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The poststress translocation of intestinal microflora to the internal environment of the body is proposed to be regarded as the mechanism of neuroimmune cooperation in the realization of adaptative raction. It is pointed out that the effectiveness of the adaptive process depends on the state of microbiocenosis as a mediating factor. The inclusion of remedies for the correction of intestinal microbiocenosis into the complex therapy of patients with chronic pathology (as a specific manifestation of dysadaptive state) makes it possible to achieve results which cannot be achieved by the standard approach. We should return to the initial interpretation of I.I.Mechnikov's thesis on the basic role of dysbacteriosis in the development of the pathological process.

In 2100 children of different age groups the microbiocenosis of the large intestine was studied. The study revealed that the colonization of the mucous membrane of the large intestine with staphylococci developed in 30% of children with intestinal dysbacteriosis. Young children were mainly affected (91%). The prevailing species among isolated staphylococci was S. aureus (86%), capable of persistence in the intestine (30.9%). In children non typing S. aureus strains mainly circulated (70%), and among phage-typing strains isolates of phage group III prevailed (70.2%). The colonization of the intestine with coagulase-negative staphylococci was possible (14%). Microecological intestinal disturbances in children of different age groups were characterized by different degrees of changes in normal microflora with the prevalence of opportunistic microorganisms in the microbial picture.

Acute enteric infections (AEI), including shigellosis, are characterized by their extremely wide spread in Tajikistan. Their hyperendemicity is due to a high activity of the water route of transmission under the conditions of hot climate. The morbidity level of AEI both in the republic as a whole and in its individual territories has been found to directly depend on the degree of the potential epidemiological danger of the water supply system, as well as on the quality of water used by the population in the presence of its pronounced deficiency. The important role of breast feeding for the prophylaxis of AEI among young children is shown.

The article deals with the main scientific propositions of an original epidemiological theory, viz. the theory of the etiological selectivity of the main (primary) routes of transmission and their differences in various nosological forms of enteric infections (the theory of conformity). As proved on the basis of scientific investigations carried out for the period of several years, the role of various routes forming the fecal-oral mechanism of transmission (alimentary, aqueous, household) is highly different. In some enteric infections one of these routes becomes the primary (main) route, while other routes are secondary (additional). The primary route determines the wide spread of the corresponding nosological forms of enteric infections (the theory of conformity) and the preservation of their causative agents in nature as species. The secondary routes are only complementary to the activity of the main route of transmission in some degree. In controlling enteric infections, the measures taken with a view to suppressing the activity of the primary route of transmission are, from the epidemiological standpoint in the close and remote prospects, the cardinal ones, while the measures directed against the secondary routes are only palliative.

The Republic of Tajikistan belongs to the territories, traditionally hyperendemic with respect to acute enteric diseases (AED). The problem of AED still remains topical in recent years, especially among child population. The study of the etiological structure of AED in children has made it possible to establish that more than 70% of these diseases are of infectious nature. The leading role in the etiological structure of these diseases belongs to Shigella infections (32.4%), enterovirus diarrhea (12.1%) and Escherichia infections (8.9%). No significant differences in the character of the etiological structure of AED in children of urban and rural areas have been detected with the exception of enterovirus diarrhea, found to occur 2.7 times more frequently on children of urban areas (15.9%) than in those of rural areas (5.8%). The ascertaining of the etiological structure of AED in Tajikistan will make it possible to essentially increase epidemiological surveillance on AED and render it more concrete.

The dependence of the quantitative content of Escherichia coli in the feces of newborn infants 3 days after birth on the titer of anti Re-glycolipid antibodies in umbilical blood and in mother milk was studied. The reverse correlation between the number of bacteria in feces and the titers of anti Re-glycolipid antibodies was established, the amount of bacteria depending more on antibody titers in umbilical blood than on those in mother milk. The conclusion was made that antiglycolipid antibodies played an important role in the regulation of the quantitative content of E. coli in the intestine of newborn infants. In case of the deficiency of such antibodies intestinal dysbacteriosis may develop in newborn infants.

Acute enteric infection was reproduced in rabbits, used as an experimental model, receiving Aspergillus flavus metabolites with food for 15 days and inoculated rectally with enterotoxigenic strain Klebsiella pneumoniae K24 6723. Pathomorphological study revealed the penetration of Klebsiella into microplicate cells of the intestinal epithelium, the proliferation of bacteria in the lamina propria and in the cupolas of Peyer's patches, as well as in phagolysosomes of leukocytes and macrophages. The lesion of the mucous membrane in both large and small intestine, accompanied by the hyperplasia of lymphoid follicles, was noted. As a rule, surface epithelium was dystrophically changed and peeled off into the lumen of the intestine. The specificity of such lesion was confirmed by the detection of Klebsiella in Coons' direct immunofluorescence test. The experimental model confirmed the role of a decrease in immunological protective reactions of the body, caused the action of A.flavus metabolites, in the development of the infectious process, initiated by opportunistic enterobacteria.

Different E. coli of 0-groups, enteropathogenic (EPEC), enteroinvasive, enterotoxigenic (ETEC) and diarrheogenic in sporadic child diarrhea (DESCD), regarded as the causative agents of enteric infections, were detected in 70-80% of cases (1,146 E.coli carriers) in the feces of child and adult patients with acute enteric infections (AEI) irrespective of their age; in 35% of cases the same patient had a combination of two or more varieties of EPEC, ETEC or DESCD. Only EPE were excreted by 3.5-11.3% of patients, depending on their age; only ETEC were excreted by 1.7-3.4% of patients and only DESCD, by 23.1-32.8%. In 30-40% of cases diarrheogenic E.coli of the corresponding 0-groups were isolated as monocultures. The complex of bacteriological criteria, serving as the basis for the diagnostics of AEI (the necessity of the quantitative and qualitative characterization of the contamination of the seed material, E.coli serological labeling, the determination of E.coli pathogenicity factors) is discussed.

Some data on the specific features of the clinical course of acute enteric infections (AKI) and hypertensive disease (HD) are presented. The data indicate that the pathogenetic mechanisms of these diseases often act on the same points and in some cases in the same direction. 32,448 AEI patients were placed under observation, among them 29,398 patients with alimentary toxicoinfections and 3,050 patients with salmonellosis. Of these 1,483 patients had HD of stages II and III. In 266 patients of this group hypertensive crises of types I and II developed. In 128 AEI patients acute disturbances in cerebral blood circulation were observed. In 67.2% of cases these patients were found to have HD in their medical history. The treatment of patients with the combination of AEI and HD included rehydration with polyionic crystalloid solutions and the administration of hypotensive preparations.

The authors criticize the nosological principle of the diagnosis of toxic infections and believe that in a vast majority of cases such diagnosis must be based on syndromes. The only exceptions are cases of mass outbreaks and hospital infections. The definition of alimentary toxic infection is given, the difficulties of their clinical diagnosis and the ways to overcome these difficulties are indicated.

In the seventies a considerable rise in dysentery morbidity was observed in all republics of the USSR, in the whole of the USSR, in Bulgaria and in the German Democratic Republic. An increase in cholera morbidity in the world, as well as in the number of countries affected by this infection, was registered. A tendency towards a rise in virus hepatitis incidence was observed in the USSR. The dynamic study of the ozone content in the stratosphere, solar activity, disturbances in the magnetic field of the Earth, air temperature for the period of 1967-1980 was carried out. Strong and moderate correlation between dysentery and air temperature in summer was established. The maximum morbidity level in the USSR in 1972 was probably the consequence of unusually high air temperature in summer.

Thymectomy in puberal rats resulted in the development of pronounced enteric dysbacteriosis, correlating with the degree of T- and B-lymphocyte deficiency in the lymphoid organs and the blood stream during the first 2 months. Microbiocenosis restores probably due to more intensive functioning of alternative regulating mechanisms. A simple and informative characteristic indicating the degree of dysbacteriosis developing in the intestine is proposed: the index of dysbacteriosis.

The problem of the stability of the development of Shigella population in the intestine, depending on the dose of the infective agent, is analyzed. The agent is reproduced in the intestinal mucosa in short cycles, starting with adhesion and followed by penetration, intracellular multiplication and, finally, emission of free bacteria and hulled tops of villi with Shigella intracellular microcolonies. This form of emission maintains high concentration of bacteria and ensures, in case of the adhesion of hulled material, high local concentration provoking the repetition of the cycle. Depending on the dose, chains of cycles either progressively develop or maintain a constant level, or become extinct. Stable development of the chains of infectious cycles forms a focus of infection in the body (in the intestine). The growth of the populations of infective agents in live tissues, following the chain of cycles, produces a new type of microbial culture, differing from the types obtained by batch and flow cultivation. The aggregation and accumulation of infective agents in the hulled material is the particular case of the formation of infections, highly active particles and accumulations of infective agents, ensuring the development of infection with a relatively small number of organisms.

Materials obtained in the study of conditions for contacting acute enteric infections of uncertain etiology, based on the analysis of the age structure of patients, the structure of clinical diagnoses and the monthly dynamics of cases registered in one of the districts of Moscow for 3 years (1984-1986), are presented. An important role of the alimentary factor in the spread acute enteric infections of uncertain etiology among the population of different age groups and everyday contacts in the spread of such infections among young children has been shown. The authors put forward a suggestion concerning the formation of natural immunity to infective agents, serving as etiological factors in the development of enteric infections of uncertain etiology, in children of preschool age.

The capacity of P. mirabilis and P. vulgaris strains isolated in acute enteric infections in children for producing enterohemolysin, a new type of hemolysin, has been shown. The relationship between the capacity of Proteus cultures for producing enterohemolysin and their capacity for inducing toxic secretory reaction on a ligated loop on the small intestine of rabbits in the absence of known thermostable and thermolabile antitoxin in bacteria.

As the result of the serotyping of 1,223 NAG vibrio strains isolated in the Uzbek SSR from the environment and 659 strains isolated from gastroenteritis patients and from vibriocarriers, the serovars of 563 strains (46%) and 420 strains (63%), respectively, were determined. The prevailing serovars were 08, 06, 09, 014, 05, 039, 041, 013, 019 among the strains isolated from the environment and 08, 041, 037, 05, 039, 024, 06 among the strains isolated from humans. The strains belonging to serovars 05, 06, 08, 024, 037, 039, 041 were isolated both from the environment and from humans. The possible role of these strains in the development of acute gastroenteritis and in the formation of vibriocarriership in humans is pointed out.

Introduction of antibiotic-resistant bifidobacterial and lactobacterial strains, separately or together, does not decrease the degree and duration of contamination of the small intestine by enterobacteria after oral administration of antibiotics in large doses. The use of antibiotic-resistant bifidobacterial and lactobacterial strains allows one to decrease contamination of the small intestine by enterobacteria, resulting from the administration of antibiotics in near-therapeutic doses. The therapeutic effectiveness of bacterial preparations with respect to antibiotic dysbacteriosis has been found to depend on the level of resistance to the administered antibiotic. Antibiotic-resistant strains of bifidobacteria decrease the number of opportunistic microorganisms in the intestine in cases of dysbacteriosis caused by irradiation and administration of antibiotics.

Altogether 587 children with diagnosed acute enteric infections were examined. In 26.4% of them pathogenic enterobacteria were detected, and in 59%, opportunistic enterobacteria. In 38.2% of children these bacteria were found to be the etiological factor of the disease. A reverse relationship between the contamination of feces with pathogenic enterobacteria and the age of children was established.

The normal microflora of the intestine produces essential influence on the vital activity of the host. The exposure of the body to the action of different unfavorable factors (roentgen radiation, the administration of antibiotics, Salmonella infection, etc) results in changes in the normal microflora of the gastrointestinal tract. This work was aimed at the study of the influence of Streptococcus faecium YDC-48 on the intestinal microflora of mice in experimental (chemotherapeutic, postirradiation) dysbacteriosis and Salmonella infection. The effect of the oral administration of S. faecium YDC-48 on the correction of the intestinal microflora of mice in cases of dysbacteriosis etiology was studied. The intragastric administration of S. faecium YDC-48 was found to induce an increase in the level of lactobacterin and a decrease in the number of opportunistic microorganisms in chemotherapeutic and postirradiation dysbacteriosis. The oral administration of S. faecium YDC-48 decreased the manifestations of intestinal dysbacteriosis in experimental Salmonella infection. The possibility of developing a preparation on the basis of S. faecium YDC-48, a representative of normal intestinal microflora, is discussed.

A study was made of possible etiological association between klebsiellae and acute enteric diseases in children of creches age. The mean frequency of isolation of klebsiellae from these children constituted 22.3%, and from somatic patients - 38.5%. Both in the patients with enteric diseases and in somatic patients with intestinal disturbances the appearance of klebsiellae was preceded by oher diseases or by prolonged treatment with antibiotics leading to reduction of general resistance of the organism. Clinical manifestations were unitypical in the patients of both categories. In healthy children the incidence of klebsiellae was less (4.7%) and without any clinical manifestations. I is suggested that there is an etiological association between klebsiellae and acute enteric diseases under definite conditons.

Out of 4,082 Escherichia strains isolated from 989 hospitalized patients with acute enteric infections 2,979 strains belonged to 139 O-groups and the remaining strains could not by typed with O-sera (O1-O164) or were in the serological R-form. 19.3% of the strains isolated from 354 patients showed a positive reaction for thermolabile enterotoxin (TLET) determined in the radioimmunoassay. Escherichia with pronounced reaction for TLET were isolated from 5.5% of the patients. The serological picture of Escherichia with a positive reaction for TLET comprised 78 O-groups, showed practically no variations in children of different age and adult patients and was related to the intensity of reaction for TLET. The number of enterotoxigenic Escherichia greatly varied within individual O-groups: from 3.1 +/- 3.63% (O11) to 100 +/- 9.81% (O114) of the total number of known strains in these O-groups. In most O-groups the number of enterotoxigenic strains varied from 10% to 50%. The most widely spread serovars of etiologically important enterotoxigenic Escherichia belonged to 24 O-groups and were often isolated as monocultures. The capacity for producing TLET (and, probably, some other antigenically related substances) in widely spread among Escherichia; still, the determination of enterotoxicity is a necessary, but not sufficient criterion of their etiological importance in acute enteric infections.

The simultaneous study of fecal samples from persons bathing and not bathing in the sea, as well as samples of sea water, was carried out in recreational zones. The presence of enterobacterial contamination was more frequently detected in persons who bathed in the sea than in those who did not bath (13.5% and 0.9% respectively).

An increase in the percentage of antibiotic resistant and hemolysin-producing enterobacteria occurring in the process of the development of postradiation intestinal dysbacteriosis was due to a sharp increase in the number of such bacteria among the representatives of the genera inhabiting the large intestine of mice (E. coli, E. aerogenes, E. cloacae, P. morganii) and to the appearance of antibiotic-resistant and hemolysin-producing strains in the intestinal tract; these strains belonged to the genera which had not been detected in the intestines of the animals before irradiation. In postirradiation dysbacteriosis a considerable decrease in the percentage of colicin-producing strains was observed. The dissemination of enterobacteria in the small intestine of irradiated mice occurred as the result of exogenous and endogenous infection.

234 strains, including 104 K. pneumoniae strains, 28 K. oxytoxica strains, 64 E. cloacae strains and 40 E. aerogenes strains, have been isolated from the intestine of 266 children with diarrhea, aged up to 1 year, and studied for enterotoxigenicity. By the coagglutination test, made with G. Kronvall's staphylococcal reagent prepared with the use of antiserum to Escherichia coli LT-enterotoxin, and the biological assay on suckling mice enterotoxigenic activity has been revealed in 119 strains, including 48 K. pneumoniae strains (12.6%), 33 E. cloacae strains (27.4%) and 23 E. aerogenes strains (19.7%). The strains producing only LT-enterotoxins, only ST-enterotoxins, and both LT- and ST-enterotoxins have been found. The determination of the enterotoxigenic activity of the clinical isolates of opportunistic enterobacteria makes it possible to improve the etiological interpretation of acute intestinal infections.

In this study the importance of epidemiological, microbiological and epidemiological characteristics for the determination of the staphylococcal etiology of the most widespread diseases was determined. Microbiological study was found to be of leading importance for the confirmation of the staphylococcal etiology of diseases with the closed focus of infection. In such diseases 80% of cases were found to be caused by staphylococcal infection. In diseases with the open focus of infection the etiological diagnosis was based on the data of epidemiological history, the results of bacteriological studies in their dynamics. Immunological studies were of auxiliary significance. Staphylococcal etiology was confirmed in 59-72.4% of cases. Staphylococci were found to cause 12.8% of cases of intestinal diseases in little children. The etiology of the diseases was confirmed by the data of epidemiological history, and the results of bacteriological and immunological studies.

The clinical course and epidemiological features of campylobacteriosis in Moscow and Moscow Province in 1986-1987 are described. The specific proportion of this infection in the structure of acute enteric infections is, on the average, 4.8%. The level of Campylobacter contamination of animals and birds and their role in the spread of campylobacteriosis have been established. The possible ways and factors of the transfer of this infection are discussed.

The paper presents the results of virological, serological, and epidemiological examinations of patients with acute enteric infections of obscure etiology carried out for detection of rotavirus gastroenteritides. Rotaviruses have been found to play a certain role in generating acute gastroenteritides in infants under 3 years, mostly among infants, of 1-2 years, the least among those of 0-6 months of age. Adult family members were the source of infection for the children. The season of infection falls on October-December.