[Evaluation of the placental morphofunctional state in perinatal HIV transmission].

The paper presents the results of investigating the mechanisms of placental insufficiency and transplacental infection of infants born to HIV-infected mothers who have received specific antiretroviral therapy mothers and who have not.

[Chronic viral hepatitis in St.Petersburg].

Morbidity data on chronic viral hepatitis including cirrhotic stages of disease and lethality indexes in St. Petersburg are provided. The necessity of isolation in ICD- 10 and statistical accounting of chronic viral hepatitis diagnosis with outcome into cirrhosis (cirrhotic stage) is shown. During use of viral etiology liver cirrhosis diagnosis the disease is registered in the structure of liver diseases which does not allow to have data on unfavorable outcomes of chronic viral hepatitis and for complete morbidity accounting.

[Low-manifest infections in children and adolescents with consequences of perinatal damage of nervous system].

AIM: Study the specter of low-manifest infections (LMI) and their role in children and adolescents with diseases of central nervous system (CNS) against the background of consequences of perinatal damage of nervous system (PDNS). MATERIALS AND METHODS: Infectologic and neurologic examinations were carried out in 42 patients with consequences of PDNS (17 girls and 25 boys, 3 - 15 years). Detection of LMI resulted in etiotropic therapy with evaluation of clinical and laboratory data in dynamics. RESULTS: In 93% (39/42) of patients causative agents of LMI were diagnosed in various combinations and in various biological materials. Among those: Chlamydia spp.--in 71% of patients, Mycoplasma spp.--in 31%, Ureaplasma urealyticum--in 14% (in total the listed microorganisms were diagnosed in 83% of patients); Herpesviridae family viruses--in 75% (HHV-6--in 67%, VEB--in 36%, CMV--in 11%, HSV-1,2--in 11%). Combination of Chlamydia spp. with HHV-6 (R tetr = +0.61) and with VEB (R tet = +0.74) (P < 0.05) was detected. None of the patients had typical signs of encephalitis clinically or based on MRT. MRT signs of gliosis-atrophic changes in the CNS were detected in all the patients. Reduction of a number of psycho-neurologic and neurologic syndromes was noted in all the patients during LMI therapy. CONCLUSION: Most of the patients with consequences of PDNS had low-intensity inflammatory-degenerative process in the CNS determined by LMI, first of all by Chlamydia spp. as well as Mycoplasma spp.

[Clinical and morphological features of infectious endocarditis in HIV-infected intravenous drug abusers].

The aim of this work was to study the clinical course and morphogenesis of infectious endocarditis in HIV-infected intravenous drug abusers. In this patients, endocarditis was an acute disease with high frequency of thromboembolic complications and ill-defined exudative component of the inflammatory reaction. Autopsies dated to 1993-2008 showed that neither the presence of morphological signs of early HIV infection nor chronic hepatitis C with minimal or moderate inflammation has an appreciable effect on the intrahospital mortality rate in these patients.

[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.

[Pathogenic aspects of influenza during the epidemics caused by A/H1N1v virus in 2009-2010 according autopsy data].

The paper is based upon the results of clinic-pathological and virological correlations in 29 lethal cases of influenza in Saint-Petersburg and Leningrad region during the epidemics 2009/2010. Immunohistochemical analysis of lungs, heart and brain using monoclonal sera to HA and HP proteins of influenza virus, virological and morphological analysis of experimental influenza in mice infected by A/WSN/33 (HIN1) and A/California/07/09 (H1N1) viruses had been carried out. In the majority of investigated strains was proved the amino acid mutation with replacement D222G. The replication of virus was demonstrated at the late stages of diseases, but the desquamation of respiratory epithelium and cytoproliferative weren't found out. Besides the "influenza cells", previously described by A. V Zinserling the cells with enlarge light nuclei were observed. Patients with influenza died from respiratory distress syndrome with minimal bacterial infection. We've established that H1N1 virus not only damages the cells of respiratory epithelium and alveolar macrophages but it can injure endothelium of different organs and neuroglia. The questions which have to be discussed are listed.

[The topical problems of morphological diagnosis and the pathomorphism of HIV infection].

The paper analyzes the frequency of admissions to the S. P. Botkin Clinical Infectious Hospital and the City AIDS Center among patients with HIV infection and the structure of fatal outcomes. It is concluded that there is a considerable increase in mortality and the number of patients needing hospitalization. The dead HIV-infected patients autopsied at the Unit of Morbid Anatomy, S. P. Botkin Hospital, in the past years are characterized in detail. The topical problems of HIV infection the solution of which require the participation of pathomorphologists are discussed.

[Characteristics of perinatal visceral lesions caused by chlamydia trachomatis].

Twenty-three autoptic cases of perinatal chlamydiasis were analyzed. Its etiology was verified by immunofluorescence technique using monoclonal antibodies. The morphological characteristics of visceral lesions are given. Data on the possible routes of infection and evidence for the development of generalized chlamydiasis are presented. The kidney may be suggested to be the site of pathogen persistence.

[Analysis of fatal outcomes issues of typhus fever].

The nature and frequency of complications in patients with typhus fever are of importance for its outcome. The causes of death were studied in 126 patients who had died from this disease. The immediate causes of death were as follows: infectious-toxic shock (31.7%), pneumonia (28.6%), and perforative peritonitis (26.2%). The pathomorphism of Payer's patches does not allow the stages of the disease to be identified. An immunohistochemical study established a drastic preponderance of granulomatous macrophages without proliferation markers with a simultaneous reduction in the count of T and B lymphocytes and dendritic cells.

[Clinical and morphological characteristics of infective endocarditis in HIV-infected drug addicts].

Infective endocarditis (IE) in drug addicts is characterized by the involvement of the right heart with evolving septic pulmonary thromboembolism. Staphylococcus aureus is the causative agent of IE in 71.8% of cases. The specific feature of the course of IE in drug addicts is a relatively low hospital mortality rate (35.5%). The main cause of death was generalized infection with a developing multiple organ dysfunction. Pyonecrotic foci in the organs and tissues and septic vasculitis were histologically detected along with pronounced dystrophic changes. The presence of morphological signs of HIV infection at early stages, as well as viral hepatitis C do not affect mortality rates in drug addicts with IE.

[Perinatal pathology in HIV-infection].

The analysis of the literature and that of own authors' data (structural changes in placenta, fetuses and deceased children) is given. Most typical changes associated with HIV infection (peculiar enlargement of the cells and changes in the size of the nuclei in the cells of different histogenesis) are described. The ways of perinatal infection, pathogenesis of intrauterine infection are discussed.

[Infective endocarditis: the features of its clinical course and the prognosis].

The paper covers an investigation of 150 patients with infective endocarditis (IE), including 100 patients (aged 18 to 30 years old) with intravenous drug abuse as the main risk factor. This subgroup is characterized by an acute clinical course of IE, with tricuspid valve disorder in most cases and septic pulmonary embolism relapse in 72% of cases. Heart failure, multiple cardiac valvular disorder and focal lung destruction were found to be the main factors of unfavorable outcome. A relation between the size of vegetation on the heart valves and the mortality rate was established. At the same time, secondary immunodeficiency due to HIV-infection had no significant effect on the mortality rate in the group of drug addicts. More frequent cases of heart failure with systemic circulation embolism lead to higher hospital mortality in the group of patients with a subacute clinical course of IE. In elderly patients other concomitant pathology resulted in late IE detection and a high mortality rate.

[Clinical and morphological characteristics of laryngeal papillomatosis in children].

Respiratory papillomatosis was studied clinically and morphologically in 35 children with immunohistochemical detection of human papilloma virus. More frequent detection of viral antigen in the superficial layers of the epithelium in children with frequent recurrences was observed. Correlation between clinical efficiency of prospidine and immunohistochemical findings was noted. Suggestion on the indirect link between viral damage and intranuclear inclusions (although viral antigen in these inclusion was not observed) was made.

[Clinical and molecular correlation between chronic hepatitis and hepatocellular carcinoma induced by hepatitis B virus].

The role of X-gene of hepatitis B virus (HBV), telomerase gene, structural HBV proteins is considered. Both factors of the virus and those of the host are involved in hepatocarcinogenesis. The duration of chronic B hepatitis may influence mitogenic and mutagenic conditions for accumulation of occasional genetic and chromosomal damage and result in hepatocarcinoma development.

[The role of intrauterine infection of the central nervous system with herpes simplex viruses in development of encephalopathies in infants]. / Znachenie vnutriutrobnogo infitsirovaniia tsentral'noi nervnoi systemy virusami prostogo gerpesa v razvitii éntsefalopatii u detei rannego vozrasta.

Intrauterine infections often affect the infant brain and cause meningoencephalitis and long-term encephalopathy. In this study we have analysed morphological changes in different parts of CNS of 22 deceased infants who had suffered from encephalopathy of different degree due to persistence of herpes simplex viruses. Morphological, immunofluorescent, serological methods were used. Antigens of herpes simplex viruses I and/or II were detected in the CNS of most examinees. Relevant antibodies were detected in the serum and cerebrospinal fluid. Intrauterine infection was confirmed by the presence of specific for herpes simplex viruses morphological changes in the placentas. Hydrocephaly, secondary microencephaly, false cysts, microgyria were found macroscopically. There were herpes simplex viruses specific histological changes such as nuclear hyperchromatosis, intranuclear basophilic and acidophilic inclusions and nonspecific changes (gliosis, productive vasculitis). The data demonstrate that intrauterine herpes simplex viruses persistence in the CNS is an important cause of infantile encephalopathy, specific and nonspecific changes indicate a chronic course of the infection and depend on the degree of clinical symptoms.

[Pathological anatomy of HIV infection according to data in Saint-Petersburg]. / Patologicheskaia anatomiia VICh-infektsii po materialam Sankt-Peterburga.

The results of postmortem investigation of 101 cases of HIV infection at its different stages in Saint-Petersburg are analyzed. The challenges to a pathologist performing the autopsy are discussed. There has been an increase in the number of deaths since 2000, among drug users in particular. Macrophacytic transformation and specific HIV-related encephalitis are among the most important changes directly associated with immunodeficiency virus. Among secondary infections, cryptococcosis, cytomegaly, pneumocystosis, and tuberculosis are most common and significant.

[Morphological and immunohistochemical characteristics of primary brain lymphomas in AIDS patients]. / Morfologicheskie i immunogistokhimicheskie osobennosti pervichnykh limfom mozga u bol'nykh SPIDom.

Primary lymphomas of the brain were studied in 6 AIDS patients. The lymphomas were characterized by multicentricity, extended necroses and location in large hemispheres. Two types of tumor cell growth were recorded: diffuse and perivascular with vascular wall destruction. According to the International Histologic Classification (2001), these lymphomas were classified as diffuse B-cell large cell lymphomas subdivided into 3 variants: immunoblastic with plasma cell differentiation, centroblastic polymorphic and large cell anaplastic (by Kils classification criteria). Immunohistochemically (LMP-1) and by hybridization in situ (RNA EBER-1,2) Epstein-Barr virus was found in tumor cells from all the patients. In 5 of 6 cases studied expression of the antiapoptotic protein bcl-2 and in 2 cases expression of mutant p53 were revealed.

[Chronic and slow neuroinfections. Current status of problem]. / Sovremennoe sostoianie problemy khronicheskikh i medlennykh neiroinfektsii.

Some causes and conditions of chronic and slow neuroinfections were reviewed: brain immunological "priveledge"; congenital immunodeficiencies including clinically latent; immunomodulation induced by microorganisms due to infection of immune cells, inactivation of cytokines making difficulties to antibodies; disorders of genetic control of immune reaction; immunopathologic processes are of great importance for the agents persistence including autoimmunity. Microorganisms can locate in the neurons, glyocytes, endothelium. Neuroinfections chronic course depends on the agents properties and peculiarities of nervous system reactivity.