MONO- AND MIXED-HERPESVIRUS INFECTIONS: ASSOCIATION WITH CLINICAL SYNDROMES OF IMMUNODEFICIENCY

In recent years, the number of hard diagnosed, polysymptomatic and polysyndrome conditions and diseases caused by mono- and mixed-herpes infections has sharply increased in the practice of physicians of all specialties. The clinical aspects of the close attention of physicians, virologists and epidemiologists to this viral family are due not only to the onset of atypical forms of these infections, but also to the emergence of the relative new concept of “active chronic atypical infection” caused by herpesviruses and in particular the Epstein-Barr virus. We observed 198 people of both sexes aged between 23 and 60 years, suffering from mono- and mixed herpetic infections (EBV, CMV, HSV 1/2, and HSV type 6). 36% of these, suffered from mono-herpesvirus infections, mixed-herpesvirus infections were diagnosed in 63.7% of cases. A study of functioning characteristics of antiviral protection system as well as defects and disorders in the system of interferons was carried out in patients suffering from various mono-, mixed herpes virus infections and bacterial co-infections. The main clinical syndromes associated with these herpetic infections, as well as prevailing nosological forms of concomitant diseases were revealed. The revealed clinical syndromes and functioning characteristics of an antiviral protection will allow developing of a conceptual, individualized, etio- and immunopathogenetic therapy

EARLY DIAGNOSTICS OF AUTOINFLAMMATORY DISORDERS ASSOCIATED WITH POST-VIRAL CHRONIC FATIGUE SYNDROME AND COGNITIVE IMPAIRMENTS IN CHRONIC MIXED HERPES VIRAL INFECTIONS

The steady increase in the number of autoimmune diseases and immune-mediated autoinflammatory processes causes an increased interest of doctors of all specialties in this topic and makes the issue of early detection of autoimmune disorders / autoimmune syndrome (AS) extremely urgent. These disorders often develop against the backdrop of an atypical stream of chronic active viral infections caused by persistent viruses, in particular those of the Herpesviridae family, and remain undiagnosed due to polysymptomatic disease, and various “clinical masks” of the disorders caused by them. The semi-quantitative method developed by us for screening assessment of the content of autoantibodies in the blood serum of patients suffering from ACAI caused by herpes viruses using the ELISA method (Immunodot) is a highly specific screening method that can allow for an objective assessment of the dynamics of the autoimmune process, as well as control the effectiveness of the ongoing complex antiviral and immunomodulatory therapy. The detection of autoantibodies of various specificity in the blood serum of patients suffering from an atypical chronic active infection caused by herpes viruses (ACAI) is an early diagnostic marker, necessary, first of all, to identify autoimmune pathology of the nervous system, which is associated with a long course of the active mixed herpes-viral process

Peculiarities of post-viral chronic fatigue syndrome associated with mild cognitive decline in patients with atypical chronic active herpesvirus infections

According to modern ideas, changes in the functioning of the immune system affect the immune processes in the nervous system, contributing to the development of neuro-immuno-inflammation and thereby indirectly affect the rate of progression of neurodegenerative processes. The aim of our study was to investigate the prevalence of post-viral chronic fatigue syndrome and cognitive impairment (aMCI) among patients with atypical, chronic active herpesvirus infections (ACA-HVI).Under our supervision were 126 patients of both sexes aged 18 to 60 years with ACA-HVI.It was established that mono-EBV infection affects 27.7%; mixed EBV infection is observed in 72.3% of patients. When assessing cognitive functioning using CGI, MMSE scales, the incidence of aMCI was found to be 68.3%: with mixed HVI — 87.4%, with mono HVI — 38.8%. During the study, significant limitations were identified in the use of standard scales due to the impossibility of conducting a comprehensive assessment of clinical status parameters and cognitive dysfunctions, as well as correlation of these parameters and assessment of dynamics of the immunocorrection. To achieve this goal the Scale of assessment of the criterion clinical symptoms of patients with ACA-HVI with CFS was used. It was shown that in mixed-HVI, the severity of symptoms exceeded the severity of symptoms of patients with mono-HVI and was 52.7 (43.1-62.2) and 38.0 (31.9-42.8) points, respectively (p > 0.05). Thus, it was found that patients suffering from mixed HVI have more pronounced, severe manifestations of CFS and aMCI, which are 1.5 times higher than similar manifestations in patients with mono-HVI, significantly reducing the quality of life of these patients, worsening their social adaptation.Prolonged persistence of herpes viruses in immune-compromised people creates conditions for constant antigenic stimulation and immune imbalance with the onset of secondary immunodeficiency or clinical manifestation of existing primary disorders in the immune system, which creates the prerequisites for the development of neuro-immuno-inflammatory changes in nervous system, followed by the formation of clinical manifestations of ME/CFS with different cognitive impairments that may be classified as aMCI

The local interferon-corrective therapy in children with congenital cleft lip and palate, suffering from the recurrent respiratory infections

It is known that children with congenital cleft lip and palate are suffering from recurrent respiratory infections, which worsen the state of their health, and also complicate the results of reconstructive surgical treatment. The aim of the study was to detect defects of mucosal immunity in children with congenital cleft lip and palate, suffering from recurrent respiratory infections, and to create the program of local interferon corrective therapy with an assessment of its effectiveness. The studies included 56 children from the age of 1 to 3 years. Three groups of children were formed: group 1 – 26 children with congenital cleft lip and palate (antibiotic therapy); group 2 — 30 children with congenital cleft lip and palate (antibiotic therapy + local interferon therapy), group 3 — the control group. The clinical examination included a medical history, an assessment of the symptoms of recurrent episodes of acute respiratory infections and exacerbations of chronic infections. Microbiological studies were performed using standard methods. The status of local immunity was detected: the concentrations of secretory IgA, cytokines IL-17, IL-4, IL-6, IL-1β, IFNγ in the oral fluid were tested by ELISA. Results of the study established that in group 1 and group 2 clinical criteria of immunodeficiency with an infectious syndrome were revealed: repeated acute respiratory viral infections from 10 or more times a year, complicated by frequent exacerbations of chronic bacterial infection (up to 10 or more per year). Assessment of the state of local immunity in children with congenital cleft lip and palate revealed a lack of sIgA compared with the control group. Before treatment in group 2 oral fluid level of IL-17, IL-6 were statistically significant increase (p < 0.05); the results of the study also established increase in the level of IL-1β and a decrease in anti-inflammatory IL-4 and regulatory IFNγ relative to the control group (p > 0.05). After complex treatment with the inclusion of local interferon therapy in group 2 the appearance of sIgA, increase in the concentration of IL-4, IL-1β and a decrease IL-17 in oral fluid were observed (p > 0.05). The concentrations of IL-6, IFNγ did not change (p > 0.05). After treatment in group 2 there were a decrease in exacerbations of chronic upper respiratory tract infection and in frequency of acute respiratory viral infections compared with group 1 (p < 0.05). Positive clinical efficacy of local interferon therapy (the gel of recombinant IFNα2b in combination with oxidants — Viferon gel) in the process of staged rehabilitation of children with congenital cleft lip and palate has a protective clinical effect in reducing the frequency of acute respiratory viral infections, reducing the number of postoperative complications, reducing hospital stay, duration of antibacterial therapy and the number of exacerbations of chronic bacterial infection

The defect of medical care is a crime committed by a doctor

The variant of the forensic medical assessment of the quality of medical care was presented, this defect is a criminal offence, measures to prevent such offenses are necessaryПредставлен вариант судебно-медицинской оценки качества медицинской помощи, установленный дефект определен как преступление, которое диктует необходимость мер профилактики подобных правонарушени

Изменение структуры хромосом лимфоцитов при персистирующих инфекциях у детей

Children with chronic diseases of respiratory tract were investigated for IgM and IgG serum antibodies to viruses (Herpes simplex virus, Epstein-Barr virus, Cytomegalovirus) and bacteria (Chlamydia trachomatis + pneumoniae, Mycoplasma pneumonia) by ELISA and for telomere length of their lymphocytes by fluorescent hybridization in situ followed by flow cytomerty (FlowFISH). The purpose of the study was to compare the lymphocyte telomere length of these seropositive and seronegative children. Regression analysis and analysis of percent distribution relative to the regression line have compensated age differences between seropositive and seronegative groops and demonstrated shorter telomeres in lymphocytes of children those have serum antibodies to viruses in all combinations (including combinations with antibodies to bacteria) in contrast to seronegative children of the same age.Дети с хроническими заболеваниями респираторного тракта были обследованы на наличие IgM и IgG антител в сыворотке крови против вирусов (Herpes simplex, Epstain-Barr, Cytomegalovirus) и бактерий (Chlamydia trachomatis + pneumoniae, Mycoplasma pneumoniae) методом ELISA. Параллельно определяли длину теломер лимфоцитов периферической крови с помощью гибридизации in situ и проточной цитометрии (FlowFISH) с целью сравнения длины теломер у серопозитивных и серонегативных пациентов. Применение регрессионного анализа и анализа альтернативных признаков (в процентах) позволило нивелировать возрастные отличия серопозитивной и серонегативной групп и установить, что теломеры лимфоцитов детей, имеющих антитела против вирусов в различных сочетаниях, в том числе в сочетаниях с антителами против бактерий, короче теломер лимфоцитов серонегативных детей того же возраста

Changes in the Structure of the Chromosomes of Lymphocytes during Persistent Infection in Children

Children with chronic diseases of respiratory tract were investigated for IgM and IgG serum antibodies to viruses (Herpes simplex virus, Epstein-Barr virus, Cytomegalovirus) and bacteria (Chlamydia trachomatis + pneumoniae, Mycoplasma pneumonia) by ELISA and for telomere length of their lymphocytes by fluorescent hybridization in situ followed by flow cytomerty (FlowFISH). The purpose of the study was to compare the lymphocyte telomere length of these seropositive and seronegative children. Regression analysis and analysis of percent distribution relative to the regression line have compensated age differences between seropositive and seronegative groops and demonstrated shorter telomeres in lymphocytes of children those have serum antibodies to viruses in all combinations (including combinations with antibodies to bacteria) in contrast to seronegative children of the same age

Изменение структуры хромосом лимфоцитов при персистирующих инфекциях у детей

Children with chronic diseases of respiratory tract were investigated for IgM and IgG serum antibodies to viruses (Herpes simplex virus, Epstein-Barr virus, Cytomegalovirus) and bacteria (Chlamydia trachomatis + pneumoniae, Mycoplasma pneumonia) by ELISA and for telomere length of their lymphocytes by fluorescent hybridization in situ followed by flow cytomerty (FlowFISH). The purpose of the study was to compare the lymphocyte telomere length of these seropositive and seronegative children. Regression analysis and analysis of percent distribution relative to the regression line have compensated age differences between seropositive and seronegative groops and demonstrated shorter telomeres in lymphocytes of children those have serum antibodies to viruses in all combinations (including combinations with antibodies to bacteria) in contrast to seronegative children of the same age.Дети с хроническими заболеваниями респираторного тракта были обследованы на наличие IgM и IgG антител в сыворотке крови против вирусов (Herpes simplex, Epstain-Barr, Cytomegalovirus) и бактерий (Chlamydia trachomatis + pneumoniae, Mycoplasma pneumoniae) методом ELISA. Параллельно определяли длину теломер лимфоцитов периферической крови с помощью гибридизации in situ и проточной цитометрии (FlowFISH) с целью сравнения длины теломер у серопозитивных и серонегативных пациентов. Применение регрессионного анализа и анализа альтернативных признаков (в процентах) позволило нивелировать возрастные отличия серопозитивной и серонегативной групп и установить, что теломеры лимфоцитов детей, имеющих антитела против вирусов в различных сочетаниях, в том числе в сочетаниях с антителами против бактерий, короче теломер лимфоцитов серонегативных детей того же возраста