IMMUNOLOGY TEXTBOOK - Mercury Podillia 2013

ACQUIRED IMMUNODEFICIENCY STATES

Prevention and Immunorehabilitation in Secondary Immunodeficiencies

The Prevention of secondary immunodeficiencies can be either preventative or anti-relapse in nature. The former involves timely and comprehensive Treatment of conditions that may cause these defects, early Diagnosis of immune system imbalances, and prompt correction of such imbalances.

Anti-relapse immunoprophylaxis is based on the clinical dispensary monitoring of patients and the immunorehabilitation of those diagnosed with secondary immunodeficiencies. Such patients require regular follow-up examinations; if negative shifts within The Immune System are detected over time, immunocorrection is warranted. For instance, research shows that children recovering from purulent-septic diseases require immunorehabilitation because, despite Clinical Recovery, their cellular and humoral Immunity parameters do not fully normalize: IgG remains low, while IgM and IgA are at subnormal levels—or even above normal in some children, reflecting the body's readiness for reinfection. If decreased indicators of immunological reactivity persist during remission, a comprehensive set of active rehabilitation measures is implemented.

Nonspecific immunorehabilitation and immunoprophylaxis represent a crucial phase in treating patients with secondary immunodeficiencies during remission. The administration of "mild" immunostimulators in cases of adequately preserved immune reactivity helps prevent disease relapses, thereby ensuring successful immunorehabilitation. To this end, during the remission period, patients are prescribed oral adaptogens and herbal immunostimulators (such as echinacea, ginseng, eleutherococcus, aralia, zanthoxylum, schisandra, rhodiola rosea, etc.), alongside Vitamins and micronutrients. Courses of physioimmunotherapy (such as ELF therapy and magnetotherapy), hardening Procedures, a rational diet tailored to the clinical manifestations of the immunodeficiency, and the THERAPEUTIC USE OF local natural factors and spa treatments are also employed.

Children with secondary immunodeficiencies remain under dispensary observation until complete immunological rehabilitation is achieved and the clinical manifestations masking it have resolved. This monitoring is overseen by a primary care physician, with consultations and treatment adjustments provided by an immunologist. The frequency of check-ups depends on clinical symptoms in accordance with METHODOLOGICAL GUIDELINES FOR the dispensary care of the pediatric population. Immunological control is carried out during treatment, after which it is recommended to evaluate the child twice at 6-month intervals, following which the child may be discharged from the register accompanied by a stage-by-stage epicrisis.

Immunoprophylaxis of occupational secondary immunodeficiencies. Two regimens have been clinically tested: the first regimen includes sodium nucleinate, multivitamin complexes (Vitrum, Multitabs, Unicap), and adaptogens (eleutherococcus extract, ginseng tincture); the second regimen includes antioxidants (a-tocopherol, ubiquinone), medications with favorable metabolic properties (riboxin, Preductal MR), multivitamins, and adaptogens prescribed for a duration of 20 to 45 days.

Immunorehabilitation of Patients with Recurrent Viral Respiratory Tract Infections

During the acute phase, treatment corresponding to the Etiology AND Pathogenesis of the viral infection is prescribed, utilizing antiviral and antibacterial agents alongside detoxification and vitamin therapy. During remission (preferably immediately following immunocorrective therapy), it is advisable to prescribe:

✵ eleutherococcus or ginseng extract or infusion in a therapeutic dose for 1–2 months (immunological adaptogen);

✵ oxygen cocktail with lingonberry and rosehip fruit infusions, 2–3 courses per year, 10 sessions each;

✵ dibazole (orally) in a therapeutic dose for 10–12 days;

✵ antioxidant complexes (vitamins A, C, E, and Trace Elements such as zinc, selenium, and copper);

✵ as a prophylactic measure during contact with ARVI and for immunomodulatory purposes, nasal interferon and subcutaneous heparin in a therapeutic dose (100 IU/kg) for 5–6 days, with primary hemostasis parameters monitored after a week.

If the Clinical presentation of the secondary immunodeficiency is further characterized by subfebrile temperatures, it is advisable to introduce cinnarizine, nicotinic acid, and glutamic acid into the Background therapy regimen following dibazole. Subsequently, a complex of vitamin-rich herbs and plants with elevated bioelement content is prescribed in the form of infusions for 4–6 months. Good clinical efficacy can be achieved by administering Glycine—particularly to children with heightened neuromuscular excitability—at 0.5–1 tablet 2 times a day for 10–12 days.

Immunorehabilitation of Immunodeficient Patients with Clinical Manifestations of Chronic Bronchitis Resistant to Conventional Therapy

Upon completion of the primary course of immunocorrective therapy, which should also be initiated during the acute phase, we recommend implementing the following dispensary immunorehabilitation protocol:

1. Lysozyme (Lysobact) 1 tablet 3 times a day for one week each month, repeated for 3–4 courses (at a therapeutic dosage, preferably dissolved in milk; do not administer in cases of egg allergy).

2. Eleutherococcus (or schisandra) extract for 30 days.

3. Oxygen cocktails with vitaminized syrups every 10 days for 2 months.

4. Glycyram 25 mg, 1–2 tablets 2–3 times a day 30 minutes before meals, for 10 days every third month over the course of 1 year, or ultrasound therapy applied to the adrenal region (3 sessions).

5. Phytotherapy using herbal infusions of mint, St. John's wort, and nettle (3–4 times a day for a month, alternating 10 days for each herb); these courses should be repeated 2–3 times a year.

6. Background rehabilitation concludes with a short-course (twofold) immunization with staphylococcal toxoid or a course of Broncho-Vaxom lasting 10–30 days.

In the presence of abscess formation complicating Pneumonia, it is advisable to concurrently incorporate Applications of a 25–30% dimexide solution (which can also be administered via Electrophoresis) targeting the PROJECTION OF THE lesion area, for up to 8–10 sessions, alongside lysozyme therapy.

Immunorehabilitation Regimen for Recurrent Bacterial Bronchitis

1. Phytoncide antibacterial agents in rotation: garlic tincture, chlorophyllipt tincture, calendula tincture, 10 days each orally at an age-appropriate dose (1 drop per year of life, but not exceeding 20 drops);

2. Lysozyme, 1 tab. 3 times daily, for one week each month, repeated for 3–4 courses;

3. Glycyram, 25 mg, 1–2 tabs. 2–3 times daily 30 min before meals, for 10 days every third month for 1 year to suppress infectious allergic processes;

4. UHF therapy to the solar plexus area, 5 sessions per course, twice a year;

5. Probiotics (bifidumbacterin, lactobacterin, Lactiv-Ratiopharm, etc.) in case of a tendency toward bacterial dysbiosis and following antibiotic therapy, monitored by the intestinal bifidoflora composition. Linex or Hilak Forte may be used.

Courses of phytoncide antibacterial agents can be repeated 2–3 times a year.

A mandatory prerequisite for immunorehabilitation is immunological monitoring of its effectiveness. When implementing it, one should keep in mind the timeframe for each agent to take effect and avoid prematurely discontinuing a drug and replacing it with another, even if they belong to the same immunological action group. Restoring the body's immunological competence is a gradual process that requires a thoughtful and strictly evidence-based approach to therapy, taking into account current clinical manifestations and the underlying causative pathology.

Immunoregulation in Adenoiditis, Chronic Tonsillitis, and Rhinitis

Comprehensive treatment regimens for tonsil and adenoid hyperplasia:

- propasol for 10 days;

- calendula for 10 days + estifan for 3 weeks;

- chlorophyllipt orally for 2 weeks;

- IRS-19 spray, irrigate Tonsils twice daily, 2-week course.

The tonsils shrink and decrease in size.

Comprehensive treatment regimen for chronic tonsillitis (exacerbation phase). Criteria: adhesions with the faucial pillars and signs of chronic intoxication.

- amoxicillin or amoxiclav for 7 days at age-appropriate doses;

- leukinferon, 5 injections, or Viferon, 5–7 suppositories of 500,000 IU, every other day;

- propasol for 10 days + plasmol, 5 procedures;

- licopid, 1 mg for children and 10 mg for adults, for 10 days;

- estifan + Lugol's solution;

- UV irradiation of the tonsils, 5 procedures;

- 30% dimethyl sulfoxide (DMSO) compresses applied to the submandibular and cervical Lymph Nodes;

- ribomunyl for 6 weeks, 1 tab. twice daily, 4 days a week.

Comprehensive treatment regimen for chronic rhinitis associated with acute respiratory infections (ARIs)

- Ribomunyl 1 tab. 2 times a day, 4 days a week for 6 weeks, or IRS-19 for 10 days (nasal spray);

- applications with 30% Dimexide on the nasal bridge and maxillary sinus projections #10 every other day;

- aloe vera nasal electrophoresis;

- vasoconstrictors — Sanorin is preferred as it causes less drying of the mucous membrane.

Immunorehabilitation complex for frequently and chronically ill children

Complex immunomodulating therapy is primarily aimed at stimulating both T- and B-Cell immunity, as well as directly targeting the phagocytic link. The Nature of immune imbalance can be preliminarily assessed based on the clinical presentation of recurrent morbidity episodes: by etiology (viral, bacterial, fungal, or their associations); by pathogenetic Blood response (leukocytosis, leukopenia, lymphocytosis/lymphopenia, neutrophilia/neutropenia); and by clinical presentation (Typical symptoms of viral, fungal, or bacterial infection, colonization, etc.).

Without fear of hyperstimulation or exacerbating the imbalance between individual Components of the immune system, the following may be prescribed:

- Thymalin 10 mg, course of 5 injections;

- Ribomunyl or Likopid According to the standard regimen;

- a micronutrient-vitamin complex and biological products for the prevention and treatment of dysbiosis, combined with increased parental attention to the child, age-appropriate Nutrition, and body-hardening physical measures.

If the desired outcome is not achieved, the child should be examined at a specialized center or department to develop an individual immunorehabilitation program, and sometimes even for in vitro drug Selection.

In cases where there is no realistic opportunity to perform an immunological examination of the patient to identify the immune defect and select targeted therapy (for example, in rural areas), practical therapeutic rehabilitation regimens based on the patient's clinical data can be recommended.

Such treatment regimens may include:

a) biogenic stimulants that enhance the presentation of various Antigens (bacterial, viral, fungal, and mixed) via the phagocytic system;

b) agents that stimulate anabolic processes;

c) agents that activate oxidation-reduction reactions in Tissues (including immunocompetent Organs);

d) trace elements and their compounds;

e) medications that improve metabolic processes in The Nervous system with an indirect effect on the immune system (amino acid preparations to stimulate protein METABOLISM and Energy processes in Brain tissues and increase their respiratory activity; nootropic agents to facilitate associative connections between brain Cells; and agents that compensate for Central Nervous System Hypoxia and improve Lipid Metabolism, such as calcium pangamate).

Clinical indications in such cases may include:

1. Recurrence of Inflammatory Diseases with a risk of developing chronic forms and establishing a chronic focus of infection.

2. Predisposition to generalized pyogenic-septic disease (based on clinical data).

3. Presence of unusual adverse reactions or pseudo-allergic reactions to conventional medications.

4. Prolonged asthenovegetative dysfunction of the nervous system, peripheral blood abnormalities such as neutropenia, leukopenia, thrombocytopenia, lymphopenia, etc.

To prevent the progression of chronic disease, the following prophylactic treatment incorporating immunorehabilitation elements is recommended:

1. As the acute phase of inflammation subsides, subcutaneous injections of aloe extract are prescribed: 0.3–0.5 ml for preschool children and 1 ml for adults, administered as a course of 15–20 injections every other day.

2. Intravenous administration of sodium thiosulfate (oral administration is also possible, though slightly less clinically effective) aimed at mild desensitization, detoxification, and anti-inflammatory action. The clinical effects are mediated by sulfur compounds neutralizing the excess mediators of immediate and delayed hypersensitivity, which collectively constitute the morphological equivalent of a chronic process. When administered orally, a 10% sodium thiosulfate solution is used, dosed by age at 1 teaspoon, dessert spoon, or tablespoon 3 times a day; intravenously, a 30% solution is applied at 1-1.5 ml up to age 5, 2-3 ml for children over 5, and 5 ml for adults, once daily, with a standard treatment course of 10-14 days.

3. Calcium glycerophosphate (to stimulate anabolism in the tissues of immunocompetent organs) administered orally for 5-7 days.

If the infectious process shows a tendency toward generalization (key clinical signs include generalized biological areactivity, asthenization, prolonged microcirculation disorders, leukocytosis with neutrophilia in the absence of a localized purulent focus or, conversely, leukopenia in a manifest purulent-inflammatory process, and a mismatch between the Temperature response and clinical manifestations, especially against the background of perinatal brain injury), the following is recommended:

1. In the case of a leukopenic blood response, prevention of secondary immunodeficiency should be initiated with subcutaneous plasmol: 0.2-0.3 ml for preschool children and 1 ml of the solution for adults, administered once daily for 10-14 days. In the case of leukocytosis, treatment should begin with injectable dibazol, with a course of up to 2 weeks at age-appropriate therapeutic dosages.

2. Concurrently, a course of Vitamin P is prescribed orally (in the form of "ascorutin"), or preferably by injection (in the form of "urutin") at 0.2-0.3 ml for infants, 0.3-0.4 ml for preschoolers, and 1 ml subcutaneously for adults, once daily for 20-30 days. Vitamin P stimulates the functional activity of immunocompetent cells, likely due to its activating effect on redox processes in tissues.

3. To replenish bactericidal factors, the next prescribed agent may be lysobact (lysozyme; a prior biological tolerance test is mandatory). Lysozyme is prescribed by injection or orally for a 7-10 day course once daily, along with echinacea.

4. It is recommended to conclude the prophylactic regimen with UHF therapy targeting the solar plexus area, consisting of a 5-session course, which can be alternated with ultrasound therapy applied to the Adrenal gland projection zone.

In the event of unusual drug reactions manifesting as intolerance, it is recommended to employ a complex of cell membrane-stabilizing agents, which facilitates the adaptation of the receptor apparatus in immune system cells:

1. Vitamin E parenterally via intramuscular injections for a course of 7-10 days.

2. Enteral administration of zinc oxide to stimulate the chemotaxis of polymorphonuclear leukocytes and monocytes, as well as to stabilize the membranes of these cells. Zinc oxide is prescribed at doses corresponding to daily requirements, ranging from 4-6 mg in infants to 10-20 mg in older children and adults, divided into 2 doses.

3. Concurrently, daily ultrasound therapy applied to the adrenal gland projection zone, for a course of 5 sessions.