Peculiarities of radiological and laboratory values in patients with community-acquired pneumonia during COVID-19 pandemic

Literature and personal data on community-acquired pneumonia during the epidemic of a new coronavirus infection COVID-19 are presented. It was found that men and patients with moderately to severe form were treated for community-acquired pneumonia more often. The most common localizations were as follows (in descending frequency): bilateral multisegmental, right-sided lower lobe, left-sided lower lobe. Men as compared to women more often had the following localization of pneumonia: right-sided lower lobe pneumonia at the age of 20–30, 51–60; right-sided multisegmental in all age groups; left-sided lower lobe pneumonia at the age of 51–60, left-sided upper lobe pneumonia at the age of 20–50; left-sided multisegmental pneumonia in all age groups; slightly more frequent bilateral lower lobe pneumonia in different age groups; bilateral multisegmental pneumonia at the age of 20–30 and over 60. Conversely, the most common localization in women was as follows: right-sided lower lobe pneumonia at the age 31–50, right-sided upper lobe pneumonia at the age 20–30, left-sided lower lobe pneumonia at the age 20–50 and over 60, left-sided upper lobe pneumonia at the age over 60, bilateral lower lobe pneumonia at the age 31–40, bilateral multisegmental pneumonia at the age 41–60. Right-sided lower lobe pneumonia was equally often registered irrespective of gender in persons older than 60 years old. Right-sided upper lobe pneumonia was not registered in patients aged 31–40 and 41–50 years, and over 60 years old. The most frequent localization of pneumonia in mild form was left-sided lower lobe (35.3 %), right-si­ded lower lobe (20.6 %), and bilateral lower lobe (14.7 %). The least frequent were upper lobe localization of pneumonia in the right, left, and both lungs (2.94 % each), and left multisegmental pneumonia was not observed at all. The most frequent localization of pneumonia in the moderate form was the lower lobes of the right lung (29.4 %), left lung (18.3 %), and multisegmental in both lungs (28.8 %). It was least frequently registered in the upper lobe of the right lung (2.6 %), left lung (3.9 %) but was not registered in the upper lobes of both lungs. The most frequent localization of pneumonia in severe form was bilateral multisegmental (37.5 %). Right-sided multisegmental, left-sided lower lung and bilateral lower lung were the least common — 12.5 % for each. Subfebrile fever was registered more frequently in almost all localizations. More often normal or subfebrile temperature was registered in all localizations, except for right-sided upper lobe pneumonia, in which higher (febrile, pyretic) temperature was registered more often. In all localizations within three days after hospitalization most patients had normal leukocyte count, leukopenia was slightly more frequent in left-sided lower lobe pneumonia, leukocytosis — in the bilateral upper lobe, bilateral lower lobe, and right-sided upper lobe. In general, leukocytosis in community-acquired pneumonia was registered in 38.8 % of patients. In the first three days after hospitalization, a normal amount of lymphocytes was registered in the majority of patients, lymphopenia was observed in one-third of patients with right-sided upper and left-sided lower lobe localization.

Peculiarities of complete blood count indicators in patients with community-acquired pneumonia during the COVID-19 pandemic

The article presents the literature review data on the community-acquired pneumonia and the survey of patients with community-acquired pneumonia during the pandemic of the new coronavirus infection COVID-19. There are no changes in the rate of leukocytosis detection in patients with mild course of the di­sease within 10 days of hospital stay. There is a tendency to increase the proportion of people with a normal number of leukocytes and lymphocytes from day 4–6 of hospital treatment. Significantly, leukopenia was detected in 9.3 % of patients 1–3 days after hospitalization and was not observed in the future. Lymphopenia was registered in the first 1–6 days of hospital stay and was not observed from day 7–9. Granulocytosis was detected in 27.6 % of patients on day 1–3 in the hospital and in the following days their percentage decreased significantly; at the same time, the number of people with normal range of granulocytes increased significantly. Normal platelet counts were observed in most patients (93.8 %) on day 1–3 of hospital stay, and thrombocytopenia was recorded only in 6.3 % of individuals on day 1–3 after hospitalization. In moderate-to-severe form, 24.7 % of patients had leukocytosis on day 1–3 of hospital stay, and on day 7–9 of treatment, it was detected already in 28.8 % (p > 0.05). The majority of patients (66.7 %) had normocytosis in the first three days, and leukopenia was observed in 8.7 % of people on day 1–3. Significantly, the share of detected lymphocytosis increased, and lymphopenia — decreased from 4–6 days of hospital stay. Granulocytosis was registered in 23.2 % of patients on day 1–3 of hospital stay, followed by a significant decrease in the percentage of granulocytes from days 4–6. Band neutrophils were elevated in the first three days among 51.6 % of patients, and their percen­tage significantly decreased after the fourth day. Most individuals (77.3 %) had a normal platelet count on day 1–3 in the hospital, and thrombocytopenia at this time was found in 16.7 %. The majority of patients aged 20–30 years had a normal number of leukocytes (65.5 %), and 25.5 % had leukocytosis 1–3 days after hospitalization. Lymphocytosis in the first 3 days was registered among 9 % of people and then increased significantly, lymphopenia was observed in 31 % of patients on day 1–3 and subsequently decreased, granulocytosis — in 25 % of cases, elevated levels of band neutrophils — in 43.8 %, thrombocytosis — in 7.3 %, thrombocytopenia — in 10.9 %. Among patients aged 31–40 years in the first 3 days after hospitalization, leukocytosis was registered in 28 % of cases, leukocyte count was normal in 72 %, leukopenia was not detected, 48 % of patients had lymphopenia, 15.8 % — granulocytosis, levels of band neutrophils were elevated in 65.2 %, thrombocytosis was observed in 8 % of cases, thrombocytopenia — in 8 %. Most patients (66.7 %) aged 41–50 years on day 1–3 after hospitalization had normocytosis, 19 % — leukocytosis, 14.3 % — leukopenia, 14.3 % — lymphocytosis, 38.1 % — lymphopenia, 3 (25 %) people had granulocytosis, levels of band neutrophils were elevated in 65 % of cases, thrombocytosis was detected in 4.8 %, thrombocytopenia — in 28.5 %. Among patients aged 51–60 years in the first 3 days after hospitalization, the following indicators of complete blood count were found: 16.1 % of individuals had leukocytosis, number of leukocytes was normal in 83.9 % of cases, leukopenia was not detected, lymphocytosis was found in 16.1 % of people, lymphopenia — in 22.6 %, granulocytosis — in 20 %, elevated levels of band neutrophils — in 39.3 %, thrombocytosis — in 3.2 %, thrombocytopenia — in 16.2 %. Patients older than 60 years on days 1–3 after hospitalization had the following changes: 38.8 % — leukocytosis, white blood cell count was normal in 49 % of cases, 12.2 % of people had leukopenia, 12.2 % — lymphocytosis, 51.1 % — lymphopenia, granulocytosis was not observed, 25 % had granulocytopenia, 60 % — elevated levels of band neutrophils, 8.2 % — thrombocytosis, and 18.3 % — thrombocytopenia.

Results of isolation and genotyping of measles viruses that circulated in 2012–2017 in the Odesa region

Background. The circulation of different strains of the measles virus is closely related to the region and the incidence rate since circulating strains can change during epidemic outbreaks and in interepidemic periods. According to the WHO, the B3 strain is most common during outbreaks worldwide. Therefore, typing of circulating strains of measles virus, especially during an epidemic outbreak, is an important process, inclu­ding for predicting the development of an epidemic. The study was aimed to identify and determine the genotype of measles virus types that circulate in Ukraine during 2012–2019. Materials and methods. Materials of the reporting documentation of the State Institution “Odessa Regional Laboratory Center of the Ministry of Health of Ukraine” in the Odessa region during 2012–2019 were used and analyzed. Materials from patients with suspected measles were used for molecular biological, genetic, analytical, and statistical approaches investigation. Following the standard WHO protocol for sequencing and phylogenetic analysis, circulating measles virus strains were isolated from the patient in a special culture of Vero/SLAM cells. Measles virus RNA was isolated from the resulting virus-containing material after cultivation and RT-PCR was performed. The resulting cDNA was sent for genotyping, which was carried out at the WHO reference labo­ratory for the diagnosis of measles and rubella in Luxembourg (WHO RRL). Results. Twenty strains of measles virus from 45 samples (urine and nasopharyngeal swabs) from patients diagnosed with measles were isolated during 2012–2014. Virus isolation was not carried out in 2015–2016 due to isolated cases of the disease. Twenty-four virus strains from 164 samples were isolated in 2017. Conclusions. The results obtained at the State Institution “Odessa Regional Laboratory Center” demonstrated that during the interepidemic period of 2012–2014, the D4 geno­type circulated in the region. But since 2017, when there was an increas of cases associated with a new epidemic outbreak, B3, genetic line MVs/Kabul.AFG/20.2014/3 B3 mainly circulates in the region of southern Ukraine. As you can see, these data completely coin­cide with the data about circulating genotypes that were found at a certain time in the European Region, according to the data from the literature.

Listeriosis: the review of a problem, presentation of a clinical case of listeria sepsis in a 4-month child

Listeriosis is an infectious disease caused by Listeria monocytogenes microorganisms. A human can catch an infection through fecal-oral, aerogenous, or transplacental route. The listeriosis incidence in Ukraine is sporadic, single cases are not related to each other. Listeriosis is characterized by a high rate of mortality and polymorphism of clinical manifestations. The symptoms of the disease are multiple-organ: damage to the central nervous system, septic symptoms, aborts, mastitis; listeriosis can also be subclinical. The disorders of the central nervous system are associated with meningitis, meningoencephalitis, or brain abscess. The importance of the problem of diagnosis and treatment of listeriosis derived from the disease sporadicity, polymorphism of its manifestations, difficulties in etiological verification of the diagnosis. The case described is specific due to the diagnostic mistake: a child was not diagnosed with sepsis. Listeriosis in this child had a progressive course with sepsis development. Listeriosis is a rare infection, therefore it was difficult to suggest this particular infection intra vitam.

Abstracts of the scientific-practical conference with international participation "Infectious diseases of today: etiology, epidemiology, diagnosis, treatment, prevention, biosafety" (October 12–13, 2021, Kyiv, Ukraine) timed to the 125th anniversary of the State Institution "L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the National Academy of Medical Sciences of Ukraine "and the annual "Reading" in memory of Academician L.V. Gromashevsky

No abstract

Prolonged subfebrile condition, pyretic fever and febrile attacks of unknown genesis: new approach to diagnosis and treatment. Part 1. Clinical picture

Background. The study was aimed to establish the true etiological cause of such pathological conditions as prolonged low-grade fever, fever of unknown genesis, and cases of rapid short-term febrile increase of temperature of unknown origin. Materials and methods. The design of the study was clinical-diagnostic and included the search for ways to diagnose and treat such pathological conditions as prolonged subfebrile fever, fever of unknown genesis, and cases of rapid short-term febrile increase of temperature of unknown origin. The studies were prospective-retrospective and were longitudinal with long-term periodic follow-up of a certain part of the same patients during 1–10 years after diagnosis of CBIS (chronic bacterial intoxication syndrome) and appropriate treatment. According to the effectiveness of the obtained results, the study was direct, because it undoubtedly led to the recovery of the patient with the improvement of his/her state and life. All patients (infants and adults aged till 80 years) who went to the hospital during 2009–2020 with complaints about violation of the temperature regime (subfebrile or febrile increase). Results. During 2009–2020, 3999 patients (adults — 2047/3999, 51.2 %, children — 1952/3999, 48.8 %) with a fever of unknown origin, namely 1578/2047 (77.1 %) adults and 1206/1952 (61.8 %) children with prolonged subfebrile fever, 70/2047 (3.4 %) and 25/1952 (1.3 %), respectively — with febrile fever and 399/2047 (19.5 %) and 721/1952 (36.9 %) — with febrile attacks (FA), were observed by the authors. In all 3999 (100 %) patients, there was detected a focus of chronic bacterial infection in the kidneys. Herewith in more than 2/3 cases (2780/3999 patients, 69.5 %), there was diagnosed the locally asymptomatic nephrodysbacteriosis without clinical, general laboratory (inclu­ding almost normal general analysis of urine) and instrumental signs of the inflammatory process in the kidneys. In 960/3999 (24.0 %) ca­ses, there was first established the latent form of delayed clinically asymptomatic chronic pyelonephritis. 259/3999 (6.5 %) patients were diagnosed with chronic pyelonephritis at the stage of clinical exacerbation. As a consequence of the formation of a focus of chronic bacterial infection in the kidneys, the patients developed monosymptomatic (only with temperature increase) or full-symptom CBIS, namely: 2024/2784 (72.7 %) children and adults with prolonged subfebrile fever there presented with typical clinical manifestations of CBIS in various combinations, but in 760/2784 (27.3 %) cases, the subfebrile temperature was monosymptoma­tic without other complaints and clinical symptoms. The diagnosis was confirmed by bacteriological examination of warm urine (three times, for three days running) and toxicological blood examination using the diagnostic system Toxicon. Urine cultures of various bacteria were isolated from urine in all 3999 (100 %) patients. Herewith in 2205/3999 (55.1 %) cases, there were isolated one culture of bacteria in each case, in 1608/3999 (40.2 %) patients — simultaneously two cultures of different bacteria, i.e. another 3216 strains, in 186/3999 (4,7 %) — three cultures (558 strains). That is, in general, there were isolated 5979 strains of different bacteria, which were considered as diagnostic confirmation of the presence of a focus of chronic bacterial infection in the kidneys in all 3999 patients with prolonged subfebrile fever, fever of unknown genesis, or febrile attacks. The main factors of the occurrence of temperature regime disorders on the background of CBIS were Enterococci (2471/3999 strains from 61.8 % of patients), Escherichia coli — 1495/3999 strains (from 37.4 % of patients) and Staphylococci (Staphylococcus aureus and Staphylococcus haemolyticus) and Streptococci (Streptococcus pyogenes): a total of 696/3999 strains (from 17.4 % of patients). In 818 (100 %) patients who were examined using the Toxi­con system, all, without exception, the indicators of cytolytic activity of toxic proteomes, which were tested, significantly exceeded the norm (p < 0.001). In the vast majority of patients (in 664/818 or 81.17 % of cases), there was detected severe toxemia, in 140/818 (17.11 %) — moderate and only in 14 (1.71 %) — mild. All 3999 patients with prolonged subfebrile fever, fever of unknown genesis, and FA were treated with bacterial autovaccines made from strains, isolated during the bacteriological examination. One cycle consisted of 2–3 courses of immunization with bacterial vaccines. One course included 10 or 12 subcutaneous injections in increasing dosage during 19–21 days. Between courses, there was maintained an interval of 3 to 4 weeks. The treatment cycle generally lasted from 70 to 110 days, depending on the number of courses. Intervals between treatment cycles were usually maintained for 3 months. The effectiveness of such treatment was 71.2 % after the first cycle, 92.8 % — after the second, and 99.2 % — after the third with full recovery of the ability to work, lost during the illness, and the emotional level of personal life. Conclusions. It has been established that the etiological cause of the occurrence of prolonged subfebrile fever, febrile fevers of unknown genesis, and febrile attacks is such a clinically and nosologically separate disease as chronic bacterial intoxication syndrome, which develops on the background of a chronic bacterial focus, usually locally asymptomatic infection in the kidneys, called nephrodysbacteriosis, and is usually associated with severe bacterial endotoxicosis that was confirmed by appropriate toxicological examination of the blood. The use of bacterial autovaccines was proved to be an effective method of treatment (up to 99.2 %) of patients with increased temperature of bacterial-toxic origin.

The role of Herpesviridae infection in the progression of comorbid somatic pathology

Background. The objective was to study the peculiarities of cellular and humoral immunity in patients with chronic obstructive pulmonary disease (COPD) group B and C, GOLD 2–3, who have signs of metabolic syndrome (MS) and Herpesviridae infection. Materials and methods. Forty-two patients with B and C groups of COPD, GOLD 2–3, associated with MS were examined. Eighteen individuals had COPD combined with MS, and Herpesviridae infection. The average age of patients was 51.3 ± 4.2 years. The comparison group included 24 people with COPD and MS without signs of Herpesviridae infection. All patients underwent determination of herpes simplex virus (HSV) type 1 and cytome­galovirus (CMV) antigens in the blood and saliva, titer of specific immunoglobulin (Ig) G and IgM antibodies to HSV type 1 and CMV, a comprehensive immunological examination with a study of cellular and humoral immunity indexes, cytokine status. Results. The study of the activity of herpes viruses in the blood of patients of the main group did not reveal active replication of HSV type 1 and CMV; in the saliva of 15 individuals (83.3 %), an active replication of HSV type 1 was detected, and in 12 people (66.7%) — of CMV. All patients in the main group had a severe course of Herpesviridae infection with an exacerbation rate of more than 6 times a year. The immunological status of patients of the main group showed immunodeficiency mainly of T-cell immune system and NK-cells, a significant increase in the relative number of T- and B-lymphocytes with early and late markers of activation on the background of autoimmune manifestations and inflammatory changes in peripheral blood. Conclusions. The presence of chronic persistent infection of HSV type 1 and CMV causes a severe course of COPD associated with MS, induces the development of infectious exacerbations of COPD and more significant manifestations of systemic inflammation in atherosclerosis as a morphological substrate of MS.

Abstracts of scientific and practical conference with international participation "Current infectious diseases. Modern aspects of clinic, diagnostics, treatment and prevention" November 25–26, 2021

No abstract

Clinical picture in a child who often gets sick (a new look at the origin, diagnosis and treatment). Report 2. Diagnosis and treatment

Objective: to determine the clinical picture in children who often get sick, taking into account the currently available data from the medical literature and authors’ observations accumulated over the past 25 years of clinical practice. Materials and methods. The design of the study was clinical and diagnostic and included the search for ways to diagnose and treat pathological conditions that compose the current clinical picture of children who often get sick. The studies were prospective and retrospective, longitudinal, with long-term follow-up of a certain part of the same patients for 1–10 years after diagnosis of “frequently ill child” and appropriate treatment. In terms of the effectiveness of the results, the researches were direct, because it undoubtedly contributed to the recovery of the child with the improvement/normalization of his general state and quality of life. The studies were multicenter, conducted in an outpatient setting at the premises of two clinics specialized in the field of chronic infectious diseases, with full laboratory researches and the department of pediatric infectious diseases of the medical university. The participants were children from infancy to 14 years of age, whose parents in 2009–2020 consulted with complaints about frequent illnesses of their children. Results. In 2010–2020, the authors supervised 3,547 children, who often get sick (6–12 episodes a year and even more: 1–2 diseases a month), and the period of each episode of their illness lasted more than 5–7 days. There were 862/3,547 (24.3 %) children under 3 years of age, 1,295/3,547 (36.5 %) from 3 to 7 years of age, and 1,390/3,547 (39.2 %) from 7 to 14 years of age. Given the clinically dominant symptoms, which are often intertwined into one holistic picture of these common diseases, children were divided into two large groups of observations. Group I, which was conventionally called “Clinical picture of frequently ill children with purulent-inflammatory diseases”, included 1,595/3,547 patients (45 %). Another 1,952/3,547 (55 %) individuals were included in group II with a conditional name “Clinical picture of frequently ill children with dominant toxic manifestations”. The second group of patients who often get sick also includes patients with fever not associated with acute purulent-inflammatory conditions or their recurrences. This group under supervision consisted of 1,952/3,547 (55 %) children — from infancy to 14 years with thermoregulatory disorders, including persistent low-grade fever — 1,206/1,952 (61.8 %), febrile seizures — 721/1952 (36.9 %) and 25/1,952 (1.3 %) children of mostly school age with fever at the level of 38–40 ºC and above for several months to 4 years and other symptoms of chronic bacterial intoxication syndrome. All children were examined bacteriologically (nasopharyngeal, oral swab culture, etc., as well as warm urine tests three times, three days in a row), toxicologically using Toxicon diagnostic system; they also underwent general clinical exa­minations, enzyme-linked immunosorbent assay and polymerase chain reaction, determination of immunological status, according to indicators — instrumental examination. Two foci of chronic bacterial infection were found to be present in all frequently ill children: in the nasopharynx, which in 3,467/3,547, or 97.7 % of cases, was associated with S.aureus, and in the kidneys (nephrodysbacteriosis), which was dominated by enterococci and Escherichia coli accounted for almost 2/3 (3,312/5,313, or 63 %) of all isolated urinary strains and detected in the urine of a total of 3,312/3,547 (93.4 %) children. Based on toxicological examination of the blood, severe toxemia was found in the vast majority of children (77/96, or 80.2 %), 16/96 (16.7 %) had moderate and only 3/96 (3.1 %) — mild form. The form of intoxication was mainly compensated in 87/96 (90.6 %) patients, another 9/96 (9.4 %) had generalization stage. When determining the immune status studied in 2,160/3,547 (60.1 %) of frequently ill children from infancy to 14 years of age in both observation groups, it was found that cellular and humoral immunity was usually either within normal limits or often even higher than normal. Only in 67/2,160 (3.1 %) cases, mild cellular immunodeficiency was detected, and in 7/2,160 (0.3 %) children — selective IgA deficiency. Treatment of all 3,547 frequently ill children of both observation groups was performed using bacterial autovaccines made from strains isolated during bacteriological examination. The number of children who underwent treatment the consequences of which can be considered established and not associated with concomitant use of antibacterial drugs was 3,159/3,547, or 89.1 %. In total, 3,093/3159, or 97.9 % of frequently ill children, recovered completely within 6–24 months after starting antibiotic-free bacterial autovaccine treatment. Conclusions. The clinical picture of a child who often gets sick is currently collective and consists of symptoms of recurrent respiratory diseases or recurrent acute respiratory viral infections, recurrent purulent-inflammatory diseases of the nose, pharynx, mouth, ears, eyes and bronchopulmonary system, as well as clinical manifestations of chronic bacterial intoxication syndrome developed on the background of nephrodysbacteriosis. The etiological and pathogenetic diagnosis is confirmed by the results of bacteriological and toxicological examinations. Standard treatment of frequently ill children using antibiotics is not effective. A positive clinical effect can be achieved in 97.9 % of children with complete recovery after the use of bacterial autovaccines made from strains isolated during bacteriological examination.

Determination of diphtheria risk indicators based on the study of antidiphtheria immunity in the population of Dnipropetrovsk region

Background. Vaccination is the most effective part of primary prevention. Serological monitoring of infectious diseases covered by national immunization programs is very important as it provides up-to-date information on the burden of the infection and the immunological status of the population. The study was aimed to present an analysis of epidemiological monitoring of the protection against diphtheria of the population, to show the generalized epidemiological situation regarding diphtheria, and to determine the risk of diphtheria among the population of Dnipropetrovsk region. Materials and methods. Epidemiological analysis of diphtheria immunity (2017–2019) was performed based on the results of enzyme-linked immunosorbent assay of IgG antibodies levels against diphtheria toxin in 271 residents of Dnipropetrovsk region. Results. Analysis of the results revealed that only 30.6 % (n = 83) of the population have levels of antitoxic antibodies of 1.0 IU/ml or more, which provides sufficient protection against diphtheria in the next 5–7 years of life. At that time, the majority of the population (69.4 %) needs immediate one-time booster vaccination (n = 134; 49.5 %) or immediate basic vaccination (n = 54; 19.9 %) due to low levels of antitoxic diphtheria antibodies. In the age group 8–15 years, 65.9 % (n = 62) of patients require immediate basic or booster vaccination, which indicates that children of this age do not have basic immunological protection due to violations of the vaccination schedule or its absence. In the group aged 27 years and older, 79.1 % (n = 72) of the subjects do not have protective levels of anti-diphtheria antibodies, which indicates a lack of actual protection against diphtheria. Conclusions. The results indicate insufficient protection of the population against diphtheria. In this regard, the development of strategic measures for mass immunoprophylaxis of diphtheria both in children and adults is relevant. The country should conduct regular epidemiological monitoring, which would study the population’s immunity against diphtheria and other controlled infections, and draw up a long-term strategic and tactical plan to address shortcomings in the work of mass immunoprophylaxis of the population.