[Description of the case of adverse pasteurellosis in a cirrhosis patient. Case report].

The article describes a clinical case of an unfavorable course of pasteurellosis in a patient with liver cirrhosis. Possible variants of the clinical course, clinical and epidemiological data, on the basis of which pasteurellosis can be suspected, modern recommendations for antibiotic therapy are considered.

[Listeriosis of the Central nervous system].

OBJECT: To study the main causes of severe course and high mortality in patients with nervous form of listeriosis. MATERIALS AND METHODS: The analysis of the course of Listeria meningoencephalitis (LM) in 36 patients aged from 9 to 85 years, who were treated in the Infectious clinical hospital No. 2 DZM (IKB No. 2 DZM). Along with standard examination methods, blood and cerebrospinal fluid (CSF) polymerase chain reaction tests were performed to identify Listeria monocytogenes. The sensitivity of the pathogen to antibiotics was determined by serial dilutions on the WalkAway 96 Plus device of Siemens, USA. RESULTS: LM in 84% of cases developed in patients with disorders in the immune system, in particular, with infection with the human immunodeficiency virus - in 25% of cases. The clinical picture of the disease, changes in CSF were not typical for bacterial purulent meningitis of another etiology. It is noted that LM is characterized by early involvement of the substance and ventricles of the brain in the process. CONCLUSION: Severe course and high mortality are due to atypical picture of the disease, late diagnosis, low bioavailability of the pathogen for antibiotics (intracellular persistence of the pathogen) and frequent resistance to them. The mortality from the nervous form of listeriosis was 33.3%.

[Use of immunological and molecular biological methods to diagnose cerebral toxoplasmosis in HIV infection].

Cerebral toxoplasmosis is one of the leading causes of neurologic diseases with high mortality rates in patients with HIV infection. Invasion was difficult to diagnose for a number of objective reasons. The objective of the investigation was to determine the clinical sensitivity of different laboratory techniques as both a single study and their various combinations to verify the diagnosis of cerebral toxoplasmosis in HIV-infected patients. Blood and cerebrospinal fluid were tested in 51 patients with Stage 4B HIV infection (AIDS) with the verified diagnosis of cerebral toxoplasmosis. Separate determination of specific antibodies of IgG, IgM, IgA and toxoplasma DNA in the blood and cerebrospinal fluid was shown to have an insufficient clinical sensitivity (37.3-68.6%). The benefits of various combinations of immunological and molecular biological assays enhancing the diagnostic efficiency up to 76.5-96.1% are demonstrated.

[Acute toxic dystrophy of the liver during antituberculosis therapy].

The paper considers a case of acute toxic dystrophy of the liver developing as a manifestation of an idiosyncratic dose-independent unpredictable reaction during standard antituberculosis therapy. The process of liver damage was fulminant with massive diffuse centrilobular necroses, lymphoid-eosinophilic infiltration in the portal tracts, and the development of liver failure.

[Features of epidemiology and diagnostics of toxoplasmosis during HIV-infection].

AIM: Comparative assessment of effectiveness of serologic methods for toxoplasmosis diagnostics in patients with HIV-infection. MATERIALS AND METHODS: Sera and CSF samples from 166 patients with AIDS stage IIIB were tested for antibodies to Toxoplasma gondii by indirect immunofluorescence, ELISA and immunoblotting. Results of serological tests were compared with clinical, pathological data as well as with results of MRI and PCR. RESULTS: Clinical value of IgG detection in blood and CSF by ELISA was shown--high level of antibodies marked reactivation of the invasion. IgG antibodies in CSF were detected only if high levels of IgG were present in the blood. Detection of antigenic determinants with molecular mass 18 - 20 and 65 - 70 kDa in immunoblotting was proposed as a criterion of cerebral toxoplasmosis reactivation. CONCLUSION: Complex laboratory serologic tests along with data obtained by MRI, PCR and microscopy of T. gondii cysts enhances the effectiveness of toxoplasmosis diagnostics. Knowledge of toxoplasmosis reactivation criteria in patients with AIDS will allow to develop the optimal protocol of toxoplasmosis diagnostics and substantiate measures for its prevention.

[The pattern of central nervous system lesions in HIV-infected patients of the specialized unit in infectious disease hospital].

AIM: To define the incidence and features of brain lesion (BL) in HIV-infected inpatients. SUBJECTS AND METHODS: Four hundred and fifty-eight patients with Stage 4B HIV infection (AIDS) and central nervous system (CNS) lesion admitted to Infectious Diseases Hospital Two, Moscow, were followed up in 2003-2009. The authors used cerebrospinal fluid (CSF) microscopic and bacteriological assays for DNA of T. gondii, M. tuberculosis, herpes simplex virus (HSV) types 1 and 2, cytomegalovirus (CMV), HSV type 6, and varicella-zoster virus, Cr. neoformans, C. albicans, C. glabrata, and C. krusei. Blood and CSF were tested for IgM and IgG T. gondii antibodies; brain magnetic resonance imaging was carried out. RESULTS: In patients with late-stage HIV infection, the principal cause of neurological diseases was cerebral toxoplasmosis (34.7% of BL cases) and a generalized process involving the brain, lung, heart, liver, and eyes in 11.5%. There was commonly cerebral toxoplasmosis concurrent with CMV infection with clinical manifestations. 16-32% of the inpatients developed tuberculosis meningoencephalitis that was a manifestation of hematogenous disseminated tuberculosis involving the lung. There was a rise in the incidence of cancers (brain lymphomas, astrocytomas) running with CNS lesion. Mental disorders progressing to dementia were a distinctive property of CMV ventriculoencephalitis, one of the leading factors in the development of AIDS dementia complex. Molecular diagnostic techniques are needed to ascertain the etiology of BL in HIV infection. CONCLUSION: The CSF test for DNA of causative agents is a specific and most sensitive method for diagnosing a relevant CNS lesion.

[Lung pathology in HIV-associated infections].

The lung and intrathoracic lymph nodes taken from 153 persons who had taken from HIV infection at the age of 20 to 32 years, with the development of various infectious diseases were examined. Secondary diseases were of generalized progressive pattern. Among these diseases accompanied by pulmonary lesions tuberculosis, as well as bacterial pneumonias, cytomegalovirus infection, pneumocystic pneumonia, cryptococcosis, and non-tuberculous mycobacterial diseases were most common. Lung tissue reactions at terminal stages of HIV infection were polymorphic, which had been caused by severe immunodeficiency, a change in the course of diseases, obliteration of typical morphological signs, and a mixed lung lesion. This makes the differential diagnosis of diseases difficult and requires a comprehensive study of specimens in each specific case, by widely employing additional methods and stains to detect different pathogens.

[Spectrum, clinical features, diagnosis of opportunistic and comorbid pathology in HIV-infected patients admitted to infection hospital of Moscow].

AIM: To analyse structure, clinical features, diagnosis of opportunistic and concomitant diseases in patients with HIV infection admitted to infection hospital of Moscow. MATERIAL AND METHODS: A total of 4155 patients with HIV infection (1518 of them with AIDS) most of them (89%) at the age of 20-39 years were treated in Moscow AIDS hospital in 2006-2007. The examination included standard blood and urine tests, device diagnosis, immunological, bacteriological and molecular investigations of biological materials for detection of opportunistic infections. Cell-mediated immunity was also studied. HIV infection resulted in a lethal outcome in 255 (6.1%) inpatients. RESULTS: Leading causes of hospitalization of patients at early stages of HIV infection were bacterial bronchitis or pneumonia, hepatic pathology (chronic viral hepatitides, alcohol-associated diseases), sepsis. One-third of the inpatients were at AIDS stage characterized by tuberculosis (66.3%), visceral candidosis (12%), manifest cytomegalovirus infection (10.1%), cerebral toxoplasmosis (9.2%), pneumocystic pneumonia (5.5%). The number of HIV-infected persons with atypical mycobacteriosis, lymphoproliferative diseases, brain tumors increased. Chronic hepatitis C prevailed among liver damage cause in HIV infection, it also often caused hospitalization and death of patients. 60.3% patients having HIV infection who died without AIDS stage had hepatic cirrhosis. Tuberculosis was a leading cause of severe pulmonary pathology, most frequent opportunistic disease, main cause of death in patients with HIV infection. One-third of patients had generalized tuberculosis. Tuberculosis was diagnosed in more than 40% HIV-infected patients with pulmonary lesion, in 65% AIDS patients, 36% dead AIDS patients. CONCLUSION: To render effective anti-HIV treatment, infection hospital must be equipped with facilities providing device tests, molecular diagnosis, modern etiotropic and pathogenetic medication.

[Pathomorphological changes in the lung in tuberculosis patients died from HIV infection at the stage of AIDS].

The authors revealed the typical morphological changes of lung tuberculous lesion in HIV infection at the stage of AIDS: these included alterative changes without typical tuberculosis granulomas; a well-defined exsudative inflammatory component with a predominance of leukocytic infiltration and a drastically decrease of and, occasionally, a complete disappearance of macrophages and lymphocytes; formation of pyonecrotic foci; the focal monomorphic pattern illustrating the loss of the signs of process indulation. These signs suggest the specific features of immunity and the course of specific inflammation as immediate hypersensitivity with the acutest progression of tuberculosis.

[Cytomegalovirus infection of the gastrointestinal tract in patients with HIV-infection].

AIM: To study clinical and morphological characteristics of gastrointestinal cytomegalovirus (CMV) infection in HIV-infected subjects. MATERIAL AND METHODS: The examination of 70 HIV-infected subjects (all of them had secondary diseases, AIDS, CMV infection in the gastrointestinal tract; mean age 31.2 +/- 1.4 years) observed from 1993-2005 included conduction of flow cytofluorimetry (to assess immunity), esophagogastroduodenoscopy, colonoscopy, PCR (to assay CMV DNA in blood leukocytes), examination of biopsy and autopsy samples for CMV DNA and other pathogens of opportunistic diseases). There were 55 lethal outcomes. In autopsy, a total macroscopic and microscopic examination of the gastrointestinal tract was made. Serial histotopographic sections were studied with a wide spectrum of histological stains. RESULTS: CMV gastrointestinal lesion was diagnosed in 38.9% of 180 HIV-infected subjects who had stomatitis, pharyngitis, esophagitis, gastritis, enteritis, enterocolitis or colitis. Diagnostic criteria of viral lesion were high blood concentrations of CMV DNA, the presence of cytomegalocells, CMV DNA in biopsy or autopsy material. CONCLUSION: CMV infection manifested with severe pain, loss of weight, weakness, remitting fever. Gastrointestinal lesions were erosive-ulcerous or ulceronecrotic. The following pathogenetic chain of CMV infection course in the gastrointestinal tract was established: vasculitis--microcirculatory disorders--segmental ischemia--necrosis with inflammatory infiltration and CMV transformation of the cells--fibrosing--cicatricial transformation of the organ wall. Developing sclerosis due to CMV involvement of the intestine may promote cancer, but this should be proved in further studies. CMV gastrointestinal infection was successfully treated by cimeven (ganciclovir) and valcit (valganciclovir). The effect was achieved in 91% cases.

[Pathomorphogenesis of cytomegalovirus lungs lesions in HIV infection]. / Patomorfogeneziz tsitomegalovirusnogo porazheniia legkikh pri vich-infektsii.

Pathomorphologic characteristics of cytomegalovirus (CMV) lung damage in 18 patients who died of HIV infection are outlined. The following variants of lung lesions are distinguished: 1) CMV transformation of the cells in the respiratory compartments and tracts; 2) pneumonias with development of caverns with CMV transformed cells; 3) productive CMV alveolitis with granuloma formation; 4) pulmonary fibrosis and "adenomatosis" associated with CMV infection; 5) CMV transformed cells in secondary lesions--tumours and infections. Heterogeneous number and distribution of CMV cells at early stages, tumours and purulent foci were documented in CMV infections of the lungs.

[Generalized cryptococcosis in HIV infection]. / Generalizovannyi kriptokokkoz pri VICh-infektsii.

Two cases of generalized cryptococcosis in patients who died of HIV infection are described. The course of the disease was masked by other diseases and final diagnosis was established after necropsy. Leukemia was a clinical "mask" in one case and generalized tuberculosis in the other. Numerous cryptococci were found in different organs histologically with positive Shiff-reaction. Ultrastructurally, cryptococci were of variable forms this probably reflecting different stages of interaction between microorganisms and the host.

[Method of morphological study of the conducting system of the human heart]. / K metodike morfologicheskogo issledovaniia provodiashchei sistemy serdtsia cheloveka.

A modified technique of heart dissection is proposed to prevent the damage to the conducting system.

[Analysis of autopsies in HIV infection]. / Analiz autopsii pri VICh-infektsii.

The analysis of 321 necropsies made in Clinical Infections Hospital N 2 from 1991 to 2001 showed a significant increase in the number of deaths of HIV-infection beginning from 1996. The highest mortality (40%) was registered among males aged 25-34 years. The deceased had a wide spectrum of opportunistic diseases (infections and tumors). The deceased with AIDS most frequently had cytomegaloviral infections (19%), tuberculosis (14%), Kaposi's sarcoma (10%), bacterial pneumonias (8%), toxoplasmosis (7%). A late stage of AIDS was characterized by generalized opportunistic diseases, the presence of several severe infectious diseases and more frequent neoplasms.

[Clinical and structural parallels in changes of the myocardial conduction system in diphtheria patients]. / Klinicheskie i strukturnye paralleli izmenenii provodiashcheisistemy serdtsa i miokarda u bol'nykh difteriei.

AIM: Comparison of the results of clinical device investigations of the heart with morphological autopsy evidence in diphtheria. MATERIAL AND METHODS: Hearts of 309 patients with diphtheria aged 25 to 80 years and 60 hearts of patients who died of diphtheria were investigated using ECG, echo-CG, doppler echo-CG, Holter ECG monitoring, biochemical tests of blood. Structural study of cardiac conduction included examination of the sinus-atrial node, atrioventricular node and bundle regarding the adjacent myocardium. RESULTS: Variants of structural-functional state of the myocardium and conduction system are explained by variability of the pathological processes which arose due to individual features of the conduction system structure and location, relationships with the myocardium. In acute diphtheria (day 1-10) dystrophic, necrobiotic and vascular disorders prevailed followed on days 11-30 by inflammation ending in myocardiosclerosis. Nodes and bundles of the conduction system are affected less frequently than the myocardium. CONCLUSION: A correlation exists between structural state of the cardiac conduction system and variants of clinical affection of the heart in diphtheria.

[Liver involvement in secondary infections in HIV-infected patients]. / Porazheniia pecheni pri vtorichnykh zabolevaniiakh u bol'nykh s VICh-infektsiei.

AIM: To determine spectrum and frequency of hepatic lesions, clinical, laboratory and morphological characteristics of hepatic pathology in secondary diseases in HIV-infected patients. MATERIAL AND METHODS: In 1991 to 2002 the authors observed 59 HIV-infected patients with hepatic affection caused by opportunistic infections and tumors. The examination included biochemical tests of blood, immunological tests, biopsies and tests of the autopsy material for CMVDNA, T. Gondii, M. Tuberculosis. Polymerase chain reaction, puncture biopsy of the liver, ultrasound investigation of the abdominal organs. 57 lethal outcomes were registered. RESULTS: Hepatic lesion was of tuberculous origin in 42.4%, CMV--in 16.9%, toxoplasmic--in 6.8%. 3 patients had fungal infection. Cancer of the liver was diagnosed in 18.6%. Clinical picture in most of the examinees was not clear and did not correspond to morphological severity of the condition. Ultrasound detected hepatic lesions if they were caused by CMV infection, toxoplasmosis and malignant tumors. Biochemical parameters were changed moderately. Patients with CMV hepatitis showed significant rise in the activity of GGT and AP. CONCLUSION: Apart from virus hepatitis B, C and D, the liver of HIV-infected patients got affected with tuberculosis, CMV-infection, toxoplasmosis, cancer. Hepatitis in HIV-infected subjects unrelated to viruses or medicines indicates a generalized disease, late stage of HIV-infection with a fall of the number of CD4-lymphocytes under 100 cells/microl.

[Ultrastructure of the heart conduction system in diphtheria]. / Ul'trastruktura provodiashchei sistemy serdtsa pri difterii.

Cytoarchitectonics and ultrastructure of the node and conducting myocardiocytes of the conducting system of the heart and surrounding blood capillaries and nervous fibers are described. In diphtheria, metabolic and destructive changes were found in the node myocytes, conducting myocardiocytes and surrounding structures. The most noticeable changes were seen in the left pedicle of the atrioventricular fascicle and later others components of the conducting heart system. These changes are more pronounced in clear cells of conducting myocardiocytes as compared to the node myocytes.

[Clinical and morphological aspects of shigellosis flexneri in patients with an aggravated premorbid state]. / Kliniko-morfologicheskie osobennosti shigelleza fleksnera u bol'nykh s otiagoshchennym premorbidnym fonom.

The analysis of 10 fatal outcomes in patients with acute shigellosis during the period of 1999-2000 made it possible to find out that most of deceased shigellosis patients belonged to the group inclined to alcohol abuse and having initial alimentary disturbances. In 6 cases of acute shigellosis with fatal outcome the causative agent was S. flexneri 2a, in 2 cases--S. flexneri 3a, in 1--S. flexneri 4b. The main cause of fatal outcomes was accompanying double pneumonia. Lesions of the intestinal tract in deceased shigellosis patients were of destructive character, resulting, in a number of cases, in serous and perforative peritonitis.

[Morphological characteristics of heart conduction system in diphtheria]. / Morfologicheskie izmeneniia provodiashchei sistemy srdtsa pri difterii.

Heart conductive system (HCS) including the sinoatrial node (SAN), atrioventricular node (AVN), AV bundle (AVB) and its left and right parts was studied histologically. It is shown that different portions of HCS are damaged in diphtheria with different frequency and intensity, the frequency depending on the depth of their location. Left part of AVB is affected most frequently, followed by the right part of AVB, AVB, AVN and the least frequently SAN.