Ehinokokozes diagnostikas pilnveidošana, izmantojot etioloģiskus, bioķīmiskus, imunoloģiskus un imūnģenētiskus marķierus, un riska faktoru apzināšana Latvijā

The doctoral thesis “Improvement of Echinococcosis Diagnostics Using Ethiological, Biochemical, Immunological and Immunogenetic Markers and Identification of Infection Risk factors in Latvia” is devoted to the chronic parasitic disease that is not yet fully understood in Latvia and its diagnostic and treatment principles should be improved. The incidence of echinococcosis in European countries varies, ranging from 0.1 to 10/100,000 cases, and Latvia also has a relatively high number of newly diagnosed cases every year despite the relatively small population. It is important to mention that Latvia is geographically close to endemic areas of this zoonosis, such as Russia, Belarus, Poland, but there have been no targeted studies of morbidity, risk factors, diagnosis and treatment in our country. The aim of the thesis was to determine the prevalence of echinococcosis in Latvia, to identify risk factors of disease and to improve diagnostic and treatment tactics. To achieve our goal the study included more than a hundred patients whose data were analyzed in retrospective manner and a group of patients was surveyed to identify potential risk factors also immunogenetic and we also sought for new immunologic markers that could improve diagnostics. As a result of the analysis, it was found that risk factors can be distinguished in the Latvian patient population, for example, the risk will be increased if patient lives in a rural household as well if he owns livestock and slaughter them at home as well there is increased risk in owning dogs and cats. It was also found that IL-10 detection may be useful in cases of alveolar echinococcosis, as it could be a marker that allows a more accurate choice of treatment duration for these patients. The analysis of the prevalence of HLA Class II gene alleles revealed that there are alleles and haplotypes that can determine severity of the disease. There is also a reason to comply with the recommended treatment regimens as better result of the treatment will be for those patients who receive treatment early, that is, in the first year after the detection of the infection, those who have longer courses of treatment, at least continuously for 6 months and those who have the treatment every year. Analyzing biochemical parameters, it can be concluded that the risk of dying is increased in those patients who have increased levels of ESR, SF, GGT and bilirubin. From immunogenetic data it was concluded that in the case of cystic echinococcosis, a more severe course of the disease may be connected with alleles HLA-DRB1*17:01 and *04:01, -DQB1*03:02, -DQA1*04:01 and haplotypes HLA-DRB1*04/-DQB1*0301/-DQA1*0103, HLA-DRB1*11:01/-DQB1*0602-8/-DQA1*0103 but in case of alveolar echinococcosis more severe presentation with alleles *17:01 and *11:01, -DQB1*03:01 and haplotypes HLA-DRB1*17:01/-DQB1*03:01/-DQA1*01:02, HLA-DRB1*11:01/-DQB1*03:01/-DQA1*01:03 and HLA-DRB1*11:01/-DQB1*03:01/-DQA1*03:01. On the other hand we concluded that following alleles may be protective: in case of cystic echinococcosis HLA-DRB1*01:01 and *15:01, -DQA1*01:01, in case of alveolar echinococcosis alleles HLA-DRB*01:01. And protective haplotypes in all patients were HLA-DRB1*01:01/-DQВ1*03:01/-DQA1*01:01 and HLA-DRB1*01:01/-DQB1*02:01-2/-DQA1*02:01. All of this has led to the conclusion that biochemical, immunological and immunogenetic markers of echinococcosis patients play an important role in the diagnosis and treatment of the disease, as well may partially predict the course and outcome of the disease.