Critical Analysis of Suggested Mechanisms of Pathogenesis of the Post streptococcal Glomerulonephritis

A.A. Totolian, L.A. Burova

Department of Molecular Microbiology of Research Institute of Experimental Medicine,
Russian Academy of Medical Science, St.-Petersburg, Russia

Acute glomerulonephritis is a severe kidney disease that develops as a result of streptococcal skin and upper respiratory infections most commonly caused by M serotypes of the group A b-hemolytic streptococci (GAS). Most often this process is acute, but can have a tendency to the chronisation which often leads to renal dysfunction with the development of secondary renal hypertension that can be fatal. In spite of the numerous clinical and experimental studies data on the pathogenesis of the post streptococcal glomerulonephritis remain limited and come to several approaches:

     1) cross-reactive antigenes of GAS and renal tissue;

     2) streptokinase of GAS, some allele variants of which can transform plasmin to plasminogen that leads to complement activation and deposition of the C3 complement fraction in glomeruli;

     3) cysteine protease or pyrogenic exotoxin B of GAS that bind plasmin and laminin as well as break up fibronectin and vitronectin;

     4) increased serum concentration of different highly active oxygen-containing substances;

     5) IgG Fc-receptors of GAS. All of above hypothesis have arguments "pro" and "contra", so, further experimental studies is necessary for more detail understanding of pathogenesis of the post streptococcal glomerulonephritis.

Key words: group A streptococci, IgG, Fc-receptor proteins, glomerulonephritis, induction factors, anti-IgG, immune complex, anti-inflamatory cytokines.




Antimicrobial Resistance



Role of Fusidic Acid in Clinical Practice

(Literature Review)

J.A. Belkova

Research Institute for Antimicrobial Therapy, Smolensk, Russia

The widespread of multy-resistant Gram-positive pathogens, especially methicillin-resistant staphylococci made us to reconsider our attitude to such an "old" drug as fusidic acid and to draw attention to its usefulness in therapy of the infection caused by these microorganisms. In present review the information on chemical and physical properties, antimicrobial activity, mechanism of action, pharmacokinetic, pharmacodynamic, clinical indications, clinical efficacy and spectrum of possible adverse drug reactions of fusidic acid is given. Pharmacological profile, safety, low level of resistance, absence of cross-resistance with other antimicrobials and possibility of step therapy allow to recommend fusidic acid to more frequent clinical use, especially in infections caused by methicillin-resistant strains Staphylococcus aureus.

Key words: fusidic acid, antimicrobial therapy, antimicrobial resistance, S.aureus, MRSA.



Efficacy of Cefepime Monotherapy and The Combination of Ceftazidime with an Aminoglycoside in The Treatment of Infections in Oncology Patients with Severe Neutropenia

V.V. Ptushkin, S.V. Minenko, V.B. Larionova, N.V. Zjukov, E.N. Sokolova, N.V. Dmitrieva

Oncology Research Centre Named Under N.N. Blohin, Russian Academy of Medical Science, Moscow, Russia

The combination of ceftazidime with an aminoglycoside is a commonly used standard for empiric therapy of febrile neutropenia. A lot of attention is paid to the development of effective monotherapy for the treatment of this condition. One of the most perspective "candidate" for monotherapy is cefepime. We performed a retrospective study of iv cefepime (2 g 3 times per day) monotherapy (19 cases of infection in 15 patients) compare to combination of iv ceftazidime (2 g 3 times per day) with an iv aminoglycoside (22 cases of infection in 20 patients). All patients had prolonged IV grade neutropenia as a result of cytostatic chemotherapy regarding different types of solid and haematologic neoplasm. Overall efficacy was: in cefepime group – 68,5%, in ceftazidime-aminoglycoside group – 40,9% (š=0,07). The modification of antimicrobial therapy was necessary in 42% of cases in cefepime group and 72,7% – in ceftazidime-aminoglycoside group (š=0,04). The mean cost of antimicrobials in cefepime group was 518 (429–606) USD, in ceftazidime-aminoglycoside group – 482 (368–596) USD. In 9% of patients in ceftazidime-aminoglycoside group nephrotoxicity was documented. No toxicity was detected in cefepime group. Results of present study suggest that cefepime monotherapy can be used as an alternative to the standard combination therapy for treatment of the febrile neutropenia.

Key words: neutropenia, infection, febrile neutropenia, neutropenic fever, antimicrobial therapy, cefepime, ceftazidime, aminoglycosides.




Laboratory Diagnostics



Specificities of The Susceptibility Testing by Disk-Diffusion Method

G.K. Reshedko, O.U. Stetciouk

Institute of Antimicrobial Chemotherapy, Smolensk, Russia

The approach to administration of antimicrobials is often based on the results of microbiological studies that include microorganism isolation, identification and, most important, susceptibility testing. Majority of microbiological laboratories in Russia for the susceptibility testing use disk-diffusion method. This method is technically simple and has good reproducibility. But at the same time there are some specific features that may lead to incorrect results. In present article the main specificities of disk-diffusion method as well as common sources of incorrect results are indicated, practical recommendations for the improvement of quality of susceptibility testing by disk-diffusion method are given.

Key words: susceptibility testing, microbiological diagnostic, antimicrobial resistance, disk-diffusion method.


Guideline for Clinicians



Treatment of Lower Urinary Tract Infection in Pregnancy

S. Krcmery1, J. Hromec2, D. Demesova2

1 Department of Geriatric Medicine, Comenius University School of Medicine, Bratislava, Slovac Republic
2 Fourth Department of Medicine, Comenius University School of Medicine, Bratislava, Slovak Republic

Translated and reprinted with permission from "International Journal of Antimicrobial Agents" 2001; 17:279-82.

Urinary tract infection (UTI) is a common complication of pregnancy. Approximately 20–40% of women with asymptomatic bacteriuria will develop pyelonephritis during pregnancy. All pregnant women, therefore, should have their urine cultured at their first visit to the clinic. In a clinical study comprising single-dose treatment with 3 g of fosfomycin trometamol versus a 3-day course of 400 mg ceftibuten orally, the inclusion criteria were acute symptomatic lower UTI (acute cystitis), significant bacteriuria (>103 CFU/ml), pyuria and confirmed pregnancy. Excluded were patients with asymptomatic bacteriuria or acute pyelonephritis. Predisposing factors comprised a history of recurrent UTI, diabetes mellitus, analgesic nephropathy, hyperuricaemia or Fanconi’s syndrome. Escherichia coli was the most frequently isolated pathogen in both groups. Therapeutic success (clinical cure and bacteriological eradication uropathogens) was achieved in 95,2% of the patients treated with fosfomycin trometamol versus 90,0% of those treated with ceftibuten (p, non-significant).The treatment of acute cystitis in pregnant women using a single-dose of fosfomycin trometamol was equally effective as the 3-day course of oral ceftibuten. Both regimens were well tolerated with only minor adverse effects. Long-term chemoprophylaxis should be suggested in patients with recurrent UTI or following acute pyelonephritis during pregnancy.

Key words: Urinary tract infection in pregnancy, single-dose fosfomycin trometamol, ceftibuten.

Go to content