The course and outcome of edema and swelling of the brain (OSB) essentially depend on many factors, including the feature of the pathogenesis of the disease associated with the factors ofpathogenicity of the causative agent. There was developed the multivariate mathematical analysis of the clinical picture of OSB with the using of an alternative algorithm of the distributions offrequencies of symptoms in differentiated groups of patients with the presence of OSB and without of OSB signs of this complication that permitted to make more accurately diagnose of OSB and judge the effectiveness of the taken therapy. The lack of clinical effect of antibiotic therapy is caused among other things the low bioavailability of the pathogen. BBB is not associated with an HLB so attempts on the base of the measurement of the spinal fluid pressure to detect the presence and severity of OSB have not been scientifically justified. The analysis of CSF indices - lactate, protein, glucose, D-DF, pH level against the background of OSB will allow to avoid unsound replacement of etiotropic drugs
The aim of the study. Comparative assessment of the state of cells of the immune system in patients with purulent bacterial meningitides caused by N.meningitidis and S.pneumoniae . Materials and methods. By the method offlow cytofluorometry there were tested blood and cerebrospinal fluid of 65 patients with bacterial purulent meningitis, with the meningococcal (38 people) and pneumococcal (27 people) nature of the disease. Results. There were revealed general consistencies of the immune response to CNS infection with meningococcus andpneumococcus: the fall of the number of CD16+ CD56+(NK) and the gain in the number of CD19+ cells in the blood, an increase in the absolute number of T lymphocytes, especially, CD3+ CD8+ and NK. In pneumococcal meningitis there was noted the more pronounced upsurge in the absolute number of the NKT (CD3+CD56+) and B-lymphocytes in the blood whereas in cerebrospinal fluid - the more pronounced upturn in the absolute number of NKT that testified to the severe course of the disease. Conclusion. As a result of performed studies there was identified a series of consistencies for the development of the immune response in bacterial purulent meningitides of meningococcal and pneumococcal etiology, which show the high informativeness of the study of immunograms of cerebrospinal fluid in these diseases as compared with blood. In the latter case, immunological studies may contribute not only to the identification of general consistencies of the development of the immune response in bacterial meningitis, but also serve as a basis for the differentiation of the impact of meningococcal and pneumococcal infection on immunocompetent cells, as well as to reflect the severity of the course of the disease, affecting the nature of the therapy.
Object. To study the main causes of severe course and high mortality in patients with nervous form of listeriosis. Materials and methods. The analysis of the course of Listeria meningoencephalitis (LM) in 36 patients aged from 9 to 85 years, who were treated in the Infectious clinical hospital No. 2 DZM (IKB No. 2 DZM). Along with standard examination methods, blood and cerebrospinal fluid (CSF) polymerase chain reaction tests were performed to identify Listeria monocytogenes. The sensitivity of the pathogen to antibiotics was determined by serial dilutions on the WalkAway 96 Plus device of Siemens, USA. Results. LM in 84% of cases developed in patients with disorders in the immune system, in particular, with infection with the human immunodeficiency virus - in 25% of cases. The clinical picture of the disease, changes in CSF were not typical for bacterial purulent meningitis of another etiology. It is noted that LM is characterized by early involvement of the substance and ventricles of the brain in the process. Conclusion. Severe course and high mortality are due to atypical picture of the disease, late diagnosis, low bioavailability of the pathogen for antibiotics (intracellular persistence of the pathogen) and frequent resistance to them. The mortality from the nervous form of listeriosis was 33.3%.
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