[Pulmonary paecilomycosis: Diagnosis and treatment].

AIM: To represent the advances of Russia and Uzbekistan in studying the problem of paecilomycosis. The goal of the investigation was to develop the diagnosis and treatment of pulmonary paecilomycosis (PP). SUBJECTS AND METHODS: Two hundred and twenty-five people, including 200 patients with bronchopulmonary infection with fungi of the Paecilomyces genus and 25 clinically healthy individuals (a control group), were examined. Clinico-anamnestic, laboratory diagnostic, mycological, and immunological studies were conducted; a lymphocyte antigen-binding test was used for differential diagnosis. Paecilomyces infection was diagnosed by microscopically examining the morphology of the fungi in the pathological material (blood, sputum) and by isolating the cultured fungi in the media (Sabouraud's and Czapek's ones). The severe complication of PP - atypical paecilomycosis-associated myocarditis (APAM) - was studied in 112 patients with helminthiasis-complicated paecilomycosis. These patients underwent using the conventional echocardiography. RESULTS: Bronchopulmonary paecilomycosis resulting from primary and secondary infection with fungi of the Paecilomyces genus was clinically manifested as chronic obstructive bronchitis (11.5%), recurrent pneumonia (13.5%), exogenous allergic alveolitis (37%), and asthma (26%) complicated by helminthiasis (12%). Iodine deficiency promotes the prevalence of paecilomycosis and echinococcosis favors Paecilomycosis infection; moreover, the helminth capsule itself serves as a nutrient medium for the development of the mycelial form of the fungus. APAM is a severe complication of PP. Almost 50% of the patients with PP presented with carditis. The patients with APAM occasionally experienced fear and the most severe intermittent pain. The latter first occurred in the chest.and irradiated to the axilla, left hand, and its fingertips, paralyzing the arm. In some patients, the pain manifested itself in both arms with abdominal irradiation, by being accompanied by faints. Current analgesics (meloxicam, tizanidine, nimesulide, morphine, promedole) in combination with fluconazole provided a temporary positive effect. CONCLUSION: Further investigations that must also include neurologists and anesthetists are required to work out effective pain relief regimens for APAM in patients with PP.

[Liver function and pathogenetic therapy for echinococcosis].

This paper contains the results of examining and treating 64 patients with hepatic echinococcosis, treated at the Surgery Unit of the Samarkand Medical Institute Clinic. Forty-five healthy donors of a blood transfusion station formed a control group. There were a total of 109 examined persons. The liver functional status depended on segmental liver involvement by an echinococcal cyst. The cysts were most frequently located in the 7th-8th segments of the liver (32.31%). The number and sizes of cysts also affected the functional status of the cyst-affected liver. The sizes of hepatic cysts varied from 4 to 2 cm. Hepatoprotective agents should be used in different forms of hydatid disease of the liver to correct its function that is changed in multiple and complicated echinococcosis and giant hepatic cysts. They normalize liver function and enzyme activity in the hepatocytes, reduce energy expenditure in the liver, promote hepatocyte regeneration, and convert neutral fats and cholesterol into easily metabolizing forms.

[The epizootology and epidemiology of echinococcosis and paecilomycosis].

Fungi of the genus Paecilomyces, a causative agent of the fungal disease paecilomycosis, have been found in the blood of productive animals (sheep, cattle, pigs, goats) that are carriers of Echinococcus larvocysts. In the Republic of Uzbekistan, the echinococcosis affection of sheep, cattle, pigs, and goats continues to remain high. Domestic fowls (chickens, turkeys, and gooses) have been established to be blood carriers of Paecilomyces fungi, which is also true for wild birds, such as my-lady's-belts, quails, chukars, and crows. The degree of fungal affection has been also established for birds.

[Study of the pathogenesis of paecilomycosis-complicated echinococcosis].

Experiments were carried out on 35 lambs infected with echinococcus eggs taken from canine donors, 5 lambs with echinococcosis, 5 lambs with echinococcosis + paecilomycosis, 5 lambs with coenurosis, 5 with cysticercosis ovis, 5 with alveococcosis, 5 with paecilomycosis, inoculated by the material taken from patients; and 5 healthy lambs formed a control group. Cystic hydatidosis was found to induce substantial cardiovascular changes.

[Procedure for Latrodectus reproduction in the laboratory setting and the preparation of the first Russian matrix from its venom to manufacture homeopathic remedies with antiparasitic activity].

The investigation was undertaken to study the biology and ecology of Latrodectus, the possibilities of its importation to Russia from other countries, to breed Latrodectus in the laboratory setting, and to design the first homeopathic matrix of Latrodectus to manufacture homeopathic remedies. The authors were the first to devise a method for Latrodectus breeding in the laboratory setting of Moscow and its vicinities. The Latrodectus bred in the laboratory is suitable to manufacture drugs and in captivity they do not lose its biological activity. The authors were the first to prepare a homeopathic Latrodectus matrix for homeopathic medicines, by using the new Russian extragent petroleum. Chromatography mass spectrometry was used to identify more than a hundred chemical compounds in the Russian petroleum. The biological activity of the petroleum Latrodectus matrix for the manufacture of homeopathic remedies was highly competitive with that of the traditional Latrodectus venom matrix made using ethyl alcohol. The homeopathic Latrodectus matrix made using glycerol lost its biological activity because of glycerol. The biological activity of homeopathic matrixes made from Latrodectus inhabiting the USA, Uzbekistan, and the south of Russia and from that bred in the laboratory was studied. The homeopathic matrix made from the Latrodectus living in the Samarkand Region, Republic of Uzbekistan, has the highest biological activity.

[The agent Latrodectus and canine paecilomycotic eclampsia as a laboratory model in the survey of treatment for mycoses and parasitic diseases].

The extragent used to prepare a Latrodectus mactans hydrocarbon extract is a multicomponent system composed of alkanes, alkenes, and arenes. More than 100 compounds were identified in the hydrocarbon extract (petroleum). The petroleum matrix of Latrodectus mactans was first obtained to manufacture homeopathic remedies. The authors could prepare the first Russian homeopathic medicine from Latrodectus mactans, which proved to be effective in treating canine eclampsia. Canine experiments provide a rationale for the authors' choice as the only homeopathic remedy among thousand known drugs to treat female eclampsia. It is Latrodectus mactans that is in the list of homeopathic medicines permitted for use in accordance with Order No. 335 (Supplement 2) of the Ministry of Health and Medical Industry of Russia, issued on November 29, 1995. It is manufactured from Latrodectus mactans living in the USA.

[Cardiac involvement in adults with echinococcosis].

Experiments have established that the first target for echinococcus is the liver and lung and that for pathogenic fungi and protozoa is the heart. Adult patients with hepatic hydatid disease complicated by paecilomycosis have been found to have atypical paecilomycosis-associated myocarditis, the treatment of which was developed by the authors, by using antibiotics, fungicides, and homeopathic remedies.

[Development of a new hydrocarbon extract from the medicinal raw material of Circassian walnut (Juglans regia) and study of its antiparasitic activity].

The authors developed a technology for preparing a hydrocarbon extract from the medicinal raw material of Circassian walnut (Juglans regia), including its green fruits, green leaves, and fresh roots. To prepare the preparation, they obtained for the first time a new extragent called petroleum Russia that was found to contain more than hundred chemical compounds by chromatography mass spectrometry. The new agent was named irillen. Experiments on albino mice and albino rats established that the new agent was low toxic. The lethal doses of irillen were calculated: LD50 was 16377 +/- 457.5 mg/kg; LD16 = 12986.4 mg/kg; LD84 was 18976.6 mg/kg for albino mice; LD50 was 16998.0 +/- 535.4 mg/kg; LD16 = 12875.3 mg/ kg; LD84 = 18583.4 mg/kg for albino rats. The irillen prepared by the authors should be referred to as a low toxic and practically nontoxic agent (Toxicity Class IV and V). Irillen has a broad spectrum of antiparasitic activity. It is effective in treating toxocariasis in dogs, larval alveolar echinococcosis, ascaridiasis, and eimeriasis in chickens, and siphachiasis.

[Immunorehabilitation in patients with paecilomycosis-complicated echinococcosis and asthma].

Paecilomycosis is a new type of systemic mycosis caused by different species of fungi of the genus Paecilomyces. Paecilomycosis-complicated echinococcosis and asthma run a severe course. A complication of mycosis is accompanied by secondary immunodeficiency. A good result was obtained in the treatment of ill children by using the fungicide diflucan and the immunomodulator polyoxidonium. In the examinees with paecilomycosis-complicated echinococcosis, secondary immunodeficiency was characterized by a statistical significant reduction in the blood levels of the lymphoid cells CD3+, CD4+, CD8+, CD16+, CD21+, by phagocytosis, a decrease in its quantitative parameters, and an increase in the counts of immunoglobulins and circulating immunocomplexes. To normalize the immune status in patients with paecilomycosis-complicated echinococcosis, it is expedient to postsurgicallyuse fungicides, such as nizoral, diflucan, orungal, mycosyst, and the immunomodulators polyoxidonium and irillen.

[Amino acid exchange in paeci lomycosis-complicated echinococcosis].

The authors have detected atypical paecilomycosis-associated myocarditis with impaired amino acid exchange and pain syndrome for the first time. At first, pain occurs in the chest and radiates into the axilla, to the left arm to the finger tips, by paralyzing the arm. In some patients, pain manifests itself in both arms with radiation to the belly, by accompanying by fainting. The skin is wet, cold; the pulse is frequent and of poor volume and difficult-to-count. Heart pain spreads into the armpit and down the arm, by making the fingers numb. Attempts to use current analgesics (movalis, sirdalud, nimesil, morphine) in combination with fungicides (diflucan, mycosist, orungal) have failed to yield positive results. The homeopathic drug Latrodectus mactans, prepared from caracurt venom, in combination with the authors' designed diet and other homeopathic agents have relieved pain syndrome and normalized amino acid exchange, which offered possibilities for successful surgical treatment for echinococcosis with later recovery.

[Experimental rationale for a procedure for correction of the residual cavity in hydatidectomy].

Thirty-six piglets (15 days old) were inoculated with Echinococcus according to the authors' procedure. Hepatic hydatid cyst growth in the piglets was ultrasonographically monitored 3 months after inoculation. In 15 piglets, the size of hepatic hydatid cysts was as high as 6.5 x 8.5 cm 5 months after infection. The cavity of larvocystic fibrous capsule was eliminated, by inverting the resection margins inward with interrupted catgut sutures. For content aspiration, the cystic bed was occasionally drained by a polyvinyl chloride tube with two side holes, which was brought outward through an individual incision. Thesubhepatic area was also drained by a "cigar" tampon through an individual incision. The wound healed in layers, tightly. Marginal resection of the liver was performed to stimulate regenerative processes in the resected area.

[Echinococcosis complicated by paecilomycosis].

Two hundred and thirty-six echinococcosis patients aged 17 to 70 years were examined for paecilomycosis. Seventy-five subjects of different ages who were considered to be clinically healthy were prepared as a control. Of them who had physiological parameters of blood fungi, 24 subjects, including 9 subjects aged 17 to 23 years and 15 subjects aged 15 to 30 years, were eligible. The other examinees were patients with paecilomycosis of varying stages. Nizoral, fluconazole, diflucan, orungal, mycosyst, and teknazol, which have been tested by the authors, are proposed for use in paecilomycosis-complicated echinococcosis prior to and after surgery. It is advisable to use one fungicide. In this respect, the authors have conducted clinical trials that have yielded positive results.

[Antimicrobial, echinococcidial and immunostimulating properties of the drug Cheblin-SK-1]. / Protivomikrobnye, protivoékhinokokkoznye i immunostimuliruiushchie svoistva preparata Cheblin-SK-1.

The antimicrobial properties of the drug Cheblin-CK-1 (CCK-1) were determined in mice intraabdominally inoculated with Proteus mirabilis-4691 in a dose of 140-200 million daily cultured microbial bodies. Its comparison agent was ampicillin. CCK-1 was found to act as an antibiotic similar to ampicillin in its effects. The antimicrobial activity of CCK-1 against Staphylococcus aureus and Escherichia coli isolated from the contents of echinococcal cysts from patients operated on was also established. Its echinococcidial activity was found in experiments on the cotton rats and piglets inocculated with echinococci. CCK-1 was also tested on volunteers. Before surgery, 186 patients with echinococcosis took the drug and 26 patients with the same disease did not and they served as controls. At first the drug suppressed the growth of parasitic larvocysts with destruction and death of 85-95% of germinal elements of larvocysts and then killed parasites. In patients receiving a complete course of its therapy, protein and amino acid metabolisms restored, followed by immunity recovery.

[Mediastinal echinococcosis]. / Ekhinokokkoz sredosteniia.

Among 29,875 autopsies 59 cases of mediastinal echinococcosis were revealed. Among 4178 patients with thoracic echinococcosis 55 patients had mediastinal echinococcosis. All the patients were operated, most of them underwent ideal ecinococcectomy. Intraoperative prophylaxis of echinococcosis was performed: plearal cavity was treated by low-frequency ultrasound and glycerin. 7 examined patients demonstrated reduction of immune and phagocytosis indices in blood (DC3+, CD4+, CD8+, CD16+, CD21+). Increase of immunoglobulines A, M, G and circulating immune complexes was revealed. Reactions of scolexprecipitation and lymphocytes antigen-fixing were positive.

[Immunity induced by immunomodulators during echinococcal immunosuppression]. / Immunitet pri vvedenii immunomoduliatorov na fone ékhinokokkovoi immunosupressii.

The echinococcal immunosuppression induced in experimental mice by a human parasite strain is accompanied by immunosuppression, whereby the administration of immunomodulants favors normalization of the cell and humoral immunity chains. Among a series of preparations studied, the best results were obtained for polyoxidonium: in the case of immunosuppression induced by cyclophosphan, polyoxidonium administration led normalization of the cell and humoral immunity and the phagocytosis of neutrophils and macrophages.

[An improvement in a new method for the surgical treatment of echinococcosis]. / Sovershenstvovanie novogo sposoba khirurgicheskogo lecheniia ékhinokokkoza.

Parasitic cysts were intraoperatively treated with glycerol in 179 patients with echinococcosis at various sites and 3% hydrogen peroxide in 165 patients with hepatic echinococcosis. Experiments on 60 cotton rats experimentally infected with Echinococcus alveolaris and 156 albino mice with E. granulosus provided evidence for the surgical use of 80-100% glycerol or 3% hydrogen peroxide to treat the cysts. Intraoperative glycerol treatment of cysts in patients with complicated hepatic echinococcosis fails to normalize amino acid metabolism, as well as immunity even a year postoperatively. The glycerol method has no contraindications for pulmonary and hepatic echinococcosis. Hydrogen peroxide has a damaging effect on all germinal elements of both E. alveolaris and E. granulosus. The authors recommend that 3% hydrogen peroxide should be intraoperatively used for treatment of cysts. After surgery, there is a tendency for amino acid metabolism to become normal in such patients.

[A trial of the preparation Cheblin-SK-1 in models of nematodiases]. / Ispytanie preparata Cheblin-SK-1 na modeliakh nematodozov.

A kerosene milky-stage walnut (Juglans spp.) extract, a folk medication, has come into wide use in the past 30 years. The drug CK-I was prepared on a scientific basis. Its acute toxicity and toxicological profile were studied on albino mice and rats, chickens, chicken embryos, piglets. The maximum non-lethal dose of CK-I was 19 g/kg for albino mice and 21 g/kg for albino rats. The drug can be classified as i.v. hazard class. The anthelmintic effects of CK-I were examined in mice with cyphaciasis and in chickens with ascariasis and heterakiasis. In murine cyphaciasis, CK-I given in a dose of 75 mg/kg to albino mice provided 100% efficiency. Its doses of 800 and 1000 mg/kg were required to achieve this effect in chick ascariasis and heterakiasis, respectively.

[Treatment of hydatid cysts' residual cavities (experimental and clinical study)]. / Obrabotka polosti kist pri gidatidnom ékhinokokkoze (éksperimental'no-klinicheskoe issledovanie).

Experimental series of 60 cotton rats and 150 white mice infected with echinococcus showed that 80-100% glycerin and 3% peroxide solution were effective scolicidal solutions for inactivation of the parasite. 344 patients have been operated on for hydatid disease with inactivation of the parasite by means of these scolicidal solutions. Glycerin during the surgical management of the hydatid cysts is effective and harmless in uncomplicated hydatid liver disease and any hydatid pulmonary cysts. Glycerin is contraindicated in complicated hydatid liver disease because of immunity disturbance. In complicated hydatid liver disease management of the hydatid cysts by 3% peroxide is effective and harmless. It is necessary to correct the hydatid liver disease patients' immunity in the preoperative and postoperative periods. Tactivin and antiechinococcus drug SK-1 are effective immunomodulators in hydatid liver disease.

[Homeopathic preparation Cheblin-CK-1 in the pathogenetic therapy of echinococcosis]. / Ispol'zovanie gomeopaticheskogo preparata Cheblin-CK-1 v patogeneticheskoi terapii ékhinokokkoza.

This study was experimental and clinical. The experiments were made on 80 cotton rats. The clinical study covered 289 patients operated on for echinococcosis. Earlier studies indicated that echinococcosis is accompanied by secondary immunodeficiency and amino acid metabolic disorders. The homeopathic drug Cheblin-CK-1 used normalized amino acid metabolism 40 days after treatment in these patients. The same properties were displayed by homeopathic drugs.