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The review article discusses current trends in antibiotic resistance in bacterial and protozoal sexually transmitted infections (STIs). Antimicrobial resistance in STIs has increased significantly in recent decades due to the overuse and misuse of antibiotics, fueled by population migration and the high incidence of STIs worldwide. While emerging cephalosporin-resistant strains of Neisseria gonorrhoeae are one of the most pressing problems in the world, other pathogenic STIs that are resistant to antibiotics, such as Mycoplasma genitalium and Chlamydia trachomatis, are increasingly being reported. The emergence of multidrugresistant strains of bacterial STIs is of particular concern for researchers. The emerging global crisis in STI treatment is the result of neglect and inattention to repeated warnings from researchers about the emergence of STI strains resistant to the existing antibiotics, as well as shifting priorities in the pharmaceutical industry, which limited the development of new antibiotics. The current antimicrobial portfolio does not provide cause for optimism, as it contains few new antibiotics, and most developments are in the early stages of clinical trials. Experts have suggested that the failure of existing STI treatment regimens is largely inevitable and have called for the creation of entirely new classes of antimicrobial drugs that would take decades to develop. Currently, there are several promising alternative strategies for the treatment of antibiotic-resistant STIs. The use of phage therapy, antimicrobial peptides, and hydrolytic enzymes are particularly promising directions.

The purpose of the study – assessment of the level of some serum indicators of acute-phase proteins (alpha2-macroglobulin, alpha1-antitrypsin and lactoferrin) as risk factors for congenital infectious diseases (VIZ) of the fetus and newborn from pregnant women with chlamydia infection of various form. Materials and methods. Venous blood was studied in 125 pregnant women at 37-41 weeks gestation with chlamydia infection with various variants of its course. The first group included 83 women with an acute course of chlamidium infection (PCR test+, IdM+, IgG+/-); 44 patients had children with congenital infectious diseases (VIZ), and 39 had healthy children. The second group consisted of 42 pregnant women with the carrier of the pathogen Chlamydia trachomatis (PCR test–, IdM-, IgG+), 22 of them had newborns with VIZ and 20 had healthy children. Serum proteins were determined in the blood serum: alpha2-macroglobulin (a2-MG) and alpha-1-antitrypsin (a1-AT) by quantitative rocket immunoelectrophoresis, as well as the level of lactoferrin (LF) by solid-phase enzyme immunoassay (ELISA). Results. In the blood serum of pregnant women with acute infection and the birth of children with VIZ, an increased concentration of alpha2-MG, LF, a1-AT (a2-MG more than ≥ 2.8 g/l, a1-AT ≥ 3.4 g/l, LF ≥ 4.0 g/l) was found in comparison with the indicators of proteins in pregnant women of the same group who gave birth to healthy children. Pregnant women with the carrier of the pathogen Chlamydia trachomatis, who gave birth to children with a VISA, had an increased concentration of only LF (LF ≥ 4.0 mg/l), compared with those who gave birth to healthy ones. Conclusion. The determination of a2-MG, a1-AT, LF in the blood serum of pregnant women with the presence of Chlamydia trachomatis and the use of the logistic regression method revealed highly reliable predictors of intrauterine infection in the fetus and newborns.

Reiter's syndrome includes: urethritis, arthritis and conjunctivitis. Affecting the joint apparatus is preceded by urethritis or diarrhea. Skin-mucosal involvement is observed in about 10% of cases. We present five patients (male, active athletes, aged 25 to 29 years), all with asymmetric oligoarthritis within 20 days of past urethral inflammation. In 5 patients, the urethritis was the result of casual sexual contact without a condom, and they all self-medicated without visiting a doctor. Between 10--14 day of the onset of arthritis, a reddish rash on the palms and soles began to develop, subsequently the rashes became painful plaques, and all patients had conjunctivitis. The appearance of a rash forced patients to contact the general practitioner. Tests performed revealed positive antibodies against Chlamydia trachomatis (IgA and IgG), HLA-B27 positive, HIV negative, syphilis negative and elevated CRP (C-reactive protein). In one of the patients, permanent changes in the knee joint were observed, due to which he stopped actively playing sports. It is important to explain to all patients that self-medication and neglect of diseases can lead to lasting consequences for the body. The role of the general practitioner is to keep this rare syndrome in mind when running laboratory tests. [ABSTRACT FROM AUTHOR]

The use of macrolides in the treatment of chlamydial infection during pregnancy and breast feeding is reviewed from the viewpoint of evidence-based medicine. The clinical experience and research data suggest azithromycin to be safe and effective in the obstetric practice.

This publication briefly reviews contemporary methods of laboratory diagnosis of chlamydial infection. Differences in the development of immune response are due to genetic factors in the body, especially the antigenic structure of strains of Chlamydia trachomatis and the influence of innate resistance factors.

Biopsy samples of 32 patients with uveal melanoma (10), RBL (11), orbital lymphoma (7), lacrimal gland adenomas (2), rhabdomyosarcoma of conjunctiva (2) were tested by real time polymerase chain reaction (PCR) to detect the DNA of HSV 1, HSV 2, EBV, CMV, HHV-6, HHV-8, Toxoplasma gondii, Mycoplasma hominis, Ureaplasma spp. Totally, 14 of 32 (43.75 %) tumor samples revealed DNA herpesviruses, Chlamydia trachomatis, mycoplasma hominis or ureaplasma spp. Positive PCR results were revealed in orbital lymphoma almost 2 times more frequently than in RBL (6/7 - 85.7 % and 5/11 - 45.5 %; p = 0.15), and 4 times more frequently than in uveal melanoma (6/7 - 85.7 % and 2/10 - 20%; р = 0.015). The spectrum of pathogens in different tumors varied. Only genomes of lymphotropic HHV (EBV, HHV-6, HHV-8) with predominance of EBV are found in orbital lymphoma. In RBL, we could identify DNA of HHV 6, EBV, CMV, and ureaplasma. Infectious DNA were detected the least frequently (2 out of 10 patients) in biopsies of uveal melanoma: in both cases, Chlamydia trachomatis genome was found, in one of them it combined with EBV and CMV DNA. Plasma investigation revealed positive PCR results significantly less frequently than in biopsies (1/28 and 14/32; p = 0.002). Further studies are needed to assess the role of persistent pathogens, primarily human herpesviruses, Chlamydia and ureaplasma in the pathogenesis of orbit and eye tumors // Russian Ophthalmological Journal, 2016; 2: 42-46 . doi: 10.21516/2072-0076-2016-9-2-42-46 .

The dominant role in human infertility has been attributed to sexually transmitted infections (STIs) with a leading contribution of urogenital chlamydial infection (UGCI) caused by Chlamydia trachomatis (CT). the two variants of this pathogen are represented by the wild-type (wtCT) and new Swedish (nvCT) strains containing 377 bp deletion within the cryptic plasmid orf1 gene. Objective. The purpose of the study was investigation of the clinical specimens obtained from the urogenital tract of couples coping with infertility for the presence of genetic material of wtCT and nvCT. Material and methods. Clinical samples (scrapings from the urethra and cervix) obtained from 25 to 41 years old couples (n = 14) were tested for the presence of identifiable wtCT and nvCT chlamydia DNA by monoplex and duplex PCR, specific antigens C. trachomatis in elementary bodies by using immunofluorescence analysis (IFA), while detection of anti-chlamydia antibodies in sera was determined by immunoenzymatic assay (IEA). Results. The nvCT variant with typical deletion of 377 bp within the orf1 gene that belongs to the genovar e subtype E1 was detected in 100% of couples with infertility. The negative results of DNA testing for wtcT were registered in 87.5% of patients from this group, while one individual (12.5%) was likely coinfected with nvCT and wtCT of E1 and D genovars, respectively. The wtCT strains of genovar E (subtypes E1, E2, E6), g (subtypes G1, G2), F (subtypes F1), and K were identified in control group among patients with UGCI. The study revealed difficulties in detection of nvCT by nucleic acid amplification test (NAAT), IFA, and IEA; data on comparison of the efficacy of these methods are presented. Conclusion. Chronic UGCI in patients with reproductive dysfunctions can be caused by nvCT alone or as result of co-infection with nvCT and wtCT. The negative results in NAAT may not 100% correlate with the absence of UGCI that requires further confirmation in tests allowing detection of all known variants of C. trachomatis.

Introduction. It seems 90% of chronic prostatitis (CP) is abacterial, but is it true? The propose is – to estimate a spectrum of chronic abacterial prostatitis and estimate efficiency of complex treatment.Materials and Methods. Fifty six patients with chronic abacterial prostatitis 3-a category were enrolled in this study: first group (28 patients) received standard treatment and additionally - panavir, and second group (also 28 patients) - standard treatment only. All patients were examined by standard approach, including polimerase chain reaction on intracellular pathogens. Complex therapy was unique and included: doxiciclin, famcyclovir, pathogenetic therapy. Efficiency was estimated by NIH-CPSI scale and by eradication of pathogens.Results. All patients had chronic abacterial prostatitis 3-a category. Followed pathogens were revealed: Chlamydia trachomatis (17 patients), Ureaplasma urealyticum (15 patients), Mycoplasma genitalium (22 patients), virus Herpes (9 patients). These pathogens formally are not etiological factor, but in fact they maintain inflammation in the prostate. M. tuberculosis was not found. In first group total scores decreased from 20.9 to 7.9, in second group - from 20.8 to 16.3). In three months, pathogens were 17.8% patients больных in first group, and in 42.8% in second group; accordingly efficiency of standard treatment was 57,2%, and in combination with panavir – 82.2%.onclusion. Examination on intracellular pathogens as well as viruses is indicated for patients with chronic abacterial prostatitis 3-a category. Standard therapy in cobination with panavir significantly imorives results of the treatment. Low efficiency of standard therapy may be explained both by secondary immunodefficiency and by myofascial syndrome.

Results of comprehensive ELISA tests of blood serum for the presence of IgM-, IgA-, and IgG-antibodies to herpes simplex virus types 1 and 2, cytomegalovirus, Epstein-Barr virus, human herpesvirus 6, human herpes virus 8 type, Chlamydia trachomatis in 38 patients with uveal melanoma are presented. The polymerase chain reaction was used to detect DNA of these pathogens in tumor biopsies, vitreous body of 10 enucleated eyes, as well as in plasma IgG-antibodies to HHV 6 were revealed in 50% of patients; IgG-antibodies to HHV 8, in 5.3% of patients. Among the 16 patients with uveal melanoma at advanced stages, 6 patients had antibodies indicative of EBV reactivation (1.2-3.3). Chlamydia trachomatis genome was detected in both biopsies; in one of them, in conjunction with EBV and CMV DNA . Tissue samples from the identified infectious agents were related only to the spindle-cell histologic type AB of uveal melanoma. In plasma, genomes of pathogens were not determined. The results indicate the presence of infectious agents in patients with uveal melanoma and require further study of the pathogenetic role of infections in the pathogenesis of uveal melanoma.

До настоящего времени мутационная устойчивость C. trachomatis к фторхинолонам (ФХ), которые используются, наряду с макролидами и тетрациклинами, для лечения хламидийных инфекций, не была описана в клинической практике. Возможность селекции мутаций резистентности к ФХ (пре- имущественно в участке QRDR gyrA) была продемонстрирована исключительно в экспериментах in vitro. В статье описан впервые выявленный клинический случай наличия типичной мутации устойчи- вости к ФХ в QRDR gyrA C. trachomatis. Проведенное исследование тем не менее показывает, что классические механизмы резистентности к ФХ встречаются крайне редко в популяции клинических штаммов C. trachomatis.

This review presents the current published data on the epidemiology, etiology, pathogenesis, diagnosis and treatment of pelvic inflammatory disease (PID). Medical and social consequences of PID associated with the negative impact on women's reproductive health, emphasize the need for early antimicrobial therapy aimed at eradication of all potential etiotropic agents of the inflammatory focus. In the article the comparative analysis of the advantages and some limitations of conventional therapeutic strategies designed for use in situations with PID on Russian territory, the United States and Europe. Given the ubiquity of fluoroquinolone antibiotic resistance, insufficient sensitivity to first-line antibiotics (doxycycline) in the individual agents (in particular, Mycoplasma genitalium) treating PID in the circuit along with II-III generation cephalosporin, metronidazole, and it is desirable to recommend inclusion of azithromycin as an antibacterial drug first selection.

Goal: the study of the effectiveness of the method for laboratory diagnostics of urogenital chlamydial infection in patients with chronic form of the disease. Material and methods. The presence of DNAof C. trachomatis was detected by PCR in either genital or extragenital (blood) sites in eighth patients (four men and four women). Results. It is established that in biological material taken from extragenital (blood) sites, C. trachomatis was detected in all patients examined (in 100% of cases), while in clinical samples obtained from genital sites, in seven patients only (87.5%). Conclusion. We found that specific chlamydial DNAcan be detected in extragenital (blood) site, despite the negative reaction in the clinical material from the genital tract of patients with genital chlamydial infection.

The review highlights the historical aspects and modern concepts of laboratory diagnosis of chlamydial infection. The studies on investigation of different strains of Chlamydia trachomatis performed in Russian Federation and abroad are summarized. The results of research of domestic and foreign scientists aimed at finding the perfect laboratory test for identification of C. trachomatis on the basis of molecular biological methods are analyzed and presented.

This review is about analysis of data possible role of the infectious factor in development open-angle glaucoma. The obstruction of ways of outflow s an important role in increase of intraocular pressure. The reason can be various infectious agents, including Chlamydia trachomatis, Mycoplasma pneumoniae, Mycoplasma hominis, Ureaplasma urealyticum and B.fragilis. There were separate publications during last years, which are devoted to studying a role of proinflammatory cytotoxicants, they show the role of the inflammatory factor in pathogenesis of glaucomatical process. In the literary data we can see role of infections which are show communication between ontamination of bacteriumНelicobacter pylori and glaucoma development. There is data that patients with open-angle glaucoma in 63% have high level of shooting galleries of antibodies IgG in blood to C. pneumoniae. It is connected with infringement of optic disc food as a result of influence C. pneumoniae on its vascular system.

IgA-nephropathy is the most common form of primary glomerulonephritis in the world and therefore the mechanisms of this isease are actively explored. In our study, an analysis of renal biopsy issue from 117 patients IgA-nephropathy in the presence of Chlamydia trachomatis antigen related to age (before and after 60 years). It was shown that the presence of C. trachomatis in the glomerular zone influence on the severity of segmental sclerosis (p

Abstract. We had investigated serum levels of IL-6, IL-8, IL-10, IL-1ra and TNFα in peripheral blood of pregnant women at the terms of 38 to 40 weeks with polyhydramnios and serum IgG antibodies specific for Chlamydia trachomatis (titers of 1:20 to 1:40). Same parameters were tested in umbilical cord blood sera, obtained at delivery. We had found high levels of TNFα, IL-6, IL-8, IL-10 in sera from umbilical cord blood, and increased levels of TNFα in maternal sera before delivery in a group of women with high Apgar scores of their children (≥ 8 points), in comparison with control group. High levels of TNFα, IL-6, IL-10 in sera from umbical cord and increased serum concentrations of IL-6, IL-10, IL-1ra and TNFα before delivery were evaluated in group of women with circulating antibodies against C. trachomatis during pregnancy and with low degrees of newborn children (< 7 by Apgar score). We suggest that high cytokine levels in maternal blood and in sera of umbilical cord blood from women with polyhydramnios and circulating antibodies against C. trachomatis sufficiently correlate with high clinical risk of intrauterine infection in newborns. However, high inter-individual variability of the cytokine parameters does not permit their usage as independent diagnostic criteria.

Все представители порядка Chlamydiales являются облигатными внутриклеточными паразитами, и их жизненный цикл характеризуется чередованием двух форм существования (элементарные и ретикулярные тельца - ЭТ и РТ); обладают склонностью к латентному существованию или к персистенции [1]. Наибольший интерес представляют микроорганизмы, отнесенные к семейству Chlamydiaceae, в нем в отличие от прежней классификации, в которой присутствовал единственный род Chlamydia, отныне принято различать еще один род - Chlamydophila (к нему относятся Chlamydia trachomatis), а также добавлены два новых вида - Сhlamydia muridarum и Сhlamydia suis. Из всех представителей рода Chlamydia только Chlamydia trachomatis является исключительным паразитом человека, вызывая кроме эндемической трахомы, давшей название всему виду, еще и урогенитальные инфекции, передаваемые половым путем, а также реактивные артриты, конъюнктивиты и пневмонию новорожденных. Одной из фармакологических особенностей макролидов является их способность, проникая через клеточные мембраны, накапливаться внутри клеток макроорганизма, создавая при этом высокие концентрации, что определяет их выраженную бактерицидную активность не только в отношении стрептококков, стафилококков, аэробных грамотрицательных микроорганизмов, но и в отношении ряда внутриклеточных возбудителей, в частностиC. trachomatis Полученные результаты свидетельствуют о перспективности проведения дальнейших исследований по изучению возможности применения моксифлоксацина и других новых фторхинолонов в лечении урогенитальных инфекционных заболеваний, в частности хламидийной инфекции.

Non-gonococcal urethritis (NGU) is a common disease in men. The main cause of NGU is sexually transmitted infections, which can cause various complications, including reproductive ones. Chlamydia trachomatis and Mycoplasma genitalium are the most common causes of NGU, but no known viral or bacterial pathogens are detected in 28-50% of cases. Traditional research methods revealed a higher load of specific pathogens in patients with urethritis compared to the control, but these studies do not allow us to determine the total bacterial load in the urethra. Using the 16S rRNA sequencing method to characterize the urine and urethral microbiota reveals a diverse bacterial microbiota in both asymptomatic men and patients with NGU, which has a high diversity. The revealed microbiota in both healthy and patients with urethritis still has an ambiguous interpretation and requires further study.

Aim: To carry out a comparative assessment of the efficiency of combination therapy for non-gonococcal urethritis (NGU) in men., Materials and Methods: a total of 124 patients with NGU and laboratory-confirmed urogenital infection were included in the study. The diagnostic methods included microscopy of urethral smear, real-time polymerase chain reaction (PCR) for the detection of uropathogens and laser Doppler flowmetry for evaluating the urethral microcirculation. All patients were randomized into three groups matched for age, clinical manifestations, and disease duration. Patients of the group 1 received targeted antibiotic therapy. In the group 2, local peloid therapy was added, while patients in group 3 additionally received vibromagnetotherapy. The control group consisted of 22 patients aged 18 to 55 years. The study included 2 visits, at the baseline and 4 weeks after the end of treatment., Results: After the treatment, the frequency of microbiological cure was 89%. In the group 3, more pronounced improvement in main symptoms of NGU was observed. The analysis of microcirculation after treatment in the groups 2 and 3 showed a significant increase in perfusion and modulation of urethral blood flow and a decrease in venous congestion after combined therapy., Conclusion: The combined treatment, including antibiotic, peloid therapy, and vibromagnetotherapy, promotes more pronounced clinical improvement, restoration of urethral microcirculation and relief of inflammatory process in patients with NGU and can be recommended for routine clinical practice.

Purpose: Assessment of the severity of immunological disorders in patients with hlamydia trachomatis (CT) infection and the effectiveness of antibacterial therapy in combination with systemic enzyme therapy for the eradication of pathogenic pathogen and correction of detected violations of the immune system., Materials and Methods: 84 patients with identified CT infection were divided into 2 clinical groups: group 1 (42 people) received antibiotic therapy with doxycycline monohydrate for 10 days, 100 mg 2 times a day (the first dose of 200 mg) at regular intervals (daily dose of 200 mg, course - 2.0 g.) in combination with phlogenzyme, 3 tablets 2 times a day within 14 days. The second clinical group (42 people) received only doxycycline monohydrate therapy at the same doses as in the first clinical group. In all patients with CT infection (84 people) and in the control group (32 practically healthy people), the activity of immune reac-tions in the body was additionally assessed by the level of cytokines (-INF, IL-1, IL-4, IL-6), circulating immune complexes (CIC), lactoferrin (LF) and 2-macroglobulin in blood serum., Results: The level of CEC in the blood serum of patients with CT infection is significantly higher than the standard indicators (by 1.83 times) compared with the indicators of the control group (106.1+/-5.12 conventional units versus 57.8+/-3.39 conventional units, p<0.05). The level of -IFN in the blood serum of patients with CT infection is 1.64 times lower than in the control (28.9+/-4.15 pkg / ml and 47.3+/-4.26 pkg / ml, p<0.05), and indicators of IL-1 in blood serum - 3.12 times higher; the level of IL-6 is 2.13 times higher (p<0.001); the level of IL-4 is 1.65 times higher (p<0.05). The Lf level in patients with CT infection exceeded 2.37 times the indicator in the control group (1742.0+/-112.15 ng / ml and 732.1+/-36.11 ng / ml, p<0.001), 2-macroglobulin - in 1, 36 times (2.59 - 0.21 mg/l and 1.9 - 0.47 mg / l, p<0.001). The efficiency of clinical and microbiological cure in patients with CT infection, who received complex therapy with doxycycline monohydrate and phlogenzyme, was 97.6%. With monotherapy (doxycycline monohydrate), the effectiveness of clinical and microbiological cure was significantly lower - 78.6%, statistically significant (OR=11.2; 95% CI 1.3-247.9; p=0.007). The fact of a decrease in the activity of Th-2 type of the cellular link of immunity in patients with CT infection receiving systemic enzyme therapy drug was established., Discussion: One of the pathogenetic mechanisms of CT infection is an imbalance in the cytokine profile, which manifests itself in an increase in the level of cytokines of the Th-2 (IL-6) type and a decrease in the Th-1 (-IFN) type. With the predominant production of pro-inflammatory cytokines (IL-1, IL-6), the dynamics of CT infection becomes chronic. A decrease in the reserve capacity of the proteolytic enzyme system during CT infection with a subsequent increase in the level of 2-macroglobulins in the blood contributes to the dysregulation of local inflammation processes and the formation of immune disorders. With a long course of CT infection, it is most advisable to use (as a basic pathogenetic therapy) systemic enzyme therapy (phlogenzyme). The effect of systemic enzyme therapy on immune responses in C. trachomatis enhances the activity of the Th-1 type of cytokines (-IFN) and a decrease in the level of 2-macroglobulins and pro-inflammatory cytokines (IL-1, IL-6) in the blood. Systemic enzyme therapy can significantly increase the effectiveness of antibiotic therapy and reduce the risk of side effects., Conclusion: The theoretical argumentation of the pathophysiological mechanisms of disorders in the interaction of the most important functional systems made it possible to substantiate new conceptual approaches to the therapy of CT infection, taking into account the level and specific disorders in the universal systems of homeostasis regulation. In particular, a pathophysiological basis has been provided to substantiate the advisability of combining antibacterial therapy with systemic enzyme therapy drugs to correct systemic immunological disorders in patients with CT infection.

Objective: to conduct a comparative study of the composition of the microbiota of the urethra in men with sexually transmitted infections (STIs), and healthy men., Material and Methods: The study included 103 men aged 18 to 45 years: 42 men with urethritis caused by STIs and 61 clinically healthy men. Identification of pathogenic and conditionally pathogenic microorganisms in scrapings from the urethra was performed by PCR in real time (test system Androflor (DNA-Technology, Moscow)., Results: In the analysis of the total bacterial mass, it was found that the bacterial contamination of the urethral biotope in patients with STI was significantly higher than in the group of healthy men (5.8 Lg10 and 4.7 Lg10, respectively), with the highest level of bacterial contamination was detected in patients infected with N. gonorrhoeae (6.4 Lg10). Patients with STIs had significantly lower levels of relative Staphylococcus spp., Streptococcus spp., Corynebacterium spp. and their amounts in General compared to clinically healthy men: according to ROC analysis, the best diagnostic indicator (0.93+/-0.04, p<0.001), distinguishing a group of healthy individuals from patients with STI, was the amount of Staphylococcus spp., Streptococcus spp. and Corynebacterium spp. ("Amount Of Normoflor"). In patients infected with C. trachomatis, compared with clinically healthy men, the relative number was significantly higher of Bacteroides spp. / Porphyromonas spp. / Prevotella spp., Peptostreptococcus spp. / Parvimonas spp.; in patients infected with N. gonorrhoeae - Anaerococcus spp. and in patients infected with M. genitalium - Megasphaera spp. / Veillonella spp. / Dialister spp., Anaerococcus spp., Peptostreptococcus spp. / Parvimonas spp. and Eubacterium spp., Conclusion: An increase in the total bacterial contamination of the urethra in STI was found, most pronounced in infection with Neisseria gonorrhoeae. The best diagnostic indicator that distinguishes normal microbiota from the microbiota of patients with STIs is the sum of Staphylococcus spp., Streptococcus spp. and Corynebacterium spp. In patients with clinical signs of an inflammatory reaction and the presence of STIs, a decrease in the normoflora in all types of STIs and an increase in obligate anaerobic bacteria - Megasphaera spp. / Veillonella spp. / Dialister spp., Bacteroides spp. / Porphyromonas spp. / Prevotella spp., Anaerococcus spp., Peptostreptococcus spp. / Parvimonas spp. and Eubacterium spp.

Aim: To study the characteristics of health state in family-members of ENT-patients with identified Chlamydia infection., Methods: We have examined 245 members of 87 families of otorhinolaryngological patients with verified (44 families) and without (44 families) Chlamydia infection. Laboratory methods of the research included the identification of the following types: Chlamydia trachomatis and Chlamydophila pneumoniae. Chlamydia diagnostics involved both direct immune fluorescence and immune enzyme analyses as well as polymerase chain reaction. Health state in ENT-patient family-members has been evaluated by the complex method based on the special questionnaire for every family-member aimed at determining the health category, the calculation of health average coefficient for each family member followed by the determination of family identity with some definite health category., Results: in the families of otorhinolaryngological patients with verified Chlamydia infection there have been revealed considerably more family-members with acute and chronic pathology of different organs and systems associated with functional disorders. The health status of family members of ENT patients with respiratory Chlamydia was significantly worse than in families of patients with negative laboratory results for Chlamydia, which was manifested by a much smaller number of healthy family members and a large number of people with risk factors for health.

Aim: Comparative study of microflora of nasal passages during acute and chronic inflammatory nasal diseases with and without Chlamydia infection., Materials and Methods: Microflora of nasal mucosa obtained from 104 patients with acute maxillary sinusitis and chronic nasal diseases (sinusitis and rhinitis) with and without detected Chlamydia infection. Verification of the latter was performed by PCR and direct immunofluorescent method. Microbiological isolation was performed on blood agar using method of sectors. Identification of streptococci, bacteria from Enterobacteriaceae family, staphylococci, and bacteria from Neisseria genus was performed by conventional methods., Results: During acute maxillary sinusitis associated with Chlamydia infection, depletion of bacterial species diversity was observed with increase of quantity of staphylococci. Also, increase of number of staphylococcal strains with pathogenic properties in patients with Chlamydia carriage was observed., Conclusion: It could be suggested that Chlamydia, pathogenic, and opportunistic bacteria are antagonists, which compete for ecologic niche and substrate in host organism. Decrease of number of staphylococci is a response on invasion and multiplication of Chlamydia on mucosa of nasal passages.

Until the present time, ophthalmic chlamydiasis has been generally associated with diseases of auxiliary organs of the eye and its anterior segment: conjunctivitis and iridocyclitis. The morphological substrate of eye posterior segment lesion caused by C. trachomatis and C. pneumonia was studied in this investigation. The pathomorphological pattern characteristic of chlamydia-induced rabbit retinal and vitreous body lesions is composed of vitreoretinal lymphocyte-macrophageal infiltrations of varying intensity, posterior hyaloid membrane detachment, peripheral foci or folding of the retina, impaired nuclei of photoreceptors and bipolar neurons, pigment epithelial damage occurring in different concurrences in relation to the species of a causative agent and the clinical picture.

The investigation was undertaken to study changes in the structure of the vitreoretinal complex in experimental chlamydial infection. Six rabbits were inoculated with Ch. pneumonia (6 eyes) and Ch. trachomatis (6 eyes) via instillations, subconjunctivally and intravitreally. Clinical and pathomorphological study was conducted during 128 days, by using immunohistochemical techniques. All modes of inoculation resulted in the development of an intraocular infectious process as uveitis, choriorenitis, and vitreitis (endophthalmitis) of varying degrees--from subclinical to severe. Immunohistochemical study revealed the pathogen in the structures of the ocular posterior segment and in venous blood in all cases. When locally inoculated, chlamydial infection becomes disseminated, by afflicting the ocular posterior segment, no matter what the mode of inoculation is applied. The clinical picture of the lesion widely varies from subclinical manifestations to a severe process.

The use of macrolides in the treatment of chlamydial infection during pregnancy and breast feeding is reviewed from the viewpoint of evidence-based medicine. The clinical experience and research data suggest azithromycin to be safe and effective in the obstetric practice.

We examined 243 males using polymerase chain reaction (PCR), seeding, spermogram, morphological examination of spermatozoa, electrospermography, enzyme immunoassay (antibodis to chlamydia in blood serum and seminal plasma, blood hormones). Statistics were obtained with parametric and nonparametric methods. A total of 148 patients were divided into three groups. Group 1 (n = 57) consisted of males who had previously had chlamydiasis. Their blood serum and/or seminal plasma contained antichlamydial IgA or IgG. Neither seeding nor PCR detected genital infections. Group 2 consisted of 18 patients infected with C. trachomatis. Control patients (n = 73) had no genital infections, chlamydial antibodies were not detected. Normozoospermia was diagnosed in 28% males with chlamydial infection history, 11% patients infected with chlamydia and 23% controls. Asthenozoospermia was detected in 69, 89 and 73% patients, respectively. Among chlamydial infection convalescents were patients with obstructive azoospermia (2%) which was not found in infected and healthy males.

Sixty four males (age 21-45 years) with urogenital chlamidiasis were divided into two groups. 34 patients of the study group received interferon inductor and lavomax. 30 patients of the control group--interferon inductor and cycloferon. Treatment efficacy in the study group was higher.

The present situation with the use of antimicrobial drugs for the management of Chlamydia trachomatis infection during pregnancy in the Russian Federation was evaluated. The efficacy and safety of various macrolides in the treatment of chlamydial infection in practical obstetrics were analyzed. It was conclude that josamycin was inferior to azithromycin by a number of pharmacologic parameters, compliance and safety and therefore should not be used in pregnant women.

Antibiotic wilprafen (josamycin) was given in a dose 500 mg per os two times a day for 15 days to 30 male patients with a long history of chronic Chlamydia trachomatis infection (CTI) treated ineffectively. The control examination has not detected Chlamydia in 29 (96.5%) patients. The results demonstrate high efficacy of the drug wilprafen in the treatment of patients with urogenital CTI.

The results of complex treatment of 235 patients with persisting urogenital chlamidial infection are presented. The treatment regime included immunotropic agent interferone alfa-alpha 2b and antibiotic azithromycin (Sumamed, "Pliva", Croatia) 1 g per day 3 times every 7 days. Chlamidial persistence diagnosis was performed by culture method (determination of small cytoplasmic inclusions), by the method of immune fluorescence and PCR. The treatment provided positive influence on immune status (amount of CD4+; HLA-DR+ cell and IgA level normalized after the treatment). In 3 months after the treatment only 2 cases of Chlamydia trachomatis infection recurrence were registered. Treatment efficacy achieves 94.8 per cent.

The comparative evaluation of the diagnostic value of the polymerase chain reaction (PCR) and the enzyme immunoassay (EIA) in the detection of intrauterine infection (IUI) in 48 newborn infants with cerebral lesions was made. Tests for the presence of the infective agents of IUI, most frequently occurring in the region (Cytomegalovirus, Herpes simplex virus, Chlamydia trachomatis), were carried out. The levels of serum IgA, IgG and IgM were evaluated in the course of the primary screening of IUI. Laboratory samples for PCR from infants with IUI were selected at random. The study demonstrated that in PCR the frequency of positive results was significantly greater than in EIA.

A clinical and laboratory investigation was done in 68 full-term newborn babies, with clinical forms of Chlamydia infection having been identified. There have also been studied cellular and humoral links of immunity, hormonal profile, system of peroxidation, antioxidant defence. In Chlamydia infection in full-term newborns presenting with acute bronchopulmonary pathologies during the acute phase of the illness, signs are noted of activation of processes of free-radical lipid oxidation against the background of retardation of the antioxidant defense, with synthesis of hormones of the thyroidal, hypophyseal and adrenal systems being on the increase. Metabolic changes are directly related to immunologic responsiveness which is characterized by weakness of primary immune response. The degree the above changes make themselves known depend on the clinical form of Chlamydia-associated infection. The identified metabolic changes may be the basis of causative factors for change in capacity of newborn infants with chlamydial infection to adapt.

Migration of Treponema pallidum through the basal membrane to upper layers of the epidermis and destruction of the intercellular junctions (desmosomes) were revealed with the help of electron microscopy of syphilitic chancres. Active phagocytosis of the treponemas by the intraepidermal macrophages (Langerhans cells) and by epidermocytes was shown. Necrosis and apoptosis of the immune cells, basophilic leukocytes degranulation and formation of the cellular symplasts with 3 to 5 lymphocytes were observed more frequently in the case of concomitant Chlamydia trachomatis infection. More vigorous response of the cells of derma on T. pallidum was characteristic of mixed infection (syphilis + chlamydiosis), but elimination of treponemas was not complete.

In vivo effect of metronidazole on the active oxygen production by neutrophils in the peripheral blood of patients with urogenital chlamydial infection (9 females and 7 males) was studied with the use of luminol dependent chemiluminescence. Metronidazole was administered orally in a dose of 250 mg twice a day for 10 days. Blood for the specimens was collected prior to the treatment and on the next day of the treatment course completion. No effect on the spontaneous and zymozan or phorbol-12-myristate-13-acetate stimulated chemiluminescence was observed, although a significant increase in the chemiluminescence indices was stated in 3 females and 1 male. It was suggested that the changes in the individual values of the neutrophil chemiluminescence after the treatment were associated with the influence of metronidazole and/or its metabolites on the blood cells and with different activity of the host enzymes participating in the drug biotransformation.

Examination of patients with inflammatory diseases of the genital organs showed high percentage of Chlamydia infection in male localized diseases accounting for 42.8%, 48.0%, and 57.1% in urethritis, urethroprostatitis, and infertility respectively. In a major proportion of cases (73.0%) Chlamydia infection occurred in association with different kinds of microorganisms (bacteria, protozoans, fungi of Candida genus, etc.) chlamydiae are considered to be the leading etiologic factor of the female genitalia inflammatory diseases accounting for 32.4 to 51.0% depending on the method of examination employed. The most effective treatment option was found to be that of combination of realdiron with sumamed.