IMMUNOLOGY TEXTBOOK - Mercury Podillia 2013

ACQUIRED IMMUNODEFICIENCY STATES

Secondary immunodeficiencies in viral infections

Viruses can induce secondary immunodeficiencies via two pathways: directly destroying immunocompetent Cells (e.g., HIV) or altering their receptors, interaction dynamics, and modifying immunoreactivity (e.g., CMV, HSV, EBV).

Viruses can act as Inducers of secondary immunodeficiencies and provoke complications in any inflammatory process. For instance, EBV can infect B lymphocytes, leading to hypo- and agammaglobulinemia. Measles, Influenza, mumps, rubella, and CMV viruses alter the proportions between Cell populations, disrupt cellular cooperation, suppress immune responses, and increase susceptibility to bacterial agents. The chronic persistence of herpes virus in leukocytes and nerve ganglia, as well as hepatitis B and C viruses in hepatocytes, creates optimal conditions for The Development of secondary immunodeficiencies. The immunodeficiency virus itself destroys T-helper cells, causing an imbalance within The Immune System.

As an example of a T-lymphocytopenic type of immunodeficiency in a chronic viral disease, we present the clinical case of patient F., 37 years old, who received Treatment in the therapeutic department with a Diagnosis of: Chronic Bronchitis, acute exacerbation.

Patient F., 37 years old, complains of itchy rashes on the mucous membrane of the upper lip and the Skin of the nasolabial triangle. These symptoms have been recurring over the past 2 years. Exacerbations are triggered by hypothermia and acute respiratory infections (ARIs). Upon examination, a local vesicular-papular rash is revealed on the upper lip and the skin of the nasolabial triangle; in the Oral Cavity, erosive changes on the Tongue are observed and diagnosed as candidiasis (Table 76).

Immunogram of patient F., 37 years old. Data from the immunological study established that the course of the viral infection (herpes) in this patient is characterized by lymphopenia, relative T-cytosis (CD-S), a decrease in the immunoregulatory index (IRI=0.59), a slight increase in ESR, activation of the HUMORAL Immune Response via increased IgM production, activation of phagocytosis (neutrophil engulfing activity, spontaneous bactericidal activity), and a reduced functional reserve of the oxidation-reduction potential of phagocytes (NBT test result < 16). Complement levels (CH-50) are elevated.

Diagnosis: Chronic recurrent herpes virus infection of the face and Lips. Oropharyngeal candidiasis. T-lymphocytopenic immunodeficiency (DS4.9).

Conclusion: Lymphopenia combined with elevated cytotoxic lymphocyte levels, a decreased IRI, and a reduced functional reserve of the oxidation-reduction potential of phagocytes (NBT test) indicate the presence of a chronic viral infection in the patient (suppressed immune response variant). The patient presents with a T-lymphocytopenic immunodeficiency state (DS4.9).

Final diagnosis: Chronic recurrent herpes virus infection of the face and lips. Oropharyngeal candidiasis. T-lymphocytopenic immunodeficiency (DS4.9).

Etiotropic and immunotropic therapy:

1) etiotropic Antiviral Therapy includes Zovirax (acyclovir) 400 mg orally 4 times a day for 1 month; Herpevir ointment applied to the affected areas of the skin and lip mucosa 4 times a day for 7 days;

2) nonspecific antiviral therapy:

- Viferon 500,000 IU suppositories 1 time a day for 1 month; Virogel applied to the affected areas of the skin and lip mucosa twice a day for 5-7 days;

- interferon inducer - Cycloferon - 12.5% solution for injection - 2 ml, single dose 0.25 g intramuscularly on days 1, 2, 4, 6, 8, 11, 14, 17, 20, 23, 26, and 29. Prescribed following Interferon Therapy;

3) Immunofan 1 ml intramuscularly every other day, 10 doses;

4) Polyoxidonium 12 mg suppositories every 3 days, 10 doses;

5) Amixin 125 mg (1 cap.) every other day after breakfast, 20 doses;

6) Itraconazole (Intrungal) 100 mg once daily for 2 weeks.

Immunorehabilitation:

7) Thymalin 1 ml subcutaneously every other day, 10 doses;

8) Cycloferon 12.5 mg subcutaneously twice a week, 10 doses;

9) Galavit 0.1 g suppositories every other day for 20 days.

Class="center">Table 76. Immunogram of patient F., 37 years old