Features of ophthalmic pathology in autoimmune diseases

Incidence of the ophthalmic complications in autoimmune diseases is stably increasing over recent years, as well as overall increase in the number of autoimmune pathologies around the world, along with novel diagnostic approaches. According to the WHO estimates, the number of patients with visual impairment is estimated at 285 million people for 2010, causing blindness in 39 million cases. Among autoimmune diseases, diabetes mellitus, sarcoidosis and Behcet’s disease are most often complicated by these conditions. Dry eye syndrome is the most common eye complication associated with these diseases. Our aim was to describe eye complications in type I diabetes, sarcoidosis, and Behcet’s disease, as well as show the importance of research in the area, and to develop common criteria for the care of patients with ophthalmic conditions. The review considers main pathogenetic links, ethnic and genetic factors of ocular pathologies in autoimmune disorders, the main issues of timely diagnosis and the use of various schemes of conservative therapy. The results obtained upon analysis of the literature contain demonstrate the possible autoimmune nature of such eye pathologies, as uveitis and dry eye syndrome in diseases such as type 1 diabetes mellitus, sarcoidosis, and Behcet’s disease. Despite the ongoing research, there are many unresolved issues in the study of pathogenesis, as well as in therapeutic strategy. Therefore, the treatment of autoimmune eye diseases is a difficult task today, including treatment of the underlying disease, and local therapy of the visual organ. Since the primary immunopathology in the mentioned autoimmune diseases requires further studies, it is not possible to accurately predict the course of eye disease, possible complications and outcomes at the present time. Currently, there is only scarce information for creating uniform criteria for the treatment of uveitis and dry eye syndrome in autoimmune diseases. Their further development can contribute to establishment of the principles of medical care, in order to improve efficiency of treatment and quality of life in the patients. Further research and accumulation of data in the field are needed

CHARACTERISTICS OF AUTOIMMUNE INFLAMMATION IN THE PATIENTS WITH LUNG TUBERCULOSIS

Tuberculosis is a granulomatous disease caused by Mycobacterium tuberculosis, being characterized by the development of caseous granulomas in various organs, mainly in lungs. M. tuberculosis is known to be a trigger for autoimmune inflammation, due to the possible mimicry of bacterial proteins as autoantigens. Recently, a significance of mesenchymal vimentin as an autoantigen in mycobacterial infections has been actively discussed. The aim of the present study was to determine autoantibodies for various vimentin modifications in the patients with tuberculosis.The study was performed in 2014-2017 and included 28 patients with pulmonary tuberculosis (group I), 30 patients with nonspecific lung diseases (group II): 15 with granulomatous polyangiitis, and 15 with different alveolites. Control group consisted of healthy subjects (n = 40). Concentration of antibodies to mutated citrullinated vimentin (anti-MCV) was measured using ELISA (ORGENTEC, Germany). The patients with elevated anti-MCV levels were tested for antibodies to cyclic citrullinated peptide (anti-CCP) using ELISA technique (EUROIMMUN, Germany). Statistical analysis was carried out using GraphPad Prism 6 (GraphPad Software, USA), Statistica 10 (Statsoft, USA) using nonparametric analysis of samples with Mann-Whitney and Chi-square criteria, and Spearman method for correlation analysis. The differences were considered statistically significant at p < 0.05.The anti-MCV concentrations were significantly higher in patients with tuberculosis (group I, 60.7% of cases, 17/28) than in group II, and control group (23.6 and 25.0% of cases, respectively). No statistically significant differences were revealed between the results of anti-MVC and anti-CCP levels in comparison group with the control group (p = 0.18).High levels of anti-MCV antibodies in the patients with pulmonary tuberculosis reflect an opportunity of developing autoimmune process in the disease pathogenesis. Measurement of plasma anti-MCV antibody concentrations may be important for correction of the therapy, especially upon administration of immunosuppressive and hormonal corticosteroid drugs. It has been shown that anti-CCP are not characteristic to the lung diseases

Диагностика латентной туберкулезной инфекции в учреждениях различного профиля и формирование группы риска по заболеванию туберкулезом

Early diagnosis of tuberculosis remains essential for the prevention of the disease and control of its incidence. The diagnosis of latent tuberculosis infection (LTBI) has significantly improved over the last years due to the use of new immunological tests, including the Diaskintest.The aim of the study was to assess the potential of immunological assays for diagnosis of latent tuberculosis infection and determination of risk groups for tuberculosis among personnel of different institutions.Materials and methods: in 2015–2018, a prospective group-control study was conducted that included employees of various medical centres (n = 154) and healthy individuals (n = 30). There were no significant age differences between the subjects. All the subjects included in the study shared their medical history, underwent general examination, X-ray examination, and were tested with Diaskintest. Multispiral computed tomography (MSCT) of the chest was performed for every subject with a positive Diaskintest result.Results: the comparison of the number of persons with LTBI in general care hospitals, personnel of a manufacturing firm, and among healthy individuals showed that the risk of being infected with Mycobacterium tuberculosis is very similar in all the groups (from 6.8 to 10.0 %). The highest risk of developing LTBI was found in people who worked in an infectious area for more than 5 years (48.4 %). The analysis of the level of immune complexes (ICs) demonstrated that individuals with LTBI did not have isotypes of IgG3 and IgE immune complexes, which are found in patients with tuberculosis. The identification of particular isotypes indicates a borderline state between LTBI and tuberculosis and requires therapeutic intervention.Conclusions: the use of the Diaskintest makes it possible to distinguish groups of employees of various institutions who are at a higher risk of developing tuberculosis. At the same time, determination of the ICs helps to reveal the borderline condition which requires medical intervention.Ранняя диагностика туберкулеза остается крайне важной для своевременного выявления заболевания и контроля за его распространением. В настоящее время диагностика латентной туберкулезной инфекции (ЛТИ) существенно улучшилась в связи с применением новых иммунологических тестов, к которым относится проба с Диаскинтестом. Цель работы: изучение возможности иммунологических методов в диагностике латентной туберкулезной инфекции и в формировании групп риска по развитию заболевания у сотрудников учреждений различного профиля. Материалы и методы: с 2015 по 2018 год было проведено проспективное исследование по типу группа–контроль с обследованием сотрудников учреждений различного профиля (n = 154) и здоровых лиц (n = 30). Обследованные лица значимо не отличались по возрасту. У всех включенных в исследование лиц был собран анамнез, проведен общий осмотр, проведена проба с Диаскинтестом и флюорографическое обследование. При получении положительного результата по пробе с Диаскинтестом проводилась мультиспиральная компьютерная томография органов грудной клетки. Результаты: сравнение числа лиц с ЛТИ в учреждениях общего профиля, у работников предприятия и здоровых лиц показало, что риск инфицирования микобактериями туберкулеза во всех группах примерно одинаков (от 6,8 до 10,0 %). Наиболее высокий риск развития ЛТИ — у лиц с длительностью работы в очаге туберкулезной инфекции более 5 лет (48,4 %). Определение уровня иммунных комплексов показало, что у лиц с ЛТИ не должно быть изотипов иммунных комплексов IgG3 и IgE, которые определяются у больных туберкулезом. Выявление данных изотипов свидетельствует о пограничном состоянии между ЛТИ и заболеванием туберкулезом, что требует проведения лечебных мероприятий. Выводы: применение пробы с Диаскинтестом позволяет формировать группы риска по развитию туберкулезной инфекции у сотрудников учреждений различного профиля. При этом диагностика иммунного комплекса позволяет выявить пограничное состояние, которое требует проведения лечебных мероприятий

Autoimmune component in the etiology of sarcoidosis

The article presents a review of 60 publications from international and Russian databases (PubMed, Web of Science, and Elsevier) from 1960 to 2018 with the keywords "sarcoidosis," "autoimmune reactions," "antibodies," and "HLA-genotype" characterizing sarcoidosis as an autoimmune disease. The information is divided into sections: the role of triggers, clinical manifestations and combination with autoimmune diseases, immunogenetic predisposition, features of cellular immune response, humoral immune response, and immunosuppressive therapy

Diagnosis of Latent Tuberculosis Infection in Personnel of Various Institutions and Determination of the Risk Group for Tuberculosis

Early diagnosis of tuberculosis remains essential for the prevention of the disease and control of its incidence. The diagnosis of latent tuberculosis infection (LTBI) has significantly improved over the last years due to the use of new immunological tests, including the Diaskintest.The aim of the study was to assess the potential of immunological assays for diagnosis of latent tuberculosis infection and determination of risk groups for tuberculosis among personnel of different institutions.Materials and methods: in 2015–2018, a prospective group-control study was conducted that included employees of various medical centres (n = 154) and healthy individuals (n = 30). There were no significant age differences between the subjects. All the subjects included in the study shared their medical history, underwent general examination, X-ray examination, and were tested with Diaskintest. Multispiral computed tomography (MSCT) of the chest was performed for every subject with a positive Diaskintest result.Results: the comparison of the number of persons with LTBI in general care hospitals, personnel of a manufacturing firm, and among healthy individuals showed that the risk of being infected with Mycobacterium tuberculosis is very similar in all the groups (from 6.8 to 10.0 %). The highest risk of developing LTBI was found in people who worked in an infectious area for more than 5 years (48.4 %). The analysis of the level of immune complexes (ICs) demonstrated that individuals with LTBI did not have isotypes of IgG3 and IgE immune complexes, which are found in patients with tuberculosis. The identification of particular isotypes indicates a borderline state between LTBI and tuberculosis and requires therapeutic intervention.Conclusions: the use of the Diaskintest makes it possible to distinguish groups of employees of various institutions who are at a higher risk of developing tuberculosis. At the same time, determination of the ICs helps to reveal the borderline condition which requires medical intervention