[New in clinical laboratory diagnostics dermatophyte fungi in children with atopic dermatitis.]

Role of bacteria Staphylococcus spp., yeasts of Candida spp., Malassezia spp. genera in pathogenesis of atopic dermatitis (AD) in infant patients is well known. However, no data concerning the incidence of dermatophytes in such disease entity were obtained. Aim of the study was estimation of dermatophytes carriage in children with AD. Group of patients involved 44 persons 1 to 18 years old with clinically diagnosed acute AD. Especially for the study a method of skin scales collection was created: painless for patients and safe for medical personnel. The method is based on following stages - rubbing of lichenificated skin zones with sterile swab which was preliminary saturated with phosphate/Tween 80 buffer pH 7,9 and centrifuging of the suspension for sedimentation of skin scales. Microscopic examination of hydrolyzed scales was carried out at maximal magnification x1750, at that different dermatophyte and yeast fungal forms were registered. Spores of dermatophyte fungi were detected with 67,0% frequency, whereas dermatophyte mycelium - with 18,3% frequency. No correlation between dermatophyte spores and mycelium was found out (Pirson`s coefficient r=0,236), however no mycelium without spores was detected, but in 73,3% of cases spores occurred without mycelium. Yeast spores were detected in 45,2% of patients - this fact is agreed with data obtained earlier by the seeding method, but yeast mycelium was found out in 3,5% of patients.Therefore frequent occurrence of dermatophyte fungi on the skin of AD infants is revealed for the first time. At that dermatophytes were found out to exist more often in the form of spores. These results are important for choice of the further therapy.

Application of bacterial therapeutic vaccine Immunovac-VP4 in the treatment of pollinosis.

AIM: The aim of the study was to study the effectiveness of the complex use of bacterial therapeutic vaccine Immunovac-VP4 and allergen-specific immune therapy (ASIT) in pollinosis in children and adults. MATERIALS AND METHODS: Bacterial therapeutic vaccine Immunovac-VP4 was used annually, nasal and oral administration in patients before the course of ASIT standardized aqueous-salt solutions of allergens. RESULTS: The therapeutic application of bacterial vaccines, Immunoac-ВП4 before the course ASIT has helped to reduce the frequency of acute respiratory infections in 8,5 times in comparison with the control group. Clinical efficacy of complex treatment according to the results of the survey of patients in 7 years after the start of therapy was 90%. There was a significant decrease In IgG4 to causally significant allergens, General immnunoglobulin E (IgE) and a tendency to decrease IgE. CONCLUSION: The use of bacterial therapeutic vaccine Immunovac-VP4, which is a natural ligand of toll-like receptors in combination with ASIT, seems to be an effective and promising direction in the treatment of allergic diseases.

[INDUCTION OF EFFECTORS OF INNATE AND ADAPTIVE IMMUNITY IN THE PROCESS OF THERAPY OF TOPIC FORM OF RECOMBINANT INTERFERON- α2b DURING RESPIRATORY INFECTIONS IN PREGNANT].

AIM: Study immunologic phenotype of lymphocytes in the process of therapy of topic form of recombinant interferon-α2b during respiratory infections in pregnant. MATERIALS AND METHODS: 74 pregnant women from 14 weeks of gestation took part in the study, among them 55 - within 24 hours with symptoms of acute respiratory infection (ARI) of light and me- dium, severe course of infection, who do not need hospitalization. Group I - 34 pregnant womenwithARI receivingbasic therapywith human recombinant interferon-(α2b in gelform. Group II - 21 pregnant with ARI receiving only basic therapy. Control group had 19 pregnant women without signs of ARI. Relative content of principle lymphocyte subpopulations was studied by flow cytofluorimetry: CD3+, CD3+CD4+, CD3+CD8+, CD3-CD19+, CD3- CD16+56+, CD3-CD8+; immune regulatory indexwas calculated inblood within 24 hours from the onset of the disease and 8 - 10 days later. RESULTS: A disbalance of lymphocyte sub- populations was noted in pregnant women with light or medium severity course of acute respiratory infections, that was characterized by an increased content of CD3-CD16+56+ and CD3+CD8+, as well as a reduced content of CD3+ and CD3+CD8+. Inclusion of a topical form of recombinant interferon-α2b during the first days of development ofthe disease has a systemic effect on cell immunity and results in normalization of subpopulation compo- sition of blood lymphocytes that is characteristic for physiological course of pregnancy. CONCLUSION: Administration of topic form of recombinant interferon in pregnant with light or medium severity of ARI can be accompanied by activation of factors of innate and adaptive immunity.

[Choice of optimal vaccination tactics against pneumococcal infection from immunological and clinical standpoints in patients with chronic obstructive pulmonary disease].

AIM: To provide a rationale for choosing the optimal tactics of vaccination against pneumococcal infection in patients with chronic obstructive pulmonary disease (COPD) in the context of evidence-based medicine and on the basis of immunological and clinical data. SUBJECTS AND METHODS: Patients with COPD were examined during a year after vaccination with a 13-valent pneumococcal conjugate (Prevenar-13, PCV13) and a 23-valent pneumococcal polysaccharide (Pnemo-23, PPV23) vaccines. The following vaccination schemes were used: PCV13 monovaccination, PPV23 monovaccination, sequential vaccination with PPV23/PCV13, and sequential vaccination with PCV13/PPV23. RESULTS: Vaccination using all the analyzed schemes in the patients with COPD caused a statistically significant reduction in the frequency of exacerbations, the number of antibiotic cycles, and the number of hospital admissions, as shown by the results of analysis of short-term data. The use of PCV13 was followed by additional effects that were unobserved in the use of PPV23, namely: it promoted the formation of immunological memory to Streptococcus pneumoniae antigens, resulted in the enhanced activity of nonspecific resistance factors, and caused activation of antiviral defense factors. CONCLUSION: If patients with COPD need to be vaccinated against pneumococcal infection, preference should be given to PCV13 monovaccination. Short-term observations have shown that the sequential use of pneumococcal conjugate and polysaccharide vaccines is redundant and gives no additional benefit to patients with COPD. However, the sequential application of both vaccines may have additional advantages in the long term.

[Recurrent tracheal papillomatosis concurrent with asthma].

A thorough collection of complaints and history data, physical examination, and lung function tests are necessary to confirm the diagnosis of asthma. The latter must be differentiated from different diseases in the majority of patients according to age. Recurrent respiratory papillomatosis is caused by human papillomavirus and involves mainly the upper respiratory tract. The paper describes a case of tracheal papillomatosis concurrent with atopic asthma.

[New ideas on the therapeutic effect of a combination of vaccines against pneumococcal, Haemophilus influenzae type b infection, and influenza in patients with chronic obstructive pulmonary disease].

AIM: To estimate the indicators of the therapeutic effect of combination vaccination against pneumococcal, Haemophilus influenzae type b infection, and influenza in patients with chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: Clinical, bacteriological, and immunological studies, by determining the quality of life (QL), were conducted in COPD patients during a year after combination vaccination against pneumococcal, Haemophilus influenza type b infection, and influenza. RESULTS: One year after the vaccination, there were reductions in the number of COPD exacerbations by 3.7 times, in that of antibiotic therapy cycles by 3.4 times, in the levels of inflammatory mediators of interleukins 2 and 8 and interferon-γ, and in the synthesis of IgG antibodies to Streptococcus pneumoniae, Haemophilus influenzae type b, and influenza virus strains as compared to the baseline values. CONCLUSION: Combination vaccination against bacterial and viral infections substantially improves the major clinical parameters of COPD, positively affecting LQ indicators that generally characterize the therapeutic effect of immunization.

[Transplacental IgG against measles virus in umbilical blood of neonates from various regions of Russian Federation].

AIM: Determine content of protective transplacental IgG against measles virus in umbilical blood of neonates of various regions of Russian Federation. MATERIALS AND METHODS: Umbilical blood of 1147 neonates was studied, whose mothers had not previously had measles. 672 samples among those were from neonates of Moscow and Moscow Region, 475--from Rostov-on-Don. IgG values were determined in EIA using a standard kit from "Vector Best" (VectoKor-IgG). A kit from Euroimmun--Avidity: Anti-Measles Virus ELISA (IgG) was used for determination of avidity of IgG against measles virus. RESULTS: Protective (≥ 0.18 IU/ml) IgG against measles were registered in 79.9% of children in Moscow, Moscow Region and in 81.3% of neonates in Rostov-on-Don. Mean level of IgG in umbilical blood sera of neonates from the studied regions was within protective values (1.74 ± 0.13 IU/ml and 1.51 ± 0.09 IU/ml, respectively). Predominance of low level antibodies was noted in the studied samples (< 1.0 IU/ml), those are highly avid though (AI > 60%). In neonates from women aged 16 - 25 years in Moscow and Moscow Region protective antibodies were detected in 83.6%; 26 - 35 years--in 75%; women aged 36 - 43 years--in 88.2% of cases. Mean level of IgG in umbilical blood of neonates from mothers aged 36 - 43 years was 1.5 times higher than from mothers aged 16 - 25 years and 2 times higher than mothers 26 - 35 years of age. CONCLUSION: Neonates from Moscow, Moscow Region and Rostov-on-Don, similarly, in 79.9% and 81.3% of cases are protected from measles, respectively. Women aged 26-35 years in 25% of cases are a risk group for measles morbidity and require a closer attention during selection of vaccination tactics before conception, and their neonates--on reaching decree terms.

[Anti-hepatitis B vaccination and postvaccinal immunity stimulation in patients with chronic obstructive pulmonary disease].

The problem of the anti-hepatitis B vaccination of patients with chronic obstructive lung disease (COPD) was discussed due to the lack of studies concerning the developing of the postvaccinal immunity, especially when vaccination is combined with the immunomodulating treatment. The data on the vaccination safety and its influence on the clinical course of COPD are also insufficient. Therefore, in this work we investigated the efficiency of the antihepatitis B vaccination in adults with chronic obstructive pulmonary disease under the treatment with the immunomodulating Affonoleikin drug. A total of 93 patients were tested including 59 patients with severe and moderate COPD (aged from 35 to 65 years). 34 of these 59 patients were vaccinated against hepatitis B (Kombioteh) according to 0-1-6 month scheme, and 25 of them were vaccinated against hepatitis B during the treatment with Affinoleikin. The control group, consisted of 34 healthy patients. Our study demonstrated good tolerance and high immune efficiency of the anti-hepatitis B vaccine. However, after the first vaccination the level of HBs-AT was below protective level in patients with COPD compared to healthy patients. Also, 64 to 70 % of patients with COPD were seronegative excluding the patients receiving the Affinoleikin treatment, whose antibody titer was protective after the first vaccine dose, but did not reach the level typical of healthy patients. After the second vaccination we detected low and medium protective antibody levels in 58.9% of patients from the 1st group, whereas 41% were seronegative. Introduction of the third vaccine-dose led to fast and significant increase in the antibody level mainly in high concentrations with 100% seroconversion in all patients. Combined antihepatitis B vaccination and Affinoleikin treatment in patients with COPD leads to faster biosynthesis of HBs- AT in protective concentrations and decrease of seronegative response, but it has no effect on frequency and type of general and local postvaccinal response.

[Species and quantitative characteristics of pharyngeal mucosa microflora in pregnant women].

AIM: Species and quantitative characteristics of upper respiratory tract (URT) mucosa microflora in women at gestation period. MATERIALS AND METHODS: The results of a bacteriological study of 68 samples of mucus from posterior pharyngeal wall in women at gestation period (from 14 weeks), 52 of those--from pregnant women with acute respiratory infection (ARI) symptoms and 16--from women without signs of disease, are presented. Qualitative and quantitative composition of microflora was studied by a generally accepted bacteriological method. RESULTS: During primary bacteriological study 111 microorganism cultures were isolated. 88 (79.3%) of strains belonged to Gram-positive flora, 20 (18.0%)--to Gram-negative, and Candida genus fungi constituted 3 (2.7%) isolates. Streptococcus pyogenes and Moraxella catarrhalis were isolated from pregnant women with ARI signs at 23.1% and 5.8% frequency of occurrence, respectively. A higher detectability of Staphylococcus aureus--in 31.3% and Candida spp.--in 6.3% of women who did not complain as opposed to patients with URT lesions (in 21.2 and 3.9%, respectively) was determined. In patients without ARI signs the amount of bacteria did not exceed 10(5)--10(6) CFU/ml, in pregnant women with ARI diagnosis in 8 of 52 cases semination of pharyngeal mucuswas observed--10(7)--10(8) CFU/ml. CONCLUSION: Prevalence of S. aureus, Streptococcus agalactiae, S. pyogenes, Streptococcus mutans in composition of pharyngeal mucus microflora of pregnant women both with URT lesion signs and without them was shown, however the degree of semination by pathogens in the groups was different that determined the severity of disease manifestations.

[The clinical aspects of efficiency of the prevention of pneumococcal infection with vaccines in chronic obstructive pulmonary disease patients living in the West Siberian Region].

AIM: To evaluate the impact of vaccination against pneumococcal infection on the clinical aspects of the underlying disease in patients with chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS: The study conducted in the West Siberian Region (Omsk and Tyumen) enrolled 200 COPD patients aged 30 to 55 years, of whom 50 people in each city were vaccinated with Pneumo 23, as well as 50 unvaccinated persons in each city formed a comparison group. Physical examination, questionnaire survey, and medical history data collection were made during a year before vaccination and after it. Changes in the number of COPD exacerbations, hospital admissions, and disability days were compared in the groups of Pneumo 23-vaccinated and unvaccinated patients. RESULTS: In Pneumo 23-vaccinated patients with COPD, the number of its exacerbations, hospital admissions, and disability days within a year of starting the study were fewer than in the unvaccinated patients, with the more effect being seen in the Omsk dwellers, which had a beneficial effect on the clinical state of the vaccinated. CONCLUSION: Incorporation of pneumococcal vaccine along with antirecurrent, standard therapy may serve as one of the tools to alleviate COPD.

[The influence of gel-like recombinant interferon α-2b on the clinical course of acute respiratory infection and the state of mucosal immunity in the pregnant women].

The objective of the present study was to evaluate the state of local immunity of the mucous membrane in the nose of the pregnant women presenting with acute respiratory infection (ARI). A total of 55 women with this condition were examined at the outpatient basis starting from week 14 of the gestation period. Viferon gel was administered intranasally to 34 such patients. The clinical and immunological effectiveness of the application of the topical form of this recombinant interferon α-2b preparation in these patients was evaluated. It is concluded that the inclusion of Viferon in the combined treatment of ARI in the pregnant women significantly decreases the frequency of bacterial complications. Simultaneously, this preparation reduces the IL-8 level in the nasal secretion in comparison with its initial value.

[Immunization of patients with chronic obstructive pulmonary disease with vaccines of Bubo-M and hepatitis B].

AIM: To assess tolerability and immunological activity of Bubo-M vaccine and hepatitis B vaccine in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: Sixty-three patients with moderate and severe COPD aged 35-65 years were immunized against diphtheria, tetanus, and hepatitis B. Bubo-M vaccine as well as vaccine against hepatitis B were used for immunization. Immunologic effect of vaccination was assessed by measurement of serum antibody level to HBsAg as well as to diphtheria and tetanus toxoids. Assessment of antibody level to HBsAg was performed by ELISA, and levels of antibodies to diphtheria and tetanus toxoids--by micromethod in direct hemagglutination assay. Reactogenicity of Bubo-M vaccine was measured according to duration and intensity of local and systemic reactions. RESULTS: The local and systemic reactions were infrequent, serious adverse events after vaccination were not observed. Six months after vaccination, protective antibody titers to hepatitis B, diphtheria and tetanus were determined in all immunized persons--either healthy, or with COPD. During completion of vaccination schedule, significant reduction of acute respiratory infections rate and main disease exacerbations was noted in patients with COPD. CONCLUSION: Good tolerability and high immunogenicity of Bubo-M and hepatitis B vaccines were demonstrated in both groups of vacinees. These vaccines could be recommended for booster vaccination of adults with COPD.

[Effect of vaccination against pneumococcal infection and influenza in children with asthma].

Assessment of clinical course of asthma and IgG response in children with asthma immunized with pneumococcal polysaccharide vaccine (Pneumo 23) and influenza vaccine (Vaxigrip). 78 children aged 4 - 17 years old were allocated to two groups. Children from the 1st group were immunized against pneumococcal infection and influenza; children from 2nd group were immunized against pneumococcal infection only. Rate of asthma exacerbations in the 1st group of children decreased by 1.7 times compared with the period before vaccination, whereas the same rate in the 2nd group of children decreased by 1.5 times. It was accompanied by the increase of IgG level to antigens of pneumococcalvaccine in blood, which was observed in both groups. Vaccination did not result in increase of IgE levels. Immunization of children with asthma against pneumococcal infection with polysaccharide vaccine or combined immunization against pneumococcal infection and influenza reduced rate of asthma exacerbations and led to formation of immunity to vaccine strains of Streptococcus pneumoniae. Vaccination did not lead to sensitization of children.

[Evaluation of the influence of the bacterial vaccines Pneumo-23 and Act-HIB on the course of the chronic inflammatory process of the respiratory organs in children].

The effectiveness and safety of vaccination of children having chronic inflammatory lung diseses with Pneumo-23 and Act-HIB were evaluated. The group under study included 38 children having chronic pneumonia, congenital defects of lung development, Kartagener's syndrome, mucoviscidosis; of these children, 25 were vaccinated with Pneumo-23 and 13--with Act-HIB. For comparison a group of 40 children with the same pathology, but not vaccinated, was used. A favorable course of the postvaccinal period was noted. Prior to vaccination Streptococcus pneumoniae in association with Haemophilus influenzae were isolated from all patients; in a year after vaccination with Pneumo-23 these microorganisms were isolated only in monoculture: S. pneumoniae in 3 out of 25 cases (88% elimination) and H. influenzae in 10 out of 25 cases (60% elimination).

[Postvaccinal antidiphtheria and antitetanus immunity in patients with systemic connective tissue diseases]. / Postvaktsinal'nyi protivodifteriinyi i protivostolbniachnyi immunitet u bol'nykh s sistemnymi zabolevaniiami soedinitel'noi tkani.

The retrospective evaluation of the intensity of postvaccinal immunity at different periods after the primary course of immunization against diphtheria and tetanus was made. In the sera taken from 130 children with systemic connective tissue diseases the content of antibodies to diphtheria and tetanus was determined. As revealed in this study, the protective levels of antibodies to diphtheria and tetanus toxoids were retained by both sick and healthy children for 5 years and longer. Significantly lower titers of antibodies to diphtheria and tetanus toxoids were registered in children undergoing therapy with glucocorticosteroids and cytostatics at the time of the study.

[Vaccination of children under immunosuppressive therapy with ADS-m anatoxin ]. / Vaktsinatsiia ADS-m anatoksinom detei, poluchavshikh immunosupressivnuiu terapiiu.

The effectiveness and safety of the immunization of children with adsorbed DT toxoid with reduced component with disturbances in the reactivity of the body, caused by immunosuppressive therapy, are evaluated. The group under study included 53 children with glomerulonephritis, malignant tumors and acute lymphoblast leucosis, formerly receiving immunosuppressive drugs. The control group consisted of 24 patients with pyelonephritis who had not received such therapy. In the postvaccinal period no exacerbation of the main disease was registered in children. The manifestation and frequence of postvaccinal reactions did not differ from those observed in healthy children after the injection of adsorbed DT toxoid with reduced antigen content. Control serological testing demonstrated the presence of pronounced immune response in the vaccinees.

[Use of pneumococcal vaccine in patients with renal pathology]. / Primenenie pnevmokokkovoi vaktsiny u bol'nykh s pochechnoi patologiei.

The use of pneumococcal polysaccharide vaccine in patients with chronic renal pathology has proved to be expedient as it prevents the development of pneumococcal infection. However, active immunosuppressive therapy and massive proteinuria result in decreased duration of antibody persistence, which makes in necessary to repeat the injection of the vaccine 20-22 months after the first vaccination.

Yeast fungi in patients with allergic diseases: species variety and sensitivity to antifungal drugs.

Yeast microflora was studied in the skin of 91 patients with atopic dermatitis, in bronchial secretion of 13 patients with bronchial asthma and 8 patients with allergic bronchopulmonary mycosis. Forty-eight isolates were obtained. Alypophilic yeast fungi isolated from the skin were presented mainly by genera Candida spp. (48%) and Rhodotorula spp. (29%), while the cultures isolated from bronchial secretion mainly by Candida albicans. The sensitivity of yeast cultures to the antifungal drugs diflucan, clotrimazole, nizoral, orungal, exoderil, levorin, pymafuzin, and nitrofungin was determined. The most efficient drugs were diflucan, clotrimazole, nizoral, and orungal. More than half isolates were sensitive only to the high concentrations of levorin (48%), pymafuzin (75%), and nitrofungin (82%); 64% isolates were insensitive even to high concentrations of exoderil. Preliminary in vitro selection of the antifungal drugs is required for efficient elimination of the yeasts.

[The evaluation of the efficacy of a first course of immunization against diphtheria and tetanus in children with kidney diseases]. / Otsenka éffektivnosti pervichnogo kursa immunizatsii protiv difterii i stolbniaka u detei s zabolevaniiami pochek.

The results of the determination of the level of antitoxic antibodies (Ab) to diphtheria and tetanus toxoids in children with glomerulonephritis and pyelonephritis are presented. The influence of the form of the disease and the kind of medicinal therapy on level of specific Ab has been studied. As shown in this study, the injection of adsorbed DT toxoid with reduced antigen content leads to the formation of the protective titers of antidiphtheria and antitetanus Ab, but a lower level than after the injection of adsorbed DPT vaccine.