A method for the treatment of chronic urogenital candidiasis in women

 

(57) Abstract:

The invention relates to medicine, namely to dermatology and gynecology, and for the treatment of chronic, torpidly flowing forms of urogenital candidiasis in women. This object is achieved in that the previously conducted fractional plasmapheresis by a fence of 400 ml of blood, her centrifugation at 1500 rpm for 15 min, followed by removal of the supernatant plasma. In the remaining cell mass injected cold dose of 1 mg of the drug per 1 ml of leukocyte-erythrocyte mass. Carry out incubation obtained cell mass at 18-24C for 30 min with periodic stirring of the mixture and then spend reinfusion autologous cell mass intravenous drip. The course of 4-5 sessions with an interval of two days. Then enter the antifungal drug diflucan at a dose of 150 mg once. The method reduces the time immunocorrection, while reducing the doses of administered drugs and duration of treatment. table 2.

The invention relates to medicine, namely to dermatology.

Over the last decade, the frequency of urogenital candidiasis almost doubled, amounting to 40-60% in the structure of Pospolita the surrounding forms of the disease (Serov C. N., 1997).

Treatment of chronic recurrent candidiasis is a big problem in gynecology and dermatology, even despite the fact that at the present time appeared oral drugs with high antifungal activity. Known medical methods of treatment of chronic forms of urogenital candidiasis in women, including antifungal, desensitized, immunostimulirutuyu therapy (C. L. Bykov //Archives of pathology - 1984 - N 12. - S. 75 - 82; Glazkova L. K., Egorova E. C., K.S. Minsker O. B. Fungal and some parasitic diseases of female genital organs. - M., 1988. - S. 85).

Known methods of treatment of chronic forms of urogenital candidiasis antifungal drugs systemic effects such as diflucan dose 150 mg 1 time per week for 3 - 4 weeks (N.M. Gerasimova, N. M. Tereshkina //guidelines for the diagnosis, treatment and prevention of vulvovaginal candidiasis: Information sheet No. 1 Ural State medical Academy. Department of skin and venereal diseases. Protocol No. 1 dated 24.01.1997).

The disadvantages of this method are the high-dose antifungal drug, as well as a high percentage of recurrence (up to 60%). Considering kozniuk over, the administration of specific drugs, even high-performance, does not guarantee complete recovery.

Fungi of the genus Candida are to conditionally pathogenic flora and cause disease only in terms of reducing the resistant forces of the body.

Known methods of treatment of candidiasis, based on the idea that the basis of chronic recurrent candidiasis is the failure of local cellular immunity, it phagocytic link. There is a large Arsenal of immunomodulating drugs, however, in the absence of the methods is quite effective immune stimulation, to prevent recurrence designate receiving long-term (up to six months) preventive courses of Itraconazole (Spinillo, A., Colonna, L. at al. Dept of Obstetrics & Gynecol, Univ of Pavia, IRCCS Policlinico S. Matteo, Italy. J Reprod Med., 1997). The disadvantages of this method are the long duration of treatment, as well as large exchange rate antimycotic drugs.

As complete antigens, similar in structure to human tissues, causing the phenomenon of sensitization in the body. Candida Allergy leads to recurrence of the primary disease, complicates its course (Sardica N. In., Sobolev A. C., Pronina with this, it is advisable, along with the use of antimycotic drugs using methods that increase protective forces of the microorganism - reducing allergic and autoimmune reactions that increase the natural resistance and improves the General condition of the organism (C. L. Bykov //Archives of pathology - 1984 - N 12. - S. 75 - 82).

For the above-mentioned effects of chronic urogenital, including fungal infections is the use of immunomodulating drug of a new generation of interferon inducer - cycloferon 250 mg/V or V/m from 10 to 15 injections (M, Romantsev, F. I. Ershov and other Immunodeficiency States: correction cycloferon. NTFP "Polysan", St. Petersburg, 1998) with simultaneous or subsequent etiotropic therapy (A. P. Remezov, C. A. Neverov Cycloferon: application in practice. Moscow - Saint-Petersburg, 1997). To conduct etiotropic therapy used antifungal drug diflucan 150 mg 1 time per week under the supervision of elimination of fungi of the genus Candida from the body (Wood, A. G.; New England Journal of Medecine, 1994).

The disadvantages of this method are:

- course duration immunostimulating treatment with the subsequent use of diflucan (2 - 3 weeks). The duration of treatment is the major ovulation, the increased body temperature in 39.1% of cases.

The objective of the invention is the increased efficiency of treatment of chronic, torpidly flowing forms of urogenital candidiasis in women, reducing the duration of treatment, dose reduction of the medication.

This object is achieved in that pre-collect 400 ml of blood, centrifuged it at 1500 rpm for 15 min, followed by removal of the supernatant plasma; in the remaining cell mass injected cold dose of 1 mg of the drug per 1 ml of leukocyte-erythrocyte mass, carry out incubation obtained cell mass at 18 - 24oC for 30 min with periodic stirring of the mixture and then spend reinfusion autologous cell mass intravenous drip 4-5 sessions of two days each, and after the course reinfused treated with cycloferon autologous cell mass, prescribe an antifungal drug diflucan at a dose of 150 mg.

The novelty of the method.

The course reinfused autologous cell mass, incubated in vitro with cycloferon provides:

1. improvement of tissue respiration and increase cellular metabolism, elimination of specific santtana cycloferon in leuko-RBC mass increases the bioavailability of the drug to acceptor cells and its activating effect on the membrane of leukocytes;

3. the introduction of 100 - 150 ml 9% physiological NaCl solution is to launder cells, leukocyte-erythrocyte mass and remove the rest of the drug that determines the purity of the experiment;

4. the interval between treatments is selected based on the period hyperreactive phase induction of interferon upon stimulation by the cold.

The method consists in the following.

When the diagnosis of chronic urogenital candidiasis in patients previously conducted exposio 400 ml of blood in containers gamecon 500/300. After that, the blood is centrifuged at 1500 rpm for 15 min, followed by removal of the supernatant plasma (plasmapheresis centrifuge). In the remaining cell mass blood type immunomodulator cold dose of 1 mg of the drug per 1 ml of leukocyte-erythrocyte mass, incubation of the mixture is carried out at a temperature of 18 - 24oC for 30 min with periodic careful stirring of the mixture. Then in gamecon with leiko-erythrocytic mass injected 9% physiological NaCl solution up to a volume of 500 ml. and then produce centrifugation at 1500 rpm with the subsequent removal of the supernatant liquid. After incubation produced a return of leukocyte-erythrocyte Messi is two days with the withdrawal of the drug from the body.

After the procedure for elimination of fungi from the body, patients are taking antifungal drug diflucan at a dose of 150 mg.

The combination of a preliminary centrifugal plasmapheresis incubation with cell mass immunomodulator with cycloferon and the subsequent reception of diflucan reduce treatment time by cycloferon, avoids side effects, lower doses of drugs.

The time spent in the operations of the proposed method are presented in table. 1.

We were treated 18 patients with chronic continuously recurrent forms of urogenital candidiasis; treatment results are given in table. 2, which shows the treatment outcomes of the proposed method and the prototype.

Clinical example.

Patient K., diagnosed with chronic urogenital candidiasis, multiple recurrences, levered left hand - was admitted with complaints of intense itching of the vagina and perianal region, rich cheesy vaginal discharge. From the anamnesis: a disease duration of 5 years, recurrence of vulvovaginal process occur almost every menstrual cycle. Previously, patsie the spruce to the elimination of the fungi Candida from the vagina. Relapse within 2 menstrual cycles.

When entering the vagina detected fungi of the genus Candida. Examination: vaginal mucosa is hyperemic, with a large number of caseous masses.

In the study of immune status showed a decrease in T - cell immunity (CD3- 47%, CD4- 25%, CD8- 10%, CD16- 5%, decreased phagocytic ability of neutrophils to 62%).

Treatment: the patient held exposio 400 ml of blood. Blood sampling was performed in disposable system Remocon 300/500. After that, the blood was centrifuged at 1500 rpm for 15 min, followed by removal of plasma (plasmapheresis centrifuge). In the remaining cell mass was added 2 ml of cold. The incubation mixture was carried out for 30 min with periodic, careful stirring of the mixture. After incubation produced return the mixture into the bloodstream of the patient intravenously. The course of treatment consisted of 5 sessions. Intervals between treatments 2 days.

During treatment, the patient's condition improved significantly: itching of the vagina and perianal area stopped on the 3rd day (after 2 treatments), decreased the amount of discharge on the 5th day (after 2 pre); the disappearance of levered on the left hand was observed for 12 hours (after 5 treatments). After 5 treatments showed normalization of indicators of cellular immunity (CD3- 69%, CD4- 39%, CD8- 22%, CD16- 14%, phagocytic activity of neutrophils to the characteristics corresponding to the rate 82%).

After 5 treatments the patient has been diflucan dose of 150 mg once. When mycological study through week yeast-like fungi were not found. In this regard, repeated doses of the drug was not prescribed.

When monitoring a patient for six months, acute urogenital candidiasis was not. When mycological research (bakteriostaticescoy and bacteriological) with a frequency of 1 time per month fungi of the genus Candida was not found.

The positive effects of the proposed method:

1. This method of activation of leukocytes can effectively improve immunoresistance the body of the patient in the form of the activation parameters of the T-cell component of the immune system, specific indicators of phagocytosis of yeast fungi of neutrophils and lower doses of immunostimulant and dose antimycotic drug 3 times.

2. Reinfuse autologous cell is satisfied, exerted on the body by yeast-like fungi.

3. The frequency of side effects of the drug cycloferon reduced 4.5 times.

4. The treatment time is reduced by 3 times.

A method for the treatment of chronic urogenital candidiasis in women, including the use of immunomodulating drug cycloferon, wherein the pre-collect 400 ml of blood, centrifuging it at 1500 rpm for 15 min, followed by removal of the supernatant plasma and introducing the remaining cell mass of cycloferon in a dose of 1 mg of the drug per 1 ml of leukocyte-erythrocyte mass, carry out incubation obtained cell mass at 18 - 24oC for 30 min with periodic stirring of the mixture and then spend reinfusion autologous cell mass intravenous drip after reinfused treated with cycloferon autologous cell mass with an interval of two days between treatments in the number of 4 - 5 treatments, prescribe an antifungal drug diflucan at a dose of 150 mg once.

 

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