RU2279077C1 - Differential diagnosis method for distinguishing benign migratory glossitis forms - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out bacteriological examination of scrape sample taken from injured tongue zone for detecting microbial infection and oral moniliasis and additionally determining norepinephrine and histamine content in oral liquid using liquid chromatography techniques. Examination results are interpreted in terms of benign migratory glossitis forms. Norepinephrine concentration being 2.37±0.64 ng/l as high, neurogenous form is to be diagnosed. Histamine concentration growing to 0.94±0.13 ng/l, allergic form is to be diagnosed. Plenty of coccal and diplococcal flora being found, dysbiotic form is diagnosed. Blast fungi of Candida type having rounded blastospores and large quantities of young and mature forms of pseudomycelium being detected, candidal form is to be diagnosed.

EFFECT: accelerated and accurate method for determining etiological provocation factor and glossitis form.

Description

The invention relates to medicine, in particular to dentistry, and for the differential diagnosis of forms of desquamative glossitis. The etiology and pathogenesis of desquamative glossitis have not been fully identified. Many researchers recognize the fact that desquamative glossitis is a symptom of various diseases, primarily pathology of the gastrointestinal tract, nervous and endocrine systems, etc. (Vishnyak G.N., 1983; Banchenko G.V., Maksimovsky Yu.M., 2000).

Currently, a large number of methods for diagnosing diseases of the tongue are offered: cytological, rheological, biochemical studies, etc. (Banchenko G.V., Maksimovsky Yu.M., Grinin V.M., 2000). Often, to identify the causes of desquamative glossitis, a large number of patient examinations are required: ultrasound examination of internal organs, determination of hormonal status, numerous neurological studies, assessment of hematological parameters (Banchenko G.V., 1978; Borovsky E.V., Mashkillayson A.L., 2001 ) However, these general clinical trials are not strictly specific, sometimes expensive and require a long time.

The essence of the proposed method consists in the development of diagnostic criteria for identifying the etiological factors of the occurrence of various forms of desquamative glossitis.

For the prototype of the invention, a method for diagnosing the candidal form of glossitis by the method of bacterioscopic examination of the mucous membrane of the tongue, described in the work of Erina S. and others. Comprehensive treatment of candidal glossitis at the Department of Therapeutic Dentistry (Computerization in Medicine., Voronezh, 1977, p.167-168).

The method is as follows: saliva is taken in a volume of 3-4 ml and divided into two tubes of 1.5-2 ml in each. In one portion of saliva, the concentration of catecholamines, in particular norepinephrine, is determined by high performance liquid chromatography on a chromatograph with an electrochemical detector. Another portion of saliva is examined on a spectrofluorimeter to detect histamine, which is an indicator of allergy.

For bacterioscopic examination, a sterile spatula is scraped from the affected area of the tongue. A thin layer of material is applied to glass, dried and stained according to Romanovsky-Giemsa. After drying, the cytological picture is determined under a microscope at a magnification of 7 × 90.

We observed 105 patients with desquamative glossitis. By analyzing the laboratory results obtained, the following forms of desquamative glossitis can be distinguished:

1. Dysbiotic or microbial.

2. Candidiasis.

3. Neurogenic.

4. Allergic.

With a dysbiotic (microbial) form of desquamative glossitis during bacterioscopic examination, an abundance of coccal and diplococcal flora was found in smears from the tongue.

With the candidal form, a predominance of blast fungi of the genus Candida with rounded blastospores was revealed, as well as a large number of young and mature forms of pseudomycelia.

The neurogenic form of desquamative glossitis was accompanied by a high content of norepinephrine in the oral fluid - 2.37 + 0.64 ng / ml, with a norm of 0.35 + 0.12 ng / ml.

The allergic form of desquamative glossitis was confirmed by a high titer of histamine in the oral fluid, reaching 0.94 + 0.13 ng / ml, with a norm of 0.40 + 0.08 ng / ml.

Thus, based on the results obtained, it is possible to specifically identify the etiological factor of desquamative glossitis and, accordingly, to develop algorithms for the complex differentiated treatment of desquamative glossitis depending on its form.

The proposed method is easy to perform in the laboratory, allows you to quickly determine the provocative factor of desquamative glossitis.

Example 1

B-th M., 26 years old, has been suffering from desquamative glossitis for 3 years. Previous treatment (citral solution, vitamin A, physiotherapy) did not have an effective effect.

Based on cytological and biochemical studies, the neurogenic form of desquamative glossitis has been confirmed. The patient was offered the following form of therapy:

1. Tincture of peony 20-30 drops 3 times a day.

2. Phenibut 1 tablet 3 times a day.

3. Glycine 1 tablet 5 times a day.

Locally: rinsing the oral cavity with a solution of citral 30-40 drops in 1/2 cup of water.

On the 14th day of treatment, the patient did not show complaints. On examination, desquamation sites in the tongue were absent. Taste sensitivity is preserved, tongue papillae on the dorsal surface are fully restored.

Example 2

Patient P., 16 years old, complains of periodically appearing in the tongue spots of bright pink color, which change their shape. Sometimes, when eating spicy food, there is a burning sensation. In childhood, he suffered from dysbiosis, observed by a gastroenterologist about chronic gastritis.

During bacterioscopic examination of the material taken from the foci of desquamation, an abundance of coccal and diplococcal flora was found in the smears on the back of the tongue. Diagnosed with dysbiotic (microbial) form of desquamative glossitis.

The main emphasis in the treatment was on the normalization of the microflora of the oral cavity, assigned at the 1st stage of antiseptics: Septollet, Anti-angina. At stage 2, local immunotherapy was carried out: imudon course of 8-10 days. Positive dynamics was noted: oral salivation was normalized, the integrity of the epithelium of the dorsal surface of the tongue was completely restored. With repeated bacterioscopic examination, a significant decrease in the number of coccal and diplococcal flora was noted. Further observation and treatment by a gastroenterologist is also recommended.

Example 3

B-th K., 38 years old, suffers from desquamative glossitis against the background of allergic dermatitis. A biochemical study found that the histamine content in the oral fluid is 1.5 times higher than normal; a large number of eosinophils were found in the cytological preparation of the tongue.

The patient received a course of treatment: tavegil 1 tablet 2 times a day; calcium preparations, vilosen (drops in the nose).

Already by the 5th day of the disease, positive dynamics were noted. Desquamation sites disappeared, indicators of biochemical and cytological studies did not differ from the norm.

Claims (1)

A method for differential diagnosis of desquamative glossitis forms, including bacterioscopic examination of scrapings from the affected area of the tongue, characterized in that the study of scrapings from the tongue is carried out to detect microbial and candidal infections and additionally determine the content of norepinephrine and histamine in the oral fluid using liquid chromatography and based on these studies identify the form of desquamative glossitis: with a high content of norepinephrine 2.37 ± 0.64 ng / ml, the neurogenic form is diagnosed, p With an increased histamine content reaching 0.94 ± 0.13 ng / ml, it is allergic, and with an abundance of coccal and diplococcal flora, it is dysbiotic, with a predominance of blast fungi such as Candida with rounded blastospores, as well as a large number of young and mature forms of pseudomycelia - candidiasis.