[Functional status of haemostasis system in patients with visceral leishmaniasis].

During the last decades in Georgia was observed significant increase of cases of visceral leishmaniasis and fight against this disease became important problem as far as the management of this disease is rather problematic. According to references and our clinical experience patients with visceral leishmaniasis are predisposed to bleeding. The objective of our study was the assessment of functional status of hemostasis related to the degree of clinical severity. We have studied platelet count, activated partial thromboplastin time (APTT), prothrombin time, thrombin time, plasma concentration of fibrinogen, the soluble fibrin-monomeric complexes (SFMC), fibrinogen/fibrin degradation products (D-dimer) and anticoagulant protein C. Haemostatic functional tests were studied in 45 patients with visceral leishmaniasis before and after treatment (with 20-25 day intervals). Before treatment the reduction of platelet count was observed in 95%. Prolonged APTT and prothrombin time was found in severe forms of the disease. Thrombin time prolonged in 45.7%, SFMC level was increased in 80% (p=0.003) and D-dimer level in 95.6% (p=0.023). Protein C was in normal value in 73%. The results indicate that leishmania infection affects primary haemostasis, coagulation and fibrinolysis and these alterations are related to the severity of clinical symptoms. Investigation of SFMC and D-dimer showed that in case of visceral leishmaniasis activation of intravascular coagulation takes place, particularly during the severe forms of the disease, study of these markers is of the diagnostic and prognostic importance and the treatment at an early stage of infection may potentially avoid the possibility of developing an uncompensated DIC.

[Study of intravascular coagulation activation markers in patients with visceral leishmaniasis].

During last decades significant attention has been paid to the increase of protozoal infections including leishmaniasis. The management of this disease is rather problematic. Significant increase of cases of this disease was observed in Georgia as well. The problem of visceral leishmaniasis is very important nowadays. According to references and our clinical experience patients with visceral leishmaniasis are predisposed to bleeding. The objective of our study was the assessment of functional status of hemostasis in patients with visceral leishmaniasis. We have studied the intravascular activation markers of blood coagulation -- the soluble fibrin-monomeric complexes (SFMC) and fibrinogen/fibrin degradation products (D-dimer) in order to reveal the disorders of hemocoagulation. SFMC and D-dimer we studied in 45 patients with visceral leishmaniasis before and after treatment (with 20-25 day intervals). One patient with severe generalized bleeding died within 72 hours of admission. SFMC measurements were conducted by the orthophenantroline test (Renam, Russia). D-dimer level was measured using FDP-Slidex Direct kit (Bio-Meriou, France). Especially high levels of SFMC and D-dimer have been revealed in cases of severe form of visceral leishmaniasis. SFMC level was increased by 80% (p=0,003), and D-dimer level by 95,6% (p=0,023). There was correlation between numbers of platelets and intravascular blood coagulation markers. Investigation of SFMC and D-dimer showed that in case of visceral leishmaniasis activation of intravascular coagulation takes place, particularly during the severe forms of the disease. Study of these markers is of the diagnostic and prognostic importance and for the initiation of treatment at an early stage of infection, which may potentially avoid the possibility of developing an uncompensated DIC.

[An immunoenzyme method for determining IgA antibodies to lipopolysaccharide in secretions in the diagnosis of shigellosis]. / Immunofermentnyi metod opredeleniia v sekretakh IgA-antitel k lipopolisakharidu v diagnostike shigelleza.

IgA antibodies to S. sonnei and S. flexneri lipopolysaccharides (LPS) in secretions, as well as Escherichia coli LPS in coprofiltrates of children with acute diarrhea, were determined with the use of enzyme immunoassay (EIA). In adult patients with dysentery serum and salivary anti-LPS antibodies were assayed. The results of EIA showed that children aged up to 18 months had an elevated level of LPS of the causative agent in their coprofiltrates. The specificity of this assay permitted its use for finding out the agent of acute enteric infection. In adults, the levels of salivary anti-LPS antibodies in dysentery patients and in healthy persons significantly differed, which might also be regarded as a sign of Shigella infection. No significant difference in the levels of IgG antibodies to LPS in the saliva of sick and healthy persons was registered. IgA antibodies were found to be active mainly against common determinants of S. sonnei and S. flexneri LPS and thus not suitable for the differentiation of the causative agents of dysentery. For this purpose, the levels of serum IgG antibodies to LPS of different Shigella species should be determined.