Search academic texts

Information × Registration Number 0220U001086, 0117U000420 , R & D reports Title Features of clinical course and immunopathogenesis of nervous system lesions in herpes virus infection and Lyme-borreliosis, improvement of diagnostics and treatment algorithms popup.stage_title Head Rudenko Antonina, Доктор медичних наук Registration Date 22-01-2020 Organization Киевский НИИ эпидемиологии и инфекционных болезней им. Л.В. Гpомашевского popup.description2 TFeatures of clinical course and immunopathogenesis of nervous system lesions in herpes virus infection and Lyme-borreliosis, improvement of diagnostics and treatment algorithms The aim of the work is to determine the main clinical variants and peculiarities of the modern course of nervous system infections, to establish the main links of pathogenesis of lesions of the nervous system of herpesvirus and borelion etiology through a comprehensive study of the functioning of the immune system and its connection with the activity of the infectious process. To develop and implement local protocols for diagnostics and treatment of herpesvirus nervous system lesions and systemic tick-borne borreliosis. Research methods: comprehensive clinical examination of patients in the dynamics of the disease, brain and spinal cord MRI, ECG, indicators of immune status, kEEG, statistical processing. 412 patients with nervous system lesions caused by herpes family viruses were examined. The data presented show the main clinical characteristics of herpesvirus CNS lesion. An unnatural gender ratio of patients with a high prevalence of women was found. Cephalgic, vestibuloatactic syndromes, vegetative dysfunction and pyramidal disorders prevailed in the clinical state. Efficacy of ipidacrine use was studied in 24 patients with lesions of herpesvirus nervous system. A group of 112 patients with an established diagnosis of Lyme disease were also examined. A control group of 40 practically healthy people was formed. In 48 patients with Lyme disease with identified pathological MRI changes an additional study of the liquor on Borrelia s.s. was carried out. In the course of the research, the Institute of Epidemiology and Infectious Diseases named after L.V. Gromashevskiy National Academy of Medical Sciences of Ukraine was established. It is shown that in the severe course of lesions of the nervous system of herpesvirus etiology the manifestations of T-cell immune response deficiency and the severity of autoimmune reactions are more pronounced. It is shown that in the severe course of herpesvirus lesions of the nervous system there is a more pronounced decrease in the level of T-helpers and increase in the number of B-lymphocytes, suppression of biocidal activity of neutrophils, increase in the level of autoantibodies, thereby sharply reducing the effectiveness of the immune response. Correlation analysis between clinical and immune statuses of patients on herpesvirus lesions of the nervous system was performed. It was shown that the severity of clinical syndromes directly depends on the duration of the disease, the immune cellular link and the level of autoantibodies to neurointigens. In the course of ipidacrine treatment of patients with herpesvirus nervous system disorders, there was a decrease or disappearance of neurological symptoms (in 91.7%), such as sensory and motor disorders, cognitive disorders, memory improvement, reduction of emotional lability. Ipidacrine is a safe and effective pathogenetic agent for herpesvirus lesions of the central and peripheral nervous system and is well tolerated. The polymorphism of nervous system lesions was studied at the chronic stage of CHL with predominant HC lesion, in the structure of which CNS lesions prevailed - 83.0% of patients. The relative frequency of signs of pathological changes in the nervous system, manifested in a number of syndromes, has been determined: encephalopathy - 39.3%, diencephalic - 21.4%, scattered encephalomyelitis - 6.3%, polydiculo-neuropathy - 43.8%, lesions of cranial nerves - 6.3% of cases. Patients with chronic forms of CHL with predominant NS lesions have the frequency of lesions of other organs and systems: musculoskeletal system - 33.9%, cardiovascular system - 22.3%, and skin - 9.8%. In this connection, patients with chronic forms of CHL should be examined for concomitant pathology and provide appropriate recommendations for monitoring. The diagnostic significance of the EEG method in patients with nervous system lesions in case of systemic tick-borne borreliosis has been proved, and a high frequency of disorganization of the main ?-rhythm (42.7% of cases) has been established, which was observed against the background of ?-activity increase with interhemispheric asymmetry, which indicates the development of pathological process involving deep structures of the brain and cortex. Diagnostic expediency of application of the method of cognitive evoked potentials P300 to detect cognitive disorders in the form of memory impairment and targeted attention and related CNS lesions in patients with CL has been proved. A sensitive indicator of such cognitive disturbances has been revealed, which is manifested by a decrease in cortical activity of the brain in the form of a decrease in the latent period of P300 by an average of 3-4% and an increase in the amplitude of P300 by an average of 10% compared to the control group. Intrathecally humoral immune response in the group of patients under study is likely to be associated with chronic inflammatory process of autoimmune nature. According to the results of the work 3 innovations were made, 16 reports were made at scientific and practical conferences, 17 articles were published, 10 of them were published in foreign journals and collections, 21 theses. PhD thesis on "Clinical and instrumental features of chronic forms of Lyme disease with predominant lesions of the nervous system and improvement of their treatment tactics" was created. Prepared local protocols for the treatment of patients with lesions of the nervous system of herpesvirus and borreliosis Product Description popup.authors Андреєва О.Г. Дьяченко П.А. Клюс В.Ю. Муравська Л.В. Пархомець Б.А. Руденко Антоніна Олексіївна popup.nrat_date 2020-04-02 Close