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

Cover Page

Abstract

Serial immunological and neurologic evaluation, and testing for infections was performed in 32 patients (m – 23, f –9, 14–58 years) with chronic non-inflammatory unconscious states. The main group of patients (n=18) received treatment for subclinical infections and other infectious agents revealed. Treatment in the control group (n=14) was targeted only on community-acquired and nosocomial microbiota. Markers of inflammatory intrathecal responce of the central nervous system (CNS) were found in 88% (28/32) patients, and this was associated with Chlamydia spp. in cerebrospinal fluid (CSF) and/or blood (р<0.01). Markers of various mmunopathological vasculites/vasсulopathies were revealed in 84% patients (27/32), and the tendency of their interrelation with Chlamydia spp. in comparison with other subclinical infections was found. In some cases clinical data was confirmed by autopsy results. In the main group of patients during treatment we found the changes of structure of immunopathological syndrome and appearance in the CSF and/or blood of previously undiagnosed subclinical infections with further sanation of latent inflammatory process. It was accompanied by neurophysiological signs of “disbalance” of a stable pathological condition with improvement of brain metabolism according to PET data. In the control group the specified changes were not found, and the short-term and long-term results of treatment were worse. The obtained data showed that in patients with chronic non-inflammatory unconscious states in the substance and in the vessels of brain develops latent inflammatory process with immunopathological component associated with Chlamydia spp. and other subclinical infections. It appears to be the factor of additional brain damage that consolidates the pathological condition in CNS. It is reasonable to consider this process during elaboration of tactics of treatment for these patients.

About the authors

J. I. Vaynshenker

N.P. Bechtereva Institute of the Human Brain RAS (St. Petersburg)

Author for correspondence.
Email: platonova@neurology.ru
Russian Federation

I. M. Ivchenko

N.P. Bechtereva Institute of the Human Brain RAS (St. Petersburg)

Email: platonova@neurology.ru
Russian Federation

V. A. Zinserling

St. Petersburg Research Institute of Phthisiopneumology

Email: platonova@neurology.ru
Russian Federation

A. D. Korotkov

N.P. Bechtereva Institute of the Human Brain RAS (St. Petersburg)

Email: platonova@neurology.ru
Russian Federation

L. A. Melucheva

N.P. Bechtereva Institute of the Human Brain RAS (St. Petersburg)

Email: platonova@neurology.ru
Russian Federation

G. V. Kataeva

N.P. Bechtereva Institute of the Human Brain RAS (St. Petersburg)

Email: platonova@neurology.ru
Russian Federation

S. V. Lapin

Molecular medicine center of I.P. Pavlov Medical University

Email: platonova@neurology.ru
Russian Federation

I. V. Nuralova

Military Medical Research Institute

Email: platonova@neurology.ru
Russian Federation

O. V. Khlopunova

Military Medical Research Institute

Email: platonova@neurology.ru
Russian Federation

L. A. Beresina

Military Medical Research Institute

Email: platonova@neurology.ru
Russian Federation

L. B. Kulyashova

St. Petersburg Pasteur Institute

Email: platonova@neurology.ru
Russian Federation

A. A. Vyazovaya

St. Petersburg Pasteur Institute

Email: platonova@neurology.ru
Russian Federation

O. V. Kalinina

St. Petersburg Pasteur Institute

Email: platonova@neurology.ru
Russian Federation

S. V. Medvedev

N.P. Bechtereva Institute of the Human Brain RAS (St. Petersburg)

Email: platonova@neurology.ru
Russian Federation

References

  1. Бехтерева Н.П. Здоровый и больной мозг. 2 изд. перераб и дополн . Л.: Наука, 1988.
  2. Вайншенкер Ю.И., Ивченко И.М., Нуралова И.В. и др. Хроническая хламидийная инфекция как причина демиелинизации и васкулита центральной нервной системы. Некоторые аспекты диагностики. Вестник СПб университета Серия 11 Медицина 2009; 1: 91–98.
  3. Вайншенкер Ю.И., Ивченко И.М., Коротков А.Д. и др. Вегетативное состояние (длительная кома) как проявление устойчивого патологического состояния. Физиология человека 2010; 1:138–141.
  4. Горбунов В.И. Иммунные нарушения. В кн: Коновалов А.Н., Лихтерман Л.Б., Потапов А.А. (ред.) Нейротравматология справочник. М.: ИПЦ Вазар-ферро,1994: 78–80.
  5. Климаш А.В. Чрезликворная электростимуляция головного мозга у больных с посттравматическим вегетативным статусом (теоретические предпосылки, предварительные результаты). Вопр. нейрохирургии им. Н.Н. Бурденко 2009; 4: 36–42.
  6. Кондратьева Е.А. Вегетативное состояние: диагностика, интенсивная терапия, прогнозирование исхода: Автореферат дисс. канд. мед. наук. СПб, 2004.
  7. Лисяный Н.И., Руденко В.А., Маркова О.В. и др. Системные и регионарные нейроиммунные процессы при очаговых поражениях ЦНС. Физиология человека 2000; 1: 92–99.
  8. Плавинский С.Л. Биостатистика: планирование, обработка и представление результатов биомедицинских исследований при помощи системы SAS. – СПб.: Издат. дом СПбМАПО, 2005.
  9. Серопегин А.Д, Одинак М.М., Михайленко А.А. Хламидийные поражения нервной системы. Военно-медицинский журнал 2006;11: 36–41.
  10. Цинзерлинг В.А., Мельникова В.Ф. Перинатальные инфекции (вопросы патогенеза, морфологической диагностики и клинико-морфологических сопоставлений): рук. для врачей. СПб.: ЭЛБИ-СПБ, 2002.
  11. Цинзерлинг В.А., Чухловина М.Л. Инфекционные поражения нервной системы: вопросы этиологии, патогенеза и диагностики. СПб.: ЭЛБИ-СПБ, 2005.
  12. Balin B.J., Appelt D.M. Role of infection in Alzheimer’s disease. J Am Osteopath Assoc. 2001; 101: 1–6.
  13. Borer-Alafi N., Gil M., Sazbon L., Korn С. Loewenstein Communication Scale for the minimally responsive patients. 2002; 16:593–609.
  14. Byrne G.I, Ojcius D.M. Chlamydia and apoptosis: life and death decisions of an intracellular pathogen. Nat Rev Microbiol. 2004; 2: 802–808.
  15. Clark D. Human Herpesvirus Type 6 and Multiple Sclerosis. Herpes. 2004; 11: 112A–119A.
  16. Jennett B., Bond M. Assessment of outcome after severe brain damage: practical scale. Lancet .1975; 1: 480–484.
  17. Levitt D., Danen R., Levitt P. Selective infection of astrocytes by Chlamydia trachomatis in primary mixed neuron-glial cell cultures. Infect Immun. 1986; 54: 913–916.
  18. Lindsey J., Patel S. PCR for bacterial 16S ribosomal DNA in multiple sclerosis cerebrospinal fluid. Mult Scler. 2008; 14: 147–152.
  19. MacIntyre A., Abramov R., Hammond C.J. et al. Chlamydia pneumoniae infection promotes the transmigration of monocytes through human brain endothelial cells. J Neurosci Res. 2003; 71: 740–750.
  20. Regan M.J., Wood B.J., Hsieh Y.H. et al. Temporal arteritis and Chlamydia pneumoniae: failure to detect the organism by polymerase chain reaction in ninety cases and ninety controls. Arthritis Rheum. 2002; 46: 1056–1060.
  21. Socan M., Ravnik I., Bencina D. et al. Neurological symptoms in patients whose cerebrospinal fluid is culture- and/or polymerase chain reaction-positive for Mycoplasma pneumoniae. Clin Infect Dis. 2001; 32: 31–35.
  22. Stratton Ch. W., Wheldon D.B. Multiple sclerosis: an infectious syndrome involving Chlamydophila pneumoniae. Trends in Microbiology. 2006; 14 (11): 474–479.
  23. Studahl M., Hagberg L., Rekabdar E., Bergström T. Herpesvirus DNA detection in cerebral spinal fluid: differences in clinical presentation between alpha-, beta-, and gamma-herpesviruses. Scand J Infect Dis. 2000; 32: 237–248.
  24. Tsubokawa T., Yamamoto T., Katayama Y. et al. Deep–brain stimulation in a persistent vegetative state: follow-up results and criteria for selection of candidates. Brain Injury.1990; 4: 315–327.
  25. Wagner A.D., Gerard H.C., Fresemann T. et al. Detection of Chlamydia pneumoniae in giant cell vasculitis and correlation with the topographic arrangement of tissue-infiltrating dendritic cells. Arthritis Rheum. 2000; 43:1543–1551.
  26. Yucesan C., Sriram S. Chlamydia pneumoniae infection of the central nervous system. Curr Opin Neurol. 2001; 14: 355–359.

Statistics

Views

Abstract: 844

PDF (Russian): 575

Article Metrics

Metrics Loading ...

Dimensions

PlumX


Copyright (c) 2014 Vaynshenker J.I., Ivchenko I.M., Zinserling V.A., Korotkov A.D., Melucheva L.A., Kataeva G.V., Lapin S.V., Nuralova I.V., Khlopunova O.V., Beresina L.A., Kulyashova L.B., Vyazovaya A.A., Kalinina O.V., Medvedev S.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies