A description of a clinical case of a severe, protracted course of coronavirus infection (COVID-19) in a patient with advanced stage HIV infection, characterized by prolonged release of the SARS-CoV-2 virus and the formation of pulmonary fibrosis against the background of an active viral infection, is presented. COVID-19 infection occurred in an immunosuppressed patient without ART. During the period of inpatient treatment, a comprehensive examination was carried out to exclude HIV-associated lung lesions; no evidence of viral, fungal, or bacterial pathology was obtained; mycobacterial infections were also excluded. Despite two courses of antiviral therapy, the use of anti-Covid plasma and complex pathogenetic therapy, persistence of SARS-CoV-2 replication was observed for eight months, with a steady progression of the disease, ending in death.

Background. The most severe complications of antibiotic use are clostridial infection (CDI) and pseudomembranous colitis (PMC). There is a need for further study of these conditions and identification of their triggers. Aim. To identify risk factors for severe forms of antibiotic-associated diarrhea caused by Clostridioides difficile. Materials and methods. A clinical and laboratory examination of 440 patients with CDI who were treated at Botkin Clinical Infectious Diseases Hospital was conducted. CDI was confirmed by detection of toxins A and B of C. difficile in feces using enzyme-linked immunosorbent assay and immunochromatography. Metronidazole (2 g/day, in patients without comorbid pathology) and vancomycin (0.5–2 g/day) were used as a starting drug for up to 14 days. Statistical processing of the obtained data was performed using the Statistica for Windows, v.10 (StatSoft, USA) program. Results. CDI was confirmed by enzyme-linked immunosorbent assay in 202 (45.91%) patients, immunochromatography – in 149 (33.86%), endoscopically – in 203 (46.14%). CDI was most frequently recorded in 2 age groups of patients: 18–30 years old – in 137 (31.14%); over 60 years old – in 205 (46.59%). CDI was characterized by a combination of colitic and intoxication syndromes. In 43 (9.77%) patients the disease resulted in death. The diagnosis of PMС was established in 61 (13.86%) people. The risks of developing PMC when prescribing antibacterial drugs decreased in the following order: fluoroquinolones, cephalosporins, macrolides, penicillins, nitrofurans and chloramphenicol. Probiotic drugs reduced the risk of developing PMC (relative risk 0.5 [0.3; 0.7]; p=0.002). Conclusion. PMC was characterized by a combination of diarrhea, intoxication and abdominal pain. The formation of PMC was preceded by courses of antibacterial drugs of the fluoroquinolone and cephalosporin groups, eradication therapy for Helicobacter infection, the use of high doses of glucocorticosteroids, as well as intestinal superinfection in patients with previous episodes of CDI.

The aim of this controlled study was to identify polymorphisms in the genome of COVID­19 patients associated with the frequency of hospitalization.Materials and methods: Two groups of patients were formed: the main group – 56 patients with COVID­19, hospitalized at least twice during the study period, and the control group – 107 patients for whom only one hospitalization with COVID­19 was confirmed during the study period. Wholeexome sequencing of residual nasopharyngeal swabs from patients hospitalized with COVID­19 was performed on the MGI platform, followed by bioinformatics analysis and gene enrichment analysis.Result: For the first time, exome sequencing was performed from oropharyngeal swabs from 163 patients hospitalized with COVID­19 using the MGI platform. In the main group, unique variants of genetic polymorphisms were identified, including six previously undescribed ones.Conclusion: No genetic variants were statistically significantly associated with single or multiple hospitalizations of COVID­19 patients in the study. Nasopharyngeal swabs can be used for whole exome sequencing. Further studies are needed to identify unique genetic variants responsible for susceptibility to infectious diseases. Nasopharyngeal swabs can be used for whole­exome sequencing. Further studies are needed to identify unique genetic variants responsible for susceptibility to infectious diseases.

Goal. To investigate the spectrum of microorganisms, the level of antimicrobial resistance and to assess their effect on the outcomes of bacteremia among COVID­19 patients.Materials and methods. A retrospective analysis of potentially resistant bacteria detected in blood and the mortality rate among COVID­19 patients and patients with other diagnoses in the period from 01.01. – 12/31/2020.Results. In total, the analyzed pathogens were isolated from 168 patients, including 101 COVID­19 patients (group 1) and 67 patients with other diagnoses (group 2). Bloodstream infection were more often detected among COVID­19 patients (12.6 and 2.6 cases per 1000 patients, p<0.05). In group 1, the proportion of gram­-negative pathogens was higher than in group 2 (63.8% and 52.1%, p=0.012). The most commonly pathogen in group 1 is K. pneumoniae (31.5%, 41 cultures), in group 2 – S. aureus (35.2%, 25 cultures). Of particular importance is the identification of A. baumannii (32 and 4 cultures, p<0.001) and E. faecium (24 and 4 cultures, p=0.003) in group 1; S. aureus (25 and 11 cultures, p<0.001) and E. coli (9 and 6 cultures, p=0.038) – in group 2. Three leading types of microorganisms in group 1 have a high level of resistance: 96.9% of A. baumannii and 81.6% of K. pneumoniae were resistant to carbapenems, 36.8% of E. faecium was VRE. In group 1, several (22.8% and 6.0%, p=0.004) and resistant (70.3% and 41.8%, p<0.001) microorganisms were detected more frequently. The mortality rate of patients was higher in group 1 (68.3% and 50.7%, p=0.022). The occurrence of a bloodstream infection caused by a potentially resistant microorganism in COVID­19 patients is an unfavorable factor in the onset of death (p=0.022).Conclusion. COVID­19 patients with bacteremia have a high level of polymicrobial associations with a predominance of gram­-negative bacteria both in their composition and as a monoinfection. The isolated microorganisms have a high level of antimicrobial resistance, which must be taken into account when choosing antibiotics.

The issue of combating antimicrobial resistance has been relevant for several decades, since the arsenal of effective antibiotics used in infectious diseases is significantly reduced, and the development of new antibacterial drugs is significantly difficult and expensive. At the same time, the possibility of widespread use of bacteriophages in hospital settings is being discussed.Goal. Evaluation of the sensitivity to bacteriophages of hospital strains of K.pneumoniae isolated from patients in the departments of surgery and intensive care and intensive care of the Structure Clinical Infectious Disease Hospital named after S.P.Botkin.Materials and methods. The activity of bacteriophage preparations “Sextafag” (series p158, p220, p242), “Klebsiell polyvalent bacteriophage” (series y04, y07, y10, y16), “Polyvalent Pyobacteriophage purified” (series y10, y291022) (Manufacturer: NPO Microgen JSC, Moscow) was determined by preparing suspensions of microorganisms, their sowing on nutrient media with subsequent application of bacteriophages, taking into account and interpreting the results.Results. The majority of polyresistant K.pneumoniae strains showed sensitivity to the presented bacteriophage preparations, which allows them to be considered as additional antibacterial agents for the treatment of these groups of patients.Conclusion. The presented results of the study showed that hospital polyand pan­resistant strains of K.pneumoniae are sensitive to preparations of monoand polyvalent bacteriophages, which can be considered as a potential alternative in conditions of antibiotic resistance. The study did not reveal a link between the antibiotic resistance profile of the culture and sensitivity to bacteriophages.

We studied the risk factors, etiology, clinical manifestations, and treatment outcomes of COVID-19-associated invasive candidiasis (COVID-IC) in adult patients admitted to six medical facilities in St. Petersburg. (November 2020–December 2022). In this retrospective study, we included 72 patients with COVID-IC with a median age of 61 years (range 29–96), 51% of whom were women. The predisposing factors for COVID-IC were a central venous catheter (CVC) for more than 10 days (the odds ratio (OR) = 70 [15–309]), abdominal surgical treatment performed in the previous 2 weeks (OR = 8.8 [1.9–40.3]), bacteremia (OR = 10.6 [4.8–23.3]), pulmonary ventilation (OR = 12.9 [5.9–28.4]), and hemodialysis (OR = 11.5 [2.5–50.8]). The signs and symptoms of COVID-IC were non-specific: fever (59%), renal failure (33%), liver failure (23%), and cardiovascular failure (10%). Candida albicans (41%) predominated among the pathogens of the candidemia. The multidrug-resistant Candida species C. auris (23%) and C. glabrata (5%) were also identified. Empirical therapy was used in 21% of COVID-IC patients: azole-93%, echinocandin–7%. The majority of COVID-IC patients (79%) received, after laboratory confirmation of the diagnosis of IC, fluconazole (47%), voriconazole (25%), echinocandin (26%), and amphotericin B (2)%. The 30 days overall survival rate was 45%. The prognosis worsened concomitant bacteremia, hemodialysis, and long-term therapy by systemic glucocorticosteroids (SGCs), bronchial colonization with Candida spp. The survival prognosis was improved by the early change/replacement of CVC (within 24 h), the initiation of empirical therapy, and the use of echinocandin. Conclusions: We highlighted the risk factors that predispose COVID-19 patients to candidiasis and worsen the survival prognosis. Their individual effects in patients with COVID-19 must be well understood to prevent the development of opportunistic co-infections that drastically lower chances of survival.

Assessing the levels of serum IgG antibodies is widely used to measure immunity to influenza and the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) after natural infection or vaccination with specific vaccines, as well as to study immune responses to these viruses in animal models. For safety reasons, sometimes serum specimens collected from infected individuals are subjected to heat inactivation at 56 °C to reduce the risk of infecting personnel during serological studies. However, this procedure may affect the level of virus-specific antibodies, making the results of antibody immunoassays uninterpretable. Here, we evaluated the effect of the heat inactivation of human, ferret and hamster serum samples on the binding of IgG antibodies to the influenza and SARS-CoV-2 antigens. For this, serum samples of naive and immune hosts were analyzed in three variants: (i) untreated sera, (ii) heated at 56 °C for 1 h, and (iii) treated with receptor-destroying enzyme (RDE). The samples were studied through an in-house enzyme-linked immunosorbent assay (ELISA) using whole influenza virus or recombinant proteins corresponding to nucleocapsid (N) protein and the receptor-binding domain of SARS-CoV-2 Spike (RBD) as antigens. We demonstrated that the heat inactivation of the naive serum samples of various hosts can lead to false-positive results, while RDE treatment abolished the effect of the non-specific binding of IgG antibodies to the viral antigens. Furthermore, RDE also significantly decreased the level of virus-specific IgG antibodies in SARS-CoV-2 and influenza-immune sera of humans and animals, although it is unknown whether it actually removes true virus-specific IgG antibodies or only non-specifically binding artifacts. Nevertheless, we suggest that the RDE treatment of human and animal sera may be useful in preventing false-positive results in various immunoassays, while also neutralizing infectious virus, since the standard protocol for the use of RDE also includes heating the sample at 56 °C.

The first Russian clinical case of monkeypox in combination with herpes simplex type 1 infection in a 29-year-old man who returned from Portugal is described. The protocols for sequencing the virus genome are presented. Particular attention is paid to the difficulty of diagnosing vesicular rash in patients with a suspicious history.

Objective. To study the efficacy and safety of bulevirtide, the HBV and HDV entry inhibitor in patients with chronic hepatitis D, including compensated cirrhosis, in real practice. Materials and methods. Analysis of the interim 24-week results of bulevirtide therapy (monotherapy and combination with peginterferon) in 24 patients including patients with HIV co-infection. Results. After 24 weeks of treatment, the virological response rate was 75%, including patients on monotherapy (63%) and combination therapy (100%). The levels of HDV RNA declined by -2.9, -2.6 and -4.3 log10 copies/ml from initial, respectively. In 7 patients the level of HDV RNA was undetectable (3 patients on monotherapy, 4 patients on combination therapy). All patients had normal ALT. The effectiveness of treatment (virologic and biochemical response) increased with a longer treatment period, from 12 to 24 weeks. Treatment was well tolerated with no serious, severe or moderate adverse events reported. The discontinuation of treatment was observed in only one case, despite the achievement of a virological response, in an 80-year-old patient with cirrhosis, due to a deterioration in liver function, probably due to the progressive course of the disease. Conclusion. The interim real practice results demonstrated high efficacy and good tolerability of bulevirtide in patients with CHD (chronic hepatitis D), including compensated cirrhosis, and patients with HIV co-infection. Bulevirtide is recommended as the treatment of choice for CHD (as monotherapy or combination therapy with peginterferon). Key words: bulevirtide, chronic hepatitis D, combination therapy, HIV co-infection, monotherapy, peginterferon, real practice

Introduction. Several viruses including hepatitis C virus (HCV) and human immunodeficiency virus (HIV) can induce vasculitis. Aim. We aimed to study the incidence, risk factors, and severity of skin vasculitis in patients with HCV and HCV/HIV coinfection. Patients and Methods. T he study group included 331 patients (254 patients with HCV and 77 patients with HCV/HIV coinfection) referred to a specialized hepatology center for antiviral therapy of HCV infection. Results. Skin vasculitis was found in 21% (95% CI: 17–25%) of cases, n = 69/331. Skin vasculitis was observed in in 20% of patients infected with HCV (95% CI: 15–25%) and in 25% of HIV/HCV co-infected patients (95% CI; 16–35%), χ 2 = 0,892, р = 0,345. Most patients with vasculitis infected with HCV had cryoglobulinemia (94%, n = 47/50), meanwhile, in HIV/HCV co-infected patients, cryoglobulinemia was found in 63% cases ( n = 12/19), χ 2 = 10.568, р = 0.001. Multiple regression analysis showed that skin vasculitis was related with cryoglobulinemia (OR = 6,928, 95% CI: 3.245–14.790, р < 0.001), liver cirrhosis (OR = 2.015, 95% CI: 1.062–3.824, р = 0.032), duration of overt HCV infection (OR = 1.057, 95% CI: 1.021–1.094, р = 0.002), patients age (OR = 1.029, 95% CI: 1.002–1.057, р = 0.033) and inversely related with plasma alanine transaminase (OR 0.433, 95% CI: 0.229–0.820, р = 0.010). The statistical model was normalized for gender, HIV-positivity and bilirubin levels, and regression equation constant was 4.398 ( p < 0.001). The intensity of skin rashes was comparable in HCV infected and HCV/HIV co-infected patients ( χ 2 = 6.741, р = 0.081), and was highly correlated with cryoglobulin levels both in HCV infected ( r = 0.788, p < 0.001), and HCV/HIV co-infected patients ( r = 0.909, p = 0.001). Conclusion. Skin vasculitis was found in 20–25% of cases among patients with HCV infection and HCV/HIV co-infection. Cryoglobulinemia was the main factor associated with skin vasculitis, and severity of skin lesions was closely related with cryoglobulin levels.

Background: Glecaprevir/pibrentasvir (GLE/PIB) is the first pangenotypic ribavirin-free regimen allowing for treatment duration as short as 8 weeks for the majority of patients with chronic hepatitis C (CHC) genotypes (GT) 1 to 6. The results of clinical trials showed good tolerability of GLE/PIB and high virologic response rate (mostly >95%) among different patient populations. The main objective of this study was to determine how the efficacy and safety of GLE/PIB translates into real-world clinical settings in Russia. Materials and Methods: This was a prospective, multicenter observational study in patients with CHC who received the GLE/PIB regimen. The treatment regimen was prescribed by a physician in accordance with all applicable requirements before the enrollment in the study. Patients were observed for the duration of GLE/PIB therapy and at least for up to 12 weeks after the treatment completion. Real-world data were collected in patient records. Follow-up visits, procedures, and diagnostic methods followed physicians’ routine clinical practice. Results: Overall 161 patients were enrolled in the study in 11 study sites of them 128 patients had sufficient follow-up data to assess sustained virological response 12 weeks [i.e. ≥70 days] after the end of treatment with GLE/PIB (SVR12). Overall, 127 out of 128 patients (99.2%) achieved SVR12. Depending on treatment duration the following SVR12 rates were achieved: 98.7% in 8-week group (75/76), 100% in 12-week group (49/49) and 100% in 16-week group (3/3). One patient failed to achieve SVR, the exact reasons of failure couldn’t be established by the Investigator. Since only one patient didn’t achieve primary endpoint the following SVR12 rates were achieved in different subpopulations: 91.7% in patients with GT2 (11/12); 98.9% in non-cirrhotic patients (88/89); 99.1% in treatment-naïve patients (113/114); 99.1% in patients without HIV co-infection (116/117); 99.2% in patients younger than 65 years (120/121). On the other hand, SVR12 was achieved by all patients (100%) in the following subpopulations: patients with GT3 (n=76), GT1a (n=5), GT1b (n=29) and other GTs (n=6); cirrhotic patients (n=36) and those with unknown cirrhosis status (n=3); treatment-experienced patients (n=14); HIV/HCV co-infected patients (n=11); patients older than 65 years (n=7); and drug users (n=10). No clinically significant abnormalities in the key laboratory parameters were noted during the study. On contrary, the overall improvement of the liver enzymes was observed at SVR12 Visit. There were 3 patients with 3 adverse events (AEs): 2 cases were mild (cough and rash), and 1 case was severe and evaluated as a serious AE (hepatic decompensation). Hepatic decompensation led to the patient withdrawal from the study; this serious AE was preceded by 2 months of daily alcohol consumption and in the investigator’s opinion was not related to GLE/PIB intake. Of all AEs only rash was related to GLE/PIB administration according to investigator’s opinion. Conclusion: GLE/PIB has proven to be a highly effective treatment regimen in the routine clinical practice in patients with all hepatitis C virus genotypes, including those with GT3 and compensated liver cirrhosis. SVR12 rates demonstrated in this study are fully consistent with the previously published data. The regimen was well tolerated by patients.

The aim of the analysis was to describe the results of administration of pan-genotype antiviral therapy (glecaprevir / pibrentasvir, GLE / PIB) in real-world setting in three clinical centers in St. Petersburg within the city program for the treatment of chronic hepatitis C. Materials and methods. A retrospective analysis of the GLE / PIB usage of in the period from 2019 to 2022 within the city program for the treatment of chronic hepatitis C in St. Petersburg was carried out. Results. The analysis included 464 patients treated in three clinical centers of St. Petersburg: St. Petersburg State Medical Institution “Clinical Infectious Diseases Hospital named after S. P. Botkin”, St. Petersburg State Medical Institution “Center for the Prevention and Control of AIDS and Infectious Diseases” and the Clinic of Infectious Diseases of the Military Medical Academy named after S. M.Kirov”. Overall 452 out of 464 patients (97 %) achieved SVR12. According to the duration of treatment, SVR12 rates were the following: 8 weeks – 97.7 % (419 / 429), 12 weeks – 92.9 % (26 / 28) and 16 weeks – 100 % (7 / 7). The effectiveness according to fibrosis stage was as follows: F0 – 97 % (142 / 146), F1 – 100 % (74 / 74), F2 – 100 % (59 / 59), F3 – 98 % (57 / 58), F4 (CP-A, B) – 94 % (118 / 125). SVR12 according to HCV genotypes and subtypes was the following: genotype 1b – 100 % (63 / 63), genotype 1a – 91 % (21 / 23), genotype 1 unspecified – 100 % (23 / 23), genotype 2 – 98 % (50 / 51), genotype 3 – 97 % (292 / 301). In patients with an indeterminate genotype, the efficacy was 100 % (7 / 7). Antiviral therapy was well tolerated, there were no cases of discontinuation of therapy, as well as cases of the development of serious adverse events. Conclusion. GLE / PIB has demonstrated high effectiveness in the real-world setting in patients infected with prevalent genotypes of HCV, including those with genotype 3 and compensated liver cirrhosis. The results of our analysis fully correspond to the data obtained earlier in clinical trials andreal-world setting.

The aim of the study was to analyze the mortality of patients infected with the hepatitis C virus (HCV) and co-infected with the human immunodeficiency virus (HIV) with extrahepatic manifestations associated with cryoglobulinemia, and to assess the dependence of the risk of fatal outcome on such predictors as the presence of HIV infection, the presence of cirrhotic liver transformation, antiviral therapy (AVT) of chronic hepatitis C, cryoglobulin levels.Materials and Methods. The prospective study included 125 patients with HCV (n=92) and HCV/HIV infection (n=33) who had extrahepatic manifestations (arthralgia and/or skin hemorrhagic rashes and/or polyneuropathy and/or or Raynaud’s syndrome and/or xerophthalmia and/ or chronic kidney disease), as well as cryoglobulins.Results. 19 out of 125 patients (15% (95% CI 10-23%)) died in the follow-up period from 1 to 170 months (median 57 months), among which 12 people did not receive AVT for HCV infection during the follow-up period and 7 patients underwent AVT during the observation period. Unadjusted mortality among patients treated with AVT was 9% (95% CI 5–18%) (n=7/77), those who did not receive it was 25% (95% CI 15–39%) (n=12/48), χ2=5,806, p=0,016. Cox regression analysis showed that an increase in the risk of death is associated with the presence of cirrhotic liver transformation by 5,3 times and the absence of AVT by 3,7 times. The main causes of death in 69% of cases were causes not associated with liver pathology, in 26% were complications of liver cirrhosis (bleeding or progressive encephalopathy), in one case (5%) the cause of death remained unknown.Conclusions. Мortality among patients with HCV or HCV/HIV infection complicated by the development of extrahepatic manifestations associated with cryoglobulinemia is higher in the absence of AVT than in the case of AVT. Cirrhotic liver transformation and the absence of AVT significantly affect the risk of death. Patients with extrahepatic manifestations die mainly from causes not associated with liver pathology.

The article presents the results of a two-year work of the Clinical Infectious Diseases Hospital named after S.P. Botkin (Botkin Hospital) during the pandemic of a new coronavirus infection from March 01, 2020 to March 01, 2022. The characteristics of patients with a new coronavirus infection by age, severity of the disease, need for intensive care, including mechanical ventilation and ECMO, are given. Estimated hospital mortality from a new coronavirus infection. The contribution of concomitant infectious diseases (HIV infection, chronic viral hepatitis) to the lethality of patients with COVID-19 is presented. The volumes of assistance to pregnant women, women in childbirth and puerperas with COVID-19, as well as patients on program hemodialysis are presented. The structure of hospitalized patients according to nosological forms was analyzed. Against the backdrop of a massive influx of patients with COVID-19, a sharp decrease in hospitalization of patients with other infectious diseases was noted.

The new coronavirus infection (COVID-19) has become a truly global challenge for all of humanity, and, above all, for the healthcare system. Among its most important aspects that require careful analysis are the clinical and laboratory features of the course of the disease, which make it possible to determine approaches to pathogenetic therapy in severe forms of the disease.Materials and methods. A retrospective analysis of the medical records of patients with severe COVID-19 who were hospitalized in St. Petersburg State Budgetary Infectious Diseases Clinical Hospital named after S.P. Botkin” in 20202022. Clinical and laboratory characteristics were assessed, including levels of C-reactive protein, interleukin-6, and fever dynamics. The criteria for prescribing drugs for pathogenetic therapy in patients with COVID-19 and their effectiveness were determined.Results. In the treatment of patients with COVID-19, it is necessary to carefully evaluate the clinical picture of the course of the disease, which is ahead of changes in laboratory parameters. The introduction of humanized antibody preparations leads to a regression of general infectious symptoms, subjective and objective manifestations of respiratory failure and, as a result, to a reduction in the length of stay of patients in the hospital. It is extremely important to timely preventive administration of drugs during the period of increasing “cytokine storm”. The optimal time for prescribing drugs is 1–3 days from the moment of receipt, until the patient is transferred to a ventilator.

Частота регистрации смешанной криоглобулинемии и ее значение в развитии внепеченочных проявлений при хроническом гепатите С и при коинфекции хронический гепатит С/ВИЧ-инфекция ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ 1 Санкт-Петербургское государственное бюджетное учреждение здравоохранения «Центр по профилактике и борьбе со СПИД и инфекционными заболеваниями», 190103, г.Санкт-Петербург, Российская Федерация 2 Федеральное государственное бюджетное образовательное учреждение высшего профессионального образования «Первый Санкт-Петербургский государственный университет имени академика И

The fight against a new coronavirus infection (SARS-CoV-2) has been ongoing for more than two years and has clearly been delayed, necessitating an epidemiological assessment of the status of the solution, successes and shortcomings in the control of the problem on both global and regional scales. An monitoring, epidemiological analysis of SARS-CoV-2 morbidity and mortality in WHO regions and selected territories by month and week for 2020–2021 and partly for 2022 was performed. It was found that the monthly trend of morbidity and mortality in their comparison across WHO regions and in individual countries repeats to some extent the weekly dynamics, but is not equal to it in the territories under comparison. It shows the wavelike epidemic process of the new coronavirus infection caused mainly by the emergence and circulation of new variants and subvariants of the pathogen among the population. An attempt was made to explain some features of the wavelike course of the epidemic process of COVID-19 depending on a number of other additional risk factors. Significant risk factors for the spread of the infection include a low level of social responsibility of the population not providing the necessary amount of measures (masking regime, non-compliance with social distance), uncontrolled travel regulation and, finally, a low level or complete absence of collective immunity to new mutation variants of the virus. Collective immunity formed as a result of disease transmissions and specific prophylaot pxis does protect completely against infection with new virus variants, but ensures a lighter course of the disease in cases of infection, reduced hospitalizations and deaths. Morbidity and mortality from COVID-19 in Russia, Moscow and St. Petersburg are also characterized by a wave-like course, however the indicators at the height of waves and in the intervals between them don’t decrease. The reason for this situation could be overdiagnosis, shortcomings in identifying the new variant of the virus. The delta variant, characterized by a more severe clinical course and unfavorable outcomes, is still circulating in some territories. Therefore, vaccination with coverage of 80 % of the population, including 60 % of the booster dose should ensure a decrease in the incidence and prevalence of all variants of the virus, the frequency of hospitalizations and deaths. Proceeding from the wave-like nature of the epidemic process in Russia and its metropolitan areas, all preventive measures should be strengthened not only at the peak of the epidemic, but also between waves in order to prevent infections and reduce morbidity and mortality. The need for measures is evidenced by the dynamics of increasing rates from the summer to the autumn-winter period of the year. However, analysis of weekly dynamics of morbidity should be taken as a basis for monitoring and accounting for changes in the epidemic process.

Chronic kidney disease (CKD) is a significant cause of morbidity and mortality among patients infected with human immunodeficiency virus (HIV). The Central and East Europe (CEE) region consists of countries with highly diversified HIV epidemics, health care systems and socioeconomic status. The aim of the present study was to describe variations in CKD burden and care between countries. The Euroguidelines in the CEE Network Group includes 19 countries and was initiated to improve the standard of care for HIV infection in the region. Information on kidney care in HIV-positive patients was collected through online surveys sent to all members of the Network Group. Almost all centres use regular screening for CKD in all HIV (+) patients. Basic diagnostic tests for kidney function are available in the majority of centres. The most commonly used method for eGFR calculation is the Cockcroft–Gault equation. Nephrology consultation is available in all centres. The median frequency of CKD was 5% and the main cause was comorbidity. Haemodialysis was the only modality of treatment for kidney failure available in all ECEE countries. Only 39% of centres declared that all treatment options are available for HIV+ patients. The most commonly indicated barrier in kidney care was patients’ noncompliance. In the CEE region, people living with HIV have full access to screening for kidney disease but there are important limitations in treatment. The choice of dialysis modality and access to kidney transplantation are limited. The main burden of kidney disease is unrelated to HIV infection. Patient care can be significantly improved by addressing noncompliance.

Clinical characteristics and pathomorphological manifestations in 69 patients aged 18 to 86 years with a fatal outcome of the disease were examined in order to analyze the causes of severe course and high mortality of generalized forms meningococcal infection. It was found that the main clinical form was meningococcemia (90%), in the majority in combination with meningitis (52%). The fulminant course in 77% of patients with meningococcal sepsis manifested itself as a sudden onset, rapid development of typical symptoms. Hemorrhagic exanthema was detected on the first day of meningococcemia. The leading complications and critical conditions were infectious-toxic shock, disseminated intravascular coagulation and acute adrenal insufficiency (Waterhouse-Friederiksen syndrome). The severe course of meningitis (in 10%) led to the development of cerebral coma, the morphological substrate of which was edema - swelling of the brain.