[Intrauterine Pneumocystis infection]. / Vnutriutrobnaya pnevmotsistnaya infektsiya.

Pneumocystosis is well known as an opportunistic infection that is presently most frequently registered in patients with HIV infection and in those with other immunodeficiency states. Earlier, after the Second World War, Pneumocystis pneumonia was most commonly detected in debilitated and premature children; nosocomial outbreaks of pneumocystosis were studied in detail in the 1960s and 1970s. The pathogen is transmitted through the air, but a number of references indicate that it can be transmitted through the placenta. Despite the increasing number of publications on pneumocystosis in pediatrics, physicians remain unfamiliar with this disease. The paper provides evidence that Pneumocystis jiroveci can infect the fetus in utero. If unrecognized, the disease can lead to a child's death due to severe respiratory failure. The authors describe their case of generalized pneumocystosis that has developed in a child with evidence of intrauterine infection (detection of the pathogen in the autopsy material and placenta and identification of serological markers in his/her parents). The issues that are associated with intrafamilial infection and a risk for in utero transmission of P. jiroveci are discussed.

[Role of opportunistic infection causative agent in etiology of obstructive bronchitis and prolonged subfebrility in children].

AIM: Determine the role of opportunistic infections causative agents in ethology of obstructive bronchitises and prolonged subfebrilities in children. MATERIALS AND METHODS: 56 children with the diagnosis of obstructive bronchitis and 46 children with the diagnosis of prolonged subfebrility were examined for the presence of herpes, mycoplasma and pneumocystic infections. EIA, IIF, rapid culture method, PCR were used. RESULTS: The highest number of cases of mixed infection was detected in children with HHV-6 infection. Mixed infection was diagnosed 6 times more frequently in children with obstructive bronchitis and 9 times in children with prolonged subfebrility. The number of children with pneumocystosis in combination with other infections was 2.4 and 2 times higher than with monoinfection; with CMV infection--4 and 2 times; with HSV infection--5 and 4 times; EBV infection--6 and 3.7 times. The only exception was mycoplasmosis detected in children with obstructive bronchitis where the difference between the number of mono and mixed infection cases was insignificant. CONCLUSION: The data obtained give evidence of wide spread of opportunistic infections.

[Serologic characteristic of Legionella pneumophila strains isolated from potentially dangerous water systems in Russian Federation in 2007 - 2011].

AIM: Study serologic diversity of Legionella pneumophila strains circulating in potentially dangerous water systems in Russian Federation by using an international panel of monoclonal antibodies. MATERIALS AND METHODS: Serotyping of 234 L. pneumophila strains isolated from coolers of industrial facilities and systems of hot water supply in Russian Federation in 2007 - 2011 was performed by enzyme immunoassay by using an international panel of monoclonal antibodies. RESULTS: Membership of the isolated strains in 14 L. pneumophila serogroups and in 7 subgroups of serogroup 1 was established. Among the isolated cultures serogroup 1 and 6, and Oxford and Heysham subgroup strains were predominant. L. pneumophila serogroup 1 strains were predominant in cooler water, and serogroup 6--in the hot water supply systems. 7 L. pneumophila strains of the serogroup 1 were typed by monoclone MAb 3/1 associated with LPS epitope that is characteristic for the most epidemically significant legionella strains. CONCLUSION: Typing by using international panel of monoclonal antibodies for characteristic and evaluation of epidemical significance of legionella strains being isolated form potentially dangerous water systems is the most informative and methodically accessible to a wide range of biological laboratories.

[Frequency of opportunistic infections in children with immune neutropenia and their mothers].

AIM: Determine the frequency of opportunistic infections among children with immune neutropenia and their mothers. MATERIALS AND METHODS: 66 mothers and 66 children with immune neutropenia diagnosis were examined for the presence of herpes (HV) and pneumocystic infection. Opportunistic infections markers (IgM, IgG, early and late antigens, virus reproduction) were determined by enzyme immunoassay, immunofluorescence reaction and rapid culture method (vero, u937, human fibroblasts). RESULTS: Pneumocystosis was the most active infection in the group. Among mothers 26 (39.3%) cases of pneumocystic infection in acute form were detected, among children - 18 (27.3%) cases. Infection occurred only in acute form during primary infection; there were no cases of its reactivation, which is an indication of recent pneumocystosis infection. Analysis of data on detection of acute and recent herpes infections showed that HV infection markers were determined in a relatively large number of mothers and their children: herpes simplex virus - 21.2%, Epstein-Barr virus - 12.0%, cytomegalovirus - 15.0%, Human herpesvirus 6 - 10.6%, Pneumocystis carinii - 21.2%. The data provided give evidence on a possible family pattern of the infection. CONCLUSION: A necessity of examination of mothers and their children suffering from immune neutropenia was shown because the specified opportunistic infections can form intra-family foci. The presence of acute form of infection in mother may be one of the conditions of development of this infection in the child.

[Pneumocystosis is an actual infection].

Contemporary aspects ofthe problem ofdiseases caused by single-celled yeast fungi Pneumocystisjirovecii are examined. Pneumocystic infection affects children and adults with various manifestations of immunodeficiency, is a HIV-associated infection. Contemporary epidemiologic characteristics of this infection are presented, data on etiology, pathogenesis and clinical presentation ofpneumocystosis are provided, problems of laboratory diagnostics are elucidated. Morphologic, immunobiologic and molecular-genetic methods of detection of Pneumocystis jirovecii causative agent are described.

[Herpesvirus infections in immunocompromised patients].

Testing of immunocompromised patients for markers of beta-herpesviruses--human herpesvirus type 6 (HHV-6) and cytomegalovirus (CMV), as well as gamma-herpesvirus--Epstein-Barr virus (EBV), revealed that all mentioned infections are frequently detected, mainlyas mixed infections. Chronic HHV-6 infection was diagnosed in more than half of the patients, whereas markers of acute phase of CMV and EBV infections were detected in 25% and 15% of patients respectively.

[Detection of coronavirus in experimental pneumocystic pneumonia].

Transmission electron microscopy (of ultrathin sections) was used to examine the biomass of lung tissue in the immunodeficiency minipigs experimentally infected with Pneumocystis carinii. The material was found to contain pneumocysts, bacteria, and coronaviruses. There was a clear coronavirus-pneumocyst structural relationship. The findings suggest the combined effect of microorganisms of different systematic groups on the development of a pathological process in the experimental infection etiologically determined by Pneumocystis carinii.

[The rate of human herpes virus type 6 and cytomegalovirus among HIV-infected and healthy women from Chelyabinsk and Moscow].

Human herpes virus type 6 (H HV-6) and cytomegalovirus (CMV) seroprevalence among HIV-infected and healthy women of childbearing age from Chelyabinsk and Moscow was measured with ELI - SA test-system for detection of antibodies to respective viruses. Seropositivity to HHV-6 was detected in 93.5% of HIV-infected women, that is 1.2 times more often than in healthy woman of child-bearing age. Seropositivity to CMV was detected in 87% of HIV-infected women, that is 1.05 times more often than in healthy woman of childbearing age. Low titers to HHV-6 and CMV were detected in seropositive healthywomen more frequently (in 44.1 and 48.4% respectively) whereas intermediate and high titers prevailed in HIV-infected women (in 73.9% for HHV-6 and 31.4% for CMV).

[Detection of Pneumocystis carinii DNA in clinical samples from children with respiratory diseases].

Method of Pneumocystis carinii DNA detection in clinical samples (sputum) is presented. Primers to one fragment of 16S rRNA gene were used for detection of DNA. Isolation and amplification of DNA were performed in presence of internal DNA control. Analytical sensitivity of method was 200 copies of DNA per 1 ml. Analytical and diagnostic specificities were 100% and 95% accordingly. Sputum from 176 children with frequent respiratory infections were sampled before start of antibacterial therapy and studied simultaneously by the polymerase-chain reaction (PCR) and immunofluorescent assay (IFA). Results of PCR and IFA coincided in 167 (94.89%) children. From them, P.carinii was detected in sputum in 5 (2.85%) children. All children with positive results were treated with antibiotics. Repeated tests of sputum 8 days after start of treatment were all negative. PCR could be recommended as part of complex of clinical diagnostics and control of treatment.

[Antibodies to the infective agents of opportunistic infections in blood of patients with hemoblastosis complicated with pneumonia].

The examination of 112 hematological patients with diagnosed acute and chronic leucosis, lymphoma, myeloma, anemia, melanoma and other diseases revealed not a single subject among these examinees in whom no markers of opportunistic infections were detected. Low titers of antibodies to Pneumocystis carinii, cytomegalovirus (CMV), Epstein-Barr virus (EBV) were noted in 42%, 46.4% and 40.2% of examinees, respectively. Markers of acute diseases, such as class IgM, IgG antibodies in high titers, as well as P.carinii, CMV, EBV antigens, were detected in 37.5%, 30.4% and 22.3% of patients of a hematological hospital. In the group of comparison (donors) these figures were, respectively, 15.3%, 2.4% and 6.9%. The signs of monoinfection were detected in 11.6% (pneumocystosis), in 10.7% (CMV infection) and in 14.3% (EBV infection), while the markers of two infections, EBV infection and pneumocystosis, were detected in 9.8%, EBV and CMV infections in 11.6%, pneumocystosis and CMV infection in 14.3%; mixed contamination with all three infective agents was detected in 12.5% of the patients.

[Detection of Pneumocystis carinii DNA in air and washes from medical equipment in hospitals].

Results of study of rooms' air and washes from medical equipment by PCR assay to detect Pneumocystis carinii DNA are presented. PCR assay sensivity was 200 copies/ml. Method of taking of air samples by MC-2 sample-taking device was modified for P. carinii detection. Sensivity of the method was 10 copies/m3. 27 air samples and 105 washes from medical equipment were studied and P. carinii DNA was not detected. It has been shown during the study that DNA of pneumocysts remains intact at room temperature during 12 days including 2-hour ultraviolet (UV) radiation treatment. After processing of studied surfaces with 0.1% solution of chloramine with subsequent UV radiation treatment during 30 minutes results of PCR assay were negative.

[Diagnosis of pulmonary lesions in acute respiratory insufficiency in patients with depressed hemopoiesis]. / Porazheniia lëgkikh pri ostroi dykhatel'noi nedostatochnosti u bol'nykh s depressiiami krovetvoreniia.

AIM: To analyse causes of acute respiratory failure (ARF) and methods of diagnosis of pulmonary lesions in patients with depressed hemopoiesis (DH). MATERIAL AND METHODS: 50 patients with DH and ARF were examined according to the protocol including x-ray, computed tomography, fibrobronchoscopy with bronchoalveolar lavage, cytological, bacteriological, virusological studies of the lavage fluid, biopsy of the lung. The algorithm of the protocol is provided. RESULTS: Sensitivity of the lavage fluid in diagnosis of fungal, bacterial, pneumocystic and cytomegaloviral infections was 84, 78, 93 and 93%, respectively. The cytologic examination of the lavage fluid may detect lung infiltration with blood tumors. In complicated diagnostic cases lung biopsy verified pulmonary lesion but its conduction aggravated the patients' condition. ARF patients with DH, bacterial flora, fungi, cytomegalovirus and pneumocystic infection, pulmonary tumor involvement, pulmonary lesions in ATRA-syndrome, non-infectious lesions of the lungs after bone marrow transplantation were found in 38, 18, 40, 18, 8 and 4% of cases, respectively. CONCLUSION: DH patients with ARF should be examined by the protocol including both non-invasive and invasive diagnostic methods. Accurate diagnosis of ARF causes is the basic reserve in the treatment of such patients.

[Spectrum of pneumotropic pathogens in pediatric patients with acute bronchitis and pneumonia]. / Spektr pnevmotropnykh vozbuditelei pri ostrykh bronkhitakh i pnevmonii detei.

One hundred eighty nine children with acute bronchopulmonary infectious pathological processes were examined bacteriologically and serologically for typical pneumotropic pathogens, 47 of them being as well examined for atypical organisms. Microbial associations mainly with Mycoplasma and Pneumocystis and to a lesser extent with Chlamydia were isolated from the majority of the children. Reactivation of the cytomegalovirus infection was observed in 25 per cent of the children. Pneumonia and bronchitis due to Mycoplasma pneumoniae either as a monoagent or in associations were mainly stated in children over 7 years of age. No significant changes between the indices of the infection due to a definite organism and the active progression of the infectious process of the same etiology were revealed, though in the cases of chlamydiosis the changes reached almost 10 per cent. In cases of acute bronchitis and pneumonia the chlamydial or cytomegalovirus infection could be assumed to be of the persisting nature, mainly acute in cases of pneumococcal infection, mixed in cases of hemophilic or pneumocystic infection, primary contamination with a tendency to prolonged in cases of mycoplasmic infection. The findings of the examination and the clinical and anamnestic data showed that the clinical picture of acute pneumonia had specific features associated with the supposed etiological agents, still it could change under the action of associations of pneumotropic pathogens.

[Persistence of pneumotrophic infective agents in acute bronchopulmonary diseases in children]. / Persistentsiia pnevmotropnykh vozbuditelei pri ostrykh bronkholegochnykh zabolevaniiakh u detei.

175 children with acute bronchopulmonary pathology were examined for the presence of the pneumotropic infective agents by serological and bacteriological methods. In most children microbial associations with the prevalence of mycoplasmas, pneumocycts and, to a lesser extent, chlamydiae were detected. The considerable activation of cytomegalovirus (CMV) infection in children with pneumonia and bronchitis was noted. Taking into account the results of the examination and the clinico-anamnestic data, the character of infections could be established: chlamydial and CMV infections were mainly persisting; pneumococcal infection was mainly acute, hemophilic and pneumocyst infections were mixed. The clinical picture of acute pneumonia cases had characteristic features determined by the supposed etiological agent, but this picture could change under the influence of pneumotropic infective agents.

[Clinical manifestations, diagnosis and course of Pneumocystis carinii pneumonia in patients with hematologic diseases]. / Klinicheskie proiavleniia, diagnostika i techenie pnevmotsistnoi pnevmonii u bol'nykh s zabolevaniiami sistemy krovi.

AIM: To characterize clinical, diagnostic and course features of pneumonia caused by Pneumocystis carinii (PC) in hematologic inpatients. MATERIALS AND METHODS: 27 patients with blood diseases were studied. 22 of them had acute respiratory insufficiency and 5 had unclear lung affection. The data from bronchoalveolar lavage (BAL), lung biopsy, serum tests for IgG, IgM anti-PC-antibodies were used for diagnosis of PC-pneumonia. RESULTS: PC-pneumonia was diagnosed in 8 of 27 patients. Clinical manifestations characteristic for PC-pneumonia were not found. In 5 patients the diagnosis was made on the evidence provided by BAL. Lymphocyte count in BAL was elevated to 27.7 +/- 8.7%. Open biopsy of the lung and transbronchial biopsy diagnosed PC-pneumonia in 2 and 1 patients, respectively. Previous BAL examinations failed to detect PC-pneumonia in 2 of them. In all the patients PC-pneumonia was associated with another infection (bacterial, cytomegaloviral). Histologically, the picture of the disease was determined by the severity of the lung affection or its complications. 5 of 8 patients failed treatment with trimethoprim-sulphamethoxazole and died. Marked respiratory insufficiency was registered at PC-pneumonia diagnosis in all the lethal cases. CONCLUSION: Clinical and x-ray pictures of PC-pneumonia in hemoblastosis patients are not specific. All such patients with symptoms of lung infection resistant to antibacterial and antifungal therapy should be examined for PC-pneumonia.

[The host-opportunistic protozoa system. The incidence of mixed infections (Pneumocystis and cytomegalovirus) in children living in radionuclide-contaminated areas]. / Sistema "khoziain-uslovno-patogennye prosteishie". Chastota smeshannykh infektsii (pneumotsistnoi i tsitomegalovirusnoi) u detei, prozhivaiushchikh na zagriaznennykh radionuklidami territoriiakh.

The purpose of our study was to determine the influence of ionized radiation onto the frequency of mixed infections (P. carinii and Cytomegalovirus) in children inhabitants of the settlements affected with radionuclide after Chernobyl accident. Two groups of children were under survey. 1) 103 inhabitants of Novozybkov (Bryansk Province, Russia) and 38 patients under observation in Moscow paediatric hospital from another affected villages (5-15 Ci/km2) were examined serologically by the diagnostic system "Pneumo-test" and "Cytomegatest" (Nyarmedic, Moscow, Russia). Cut-off titers for P. carinii were IgM-1: 200, IgG-1: 20, for CMV IgG-1: 200, 2) Retrospective study of 563 patients with respiratory pathology and 1809 died children after acute pneumonia during 14 years period. Sputum and mucus of the patients taken by laryngoscopy and bronchoscopy were studied for P. carinii by microscopy, the section of lungs--histologically. The sediments of urine and saliva were examined for CMV by microscopy and section of different organs_-histologically. Examinations were performed by one and the same highly qualified pathologist. The results of the study were as follows. 1. Of 563 children examined for both P. carinii and CMV 186 (33%) were positive for P. carinii and 189 (33.7%) for CMV. Both pathogens were found in 46 children (8.2%), mainly among 1-2 and 6-12 month age (8.5 and 14.5%, respectively). Retrospective analysis of 1809 autopsy results shows, that in 73 cases (4%) were found only P. carinii, in 200 (11.1%) only CMV and in 24 (1.3%) two pathogens simultaneously. 2. Of 103 children surveyed serologically P. carinii monoinfection was found in 7 (8.8%), CMV-in 25 (24.3%) and coinfection in 55 (53.4%). Estimated frequency for coinfection (if combination of two infections were to be accidental) should equal 46.8%. In control group consisted of 30 children from clean Moscow region the rate of coinfection was 16.7% and estimated rate 15% (the difference between empiric and estimated rates are statistically significant, t > 4). Thus it is clear that the rate of coinfection of P. carinii and CMV is always high either in clean or in affected by ionized radiation regions. This rate determined by microscopy was higher in patients (8.2%) than in autopsy cases (1.3%) and much higher in children from affected region (53.3%) than in control (16.7%), being determined serologically. Separate interest present geometric mean titers found in the cases of coinfection. The titer for anti-CMV IgG in children from affected regions was rather high (5884 vs. 1246 in control) and on the contrary titers for anti-P. carinii IgM and IgG were lower than in control (512 vs. 1245 and 58 vs. 159 respectively). We are incline to interpret the results of our study as evidence of increased susceptibility to P. carinii and CMV in those children whose immune system was suppressed by premorbid factors or ionized radiation and peculiar symbiotic relationships of P. carinii and CMV resulting in enhancement of their infectiousness.

[The host-opportunistic protozoa system. The effect of ionizing radiation on the prevalence of cryptosporidiosis and pneumocystosis]. / Sistema "khoziain-uslovno-patogennye prosteishie". Vliianie ioniziruiushchei radiatsii na rasprostranenie kriptosporidioza i pnevmotsistoza.

The aim of this study was to determine an influence of ionized radiation on the prevalence of Cryptosporidium and Pneumocystis carinii (P. c.) infections in children inhabitants of settlements affected by radionuclides after Chernobyl accident. Survey of children from day-care centers for prevalence of Cryptosporidium was carried out in Bryansk region, Russia, and Gomel and Mogilev regions, Belarus; children from cities Mogilev and Gomel as well as small town Pochep, Bryansk region, serve as control clean zones. Survey for P. c. seroprevalence was carried out in town Novozybkov, Bryansk region, Specific Ab to P. c. determined by "Pneumo-test" system (Nyarmedic. Moscow. Russia), an evaluation of immune status included assessment of Ig in serum and saliva by Manchini method. Results of the study were as follows: 1) of 432 healthy children surveyed for Cryptosporidium oocysts 352 were from affected regions: the prevalence in Bryansk region was 8% vs. 2.8% in control, in Gomel and Mogilev 4.1% vs. 2.8%. 2) Prevalence anti-P.c. Ab accounts 56.3% in children and 78.2% in adult inhabitants of Novozybkov vs. 30% in children of control group. Special interest presents an relationship of seroprevalence P.c. and secretory immunity examined twice with 2 month interval. At the first survey IgG in seropositive for P. c. children was found in 36.8% (vs. 23.1% in control) and secretary IgA in 13.2% vs. 5.8% in control. At the second survey IgG was found in 53.4% vs. 21.8% and IgA in 2.7% vs. 1.8% in control. Taking into consideration the known fact that IgG and IgA in saliva are result of their transudation from blood through the inflammatory mucosa we consider that long ionized radiation impairs the barrier function of mucosae.

[Viral hepatitis A and B as a mixed infection in children]. / Virusnye gepatity A i B kak smeshannaia infektsiia u detei.

Serological examinations of 1,200 children, hospitalized at the viral hepatitis department over a year, for the presence of hepatitis A (HA) and hepatitis B (HB) markers have revealed a 7% incidence rate of mixed HA and HB infections. Three variants of mixed infection have been established (true mixed infection, HA combined with asymptomatic HBsAg carriership, cross superinfection) and the relative significance of each of them has been determined. Mixed infection took an unfavorable course with a tendency to the prolongation of the pathological process eventuating in chronic hepatitis, especially in cases of true mixed infections (15.9%).