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Vol 29, No 1 (2024)

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ORIGINAL STUDIES

Predicting COVID-19 outcomes in patients at advanced stages of HIV infection: a model-based approach

Tsygankova A.E., Chulanov V.P., Gerasimov A.N., Volchkova E.V., Privalenko A.A., Bakhtina V.A., Khabudaev V.A., Baimukhambetova D.V.

Abstract

BACKGROUND: Today, clinicians and their decisions extensively rely on specific treatment algorithms. These algorithms include prognostic models to identify high risk patients requiring hospital admission and clinical monitoring. This study suggests a prognostic model for forecasting COVID-19 outcomes in patients with advanced HIV infection, considering the high risk of unfavorable outcomes and the need for a specialized approach.

AIM: To develop a prognostic model that combines predictors of unfavorable COVID-19 outcomes in patients with advanced HIV infection.

MATERIALS AND METHODS: The study was based on 500 medical records of patients with advanced HIV infection admitted for confirmed COVID-19 between March 1, 2020, and December 31, 2022, and inpatient treatment at the Infectious Diseases Hospital in Moscow.

RESULTS: All 500 patients were evaluated for 167 predictive markers for unfavorable COVID-19 outcomes, outlining 50 indicators that significantly varied across the subgroups of patients with both advanced HIV infection and COVID-19 depending on the presence of favorable or poor outcomes. Oxygen therapy was the most significant factor showing a strong correlation with poor outcomes in patients with advanced HIV infection and COVID-19. Subsequently, predictors were selected stepwise to enhance the predictive accuracy of the resulting model by adding more factors.

The resulting model included seven factors: oxygen therapy requirements, CD4+ count under 50 cells/μL; manifested CMV infection with lung damage; elevated levels of lactate dehydrogenase, urea, and fibrinogen; and the presence of unspecified encephalitis. Using the available data in the calculations, a prognostic scenario and a receiver operating characteristic (ROC) curve were created to assess the practical significance of the proposed prognostic model. The area under the ROC curve was 90.9%, confirming the prediction accuracy and overall practical significance of the model.

CONCLUSIONS: The proposed prognostic model enables the assessment of potential outcomes and planning of adequate therapies in patients with HIV and COVID-19 co-infection admitted to hospitals at advanced stages of the disease.

Epidemiology and Infectious Diseases. 2024;29(1):5-17
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The effect of vaccination against the COVID-19 on the course and outcomes of a new coronavirus infection: a retrospective analysis of laboratory and clinical indicators of hospitalized patients

Fomicheva A.A., Pimenov N.N., Tsygankova A.E., Tsapkova N.N., Rokhlina D.A., Volchkova E.V., Krasnova S.V., Chulanov V.P.

Abstract

BACKGROUND: The Gam-COVID-Vac vaccine was proven effective in preventing the severe course and adverse outcomes of COVID-19 during different periods of the pandemic. However, the effect of vaccination on laboratory marker levels in hospitalized patients during the spread of the omicron variant of SARS-CoV-2 has not been sufficiently studied.

AIM: To assess the effect of vaccination on the severity and outcomes of COVID-19 in hospitalized patients during the dominance of the SARS-CoV-2 omicron variant in Russia.

MATERIALS AND METHODS: This case–control study included adult patients diagnosed with COVID-19 (U07.1) and hospitalized in infectious hospitals in Moscow between February 1, 2022, and July 31, 2022 (n=119). The main group included individuals vaccinated with two doses of Sputnik V vaccine (n=59). The control group included individuals who were not vaccinated (n=60). The median patient age was 66 [interquartile range, 41–66] years, and 58.8% were female. The chi-square test for categorical variables and the Mann–Whitney test for continuous variables were used for the analysis. P-values <0.05 were considered statistically significant.

RESULTS: Viral pneumonia was less likely to develop in the vaccinated group than in the unvaccinated group (46.7% and 18.6%, respectively, p = 0.007). The proportion of patients without lung damage (0 CT-severity scores) in the vaccinated group (72.0%) was significantly higher than that in the unvaccinated group (42.9%) (p=0.003). In the vaccinated group, the levels of C-reactive protein on admission were lower (29.1 [7.4–68.6] mg/L and 75.1 [32.4–104.0] mg/L, p <0.001), and the highest level was recorded during hospitalization (38.2 [12.0–84.0] mg/L and 92.2 [45.3–137.4] mg/L, p <0.001). The D-dimer levels before discharge were lower in the group of patients vaccinated <6 months ago than in the unvaccinated group (157.0 [107.0–297.0] ng/mL and 316.0 [125.0–556.0] ng/mL, respectively, p = 0.014). The frequency of deaths in the control group (11.7%) was 6.9 times higher than that in the main group (1.7%) (p = 0.030).

CONCLUSIONS: Completion of the primary vaccination course of Sputnik V vaccine resulted in lower levels of prognostic markers of severe COVID-19 (C-reactive protein and D-dimer) and a decrease in the frequency of pulmonary and fatal outcomes than in the unvaccinated group during the dominance of the omicron variant of SARS-CoV-2.

Epidemiology and Infectious Diseases. 2024;29(1):18-28
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“The end of the era of antibiotics” — myth or reality: what the past COVID-19 pandemic has shown

Mitrokhin S.D., Mironov A.Y., Aleshkin A.V., Galitskiy A.A., Suranova T.G., Mironova A.V.

Abstract

BACKGROUND: During the coronavirus disease 2019 pandemic, the sale of antimicrobials (AMPs) in the pharmacy network and their purchases by healthcare facilities of the Russian Federation have significantly increased. Microbiological monitoring conducted at the City Clinical Hospital No. 67 named after L.A. Vorokhobov of the Moscow Health Department in 2020–2021 revealed an urgent problem: gram-negative bacteria, which are dominated by multidrug-resistant (MDR) strains, are now mainly isolated from patients with healthcare-associated infections (HAIs). Pharmacoeconomic studies have shown that the cost of one course of targeted antibiotic therapy for HAIs can increase by 6–12 times compared with a similar course of therapy in the absence of nosocomial MDR and extensively drug-resistant (XDR) pathogens.

AIM: To increase the effectiveness of preventive measures aimed at preventing the spread of hospital-acquired pathogen strains in the intensive care unit (ICU) using effective bacteriophages against MDR strains of Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Acinetobacter baumannii, which were selected in accordance with an individualized algorithm.

MATERIALS AND METHODS: The study included two groups, totaling 20 patients, who were on prolonged mechanical ventilation in the ICU of City Clinical Hospital No. 67 named after L.A. Vorokhobov of the Moscow Health Department in 2022. The second group received 20 mL of bacteriophages via an intragastric tube for five consecutive days. The concept of a personalized approach to phage therapy for various forms of HAIs caused by nosocomial MDR pathogens in patients of a multidisciplinary hospital has been proposed and tested.

RESULTS: With this medical technology, the effectiveness of phage therapy for various nosological forms of HAIs caused by nosocomial MDR and XDR strains increased by 30%, and the effectiveness of the initial antibiotic therapy regimen was ≥70%. The economic effect of the combination of antibiotic therapy and phage therapy (booster therapy) amounted to more than 3 million rubles compared with the use of AMP alone for treating patients with HAIs caused by nosocomial MDR/XDR strains.

CONCLUSIONS: Booster therapy as a variant of IIB therapy reduces the cost of treatment of AMPs of various forms of HAIs by ≥2.5 times compared with AMPs alone.

Epidemiology and Infectious Diseases. 2024;29(1):29-39
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Modern features of legionellosis

Avdeeva M.G., Moshkova D.Y., Blazhnyaya L.P., Kulbuzheva M.I., Ilin O.I., Konchakova C.A., Shoparov A.M., Ivanova A.A., Ryabtseva P.S.

Abstract

BACKGROUND: Community-acquired Legionella pneumonia, classified as atypical pneumonia, is an important problem worldwide. Late initiation of etiotropic therapy for Legionnaires’ disease worsens the prognosis and increases the risk of death.

AIM: To clinically and epidemiologically characterize Legionnaires’ disease using data on its incidence in the Krasnodar region and to attract the attention of doctors to its timely diagnosis and the prescription of adequate etiotropic therapy.

MATERIALS AND METHODS: A hospital cohort of 26 patients who were hospitalized between 2017 and 2022 was studied for legionellosis, which was confirmed in the laboratory by the detection of Legionella antigen in the urine using immunochromatography.

RESULTS: The Krasnodar region is characterized by a sporadic incidence of legionellosis, which tends to increase in periods with high average humidity. Cases of legionellosis are recorded throughout the year, with peaks in summer and winter. The rise in incidence shifts annually and follows the month with the highest rainfall and average monthly temperature >20°C. Severe and moderate courses of legionellosis typically occur in men aged >50 years, with comorbid pathology and accompanied by lung damage of varying severity levels. Some patients may experience diarrhea (11.5%) and transient liver and kidney dysfunction. The nature of lung damage, such as polysegmental pneumonia, does not have clear clinical differential diagnostics, which makes early diagnosis difficult. An epidemiological anamnesis indicating contact with aerosol water, soil, and air conditioning systems has important diagnostic significance. Seeking specialized medical care after the 7th day of illness increases the risk of developing severe disease with complications.

CONCLUSIONS: In severe community-acquired pneumonia, the epidemiological history must be considered, kidney and liver function should be assessed, a urine test must conducted for Legionella antigens, and early empirical therapy with fluoroquinolones and macrolides must be initiated.

Epidemiology and Infectious Diseases. 2024;29(1):40-53
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Analysis of disinfectant use by medical organizations of the Republic of Tatarstan in the context of changes in the epidemiological situation 2019–2022

Lokotkova A.I., Bulycheva I.A., Mamkeev E.K., Karpenko L.G., Fazulzyanova I.M., Sabaeva F.N., Toshchev G.A.

Abstract

BACKGROUND: Disinfection is an important aspect of ensuring epidemiological safety in medical organizations, particularly during the COVID-19 pandemic.

AIM: To analyze the disinfectant use in state medical organizations of the Republic of Tatarstan from 2019 to 2022, considering changes in the epidemiological situation related to COVID-19, and provide recommendations based on the analysis.

MATERIALS AND METHODS: Electronic auction data from zakupki.gov.ru were used to analyze disinfectant purchases by state medical organizations in the Republic of Tatarstan from 2019 to 2022. Data analysis involved the application of descriptive statistical methods.

RESULTS: A total of 118 electronic auctions were analyzed. A relationship between the nature of the epidemiological situation and the selection of disinfectants for purchase based on their chemical composition and intended use was identified. Before the pandemic, medical organizations preferred quaternary ammonium compound disinfectants and antibacterial soaps for hand hygiene. During the COVID-19 pandemic, their use of chlorine-based disinfectants, hydrogen peroxide, and alcohol-based hand sanitizers containing 60–69% ethanol increased. As the epidemiological situation stabilized, a discernible shift in preferences toward compound disinfectants was noted. Antiseptics with an alcohol content >70% are increasingly sought after.

CONCLUSIONS: Medical organizations in the Republic of Tatarstan promptly respond to changes in the epidemiological situation by implementing necessary modifications to antiepidemic measures. When developing procurement strategies, not only the requirements of sanitary legislation but also the latest scientific findings in the field of disinfectology must be considered.

Epidemiology and Infectious Diseases. 2024;29(1):54-63
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REVIEW ARTICLES

Epidemiology, course and predictors of long-term COVID infection (long COVID): A review

Tsygankova A.E., Gerasimov A.N., Malov V.A., Darvina O.V., Volchkova E.V., Chulanov V.P.

Abstract

The COVID-19 pandemic has posed a serious challenge to the healthcare system in the 21st century. At present, over 771 million cases have been reported worldwide. Apart from the acute symptoms, many patients experience long-term consequences of the infection, which greatly affect their quality of life. The collection of these long-term effects is called “long COVID.” Therefore, the consequences of COVID-19 must be studied to develop effective strategies for combating them. This review aimed to provide an overview of the history of long COVID and discuss the characteristics of contemporary terminology. This review also presents data on the prevalence of long COVID, primary symptoms, and risk factors and explores potential biomarkers, prognosis, and prospects for subsequent clinical trials.

Epidemiology and Infectious Diseases. 2024;29(1):64-73
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CASE REPORTS

A case of a combined course of typhoid fever and leptospirosis

Kharlamova T.V., Barysheva I.V., Polovinkina N.A., Burdova E.Y., Bogdanova M.V.

Abstract

Coinfections are becoming increasingly relevant and urgently require research. The development of international tourism has caused the rapid spread of infectious diseases from countries with unfavorable sanitary and hygienic conditions. This article analyzes the clinical case of a patient who recently returned from India and developed a combined course of typhoid fever and leptospirosis due to astrovirus infection and blastocystosis. The disease was characterized by symptoms of enteritis, low-grade fever, and mild intoxication. The patient repeatedly sought medical help. Diagnoses of “acute respiratory viral infection” and “intestinal infection of unknown etiology” were established. Symptomatic therapy was performed without a positive effect; fever and severe asthenic syndrome persisted. The patient was hospitalized on the 18th day of illness with moderate severity. Taking into account clinical, anamnestic, and epidemiological data and laboratory examination results, typhoid fever was diagnosed. A polymerase chain reaction (PCR) test identified astrovirus RNA in the stool, and Blastocystis hominis was detected during stool examination. Despite the ongoing pathogenetic and antibacterial therapy, considering the determination of the pathogen’s sensitivity to antibiotics, the patient’s condition worsened. On day 23 of the illness, jaundice, hemorrhagic syndrome, and signs of acute renal failure were noted. Through in-depth analysis of changes in the clinical and laboratory findings, considering epidemiological history data (stay in a region endemic for leptospirosis), leptospirosis was diagnosed and treated with antibacterial therapy. Complex intensive therapy using extracorporeal treatment methods helped prevent the development of unfavorable outcomes of combined pathology. This clinical case emphasizes that doctors must be wary of imported infections and conduct additional comprehensive investigations of suspected cases.

Epidemiology and Infectious Diseases. 2024;29(1):74-81
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Исторические статьи

In honor of the 100th anniversary of the Department of Infectious Diseases at the I.M. Sechenov First Moscow State Medical University (Sechenov University)

Volchkova E.V., Malov V.A., Chulanov V.P., Yurchenko N.V.

Abstract

This article is dedicated to the 100th anniversary of the Department of Infectious Diseases of the I.M. Sechenov First Moscow State Medical University (Sechenov University). This study examined key biographical information about department heads and achievements of teams at various historical stages. Currently, the department follows the educational policies of Sechenov University up to 2030. New educational programs in Russian and English are created for students. New teaching methodologies are implemented, talented students are engaged in student research on infectious diseases, interdisciplinary Olympiads are held, and conditions are formed to enhance student involvement in research and development activities to prepare competitive professionals with new professional competencies (research, interdisciplinary, and digital), capable of advancing science and new technologies.

Epidemiology and Infectious Diseases. 2024;29(1):82-87
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