[Role of platelets in the pathogenesis of Coxiella infection].

AIM: To determine the relationship of hemostatic disorders to the direct impact of Coxiella burnetii on platelets as one of the key mechanisms of the pathogenesis of Q fever. SUBJECTS AND METHODS; Platelet functional activity, plasma hemostatic parameters, von Willibrand factor (vWF) were investigated; and polymerase chain reaction assay was used to determine C. burnetii DNA in the leukocyte and platelet sediments of 41 patients aged 39.9 +/- 0.8 years diagnosed with Q fever at the Astrakhan Regional Clinical Hospital in 2009 to 2010. RESULTS: The examinees were recorded to have hemorrhagic phenomena (34.7%) as a hematoma (27.2%), gingival (2.4%) and nasal (9.2%) hemorrhages, vomiting blood streaks (3.4%), melena (4.5%), roseolous-papular (22.1%) and hemorrhagic (9.3%) rashes on the skin. Examination of hemostasis revealed thrombocytopenia and platelet hypoaggregation, increased plasma fibrinogen homeostasis, and significantly elevated vWF during convalescence. C. burnetii genomic DNA was isolated from platelets in all the examinees, from leukocytes and platelets in 78% of cases and only from platelets in 22%. A fluorescence signal indicating the pathogen genome was more early recorded in 54.8% of cases in the platelets than in the leukocytes. CONCLUSION: At week 1 of the disease, the absence of significant plasma hemostatic changes and the retention of the control level vWF with the lower count of platelets and their aggregatory activity suggest that the platelets are able to interact with this pathogen, which is confirmed by the results of genodiagnosis of this rickettsiosis with the pathogens being isolated from the platelet sediment. The determination of platelet aggregatory activity is a primary diagnostic test to detect disorders in the hemostatic system. The higher detection rate of C. burnetii genomic DNA from the platelets than from the leukocyte sediment can recommend that platelets be used as biological material in the diagnosis of Q fever.

[Reamberin optimizes drug therapy in children with acute Epstein-Barr viral infection].

The efficacy of a 1.5% reamberin solution possessing detoxicating, antihypoxant, antioxidant, and membrane-protective properties, used as a component of the complex infusion therapy in children with acute Epstein-Barr virus infection, has been estimated. The dynamics of the inflammatory process in children treated by the drug complex including reamberin is characterized by rapid relief of general symptoms, improvement of state, and reduction in length of the febrile period of disease as compared to patients treated with glucose-saline solutions and basic therapy. The administration of reamberin in children contributed to the early elimination of metabolic shifts by the period of convalescence, as evidenced by improvement in some laboratory parameters, including protein-synthesis function of the liver.

[The content of rosette-forming neutrophils and lysozyme in patients with Q-fever].

The article deals with the results of study of 35 patients with Q-fever and 30 donors to determine the content of rosette-forming neutrophils, lysozyme activity of blood and saliva. On the second week of disease it was revealed the activation of compensative immune mechanisms and on third and fourth week inhibition of these mechanisms.

[Evaluation of safety and pharmacotherapeutic efficacy of cycloferon in treatment of Astrakhan rickettsial fever].

Clinicopathogenetic impact of cycloferon, an endogenous interferon inductor, on the process of Astrakhan rikettsial fever, its complications and outcomes was analysed. The treatment scheme with addition of cycloferon to the complex therapy was optimized. The specificity of the disease clinical process and the level of the interferon status in the patients treated with cycloferon alone or with combination of the standard therapy and cycloferon was shown. It was observed that in the patients with moderate severity of the disease the combined use of the standard therapy and cycloferon was in favour of arresting the disease clinical signs (fever, headache, weakness, eruption, hepatomegaly, arthralgia and myalgia, lymphatic gland inflammation, primary affect) and lowered the hospitalization term vs. the standard therapy alone. In the patients with moderate severity of the disease the levels of the serous interferon-alpha before the treatment were found lower, while those of interferon-gamma were higher. The use of cycloferon in the treatment scheme resulted in increase of the interferon-alpha levels and decrease of the higher levels of interferon-gamma. The standard therapy in combination with cycloferon in the patients with moderate severity of the disease provided changes in the immune status: increase of the relative content of T- and B-lymphocytes and normalization of their absolute number. Normalization of the phagocytic activity and the coefficient of the active phagocytes, as well as increase of the phagocytic index, the levels of immunoglobulins G, A and M and the number of the circulating immune cells were stated. The standard therapy with addition of cycloferon resulted in normalization of the levels not only of succinic denydrogenase, lactate dehydrogenase and glucose-6-dehydrogenase but also of alpha-naphthylacetate esterase and alpha-naphthylbutirate esterase in the neutrophils, as well as of the whole spectrum of the monocyte enzymes, except NAD-diaphorase. The adverse reactions were observed in 2.5% of the cases (9 subjects). All of them were mild and did not require discontinuation of the drugs use.

[Experimental and clinicolaboratory evaluation of complex therapy efficacy in arboviral infections].

Search for drugs efficient in prophylaxis and treatment of dangerous infections (especially arboviral ones) is rather actual, since no specific therapy is available. Many-year investigations of interferon inductors showed that they had immunomodulating, antiviral and antiinflammatory effects and were low toxic. The present study demonstrated that the protective effect was the following: Venezuelan equine encephalitis (VEE)--cycloferon > amixin = ridostin, Rift Valley fever (RVF)--cycloferon > amixin > ridostin, predator pox (PP)--cycloferon > amixin = ridostin, that was obvious that cycloferon was the most active agent in the treatment of VEE, RVF and PP, thus making it possible to acknowledge its priority in prophylaxis and therapy of dangerous viral infections (DVI). Ribavirin in combination with cycloferon solution or cycloferon tablets provided shorter periods of the fever, minimized the intoxication syndrome, promoted earlier resolution of hemorrhagic eruption and lowered the frequency of complications, which was in favour of the disease prognosis.

[Clinical efficacy of cycloferon in complex therapy of infectious mononucleosis in pediatrics].

The results of the cycloferon use in therapy of 80 children at the age of 1 to 15 years with infectious mononucleosis are presented. The children were divided by chance sampling into two comparable groups of 40 subjects each. In the first group the children in addition to the standard therapy were treated with cycloferon for 10 days, intramuscularly or orally depending on the age. The reference group included the patients under the standard therapy alone. The efficacy of the drug was evaluated by reduction and more rapid disappearance of the main clinical symptoms of the disease. The improvement of certain laboratory indices, including those of the liver protein synthesis function were recorded, that allowed to reduce the hospitalization term. No side effects of the cycloferon use were observed.

[Implication of functional platelet activity in pathogenesis of Q-fever].

AIM: To ascertain the role of platelets in pathogenesis of clinical symptoms in patients with Q-fever. MATERIAL AND METHODS: We studied hemostasis with estimation of functional platelet activity in 49 patients with Q-fever. RESULTS: Hemorrhagic syndrome (HS) occurred in 34.4% patients with Q-fever (QF) during seasonal rise of morbidity. HS manifested with petechiae (12%), hematomas (32%), nasal bleeding (17%), stomatorrhagia (9%), melena (12%). Characteristics and duration of such symptoms as weakness (100%), myalgia (72%), arthralgia (52.9%) suggested hemocoagulatory disorders as a cause of the symptoms appearance. At the height of the disease thrombocytopenia was accompanied with inhibition of platelet aggregation activity, but regression of the clinical symptoms was associated with an increase in platelet count and platelet hyperaggregation. Fibrinogen content was elevated during hospitalization in 50% patients. CONCLUSION: Clinical manifestations of HS are typical for Q-fever prevalent in the Astrakhan Region. Hemostatic disorders because of altered functional activity of platelets were registered in all the cases and evidence for pathogenetic unbalance of homeostasis in Q-fever patients.

[Hemostatic disorders and their implication in the pathogenesis of Astrakhan rickettsial fever].

AIM: to define a role of hemostatic disorders in the pathogenesis of Astrakhan rickettsial fever (ARL). SUBJECTS AND METHODS: Platelet functional activity and plasma hemostatic parameters were studied in 89 patients of moderate ARL. RESULTS: The clinical manifestations of hemostatic disorders at the height of ARL were characterized by the appearance of typhoid maculopapular rashes in 91.4% of the patients, solitary elements of which were transformed to petechiae in 20% of cases. At convalescence (on day 10.2 +/- 1.3 of the disease), all eruptions regressed via pigmentation. At the peak of the fever, there were nasal hemorrhages and bleedings from the sites of injections; lowered platelet aggregation was detectable in the presence of thrombocytopenia at the height. Coagulation hemostasis changes were characterized only by elevated fibrinogen levels. Increased platelet functional activity and decreased fibrinogen concentrations were observed at convalescence. CONCLUSION: The basis of the clinical manifestations of ARL is hemostatic disorders due to thrombocytopenia and diminished platelet functional activity. In early convalescence, there was improved platelet aggregatability; however, the increasing trend for the rate of aggregation and the radius of aggregates suggests a risk of thrombogenesis in convalescents, which requires their follow-up with obligatory hemostatic monitoring.

[Prospects for treating mosquito-borne flavivirus encephalitides].

The Japanese encephalitis virus and West Nile virus belong to the family Flaviviridae, genus Flavivirus; they have a similar transmission cycle, with birds serving as the natural vertebrate host and mosquitoes, primarily, Culex species, both serving as the enzootic vectors and infecting humans. These arboviruses have caused more human cases of severe neuroinvasive disease worldwide during the past decade than other mosquito-borne flaviviruses. The current data and concepts on the clinical manifestations, pathogenesis, diagnosis, and treatment of infections caused by West Nile virus and Japanese encephalitis virus, are considered. The need for developing innovative approaches to etiotropic therapy for West Nile fever and Japanese encephalitis is emphasized; these approaches should be based on the comprehensive insight and extensive studies of the pathogenesis of flaviviral infections.

[Clinical laboratory characteristics of the course of local oropharyngeal diphtheria in patients with chronic tonsillitis]. / Kliniko-laboratornye osobennosti techeniia lokalizovannoi formy difterii rotoglotki na fone khronicheskogo tonsillita.

Of 115 patients admitted to hospital in 1994-1997 for stomatopharyngeal diphtheria (SPD), 41(35.7%) patients had compensated chronic tonsillitis (CT), while 17(14.8%) patients had decompensated CT. The ENT examinations carried out from the first day of the hospitalization helped to establish CT diagnostic criteria in localized form of SPD. It is shown that CT in diphtheric patients, especially decompensated CT, delays regress of local symptoms, extension of microbiocenotic spectrum and stomatopharynx contamination, prolongs carriage of diphtheric corinobacteria.

[Isolation of the West Nile Fever virus from human patients during an epidemic outbreak in the Volgograd and Astrakhan regions]. / Vydelenie virusa likhoradki Zapadnogo Nila ot bol'nykh liudei v periodépidemicheskoi vspyshki v Volgogradskoi i Astrakhanskoi oblastiakh.

Two strains of West Nile virus LEIV 27889 Vig and Ast 986 were isolated from the brain of a dead subject and from the blood of a patient, respectively, during an outbreak of serous meningitis and meningoencephalitis in July-September, 1999, in the Volgograd region, Krasnodar territory, and Astrakhan region. These strains reacted with convalescent sera in hemagglutination inhibition test, which proves their etiological role in this outbreak.

[Interferon efficacy in treating patients with Astrakhan fever]. / Effektivnost' interferonov pri lechenii bol'nykh astrakhanskoi likhoradkoi.

Astrakhan fever is a new endemic rickettsiosis belonging to the group of tick-borne spotted fevers. Adjuvant use of interferons in basic treatment of Astrakhan fever elevates its efficacy. The maximal contribution of interferons can be reached at administration of alpha-2 and gamma-interferons in daily doses 15,000-25,000 and 1500-2500 IU/kg, respectively. The response is higher at early administration of the medication. Interferons induce side effects early in the course: intensification of hyperthermia and pains.

[The primary effect and characteristics of the course of a new tick-borne rickettsiosis--Astrakhan fever]. / Pervichnyi éffekt i osobennosti techeniia novogo kleshchevogo rikketsioza--astrakhanskoi likhoradki.

Clinicomorphological characteristics are given of primary reaction at the site of tick (Rhipicephalus pumilio) bite in new rickettsiosis spreading in Astrakhan Province--Astrakhan fever. The disease presented with long-term fever (body temperature 39-40 degrees C), intoxication, conjunctivitis, hepatomegaly, regional lymphadenitis, disseminated roseolous papular-hemorrhagic rash, arterial hypotension.