Author/Editor		Terčelj-Zorman, Marjeta
Title		Imunost pri okužbah z legionelo
Translated title		Immunity of legionella infection
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 37, št. Suppl 5
Publication year		1998
Volume		str. 67-74
Language		slo
Abstract		Legionella pneumophila, which causes legionnaires' disease, is a gram-negative bacillus, requiring special nutrient media. Legionella pneumophila is a fast, intracellularly in vivo growing bacteria, mainly within macrophages and other phagocytes. legionella pneumophila is a ubiquitous opportunistic bacterium capable of causing severe infection, especially in immunosupressed patients. Having entered the respiratory system, Legionella pneumophila adheres to alveolar macrophages and multiplies within, while only a minor proportion of the bacteria is destroyed in the process. There is humoral response with specific antibodies during the first days. The macrophages eventually dissolve and the multiplied bacteria are released into the alveolar space. The extracellular bacteria, or their parts, cause a redeployment of polimorphonuclears from the circulation and the emergence of specific antibodies. Humoral antibodies develop readily in response to these bacteria not only in infected patients but also in persons who have had subclinical exposure. The serum titers of specific immunoglogulins may rise quite high in earlly convalescence after Legionella infection. The host defense mechanism against Legionellais cellular immunity, based on lymphocytes as well as on the emergence of cytokines, which in turn activate macrophages. It seems that often macrophages, the killer cells, are the most important mechanisms of infection control. A vaccine prepared from dead Legionella also activates cellular immunity, and thus resistance to infection. Research has shown that macrophage resistance and sensitivity to infection are, to a high degree, genetically determined. Legionella may merely cause as severe infection in immunocompromised patients, as do other ubiquitous opportunistic microorganisms.(Abstract truncated at 2000 characters)
Summary		Legionela je ubikvitarna oportunistična bakterija, ki lahko pri človeku povzroči tudi težko obliko okužbe, posebno pri imunsko oslabljenem bolniku, pri HIV-pozitivnih bolnikih ter še posebno pri transplantiranih bolnikih. Bakterija rate in vivo znotrajcelično, predvsem v makrofagih in drugih fagocitih. Po vnosu bakterije z aerosolom ali aspiracijo se bakterija prilepi na alveolarni makrofag. Alveolarni makrofag v manjšem deležu uniči le nekaj bakterij, ostale pa se razmnožujejo v njem. V pvih urah in dnevih okužbe je odziv s specifičnimi protitelesi skromen. Nenehno razmnoževanje legionel v makrofagu povzroči njihovo lizo in izpust bakterije v alveolarni prostor. Zunajcelične bakterije ali njeni deli povzročijo prerazporeditev polimorfonuklearcev iz cirkulacije in nastajanje specifičnih protiteles. Specifična humoralna protitelesa proti legioneli nastanejo pri okuženih bolnikih, ki so zboleli, pa tudi pri osebh s subklinično okužbo. Titri specifičnih imunoglobulinov lahko močno narastejo pri tistih, ki so ravnokar prebolevali okužbo z legonelo. Celična imunost pa je gostiteljev glavni obrambni mehanizem proti legionelni okužbi. Izgleda, da sta celita ubijalka in z limfokinom aktivirana celica ubijalka najbolj pomembni pri nadzoru okužbe z legionelo, ob že prisotni neposredni aktivaciji makrofagov s citokini. Osnova pa je na limgocitih in nastanku citokinov, ki tudi aktivirajo makrofage. Cepivo, pripravljeno iz legionele in iz njenih sestavih, aktivira celično imunost in odpornost proti okužbi. Iz mnogih raziskav je bilo razvidno, da sta makrofagna odportnost in občutljivost za okužbo zelo odvisni od genetske zasnove. V 36-mesečno študijo je bilo vključenih sto bolnikov s težko pljučnico, hospitaliziranih v Bolnišnici Golnik. Bolniki so ustrezni poprej postavljenim kliničnim kriterijem za težko pljučnico, sumljivo za legionelno okužbo.(Izvleček prekinjen pri 2000 znakih)
Descriptors		LEGIONNAIRES' DISEASE LEGIONELLA PNEUMOPHILA IMMUNITY, CELLULAR ANTIBODY FORMATION IMMUNOLOGIC TESTS