[Usage of real time polymerase chain reaction for diagnostics of different tick-borne infections].

AIM: To create and test the complex of polymerase chain reaction-based methods for detection of pathogens vectored by ticks in clinical and environmental samples. MATERIALS AND METHODS: Real time PCR methods with hybridization-fluorescent detection were developed for detection of tick-borne encephalitis virus, Borrelia burgdorferi sensu lato, Anaplasma phagocytophillum, Erlichia muris/E. chaffeensis, and B. miyamotoi. First four methods were combined in one assay in multiprime format. Efficacy of the assay was assessed by testing of blood samples from patients with tickborreliosis (166 patients), tick-born encephalitis (22 patients) and mixed infection tick-borne encephalitis + borreliosis (21 patients) from Sverdlovsk region. RESULTS: It was shown that using PCR-based assay for testing the blood samples obtained during admission, it was possible to determine the etiology of disease in 39% of patients, whereas on the basis of serological data diagnosis, as a rule, is made not earlier than on 2nd week of therapy. False-positive results of PCR diagnostics were not observed. Infections caused by Anaplasma or Erlichia were not observed. It was shown that > 50% of cases of tick borreliosis without erythema were caused by B. miyamotoi, whereas B. burgdorferi sensu lato predominated as a causative agent of erythemic form of borreliosis. CONCLUSION: Proposed complex of methods is useful for rapid diagnostics of tick-borne infections including previously unknown infection caused by B. miyamotoi.

Serum levels of interleukin 6 in recently hospitalized tick-borne encephalitis patients correlate with age, but not with disease outcome.

Infection with many encephalitic viruses is associated with the induction of the proinflammatory cytokine interleukin (IL)-6. In some situations, induction of high levels of this cytokine is associated with a protective response, but in others it can be linked to tissue damage and disease. In the studies reported here, levels of serum IL-6 and virus-specific antibodies were measured on admission to hospital and correlated with clinical outcomes. Only some patients demonstrated raised levels of serum IL-6, and there was no correlation between high levels of this cytokine and either gender or the severity of clinical disease. A statistically significant association between raised IL-6 and age was observed, with all individuals below the age of 26 showing normal levels of serum IL-6, regardless of clinical presentation. Furthermore, not all patients had detectable levels of virus-specific serum immunoglobulin G (IgG) antibodies, but an inverse and statistically significant correlation between raised IL-6 levels and IgG titre was observed. Consequently, serum levels of IL-6 cannot be used as a reliable indicator of disease outcome.

[Acoustic brain stem evoked potentials in patients in patients with different forms of acute tick-borne encephalitis]. / Dinamika akusticheskikh stvolovykh vyzvannykh potentsialov u bol'nykh s raznymi formami kleshchevogo éntsefalita v ostrom periode.

Acoustic brain stem evoked potentials (ABSEP) have been investigated in 90 patients with different types of tick-borne encephalitis, in acute and remote stages. In all types of tick-borne encephalitis structural alterations mainly concerned II, III, IV and V complexes; changes of peak III, V latencies and interpeak I-III, I-V intervals have been detected as well. Focal type with multilevel CNS affection was distinguished by interpeak interval (III-V) elongation, higher per cent of abnormal III, V complexes and changes in wave amplitude V/I ratio. Stabilization of the peak latency and interpeak intervals in fever type occurred in 1-2 months, in meningeal type--in 2-3 months, in focal type--in 6-12 months. In several cases the ABSEP appearance preceded a focal type development, positive ABSEP dynamics was behind local neurological symptom regress. ABSEP method in acute tick-borne encephalitis allows predicting disease dynamics and outcome, conducting timely treatment correction and adequate rehabilitation, and substantiating optimal terms of out-patient clinical control in different types of the disease.

[Clinical pathogenic peculiarities of chronic Russian tick-born encephalitis]. / Kliniko-patogeneticheskie osobennosti khronicheskogo kleshchevogo éntsefalita.

Clinical, serologic, epidemiological and neurological studies were carried out in 23 patients (18 men, 5 women) aged 15-69 years who had chronic Russian tick-borne encephalitis (RTE). With permanent stable humoral immunity the fact that these forms might develop was confirmed in 73.9% of the cases. In 26.1% of the patients were found to have incomplete vaccination and vaccine therapy combined with RTE viral infection. The following conditions underlay chronization were observed in all forms of acute RTE: fever in 4.3%, meningitis in 30.4%, focal lesion in 43.5% (the encephalitic syndrome in 8.7%, poliomyelitis in 8.7%, encephalopoliomyelitis in 26.1%). Initially progressive course was found in 21.7% of the cases. There was a primary rise of the hyperkinetic syndrome after the meningeal and focal forms of RTE with the encephalitic syndrome; while development of the amyotrophic syndrome (ATS) was found after the focal form with the poliomyelitic and encephalopoliomyelitic syndrome. The amyotrophic lateral sclerosis (ALS) syndrome occurs as both primary progressive RTE and ATS transformation independently of the initial RTE form. Latent periods of development of ATS and ALS syndrome were virtually equal (mean 1.4 years) and did not depend on the initial form of acute RTE. The duration of development of latent chronic forms makes it necessary to follow up RTE patients for at least 3 years.

[Clinico-morphological characteristics of cardiogenic non-bacterial cerebral embolism]. / Kliniko-morfologicheskie osobennosti kardiogennykh nebakterial'nykh émbolii sosudov golovnogo mozga.

Clinical and morphological studies were carried out in 194 patients who died in the acute period of ischemic brain stroke. Disorders of the heart rhythm were found to play the leading part in the origin of cardiogenic embolisms of cerebral vessels. It has been recorded that left atrial thrombus formation was prevalent in heart rhythm disorders whereas left ventricular was prevalent in lack of those disorders. In different heart diseases complicated by atrial fibrillation and cerebral thromboembolism, the one-third of cases did not show any heart thromboses. The content of embolisms in cerebral arteries corresponded to the material of their source, whereas the site was specified by mechanical obstruction, with no changes in the vascular wall. It has been disclosed that in the majority of cases, stable embolism precipitates white infarction or white infarction with the hemorrhagic component whereas embolus lysis is responsible for hemorrhagic infarction and (or) a transitory ischemic attack. The clinical manifestations of hemorrhagic infarction differ from white infarction in less gravity and regression of the neurological symptomatology.

[Comparative dynamics of the epileptic syndrome in patients with open and closed war-time head injuries in the late period]. / Sravnitel'naia dinamika épilepticheskogo sindroma u bol'nykh s otkrytoi i zakrytoi voennoi travmoi cherepa v otdalennom periode.

The dynamics of the epileptic syndrome was studied in 55 patients with penetrating cranial wound and in 65 patients with closed cranial injury. Account was taken of the anamnesis, all-round clinical examination data, EEG and computer-aided tomography readings. The patients had been followed up over 40 years. Among the patients with fighting cranial injury, the incidence of the epileptic syndrome amounted to 14.01%. The epileptic syndrome was established to occur most frequently during the first year after injury, with that time (in patients with penetrating cranial wound) being the less the graver injury and longer consciousness loss. At the same time the later was the onset of epileptic attacks in patients with closed cranial injury the rarer was their incidence and more pronounced were mental disorders. In patients with penetrating cranial wound, focal and secondary-generalized attacks dominated in the structure of the epileptic syndrome, whereas in patients with closed cranial injury, convulsions and psychomotor fits ranked the first. With age the rate of epileptic attacks declined along with reduction and disappearance of epileptic activity on the EEG, augmentation of mental disorders and atrophy of substantia medullaris.

[Dynamics of focal seizure activity during induced sleep in epileptics with uni- and bitemporal foci]. / Dinamika fokal'noi sudorozhnoi aktivnosti v sostoianii indutsirovannogo sna u bol'nykh épilepsiei s mono- i bitemporal'nymi ochagami.

SEEG examination was conducted in 65 patients with temporal epilepsy during hexabarbitone-, diazepam- and sombrevin-induced sleep. It was found that hexabarbitone promotes manifestation of the dependent epileptic foci, while diazepam and sombrevin reveal the determinant epileptic foci and contribute to inhibition of dependent epileptic foci, mainly those localized in the cortex. The fusiform rhythm is mainly marked by cortical representation and is not recorded in the deep structures of the temporal lobes on the side of the determinant epileptic focus. The principal epileptic foci were localized in the limbic structures of the temporal lobes, which possibly determined their determinant role in epileptogenesis. In bilateral independent epileptic foci with a high level of spastic activity, focal epileptic discharges were preserved in the various methods of sleep activation. The possibility of topical diagnosis of the determinant and dependent epileptic foci provides for adequate tactics of surgical management of epilepsy.