[Clinical features of pertussis in adults].

AIM: To study the clinical features of pertussis in adults. SUBJECTS AND METHODS: The clinical manifestations of pertussis in adults were analyzed in 62 patients treated in the Core Unit and Obstetric Unit, Clinical Infectious Diseases Hospital One, Moscow Healthcare Department, in 2011-2013. RESULTS: Investigations conducted in the familial foci of pertussis showed that its incidence rate was 23.7 and 10% in adults and in pediatric institutions, respectively. The source of infant infection was adults in almost one third of cases, mothers in 72% and fathers in 27.7%. Assessment of the symptom complex of pertussis in the sick mothers in the observed period ascertained that 94±3% had experienced the typical form of whooping cough: 72.0±5.7 and 22.0±5.3% had its mild and moderate forms, respectively. The disease had run a latent course in 6±3% of the patients. The paper describes cases of pertussis in 5 pregnant women admitted to the obstetric unit for complaints of persistent cough. The diagnosis of whooping cough in all the cases was based on clinical and epidemiological findings and serological tests showing specific IgA and IgG antibodies. Three and two patients experienced moderate and mild pertussis, respectively. CONCLUSION: Pertussis now remains one of the infectious diseases relevant not only to a pediatric population, but also to an adult one. Adult pertussis maintains the main clinical features typical for this infection with a predominance of its mild forms, which makes its diagnosis difficult. A serological test (enzyme immunoassay) is of high diagnostic value for verifying whooping cough in adults under the present conditions.

[Masked deficiency of C4 component of complement in patients with chronic gastrointestinal tract diseases of different etiology].

AIM: Frequency of occurrence detection of C4A and C4B complement system deficiency in patients with chronic gastrointestinal tract (GIT) diseases including gastric ulcer (GU) and duodenal ulcer (DU). MATERIALS AND METHODS: 74 patients with chronic GIT diseases were examined. Endoscopy with stomach mucosa condition evaluation based on histobacterioscopic examination of gastroduodenal biopsy samples was used. Intestine microbiocenosis evaluation was performed by using microflora degree of manifestation according to Federal Standard of Russian Ministry of Health No 231 -91500.11.0004-2003. C4A and C4B isotypes in blood sera of patients were measured by using enzyme immunoassay. RESULTS: Chronic gastroduodenitis was diagnosed in 35.1%, pangastritis B--in 41.9%, GU and DU--in 23% of patients. Histological evaluation of biopsy samples revealed marked inflammatory changes in stomach and duodenum mucosa in 77% of patients. Stomach mucosa infection rate by Helicobacter pylori reached 85%. Microbiological disorders manifestation in microflora of patients matched endoscopic and histobacteriscopic changes in it and was the highest for GU and DU. In 76.0% of cases C4A and C4B isotype deficiency in blood sera matches the development of erosive-ulcerous process in stomach and duodenum mucosa with marked background dysbiotic GIT microbiota disorders. CONCLUSION: Patients with functional deficiency of C4A and C4B isotypes have a genetic burden to susceptibility to chronic GIT diseases whereas H.pylori infection deteriorate the disease.

[Determination of protease activity in blood and in microorganisms].

For determination of protease activity it is possible to use immunoglobulins. Since proteolytic products apparently do not retain substrate antigenic determinants, it is possible to use ELISA methodsfor monitoring for enzymatic process. ELISA determination of functional activity of specific IgA1-protease has been applied not only for detection of this enzyme, but also for measurement of its inhibition constants. Fixed on a micropanel IgG may be used for evaluation of total proteolytic activity. Depending on pH values, it is possible to measure activity of neutral, alkaline and acid proteases. This approach has allowed to estimate total proteolytic activity of neutral proteases of serum. Measurement of a total level of serum pepsinogene activity can have diagnostic importance in gastroenterology, due to decisive contribution of pepsinogen I to the measured activity.

[Principles of constructing synbiotic preparations, and evaluation of their clinical effectiveness].

The problem of constructing means of correction of gastrointestinal microflora is utterly important. The most promising direction here seems to be construction of synbiotics containing a multiprobiotic complex of bifidobacteria and lactobacilli, modeling the microbiocenosis of a certain age group, inulin, as a prebiotic factor and a vitamin and mineral complex. The aim of the study was to evaluate the biologically active food supplement "Normospectrum" vs. the commercial preparation "Bifidumbacterin", its ability to correct the intestinal microflora and the functional condition of the gastrointestinal tract in children. "Normospectrum" was well tolerated, favored regression of the main clinical manifestations, and had positive effect on the intestinal microbiocenosis, increasing the proportion of bifidobacteria, lactobacilli and escherichiae with full enzymatic activity, and lowering the proportion of conditionally pathogenic bacteria and fungi in the intestinal tract. The effects of "Normospectrum" on the functional disturbances of the gastrointestinal tract and the intestinal microflora were much more profound than those of "Bifidumbacterin". Good tolerance and positive effects of the new probiotic preparation "Normospectrum" on the intestinal microbiosis allows recommending it for broad clinical application in children when correction of dysbiotic shifts in the intestinal microflora is necessary.

[Dysbiotic conditions and their management].

The authors present data concerning the role of normal intestinal microflora as a non-specific resistance factor. They systematize the notion of intestinal dysbacteriosis as a clinicolaboratory syndrome, observed in patients with various gastrointestinal pathology, adduce the characteristics of the preparations of probiotics, prebiotics, and synbiotics, and discuss the mechanisms of their action, as well as their efficacy in the management and prevention of microecological disturbances of the intestinal tract. It is recommended that probiotic preparations are administered according to the principle of microecological adequacy, taking into account the condition of the microflora, as well as the phase, stage, and character of the underlying disease. Some preparations should be used for preventive, others--for therapeutic purposes. The authors stress that antibioticotherapy is indicated only in cases of clinically severe infectious process; such therapy should be followed by reestablishment of the normal microflora with proper probiotic preparations.

[Microbial ecology and the state of the gastrointestinal mucosa in patients with allergic diseases]. / Mikrobnaia ékologiia i sostoianie slizistoi obolochki zheludochno-kishechnogo trakta u bol'nykh allergicheskimi zabolevaniiami.

Patients with allergic diseases of the skin and the respiratory system were found to have a high rate of disturbances in the microbial ecology of the gastrointestinal tract and the involvement of all its sections into the pathological process. On the mucous membrane of different sections of the digestive tract spiral-like bacteria were detected in a large percentage of cases. The possibility of the fact that the development and maintenance of the allergic process were evidently linked with the detected changes in the microbial ecology and pathomorphological features of the gastrointestinal mucosa could hardly be excluded, which made it necessary to make corrections in the therapeutic process.

[Clinical and microbiological features of acute enteric mixed infection caused by Hafnia alvei and rotavirus]. / Kliniko-mikrobiologicheskie osobennosti ostroi kishechnoi mikst-infektsii, vyzvannoi bakteriiami Hafnia alvei i rotavirusom.

The data obtained in the clinical and laboratory study of 72 hospitalized patients with acute enteric infection are presented. The observed outbreak was caused by H. alvei producing heat-stable enterotoxin. The role of this etiological agent is also confirmed by simultaneous occurrence of the disease after using the same foodstuff, a short incubation period, the severity of the course of the disease with pronounced symptoms of neurotoxicosis, a high detection rate of H. alvei in material taken from patients at the acute period of the disease, rapid disappearance of this agent in the period of convalescence and a pronounced rise in the titer of specific antibodies to H. alvei in the dynamics of the disease. At the same time in the feces of 8 patients rotavirus antigen was detected, which, in combination with residual catarrhal phenomena, hyperemia and granularity of the pharynx, yellow stool, was indicative of the simultaneous circulation of rotavirus among these patients.

[Treatment efficacy in acute intestinal infections, chronic diseases of the gastrointestinal tract and viral hepatitis B using large doses of Russian Bifidumbacterin-forte]. / Effektivnost' lecheniia ostrykh kishechnykh infektsii, khronicheskikh boleznei zheludochno-kishechnogo trakta i virusnogo gepatita B bol'shimi dozami otechestvennogo Bifidumbakterina forte.

Until now viral and bacterial acute intestinal infections have a high percent in the whole structure of modern intestinal disorders morbidity. Taking into consideration inefficacy of antibacterial treatment in a number of cases, probiotics with antagonist effect on a wide range of bacteria have found a wide usage. This study proves clinic and morphological efficacy of large doses Bifidumbacterinum forte for the treatment of the diseases mentioned. The patients of the test group demonstrated a relation dyspeptic disturbances, improvement of total state in a shorter period than the patients of control group.

[The efficacy of the new bacterial preparation biosporin in treating acute intestinal infections]. / Effektivnost' novogo bakteriinogo preparata biosporina pri pechenii ostrykh kishechnykh ifektsii.

The clinico-laboratory study of the new probiotic Biosporin revealed its effectiveness in the treatment of patients with acute enteric infections. The pronounced curative action of the preparation, manifested by the rapid normalization of stool, the disappearance of abdominal pains and the decrease of dysbiosis in the intestine, was demonstrated. The best results were registered after the administration of Biosporin containing 2 x 10(9) microbial cells (Bacillus subtilis and Bacillus licheniformis). Biosporin was well tolerated by the patients, no side effects were observed. Biosporin is recommended for use in medical practice for the treatment of patients with acute enteric infections.

[Pathomorphology of the large intestinal mucosa in acute infectious colitis]. / Patomorfologiia slizistoi obolochki tolstoi kishki pri ostrykh infektsionnykh kolitakh.

634 biopsies of distal colon mucosa from 393 patients with acute intestinal bacterial and viral infections were studied histologically, histochemically and morphometrically. Acute catarrhal or catarrhal-hemorrhagic inflammation was found regardless of the colitis etiology (Shigella, Salmonella, Campylobacter, rotavirus). The most pronounced inflammation was in shigellosis and minimal one in rotavirus infection. Marked eosinophilic infiltration of the epithelium and tunica propria was observed in colonic contamination with C. pylori. Correlation analysis between morphometric indices in shigellosis and salmonellosis revealed a decrease in the number of strong functional links and the appearance of new ones indicating morphofunctional derangement.

[The chemoprophylaxis and chemotherapy of opportunistic infections]. / Khimioprofilaktika i khimioterapiia opportunisticheskikh infektsii.

Actual problems of organization and performance of chemoprophylaxis and chemotherapy of surgical opportunistic infections are discussed with an account of the main principles of and new approaches to the use of antibacterial drugs. The analysis of the authors' observations showed that the pre- and postoperative use of parenteral antibacterial drugs such as cephalosporins (cefazolin and ceftriaxone) and their combinations with aminoglycosides, the simultaneous use of beta-lactams and lysozyme, the local application of new ointments based on polyethylenglycol, foaming agents and gentacycol were prophylactically efficient in patients with high risk of surgical infections. Endolymphatic administration of gentamicin and cefotaxime was highly efficient in the treatment and prophylaxis of severe surgical infections with lymphogenous dissemination of the pathogen or its risk. In the prophylaxis of endogenous infections special attention should be paid to the suppression of the opportunistic intestinal microflora by the use of fluorquinolones and selective decontamination followed by the correction of the intestinal microbiocenosis with probiotics (bifidobacteria), lysozyme and immunological lactoglobulins as dosage forms or dry milk biologically active additives to children diet and dietotherapy.

[Augmentin in the clinical picture of infectious diseases]. / Augmentin v klinike infektsionnykh boleznei.

Augmentin is a new combination manufactured by Smith Kline Beecham (Great Britain). It is composed of amoxycillin and clavulanic acid and has antibacterial activity. Augmentin was used in clinical trials in the therapy of 50 adult patients with suppurations after surgical operations on the organs of the abdominal cavity, general staphylococcal infections, pneumonia and prophylactically during the preoperative period. It was also used in the treatment of 30 children patients with bronchopulmonary affections and inflammatory otorhinolaryngological diseases. The clinical trials were performed in the Clinic of Infectious Diseases of the N. G. Gabrichevskii Moscow Research Institute of Epidemiology and Microbiology. For comparison ampicillin was used in the trials. Augmentin was shown to be an efficient formulation with antibacterial activity which could be successfully used in the parenteral therapy of severe affections due to organisms sensitive to it. In the treatment of the children patients with pneumonia augmentin by its therapeutic efficacy proved to be superior to ampicillin. The tolerance of augmentin was good.

[Chemotherapy of Campylobacter infections]. / Khimioterapiia kampilobakterioza.

A total of 600 patients with suspected alimentary food poisoning were hospitalized. The ++clinico-laboratory findings showed that 27 (4.5 per cent) of them had Campylobacter infection. The cultures of Campylobacter jejuni and Campylobacter coli were isolated from 24 and 3 patients, respectively. The patients underwent complex pathogenetic treatment with oral rehydration saline solutions, symptomatic agents, enzymatic preparations and diet (the basic therapy) supplemented with biological bacterial preparations in less severe cases (8 patients). Antibacterial drugs such as furazolidone (roxytromycin), gentamicin and levomycetin, as well as fluoroquinolones such as ofloxacin and ciprofloxacin were additionally used in the treatment of both the patients with the generalized infection and those with more severe processes of the disease, pronounced diarrhea with blood traces and persisting isolation of Campylobacter (12 patients). The most favourable results in the treatment of more severe patients with Campylobacter infection were obtained with the fluoroquinolones used after inadequately efficient therapy with furazolidone or antibiotics especially in the cases with repeated isolation of campylobacteria.

[Rotavirus infection in a maternity home based on virological and serological study data]. / Rotavirusnaia infektsiia v rodil'nom dome po dannym virusologicheskikh i serologicheskikh issledovanii.

The studies carried out in a maternity house, employing a set of virological and serological methods, revealed the facts of introduction of rotavirus infection into the maternity house, and followed the further spread of the infection. Epidemiological surveys evaluated the sources of infection (parturients, newborns, medical personnel), means of spread of rotavirus infection, and analysed the epidemiological advantages of wards for mother and newborn baby staying together.

[Morphological and morphometric characteristics of the large-intestinal mucosa in Campylobacter infections]. / Morfologicheskie i morfometricheskie osobennosti slizistoi obolochki tolstoi kishki pri kampilobakterioze.

Twenty-two biopsy specimens of colon mucosa were obtained from 16 patients with gastrointestinal campylobacteriosis histologically, histochemically and morphometrically. At the height of the disease colon mucosa of these patients showed a morphological picture of acute hemorrhagic and erosive--hemorrhagic colitis. When compared with such for other intestinal infections (shigellosis, salmonellosis, rotaviral gastroenteritis), the morphological features appeared to vary permitting a differential diagnosis with acute colitis due to above infections, but objective criteria to differentiate campylobacter-induced colitis from colitis in aggravation of nonspecific ulcerative one and Crohn's disease still remains to be found.

[Patho-anatomic changes in rotaviral gastroenteritis in children]. / Patologoanatomicheskie izmeneniia pri rotavirusnom gastroénterite u detei.

Two children (a 6-month-old girl and a 9-month boy) died from Rotavirus gastroenteritis as evidenced by virological, electron microscopic, and immune fluorescence studies of intestinal tissue. Histological and morphometric examinations of the small intestine revealed acute diffuse enteritis with enlarged and shortened villi, infiltration of intrinsic plates with lymphocytes, plasma cells and macrophages, enhanced mitotic activity of epitheliocytes and their increased lymphocyte-induced infiltration. The hepatic tissue showed central lobular fatty infiltration. The above changes should be regarded as manifestations of Rotavirus infection. Pneumonia detected in one of the children had been caused by influenza infection.

[Isolation of the human rotavirus in a cell culture of green monkey kidneys]. / Vydelenie rotavirusa cheloveka na kul'ture kletok pochek zelenykh martyshek.

Properties of a virus isolated from a patient with rotavirus gastroenteritis (the diagnosis verified by direct electron microscopy) were studied. The virus was identified as a rotavirus in tissue culture neutralization and complement fixation tests. It was shown to replicate through a significant number of passages in continuous cell cultures (Vero, RH) as well as in primary cell cultures of human and animal origin (human embryo kidney, green monkey kidney); some features associated with rotavirus propagation are described.

[Use of the agar diffusion precipitation method for detecting rotavirus antigen]. / Ispol'zovanie metoda diffuzionnoi pretsipitatsii v agare dlia obnaruzheniia rotavirusnogo antigena.

The possibility of rotavirus detection in feces of patients with acute enteric diseases by the agar gel diffusion (AGD) test was studied. The effectiveness of this method was compared with that of the standard method, direct electron microscopy. Both methods showed good correlation of the results, but the AGD test is methodically much simpler which recommends it for diagnosis of rotavirus infection. Rotavirus-specific hyperimmune calf serum may by used as a serological diagnostic preparation for the detection of human rotavirus antigen.