[Serological diagnosis of pertussis in older persons.] / Серологическая диагностика коклюша у лиц старшего возраста.

The aim of the work was to assess the effectiveness of serodiagnosis of pertussis in people over 50 who complained of prolonged cough. The study included 30 patients over the age of 50 who applied to the consultative diagnostic center complaining of a prolonged cough in the period from 2015 - 2020. Blood serum samples were investigated in enzyme immunoassay with the definition of antitussive antibodies of three classes - IgM, IgG, IgA in the commercial test system RIDASCREEN (R-Biopharm AG, Germany). It was found that in the serum samples of individuals over the age of 50, IgM antibodies above the threshold level were not detected. Patients were divided into two groups - with IgG and IgA antibodies above the threshold level (group 1) and below the threshold level (group 2). In the first group, in 83.3% and 61.1% of patients, the levels of antibodies of the IgG and IgA class significantly exceeded the threshold level (189.8 ± 16.7 U / ml and 290 ± 20 U / ml, respectively), which indicated a pertussis infection; in 5.6% and 38.9% of patients, IgG and IgA class antibodies slightly exceeded the threshold level (20 U / ml and 43 ± 2.3 U / ml, respectively), which indicated a dying infection. In the second group, in 100% of patients, antibodies of the IgM and IgA classes were determined below threshold levels, and IgG antibodies were detected in 58.3% of individuals at low rates, which corresponded to the natural immunological background of individuals not infected with pertussis pathogen. Therefore, in the presence of a prolonged cough in adults, it is advisable to study blood serum samples for the presence of antitussive antibodies of three classes, which is especially important when people of older age live in families with young children and pregnant women.

[Whooping cough in different periods of pregnancy].

AIM: To study the clinical course, diagnosis of pertussis in pregnant women. MATERIALS AND METHODS: Under observation were 25 pregnant women with whooping cough. The age structure was dominated by patients from 6 to 35 years old, amounting to 64%. At the time of hospitalization in 2 (8%) patients the gestation period corresponded to the first trimester, in 7 (28%) II, in 9 (36%) III. In 7 (28%) patients, the diagnosis of whooping cough was made during childbirth. The following methods were used to verify pertussis: bacteriological, PCR and serological (ELISA). RESULTS AND DISCUSSION: Clinical analysis showed that pregnant women with pertussis who came to the hospital were admitted to hospital mainly in the late stages of the disease (at 45 week in 68.6% of cases). Pertussis infection in all cases was typical: in moderate form 96%, mild at 4%. In 64% of patients, whooping cough accompanied by other respiratory diseases, which were the main cause of development of bronchitis. The use of ELISA allowed to confirm the clinical diagnosis in 91.7% of patients. CONCLUSION: The course of whooping cough in pregnant women is characterized by a typical symptom complex. To improve the verification of the diagnosis, it is advisable to use modern laboratory tests (PCR, ELISA).

[Definitionof anti-pertussis antibodies by immunoassay.]

Comparative analysis of efficiency of identification the anti-pertussis of antibodies of three classes (IgM, IgG, IgA) by means of four commercial test systems used for serological diagnosis of whooping cough in the Russian Federation by RIDASCREEN (R-Biohharm AG, Германия), NOVATEC (Immunodiagnostica GmbH, Germany), DRG Diagnostics (Germany), Savyon Diagnostics (Israel) is carried out. The research included 42 serums of blood of the children and adults with whooping cough hospitalized in Infectious diseases clinical hospital No. 1 of the Moscow Department of Healthcare. In work the commercial test systems - RIDASCREEN (r-Biofarm, Germany), NOVATEC (Germany), DRG (Germany), Savyon (Israel) are used, according to instructions of producers. Complete coincidence of results of a research is established in 40,5% cases, in 42,9% not complete coincidence of results on dynamics of development of one class of antibodies is revealed and in 9,5% cases the discrepancy of results on two classes of antibodies is revealed. In total discrepancies of results - 7,1%. At determination of antibodies of the class IgM in serum of blood of patients with whooping cough the greatest number of positive results is defined in the SAVYON - 83,3±6,3% (35 serums), NOVATEC - 71,4±8,2% (30 serums), RIDASCREEN - 61,9±9,7% (26 serums), DRG - 45,2±11,7% (19 serums). Class IgG antibodies in all test systems were defined at one level. Some distinctions took place in determination of IgA. The high percent of identification of IgA was in the RIDASCREEN - 59,5±10,0% (25 serums) and DRG - 50,0±11,2% (21 serums). In the NOVATEC and SAVYON this percent was lower - 45,2±11,7% and 26,2±13,9%, respectively (19 and 11 serums). Thus, the research showed that for serological researches any of these 4 test systems can be used. It is recommended to conduct diagnostic testings of serums of blood in one chosen test system for obtaining comparable results and to interpret the results received in one test system when obtaining doubtful results it is necessary to investigate serums in dynamics at the same time in one test system.

[COMPLEX IMMUNOGLOBULIN PREPARATION FOR THERAPY OF PERTUSSIS IN YOUNG CHILDREN].

AIM: Study the possibility of inclusion of complex immunoglobulin preparation (CIP) pos- sessing specific activity against pertussis exotoxins into complex therapy of pertussis infection in young children. MATERIALS AND METHODS: -2 groups of children with.pertussis younger than 3 years were examined. The main group (50 individuals) received CIPper os - 1 dose 1 - 2 times per day for 5 days, comparison group (34 children) received only basic therapy. Evaluation of clinical effectiveness of CIP was carried out, the content of anti-pertussis class G antibodies and total IgE in patients were studied. RESULTS: A good clinical effectiveness of the preparation was shown, as well as immune modulating activity against humoral immune response to pertussis infection. CONCLUSION: The detected positive effect of CIP on pertussis -course in children has indicated a principally novel use of this per oral drug form.

[Clinical features of pertussis in adults].

AIM: To study the clinical features of pertussis in adults. SUBJECTS AND METHODS: The clinical manifestations of pertussis in adults were analyzed in 62 patients treated in the Core Unit and Obstetric Unit, Clinical Infectious Diseases Hospital One, Moscow Healthcare Department, in 2011-2013. RESULTS: Investigations conducted in the familial foci of pertussis showed that its incidence rate was 23.7 and 10% in adults and in pediatric institutions, respectively. The source of infant infection was adults in almost one third of cases, mothers in 72% and fathers in 27.7%. Assessment of the symptom complex of pertussis in the sick mothers in the observed period ascertained that 94±3% had experienced the typical form of whooping cough: 72.0±5.7 and 22.0±5.3% had its mild and moderate forms, respectively. The disease had run a latent course in 6±3% of the patients. The paper describes cases of pertussis in 5 pregnant women admitted to the obstetric unit for complaints of persistent cough. The diagnosis of whooping cough in all the cases was based on clinical and epidemiological findings and serological tests showing specific IgA and IgG antibodies. Three and two patients experienced moderate and mild pertussis, respectively. CONCLUSION: Pertussis now remains one of the infectious diseases relevant not only to a pediatric population, but also to an adult one. Adult pertussis maintains the main clinical features typical for this infection with a predominance of its mild forms, which makes its diagnosis difficult. A serological test (enzyme immunoassay) is of high diagnostic value for verifying whooping cough in adults under the present conditions.

[Evaluation of the immunological activity and safety of group B meningococcal vaccine prepared from a natural complex of specific polysaccharide and outer membrane proteins]. / Otsenka immunologicheskoi aktivnosti i bezopasnosti meningokokkovoi gruppy B vaktsiny iz prirodnogo kompleksa spetsificheskogo polisakharida i belkov naruzhnoi membrany.

Immunological activity and safety of group B meningococcal vaccine prepared from a natural complex of specific polysaccharide and outer membrane proteins were under study. The immunological safety of the vaccine was evaluated by the absence of antibodies to denaturated and native DNA (d-DNA and n-DNA). As shown with the use of the enzyme immunoassay (EIA), the administration of the vaccine did not induce antibody formation to d-DNA and n-DNA during the observation period. The titer of bactericidal antibodies in the immune bacteriolysis assay (IBA) to the vaccine strain B:2b:P1.2 after immunization increased four-fold and greater in 80% of the vaccinated persons. The significant increase of bactericidal antibodies to heterologous strains B:2a:P1.2 and B:15:P1.7 was registered in 20-30% of the vaccinees, respectively. A month after the repeated vaccination an increase in specific IgG antibodies to the complex antigen was found to occur according to EIA results. The use of RIB made it possible to evaluate the preventive activity of group B meningococcal vaccine as a whole and to suppose that the vaccine induced mainly type-specific response.

[Inborn deficiency of complement C4A and C4B isotypes in persons infected with Chlamydia]. / Vrozhdennye defitsity izotipov C4A i C4B komponenta C4 komplementa u lits, inifitsirovannykh khlamidiiami.

The difference in the functional activity of the isotypes A and B of component C4 of human complement was used to determine their ratio to detect the inherited deficiency of the isotypes. The frequency of deficiency in healthy persons blood donors was equal for C4A and C4B (0.14 for each isotype), i.e. 14% of total number (22) donors, or 28% totally. These results agree with the literary data, on which the frequency of deficiency of C4A is 0.14, and of C4B is 0.11-0.16. The inherent deficiencies of C4A and C4B for persons infected by Chlamydia were studied. For this purpose the patients (35 persons) with in blood antibodies (IgG or IgM) to Chlamydia (C. trachomatis, C. psittaci and C. pneumoniae) were investigated. The frequencies of deficiency of C4A and C4B were 0.29 and 0.46 respectively. Thus, the number of the undeficiency patients was only 25%, while among healthy persons 70-75% of individuals not having deficiencies of isotypes C4 were observed. The deficiencies of isotypes of C4 at this pathology is detected for the first time. The obtained data suggest the existence of the predisposition to the development of diseases stipulated by Chlamydia in persons with inherent deficiency of C4 component of complement.

[The isotypic characteristics of antibodies in persons inoculated with a serogroup-A meningococcal polysaccharide vaccine]. / Izotipicheskaia kharakteristika antitel u privitykh meningokokkovoi polisakharidnoi vaktsinoi serogruppy A.

In this work the results of the study of specific antibodies (Ab), isotypes IgM, IgG, IgA, types kappa and lambda, in 235 serum samples from 27 adults immunized with group A meningococcal polysaccharide vaccine (AMPV) in a single injection of 50 microg and from 20 control subjects are presented. The study was made by the method of sandwich EIA. The study revealed that in a month after the injection of the vaccine the intensive synthesis of IgA, IgG and IgA Ab and their subsequent circulation for 2 years were observed; 3 years after immunization (the term of observation) the prevalence of IgG and IgA antibodies was registered. Prior to immunization the ratio of kappa and lambda Ab was 1.7. In a month after immunization the maximum ratio of 3.2 was achieved and in all subsequent terms of examination this ratio remained higher than prior to immunization (3.1 -- 2.3). As revealed in this study, the injection of AMPV induced the intensive synthesis of antibodies of types kappa and lambda during the first year after immunization, then the production of type lambda Ab decreased by the second year and in 2 and 3 years after immunization the circulation of type kappa Ab prevailed.

[The Neisseria meningitidis serotypes and subtypes circulating among bacterial carriers in Moscow (1989-1991)]. / Serotipy i subtipy Neisseria meningitidis, tsirkuliruiushchikh sredi bakterionositelei v Moskve (1989--1991 gg.).

N. meningitidis strains isolated from 218 healthy carriers in 1989-1991 in closed communities of adults, irrespective of cases of meningococcal infection registered in these communities, were characterized with a variety of different type and subtype antigens. Only in 139 strains (63.76%) their types and/or subtypes could be determined with the use of a set of 6 serotypes and 11 subtypes of monoclonal antibodies. 26 group B strains and 31 group C strains had multiple antigenic composition. 13 group A strains were found to be more homogeneous: 8 of them, isolated in one area, belonged, according to Dr. Achtman's data, to a definite clone VI-1, heretofore unknown. No prevailing serotype/subtype could be revealed, which reflected the wide heterogeneity of N. meningitidis at the period of the decrease of morbidity in meningococcal infection. The observed stability of serotype/subtype of strains, isolated from the same carriers and circulating in the same communities, suggests that the serotype/subtype of N. meningitidis is a valuable epidemiological marker.

[The antilysozyme activity of the meningococci isolated from bacterial carriers in closed collectives with different epidemiological situations]. / Antilizotsimnaia aktivnost' meningokokkov, vydelennykh u bakterionositelei v zakrytykh kollektivakh s razlichnoi épidemiologicheskoi obstanovkoi.

The degree of the antilysozyme activity (ALA) of 430 Neisseria meningitidis strains isolated from 379 healthy carriers in 11 closed groups with different epidemiological situation and in 3 family foci was studied by the method of delayed antagonism. 87% of the strains exhibited ALA in a concentration of lysozyme between 1 and 10 micrograms per ml of the medium; about 11% of them were highly active, inactivating 20 and 25 micrograms of lysozyme per ml. ALA was shown to be the constant sign of carriership. The ALA of 39 strains isolated in cases of prolonged carriership (exceeding 2 weeks) was essentially higher than the ALA of 20 strains obtained in a single isolation. N. meningitidis strains of groups A, B and C, mostly responsible for the appearance of the generalized forms of diseases, were essentially less active than N. meningitidis strains of groups X, Y, Z, 29E, W-135, as well as strains not classified with any group. No correlation between ALA and the presence or absence of hyaluronidase was noted. Analysis of the data obtained in this study revealed that the ALA of N. meningitidis strains isolated in closed groups and families was not linked with the presence or absence of morbidity in the generalized forms of meningococcal infection and the spread of carriership in these groups, but reflected only differences in the serological picture of strains circulating there. The role of ALA in the formation of prolonged N. meningitidis carriership requires further study.

[Immunological effectiveness of a dried group-A meningococcal polysaccharide vaccine]. / Izuchenie immunologicheskoi éffektivnosti sukhoi polisakharidnoi meningokokkovoi vaktsiny gruppy A.

The immunological effectiveness of dried group A meningococcal polysaccharide vaccine, developed at the Gabrichevsky Research Institute of Epidemiology and Microbiology, Moscow, for children aged 5-14 years was studied. The intensiveness of the immune response of children to 0.5 ml of the vaccine introduced in a single injection was evaluated by a rise in the level of agglutinating antibodies to group A meningococcal polysaccharide in the sera of the vaccinees 3-4 weeks after immunization with the following optimum doses: 25 micrograms for children aged 5-8 years, 50 micrograms for children aged 9-13 years and 75 micrograms for children aged 14 years and over. The vaccine was shown to be highly immunogenic. Antibodies to group A meningococcal polysaccharide were identified as IgM. These antibodies in a titer of 1:40 and higher could be detected in 90% of the vaccinated children in the younger age group, 7 months after immunization.

[Safety and reactogenicity of a group-A meningoccal polysaccharide vaccine for children 5 to 14]. / Bezvrednost' i reatkogennost' meningokokkovoi polisakhatridnoi vaktsiny gruppy A dlia detei 5-14 let.

The safety and reactogenicity of group A meningococcal polysaccharide vaccine prepared at the G. N. Gabrichevsky Research Institute for Epidemiology and Microbiology (Moscow) and intended for the immunization of children aged 5-14 years were studied. The data obtained in this study made it possible to characterize the preparation as safe and mildly reactogenic. Shifts in the blood formula registered 24 hours after the injection of the vaccine remained within the limits of physiological fluctuations. Subfebrile temperature persisting for 2 days was registered in some of the children aged 5-8 years. Local reaction in the form of hyperemia at the site of injection was insignificant. The optimum vaccination dose will be determined on the basis of the whole complex of the data presented in this work, as well as the data on the immunological activity of the preparation.