Vol 83, No 11 (2011)

Aim. To evaluate effects of HCV/HIV coinfection on blood lymphocyte phenotype including cells CD56+. Material and methods. We studied standard immunogram, subpopulational composition and functional activity of blood cells CD56+ in 67 patients with verified diagnosis of HIV infection and virus hepatitis C. Results. We discovered some pathogenetically sound indices of immune status in patients with HCV/ HIV coinfection. Some of the immune shifts detected changed in response to intake of narcotic drugs, antiretroviral treatment, hepatic cirrhosis, pneumonia. Conclusion. Parameters of subpopulational composition and functional activity of cells CD56+ in the blood of patients with HCV/HIV coinfection elucidate some unknown features of the above infectious process which should be considered in this coinfection treatment and prophylaxis.

Aim. To describe clinical and laboratory characteristics of pneumocystic pneumonia (PP) in patients with HIV-infection for improvement of diagnosis quality. Material and methods. Detailed examination was performed in 111 HIV-infected patients with suggested diagnosis of PP. The following investigations were made: clinical, x-ray examinations, total count and biochemical blood tests, enzyme immunoassay, indirect immunofluorescence reaction (IIFR) for Pneumocystis jiroveci antigens in bronchoalveolar lavage fluid (BALF)or induced sputum. For diagnosis of other secondary diseases PCR was used for investigation of BALF and bronchial biopsy to detect DNA of Mycobacterium tuberculosis complex, Candida albicans, Cytomegalovirus, Toxoplasma gondii, Mycoplasma spа., Herpes simplex I, II. DNA of cytomegalovirus in blood was detected with PCR. Microscopic tests of the sputum were conducted for detection of acid-resistant mycobacteria. Results. PP was associated with other secondary diseases in 59% patients (pulmonary tuberculosis - 16%, CMV pneumonia - 31%, combination of all the lesions - 5%).PP diagnosis was cancelled and pulmonary tuberculosis was diagnosed in 12 patients.In combination of PP with other pathology dominant were symptoms observed in PP monoinfection and only effective anti-pneumocystic treatment revealed signs of comorbid pathology. Tuberculosis patients had weaker signs of respiratory failure, symmetric bilateral interstitial or small-focal alterations were detected less frequently. Conclusion. Current PP course characteristics in HIV infection are identified. In clinical diagnosis of PP special attention should be paid to data complex especially to increasing respiratory failure, high ESR, elevated lactate dehydrogenase, low blood pO2, fast response to ex juvantibus therapy. The most effective method of the diagnosis verification - BALF IIFR.

Aim. To study characteristics of leukocytic infiltration of the liver in patients with chronic viral hepatitis B and C (CVHB and CVHC) with consideration of hepatitis activity and fibrosis severity. Material and methods. The examination of 37 patients with CVHB (n = 13) and CVHC (n = 24) included liver puncture biopsy by Mengini, subsequent histological and morphological investigation of liver biopsy with immunohisto- and immunocytochemistry. Results. In CVHB and CVHC patients leukocytic infiltrates (LI) of the liver present primarily with T-lymphocytes (CD3+), NKT cells (CD3+CD16+CD56+), NK cells (CD16+CD56+), T-regulatory lymphocytes (CD4+CD25+), cytotoxic T-lymphocytes (CD8+). Cytotoxic lymphocytes (CD8+) and NK cells (CD16+CD56+) detected in hepatic LI of patients with chronic viral hepatitis are similar in composition with cells in hepatic tissue infiltrates in autoimmune hepatitis. We are the first to detect the complex of T-regulatory cells (CD4+CD25+)in hepatic parenchyma of these patients. This complex suppresses cellular immune response in virus elimination and damaged tissues and supports development of persistent viral infection with autoimmune component. Conclusion. The complex of T-regulatory cells (CD4+CD25+) isolated in hepatic LI evidences for existence of a morphofunctional base for autoimmune manifestations in the presence of persistent viral infection.

Aim. To reveal clinical and morphological characteristics of renal damage in patients with cryoglobulinemia (CGE) associated with chronic viral hepatitis C (CVH-C) for upgrading diagnosis, prognosis and optimization of the treatment methods. Material and methods.Њ Two groups of CVH-C patients were studied: with CGE (group 1, n = 64) and free of CGE (group 2, n = 62) matched for gender, age and duration of the disease. Biopsy of the liver for assessment of the histological activity index and histological sclerosis index by METAVIR scale was conducted in 63 patients. Of patients with CGE-related damage to the kidneys, 48 were examined for clinical picture with morphological investigation of renal tissue in 15 of them including semiquantitative evaluation of fibrosis degree and activity. Results. Patients with CVH-C and CGE had a wider spectrum of systemic lesions than CVH-C patients without CGE. Only CGE patients demonstrated more severe affection of the skin, joints, kidneys and the nervous system. Therefore, CGE can be considered as a marker of poor prognosis. Liver biopsy showed that CGE patients had more pronounced fibrosis (3-6 points) versus 0-2 points in 80% patients from group 2. Duration of CVH-C from probable infection to renal damage in 48 patients with CGE glomerulonephritis (GN) averaged 197.05±18.5 months. Renal biopsy diagnosed CGE mesangiocapillary GN in 13 patients and membranoproliferative GN in 2 patients. Patients with HCV infection had a more severe proliferative form of nephritis - mesangiocapillary GN. In 48 GN patients with HCV-infection and CGE, GN ran latently with moderate urinary syndrome in 29 (60.4%) patients, with nephrotic syndrome - in 9 (18.6%), with acute nephritic syndrome - in 10 (21.0%) patients. Most of the patients had arterial hypertension, 13 patients had creatinemia (3.02±0.55 mg/dl), rapidly progressive GN was diagnosed in 4 patients. Conclusion. Persistent CGE marks poor prognosis in CHC patients and is an indication for antiviral treatment to prevent severe organ lesions, first of all of the kidneys. Development of CGE vasculitis with severe damage to the kidneys demands immunosuppressive therapy in combination with plasmapheresis or cryapheresis followed by antiviral drugs. As shown by pilot results, a new approach with rituximab is perspective but further evidence is needed for final conclusions.

Leptospirosis (Weil-Vasiliev disease) is a zoonotic natural focal disease running as an acute fever with severe intoxication, lesion of the kidneys, liver, CNS, hemorrhagic syndrome, complications, frequent lethal outcomes. Clinical features of leptospirosis in patients with comorbid diseases are not studied adequately. Lethal outcomes are often caused by such serious complications as infectious-toxic shock, acute renal-hepatic failure, massive hemorrhagic syndrome, infectious myocarditis, etc. Two cases of leptospirosis with irreversible complications are reported: one case with severe lesion of the kidneys and heart, and the other case with lethal damage to the kidneys. The evidence for a severe course of leptospirosis complicated with renal insufficiency is provided. Lethal outcomes in leptospirosis are often associated with late diagnosis because of the disease manifestation similarity with such diseases as hemorrhagic fever and renal syndrome. It is shown that leptospirosis runs a very severe cause in exacerbation of preexisting infection or somatic disease. The necessity of consideration of the background pathology demands an early and individual correction of diagnostic algorithms, conduction of etiotropic and pathogenetic therapy, rehabilitation measures. Comorbid diseases in leptospirosis patients have an essential negative effect on leptospirosis clinical picture, on a course of infectious process (aggravation of endogenic intoxication, polyorganic disorders, nonspecific complications).

Epidemiologists register a trend in the latest decades for expansion of the areas of natural-focal transmissive fevers morbidity in the Astrakhan region. This is explained by reconfiguration of natural landscapes as a result of increasing anthropogenic impact. The Astrakhan territory exclusively contains 4 types of landscape with evolutionally formed several natural foci of transmissive fevers: Crimean hemorrhagic fever, West Nile fever, Astrakhan rickettsial fever, Q-fever. Early diagnosis of these diseases determines further treatment, prophylactic policy in the infection focus.

Food allergy (FA) - a condition of high sensitivity to food products - is widely spread allergic disease treated by allergologists, gastroenterologists, dermatologists, physicians, pulmonologists. FA pathogenesis involves immunological mechanisms with participation of immunocompetent cells and production of IgE and IgG. Treatment aims at elimination of causative antigen. Proteins of cow milk, hen's eggs, cereals, fish, citrus fruit, nuts, tomatos are most common such antigens. It is especially important for infants. FA manifests with anaphylactic shock, oral allergic syndrome, respiratory symptoms, abdominal impairments. The digestive system is both a target and a course of FA formation. FA arises mostly because of defects of gastrointestinal immune system, inability to synthetize IgA in adequate quantity while IgA has protective properties. Therefore, FA treatment should include probiotics, cytoprotectors, enzymes, sorbents. Atopic dermatitis, one of FA manifestations, is treated with non-hormonal drugs containing lipids, urea, topic inhibitors of calcinevrin. On demand, topic glucocorticosteroids, sometimes in combination with antimicrobial and antifungal drugs are added. Multidisciplinary approach to FA problem gives positive results.

Aim. To assess efficacy of rituximab in patients suffering from Wegener's granulematosis (WG) with renal disease. Material and methods. We analysed clinical laboratory data from 9 WG patients with renal disease treated with rituximab in E.M. Tareev clinic. Results. The treatment led to a complete remission in 7 (77.8%) patients, a partial remission - in 2 (22.2%) patients. Vasculitis activity regressed including renal damage (a decrease of 24 h proteinurea, enhanced glomerular filtration rate). A prednisolone dose decreased from 38.3 to 10 mg/day (to month 6) and to 7.5 mg/day (to month 12). Non-selective cytostatic drugs were discontinued in all the patients. Recurrences occurred in 3 (33.3%) patients, one with lethal outcome after 6 months of rituximab administration, in two cases one more course of rituximab produced another complete remission. Serious side effects were absent. Conclusion. Rituximab demonstrated high efficacy in the treatment of WG with renal affection resistant to standard therapy, in multiple side effects of standard immunosuppressive therapy and recurrent course. Rituximab help overcome steroid dependence even at late stages of the disease.