Method of predicting course of wound process in case of purulent-inflammatory diseases of maxillofacial region of microbic etiology

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to laboratory analysis and can be used for prediction of course of wound process in case of purulent-inflammatory diseases if maxillofacial region of microbial etiology. In carrying out microbiological analysis of wound discharge, presence or absence of microorganisms and their concentration are determined, in case of immunologic analysis registered are total number of leukocytes, ESR, levels of medium circulating immune complexes (CIC), antibodies to streptococcus (ASL-O), immunoglobulin A (IgA). Analysis is carried out befire and on 5-7 day after operation, and in case of complete elimination of microorganisms in wound or reduction of their concentration to <103 CFU/tamp., as well as reduction in blood serum for not less than 30% of total number of leukocytes, antibodies to streptococcus, and reduction for not less than 25% of value of ESR, CIC, IgA, favourable course of wound process is predicted, in case if indices are different - prediction is unfavourable.

EFFECT: method allows to reduce time of patient's hospitalisation, carry out adequate therapy in post-operational period in due time, does not require additional equipment for carrying out microbiological and immunological analysis.

3 ex

 

The invention relates to medicine, namely to laboratory research in forecasting the course of wound healing in patients with purulent-inflammatory diseases of maxillofacial area microbial etiology.

There is a method of evaluating the course and prognosis of the development of purulent wounds with phlegmon of the maxillofacial area based on visual assessment of the amount and nature of exudate, diagnostic cytochemical studies of neutrophils in the wound, determining their overall biological activity (the activity determination of chromatin DNA, myeloperoxidase, the content of glycogen and cationic proteins), the degree of change which determine the General biological indicator of tissue index of neutrophilic granulocytes wound exudate, which predict the course of the wound process (Patent RF №2233449, IPC G01N 33/52, publ. 2004).

However, this method does not allow one to appreciate the views of the pathogen and its relationship to antibiotic therapy and in combination with indicators of natural anti-infective resistance of the microorganism to predict the further course of the infectious process.

There is a method of predicting the state of reactivity of the organism in odontogenic inflammatory diseases, including study sluny field of ultrahigh frequency, and by changing the dielectric conductivity of the sample to predict the reactivity of the organism in the odontogenic inflammatory process (Patent RF №2081414, IPC G01N 33/487, publ. 2006).

However, the method has several disadvantages: does not allow one to appreciate the views of the pathogen, its relation to antibacterial therapy; does not allow to assess the condition of the anti-infective resistance of the microorganism. The disadvantages of this method include that it requires special equipment that is not in the practical laboratories.

The closest is a method for predicting adverse currents purulent-inflammatory diseases of bacterial etiology, including isolation of pure cultures of pathogens, their identification, determination of ability to inactivate the bactericidal activity of blood serum (RF patent 02143691, IPC G01N 33/52, publ. 2006). The level of expression of the identified indicators predict the further course of the inflammatory process.

However, in the proposed method does not take into account the fact that the causative agent of the inflammatory process may be a microorganism selected in monoculture, and the state of cellular and humoral immunological parameters antimicrobial protection that can further characterize the inflammatory process.

Task p is izlagaemogo of the invention is to remedy these disadvantages, improving the accuracy of predicting the course of the inflammatory process in chronic inflammatory diseases of maxillofacial area, allowing time to adjust therapy. This is achieved by the fact that in complex microbiological and immunological study takes into account all significant sources of inflammation.

To do this, in the proposed method, including the taking of specimens, conducting microbiological studies isolation of pure cultures of pathogens from the sample, identification, determination of the ability to change the bactericidal activity of serum, predicting the course of the wound process in the level of expression of the identified indicators proposed to determine the concentration of the identified microorganisms. Conduct immunological study of serum prior to surgery and for 5-7 days after surgery to check the total number of leukocytes, erythrocyte sedimentation rate, average circulating immune complexes CEC, antibodies to Streptococcus SLA, immunoglobulin A IgA. Prognosis of wound process is favorable when the total elimination of microorganisms in the wound or the reduction of their concentration to a value of <103CFU/temp. while reduction in serum total number of leukocytes and asle-On at least the eat 30%, the decrease in ESR, CEC, IgA not less than 25%; in other terms, the prognosis is poor.

The definition for surgical intervention in a sample the presence of microbial growth allows to judge about the etiological agent causing the inflammatory process, and the definition of immunological factors - the presence or absence of violations in the antimicrobial defense of the organism. The study listed indicators for 5-7 days after surgery allows in the early stages to assess the condition of the wound, and dynamics of immunological indicators - protective potential of the organism.

A comparative analysis on the efficacy of treatment in 60 patients revealed a complex immuno-microbiological indicators early to predict the further course of the wound process that provides an opportunity to correct the treatment of the event.

As shown by long-term observations of the wound in patients with purulent-inflammatory diseases of maxillofacial area most often appear streptococci, which correlates with an increased level of antibodies in the blood to this pathogen. In the result, it was proved that when the total elimination of microorganisms, confirmed the reduction of the titer of antibodies to Streptococcus as the most frequent pathogen (in 83% of the EN inoculated streptococci), as well as the normalization of other anti-inflammatory factors (reduction in the number of leukocytes, ESR, CEC, IgA) indicate a favorable prognosis of wound process.

The method is as follows.

At the time of surgery and for 5-7 days after surgery in a patient taking a swab from the wound and sow quantitative method on solid nutrient medium: 5% sheep blood, yolk-salt agar, Wednesday, Saburo, thioglycolate environment.

In the presence of growth count the number of grown colonies of each pure culture, determine the concentration of each species and expressed in colony forming units per swab (CFU/temp.) Identification of the isolated microorganisms carry out the conventional methods.

In the blood before surgery and on day 5-7 determine the total number of leukocytes, erythrocyte sedimentation rate, levels of immunoglobulins G, A, M class, emphasizing indicators IgA, antibodies to Streptococcus (SLA, medium circulating immune complexes, the complex which determine the ability to change the bactericidal activity of serum, and the above values of these indicators make a prediction about the future course of the wound process.

Example 1.

Patient C., And a/b No. 121, born in 1954, he enrolled in an emergency in the Department of maxillofacial surgery with a diagnosis of odontogenic phlegmon podjela the things the right pane. Surveyed.

On the day of receipt conducted by opening and draining lesions of odontogenic infection, started a course of antibiotic and anti-inflammatory therapy.

Laboratory tests prior to surgery. CBC: L - 17,5; ESR - 38; Immunological analysis: IgA - 2,8; CEC - 79%; asle-About - 400 units Microbiological research: selected S. viridans group at a concentration of 105CFU/tmp.

Laboratory studies on the 5th day after surgery. Clinical analysis: L - 8,5, which is 52% lower than the original data; ESR - 12, which is 69% lower than the original data; Immunological analysis: IgA is 2.1, which is 25% lower; CEC - 53%, and 33% lower; asle-About - 200 units, which is 50% lower. Microbiological examination: no growth.

Prognosis of wound healing purulent-inflammatory diseases favorable.

In the recovery area - wound healing by primary intention (overlay deferred seams in the recovery area on the 5th day). Suture removal 10 days. Received excellent results. Discharged for outpatient monitoring of the surgeon on a residence.

Example 2.

Patient D., and b/W. 14517, born in 1967, received 12.12.06, with a diagnosis of odontogenic phlegmon submasseteric space left. In an emergency an autopsy and draining all stakeholders spaces.

Laboratory tests prior to surgery. Kleene is a mini-blood: L - 21,6; ESR - 33; Immunological analysis: IgA - 3,1; CEC - 124%; asle-About - 800 units Microbiological research: selected S. viridans group at a concentration of 105CFU/temp. and S. group D at a concentration of 103CFU/ml

Started a course of antibiotic therapy, physical therapy - magnetic therapy in the lower jaw on the left. The cleansing of the wounds on day 7, appeared pink granulation from the bottom of the wound, reducing the size of the wound by one third and healing by second intention under ointment and a bandage.

Laboratory studies on the 6th day after the operation. CBC: L is 8.5, which is 40% below the original data; ESR - 15, which is 55% lower than the original data; Immunological analysis: IgA is 2.0, which is 36% below the original data; CEC - 53%, and 57% lower than the original data; SLA-250 units, which is 60% below the original data. Microbiological examination: dedicated S. viridans group at a concentration of 102CFU/temp. The forecast is favorable.

Discharged for outpatient monitoring of the surgeon on a residence. When examined after 5 days of inflammatory process was arrested.

Example 3.

Patient G., and b/W 340, born in 1962, he entered tploc MONICA with a diagnosis of odontogenic phlegmon right submandibular region. Entered 5 days from the onset of the disease. On the day of receipt underwent surgical treatment with drainage and submandibular okolopochechnogo spaces to the right

Laboratory tests prior to surgery. CBC: L - 16,5; ESR - 40; Immunological analysis: IgA - 2,6; CEC - 109%; asle-About - 400 units Microbiological research: selected S. viridans group at a concentration of 105CFU/temp. and S.haemolyticus 103CFU/ml

Antibacterially therapy was carried out based on the data of sowing microbial flora on the identification and antibiotic sensitivity. However, complaints, and clinically noted the increasing negative dynamics with the spread of the inflammatory infiltrate along the neighbouring region (podvodlodkoy and submandibular left).

Laboratory studies on the 5th day after surgery. CBC: L - 17,3 - index unchanged; ESR - 35, which is 13% lower; Immunological analysis: IgA - 2,3, which is 18% lower; CEC - 111% indicator is unchanged; asle-About - 400 unit - the indicator is unchanged. Microbiological examination: dedicated S. viridans group at a concentration of 105CFU/temp. The prognosis is poor.

After opening the primary site of infection audited exposed areas with the disclosure of purulent streaks on podvodburstroy and submandibular areas on the left. The resulting pus. Space drained and treated. Wound healing by second intention on the 17th day.

The proposed method for predicting postoperative teenagey-inflammatory diseases of maxillofacial area allows you to reduce the time of stay of the patient in hospital, to carry out adequate therapy in the postoperative period. The method does not require additional equipment to conduct microbiological and immunological research.

A method for predicting the course of the wound process in purulent-inflammatory diseases of maxillofacial area microbial etiology, including the taking of specimens, conducting microbiological studies isolation of pure cultures of pathogens from the sample, identification, determination of the ability to change the bactericidal activity of serum, predicting the course of the wound process in the level of expression of the identified indicators, wherein determine the concentration of the identified microorganisms, conduct immunological study of serum prior to surgery and for 5-7 days after surgery to check the total number of leukocytes, erythrocyte sedimentation rate, average circulating immune complexes CEC, antibodies to Streptococcus SLA, immunoglobulin A IgA, and total elimination of microorganisms in the wound or the reduction of their concentration<103CFU/temp., while reduction in serum total number of leukocytes and SLA-not less than 30%, the decrease in ESR, CEC, IgA not less than 25% - predicts favorable course of the wound process is and, other indicators - the prognosis is poor.



 

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2 ex, 3 tbl

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