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Introduction. Bacterial coinfection and secondary bacterial infection are considered critical risk factors for the severity and mortality of SARS-CoV-2-caused pneumonia. The aim of the study was to analyze a pattern of microbial associations between K. pneumoniae and A. baumannii isolated from the lower respiratory tract discharge and sectional material (lung tissue) of patients diagnosed with pneumonia, and to compare resistance level in monoculture and associations during new coronavirus infection pandemic. Materials and methods. A bacteriological study of 2689 sputum and bronchial washing samples from patients at infectious diseases hospitals, and 1411 lung pathological material samples was carried out. Bacterial isolates were identified by mass spectrometry. Antibiotic sensitivity for isolates was determined by the disk diffusion method. Genetic determinants of resistance to beta-lactam antibiotics were detected by PCR. Statistical data processing was performed using SPSS version 22 software. Results. K. pneumoniae and A. baumannii isolates were predominantly found in two- and three-pathogen associations. It was established that the resistance level of K. pneumoniae isolates in association with A. baumannii is significantly higher compared to that in monoculture for all antimicrobial drugs studied. At the same time, K. pneumoniae in combination with Candida spp. vs monoculture showed significantly lower level of resistance to ciprofloxacin, amikacin, cefotaxime, ceftazidime and amoxicillin/clavulanic acid. K. pneumoniae isolates carried resistance determinants to extended-spectrum beta-lactamases: OXA-48 — (22.5%), OXA-51 — (5.6%), OXA-23 — (4.2%), KPC — 70.9%, NDM — 7%. Of these, 14.1% of strains had the ability to co-produce serine carbapenemases OXA-48 and KPC. Sputum and lung tissue A. baumannii isolates exhibited extremely high multiple resistance regardless of their associations with other microorganisms. Microbiome species similarity in the lower respiratory tract and lung tissue discharge was revealed. The proportion of lung tissue vs sputum resistant strains of K. pneumoniae and A. baumannii was significantly higher. Conclusion. The detection of of multiple drug resistant K. pneumoniae and A. baumannii isolates as well as their associations may indicate aggravated pneumonia severity.

The global outbreak of the new coronavirus infection COVID-19 is still ongoing, leading to coinfections such as malaria and COVID-19 and others. As evidenced by the increase in various reports of coinfections. In recent years, Uzbekistan has achieved epidemiological stability for malaria and in 2018 received an official World Health Organization certificate confirming the country’s “malaria-free” status. At the present stage during the COVID-19 pandemic, imported malaria from abroad is relevant for our republic and, therefore, there is a constant danger of renewed transmission from imported cases. In this article presented the clinical case of coinfection of COVID-19 and malaria in a patient. From the epidemiological data, the patient was a citizen of Cameroon. During treatment of coronavirus infection, the patient noted intermittent chills all over the body and sweating, clinical symptoms of tropical malaria began to appear. Microscopy of a thick drop and a thin blood smear confirmed the presence of Pl. falciparum. The patient was prescribed antimalarial therapy with mefloquine, resulting in clinical recovery.

Introduction. Parenteral viral hepatitis (B, C, D) and HIV share modes of transmission and risk groups, in which the probability of infection with two or more of these viruses simultaneously is increased. Mutual worsening of the course of viral infections is important issue that occurs when HIV positive patients are coinfected with parenteral viral hepatitis. The aim of the study was to determine the prevalence of HCV, HBV and HDV in HIV positive patients in the Novosibirsk region and to give molecular genetic characteristics of their isolates. Materials and methods. Total 185 blood samples were tested for the presence of total antibodies to HCV, HCV RNA, HBV DNA and HDV RNA. The identified isolates were genotyped by amplification of the NS5B gene fragment for HCV, the polymerase gene for HBV and whole genome for HDV. Results. The total antibodies to HCV were detected in 51.9% (95% CI: 44.758.9), HCV RNA was detected in 32.9% (95% CI: 26.639.5) of 185 studied samples. The distribution of HCV RNA positive cases completely repeated the distribution of HCV serological markers in different sex and age groups. The number of HCV infected among HIV positive patients increases with age. HCV subgenotypes distribution was as follows: 1b (52.5%), 3а (34.5%), 1а (11.5%), 2а (1.5%). 84.3% of detected HCV 1b isolates had C316N mutation associated with resistance to sofosbuvir and dasabuvir. The prevalence of HBV DNA in the studied samples was 15.2% (95% CI: 10.721.0). M204I mutation associated with resistance to lamivudine and telbivudine was identified in one HBV isolate. Two HDV isolates that belonged to genotype 1 were detected in HIV/HBV coinfected patients. Conclusion. The data obtained confirm the higher prevalence of infection with parenteral viral hepatitis among people living with HIV in the Novosibirsk region compared to the general population of that region. The genetic diversity of these viruses among HIV infected individuals is similar to that observed in the general population.

Introduction. In July 2021, a mass mortality of seabirds of unclear etiology occurred on the coast of the Sea of Japan in the Khasansky district of Primorsky Krai. According to the Department for Protection of Wildlife and Specially Protected Natural Territories of Primorsky Krai, over a thousand dead birds were found on the coast. The main case occurred in the population of birds Rhinoceros auklets (Cerorhinca monocerata, Alcidae), also among the dead birds were found several dozens of gulls (Larus spp.) and terns (Sterna spp.), single individuals of other species. The peak of mortality in bird populations occurred on July 13–17, 2021. This territory is a recreational area, in the summer months a large number of people rest there. The current situation has caused increased attention of the entire scientific community, as well as organizations that protect the citizens health and the environment. The aim. To establish possible etiology of the epizootic outbreak and describe the cause of birds’ death.Materials and methods. Comprehensive examination using classical methods of virology, microbiology and toxicology, as well as the most modern research methods such as MALDI TOF-mass spectrometry and NGS.Conclusion. As a result of the studies, it was determined that the cause of birds’ death was infectious peritonitis with endogenous intoxication syndrome induced by a complex of pathogenic microorganisms, such as enteropathogenic Escherichia coli, Proteus vulgaris, Proteus mirabilis, Proteus pennery, Enterococcus faecalis and Wickerhamomyces anomalus, related to Candida pelliculosa.

Relevance According to many researchers, hepatitis D worsens the prognosis of hepatitis B in 80–90% of cases, accelerating fibrosis and leading to liver cirrhosis or hepatocellular carcinoma. Aims. To present a review of data on prevalence of hepatitis D in the Russian Federation and abroad. Conclusions. Hepatitis D is most common in such regions of the world as: Africa, South America, Middle East, North Asia and in some Mediterranean countries. Conclusions. Injecting drug users play a large role among vulnerable populations. Hepatitis B vaccination limits the spread of hepatitis D.

The purpose of the research is identifying and determining clinical and laboratory features of coinfection caused by Opisthorchis felineus and Lamblia intestinalis.Materials and methods. We described a clinical picture and laboratory abnormalities in 50 patients with O. felineus infection. Of these cases, 25 people were diagnosed with lambliosis. The therapy included three consecutive stages: preparatory stage, antiprotozoal and anthelmintic treatments, and rehabilitation stage. The preparatory stage was aimed to improve the biliary tract function, to reduce intoxication symptoms, and to stop acute allergic reactions. The patients received choleretics, antispasmodics, antibacterial drugs, antihistamines, enzymes, and adsorbents for 2–4 weeks. At the end of the preparatory stage, the patients from the second group were prescribed albendazole of 800 mg per day in two doses of 400 mg per os during meals for 5 days. In the second treatment stage, the patients with opisthorchosis received praziquantel at a dose of 75 mg/kg of body weight per os for one day in three doses. The rehabilitation phase lasted for four months. The next step was to assess lamblia eradication results by the control coproprotozooscopy and/or biliprotozooscopy for cysts and/or vegetative forms of L. intestinalis at 7 days, 1 month and 6 months after treatment with albendazole. The control coproovoscopy for O. felineus eggs was performed at 6 months after praziquantel treatment.Results and discussion. We studied the influence of L. intestinalis on the nature and severity of clinical and laboratory symptoms of opisthorchosis. It was revealed that clinical symptoms (abdominal pain, nausea, low-grade fever or dermatosis) and laboratory syndromes (cytolysis and cholestasis) were more pronounced in case of concomitant helminth and protozoan infections. Lambliosis is more difcult to treat when combined with opisthorchosis.

Aim. To study the features of clinical and radiological manifestations and diagnosis of COVID-19, respiratory tuberculosis and opportunistic lung infections (OIL) coinfection in patients with late stages of HIV-infection with immunodeficiency. Materials and methods. The study included 29 patients with COVID-19 coinfection, respiratory tuberculosis and opportunistic lung infections in the late stages of HIV-infection with immunodeficiency (group 1) and 29 patients similar in all parameters without COVID-19 (group 2). All patients were underwent clinical and laboratory, radiation and bronchological examination, and microbiological, immunological, molecular genetic, cytological and histological examination of diagnostic material of the respiratory tract, cerebrospinal and pleural fluid, blood, urine and feces to identify pathogens of coinfection. Statistical data processing was carried out using the Microsoft Office Excel 2010 program with the calculation of the average in the group and the standard error of the average, confidence interval. Results. It has been established that co-infection with COVID-19, respiratory tuberculosis and opportunistic lung infections in patients with late stages of HIV-infection with immunodeficiency is manifested by a pronounced intoxication syndrome, bronchopulmonary manifestations and symptoms of damage to other organs and systems, which is due to the generalization of tuberculosis with extrapulmonary lesions and the development of opportunistic lung infections, as in patients without COVID-19. A computed tomogram of the chest organs with this coinfection visualizes the syndrome of dissemination, the syndrome of adenopathy and the syndrome of pathology of the pulmonary pattern, represented by the compaction of interstitial tissue in the frosted glass type, which is associated with the simultaneous layering of various pathologies, which complicates their differential diagnosis. This determines the similarity of clinical and radiological manifestations of COVID-19 coinfection, respiratory tuberculosis and opportunistic lung infections in patients with late-stage HIV-infection with immunodeficiency, as in patients without COVID-19. This requires complex microbiological and molecular genetic research methods to identify specific pathogens for the appointment of timely treatment. Conclusion. Patients with COVID-19 coinfection, respiratory tuberculosis and opportunistic lung infections in the late stages of HIV-infection with immunodeficiency pose a high risk of infection in a healthy population, taking into account their social maladaptation and non-adherence to examination and treatment. This requires an active diagnosis of COVID-19 in all patients with respiratory tuberculosis and HIV-infection who are registered in the office of anti-tuberculosis care for HIV-infected in an anti-tuberculosis dispensary, for emergency isolation and treatment.

An important aspect of monitoring, further timely and effective treatment of HIV-TB coinfection is timely and correct diagnosis based on comprehensive clinical, laboratory and instrumental studies. Many factors play a role in the development of tuberculosis in HIV-infected people, but the key and quite important elements are the study of genetic markers and biomarkers of inflammation. A number of studies have been carried out on inflammatory markers, but IL-6, INF-γ, MIG, CRP, IL-18 remain relevant and insufficiently studied in coinfection. A comprehensive study of them will be important in the screening of HIV-TB coinfection). Determining the presence of (SNP) rs4331426 located in chromosome 18q11.2 in HIV-infected and AIDS patients will solve the issue of predisposition to the development of tuberculosis in the early stages of HIV infection and contribute to the development of further tactics of patients treatment and management.

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.

A search for new targeted therapeutic strategies based on examining immunopathogenetic mechanisms for emerging co-infections is relevant and may further contribute not only to optimizing choice of immunotropic drugs, but also to achieving positive clinical and immunological remission for abnormal infectious processes. Previously, our studies found that recurrent viral-bacterial respiratory infections are associated with dysfunction of neutrophilic granulocytes (NG) with varying degree of intensity in altered effector properties. NG dysfunctions are often associated with diverse phenotypic profiles characterized by varying density for expression level of functionally significant trigger receptors. The aim of the study was to pinpoint phenotype transformation in CD64-CD32+CD16+CD11b+, CD64+CD32+CD16+CD11b+ neutrophilic granulocytes in experimental model of viral-bacterial infection in vitro. We examined 52 peripheral blood samples collected from 13 healthy adult volunteers. Viral, bacterial and virus-bacterial infection was modelled in vitro by incubating blood-derived cell samples with formyl-methionyl-leucyl-phenylalanine (fMLP), double-stranded RNA (dsRNA) or in combination followed by assessing changes in immunophenotyping of CD64-CD32+CD16+CD11b+NG, CD64+CD32+CD16+CD11b+NG by using using MAbs CD16-ECD, CD64-FITC, CD32-PE, CD11b-PC5 conjugates (Beckman Coulter International SA, France). It was demonstrated that NGs from healthy adult volunteers were dominated by CD64-CD32+CD16+CD11b+NG as well as minor subset СD64+CD32+CD16+CD11b+ NG varying in expression density of membrane molecules. Percentage of the minor subset СD64+CD16+CD32+CD11b+ NG was significantly increased after exposure with dsRNA, fMLP and dsRNA+fMLP compared to untreated samples. Comparative analysis revealed that various immunotropic agents differed in affecting expression of surface receptor molecules CD16, CD32 and unidirectional effects, but of varying magnitude altering CD11b marker both in major and minor subsets. Preincubation with dsRNA followed by adding fMLP allowed to find that they co-stimulated expression of surface receptors in both NG subsets. We generated an experimental model of viral-bacterial co-infection in vitro by using fMLP and dsRNA and observed types of phenotype transformation in CD64-CD32+CD16+CD11b+ NG and CD64+CD32+CD16+CD11b+ NG subsets. This model can be used to evaluate transformation of other NG subset phenotypes, NG functional activity, features of NET formation as well as impact of various immunotropic agents on NG.

Current study was aimed at investigating prevalence of overt and occult hepatitis B infection in HIV-positive individuals as well as molecular-epidemiological characteristics of the circulating hepatitis B virus (HBV) strains in the Far Eastern Federal District (FEFD). A total number of 297 blood serum/plasma samples obtained from HIV-positive patients residing in the FEFD were enrolled in the study. The first control group included 351 blood serum/plasma samples of general population without indication on HIV and HBV-infection that underwent laboratory check up at the Centers for AIDS Prevention and Control. After evaluating the group of HIV-positive patients 20 HIV-HBV positive samples were selected for further detailed analysis. The second control group included 43 patients with chronic hepatitis B. All groups were age and gender-matched. The research included serological and molecular-genetic (real-time PCR, positive for HBV DNA samples underwent clonal sequencing of PCR-amplified HBV P/S gene) assessment of the biological material followed by a phylogenetic analysis of the HBV sequences. Our research revealed that HIV-positive patients are exposed to a higher risk of HBV infection compared to general population enrolled in the study, which is evident from the prevalence of anti-HBcAg antibodies in the groups examined. HIV-positive vs. first control group was positive for anti-HBcAg antibodies at higher rate (35.02%, CI 95: 29.59–40.45% versus 22.22%, CI 95: 17.87–26.57%, p = 0.0003). Abundance of ongoing HBV-infection markers was also higher in HIV-positive individuals compared to general population (6.73%, CI 95: 3.88–9.58% versus 0.85%, CI 95: 0–1.81%, p = 0.0001, respectively). Should be noted, that HBsAg-negative HBV infection in HIV-positive patient cohort comprised 1.01% (CI 95: 0–2.15%) whereas in general population this index was as low as 0.28% (CI 95: 0–0.84%). Virus hepatitis С and D were revealed at higher rate in HIV-positive individuals compared to patients with HIV-negative chronic HBV infection (p = 5.84 × 10–7 and p = 0.000001 respectively). HCV and HDV prevalence rates comprised 50.0% (CI 95: 27.46–77.46%) and 40.0% (CI 95: 17.97–62.03%) in HIV-positive patients. Similar indices in control group were 4.65% (CI 95: 0–10.94%) and 4.65% (CI 95: 0–10.94%), respectively. The phylogenetic analysis of the six isolated HBV sequences showed that the five samples belonged to genotype D, with dominant subtype D2 (verified in 4 cases). Further, HBV genotype С was detected only in one case. The obtained data indicate a necessity for further in-depth diagnostic examination of viral hepatitis in HIV-positive patients to lower a risk of developing life-threatening complications as well as preventing hepatitis spread in human population.

Dengue is a mosquito-borne viral infection caused by dengue virus (DENV) belonging to a group of Flaviviridae. Disease is widely spread in tropical and subtropical regions of Southeast Asia, Africa and the Americas. DENV infection causes a spectrum of illness including flu-like syndrome and potentially life-threatening dengue hemorrhagic fever. Confirmation of DENV infection requires serological serum tests or detection of viral genetic material in a serum sample. There no specific treatment for dengue but symptomatic therapy should be implemented in all cases. Recently there are two modern DENV vaccines available for the people living in the countries at a risk of infection. Efficiency and safety profile of both vaccines are debatable. Dengue symptoms may imitate clinical picture of other diseases that are typical for endemic DENV regions. We present a case of 22-year-old Indonesian woman treated originally due to typhoid fever who develop the symptoms of DENV infection.

Hepatitis delta virus (HDV) is a defective virus and obligate companion of hepatitis B virus (HBV). The clinical significance of HDV and HBV coinfection is associated with more severe forms of acute or chronic viral hepatitis, a higher risk of developing liver cirrhosis and hepatocellular carcinoma compared to BGV-monoinfection. Current knowledge of the molecular biology of pathogens confirms the existence of a very complex relationship between the HBV, HDV, infected hepatocytes and cells of the immune system. Despite the fact that HBV viremia can now be controlled by using nucleoside analogues in the majority of patients, the problem of treating HDV and HBV coinfection is far from being resolved. Fundamental studies in recent years have led to significant progress in understanding the biology of HDV and provide the basis for the development and introduction into clinical practice highly effective antiviral drugs.

Aim is to assess repeatedly cytogenetic effects of co- or monoinfection caused by Lyme borreliosis and tick-borne encephalitis during the acute and convalescent periods of the disease depending on variants of glutathione-S-transferase (GSTM1 or GSTT1) genes in the patient’s genotype. Material and methods: The study included 186 patients and 166 healthy (control) residents of the north of the Tomsk and Tyumen regions, who were examined by clinical, laboratory and cytogenetic methods (micronucleus analysis). Among the 186 examined patients, Lyme borreliosis was diagnosed in 65 individuals, tick-borne encephalitis was in 59 patients, and coinfection was found in 62 individuals. The material for the study (smears of buccal cells) was obtained repeatedly during admission of patients to treatment, and also after 1 week, 1, 3 and 6 months. Polymerase chain reaction was used to analyze the alleles of the GSTM1 and GSTT1 genes. Results: significant increase in the frequency of micronucleated buccal cells in patients with coinfection, as compared with the groups of control and patients with monoinfection. The significantly increased frequency of micronucleated cells was associated with the mutant inactive alleles of the GSTM1(0/0) and GSTT1(0/0) genes. If the patients were carriers of the mutant allele of the GSTM1(0/0) gene, the cytogenetic instability could persist for half a year. It was found that chronic arthritis in the Lyme borreliosis patients was associated with a long persistence of an increased frequency of micronucleated cells. Conclusion: Significant differences in the frequency and the lasting of persistence of micronucleated cells between groups of patients with coinfection and monoinfections were found. The most significant increase in those parameters was detected in the coinfected patients in whose genotype contained non-active forms of the GSTM1(0/0) and GSTT1(0/0) genes.

The review touches upon a problem of coinfection caused by several important fungal infections (aspergillus, candida, pneumocystis, cryptococcus) and infectious or parasitic diseases. The authors also investigate epidemiologic determinants of such clinical forms of pathologic process. There are a lot of scientific gaps in the studying coinfections concerning mycosis and other infections. Physicians and infection control practitioners sometimes reveal such cases therefore complex characteristics of the coinfections is required.

Data on hepatitis B (HBV) and c (HCV) viruses interference in hematological patients are described. Patients with a hematological malignancy are at high risk of HBV and HCV infection as recipients of multiple transfusions. Results of the laboratory testing of 339 blood samples of patients treated at the National Research center for Hematology, Russian Federation, were studied. Among these patients, HBV/HCV coinfection markers were observed in 153 patients; HBV markers only, in 76 patients; HCV markers only, in 110 patients. The vast majority of coinfected patients had HBV DNA in blood (significantly more in HBsAg-negative patients: 100% vs. 82.8%, p = 0. 0005). HBsAg-negative coinfected patients had low HBV DNA levels (102-103ME/ml) and reduced (or completely absent) HCV RNA levels. The virus interference leads to a decrease in the viral nucleic acid concentrations. Thus, virus detection should include implementation of high sensitive molecular techniques (such as real-time PCR), and an enhanced set of serological HBV markers along with routine screening methods (HBsAg, anti-HCV).

Aim. To reveal the specific features of changes in the parameters of lipid peroxidation – antioxidant defense and the status of the reproductive system in women of fertile age with monoinfection (HIV) or coinfection (HIV and hepatitis B and/or C). Subjects and methods. 81 reproductive-aged women were examined and divided into 3 groups: 1) 28 apparently healthy women (controls); 2) 26 patients with HIV monoinfection; and 3) 27 patients with HIV coinfection (HIV + hepatitis B and/or C) who had not previously received antiretroviral therapy. Results. The HIV coinfection group showed the higher values of primary (conjugated dienes) and secondary (ketodienes and conjugated trienes) lipid peroxidation products in the presence of lower superoxide dismutase activity and obvious α-tocopherol deficiency than the control and HIV monoinfection groups. HIV coinfection in reproductive-aged women was accompanied by the high frequency of luteal phase deficiency. Conclusion. HIV coinfection is characterized by a more pronounced oxidative stress, antioxidant factor deficiency, and the high frequency of luteal phase deficiency in the patients.

There are no defined risk factors for progression of TB in HIV-positive patients with relapses of pulmonary tuberculosis (RTB/HIV) nowadays. In order to identify the risk factors of disease progression 23 patients with RTB/HIV were examined; we determined complex influence of clinical, radiological, immunological and laboratory parameters on the progression of TB. We determined the following risk factors: the presence of systemic inflammatory response syndrome, massive bacterial excretion, multiple destructive process in the lungs, reducing the number of CD4+-cells < 200 cells/mm ("large criteria"). Each "large criterion" is estimated at one point. To enable the laboratory data as predicting disease progression criteria in patients with RTB/HIV the simultaneous presence of any 3-of-9 indicators that relate to "small criteria" is necessary in patients (reduction of Hb level 2.0 units, decreased lymphocyte level and

The aim was to estimate the thiol-disulfide compounds depending on the variant of disease course in tuberculosis/HIV co-infected patients with newly diagnosed tuberculosis (NDT/HIV). Materials and methods. The study involved 54 patients with NDT/HIV, who were treated in the clinic of Zaporizhzhia regional clinical tuberculosis dispensary during 2010 – 2014 (average age 37,8 ± 1,2 y), 41 (75,9%) men, 13 (24,1%) women. Focal tuberculosis was diagnosed in 5 cases (9,3%), infiltrative – in 25 (46,3%) cases, disseminated – in 24 (44,4%) cases. The control group included 32 healthy individuals – blood donors (average age 35,9 ± 2,5 y), 22 (68,7%) men, 10 women (31,3%). Patients depending on the results of the treatment were retrospectively were divided into 3 groups: 1 – 15 patients with positive dynamics, 2 - with progressive disease course without systemic inflammatory response syndrome (n=13), 3 –with progressive disease course with SIRS (n=26). Results. Levels of aldehyde-phenylhydrazone in 2nd and 3rd groups were significantly higher than in control in 1,3 and 1,2 times accordingly (p˂0,01 for both values), in the 3rd group they were higher in 1,1 times than in group 1, p˂0,05. Ketone-phenylhydrazone levels were higher in all groups compared with the control, in the 3rd group patients they were 1,1 times higher than in group 1, p˂0,05. The malondialdehyde level in 3rd group patients was higher than other groups parameters in 1,4 times in comparison with 1-t (p˂0,005) and 1.2 times – with 2nd group (p˂0,05). Conclusion. Imbalance in the “oxidants-antioxidants” system both through increased free radical peroxidation, and because of thiol-disulfide balance shifts at the disease progression was detected.

To determine frequency of Herpes simplex (HSV), Varicella zoster viral (VZV) and Сytomegaloviral (CMV) coinfection with tuberculosis (TB) we examined 45 patients with pulmonary TB and 62 healthy donors, 25 of them were healthcare workers in tuberculosis hospital and the rest 37 had no previous contact with TB. None of the participants had vesicular rash of skin or mucosa. For diagnosis of herpes viral infection enzyme-linked immunosorbent assay for detection of HSV, VZV, CMV IgG in PBMC supernatants was performed. A significant increase in CMV (53.3%) and HSV (40%) infection in TB patients was observed comparing to healthy donors (p < 0.05; 19.4 and 16.1% respectively). Frequency of VZV infection in TB patients (17.8%) and healthy donors (8.1%) differed statistically unsignificantly. Levels of specific IgG secretion in PBMC culture in both groups in case of VZV and CMV infections didn’t differ, but in case of HSV coinfection in TB patients mean level of HSV IgG secretion (1.106 ± 0.297 OD) significantly exceeded mean level of HSV IgG in PBMC supernatants of healthy donors with asymptomatic HSV infection (0.285 ± 0.048 OD, р < 0,05). The obtained data give evidence of an association of pulmonary TB and herpes viral infections. Influence of these coinfections on course and morbidity of TB requires further research.

A significant part of liver disease, once considered the result of infection by hepatitis B virus (HBV), are the result of infection HBV, and hepatitis delta virus (HDV). HDV is hepatotropic, defective RNA virus that requires obligatory HBV presence for its replication and the formation of infectious particles. About 10% of patients with chronic HBsAg-positive hepatitis infected by HDV. HDV results in coinfection (simultaneous infection of HBV and HDV) and superinfection (HDV infection with chronic hepatitis B). The natural course of the infection is characterized by rapid progression to liver cirrhosis and hepatocellular carcinoma. Diagnosis of HDV-infection is based on the detection of delta antigen, antibodies to the virus (anti-HDV IgM and IgG) and RNA HDV in serum. The effectiveness of antiviral therapy proved only on the treatment by interferon (IFN-2α and PEG-IFN-2α). The only way to protect against HDV infection is vaccination against hepatitis B.

Pharyngitis is one of the manifestations of SARS-CoV-2 infection, which features specific changes in the pharyngoscopic pattern, long fluctuating course and increase in symptoms severity after a physical exercise, which requires long-term therapy with topical agents. A comparative analysis of Tonsilgon N effect on the course of SARS-CoV-2 associated pharyngitis as well as post-COVID syndrome development was carried out in this study. 164 patients with acute pharyngitis associated with SARS-CoV-2 were included in the study. Main group ( n =81) received Tonsilgon N oral drops in addition to the standard treatment regimens for pharyngitis and control group ( n =83) received standard regimen alone. Treatment regimen lasted for 21 days for both groups, followed by follow up examination in 12 weeks for assessment of post-COVID syndrome development. Patients taking Tonsilgon N showed a statistically significant symptoms improvement in throat pain relief ( p =0.002) and throat discomfort ( p =0.004), however, no statistically significant difference in two groups were observed in inflammation severity based on pharyngoscopy examination ( p =0.558). Addition of Tolzilgon N to the regimen reduced occurrence of secondary bacterial infections and therefore use of antibiotics more than 2.8 times ( p <0.001). Compared with the control group long term topical therapy with Tolzilgon N showed no increase in occurrence of side effects such as allergic reactions ( p =0.311) as well as subjective burning sensations in the throat ( p =0.849). In main group occurrence of post-COVID syndrome was observed 3.3 times less than in the control group (7.2% vs 25.9%, p =0.001). These results give us the ground for indication of Tonsilgon N use in the treatment of viral pharyngitis associated with SARS-CoV 2 infection and in prevention of post-COVID syndrome.

Introduction: Parenteral viral hepatitis (B, C, D) and HIV share modes of transmission and risk groups, in which the probability of infection with two or more of these viruses simultaneously is increased. Mutual worsening of the course of viral infections is important issue that occurs when HIV positive patients are coinfected with parenteral viral hepatitis. The aim of the study was to determine the prevalence of HCV, HBV and HDV in HIV positive patients in the Novosibirsk region and to give molecular genetic characteristics of their isolates., Materials and Methods: Total 185 blood samples were tested for the presence of total antibodies to HCV, HCV RNA, HBV DNA and HDV RNA. The identified isolates were genotyped by amplification of the NS5B gene fragment for HCV, the polymerase gene for HBV and whole genome for HDV., Results: The total antibodies to HCV were detected in 51.9% (95% CI: 44.758.9), HCV RNA was detected in 32.9% (95% CI: 26.639.5) of 185 studied samples. The distribution of HCV RNA positive cases completely repeated the distribution of HCV serological markers in different sex and age groups. The number of HCV infected among HIV positive patients increases with age. HCV subgenotypes distribution was as follows: 1b (52.5%), 3а (34.5%), 1а (11.5%), 2а (1.5%). 84.3% of detected HCV 1b isolates had C316N mutation associated with resistance to sofosbuvir and dasabuvir. The prevalence of HBV DNA in the studied samples was 15.2% (95% CI: 10.721.0). M204I mutation associated with resistance to lamivudine and telbivudine was identified in one HBV isolate. Two HDV isolates that belonged to genotype 1 were detected in HIV/HBV coinfected patients., Conclusion: The data obtained confirm the higher prevalence of infection with parenteral viral hepatitis among people living with HIV in the Novosibirsk region compared to the general population of that region. The genetic diversity of these viruses among HIV infected individuals is similar to that observed in the general population.

The article considers a case from clinical practice: a mixed infection of viral hepatitis A and hemorrhagic fever with renal syndrome. Hepatitis had a protracted course and proceeded with the development of acute hepatic encephalopathy. Hemorrhagic fever was characterized by an atypical course with lung and heart damage.

Introduction: Hepatitis D (delta, 5) is caused by an RNA virus (hepatitis D virus, HDV) from genus Deltavirus, and is the most severe and difficult to treat disease among both viral hepatitis and infectious diseases in general. The development of HDV infection in the host organism is possible only in the presence of hepatitis B virus (HBV). Coinfection with HBV and HDV is associated with a more rapid progression of chronic viral hepatitis (CVH) to liver cirrhosis (LC) and an unfavorable outcome in comparison with HBV monoinfection. Data on the influence of clinical, biochemical and virological factors on the infectious process in patients with hepatitis D are limited due to the insufficient amount of research on this theme.The study aimed to determine demographic, clinical, biochemical, and virological factors influencing the course and progression of CVH D in patients followed during 10 years, residing in the territory of the Tuva Republic, one of the endemic regions of the Russian Federation., Material and Methods: Changes in clinical and laboratory parameters were analyzed in dynamics in 121 HDV infected patients with a different course of the disease, who were under observation from 2009 to 2019. Three groups of patients were identified: group 1 - 61 patients with disease progression of chronic hepatitis to LC (Child-Pugh class B-C), group 2 - 49 patients with non-progressive chronic hepatitis, and group 3 - 11 patients with slowly progressive LC (class A). Demographic data, the presence of detectable HBV DNA, indicators of the functional state of the liver: alanine aminotransferase (ALT/GPT), aspartate aminotransferase (AST/GOT), alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), and total bilirubin content were analyzed. The severity of hepatic encephalopathy was assessed by the duration of the numbers connection test (NCT)., Results: All patients belonged to the same ethnic group (Tuvinians), were infected with HDV genotype 1 and were positive for HDV RNA throughout the entire follow-up period. There were no significant differences in sex ratio and mean age at the time of inclusion in the study between the groups. In group 1, the average number of years from inclusion in the study to the formation of LC was 3.65 ± 2.3 years, years to the lethal outcome: 4.5 ± 3 years. Significantly higher levels of AST/GOT, ALP, GGT, total bilirubin (TB) and NCT grade were found in group 1 compared to group 2. ALT/GPT levels did not differ significantly in these groups. When comparing groups with disease progression and slowly progressive LC (groups 1 and 3), no significant differences were found in any of the clinical and biochemical parameters. ALT/GPT, GGT, TB and NCT values were significantly higher in patients with slowly progressive LC (group 3) compared to group 2. No differences in AST/GOT and ALP levels were found between these groups. Detectable HBV DNA was significantly more frequent in patients with progressive disease and with chronic viral hepatitis than in patients with slowly progressive LC. There were no significant differences in the frequency of HBV DNA detection in patients from groups 1 and 2., Conclusion: The results obtained on a relatively homogeneous cohort demonstrated that age and gender are not the factors influencing the progression of chronic viral hepatitis D to cirrhosis. The lack of detectable HBV DNA is associated with the slow progression of LC. The revealed differences in clinical and biochemical parameters reflect the degree of functional liver damage in chronic viral hepatitis D and HDV-associated cirrhosis.

The review is devoted to assessing the prevalence of human papillomavirus (HPV) in combination with other viral agents for head and neck tumors (HNT). HPV is recognized as an etiological factor in the development of cervical cancer, but there is evidence that it may be involved in carcinogenesis in other locations, in particular the upper respiratory tract. However, HPV is not the most important factor in tumor growth and progression. Recently, many researchers have reported the presence of concomitant co-infection, affecting tumor progression. Of all the studies analyzed, only 3 studies showed the absence or low rates of co-infection in HNT: from the Czech Republic (0%), China (0.6%) and Japan (3%). Most often, HPV infection was detected together with the Epstein-Barr virus (EBV) - from 12.5 to 34.1% of cases. In Russia, the prevailing combination of viral co-infection was a combination of EBV and cytomegalovirus (9.5%) and a combination of EBV and herpes simplex virus (6.7%). Thus, the degree of incidence of HPV in HNT varies greatly, and the mechanisms of coinfection are poorly understood, which raises the question of whether HPV and concomitant infection can be involved in tumor progression. This makes further research in this direction relevant and promising.

Introduction: The current epidemic situation in Russia is characterized by increasing rate of co-infection (HIV/tuberculosis). Damage to the organ of vision is more common among patients with this pathology, presenting significant difficulties in diagnosis of the ophthalmic manifestations. High-tech imaging method - optical coherence tomography (OCT) allows exploration of the eye tissues with high accuracy and depth, as well as evaluation of the structure of the choroid and microcirculation parameters of the anterior and posterior eye segments.

A review of scientific literature data on clinical and epidemiological characterization of viral hepatitis B, C and Epstein-Barr viral infection is presented. Scopus, Web of Science, MedLine, The Cochrane Library, PubMed, CyberLeninka, RSCI databases were used to find the necessary literature. It was shown that Epstein-Barr virus along with hepatitis B and C viruses plays a significant role in the development of virus-mediated autoimmune liver diseases, as well as other organs (intestine, heart, kidneys, thyroid gland, etc.). The similarity of these nosologies is also evident in the nature of the course of the disease: the presence of a primary infection in a manifest or latent form, with possible subsequent chronization of the process and its periodic reactivation. Wide distribution of pathogens in the human population determines the possibility of mixed infections with Epstein-Barr virus and hepatitis B and C viruses, however, this problem has not been adequately described in the scientific literature. The review suggests that the role of Epstein-Barr virus in the development of liver diseases and extrahepatic pathology should not be ignored, and the combination of this pathogen with hepatitis B and C viruses required further in-depth studies., Competing Interests: The authors declare no conflict of interest.

Aim was to estimate and compare clinical efficiency of cycloferon use against basic therapy in treatment of HIV and/ or herpes infection. There were comparisons of treatment results with patient (n=1274) groups' heterogeneity taken into account. 9 randomized clinical trials with cycloferon efficacy data were mobilized, in all studies there were protocols of injections, tablets or liniments cycloferon administration. Homogeneous and symmetric groups combination during meta-analysis increased statistic power of comparisons and led to integrative efficiency assessment, proved its' stability in statistic models. Cycloferon use in children and adults with HIV and/ or herpes infection was more the 3 times more effective to provide stable remission and exacerbation frequency diminish against basic therapy.

Purpose: To analyze ophthalmic pathologies in HIV-infected patients of the ophthalmic hospitals of Perm city., Material and Methods: Medical records of 75 HIV patients registered in Perm Regional Centre for Prevention and Control of AIDS and Infectious Diseases who had received treatment in ophthalmic in-patient clinics of Perm in 2005-2015 years were analyzed retrospectively. Patient examination included traditional ophthalmological methods, as well as immunological (determination of CD4 cells and viral load), serological (detection of antibodies to herpes simplex virus, cytomegalovirus, chlamydia, toxoplasma), general clinical methods, and consultations by allied specialists., Results: Ophthalmopathology requiring in-patient care was detected in 75 people (84 eyes). Men comprised 76%, women - 24%; average age was 32.82±8.68 years. The stage of HIV infection was known in 78.66% of patients: stage II - in 5% of cases, stage III - in 32%, stage IV - in 63%. Co-infection (hepatitis B and C, syphilis, tuberculosis) was detected in 81% of patients. HIV-related diseases (cytomegalovirus and herpes infection, candidiasis, toxoplasmosis) were observed in 48% of individuals. The time of emergence of ocular pathology from the time of HIV detection ranged from 1 day to 14 years. Inflammatory ocular diseases occurred in 55% of cases, dystrophic disorders - in 18%, eye traumas - in 24%, and strabismus - in 3% of patients. Reduced level of CD4 (less than 500 cells/mm 3 ) was more prevalent (72.13%) among the study patients. As of the time of the study, only 36.4% of patients were receiving antiretroviral therapy., Conclusion: Among the studied individuals, eye lesion was mostly severe, inflammatory in nature; it occurred more frequently in stage IV HIV patients with reduced number of CD4 lymphocytes who was not receiving antiretroviral therapy.

The aim of this work was to assess the state of the fallopian tubes in women with urogenital chlamydia (UC) and infertility. 344 women 18-49 y.o with infertility have been investigated. UC was detected in 133 of them -38.7%, (main group), UC was absent in 211 (61.3%) patients (comparision group). In the main group prevailed the tubal or tubal peritoneal factor of infertility (51.9% versus 19.4% in the comparison group, p<0.001). UC in women in the main (62.4%) was in the form of mixed infection. Obstruction of the fallopian tubes and adhesions in the pelvic region were more often detected in patients of the main group (p<0.05). The most pronounced lesions of the fallopian tubes were observed in women with chlamydial mixed infection. Adhesive process in the small pelvis was established by laparascopy in 72.2% of women in the main group and in 27.8% in the comparison group (p<0.001). There was a correlation between the extent of the adhesion process in the small pelvis and the presence of chlamydial mixed infection. A histological study was carried out of the tissues of the fallopian tubes in 12 women diagnosed with an ectopic pregnancy, 5 of whom had UC. Women with UC have alternating areas with signs of acute inflammation and various stages of the reparative processand in 4 women with UC the above mentioned signs and sclerosis were detected also in the the submucosa, which can cause destruction of the functional activities of the fallopian tubes and obstruction as well. All this causes a violation of the transport of spermatozoa, the embryo and leads to a ectopic pregnancy and infertility. Obtained results explain the inefficiency of restoring reproductive function in women after elimination of UC with preserved patency of the fallopian tubes.

The purpose of the study is to determine the nature of the impact of antiretroviral therapy on the development of liver fibrosis in patients coinfected with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), depending on the order of pathogens acquisition. The fact is that the HIV/HCV coinfection is one of the most common pathological conditions worldwide and liver disease is a major cause of death for these patients. We have previously described the phenomenon, according to which the order of viral pathogens acquisition in HIV/HCV coinfected patients has a significant impact on the degree of progression of liver fibrosis. Introduction to clinical practice of antiretroviral therapy greatly increased the life expectancy of HIV-infected patients, however, the impact of ART on a progressive course of liver fibrosis in HIV/HCV coinfected patients have not yet been definitively established.

Nowadays it is common to observe the growth of viral-viral and viral-bacterial co-infections in children of different ages, due to dysfunction of lymphocytes (DL), which can be connected with the process of the accelerated shortening of the end structures of chromosomal telomeres, telomere length changes are described in lymphocytes of children with chronic mono-infections. The conducted study has shown the shortening of telomere lymphocytes in children with CDRT seropositive for mixed-herpes viral infections (herpes simplex virus, virus, Epstein-Barr virus and cytomegalovirus in various combinations) and for bacterial co-infections - Chlamydia trachomatis and (or) Mycoplasma pneumoniae. The use of regression analysis and attribute analysis (in percent) made possible to neutralize age-groups differences of seropositive and seronegative children. Thus showed that children, who suffer from chronic diseases of the respiratory tract associated with mixed-herpes viral and bacterial co-infections, have more pronounced telomere shortening of lymphocytes than seronegative children of the same age.

To investigate the effectiveness of Ingaron (interferon-) in the treatment of HPV infection associated with sexually transmitted infections, the authors analyzed the scientific literature on the association of human papillomavirus infection with other viral and microbial pathogens. A clinical case of the association of human papillomavirus infection, urogenital infections (urogenital chlamydia and genital herpes) and localized scleroderma penis is described. The results of integrated therapy of diseases with the help of Interferon-gamma have been presented. According to the literature, up to 70-80% of HPV infections are associated with microbial (opportunistic, obligate pathogens) and viral infectious agents. Chronic inflammation caused by bacterial and viral associations destroys the immune system and it leads to the ineffectiveness of the therapy. Pathogenic therapy of sexually transmitted infections in combination with interferon-gamma (Ingaron) contributes to the eradication of bacterial pathogens, prevention of viral STI recurrence and elimination of high oncogenic risk types of HPV. Thus, we can reasonably infer that Ingaron (interferon-) alleviates the initial immune disturbances, improves the effectiveness of the treatment and may be recommended for treating HPV infection associated with sexually transmitted infections.

The present review considers malaria infection concurrent with different species of helminths, bacterial and viral infections, as well as mixed malaria pathogens in the subtropical and tropical countries of the world, causing the clinical picture and epidemiological situation to be different. Malaria co-infections with different pathogenic micro-organisms, such as HIV, tuberculosis, viral hepatitides, and others, affect almost one third of the planet's population. It is known that people who are at risk for malaria may be also at risk for other parasitic and infectious diseases, most commonly helminthisms.

The technique of immune blotting was used to analyze surface proteins obtained from cells M Tuberculosis exposed to partialmode of delipidization. At that, there were applied serums of patients with tuberculosis of lungs; HIV agents and patients with concomitant infection tuberculosis-AIDS and also HIV-negative patients without clinical signs of disease of lungs and with chronic diseases of lungs of other etiology The fractions oflow-molecular antigens with molecular mass 6.5-30 kilodaltons became diagnostically significant. To this fraction of antigens reacted serums of all patients with tuberculosis of lungs and serums of 91% of patients with concomitant tuberculosis-AIDS infection. The antigens of protein fractions with high (70-100 kilodaltons) and interim (30-69 kilodaltons) molecular mass became diagnostically insignificant.

The aim of the current study was to examine the expression level and possibilities of apoptotic markers in realization of placental insufficiency in pregnant women with urogenital infections. The study was conducted on 250 pregnant women with urogenital infections (1-st group - 50 pregnant women with bacterial infections (Chlamydia, ureaplasma, mycoplasma), 2-nd group - 50 pregnant women with viral infections (CMV and herpes simplex virus), 3-rd group - 150 patients with mixed viral and bacterial infections) and 50 pregnant women with normal pregnancy. The content of apoptosis inducers: sFasL and TNF-α in blood serum of pregnant women was determined; the level of caspase-3 in placental sample was analyzed; sonographic examination of the placenta was performed. Maximal indices of apoptosis inducers were observed in the 3-rd group (with mixed viral and bacterial infections). Changes in the placenta according to ultrasound data were determined in all pregnant women with urogenital infections. It was suggested that increased placental cell death in apoptosis might be one of the key points, triggering the development of placental dysfunction.

Aim: To reveal the specific features of changes in the parameters of lipid peroxidation - antioxidant defense and the status of the reproductive system in women of fertile age with monoinfection (HIV) or coinfection (HIV and hepatitis B and/or C)., Subjects and Methods: 81 reproductive-aged women were examined and divided into 3 groups: 1) 28 apparently healthy women (controls); 2) 26 patients with HIV monoinfection; and 3) 27 patients with HIV coinfection (HIV + hepatitis B and/or C) who had not previously received antiretroviral therapy., Results: The HIV coinfection group showed the higher values of primary (conjugated dienes) and secondary (ketodienes and conjugated trienes) lipid peroxidation products in the presence of lower superoxide dismutase activity and obvious α-tocopherol deficiency than the control and HIV monoinfection groups. HIV coinfection in reproductive-aged women was accompanied by the high frequency of luteal phase deficiency., Conclusion: HIV coinfection is characterized by a more pronounced oxidative stress, antioxidant factor deficiency, and the high frequency of luteal phase deficiency in the patients.

Efficacy, safety, and economical aspects of treatment with abacavir, zidovudine, stavudine, and phosphazide in the schemes of antiretroviral therapy of the HIV-infected patients receiving therapy for hepatitis C virus were tested. Clinical, immunological, and virologic efficacy of treatment and dynamics of hemoglobin, thrombocytes, and alanine aminotransferase as markers of common adverse events recorded at the start of the antiviral therapy of chronic hepatitis C and after 4, 8, 12, 24, 48 weeks of the treatment were evaluated. The usage of these drugs in the schemes of antiretroviral therapy exhibited efficacy, high tolerability and safety for all HIV reverse transcriptase inhibitors.