AIMDiabetes mellitus (DM) is known to be a risk factor in adverse outcomes and complications in many infectious diseases. In the combination of hemorrhagic fever with renal syndrome (HFRS) and DM there are mutually exclusive pathogenetic States - hyperosmolarity, characteristic of DM is layered on the reduction of osmotic blood pressure in HFRS. Under these conditions, the effect of one disease (DM) on the clinical manifestations of another (HFRS) is not obvious. The aim of the work is to find out the clinical features during hfps in patients with DM.MATERIALS AND METHODSThe study is based on the results of the retrospective studies "case - control" - studied the information contained in medical records of patient (form 003/u), who suffered HFRS in 2006-2018. The Selection of cards produced randomly. In the end, there were formed two groups: the first - 981 patient who suffered HFRS and had no signs of diabetes; the second, 33 patients who suffered HFRS on the background of previously existing (28 people), or the first identified (5) diabetes.RESULTSWith a combination of HFRS and DM, a mild course of the disease is 2.5 times more common, there are no severe forms. Among this group of patients, complications are almost 10 times less common, less likely to develop infectious - toxic shock, acute kidney damage (class F by RIFLE), pulmonary edema. The combination of DM and HFRS is manifested by less high and prolonged fever, less high levels of urea and creatinine in the blood.CONCLUSIONHFRS in combination with DM is easier, apparently, high osmolarity of the blood is a stabilizing factor during the disease.

We analyzed more than 30 original articles and reviews to evaluate the current state of the issues of epidemiology, treatment, and prevention of hemorrhagic fever with renal syndrome in the world. A literature search was conducted using the Cochrane Library, PubMed, eLIBRARY databases and official WHO, UR Rospotrebnadzor, Rospotrebnadzor of the Russian Federation, and Center for Disease Control and Prevention data. Hemorrhagic fever with renal syndrome (HFRS) is an acute infectious disease characterized by fever, hemodynamic disorders, hemorrhagic syndrome and kidney damage in the form of acute interstitial nephritis with the development of acute kidney injury. It is caused by RNA-containing viruses of the Hantaan genus, belongs to the group of zoonotic infections, and is transmitted through the air. The Udmurt Republic is one of the regions of the Volga Federal District endemic for HFRS. Annually, from 300 to 2,000 people get sick in the territory of the republic. HFRS affects the most able-bodied part of the population, mainly men aged 20-50. Mortality reaches 20% in certain years of observation. The doctor’s lack of caution regarding HFRS (the initial period of the disease has similar symptoms with acute respiratory diseases) leads to late hospitalization of the patient, often with serious complications that are fatal. The main diagnostic search is carried out by the general practice service of the outpatient clinic. The materials of the article can help to correctly establish a preliminary diagnosis, taking into account clinical and epidemiological data, as well as to prescribe the necessary amount of laboratory and instrumental tests to clarify the diagnosis.

Ixodes tick-borne borrelioses (ITBB) are caused by two different spirochetes: Borrelia from the group of Borrelia burgdorferi sensu lato, the agents of the classic Lyme borreliosis (LB), and Borrelia miyamotoi that belongs to the group of Borrelia causing tick-borne relapsing fevers. ITBB caused by B. miyamotoi (BM-ITBB) is a previously unknown infectious disease discovered in Russia. It is known that the LB sequelae may reduce the long-term life guality of convalescents.AIMTo study the follow-up of those who have recovered from new BM-ITBB infection in comparison with persons who have had LB.SUBJECTS AND METHODSThe investigation enrolled 41 patients with BM-ITBB and 41 patients with LB who were treated at the Republican Infectious Diseases Hospital of Udmurtia. Within a year after the disease, they were followed up through clinical and instrumental examination of cardiac performance, expanded biochemical analysis of blood and urine, which could; estimate kidney and liver functions, and psychological questioning.RESULTSAsthenic syndrome and complaints about and objective signs of cardiac dysfunctions persisted supraventricular extrasystoles, left ventricular diastolic dysfunction, and elevated and/or unstable systolic blood pressure were detected in 20-30% of the convalescents for a long time. Kidney dysfunctions were manifested in albuminuria and the decrease of glomerular filtration rate. A year following the disease, 10-20% patients had persistently elevated concentrations of alanine aminotransferase, aspartate aminotransferase, and C-reactive protein and had higher levels of total cholesterol and low-density lipoproteins. The pathological consequences of ITBB were polymorphic and varied in different patients; in general, only 68% of them showed health improvement.CONCLUSIONWe assume that a significant role in the pathogenesis of BM-ITBB and LB is played by vascular endothelial damage possibly associated with the inflammatory and autoimmune aspects of an immune response in Borrelia infection. The consequences of this damage may persist and even intensify during a year, which provokes chronic dysfunction of the heart, kidney, or liver in a number of convalescents.

The purpose of the study the clinical picture of a «new» infection — ixodic Lyme borreliosis caused by B. miyamotoi. The work is based on the results of a prospective observation of 76 patients with disease caused by B. miyamotoi. Diagnosis is confirmed by PCR. The study shows that a syndrome of fever and a manifestation of intoxication — headache, fatigue, myalgia, vomiting and other substances are at the heart of a typical clinical picture. In some cases, for unclear reasons, the pathological process involves internal organs — lungs, liver, kidney, gastrointestinal tract, heart. This fact may be the cause of a diagnostic error.

linico-functional analysis of the heart in 48 patients with tick-borne borreliosis in the acute period was conducted. It were e valuated the data of physical, electrocardiographic and echocardiographic studies, as well as the activity of cardiospeci fi c enzymes in blood se-rum. Presented clinical symptoms of heart disease, the frequency of patients with borreliosis, caused by borrelia burgdorferi s ensu lato and borrelia myamotoi. ECG abnormalities, echocardiogram picture of heart disease were described. Identifi ed clinical and functional changes fi t into the manifestations of benign myocardiodystrophy and less favorable myocarditis.

Сlinico-functional analysis of the heart in 48 patients with tick-borne borreliosis in the acute period was conducted. It were evaluated the data of physical, electrocardiographic and echocardiographic studies, as well as the activity of cardiospecific enzymes in blood serum. Presented clinical symptoms of heart disease, the frequency of patients with borreliosis, caused by borrelia burgdorferi sensu lato and borrelia myamotoi. ECG abnormalities, echocardiogram picture of heart disease were described. Identified clinical and functional changes fit into the manifestations of benign myocardiodystrophy and less favorable myocarditis.