[Low-manifest infections with CNS damage in patients in prolonged unconscious state of non-inflammatory etiology].

AIM: Study of specter of low-manifest infections (LMI) with central nervous system (CNS) damage and their role in patients in prolonged unconscious state (PUS) of noninflammatory etiology. MATERIALS AND METHODS: 32 patients (23 male, 9 female; age 14-58) in PUS of various etiology were examined. The main group (18 patients) received therapy against all infectious diseases including LMI; control group (14 patients)--only against common and nosocomial microflora. Patients were immunologically, infectologically and neurologically examined in dynamic. The data obtained were treated by using STATISTICA for Windows (version 5.5). RESULTS: Significant differences in immune and infectologic status depending on the nature of primary CNS damage were not detected. Immunodeficiency was detected in all patients; 94% of patients had increased non-specific IgM and IgE. Among LMI agents Chlamydia spp. were predominant. Cultural and/or PCR methods detected this microorganism during the primary examination in cerebrospinal fluid samples in 56% patients and in blood samples in 56%; during the second diagnostics or autopsy--only in 13 and 25%, respectively. Detection of Bacteroides fragilis, Human Herpes Virus (HHV-6), Virus Epstein Barr (VEB), Cytomegalovirus (CMV) in cerebrospinal fluid, blood and on mucous membranes of nasopharynx and conjunctiva was grouped more frequently with the presence of Chlamydia spp. in the CNS (p < 0.05) than with other LMI agents. Sanation of CNS from LMI was significantly accompanied by regeneration of communicative activity in comparison with the control group. CONCLUSION: In patients with PUS high frequency of CNS infection by various LMI agents and primarily Chlamydia spp. should be considered. Sanation from LMI can become a "window" for effective neuro-regenerative treatment.

[To the differential diagnosis of arthritis of pseudotuberculous and chlamydial etiology].

AIM: to define main differential diagnostic criteria for arthritides of chlamydial and pseudotuberculous etiology and to improve patient examination tactics. SUBJECTS AND METHODS: Forty-six patients with pseudotuberculosis and 41 patients with chronic urogenital chlamydial infection with articular involvement were examined. A bacteriological method of polymerase chain reaction (PCR), agglutination test, enzyme immunoassay (EIA) (IgA, IgG, IgM), indirect hemagglutination (IHA) test were used to diagnose pseudotuberculosis. Diagnostic techniques for chlamydiasis involved cultural, direct immunofluorescence (DIF), real-time PCR, and EIA (IgM, IgG, IgA). RESULTS: Patients with pseudotuberculosis developed polyarthritis and oligoarthritis in 56 and 39%, respectively. The development of arthritides was accompanied by fever in 89%, exanthema in 57%, gastrointestinal lesion in 56%, hepatomegalia in 78%. The pseudotuberculous etiology of the disease was confirmed by the agglutination test in 71% of the patients and by IHA in 7%. EIA revealed IgG in 78% of the patients, IgA in 11%, and IgM in 29%. PCR of synovial fluid (SF), synovial shell, and other biological substrates revealed Yersinia pseudotuberculosis DNA in 43%. Chlamydiasis and polyarthritis developed in 71 and 19%, respectively. The diagnosis of chlamydiasis was verified by EIA detection of IgG and IgA in 76 and 27% of cases, respectively. DIF, PCR, and culture studies of urethral scrapes found Chlamydia in 9, 32, and 29% of cases, respectively. Examination of SF and synovial shells revealed Chlamydia trachomatis in 24% of the patients and culture studies detected the pathogen in 21%. CONCLUSION: Asymmetrical polyarthritides mainly involving the knee joints are the most common arthritides of pseudotuberculous etiology. EIA detection of serum IgG and IgA and PCR study of SF are optimal diagnostic tools. Artritides of chlamydial etiology are asymmetrical oligoarthritides predominantly involving the knee and ankle joints. Examination of urethral and cervical canal scrapes, SF by culture and PCR studies and that of serum IgA and IgG by EIA are optimal diagnostic tests.

[The role of the outer-membrane antigens of Yersinia pseudotuberculosis in the pathogenesis and diagnosis of pseudotuberculosis]. / Rol' antigenov naruzhnoi membrany Yersinia pseudotuberculosis v patogeneze i diagnostike psevdotuberkuleza.

The degree of manifestation of the virulent properties of Y. pseudotuberculosis strains was found to be directly related to the concentration of protein with a mol. wt. of 103 kD (invasin), localized in the outer membrane and necessary for the realization of the process of the penetration of the infective agent into eukaryotic cells. Antiserum to INV-2-BSA, an active synthetic fragment of invasin, capable of detecting one antigenic band with a mol. wt. of 103 kD, was used for the creation of a diagnostic enzyme immunoassay system. The new variant of the diagnostic system was shown to be highly effective in the diagnosis of the disease at an early period.

[The efficacy of using thymogen in an experimental infection caused by Yersinia enterocolitica]. / Effektivnost' primeneniia timogena pri éksperimental'noi infektsii, vyzvannoi Yersinia enterocolitica.

The effect of thymogen of the course of the infectious process caused by Y.enterocolitica serovars O3 and O9 in guinea pigs was studied. Thymogen was introduced into the animals on day 2 after their infection with Y.enterocolitica O3 and O9, introduced in daily injections of 10 micrograms/kg of body weight for 4 days. The evaluation of the characteristics of cell reactions in the lymphoid organs of the immune system (the thymus, the spleen, lymph nodes), nonspecific resistance and specific humoral response showed the effectiveness of using thymogen: this preparation produced an immunoregulatory effect in the infected animals; it decreased their polyclonal immune response, the development of autoimmune reactions and promoted the intensive development of delayed hypersensitivity (DH) after their enteral infection with Y.enterocolitica O9 and had no effect on the development of DH in the animals infected with Y.enterocolitica O3; it also enhanced the nonspecific resistance of the body, thus leading to a decrease in the dissemination of the infective agents in different organs and tissues and to their subsequent elimination from the body.

[The immunity indices in an experimental infection caused by Yersinia enterocolitica O3 and O9]. / Pokazateli immuniteta pri éksperimental'noi infektsii, vyzvannoi Yersinia enterocolitica O3 i O9.

Some characteristics of cell reactions in the lymphoid organs of the immune system (the thymus, the spleen, lymph nodes), nonspecific resistance and specific humoral response in guinea pigs after their enteral infection with Y.enterocolitica serovars O3 and O9, differing in their virulence, were studied. Differences in the course and severity of Yersinia infections in guinea pigs were established: Y.enterocolitica O3 induced the development of the localized process and Y.enterocolitica O9, the generalized process. The reaction of the immune system was characterized by polyclonal immune response with decreased characteristics of nonspecific resistance, by the development of delayed hypersensitivity manifested by cell reactions in the lymphoid organs, by autoimmune reactions in the lymphoid organs, by autoimmune reactions and by the active production of agglutinins; the time of this reaction coincided with the maximum manifestations of the development of the infectious process.

[The protective activity of Yersinia pseudotuberculosis antigens]. / Protektivnaia aktivnost' antigenov Yersinia pseudotuberculosis.

Samples of Y.pseudotuberculosis (serovar I) antigens, represent a high-molecular lipopolysaccharide (LPS) fraction with a mol. wt. of 22.5 kD and fractions of outer membrane proteins isolated by the method of M. Osborn and R. Munson (1974), were tested in comparison with the activity with live cells of Y. pseudotuberculosis I attenuated mutant KV 9/2, having lost its Cad plasmid of virulence with a mol. wt. of 47 MD and carrying 2 attenuating markers: resistance to crystal violet and nalidixic acid. In experiments on guinea pigs pathomorphological studies demonstrated high protective activity of Y.pseudotuberculosis I attenuated mutant KV 9/2 and a pronounced protective effect achieved after the immunization of the animals with complex biopolymers, including a high-molecular LPS fraction and outer membrane proteins.

[Effectiveness of the use of nutrient media in isolation of Yersinia]. / Effektivnost' primeneniia pitatel'nykh sred dlia vydeleniia iersinii.

Three liquid nutrient media (phosphate buffer medium, 1% buffered peptone water pH 7.6-7.7, buffer casein yeast medium) and live solid media (Endo's, Serov's, and differential diagnostic medium with bromothymol blue, made in this country, and two foreign ones, agar deoxycholate and McConkie's) are compared in examinations of the material from 213 patients with acute intestinal diseases and from 460 small mammals. The results demonstrate a higher efficacy of bacteriologic investigations carried out in the new buffer casein yeast medium or 1% buffered peptone water, pH 7.6-7.8. The data are also indicative of the essential advantages of the differential diagnostic medium with bromothymol blue and prompt its wide practical use.

[The use of streptococcal immunoglobulin Fc receptors in the technology of producing a pseudotuberculosis diagnostic test system]. / Ispol'zovanie streptokokkovykh immunoglobulinovykh Fc-retseptorov v tekhnologii polucheniia diagnosticheskoi psevdotuberkuleznoi test-sistemy.

The conditions of obtaining the IgM from hyperimmune sera to Yersinia pseudotuberculosis have been established. The process includes the adsorption of these sera by streptococci belonging to serological groups G and A and having receptors which bind the Fc-fragment of IgG and IgA molecules. The data confirming the fact that specific antibodies to Y. pseudotuberculosis belong to IgM have been obtained. The use of isolated IgM fractions for the preparation of a pseudotuberculosis diagnostic assay system has made it possible to establish that the new method of obtaining sensitin is economical and ensures a 3.5-fold greater yield of the conjugate and simplifies the technological cycle of its preparation.

[The prevalence of Yersinia and its serologic variants in patients with acute intestinal diseases of undetermined etiology in Leningrad]. / Rasprostranennost' iersinii i ikh serologicheskie varianty u bol'nykh ostrymi kishechnymi zabolevaniiami neustanovlennoi étiologii v Leningrade.

Among Yersinia enterocolitica strains of 32 serovars, proposed as typing strains, some strains were found to belong to new species. Y. enterocolitica sensu stricto was represented by 21 serovars in the collection of typing strains. The occurrence of different Yersinia serovars in patients with acute enteric diseases of unknown etiology in Leningrad in 1983-1986 was determined with the use of the set of monoreceptor to 21 serovars. Out of 2,947 cultures studied by biochemical and serological methods, 81% were typed. Among them 18 Y. enterocolitica serovars were determined. Their characteristic feature was the prevalence of serovar O3 and an insignificant proportion of serovar O9. More frequently Yersinia were detected in patients with the primary diagnosis of acute enteric diseases (93.5%). The overwhelming majority (two-thirds) of Yersinia strains were isolated from children. A great number of strains detected in this study (70%) was isolated on days 10-15 of the bacteriological examination. In 927 cultures the following biovars were determined: the strains of serovar O3 belonged to biovar 4 and all other strains, to biovar 1.