[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 adhesive properties of salmonellae in the dynamics of the infectious process]. / Adgezivnye svoistva sal'monell v dinamike infektsionnogo protsessa.

In patients with toxic infections salmonellae were identified in 31% of cases. The patients were divided into two groups: the control group receiving treatment with infusion solutions and the test group treated, in addition to the usual scheme of therapy, with indomethacin in a daily dose of 150 mg. The study revealed that salmonellae isolated at the initial stages of the disease possessed highly pronounced adhesive properties. The adhesive properties of salmonellae isolated at the stage of convalescence from the patients of the test group were considerably less pronounced than those of salmonellae isolated from the same patients at the peak of the disease. In the control group no differences in the adhesive properties of salmonellae isolated from the same patients were established.

[Characteristics of the mechanisms of the immune response in typhoid fever and the bacterial carrier state]. / Osobennosti mekhanizmov immunnogo otveta pri briushnom tife i bakterionositel'stve.

During the acute period of typhoid fever, as well as in the early and, partially, late convalescence periods, a considerable increase in the level of T-lymphocytes and their helper activity and, in some cases, in the number of B- and D-cells and the populations of neutrophils with receptors for C3 and Fc IgG was observed. In chronic carriers immune shifts of a different character have been recorded: an increase in suppressor activity and a decrease in the number of the above-mentioned neutrophils. These data prompt the use of immunological criteria for the prediction of chronic carrier state in typhoid fever.

[Detection of microbial variants of Salmonella typhi in the bone marrow of typhoid patients and carriers]. / Vyiavlenie mikrobnykh variantov Salmonella typhi v kostnom mozge bol'nykh briushnym tifom i bakterionositelei.

The immunofluorescence test with the use of antisera to S. typhi and its L-forms permits the detection of the infective agent in bone marrow smears. This diagnostic method is particularly important in cases of carrier state in the latent phase and in differential diagnosis. As revealed in this study, the microbial variants of S. typhi, reacting with antiserum to its L-forms, are present in the bone marrow of carriers. They are localized, as a rule, on the membranes of lymphoid and erythroid cells, which probably leads to the formation of rosettes.

[Antiendotoxic activity of the blood sera of typhoid fever patients]. / Antiéndotoksicheskaia aktivnost' syvorotok krovi bol'nykh briushnym tifom.

The ability of blood sera obtained from healthy persons and typhoid patients to induce agglutination of red blood cells sensitized with chemotype Re glycolipid has been studied. The blood sera of healthy persons have been shown to possess low endotoxin-binding activity (the reciprocal titer amounts to 21.6 +/- 3.7). In typhoid patients with a severe clinical course of the disease the titers are slightly elevated (49.8 +/- 12.8), in patients with a moderate course a sharp elevation of the titers is observed (240.3 +/-32.8), and in chronic carriers the titers are at a medium level (119 +/- 24.7). The highest titers (288 +/- 72.2) were observed during the first 2 weeks in a moderately severe course of the disease, and by the end of the disease these titers dropped (143.1 +/0 27.4). The endotoxin-binding activity of the sera was inhibited by glycolipid Re and dextran sulfate. The activity of the sera decreased after treatment with 2-mercaptoethanol. The conclusion on a protective role played by antibodies to glycolipid Re and by proteins binding glycolipid and other polyanions has been made on the basis of the data obtained in this study.

[The quantity of immunoglobulins (A, G, M) in different forms of typhoid fever]. / Kolichestvennoe soderzhanie immunoglobulinov (A, G, M) pri razlichnykh formakh briushnotifoznoi infektsii

Results of determination of the quantitative content of immunoglobulins (IgA, IgG and IgM) demonstrated chronic typhoid carrier state to be a dynamic process characterized by high IgA and IgG indices which began to form as early as the acute period. A complex of clinico-laboratory indices permitted to detect the latent phase of the carrier state among the persons who sustained typhoid fever within the range of 30%; this confirmed the statement of a number of investigators put forward earlier that the true number of carriers was much greater than that recorded.

[Quantitative determination of specific immunoglobulins in the serum of bacterial carriers of abdominal typhus]. / Kolichestvennoe opredelenie spetsificheskikh immunoglobulinov v syvrotkakh bakterionositelei pri briushnom tife

As a result of determination of immunoglobulins of class A and M by the method of simple radial immunodiffusion with the use of monospecific antiglobulin sera it appeared that in the sera of carriers immunogolubins M were contained in much lesser quantity than in typhoid patients. The content of immunoglobulins A was somewhat greater in the blood sera of carriers.