[Diagnosis of latent primary intrathoracic tuberculosis of respiratory system in the phase of calcification in children]. / Diagnostika skrytoi aktivnosti pervichnogo vnutrigrudnogo tuberkuleza organov dykhaniia v faze kal'tsinatsii u detei.

The paper shows the latent activity of newly diagnosed intrathoracic tuberculosis in the phase of calcification in children: clinical and X-ray changes, tuberculin sensitivity (Manteaux test), the presence of Mycobacterium tuberculosis (MBT) in the sputum and blood (cultivation, bacterioscopy, polymerase chain reaction PCR), the blood levels of acute-phase reagents: haptoglobin and alpha 1-protease inhibitor (alpha 1-PI), immunological parameters, tuberculosis antibodies (TAb), and MBT antigen. Ninety children were examined before treatment. Twenty-five children (Group 1) were found to have single minor calcified masses in one group of intrathoracic lymph nodes or in the lung. Thirty-five children (Group 2) had multiple lymph nodes or foci in the lung in the phase of consolidation and calcification. Thirty children (Group 3, controls) were diagnosed as having intrathoracic tuberculosis in the phase of infiltration. The signs of the latent activity of tuberculosis were detected in all the children of all three groups, being more pronounced in Group 3. Thus, MBT and TAb were revealed in 90% of the children in Group 3 and in 52.9 and 76.0% in Groups 1 and 2, respectively. There were higher levels of alpha 1-PI in 96.6 and 75.0% in Groups 3 and 1, respectively. There were signs of intoxication in 80 and 88% and a hyperergic Mantoux reaction in 44.0 and 43.3%, respectively. The frequency of the signs of activity did not greatly differ. Thus, children with newly diagnosed respiratory tuberculosis in the phase of calcification should be regarded as having the signs of tuberculosis activity, followed up as Group I patients, and prescribed chemotherapy for 3-6 months or more, depending on the extent of the process.

[Tuberculous IgE antibodies. Part II. Study of its concentrations in different forms of tuberculosis]. / Protivotuberkuleznye IgE-antitela. Chast' II. Issledovanie kontsentratsii pri razlichnykh formakh tuberkuleza.

Tuberculosis-afflicted lung are infiltrated by two functionally types of lymphocytes, which presumably counteract with each other by producing proinflammatory (type 1) and anti-inflammatory (type 2) cytokines. It is held that irregular sequestration of antigen into different compartments of the lung may lead to preferential activation of T-helper 1 or T-helper 2 lymphocytes. Unlike IgE antibodies, specific tuberculosis IgE antibodies are seen only in tuberculosis infection. The mean values of IgE antibodies in tuberculosis (7.661 +/- 0.849 IU/ml) are significantly greater than those in other pulmonary diseases (1.768 +/- 0.116 IU/ml). Low concentrations of tuberculosis IgE antibodies in persons with a marked hyperergic response to tuberculin (1.808 +/- 0.097 IU/ml) are of importance. Significant concentrations of mycobacterial IgE antibodies are mainly detected in fibrocavernous (14.56 +/- 1.11 IU/ml), infiltrative (10.10 +/- 1.08 IU/ml), peripheral lymph nodal (10.53 +/- 1.09 IU/ml) tuberculosis rather than intrathoracic lymph nodal tuberculosis (4.555 +/- 0.340 IU/ml). There is a particularly considerable increase in specific IgE antibodies in a phase of decay (15.98 +/- 1.64 IU/ml) and infiltration (12.66 +/- 1.08 IU/ml). These groups also show a concurrent rise in tuberculosis IgG antibodies, which nevertheless disagree with the increase of IgE (the correlation coefficient is 0.599).

[Anti-tuberculous IgE antibodies. I. Immunodominant antigens]. / Protivotuberkuleznye IgE-antitela. I chast'. Immunodominantnye antigeny.

It is widely accepted that protection against tuberculosis is provided by the formation of type 1 immune response, which is characterized by the production of IFN-gamma and IL-2. However, type 2 antimycobacterial immune response is also present: specific IgE antibodies that are IL-4 dependent, are usually found in tuberculosis patients. There is elevated production of type 2 cytokines in some cases. Thus, both types of an immune response can simultaneously develop, probably counteracting with each other. It is unknown which of mycobacterial antigens are capable of inducing a preferential type 2 response. To detect these antigens, the authors studied tuberculosis IgE antibodies in the sera of 500 tuberculosis patients by using the ELISA assay with ultrasonic disintegrated M. Tuberculosis H37Rv (sonicate). Antigens recognized by IgE antibodies were found to be localized in the cell wall of mycobacteria. The IgE-response was specific since the sera did not react with the antigens of atypical mycobacteria and other bacterial species.

[Tuberculosis in children: diagnosis of and methods for the evaluation of chemotherapy]. / Diagnostika i metod opredeleniia éffektivnosti khimioterapii tuberkuleza u detei.

The authors propose to determine altered forms of Mycobacteria, including sputum and blood granular forms, and the level of tuberculosis antibodies and serum Mycobacterium antigens by enzyme immunoassay as additional criteria for diagnosis of active primary tuberculosis in children. The diagnostic value of these indices is accounted for by the fact that they are found significantly more frequently and their level is significantly higher than the similar indices in healthy, tuberculosis-infected children and tuberculin-negative, prior BCG-vaccinated ones. By taking into account an decrease in the detection rate of sputum and blood granular mycobacteria and a change in the level of tuberculosis antibodies during chemotherapy, which are observed along with positive clinical and X-ray changes of a process, these tests should be recommended for evaluation of the efficiency of primary a bacillary tuberculosis in children.

[Value of enzyme immunoassay in the diagnosis and differential diagnosis of abacillary tuberculosis in children and teenagers ]. / Tsennost' immunofermentnogo analiza v diagnostike i differentsial'noi diagnostike abatsilliarnogo tuberkuleza u detei starshego vozrasta i podrostkov.

Positive enzyme immunoassay (EIA) was found in 59.6% of patients of tuberculosis. Positive responses were significantly more frequently detected in patients with pulmonary tuberculosis than in those with intrathoracic lymph nodal tuberculosis (ITLNT) (62.2 +/- 7.4 versus 38.9 +/- 11.8%, respectively; p < 0.05. There was no significance difference in the rate of positive responses in patients with ITLNT (38.9 +/- 11.8%) and healthy individuals inoculated with Mycobacterium tuberculosis (17.6 +/- 9.5%). Sixteen (61.5%) patients with pneumonia showed a positive response, which amounted to 38.5% specificity of the method. The findings suggest that EIA may not be used as a screening test for early diagnosis of tuberculosis in children and teenagers and for differential diagnosis of pulmonary tuberculosis and nonspecific pneumonia. EIA data may be assessed only in combination with other diagnostic criteria.

[Improvement of diagnostics and methods of determining effectiveness of chemotherapy against tuberculosis in children]. / Sovershenstvovanie diagnostikik i metodov opredelneniia éffektivnosti khimioterapii tuberkuleza u detei.

Altered Mycobacterial forms, particularly granular forms, in the sputum and blood, as well as the serum level of tuberculosis antibodies and mycobacterial antigens by enzyme immunoassay are proposed to be determined as additional criteria for diagnosing active primary tuberculosis in children. The diagnostic value of these indices is accounted for by that they are more frequently detected and their levels are significantly higher than the similar ones in healthy, tuberculosis-infected children, and tuberculin-negative, earlier BCG vaccinated children. By taking into account a reduction in the detection rate of granular forms of Mycobacteria in the sputum and blood and altered levels of tuberculosis antibodies during chemotherapy, which were observed in parallel to the positive clinical and X-ray changes, these tests may be recommended for evaluation of the efficiency of treatment for primary abacillary tuberculosis in children.

[Immunity parameters in children with prior intrathoracic tuberculosis]. / Pokazateli immuniteta u detei, perenesshikh vnutrigrudnoi tuberkulez.

Fifty-four children who had experienced intrathoracic tuberculosis were clinically and immunologically studied 3-10 years following chemotherapy. The count of T cells and their functional activity were found to be normal in 90.7% of children. Tuberculosis antibodies were identified in 62% of children, which suggests only long preserved specific sensitization. The tuberculosis antigen titer 1:16 was detected in 5.5% of children with residual changes, which generates the necessity of examining such children for a latent active process.

[Detection of antituberculosis antibodies and antigens by enzyme immunoassay in young and preschool children suffering from tuberculosis]. / Opredelenie protivotuberkuleznykh antitel i antigenov metodom immunofermentnogo analiza u detei rannego i doshkol'nogo vozrasta, bol'nykh tuberkulezom.

Antituberculosis antibodies and mycobacterial antigens were detected in 74 young and preschool children suffering from tuberculosis by using enzyme immunoassay (EIA). They were found in 75.7% and 68.9% of children, respectively. The highest levels of antibodies were significantly greater in patients with active disseminated processes than in those with active restrictive processes. There were no great differences in the levels of antigens between the patients having different activities of a tuberculosis process. Follow-up indicated that there was a reduction in the levels of antibodies and antigens at 6-month treatment. The use of enzyme EIA in children ill with tuberculosis may serve an additional criterion for diagnosis of tuberculosis, evaluation of its activity and course.

[Use of immunochemical studies to predict the course of fibrous cavernous tuberculosis of lung and postoperative complications in patients on chemo and laser therapy]. / Ispol'zovanie immunokhimicheskikh issledovanií dlia prognoza techeniia fibrozno-kavernoznogo tuberkuleza i posleoperatsionnykh oslozhnenií u bol'nykh, poluchavshikh khimio- i lazerterapiiu.

A total of 103 patients with fibrocavernous tuberculosis of the lung were examined. They all received chemotherapy, including 3 - 4 antituberculous agents. Laser therapy was performed with a UZOR-2K low-energy semiconductor laser. In patients with profound changes in the serum level of protein, with high antigenemia and antibody production, the course of the disease was found to be poor; X-ray positive changes were achieved to a lesser extent, bacterial expellation stopped less frequently and more slowly. The decreases in the serum content of the proteins tested, in the level of antigenemia and antibody production which occur with drug and laser therapies are also an important factor of preoperative preparation, which is highly effective in preventing postoperative complications.

[Mycobacterial antigens and antitubercular antibodies in patients with tuberculosis salpingo-oophoritis]. / Antigeny mikobakterií i protivotuberkuleznye antitela u bol'nykh tuberkuleznym sal'pingooforitom.

Sixty two and 59 patients with tuberculous and nontuberculous salpingo-oophoritis, respectively, and 30 healthy females were examined. It was found that indirect solid-phase enzyme immunoassay (EIA) using ultrasonography of Mycobacterium tuberculosis H37Rv could detect antituberculosis antibodies in 66.7% of patients with tuberculous salpingo-oophoritis, and in 10% of healthy females. That using the antigen isolated from the cell wall extract of M. tuberculosis (whose molecular weight was 38 - 42 kD) could reveal them in 70.2, 4.3%, and 6.7%, respectively. After dissociation of immune complexes, EIA inhibition using affinity-purified antimycobacterial antisera displayed mycobacterial antigens in 75.0 and 4.3% of patients with tuberculous and nontuberculous salpingo-oophoritis, respectively, and in none healthy female. Thus, the detection of mycobacterial antigens and antituberculosis antibody may be successfully used in the complex diagnosis of tuberculosis of the female genitals.

[Specific antitubercular immunity in patients with tuberculosis and other pulmonary abnormality: diagnostic value of its study]. / Diagnosticheskoe znachenie izucheniia spetsificheskogo protivotuberkuleznogo immuniteta u bol'nykh pri tuberkuleze i drugoí legochnoí patologii.

A hundred and seventy one patients with revealed rounded lung formations of tuberculous and non-tuberculous origins were examined. Mycobacterial antigens, cellular antituberculosis immunity, and antituberculosis antigens were determined. Cellular sensitization to mycobacterial antigens was found to develop in about 50% of patients with round lung formations of tuberculous origin. This sensitization to PPD was more revealed by BTR rather than by TMR. At the same time, the latter is positive in healthy donors and in patients with non-tuberculous abnormality. Finally it can be concluded that cell tests are little suitable for immunodiagnosis of tuberculosis. It was also ascertained that determination of antituberculosis antigens and antigenemia might be a important component of examinations of patients with rounded lung formations in order to make a differential diagnosis of tuberculosis and non-tuberculous abnormality as with their determination, high sensitivity and specificity of appropriate tests can be achieved. These tests are more informative for the immunodiagnosis of tuberculosis than that of infiltrative tuberculosis.

[Principles and methods of immunodiagnosis in tuberculosis]. / Printsipy i metody immunodiagnostiki tuberkuleza.

The paper provides data on the current principles of tuberculosis immunodiagnosis, characterizes agents (antibodies, antigens, recombinant proteins, anti-idiotypes) used for these purposes, describes some difficulties arising in designing antigen and antibody diagnostic kits, presents the results of using various agents for the immunodiagnosis (primarily for serodiagnosis) of tuberculosis, discusses the diagnostic problems of tuberculosis during mass surveys and at tuberculosis hospitals. The results obtained at the Central Research Institute of Tuberculosis are given on the above issues along with references.

[Dynamics in bacterial isolation and antigenemia in patients with infiltrative pulmonary tuberculosis]. / Dinamika bakteriovydeleniia i antigenemii u bolnykh infiltrativnym tuberkulëzom lëgkikh.

A hundred patients with infiltrative pulmonary tuberculosis were studied. They were examined for bacterial isolates and mycobacterial antigens in the immune complexes. The isolates were detected in 76%. In most cases, isolation stopped 3 months following chemotherapy and in the absolute majority of cases (except one) 9 months after. Isolation of L-forms remained for a longer period of time, at month 6 of therapy there was an increase in the number of patients who were found to have L-forms of the bacteria. Most (97%) patients with infiltrative tuberculosis displayed mycobacterial antigens circulating in the immune complexes. Antigenemia retained in a considerable (40%) number of patients long (up to 9 months) and in most cases with the unfavourable course of the disease.

[Production of purified antigenic drug from Mycobacterium tuberculosis humanus and its use for serodiagnosis of tuberculosis]. / Poluchenie ochishchennogo antigennogo preparata iz mikobakterii tuberkulëza vida Humanus i ego ispolzovanie dlia serodiagnostiki tuberkulëza.

A variety of antigenic preparations from whole bacteria M. tuberculosis humanus (H37Rv) and relevant subcellular components have been tested using indirect ELISA for determination of antituberculous antibodies. Cell membranes of mycobacteria and antigens isolated from KCl-extracts of cell membranes in gel Toyopearl HW 55 F demonstrated the highest activity. Fraction 6 usage raised the reaction sensitivity to 83.3% in specificity 86.7%. As indicated by the ELISA, the highest antibodies content under the above antigen introduction was reached in patients with fibrocavernous tuberculosis, the lowest one in focal tuberculosis.

[The determination of mycobacterial antigens found in immune complexes]. / Opredelenie antigenov mikobakterii, nakhodiashchikhsia v immunnykh kompleksakh.

By using affine isolation from hyperimmune rabbit sera on homologous mycobacteria humanus (H37Rv) and affine purification on atypical mycobacteria and BCG mycobacteria, the authors obtained a preparation of antituberculous antibodies. These were used in indirect ELISA to detect antigens (after IC dissociation) in tuberculous patients. Out of 70 patients with infiltrative pulmonary tuberculosis, 30 patients with other pulmonary diseases and 30 healthy donors the antigens were found in 77.1% of tuberculous cases and in 6.7% of healthy subjects. The results of the test say in favour of its benefits in practical application. The antigens levels and incidence of positive reaction are higher in patients with destructive tuberculosis and in the bacterial discharge.

[Immunoglobulin E in ankylosing spondylarthritis]. / Immunoglobulin E pri ankiloziruiushchem spondiloartrite.

Ankylosing spondylarthritis (AS) patients (n-95) were examined for IgE concentrations using radioimmunoassay (commercial kits "Pharmacia"). Elevated IgE concentrations (greater than 100 Ku/l) were recorded in 16% out of 45 patients with central AS and in 40% out of 50 patients with peripheral AS (p less than 0.05). High IgE levels showed frequent association with a CIC rise and extraarticular manifestations (uveitis, focal nephritis). It is suggested that AS extraarticular signs arise in response to vascular affection due to IgE overproduction and formation of IgE-containing immune complexes.

[Antituberculosis antibodies detected by an immunoenzyme test in patients with pulmonary tuberculosis]. / Protivotuberkuleznye antitela, opredeliaemye s pomoshch'iu immunofermentnogo testa, u bol'nykh tuberkulezom legkikh.

The method of indirect solid-phase enzyme immunoassay (EIA) was used to detect antibodies in the sera of 166 pulmonary tuberculosis patients and 56 healthy donors. A preparation with a mol. mass of 38-42 kD was used as an antigen which was isolated from the mycobacteria H37Rv by a consecutive separation under high pressure, extraction of KCl cellular membranes and gel-filtration in the gel Toyopearl HW 55F. Antituberculous antibodies (AtAb) were detected by the EIA method in 94% of pulmonary tuberculosis patients which was much higher as compared to the same parameter in healthy subjects (10.7%). Hence, AtAb detection by this method can serve as an additional criterion for tuberculosis diagnosis. The detection rate and AtAb level are higher in fibrocavernous tuberculosis than those in infiltrative tuberculosis. The AtAb detection rate is higher in manifested intoxication than in moderate one or its absence. AtAb are more often detected in chronic than in newly diagnosed tuberculosis, in the disseminated forms than in the limited forms, in pronounced infiltration in the lungs as compared to a moderate form, and also in patients with bacillary excretion than in those whose sputum had no M. tuberculosis.

[The peripheral joint syndrome in ankylosing spondylitis--one of the variants of reactive arthritis]. / Perifericheskii sustavnoi sindrom pri ankiloziruiushchem spondiloartrite--odin iz variantov reaktivnogo artrita.

In 75 patients with central (n = 37) and peripheral (n = 38) ankylosing spondylarthritis, EIA was used to detect serum antibodies to Klebsiella (IgG and IgA) and to the common enterobacterial antigen (CEBA) as compared to the level of the ESR, C-reactive protein and circulating immune complexes. Out of the 75 patients, 53 were examined for the intestinal microflora. Serum antibodies to Klebsiella were demonstrated more frequently in the peripheral form than in the central one, particularly in demonstrating Klebsiella coproculture. The presence of serum antibodies correlated with the disease activity. In the central form, enterobacteria without Klebsiella prevailed in the intestine. In both forms, antibodies to CEBA were demonstrated not so frequently (in 1/4 of the patients). In both forms, a large number of cases (74-80%) showed intestinal dysbacteriosis; in the peripheral form, however, it reached a greater degree. As to the central form, the etiological role of Klebsiella is not absolutely clear. It is more remarkable in the peripheral articular syndrome (reactive arthritis towards Klebsiella?) associated with ankylosing spondylarthritis.

[Anti-tuberculosis antibodies in the immunoenzyme test in relation to the effectiveness of chemotherapy of tuberculosis]. / Protivotuberkuleznye antitela v immunofermentnom teste v zavisimosti ot éffektivnosti khimioterapii tuberkuleza.

A method of indirect solid-phase EIA was used to detect serum antibodies in 110 patients with destructive tuberculosis. The preparation with a molecular mass of 38-42 kD isolated from the mycobacteria H37Rv was used as an antigen. Changes in the level of antituberculous antibodies were found during treatment, which are most manifested in 4-6 months of antituberculous therapy and depend on treatment efficiency. The effective therapy is accompanied by a decrease in the level of antituberculous antibodies by that time, while in ineffective therapy it remains high. Hence, changes in the level of antituberculous antibodies may serve as an additional criterion of chemotherapy efficiency.