Botulism is an acute infectious disease caused by a neutrotoxin produced by the bacterium Clostridium botulinum and characterized by severe bulbar lesions. Botulism is characterized by the complexity of diagnosis and in adverse cases can lead to death. At the moment, in the complex therapy of botulism, the introduction of a mixture of antitoxic serums is mandatory. In addition to specific treatment, pathogenetic therapy is performed for all patients. Specific prophylaxis is carried out with polyanatoxin to a narrow group of people in contact with Clostridium botulinum or their toxins. However, neutralizing anti-botulinum antibodies may be detected in the blood serum of a number of individuals, which have a protective effect when encountering an infection. This article presents a clinical case of severe botulism in an adult patient with simultaneous absence of symptoms of the disease in family members.Botulinum toxin preparations have long been used in aesthetic medicine. It is worth noting that the botulinum toxin molecule has a high molecular weight and can cause an immune response with repeated injections, especially in areas rich in lymph nodes. Forming specific antibodies belong to the IgG class and may have neutralizing properties. In the above clinical case, the patient’s wife, during repeated injections of botulinum toxin, most likely, the formation of neutralizing antibodies occurred, which, in turn, protected the woman from the disease.

Objective. The purpose of the work was to study the clinical picture of acute brucellosis in patients of brucellosis in the Astrakhan region at the present stage. Due to the presence of epizootic foci of brucellosis in AO and the incidence of brucellosis among people, clinicians should pay attention to the clinical and epidemiological picture and diagnosis of this disease.Materials and methods. A clinical retrospective analysis of 46 case histories of patients with acute brucellosis who were treated at the regional Infectious Diseases Clinical Hospital named after A. M. Nichoga in 2012-2021 was carried out. A descriptive method was used to study the medical histories of patients with acute brucellosis. The epizootic situation of brucellosis in JSC was studied on the basis of data from Rospotrebnadzor (reporting forms for 2012-2021, form 2).Results. Among the patients, 38 males (82.6%) prevailed. There were 8 women (17.4%). The age of patients with acute brucellosis ranged from 18 years to 77 years. The patients were mainly young and middle-aged people (under 50 years old) – 36 patients (78.3%). There were 10 patients aged 51-77 years (21.7%). The average age was 41.4 ± 2.39 years. Acute brucellosis was recorded mainly in the spring and summer period of the year. In March-August, 39 cases (84.8%) were detected, in autumn – 6 cases (13.0%), in winter – 1 case (2.2%). In most patients, the disease began acutely with chills (84.8%), in some patients with tremendous chills and a rapid increase in body temperature to high numbers (39-40 °C). Fever was observed in all patients (100%). In most cases (69.6%), the fever was subfebrile, did not exceed 38.0 °C. 11 (23.9%) patients had febrile body temperature (up to 40.0 °C) and 3 patients had hyperpyretic (up to 40.6 °C). However, febrile fever was short-lived and persisted for 5-8 days. Then the body temperature dropped to subfebrile numbers. In general, the fever in patients with brucellosis was undulating and lasted 10-15 days.Conclusion. Thus, in the Astrakhan region, the epidemiological and epizootic situation for brucellosis is unstable. The incidence of brucellosis in cattle and small cattle is registered annually in the region. Acute brucellosis in humans is registered annually in isolated cases and has a moderate course.

The Astrakhan region is not a natural focus of Lyme borreliosis, however, the geographical proximity of endemic territories contributes to the migration of this disease. In 2019, for the first time, a case of Lyme disease was registered in a resident of Astrakhan, who was on vacation in Kislovodsk. In 2022, 3 cases of Lyme disease were again reported in residents of Astrakhan who traveled to regions endemic for tick-borne borreliosis. In 2022, Lyme disease was detected in a resident of Astrakhan who did not travel to the Lyme-borreliosis-endemic regions.

Objective. To study the features of the clinical picture of mixed intestinal infections in patients treated at the Regional Infectious Clinical Hospital named after A.M. Nichoga in the period from 2017 to 2021. Materials and methods. The clinical picture was studied in 55 patients with mixed intestinal infection who were treated at the Regional Infectious Hospital named after A.M. Nichoga (Astrakhan). Results. Mixed intestinal infections in most cases were registered in the summer-autumn period (51 % 92.7 %) in the form of sporadic morbidity. Epidemiological anamnesis data show that the majority of patients drank unboiled water, swam in the river, where they accidentally swallowed water, consumed food products of questionable quality, chicken meat, eggs insufficiently heat-treated, unwashed vegetables and fruit. Four patients arrived in Astrakhan from amoebiasis-endemic regions (Uzbekistan, Turkmenistan, Turkey, Egypt); 51 patients (92.7 %) had a moderate form of the disease,4 patients (7.3 %) a severe form. The clinical picture of mixed intestinal inflections was characterized by the symptoms of shigellosis and salmonellosis. Two patients, diagnosed shigellosis + amoebiasis had manifestations of ulcerative colitis complicated by intestinal bleeding; 2 patients, diagnosed salmonellosis + amoebiasis, developed dehydration shock. The treatment of patients with a severe form was carried out in the Intensive Care Unit and Resuscitation Unit of the Regional Infectious Clinical Hospital. Conclusions. The clinical picture of mixed bacterial intestinal infections and intestinal amoebiasis is mainly determined by the symptoms of shigellosis and salmonellosis and is manifested by the phenomena of intoxication, dehydration and the development of colitic and gastroenterocolitic syndromes.

Журнал для непрерывного медицинского образования врачей Случай завозной тропической малярии у жителя АстраханиВ ПОМОЩЬ ПРАКТИКУЮЩЕМУ ВРАЧУ Федеральное государственное бюджетное образовательное учреждение выс

Acute intestinal infections, including intestinal amebiasis, remain a pressing public health problem. Amebiasis still represents an important and partially solved problem to health care. In the Astrakhan region, intestinal amebiasis is being continuously recorded. We analyzed the clinical picture of acute intestinal amebiasis in 150 adult patients dominated by female patients comprising 60.7%, aged 18 to 79 years old, and treated within 2010–2016 at the Regional Infectious Clinical Hospital. All patients were mostly of young and middle age (up to 50 years) — 108 patients. More than 50% of patients were admitted to the hospital within the first three days of the disease. However, in 35 cases (23.3%), late hospitalization was carried out (5 days after the onset). Proper diagnosis was made to 44 patients (29.3%), most commonly diagnosing preliminarily with acute gastroenteritis and acute dysentery. All cases of intestinal amebiasis were confirmed by detecting in the feces of patients with a vegetative form of entamoeba histolytica. The disease was featured with sporadic course, being mostly recorded during the summer-autumn period (78.0%). In 142 patients (94.7%), the moderate severity was observed. Cardiovascular disorders were mainly found in severe amebiasis as well as patients comorbid with cardiovascular diseases. A coprological method was used to confirm the diagnosis. Microscopic examination of feces was carried out immediately after defecation (warm type). A combination therapy was applied to patients with intestinal amebiasis. A great attention was paid to patient nutrition: high-protein sparing diet, grated food. Patients with ulcerative colitis received individualized diet (restricted carbohydrates, exclusion of milk and fiber). Etiotropic therapy was carried out with using 5-nitroimidazole preparations: metronidazole (Trichopol, Flagin, Tiberal), MacGioror, Tinidazole (Phasycin) combined with tetracycline. The treatment included group B vitamin cocktail, methyluracil (suppository), enzymes (creon, mezim, pancreatin), enterosorbents (smecta, polyphepan, enterosgel), antispasmodics (no-spa, drotaverin). Patients were administered with therapeutic microenemas containing furacilin solution, rosehip oil, and sea buckthorn oil. Infusion therapy consisting of polyionic solutions was applied by assessing blood electrolyte level. Fresh frozen plasma and albumin were transfused upon decline of serum protein and albumin level. Packed erythrocytes Erythrocyte mass and hemostatic drugs were injected in case of severe intestinal amebiasis if indicated: dicynone, cryoprecipitate, and calcium preparations. Finally, anemia cases were treated as well. In all cases, the disease outcome was favorable, without any mortality. Complications were noted in the form of intestinal bleeding observed in 6 patients (4.0%), wherein amebiasis proceeded together with ulcerative colitis. Acute intestinal amebiasis is currently featured with typical clinical picture that proceeds with less severe symptoms. Intestinal bleeding was observed in patients with intestinal amoebiasis in combination with ulcerative colitis. Chronization of intestinal amebiasis occurs in single cases (3.9%).

AIM. To lay down criteria for the differential diagnosis of Crimean-Congo hemorrhagic fever with a number of natural focal diseases prevalent in the Astrakhan region. METHODS. A retrospective analysis of clinical, epidemiological and laboratory data of patients with Crimean-Congo hemorrhagic fever (74 cases), Astrakhan rickettsial fever (75), Q fever (75) and leptospirosis (25) was carried out in 2000-2013. RESULTS. The basic clinical symptoms characteristic of the Crimean-Congo hemorrhagic fever for the differential diagnosis of Astrakhan rickettsial fever, Q fever and leptospirosis were distinguished. The early diagnosis of Crimean-Congo hemorrhagic fever was based on the epidemiological data taking into account spring-summer seasonality of the disease, patient’s visits to countryside, contact with animals, and data about tick bites and contact with ticks. Timely prescription of adequate antiviral and pathogenetic therapy helped to reduce the rate of severe forms and mortality from Crimean-Congo hemorrhagic fever. CONCLUSION. Differential diagnostic features of Crimean-Congo hemorrhagic fever were: the presence of the primary affect on the site of the tick bite, high body temperature, two-wave fever, significant signs of intoxication, the relative and absolute bradycardia, hemorrhagic rash, abdominal bleeding, changes of peripheral blood leukopenia and thrombocytopenia.

Aim. To lay down criteria for the differential diagnosis of Crimean-Congo hemorrhagic fever with a number of natural focal diseases prevalent in the Astrakhan region. Methods. A retrospective analysis of clinical, epidemiological and laboratory data of patients with Crimean-Congo hemorrhagic fever (74 cases), Astrakhan rickettsial fever (75), Q fever (75) and leptospirosis (25) was carried out in 2000-2013. Results. The basic clinical symptoms characteristic of the Crimean-Congo hemorrhagic fever for the differential diagnosis of Astrakhan rickettsial fever, Q fever and leptospirosis were distinguished. The early diagnosis of Crimean-Congo hemorrhagic fever was based on the epidemiological data taking into account spring-summer seasonality of the disease, patient’s visits to countryside, contact with animals, and data about tick bites and contact with ticks. Timely prescription of adequate antiviral and pathogenetic therapy helped to reduce the rate of severe forms and mortality from Crimean-Congo hemorrhagic fever. Conclusion. Differential diagnostic features of Crimean-Congo hemorrhagic fever were: the presence of the primary affect on the site of the tick bite, high body temperature, two-wave fever, significant signs of intoxication, the relative and absolute bradycardia, hemorrhagic rash, abdominal bleeding, changes of peripheral blood - leukopenia and thrombocytopenia.