Treatment of mumps orchitis in children

 

(57) Abstract:

The invention relates to medicine, in particular infectious diseases, and for the treatment of mumps orchitis in children. For this purpose it is proposed to use along with comprehensive symptomatic therapy from the first day of the disease the drug "Viferon" intrarectal 2 times a day for 5 days. While children up to 7 years enter Viferon-I, and children older than 7 years - Viferon-II. The method allows to increase the body's defenses when mumps orchitis, reducing the terms of relief of an acute process and preventing the development of complications. 2 C.p. f-crystals, 1 table.

The present invention relates to medicine, namely to the treatment of complicated forms of mumps is a viral infection (RSI) - orchitis in children.

Mass active immunization of children live mumps vaccine (DRI), carried out in autumn of 1981 allowed after 12 years to reduce the incidence of RSI in St. Petersburg to a minimum level - of 29.9 per 100 thousand of us.

However, since 1994, there has been intensive growth of registered cases of the MBC is the incidence rate among children was in 1995, 454,0, and in 1996 reached 1310,0 100 thousand child population. PST - the highest prevalence was recorded among students 12 to 14 years (more 2500,0 100 thousand child population).

This Postroenie" this infectious nanoform led to a sharp increase in the number of most serious complicated variants of the MBC, characterized by the involvement of boys of the reproductive organs (testicles). According to most researchers, this may lead to atrophy of the testicles, impaired spermatogenesis, azoospermia and, eventually, to male infertility.

Despite such serious residual medical and social consequences of orchitis up to the present time effective pathogenetically substantiated therapeutic tactics in this complication remains insufficiently developed.

It is known that in most cases therapy of patients with mumps orchitis is to use local and General events, including strict compliance with bed rest, physiologically optimal (elevated) position of the testes, as well as the purpose of symptomatic funds (antipyretic, analgesic, giposensibiliziruyuschey drugs) Miller M. et al., 1979; Ignatiev Y. D. et al., 1982, etc. In the use of the acute phase of the disease, however, long-term outcomes are often unfavorable. So, atrophy of the seminiferous epithelium was observed in the affected testicle every second, suffered this complication (Bendershy-Malbe N, 1982), and in the structure of causes of male infertility 16% due to the previously transferred the MBC, accompanied by orchitis (Niermann, 1980).

The closest solution to the proposed method of treatment are the recommendations to include in the complex of therapeutic effects, in addition to symptomatic therapy, drugs corticosteroids (Kazantsev, A. P., 1988 - "mumps" L., 1988, c. 151 - 152), which according to the author, leads to improved short-and long-term results. However, there are indications that the use of small doses of prednisolone (or equivalent) of the desired effect to achieve is not always possible - long remain intoxication symptoms, including fever reaction in the course of the treatment process may involve the second egg. This dictates the need to significantly increase the dose of corticosteroids, combining their appointment with a course of antibiotic therapy.

Obviously, based on empirical clinical observations hormonal therapy used in combination with ant is aktivnosti, but the reality of possible adverse reactions (nephrotoxicity, ototoxicity, and others).

However, undeniable is the fact that the nature and outcome of any infectious disease, including the MBC, largely related to the body's defenses. In response to the implementation and replication of the virus is the activation of adaptive systems of the body, which leads to the release of biologically active compounds (cytokines, prostaglandins), which has anti-inflammatory action. It is known that the system of interferonogenesis is crucial, as non-specific defenses. It was found that regulatory mediators, the most important of which is interleukin-1 and tumor necrosis factor-alpha produced in the early stages of development of cellular immune response by cells of the monocyte-macrophage system, mediate effector functions of phagocytes. When the infection is a viral infection of endogenous interferon rapidly synthesized phagocytes and other cells of the body, reaching a maximum by the end of the first day of the disease.

It is known that interferon is a low molecular weight protein, providing antiviral, antiproliferative leads to rapid elimination of the pathogen, preventing its persistence in the human body.

Given that etiotropic therapy of MBC, including its complicated forms at the present stage is practically absent, and the methods used (prednisolone + antibiotics) are sometimes not effective enough, with the aim of eliminating the above disadvantages, the authors propose a method for the treatment of mumps orchitis, characterized in that, in addition to symptomatic therapy from the first day of development of complications (orchitis) prescribe the drug VIFERON-I (up to 7 years) or VIFERON-II (over 7 years), 2 times a day intrarectal within 5 days. VIFERON represents suppositories containing recombinant interferon-alpha 2 and membrane-stabilizing drugs (alpha-tocopherol acetate and ascorbic acid) in therapeutically effective doses. Despite the wide use of VIFERON in clinical practice in various infectious diseases, indications for its use in the treatment of MBC in the available literature could not be found.

VIFERON got children within 5 days of acute orchitis 2 times a day with an interval of 12 hours in the medication VIFERON-II, because the observed age of the children ranged from 8 to 14 years. About the children, treated by traditional methods (symptomatic therapy in combination with corticosteroids and gentamicin). Children in the comparison group were representative age, duration of development of complications and the severity of the disease.

Comparative clinical efficacy in children of these two groups are presented in table. Noteworthy, that the children of the main group tended to be more rapid disappearance of swelling of the salivary glands (P > 0.05), and significantly faster (P < 0,001) were eliminated local manifestations of orchitis.

The effectiveness of the proposed method of treatment can also be illustrated by the following examples.

Clinical example of a patient with complicated form of the MBC: 2-sided mumps, 2-sided submaxillary; complication - right orchitis who received traditional therapy - symptomatic treatment in combination with prednisone and gentamicin.

Patient I. , 14 years old (case history N 658), from the hearth of mumps infection. The disease began acutely: malaise, fever, 2-sided increase in the parotid and submandibular salivary glands (parotitis + submaxillary).

On the 5th day of the disease is marked re polyspermia tissue of the scrotum.

When seen in the clinic on day 6 of illness: the body temperature of 39.5oC, weakness, lethargy, headache, chilling. In a throat slightly pronounced hyperemia, moderately pronounced increase in the parotid and submandibular salivary glands on both sides. Symptom of Marcona negative. The right testicle is enlarged compared with a norm of 2.5 times, sharply painful to palpation. Scrotal skin is hyperemic, edematous. From other organs and systems of the body revealed no pathology.

In the peripheral blood is a small leukocytosis, neutrophilia with left shift, monocytopenia, ESR - 31 mm/h Amylase blood upon receipt of 10.3 mg/CL.

Given the child's clinical symptoms, on the background of symptomatic therapy was prescribed course of prednisolone (60 mg/day/muscle), and gentamicin/muscle 2 times a day for 7 days.

At admission (day 6 of illness) the level of alpha-interferon in the blood was 34,0 IU/ml, IFN-γ, and 9.0 IU/ml Titer protivoprostudnyh antibodies in the blood is 1:40. In saliva specific antigen amounted to 0.34 Rel. unit

Despite the ongoing comprehensive therapy, including hormonal drugs and antibiotics, phenomena orchidinae intoxication, the child continued high fever. Only 4 days from the start of this therapy was a positive dynamics of the local changes, and General toxic effects. In the phenomenon of orchitis were stopped only on the 12th day of the disease, the increase in salivary glands disappeared by the 11th day of illness.

Upon completion of the course prednisonetherapyhy in combination with antibiotics the level of gamma-interferon in the blood 15.6 IU/ml, whereas alpha-interferon in the blood was not found! Marked increase in titers protivoprostudnyh antibodies in the blood up to 1:1280. Drew attention to the increase in saliva concentrations of mumps antigen - to 0.48 Rel. unit

Clinical example of a patient with complicated form of the MBC: 2-sided mumps; complication - left-orchitis receiving proposed by the authors of the interferon therapy.

Sick Hours , 13 years old (case history N 3000) from the hearth mumps infection. Ill acute: fever to 39,1oC for 2 days, lethargy, impaired health, a moderately severe swelling of the parotid glands on both sides. On the 4th day of illness - again raising the temperature to 39,3oC, increased symptoms of intoxi the

When viewed in hospital on day 5 of illness were identified: body temperature - 39,2oC, lethargy, negativity; in the throat is a small diffuse hyperemia, 2-sided increase painful to palpation of the parotid salivary glands. Symptom of Marcona negative. The left testis was increased compared to normal in 2 to 2.5 times, sealed, surface smooth, sharply painful palpation. The skin of the scrotum swollen, hot to the touch, sharply painful. From other organs and systems revealed no pathology.

In the peripheral blood - leukopenia, neutrophilia with left shift, monocytopenia, increased to 15 mm/h for ESR. Amylase blood upon receipt of 12.7 mg/CL.

In addition to symptomatic therapy, the child was assigned to the course proposed by the authors of the drug - VIFERON-II within 5 days intrarectal with intervals of 12 hours.

In the course of treatment (3 days) the level of alpha-interferon in the blood was 30,0 IU/ml of IFN-γ is 12.5 IU/ml Titer protivoprostudnyh antibody is 1:160. In saliva specific antigen practically were not found (0,04 Rel. ed).

The result of therapy the duration of the intoxication syndrome and fever was three days, the salivary glands were intagra interferonoterapii (after 1 day) the level of alpha-interferon in the blood reached 42.4 IU/ml, gamma-interferon - 26,7 IU/ml Titer protivoprostudnyh antibodies in the blood is 1:1280. Mumps antigen in saliva was detected at a minimal level of 0.10 Rel. unit

Thus, a comparison of the clinical efficacy of two therapies (prototype suggested by the authors of the method of treatment) clearly demonstrates the advantages of the second, which is manifested not only greater clinical efficacy, but also favorable dynamics from laboratory parameters (condition interferonogenesis, the value of specific antigen in the saliva).

A significant advantage offered by the authors of the method of treatment of mumps orchitis in children compared with the prototype (hormonal therapy in combination with antibiotics) is its intrarectal injection, providing not only easy, painless its introduction, the longer the circulation of interferon in the bloodstream than parenteral administration, but also its proximity to the target organ (testes). In addition, this treatment virtually prevents the possibility of adverse immunological changes and adverse reactions.

The proposed methods is their infections, by using the regional Centre of the North West zone of the Russian Federation.

Authors suggest a method for the treatment of mumps orchitis in children can be used successfully not only in adults with similar disorders, but is also used for the treatment and prevention of other complicated forms of the MBC children (meningitis, pancreatitis).

1. Treatment of mumps orchitis in children by conducting a comprehensive symptomatic therapy, characterized in that from the first day of the disease in addition to symptomatic therapy administered medication "Viferon" 2 times daily intrarectal within 5 days.

2. The method according to p. 1, characterized in that children up to 7 years enter Viferon-1.

3. The method according to p. 1, characterized in that children older than 7 years imposed Viferon-II.

 

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