[Etiology of the epidemic outbreak of community-acquired pneumonia in children in St. Petersburg]. / Etiologiia épidemicheskoi vspyshki vnebol'nichnoi pnevmonii u detei Sankt-Peterburga.

In September-December 1998 the epidemic rise of outhospital pneumonia (EP) among children was observed in St. Petersburg, which led to a twofold increase in morbidity rate this year. The study of the etiology of EP during the period of 1998-2001 confirmed the prime role of Streptococcus pneumoniae (74.5%) and, for the first time in Russia, revealed the epidemic outbreak of acute chlamydiosis (Chlamydia pneumoniae), diagnosed in 67.3% of children, the maximum occurrence (87.5%) in 1998 with only 19% of the patients having the disease in the form of monoinfection. The prevalence of S. pneumoniae and C. pneumoniae in the etiology of EP and more severe course of mixed infection suggested that these infective agents played a leading role in the epidemic outbreak of acute respiratory infections in St. Petersburg.

[Immunoserodiagnosis of acute Streptococcus pneumoniae and Chlamydia pneumoniae infections in the period of epidemic rise of non-hospital pneumonia in children in St. Petersburg, 1998-2001]. / Immunoserodiagnostika ostroi pnevmokokkovoi i khlamidiinoi infektsii pri épidemitseskom pod"eme vnebol'nichnoi pnevmonii u detei v Sankt-Peterburge v 1998-2001 gg.

The dynamics of the antibody formation to S. pneumoniae and C. pneumoniae in children during the epidemic outbreak of non-hospital pneumonia in St. Petersburg in 1998-2001 was studied. For the first time the inhibiting influence of acute C. pneumoniae infection on the synthesis of antibodies to S. pneumoniae in acute mixed infection was established. The prolonged (up to days 29-39 of the disease) circulation of IgM and IgG antibodies in acute chlamydial infection, as well as the prevalence of the primary infectious process, were detected.

[Pneumococcal and chlamydial infections in a closed community]. / Pnevmokokkovaia i khlamidiinaia infektsiia v zakrytom kollektive.

An epidemic outbreak of acute respiratory infection (295 patients) in an organized group of young people was observed in December-May 1997-1998. Pneumococcal etiology was established by means of indirect immunofluorescence reaction in cases of outpatient pneumonia (81.9%), acute bronchitis (80%) and acute respiratory diseases (92.5%). Respiratory chlamydiosis caused by Chlamydia pneumoniae was detected in enzyme immunoassay with the use of immunoComb Chlamydia Bivalent IgG in patients with pneumonia (66.7%), acute bronchitis (60%) and acute respiratory diseases (50%). Synergic relationship between pneumococcal and chlamydial infections was noted.

[Streptococcus pneumoniae adhesion to mouse tracheal explants and its inhibition by carbohydrate preparations]. / Adgeziia Streptococcus pneumoniae na éksplantatakh trakhei myshei i ee ingibirovanie uglevodnymi preparatami.

The method for the cultivation of tracheal explants of non-inbred mice was developed. The adhesive capacity of 34 S. pneumoniae strains belonging to 15 serotypes was studied. The geometric mean of S. pneumoniae concentrations attached to the organ culture was 8.93 x 10(4) CFU/ml. D-galactose blocked adhesion, on the average, 4.35 x 10(4) (95.5%) CFU/ml. The level of S. pneumoniae adhesion and the degree of its inhibition were dose- and strain-dependent. The use of different variants of the combination of D-galactose and S. pneumoniae made it possible to come to the conclusion that this monosaccharide blocked the receptors of epithelial cells and bacterial adhesins.

[Anti-pneumococcal immunity in extra-hospital acute pneumonia in children]. / Antipnevmokokkovyi immunitet vnebol'nichnoi ostroi pnevmonii u detei.

The results of the pulmonological examination, carried out with the use of the indirect immunofluorescence test, of 134 children aged 1 month to 14 years in the course of acute pneumonia are presented. Antibodies to the surface components of Streptococcus pneumoniae cells were detected in the blood of all patients, local humoral immunity prevailing over systemic immunity at the acute period of the disease. Early and intensive formation of antipneumococcal antibodies was shown to occur during the first week of the disease. The lowest and least stable antipneumococcal immunity appeared in acute pneumonia in children during the first 3 years of life, though in one-fourth of these patients high antibody levels were observed. The early use of antibiotic therapy induced the pronounced suppression of the formation of these antibodies. Acute respiratory viral and mycoplasmic infections did not influence on the synthesis of antipneumococcal antibodies during acute pneumonia in children.

[The etiology of sporadic acute pneumonia in children]. / Etiologiia sporadicheskoi ostroi pnevmonii u detei.

The complex microbiological study of tracheobronchial washings and the detection of antibodies to surface components of whole bacterial cells in the indirect fluorescence test permitted the determination of the pneumococcal etiology of acute pneumonia (AP) in 134 children aged 1 month to 13 years (97.1%). In the course of AP 13 patients (9.4%) were found to have acute infectious processes caused by Haemophilus influenzae (5 cases), different enterobacteria (4 cases), Moraxella catarrhalis (2 cases), as well acute infectious destruction of the lungs and pyopneumothorax (1 case), whose etiological factors were Staphylococcus aureus and nontyping H. influenzae strains.

[A method for preventing experimental pneumococcal infection]. / Sposob profilaktiki éksperimental'noi pnevmokokkovoi infektsii.

Lethal pneumococcal infection in mice, infected intranasally, can be induced only by highly virulent strains of pneumococci. The introduction of N-acetylglucosamine and/or D-galactose, both 1 hour before the introduction of pneumococci or simultaneously with their introduction, prevented the development of this infection in 83-91% of mice used in the experiment. The use of the mixture of these carbohydrates did not change the level of their activity. These carbohydrates were shown to be capable of protecting mice from the intranasal introduction of 100-1000 LD50 of Streptococcus pneumoniae highly virulent strains, adapted to the respiratory tracts and lungs of mice.

[The use of halotherapy for the rehabilitation of patients with acute bronchitis and a protracted and recurrent course]. / Primenenie galoterapii dlia reabilitatsii bol'nykh ostrym bronkhitom s zatiazhnym i retsidiviruiushchim techeniem.

Halotherapy was used for rehabilitation in 25 patients with acute bronchitis of long-standing and recurrent types. The main therapeutic action was ensured by aerodispersed medium saturated with dry highly dispersed sodium chloride aerosol, the required mass concentration being maintained in the range of 1 to 5 mg/m3. Therapy efficacy was controlled through assessment of clinical, functional, immunological and microbiological findings. Metabolic activity values were taken into consideration as well. Positive dynamics of the function indices in the clinical picture resulted from elimination of pathogenic agents, control of slowly running inflammatory lesions and stimulation of some immune system factors. Favourable changes in metabolic activity were present: normalization of serotonin excretion, marked decrease of unbalance in lipid peroxidation-antioxidant system.

[Etiology of the infectious process in pulmonary and mixed forms of mucoviscidosis in children]. / Etiologiia infektsionnogo protsessa pri legochnoi i smeshannoi formakh mukovistsidoza u detei.

The specific features of an infectious process were studied in 150 children treated for mucoviscidosis at the State Pulmonology Research Center, Ministry of Health and Medical Industry of the Russian Federation. Hemophilic bacilli, Staphylococcus aureus, and Pseudomonas aeruginosa were fond to play the leading role in the etiology of the infectious process in the bronchopulmonary system. Pneumococcal infection was first ascertained to be important in the course of the disease. Developmental stages of a pyoinfectious process from the onset of its contamination, acute infection to chronic one were followed up. The most severe, prognostically unfavourable course of the disease was demonstrated to be associated with Pseudomonas aeruginosa infection.

[A new conception of the pathogenesis of chronic bronchitis]. / Novoe predstavlenie o patogeneze khronicheskogo bronkhita.

Clinical microbiological and immunological comparisons and data on various pneumococcal pathogenetic factors suggest chronic pneumococcal infections affecting cells and tissues of the bronchial tree to underlie pathogenesis of chronic bronchitis (CB). CB pathogenetic and clinical variants depend on the mechanisms regulating pneumococcal exudative and destructive inflammation. An obvious role of acute respiratory infections and acute bronchitis in the onset and aggravation of chronic bronchitis necessitates appropriate preventive measures.

[The virulence of Streptococcus pneumoniae strains--the causative agents of pneumococcal infection at different sites]. / Virulentnost' shtammov Streptococcus pneumoniae--vozbuditelei pnevmokokkovoi infektsii razlichnoi lokalizatsii.

A total of 256 S. pneumoniae strains, the causative agents of infectious processes with different localization, were studied for their virulence (in experiments on mice), neuraminidase and aldolase-protease activity (APA). In pneumococcal strains isolated 18-20 hours after intraperitoneal infection their virulence for mice increased, on the average, 1,000-fold and the average level of extracellular and cellular neuraminidase and APA increased 2- to 5-fold in comparison with the initial values. Pneumococcal strains causing acute pneumococcal infections with different localization, or the aggravation of such infections, exhibited higher virulence for mice and higher levels of neuraminidase and APA, while the inflammatory process at the period of clinical remissions was mainly maintained by S. pneumoniae cultures with low virulence.

[A comparison of their virulence for mice and the enzymatic activity of Streptococcus pneumoniae strains]. / Sravnenie virulentnosti dlia myshei i fermentativnoi aktivnosti shtammov Streptococcus pneumoniae.

In most cases no correlation between the virulence of S. pneumoniae and their enzymatic activity was registered in 101 S. pneumoniae strains isolated in pneumococcal infections of different localization. Pneumococcal strains belonging to different serotypes and characterized by their low virulence for mice (LD50 = 10(6) colony-forming units) had the highest neuraminidase and protease-alzolase activity in comparison with highly virulent cultures of these bacteria. In pneumococcal cultures in the R-form avirulence for mice occurred mainly in combination with low enzymatic activity.

[Exogenous and endogenous risk factors in the development of nonspecific lung diseases in young people]. / Ekzogennye i éndogennye faktory riska v razvitii nespetsificheskikh zabolevanii legkikh u lits molodogo vozrasta.

An organized community numbering 900 normal subjects aged 18 to 19 years were examined. Acute pneumonia was encountered in 15% of persons of the group under study per year. To identify persons with premorbid condition of nonspecific pulmonary diseases, anamnestic screening and outpatient examinations (microbiological and immunologic studies) were performed. As a result, the group constituted by subjects at risk for disease accounted for 18.6%, whereas S. pneumoniae was found in 44.9%. The immunologic findings were compared to the data obtained in the anamnestic screening. It was inferred that certain anamnestic signs correlated with the immune status. The leading factor in the formation of the premorbid condition lies in integral shifts in the immunologic system during adaptation. It follows from the data obtained that persons with risk factors need immune correction.

[The etiology of acute pneumonia]. / Etiologiia ostroi pnevmonii.

Based on the results of the authors' own investigations and the reported data it is shown that primary (extrahospital) acute pneumonia (AP) is of pneumococcal etiology in the overwhelming majority of patients. At the same time in 2/3 of cases, AP is associated with influenza and other acute respiratory virus infections. If primary AP runs an unfavourable course, a secondary infectious inflammatory process induced by different opportunistic bacteria may occur. The secondary (intrahospital) APs developing in the presence of marked disorders of the total and local defence are polyetiologic in nature. This is often caused by the association of a number of causative agents belonging to the families of different aerobic and anaerobic bacteria and by a change of etiological factors in the course of the disease. Gram-negative enterobacteria, Pseudomonas and nonsporulating obligate anaerobes are the main causative agents of secondary pneumonias as well as of infectious processes that complicate primary APs.

[The role of different microorganisms and infectious processes in the occurrence and course of bronchial asthma]. / Rol' razlichnykh mikroorganizmov i infektsionnykh protsessov v vozniknovenii i techenii bronkhial'noi astmy.

The role of infection in bronchial asthma (BA) is unknown. The pathogenesis of BA contributes to the origin of infectious processes induced by different microorganisms. In view of the predominance of associations of viruses and bacteria in the etiology and pathogenesis of acute respiratory infections, it is difficult to define in vivo the share and role of these microorganisms which participate in the origin and enhancement of hypersensitivity, hyperreactivity and alterations in beta-adrenoreactivity. Some factors of bacterial pathogenicity promote BA progress. On contact with basophils and mast cells bacteria (both pathogenic ones and ordinary commensals) are capable of liberating histamine and other mediators during colonization of the bronchial tree and origin other infectious process. This mechanism of mediator liberation may contribute to the transformation of pre-asthma to BA or provoke its exacerbation.

[Antibiotic sensitivity of Haemophilus influenzae isolated from patients with inflammatory lung diseases]. / Chuvstvitel'nost' k antibiotikam Haemophilus influenzae, vydelennykh ot bol'nykh vospalitel'nymi zabolevaniiami legkikh.

In 1980-1986 the sensitivity of 2,045 H. influenzae strains isolated from the bronchial contents of patients with inflammatory lung diseases were studied. This study revealed that 60-80% of H. influenzae cultures circulating in Leningrad were sensitive to tetracyclin, chloramphenicol and erythromycin. During the period of observation the tendency towards the decrease of the number of highly sensitive H. influenzae cultures and the increase of the number of strains resistant to all antibiotic preparations was followed. Most of H. influenzae strains isolated in Leningrad were sensitive to penicillin, oleandomycin and ampicillin. In 1983 the appearance of H. influenzae strains, multiresistant to antibiotics, was noted. In 1986 these strains constituted 4.5% of all isolated cultures.

[Epidemiologic problems of pneumococcal infection]. / Nekotorye voprosy épidemiologii pnevmokokkovoi infektsii.

During the microbiological examination of 314 tentatively healthy donors, residents of Leningrad, Streptococcus pneumoniae was detected in the rhinopharynx of 94 donors (29.9%) in amounts ranging from a few individual microbial cells to 10(6) microbial cells with the mean geometric concentration equal to 3.58 lg. Antipneumococcal antibodies were detected in the blood of 147 donors (46.8%). The occurrence of antipneumococcal antibodies was approximately 2.5 times higher than the average level of carriership, but in most cases the dynamics of immunological reactions changed in the same direction. Considerable monthly and annual fluctuations in the occurrence of pneumococcal carriership and antipneumococcal antibodies, as well as their correlation with the epidemic rises of acute respiratory diseases, influenza and other acute respiratory viral diseases, were established. These data indicate that pneumococcal infection plays a definite role in the epidemic rises of acute respiratory diseases.