Vol 95, No 6 (2019)
- Year: 2019
- Articles: 9
- URL: https://bakhtiniada.ru/0042-4609/issue/view/6053
- DOI: https://doi.org/10.25208/0042-4609-2019-95-6
Full Issue
REVIEWS
Actinic keratosis: аctual view
Abstract
The article summarizes information about the actinic keratosis. Presented data of the literature about the prevalence of the disease, the features of the clinical picture, diagnosis, differential diagnosis and treatment of dermatosis.
Vestnik dermatologii i venerologii. 2019;95(6):5-13
5-13
Precision therapy for psoriasis patients
Abstract
In this review, we systematized information in a new direction — precision medicine in the aspect of the study of psoriasis. An idea of relevance, basic concepts is given, a modern classification of biomarkers is given. Examples of each type of biomarker are presented, their role in the diagnosis and treatment of patients. The relationship of a personalized and precise approach to patient management is indicated. The main directions of development of this section of medicine are indicated.
Vestnik dermatologii i venerologii. 2019;95(6):14-21
14-21
ORIGINAL STUDIES
Coamplification of Mycobacterium leprae genome sections by real-time PCR: Detection of the pathogen and the possibility of a semi-quantitative assessment of the bacterial load
Abstract
Aim. To develop a method for coamplification of single-copy genes and repetitive elements of the Mycobacterium leprae genome in the analysis of clinical material from leprosy patients with an assessment of the clinical significance of the study results.
Materials and methods. Skin scarification and biopsy samples from patient R. with a diagnosis of “A30.5 Leprosy. Multibacillary form. Lepromatous type. Active stage” were used as empirical material for the study. A search for M. leprae DNA in the clinical material was performed by the method of real-time PCR (RT-PCR) using primers and hydrolysis probes for the single-copy species-specific genes rpoB (encodes the β-subunit of bacterial RNA polymerase), sodA (encodes the superoxide dismutase enzyme) and mntH (encodes the manganese transport protein), as well as for RLEP — the non-coding repetitive element of the genome.
Results. Using various RT-PCR assays, consistent results were obtained concerning the presence or absence of M. leprae DNA in the studied clinical samples. The high sensitivity of PCR was confirmed for the detection of the repetitive element RLEP compared to the single-copy genes rpoB, sodA and mntH, which consists in reducing the number of amplification cycles (Ct) needed for exceeding the threshold fluorescence value of hydrolysis probes and leading to the maximum intensity of the fluorescence signal. When constructing standard graphs for calibrating the accumulation of a fluorescent signal for simultaneously analyzed portions of the M. leprae genome in dilutions from 1 to 1,000, significant differences in the results of co-amplification were noted depending on the quantitative presence of the DNA being detected.
Conclusion. Coamplification of M. leprae genome sections with varying degrees of copy number variation by the RTPCR method provides for effective detection of the M. leprae DNA in clinical material and forms a basis for a quantitative assessment of the bacterial load in skin scarification and biopsy samples.
Materials and methods. Skin scarification and biopsy samples from patient R. with a diagnosis of “A30.5 Leprosy. Multibacillary form. Lepromatous type. Active stage” were used as empirical material for the study. A search for M. leprae DNA in the clinical material was performed by the method of real-time PCR (RT-PCR) using primers and hydrolysis probes for the single-copy species-specific genes rpoB (encodes the β-subunit of bacterial RNA polymerase), sodA (encodes the superoxide dismutase enzyme) and mntH (encodes the manganese transport protein), as well as for RLEP — the non-coding repetitive element of the genome.
Results. Using various RT-PCR assays, consistent results were obtained concerning the presence or absence of M. leprae DNA in the studied clinical samples. The high sensitivity of PCR was confirmed for the detection of the repetitive element RLEP compared to the single-copy genes rpoB, sodA and mntH, which consists in reducing the number of amplification cycles (Ct) needed for exceeding the threshold fluorescence value of hydrolysis probes and leading to the maximum intensity of the fluorescence signal. When constructing standard graphs for calibrating the accumulation of a fluorescent signal for simultaneously analyzed portions of the M. leprae genome in dilutions from 1 to 1,000, significant differences in the results of co-amplification were noted depending on the quantitative presence of the DNA being detected.
Conclusion. Coamplification of M. leprae genome sections with varying degrees of copy number variation by the RTPCR method provides for effective detection of the M. leprae DNA in clinical material and forms a basis for a quantitative assessment of the bacterial load in skin scarification and biopsy samples.
Vestnik dermatologii i venerologii. 2019;95(6):22-28
22-28
Molecular typing of T. pallidum clinical isolates and their resistance to macrolides in the Russian Federation during 2018–2019
Abstract
Based on arp, tprII and tp0548 genes variability molecular typing of Treponema pallidum is a worldwide method for syphilis epidemiology analysis, including the ability to monitor antimicrobial-resistant variants of the causative agents of the disease.
The aim of the study is to characterize the molecular subtypes of T. pallidum isolated from syphilis patients’ clinical material in 2018–2019, to assess the known antibiotic resistance determinants presence, and to compare the results with known Russian and foreign data.
Materials and methods. 64 T. pallidum clinical isolates obtained from 10 regions of the Russian Federation: Astrakhan, Irkutsk, Kaluga, Moscow, Novosibirsk and Omsk regions, the Stavropol Territory, the Republic of Sakha (Yakutia), Tuva and Chuvashia were studied. The arp gene variability was estimated by the number of internal tandem repeats from 60 base pairs analyzed by PCR. The variability of tprII genes was based on the restriction fragment length polymorphism. The nucleotide sequence of the tp0548 gene with a length of 84 base pairs (positions 131–215) variable region, as well as the genetic determinants of macrolide resistance in the 23S rRNA gene, were studied by capillary sequencing.
Results. 14 d/f molecular subtype of T. pallidum was absolutely prevalent in 9 of 10 examined subjects of the Russian Federation, taking 93.75 % of the total number of clinical isolates, and it was consistent with data on its stable dominance over 2011–2017. The most common in Western Europe molecular subtype of T. pallidum 14 d/g was found in the Kaluga and Omsk regions, taking 4.69 % of the analyzed samples. The molecular subtype of T. pallidum 14 b/f, sporadically but stably occurring over the many years of monitoring, was represented by a single clinical isolate (1.56 %) from the Republic of Tuva. A2058G 23S rRNA mutation causing resistance to macrolides was detected both in all (3 of 3) representatives molecular subtype 14 d/g and in 2 of 60 clinical isolates molecular subtype 14 d/f (from Moscow and Omsk region). In fact, the resistance to macrolides was found in 7.81 % T. pallidum Russian clinical isolates found during 2018–2019, that exceeds the WHO threshold level allowing to recommend a drug for the STI treatment.
Conclusion. The contemporary molecular epidemiology of syphilis in the Russian Federation is characterized by the dominance of the molecular subtype T. pallidum 14 d/f, and significantly distinguishes the local population from those in the neighboring states of Europe and Asia. The continued spread of the determinants of resistance to macrolides makes us cautious about the use of this group of drugs for the treatment of syphilis and is an argument in favor of an appropriate review of current clinical recommendations.
The aim of the study is to characterize the molecular subtypes of T. pallidum isolated from syphilis patients’ clinical material in 2018–2019, to assess the known antibiotic resistance determinants presence, and to compare the results with known Russian and foreign data.
Materials and methods. 64 T. pallidum clinical isolates obtained from 10 regions of the Russian Federation: Astrakhan, Irkutsk, Kaluga, Moscow, Novosibirsk and Omsk regions, the Stavropol Territory, the Republic of Sakha (Yakutia), Tuva and Chuvashia were studied. The arp gene variability was estimated by the number of internal tandem repeats from 60 base pairs analyzed by PCR. The variability of tprII genes was based on the restriction fragment length polymorphism. The nucleotide sequence of the tp0548 gene with a length of 84 base pairs (positions 131–215) variable region, as well as the genetic determinants of macrolide resistance in the 23S rRNA gene, were studied by capillary sequencing.
Results. 14 d/f molecular subtype of T. pallidum was absolutely prevalent in 9 of 10 examined subjects of the Russian Federation, taking 93.75 % of the total number of clinical isolates, and it was consistent with data on its stable dominance over 2011–2017. The most common in Western Europe molecular subtype of T. pallidum 14 d/g was found in the Kaluga and Omsk regions, taking 4.69 % of the analyzed samples. The molecular subtype of T. pallidum 14 b/f, sporadically but stably occurring over the many years of monitoring, was represented by a single clinical isolate (1.56 %) from the Republic of Tuva. A2058G 23S rRNA mutation causing resistance to macrolides was detected both in all (3 of 3) representatives molecular subtype 14 d/g and in 2 of 60 clinical isolates molecular subtype 14 d/f (from Moscow and Omsk region). In fact, the resistance to macrolides was found in 7.81 % T. pallidum Russian clinical isolates found during 2018–2019, that exceeds the WHO threshold level allowing to recommend a drug for the STI treatment.
Conclusion. The contemporary molecular epidemiology of syphilis in the Russian Federation is characterized by the dominance of the molecular subtype T. pallidum 14 d/f, and significantly distinguishes the local population from those in the neighboring states of Europe and Asia. The continued spread of the determinants of resistance to macrolides makes us cautious about the use of this group of drugs for the treatment of syphilis and is an argument in favor of an appropriate review of current clinical recommendations.
Vestnik dermatologii i venerologii. 2019;95(6):29-36
29-36
CLINICAL PRACTICE GUIDELINES
Diagnostics of anxiety and dermatological index of life quality in patients with chronic actinic dermatitis
Abstract
65 patients with chronic actinic dermatitis were examined, with the determination of dermatological and psychological indices, allowing to determine the quality of life and the severity of depressive and anxiety disorders in patients.
Vestnik dermatologii i venerologii. 2019;95(6):37-43
37-43
Photodynamic therapy as an up-to-date medical technology for the treatment of vulgar acne
Abstract
Background. Acne occurs in at least 85 % of male and female teenagers, often lasts a long time, with relapses in the 3rd and 4th decades of life. Since 2000, the technology of photodynamic therapy (PDT) has been actively used in many countries. Over the past two years, numerous important studies on the effectiveness of PDT for the treatment of acne have been conducted.
Aim. To generalize most recent information on the effects of PDT and to show its applicability in clinical
practice.
Methods. The data search and analysis were carried out using the US National Library of Medicine (PubMed database) and E-library online resources. The study included original articles published over the past two years and devoted to or related to the use of PDT for the treatment of acne vulgaris.
Results. A total of 55 articles were discovered. A total of 9 clinical trials or descriptions of clinical cases meeting the criteria for analysis were selected. The investigated clinical studies used various and ambiguous, non-standardized approaches in terms of photosensitizer incubation periods, cumulative doses of the light source energy and the number of treatment sessions. An analysis of the publications revealed a trend to use shorter incubation periods and less active photosensitizers in order to reduce the risk of such adverse events as erythema, edema, hyperpigmentation and blistering.
Discussion and conclusions. PDT is an effective and promising medical technology for the treatment of acne. PDT can be used for mild and severe inflammatory and cystic acne in patients with various skin types and lesion localizations. This type of acne therapy is currently performed using various approaches. Further research is needed to develop optimal and standard procedures for implementing this relevant and clinically beneficial medical technology.
Aim. To generalize most recent information on the effects of PDT and to show its applicability in clinical
practice.
Methods. The data search and analysis were carried out using the US National Library of Medicine (PubMed database) and E-library online resources. The study included original articles published over the past two years and devoted to or related to the use of PDT for the treatment of acne vulgaris.
Results. A total of 55 articles were discovered. A total of 9 clinical trials or descriptions of clinical cases meeting the criteria for analysis were selected. The investigated clinical studies used various and ambiguous, non-standardized approaches in terms of photosensitizer incubation periods, cumulative doses of the light source energy and the number of treatment sessions. An analysis of the publications revealed a trend to use shorter incubation periods and less active photosensitizers in order to reduce the risk of such adverse events as erythema, edema, hyperpigmentation and blistering.
Discussion and conclusions. PDT is an effective and promising medical technology for the treatment of acne. PDT can be used for mild and severe inflammatory and cystic acne in patients with various skin types and lesion localizations. This type of acne therapy is currently performed using various approaches. Further research is needed to develop optimal and standard procedures for implementing this relevant and clinically beneficial medical technology.
Vestnik dermatologii i venerologii. 2019;95(6):44-54
44-54
DRUG TREATMENT IN DERMATOVENEROLOGY
Guselkumab in the treatment of patients with plaque psoriasis of moderate and severe severity: Efficacy and safety of interleukin-23 blockade
Abstract
Materials and methods. In this paper, we review publications on the significance of interleukin-(IL)-23 in the pathogenesis of plaque psoriasis and analyse the results of the 1st and 2nd phase clinical studies, as well as the 3rd phase comparative studies VOYAGE 1, VOYAGE 2, NAVIGATE and ECLIPSE on the efficacy and safety of Guselkumab — a blocker of the p19 subunit in IL-23. The review was conducted using the scientific literature databases PubMed and RSCI.
Results. The high efficiency and safety of Guselkumab in the treatment of patients with plaque psoriasis is demonstrated. The PASI 90 value during Guselkumab treatment reached 73.3 % and 80.2 % at the 24th and 16th week (VOYAGE 1). The therapeutic effect persisted following treatment for 48 weeks. It is shown that Guselkumab therapy is effective in patients having undergone unsuccessful therapy with other genetically engineered biological preparations. The reviewed comparative studies show a higher therapeutic efficacy of Guselkumab compared to TNF-α blockers, IL-12/23 p40 subunit, IL-17. The incidence of adverse events during therapy using Guselkumab and other biological drugs used in comparative studies
was low and comparable.
Conclusion. The IL-23 subunit p19 blocker Guselkumab is an effective and safe drug for the treatment of patients with plaque psoriasis of moderate and severe severity.
Results. The high efficiency and safety of Guselkumab in the treatment of patients with plaque psoriasis is demonstrated. The PASI 90 value during Guselkumab treatment reached 73.3 % and 80.2 % at the 24th and 16th week (VOYAGE 1). The therapeutic effect persisted following treatment for 48 weeks. It is shown that Guselkumab therapy is effective in patients having undergone unsuccessful therapy with other genetically engineered biological preparations. The reviewed comparative studies show a higher therapeutic efficacy of Guselkumab compared to TNF-α blockers, IL-12/23 p40 subunit, IL-17. The incidence of adverse events during therapy using Guselkumab and other biological drugs used in comparative studies
was low and comparable.
Conclusion. The IL-23 subunit p19 blocker Guselkumab is an effective and safe drug for the treatment of patients with plaque psoriasis of moderate and severe severity.
Vestnik dermatologii i venerologii. 2019;95(6):68-77
68-77
CLINICAL CASE REPORTS
Distributed glabrous skin mycosis involving foot nail lesions and showing resistance to antifungal therapy
Abstract
This article presents an analysis of publications on strains resistant to antifungal drugs and describes a clinical case of a 57-year-old patient suffering from distributed glabrous skin mycosis with foot nail lesions resistant to antifungal therapy. The clinical picture, diagnosis and treatment of the fungal disease is described. Against the background of antifungal treatment, the clinical and mycological cure of the trunk skin and foot nail mycosis was achieved.
Vestnik dermatologii i venerologii. 2019;95(6):55-60
55-60
A clinical observation of a Mycobacterium avium skin lesion in a patient with pulmonary tuberculosis
Abstract
Mycobacterium tuberculosis and non-tuberculous mycobacteria (NTMB) are clinically distinct. Rapid detection and differentiation of M. tuberculosis complex (MTBC) and NTMB is critical for infection control. Due to the high prevalence of these diseases, the likelihood of co-infection is sufficiently high; however, information on the prevalence and occurrence of such combinations is extremely scarce. In this research, on the basis of a clinical case, an approach to developing a therapeutic strategy for cases of combined Mycobacterium avium and tuberculosis infections is presented.
Vestnik dermatologii i venerologii. 2019;95(6):61-67
61-67