IgA and PCR study of SF are optimal diagnostic tools. Artritides of chlamydial etiology are asymmetrical oligoarthritides predominantly involving the knee and ankle joints. Examination of urethral and cervical canal scrapes, SF by culture and PCR studies and that of serum IgA and IgG by EIA are optimal diagnostic tests.
Terapevticheskii arkhiv. 2010;82(11):53-57
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Effect of the anti-inflammatory peptide preparation ingramon on the blood levels of acute-phase proteins and chemokines in patients after coronary stenting
Potekhina A.V., Provatorov S.I., Aref'eva T.I., Kukhtina N.B., Masenko V.P., Kaznacheeva E.I., Ruleva N.Y., Noeva E.A., Osyaeva M.K., Sidorova M.V., Bespalova Z.D., Krasnikova T.L., Potekhina A.V., Provatorov S.I., Arefyeva T.I., Kukhtina N.B., Masenko V.P., Kaznacheyeva E.I., Ruleva N.Y., Noyeva E.A., Osyaeva M.K., Sidorova M.V., Bestalova Z.D., Krasnikova T.L.
Abstract
Aim. To study the effect of the anti-inflammatory peptide preparation ingramon on the peripheral blood levels of inflammatory markers in patients with exercise-induced stable angina after coronary stenting (CS). Subjects and methods. The investigation enrolled 64 patients with stable angina who had undergone coronary bypass surgery, of them 34 patients received ingramon in addition to standard therapy. The blood levels of high-sensitive C-reactive protein (hs-CRP), fibrinogen, the chemokines MCP-1, IL-8, IP-10, and MID were measured before and 1, 2, and 7 days and 1, 3, and 6 months after surgery. Twenty patients who had gone coronarography (CG) only were examined as a control group. Results. In the postCS patients receiving only standard therapy, the levels of hs-CRP and fibrinogen were much higher on days 1, 2, and 7 after surgery than in the CG patients. On day 1 following CS, the increment in hs-CRP correlated with the length of implanted stents. During ingramon therapy, the content of hs-CRP and fibrinogen was considerably lower on days 1, 2, and 7 after CS than in the control group; this trend persisted a month after surgery; there was also a reduction in MCP-1 levels within the first 24 hours after initiation of therapy. The levels of the chemokines IP-10, MIG, and IL-8 were significantly unchanged. Conclusion. When added to standard therapy, ingramon exerts a positive effect against risk factors for coronary heart disease (CHD) and its events. Further investigations are required to define the impact of ingramon therapy on prognosis in patients with CHD.
Terapevticheskii arkhiv. 2010;82(11):58-63
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Acute lymphoblastic leukemias with translocations (1;19)(q23;p13): a description of 3 new cases and a review of the literature
Gindina T.L., Mamaev N.N., Zubaydullina S.R., Kondakova E.V., Gindina T.L., Mamayev N.N., Zubaidullina S.R., Kondakova E.V.
Abstract
Aim. To discuss the specific features of the cytogenetics and clinical manifestations of acute lymphoblastic leukemias (ALL) with balanced and unbalanced translocations (1;19)(q23; p13). Materials and methods. Bone marrow cells with differential staining of chromosomes into G-segments underwent cytogenetic study that was added by fluorescence in situ hybridization in 2 cases. The karyotypes of 3 patients with ALL previously untreated at 5, 18, and 23 years of age were studied. Results. Balanced translocations (1;19)(q23; p13) were found in 2 of the examinees while unbalanced translocation was noted in 1 case. Modal chromosomal classes were 46, 47, and 55-65 if the cells had additional structural (+1q, 6q-, etc.) and numerical chromosomal abnormalities (nonrandom trisomies and tetrasomies of chromosomes of different pairs). Conclusion. Translocation (1;19)(q23; p13) is characteristic for patients of different age groups, mainly for those with pre-B cell ALL. It is commonly concurrent with other karyotypic changes, namely, 6q deletion, 1q trisomy, and high hyperdiploidy.
Terapevticheskii arkhiv. 2010;82(11):63-67
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Clinical manifestations of neuroborelliosis in the Volga Region
Nafeev A.A., Klimova L.V., Nafeyev A.A., Klimova L.V.
Abstract
Ixodes tick-borne borrelioses (TBB) are a group of etiologically independent acute infectious natural-focal transmissive and polysystemic diseases caused by Borrelia and transmitted by the ticks. These diseases tend to be chronic and recurrent, as well as latent, mainly involving the skin, nervous system, locomotor apparatus and heart. The signs of nervous system lesion are recorded in both acute (subacute) and chronic course of the disease. The comparatively low notification rate of TBB in the Ulyanovsk Region, particularly involving the nervous system, in the absence of the gold marker of this disease - erythema migrans (it was absent in both cases) did not allow clinicians to make a correct diagnosis at the early stages of patient examination. The currently available methods, in this case, Western blot, are of great importance in diagnosing the disease. By taking into account delayed antibody generation within the first weeks of the disease, it is necessary to continue examination by the methods available in the practical health arsenal (ELISA) and in the later periods, with the epidemiological history and clinical picture of encephalitis being borne in mind.
Terapevticheskii arkhiv. 2010;82(11):68-70
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Use of a nonselective endothelin receptor antagonist in idiopathic pulmonary hypertension
Arkhipova O.A., Martynyuk T.V., Lazutkina V.K., Ataullakhanova D.M., Stukalova O.V., Danilov N.M., Samoylenko L.E., Chazova I.E., Arkhipova O.A., Martynyuk T.V., Lazutkina V.K., Ataullakhanova D.M., Stukalova O.V., Danilov N.M., Samoilenko L.E., Chazova I.E.
Abstract
Idiopathic (primary) pulmonary hypertension (IPH) is a rare disease of unknown etiology, which is characterized by elevated pulmonary artery pressure, increased total pulmonary vascular resistance, frequently a malignant course with evolving right ventricular decompensation, and a fatal outcome. The diagnosis of IPH is established on the increments in the mean resting and exercise pulmonary artery trunk pressure by more than 25 and more than 30 mm Hg at rest and during exercise, respectively, with a normal pulmonary artery wedge pressure. Endothelin receptor antagonists (ERA) are one of the effective classes of drugs for the treatment of patients with IPH. Bosentan is the first drug from the ERA class that blocks the receptors of both types and that has been recommended by the WHO to treat patients with functional class II-IV pulmonary hypertension. The described case demonstrates the possibility of concomitantly using bosentan in a female patient with IPH shortly after ineffective treatment with a calcium antagonist.
Terapevticheskii arkhiv. 2010;82(11):70-73
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Relapsing fever borrelioses: forgotten and new ones
Platonov A.E., Maleev V.V., Karan' L.S., Platonov A.E., Maleyev V.V., Karan L.S.
Abstract
Relapsing fever borrelioses are widely spread in the endemic regions of Eurasia, Africa, and America as before and account for significant morbidity and mortality; however, these infections have been recently underestimated. The pathogens of the fevers are the Borrelia species transmitted by ticks of the Ornithodoros genus; they genetically differ from the pathogens of Lyme borreliosis - Borrelia burgdorferi sensu lato transmitted by Ixodes ticks. The species Borrelia miyamotoi belongs to the genetic species of Borrelia, the causative agents of relapsing fevers. The authors found Borrelia of this species in the Ixodes ticks of Russia and first showed that B. miyamotoi were able to induce multiple cases in man, which had been earlier diagnosed as erythema-free Ixodes tick-borne borreliosis. The review considers the pathogenesis, clinical picture, diagnosis, and treatment of "old" relapsing fever borrelioses versus the available data on the "new" infection caused by B. miyamotoi. This must assist Russian physicians and scientists both to treat "old" and new tick-borne relapsing borrelioses and to schedule studies of the "new" B. myamotoi infection.
Terapevticheskii arkhiv. 2010;82(11):74-80
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