[Invasive streptococcal (group A) infection of soft tissues in a Moscow surgical hospital].

AIM: To study features and risk factors of soft tissue's invasive streptococcal infection in surgical unit's patients: a) emm-types of the most often recovered streptococcus; b) human immune response for streptococcal antigens (streptolysin-O and the group A carbohydrate antigen); c) main patient's conditions that complicate the course of soft tissue's streptococcal infection. PATIENTS AND METHODS: 101 surgical unit's patients with soft tissue's infection, which group A streptococcal (GAS) nature, were examined. Emm-types were determined by comparison ofemm gene sequenced part with data of CDC Streptococcus Laboratory. ASO and specific anti-group-carbohydrate IgM were measured with photometry and ELISA4 accordingly. Patient's personal data were analyzed by standard statistical programs. RESULTS: Among 34 emm-types of all streptococcal isolates emm28 and emm64 were registered only in invasive infection. Emm-types 1, 49, 60, 66, 77, 84, 88 were most often. Among 23 sera from invasive GAS-infection's patients, 15(65%) were ASO-negative, 6 (26%) were ASO-low-positive, and 2 (8%) were positive, but negative for the anti-group-A-carbohydrate IgM. CONCLUSION: Lower levels of the humoral immune response as well as risk factors such as trauma, alcoholism, diabetes, chronic venous insufficiency contributed to development of severe forms of GAS-infection. The main streptococcal emm-types for soft tissue's invasive GAS infection in one of Moscow surgical unit's patients in 2008-2011 were registered.

[Humoral immune response in patients with angina and soft tissue infections of group a streptococci etiology].

AIM: Evaluate informativity of simultaneous determination of antibodies (AB) against extracellular (AB against streptolysin-O-ASL-O) and cellular (IgM against A-polysaccharide - A-PSC) antigens in patients with angina and soft tissue infections caused by serogroup A streptococci (SGA) and identify features of humoral immune response to SGA infection according to infectious process localization. MATERIALS AND METHODS. 2 groups of patients with bacteriologically confirmed SGA infection (50 cases of angina - group 1 and 51 case of soft tissue infection - group 2) were examined for the presence of ASL-O by using Architect ci8200 analyzer (Abbott, USA) and IgM against SGA A-PSC by EIA. RESULTS. In group 1, 23 (46%) individuals were recognized as positive by ASL-O level, and in group 2 - 20 (39%; p>0.05); conditionally significant exceeding of normal values (more than 1.5 times) was detected in 25% of patients of each group. Increased level of antibodies against SGA A-PSC was detected in 43 (86%) patients of group 1, and in 30 (59%) of patients of group 2 (p<0.05). In group 1 exceeding of normal values of anti-A-PSC IgM was noted mostly by 1.5 +/- 0.5 times (74%). In group 2 in 43% of patients the level of anti-A-PSC IgM was above normal more than 2 times and in most cases in uncomplicated variants of disease course. In 45% of patients with severe form of soft tissue infection this parameter did not exceed normal values (p<0.05). CONCLUSION. In acute period of disease with simultaneous determination of ASL-O and IgM against A-PSC sensitivity of serologic diagnostics of SGA etiology angina and SGA infection of soft tissues was established to reach 92% and 72%, respectively, and humoral immune response to cellular AG in each form of SGA has its features.

[Development of Streptococcus pyogenes cells inactivation for turbidimetric determination of bacteriolytic activity of phage-associated enzyme].

AIM: Development a method of treatment of Streptococcus pyogenes bacteria that does not disrupt the integrity of surface structure of cell and provides optimal reproducibility of enzyme preparation activity test results. MATERIALS AND METHODS: Museum cultures of S. pyogenes M29 and S. pyogenes T1 were used, as well as standard strain S.pyogenes T5 (ATCC) and 3 phage-associated lysine PlyC preparations (enzybiotics): 2 isolated from phage C1, third--recombinant enzyme obtained by cloning phage C1 DNA. 3 methods of S. pyogenes cells treatment were used: inactivation by chloroform, antibiotics and heating. RESULTS: Treatment of S. pyogenes cells by rifampicin and gentamicin allows simultaneous turbidimetric determination of enzyme preparations activity and streptococci lysis effectiveness with a good reproducibility of test results. Comparison of kinetic curves of streptococci lysis killed by heating with curves of live culture lysis showed that heat treatment of cells results in a decrease oflysis depth and a reduction of enzyme activity. Pattern and effectiveness of lysis of cells incubated with chloroform approached curve of live streptococci lysis, however this method did not exclude lysis of part of cells and required presence of equipment for work with chemical substances. CONCLUSION. S. pyogenes test culture inactivation method by 2-step treatment of culture with antibiotics that does not disrupt the integrity of surface structure of cells and provides optimal reproducibility of enzyme preparation activity test results was developed.

[Mechanism of development of epidemic process of group A streptococcal infection in children collectives].

AIM: To study the characteristics of group A streptococcal infection epidemic process in children aged 12 - 14 years arrived to summer camp "Orlenok" (Tuapse) from different regions of Russia. MATERIALS AND METHODS: Epidemiological (retrospective analysis of incidence of acute respiratory infections, tonsillitis, and scarlet fever), microbiological (isolation and identification of group A streptococci [GAS]), and molecular biological (pulse-electrophoresis, analysis of spe and emm genes) methods were used for the study. Objects of the study were GAS strains isolated from patients and carriers. RESULTS: Performed genotyping showed that cases of GAS infection in newly formed children collectives were caused by 2 - 3 epidemically important clones, which were genotypically heterogenous. CONCLUSION: Performed molecular biologic studies demonstrated polyclonal structure of GAS that determines the features of development of epidemic process.

[Genetic characteristic of toxigenicity of group A streptococci cultures isolated from patients with tonsillitis].

Twenty-eight strains of group A streptococci (GAS) isolated from patients with lacunar and fibrinous-necrotic forms of tonsillitis during its 1st or recurrent episode were tested for presence of genes of erythrogenictoxins A, B, C, and Fusing PCR assay. Obtained results allow to consider that clinical features of the disease (severity, repeatedness, clinical form) can be determined by toxigenicity of GAS. Express identification of S. pyogenes on the basis of detection of erythrogenic toxins genes spe B and spe F (mf) can be used for etiologic confirmation of diagnosis, whereas detection of erythrogenic toxins genes spe A and spe C can be recommended for prediction of the disease's course.

[Bacteriophage enzymes for the prevention and treatment of bacterial infections: stability and stabilization of the Streptococcus pyogenes cell lysing enzyme].

The effect of various compounds on the activity and stability of a phage-associated enzyme lysing cells of streptococci of groups A and C (PlyC) was investigated. Substantial inhibition of the enzyme activity was revealed at an increased ionic strength (in the presence of NaCl) and upon the addition of carbohydrates (mono-, di-, and polysaccharides), i.e., agents stabilizing many enzymes. It was established that the enzyme activity was substantially reduced in the presence of positively charged polyelectrolytes and surfactants, whereas incubation with micelle-forming substances and negatively charged polyelectrolytes led to PlyC activation and stabilization. It was shown that, in the mycelial polyelectrolyte composition M16, the enzyme retained its activity for 2 months; while in a buffer solution under the same conditions (pH 6.3, room temperature), it practically completely lost its activity in 2 days. Characteristics of the enzyme thermal inactivation were found, in particular, its semiinactivation time at various temperatures; these allowed us to estimate its behavior at any temperature and to recommend conditions for its storage and use.

[Typing of group A streptococci isolated from urban population of different social status and age].

Pulse-electrophoresis, sequencing of emm genes coding protein M and PCR analysis of speA, speB, and speC genes were used for characterization of group A streptococci (GAS) isolated in different years in Moscow and Tuapse mostly from children and military staff. It has been shown that epidemic process of streptococcal infection caused by GAS in Moscow is based on circulation of many independent clones of Streptococcus pyogenes. Obtained data on complex typing of S. pyogenes would be useful for study of molecular epidemiology of diseases caused by GAS and improvement of epidemiologic surveillance.

[In vitro bactericidal action of a complex of natural cytokins on Streptococcus pyogenes].

The data on the antimicrobial in vitro action of a complex of natural cytokins (CNC)--the substance and the preparation "Superlymph"--on virulent museum and clinical macrolid-resistant group A beta-hemolytic streptococci, are presented. CNC suppressed the growth of museum test culture of streptococci in the concentration dependent manner. Moreover, the preparation "Superlymph" proved to be an effective antistreptococcal remedy in its action on erythromycin-resistant group A streptococcal (GAS) strains. The substance of the preparation induced the lysis of GAS cells, grown on lawn plates and in the system of spectrophotometric analysis. The effect thus established could be caused by cationic antimicrobial peptides (protegrins), contained in "Superlymph".

[Pulse electrophoresis of serogroup A streptocci isolated in Moscow].

Pulse electrophoresis of group A streptococci (GAS) isolated in 1998 - 2004 in Moscow from patients during outbreaks of tonsillitis in child institutions, military unit and also from sporadic cases in children and adults was performed. During analysis of 48 strains 16 pulse electrotypes were recognized. These data allow to consider that in different child institutions (and other groups) accumulation and spreading of most adapted to such environment variants of GAS are take place and population structure of GAS in such institutions is unique on molecular and other characteristics. This study showed that complex typing of GAS (use of pulse electrophoresis and PCR for detection of erythrogenic toxins A and C) will help to improve molecular-epidemiologic surveillance for streptococcal group A infection, development of recommendations on reduction of morbidity from this infection and also to decrease risk of its severe forms, complications and mortality.

[Genotypic emm-typing of streptococcal cultures, group A, isolated from patients with different clinical manifestations of streptococcal infection in Moscow].

The results of the intraspecific typing of group A streptococci (SGA), isolated from patients with different manifestations of group A streptococcal infection, carried out in Russia for the first time, are presented. The genotypic method of emm-typing, based on sequencing the DNA area coding the variable part of the molecule of SGA M-protein was used. The data obtained in this study made it possible to follow changes in the pattern of SGA M-types in Moscow and the specific features of SGA in comparison with the analogous data on other territories. New emm-types of SGA circulating on the territory of Russia were detected and described.

[The pharyngeal beta-hemolytic streptococcal carrier state among blood donors]. / Glotochnoe nositel'stvo beta-gemoliticheskikh streptokokkov sredi donorov krovi.

459 blood donors aged 18-50 years were examined in 1987-1988 in Moscow. Among them, carrier state with respect to beta-hemolytic streptococci was detected in 107 donors (23.3%). The number of carriers gradually decreased with the increase of age of the examined donors. Group C streptococci occurred least of all (6.9%). Group A beta-hemolytic streptococci were isolated in 16.7% of the carriers. The isolation rate of streptococci from blood achieved its maximum in autumn and winter months and did not depend on preceding diseases, unhealthy working conditions, the rhesus factor and, with the exception of group A streptococci, the blood group. Among tonsillectomized donors carrier state with respect to beta-hemolytic streptococci occurred 2.2 times less frequently than among donors who had not undergone tonsillectomy. Carrier state with respect to beta-hemolytic streptococci was accompanied by higher levels of salivary sIgA antibodies to polysaccharide A, serum antibodies to polysaccharide A and circulating polysaccharide A. All beta-hemolytic streptococci were sensitive to erythromycin. All groups of streptococci showed the highest percentage of cultures resistant to gentamicin and tetracycline. In 100% of cases group A streptococci were sensitive to benzylpenicillin, methicillin, ampicillin, erythromycin and lincomycin.

[The production of erythrogenic toxin and the epidemic process in respiratory streptococcal infection]. / Produktsiia éritrogennogo toksina i épidemicheskii protsess respiratornoi streptokokkovoi infektsii.

The capacity of Streptococcus pyogenes, isolated from clinically healthy children in a large organized group, for producing erythrogenic toxin A, B and C was studied. The dynamics of toxin production was compared with changes in the levels of morbidity and carrier state, as well as with some characteristics of the interaction between the populations of the infective agent and the host by such values as virulence and susceptibility. Similarity in the dynamics of the parameters under study was noted. The seasonal dynamics of characteristics which determined the capacity for toxin production significantly influenced the levels and one year morbidity dynamics with respiratory streptococcal infection. The study demonstrated the information value of the characteristics of toxin production for understanding both the interval mechanisms of the epidemic process and the influence of the external ones on subsequent epidemic situation.

[Streptococcal group A carriage: new data on the characteristics of the biology of the causative agent and of the immune response of the host]. / Nositel'stvo streptokokka gruppy A: novye dannye po kharakteristike biologii vozbuditelia i immunnogo otveta khoziaina.

Carriership of group A streptococcus (A-STR) was registered with significantly greater frequency among children of preschool and early school age (29.8%) than among adults (4.0%). Cultures of A-STR isolated from carriers were characterized by their low capacity for secreting erythrogenic toxin of type A (ET-A), lipoteichoic acid and by lower content of surface proteins than those isolated from tonsillitis and scarlet fever patients. Highly hydrophobic strains of A-STR prevailed in long-time carriers and patients. Elevated immunological characteristics for group-specific polysaccharide A and ET-A were more frequently detected in children than in adults, which correlated with frequency of A-STR carriership in these groups and the capacity of the infective agent to produce ET-A. Some specific features in the character of humoral immune response in carriers, manifested mainly by defects of local immunity (a low level of SIgA to polysaccharide A), were established.

[The epidemic process of an acute streptococcal respiratory infection in large organized collectives of children]. / Epidemicheskii protsess ostroi respiratornoi streptokokkovoi infektsii v krupnykh detskikh organizovannykh kollektivakh.

The study of the specific features of the development of the epidemic process of scarlet fever, tonsillitis, and acute respiratory diseases (ARD) in two large organized groups of children revealed the presence of some differences which depended on the character of prophylactic measures taken in these groups. Thus, in the absence of prophylaxis with bicillin a pronounced increase in the level of carriership, accompanied by an increase in the infective capacity of carriers, was noted. This resulted in a high level and unfavorable dynamics of morbidity in scarlet fever, tonsillitis, and ARD. On the contrary, the use of prophylaxis with bicillin ensured the stability of the level of carriership, while the infective capacity of carriers was not pronounced. At the same time a rise in ARD morbidity was insignificant, and morbidity in scarlet fever and tonsillitis was reduced to nil.

[The hydrophobicity of Streptococcus pyogenes as a possible marker of its virulence]. / Gidrofobnost' Streptococcus pyogenes kak vozmozhnyi marker ego virulentnosti.

The hydrophobicity of 366 S. pyogenes cultures isolated from the pharynx of tonsillitis and scarlet fever patients and healthy children, as well as museum strain of type M29, was studied. The study revealed that the hydrophobicity of cultures isolated from scarlet fever patients exceeded that of cultures isolated from healthy carriers and tonsillitis patients. Among S. pyogenes cultures isolated in cases of prolonged carriership a considerable proportion of highly hydrophobic cultures was detected, which was probably indicative of an important role played by the hydrophobicity of streptococci in retaining them on the barrier epithelium. This was confirmed by the presence of correlation between the hydrophobicity of culture of S. pyogenes, type M29, and its adhesion to the fibronectin receptor and HEp-2 cells. For S. pyogenes of type M6, epidemic in the group of children under observation during the period of 1987-1988, the values characterizing its hydrophobicity were registered which significantly exceeded average hydrophobicity values. At the period of a rise in morbidity S. pyogenes cultures were characterized by significantly higher hydrophobicity. The variability of the hydrophobicity index and its relationship with the dissociation of cultures were established. The hydrophobicity index may be used as one of the virulence markers of S. pyogenes strains.

[The manifestations of a scarlatina epidemic process in a large city and their interpretation]. / Proiavleniia épidemicheskogo protsessa skarlatiny v krupnom gorode i ikh interpretatsiia.

The average morbidity level in scarlet fever for the period of 1972-1990 in Moscow was 230.9 cases per 100,000 of the population and the annual economic damage was 2-2.5 million rubles. The highest morbidity rate values were registered among children attending children's institutions, and in this group among children aged 3-6 years. Cohort and disperse analysis revealed that age-dependent fluctuations of morbidity rate had a regular character and significantly differed. An increase in scarlet fever morbidity was registered simultaneously with elevated levels of morbidity in tonsillitis and acute respiratory diseases and occurred several weeks after a rise in tonsillitis morbidity. Contamination with group A streptococci was higher among "organized" children of preschool age than among other groups of the population. T serovars 4/28, 8/29/Imp.19, 3/13/B3254 and 1, constituting 44% of all isolated Streptococcus pyogenes strains, and OF type 2 (44%) and 22 (20%) occurred most frequently. Among the strains isolated from patients T-4 and OF-2 types prevailed.

[Frequency of genes speA, speB, and speC in Streptococcus pyogenes strains and the identification of the infective agent by polymerase chain reaction]. / Chastota vstrechaemosti genov speABC v shtammakh Streptococcus pyogenes i identifikatsia vosbuditelia s pomoshch'iu PTSR.

In cultures of S. pyogenes isolated from patients and carriers in different territories of the Russian Federation the genes of erythorogenic toxins A, B and C (speA, speB and specC) were detected. The possibility of the identification of S. pyogenes by means of PCR on the basis of primers to erythrogenic toxin B was determined. Gene speB was detected in all S. pyogenes cultures under study and proved to be species specific. Genes speA and speC were detected, respectively, in 29.4% and 9.35% of the S. pyogenes cultures under study. A test system for the identification of S. pyogenes on the basis of primers to gene speB was developed. The prospects for the detection of genes speA and speC for intraspecific typing of this infective agent were evaluated.

[Chronicity of the rheumatoid process]. / K voprosu o khronizatsii revmaticheskogo protsessa.

The authors considered the problem of chronicity of a rheumatic process as a result of streptococcus persistence in the patient's body. Using a bacteriological method and luminescence microscopy streptococcal bacteremia was found in patients with rheumatic fever in the active phase in 12.5 and 31.2%, respectively. Four examinations of patients with 2-3 day intervals resulted in a 3-fold increase in the detection of streptococcal bacteremia reaching 88.9% in blood testing by the immunofluorescence method and 44.1% by the bacteriological method. In patients with rheumatic fever in the inactive phase streptococci were found in the mediastinal lymph nodes, left auricula atrii tissues, and in the myocardium. In the imprints of biopsies prepared from appropriate tissues, streptococcal L-forms and cells were detected in the immunofluorescence reaction.

[Susceptibility of beta-hemolytic streptococci to antibiotics and alternative drugs]. / Chuvstvitel'nost' beta-gemoliticheskikh streptokokkov k antibiotikam i al'ternativnym preparatam.

Antibiotic susceptibility of the circulating beta-hemolytic streptococci of serogroups A, B, C and G isolated from healthy and sick children and adults within 1987-1996 (more than 900 cultures) was studied. It was shown that the MICs of betalactam antibiotics did not change (within the susceptibility levels) with respect to the serogroup A, C and G streptococci. The number of the strains resistant to erythromycin and lincomycin increased the same as the frequency of the strains simultaneously resistant to chloramphenicol, tetracycline and gentamicin. Tomicid and solkarmon, drugs alternative to antibiotics, were found to be active against the above streptococci groups and efficient in the treatment and prophylaxis of streptococcoses. A suggestion that betalactams are not safe in the treatment of the toxic shock syndrome due to the group A streptococci is discussed.

[Antibiotic sensitivity of streptococci of the A, B, C and G serogroups isolated in 1987-1990]. / Chuvstvitel'nost' k antibiotikam streptokokkov serologicheskikh grupp A, B, C, i G, vydelennykh v 1987-1990gg.

Antibiotic susceptibility of 1114 cultures of beta-hemolytic streptococci belonging to serogroups A, B, C and G was tested. The cultures were isolated from healthy and diseased children and adults. Group A, C and G streptococci were shown to be highly susceptible to beta-lactams, erythromycin, lincomycin, chloramphenicol and ristomycin. Erythromycin, lincomycin, ristomycin and ampicillin (a beta-lactam) proved to be the most active antibiotics against group B streptococci. Streptococci of the four groups had low susceptibility to tetracycline and especially gentamicin. The different antibiotic susceptibility of the streptococcal cultures isolated from the diseased and healthy children and adults is discussed.