Infectious factors of the brain damage in the long-term unconscious states

Serial immunological and neurologic evaluation, and testing forinfections was performed in 32 patients (m 23, f 9, 1458years) with chronic non-inflammatory unconscious states. Themain group of patients (n=18) received treatment for subclinicalinfections and other infectious agents revealed. Treatment in thecontrol group (n=14) was targeted only on community-acquiredand nosocomial microbiota. Markers of inflammatory intrathecalresponce of the central nervous system (CNS) were found in 88%(28/32) patients, and this was associated with Chlamydia spp. incerebrospinal fluid (CSF) and/or blood (р0.01). Markers ofvarious mmunopathological vasculites/vasсulopathies wererevealed in 84% patients (27/32), and the tendency of their interrelationwith Chlamydia spp. in comparison with other subclinicalinfections was found. In some cases clinical data was confirmedby autopsy results. In the main group of patients during treatmentwe found the changes of structure of immunopathological syndromeand appearance in the CSF and/or blood of previouslyundiagnosed subclinical infections with further sanation of latentinflammatory process. It was accompanied by neurophysiologicalsigns of disbalance of a stable pathological condition withimprovement of brain metabolism according to PET data. In thecontrol group the specified changes were not found, and theshort-term and long-term results of treatment were worse. Theobtained data showed that in patients with chronic non-inflammatoryunconscious states in the substance and in the vessels ofbrain develops latent inflammatory process with immunopathologicalcomponent associated with Chlamydia spp. and other subclinicalinfections. It appears to be the factor of additional braindamage that consolidates the pathological condition in CNS. Itis reasonable to consider this process during elaboration of tacticsof treatment for these patients.