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II. ДИАГНОСТИКА И ЛЕЧЕНИЕ
A PRACTICAL CASE IN THE DIAGNOSIS OF SEXUALLY TRANSMITTED INFECTIONS
Nurakhova A.D.1, Abdilova G.B.2, Zhakupkalieva Zh.Z.3
1Kazakh Medical University of Continuing Education, Almaty, Kazakhstan 2National Scientific Center of Surgery named after A.N. Syzganov, Almaty, Kazakhstan 3Almaty Regional Center for the Prevention and Control of AIDS, Almaty, Kazakhstan
Abstract
We are reporting a case of diagnosis of a mixed sexually transmitted infection. In the above case, the question of diagnosing urogenital infections caused by mixed flora is raised. Conclusions were made about the need for an integrated approach to the diagnosis and, in general, the management of patients with chronic inflammatory diseases of the urogenital tract. Compliance with the principles of interdisciplinary integration in the implementation of diagnostic and treatment technologies will allow adequate rehabilitation of urological, gynecological and reproductive health of patients.
АВТОРЛАР ТУРАЛЫ
Нурахова Алма Дандыбаевна -
Казак, медициналык узд!кс!з б!л!м беру университетам клиникалык зертханалык диагностика кафедрасы, доцент, медицина Fылымдарыньщ кандидаты, доцент.
Абдилова Гульнур Бекмурзаевна -
А.Н. Сы^анов атындагы УлттыкFылыми хирургия орталы^ыныц клиникалык диагностикалык зертханасыныц мецгеруш1с1
Жакыпкалиева Жанна Заркы/нбещызы - зертханашы дэрйвр, Алматы облыстыкЖИтС-тыц алдын алу жэне 0Fан карсы курес орталы^ы.
Туйш cвздep
тpихoмoнac инфекцияш, хла-мидиалды инфекция, жанама иммунoфлуopеcценттiк реакция, иммунoфлуopеcценциянын ткелей pеaкцияcы
Случай из практики при диагностике инфекций, передаваемых половым путем
Нурахова А.Д.1, Абдилова Г.Б.2, Жакупкалиева Ж.З.3
1Казахский медицинский университет непрерывного образования, г. Алматы, Казахстан Национальный научный центр хирургии им. А.Н.Сызганова, г. Алматы, Казахстан 3Алматинский областной центр по профилактике и борьбе со СПИД, г. Алматы, Казахстан
Аннотация
Мы сообщаем о случае диагностики смешанной инфекции, передаваемой половым путем. В выше указанном случае затрагивается вопрос диагностики урогенитальных инфекций, вызванных смешанной флорой. Были сделаны выводы о необходимости комплексного подхода к диагностике и, в целом, ведению больных хроническим воспалительными заболеваниями органов урогенитального тракта. Соблюдение принципов междисциплинарной интеграции при осуществлении диагностических и лечебных технологий будет позволять адекватной реабилитации урологического, гинекологического и репродуктивного здоровья пациентов.
МРНТИ 76.29.50 UDC 616-093/-098
ABOUT THEАUTHORS
Nurakhova Alma Dandybaevna - Associate Professor, Department of Clinical Laboratory Diagnostics, KazMUNO, candidate of medical sciences, assistant professor.
Abdilova Gulnur Bekmurzaevna - head of the clinical diagnostic laboratory of the National Scientific Center of Surgery named after A.N.Syzganova.
Zhakupkalieva Zhanna Zarkynbekovna
- laboratory doctor, Almaty Regional Center for the Prevention and Control of AIDS.
Keywords
trichomonas infection, chlamydial infection, indirect immunofluorescence reaction, direct immunofluorescence reaction.
Жыныстык жолмeн 6epmeTrn инфeкциялаpды диагностикалау тэжipибeciнeн алынFан жаFдай
Нурахова А.Д.1, Абдилова Г.Б.2, Жакыпкалиeва Ж.З.3
1Казак медициналык Yздiксiз б^м беру университету Алматы каласы, Казакстан
2А.Н.Сыз?анов атында?ы Улттык fbrnb^ хирургия орталы^ы, Алматы каласы, Казакстан
3Алматы облыстык ЖИТС-тык алдын алу жэне о?ан карсы 1^рес орталы^ы, Алматы каласы, Казакстан
Ацдатпа
Бiз apaлac жыньютык инфекция диaгнoзы туралы хабарлап oтыpaмыз. ЖoFapыдa квpcетiлгенжагдайда, apaлac флopaдaн туындаган уpoгенитaльды инфекцияларды диaгнocтикaлaу туралы мэ^ле квтеpiледi. Диaгнoзды кешендi турде кабылдау кaжеттiлiгi туралы жэне неcеп-жыныc жoлдapыныц coзылмaлы кабыну аурулары бар наукаатарды бащару туралы кррытынды жа^лды. Диaгнocтикaлыкжэне емдеу технoлoгиялapын енпзуде пэн аралык интеграция кагидаларын ca/ктап, наука^ардын уpoлoгиялык гинекoлoгиялык жэне pепpoдуктивтi денcaулыFЫн калпына келтipуге мумюн^к беред 'г
ОБ АВТОРАХ
Нурахова Алма Дандыбаевна - доцент кафедры клинической лабораторной диагностики Казахского медицинского университета непрерывного образования КазМУнО, кандидат медицинских наук.
Абдилова Гулнур Бекмурзаевна -
заведующая клинико-диагностической лабораторией Национального научного центра хирургии им. А.Н.Сызганова.
Жакупкалиева Жанна Заркынбековна
- врач-лаборант, Алматинский областной центр по профилактике и борьбе со СПИД.
Ключевые слова
трихомонадная инфекция, хламидийная инфекция, реакция непрямой иммуноф-люресценции, реакция прямой иммунофлюоресценции
Figure 1.
Scheme of the indirect immunofluorescence reaction [3]
Figure 2.
Trichomonas in the smear from the ejaculate
Introduction
According to modern data, mixed urogenital infections cause a pathological process characterized by a complex complex of intermicrobial relationships and interactions of various populations of microorganisms with a single pathogenesis, in the development of which each of the microorganisms makes a certain contribution. Microbial associations with varying degrees of etiological significance of each microorganism can form an atypical development and course of inflammatory diseases of the genitourinary tract, which must be taken into account when assessing the clinical picture, laboratory data and prescribing appropriate therapy [1].
To date, the factors of the evolution of the epidemic process of sexually transmitted infections (STIs) are manifested as an increase in the incidence of mixed infections leading to interfering syntropia, the phenomenon of gradual debut and activation of the disease, the predominance of subacute, torpid, asymptomatic (subclinical) and atypical variants of the course of STIs. cases of persistent and inapparent STIs, as well as an increase in the incubation period of STIs, the duration of infection of the body of patients with these infections and cases of multifocal lesions with simultaneous registration of pathogens of various STIs in several localizations, a combination of a mild clinical course of the above infections with damage to the ascending genital
tract, an increase in cases of complicated course of STIs with the formation of a complex of pathological symptoms and syndromes. These factors are signs of clinical pathomorphosis of STIs, which must be taken into account when determining the diagnostic route of patients and prescribing treatment for them [2].
Case report
A 42-year-old patient consulted a urologist with the fact that his sexual partner in one of the laboratories found Tr.vaginalis in a scraping from the posterior vaginal fornix. The doctor sent a swab from the patient's urethra and a swab from this patient's prostate to the diagnostic laboratory. Tr.vaginalis was not detected in the above biological materials. Then the attending physician decided to send the patient's ejaculate for examination. The biological sample of the specified patient was analyzed by the method of indirect immunofluorescence (RIIF) (Fig. 1) [3] using the diagnostic kit "TrichoScan" LLC "Agrobiomed", Russia. The smears were viewed in a luminescent microscope
"Mikromed", Russia, with an immersion objective (100x) using a special non-fluorescent immersion oil, using a system of filters that provide exciting light with a wavelength of not more than 490 nm and emission with an average wavelength of 520 nm. The results were recorded immediately after the preparation was mounted. As a result, Trichomonas were found (Fig. 2) in the form of polymor-phically limited structures with a bright green glow. Mobile forms were also identified, in which flagella were stained. At the same time, nonspecific bacterial flora was present, which was stained orange. Also identified were epithelial cells, leukocytes, sperm, colored orange. The result was assessed as positive. The result of the analysis was sent to the attending physician. 1.5 months after the appropriate treatment, the above mentioned patient again passed the analysis in order to re-carry out the study of the ejaculate. This time the patient was found to have Chlamydia trachomatis. In the smear after performing the direct immunofluorescence reaction (DIF) using the diagnostic kits "ChlamyScan" LLC "Agrobiomed", Russia, a bright green glow was recorded in the form of a dot, which is characteristic of elementary chlamydial bodies, and in the form of an oval, which is characteristic of reticular bodies Chlamydia trachomatis, which stood out against the background of epithelial cells stained in red-orange. The result of the analysis was assessed as positive. The results of the study were also addressed to the attending physician.
This diagnostic case from practice confirms the literature data on the high prevalence of mixed urogenital infections causing a variety of obstetric pathologies: missed pregnancy, recurrent miscarriage, premature rupture of the membranes, premature birth, postpartum endometritis, chorioamnion-itis, placentitis, intrauterine infection, fetal infection fetal malformations, failures in attempts at extracorporeal fertilization. Only in 10.5% of patients with trichomoniasis proceeds as monoinfection, in 89.5% of cases mixed Trichomonas infections are detected in various combinations [4, 5].
Discussion
One of the most common diseases of the genitourinary tract today is urogenital tricho-moniasis, which occupies a leading place in the structure of STIs. Trichomonas infection affects the genitourinary tract of both women and men, and up to half of the infections are asymptomatic [6, 7]. Trichomonas carriage occurs in 40-50% of patients with mixed urogenital infection, and in 30-56% of cases, trichomoniasis is the cause of inflammatory diseases of the urogenital tract in women [8]. The main habitat of Trichomonas in men is the urethra, since Tr.vaginalis has a tropism to the squamous epithelium, from where it further penetrates into the glands and lacunae of the urethra, and the possibility of Trichomonas spreading through the lymphatic tracts and their entry into the lymph nodes has been experimentally proved [9]. Trichomoniasis rarely occurs as a monoinfection. with mixed infection, Trichomonas are often a reservoir for the preservation of pathogenic microorganisms. these pathogens persist inside Trichomonas and are the cause of the recurrence of the disease concomitant with trichomoniasis. in most (70-90%) patients, Tr.vaginalis is a member of microorganism associates, most often (29.1%) including mycoplasmas, gardnerella, ureaplasma, chlamydia, fungi, and gonococci. One of the factors determining the formation of such associates is the ability of Trichomonas to carry out incomplete phagocytosis of various microorganisms and viruses, creating a reservoir of pathogenic flora in the body [6].
The outcome of any infectious process is determined, as a rule, by three components: the pathogen (etiological factor), environmental conditions affecting the results of the relationship between the macro- and microorganism, and the state of the macroorganism having a pathological process. All of them have undergone some changes. In the group of increased epidemiological risk, there is an
increase in the number of persons with aggravated premorbid status. Of the endogenous pathological factors that cause a long course of the inflammatory process of the urogenital tract, anemia, systemic blood diseases, diabetes mellitus, glomerulone-phritis, and tumors are distinguished.
An important role in the development and regulation of the inflammatory process is played by the immune system, which provides the basic mechanisms of adaptation of the body. Inflammatory processes of the urogenital tract often occur against the background of altered immunity. Patients have a significant decrease in both the relative and absolute number of B-lymphocytes. An imbalance of the immunoregulatory index, a decrease in the number of natural killer cells, a change in the process of induction of cytokines, which manifests itself in the form of persistent states, are often recorded. Transformations in the immune system also lead to a change in the hormonal background and, therefore, to an even more significant disruption in the system of anti-infectious resistance [10].
From the general biological reactions of the body to the invasion of pathogenic microorganisms, and even more so to their communities, the phenomenon of disseminated thrombus formation in microvessels around the foci of inflammation and tissue destruction is currently distinguished. Like edema, lekopedesis, phagocytosis and other components of inflammation, the blockade of microcirculation around the lesions is a natural reaction that participates in the isolation of the affected areas and thereby prevents the dissemination of infection, as well as intoxication of the body with tissue destruction products and bacterial toxins. At the same time, it is the intensity and prevalence of blockade of organ microcirculation in inflammatory diseases that lead to the formation of destructive non-draining formations, in which the pathogen is localized and to which the access of drugs slowing down the treatment process is difficult [11].
At the present stage of development of medicine, interdisciplinary approaches to the diagnosis and treatment of STI patients are becoming increasingly important. However, in practice, treatment most often begins without a systematic analysis of the data of a full examination, which does not lead to the expected results and leads to the chroniza-tion of the process. It is the increase in the interdisciplinary value of profile standards and protocols for patient management that is the key to their successful rehabilitation.
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