Vol 15, No 2 (2025)

Monkeypox, caused by a zoonotic virus, and has emerged as a significant public health issue, particularly with recent outbreaks extending beyond its traditional endemic areas in Central and West Africa. This virus, which belongs to the Orthopoxvirus genus, is closely related to the variola virus that causes smallpox. The resurgence of monkeypox underscores the urgent need to understand its epidemiology, clinical management, and public health responses, especially given the global spread observed in 2022. Monkeypox primarily transmits from animals to humans, with rodents and monkeys acting as the primary reservoirs. Secondary human-to-human transmission occurs through respiratory droplets or contact with contaminated materials. Clinically, monkeypox manifests with symptoms similar to smallpox, such as fever, rash, and lymphadenopathy, although it is generally less severe. Supportive treatments, including antivirals like tecovirimat, have shown efficacy in alleviating symptoms and reducing disease severity. Additionally, the development of new antiviral agents and treatment protocols remains an area of active research. Vaccination plays a crucial role in managing monkeypox outbreaks. The smallpox vaccine, which provides cross-protection against monkeypox, has been instrumental in controlling the spread of the disease. Public health strategies have emphasized targeted vaccination campaigns, thorough contact tracing, and comprehensive surveillance efforts. These measures highlight the necessity of rapid and coordinated actions to manage and prevent outbreaks effectively. Addressing the global burden of monkeypox requires strengthening healthcare infrastructure, enhancing disease surveillance systems, and fostering international collaboration. Efforts to improve diagnostics, vaccine distribution, and public health education are also vital. By focusing on these areas, the global community can improve its capacity to manage and mitigate the impact of this re-emerging infectious disease. Effective response strategies are essential for controlling current outbreaks and preventing future ones, ultimately reducing the global impact of monkeypox and improving public health outcomes.

Introduction. Being considered as one of the most difficult to cure, vulvar malignant neoplasms belong to rare oncopathologies of the female reproductive system. It is established that vulvar squamous cell cancer develops via two pathways. In the first scenario, the tumor may develop during vulvar dystrophic diseases such as scleroatrophic lichen and differentiated intraepithelial neoplasia. Another opportunity is directly related to HPV infection. Highly oncogenic HPV types are known to be associated with cervical carcinogenesis and are involved in developing vulvar, vaginal, and anal intraepithelial neoplasia, which are considered precursors to carcinomas. In recent decades, a rise in incidence of vulvar cancer developed after preceding degenerative processes was noted. A relationship between human papillomavirus and cervical cancer has long been known and confirmed, so an issue regarding a potential relation between the etiology of vulvar cancer and of HPV remains relevant. The aim of the paper is to systematize and analyze the study data on vulvar carcinogenesis related to HPV infection.

Materials and methods. A literature search was performed using PubMed, Web of Science and Google Scholar databases. A literature review was conducted by analyzing studies published between 1993 and 2024. The review included papers in which HPV was found in more than one case of vulvar tumor and if HPV DNA was detected by using polymerase chain reaction. Initially 249 articles were selected, 25 papers were included in the qualitative analysis, from which 6 case-control studies that fully met the specified inclusion criteria were further analyzed. Overall HPV prevalence was calculated as the percentage of all HPV tested cases.

Results. A high prevalence of papillomavirus infection in vulvar tumors was shown (31%), with HPV type 16 occurring in the vast majority of cases. The prevalence of HPV in vulvar tumors in case-control studies was 30% (OR = 10.46).

Conclusion. The results of the current systematic review confirmed that HPV infection is a key risk factor for developing vulvar malignancies. We demonstrated a high prevalence of HPV infection in vulvar tumors. In addition, a high incidence of highly oncogenic HPV types in tumor tissue was shown.

Accumulation of mutations in the amino acid sequence of immunologically significant regions of the outer capsid proteins in locally circulating rotaviruses may reduce the effectiveness of vaccine-generated protection. The aim of the work was to comparatively analyze Russian rotaviruses and strains of the Indian pentavalent vaccine approved for use in the Russian Federation in 2020.

Materials and methods. There were used 38 rotavirus-positive samples derived from children with acute intestinal infection identified in 2022–2023. cDNA fragments of the VP7 gene 877 bp long were sequenced by two strands using “Nanofor 05” device. Phylogenetic analysis was performed using BEAST software package. The final sample included 161 VP7 gene sequences of RVA isolates from three Russian cities (Nizhny Novgorod, Moscow, Novosibirsk), other countries, and vaccine strains.

Results. Based on the results of phylogenetic analysis, Russian rotaviruses were found to belong to 13 lineages and/or sublineages (G1-I-A, G1-II-C, G2-IVa-1, G2-IV-3, G3-I, G3-3-а, G3-3-е, G4-I-с, G6-I, G8-IV, G9-III-d, G9-VI-е, G12-III). Vaccine strains (D, WI79-9, A41CB052A, DS-1, SC2–9, P, WI78-8, ST3, BrB-9, WI79-4, AU-32, 116E) were grouped separately in each case (G1-III, G1-II-A, G2-I, G2-II, G3-3-d, G4-I-а, G6-IV, G9-I, G9-II). Comparative analysis in the regions of antigenic epitopes targeted by neutralizing antibodies showed 3 to 6 amino acid differences between Russian and homotypic vaccine strains. The highest number was observed in isolates of sublineages G1-I-A, G2-IVa-1 and lineage G3-I. In the regions of T-cell epitopes, 1 to 4 substitutions were found. The greatest number of differences had rotaviruses of the G3-I lineage and the G4-I-c sublineage.

Conclusion. For the G3P[8] variant of the G3-I lineage, which is widespread in Russia, 6 substitutions in neutralizing epitopes and 4 substitutions in T-cell epitopes were found in comparison with homotypic vaccine strains. The study results are important for understanding a potential impact of vaccines on the antigenic structure of the rotavirus population in Russia.

Introduction. Despite the great advances made in the field of virology and their diagnostics, a number of difficulties affect improvements in the control and elimination of hepatitis C virus (HCV) infection at present. New cases of HCV infection still occur worldwide, including Tomsk Region (TR). The aim of the study was to analyze the epidemiological situation with regard to acute and chronic forms of HCV in adults and children for the period 2022–2023, and the structure of morbidity in TR.

Materials and methods. The features of the HCV epidemic process were assessed using official data presented in the State Report “On the state of sanitary and epidemiological well-being of the population in the Russian Federation in 2023”, statistical reporting form No. 2, federal statistical surveillance form No. 65 “Information on chronic viral hepatitis” form 065 for the period of 2023, quarterly reports of regions to the Ministry of Health of the Russian Federation within the framework of the implementation of measures aimed at combating HCV infection in 2021–2030.

Results. In TR, stable incidence rates of first-time detected forms of chronic viral hepatitis have been registered over the last years: in 2023 — 18.82 cases of chronic hepatitis C per 100 thousand population, in the population of children — 11.2 cases per 100 thousand population. Indicators of HCV morbidity in the TR indicate a tendency towards the spread of HCV infection in all age groups with an increase in the age limit. Genotypic diversity of HCV infection in the TR in 2023 is represented by subtypes 1a, 1b, 2, 3a/3b. The planned coverage of antiviral therapy in 2024 cannot significantly affect the epidemiologic situation on HCV in TR and achieve the results of elimination by 2030 and requires annual increase of funding.

Conclusion. The incidence rate of HCV infection in the TR is 1.7 times lower than the all-Russian one. Low level of HCV prevalence in the pediatric population in the TR made it possible to carry out micro-elimination of HCV among children. Insufficient level of HCV genotypes determination requires increasing the coverage of genotyping for epidemiologic surveillance in each region.

Currently, bacterial meningitis (BM) remains a form of life-threatening infectious pathology, with a mortality rate ranging from 4% to 35% and poor prognosis often accompanied by diverse specific and non-specific complications, including infectious toxic shock, cerebral edema, ventricular inflammation, hydrocephalus, acute cerebrovascular accidents, venous sinus thrombosis, disseminated intravascular coagulation (DIC) syndrome, respiratory distress syndrome (RDS) syndrome, inappropriate secretion of antidiuretic hormone, and systemic inflammatory response syndrome. In clinical practice, the early identification of the causative microorganism and the implementation of proper antibiotic treatment, as well as a comprehensive assessment of the patient’s status and management, are crucial for minimizing a risk of related severe complications and mortality. The BM etiology is characterized by a highly variable nature, contingent upon a multitude of factors such as geographic location, temporal context, patient age, immunological status, and other variables. Over the past two to three decades, advancements in conjugate vaccines and the use implementation of antibiotic treatment have brought about alterations in the spectrum of pathogens responsible for meningitis. The objective of this study was to delve into the etiological profile and prognostic implications of cerebrospinal fluid (CSF) parameters among patients with diagnosed meningitis admitted to the Neuroinfectious Diseases Division of the Infectious Clinical Hospital No. 2 (Moscow) between 2022 and 2023. A retrospective analysis of medical records of meningitis patients admitted to the Infectious Clinical Hospital No. 2 during 2022–2023 was conducted. The data were analyzed using the k-means clustering algorithm implemented in the Loginom analytics software to create a scenario, as well as OLAP cubes. The study involved the analysis of medical records for 110 patients aged 18–89 years old. Among the BM pathogens identified, Neisseria meningitidis emerged as the most prevalent in this patient cohort, accounting for 68.2% of cases. Within the group of meningococcal meningitis cases, serovariants A and W135 were the most frequently detected, accounting for 49.3% and 33.3%, respectively. Significant alterations in cerebrospinal fluid parameters, characterized by elevated cell counts and lowered glucose levels, were observed among patients with purulent meningitis resulting from serogroup A Neisseria meningitidis infections. A combination of elevated baseline cell level along with high concentrations of proteins, and lactate, coupled with the presence of D-dimer in cerebrospinal fluid, has been associated with a severe disease progression and the emergence of critical and life-threatening sequelae.

Chronic rhinitis is the most common ENT disease. Over the past decade, there has been an increased incidence of chronic rhinitis. In all forms of chronic rhinitis, there is a decrease in the protective properties of nasal mucous membrane, which can be accompanied by activation of nasal bacterial microflora. Dysbiosis of nasal mucous microbiota contributes to the development of inflammation, activation of immune cells with the development of immune reactions, activation of lipid peroxidation processes and changes in the activity of antioxidant defense factors in nasal cavity and blood. There is evidence that different phenotypic variants of chronic rhinitis are characterized by own specific spectrum of microorganisms in the nasal cavity, which significantly affects the course of diseases, as well as the state of the lipid peroxidation — antioxidant protection (LPO–AOP) system. The aim of our work was to comparatively assess quantitative composition of the microbial flora and indicators of the LPO–AOP system in patients with various forms of chronic rhinitis. The article presents the results of a laboratory examination of 165 patients with chronic rhinitis, including 45 patients with chronic allergic rhinitis, 49 patients with chronic vasomotor rhinitis, 32 patients with chronic atrophic rhinitis, and 39 patients with chronic infectious rhinitis. The control group consisted of 40 apparently healthy donors. In accordance with the study design, at the first stage, all subjects underwent a bacteriological examination of nasal mucous membrane and a quantitative assessment of the isolated microflora representatives. At the second stage, the LPO–AOP indices were determined in the blood plasma using a spectrophotometric method. Statistical analysis of the obtained results was performed using the Statistica 8.0 software package. To assess differences in the groups, the Kruskal–Wallis, Mann–Whitney, and Wilcoxon nonparametric tests were used. The critical level of statistical significance for testing scientific hypotheses was considered equal to p < 0.05. The data are presented as a median (Me) and interquartile range (Q₂₅–Q₇₅). Changes in nasal mucosa microbiome induce a decrease in the activity of antioxidant defense factors in all studied phenotypic forms of chronic rhinitis. In cases of chronic allergic, vasomotor and infectious rhinitis, a significant increase in the level of both primary and secondary lipid peroxidation products is observed. Studies show that the greatest increase in lipid peroxidation activity is recorded in chronic infectious rhinitis, as well as the greatest nasal mucosa dysbiosis is revealed in this phenotype. Thus, the leading pathogenetic mechanism in chronic rhinitis is presented by hypoxia due to intermittent nasal congestion, which contributes to changes in the LPO–AOP system. At the same time, activated microbial flora also contributes to aggravation of such changes.

Introduction. Sulfur mustard (SM) is an important chemical warfare agent. Lack of antidote and pathogenetic means in the arsenal of modern medicine for the treatment of SM poisoning requires further studies on the pathogenesis and development of protective medical devices and treatment schemes. The aim is to assess the features of immune response and intestinal bacterial translocation during SM intoxication. Materials and methods. The experiments were performed with Chinchilla male rabbits. SM was injected to laboratory animals intramuscularly at a dose of 63 mg/kg, amounting to 1.0 LD84. The test materials presented by blood samples collected by cardiac puncture and from the lateral ear vein. Cardiac blood was used to produce serum and subsequently to determine the level of the sepsis-associated humoral factors (lipopolysaccharide, sCD14, procalcitonin, TNFa, IL-6, IL-10) by using enzyme-linked immunosorbent assay. Results. In the peripheral blood of rabbits there were found changes characterized by decreased total leukocyte count, a development of lymphocytopenia and monocytopenia, as well as two-phase granulocyte count dynamics. The blood leukocyte formula showed the most significant changes related to three cell subsets: segmentonuclear neutrophils, lymphocytes and plasmocytes. The analysis of blood serum for assessing level of the sepsis-associated humoral factors showed that the earliest pathobiochemical change was related to higher sCD14. On day 2 post-exposure, a simultaneous increase in the levels of TNFa, IL-6, IL-10 was reported. The cytokine level was decreasing to baseline range starting from day 3 onwards, whereas the clinical manifestation of SM intoxication was increasing and reaching the maximum magnitude. The analysis of blood serum for lipopolysaccharide level showed its increase on day 3 and 4 post-exposure. Conclusion. The study data in the context of the proposed interpretation, allow to highlight the following phasing of pathological changes during an extremely severe SM intoxication: day 1 — myeloid phagocytic system activation and hyperphagocytosis; day 2 — systemic inflammatory and compensatory anti-inflammatory response syndromes; days 3–4 — “immune paralysis”, intensified bacterial translocation, depletion of the endotoxin-binding system and “endotoxin aggression”.

Helicobacter pylori (HP) continues to be a serious public health issue worldwide, causing significant morbidity and mortality due to peptic ulcer disease and stomach cancer. This study was conducted to investigate the prevalence and intrafamilial transmission of HP infection among the population of Armenia. Materials and methods. In this study, the immunochromatographic method was used to detect HP microorganisms in stool samples. Results. The average age of the patients tested for HP was 29.9±2.0 years, with an age range from 2 months to 75 years. The study included 316 female patients, of whom 37.7% (95% CI: 32.4–43.0) tested positive for HP microorganisms, and 180 male patients, of whom 39.4% (95% CI: 32.3–46.5) tested positive. The highest prevalence of infection was observed in the following age groups: 50–59 years (65.1%), 40–49 years (47.1%), 30–39 years (41.1%), 20–29 years (40.4%), and 60–69 years (40.0%). Conclusion. Our research on patients with inflammatory diseases of the upper gastrointestinal tract, their family members, and others revealed a high infection rate of HP across all age groups. The study demonstrated a significant prevalence of HP infection among the population of Armenia, indicating a high likelihood of intrafamilial transmission.

Introduction. The epidemic process of medical care-related infections complies to the general laws for development of epidemic process, although it has specific features. The probability for development of surgical site infection becomes precipitated by risk factors, which contribute to emergence of surgical site infection based on traits of pathology, patient populations and the specifics of hospital facility. The aim of the study was to evaluate HIV-related effect on developing surgical site infection in patients with chronic spondylitis. Materials and methods. A retrospective cohort epidemiological study was conducted. The inclusion criteria were met by 809 examined patients including 119 HIV-positive patients who underwent 192 surgical interventions. At admission, a patient provided a discharge summary describing the disease profile as well as HIV-positive status verified by infectious disease specialist through a comprehensive data assessment, no more than a month prior to admission. HIV-infected and HIV-free patients comprised exposed and unexposed cohort, respectively. Results. Tuberculous spinal lesions prevailed in HIV patients (p ≤ 0.001; RR = 4.864; 95% CI [3.070–7.707]). Almost all patients were at stage 4 HIV, and one patient — stage 3. The incidence of surgical site infection in patients with chronic infectious spondylitis was 5.01 per 100 operations (49 cases per 978 operations), in HIV patients it developed only in 2 cases of tuberculous spondylitis (the incidence was 1.04 per 100 operations). HIV-infection did not increase the risk of surgical site infection (p = 0.009; RR = 0.174; 95% CI [0.043–0.711]. Surprisingly, it turned out to observe higher risk of revision interventions in HIV-free patients (p = 0.007; RR = 1.783; 95% CI [1.149–2.768]). Conclusion. HIV-positive patients had higher risk of developing a tuberculous than a nonspecific lesion. The HIV status of patients with chronic infectious spondylitis did not significantly affect development of surgical site infection and increased incidence of revision operations. A potential reason for the final result is the long-term use of anti-tuberculosis drugs acting, in this case, as a preventive measure against developing surgical site infection.

Abstract. The aim of the study is to increase the accuracy of Acinetobacter seifertii species identification by the phenotypic method. Study objects: 5 strains of A. seifertii (3 isolated in the microbiological laboratory at the Military Medical Academy, 2 strains obtained from the Pasteur Institute (St. Petersburg)). Clinical strains of the A. baumannii group (Ab group) isolated at the Military Medical Academy in 2023–2024 were also studied: A. baumannii (n = 152), of which 37 strains of the tryptophandestruens biovar, A. nosocomialis (n = 12), A. pittii (n = 6), 3 strains of A. calcoaceticus from the Neva River. The type of such strains was determined by MALDI-ToF mass spectrometry. The belonging of the strains to the Ab group was established by taxonomic tests. The biovar A. baumannii bv. tryptophandestruens was determined by a chromogenic reaction on sodium benzoate-containing nutrient medium. Urease of rapid activity was detected by a micro-volumetric method assessed 3 hours later. Utilization of D-xylose as the only carbon source was determined on a nutrient medium containing (g/l): D-xylose 2.0; NH₄CI 5.0; NH₄NO₃ 1.0; Na₂SO₄ 2.0; K₂HPO₄ 3.0; KH₂PO₄ 1.0; MgSO₄ 0.1; bromothymol blue 1.6% aqueous solution 4 ml; bacteriological agar 15.0; distilled water 1 L; pH 7.2±0.2; sterilization at 112°C 20 min. A pure bacterial culture was studied, in which signs of the Ab group and growth on a sodium acetate-containing nutrient medium were previously detected (control of no auxotrophy). The agar bacteria culture was suspended in 0.1 ml of 0.85% sodium chloride solution, one loop of bacterial suspension was sown with a stroke on a nutrient medium with D-xylose and a medium without D-xylose (control), incubated aerobically at 30°C 24–48 hours. The absence of bacterial growth on a medium with D-xylose and a medium without D-xylose in the presence of their growth on a nutrient medium with sodium acetate indicates belonging to the species A. seifertii. Studies showed that all A. seifertii strains do not utilize D-xylose, and all strains of other species of the Ab group utilize D-xylose. A. seifertii bacteria do not utilize L-arabinose, however, 29.6±3.7% of A. baumannii strains do not utilize L-arabinose, including all 37 strains of the tryptophandestruens biovar, which determines the unreliability of this test for the identification of A. seifertii. Most strains of A. seifertii (4 out of 5) have a urease of rapid activity, which suggests their proximity to the species A. nosocomialis. A method has been developed for identification of A. seifertii bacteria based on a set of phenotypic features of Ab group bacteria with a test for D-xylose utilization. It has been established that the use of the D-xylose utilization test in conjunction with the detection of rapid urease activity allows to accurately identify the bacteria A. seifertii and A. nosocomialis among other species of the Ab group.

The article presents a clinical case of monkeypox (MPOX) infection, a rare acute viral zoonosis until 2022, previously endemic in Africa, but currently recorded worldwide, including Europe and Bulgaria. The clinical case describes a 35-year-old man, healthy before the current disease, hospitalized to urology clinic with a diagnosis of cavernitis-complicated acute balanoposthitis. In the department, surgical treatment of liberatio cordi periglandularis penis was performed. The combination of intoxication syndrome with characteristic elements of pustular rash, initially treated as staphyloderma, served as the basis for infectious disease specialist to assume that the patient had MPOX, which was subsequently confirmed by using polymerase chain reaction (PCR) method, after which the patient was transferred to the infectious disease clinic for isolation and treatment, which included detoxication, antibiotic and analgesic therapy. Upon discharge, the patient observed the quarantine regime until all elements of the rash had completely healed, and one-month follow-up observation after discharge showed no deviations from the norm. Due to the presence of a urogenital complication, cavernitis, a rare for this infection, a multidisciplinary approach was required, including urologists, dermatologists and infectious disease specialists. The surgical, pathogenetic and symptomatic treatment led to the patient complete recovery. Although monkeypox-related urogenital complications are rare, they can occur, which requires increased attention to such atypical disease manifestations. MPOX is a rare viral disease that has attracted the attention of health professionals due to its increasing incidence in countries where it is not typically endemic. The key finding of the current study is the necessity for increased vigilance by professionals of various specialties to rare and emerging infectious diseases such as MPOX to control their spread.