Importance of associated microorganisms in the development of acute pneumonia

Sputum samples obtained from 106 patients with acute pneumonia have been studied by the quantitative microbiological method. Different microbial associations have been shown to play an important role in the development of acute pneumonia (67.9%). Microbiological studies have revealed the prevalence of pneumococci in the etiological structure of the disease. Staphylococci, hemophilic bacteria and Neisseria have been found to take part in the development of acute pneumonia in a lesser number of cases and more often occur in combination with pneumococci or form different associations themselves. The so-called "etiological" type of microbial associations has been determined, two or three microbial species being isolated at high concentrations (10(6) and over) and the percentage of patients with such combinations being 59.7 +/- 5.8%. The analysis of the clinical course of the disease has revealed that the presence of different microbial species in patients linked, to a great extent, with the clinical picture of the disease. These data may be used for prescribing adequate etiotropic therapy and for prognostication. Quantitative bacteriological studies carried out in the dynamics of the disease permit timely detection of changes in the microflora of the respiratory tracts, the evaluation of the effectiveness of antibacterial therapy in the process of its implementation and the rational correction of therapeutic measures.     

Etiology of acute pneumonias in an organized collective

In this work the immune structure of an organized group with respect to acute respiratory infections and the etiological structure of cases of acute pneumonia was studied. The sera taken from 602 persons were tested for the presence of antibodies to 14 infective agents of the viral, bacterial and mycoplasmal nature. The data indicate that all these agents circulate in the group under study with the prevalence of influenza A (H3N2), influenza B and group III parainfluenza viruses. Among etiological agents of acute pneumonia, the combination of Staphylococcus with Mycoplasma pneumoniae and adenovirus was noted. The Legionella etiology of some group cases of acute pneumonia among young persons was established on the basis of the increased titers of L. pneumophila antibodies in the indirect hemagglutination, indirect immunofluorescence and enzyme immunoassay. The source of this infection was highly dispersed water aerosol, containing the infective agent, in shower baths. This was bacteriologically confirmed by the isolation of three Legionella strains. The study showed that no transfer of Legionella infection in the group through contacts was possible.     

Diagnostic value of different laboratory methods in the diagnosis of pneumonia caused by Haemophilus influenzae type B

Comparative analysis of the diagnostic value of different laboratory methods in the diagnosis of H. influenzae b (Hib) pneumonia in children (bacteriological method, latex agglutination, counter immunoelectrophoresis, the passive hemagglutination test and the enzyme immunoassay (EIA) was carried out. EIA proved to be the most informative method for the diagnosing Hib pneumonia. EIA makes it possible to detect specific Hib antigens in different clinical materials in 48.8% of cases, as well as high titers of antibodies to mis infective agent in 61.7% of cases. The authors propose the unified criteria of the laboratory diagnosis of Hib infection in children.     

Etiological structure of pneumonias in children and adults

The bacteriological study of sputa, nasopharyngeal smears and bronchial washings taken from pneumonia patients has shown that the leading etiological agent was Streptococcus pneumoniae isolated in the diagnostic titre (10(7) bacteria per ml) in 78.1% of the cases. Staphylococcus aureus, Haemophilus influenzae, enterobacteria and yeast-like fungi have been found to play an insignificant role in the etiology of acute pneumonia (2.5 +/- +/- 0.9%). The results of the serological diagnosis by means of the complement fixation test have revealed that, alongside S. pneumoniae, the following infective agents are of etiological importance in cases of acute pneumonia: respiratory viruses (more than 50%), Mycoplasma pneumonia (10%), Chlamydia psittaci (6.4%) and Legionella pneumophila (3.8%). The study has first revealed that, under the conditions of Alma-Ata, serotypes 19, 23, 8 and 4 prevail among circulating pneumococci. This study has also shown that the use of M. pneumoniae antibody erythrocyte diagnosticum enhances the detection rate of mycoplasma infections in pneumonia patients.     

Etiology of acute pneumonia occurring against a background of influenza and other acute respiratory viral infections

The etiology of acute pneumonia (AP) was studied in 229 patients who had the disease simultaneously with influenza (106 patients), other viral and mycoplasmal infections (48 patients), and without concomitant acute viral infections (75 patients). The use of the quantitative microbiological method and the indirect immunofluorescence test with autostrains or Streptococcus pneumoniae strains of serotypes 2, 3, and 6, prevailing in Leningrad in patients with acute inflammatory diseases of the lungs, made it possible to find out the pneumococcal etiology of AP in 95% of patients irrespective of the presence of acute respiratory viral infections. The etiological role of opportunistic bacteria was revealed in 13 AP patients (5.7%); in 2 of them the causative agent of AP was Staphylococcus aureus and in 11, various species of Gram-negative enterobacteria. The latter were the cause of complications in 8 cases of pneumococcal pneumonia.     

Isolation and identification of the infective agent of severe acute respiratory syndrome (SARS) from a patient with atypical pneumonia

The virological, morphological, molecular biological and immunochemical study of the infective agent isolated from the patient with the symptoms of atypical pneumonia, hospitalized in the infectious department of the clinical hospital in Blagoveshchensk, was carried out. Thus the fact of the appearance of SARS virus on the territory of Russia was proved. The isolated infective agent, identified as coronavirus strain CoD, was partly characterized and deposited to the virus collection of the Center of Special Laboratory Diagnostics and Treatment of Quarantine and Exotic Infectious Diseases.     

Immunological factors in the evolution of the epidemic process in meningococcal infection

The results obtained in 1987 in the study of the immunostructure of the population of Yaroslavl with respect to meningococcal polysaccharides, groups, A, B, C, and lipopolysaccharide are presented in comparison with earlier results obtained in 1976. The regulating role of the immunological factor in the evolution of the epidemic process of meningococcal infection has been confirmed. The level of antibodies to meningococcal polysaccharides, groups A and B, has been found to reflect the intensity of the circulation of the infective agent among the population. The comparison of the results of investigations carried out in 1976 and 1987 has revealed the essential role of the lipopolysaccharide antigen in the formation of the postinfection immunity of the population to meningococcal infection, irrespective of the group of the infective agent.     

Prediction of the pathogens that are the cause of pneumonia by the battlefield hypothesis

Commensal organisms are frequent causes of pneumonia. However, the detection of these organisms in the airway does not mean that they are the causative pathogens; they may exist merely as colonizers. In up to 50% cases of pneumonia, the causative pathogens remain unidentified, thereby hampering targeting therapies. In speculating on the role of a commensal organism in pneumonia, we devised the battlefield hypothesis. In the "pneumonia battlefield," the organism-to-human cell number ratio may be an index for the pathogenic role of the organism. Using real-time PCR reactions for sputum samples, we tested whether the hypothesis predicts the results of bacteriological clinical tests for 4 representative commensal organisms: Streptococcus pneumoniae, Haemophilus influenzae, Pseudomonas spp., and Moraxella catarrhalis. The cutoff value for the organism-to-human cell number ratio, above which the pathogenic role of the organism was suspected, was set up for each organism using 224 sputum samples. The validity of the cutoff value was then tested in a prospective study that included 153 samples; the samples were classified into 3 groups, and each group contained 93%, 7%, and 0% of the samples from pneumonia, in which the pathogenic role of Streptococcus pneumoniae was suggested by the clinical tests. The results for Haemophilus influenzae, Pseudomonas spp., and Moraxella catarrhalis were 100%, 0%, and 0%, respectively. The battlefield hypothesis enabled legitimate interpretation of the PCR results and predicted pneumonia in which the pathogenic role of the organism was suggested by the clinical test. The PCR reactions based on the battlefield hypothesis may help to promote targeted therapies for pneumonia. The prospective observatory study described in the current report had been registered to the University Hospital Medical Information Network (UMIN) registry before its initiation, where the UMIN is a registry approved by the International Committee of Medical Journal Editors (ICMJE). The UMIN registry number was UMIN000001118: A prospective study for the investigation of the validity of cutoff values established for the HIRA-TAN system (April 9, 2008).     

Experience of microbiologic diagnostics of acute pneumonia cases arose in town Verkhnyaya Pyshma in July-August 2007

Bacteriologic, serologic, and PCR tests of blood, sputum, serum and autopsy samples from 91 patients were performed during outbreak of pneumonia in town Verkhnyaya Pyshma in July-August 2007. Streptococcus pneumoniae was isolated from 20% of diagnostically meaningful samples of sputum and from 50% of autopsy samples. Diagnosis of Legionnaires' disease was confirmed in 48% of cases. It was shown that association of Streptococcus pneumoniae and Legionella pneumophila determined the affect during such pneumonia. Need for establishment of diagnostic procedure for patients with pneumonia including those caused by atypical agents was revealed.     

慢性阻塞性肺疾病急性加重期病原学及细菌药性分析

目的:探讨慢性阻塞性肺疾病急性加重期病原学特点及细菌耐药情况,为临床合理使用抗生素提供科学依据。方法:回顾性分析我院呼吸内科和老年学科2008年1月-2009年1月563例慢性阻塞性肺疾病(急性加重期)住院患者痰培养及药敏试验结果。结果:563例患者中检出阳性结果205例,检出率为36.41%。其中G+菌46例、G-菌119例、真菌40例。G+菌以金黄色葡萄球菌最多(14例),其次为表皮葡萄球菌和草绿色链球菌;G-菌以铜绿假单胞菌最多(37例),其次为克雷伯菌;真菌以白色念珠菌最多(20例)。G-杆菌对氨苄西林、哌拉西林、头孢唑啉、复方新诺明耐药严重,对亚胺培南、含β-内酰胺酶抑制剂的联合制剂较敏感。金黄色葡萄球菌对多种抗生素严重耐药,对万古霉素、亚胺培南较敏感。真菌对氟康唑敏感占50.81%,对伊曲康唑敏感占30.12%,对酮康唑敏感占30.83%,对5-氟胞嘧啶敏感占10.74%。结论:慢性阻塞性肺疾病急性加重期以G-为主,真菌感染有增多趋势,病原菌呈现多重耐药现象。     

Etiology of pneumonia in children in the absence of pneumococcal and antihaemophilus vaccines

Childhood pneumonia represents an important pathology, a cause of morbidity and mortality worldwide. Our study aims to determine etiology of pneumonia in hospitalized children using several laboratory methods. We performed a prospective study that enrolled 560 children age 1 up to 18 years old all diagnosed with pneumonia by clinical and radiological features. We applied various laboratory methods (serologic, bacteriologic: bronchial aspirate, sputum, pleural effusion and blood culture) in order to identify a pathogen agent that caused pneumonia. Statistics used Statistical Package for Social Science. An etiology was established in 68.92% of all cases included in the study, as follows: in 33.93% viral etiology, in 25.13% we identified Streptococcus pneumoniae, in 20.2% Mycoplasma pneumoniae, Klebsiella pneumoniae in 8.29%, Staphylococcus aureus in 7.51%, Haemophilus influenzae in 4.92%. Mixed bacterial and viral infection was identified in 4.40% of all cases. A potential causative agent of childhood pneumonia was determined in most cases, S. pneumoniae being the main agent involved in community acquired childhood pneumonia in our country.     

Detection of Antibody-Coated Bacteria in Expectorated Sputum for Diagnosis of Lower Respiratory Infections

We evaluated antibody-coated bacteria (ACB) in expectorated sputum to discriminate contaminating or colonizing organisms from true pathogens. We examined 60 expectorated sputum samples from 51 patients with lower respiratory infections (chronic obstructive pulmonary disease 25, pneumonia 20, purulent tracheobronchitis 6). All samples were examined with quantitative culture and immunofluorescent demonstration of ACB. From the results of quantitative culture, we divided specimens into pathogen-isolated and pathogen-free samples. Among pathogen-isolated samples, in which we isolated accepted pathogenic organisms at ≥ 10⁷ colony-forming units per ml, 16 of 23 samples were ACB-positive (69.5%). In contrast, among pathogen-free samples, in which we isolated accepted pathogens at < 10⁷ colony forming units per ml or only upper respiratory flora, only 3 of 37 samples were ACB-positive (8.1%). The ACB-positive rate was significantly higher in pathogen-isolated than in pathogen-free samples (P < 0.001). Consequently, detecting ACB in expectorated sputum shows good potential as another criterion for distinguishing contaminating or colonizing organisms from true pathogens.     

Microflora of the upper respiratory tract in young children under normal conditions and in respiratory tract diseases. Microbial count of the upper respiratory tract in healthy children and in children with pneumonia

The results of the inoculation of material taken from the anterior section of the nasal cavity and from the pharyngeal mucosa of 50 healthy young children and 298 acute pneumonia patients were analyzed. 23 microbial species were isolated. In the samples taken from the anterior section of the nasal cavity, monocultures were detected in 86 samples and 54 variants of associations including 2-4 species, in 139 samples. In the samples taken from the pharynx, monocultures were detected in 59 samples and 180 variants of associations including 2-6 species, in 282 samples. Differences in the contamination of the nasal cavity and the pharynx in healthy children and in pneumonia patients were revealed. These differences were manifested in the structure of the microflora (monocultures, associations, their composition), the assortment of microbial species and their concentration. In young children with pneumonia the microflora of the upper respiratory tract was found to reflect the severity of acute pneumonia and the intensity of the pathological process in the lungs (uncomplicated, pyodestructive pneumonia, pyodestructive pneumonia with fatal termination, acute purulent pleurisy).     

Surveillance of Elderly Hospital Patients for Pulmonary Tuberculosis

A restrospective study of pulmonary tuberculosis in a general hospital showed that the diagnosis had been frequently overlooked in the middleaged or elderly because the patient also suffered from a more acute condition which preoccupied the attention of the doctor. The commonest error was to discount chest x-ray abnormalities by omitting sputum culture or serial radiography.Surveillance was carried out on all patients aged 60 or over admitted to a large general hospital whose routine chest radiograph showed signs of possible pulmonary tuberculosis whether apparently active or inactive. Three sputum samples from each patient were examined for Mycobacterium tuberculosis without reference to the clinical presentation. In a nine-month period six out of 81 patients proved to have active pulmonary tuberculosis (7·4%). It is suggested that this may be a useful method of screening the elderly hospital population for pulmonary tuberculosis.     

Direct versus indirect radiation action in irradiated vegetal embryos

Maize is one of model plants useful for genetic investigations and also very important for its agrotechnical utilizations. Here the genotoxic effects of low dose X-rays and accelerated electrons in maize caryopses was carried out with focus on the influence of water content at the moment of seed irradiation. X-ray photon beam as well as accelerated electrons were provided with 2.40 Gy min^?1 dose rate. Pre-soaked and dry maize caryopses were irradiated with 0.5–3.0–6.0 Gy. Cytogenetic investigations were carried out based on microscope observations of chromosomes stained by Feulgen method. The mitotic index was found diminished in hydrated samples indicating the negative influence of indirect effects of water radicals. As known the water radiolysis release free radicals that attack biomolecules in addition to the directly absorbed radiation impact. Slight positive influence of 0.5 Gy radiation dose on cell division was evidenced. Chromosomal aberrations were identified like: vagrand chromosomes, C-metaphases, picnotic chromosomes, chromatide bridges. General tendency of aberrant mitoses enhancing was recorded in watered samples — with up to the twice increase for 6.0 Gy radiation dose. The results evidenced the hydration role in monitoring cytogenetic effects of low dose radiations in plant systems -with possible biotechnological applications.     

Application of different methods in the diagnosis of respiratory mycoplasmosis

A complex of methods for the detection of Mycoplasma pneumoniae and Mycoplasma hominis in children and adults with respiratory diseases (acute, chronic and obstructive bronchitis, pneumonia, recurring croup, bronchial asthma), as well as in children frequently having acute respiratory diseases, has been worked out and tested. Both infective agents are frequently detected in the above mentioned pathological processes as monoinfection or mixed infection. Mycoplasma antigens are capable of prolonged (up to 1 year) persistence in the patient body in spite of etiotropic therapy and the presence of specific antibodies. The method of the preliminary treatment of specimens for the polymerase chain reaction is proposed: the specimens are subjected to prolonged deproteinization, which makes it possible to detect M. pneumoniae in some cases of chronic infection when it cannot be detected by routine methods.     

Streptococcus pneumoniae serotypes in children with acute pneumonia and pleurisy

The study of pneumococci of different serotypes, isolated from patients with acute pneumonia and pleuritis and from healthy children was carried out. Among the pneumococcal serotypes causing pneumonia and pleuritis in children serotypes 1, 6, 19, 14 and 3 were most widely spread and constituted 62.3% of all isolated pneumococci. In young children cases of acute pneumonia and pleuritis were more often induced by serotypes 6 and 14 and in older children, by serotypes 1 and 3. In patients with uncomplicated pneumonia and pleuritis differences in the detected serotypes of pneumococci were observed, and the disease course differed in severity. Serotypes 14, 3 and 3 induced destructive processes in the lungs more often than other serotypes. Monitoring of the sensitivity of pneumococci to antibiotics showed that most of the strains retained high sensitivity to penicillin and ampicillin. In most cases the detected resistant pneumococcal strains belonged to serogroup 19.     

Serological study on Chlamydophila pneumoniae in patients with community-acquired pneumonia

This study aimed to evaluate the incidence of Chlamydophila pneumoniae antibodies in patients with community acquired pneumonia (CAP) by a new ELISA test (EIA CP-IgG, IgA, IgM--Eurospital, Trieste, Italy). From January 1999 to July 2001 141 patients with clinical signs of CAP were enrolled in sixteen Italian Hospitals. Specific IgM and IgG antibodies anti-C. pneumoniae in serum and IgA in both serum and sputum were detected. At a primary inspection (time T-0) serum and sputum samples were taken from 115/141 patients, whereas serum was collected from only 100/141 patients after 30 days (time T-30). At T-0 24/115 (20.8%) patients showed serological markers thus suggesting an acute C. pneumoniae infection. In 23/24 patients the overall serological pattern found at T-0 was confirmed at T-30. In 32/115 patients (27.8%) serological markers of C. pneumoniae past infection were found positive and were confirmed 30 days later. These data support the role of C. pneumoniae as an important aetiological agent of CAP throughout different geographic areas of Italy. The test was suitable for the laboratory diagnosis of C. pneumoniae infection. In particular, the presence of specific IgA anti- C. pneumoniae in both serum and sputum proved useful to define different stages and evolution of infection.     

Clinical and X-ray features of pneumonia in drug addicts

The authors observed 68 drug addict in-patients, who received treatment for the pneumonia at the Primorski Regional Clinical Hospital and Vladivostok Municipal Clinical Hospital No. 1. The article details the specific features of the pneumonia of these in-patients. It was distinguished the 3 groups of hospital patients with the following characteristic features: patients with the respiratory distress syndrome of the adults; patients with the primary infective endocarditis mainly with the damage of respiratory (right) heart; patients with non-specific pneumonia. The peculiarities of the clinical process with the X-Ray pictures of the disease were also presented. The article identifies the acute beginning of the disease; the strongly pronounced intoxication syndrome; the usual cases of the late going to hospital of those patients; the extensiveness of the damage; the occurrence of the following complications at the early stage: pulmonary destruction, exudative pleurisy, empyema; the long period of the disease process; the development of the extensive pulmonary fibrosis. It was identified the 33.7% lethality for these groups of in-patients, while the average lethality of the in patients treated for pneumonia was 3.3% for the same period of time. The complicated pneumonia process of young patients with the infective endocarditis with damages of respiratory (right) hearts let us suppose their drug addiction.     

Experimental tick-borne rickettsiosis in murine rodents

The comparative study of the duration and level of rickettsiemia in wild rodents, natural carriers of rickettsiosis, after their experimental infection with Rickettsia sibirica has been carried out. All those species under study (common voles, meadow mice and great gerbils) have been found to be faintly susceptible to this infective agent. Large infective doses produce no visible signs of the disease in these animals, rickettsiemia for a short time and its level is not high. Great gerbils have been found to be most susceptible, and meadow mice least susceptible to R. sibirica. Different species also show differences in the immune transformation of the body.