[Water-borne epidemics of Sonne dysentery--a myth or reality?].
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Biomedical subjects
Publications and source records attributed to Iu P Solodovnikov.
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The authors analyze the diagnostic errors that occurred at bacteriologic laboratories of one of the districts of Russia and that led to misrepresentation of the true etiologic structure of acute enteric infections and therefore to useless ineffective antiepidemic measures. They emphasize strict adherance to a certain order of stages of laboratory diagnosis and to methodologic recommendations on microbiologic diagnosis of diseases induced by enterobacteria.
The data on the etiological structure of Shigella infections in the USSR in 1988-1989 are presented. The study showed the dominating role of S. flexneri with S. sonnei also retaining great importance in Shigella infections. The process of the liquidation of S. dysenteriae and S. boydii infections began in some large cities. The domination of dysentery caused by S. flexneri and a high typhoid rate, particularly in Central Asia, were due to poor water supply of the population. The spread of dysentery caused by S. sonnei was completely independent of the water factor. The decisive role in the transmission of S. sonnei in infective doses was explained by decentralized milk supply.
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On the basis of the epidemiological analysis of morbidity data for several years the many-sided dynamic characterization of the epidemic process of Sonne dysentery in a small district is presented. As revealed by this analysis, the epidemic process developed in the presence of residual activity of the water factor; this activity was mediated by transmission of this infection through milk products contaminated in the course of their manufacture and distribution. The possibility of appearance of an intricate chain of interrelated transmission factors is shown, as exemplified by a specific epidemic situation; to determine the activity of these factors, profound epidemiological analysis of morbidity data is needed.
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A simple and sensitive method for rapid detection of an antigen is offered. 0.025 ml of antiserum is placed on the slide, 0.025 ml of clarified extract containing the antigen added, and then 0.025 ml of intact 20.10(6) suspension of Kowan 1 Staphylococcus strain is added. When antigen-antibody complex is forming, staphylococcal cell aggregation starts. A staphylococcal reagent, manufactured by the Pasteur Research Institute of Epidemiology and Microbiology in Leningrad, may be employed, this making the method more available. The indication sensitivity is 0.2-1.25 mln cells per ml, this value depending on the bacterial species.
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The article deals with original data characterizing the biochemical picture of S. sonnei circulating in the USSR in 1983-1985. Sub-biovars IIe, IIg and Ia have been shown to prevail practically in all regions, irrespective of the intensity of functioning of the centralized alimentary and chronic water routes of transmission of shigellae. These sub-biovars most frequently cause significant alimentary outbreaks of Sonne dysentery transmitted with milk. Doubts are expressed concerning the importance of the immunological factor in the formation of the biochemical picture of S. sonnei. The necessity of the additional differentiation of strains belonging to the prevalent sub-biovars for epidemiological purposes is emphasized.
The medicinal resistance and plasmid profiles of 62 S. dysenteriae strains 1, isolated in the USSR in 1986-1988 from Soviet and foreign citizens (from Afghanistan, Vietnam) and 8 strains obtained from India in 1987 were studied. Pronounced similarity between the phenotypes of medicinal, including conjugative, resistance in the strains of Soviet and foreign origin was established. In the Soviet S. dysenteriae strains 1 the presence of two main types of plasmid DNA profiles (140, 6, 4, 2 MD and 140, 35, 6, 2 MD), similar to those in the strains of Afghan and Indian origin, was shown. In the Vietnamese strain the plasmid DNA profile was found to be quite different (70, 35, 6, 2 MD). Similarity between the phenotypes of medicinal resistance and the plasmid DNA profiles in the Soviet, Afghan and Indian strains under study indicated that the intensive and permanent penetration of the infective agents of Grigor'ev-Shiga dysentery from Afghanistan to the territory of the USSR, especially to Uzbekistan, occurred during the period of the stay of Soviet troops in Afghanistan.
The properties of 71 S. dysenteriae 1 strains isolated from patients in the USSR and India in 1986-1988 were studied. The cultures possessed typical biochemical and serological properties. As revealed in this investigation, high fastidiousness of this infective agent to the quality of synthetic nutrient could become the cause of false negative reactions in different substrates used for the identification of enterobacteria, thus leading to diagnostic mistakes. The variability of the biochemical activity of different strains with respect to arginine, glycerol, maltose and trehalose (as well as the stability of these signs) was regarded as the theoretical substantiation of the possibility, in principle, to work out the scheme for the subdivision of S. dysenteriae 1 into independent biochemical variants.
The etiological role of S. boydii in Shigella infections registered at different territories of the USSR in 1986-1987 was analyzed. As established by this analysis, S. boydii infection occurred mainly at the territories with unsatisfactory water supply of the population; from these territories the infection spread to ther territories of the USSR. The dominating serovars causing S. boydii dysentery, as well as Shigella infections, at different territories of the USSR was shown to be identical, which was indicative of the fact that the immunological factor had no influence on the etiological structure of Shigella infections, determined by the activity of the main routes of the transfer of infection. On the whole, S. boydii serovars 2, 4 and 1 were found to prevail in the USSR.
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Data on the amounts, nomenclature and trends in the dynamics of the use of chemotherapeutic drugs in medicine and agriculture in the RSFSR in 1971-1983 were examined. It was shown that the amounts of their use for these purposes permanently increased. The levels of the use of antibacterial drugs in agriculture markedly exceeded (1.5 to 9 times in different years) those in medicine. On the whole tetracyclines, penicillins and nitrofurans were the drugs most widely used in both medicine and agriculture. The proportions of their use amounted to 39.7-61.2, 9.8-28.1 and 8.3-17.9 per cent, respectively. The use of chloramphenicol and aminoglycosides was somewhat lower, i.e. 10.6-15.8 and 6.5-9.2 per cent, respectively. The proportion of the use of the drugs of other groups did not exceed 2.1 per cent. It was stated that the chemotherapeutic drugs used in medicine for treatment of patients were widely used for nonmedical purposes. Among them are tetracyclines, chloramphenicol, aminoglycosides and lately nitrofurans. The levels of the use of some chemotherapeutic drugs and variability in their MICs for the Shigella populations tested were compared. It was concluded that the level of the drug use was not the only factor influencing development of the resistance in Shigella spp.
The results of the study of the epidemiological regularities of viral hepatitis non-A, non-B with the fecal-oral mechanism of the transfer of infection in one of the regions of the Turkmenian SSR are presented. These results have been confirmed by serological and virological laboratory methods. The territories, groups of the population (age groups) and the time of the maximum epidemic risk of infection have been determined. The main (primary) role of the water route (polluted ground water) in the spread of this infection has been proved.
The materials, comprehensively characterizing the water outbreaks of gastroenteritis with its etiology established and its clinico-epidemiological interpretation made, are presented. Along with other data, the water nature of the outbreak was verified by the detection of rotavirus antigen, made in the enzyme immunoassay, not only in patients, but also in water samples from the surface water source and from sewage. To isolate the infective agent from environmental objects, bentonite, a mineral sorbent, has been used for the first time. The authors believe that the water route plays the main (primary) role in the spread of rotavirus gastroenteritis and the adult population is the main reservoir of this infection. The fact the disease is registered mainly among younger age groups of the child population reflects only the maximum manifestation of rotavirus infection among these age groups.