[Clinical, x-ray, and laboratory features of tuberculosis and osteomyelitis of the spine].

In 20% of cases, tuberculous spondylitis running with a prevalence of the exudative-necrotic type of a local tissue reaction has an acute onset with febrile fever, severe pains, and progressive neurological disorders and clinically resembles acute hematogenous osteomyelitis of the spine. With a predominance of the productive type of a tissue reaction, tuberculous spondylitis resembles subacute hematogenous osteomyelitis of the spine. History data, laboratory parameters, and an X-ray follow-up are of great importance in its differential diagnosis.

[Neutrophilic and lymphocytic factors of an immune response in renal tuberculosis]. / Neitrofil'nye i limfotsitarnye faktory immunnogo otveta pri nefrotuberkuleze.

Fifty-eight patients with nephrotuberculosis at its peak were found to have a high functional activity of neutrophilic granulocytes, as determined by the lysosomal cation test, by the levels of myeloperoxidase and lactoferrin. The subpopulation of lymphocytes, concentrations of tumor necrosis factor-alpha (TNF-alpha), interleukin-2 (IL-2), as well as those of IL-2 in a combination with its soluble receptor (SR-2) in the serum and supernatant of cellular cultures stimulated by phytohemagglutitin and PPD were studied. The findings suggest that there is a close correlation between the high concentrations of IL-2 and PP-alpha and the decreased content of activated lymphocytes expressing receptors to IL-2 (CD25+). Clinical remission has been ascertained to be attended only by a partial normalization of immunological parameters with antituberculous therapy.

[Clinical and laboratory features in tuberculosis and osteomyelitis of the spine]. / Kliniko-laboratornye osobennosti pri tuberkuleze i osteomielite pozvonochnika.

Tuberculous spondylitis runs atypically with its acute onset, high fever, and violent pain in 20% of cases. This disease is characterized by a high specific activity of T lymphocytes, by high levels of antituberculous antibodies, by a higher activity of adenosine deaminase, by higher concentrations of IgA and IgE. The gradual onset and few-symptom course of hematogenous osteomyelitis were revealed in 15% of cases. In osteomyelitis, there was a low concentration of antituberculous antibodies, higher levels of low and medium molecular mass, and IgG.

[TNF-alpha in prognosis of a recovery of the spinal marrow function in patients with spinal tuberculosis]. / Faktor nekroza opukholi alfa v prognoze vosstanovleniia funktsii spinnogo mozga pri tuberkuleze pozvonochnika.

The TNF-alpha significance in forecasting a degree of recovering of the spinal marrow functions was studied in complicated courses of tuberculous spondylitis in 37 patients with generalized and multiple tuberculosis. The TNF-alpha level in the cerebrospinal fluid was found to be related with a severity of inflammation and of neurological disorders, as well as with a degree of spinal marrow compression and with a speed of regression of postoperative disorders in the spinal marrow. The initial TNF-alpha concentration of > or = 400 pg/ml was indicative of a possibility to ensure a fast regression of postoperative disorders in the spinal marrow, while no complete recovery of spinal-marrow functions was observed in cases the TNF-alpha was < 400 pg/ml.

[Immunity in patients with active tuberculous spondylitis]. / Immunnyi status bol'nykh aktivnym tuberkuleznym spondilitom.

Immunological parameters were studied in 45 patients with active tuberculous spondylitis, admitted for surgical treatment, who were divided into 2 groups in accordance with the prevalence of exudative-necrotic, or productive components of inflammation in the vertebral bodies and paravertebral tissues. The patients with a predominantly exudative-necrotic component of inflammation exhibited a severe clinical course with frequent neurological disorders, large abscesses in the paravertebral tissues, inflammatory changes in the leukogram, enhanced specific T-lymphocytic activity in the PPD blast-transformation reaction, significant increases in the levels of tuberculosis antibodies and IgE, IL-2 and it soluble IL-2 receptor RR-alpha, an excessively high increase in the functional activity of neutrophilic granulocytes, and lower with IgG2. The degree of immunological disorders corresponds to the severity of a course of tuberculous spondylitis.

[State of local immunity in patients with inflammatory diseases of the spine]. / Sostoianie mestnogo immuniteta u bol'nykh s vospalitel'nymi zabolevaniiami pozvonochnika.

The paper presents the results of examination of spinal fluid in tuberculous spondylitis (n = 83), its sequelae (n = 58), spinal osteomyelitis (n = 25) for the levels of tuberculosis antibodies (TAb) by applying the routine enzyme immunoassay, specially adapted to this biological object, and immunoglobulins. A relationship was found between TAb detection and the rate of the process and the severity of a spinal cord lesion. Forty one patients had severe spinal cord disorders (paraplegia and deep paraparesis). To detect TAb in CF is shown to be of differential diagnostic value. There is new evidence for impaired blood-brain and immunological barriers in active tuberculosis in the spine with spinal cord compression.

[Experience in standardization of immunological diagnosis of extrapulmonary tuberculosis]. / Opyt standartizatsii immunologicheskoi diagnostiki vnelegochnogo tuberkuleza.

An uniform multi-levelled approach to immunodiagnosis of tuberculosis of different sites is proposed with regard to latest information on the local immune response based on the detection of tuberculosis antibodies in blood and biological fluids from anatomic lesion areas. If necessary, immunological diagnosis is specified by using a set of serological tests and Koch's provocative test, as well as data on specific T-lymphocyte proliferation.

[Spectrum of tuberculosis antibodies in patients with tuberculosis and borderline urinary tract diseases]. / Spektr protivotuberkuleznykh antitel u bol'nykh tuberkulezom i pogranichnymi zabolevaniiami mochevydelitel'noi sistemy.

The spectrum of tuberculosis antibodies detectable by indirect hemagglutination test, complement consumption, passive hemaagglutilution test (PHAT), and enzyme-linked immunosorbent assay (EISA) in patients with urinary tract diseases (tuberculosis, nonspecific disorders) was studied. In untreated bacteria-isolating patients in the early phase of disease, antibodies were found in 61.8%, their different types were detectable at different rates so it is more advisable to explore responses by using several serological tests. During treatment there is an increase in antibody detection rates by ELISA. At this time only can PHAT and ELISA be made. High seropositive rates (85-100%) are ensured by PHAT and ELISA in new case in end-stage disease. The antibodies are detected in 75 of the pretreated patients with nephrotuberculosis largely by PHAT and ELISA. Examination of patients with nonspecific disease by ELISA clarifies the clinical status of these patients.

[Surgery on tuberculosis lymphatic system and abdominal organs]. / Khirurgiia tuberkuleza limfaticheskoi sistemy i organov briushnoi polosti.

The paper presents data on surgery for tuberculosis of the lymphatics and abdominal organs. Removal of tuberculosis-affected peripheral lymph nodes during etiotropic therapy yields positive therapeutical results in 84.6% of patients. The efficiency of early operations has been first evidenced by a dynamic study of the systemic immunity. Complicated abdominal tuberculosis is encountered in 44.2% and forced emergency and planned operations on the abdomen to be performed; good late results should be consolidated by combined bactericidal therapy.

[Detection of antitubercular antibodies in children and adolescents at the health resort stage of management]. / Vyiavlenie protivotuberkuleznykh antitel u detei i podrostkov na sanatornom étape lecheniia.

Antituberculosis antibodies were detected in 164 children and adolescents who had tuberculosis and who were infected with mycobacteria. The diagnostic value of indirect hamagglutination tests with phosphatide antigen and tuberculin, complement uptake, passive hemolysis, and enzyme immunoassay for evaluating the progression of tuberculosis was defined in patients at a specialized sanatorium. The significance of the tests increases when they are concurrently used.

[Pathogenetic rationale and diagnostic methods in allergic tuberculous synovitis of the knee joint]. / Patogeneticheskoe obosnovanie i metodika diagnostiki tuberkulezno-allergicheskogo sinovita kolennogo sustava.

The pathogenesis of tuberculous allergic synovitis was specified in the experiments on 44 rabbits by applying original simulation methods, including bivalent sensibilization, parallel study of the synovial fluid and serum of laboratory animals. A role of the synovial layer as an organ of immunogenesis and its impact on antibody titers were defined. A new diagnostic test, involving a diagnostic parameter and an equation for its calculation was developed. An algorithm was proposed for examining patients with synovitis (arthritis) of unknown etiology, which includes a set of significant clinical and laboratory parameters. Its testing in 64 patients enabled the tuberculous nature of the disease to be identified in 30% of cases.

[Indicators of systemic and local immunity in patients with spinal tuberculosis]. / Pokazateli sistemnogo i mestnogo immuniteta u bol'nykh tuberkulezom pozvonochnika.

The examination of 33 patients with tuberculous spondylitis and its sequelae revealed inhibition of T-cell immunity in 40% of the examinees, antituberculous antibodies in the blood of 73% of patients. An enzyme immunoassay detected antituberculous antibodies in cerebrospinal fluid of 70% seropositive sufferers with spinal tuberculosis. Positive results of this test serve a direct indication to spinal decompression and intensive pre- and postoperative antituberculosis treatment.

[Characteristics of immunity in patients with destructive pulmonary tuberculosis]. / Osobennosti immuniteta u bol'nykh s destruktivnym tuberkulezom legkikh.

Parameters of systemic immunity, activity of cation proteins of neutrophilic granulocytes and individual blood serum proteins were studied in two groups of patients: with newly diagnosed (83) and chronic destructive pulmonary tuberculosis (105). Four levels of T-lymphocytes were established per their absolute content in 1 ul of the peripheral blood, which had different interconnection with cell response intensity to mitogenic PHA stimulation and the values of the lysosomal cation++ test in both groups of patients. Indications for the prescription of immune active preparations based upon the T-cell level and, when necessary, supplemented by information related to the values of BTR with PHA and BTR with PPD were developed for both groups of patients independently of hereditary consolidated serum proteins.

[Indices of humoral immunity in inhabitants of the Far North infected and sick with tuberculosis]. / Pokazateli gumoral'nogo immuniteta u infitsirovannykh i bol'nykh tuberkulezom zhitelei Krainego Severa.

As a result of a complex study of the humoral immunity indices in tuberculosis infected and affected inhabitants of the Extreme North with reference to the immunoglobulin A, G, M levels, titers of heterohemagglutinins (HHA) and specific antibodies defined by means of indirect hemagglutination test (IHAT), complement fixation test with tuberculin and IHAT with phosphatidic antigen (IHAT-Ph), two simple and quite informative tests, i.e. HHA and IHAT-Ph, are recommended for the practical use in health system. HHA level greater than 1/4 indicates the absence of immunodeficiency in system B. The results of IHAT-Ph, being adequate to the main clinical manifestations of tuberculosis (including bacillary excretion and lung tissue destruction), can be used as an additional diagnostic and evaluation method of tuberculous activity when the subjects from specific infection foci are examined or during their inpatient and dispensary observation and management.

[Comparative evaluation of the immunoenzyme system used in the serodiagnosis of tuberculosis and non-tuberculous diseases]. / Sravnitel'naia otsenka immunofermentnoi test-sistemy pri ispol'zovanii dlia diagnostiki serodiagnostiki tuberkuleza i netuberkuleznykh zabolevanii.

A method for detection of antituberculous antibodies by enzyme immunoassay system developed by the authors, was tested on 317 blood serum samples taken from patients with tuberculosis and non-tuberculous diseases of the lungs, vertebral column, kidneys and genitalia. Depending on the process site, the detection rate of specific antibodies and their specificity made up 57-77% and 85-95%, respectively, which practically agrees with the data produced as a result of a simultaneously conduction of three routine serologic reactions.