Vol 7, No 1 (2017)



Antipova A.Y., Lavrentieva I.N.


Discovery of new parvoviruses led to taxonomical structure and the nomenclature of the Parvoviridae family reevaluation. There are two subfamilies: Densovirinae and Parvovirinae. Densovirinae subfamily consists of viruses of arthropoda. The Parvovirinae subfamily includes eight genuses of vertebrate animals viruses. In this review parvoviruses which are of interest to practical health care will be considered. Data on molecular and biological and virological characteristics of viruses, epidemiological and clinical features of the infections caused by these viruses are submitted. Parvoviruses which
are interesting for human health care belong to five genuses: Bocaparvovirus, Dependoparvovirus, Erythroparvovirus, Protoparvovirus and Tetraparvovirus. The most known person pathogenic parvovirus is the Primate erythroparvovirus 1 virus which was earlier called by Human parvovirus B19. It was discovered in 1975. It relates to the Erythroparvovirus genus. In this review the main attention is paid to less known viruses of this family. In viral lower respiratory tract infections structure the leading place is taken by Human Bocavirus — Primate bocaparvovirus 1 and Primate bocaparvovirus 2 relating to the Bocaparvovirus genus. In 2005, the virus of human, Primate tetraparvovirus 1, was discovered which belongs to the genus Tetraparvovirus. Clinically acute form of a tetraparvoviral infection is a top and lower respiratory tract and an alimentary tract disease. The virus possesses teratogenic action. Protoparvovirus genus representatives cause an alimentary tract disease also. Two species, pathogenic for the person are described. Bufavirus (Primate protoparvovirus 1) was found in 2012. Tuzavirus (Primate protoparvovirus 2, Tusavirus 1) was highlighted in 2014. Rodent protoparvovirus 1 which consist of rodents viruses is very interesting species for therapy of the human. Viruses of this species are capable to infect a wide range of human cancer cells, have the expressed carcinolytic properties and are perspective for treatment of person with a cancer. The human virus of the Dependoparvovirus genus called Human adeno-associated virus was discovered in 1965 in the drugs of an adenovirus. This virus isn’t associated with any disease however the virus can be located in a certain locus of the 19th human chromosome and is a perspective candidate like a vector for the treatment of genetic diseases.

Russian Journal of Infection and Immunity. 2017;7(1):7-20
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Kormilitcyna A.V., Kalinina N.M.


The publication provides an overview of current scientific and medical literature devoted to the study of mechanisms of immunopathogenesis of acne. The concept of the pathophysiology and immunopathogenesis of acne expanded significantly in recent years, many scientists have pointed out the link between the presence of acne and disorders of the endocrine, nervous, digestive and immune systems. Despite the fact that the individual links in the pathogenesis of acne are well studied, there are still questions about the role of commensal Propionibacterium acnes in the initiation and development of acne. So far there is no information on the number of P. acnes in healthy and diseased skin, the relationship between the numder of P. acnes and severity of the disease, also an important question remains unanswered — why do P. acnes cause inflammation for some people, while it don`t for the others? Despite the presence of bacterial factor in the pathogenesis of acne, there are a large number of studies showing that the nature of the patient’s immune response to P. acnes is more important than the infectious agent. For quite a long time data was received that proinflammatory cytokines play an important role in the initiation of acne. Interleukins IL-6 and IL-8 are involved in the stimulation of sebum hypersecretion, and subpopulation Th1 derived from a patient with acne, recognize P. acnes antigens. A number of recently obtained results suggest that P. acnes is a potent inducer of Th17 and Th1, and the study of the role of proinflammatory cytokines in the development of acne suggests new possibilities of acne therapy. Presented in this article is a clinical case clearly illustrates the part of the immune inflammation in acne. Prospective areas of research on the role of signaling molecules in the pathogenesis of acne are covered: such as the mechanism of action of nitric oxide on the secretion of interleukin IL-1 beta, which was shown as a dominant etiological factor in acne vulgaris, as well as an attempt to establish a link between the concentration of the neuropeptide substance P in the serum and the intensity psychological stress in the patients with acne in comparison with those in healthy persons. From the presented literature review it is shown that the immunopathogenesis of acne itself, as well as its connection with disturbances of the nervous, endocrine and digestive systems are the subject of intensive study of both dermatologists and clinical immunologists, who are inquired by patients with acne.

Russian Journal of Infection and Immunity. 2017;7(1):21-26
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Konshina O.S., Sominina A.A., Smorodintseva E.A., Stolyarov K.A., Nikonorov I.Y.


Analysis of changes in the population immunity level in adults for more than 20 Russian cities, collaborating with the Federal Center for Influenza, to circulating influenza viruses A(H1N1)pdm09, A(H3N2) and B in the period from 2009 to 2015 performed. By the beginning of the pandemic (October 2009) the population of Russia was almost seronegative to influenza A(H1N1)pdm09 virus. After the pandemia first wave mean geometric titers (GMT)s of antibodies to the pandemic virus increased by 2.6 times, after the second one by 4.9 times in comparison with initial GMT (1:5.5). A consistent increase in GMTs antibody after each of the subsequent seasons of active circulation of pandemic virus was observed reaching the maximum (1:41) by April 2013, after the next epidemic caused by this virus. The proportion of people with protective antibody titers in October 2009 to already started circulating influenza A(H1N1)pdm09 virus was 8.2%, to influenza A(H3N2) virus — 58.3%, and influenza B virus — 59.7%. Level of population immunity in adults to seasonal influenza A(H3N2) and B viruses throughout the observed period was significantly higher than to influenza virus A(H1N1)pdm09. The percentage of persons with protective antibody titers during the observed period varied for virus A(H3N2) in the range from 58.3 to 75.5%, for influenza B virus — from 59.7 to 82.3%. Accordingly, incidence rate for ILI and ARI in adult groups the population during influenza epidemic caused by these pathogens was lower than in the epidemics, associated with active circulation of influenza A(H1N1)pdm09 virus. The data obtained can be used in influenza forecasting for the upcoming season regarding the etiology and the expected epidemic intensity need for the relevant preventing measures development to decrease the burden from influenza.

Russian Journal of Infection and Immunity. 2017;7(1):27-33
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Vyazovaya A.A., Vetrov V.V., Lyalina L.V., Mokrousov I.V., Solovieva N.S., Zhuravlev V.Y., Vishnevskiy B.I., Narvskaya O.V.


In the late 90-ies of XX century in Russia there was an exacerbation of the epidemic situation of tuberculosis (TB) and “explosive” increase in pathogen drug resistances. Regardless of lower incidence of pulmonary TB in recent years, the number of cases caused by multidrug-resistant (MDR) mycobacteria was increasing due to a reduction in the effectiveness of treatment. Among the 11 subjects of the North-West Federal District the Leningrad Region is leading in the number of ineffective chemotherapy outcomes in newly diagnosed bacteriologically confirmed TB cases. A specific feature of the current epidemic situation in the Leningrad Region is the prevalence (74.1% in 2014) of MDR strains among previously treated patients with pulmonary TB. The aim of the research was a comparative genotypic characterization of Mycobacterium tuberculosis strains, isolated from patients with chronic pulmonary tuberculosis in the Leningrad Region in 1999–2004 and 2010–2014. As defined by spoligotyping, the Beijing family genotype was prevailing among M. tuberculosis strains of previously treated patients from Leningrad region (76.5% in 2010–2014 versus 56.3% in 1999–2004). The proportion of other genotypes strains — LAM and T decreased from 16.7 and 12.5% to 10.3 and 2.9%, respectively. The proportion of multi-drug resistance in the studied subpopulations of the Beijing genotype strains remained virtually constant (86.5 and 88.9%). The extensive drug resistance was not observed among MDR Beijing strains in 1999–2004, whereas in 2010–2014 it reached 33.3%. MIRU-VNTR-typing (12 loci) of 68 M. tuberculosis strains revealed 20 profiles; of these, five were presented by clusters MIT1, MIT46, MIT16, MIT17, MIT571, comprising two or more strains. The largest clusters MIT16 (223325153533) and MIT17 (223325173533) included 25 (48.1%) and 21 (40.4%) apparently highly transmissible Beijing genotype strains. Previously, clinical significance and mainly epidemic pathways for MDR M. tuberculosis Beijing strains belonging to these MIRU-VNTR-types were proved in a number of Russian regions. These findings require in-depth analysis of the situation in the region studied.

Russian Journal of Infection and Immunity. 2017;7(1):34-40
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Senyuta N.B., Ignatova A.V., Lomaya M.V., Goncharova E.V., Scherback L.N., Dushenkina T.E., Gugunov D.V., Mudunov A.M., Gurtsevitch V.E.


It is well known that the Epstein–Barr virus (EBV) being widely spread in the human population is also the etiologic agent for a number of malignancies. A notable feature of tumors associated with EBV is their different incidence in various geographical regions, that, as suggested, related with mutational events in multiple loci of the EBV genome and its oncogene, the latent membrane protein 1 (LMP1), associated with the transforming potential of the virus. Given the multi-ethnic composition of Russian population and the diversity of geographical areas and conditions of their residence, it was relevant to examine the representatives of different geographical regions for the nature of their relationship with EBV. To solve this task the antibody response to locally circulating EBV strains, determined by indirect immunofluorescence, was studied in residents of the Central, North Caucasus and Far Eastern Federal Districts, represented by healthy individuals and patients with various head and neck tumors. The levels of antibody titers obtained were compared with the incidence rates of nasopharyngeal tumors (NPT) in population of above Districts. In order to determine possible structural modifications in LMP1 gene of EBV strains persisting in selected geographic regions, samples of the gene have been amplified from a biological material collected by “nested” PCR and sequenced. The results obtained have shown that levels of antibody response to EBV among representatives of the regions included in the study vary significantly. It was found that in residents of the Dagestan and the Chechen Republics, the inhabitants of the North Caucasus Federal District, the correlation between enhanced humoral response to EBV and increased incidence of NPT was detected. Since among NPT the EBV-associated form of nasopharyngeal carcinoma (NPCEBV) is dominated, the findings allow us to suggest that the population of these Republics have genetic predisposition to increased EBV replication and, consequently, an elevated incidence of NPCEBV. The study also showed that representatives of the regions tested are infected with EBV strains, LMP1 variants of which such as B95.8, China 1, Med+, Med– and NC, are known in the literature. However, LMP1 variant, specifically associated with NPCEBV, has not been identified. This study showed for the first time the genetic heterogeneity of EBV strains circulating among population of different geographical regions of the country, and the existence of correlation between antibody response to EBV and the incidence of nasopharyngeal tumors, including NPCEBV.

Russian Journal of Infection and Immunity. 2017;7(1):41-50
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Savchenko A.A., Gvozdev I.I., Borisov A.G., Cherdancev D.V., Pervova O.V., Kudryavcev I.V., Moshev A.V.


The research aim was to study the phagocytic activity and the blood neutrophils respiratory burst state amongst the patients with widespread purulent peritonitis (WPP) in the dynamics of the postoperative period. The study was involved patients with acute surgical diseases and injuries of the abdominal organs complicated by WPP. Blood sampling was performed prior to surgery (pre-operative period) and at 7, 14 and 24 day post-operative period. The neutrophil phagocytosis level was determined by flow cytometry using FITC-labeled staphylococcal protein A. There was counted the percentage of fluorescent neutrophils (defined as the phagocytic index — PI) and average of the cell fluorescence (phagocytic number — PN). According to the fluorescence intensity divided phagocytic neutrophils in an active (high PN) and weakly phagocytic (low PN). Condition of the respiratory burst in the neutrophils was examined using a chemiluminescent assay. It was found that patients with WPP in the preoperative period had increased phagocytic activity of the blood neutrophils. The maximum phagocytic activity observed on day 7 of the postoperative period and by 24 days the number of phagocytic cells is reduced to control level whereas phagocytic activity of the cells remains at the preoperative level. In the preoperative period in patients with WPP the amount of active phagocytic blood neutrophils 3.3 times higher than the number of weakly phagocytic cells. By the end of the observation period the number of active and weakly phagocytic neutrophils returning to normal. In the study of the state of respiratory burst in the neutrophils by the WPP patients discovered that the primary synthesis levels of reactive oxygen species (ROS) increases only with 7 days of postoperative period and the induced activity of NADPH-oxidase remains elevated to the end of the observation period. At the same time, the synthesis of secondary ROS in the blood neutrophil of the WPP patients increased already in the preoperative period and remains high until the end of the survey. Using correlation analysis it was found that if healthy people had a competitive relationship between the level of synthesis of primary ROS and the activity of phagocytosis then all detected correlations in the WPP patients characterized by high level of coordination between the respiratory burst and the phagocytic activity of the neutrophils. These relationships are identified in the preoperative period, postoperatively do not exist. It can be assumed that the surgery and the subsequent treatment leads to complete incoordination in the neutrophils the mechanisms of phagocytosis and respiratory burst.

Russian Journal of Infection and Immunity. 2017;7(1):51-60
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Shipilov M.V., Tutelian A.V.


Interleukin-6 (IL-6) is a potent proinflammatory cytokine, which level is increased in the peripheral blood in many infectious diseases, including the flu A(H1N1)pdm09, in some cases (when the excess of his development of immune cells), resulting not only to strengthen the immune system, but also to the development of a “cytokine storm” is characterized by multi-organ failure and often followed by death. To reduce errors, increase the statistical power and increase the reliability of the results according to different researchers, as well as on the results of their own research was conducted a meta-analysis (a quantitative systematic review) of IL-6 studies in peripheral blood of patients with influenza A(H1N1) pdm09. Question: to determine with a high level of confidence, whether IL-6, a marker of the severity and prognosis of the disease. Searches were carried out research work on this subject in a variety of electronic databases (Medline, EMBASE, the Cochrane Controlled Trials Register, and others), reviews, theses, magazines, conference proceedings, and others. In the process of carrying out a meta-analysis of 5 scientific papers were selected that meet the criteria for inclusion/noninclusion in the study (characteristic of scientific papers, diagnostic criteria, age of patients, comparable groups of patients, the presence of self-control, research methodology, statistical criterion and the total number of independent stu dies). Selected studies have shown sufficient uniformity (homogeneity) comparison groups. The results of the meta-analysis are presented in tables, charts and blobogramme, meta-analysis of 5 scientific papers showed that in moderate and severe influenza A(H1N1)pdm09 noted a significant increase in the concentration of IL-6 in peripheral blood of patients compared with the control a group of individuals (healthy). Severe influenza A(H1N1)pdm09 with a high probability of death is characterized by an even greater increase in IL-6 levels (in comparison with the moderate flow) — 11 pg/ml or more. Thus, the results of a meta-analysis of IL-6 with a high degree of probability is defined as a biomarker of disease severity and prognosis of development. At the same time, a result of meta-analysis of observed quite significant changes of the absolute values of the concentration of IL-6 in peripheral blood, which can be explained by using various test patterns and laboratory equipment, so that necessary to accumulate research experience level IL-6 on one and the same test systems and laboratory equipment.

Russian Journal of Infection and Immunity. 2017;7(1):61-68
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Mamaeva T.A., Zheleznova N.V., Nаumova M.A., Chekhlyaeva T.S., Vorobeychikovc E.V., Ben Mamou M., Aleshkin V.A.


To estimate ELISA serological studies results of IgM and IgG specific Measles and Rubella Viruses (MRV) antibodies detection the “in-house” laboratory controls (ILC) including the specific markers of MRV infections were for the first time commercially prepared by the Vector Best PLC (Russia): “Measles-IgM, ser.1”, “Measles-IgM, ser.2”, “Rubella-IgM”, Measles-IgG” and “Rubella-IgG”. This task was realized under the special Executive Order of the Government of Russia N 523-r, 2014, April, 4. According to passport characteristics ILC samples are the lyophilized human sera, inactivated by heating (1 hour at 56°C) and stabilized by the mixture of sucrose (5%) and ProClin-3000 as the conservation agent. Samples are free of HBs Ag, anti-HVC, T.Pallidum, HIV-1/2, HIV-1Ag р24.The aim of the study was to evaluate the possibility of using the ILC for detection of the MRV IgM and IgG antibodies by ELISA with commercial ELISA kits used in Russia and CIS countries. In the process of detecting the specific activity of “Measles-IgM, ser.1”, “Measles-IgM, ser.2” and “Rubella-IgM” by ELISA kits of different formats (Vector Best, EcoLab and Siemens Companies) the statistically different results were received (p < 0.05). The optical density (OD) values of IgM in the “Measles-IgM, ser.1” and “Measles-IgM, ser.2” ILC, obtained by ELISA “VectoMeasles IgM” (Vector Best) were significantly higher than those obtained by ELISA IgEnzygnost®Anti-MeaslesVirus/IgМ. These values consisted for the ser. 1–1.33±0.02 о.u. vs. 0.18±0.01 о.u. (р < 0.05) and for the ser. 2–2.83±0.03 о.u. vs. 0.7±0.02 о.е. (р < 0.05) in the Vector Best and Siemens ELISA kits correspondently. In the “Rubella-IgM” ILC the OD values of the specific IgM by the “ELISA-Rubella IgM” EcoLab were also higher than those obtained by IgEnzygnost®Anti-RubellaVirus/IgМ ELISA kit. These values consisted 2.92±0.04 о.u. vs. 0.88±0.03 о.u. (р < 0.05) in EcoLab and Siemens ELISA test-systems correspondently. In the studies when the ILC working solution parameters for ELISA of “capture” and “indirect” formats were evaluated the statistic reliability and high information capability of the mathematic models of the OD value changes vs. the degree of dilution of the initial ILC were determined. For the “capture” and “indirect” formats the determination coefficient (R2) consisted 97.34 and 99.29 correspondently, the Fisher criteria (F) — 219.62 and 556.55 correspondently, the significance level (p) — < 0.05 for both formats. The evaluated optimal working dilution degrees of the IgM-containing ILC make possible to exclude the influence of the IgG antibodies as the non-target marker in the ILC. On the other hand, taking into account the format of the used ELISA kit the optimal working dilution degrees give the possibility to obtain the desirable 2–3 “cut-off” values of the specific marker. Moreover, the issue of the target marker quantitative content in ILC is discussed in the study. In order to improve the quality of the commercial MRV IgM and IgG ELISA test-systems the joint studies with those who develop and produce these systems are desirable to be organized.

Russian Journal of Infection and Immunity. 2017;7(1):69-78
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Popova A.Y., Bichurina M.A., Lavrentyeva I.N., Zheleznova N.V., Antipova A.Y., Shcherbakova S.A., Boiro M.Y., Totolian A.A.


A goal for measles elimination globally by 2010–2020 was recognized as one of the priorities in the WHO program “Health for All in the 21st Century” (1998). However measles outbreaks occurred in 2010–2016 in countries with high level of measles vaccine coverage including USA and some European countries.Large measles outbreaks were also registered on the African continent and particular in the Republic of Guinea as a result of the decline of measles vaccine coverage due to the Ebola virus epidemic in the Republic of Guinea in 2014–2015. WHO recommends carrying out the routine measles vaccination as well as the supplemental immunization activities after the stop of the Ebola virus transmission. Effectiveness of the activities is definitely connected with the detection of the epidemically significant for the supplemental immunization age groups. The aim of the study was to evaluate the measles immunity level in different age groups of population in the Republic of Guinea. Materials and methods. Twenty five blood serum samples of healthy adult Guineans aged 28–66 and 121 blood serum samples of adolescences and adults admitted to hospital in the town of Kindia (Republic of Guinea) for indoor treatment were tested by ELISA. The specific measles virus antibodies were detected using the following commercial ELISA test-systems produced by Euroimmun Medizinische Labordiagnostika AG Company (Germany): IgM-antibodies — by “Anti-Measles Virus ELISA (IgM)”, IgG-antibodi es — by “Anti-Measles Virus ELISA (IgG)”, IgG-avidity measles virus antibodies — by “Avidity: Anti-Measles Virus ELISA (IgG)”. A part of sera was studied by “Vector-Best IgM-measles” and “Vector-Best IgG-measles” ELISA test-systems (Russia). Results and discussion. The comparative quantitative study of the measles immunity level (i.e. IgG-antibodies titers) of the healthy adult Guineans in 2015 and 2016 revealed the lack of IgGantibodies in serum of only one person aged 30. In 68.7% of cases studied the IgG-antibodies titers didn’t change significantly during the year. In the most part (68.0%) of the 25 tested sera the high levels of the IgG-antibodies titers were detected (≥ 1000 IU/L). In addition the IgG-antibodies of high avidity were revealed in the most part (87.5%) of blood serum samples thus evidencing the history of measles virus infection in the past among the examined adults aged 28+. The ELISA studies of 121 blood serum samples from patients with different clinical diagnosis being on indoor treatment in the hospital of the town of Kindia (Republic of Guinea) revealed 21 anti-measles IgG negative patients. Among patients with the known age (n = 113) IgG-antibodies to measles virus were determined in 78.8% of the samples tested. At the same time in each age group the seronegative patients as well as the patients with low titers of the specific IgG-antibodies to measles virus were revealed. Among patients of 18–40 years of age the part of seronegative patients was equal to 28.5±5.1%. This cohort may be susceptible to measles virus infection and facilitate the support as well as the development of active epidemic process in case of measles outbreaks in the Republic of Guinea.

Russian Journal of Infection and Immunity. 2017;7(1):79-84
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Kurtasova L.M., Shakina N.A., Ikkes L.A.


Objective: to measure cell susceptibility of peripheral blood leukocytes to interferon-α2 in vitro at children during the acute period in 1 and 6 months after infectious mononucleosis caused by the Epstein–Barr virus. 47 children aged 4–6 years with moderately severe form of the disease in the acute period of infectious mononucleosis caused by the Epstein–Barr virus (EBV) were examined, as well as in 1 month (n = 17) and 6 months (n = 11) after the disease. The focus group consisted of 36 nearly healthy children. The cell susceptibility to interferon-α2 in vitro was determined by the method of Kurtasova L.M. et al. (2007). Chemiluminescence of blood leukocytes was studied by De Sole et al. (1983). The susceptibility change of peripheral blood leukocytes to interferon-α2 in vitro at children with infectious mononucleosis caused by Epstein–Barr virus in dynamics of the disease has been revealed. The expansion of the range of cell susceptibility to interferon-α2 in 6 months after the disease has been enclosed. The dependence of the susceptibility of peripheral blood leukocytes to interferon-α2 in vitro on the dose and the period of the disease has been fixed.

Russian Journal of Infection and Immunity. 2017;7(1):85-90
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Kostyuchenko M.V., Ponomarenko D.G., Rakitina E.L., Logvinenko O.V., Sannikova I.V., Dejneka D.A., Golub O.G.


The brucellosis remains to one of the most urgent dangerous infections in regions with developed livestock production. An exclusive polymorphism of symptoms, variety of forms of a disease, small informational content of results of routine laboratory all-clinical inspection, quite often leads to diagnostic mistakes at a pre-hospital stage. Improvement of a complex of laboratory diagnosis of a brucellous infection demands development of the modern padding methods of verification based on cell-like factors of immunity as leaders in an immunogenesis and a pathogenesis of a brucellosis. Considering the leading role of cell-like immunity in formation of protection against the majority of bacteriemic especially dangerous infections, studying of cell-like reaction in response to antigenic stimulation, it is necessary to consider the most informative (marker) and objective at assessment of immunologic reorganization of an organism at a disease or vaccination. The following markers (receptors) of activation of lymphocytes can act as perspective indexes of a specific cell-like antigenreactivity: CD25 — a high-affine receptor of interleukin 2 (IL-2Ra), a marker of early activation of Tlymphocytes; HLA-DR — an antigen of the main complex of a histocompatibility of a class II, an expression of a marker is associated not only with late, but also long-lived activation of lymphocytes; CD95 (Fas, APO-1) — a receptor of an induction of an apoptosis (“cell death”), a marker of “late” activation (CD4+ lymphocytes is presented mainly) and Fas L (CD178) — a receptor of an induction of an apoptosis, expresses generally on CD8+ cages. The work purpose — to estimate an opportunity and prospects of use of technology of a flowing cytofluorometry and the in vitro cell tests for diagnosis of a acute brucellosis. 35 people with the diagnosis “Acute brucellosis” and 12 people — not the patients who did not have a brucellosis, are not vaccinated against a brucellosis (control group) participated in a research. Blue blood served as material of a research. Defined quantity of the lymphocytes expressing receptors of CD25, HLA-DR, CD95, CD95L (CD178) at activation by a specific antigen. The received results processed statistically with use of Microsoft Excel 2010. During the research it is established that intensity an antigen-stimulated activation of lymphocytes of in vitro, it is possible to use as a marker of a acute brucellous infection at the person. The most perspective indexes of activation of lymphocytes of in vitro, it is possible to consider receptors to IL-2 (CD25) and apoptosis markers — CD95, CD95L (CD178). Thus, the conducted researches indicate an opportunity and the actual prospect of use of technology of a flowing cytofluorometry and cell-like in vitro tests for diagnostics of a acute brucellosis.

Russian Journal of Infection and Immunity. 2017;7(1):91-96
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