Nature of the epidemic process in Sonne and Flexner dysenteries and the causes of its induction

A comparative study of the epidemic process in Sh. sonnei and Sh. flexneri dysentery in different regions of the USSR revealed that the morbidity level of Sh. sonnei dysentery changed simultaneously in the regions under study at intervals of 2-3 years. Sh. flexneri dysentery showed morbidity rises occurring at intervals 6-8 years, and their occurrence did not coincide with the periods of elevated morbidity in Sh. sonnei dysentery. The data obtained in the cohort analysis and in the study of recurrent morbidity suggest that Sh. flexneri dysentery produces more pronounced postinfection immunity than Sh. sonnei dysentery, and the immunological factor probably affects the dynamics of the epidemic of these Shigella infections.     

Assessment of the diagnostic effectiveness of antigenic preparations from Sonne shigellae]

The authors studied the diagnostic possibilities of 4 diagnistic agents from Sh. sonnei. A total of 1500 from 1122 persons were investigated. Specificity and sensitivity of the diagnostic agents from Sh. sonnei were determined. Methodical priciples of the objective assessment of the diagnostic efficacy of the antigenic preparations in the controlled epidemiological trial were elaborated. A possibility of establishment of the etiological diagnosis of Sonne dysentery in the passive hemagglutination or blast agglutination tests by the results of testing with the diagnostic agents of the serum obtained from the patient once or by determining the dynamics of the antibody titre rise in coupled serum portions was not great.     

Current methods of intraspecies typing of Shigella sonnei. 3. Bacteriophage typing]

Data are presented concerning the study of the phage type of Sh. sonnei isolated in various regions of the USSR. The strains isolated belonged to 64 phage types corresponding to the Hammarstr?m's scheme. A variety of Shigella sonnei phage types both in one and in different territories of the country provided future prospects for successful use of phage typing for the purpose of epidemiological supervision and analysis of dysentery morbidity.     

Recurrent Sonne dysentery morbidity caused by Shigella of varying enzymatic types]

The proportion of repeated cases of dysentery caused by Sh. sonnei does not exceed 3.59% of the total number of bacteriologically confirmed cases of this infection. The frequency of reinfection depended on the enzymatic type of the causative agent. The rarest cases of reinfection were those occurring after the primary infection with Sh. sonnei, biochemical type 2, whereas the most frequent after the primary infection with Sh. sonnei, type 3. Reinfection with heterologous Sh. sonnei was registered mostly 6-12 months after the primary infection, and with homologous Sh. sonnei after a 1 year and later.     

Characteristics and trends in the development of an epidemic process of Sonne and Flexner dysentery among preschool children

The results of studies indicate that the morbidity rates of dysentery among children attending preschool institutions and children brought up at home converged in recent years. This phenomenon was most pronounced among children of the kindergarten age group. At the same time dysentery caused by Sh. sonnei and Sh. flexnery produced a higher morbidity rate among children attending nursery in comparison with that among children of the same age group brought up at home. Group infections in preschool institutions were caused by Sh. sonnei in 89.1% of cases and by Sh. flexneri in 10.9% of cases. Outbreaks due to the transfer of infection through everyday contacts were observed only in dysentery caused by Sh. sonnei, constituting 71.4% of the total number of dysentery outbreaks.     

Patterns determining the dynamics of the epidemic process in Sonne dysentery and its relation to the type of causative agent]

The results of studying the dynamics of the epidemic process of dysentery, based on the data from 3 districts of Moscow, are presented. The study revealed the periodicity of 3 years in the course of the epidemic process of dysentery, occurring against the background of a considerable predominance of Sh. sonnei, biochemical type 2. The use of the cohort method for analyzing the age structure of dysentery cases showed the possibility of using this method to find out to what extent the epidemic process repeatedly affected the same groups of population.     

Use of intraspecific differentiation of Sh. sonnei for the purpose of studying patterns in the epidemic process of dysentery]

The use of complex typing of Sh. sonnei by the colicinogenic and enzymatic properties in epidemiological analysis of dysentery caused by Sh. sonnei, apart from establishment of epidemiological connections in the foci, offered a possibility of introducing significant corrections in the determination of the sizes and duration of existence of the epidemic foci, as well as in detection of the sources and factors of transmission of the infection established in epidemiological examination. Typing of Sh. sonnei also aided in ascertaining that, apart from general regularities in the individual territories, the epidemic process in individual groups of the population and in different seasons of the year could also course autonomously.     

Serological method of detecting the antigens of the causative agent of Sonne dysentery in lysates of the fecal inoculates from patients]

Serological method of detection of Sh. sonnei antigens in the lysates of the patients, fecal cultures is suggested and approved. In the majority of cases of the results of bacteriological and serological methods of study of the feces coincided. Data confirming the specificity of the antibody neutralization test (ANT) in Sonne dysentery are presented. In connection with detection of the screening action of the Vi-antigen of typhoid bacilli there were elaborated additional methods for verifying the specificity of the ANT results. It is recommended to keep agar plates after selection of suspicious colonies during the bacteriological test; the lysate of the microbial crop should be additionally subjected to the ANT, this considerably increasing the percentage of laboratory confirmations of dysentery caused by Sh. sonnei.     

Tendencies in the epidemic process of dysentery in Ryazan

In shigellosis caused by Sh. sonnei and Sh. flexneri the epidemic process was found to have considerable difference in the tendencies and pace of its development. Shigellosis which dominated in the etiological structure at the period following 1966 was dysentery caused by Sh. sonnei; it showed the tendency towards a decrease in morbidity rate. Dysentery caused by Sh. flexneri was second in respect to the frequency of its occurrence after 1966 and showed the tendency towards increase. The simultaneous circulation of Sh. sonnei and Sh. flexneri, the differences in the epidemiology of these types of shigellosis make it imperative that they be studied separately, taking into ccount their etiological selectivity to the main routes of transmitting the infection.     

Manifestations of the cyclic nature of the epidemic process in dysentery

Different forms of dysentery, especially those caused by Sh. sonnei and Sh. flexneri, have been found to differ considerably in their cyclic recurrence. The development cycles of the epidemic processes of dysentery have an objective character, occur in the presence of any tendencies in the morbidity rate, and depend on the natural factors. Thus, the cycles of increase and decrease in morbidity are 3, 6, 9, 12 years for dysentery caused by Sh. sonnei and 6, 7, 8 years for dysentery caused by Sh. flexneri.     

Etiologic structure of bacterial dysentery in the USSR in 1983-1985

The etiological structure of dysentery in the USSR in 1983-1985 is characterized. Sonne dysentery was found to prevail in the territories with adequate water supply, while dysentery caused by Shigella flexneri prevailed at the territories with unsatisfactory water supply. S. dysenteriae and S. boydii were found to play a limited role in the etiology of dysentery. In the presence of global pandemic, an increase in the isolation rate of S. dysenteriae I in the USSR is observed. The data on the biochemical structure of S. sonnei are presented.     

The etiological structure of shigellosis in the USSR in recent years

The characterization of etiological structure of Shigella infection in the whole of the USSR, in individual union republics and at a number of other administrative territories of the USSR in recent years is presented. S. flexneri has been shown to prevail at the territories with unsatisfactory water supply of the population, and S. sonnei prevails at the territories with good water supply. At the former territories S. dysenteriae and S. boydii retain their etiological importance, while at the latter ones their role is insignificant. At a number of territories the infectious process has stopped: no isolation of these shigellae from dysentery patients and carriers is observed any longer. Among the causative agents of Flexner's dysentery, S. flexneri 2a, 6 and 1b (in different combinations) play the leading role.     

Use of data on Shigella contamination and immunity indices for studying the activity of the epidemic process in dysentery

The comparative study of the monthly distribution of characteristics indicating the levels of contamination with Sh. sonnei and Sh. flexneri separately, as well as the seasonal dynamics of the corresponding antibodies, in the years with high and low morbidity levels has been made with the use the indirect hemagglutination test. The possibility of using these characteristics for the evaluation of the activity of the epidemic process in dysentery caused by Sh. sonnei is shown.     

Surface components of shigellae involved in adhesion and haemagglutination

Strains of Shigella species were studied for their ability to adhere and agglutinate mammalian erythrocytes. Shigella dysenteriae and Sh. flexneri exhibited haemagglutinating (HA) properties when cultured in Casamino Acids-Yeast Extract (CYE) broth in the presence of 1 mmol 1^-1 calcium chloride, but other shigellae did not show this property under the same culture conditions. Repeated subcultivation of Sh. boydii, Sh. sonnei and HA negative strains of Sh. dysenteriae and Sh. flexneri in CYE broth medium induced adhesive and haemagglutinating properties that were inhibited by sodium periodate. HA activities of Shigella spp. were also inhibited by N -acetylneuraminic acid, α₁-glycoprotein and fetuin, but not by protease. Electron microscopy of Sh. dysenteriae 1, Sh. flexneri 2a, Sh. boydii 12 and Sh. sonnei 1 grown in CYE broth showed the presence of an extracellular slime layer that promoted agglutination of erythrocytes. The slime layer extracted from the cell surface of Shigella spp. showed HA properties, whereas lipopolysaccharide (LPS) obtained from the same strains, except Sh. dysenteriae 1, did not agglutinate erythrocytes. This evidence suggests that the cell surface haemagglutinin is a loosely bound slime layer which is expressed in CYE broth medium.     

痢疾杆菌不同群、型间交叉保护性试验研究

本文对痢疾杆菌不同群、型间的交叉保护作用进行了观察。试验模型为恒河猴,将其分为４组,第一、三组分别为感染过福氏１ａ和宋内菌并已康复的猴;第四组为用双价菌苗株ＦＳ（福氏２ａ和宋内）免疫的猴体,剂量依次为４×１０１０、６．５×１０１０、６×１０１０,共１６．５×１０１０活菌,第二组为空白对照。所有４组皆用福氏２ａ２５８００×１０８活菌攻击。从发病率来看,不同菌群与菌型间没有明显的交叉保护作用;从发病程度看则一组显著低于对照组,三组与对照组无显著差异,此结果表明痢疾杆菌Ｂ群内存在交叉保护作用,但较同型保护作用弱。     

Differential characteristics of the I and II phases and R-form of Sh. sonnei]

Characteristics of various phases of Sh. sonnei were determined on the standard strains of Sh. sonnei of phases I and II and R-form used for the industrial production of agglutinating monoreceptor sera. Bacteria of phase I displayed a distinct morphological, cultural and serological differences. For the differentiation of Sh. sonnei of the II phase and R-form, representing the greatest difficulty in this respect, it is recommended to use phages RFfm and 6-SR, and also indirect immunofluorescence method with the application of agglutinating monophasic serum against the II phase of Sh. sonnei. In addition, a study was made of over 20 various Sh. sonnei strains at different dissociative process phases. Verification data completely confirmed the specificity of phages RFfm and 6-SR for Sh. sonnei in the II phase. The efficacy of the immunofluorescence method was confirmed on 6 strains.     

Determination of the O antigen of Shigella sonnei by a competitive immunoenzyme method

A technique for immunoenzymatic diagnosis of dysentery by Shigella sonnei O-antigen was developed. For induction of antibodies to O-antigen rabbits were immunized by intravenous administration of a commercial antidysentery vaccine. Specific antibodies to O-antigen belonging to class G immunoglobulins and not binding to O-antigens of Sh. flexneri and Salmonella typhimurium were obtained. beta-Lactamase of Bacillus licheniformis 749/c was used as a marker enzyme in the immunoenzymatic assay. To increase the sensitivity, beta-lactamase molecules were preliminarily linked with glutaric aldehyde into oligomers. Conjugates of Sh. sonnei O-antigen with the oligomers of B. licheniformis 749/c beta-lactamase were prepared with the periodate method by oxidizing O-antigen. The conjugate was used in competing solid phase immunoenzymatic assay for determination of Sh. sonnei O-antigen in blood serum of patients with dysentery. The sensitivity of the assay is 0.5-1 ng per 1 ml of O-antigen.     

The mechanism of the development of the epidemic process in Sonne dysentery

An epidemic outbreak of Sonne dysentery has been studied. The data of epidemiological monitoring before and after the epidemic have been analyzed. The real prognostication value of controlling the biological properties of Shigella sonnei and the increase of their intrapopulation heterogeneity at the period of the activation of the epidemic process of Sonne dysentery has been established.     

Immunoelectrophoretic analysis of the antigenic structure of Sh. sonnei]

The authors studied the antigenic composition of 105 Sh. sonnei strains freshly isolated from patients suffering from acute dysentery and carriers. Immunophoregrams of pure S-and R-forms species were obtained. Up to 13 antigens differing by electrophoretic and diffusion mobility and immunological specificity were revealed among soluble Sh. sonnei antigens The position of common and specific antigens was determined on the immunophoregram. Along with the thermostable somatic O-antigen detected at the I phase of the S-forms, and two thermolabile O-antigen components at the II phase, and the R-forms, there was revealed a surface, relatively thermolabile, K-antigen of A-type capable of agglutinating live bacteria in the O-antiserum; position of the latter on the immunophoregram was also determined.     

Experience with the diagnosis of dysentery in adults by determining antibodies to Shigella in the saliva]

Concentration of immunoglobulins and titres of antibodies to Sh. sonnei, Sh. flexneri and enteropathogenic E. coli 0111 was determined in mixed saliva and the blood serum of patients suffering from Sonne dysentery, acute intestinal diseases of unknown etiology, and healthy individuals. The sum total immunoglobulin concentration in mixed saliva proved to be 53--81 times less than in the blood serum, but in the first substrate there was 53--75, and in the second--15% of immunoglobulin A. There proved to be distinct changes in the specific IgA-antibodies in the saliva of patients with Sonne dysentery. A preponderant accumulation of IgG-antibodies was noted in the blood serum. Elevation of both types of antibodies was maximal during the second week of the disease. Sonne dysentery was diagnosed in 80% of the patients by recording the intensity of shifts in the specific antibodies in the saliva, and in 63%--in the blood. The expediency of immunological testing of saliva for the diagnosis of dysentery is substantiated.