The course of labor in term patients with concomitant acute intestinal infections

BACKGROUND: Literature data on the course of labor in women with concomitant acute intestinal infections are very scarce. Individual works and articles are devoted to the coverage of this most important final stage of pregnancy. There are no developed specific tactics of labor management in patients with acute intestinal infections, therefore obstetricians and gynecologists have to use generally accepted standards of labor management in this group of patients, without having a clear idea of the frequency and nature of clinically relevant complications in childbirth. AIM: The aim of this study was to evaluate the course of labor in women with concomitant AIIs at full-term pregnancy. MATERIALS AND METHODS: We examined 120 patients aged 19 to 39 years, delivered in Clinical Infectious Disease Hospital named after S.P. Botkin, St. Petersburg in 2017-2019. The main group consisted of 60 women with concomitant acute intestinal infections who gave birth, and the comparison group comprised 60 conditionally healthy women. The spectrum of acute intestinal infection pathogens in pregnant women, the course of labor, complications during labor and the condition of newborns were evaluated. RESULTS: Women of the both study groups did not differ in the duration of labor and the anhydrous interval, the frequency of birth abnormalities, the volume of blood loss, and the frequency of maternal injury and complications in the postpartum period. The frequency of premature rupture of membranes, acute and chronic fetal hypoxia, and episiotomy was higher in patients of the main group. Asphyxia in the first minute after birth was also more common in newborns from women with concomitant acute intestinal infections. CONCLUSIONS: Acute intestinal infections may complicate the course of labor. Labor management in women with concomitant acute intestinal infections requires continuous monitoring of the condition of the fetus during labor and the provision of timely medical care to the newborn.

Epidemiological, ecological and clinico-laboratory characteristics of hemorrhagic fever with renal syndrome in Saint-Petersburg and suburb

The goal is to identify the epidemiological, territorial-epidemiological, environmental, clinical and features of hemorrhagic fever with renal syndrome in order to improve epidemiological surveillance in a large metropolis of the Northwestern Federal District.Materials and methods. An epidemiological analysis of cases of hemorrhagic fever with renal syndrome in St. Petersburg for 2005–2019 was carried out and the clinical and epidemiological characteristics of 135 patients hospitalized in the S.P. Botkin Clinical Infectious Disease Hospital were studied. 70 patients identified combined HFRS diseases associated with other pathogens of viral and bacterial nature. An epidemiological analysis of cases of hemorrhagic fever with renal syndrome in St. Petersburg for 2005–2018 and long-term monitoring of the zoological, epizootological state of small mammals in several districts of St. Petersburg and its suburbs were carried out. The clinical and epidemiological characteristics of 135 patients were studied, of which 70 patients identified combined hemorrhagic fever with renal syndrome diseases associated with other pathogens of a viral and bacterial nature. To assess the epizootological situation, trapped rodents were examined for the presence of viral antigen and antibodies using the method of indirect immunofluorescence with the Xantagnost diagnosticum and enzymelinked immunosorbent assay.Results. The long-term dynamics of the incidence rate in St. Petersburg had a fluctuant rising character with two peaks. The proportion of diseases during the first rise was 11,5%, the second – 44,2% of the long-term incidence. Men prevailed in the age groups of 20-49 years without changes in periods. The proportion of women 20–49 years old was 20,7%, increased to 52,8 % in age groups over 50 years old. When distributed by month in a period of high incidence, the seasonal rise began in September with a peak in October. Infection with hemorrhagic fever with renal syndrome patients – residents of the city occurred mainly (with 35.5%), in the nearby territories of the Northwestern Federal District with 8.9% - in remote areas and with 5,9% in the countries of near and far abroad. The epidemiological situation in places of temporary residence and infection of people was characterized by an increase in the number of small mammals (redbacked voles) and, in particular, infection from 2,9 to 4,4%. Hemorrhagic fever with renal syndrome diseases occurred in the form of moderate severity in 94,4% cases. Severe forms were found in only 5,6% of cases. In the structure of combined infection in 25,9–22,3%, there was a combination of hemorrhagic fever with renal syndrome with gastroenterocolitis and influenza, serologically confirmed. In 17,6% of cases, hemorrhagic fever with renal syndrome was combined with other zoonoses (Lyme disease, tick-borne encephalitis, pseudotuberculosis, leptospirosis, tularemia), in 17,6% with of various etiologies. The presence of combinations of hemorrhagic fever with renal syndrome with other infections complicates the clinical diagnosis.

Novel coronavirus infection (COVID-19) in tuberculosis patients in St. Petersburg

The aim of this work was to attempt to analyze the demographic structure, clinical and radiological forms of tuberculosis and COVID-19, as well as the course and outcome of the disease in patients with this coinfection in the light of a new and still poorly understood problem of the mutual influence of tuberculosis and COVID-19.Material and methods. Examination and treatment were carried out in the infectious-tuberculosis departments of the Botkin Clinical Infectious Disease Hospital. We examined 63 patients identified in the first seven months of the epidemic in the multimillion city of St. Petersburg (Russia). Tuberculosis, confirmed by conventional bacteriological and molecular genetic methods, had an active phase in all of them. The new coronavirus infection was verified by a positive polymerase chain reaction test for SARS-CoV-2.Results. Tuberculosis in 43 patients was detected simultaneously with COVID-19, in 20 people it preceded coronavirus infection. Disseminated forms of tuberculosis prevailed - 50.8%; in 36.5%, two or more organs and systems were affected, which is associated with a high proportion (54.0%) of HIV-positive patients with an advanced stage of the disease. Lung damage with COVID-19 was noted in 36.5%. Fatal outcomes ended in 20.6% of cases of coinfection, the structure of the causes of death is given.Conclusion. An assumption was made about the possibility of an aggravating effect of tuberculosis on COVID-19 in the case of severe or widespread forms of these diseases. The negative influence of HIV infection on the outcome of the disease has also been shown. Further follow-up is required to identify more reliable associations between tuberculosis and COVID-19.

The most common infections leading to hospitalization in educational- research hospital of Yazd

Infectious diseases are one of the diseases that are generally better suited to diagnostic and antibiotic treatments. However, there is significant mortality in infectious diseases. This study was done to determine the infection leading to admission. This study was performed on hospital data. All patients admitted in Shahid Sadoughi hospital in Yazd province in one year were studied. The final diagnosis is based on symptoms and clinical infectious disease by a specialist. Data were analyzed by statistical software SPSS and Chi-square tests. In the time period examined, 1326 patients were enrolled, 56.7% were male and 43.3% female that age range were 14-95 years. The most commonly reported illness at the time of hospital discharge was pneumonia (16.7%), UTI (11.2%), diabetic foot ulcer and cellulite (13.7%). There was a significant relationship between the most commonly diagnosed illnesses age and gender at the onset and discharge of patients (P value<0.05). It is worth noting that cases without diagnosis were 20.1% and in the elderly group with a population of 53.6% of the total hospitalized patients, pneumonia and UTI were the most common complications. The present study has shown that pneumonia is the most prevalent among the causes of hospitalization among the elderly and non-elderly patients in the infectious part, and there is a significant relationship between age and sex and the prevalence of disease in patients were in Hospital.

The COVID-19 pandemic: a systematic review of the current evidence

Introduction. An epidemic of Coronavirus Disease 2019 (COVID-19) begun in December 2019 in China, causing primary concern. One of the important issues is its rapid spread around the world. Among the questions raised, disease epidemiology, clinical, laboratory symptoms and radiological findings and treatment of COVID-19 disease have been identified in some studies. But no systematic review on current evidences about COVID-19 has been published.Objective. The aim of this study was to determine the COVID-19 epidemiology, clinical features, diagnosis and treatment.Data sources. We performed a systematic review of the literature, using the keywords: “coronavirus” and “2020”, “COVID-19” in databases: Science Direct, PubMed, Springer and Scopus during January 1, 2020 to February 23, 2020.Study Selection. All observational studies, as well as case reports and editorial that published in English were include. Data Extraction. Data on the disease control methods of COVID-19 were extracted by multiple observers.Results. 131 articles were retrieved. After screening by abstract and title, 58 articles were selected for full-text assessment. Of them, 43 were finally included for review. The COVID-19 has spread rapidly and can be transmitted via close human-to-human contact via nasopharyngeal or oropharyngeal droplets. The COVID-19, causing considerable problems, especially in patients with comorbidities and old patients. Fever, cough, sore throat and diarrhea are the main clinical features of this emerging disease. The most common radiological finding is bilateral ground-glass view and Lopinavir and Ritonavir are among the antiviral drugs used.Conclusion. COVID-19 is a new clinical infectious disease and can be a serious problem for health systems. Additional research is needed to elucidate factors that may mediate the pathogenesis of the severe and fatal associated disease.

Lyme borreliosis: clinical and epidemiological features of its course in the territory of large industrial center of Western Urals

Objective. Since the territory of the Western Urals is widely known for its high morbidity and mortality rates associated with tick-borne infections, including ixodic tick-borne borreliosis, the study was aimed at estimation of the role of specific prevention in the prevalence of ITB. Materials and methods. A continuous retrospective clinical and laboratory analysis of 1214 adult patients admitted to Perm Regional Clinical Infectious Disease Hospital with lyme - borreliosis in 2012-2019 was carried out. Results. The disease is registered more often in persons over 50 years old, infection mainly occurs while visiting forests and park zones that requires the use of means of protection to reduce the number of the carriers of infection. Every third patient has mixed infection, where pathogens circulating in the ticks of the given territory of the Western Urals are combined. The increase in the number of non-erythemic forms in the recent years is probably associated with the development of immunodeficiency in the population of the industrial center, as well as with the use of more sensitive and informative methods of laboratory diagnostics. Conclusions. Specific prophylaxis is highly effective, helping to prevent infection in more than 90% of cases.

A Collaborative Tale of Diagnosing and Treating Chronic Pulmonary Aspergillosis, from the Perspectives of Clinical Microbiologists, Surgical Pathologists, and Infectious Disease Clinicians

Chronic pulmonary aspergillosis (CPA) refers to a spectrum of Aspergillus-mediated disease that is associated with high morbidity and mortality, with its true prevalence vastly underestimated. The diagnosis of CPA includes characteristic radiographical findings in conjunction with persistent and systemic symptoms present for at least three months, and evidence of Aspergillus infection. Traditionally, Aspergillus infection has been confirmed through histopathology and microbiological studies, including fungal culture and serology, but these methodologies have limitations that are discussed in this review. The treatment of CPA requires an individualized approach and consideration of both medical and surgical options. Most Aspergillus species are considered susceptible to mold-active triazoles, echinocandins, and amphotericin B; however, antifungal resistance is emerging and well documented, demonstrating the need for novel therapies and antifungal susceptibility testing that correlates with clinical response. Here, we describe the clinical presentation, diagnosis, and treatment of CPA, with an emphasis on the strengths and pitfalls of diagnostic and treatment approaches, as well as future directions, including whole genome sequencing and metagenomic sequencing. The advancement of molecular technology enables rapid and precise species level identification, and the determination of molecular mechanisms of resistance, bridging the clinical infectious disease, anatomical pathology, microbiology, and molecular biology disciplines.

Elucidation of environment dependent antibiotic resistance mechanisms

The propensity of pathogens to evolve resistance to antibiotics used in clinical infectious disease therapeutics has been an increasing concern in recent decades. Acquisition of resistance often translates into treatment failure and puts patients at risk of serious adverse outcomes. Current laboratory testing of antibiotic susceptibility does not account for the different microenvironments that bacteria encounter within the human body, providing results that often do not translate into the clinic. Our goal is to better understand evolutionary strategies employed by Staphylococcus aureus in development of resistance in distinct environments. We used adaptive laboratory evolution (ALE) to generate isogenic strains resistant to several antibiotics. Different media were used to mimic distinct environments and multi-omics approaches applied in the understanding of resistance mechanisms. Evolved strains presented phenotypes similar to those observed in clinical resistant isolates. Mutational analysis indicated that resistance was specific and condition-dependent. Distinct mutations led to resistance phenotypes under a particular environmental condition, but these mutations did not necessarily translate into resistance under a different environmental condition. Furthermore, resistant strains possessed distinct transcriptional landscapes, even when the same systems were mutated, suggesting that similar evolutionary paths translate into distinct resistance mechanisms. We identified several resistance mechanisms employed by S. aureus that were not only environment-dependent, but also environment specific. Additionally, we showed that ALE can be applied in pathogens of interest to study antibiotic resistance evolution and prediction of clinical resistance mechanisms, as supported by the significant overlap of mutations identified via ALE and those reported in clinical isolates.

Clinical, Laboratory and Imaging Features of COVID-19: A Systematic Review and Meta-analysis

Introduction: An epidemic of Coronavirus Disease 2019 (COVID-19) begun in December 2019 in China, causing a Public Health Emergency of International Concern. Among raised questions, clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews have been published on this matter. Methods: We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of confirmed cases of COVID-19. All the observational studies, and also case reports, were included and analyzed separately. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI). Measures of heterogeneity were estimated and reported. Results: 660 articles were retrieved. After screening by abstract and title, 27 articles were selected for full-text assessment. Of them, 19 were finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5-92.9%), cough (57.6%, 40.8-74.4%) and dyspnea (45.6%, 10.9-80.4%) were the most prevalent clinical manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required intensive care unit (ICU), with 32.8% presenting acute respiratory distress syndrome (ARDS) (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock and 13.9% (95%CI 6.2-21.5%) with a fatal outcome. Discussion: COVID-19 is a new clinical infectious disease, causing considerable compromise, especially in patients with comorbidities, requiring ICU in at least a fifth of them and sometimes with fatal outcomes. Additional research is needed to elucidate factors that may mediate the pathogenesis of the severe and fatal associated disease.