Этиологические аспекты вирусного энцефалита, изученные с использованием ПЦР-анализа церевроспинной жидкости, с учетом ВИЧ-статуса пациентов

Аннотация

Ключевые слова: В работе обследовано 124 пациента с острым вирусным ВИЧ, энцефалитом, поступивших в РНЦЭМС в период с 2014 по вирусный энцефалит, 2019 г. Изучены результаты ПЦР-диагностики ликвора при ПЦР, вирусных энцефалитах с учетом ВИЧ-статуса пациентов. спинномозговая жидкость. Результаты показали, что ПЦР-тестирование предлагает более надежный диагноз и, когда позволяют лабораторные ресурсы, его следует использовать для анализа спинномозговой жидкости, чтобы более точно идентифицировать этиологический агент, ответственный за ЦСЖ. Для улучшения выявляемости причинных факторов СВЭ и повышения эффективности таргетной терапии, переходя от эмпирических и симптоматических к этиотропным подходам, рекомендуется повторная ПЦР-диагностика ЦСЖ в режиме реального времени в тех случаях, когда причина СВЭ остается неустановленной. Relevance: Despite the availability of numerous diagnostic methods at the beginning of the 21st century, the cause of encephalitis remains undetermined in 62% of patients, and in 10% of cases, a non-infectious origin is diagnosed (3). According to Lobzin Y.V. and Zhdanov K.V. in their “Manual of Infectious Diseases”, the following 93 Жамият ва инновациялар – Общество и инновации – Society and innovations Issue – 4 № 3 (2023) / ISSN 2181-1415 statistics are reported: “...out of confirmed or probable cases, 69% were viral, 20% were bacterial, 7% were related to prions, 3% were parasitic, and 1% were fungal. It is crucial to acknowledge that the inability to determine the cause in many instances may be due to challenging diagnostic cases, as well as limited access to suitable samples and suboptimal sample processing; despite extensive laboratory capabilities, the etiology of encephalitis remained unclear in 64% of patients” (1). Presently, scientific studies concentrate on the quality of inflammatory and immune responses in cerebrospinal fluid (CSF) patients, drawing correlations between local and systemic immune responses in central nervous system (CNS) infections (2,4). Numerous publications explore neuroinfections during childhood or specifically address the prevention, diagnosis, and treatment of tick-borne encephalitis (5,6). However, there is a scarcity of research focusing on the clinical aspects, diagnosis, inflammatory response, and immune response parameters of CSF in encephalitis among adults, depending on the etiological factor. The aim of the research is to investigate the outcomes of PCR diagnostics in cerebrospinal fluid for viral encephalitis, considering the HIV status of the patients involved. Data and Methods. We examined 124 patients with severe viral encephalitis (SVE). The diagnosis of SVE was based on general infectious, general cerebral and focal neurological symptoms, and the detection of infectious agents. HIV infection was diagnosed according to the national clinical protocols for HIV infection in Uzbekistan according to the WHO classification of clinical stages of HIV infection in adults and adolescents (2010). All patients with SVE were treated as inpatients at the RSCEMC from 2014 to 2019. Based on HIV status, the patients were divided into 2 groups: Group I – 72 (58.1%) patients with SVE with HIV seronegative status (HIV-) and Group II – 52 (41.9%) patients with SVE with HIV seropositive status (HIV+). Out of the number of SVE patients with HIV (+), 41 patients (33.1%) had injecting drug addiction. In Group I, the average age of the patients was 49.82 ± 2.96 years old; there were 45 (62.5%) and 27 (37.5%) male and female patients, respectively. In Group 2, the average age of patients was 42.28 ± 2.74 years. There were 29 (55.8%) men and 23 (44.2%) women. The age and sex distribution of Group 2 patients are shown in Table 1. Table 1. Distribution of patients by sex and age. Group I – SVE, HIV (-) patients n=72 (58,1%) Age men women all (Years) n % n % n % 18-44 21 29,20% 15 20,80% 36 50,00% 45-59 14 19,40% 9 12,50% 23 31,90% 60-74 10 13,90% 3 4,20% 13 18,10% TOTAL 45 62,5%** 27 37,50% 72 100,00% Group II – SVE, HIV (+) patients n=52 (41,9%) Age men women all (Years) n % n % n % 18-44 19 36,50% 15 28,80% 34 65,40% 94 Жамият ва инновациялар – Общество и инновации – Society and innovations Issue – 4 № 3 (2023) / ISSN 2181-1415 45-59 8 15,40% 8 15,40% 16 30,80% 60-74 2 3,80% 0 0,00% 2 3,80% total 29 55,8%* 23 44,20% 52 100,00% TOTAL 74 59,7% 50 40,3% 124 100,00% As it was shown in Table 1, the structure of patients in Group I was somehow different from that in Group II. Thus, males prevailed in both groups (62.5% and 55.8% in groups I and II, respectively). It should also be noted that there was a percentage shift toward the younger age of patients in group I compared to group II. Patients were examined according to the following algorithm: complaints, medical history; general clinical tests; biochemical tests; diagnostic lumbar puncture (LP) with the clinical and biochemical examination; cerebrospinal fluid, diagnostic LP with PCR; MRI of the brain. Statistical pro