Introduction. Puumala virus (family Hantaviridae, genus Orthohantavirus) is distributed in most regions of the European part of Russia. However, information about its genetic variants circulating on the territory of the Central Federal District is extremely scarce. Materials and methods. Rodents tissue samples were tested after reverse transcription by PCR for the presence of hantaviral RNA. The amplified fragments of the L segment were sequenced by the Sanger method. For two samples, sequences of all three segments were obtained using the NGS method. Phylogenetic trees were built in the MEGA-X software. Results. Puumala virus was found in six samples. Based on the phylogenetic analysis of sequences of three segments, the obtained genetic variants belong to the sublineage previously designated as W-RUS. Conclusion. A genetic variant of the Puumala virus, belonging to the subline W-RUS, circulates on the territory of the Volokolamsk district of Moscow region.

Журнал для непрерывного медицинского образования врачей ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ Выявление РНК вируса денге в различных биологических жидкостях 1 Федеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И.Пирогова» Министерства здравоохранения Российской Федерации, 117997, г.Москва, Российская Федерация 2 Федеральное бюджетное учреждение науки «Центральный научно-исследовательский институт эпидемиологии» Федеральной службы по надзору в сфере защиты прав потребителей и благополучия человека, 111123, г.Москва, Российская Федерация 3 Государственное бюджетное учреждение здравоохранения города Москвы «Инфекционная клиническая больница № 1 Департамента здравоохранения города Москвы»,

INTRODUCTION:In Russia, the approved morbidity statistics system is represented by the International Classification of Diseases of the 10th revision (ICD-10). This classification provides two forms of dengue fever (DF): dengue fever (A90) and hemorrhagic dengue (A91). Official statistics on the ratio of forms of DF is not published in open sources and this lack of information about the real ratio of the forms of DF makes it difficult to objectively assess the factors that determine the severity of this disease.THE AIM:compare the clinical and epidemiological features of dengue fever and hemorrhagic dengue fever in patients hospitalized in 2009-2019 to the City Infectious Clinical Hospital No. 1, Moscow.MATERIALS AND METHODS:A retrospective cohort study. We analyzed the patient database and reviewed 391 medical records of patients with diagnosed dengue fever. We compared gender, age characteristics, travel geography including information about previous visits of patients to endemic regions and dengue virus serotype. To determine the primary and re-infection rate, an analysis of IgG for the dengue virus was carried out on days 1-5 of the disease. To compare indicators, 95% confidence intervals for proportions, medians, and interquartile ranges were calculated. The significance of differences between independent samples for assessing qualitative characteristics was carried out using the criteria χ2, the odds ratio. To assess the quantitative characteristics, the Mann-Whitney test was used. Differences were considered statistically significant at p ≤ 0.05.RESULTS:The proportion of patients with dengue fever was 14.9% of all hospitalized with febrile illnesses that developed after international travel. Hemorrhagic dengue fever (DHF) was diagnosed in 15.7% of patients with dengue fever. DHF developed significantly more often in women, as well as in those who had history of repeated visits to endemic regions. However, DHF was also diagnosed in 10.9% of first-time travelers to tropical countries. We did not find significant differences in the rates of DHF development depending on age and dengue virus serotype. In a number of patients who had not previously traveled to endemic regions, IgG to the dengue virus were detected, which may indicate a previous infection with related flaviviruses.CONCLUSION:It has been established that in the regions most visited by Russians, there is a circulation of all serotypes of the dengue virus with an annual change in the predominant serotype.

The aim of the work is to summarize the available literature data on cases of visceral leishmaniasis in children registered in the Russian Federation, as well as to describe our own clinical observation of autochthonous visceral leishmaniasis in a 9-year-old child, in the diagnosis of which the polymerase chain reaction (PCR) method was used.Materials and methods: a review of domestic and foreign literature over the past 20 years, including Internet resources, was carried out. We observed a 9-year-old child hospitalized in the Russian Children's Clinical Hospital. Leishmania DNA was determined in blood serum by PCR using the Amplisens – Leishmania-Fl reagent kit.Results. It was established that the infection of the patient observed by us occurred on the territory of the Russian Federation in the Crimea. The diagnosis of leishmaniasis was confirmed by morphological examination of the bone marrow and the detection of pathogen DNA in the blood serum by PCR.Conclusion. On the territory of the Russian Federation there are foci of autochthonous visceral leishmaniasis in the Crimea and the North Caucasus. Polymerase chain reaction is an alternative to bone marrow aspirate microscopy for the diagnosis of visceral leishmaniasis.

This article contains additional information on the features of the clinical picture of Crimean hemorrhagic fever (CHF) in children, the ongoing activity of CHF virus circulation in the territory of the Republic of Crimea, confirms the possibility of imported cases of CHF in non-endemic regions, which is associated with the likely risks of nosocomial and intrafamilial cases of this infection. The data on the course of the disease, clinical and laboratory diagnostic examination of a child infected with CHF in the Crimea are presented.

Лихорадка Западного Нила на территории Московской агломерацииОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ 1 Федеральное государственное бюджетное образовательное учреждение высшего образования «Московский государственный медико-стоматологический университет имени А.И.Евдокимова» Министерства здравоохранения, 127473, г.Москва, Российская Федерация 2 Федеральное государственное автономное научное учреждение «Федеральный научный центр исследований и разработки иммунобиологических препаратов им.М.П.Чумакова РАН» (Институт полиомиелита

Chikungunya fever (CF) is an acute vector-borne disease common in countries with tropical climates. Over the past decade, the range has expanded due to the transfer of the virus to the Western hemisphere. In children, the disease occurs with a greater frequency of damage to the nervous system, the development of hemorrhagic syndrome. Severe forms of CF develop during intranatal infection. The article presents clinical and catamnestic observation, an assessment of laboratory data of a 14-year-old child who fell ill with CF while visiting Thailand. A review of the literature on the CF course peculiarities in childhood is given. Due to increased travel to tropical countries in recent years, the number of imported diseases, including arbovirus fevers, has increased; age composition of patients has expanded, including children. Information about this pathology is necessary for pediatricians and infectious disease specialists.

Leishmaniasis is a vector-born parasitic disease characterized by predominant cutaneous or visceral involvement with fever, hepatosplenomegaly and anemia. Leishmaniasis has relatively high prevalence in tropical and subtropical areas. Several sporadic and mostly imported cases are detected in Russian Federation. Nevertheless, some local incidents are noted in southern areas (Crimea, Dagestan). Lack of epidemiological alertness hampers confirmation of diagnosis and may lead to incorrect treatment. The article summarizes current state of knowledge in epidemiology, diagnostic approach and treatment of leishmaniasis. Particular clinical case is discussed.

Lassa virus is the causative agent of a dangerous zoonotic disease distributed in West Africa. A primary reservoir host of Lassa virus is Mastomys natalensis . These mice associate closely with humans and are commonly found in villages. Consequently, previous studies of Lassa virus have focused on rural areas. The prevalence of the virus in large cities has not been studied. We conducted a study in N’Zerekore city, which has a population of approximately 300,000 residents. Small mammals were captured during a pilot study in May, and the main study was performed in August 2018. Based on the pilot study, we designed and implemented a stratified random sample to investigate the prevalence of Lassa virus among M. natalensis in N’Zerekore. The total sampling efforts consisted of 45 and 985 trapping nights in May and August, respectively. Samples of rodent tissues were screened for Lassa virus by RT-PCR. In May, we trapped 20 rodents, including 19 M. natalensis . Viral RNA was detected in 18 M. natalensis . In August, 149 small mammals were captured, including 43 M. natalensis . The prevalence of Lassa virus among M. natalensis in N’Zerekore was 23.3% (CI 95%: 11.8–38.6%). Sequencing showed that the isolates belonged to lineage IV. We detected four Lassa virus hotspots located in different parts of the city. The largest Lassa virus hotspot was found in the neighborhood of the central market, which suggests that the virus was originally introduced into the city through the market.

Human babesiosis caused by parasitic protozoan Babesia spp. is sporadic zoonotic vector-borne infection. The course of babesiosis and prognosis depend on the type of pathogen and on the patient's immunological status. Significance this disease is a severe, often fatal course with immunocompromissed patients resembling complicated falciparum malaria. In Europe to date, more than 50 cases of confirmed human babesiosis have been reported in most cases caused by Babesia divergens. Possible there are unrecognized cases. Pathogen is an obligate intraerythrocyte parasite of vertebrate animals. The organism is transmitted from animal to man through bite of Ixodidae tick. Asexual reproduction of the parasite occurs in a vertebrate host. The pathogenesis of babesiosis is caused by the destruction of host cells. Intensive haemolysis of red blood cells leads to the development of haemolytic anemia, haematuria, jaundice, and polyorgan failure may develop. The clinical manifestations of the disease are nonspecific. Detection of intraerythrocyte parasites in blood smears stained Gimsa-Romanovsky confirms the proposed diagnosis. Blood smears and some laboratory signs from fatal cases were analyzed in the Reference-centre of E. I. Martsinovskiĭ Institute. Original microphotographs B. divergens are shown. The main morphological forms of the parasite are shown. In addition to the well-known tetrades of parasites «Maltese Cross», for the first time, the parasites dividing into 6 interconnected trophozoites - "sextet" - were found. Originally, the invasion of Babesia in a normoblast is shown. An unusually high multiple invasion (14 parasites) of erythrocytes is noted. Because the patients, initially, were incorrectly diagnosed with malaria, the differential diagnosis of Babesia with Plasmodium is described step-by-step. It is important, since the treatment with antimalarial drugs is ineffective. Deviation laboratory signs are discussed. Complex morphological characteristics allowed us to speciated the parasites as B. divergens. DNA was detected in the sample with specific primers Bab di hsp70F/Bab di hsp70R and the probe Bab di hsp70P. The sequence demonstrated 99-100% and 98% similarity to the 18S rRNA gene fragment of B. divergence and Babesia venatorum, respectively. Molecular biological and serological methods of laboratory diagnosis of babesiosis are considered.

The most of ixodes ticks in Tula region belongs to the group of pasture mites. It is generally accepted to estimate the tick’s contamination by the tick-borne encephalitis virus and raoueti inducing Lyme Borellia. The aim of the present work was to educe the aetiologic agents of the set of potentially-enable infections out of ticks Dermacentor reticulatus, Ixodes ricinus and Ixodes сrenulatus collected at the different terrains of Tula Region by PCR method. The results: a considerable number of pathogenic rickettsiae R. raoultii was educes from the ticks D. reticulatus, which including them as the component of mixed infection together with the human monocytic ehrlichiosis agent. R. raoultii was determined in more than a half of the cases in ticks I. ricinus including the mixed infection together with ticks’ borreliosis virus and Kemerovo fever agent. Conclusion. The reasons, induced the quantity changes of the ticks’ distribution at Tula Region terrains, apparently promote the rise in frequency of the ticks contamination with the agents of herd tick-transmissive infection. It demand an infectiologist’s attention rise and dictate the necessity of the above mentioned diseases monitoring as well as Fr. tularensis, the tick-borne encephalitis virus and Lyme disease.

A case of Tick-borne spotted fever in a child after a visit to an endemic region, the Republic of Crimea, is described. The disease caused difficulty in terms of clinical diagnosis, which led to the delayed prescription of specific therapy with doxycycline. The diagnosis of Тick-borne spotted fever was made on the basis of detectingR. conoriiDNA in a washout with primary affect. In the course of the disease, IgM class antibodies were detected during serological analysis of paired serum.

Background. During the study of the genetic variability of the tick-borne encephalitis virus (TBEV) in Eastern Siberia, a group of 22 strains with a unique genetic structure significantly different from all known TBEV subtypes was identified. This TBEV variant was tentatively called “group 886”. Therefore, for this original TBEV variant it was necessary to study the genetic, biological properties of the “group 886” strains, clarify its TBEV taxonomic status, its range, evolutionary history, etc.Aim. The generalization of the currently available data on genetic and biological properties of TBEV “886” group.Materials and methods. The genetic structure of “group 886” strains was studied by the complex of molecular-genetic methods (MHNA, sequencing of fragments or the complete genome).Results. It was shown that “group 886” strains form a separate cluster on phylogenetic tree, and the level of genetic differences from other genotypes is more than 12 %. It was defined that this TBEV variant has its own area (Irkutsk region, Republic of Buryatia, Trans-Baikal region, Northern Mongolia). Its ecological connection with all links of the transmissive chain (ixodid ticks, small mammals, human), participation in human pathology, stability and duration of circulation in the Baikal region, individual evolutionary history were proved. Some phenotypic characteristics of the “group 886” strains were considered.Conclusion. The presented data testify to the validity of the “886 group” isolation as an independent genetic type. Taking into account the geographical distribution of this TBEV genotype, we propose to assign it the name “Baikal genotype/subtype”.

We present an analysis of 28 leptospirosis cases, associated with abroad traveling, and registered from 2011 to 2017 years. The relative ratio of leptospirosis with other imported infectious diseases is shown, and clinical and epidemiological features of imported leptospirosis cases were described.

Ixodes tick-borne borreliosis caused by Borrelia miyamotoi (ITBB-BM) is a previously unknown infectious disease discovered in Russia.AIMThe present study continues the investigation of the clinical features of ITBB-BM in the context of an immune system-pathogen interaction.SUBJECTS AND METHODSThe study enrolled 117 patients with ITBB-BM and a comparison group of 71 patients with Lyme disease (LD) that is ITBB with erythema migrans. All the patients were treated at the New Hospital, Yekateringburg. More than 100 clinical, epidemiological and laboratory parameters were obtained from each patient's medical history and included in the general database. A subset of patients hospitalized in 2015 and 2016 underwent additional laboratory examinations. Namely, the levels of B. miyamotoi-specific IgM and IgG antibodies were measured by the protein microarray containing GlpQ protein and four variable major proteins (VMPs): Vlp15/16, Vlp18, Vsp1, and Vlp5. The blood concentration of Borrelia was estimated by quantitative real-time PCR.RESULTSIn contrast to LD, first of all (p<0.001) the following clinical features were typical for ITBB-BM: the absence of erythema migrans (in 95% of patients), fever (93%), fatigue (96%), headache (82%), chill (41%), nausea (28%), lymphopenia (56%), thrombocytopenia (46%), the abnormal levels of alanine aminotransferase (54%) and C-reactive protein (98%), proteinuria (61%). Given the set of these indicators, the course of ITBB-BM was more severe in approximately 70% of patients. At admission, only 13% and 38% of patients had antibodies to GlpQ and VMPs, respectively; at discharge, antibodies to GlpQ and VMPs were detected in 88% of patients. There was no statistically significant association of the antibody response with individual clinical manifestations and laboratory parameters of the disease. However, patients with more severe ITBB-BM produced less IgM antibodies to VMPs and GlpQ at the time of discharge.CONCLUSIONITBB-BM is a moderate systemic disease accompanied by the production of specific antibodies in virtually all patients.

Following article represents an analysis of the epidemiological situation of tick-borne diseases in Moscow. The study presents incidence rates of Lyme borreliosis in Moscow city population and an estimation of Ixodid ticks abundance in «Sokolniki» park and its adjacent part «Losiniy Ostrov». We estimated the prevalence of tick-borne diseases in quested ticks collected from vegetation. We developed recommendations to prevent tick bites of «Sokolniki» park visitors. The article discussed the need to develop specific strategy and tactics for the metropolis to take preventive action against tick-borne diseases.