Impaired immune response associated with ABO antigen system in patients with purulent abscesses and dysentery

On the basis of a considerable number of facts--the results of the immunological survey of 197 patients with purulent infections of soft tissues and 103 shigellosis patients--the character and manifestation of immunological disturbances were found to depend on the genetic markers of blood (antigens of the AB0 system) which proved to differ in different type of pathology in patients.     

Anaerobic infections of the soft tissue and bones

Severe soft tissue infections, usually necrotizing, are associated with a mortality of 40-60% and with amputations where the bones and joints are involved. The anaerobic bacteria associated with these infections are usually present in patients with underlying predisposing conditions (diabetes, vascular problems, immunosuppression). They are in the majority polymicrobial, endogenous or exogenous. There are many clinical and laboratory characteristics to establish the diagnosis of the different forms of these infections. Treatment of necrotizing soft tissue and bone infections requires early and aggressive surgical debridment. Timing of diagnosis and surgery influence essentially the outcome. Colostomy can be helpful in cases of perineal involvement. Antibiotic covering (broad spectrum) is mandatory as well as the systemic support of the patient.     

Circulation changes depending on manifestations in soft tissue tensioning in the leg lengthening process

Surgical intervention was found to intensify circulation in the limb and redistribute the blood flow. Leg lengthening led to arterial inflow limitation due to the magisterial artery strain. The changes were accompanied both by increase of functioning capillaries in number and increase of venous outflow dependence on blood inflow. The decreased after surgery oxygen tension in m. gastrocnemius did not change throughout distraction. The increase of functioning capillaries in number in resting contributed to maintenance of tissue oxygenation in the initial period of distraction, and in case of maximal tissue tensioning hydrostatic pressure increased in the capillaries due to arterial pressure rise. Restoration of the circulation parameters in the fixation period started with an increase of circulation volumetric rate in vessels with preservation of the rest mechanisms of the tissue oxygenation maintenance.     

Anti-anaerobic activity of serum from patients treated with tigecycline for skin/soft tissue infections

To gain additional data concerning the anti-anaerobic activity of tigecycline in serum, we analyzed blood samples from six patients with a complicated skin/soft tissue infection who were receiving IV tigecycline 50 mg every 12 h. Venous blood samples were obtained after multiple doses of tigecycline at 1, 6 and 12 h after the initiation of a 1 h IV infusion. Sera from these samples were tested to determine serum inhibitory and bactericidal activity over time against 4 anaerobic bacteria (Bacteroides fragilis, Peptoniphilus asaccharolyticus, Prevotella bivia and Finegoldia magna). An analysis of serum titers found that tigecycline exhibited early (1 h) and prolonged (12 h) inhibitory activity against each study isolate. Moreover, it provided bactericidal activity for 12 h against these strains with the exception of F. magna. Tigecycline was found to exhibit antibacterial activity at serum concentrations below the MICs of the anaerobic bacteria tested. This finding further supports that the antimicrobial activity of tigecycline can be greater than that suggested by the free fraction of drug and that serum appears to enhance this antibacterial activity.     

Use of pefloxacin in the treatment of patients with purulent wounds of soft tissues]

Pefloxacin was used in the treatment of 25 patients with wound infection in a dose of 400 mg orally twice a day for 10-12 days. As the monotherapy it was applied to 15 patients. 7 patients with clinical signs of non-clostridial anaerobic infection were treated with pefloxacin in combination with intravenous metronidazole. Pefloxacin was highly efficient in 96 per cent of the cases with extensive posttraumatic purulent wounds with and without bone affection, acute purulent wounds of the soft tissue, purulent wounds of the soft tissues in diabetic patients, trophic or decubitus ulcer. 266 clinical isolates of Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Proteus mirabilis, Enterobacter spp. and Acinetobacter spp, were tested and 75 to 100 per cent of them was shown to be susceptible to pefloxacin and ciprofloxacin. At the same time the isolates of Pseudomonas aeruginosa and Klebsiella spp. were more susceptible to ciprofloxacin. The pathogen eradication and eradication with superinfection in the cases treated with pefloxacin amounted to 92 per cent. The drug tolerance was good. No clinically significant adverse events were recorded.     

Three mouse monoclonal antibodies to human differentiation antigens: reactivity with two mucin-like antigens and with connective tissue fibers

Three human differentiation antigens (MU78, MT334, and MQ49) have been defined by mouse monoclonal antibodies developed from mice immunized with ovarian carcinoma cell lines. Their distribution was determined on 148 cultured cell lines of various histologic types and on frozen sections of 16 normal tissues. MU78 was found in fibrillar structures in soft connective tissue with a distribution resembling that of elastin fibers; however, elastin fibers in elastic cartilage and in the aorta were nonreactive. MU78 was detected in cultured carcinoma cells of various histologic types, where it had a nonfibrillar, cytoplasmic distribution, but was not detected in normal epithelial cells in frozen sections. Cultured fibroblasts, astrocytomas, melanomas, and lymphomas did not contain MU78. In cell lines, MU78 appears to be a protein of 2000-5000 daltons. The other two antigens, MT334 and MQ49, are both mucin-like molecules, and the determinants are probably carbohydrate in nature. Of the normal tissues examined, MT334 was detected only in goblet cells of the colon, though it was present in a variety of carcinomas in culture. It was detected as both a cytoplasmic and secreted component. MQ49 was detected in various secretory epithelial cells, in Hassall's corpuscles in the thymus, and in cultured carcinomas of various histologic types. It was found on the cell surface as well as in the cytoplasm and is present on a glycolipid as well as on a sulfated mucin. These results, and results of other recent studies, demonstrate the importance of mucin-like molecules as antigens in epithelial cells and secretions.     

Brain-derived antigens in lymphoid tissue of patients with acute stroke

In experimental animals, the presence of brain-derived constituents in cervical lymph nodes has been associated with the activation of local lymphocytes poised to minimize the inflammatory response after acute brain injury. In this study, we assessed whether this immune crosstalk also existed in stroke patients. We studied the clinical course, neuroimaging, and immunoreactivity to neuronal derived Ags (microtubule-associated protein-2 and N-methyl d-aspartate receptor subunit NR-2A), and myelin-derived Ags (myelin basic protein and myelin oligodendrocyte glycoprotein) in palatine tonsils and cervical lymph nodes of 28 acute stroke patients and 17 individuals free of neurologic disease. Stroke patients showed greater immunoreactivity to all brain Ags assessed compared with controls, predominantly in T cell zones. Most brain immunoreactive cells were CD68(+) macrophages expressing MHC class II receptors. Increased reactivity to neuronal-derived Ags was correlated with smaller infarctions and better long-term outcome, whereas greater reactivity to myelin basic protein was correlated with stroke severity on admission, larger infarctions, and worse outcome at follow-up. Patients also had more CD69(+) T cells than controls, indicative of T cell activation. Overall, the study showed in patients with acute stroke the presence of myelin and neuronal Ags associated with lymph node macrophages located near activated T cells. Whether the outcome of acute stroke is influenced by Ag-specific activation of immune responses mediated by CD69 lymphocytes deserves further investigation.     

Clinical and laboratory effect of leukinferon in purulent infections

Clinical trials of human leukocytic alpha-interferon for injections, leukinferon were performed in 51 patients with different forms of surgical purulent infections. It was shown that leukinferon lowered the terms of normalization of body's temperature, leukocytosis, respiratory neutrophilic outbreak and levels of active T-lymphocytes. The same was observed when leukinferon was used prophylactically in cardiosurgical patients. The effect of leukinferon depended on the level of radical operations on primary purulent foci and severity of the patient's state. Leukinferon had immunomodulatory properties and mainly influenced the system of neutrophilic phagocytes. The action was lymphocyte-mediated. The rapid effect of leukinferon makes it necessary to recommend it for treatment of patients with purulent infections as an agent of urgent immunomodulation.     

Effect of antibiotics on indices of immunologic reactivity in mice

The effect of ristomycin, chloramphenicol, kanamycin, benzylpenicillin, streptomycin, and cephaloridine on the indices of cellular and humoral immunity was studied comparatively on intact animals and on animals with secondary immune deficiency. The study of the antibiotic effect on the count of rosette-forming lymphocytes (RFL) and the total count of lymphocytes showed that all the antibiotics except streptomycin induced a significant decrease in the count of RFL. The most active was kanamycin. It lowered the count of RFL 5-fold as compared to the control. The total count of lymphocytes was lowered after administration of ristomycin, chloramphenicol and kanamycin. In the animals with immune deficiency induced by cyclophosphamide benzylpenicillin potentiated the inhibitory effect of cyclophosphamide on the weight of the lymphoid organs, while streptomycin lowered the effect of cyclophosphamide. No such effect was observed with the use of the other antibiotics. The data indicated the necessity of taking into account the effect of various antibiotics on the immune system, especially under conditions of immune deficiency.     

Immunologic reactivity to incompatible blood group substances of the ABO system in scleroderma.

The immunization with incompatible blood groups substances of the ABO system yielded distinct increases in the isohemagglutinin titers and their scores in 16 patients suffering from systemic sclerosis (scleroderma) and in 16 controls. The difference between these two groups was not statistically significant, which suggests an intact humoral immunological reactivity of these antigens. However, investigations with further antigens would be necessary to judge the immunological factors supposed to be involved in the pathogenesis of systemic sclerosis. The method may be recommended for testing the humoral immunological response in similar problems.     

Plasma-circulating levels of natriuretic peptides in patients with bone and soft tissue injuries

To evaluate the release and possible role of N-terminal end of atrial natriuretic factor (ANF) prohormone (proANF-1-30) and C-terminal end of ANF prohormone (aANP-1-28) in patients with soft tissue and bone injuries, 20 patients with soft tissue injuries, 18 bone-fractured patients, and 21 healthy controls were examined. Samples were collected from patients within 24 h after injury. Plasma level of proANF-1-30 and aANP-1-28 were higher in orthopedic patients than the soft tissue injury patients compared to controls (P < 0.005, P<0.05, respectively). proANF-1-30 was over 15-fold greater than aANP-1-28 in the healthy control samples. These data hypothesized that the concentration of proANF-1-30 may be related to tissue damages in man.