[Clinical picture, diagnosis and treatment of leptospirosis].
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Biomedical subjects
Publications and source records attributed to K S Ivanov.
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Ninety six patients with hemorrhagic fever and the renal syndrome were followed up. Reaferon was included into the complex therapy of 57 cases. The drug was administered intramuscularly in a dose of 2 x 10(6) IU twice a day for 5 days. The use of reaferon in the complex therapy resulted in a decrease in the period of the general intoxication by 3.4 +/- 1.3 days. The use of the drug at the initial stages prevented acute renal failure. When reaferon was used at the stage of oliguria, the level of proteinuria and the risk of the further affection of the kidneys lowered. After the completion of the treatment course with the use of reaferon, a significant increase in the content of the T-helper cells was observed which could be indicative of an activation of the mechanisms providing the immunity development and pathogen elimination. Reaferon promoted a decrease in the concentration of the circulating immune complexes of the blood serum. No significant adverse reactions to the use of reaferon were recorded. The results are in favour of the reaferon use in complex therapy of patients with hemorrhagic fever and the renal syndrome, especially at the initial stages until the syndrome of acute renal failure developed.
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Outpatient control over the patients who went through infectious diseases in Afghanistan is determined by a structure of the dominant nosological forms of infectious diseases: typhoid, paratyphoid, intestinal amebiasis and other acute intestinal infections, viral hepatitis, malaria. A considerable number of servicemen who went through infectious diseases had led to a re-enforcement of "infections service" inside the organic structure of the 40th Army, as well as to elaboration of a rational system of outpatient control, including regular medical examinations by organic physicians, and infectionists, laboratory, functional and instrumental methods of examination by organic medical units and specialized health care establishments and sanitary-epidemiological units.
Taking into account the prognosticated modern character of combat actions, a new organic structure of Russian Armed Forces, and estimated structure of infectious diseases in war period, it was stressed that anti-infectious platoons (inside medical companies of Brigades) would perform the main part of diagnosis and treatment of minimally sick patients (85% from all infectious cases). There are proposals towards elaboration of a new organic structure of the military field infectious hospital.
The authors studied the information efficiency of stable-phased immunofermental analysis (IFA) in differential diagnosis of infectious diseases of respiratory system and pulmonary tuberculosis. IFA method was used on 60 infectious patients with non-tuberculous pathology, 64 patients with pulmonary tuberculosis and 200 donors. It was found out that the minimal diagnostical IFA titer in pulmonary tuberculosis was 1:320 (antibody revealing frequency--up to 89.2%; specificity--95%). IFA method with phosphatide antigen has a great practical significance in differential diagnosis of influenza, acute respiratory viral infections and pneumonias with pulmonary tuberculosis.
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The experience in treating infectious diseases in wounded and traumatized persons from the contingent of the Soviet Troops in ++Afghanistan is described. The syndrome of the joint effect of the injury and infection is characterized. Features of the chemotherapy of the injured patients with viral hepatitis, malaria, typhoid fever and enteric and ++extra-enteric amebiasis under the ecological and professional stress and with an account of the etiology of the wound infection are presented. The favourable effect of the developed methods for chemotherapy of the joint affections was shown.
The article studies clinic manifestations after the prescription of polyphepanum, SKN-1P (based on recovered carbon) and enterodesum in 35 patients with acute dysentery, 104 patients with acute gastroenterocolitis, and 123 patients with typhoid. The first two drugs turned out to be highly effective for treatment of these infections. Enterosorption produced an insignificant positive effect in cases of typhoid. An early prescription of enterosorbents in enhanced doses could rapidly stop the basic proliferation of acute intestinal diseases. It is reasonable to start enterosorption even at the pre-hospital stage.
The article summarizes the experience of diagnosis and treatment of El Tor cholera in servicemen during an outbreak of intestinal polyinfection in the conditions of dry hot climate in desert and mountainous terrain of Afghanistan. The authors describe the clinical course of El Tor cholera which is stipulated by the mixed character of dehydration, polymorphism of clinical symptoms and more severe forms of concomitant infections.
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Metabolites of connective tissue (free serum oxyproline, protein-bound plasma oxyproline, total urine oxyproline, serum glycosaminoglycans), proteolytic enzyme elastase, proteolysis inhibitors (alpha 1-inhibitor, alpha 2-macroglobulin) were investigated in 103 patients with viral hepatitis A. It was established that connective tissue and its metabolites produce a negative effect on hepatocytic repair. Longterm convalescence is attributed to elastase hyperactivity in the presence of relative deficiency of proteolytic inhibitors.
Hypoxia plays an important role in pathogenesis of infectious diseases. Therefore, its correction is an essential factor in pathogenetic antibacterial treatment. Hyperbaric oxygenation (HBO) as a leading method in current antihypoxic therapy was studied in combined medication for typhoid, diphtheria, meningococcal infection, viral hepatitis. HBO sessions were given to 331 patients, 363 controls did not receive HBO. Utilization of HBO provided much better saturation of blood with oxygen, eliminated metabolic disorders, warranted favorable course and outcomes of the diseases.
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The authors investigated the clinical importance of determination of the O-antigen in coprofiltrates of patients with acute Sonne dysentery by means of immunoenzymatic analysis. It was found that use of immunoenzymatic analysis is justified for etiological diagnosis of dysentery as well as with the purpose of forecasting recurrence of the disease.
The antigen-specific method for the determination of specific immune complexes in the blood serum of patients with acute Sonne dysentery has been developed on the basis of the enzyme-linked immunosorbent assay with the use of reagents manufactured in the USSR. The possibility of the early prognostication of prolonged carrier state by using the proposed method for the determination of the level of specific circulating immune complexes has been shown.