[The content of substances of low and medium molecular mass in biologic liquids in patients with erysipelas].

The endogenic intoxication is a metabolic response to any aggressive factor. The concentration of substances of low and medium molecular mass biologic liquids of organism w and medium molecular mass is a common indicator of intoxication syndrome. The study analyzed the role of uptake of substances of low and medium molecular mass in biologic liquids of organism in pathogenesis of erysipelas depending on period, form and ration of disease. The sampling included 76 patients with erysipelas aged from 27 to 62 years being in infection hospital for treatment. The concentration of substances of low and medium molecular mass was detected using M. Ya. Malakhova technique (1996). It is established that under erysipelas in organism occurs uptake of toxic substances in blood and gradual increase of concentration of substances of low and medium molecular mass in blood plasma and erythrocytes paralleled by corresponding changes of their concentration in urine. The altitude of increase of concentration level of substances of low and medium molecular mass and their reapportion between biologic mediums of organisms depends on period, form, ratio of course and degree of severity of pathologic process.

Elements of renal injury in patients with erysipelas.

Erysipelas is an infectious disease caused by group A beta hemolytical streptococci which may produce renal lesions, most frequently glomerular disease. Renal injury although known is less studied in practice. Rarely bioptical exams have been performed, thus the problem of the relationship erysipelas glomerular disease is practically not solved. The aim of this study was a cross-sectional analysis of renal involvement produced by erysipelas in two departments where patients with erysipelas are diagnosed and treated: Dermatology and Infectious Diseases. We investigated 166 patients (86M, 80F; mean age 61.66 +/- 18.42) with erysipelas hospitalized in the Departments of Dermatology (55 patients-33%) and Infectious Diseases (111 patients-66%) during 2005-2009. The diagnosis was established on clinical and biological data. In these patients clinical and biological exam has been performed. We assessed GFR and urinalysis (hematuria and proteinuria). The control group consisted of 110 apparently healthy persons. Of the 166 patients with erysipelas we found asymptomatic urinary abnormalities in 82 (47%), isolated proteinuria in 19 (11%) patients and proteinuria associated with hematuria in 21 (13%) patients, and isolated hematuria in 38 (23%) patients. We did not find patients with nephrotic or nephritic syndrome. In the control group we found asymptomatic urinary abnormalities in 25 (23%) of the patients. A statistically significant difference was between the two groups (p < 0.01). Asymptomatic urinary abnormalities have been more frequent in patients with erysipelas from the Infectious Diseases Department compared to those from the Dermatology Department. A statistically significant difference has been found (p < 0.03). In patients with recurrent erysipelas (43 patients-26%) we found asymptomatic urinary abnormalities in 26 (54%) of the patients compared to the presence of asymptomatic urinary abnormalities in patients with acute erysipelas in 56 out of 123 (46%). Mean GFR in patients with erysipelas was of 73.94 +/- 27.79 ml/min. It was lower in patients with recurrent erysipelas, 72.13 +/- 24.74 mL/min respectively. Association of proteinuria with hematuria was more frequent in patients with recurrent erysipelas. Patients with asymptomatic urinary abnormalities during the course of erysipelas need to be closely monitored during antibiotic treatment.

Antiprotease activity in urine of patients with inflammatory skin disorders.

Polymorphonuclear leukocytes contain well-defined proteolytic enzymes in their azurophilic granules that can be released into tissues during inflammation, producing a localized excess of proteases that causes a protease-antiprotease imbalance with subsequent tissue destruction. The antiproteolytic compounds of the epidermis, such as the protease inhibitors elafin and antileukoprotease, are thought to counteract the proteolytic tissue damage. We investigated the urine of patients suffering from inflammatory skin conditions (e.g., erysipelas, psoriasis) for the presence of urinary antiprotease activities. Purification of elastase-inhibitory activities from pooled urine samples by cation exchange high-performance liquid chromatography and preparative and analytical reverse-phase high-performance liquid chromatography yielded two different types of inhibitors. One was a cationic, acid-stable, and elastase-specific inhibitor of M(r) 6,000 by size-exclusion high-performance liquid chromatography. N-terminal amino acid sequence analysis of the first 28 residues showed identity with elafin, an elastase-specific inhibitor recently isolated from psoriatic scales. The second anti-protease activity was due to two forms of urinary bikunin, the inhibitory subunit of inter-alpha-inhibitor. Both bikunin fragments, with M(r) 4,000 and 16,000, were identified by N-terminal amino acid sequence analysis of the first 10 residues and were characterized by an antiproteolytic profile against human leukocyte elastase, cathepsin G, and trypsin. Urinary protease inhibitors may serve as diagnostic markers of inflammatory diseases.