Objective. To analyze specific characteristics and mechanisms underlying the development of organ pathology in patients with chronic brucellosis (CB). Patients and methods. This study included more than 500 patients with CB treated in Saratov hospitals in 2003–2018. In addition to standard examination, all study participants have undergone the assessment of their lipid peroxidation/antioxidant defense system, levels of major cytokines, markers of endotoxicosis (ET), and tissue-specific autoreactive antibodies. Results and discussion. The vast majority of patients (98.2%) had their musculoskeletal system affected; lesions to the autonomic nervous system and peripheral nervous system were observed in 97.5% and 88.8% of patients, respectively; almost half of males (45%) had their reproductive organs affected; approximately one-third of participants (26.7–32.9%) had cardiovascular disorders with myocardial lesions. The severity of systemic inflammation, ET, and autoimmune reactions depended on the CB activity and determined the development of organ pathology. We found that vascular and mechanical factors were important for the development of lesions to the peripheral nervous system and reproductive organs in men. Patients, in whom the diagnosis of CB was verified 2 years following onset of symptoms, were more likely to develop exacerbations, had more organs and systems affected, and had higher risk of disability. Conclusion. Comprehensive examination revealed multiple organ lesions in all CB patients, associated not only with damage caused by the pathogen at the site of specific inflammation, but also with the involvement of vascular and mechanical factors, as well as the consequences of systemic inflammatory response, ET, and autoimmune reactions. Late diagnosis was associated with more severe clinical manifestations of CB. Key words: brucellosis, clinical manifestations of chronic brucellosis, systemic inflammation, endotoxicosis

The symptoms similar to those detected in rheumatic diseases in patients infected with human immunodeficiency virus (HIV) are due to various pathogenetic mechanisms (immune cell imbalance, antibody production, etc.). The occurrence of rheumatic symptoms and syndromes in HIV infection can lead to diagnostic errors and wrong treatment policy (use of immunosuppressive therapy instead of high-dose antiretroviral therapy). The paper describes two clinical cases of HIV infection in the stage of acquired immunodeficiency syndrome (AIDS) in young and middle-aged women, who were misdiagnosed rheumatic diseases at baseline. In the first case, a 34-year-old woman was suspected to have systemic lupus erythematosus before HIV infection diagnosis, whereas the leading clinical syndrome was nephropathy (nephrotic syndrome, hypertension). In the other case, in a 62-year-old woman, the manifestations of the advanced stage of HIV infection at baseline were regarded as mixed connective tissue disease, while the greatest similarity was found in the concurrence of Sjö gren’s syndrome. The paper discusses the reasons for diagnostic difficulties in each case and the specific features of organ damages in comparison with the data available in the literature.

The article presents the results of urological examination (spermograms and data of ultrasound examination) of 22 patients with chronic brucellosis and diseases of the scrotum (6 patients with orchitis, 16 with orchiepididymitis) before and after conventional therapy (10 patients) and combined treatment with the inclusion of cycloferon (2 courses of 5 intramuscular injection [0.25 g] with an interval of 10 days)--12 patients. It is shown that the administration of cycloferon leads to more effective relief of intoxication symptoms and inflammation in the testes and appendages (reduction of scrotal wall thickness, size of testes and/or adjuncts, and the incidence and severity of hydrocele), and has a positive effect on spermatogenesis (reduction of semen viscosity, the number of white blood cells in semen, sperm agglutination associated with the formation of sperm antibodies in most patients after treatment), as well as reduces the number of exacerbations of chronic orchitis/orchiepididymitis by 2.4 times.

Проведено урологическое обследование 150 мужчин, больных хроническим бруцеллезом, и 150 здоровых жителей сельской местности без бруцеллеза в анамнезе с заведомо известной фертильностью. Поражение урогенитального тракта встречается у 14–27 % сельских жителей мужского пола. Наличие бруцеллезной инфекции повышает распространенность данной патологии до 37–52 %. При этом наиболее часто диагностируются хронические простатит, орхоэпидидимит и орхит. К особенностям поражения репродуктивной системы при бруцеллезе можно отнести более раннее развитие нарушений копулятивной функции и увеличение в структуре хронического простатита (ХП) доли воспалительного ХП. Результаты проведенного исследования позволяют говорить о высокой степени обусловленности хронического простатита и орхоэпидидимитов наличием хронической бруцеллезной инфекции.

Clinical and pathogenetic efficacy of cytoflavin as a component of combined therapy of chronic brucellosis was tested in 50 patients who repeated its beneficial effect on the quality of life. The mechanism of cytoflavin action consists of lowering severity of endogenous intoxication and systemic inflammation.

The comparative characteristic of physiotherapeutic and reflexotherapeutic techniques of EHF-therapy is presented. It is shown that application of the technique with individual selection of influence points of low-intensive electromagnetic radiation (EMR) of the extremely high-frequency (EHF) a range and with possibility of correction in the course of treatment raises its efficiency in a greater degree, than applica-tion of uniform scheme EHF-therapy.

Patients with chronic brucellosis underwent a complex clinical and laboratory studies to determine the indicators reflecting the degree of systemic inflammation and endotoxicosis. On the basis of an analysis of the findings, an integral quantitative approach was applied to describing the associations between various pathophysiological processes and clinical manifestations; criteria for the activity of the infectious process were objectivized, and the form of chronic brucellosis was defined. The mathematical simulation method was shown to be an adequate tool to objectivized the differential diagnosis of the clinical forms of the disease.