Diseases and pathogenes
Ventilator-Associated Pneumonia: Debatable Questions in Terminology, Diagnostics and Empirical Antimicrobial Therapy
V.A. Rudnov
Ural State Medical Academy, Ekaterinburg, Russia
The present literature review is devoted to the one of the actual problems in the intensive care units – to the nosocomial pneumonia that is developing during mechanical ventilation (ventilator-associated pneumonia – VAP) in patients with different types of critical conditions. The questions of terminology and diagnosis of VAP are discussed. The appropriateness of complex approach to diagnosis of VAP including clinical, laboratory and roentgenological data, as well as results of microbiological studies is shown. Advantages and disadvantages of invasive methods of microbiological diagnostic are analysed. Risk factors of VAP determined by the multiple regression analysis are listed. Problems of antimicrobial therapy of VAP with particular attention to the choice of antimicrobials for empiric therapy are discussed.
Key words: ventilator-associated pneumonia, diagnostic, antimicrobial therapy.
The Natural Course of Combined Hepatitis B and C
V.V. Gorbakov, A.I. Hazanov, N.P. Blokhina, I.V. Maev, O.N. Rumiantcev, N.L. Tordiya, A.V. Karshieva
State Medical Institute of Postgraduate Course, Ministry of Defense, Moscow, Russia
Moscow State Medical and Dental University, Moscow, Russia
One hundred thirty six patients in whom HÂsAg and anti-HCV have been simultaneously detected were investigated. In all cases the complete clinical, laboratory and instrumental procedures including detection of HBV-DNA and ÍÑV-RNA by PCR were performed.
In patients with simultaneously detected HÂsAg and anti-HCV the rate of detection of HBV-DNA was only 7% when ÍÑV-ÐÍÊ has been detected in 84% of cases. Thus, in vast majority of patients included in the study only replication of HCV was found. After infection by HCV in patients with chronic hepatitis B (CH B) HBV-DNA and ÍÑV-RNA were detected simultaneously in 42% of cases, in 33% of patients only ÍÑV-RNA and in 25% of patients only HBV-DNA were found. It indicates that infection of CH B patients by HCV after 1,5–2 years results in stable disappearance of the genome of one of the viruses from serum in half of patients, moreover the elimination of HBV-DNA was found to be more common. However, to make the final conclusion about the course of combined viral hepatitis B and C we need the results of studies on larger quantity of patients.
Key words: viral hepatitis, hepatitis B virus, hepatitis Ñ virus, combined viral hepatitis.
Amebiasis: Clinical Presentations, Diagnostics, Treatment
A.M. Bronstein1, N.A. Malishev2, V.I. Lucshev3
1 Institute of Medical Parasitology and Tropical Medicine Named Under E.I. Martzinovski,
Moscow Medical Academy Named Under I.M. Setchenov, Moscow, Russia
2 Clinical Infectious Diseases Hospital No.1, Moscow, Russia
3 Department of Infectious Diseases, Tropical Medicine and Epidemiology of Russian State Medical University, Moscow, Russia
Amebiasis is a parasitic human disease caused by pathogenic strains of Entamoeba histolytica, and is one of the most important problems of public health in developing countries and one the main causes of death from parasitic intestinal diseases.
The overview of amebiasis, its clinical presentations, treatment and prophylaxis are given. Approaches to the therapy of invasive and noninvasive amebiasis are presented.
For infectious diseases clinicians, pediatricians, epidemiologist.
Key words: diarrhea, protozoal infections, amebiasis, amebicides.
Antimicrobial Resistance
b-Lactamases of Aerobic Gram-Negative Bacteria: Description, Principles of Classification, Methods of Detection and Typing
M.V. Edelstein
Institute of Antimicrobial Chemotherapy of Smolensk State Medical Academy, Smolensk, Russia
b-Lactamases are represented by extensive range of genetically and functionally different enzymes that are able to destroy b-lactams that leads to development of resistance to these antibiotics in b-lactamases producing bacteria. Intrinsic production of b-lactamases is a common phenomenon for wide range of microorganisms. But at the present time the wide spread of plasmid-mediated b-lactamases that leads to secondary (acquired) resistance to b-lactams becoming more common.
The aim of this review is to describe the main structural and functional groups of b-lactamases of aerobic Gram-negative bacteria, with especial attention to plasmid-mediated TEM- and SHV-types b-lactamases, their evolution and role in the development of resistance to different b-lactams. The recent methods of detection and typing of b-lactamases are described.
Key words: b-lactamases, antimicrobial resistance, Gram-negative bacteria, microbiological diagnostics.
Antimicrobial Agents
Moxifloxacin – the New Fluoroquinolone with Broad Spectrum of Activity
(The Literature Review)
L.S. Stratchounski, V.A. Kretchikov
Research Institute of Antimicrobial Chemotherapy, Smolensk, Russia
Moxifloxacin – new broad spectrum 8-methoxyquinolon with high activity against Gram(+) and Gram(-) microorganisms as well as against anaerobes and intracellular pathogens. It is also active against microorganisms that are resistant to other classes of antimicrobials, including penicillin- and macrolide-resistant pneumococci and b-lactamase-producing Haemophilus influenzae. In the controlled clinical trials the high clinical efficacy and safety of moxifloxacin have been demonstrated for community-acquired pneumonia, exacerbation of chronic bronchitis, acute sinusitis, skin and soft tissue infections, pelvic inflammatory diseases.
In the article the literature review of microbiological studies and clinical trials on moxifloxacin is presented.
Key words: moxifloxacin, fluoroquinolones, respiratory tract infections.
Laboratory Diagnostics
New Methods for Identification
of Listeria monocytogenes
T.I. Karpova1, S.A. Ermolaeva1, I.V. Lopirev1, N.S. Brodinova1, I.S.Tartakovski1, J.A. Vazquez-Boland2
1 Research Institute of Epidemiology and Microbiology Named Under N.F. Gamaleya RAMS, Moscow, Russia
2 University Complutence, Spain
Identification of Listeria monocytogenes in clinical specimens is often complicated because of morphological and biochemical properties of this pathogen. In present article the traditional bacteriological methods of identification of L.monocytogenes are compared with PCR and original method of identification based on induction of lecithinase activity in the presence of activated charcoal. In the PCR with specific to the gene plcA primers there was 100% specificity and high sensitivity. At the same time in 89% of L.monocytogenes strains the specific induction of lecithinase activity by activated charcoal has been shown, when no such a phenomenon have been observed in non-monocytogenes Listeria and other bacteria studied.
Key words: Listeria monocytogenes, identification, lecithinase activity, PCR.