Workshops

MORPHOLOGICAL DIFFERENTIATION OF
ULCERATIVE COLITIS AND CROHN'S DISEASE

Gargin V.V., professor, Doctor of Science,
associated professor
Kharkiv National Medical University, Kharkiv, Ukraine

Microscopic analysis of biopsies, in combination with clinical, laboratory, radiographic, endoscopic and therapeutic observations, is commonly used for the diagnosis of Ulcerative colitis (UC) and its differentiation from Crohn's disease (CD). Such differentiation is important because the inappropriate use of steroids or delayed use of antibiotics in infectious diseases could have serious consequences.
Microscopically CD is characterized by transmural inflammation whereas UC is mucosal disease. The histological diagnosis is largely based on the finding of granulomas in addition to some other criteria, especially mucosal distortion. In addition, segmental distribution of crypts or crypt atrophy, segmental distribution of mucin depletion, mucin preservation at the edge of ulcer or in crypts with surrounding neutrophils, and the presence of mixture of biopsies with focal inflammation and severe diffuse or patchy inflammation have significant discriminative value. Furthermore, in contrast to UC, typical CD shows segmental or focal distribution of the disease in the bowel and focal or patchy inflammation within a biopsy specimen. In contrast, Paneth cell metaplasia has only limited discriminative value while cryptitis and crypt abscesses have no significant discriminative value.

Bondarenko A.V.
BARTONELLA INFECTION IN HIV-INFECTED PERSONS
Andriy Volodymyrovych Bondarenko
PhD, Associate Professor of Infectious Diseases

The spectrum of Bartonella infections has expanded rapidly since the first HIV-infected patient with unusual, vascular proliferative lesions of bacillary angiomatosis was described in 1983. Of more than 24 species of Bartonella described until now, only B. henselae, and B. quintana are the most frequently described human pathogens in HIV-infected persons.
This species can cause a broad spectrum of disease in HIV-infected individuals, including bacillary angiomatosis, hepatic peliosis, osteomyelitis, unexplained fever, bacteremia, and endocarditis. Risk factors for B. henselae infection consist of contact with cats or fleas, whereas B. quintana infections are associated with low income, homelessness, and louse infestation. Regardless of the manifestations, serologic tests may help support the diagnosis. In patients with addiction to parenteral drugs, seroprevalence ranged from 15% to 47.5%; in patients with HIV infection, it varied between 17.3% and 40%.
Together with I. Mechnikov Institute of Microbiology and Immunology we develop express method for laboratory diagnostics of B. henselae-infection due to indirect immunofluorescent assay by determination of Bartonella antigens and antibartonellosis antibodies levels in blood serum. Antibiotic therapy is strongly recommended for all HIV-infected patients with Bartonella infections. Relapses of Bartonella infections in HIV-infected persons are common, particularly after relatively short antibiotic courses. Visceral disease may be progressive and fatal without appropriate antibiotic therapy.