Pathogenesis of diphtheria carrier state from the immunological point of view.

Results of a comparative investigation of diphtheria antitoxin and type-specific antibacterial antibodes in 264 carriers of diphtherial bacteria, 41 diphtheria patients and 263 non-infected subjects are presented. A high level of antitoxin did not prevent the development of toxigenic-strain carrier state. A basically similar immunological antibacterial response was observed in patients with manifest forms of diphtheria and in carriers of toxigenic strains; such a response could not as yet be detected in carriers of non-toxigenic strains. It has been suggested that the infectious process in the toxigenic-strain carrier state is due to factors of the virulence responsible for infectivity and invasiveness of the diphtherial microbe. The toxin plays no pathogenic role in carrier state.     

Immunoepidemiological characteristics of the duration of a meningococcal carrier state

The duration of meningococcal carriership in children and adults in the foci of infection and outside such foci and the immunological characteristics relating to group-specific meningococcal antigens A, C, X, Y and Z at different periods after the detection of the infective agent in the nasopharynx have been studied. Carrier state has been shown to last, on the average, 11 days. The duration of the release of meningococci from the nasopharynx has proved to be influenced by the epidemic situation in a given group. Differences in the time course of the immunological reorganization of the body in response to antigenic challenge in prolonged and short-term carrier state have been detected. These data suggest that rapid immune response to meningococcal antigens in the process of short-term carrier state is probably one of the factors preventing the prolonged colonization of the nasopharynx by the infective agent.     

Salmonella carrier state and biological characteristics of the infectious agent

Salmonella carrier state (42.6%-S. enteritidis and 34.4%-S. dublin) was demonstrated in subjects after acute salmonellosis as well as in healthy persons infected with salmonella as a result of occupational exposure to poultry (8.8% in humans exposed to chickens and 6.1% in those exposed to ducks) and sheep (2.8%). The carrier state was accompanied by intermittent pain in the epigastrium, diminished appetite, diarrhoea etc. Most of the carrier subjects with a history of salmonellosis exhibited, upon rectoromanoscopy, a varying degree of proctosigmoiditsi. The etiological role of S. typhimurium was proved beyond doubt, as well as its ability to cause salmonellosis outbursts, sporadic cases of the disease and the carrier state. When large industrial facilities specializing in poultry processing were investigated, the salmonella carrier state was revealed in practically healthy poultry--in 16% of chickens and 12% of ducks. The salmonella organisms isolated from carrier persons had, with some exceptions, typical properties, being virulent in that they caused death of experimental animals, seeded their internal organs and induced pathogenicity-associated enzymes. Multiple resistance to antibiotics was demonstrated in salmonella isolated from poultry; also determined was its plasmid nature. Pronounced resistance of the above salmonella subtypes to tetracycline-related antibiotics and streptomycin may be due to the fact that these drugs are used in poultry raising.     

Pathogenetic and immunological characteristics of different forms of the Salmonella typhi carrier state

Infectious granulomas with macrophages containing Salmonella typhi have been detected in the immune organs of the intestine of typhoid patients by means of morphological investigation techniques, immunofluorescent and electron microscopy. This suggests that typhoid granulomas form the basis of S. typhi primary carriership complicated by the relapses of this infection in cases of weakened cell-mediated immunity, which is proved by a decrease in the level of T-lymphocytes and by increased leukocyte migration index in relapses of typhoid fever and in S. typhi primary carriership. At the same time, the formation of S. typhi secondary carriership occurs in the process of the colonization of the altered organs and tissues of the body by S. typhi. This secondary carriership differs from the primary one by a number of pathogenetic signs. The detailed characterization of these two forms of S. typhi carriership is presented.