{"id":10061,"date":"2020-04-23T03:55:20","date_gmt":"2020-04-23T00:55:20","guid":{"rendered":"https:\/\/www.synevo.ro\/product\/salmonella-serologie\/"},"modified":"2025-02-05T15:33:23","modified_gmt":"2025-02-05T13:33:23","slug":"salmonella-serologie","status":"publish","type":"product","link":"https:\/\/old.synevo.md\/ru\/shop\/salmonella-serologie\/","title":{"rendered":"\u0421\u0430\u043b\u044c\u043c\u043e\u043d\u0435\u043b\u043b\u0430 - \u0441\u0435\u0440\u043e\u043b\u043e\u0433\u0438\u044f"},"content":{"rendered":"<p><strong><em>\u041e\u0431\u0449\u0430\u044f \u0438\u043d\u0444\u043e\u0440\u043c\u0430\u0446\u0438\u044f<\/em><\/strong><\/p>\n<p>Genul Salmonella apartine familiei Enterobacteriaceae si include bacili Gram-negativi nesporulati, facultativ anaerobi. Clasificarea curenta separa genul in doua specii: <em>Salmonella enterica<\/em>, ce contine 6 subspecii (I, II, IIIb, IV si VI) si <em>Salmonella bongori<\/em> care constituia anterior subspeciile V. Subspeciile I contin aproape toate serotipurile patogene pentru om. Membrii celor 7 subspecii de Salmonella pot fi serotipati in mai mult de 2500 serotipuri (serovaruri) pe baza reactivitatii imunologice a antigenelor somatice polizaharidice O termostabile si a antigenele flagelare H termolabile.<\/p>\n<p>Serotipurile specifice de Salmonella produc adesea sindroame clinice caracteristice cum ar fi gastroenterita, febra tifoida, bacteriemie si infectie vasculara, infectii localizate, precum si starea de purtator cronic; evolutia infectiei este influentata semnificativ de serotipul implicat.<\/p>\n<p><strong>Febra tifoida<\/strong> este o afectiune sistemica severa caracterizata prin febra si dureri abdominale produsa ca urmare a infectiei diseminate cu <em>S. typhi<\/em> \u00a0\u0438\u043b\u0438 <em>S. paratyphi<\/em>. Pacientii imunodeprimati prezinta un risc crescut de boala severa. Desi tabloul clasic cuprinde de obicei manifestari cu caracter acut, se intalnesc adesea si simptome nespecifice, cu debut insidios. Diagnosticul de febra tifoida trebuie luat in considerare la orice persoana cu febra care a calatorit recent intr-o regiune tropicala sau sub-tropicala. Un procent de pana la 10% dintre pacientii cu febra tifoida netratata excreta S. typhi in scaun o perioada de maxim 3 luni, iar 1-4% dezvolta <strong>starea de purtator cronic<\/strong>.<\/p>\n<p><strong>Gastroenteritele<\/strong> produse cel mai frecvent de serovarurile S. enteritidis si S. typhimurium au in majoritatea cazurilor o evolutie autolimitanta; dupa 6-48 ore de la ingestia de apa sau alimente contaminate apar greata, varsaturi, diaree, dureri abdominale, febra si frisoane. Cel mai adesea diareea este moderata, fara caracter sanguinolent si se remite in maximum 7 zile; persistenta diareei mai mult de o saptamana sugereaza un alt diagnostic. Dupa rezolutia gastroenteritei, agentul patogen poate persista in scaun 4-5 saptamani, in functie de\u00a0 serotipul de Salmonella. Tratamentul antibiotic poate sa creasca durata portajului.<\/p>\n<p>Un procent de pana 8% dintre pacientii cu gastroenterita dezvolta <strong>bacteriemie<\/strong>, iar la 5-10% dintre acestia vor\u00a0 aparea <strong>infectii localizate<\/strong>. Salmonella prezinta o susceptibilitate fata de grefele vasculare, infectia rezultata fiind asociata cu mortalitate mare. Printre infectiile extraintestinale localizate se numara: endocardita, infectiile SNC, osteomielita, colecistita, abcesele hepatice, ovariene sau testiculare. Afectarea articulara poate fi de doua feluri:<\/p>\n<p style=\"padding-left: 30px;\">-<em>artrita septica<\/em>: incidenta 0.1-0.2%; se dezvolta in special la pacientii cu artroza, boli de tesut conjunctiv, siclemie, proteze articulare; sunt afectate cel mai adesea articulatiile genunchiului, soldului si umarului; diagnosticul este stabilit prin examenul microbiologic al lichidului sinovial;<\/p>\n<p style=\"padding-left: 30px;\">-<em>artrita reactiva<\/em>: incidenta 0.6%; se dezvolta in special la pacientii cu marker HLA-B27 precum si la cei care au primit tratament antibiotic pentru gastroenterita; apare dupa 1-4 saptamani de la infectia enterala; sunt afectate cel putin 3 articulatii (in special genunchi, glezna, pumn, sacroiliaca); durata medie: 5 luni; culturile bacteriene din lichidul sinovial sunt negative<sup>2<\/sup>.<\/p>\n<p>In ceea ce priveste mecanismul patogenic al artritei reactive se considera ca bacteriile supravietuiesc la nivelul mucoasei digestive si ganglionilor limfatici si sunt transportate ulterior, prin intermediul mononuclearelor, la sinoviala. La acest nivel au fost puse in evidenta prin tehnici de biologie moleculara antigene peptidice si acizi nucleici din bacteriile incriminate, care alaturi de proprietatile imunogenetice ale gazdei determina aparitia unei artrite reactive declansate de infectie<sup>1<\/sup>. Marker-ul genetic HLA-B27 este prezent la aproximativ 80% din pacientii cu artrita reactiva, comparativ cu prevalenta sa de 7% in populatia generala. Teoria <em>peptidului artritogen<\/em> propune un model conform caruia, in cursul unei infectii, un peptid bacterian care este antigenic, similar cu un peptid propriu (un component al cartilajului) ar fi recunoscut preferential de celulele prezentatoare de antigen HLA-B27 pozitive. Ca urmare a prezentarii antigenului limfocitele CD8+ activate vor reactiona incrucisat fata de peptidul propriu cu structura similara, generand boala. Totusi aceasta teorie nu explica specificitatea de organ intalnita la pacientii cu artrita reactiva, avand in vedere faptul ca antigenul HLA-B27 este intalnit pe suprafata tuturor celulelor nucleate.<\/p>\n<p>Artrita reactiva dupa infectii enterale afecteaza in mod egal ambele sexe<sup>5<\/sup>. Cel mai frecvent se manifesta prin forme acute de boala: atac autolimitant (35%), in care pacientul prezinta un singur episod in cursul evolutiei, sau atacuri intermitente (35%), cu <em>restitutio ad integrum<\/em> intre atacuri. Mai rar, prezinta forme cronice cu evolutie ondulanta (25%), fara revenire la normal intre atacuri, sau severa, distructiva, cu spondilita secundara<sup>1<\/sup>.<\/p>\n<p>Testul Widal este unul dintre cele mai utilizate teste de diagnostic pentru febra tifoida in tarile in curs de dezvoltare. Acest test demonstreaza prezenta aglutininelor somatice (O) si flagelare (H) in serul pacientilor folosind suspesii ce contin Salmonella enteritidis (OH), paratyphi B (OH)\/(O)\/(H), paratyphi C (OH), typhi (OH) \/(O)\/(H), typhimurium (OH)<sup>3<\/sup>. Valori serice crescute ale titrului de anticorpi apar la sfarsitul primei saptamani de boala si ating un varf la 4-5 saptamani. O singura determinare nu este suficienta pentru a stabili un diagnostic de certitudine, deoarece concentratiile serice de anticorpi pot fi influentate de diferite situatii, cum ar fi imunizarea sau infectiile anterioare, administrarea de medicamente sau imunosupresia<sup>4<\/sup>.<\/p>\n<p>Diagnosticul etiologic al artritei reactive se bazeaza pe demonstrarea unei infectii recente sau persistente, una dintre metode fiind determinarea anticorpilor anti-bacterieni, in cazul de fata anti-Salmonella.<\/p>\n<p><strong><em>Recomandari pentru determinarea anticorpilor anti-Salmonella <\/em><\/strong>\u2013 utilitate in diagnosticul<strong>\u00a0 <\/strong>febrei tifoide, precum si al artritei reactive<sup>3;5<\/sup>.<\/p>\n<p><strong><em>Pregatire pacient<\/em><\/strong><em> - <\/em>\u00e0 jeun (pe nemancate)<sup>3<\/sup>.<\/p>\n<p><strong><em>Specimen recoltat<\/em><\/strong><em> - <\/em>sange venos<sup>3<\/sup>.<\/p>\n<p><strong><em>Recipient de recoltare <\/em><\/strong><em>-<\/em> vacutainer fara anticoagulant cu\/fara gel separator<sup>3<\/sup>.<\/p>\n<p><strong><em>Prelucrare necesara dupa recoltare<\/em><\/strong><em> - <\/em>se separa serul prin centrifugare<sup>3<\/sup>.<\/p>\n<p><strong><em>Volum proba <\/em><\/strong><em>- <\/em>2 mL ser<sup>3<\/sup>.<\/p>\n<p><strong><em>Cauze\u00a0 de respingere a probei<\/em><\/strong> <em>- <\/em>specimen intens hemolizat\/lipemic\/contaminat bacterian<sup>3<\/sup>.<\/p>\n<p><strong><em>Stabilitate proba<\/em><\/strong> \u2013 1 luna la -20\u00b0C<sup>3<\/sup>.<\/p>\n<p><strong><em>Metoda <\/em><\/strong>- <span style=\"text-decoration: underline;\">testul Widal (aglutinare in tub)<\/span><sup>3<\/sup>.<\/p>\n<p><strong><em>Valori de referinta <\/em><\/strong><\/p>\n<p style=\"padding-left: 30px;\">Salmonella typhi-OH: &lt; 1\/100<\/p>\n<p style=\"padding-left: 30px;\">Salmonella enteritidis-OH: &lt; 1\/100<sup>3<\/sup>.<\/p>\n<p><strong><em>Interpretarea rezultatelor<\/em><\/strong><\/p>\n<p>In febra tifoida anticorpii serici incep sa fie detectabili la sfarsitul primei saptamani de boala, titrurile atingand un varf in saptamanile 4-5, iar apoi scad treptat. Testul poate fi negativ in primele zile de la debut.<\/p>\n<p>Daca in serul pacientului exista anticorpi specifici pentru Salmonella se produce o aglutinare vizibila in tub, iar in lipsa anticorpilor suspensia ramane omogena, laptoasa.<\/p>\n<p>Efectuarea unui singur test nu este suficienta pentru a pune un diagnostic pozitiv. O crestere semnificativa a titrului intre doua testari succesive este sugestiva pentru boala. In cazul in care primul esantion este luat tarziu sau atunci cand pacientii sunt tratati cu antibiotice, nu se inregistreaza o crestere, ci o scadere a titrului de anticorpi. \u00a0Persoanele ce urmeaza tratament cu antibiotice in fazele timpurii ale bolii nu vor avea un test pozitiv.<\/p>\n<p>Populatia vaccinata impotriva Salmonellei poate da reactii fals pozitive. Acest lucru poate fi diferentiat de infectia recenta prin repetarea testului dupa o saptamana.<\/p>\n<p>Unele persoane, care au suferit de febra tifoida in trecut, pot dezvolta uneori anticorpi anti-Salmonella in timpul unor infectii independente sau strans legate de acest germene. Acest lucru este numit raspuns anamnestic si poate fi diferentiat de infectia adevarata prin lipsa cresterii titrului la repetitia acestuia, dupa 7 zile.<\/p>\n<p>In concluzie, titruri \u00a0&gt; 1\/100 sunt considerate semnificative pentru diagnostic, testul Widal fiind un test simplu, ieftin si relativ neinvaziv, care poate avea un rol important in diagnostic in situatiile in care culturile din sange nu pot fi obtinute<sup>3<\/sup>.<\/p>\n<p>In cazul artritei reactive, obtinerea unor titruri crescute pentru anticorpii anti-Salmonella poate sugera originea enterala a infectiei care a precedat aparitia bolii<sup>5<\/sup>.<\/p>\n<p><strong><em>Limite si interferente<\/em><\/strong><\/p>\n<p>Rezultatele testului trebuie corelate cu manifestarile clinice, datele epidemiologice, precum si alte date disponibile pentru evaluarea corecta a pacientului<sup>3<\/sup>.<\/p>\n<p><span style=\"font-size: small;\">\u00a0<\/span><\/p>\n<p><span style=\"font-size: small;\">\u0411\u0438\u0431\u043b\u0438\u043e\u0433\u0440\u0430\u0444\u0438\u044f<\/span><\/p>\n<p><span style=\"font-size: small;\">1. C.L. Constantinescu. Artrita reactiva. In In Esentialul in Reumatologie. Editura Amaltea, 2007, 108.<\/span><\/p>\n<p><span style=\"font-size: small;\">2. David A. Pegues, Samuel I. Miller. Salmonella Species, Including Salmonella Typhi. In Mandell, Douglas, and Bennett\u2019s Principles and Practice of Infectious Diseases, 7th edition, Churchill Livingstone, Elsevier, 2010, 2921-2924.<\/span><\/p>\n<p><span style=\"font-size: small;\">3. Laborator Synevo. Referinte specifice tehnologiei de lucru utilizate 2010. Ref Type: Catalog.<\/span><\/p>\n<p><span style=\"font-size: small;\">4. Mayo Clinic. Mayo Medical Laboratories. Test Catalog: Salmonella Antibody, Serum. www.mayomedicallaboratories.com. Ref Type: Internet Communication.<\/span><\/p>\n<p><span style=\"font-size: small;\">5. Sofia Constantiniu, Angela Romaniuc, Cecilia Durnea, Rodica Chiriac, Elena Rezus, Mariana Mutica, Oana Constantiniu. Antibacterial Antibodies in Sera of Patients with Reactive Arthritis and Other rheumatoid Diseases. In The Journal of Preventive Medicine, 2003, 11(1), 29-39.<\/span><\/p>","protected":false},"excerpt":{"rendered":"<p>\u0421\u0430\u043b\u044c\u043c\u043e\u043d\u0435\u043b\u043b\u0435\u0437 \u2013 \u044d\u0442\u043e \u043e\u0441\u0442\u0440\u0430\u044f \u043a\u0438\u0448\u0435\u0447\u043d\u0430\u044f \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u044f, \u043f\u0435\u0440\u0435\u0434\u0430\u044e\u0449\u0430\u044f\u0441\u044f \u0444\u0435\u043a\u0430\u043b\u044c\u043d\u043e-\u043e\u0440\u0430\u043b\u044c\u043d\u044b\u043c \u043f\u0443\u0442\u0435\u043c. \u0415\u0435 \u0432\u043e\u0437\u0431\u0443\u0434\u0438\u0442\u0435\u043b\u044f\u043c\u0438 \u044f\u0432\u043b\u044f\u044e\u0442\u0441\u044f \u0440\u0430\u0437\u043b\u0438\u0447\u043d\u044b\u0435 \u0431\u0430\u043a\u0442\u0435\u0440\u0438\u0438 \u0440\u043e\u0434\u0430 Salmonella (Salmonella enterica). \u0427\u0430\u0449\u0435 \u0432\u0441\u0435\u0433\u043e \u043e\u043d\u0430 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\u043a\u0438\u0448\u0435\u0447\u043d\u0438\u043a\u0430: \u0434\u0438\u0430\u0440\u0435\u0435\u0439, \u0441\u043f\u0430\u0441\u0442\u0438\u0447\u0435\u0441\u043a\u0438\u043c\u0438 \u0431\u043e\u043b\u044f\u043c\u0438 \u0432 \u0436\u0438\u0432\u043e\u0442\u0435 \u0438 \u043b\u0438\u0445\u043e\u0440\u0430\u0434\u043a\u043e\u0439. \u041f\u0440\u0438 \u0440\u0430\u0441\u043f\u0440\u043e\u0441\u0442\u0440\u0430\u043d\u0435\u043d\u0438\u0438 \u0438\u043d\u0444\u0435\u043a\u0446\u0438\u0438 (\u0432 5-10 % \u0441\u043b\u0443\u0447\u0430\u0435\u0432) \u0435\u0441\u0442\u044c \u0440\u0438\u0441\u043a \u0443\u0433\u0440\u043e\u0437\u044b \u0436\u0438\u0437\u043d\u0438: \u0432\u043e\u0437\u043c\u043e\u0436\u0435\u043d \u0441\u0430\u043b\u044c\u043c\u043e\u043d\u0435\u043b\u043b\u0435\u0437\u043d\u044b\u0439 \u0441\u0435\u043f\u0441\u0438\u0441, \u043c\u0435\u043d\u0438\u043d\u0433\u0438\u0442, \u043f\u043d\u0435\u0432\u043c\u043e\u043d\u0438\u044f, 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\u0438\u0441\u0441\u043b\u0435\u0434\u043e\u0432\u0430\u043d\u0438\u044f.<\/p>","protected":false},"featured_media":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"product_brand":[],"product_cat":[961],"product_tag":[],"class_list":{"0":"post-10061","1":"product","2":"type-product","3":"status-publish","5":"product_cat-serologie-boli-infectioase","7":"first","8":"instock","9":"sold-individually","10":"shipping-taxable","11":"purchasable","12":"product-type-simple"},"_links":{"self":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product\/10061","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/types\/product"}],"replies":[{"embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/comments?post=10061"}],"wp:attachment":[{"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/media?parent=10061"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_brand?post=10061"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_cat?post=10061"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/old.synevo.md\/ru\/wp-json\/wp\/v2\/product_tag?post=10061"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}