RU2734820C2 - Method for prediction of bacterial translocation in chronic echinococcosis - Google Patents

Abstract

FIELD: medical microbiology.

SUBSTANCE: invention can be used for prediction of bacterial translocation in chronic echinococcosis. That is ensured by determining the immunological blood indices, the intensity of cell and humoral immunity and with the preoperative level reduction compared to the control of total T-lymphocytes from 1301 to 1065.5, T-helpers from 842 to 673, T-suppressors from 349 to 238, B-lymphocytes from 485 to 217 and if observing an increase in pre-operative preoperative values compared to IgE control from 28.6 to 54.2, IgG from 800 to 5868, IgM from 60 to 278.7, IgA from 90 to 425.2, SIgA from 266.8 to 551.4, translocation of bacteria is predicted in chronic echinococcosis.

EFFECT: use of the given method enables predicting infectious complications, particularly translocation of bacteria in chronic echinococcosis, which contributes to the timely prescription of the antibacterial therapy.

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Description

The invention relates to medical microbiology and can be used as a method for predicting bacterial translocation in chronic echinoccosis.

A known method for predicting the translocation of bacteria with mechanical obstruction of the small intestine (1 - Bulletin VSNTS SB RAMS, 2008, 4 (62): 76-79), taken as an analogue.

As a prototype, a method for predicting the translocation of bacteria into the blood in generalized periodontitis is adopted, according to which pure cultures of symbiont strains are isolated from the biocenosis of the periodontal pocket, they are identified, the number and direction of signals received and emitted by each symbiont strain according to hemolytic activity (GA) are determined according to antilysozyme activity (ALA) and growth in relation to other symbiont strains, if the symbiont strain received signals to enhance hemolytic activity of more than 25% of the total number of received signals on the biocenosis to enhance GA, ALA and growth and / or signals to enhance antilysozyme activity of more than 30% or more, and / or signals are given to suppress the growth of other symbiont strains 20% or more of the total number of signals given by the biocenosis to suppress GA, ALA and growth, predict the translocation of this symbiont strain into the blood (2 - Patent RF No. 2472858, 2011 IPC C12Q 1/02). However, using this method it is impossible to accurately predict the translocation of bacteria into the blood in chronic echinoccosis.

The purpose of the invention is to improve the accuracy of predicting the translocation of bacteria into the blood in chronic echinoccosis.

The technical result is achieved by the fact that the intensity of cellular and humoral immunity is additionally determined and with a decrease in the level of the indicator before the operation compared to the control of total T-lymphocytes 1301 to 1065.5, T-helpers from 842 to 673, T-suppressors from 349 to 238, B-lymphocytes from 485 to 217 and with an increase in the level of indicators before surgery compared to control IgE from 28.6 to 54.2, IgG from 800 to 5868, IgM from 60 to 278.7, IgA from 90 to 425.2, SIgA from 266.8 to 551.4 predict bacterial translocation in chronic echinococcosis.

The method is implemented as follows.

Patients are admitted to the clinic with a diagnosis of echinococcal cyst of the liver. Complaints of minor recurrent pain in the right hypochondrium.

The patients' condition is satisfactory. The skin is of normal color. The rib cage is symmetrical, painless on palpation. The boundaries of the heart are not expanded. Heart sounds are rhythmic, sonorous. The tongue is clean and moist. The abdomen is not swollen, symmetrical, participates in the act of breathing, on palpation it is soft, moderately painful in the right hypochondrium. Intestinal peristalsis is heard. There are no peritoneal symptoms. With abdominal percussion, there is no accumulation of fluid in sloping places. Liver along the edge of the costal arch. The spleen is not enlarged during percussion, not palpable. Stool - there is a tendency to constipation.

According to ultrasound data: the liver is not enlarged in size. The contours are smooth and clear. The structure of the parenchyma is heterogeneous, with increased echogenicity. Against this background, the projection of the liver segments is determined by a fluid formation, of an irregular rounded shape in a dense layered capsule with multiple internal septa. The vascular pattern is preserved. Intra- and extrahepatic bile ducts are not dilated. Hepaticoholedochus of usual diameter, free lumen.

Operation: echinococcectomy, subtotal pericystectomy, atypical resection of damaged liver segments. Laparotomy. The left lobe is completely replaced, compresses and pushes the medially damaged segments. The lymph nodes are enlarged.

During the mobilization of the cyst, venous blood was obtained from the mesentery of the intestine, blood from the peripheral vein, and a biopsy of the lymph node was performed for microbiological examination. Microbiological examination in the lymph node at the beginning of the operation revealed the growth of S. aureus and B. fragilis

Then the fibrous capsule of the cyst was opened, echinococcectomy was performed with a vacuum aspirator. The residual cavity was treated with a hypertonic sodium chloride solution. Hemostasis. After that, a repeated sampling of biological material was performed (venous blood from the mesentery of the intestine, blood from a peripheral vein, biopsy of the lymph node). Repeated microbiological examination in the lymph node revealed the growth of S. aureus, B. fragilis and Prevotella melaninogenicus.

Bacteriological examination of venous blood from the mesentery of the intestine, blood from the peripheral vein did not reveal the growth of microflora.

An immunological study was carried out, in which the tension of cellular and humoral immunity was determined and with a decrease in the level of the indicator before the operation compared to the control of total T-lymphocytes 1301 to 1065.5, T-helpers from 842 to 673, T-suppressors from 349 to 238, B - lymphocytes from 485 to 217 and with an increase in the level of indicators

before surgery compared to control IgE from 28.6 to 54.2, IgG from 800 to 5868, IgM from 60 to 278.7, IgA from 90 to 425.2, SIgA from 266.8 to 551.4 predict bacterial translocation with chronic echinococcosis. On the basis of immunological studies, a decrease in indicators of cellular immunity and an increase in humoral immunity were determined. Based on the analysis performed, translocation of bacteria into the blood was predicted.

In the postoperative period, the normalization of indicators of the cellular component of immunity was noted. In the state of the humoral link of immunity, the increased content of Ig G. and SIgA remained. The level of antigen-specific CEC and IgM decreased to normal values.

The postoperative period was free of infectious complications.

Thus, the obtained results of the study allow us to conclude that in patients with an echinococcal cyst of the liver, an immune deficiency of the cellular type was detected before the operation: depression was noted as T-total. lymphocytes and their subpopulations.

The method is confirmed by the following examples.

Example 1

Patient F., 33 years old, was admitted to the clinic with complaints of minor recurrent pain in the right hypochondrium, which bothered for a year. The patient's condition is satisfactory. The skin is of a physiological color. The rib cage is symmetrical, painless on palpation. With auscultation of the lungs, vesicular breathing is carried out in all parts of the lungs, there is no wheezing. Respiration rate is 16 per 1 min. The boundaries of the heart are not expanded. Heart sounds are rhythmic, sonorous. HELL 130/90 mm Hg. Pulse 74 per minute. rhythmic, satisfying filling and tension. The tongue is clean and moist. The abdomen is not swollen, symmetrical, participates in breathing, soft on palpation, moderately painful in the right hypochondrium. There are no peritoneal symptoms. With abdominal percussion, there is no accumulation of fluid in sloping places. Liver along the edge of the costal arch. The spleen is not enlarged during percussion. Stool - a tendency to constipation.

According to ultrasound data: the liver is not enlarged in size. The structure of the parenchyma is heterogeneous, with increased echogenicity. In the projection of the IV and partially II-III segments, a liquid formation is determined, of an irregular rounded shape in a dense layered capsule, up to 6 mm thick, with the presence of multiple internal partitions, with somewhat heterogeneous contents, dimensions 85 × 95 × 127 mm. The mass is projected onto the portal vein bifurcation area. The vascular pattern is preserved. Intra- and extrahepatic

the bile ducts are not dilated. Hepaticoholedoch with a diameter of 8.3 mm, the lumen is free. The gallbladder was removed.

When examining: SCT - in segment IV with extension to segments II and III, an oval-shaped volumetric formation is determined, measuring 90, (× 70.0 mm. The content of the formation is a liquid with a density of 3 units. Inside the formation of a septum, without soft tissue components. Capsule 2 , 0 mm, no calcifications Contrast substance does not accumulate Intra- and extrahepatic bile ducts are not dilated Choledoch with a diameter of 8 mm.

Diagnosis: echinococcal cyst of the left lobe of the liver. Diabetes mellitus type 2, moderate to severe, is compensated.

Operation: echinococcectomy, subtotal pericystectomy, atypical resection of the P-III liver segments. Laparotomy. The left lobe is completely replaced, compresses and pushes medially II and III segments. A cyst with a diameter of about 10 cm with fibrin deposits on the wall is located. Lymph nodes are enlarged up to 1 cm.

During the mobilization of the cyst, venous blood was obtained from the mesentery of the intestine, blood from the peripheral vein, and a biopsy of the lymph node was performed for microbiological examination. Microbiological examination in the lymph node at the beginning of the operation revealed the growth of S. aureus and B. fragilis.

The fibrous capsule of the cyst was opened, echinococcectomy was performed with a vacuum aspirator. The residual cavity was treated with a hypertonic sodium chloride solution. Hemostasis was performed. Then repeated sampling of biological material (venous blood from the mesentery of the intestine, blood from the peripheral vein, biopsy of the lymph node) was performed. Repeated microbiological examination in the lymph node revealed the growth of S. aureus, B.fragilis.

Bacteriological examination of venous blood from the mesentery of the intestine, blood from a peripheral vein, microflora growth was not detected.

An immunological study was carried out, in which the tension of cellular and humoral immunity was determined and with a decrease in the level of the indicator before the operation compared to the control of total T-lymphocytes 1301 to 1065.5, T-helpers from 842 to 673, T-suppressors from 349 to 238, B - lymphocytes from 485 to 217 and with an increase in the level of indicators before surgery compared to control IgE from 28.6 to 54.2, IgG from 800 to 5868, IgM from 60 to 278.7, IgA from 90 to 425.2, SIgA from 266.8 to 551.4 they predict bacterial translocation in chronic echinococcosis.

Perioperatively for prophylactic purposes, the patient received intravenous ofloxacin at a dose of 400.0 mg per day for 3 days.

In the postoperative period, the normalization of indicators of the cellular component of immunity was noted. In the state of the humoral link of immunity, the increased content of Ig G. and SIgA remained. The level of antigen-specific CEC and IgM decreased to normal values.

The postoperative period proceeded without infectious complications, the patient was discharged from the clinic in a satisfactory condition.

Example 2

Patient 3., 49 years old, on admission presents complaints of recurrent pain in the right hypochondrium, noted by the patient for three years.

The patient's condition is satisfactory. The skin is of normal color. The rib cage is symmetrical, painless on palpation. With auscultation of the lungs, vesicular breathing is carried out in all parts of the lungs, no wheezing. Respiration rate is 18 per 1 min. The boundaries of the heart are not expanded. Heart sounds are rhythmic, sonorous. BP 135/95 mm Hg. Pulse 76 / min. rhythmic, increased filling and tension. The tongue is coated. The abdomen is not swollen, symmetrical, participates in the act of breathing, on palpation it is soft, moderately painful in the right hypochondrium. Intestinal motility is reduced. There are no peritoneal symptoms. With abdominal percussion, there is no accumulation of fluid in sloping places. Liver along the edge of the costal arch. The spleen is not palpable. Stool - there is a tendency to constipation.

Ultrasound of the liver: The contours are even, clear, the sizes are normal. The structure of the parenchyma is heterogeneous, with increased echogenicity. Against this background, in the projection of the IV and partially III segments, a liquid formation is determined, of an irregular rounded shape in a dense layered capsule, up to 5 mm thick, with the presence of internal partitions, with inhomogeneous contents, dimensions 75 × 85 × 117 mm. The vascular pattern is preserved. Intra- and extrahepatic bile ducts are not dilated. Hepaticoholedoch with a diameter of 10 mm, the lumen is free.

Examination: SCT - in segment IV with extension to segment III, an oval-shaped volumetric formation, 80.0 × 65.0 mm in size, is determined. The content of the formation is a liquid with a density of 2.5 units. Inside baffle formation, no soft tissue components. Capsule 2.0 mm thick, no calcifications. The contrast agent does not accumulate. The intra- and extrahepatic bile ducts are not dilated. Choledoch with a diameter of 7.5 mm

Conducted laparotomy, echinococcectomy, subtotal pericystectomy, atypical resection of P-III liver segments. The left lobe is completely replaced, squeezes and pushes medially the III segment. A cyst with a diameter of about 10 cm with fibrin deposits on the wall. Lymph nodes are enlarged up to 1 cm

During the mobilization of the cyst, venous blood was obtained from the mesentery of the intestine, blood from the peripheral vein, and a biopsy of the lymph node was performed for microbiological examination. Microbiological examination in the lymph node at the beginning of the operation revealed the growth of S. aureus and B. fragilis

Then the fibrous capsule of the cyst was opened, echinococcectomy was performed with a vacuum aspirator. The residual cavity was treated with a hypertonic sodium chloride solution. After that, a repeated sampling of biological material was performed (venous blood from the mesentery of the intestine, blood from a peripheral vein, biopsy of the lymph node). Repeated microbiological examination in the lymph node revealed the growth of B. fragilis and Prevotella melaninogenicus.

Bacteriological examination of venous blood from the mesentery of the intestine, blood from the peripheral vein did not reveal the growth of microflora.

Immunological research. When studying the parameters of immunity, an increase in T-help and a decrease in T-sup was revealed. Spontaneous chemiluminescence is increased. At the same time, a decrease in phagocytic activity was also noted, and the level of the phagocytic index was very low. The indices of the humoral link of immunity were manifested by an increase in IgG.JgE and SIgA.

Perioperatively for prophylactic purposes, the patient received intravenous ofloxacin at a dose of 400.0 mg per day for 3 days.

In the postoperative period, the normalization of indicators of the cellular component of immunity was noted. In the state of the humoral link of immunity, the increased content of Ig G. and SIgA remained. The level of antigen-specific CEC and IgM decreased to normal values.

As a result of the conducted microbiological studies of biopsies of the lymph nodes of the colon splash, blood cultures from the portal and peripheral vein systems in the patient during the operation, the following conclusions can be drawn:

(the presence of microorganisms in the lymph nodes and in the blood of patients at the beginning of the operation indicates their translocation to places that must be sterile;

(the cause of microbial translocation is the presence of a pronounced pathological process (echinococcal cyst of the liver);

(quantitative and qualitative changes in the microflora isolated from biosubstrates during surgery indicate an increase in microbial translocation;

(the presence of microbial translocation in a patient with an echinococcal cyst of the liver can be considered as one of the complex mechanisms for the development of a probable infectious complication that requires prophylactic antibacterial drugs.

According to the claimed method, tests were carried out on 31 patients. Tests have confirmed the achievement of the aim of the invention - increasing the accuracy of predicting the translocation of bacteria into the blood in chronic echinoccosis.

Sources of information:

1 - Bulletin of VSNTs SB RAMS, 2008, 4 (62): 76-79

2 - RF Patent No. 2472858, 2011, IPC C12Q 1/02

Claims (1)

A method for predicting the translocation of bacteria in chronic echinococcosis by determining the immunological parameters of blood, characterized in that it additionally determines the intensity of cellular and humoral immunity and when the level of the indicator decreases before surgery compared to the control of total T-lymphocytes from 1301 to 1065.5, T-helpers with 842 to 673, T-suppressors from 349 to 238, B-lymphocytes from 485 to 217 and with an increase in the level of indicators before surgery compared to IgE control from 28.6 to 54.2, IgG from 800 to 5868, IgM from 60 to 278.7, IgA from 90 to 425.2, SIgA from 266.8 to 551.4 predict bacterial translocation in chronic echinococcosis.