Наукові праці. Кафедра інфекційних хвороб

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Author: search.filters.author.Kozko, Volodymyrsearch.filters.applied.f.itemlanguage: search.filters.itemlanguage.en

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    Myelin basic protein and its diagnostic value in hiv-infected individuals with 4th clinical stage and neuroinfections
    (2021) Kozko, Volodymyr; Hvozdetska-Shaar, Maryna; Sokhan, Anton; Yurko, Kateryna; Solomennyk, Ganna
    It was shown that in HIV-infected patients, pathomorphological changes in the white matter in the form of demyelinization are already observed in the early stages of the disease. The most studied marker of this process is myelin basic protein that can be detected in cerebrospinal fluid or serum immediately after acute myelin breakdown. The aim. To assess the diagnostic value of myelin basic protein content in serum and cerebrospinal fluid of HIVinfected individuals with 4th clinical stage and central nervous system opportunistic infections. Materials and methods. Using ELISA with diagnostic kit “MBP ELISA” (Ansh Labs, USA), we studied the myelin basic protein content in serum and cerebrospinal fluid of 53 HIV-infected patients with 4th clinical stage and central nervous system opportunistic infections depending on its etiology, the outcome of the diseases and according to Glasgow coma scale score. As well correlation analysis with some laboratory and clinical indicators was performed. Results. We found significantly increased myelin basic protein content in both cerebrospinal fluid and serum of HIVinfected patients 4th clinical stage with central nervous system opportunistic infections compared to control (p˂0.01), which indicate the presence of active demyelinization in central nervous system. The highest cerebrospinal fluid myelin basic protein was registered in patients with an unfavourable outcome of the disease, as death or residual neurologic deficit, and patients with cerebral toxoplasmosis. The cerebrospinal fluid myelin basic protein had an association with the size of white matter lesions on magnetic resonance imaging and serum myelin basic protein content. Conclusions. Myelin basic protein detection in cerebrospinal fluid as well as in serum can serve as an additional quantitative marker of myelin disruption, which can be used along with magnetic resonance imaging for the diagnosis improvement and prognosis of central nervous system opportunistic infections in HIV-infected individuals with 4th clinical stage
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    Problems of early malaria diagnostics in non-endemic countries
    (2018) Kozko, Volodymyr; Mohylenets, Olena; Makhmudov, Yu.; Merkulova, Nina; Yekimova, N.
    Analysis of clinical and epidemiolodical features of malaria in Kharkiv region was perfomed. Main reasons of malaria misdiagnosis on early terms of the disease were revealed. Practical recommendations were done.
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    Non-invasiv estimation of activity of nekroinflammatory process in the patients liver with chronic hepatitis C
    (2018-04-08) Kozko, Volodymyr; Vinokurova, O.; Shchebetenko, V.; Boiko, O.
    79 patients with chronic hepatitis C were examined. Using the Geno Fibro Test system (an alternative to liver biopsy), the necroinflammatory process o f the liver was evaluated in patients. Studies were conducted on the existence of a link between the main biochemical indices and the degree of necroinflammatory activity o f the liver in patients. With the use o f modern statistical methods o f research, the level o f ALT is established fo r minimal, moderate and high activity o f the necroinflammatory process in the liver in patients with chronic hepatitis C.
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    Application of apri index for noninvasive evalution of liver fibrosis activity in patients with chronic hepatitis C
    (2018-04-24) Kozko, Volodymyr; Vinokurova, O.; Baichykova, A.; Pavlova, A.
    seventy-nine patients, age from forty to forty-five years old, with chronic hepatitis C were examined in the clinic. All the patients studied determined the stage o f fibrosis and the severity o f the disease with the help o f the GenoFibroTest system, an expert system o f biochemical blood indices. Modern statistical methods were used to determine the dependence between the stages o f fibrosis and APRI. It was found that the APRI value from 0 to 1 corresponds to F0 - F1, more than 1 to F2-F4, respectively.
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    The role of polymorphism ASP299GLY of the gene TLR 4 in patients co-infected with HIV/HCV
    (Tbilisi State Medical University, 2018-07) Yurko, K.; Kozko, Volodymyr; Solomennik, A.; Bondar, O.; Sokhan, A.; Gavrylov, Anatoliy
    For the first time it was conducted complex research of metabolic disorders in patients co-infected with HIV/HCV and was shown that they are characterized by disturbances of mineral, lipid and carbohydrate metabolism types. It was established significantly higher values of indicators of mineral, lipid and carbohydrate metabolism types in patients co-infected with HIV/HCV compared with patients with chronic hepatitis C and HIV-infected persons. In patients co-infected HIV/HCV appears significantly more frequent the polymorphism Asp299Gly of the gene TLR4 (χ2 = 4,5; p<0,05) when compared with healthy donors, which plays a significant role in the development of metabolic disorders, such correlation is confirmed by those relationships: a strong direct relationship between the polymorphism Asp299Gly of TLR4 gene and the content of insulin (r = 0,66; p<0,001), insulin resistance (r=0,66; p<0,001), the absolute number of CD45+ of T-lymphocytes (r=0 45; p<0,001); a moderate direct relationship with the content of TNF-α (r=0,32; p<0,05), CRP (r=0,34; p<0,05), the absolute number of CD3+ of T-lymphocytes (r=0,34; p<0,05), the content of triglyceride (r=0,39; p<0,02), moderate inverse relationship with the zinc content (r = -0,34; p<0,05 ), the relative number of CD4 +,% (r = -0,32; p<0,05). The system of monitoring of metabolic disorders in patients co-infected with HIV/HCV based on the definition of polymorphism Asp299Gly gene TLR4, the presence of which indicates a high risk of metabolic disturbances (OR=23,3; p<0,05) and requires further investigation, namely the definition of an index of insulin resistance, insulin levels, TNF-α, C-reactive protein, zinc and triglyceride levels in dynamics at intervals of 6 months that allow for timely diagnosis and correction of metabolic disorders.
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    Diagnostic value of neurospecific markers NSE, S-100, GFAP, MBP and BDNF in cerebrospinal fluid in patients with viral meningitis
    (2018) Kozko, Volodymyr; Sokhan, A.; Burma, Ya.
    The aim of the work - to determine the diagnostic value of the levels of neurospecific markers NSE, GFAP, S-100, MBP, and BDNF in the CSF of adult patients with viral meningitis. Patients and Methods. 50 cases of acute viral meningitis were analyzed. There were 21 patients with HSV 1,2 infection, 19 patients with EBV infection, 10 patients with enteroviral meningitis. The CSF level of neuro-specific markers was determined in the first and 10-12 days of treatment using the ELISA method. Results. The most significant changes were identified in patients with severe illness. On the first day o f treatment, the levels of NSE, S-100, GFAP, MBP, and BDNF in patients with moderate severity of the disease were lower in patients with enteroviral meningitis (P<0.001). In severe cases NSE, GFAP and BDNF were higher (P<0.05) in patients with HSV neuroinfection. The neuro-specific markers NSE, S-100, GFAP and MBP on the first day of treatment were in direct strong correlation with the severity of neurological symptoms. The strongest (r=0.712) direct correlation is observed between the severity of neurological symptoms and the level of NSE and GFAP. At the same time, we found a strong reverse correlation (r=-0.727) between the level of BDNF and the duration of neurological symptoms. Conclusions. Increased levels of NSE, S-100, GFAP and MBP indicate presents damages of neurons astroglia and myelin nerves in all cases of viral meningitis. Major changes are observed in patients with severe neuroinfection. In patients with severe herpes viral meningitis/meningoencephalitis, the activity of regenerative processes in the tissues of the central nervous system decreases due to a decrease of CSF BDNF level (P<0.05).
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    Factors affecting the fatal outcome in HIV-infected patients with encephalitis
    (Tbilisi State Medical University, 2018-08) Hvozdetska, M.; Kozko, Volodymyr; Yurko, K.; Gavrylov, Anatoliy; Solomennyk, A.
    Despite the successful use of ART up to 40-70% of HIV(+) individuals have neurologic complications caused both by the HIV itself and by the reactivation of OIs on the background of severe immunodeficiency. Nowadays, there are no universally recognized criteria that allow predicting the outcome of encephalitis caused by OIs in this category of patients. The aim of our study was to assess factors affecting the fatal outcome in HIV(+) patients with CNS involvement. Retrospectively we selected 53 HIV(+) patients with confirmed encephalitis due to OIs. Depending on the outcome of the disease, patients were divided into groups: non-survivors (n=22) and survivors (n=31), after compared their clinical manifestation, history of the disease and life, CSF results in the first days of admission. It has been established that the factors affecting the fatal outcome in HIV(+) patients with encephalitis are: the severity of the patient’s condition upon admission, acuteness of the onset of the disease, the severity of neurologic symptoms, the degree of co-morbidity, the level of immunosuppression and viral load, absence of ART.
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    Biochemical parameters of cerebrospinal fluid in patients with acute viralmeningitis and meningoencephalitis
    (2018) Kozko, Volodymyr; Sokhan, A.; Burma, Ya.; Kuznetsova, Anastasiia; Gavrylov, Anatoliy
    The aim. Determination of the diagnostic value of lactate, lactate dehydrogenase, cholinesterase, acid phosphatase and cholinesterase in CSF for early diagnosis and prognosis of acute viral meningitis and meningoencephalitis. Materials and methods. 92 patients with a confirmed viral etiology of the disease were examined. Among them – 20 patients with HSV 1,2 neuroinfection, 19 patients with EBV, 15 with VZV, 14 with HHV-6 and 24 patients with enterovirus neuroinfection. Patients were divided into groups depending on the etiology and severity of the disease. In addition to analyzing the clinical course of the disease, we conducted a CSF study to determine the level of lactate, lactate dehydrogenase, creatinine kinase, cholinesterase and acid phosphatase on admission to hospital and after 10-12 days of treatment. Results of the study. The highest mean age was observed in patients with VZV meningitis – 38.27±18.24 years, the youngest were patients with enterovirus infection – 24.05±5.72 (р˂0.001). The number of women and men was the same in almost all groups, but among patients with HSV 1, 2 neuroinfection women were significantly prevalent – 16 (80 %) out of 20 cases. The most severe course was observed in groups of EBV and HHV-6 neuroinfections. Neuroinfections of enterovirus etiology had the most favorable course. The obtained data indicate the dependence of the levels of indicators, which were determined primarily from the severity of the disease. So the level of creatinine kinase and acid phosphatase in patients with moderate severity was significantly higher in comparison with severe patients (p<0.05). The lactate level was higher in patients with severe neuroinfection (p<0.05). The highest levels of lactate were detected in patients with HHV-6 meningoencephalitis (p<0.05). The level of cholinesterase was significantly lower in severe patients. Conclusions. The obtained data confirm the presence of deep metabolic disturbances in the brain tissues in all patients with acute viral neuroinfections both at the onset of the disease and in the dynamics of treatment. Determination of levels of creatinine kinase, acid phosphatase, lactate and cholinesterase in CSF of patients with acute viral neuroinfection has a high diagnostic value, but cannot be used to predict an unfavorable course of the disease
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    Parenteral hepatitis B: matematical search for the prognosis of the disease
    (2017-04) Козько, Володимир Миколайович; Винокурова, Ольга Миколаївна; Мовчан, Юлія Олександрівна; Kozko, Volodymyr; Vinokurova, O.; Movchan, Yu.
    Аn acute viral hepatitis B is dangerous because it can cause hepatic insufficiency, hepatic encephalopathy, cirrhosis and primary liver cancer, so it is very important to determine the criteria for unfavorable flow o f the hepatitis B in the early stages o f hospitalization. 29 patients with acute hepatitis B were inspected. Number o f clinical and biochemical indexes was studied and processed by original statistical methodologies. The reliable criteria o f unfavorable prognosis o f disease were established.
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    Pathomorphological peculiarities of tuberculous meningoencephalitis associated with HIV infection
    (2017) Kozko, Volodymyr; Bondarenko, A.; Gavrylov, Anatoliy; Shevchenko, O.; Gargin, Vitaliy
    Background and aims: One of the most severe manifestation displays of tuberculosis (TB) generalization is meningitis/meningoencephalitis. The purpose of this work was to improve the diagnostic efficiency of TB central nervous system (CNS) affection in human immunodeficiency virus (HIV)-infected persons. Materials and methods: Meninges and cerebral tissues, taken from died patients, who were HIV-infected and dead from TB of CNS affection, were investigated histologically. Results and discussion: Our examination showed that clinical course of the pathologic process loses the peculiarity of TB-undulating character, and changes in tissues have monomorphism that appears in the presence of the same type of granulomas with a few Pirogov–Langhans cells. Alterative reactions with formation of the large fields of caseous necrosis, necrotic focuses, areas of infiltration with polymorphic cellular elements went out on the first plan in the disorder of cerebrum in patients with the terminal stage of HIV infection. The tendency to decrease in inflammatory–proliferative processes was observed, which is confirmed by the presence of the poorly expressed cellular reaction on the peripheries of focuses of caseous necrosis. Conclusion: Morphologic features of tuberculous meningoencephalitis in HIV-infected patients are the presence of edema, gliosis, trombovasculitis, small focal hemorrhage, tuberculous granuloma formation with a small number of Pirogov–Langhans cells, and the prevalence of alterative–exudative reactions.