Diseases and Pathogens


Current understanding of Clostridium difficile infection

Yu.V. Lobzin, S.M. Zakharenko, G.A. Ivanov

Academy of Military Medicine, Saint-Petersburg, Russia

At the present time Clostridium difficile is the main causative pathogen of nosocomial diarrhea, that linked to the use of antimicrobials. But at the same time there is an unjustified little attantion paid to this problem in Russia. In the present literature review the following topics are described in details: the epidemiology of C. difficile infection; the microorganism – macroorganism interaction and the role of different factors of pathogenesity; the clinical manifestation of different C. difficile-associated pathologies; the comparative characteristic of different methods for the diagnosis of C.difficile infection; recent approaches to the therapy of this infection.

Key words: Ñ. difficile, antibiotic-associated diarrhea, antibacterial therapy, C. difficile-associated diarrhea, pseudomembranous colitis.


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The Role of Non-Antimicrobial Drugs in the Treatment of Pneumonia

I.V. Smolenov, Ya.G. Alekseeva, N.A. Smirnov

Volgograd State Medical Academy, Volgograd, Russia

In the present review the analysis of the efficacy and appropriateness of the use of non-antimicrobial medications in the treatment of community-acquired pneumonia is presented. It is shown, that at the present time there is no convincing data that can prove the expediency of use of immunomodulators, biogenic stimulators, vitamins, anti-histamine and non-steroid anti-inflammatory drugs in the treatment of pneumonia. The efficacy and safety of the vast majority of above drug are not confirmed by the well designed randomized multicenter studies and require further investigation. At the same time the addition of non-antimicrobials to the adequate antimicrobial therapy leads to significant increase of the cost of therapy, enhance risk of adverse reactions and decrease of compliance.

Key words: pneumonia, immunomodulators, biogenic stimulators, vitamins, anti-histamines, non-steroid anti-inflammatory drugs.


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Aetiology of Kawasaki Disease

L.V. Bregel1, V.M. Subbotin2, Yu.M. Belozerov3

1 State Institute for Postgraduate Medical Education, Irkutsk, Russia
2 Regional Hospital, Irkutsk, Russia
3 Moscow Research Institute of Pediatrics and Pediatric Surgery, Moscow, Russia

Kawasaki disease is hyperimmune vasculitis with presumably infectious origin. Predisposing factors are probably heredity and atopy. Although etiology of Kawasaki disease is still unknown, there are a lot of facts, arguing for the trigger role of infection in pathogenesis of this systemic disease. The different infectious agents, both superantigens of certain bacteria and conventional viral and/or microbial antigens are considered as a cause of Kawasaki disease. Moreover, one or more microorganisms, which are probably still unknown, may afflict host immunocompetence and develop clinical symptoms. However, in general, investigations were able not to prove or disprove any single theory. Therefore, there is an obvious need for further studies in this field of infectious diseases.

Key words: Kawasaki disease, Kawasaki systemic vasculitis, Kawasaki syndrome, mucocutaneous lymph node syndrome, etiology.


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Molecular Aspects of Yersinia Virulence

G.Ya. Tseneva, N.Yu. Solodovnikova, E.A. Voskresenskaya

Research Institute for Epidemiology and Microbiology named under L. Paster, Saint-Petersburg, Russia

The available in the literature information on the pathogenic patterns of yersiniae, peculiar properties of the molecular and genetic mechanisms that regulate the expression of the factors of the pathogenesis are analysed and summarized. Data on the role of different environmental factors for the regulation of the genes of virulence are presented. The further perspectives for the study of genetic control of pathogenesis and mechanisms of interaction of yersiniae with the host are highlighted.

Key words: yersinia, pathogenesis, biological functions, genetic control.


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Antimicrobial Resistance


Antimicrobial Resistance of Streptococcus pneumoniae in Different Regions of Russia: Results of Prospective Multicentre Study (phase À of project PeHAS-I)

R.S. Kozlov1, O.I. Kretchikova1, O.V. Sivaya2, L.I. Akhmetova3, L.A. Vishnyakova4, E.N. Gugutsidze5, V.N. Ilyina6, L.K. Katosova7, V.A. Kurchavov8, V.B. Kuzin9, N.Å. Marusina10, E.A. Molodova11, I.G. Multykh11, A.L. Pavlov12, A.I. Sinopalnikov13, I.V. Smirnov14, Yu.G. Tikhonov13, M.E. Faustova4, V.A. Larchenko15, L.S. Stratchounski1

1 Institute of Antimicrobial Chemotherapy of SmolenskState Medical Academy, Smolensk
2 Department of Clinical Pharmacology of SmolenskState Medical Academy, Smolensk
3 State Centre of Laboratory Diagnosis of Mother and Child Diseases, Ekaterinburg
4 State Centre of Pulmonology of Ministry of health of Russian Federation, Saint Petersburg
5 Central Clinical Hospital of Business Department of the President of Russian Federation, Moscow
6 Regional Clinical Hospital, Novosibirsk
7 Scientific Centre of Children Health of Russian Academy of Medical Sciences, Moscow
8 Children City Clinical Hospital N 13 named under N.F. Filatov, Moscow
9 City Infectious Hospital N 23, Nizhniy Novgorod
10 Children Republican Clinical Hospital, Kazan
11 Clinical Diagnostic Centre, Krasnodar
12 Saint-Petersburg State Medical Academy named under I.P. Pavlov, Saint.Petersburg
13 Main Military Clinical Hospital named under N.N. Burdenko, Moscow
14 City Clinical Hospital N 11, Ryazan
15 Contract Research Organization "InnoPharm", Smolensk

Objective. To determine the structure of antimicrobial resistance of clinical isolates of pneumococci in different regions of Russia.

Materials and methods. A total of 210 Streptococcus pneumoniae strains isolated in 15 centres of Central (Moscow – 5 centers, Kazan, Nizniy Novgorod, Ryzan), North-Western (Smolensk, Saint Petersburg), Southern (Krasnodar) regions, Urals (Ekaterinburg) and Siberia (Novosibirsk, Tomsk) were included in this study. Susceptibility to 19 antimicrobials – penicillin G, amoxicillin, amoxicillin/clavulanate, cefotaxime, cefepime, erythromycin, azithromycin, clarithromycin, midecamycin, midecamycin acetate, spiramycin, clindamycin, tetracycline, ciprofloxacin, levolfloxacin, chloramphenicol, co-trimoxazole, rifampicin and vancomycin – was determined by brothmicrodilution in accordance with NCCLS recommendations.

Results. β-Lactams sustain high in vitro activity against studied population of pneumococci: non-susceptibility (percentage of both intermediate and fully resistant isolates) to amoxicillin and amoxicillin/clavulanate was 0,5%, to cefotaxime and cefepime – 2%, to penicillin G – 9%. Resistance to studied macrolides/azalide (erythromycin, azithromycin, clarithromycin, midecamycin, midecamycin acetate, spiramycin) varied from 2 to 6%. Chloramphenicol, clindamycin and rifampicin also sustained high activity (proportion of non-susceptible strains was 5, 2 and 1% respectively). No resistance to levofloxacin and vancomycin was found. The highest percentage of non-susceptible isolates (27 and 33% respectively) was determined to tetracycline and co-trimoxazole. Multi-resistance (defined as resistance to 3 and more classes of antimicrobials) was found in 8% of strains.

Conclusions. β-Lactams and macrolides might be recommended as drugs of choice for the therapy of pneumococcal infections. Respiratory fluoroquinolones (levofloxacin) are highly active against pneumococci. High resistance to co-trimoxazole and tetracycline dictates the necessity to limit use of these antimicrobials for the therapy of the above infections.

Key words: Streptococcus pneumoniae, pneumococci, antimicrobial resistance.


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Antimicrobial therapy


Bases for the Rational Choice of Antimicrobials in the Treatment of Intra.abdominal Infections (Lecture)

J. Garau

Department of Medicine, Hospital "Mutua de Terrassa", University of Barcelona, Spain

Has been given on V IACMAC International conference "Antimicrobial therapy" 4–6 June 2002, Moscow.


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Individualization of Usage of Antimicrobials in Intensive Care Units (Lecture)

T. Mazzei

Department of Preclinical and Clinical Pharmacology, University of Florence, Italy

Presented on V IACMAC International conference "Antimicrobial therapy" 4–6 June 2002, Moscow.


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