IMMUNOLOGY TEXTBOOK - Mercury Podillia 2013

ACQUIRED IMMUNODEFICIENCY STATES

Secondary immunodeficiencies in intracellular infections

Chlamydial infection. Chlamydial infection is accompanied by the presence of Antibodies in the Blood, but with a deficiency of innate and acquired Immunity. Affected individuals exhibit decreased levels of NK Cells, HLA-DR lymphocytes, and T- and B-lymphocyte subpopulations, along with impaired cytokine and interferon status.

Regimen and types of immunotherapy. In persistent forms of chlamydial infection, positive effects have been observed following the inclusion of polyoxidonium, glutoxim, interferon preparations, and leukinferon in the Treatment regimen, administered conventionally or via suppositories. Highly effective is the sequential use of roncoleukin and betaleukin. In patients with urogenital chlamydia, roncoleukin and bestim are effective when administered alongside macrolides (such as vilprafen).

Local intraurethral administration of drugs (betaleukin, roncoleukin) can be more effective; the course consists of 15-20 daily instillations of 5 - 6 ml (5 ng/ml betaleukin).

Interferon Inducers are beneficial (cycloferon, neovir, arbidol, amiksin). Amiksin is prescribed at 0.25 g/day for 2 days, then 0.125 mg every 48 hours for 4 weeks; Antibiotics are administered on the 3rd day.

In cases of T-Cell deficiency, thymic preparations (tactivin, thymalin) are utilized.

Immune activation can be achieved through the administration of specific Vaccines, or in their absence, universal vaccine-like preparations (such as lycopid).

Tuberculosis. Tuberculosis is an infection characterized by the intracellular parasitism of mycobacteria, caused by a deficiency in susceptible individuals of innate immunity factors, particularly phagocytic immunity (killing, Digestion), against the Background of high allergic reactivity of both immediate and delayed types to mycobacterial Antigens.

In tuberculosis, IgG antibodies and sensitized T-lymphocytes are detected, yet they fail to provide protective immunity. The BCG vaccine does not induce lasting immunity in individuals susceptible to mycobacteria. The increasing resistance of mycobacteria to essential medications complicates treatment. Immunocorrective therapy aimed at stimulating specific and nonspecific resistance in patients can improve clinical outcomes.

Regimen and types of immunotherapy. Lycopid has been tested for activating the phagocytic link of immunity in patients with Pulmonary Tuberculosis. Its activating effect on the monocytic-macrophage system of innate immunity has been proven—specifically, the Generation of reactive oxygen species and the synthesis of IL-1 and TNF-α. Lycopid is administered at 10 mg for 10 days alongside etiotropic therapy, or as 1 tablet (10 mg) once sublingually in 3 cycles of 7 days with 2-week intervals. Cessation of bacterial excretion was observed in 80% of patients; purulent sputum and intoxication decreased, while the count of T-lymphocytes and phagocytic bactericidal activity increased.

Glutoxim is prescribed for patients with pulmonary tuberculosis (infiltrative, caseous, and disseminated forms) for 50 days intravenously and intramuscularly at 1 ml of a 3% solution twice daily. The drug reduces intoxication and pulmonary inflammation, while preventing exacerbations of chronic hepatitis and leukopenia.

Galavit reduces the generalization of tuberculosis in the Lungs. In patients with disseminated and infiltrative tuberculosis, it enhances the clinical efficacy of antituberculosis drugs and diminishes their side effects. The preparation decreases lymphocytosis, elevates the depressed levels of CD19+ B-lymphocytes, and reduces elevated IgA levels.

Polyoxidonium, when used in complex tuberculosis therapy, improves the clinical and radiological picture of the disease, stimulates the closure of pulmonary destruction cavities, and promotes the resorption of inflammatory foci. It normalizes immune status parameters and stimulates phagocytic activity.

Leukinferon in therapeutic tuberculosis patients is applied at 1 ampoule 3 times a week, with a course of 12-15 injections. In surgical cases, it is prescribed preoperatively at 1 ampoule intramuscularly, 3 times a week, for a course of 6-36 ampoules. On the 2nd postoperative day, the drug is administered intramuscularly at 1-2 ampoules every other day, and intrapleurally at 1 ampoule along with chemotherapeutic agents. It reduces intoxication, accelerates the cessation of bacillary excretion by 2-4 times, diminishes destructive Changes in the lungs, and speeds up the closure of breakdown cavities.

Roncoleukin (recombinant IL-2), administered alongside antituberculosis drugs, is given intravenously to pulmonary tuberculosis patients at 500 thousand IU every other day for 3 injections. Immediate treatment outcomes improved by 30%, the incidence of postoperative complications decreased, and immunological parameters improved.

Thus, evaluated immunomodulators combined with basic tuberculosis therapy significantly enhance its effectiveness and normalize immune status parameters.