A method of treating lymphadenopathy

 

(57) Abstract:

The invention relates to medicine, namely to immunology, and can be used to treat patients with lymphoadenopathy associated with chlamydial and/or Mycoplasma infections. This will verify chlamydial and/or mycoplasmal infection of the respiratory tract and/or peripheral lymph nodes, evaluate the immunological, and then carry out comprehensive treatment, including the use of the macrolide antibiotic, or tetracycline, or diperkenalkan in age daily dose for 7-21 days one or two courses. In the second half of the course introduce Likopid in the age dosage for 10 days and preparations containing recombinant alpha-interferon and/or interleukin-two, in the form/m injection, and/or rectal administration, and/or phonophoresis, and/or magnetophoresis within 5-20 days. The effectiveness of treatment set by the involution of the lymph nodes, the eradication of chlamydia and Mycoplasma respiratory tract and/or punctate lymph nodes and parameters normalization of immunological indexes. The method improves the effect of treatment due to the complex influence on the tissue of the lymph node with a specific infection.

Izobreteniyami, associated with chlamydial and/or Mycoplasma infections.

Known methods of treatment of lymphadenopathy based on the existence of a causal relationship between bacterial infection and the need for exposure to primary and secondary inflammation and overall impact on the body (bpts Bogomolov. Differential diagnosis of infectious diseases. - M., 2000, S. 40). Traditional methods of treatment can be divided into three groups:

1. Inhibition of microflora in the primary lesion and lymph nodes - the use of broad-spectrum antibiotics, sulfonamides, nitrofuranov etc.

2. Surgical dissection and primary drainage of purulent purulent lymphadenitis.

3. The increase of protective forces of an organism and reduced toxicity.

However, the above methods of treatment are ineffective in chlamydial and/or mycoplasmal etiology of the disease, because the antibiotics most commonly used in the treatment of lymphadenitis (broad-spectrum antibiotics, sulfonamides others), not only have no effect on intracellular pathogens (chlamydia, Mycoplasma), but also lead to the development of tolerant forms of vozbuditel and mycoplasmal infections when lymphoadenopathy, as known insensitive, time-consuming and ambiguous treated by doctors.

Upon the occurrence and persistence of opportunistic (including chlamydia and Mycoplasma) infection leading role in the defectiveness of the local and systemic immunity, which should be reflected in the complex treatment of lymphadenopathy associated with chlamydial and/or Mycoplasma infections.

The closest way to offer can serve as a method of treatment of venereal lymphogranuloma associated with Chl.trachomatis" (Semenov, C. M. et al. Chlamydial infection. 1997. Smolensk. - 1997. - 171 C.), based on the use of causal (tetracyclines, erythromycin, Biseptol), pathogenetic therapy (autohemotherapy, pyrogenes, aloe, vitamins) and surgical treatment (Bagirova).

The main disadvantage of this method of treatment is its inefficiency in most cases, the observed lymphoadenopathy; lack of adequate integrated approach in the selection of etiotropic drugs, taking into account not only the sensitivity of microorganisms to antibiotics, but the presence of defects in the immune protection in the form of violations of phagocytosis and reduce interferometry criterion etiological cure diseases, what complicates the choice of tactics of conducting the patient.

The aim of the invention is to increase the efficiency of treatment of patients with lymphoadenopathy associated with chlamydial and/or Mycoplasma infections.

This objective is achieved in that the original will verify chlamydial and/or mycoplasmal infection of the respiratory tract and/or peripheral lymph nodes, evaluate the immunological, and then carry out comprehensive treatment, including the use of the macrolide antibiotic, or tetracycline, or diperkenalkan in age daily dose for 7-21 days one or two courses in the second half of the course the purpose of licopid in the age dosage for 10 days and preparations containing recombinant alpha-interferon and/or interleukin-two, in the form/m injection, and/or rectal administration, and/or phonophoresis, and/or magnetophoresis within 5-20 days; moreover, the effectiveness of treatment set by the involution of the lymph nodes, the eradication of chlamydia and Mycoplasma respiratory tract and/or punctate lymph nodes, and normalization of indicators of immunological indexes.

The proposed method is based on the use of complex adequate causal particular treatment.

In recent years there has been a clear tendency to increase the number of patients children and adolescents with long-term benign enlargement of the lymph nodes unspecified origins. The lymphadenopathy in most cases is a complex reactive changes in the lymph node caused by some pathological process. In pediatric practice, causes of enlarged lymph nodes are most often viral or bacterial diseases (with priority given banal coccal flora of specific infectious diseases, such as tuberculosis, yersiniosis, tularemia, etc). In addition, other etiological factors in some cases can serve as neoplastic processes, storage disorders disorders of metabolism.

However, the traditional examination in a significant percentage of cases (according to our research up to 45%, according to some literature data up to 70%) the cause of lymphoadenopathy unable to find out. This is reflected even in the current International classification of diseases (ICD) in the diagnosis of Lymphadenopathy unspecified etiology. The current practice of diagnosing bacterial causes vasilopoulou). This approach is inefficient not only diagnosis, but also treatment.

At the same time, the observed rise in the incidence of opportunistic infections (including chlamydia and/or mycoplasmal etiology) polymorphism of clinical manifestations suggests the presence of a certain connection with these infections and also if lymphoadenopathy. Earlier this connection was established only when the venereal lymphogranuloma - specific disease of the genitals in men and women (Semenov, C. M. et al., Chlamydial infection. Smolensk. - 1997. - 171 C.). Our studies (the object of study were children aged 5 to 16 years, suffering from lymphadenopathy) allowed on the results of direct immunofluorescence in a smear from the posterior pharyngeal wall and/or in a punctate lymph nodes to detect chlamydia (chlamydia pneumoniae, chlamydia trachomatis) and/or Mycoplasma (Mycoplasma hominis, Mycoplasma pneumoniae) infection.

This gave us the basis to determine further treatment. Designed to fulfill the following positions:

1. The sensitivity of Mycoplasma and/or chlamydial infection (antibiotic groups, macrolide, tetracycline, diperkenalkan).

2. The presence of the defect immunodeficiency is>3. The mechanism of action of drugs of genetically engineered alpha-two interferon, interleukin-two, licopid.

4. The presence of synergism when combined with the influence of the drugs interferon and new macrolides.

The technical result of the claimed invention is eradication verified pathogen, increasing treatment effectiveness lymphoadenopathy to clarify the etiological nature of the disease (chlamydia and/or Mycoplasma), the purpose of adequate etiotropic drugs with synergene etiopathogenetic action (macrolides, tetracyclines, diperkenalkan and recombinant alpha-two interferon), immunomodulatory drugs (licopid, recombinant alpha-two interferon, interleukin-two), and integrated clinical and immunological evaluation of the effectiveness of therapy.

The proposed method was successfully tested in the Department of immunorehabilitation Oblast children's clinical hospital of the city of Astrakhan. During 2000-2001 was observed 120 children admitted for examination with diagnosis of Lymphadenopathy unspecified etiology".

Below are the results of testing the proposed method of treatment l is.12.00.

The Diagnosis Of Lymphadenopathy. Adenoids 1-2 tbsp.

Admitted with complaints on an enlarged lymph node in the right axillary region in the last 4 months. Ambulatory received ampicillin in remission (no effect). Early history without features. Family and risk factors is not burdened.

When entering the child's condition is moderate. Health does not suffer. Active. Skin, clean, regular color. Zev hyperemia. Nasal breathing is difficult, no discharge. Palpation of the cervical, submandibular and inguinal lymph nodes 1 size, painless, elastic; right axillary increased to 2-3 size, not fused with surrounding tissues, slightly painful. In the lungs the breath puerile, no wheezing. NPV 22 in 1 min. heart sounds loud, rhythmic. HR 98 1 min Abdomen is soft, painless on palpation. Liver +1 cm from under the costal arch, the edge of the elastic, smooth. Chair decorated, without pathological impurities. Urination is not broken.

During the survey:

Complete blood count: ER 3,921012/l, HB 130 g/l, Le 5,210%, e-13, P1, C-62, l-20, m-4, erythrocyte sedimentation rate of 3 mm/h

B/x blood tests: CRP neg., SIAL. the 4.15 mm/l, total protein 86,3 g/l, bilirubin cont. of 4.44 mmol/l, Sul. other of 2.1 ml, thymol. 1 unit

Urinalysis and scatoscopy without pathology.

R-graphy of the chest: in the lung tissue without focal and infiltrative changes. Intrathoracic lymph nodes are not enlarged.

Ultrasound of abdominal organs: liver slightly enlarged, normal echogenicity. Other organs without pathology.

Ultrasound of lymph nodes: Right in the armpit are visualized 2 increased limouze, reduced echogenicity, homogeneous structure, size 1,9x1,0 cm and 1,h,9 see

RPIF punctate lymph node: identified Mycoplasma hominis +++, chlamydia - negative.

Histological examination punctate l/u: cellular elements of l/u.

Mantoux test with 2 Tu - negative.

In the Department of child received treatment: macropen within 10 days, IFN 1 million IU/m daily 8, Likopid. The treatment was fast positive dynamics: the child's condition has improved, lymph nodes decreased in size, painless. During the control study punctate lymph nodes within 3 months after the treatment of intracellular pathogens are not detected. In the immunological characteristics of phagocytic immunodeficiency not.

Example 2. KAIRAT M, age 5 (21.07.95, R.), and/b T/3353

Date Postup is ingit).

Admitted with complaints not frequent respiratory diseases, cough, enlarged lymph node. Last appeared after suffering acute respiratory infections in early October 2000 (about 2 months). Outpatient took remission without the expressed dynamics. Early history without features. The younger brother respiratory chlamydias, bronchial asthma. The boy burdened allergological anamnesis: it was noted allergic reactions to aspirin, Chupa-Chups.

When entering the child's condition is unsatisfactory. Health does not suffer. Skin tanned. Zev not hyperemia, tonsil gipertrofirovannyy, friable, scar changed. The back wall of the pharynx grainy. Determined by palpation increased to 2-3 size submandibular, anterior - and zadaszenia, axillary lymph nodes, painless, elastic. In the lungs vesicular breathing. NPV 18 in 1 min. heart sounds, rhythmic, loud. HR 86 1 min Abdomen is soft, painless. Liver and spleen are not enlarged. Stool and urine output are not changed.

During the survey:

Complete blood count: er 4,09l012/l, HB 136 g/l, Le 8,5109e-2, p-1, p-49, l-46, m-2, the sedimentation rate of 2 mm/h

B/x blood tests: CRP neg., SIAL. the of 3.85 mmol/l thymol. a sample of 2.0%, bellyrub. nepr. 6.3 µmol immunoglobulinemia G, incomplete phagocytosis).

Urinalysis and scatoscopy - without pathology

Nasal swab (RPIF): identified Chlamidia pneumoniae +++

Mantoux test with 2 Tu neg.

Ultrasound of lymph nodes: visualized submandibular lymph nodes on the left 1,4x0,7 cm, zadaszenia 0,9x0,5 cm, a homogeneous structure, reduced echo

Ultrasound of abdomen without pathology.

The child examined by an ENT doctor diagnosed pharyngitis.

In the Department of child received treatment: rule 50 mg 2 times a day with two courses of 5 days with 5-day intervals, IFN 1 million IU/m 10 daily, phonophoresis reaferona and Pile 6 in the projection area of lymph nodes, Likopid 1 mg 2 times a day for 10 days (on the background of the 2nd year of rulide). On the background of treatment was marked involution of the lymph nodes, absence of cough, inflammation of the upper respiratory tract.

When the control smear from the nasopharynx RPIF from 20.02.2001 intracellular pathogens are not detected. The immunological: the Number of T-lymphocytes (absolute and relative) in normal, DEPARTMENT of 1.9 (lower limit of normal).

Example 3. OLGA C., age 8, (20.08.92. G. R.), and/b T/3788.

Date 18.12.2000. Discharge date 3.01.2001.

Diagnosis: Reosti, the increase in the submandibular, cervical lymph nodes within 2 years. The girl from the FAC group. Family and risk factors calm.

When entering the child's condition is satisfactory. Skin, clean, regular color. Zev not hyperemia. Palpable submandibular and peremeshanyi lymph nodes, left increased to 3 sizes, right up to 2 sizes, elastic, movable, not welded with the surrounding tissues. Nasal breathing is difficult. In the lungs breathing harsh, wheezing no. NPV 18 in 1 min. heart sounds, rhythmic, loud. HR 82 1 min Abdomen is soft, painless on palpation. The liver edge of the costal arch, elastic, smooth. Chair without pathological impurities. Symptom of Pasternack negative. Urination free, painless, occasionally recorded enuresis.

During the survey:

Complete blood count: HB 139 g/l, Le 7,9109b-1, uh-1, p-1, p-67, l-28, m-2, the sedimentation rate of 5 mm/h

B/x blood tests: CRP neg., sialic the 3,63 mm/l, total protein and 67.8 g/l, ALT 0,063 mccat/l, ACT 0,1 mccat/L.

Urinalysis and scatoscopy without pathology.

The immunological: leukopenia, T-lymphocytopenia, defective phagocytosis (KAF 0,79), hyperimmunoglobulinemia M

Ultrasound of the abdominal floors (1,9x0,9 cm), homogeneous structure, reduced echo.

The study punctate lymph node on the RPIF: detected chlamydia trachomatis +++, Mycoplasma neg.

Histological examination punctate lymph nodes: lymphoid proliferation.

Consultation LOR-of the doctor, oncologist.

In the Department of child received treatment: IFN 1.5 million IU/m 10, rule 100 mg 1 tablet 2 times a day for 5 days, multivitamin. On the background of anti-infective and stimulating therapy was observed regression of lymph nodes, but after 2 weeks again increased reaction submandibular lymph node on the left. Given the persistent nature of the identified infections was also recommended that a second course of rulide-100, course reaferona and immune complex protein candles 1 at night for 10 days, readjustment of foci of chronic infection (dental caries). After treatment after 2 months with the re-examination showed positive: polyadenine no, intracellular contamination by pathogens of the genus chlamydia and Mycoplasma on RPIF not identified in the immunological improved cellular phagocytic protection. Disappeared complaints enuresis.

Example 4. SASHA W., age 14, (6.10.86, R.), and/b T 3661.

Date th tonsillitis, offset.

Admitted with complaints on the increase in cervical lymph nodes, fatigue, lethargy. Ill for 2 months, inspected oncologist outpatient, to exclude chlamydia sent to the Department of immunorehabilitation of the CSTO. Early history without features. The mother of a child suffering from chronic pyelonephritis. Risk factors are not aggravated.

When entering the child's condition is moderate. Feel satisfactory. The skin is pure white. Zev not hyperemia. Tonsil gipertrofirovannyy to 2-3 size, loose. Determined zadaszenia, supraclavicular lymph nodes, increased to 2-3 size, elastic, painful on palpation, left welded between a movable elastic piece. In the lungs vesicular breathing. NPV 18 in 1 min. heart sounds, rhythmic, loud. HR 72 1 min Abdomen is soft, painless. Liver and spleen are not enlarged. Physiological functions are normal.

During the survey:

Complete blood count: er 3,91012/l, HB 130 g/l, Le 6,2109e-2, p-1, p-34, l-61, m-2, the sedimentation rate of 5 mm/h

B/x blood CRP neg., SIAL. the 4.15 mm/l, total protein 76,2 g/l, ALT 0,26 mccat/l, ACT 0,12 mccat/L.

The immunological: reduced % of phagocytosis is without pathology.

Punctate lymph node RPIF: identified Chlamidia pneumoniae +++, Mycoplasma negative.

Histological examination punctate lymph node: lymphoid proliferation.

Ultrasound of the lymph nodes on the neck on the left is a group of enlarged lymph nodes of a homogeneous structure, significantly reduced echo. Zadawane lymph nodes on the right is slightly increased, homogeneous, moderately reduced echo.

Ultrasound of abdominal cavity without pathology.

Consultation LOR-of the doctor: Diagnosis: Chronic tonsillitis.

In office treatment: Sumamed 250 mg for 12 days (with breaks of course for 6 days), IFN 2 million IU 1x / day/m 10, phonophoresis reaferona and Pile on the area of projection of the cervical lymph nodes 8, multivitamin.

On a background of treatment showed positive: lymph nodes decreased in size, painless. After 3 months during scheduled inspection lymph nodes 1-2 size, single. In punctate lymph nodes RPIF pathogens not detected. The immunological dynamics 4 months after hospitalization: phagocytosis indices in normal and moderately increased the content of immunoglobulin G.

Example 5. MARY C., age 10 (26.06.90, R.).

Ÿ.

Sopot. the diagnosis of dystonia on vacatoncustom type. Chronic gastroduodenitis, the period of exacerbation. Bend tubes. samples.

Was admitted with complaints of frequent colds, subfebrility in the evening (37,2-37,8o), weakness. There is about chronic tonsillitis, 2 years ago, I had nonrheumatic carditis, reactive pancreatitis. In the last 1/2 year drew attention to the increase in cervical lymph nodes.

When entering the girl's condition moderate. Skin and visible mucous membranes pale pink, turgor of tissues is saved. Polyacene, palpable all groups of lymph nodes, size 1-2, elastic. Cervical lymph nodes are enlarged to 3 size, slightly painful on palpation. In the lungs vesicular breathing, wheezing no. NPV 18 in 1 min. heart sounds, rhythmic, loud, coarse systolic murmur at the apex and 5 point. HR 68 in 1 min Abdomen is soft, with painful palpation in the epigastric region. Liver and spleen are not enlarged. Physiological functions are normal.

During examination: clinical and biochemical studies of blood and urine without pathological deviations. Instrumental investigations (ECG, Ajax) data for cardiac pathology

Received treatment: Sumamed 125 mg two courses of 5 days with 5-day intervals, phonophoresis reaferona and CMP 8 on the projection region of the tonsils, Likopid 1 mg 2 times a day for 10 days. The girl's condition has improved, with further supervision during the year exacerbations of chronic tonsillitis is not mentioned, lymph nodes of normal size, the temperature on normal numbers. In a smear from the nasopharynx in a double examination intracellular pathogens were not found.

Thus, the positive effect of the proposed method of treatment lymphadenopathy is to increase the effectiveness of treatment and immunorehabilitation, which is achieved by the objectification of diagnosis and the use of complex adequate etiotropic drugs with synergene etiopathogenetic action.

A method of treating lymphadenopathy using antibiotics, characterized in that initially will verify chlamydial and/or mycoplasmal infection of the respiratory tract and/or peripheral lymph nodes, evaluate the immunological, and then carry out comprehensive treatment, including the use of the macrolide antibiotic, or tetracycline, or diperkenalkan in age daily dosage centuries for 10 days and preparations, recombinant alpha-interferon and/or interleukin-two, in the form/m injection, and/or rectal administration, and/or phonophoresis, and/or magnetophoresis within 5-20 days, and the effectiveness of treatment set by the involution of the lymph nodes, the eradication of chlamydia and Mycoplasma respiratory tract and/or punctate lymph nodes, and normalization of indicators of immunological indexes.

 

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