[Role of Chlamydia trachomatis intraocular infection in the development of proliferative vitreoretinopathy (experimental study)].

OBJECTIVE: To study the influence of C. trachomatis infection on proliferative vitreoretinopathy (PVR) stimulation and development in an experimental model. MATERIAL AND METHODS: Intravitreal C. trachomatis injection was performed in 17 rabbits (right eyes) out of which 8 developed minimal chlamydial damage (1 was further subjected to histopathological examination with pathogen detection in ocular structures and other 7 were included in the study group). The control group consisted of 7 rabbits with no laboratory evidence of chlamydial infection. PVR was induced by 4 peripheral retinal punctures with a 19 G needle. Follow-up methods included ophthalmoscopy, ultrasonography, and PVR grading according to the Fastenberg classification. Histopathological examination, supplemented with pathogen detection by direct immunofluorescence in the study group, was performed at weeks 7 and 20. RESULTS: PVR rate and severity were higher in the study group as compared with the controls (5 out of 7 rabbits, grade 2-4 vs. 2 out of 7 rabbits, grade 0-1, p<0.01). In the study group, histopathological examination performed before and after the induction of PVR revealed a pronounced lymphocyte and macrophage infiltration, characteristic of infectious inflammation. Similarly, extra- and intracellular chlamydial inclusions could be found in the retina and/or zones of proliferation throughout the whole study period. Inflammation signs (including those of proliferation) were reliably less significant in the controls. CONCLUSION: C. trachomatis infection of the posterior segment contributes to PVR development due to associated chronic inflammation.

[Chlamydial infection of the central nervous system. Laboratory diagnosis and clinic and morphological features].

The paper presents data on the diagnosis, clinical and pathomorphological changes in the central nervous system (CNS) in neurochlamydiasis according to clinical, autoptic, and experimental evidence. It discusses the possible implication of Ch. trachomatis, Ch. pneumoniae, and Ch. psittaci in the development and course of different diseases with CNS involvement: atherosclerosis, vasculitis, multiple sclerosis, Alzheimer's disease, schizophrenia, autism, vegetative state, sequels of perinatal lesions in childhood and adolescence, HIV infection, etc. Considerable attention is paid to the specific features of diagnosis of Chlamydia-induced CNS lesions. Purposeful pathomorphological investigations are shown to be needed.

[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.

[Role of Chlamydia trachomatis and Chlamydophila pneumoniae in damage of eye posterior segment structures].

AIM: Study the ability of Chlamydia trachomatis and Chlamydophila pneumoniae to damage structures of eye posterior segment, features of development of such infectious process, its morphological and clinical characteristics. MATERIALS AND METHODS: 6 rabbits with confirmed absence of C. trachomatis, C. pneumoniae were used in the study. 3 animals were infected with C. trachomatis culture and 3 animals--with C. pneumoniae culture. Subconjunctival and intravitreal mode of infectious agent introduction were used, as well as instillation of its culture into conjunctival sac. Microbiological diagnostics included microscopy with direct immunofluorescence, culture method and determination of antibody titers. Infectious process was studied by using ophthalmologic methods and histological examination. Observation period was 4 months. RESULTS: In all the animals a development of infectious process at early stages after the infection was confirmed. Conjunctivitis symptoms, inflammatory exudation into vitreous humor, chorioretinal inflammation loci, disorders in transparency of optical media and detachment of retina were clinical manifestations. In 2 animals infected with C. trachomatis severe panuveitis was noted. In 4 animals infectious process assumed subclinical characteristics (infection with both C. trachomatis or C. pneumoniae). In pathomorphologic studies data on the ability of C. trachomatis and C. pneumoniae to cause damage to cells of retina, pigment epithelium and choroid were obtained. CONCLUSION: C. trachomatis and C. pneumoniae may play a significant role in pathology of vitreous humor, retina, pigment epithelium and choroid.

[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.

[About development of chlamydia multiple organ lesions after primary ocular infection in experiment].

Chlamidia spp. are obligate intracellular pathogens that cause a variety of diseases in humans and animals. Their generalization was proved as hematogenic spreading from the urogenital (C. trachomatis) and the respiratory (C. pneumoniae) systems. The goal was to investigate the possibility of C. trachomatis infection spreading from the primary ocular gate. 6 animals were infected by instillation in the conjunctival sack, subconjunctival and intravitreal injections of C. thachomatis culture. C. trachomatis was detected by direct immunofluorescence method in the retina, retinal pigment epithelium, choroid, brain, the pancreas, the prostate gland and the urethra after primary ocular infection. The results of our study have proved the opportunity of C. trachomatis to cause polyorganic contamination.

[Retinal lesion in experimental chlamydia eye infection].

Until the present time, ophthalmic chlamydiasis has been generally associated with diseases of auxiliary organs of the eye and its anterior segment: conjunctivitis and iridocyclitis. The morphological substrate of eye posterior segment lesion caused by C. trachomatis and C. pneumonia was studied in this investigation. The pathomorphological pattern characteristic of chlamydia-induced rabbit retinal and vitreous body lesions is composed of vitreoretinal lymphocyte-macrophageal infiltrations of varying intensity, posterior hyaloid membrane detachment, peripheral foci or folding of the retina, impaired nuclei of photoreceptors and bipolar neurons, pigment epithelial damage occurring in different concurrences in relation to the species of a causative agent and the clinical picture.

[The clinical and morphological features of Chlamydia pneumoniae-induced chorioretinitis in an experiment].

The clinical and pathomorphological features of vitreous retinochorioidal complex lesion with the pathogen Chlamydia pneumoniae were studied. Three rabbits (6 eyes) were infected with Ch. pneumoniae strain TWAR by instillation, subconjunctivally and 2 eyes were infected by intravitreally. Contamination was controlled by direct immunofluorescence and cultivation (conjunctival scrapes, venous blood). A postmortem study was conducted 128 days later, by employing an immunohistochemical analysis. On days 7-14, all cases showed the signs of a uveal reaction; 4 cases developed chorioretinitis. In 2 cases, the process ran as endophthalmitis with minimal clinical manifestations. The rate of the process was decreased by days 40-50. On the postmortem study, all the cases displayed lymphocytic-macrophageal infiltration in the vitreous body and retina in the presence of retinal focal dystrophic changes. An immunohistochemical study revealed the pathogen in different retinal layers (both inside and outside the chorioretinal foci) in all 6 cases and in the preretinal layers of the vitreous body in 5 cases. The pathogen Ch. pneumoniae is rather highly tropic to the structures of the visual organ and it is able to induce chronic lesion of the structures of the posterior portion of the eye portion with varying clinical manifestations. Dystrophic changes in infected tissues, the vitreous body and chorioretinal complex in particular, are a result of a chronic inflammatory process.

[The specific features of a structural lesion in the ocular posterior segment in experimental chlamydial infection].

The investigation was undertaken to study changes in the structure of the vitreoretinal complex in experimental chlamydial infection. Six rabbits were inoculated with Ch. pneumonia (6 eyes) and Ch. trachomatis (6 eyes) via instillations, subconjunctivally and intravitreally. Clinical and pathomorphological study was conducted during 128 days, by using immunohistochemical techniques. All modes of inoculation resulted in the development of an intraocular infectious process as uveitis, choriorenitis, and vitreitis (endophthalmitis) of varying degrees--from subclinical to severe. Immunohistochemical study revealed the pathogen in the structures of the ocular posterior segment and in venous blood in all cases. When locally inoculated, chlamydial infection becomes disseminated, by afflicting the ocular posterior segment, no matter what the mode of inoculation is applied. The clinical picture of the lesion widely varies from subclinical manifestations to a severe process.

[Acute chlamydial lesions of the nervous system: etiology, diagnosis, clinical aspects]. / Ostrye khlamidiinye porazheniia nervnoi sistemy: étiologiia, diagnostika, klinika.

The examination of 180 patients with acute neuroinfection (105 males, 75 females at the age from 18 to 45 years) has detected C. trachomatis in 23.8%, C. Pneumoniae in 66.6%, C. psittaci in 9.5% patients. Acute and chlamydial lesions of the central nervous system were characterized by all forms of neuroinfection: serous and purulent meningitides, meningoencephalitides. Development of acute neuroinfection is accompanied by sluggish chlamydial infection of the viscera.