RU2257223C2 - Method for sanitation of germ carrier respiratory way - Google Patents

Abstract

FIELD: medicine, immunology.

SUBSTANCE: method involves inhalation administration of combination of immunocorrecting agents wherein recombinant interleukin-2 is used or its combination with genetic engineering α2-interferon and with the complex immunoglobulin preparation in the daily doses for 5 days depending on age of patient. Before sanitation with an immunocorrecting agent the method involves assay of carrying type by anti-lysozyme activity of microorganisms (resident or transitory) and repeated examination after sanitation course is carried out. Carriers are subjected for additional sanitation with anti-bacterial preparations in change of carrying type from resident to transitory and with taking into account antibiotic-resistance property of the carrier strain. Method allows carrying out the effective sanitation and immune reablement of germ carriers due to recovery of the adequate natural resistance and complex of nonspecific factor of regional and systemic immunity.

EFFECT: improved and effective method for sanitation.

2 cl, 2 tbl, 5 ex

Description

The invention relates to medicine, namely to immunology, and can be used for the rehabilitation of the respiratory tract of bacteriocarriers.

Known methods for the rehabilitation of bacteriocarriers based on the presence of a causal relationship with a bacterial infection and the need for exposure to pathogenic microorganisms. Traditional methods of bacteriocarrier sanitation are based on local and / or general use of antiseptics and / or antibiotics and / or bacteriophages (Valvachev N.I., Vilenchik G.Yu., Vovk V.I. Experience in sanitizing carriers of pathogenic staphylococci among medical personnel with a specific bacteriophage / / Carrier carrier and chronic forms of infectious diseases: Thes. All-Union Scientific Conference Conf. M., 1975. Part 1. P. 54-55; Ternovskaya LN The persistence of Staphylococcus aureus in the cells of the mucous membrane of the anterior sections of the nose is the material basis for long-term carrier Twa // Staphylococcal infection St. Petersburg, 1991. S.21-26; Am J Med 94:. 371, 1993; Bukharin OV Usvyatsov B.Ya. bacteriocarrier Yekaterinburg, 1996, P.112)..

The disadvantages of the known methods of rehabilitation of bacteriocarriers are:

- Low efficiency (as a rule, no more than 50% sanitized) due to the narrow spectrum of action of the drugs used and the insufficient ability of drugs to penetrate the cell with intracellular pathogen persistence.

- High probability, even when using bactericidal antibiotics of a wide spectrum of action, including for topical use (mupirocin, bactroban), as the re-occurrence of colonization and bacteriocarrier (in 40% of cases), and the development of resistant strains.

- When using broad-spectrum antibacterial drugs simultaneously with the elimination of the pathogen, suppression of the autoflora of the macroorganism and the development of dysbiosis.

- An increase in the immunological imbalance in bacterial carriers in connection with the immunosuppressive effect of known antibacterial and antiseptic drugs, which leads to a decrease in the body's natural resistance and the development of multicomponent bacterial carriage (not only coccal, but also gram-negative flora, chlamydia, mycoplasmas, etc.).

Closest to the claimed method, the prototype analogue can serve as a method of sanitizing staphylocococcus carriers using inhalations of oil solutions of vitamins A and E (Parfenov O.G., Gritsenko V.A. The persistence of bacteria.Kuybyshev, 1990. - P.121-124).

The disadvantages of the known prototype are:

- Low efficiency (64.7-69.2% of cases).

- Lack of an adequate integrated approach, taking into account the sensitivity of microorganisms to antibiotics and the presence of defects in the immune defense, which is not corrected by the indicated pathogenetic treatment method.

- No impact on intracellular forms of pathogens.

- The possibility of developing tolerant forms of pathogens against the background of the membrane-stabilizing effect of vitamins A and E, which leads not only to prolonged, but also repeated colonization.

- The absence of an objective criterion for the etiological cure of the disease, which makes it difficult to choose the tactics of patient management.

The inventive method of rehabilitation of the respiratory tract of bacterial carriers is new and is not described in the literature.

The aim of the invention is to increase the efficiency of rehabilitation and immunorehabilitation of bacteriocarriers, which is achieved by objectification of diagnosis and the use of a complex of adequate etiotropic drugs with a synergistic etiopathogenetic effect.

This goal is achieved by the fact that initially carriers of bacteria are identified, the nature of carriage is determined by their antilysocyme activity (resident or transient), then, for subsequent rehabilitation, drugs are used that do not affect the biological properties of autoflora, but stimulate the body's defenses; for carrier sanitation, a combined inhalation of recombinant interleukin-2 or genetically engineered α2 interferon and a complex immunoglobulin preparation in age-related daily dosages daily for 5 days in one course is used; after the course of rehabilitation, an additional bacteriological examination is carried out, and when the nature of the carrier is changed from resident to transit, carriers are additionally sanitized with antibacterial drugs, taking into account the antibiotic resistance of the carrier strain.

Remediation of the organism from bacterial carriage remains one of the most difficult problems of modern medicine. Traditional methods of sanitizing bacteriocarriers using antibacterial drugs are ineffective. At the same time, carriage of bacteria as a way of reservation of the pathogen in the host organism is a key pathogenetic link in the formation of the chronic course of diseases, and it is also dangerous in the epidemic plan as a way of spreading infections. In this regard, the prevention of bacterial carriage is considered as an effective measure to reduce the incidence of respiratory infections.

At the same time, it is known that during the carriage of bacteria there is a restructuring of the defense mechanisms of the macroorganism with the formation of its immunocompromised status (immunological imbalance, immunological tolerance, immunodeficiency of local immunity), i.e. conditions are created for the survival (persistence) of the pathogen, and, consequently, the further development of bacterial carriage. In addition, if defective local protection factors occur, multicomponent bacterial carriage may occur (not only coccal, but also gram-negative flora, chlamydia, mycoplasmas). Thus, fundamentally different ways of reorganization and prevention of carriage are necessary, based both on stimulation of the immune system and natural colonization resistance of the mucous membranes of the macroorganism, and through a decrease in the persistent properties of pathogens.

Among the known immunocorrecting drugs, the most effective in this regard are cytokines and their synthetic analogues (interleukins, interferons, immunoglobulins, etc.), which have not only a direct and indirect effect on the immune system, but also universal anti-infection activity. Cytokines or endogenous stimulants are the main mediators of the body's defense reactions (Ketlinsky S.A., Simbirtsev A.S., Vorobyov A.A., 1992). Regulation of immune reactions is carried out at all stages, from reproduction and differentiation of the precursors of immunocompetent cells to the presentation of antigen and differentiation of macrophages, T and B lymphocytes into active forms. Almost all cells, responding to specific cytokine stimulation and being included in the process, themselves produce one or more cytokines, continuing the immune response reaction (Yarilin A.A., 1997, Kashkin K.P., 1998).

In conditions of secondary immunodeficiency (chronicity of the infectious process, the development of bacteriocarrier), it seems to us that interleukin-2 (IL-2) may act as a potential means of correcting immune deficiency. The biological effects of IL-2 are mediated by its binding to specific receptors present on various cellular targets. IL-2 directionally affects the growth, differentiation and activation of T and B lymphocytes, monocytes, macrophages, oligodendroglial, epidermal Langerhans cells. The expansion of the spectralizing effect of effector cells causes the elimination of a variety of pathogenic microorganisms, infected and malignant cells, as well as viral, bacterial and fungal infections. In addition, the ability of IL-2 as a regulatory cytokine to restore disturbed relationships between subpopulations of immunocompetent cells, in particular between TH1 and TH2 lymphocytes (Del Prete G., MaggE., 1992, Mossman T., 1991), is important, which ultimately regulates the balance anti-and pro-inflammatory cytokines. The result may be the optimization of the entire system of immunoreactivity that responds to an infectious pathogen and the limitation of such undesirable manifestations of a persistent infectious process as hyper- and autosensitization.

To date, in clinical practice, IL-2 has been used only in the form of intravenous or subcutaneous injections. In our proposed method of sanitizing the respiratory tract of bacterial carriers, IL-2 was first tested in the form of an inhalation route of administration, as well as in combination with other immunocorrective drugs (genetically engineered α2 interferon, a complex immunoglobulin preparation). The complex immunoglobulin preparation (CIP) contains immunoglobulins of classes G, M, A, obtained from human blood plasma, tested for the absence of antibodies to HIV and hepatitis B and C virus, and has increased (up to 15-25% compared to normal human immunoglobulins) ) concentrations of IgM and IgA. Human recombinant alpha-two-interferon is synthesized by a strain of Pseudomonas putida or E. coli with the integrated gene of human leukocyte alpha-two-interferon, has the ability to inhibit the intracellular stages of the development of bacteria, viruses, chlamydia and is a mediator of any immune process. The pronounced antimicrobial effect of the combined effect of drug combinations (interleukin-2, CIP, recombinant alpha-two-interferon) is achieved both by direct exposure to the microorganism (including intracellularly) and by activation of the macroorganism's immune response.

The technical result of the claimed invention is the eradication of a verified pathogen, increasing the efficiency of the rehabilitation of bacteriocarriers by clarifying the nature of the bacteriocarrier (resident or transient), the appointment of a complex of drugs with synergistic immunocorrective and anti-infectious action (recombinant interleukin-2, genetic engineering alpha-two interferon, complex immunoglobin, preparation), and a comprehensive clinical and immunological evaluation of the effectiveness of th therapy.

The proposed method of sanitizing the respiratory tract of bacteriocarriers was successfully tested by us in the treatment of the 101st child with respiratory diseases who is being treated at the Department of Immunotherapy of the CSTO of Astrakhan, aged 2 to 15 years, with the consent of the ethics committee of the Regional Children's Clinical Hospital.

All observed children belonged to the category of so-called “often sick children" without a clear exacerbation.

In addition to generally accepted clinical and laboratory diagnostic methods, we used an additional examination scheme, including the determination of the rhodospecific lipopolysaccharide antigen of chlamydia, Mycoplsma pneumoniae antigens in a smear from the posterior pharyngeal wall, a bacteriological study, the study of the staphylococcus resident properties of antilysocyme activity, and the study of lysozyme level and serum secretion blood, secretory IgA, the study of indicators of cellular and humoral immunity, phagocytosis.

The choice of immunological diagnostic methods was determined by their sufficient information content described by other authors, their availability for a large number of laboratories of medical institutions, and the relatively low cost of examination, which together should contribute to the wide practical use of the results of our work.

Schemes of application.

Depending on the combination of recombinant interleukin -2 with other drugs, 3 groups are distinguished:

1) children who received recombinant interleukin -2 (roncoleukin, manufactured by 000 BIOTECH, G.S.Peterburg) inhaled through a nebulizer in a dose of up to 7 years 125 thousand, over 7 years 250 thousand for 1 inhalation, daily, 1 time per day, within 5 days;

2) children who received, as an inhalation, a mixture containing roncoleukin (125 or 250 thousand units, depending on age) and genetic engineering α2 interferon (reaferon, manufactured by Vektor LLC, Novosibirsk, Russia) 100-150 thousand ME for inhalation, daily, 1 time per day, for 5 days;

3) children who received, in the form of inhalation, a mixture containing roncoleukin (125 thousand or 250 thousand units, depending on age) and a complex immunoglobulin preparation for enteral use (CIP) manufactured by the Moscow Scientific Research Institute of Electric Medicine. G.N. Gabrichevsky at a dose of 25 mg to 7 years and 50 mg over 7 years, daily, 1 time per day, for 5 days.

When evaluating clinical efficacy, elimination of bacterial and / or intracellular pathogens from the mucous membranes of the respiratory tract, the frequency of repeated respiratory diseases in the medical history, their duration, severity, the need for antibacterial therapy to relieve relapses, and normalization of laboratory parameters were taken into account.

As can be seen from the data given in table 1, the greatest efficiency of the rehabilitation of bacteriocarriers was observed with the combined use of inhalations of roncoleukin and a complex immunoglobulin preparation (100% sanitized).

The dynamics of some indicators of systemic and local immunity served as one of the laboratory criteria for the effectiveness of treatment. It turned out (table 2) that, 3 months after the course of rehabilitation, the number of children with signs of T-cell deficiency decreased by a factor of almost 3 when normalizing the ratio of the main immunoregulatory subpopulations of T-lymphocytes in every second child, improving phagocytic activity in 43% of patients . The dynamics of some indicators of local nonspecific resistance attracted particular attention: if before treatment the amount of lysozyme and IgA in the oral secretion was reduced in most patients (in 100 and 90% of cases, respectively), then after the treatment, only every tenth child retained hypoimmunoglobulinemia A , and the level of lysozyme was almost normal in all patients.

The following are the results of testing the proposed method for the rehabilitation of the respiratory tract of bacterial carriers.

Example 1. Sasha Sh. 3 years old (born January 7, 1999)

Date of receipt: 04/20/02.

Date of discharge: 05.05.02.

Diagnosis: Recurrent rhinopharyngitis, without exacerbation. He received complaints of frequent acute respiratory viral infections (8 times during the last year), characterized by a protracted course (recovery occurs in 10-12 days), accompanied by a runny nose, stuffy nose, and cough.

From the anamnesis: 5 months ago (from 11/21/01 to 12/12/01) I was treated in this department of the Department of Immunorehabilitation of the CSTO in Astrakhan. An examination revealed transient carriage of Staphylococcus aureus. Got a course of treatment aimed at immunocorrection and elimination of carriage: inhalation reaferon + CIP (complex immunoglobulin preparation), 5 days course, physiotherapy (UHF / EVT on the adrenal gland No. 7), general massage, vitamin therapy. After 2 weeks, taking a second analysis for staphylococcus carriage, the same carriage was found (Staphylococcus aureus with transient properties) as in the first case. It is recommended to apply for a second course of immunostimulation after 3-4 months.

At admission: at the time of examination, the condition of the child of moderate severity. Active. Appetite is reduced. The skin is clean, normal color. The pharynx is not hyperemic. Difficult nasal breathing, no discharge. In the lungs, puerile breathing, no wheezing. NPV 22 in 1 minute. Heart sounds are loud, rhythmic. Heart rate 102 in 1 minute. The abdomen is soft, painless on palpation. The liver 1 cm protrudes from under the costal arch, the edge is elastic, smooth. The chair is decorated without pathological impurities. Urination is not impaired.

On examination:

Complete blood count: Er. - 3.92 × 10 / l, HB 130 g / l, Le 5.2 × 10 / l, e-5, p-3, s -32, l-54, m-6, ESR - 3 mm / hour .

B / x blood test: CRP - negative, thymol - 1.0 unit, sialic acid - 3.84 mM / L, total protein - 72.5 g / L, ALT - 0.11 μCot / L, AST - 0 , 05 μkot / L, bilirubin (indirect) - 4.44 μmol / L, sublimate test - 2.1 ml, glucose - 4.1 μmol / L.

Immunogram: a defect in phagocytosis in the form of a decrease in CAF (the number of active phagocytes) to 1.3495, hyperimmunoglobulinemia G.

Urinalysis and coproscopy: no pathology.

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

A smear for staphylococcus carriage: a carriage of Staphylococcus aureus resident (Staphylococcus aureus (resident)) was found.

The Mantoux reaction with 2 TE is negative.

He received immunocorrective treatment: inhalation of Roncoleukin (125 thousand IU) + CIP (30 mg) daily for 5 days, general strengthening massage, multivitamin course. Against the background of treatment, the child developed nasal discharge and a dry cough (after the second inhalation), which stopped by the end of treatment without symptomatic agents. After a course of inhalation, the child showed improvement in general condition, increased appetite. A control study of a smear from the nasopharynx after 2 weeks and 3 months after treatment for staphylococcus aureus is negative. In the immunogram there are no signs of phagocytic immunodeficiency, the ratio of immunoglobulins by age.

Example 2. Yana S., 2 years old (born on June 14, 01). Date of admission: January 13, 03. Date of discharge: January 28, 03. Diagnosis: Recurrent obstructive bronchitis, a period of unstable remission.

Received immunocorrecting treatment for frequent bronchitis occurring with SBO.

From the anamnesis: For the first time I was treated in the immunorehabilitation department in the period from 02.20.02 to 03.03.02. During the examination, resident (intracellular) carriage of Staphylococcus aureus was found. She received treatment: a course of reaferon inhalations (150 thousand MB) with KIP (30 mg) for 5 days, general massage, multivitamins, amoxicillin inside. 3 months after the course of immunorehabilitation, persistent positive dynamics were not observed, with a second study revealed the same type of carriage. A second course of treatment was recommended. During the second course of treatment (from 10.09.02. To 09.24.02) she received: Roncoleukin inhalations of 125 thousand MB for 5 days, macropenum inside, massage, physiotherapy (EBT / UHF on the projection area of the adrenal glands No. 6), multivitamins. Moderate positive clinical dynamics were noted. It became more active, less sick, but bronchitis, SARS with a protracted course and SBO remained. In control smears, carriage of Staphylococcus aureus acquired a transient (i.e., extracellular) character. A combined course of immunostimulants (IRS - 19 and Likopid) is recommended and for a repeated course of examination of the cure after 4 months.

Upon receipt, complaints about frequent SARS (5 times in the last 4 months), which are protracted in nature, bronchitis with SBO, are retained.

Objectively: a state of moderate severity. Well-being at the time of the inspection does not suffer. The skin is clean, pale. The pharynx is not hyperemic. Lymph nodes are not enlarged. Nose breathing is free. In the lungs, harsh breathing, no wheezing. NPV 24 in 1 minute. Heart sounds are rhythmic, loud. Heart rate of 106 per minute. The abdomen is soft, painless. The liver and spleen are not enlarged. Stool and diuresis are not changed.

On examination:

Complete blood count: Er. - 3.73 × 10 / l, HB - 119 g / l, Le - 8.7 × 10 / l, e-7, p-2, s-29, l-54, m-8, ESR-5 mm /hour.

B / x blood test: CRP - neg., Total protein - 76.0 g / l, thymol-1.0 unit, bilirubin nepr. - 4.44 μmol / L, ALT - 0.13 μkot / L, AST - 0.07 μkot / L, glucose - 4.1 μmol / L.

Immunogram: combined deficiency of T-link (1 degree) and B-link (1 degree), defect of phagocytosis (decrease in the number of active phagocytes), hyperimmunoglobulinemia G.

Urinalysis and coproscopy: no pathology.

X-ray of the chest organs: a slight increase in the pulmonary pattern due to perivascular and peribronchial changes, non-structure of the roots of the lungs, lung tissue without focal and infiltrative changes.

Ultrasound of the abdominal cavity: without pathology.

Nasopharyngeal swab for staphylococcus carriage: Carriage of a transient form of Staphylococcus aureus was found.

Received treatment: inhalation of Roncoleukin (125 thousand ME) and instrumentation (50 mg) daily for 5 days, restorative massage. After the second inhalation, a frequent dry cough appeared, stopping on its own the next day after the end of inhalation. In a control study of a smear from the nasopharynx 2 weeks and 3 months after treatment of carriage, staphylococcus was not found. Clinically, the dynamics are positive: ARI was ill for 3 months once, catarrhal symptoms stopped in 2-3 days, there were no signs of bronchial obstruction.

Example 3. Roman R., 6 years old (born January 25, 1997). Date of receipt: 01/27/03. Date of discharge: 02.10.03. Diagnosis: Recurrent pharyngitis, without exacerbation. Respiratory chlamydia. Chronic tonsillitis, subcompensated. Arrives with complaints of frequent acute respiratory infections, cough.

From the anamnesis: Sick from 2 years of age, from the moment of admission to kindergarten. Exacerbations monthly, almost always receives antibiotic therapy. In October 2002, a resident carriage of epidermal staphylococcus and chlamydia of the respiratory tract was discovered in the immunorehabilitation department. Got a course of inhalation of reaferon with KIP, macropen inside. There was no elimination of staphylococossum, but chlamydia was not detected during repeated examination of a nasopharyngeal swab (RPIF). During follow-up, complaints persisted of frequent SARS (over the past 4 months 5 times), which are prone to a protracted course, constant nasal congestion.

Objectively: a state of moderate severity. Appetite is reduced. Active. The skin is clean, normal color. The pharynx is not hyperemic. Difficult nasal breathing, no discharge. Tonsils loose, hypertrophied. In the lungs, harsh breathing, no wheezing. NPV 20 per minute. Heart sounds are rhythmic, loud. Heart rate 92 in 1 minute. The abdomen is soft, painless on palpation. Liver, spleen not enlarged. Stool without pathological impurities. Urination is free, painless.

On examination:

Complete blood count: Er. 3.9 × 10 / l, HB 128 g / l, Le 6.1 × 10 / l, 6-1, e-8, p-2, s-41, l-39, m-9, SOE-5 mm / hour

B / x blood test: CRP - neg., Total. protein - 64.5 g / l, sialic acid - 3.63 mM / l, thymol sample - 2.0 units, ALT - 0.063 μkot / l, AST - 0.1 μkot / l, glucose-3.9 μmol / l

Urinalysis and coproscopy: no pathology.

Ultrasound of the abdominal cavity: without pathology.

Immunogram: decrease in the absolute and relative number of T-lymphocytes, defect in phagocytosis (decrease in the number of active phagocytes 0.384), hyperimmunoglobulinemia G.

Nasopharyngeal swab for staphylococcus carriage: Carriage of a resident strain of epidermal staphylococcus was found.

A nasopharyngeal swab (RPIF) is negative.

He received treatment: a course of Roncoleukin inhalations of 250 thousand ME with a measuring instrument (50 mg) No. 5, restorative massage, multivitamins, ultrasound on the projection area of tonsils No. 6.

No side effects were observed during treatment. During treatment, the condition of the child improved: the appetite returned to normal, breathing through the nose became free. In control smears, a change in the nature of carriage of staphylococcus (from resident to transient), sensitive to amoxicillin, was recorded. An additional course of amoxicillin 0.25 3 times a day for 5 days is recommended. When observed in the dynamics of sick much less often (1 time per quarter), treatment without the use of antibacterial drugs. An immunogram (3 months after treatment) normalization of T-cell immunity, increased CAF (1.54). Repeated smears after 3 months are negative.

Example 4. Kayardzhan S., 4 years old (03/17/98, born).

Date of receipt: 01.20.03. Date of discharge: 02.02.02.

Diagnosis: Recurrent bronchitis, without exacerbation. Adenoiditis II degree.

Received for a second course of immunostimulation.

From the anamnesis: A child from the group of frequently ill children. The examination revealed the carriage of a transient strain of epidermal staphylococcus. The first course of treatment was received from September 23, 02 to October 2, 02. (smallpox inside, inhalation of reaferon with KIP No. 5, EVT on the projection area of the adrenal glands No. 6, massage, vitamin therapy). Carriage elimination was not observed. In the following months, a tendency to frequent acute respiratory infections, bronchitis (sometimes with SBO) continued.

Objectively, upon receipt, the condition is satisfactory. Active. Appetite is reduced. The skin is dark, clean. The pharynx is not hyperemic. Difficulty breathing through the nose. In the lungs, vesicular breathing, no wheezing. NPV 20 in 1 min. Heart sounds are loud, rhythmic. Heart rate 98 in 1 min. The abdomen is soft, painless. Liver, spleen not enlarged. Physiological administration is normal.

On examination:

Complete blood count: Er. - 3.7 × 10 / l. HB - 122 g / l, Le - 7.9 × 10 / l, e-9, p-2, s-34, l-51, m-4, ESR - 5 mm / hour.

B / x blood test: CRP - negative, total protein - 68.2 g / l, sialic acid - 4.15 mM / l, thymol - 1.0 unit, ALT - 0.016 μcc / l, AST - 0.062 mkot / l.

Urinalysis and coproscopy: no pathology.

Immunogram: decreased CAF (number of active phagocytes), M. hyperimmunoglobulinemia

Nasopharyngeal swab for staphylococcus carriage: carriage of a resident strain of epidermal staphylococcus.

Ultrasound of the abdominal cavity: without pathology.

The department underwent treatment: inhalation of roncoleukin with instrumentation daily, for 5 days, restorative massage. No side effects were observed during treatment. During treatment, the condition of the child improved: breathing through the nose became free, and appetite returned to normal. In the control smear, staphylococcus carriage was not observed.

Example 5. Maxim Ch., 6 years old (born on November 4, 1997).

Date of receipt 03.02.03. Date of discharge: 02.17.03.

Diagnosis: Recurrent rhinopharyngitis, subacute period. Adenoiditis 2 degrees.

He was admitted with complaints of frequent SARS (more than 8 times a year), shortness of breath through the nose, lack of appetite, lethargy, weakness, and dry cough.

From the anamnesis: a child from 1 pregnancy, 1 urgent birth. Over the past two years after admission to kindergarten, frequent SARS have been noted (more than 8 times a year), having a protracted nature (recovery occurs in 2 - 2.5 weeks).

Upon receipt, a moderate condition. The skin and visible mucous membranes are pale pink, tissue turgor is preserved. The cervical group of lymph nodes is palpated, 1-2 sizes, mobile, not soldered together and with surrounding tissues, painless on palpation. Difficulty breathing through the nose, no discharge. In the lungs, vesicular breathing, no wheezing. NPV 20 in 1 minute. Heart sounds are rhythmic, loud. Heart rate 88 in 1 minute. The abdomen is soft, painless. The liver and spleen are not enlarged. Physiological administration is normal.

During the examination: general clinical and biochemical studies of blood and urine without pathological abnormalities.

Ultrasound of the abdominal cavity: no pathology detected.

Mantoux reaction with 2 TE: negative.

Immunogram: a defect in phagocytosis in the form of a decrease in the activity of phagocytes (1,0886), hyperimmunoglobulinemia G.

Nasopharyngeal swab for staphylococcus carriage: carriage of a resident (intracellular) Staphylococcus aureus strain.

He received treatment: inhalation of roncoleukin 125 thousand ME with instrumentation (30 mg) No. 5, restorative massage, a course of multivitamin preparations. Of the side effects, an increase in cough was noted (stopped after 2 days after the end of treatment). Already during treatment, the child's condition began to improve: activity appeared, appetite returned to normal, breathing through the nose became free. Repeated studies on staphylococcus gave a negative result. After discharge for 6 months, SARS was noted 1 time, proceeded against the background of subfebrile condition, recovery occurred on day 5.

Thus, the use of the proposed method of sanitizing bacteriocarriers induces the elimination of extra- and intracellular pathogens from the respiratory tract, significantly reduces the recurrence of respiratory diseases, reduces the severity and duration of exacerbation, has an immunocorrective effect, which generally improves the health of children and creates unfavorable conditions for persistence infections.

The main advantages of the proposed method of sanitizing the respiratory tract of bacterial carriers is a high degree of sanation induced by stimulation of the immune system and natural resistance of the body, a combination of direct and indirect effects on the immunity of cytokine-containing drugs (interferons, interleukins, immunoglobulins) with their universal anti-infection activity, as well as a convenient way of delivering immune .

A high degree of sanitation of the respiratory tract of bacterial carriers is achieved:

1. The introduction of recombinant interleukin -2, not previously used in clinical practice by inhalation, in combination with other immunobiological preparations (genetically engineered α2 interferon, a complex immunoglobulin preparation), which allows for the correction of local protective factors.

2. Stimulation of the systemic immunity of the body, which allows you to transfer the resident carriage of staphylococci, chlamydia, mycoplasmas and other intracellular persistent pathogens into a transient and further ensure the elimination of pathogens from the mucous membranes of the respiratory tract.

3. The direct anti-infective effect of recombinant interleukin 2 (Roncoleukin), which can affect not only extracellular, but also intracellular forms of pathogens.

4. Direct and indirect immunocorrective action of recombinant interleukin (Roncoleukin), stimulating both the proliferation and differentiation of immunocompetent cells, as well as non-specific resistance factors (lysozyme, etc.), the induction of complete phagocytosis.

5. The substitution effect of a complex immunoglobulin preparation (CIP), which allows to fill the deficit of local protective factors (in particular, IgM antibodies), which play an important role in the formation of anti-infection immunity.

6. The presence of a synergistic effect while using recombinant interleuktin 2 (Roncoleukin) and complex immunoglobulin preparation (CIP).

7. The absence of undesirable side effects in the form of suppression of autoflora and the development of dysbiosis.

8. The lack of potential for re-colonization and bacterial carriage due to the restoration of adequate natural resistance and nonspecific protection factors of both local and systemic immunity. Thus, the positive effect of the proposed method of reorganization of bacteriocarriers is to increase the effectiveness of treatment and immunorehabilitation, which is achieved by objectification of diagnosis and the use of a complex of adequate etiotropic drugs with a synergistic etiopathogenetic effect.

Table 2.
The dynamics of immunity indicators in frequently ill children after a course of inhalation of Roncoleukin + CIP Immunity indicators % of children with impaired performance Before treatment After treatment (after 3 months) Mature T lymphocytes Decrease in diabetes 3+ in 48% of patients Decrease in DM 3 + in 15% of patients The main regulatory subpopulations of T-lymphocytes Decrease in diabetes 4+ in 54% of patients Decrease in diabetes 4+ in 20% of patients Macrophage link Decrease in the number of active phagocytes in 63% of patients Decrease in the number of active phagocytes in 20% of patients Immunoglobulins In saliva, a decrease in IgA in 90% of patients; in serum, a decrease in IgA in 35% of patients, a decrease in IgG in 20% of patients, an increase in IgE in 40% of patients In saliva, a decrease in IgA in 15% of patients; in serum, a decrease in IgA in 10% of patients, an increase in IgE in 30% of patients B lymphocytes Decrease in diabetes 19+ in 15% of patients Not reduced Saliva lysozyme Reduced in all patients by 15-30% of the age norm 15-20% increase in lysozyme in all patients

Claims (2)

1. A method of sanitizing the respiratory tract of bacterial carriers by inhalation of a combination of immunocorrective drugs, characterized in that they use recombinant interleukin-2 or its combination with genetically engineered α2-interferon and with complex immunoglobulin preparation in daily daily doses for 5 days. 2. The method according to claim 1, characterized in that prior to the rehabilitation by immunocorrective drugs, the carrier character is determined by the antilysocytic activity of bacteria - resident or transient, and after a course of rehabilitation a second examination is carried out, and when the carrier is changed from resident to transit, carriers are additionally sanitized with antibacterial drugs taking into account the antibiotic resistance of the carrier strain.