From 2004 to 2006, a pilot project was carried out in 11 territories of the Russian Federation to test the method of active epidemiological surveillance, which makes it possible to identify the true number of measles patients among persons with maculopapular rash and fever, regardless of the primary diagnosis. Objective. To provide a clinical and epidemiological characterization of measles cases detected through active surveillance and to assess the quality of pre-hospital diagnosis. Materials and Methods. A retrospective analysis of data from 2017–2025 was conducted, including 1.691 epidemiological investigation forms for patients identified through active surveillance and 2.517 hospital records of inpatients. Laboratory verification was performed using immunoenzyme assay (IgM/IgG). Descriptive epidemiological and statistical methods were applied. Results. Active surveillance annually detected missed measles cases (ranging from 1 to 743 in different years). The average age of the patients was 22.5 years. At the pre-hospital stage, measles was not recognized in 37.7 % of hospitalized patients. Over 90 % of cases in recent years exhibited a typical clinical picture, indicating low clinical awareness among physicians. Complications were registered in 38–40 % of patients, with infants under one year of age remaining the most vulnerable group. Conclusions. The high proportion of typical measles cases among those missed indicates systemic deficiencies in clinical diagnosis. Continuous training of medical personnel, enhanced laboratory monitoring, and maintenance of high vaccination coverage are necessary maintain measles elimination status.
Patients with human immunodeficiency virus infection who have started antiretroviral therapy at advanced stages of the disease often develop immune reconstitution inflammatory syndrome. This process is associated with activation of the immune response, which can lead to uncontrolled inflammatory responses and, in some cases, the development of neoplastic diseases such as Kaposi’s sarcoma and non-Hodgkin’s lymphomas. In addition, lymphadenopathy that occurs within the framework of immune reconstitution inflammatory syndrome during cancer remission can be mistakenly interpreted as a relapse of a malignant tumor, which is an objective diagnostic complexity, especially given the possibility of the appearance of viral mutations that can reduce the effectiveness of the initial regimen and require treatment correction. In addition, patients with human immunodeficiency virus and developed immune reconstitution inflammatory syndrome may develop CNS lymphomas and cross-symptoms. The appearance of these complications against the background of immune reconstitution inflammatory syndrome requires careful differential diagnosis, since signs that can be interpreted as relapse of lymphoma can be caused precisely by inflammatory reactions or neurological symptoms associated with the reconstitution of the immune system. In this article, using the example of a clinical case and an analysis of the literature, we presented how immunological and virological changes caused by human immunodeficiency virus and antiretroviral therapy switching in a patient with lymphoma can lead to erroneous conclusions (relapse of lymphoma, development of an opportunistic infection), when only a detailed analysis of clinical, laboratory and instrumental data with the involvement of a multidisciplinary team of doctors allowed differential diagnosis of inflammatory and tumor processes associated with immune reconstitution inflammatory syndrome. It is important to note that dynamic monitoring of the viral load, instrumental control of the manifestations of the oncological process make it possible to correctly interpret possible changes and make the right clinical decisions.
Epilepsy in children is a heterogeneous group of diseases based on complex interactions of genetic, metabolic, and environmental factors. Of particular interest are the forms of epilepsy associated with mutations of sodium channel genes, in particular SCN1A, which determine the spectrum of disorders united by the concept of “genetic epilepsy with febrile seizures plus” (GEFS+). Despite the genetic nature of the syndrome, the course of the disease can be modified by additional triggers, including nutritional characteristics and the state of the intestinal microbiota. The article presents a clinical case of a 6-year-old boy with genetic epilepsy with febrile seizures plus (GEFS+) associated with the SCN1A mutation, in whom the course of the disease was complicated by primary lactase deficiency. The patient had pharmacoresistant convulsive activity with early onset and frequent afebrile seizures, despite combined antiepileptic therapy. An extended diagnostic search revealed a polymorphism of the MCM6 gene, confirming primary hypolactasia. Taking into account the correlation of exacerbations with the use of dairy products, their complete elimination was carried out, which led to a decrease in the frequency of seizures by more than 70% and an improvement in the cognitive and behavioral profile of the child. The case highlights the need for an interdisciplinary approach in treatment-resistant forms of epilepsy in children.
The expansion of international tourism and increasing migration have led to a higher risk of the emergence and spread of various infectious diseases, including those that are not endemic to Russia. Therefore, studying the characteristics of infectious diseases in children and adults returning from international travel is of considerable importance. Objective. To analyze the clinical and epidemiological characteristics of imported infectious diseases in children and adults after international travel. Materials and Methods . We conducted a single-center retrospective cohort study at Infectious Clinical Hospital No. 1 of the Moscow Department of Health. Medical records of 2005 adults and 501 children who developed illness during or after international travel and were admitted to the hospital’s isolation ward after returning from abroad between 2009 and 2019 were retrospectively reviewed. Statistical analysis was performed using IBM SPSS Statistics version 26.0. Results. The age of the study participants ranged from 1 month to 86 years. Among hospitalized patients, children 1–3 years accounted for the largest proportion (41.9 %). Children were hospitalized more frequently during the summer (176 cases, 35.1 %; p<0.001) and autumn (139 (27,7; 23,6-31,6), p<0,05), whereas adults were more commonly hospitalized in the winter (496 cases, 24.7 %; p<0.001) and in the spring (526 (26,2; 24,5–28,1), p<0,05). In the epidemiological history, travel to the Republic of Türkiye was most common among children (17.0 %), while travel to the Kingdom of Thailand predominated among adults (24.9 %). Compared with adults, children were more frequently diagnosed with enterovirus infection (37.0 % vs 19.2 %, p<0.001) among infections with a fecal-oral transmission route, and pertussis (1.5 % vs 0.1 %, p<0.05) among infections with an airborne transmission route. Among children, dengue fever was the most frequently diagnosed vector-borne infection (88.9 %). Conclusion . We identified the epidemiological characteristics and etiological structure of imported infectious diseases and demonstrated seasonal, geographic, and nosological differences in infectious diseases among children compared with adults after international travel.
The article discusses the issues of changes in complaints and diseases of children, an increase in the frequency of functional disorders, migratory pains, increased fatigue, prolongation of the recovery period after viral infections, obesity, which is all typical for almost all countries with a high level of social development. The reasons can be external influences, a sedentary lifestyle, high loads, gadgets, but also excessive, frequent drug treatment. Perhaps the only way to counteract these negative influences is to restructure the minds of doctors and society, and to intensify the preventive care in pediatrics.
