[Intrauterine Pneumocystis infection]. / Vnutriutrobnaya pnevmotsistnaya infektsiya.

Pneumocystosis is well known as an opportunistic infection that is presently most frequently registered in patients with HIV infection and in those with other immunodeficiency states. Earlier, after the Second World War, Pneumocystis pneumonia was most commonly detected in debilitated and premature children; nosocomial outbreaks of pneumocystosis were studied in detail in the 1960s and 1970s. The pathogen is transmitted through the air, but a number of references indicate that it can be transmitted through the placenta. Despite the increasing number of publications on pneumocystosis in pediatrics, physicians remain unfamiliar with this disease. The paper provides evidence that Pneumocystis jiroveci can infect the fetus in utero. If unrecognized, the disease can lead to a child's death due to severe respiratory failure. The authors describe their case of generalized pneumocystosis that has developed in a child with evidence of intrauterine infection (detection of the pathogen in the autopsy material and placenta and identification of serological markers in his/her parents). The issues that are associated with intrafamilial infection and a risk for in utero transmission of P. jiroveci are discussed.

[Role of opportunistic infection causative agent in etiology of obstructive bronchitis and prolonged subfebrility in children].

AIM: Determine the role of opportunistic infections causative agents in ethology of obstructive bronchitises and prolonged subfebrilities in children. MATERIALS AND METHODS: 56 children with the diagnosis of obstructive bronchitis and 46 children with the diagnosis of prolonged subfebrility were examined for the presence of herpes, mycoplasma and pneumocystic infections. EIA, IIF, rapid culture method, PCR were used. RESULTS: The highest number of cases of mixed infection was detected in children with HHV-6 infection. Mixed infection was diagnosed 6 times more frequently in children with obstructive bronchitis and 9 times in children with prolonged subfebrility. The number of children with pneumocystosis in combination with other infections was 2.4 and 2 times higher than with monoinfection; with CMV infection--4 and 2 times; with HSV infection--5 and 4 times; EBV infection--6 and 3.7 times. The only exception was mycoplasmosis detected in children with obstructive bronchitis where the difference between the number of mono and mixed infection cases was insignificant. CONCLUSION: The data obtained give evidence of wide spread of opportunistic infections.

[Serologic characteristic of Legionella pneumophila strains isolated from potentially dangerous water systems in Russian Federation in 2007 - 2011].

AIM: Study serologic diversity of Legionella pneumophila strains circulating in potentially dangerous water systems in Russian Federation by using an international panel of monoclonal antibodies. MATERIALS AND METHODS: Serotyping of 234 L. pneumophila strains isolated from coolers of industrial facilities and systems of hot water supply in Russian Federation in 2007 - 2011 was performed by enzyme immunoassay by using an international panel of monoclonal antibodies. RESULTS: Membership of the isolated strains in 14 L. pneumophila serogroups and in 7 subgroups of serogroup 1 was established. Among the isolated cultures serogroup 1 and 6, and Oxford and Heysham subgroup strains were predominant. L. pneumophila serogroup 1 strains were predominant in cooler water, and serogroup 6--in the hot water supply systems. 7 L. pneumophila strains of the serogroup 1 were typed by monoclone MAb 3/1 associated with LPS epitope that is characteristic for the most epidemically significant legionella strains. CONCLUSION: Typing by using international panel of monoclonal antibodies for characteristic and evaluation of epidemical significance of legionella strains being isolated form potentially dangerous water systems is the most informative and methodically accessible to a wide range of biological laboratories.

[Frequency of opportunistic infections in children with immune neutropenia and their mothers].

AIM: Determine the frequency of opportunistic infections among children with immune neutropenia and their mothers. MATERIALS AND METHODS: 66 mothers and 66 children with immune neutropenia diagnosis were examined for the presence of herpes (HV) and pneumocystic infection. Opportunistic infections markers (IgM, IgG, early and late antigens, virus reproduction) were determined by enzyme immunoassay, immunofluorescence reaction and rapid culture method (vero, u937, human fibroblasts). RESULTS: Pneumocystosis was the most active infection in the group. Among mothers 26 (39.3%) cases of pneumocystic infection in acute form were detected, among children - 18 (27.3%) cases. Infection occurred only in acute form during primary infection; there were no cases of its reactivation, which is an indication of recent pneumocystosis infection. Analysis of data on detection of acute and recent herpes infections showed that HV infection markers were determined in a relatively large number of mothers and their children: herpes simplex virus - 21.2%, Epstein-Barr virus - 12.0%, cytomegalovirus - 15.0%, Human herpesvirus 6 - 10.6%, Pneumocystis carinii - 21.2%. The data provided give evidence on a possible family pattern of the infection. CONCLUSION: A necessity of examination of mothers and their children suffering from immune neutropenia was shown because the specified opportunistic infections can form intra-family foci. The presence of acute form of infection in mother may be one of the conditions of development of this infection in the child.

[Pneumocystosis is an actual infection].

Contemporary aspects ofthe problem ofdiseases caused by single-celled yeast fungi Pneumocystisjirovecii are examined. Pneumocystic infection affects children and adults with various manifestations of immunodeficiency, is a HIV-associated infection. Contemporary epidemiologic characteristics of this infection are presented, data on etiology, pathogenesis and clinical presentation ofpneumocystosis are provided, problems of laboratory diagnostics are elucidated. Morphologic, immunobiologic and molecular-genetic methods of detection of Pneumocystis jirovecii causative agent are described.

[Herpesvirus infections in immunocompromised patients].

Testing of immunocompromised patients for markers of beta-herpesviruses--human herpesvirus type 6 (HHV-6) and cytomegalovirus (CMV), as well as gamma-herpesvirus--Epstein-Barr virus (EBV), revealed that all mentioned infections are frequently detected, mainlyas mixed infections. Chronic HHV-6 infection was diagnosed in more than half of the patients, whereas markers of acute phase of CMV and EBV infections were detected in 25% and 15% of patients respectively.

[Detection of coronavirus in experimental pneumocystic pneumonia].

Transmission electron microscopy (of ultrathin sections) was used to examine the biomass of lung tissue in the immunodeficiency minipigs experimentally infected with Pneumocystis carinii. The material was found to contain pneumocysts, bacteria, and coronaviruses. There was a clear coronavirus-pneumocyst structural relationship. The findings suggest the combined effect of microorganisms of different systematic groups on the development of a pathological process in the experimental infection etiologically determined by Pneumocystis carinii.

[The rate of human herpes virus type 6 and cytomegalovirus among HIV-infected and healthy women from Chelyabinsk and Moscow].

Human herpes virus type 6 (H HV-6) and cytomegalovirus (CMV) seroprevalence among HIV-infected and healthy women of childbearing age from Chelyabinsk and Moscow was measured with ELI - SA test-system for detection of antibodies to respective viruses. Seropositivity to HHV-6 was detected in 93.5% of HIV-infected women, that is 1.2 times more often than in healthy woman of child-bearing age. Seropositivity to CMV was detected in 87% of HIV-infected women, that is 1.05 times more often than in healthy woman of childbearing age. Low titers to HHV-6 and CMV were detected in seropositive healthywomen more frequently (in 44.1 and 48.4% respectively) whereas intermediate and high titers prevailed in HIV-infected women (in 73.9% for HHV-6 and 31.4% for CMV).

[Antibodies to the infective agents of opportunistic infections in blood of patients with hemoblastosis complicated with pneumonia].

The examination of 112 hematological patients with diagnosed acute and chronic leucosis, lymphoma, myeloma, anemia, melanoma and other diseases revealed not a single subject among these examinees in whom no markers of opportunistic infections were detected. Low titers of antibodies to Pneumocystis carinii, cytomegalovirus (CMV), Epstein-Barr virus (EBV) were noted in 42%, 46.4% and 40.2% of examinees, respectively. Markers of acute diseases, such as class IgM, IgG antibodies in high titers, as well as P.carinii, CMV, EBV antigens, were detected in 37.5%, 30.4% and 22.3% of patients of a hematological hospital. In the group of comparison (donors) these figures were, respectively, 15.3%, 2.4% and 6.9%. The signs of monoinfection were detected in 11.6% (pneumocystosis), in 10.7% (CMV infection) and in 14.3% (EBV infection), while the markers of two infections, EBV infection and pneumocystosis, were detected in 9.8%, EBV and CMV infections in 11.6%, pneumocystosis and CMV infection in 14.3%; mixed contamination with all three infective agents was detected in 12.5% of the patients.

[Detection of Pneumocystis carinii DNA in air and washes from medical equipment in hospitals].

Results of study of rooms' air and washes from medical equipment by PCR assay to detect Pneumocystis carinii DNA are presented. PCR assay sensivity was 200 copies/ml. Method of taking of air samples by MC-2 sample-taking device was modified for P. carinii detection. Sensivity of the method was 10 copies/m3. 27 air samples and 105 washes from medical equipment were studied and P. carinii DNA was not detected. It has been shown during the study that DNA of pneumocysts remains intact at room temperature during 12 days including 2-hour ultraviolet (UV) radiation treatment. After processing of studied surfaces with 0.1% solution of chloramine with subsequent UV radiation treatment during 30 minutes results of PCR assay were negative.

[HIV infection in pregnant women in Chelyabinsk].

Data on HIV infection in pregnant women in Chelyabinsk are presented. Starting from 1999, a considerable rise in the number of HIV-infected persons was registered in this city. The social and epidemiological characteristics of HIV-infected pregnant women, as well as the main routes and factors of the infective agent transmission, are given. Relationship between the spread of HIV-infection and drug addiction is revealed. The occurrence of different opportunistic infections in HIV-infected pregnant women is determined.

[Role of Chlamydia, mycoplasma and cytomegalovirus infection in the development of coronary artery disease]. / Rol' khlamidiinoi, mikoplazmennoi i tsitomegalovirusnoi infektsii v razvitii ishemicheskoi bolezni serdtsa.

AIM: To assess relationship between some infection factors and presence of coronary heart disease. MATERIAL: Patients with myocardial infarction (n=56), unstable angina (n=50), stable angina (n=50) and age - matched controls (n=49). METHODS: Levels of IgG, IgM, IgA antibodies to Chlamydia pneumonia, Chlamydia trachomatis, Chlamydia psittaci, IgG, IgM antibodies to Cytomegalovirus, and also of antibodies and antigen to Mycoplasma pneumoniae were measured in blood serum. RESULTS: Compared with controls patients with coronary heart disease had higher frequency of seropositivity to Chlamydia pneumonia, Mycoplasma pneumonia and Cytomegalovirus (p< 0.05 ) and similar levels of seropositivity to Chlamydia trachomatis and Chlamydia psittaci. Infectious burden (quantity of antibodies per one patient) was significantly higher in patients with myocardial infarction, unstable and stable angina than in controls (1.58, 1.42, 1.41 and 0.95, respectively). CONCLUSION: Our results confirm presence of association between infection and coronary heart disease.

[Associated infections in acute bronchopulmonary infections in children]. / Assotsiativnaia infektsiia pri ostrykh bronkholegochnykh zabolevaniiakh u detei.

A total of 189 children with bacterial complications of the acute respiratory viral infection (ARVI)--primarily with pneumonia and bronchitis--were dynamically examined for typical and atypical pneumotropic causative agents of the infection process (Mycoplasma pneumoniae, Chlamydia spp., Streptococcus pneumoniae, Haemophilus influenzae, Pneumocystis carini, and Citomegalovirus). A high frequency rate of the associative infection involving mycoplasmas and pneumocysts was registered (45-50%); it was lower in the cases involving Chlamydias, hemophilic bacteria, pneumococcus, and cytomegalovirus--up to 25-30%. No sharp difference was found between the indices of an infection degree and those of an active clinical infectious process involving the same pneumotropic agent: the biggest difference was observed in Chlamydia infections (9.4%) and the lowest one--in mycoplasma infections (3%). A dynamic comparison of different classes of immunoglobulins revealed that, in acute bronchitis and pneumonias, the Chlamydia and cytomegalovirus infections are, primarily, of the persistent nature; the hemophilic and pneumocystic infections are of a mixed nature; and the pneumococcus one is of the acute nature. The Mycoplasma infection, which is more often encountered in pre-school children, is of the primary type with a trend towards a prolonged clinical course. All pneumonias had a typical clinical course; the clinical picture was compared in 128 patients with the etiological factor (including a description of characteristic symptoms).

[Diagnosis of pulmonary lesions in acute respiratory insufficiency in patients with depressed hemopoiesis]. / Porazheniia lëgkikh pri ostroi dykhatel'noi nedostatochnosti u bol'nykh s depressiiami krovetvoreniia.

AIM: To analyse causes of acute respiratory failure (ARF) and methods of diagnosis of pulmonary lesions in patients with depressed hemopoiesis (DH). MATERIAL AND METHODS: 50 patients with DH and ARF were examined according to the protocol including x-ray, computed tomography, fibrobronchoscopy with bronchoalveolar lavage, cytological, bacteriological, virusological studies of the lavage fluid, biopsy of the lung. The algorithm of the protocol is provided. RESULTS: Sensitivity of the lavage fluid in diagnosis of fungal, bacterial, pneumocystic and cytomegaloviral infections was 84, 78, 93 and 93%, respectively. The cytologic examination of the lavage fluid may detect lung infiltration with blood tumors. In complicated diagnostic cases lung biopsy verified pulmonary lesion but its conduction aggravated the patients' condition. ARF patients with DH, bacterial flora, fungi, cytomegalovirus and pneumocystic infection, pulmonary tumor involvement, pulmonary lesions in ATRA-syndrome, non-infectious lesions of the lungs after bone marrow transplantation were found in 38, 18, 40, 18, 8 and 4% of cases, respectively. CONCLUSION: DH patients with ARF should be examined by the protocol including both non-invasive and invasive diagnostic methods. Accurate diagnosis of ARF causes is the basic reserve in the treatment of such patients.

[Spectrum of pneumotropic pathogens in pediatric patients with acute bronchitis and pneumonia]. / Spektr pnevmotropnykh vozbuditelei pri ostrykh bronkhitakh i pnevmonii detei.

One hundred eighty nine children with acute bronchopulmonary infectious pathological processes were examined bacteriologically and serologically for typical pneumotropic pathogens, 47 of them being as well examined for atypical organisms. Microbial associations mainly with Mycoplasma and Pneumocystis and to a lesser extent with Chlamydia were isolated from the majority of the children. Reactivation of the cytomegalovirus infection was observed in 25 per cent of the children. Pneumonia and bronchitis due to Mycoplasma pneumoniae either as a monoagent or in associations were mainly stated in children over 7 years of age. No significant changes between the indices of the infection due to a definite organism and the active progression of the infectious process of the same etiology were revealed, though in the cases of chlamydiosis the changes reached almost 10 per cent. In cases of acute bronchitis and pneumonia the chlamydial or cytomegalovirus infection could be assumed to be of the persisting nature, mainly acute in cases of pneumococcal infection, mixed in cases of hemophilic or pneumocystic infection, primary contamination with a tendency to prolonged in cases of mycoplasmic infection. The findings of the examination and the clinical and anamnestic data showed that the clinical picture of acute pneumonia had specific features associated with the supposed etiological agents, still it could change under the action of associations of pneumotropic pathogens.

[Persistence of pneumotrophic infective agents in acute bronchopulmonary diseases in children]. / Persistentsiia pnevmotropnykh vozbuditelei pri ostrykh bronkholegochnykh zabolevaniiakh u detei.

175 children with acute bronchopulmonary pathology were examined for the presence of the pneumotropic infective agents by serological and bacteriological methods. In most children microbial associations with the prevalence of mycoplasmas, pneumocycts and, to a lesser extent, chlamydiae were detected. The considerable activation of cytomegalovirus (CMV) infection in children with pneumonia and bronchitis was noted. Taking into account the results of the examination and the clinico-anamnestic data, the character of infections could be established: chlamydial and CMV infections were mainly persisting; pneumococcal infection was mainly acute, hemophilic and pneumocyst infections were mixed. The clinical picture of acute pneumonia cases had characteristic features determined by the supposed etiological agent, but this picture could change under the influence of pneumotropic infective agents.

[The diagnosis and clinical characteristics of cytomegalovirus infection in HIV-infected subjects]. / Diagnostika i klinicheskaia kharakteristika tsitomegalovirusnoi infektsii u VICh-infitsirovannykh lits.

Out of 180 HIV carriers active cytomegalovirus (CMV) infection was found in 30 patients, in 16 cases the infection manifested clinically. Most of the latter were patients with HIV infection IIIb or IIIc stage against persistent lowering of CD4-lymphocyte count under 100/mm3. Active CMV infection may be determined most significantly by the following criteria: high or moderate concentrations of CMV DNA in the blood, low concentrations of blood CMV DNA in the presence of long-term (at least 3 months) persistence of anti-CMV IgM and isolation of urinary CMV. CMV infection manifested usually as a generalized disease with typical signs of retinitis, myelitis, erosive-ulcerative colitis. Most patients had thrombocytopenia, functionally defective platelets. CNS involvement predicts poor prognosis in CMV-infected HIV carriers.