ABSTRACT. A method for identifying single nucleotide polymorphisms of the PfMDR1 gene (A958146T, A961013G, G961625T) based on the analysis of the lengths of restriction fragments using polymerase chain reaction technology with specific primers is presented. To identify the polymorphism A958146T (amino acid substitution N86Y), it was proposed to amplify a fragment of parasitic deoxyribonucleic acid with a length of 417 bp, including the 86th codon of the PfMDR1 gene, followed by treatment of the amplicon with ApoI endonuclease, the restriction site of which includes the sequence of the analyzed mutation. With the Plasmodium falciparum genotype unchanged, the isolated deoxyribonucleic acid site is divided into two fragments of size 239 and 179 bp. In the case of an altered genotype containing a single nucleotide missense mutation A T, the original fragment 417 bp will be preserved. When designing the system to detect the amino acid substitution N1042D caused by the A961013G mutation, a pair of specific primers were selected that limit the 404 bp-long section of parasitic deoxyribonucleic acid. For restriction analysis, the most optimal was the use of AseI endonuclease, which in the case of an unchanged Plasmodium falciparum genotype divides the initial amplicon into 4 fragments (132, 116, 99 and 25 bp), and in the presence of A G mutation into 3 (248, 99, 25 bp). It was found that a fragment of the PfMDR1 gene, including the G961625T mutation leading to the amino acid substitution D1246Y, contains 1 site corresponding to the restriction site of endonuclease BglII. Therefore, in the case of the wild genotype of Plasmodium falciparum, the initial fragment of deoxyribonucleic acid is cut into 2 short sections (300 and 269 bp). With the D1246 mutation, the replacement of the nucleotide G T leads to the disappearance of the restriction site, so only one source fragment (509 bp) will be recorded on the electrophoregram. Based on the analysis of the data obtained, criteria for evaluating the drug resistance of Plasmodium falciparum have been developed. The decrease in sensitivity to mefloquine and its derivatives of pathogens of tropical malaria can be evidenced by positive results obtained using the developed methods for detecting haplotypes A T (N86Y (band 417 bp)), A G (N1042D (bands 248, 99 and 25 bp)), G T (D1246Y (509 bp)). The developed methods can be used to analyze the spread of drug-resistant tropical malaria.
The features of clinical and laboratory diagnostics of hantavirus infection at the prehospital stage in the regions of the Northwestern Federal District is considered. The analysis of the terms of patients treatment from the moment of the appearance of the first symptoms of the disease was carried out. It was found that more than half of the patients sought a medical help during the height of the disease. The structure of hospitalizations of the patients with a hemorrhagic fever with renal syndrome who were admitted to inpatient treatment was studied; most patients were hospitalized by the ambulance team. The data of our own research are presented, indicating the predominance of the nonspecific symptoms in the onset of the disease. The overwhelming majority of the patients in the initial period of the disease had fever, severe headache, myalgia. Hemorrhagic syndrome was detected in a minimal number of the patients. The dynamics of the clinical picture of a hemorrhagic fever with the renal syndrome in patients admitted to hospitals in St. Petersburg was analyzed. Diversity and a rapid change of the symptoms and syndromes in dynamics were noted. In the structure of diagnoses of the direction, diseases of the respiratory system prevailed. A smaller proportion of a preliminary diagnoses were diseases of the gastrointestinal tract, pathology of the kidneys and urinary tract, diseases of the central nervous system, and only one patient was diagnosed with the hemorrhagic fever with renal syndrome. The laboratory parameters of the early period of the disease in patients were assessed. The most frequent and characteristic changes in the blood and urine parameters were revealed. Signs of hemoconcentration and thrombocytopenia were noted in almost half of the patients in the initial period of the disease. In a small part of outpatients, impaired renal nitrogen excretory function was found; the intensity of azotemia in the initial period of the diseases was low. Urine changes in the initial period were characterized by the moderate proteinuria, leukocyturia, erythrocyturia, cylindruria. The need for a thorough comparison of a clinical, laboratory, epidemiological data for a timely and correct diagnosis is noted.
Hantavirus nephropathy (CVI) is considered to be acute kidney injury (AKI) associated with hantavirus infection (CVI). This infection in the countries of the European and Asian continents causes hemorrhagic fever with renal syndrome (HFRS). However, up to 60% of kidney damage is manifested by pathological changes in urinary sediment without signs of AKI, in connection with which the problems of terminology and diagnosis of kidney damage in HFRS were discussed. A review of the world literature of recent years, devoted to the study of modern data on the pathogenesis of CVI, is presented. The data were revealed that explain the organ specificity of the pathological process in different variants of CVI. The data were revealed that explain the organ specificity of the pathological process in different variants of CVI. The mechanisms related to various aspects of the pathogenesis of hantavirus nephropathy are considered. The factors that alter the functional activity of target cells through the direct action of the virus and the factors mediated by the immune response of the biological host to viral proteins in the form of the action of cytokines ("cytokine storm") causing damage to target organs (indirect factors) are listed. The influence of the hantavirus serotype, genetic factors, and the nature of the immune response of the biological host organism on the severity of renal dysfunction was shown. The concept of "acute damage to podocytes" is disclosed, which explains massive protein uria at the onset of the disease. The molecular and cellular mechanisms of damage to the main compartments of the kidney during hantavirus infection are presented. Disorders of hemostasis and mechanisms of hypercoagulation were demonstrated that underlie glomerular AKI due to acute microvascular syndrome, which is realized in the form of disseminated intravascular coagulation (DIC), hemolytic uremic syndrome (HUS), and thrombotic microangiopathy (TMA). The results of experimental data obtained on a laboratory model of infection and in cell culture, histological studies of autopsy material, and nephrobiopsy specimens from patients with hantavirus nephropathy are demonstrated.
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