RU2302265C1 - Method for treating urogenital chlamydial infection - Google Patents

Abstract

FIELD: medicine, gynecology, urology.

SUBSTANCE: on isolating Chlamydia out of infection foci and setting a preliminary diagnosis it is necessary to determine their sensitivity to different etiotropic preparations. Then it is important to sample a patient's blood followed by centrifuging and dividing it into plasma, erythrocytic mass and leukocytic suspension. Removed blood plasma should be substituted with physiological solution, and autoerythrocytes should be returned for a patient in physiological solution intravenously by drops. Autoleukocytic suspension should be activated with laser radiation of He-Ne laser at λ=0.63 mcm. Then it should be supplemented with etiotropic preparation moxyfloxacin to be intravenously injected for a patient. The procedure should be repeated daily for about 10-12 d. The innovation suggested enables to shorten the terms of interrupting the main clinical manifestations of the disease due to a purposeful transport of etiotropic preparation being of higher bacteriological efficiency in leukocytes activated with laser radiation, into primary (urogenital tract) and secondary (extraurogenital) foci of inflammation and, also, decrease side action of chemopreparations due to decreasing their course dosage.

EFFECT: higher efficiency of therapy.

2 ex

Description

A method for the treatment of genitourinary chlamydial infection relates to medicine.

According to official figures, in recent years in Russia annually registered more than 350,000 patients with genitourinary chlamydial infection. But actually these patients are much more. This is largely due to the widespread self-medication, the lack of registration of patients in commercial diagnostic and treatment centers, as well as privately practicing doctors. Of particular importance are the common (generalized) forms of this infection, which are caused by the hematogenous introduction of the pathogen from the primary foci of infection in the genitourinary tract to other organs and tissues, which ultimately leads to the formation of secondary (extraurogenital) foci of infection in them. The most typical forms of this infection are: Reiter’s disease, vasculitis, serous meningitis, etc. The treatment of such patients is not well developed, because it is difficult to choose one or another etiotropic drug and a rational method of its administration for effective treatment. The following factors can be attributed to a complex of factors that ensure the low efficiency of the applied etiotropic therapy: the use of etiotropic drugs without taking into account the sensitivity of chlamydia to them, their insufficient doses and the timing of treatment, failure to control the cure. Therefore, the search and creation of new methods and technologies that provide adequate and effective therapy for patients with common forms of genitourinary chlamydial infection is very relevant.

Known methods for treating a genitourinary chlamydial infection, such as Reiter’s disease. The traditional complex therapy is used for treatment: massage of the prostate gland No. 10 every other day, ultrasound therapy on the perineum in the area of projection of the prostate gland No. 10, bacteriotherapy (bacteriological preparation - sporobacterin 1/2 bottle 2 times a day), Essential Fort 2 capsules 3 times per day with meals, trental 100 mg daily. Antibacterial therapy for such patients is carried out for 18 days, see the journal "Sexually Transmitted Diseases", No. 1 1998, p.22-24.

The disadvantages of this method of treatment are: insufficient treatment of the disease, long periods of treatment, as a result of which there is no final debridement of the affected tissues from chlamydia, the clinical syndromes of the disease are not completely stopped both immediately after the course of treatment and in the long-term follow-up period (2-3 months) after the end of treatment.

The closest solution to the proposed method for the treatment of urogenital chladimi infection is a method for the treatment of urogenital chladimiosis, indicated in the journal "Bulletin of the Russian Academy of Medical Sciences", No. 10, 2003, p.29-34, in the article Yu.V. Lobzina, V.N. Volzhanina, A.L. Poznyakka "New in the diagnosis and treatment of common forms of urogenital chladimiosis", and consisting in the diagnosis of the patient, etiotropic therapy, taking into account the sensitivity of the selected chlamydia to etiotropic drugs. If the patient has mixed infection, the choice of antibiotic was carried out taking into account the sensitivity of all associated microbes to it. In the treatment, chemotherapy drugs (metronidazole, delagil, mcmiror) were additionally used, which enhanced the antichlamydia and antimycoplasmic activity of such modern etiotropic drugs as josamycin and ofloxacin. Patients were treated for 20 days, the course of therapy was continuous.

The disadvantages of the above treatment method are: the use of monoantibiotic therapy was not effective enough, the biological efficacy 3 months after treatment was only 66.7%, the clinical effectiveness is also insufficient, because a long treatment period and insufficient treatment of secondary extraurogenital foci of infection were noted.

The technical result of a method for the treatment of genitourinary chlamydial infection is: increasing the effectiveness of treatment by reducing the time to stop the main clinical manifestations of the disease, increasing bacteriological efficiency due to the complete rehabilitation of the primary and secondary foci of infection both after the course of treatment (12-13 days) and in a longer period observation (2-3 months), a decrease in the course dose of the use of an etiotropic drug by 1/3, a decrease in the possibility of developing side effects of the therapy and.

This result is achieved in that in a method for treating a genitourinary chlamydial infection, including making a diagnosis, isolating chlamydia from various foci of a patient’s infection, determining their sensitivity to various etiotropic drugs and creating a concentration of the selected drug in the urogenital tract and extraurogenital foci of infection after blood sampling the patient is sequentially centrifuged to separate the patient's blood sample into plasma, erythrocyte mass and leukocyte suspension, then the removed plasma vi is replaced with physiological saline, autoerythrocytes in saline are returned to the patient intravenously, and the autoleukocyte suspension is activated by laser radiation, then the etiotropic drug with antichlamydial activity is prescribed for treatment and it is administered intravenously to the patient, repeating the treatment procedure daily for 10-12 days, moreover, the activation of leukocyte suspension is carried out by radiation of a He-Ne laser with λ = 0.63 μm and a power of 10 MW, and the antichlamydial etiotropic drug is taken from fluoroquinolono a series of, for example, moxifloxacin.

The invention is expressed in the aggregate of essential features sufficient to achieve the technical result provided by the invention.

The essential features of the treatment method, coinciding with the known features of the prototype are: A - diagnosis; B - the allocation of chlamydia from various foci of infection of the patient and the determination of their sensitivity to various etiotropic drugs; In - the creation in the genitourinary tract and in the extraurogenital foci of infection, the concentration of the selected drug.

Salient features of the proposed method of treatment are: D - after blood sampling from a patient, the patient’s blood is sequentially separated by centrifugation into plasma, erythrocyte mass and leukocyte suspension; D - the removed blood plasma is replaced with physiological saline; E - autoerythrocytes in saline are returned to the patient intravenously; G - auto-leukocyte suspension is activated by laser radiation; And - the etiotropic drug with antichlamydial activity prescribed for treatment is added to the activated suspension and administered intravenously to the patient; K - the treatment procedure is repeated daily for 10-12 days.

Particular distinguishing features: L - activation of leukocyte suspension is carried out by radiation of a He-Ne laser with λ = 0.63 μm and a power of 10 MW; M - an antichlamydial etiotropic drug taken from the fluoroquinolone series, for example moxifloxacin.

A method of treating a genitourinary chlamydial infection includes: making a diagnosis, isolation of chlamydia from various foci of infection of the patient. The primary focus - the genitourinary tract - is urethritis, prostatitis. Secondary foci - extraurogenital - these can be joints - arthritis, synovitis, eyes - conjunctivitis, maxillary sinuses. Then, the sensitivity of chlamydia to various etiotropic drugs is determined, and ultimately high concentrations of the selected etiotropic drug are created in the genitourinary tract and in the extraurogenital foci of infection. The sensitivity of chlamydia to etiotropic drugs is determined by the cultural method in advance on the eve of treatment. For the diagnosis of genitourinary chlamydial infection, as well as for the determination of antibiotic resistance in isolated chlamydia, their cultivation is used on transplanted cell culture. For this purpose, various types of cells are used that are highly sensitive to chlamydia: McCoy, Hela-229, L-229, BHK-221. In this case, preference is given to mixed cell lines from among those recommended for use and sent at the request of medical institutions. In this method, a mixed transplantable cell culture LLC + MK2 + L929 + BNK-21c with previously reduced resistance is used. When treating patients with a genitourinary chlamydial infection after collecting (exfusion) of venous blood from a patient, the collected blood is divided into plasma, erythrocyte mass and leukocyte suspension for 10 minutes at various speeds by centrifugation on a RS-6 refrigerator centrifuge. Remote toxic blood plasma is replaced in adequate amounts with physiological saline of 0.85% sodium chloride (plasma replacement solution). Autoerythrocytes in saline are returned to the patient intravenously. The autoleukocyte suspension is activated by laser radiation of a He-Ne laser with λ = 0.63 μm and a power of 10 MW for 10-15 minutes, then an etitropic drug with antichlamydial activity (sorption) is prescribed for treatment (suspension) and it is administered intravenously to the patient . As an etiotropic drug for this disease, the most effective is the drug from the fluoroquinolone series, for example, moxifloxacin 400 mg daily. Procedures for the above method of treatment of genitourinary chlamydial infection (it is also called therapeutic plasma-leukocytopheresis with antibiotic therapy) is carried out daily at the same time for 10-12 days.

An example of a specific application of this method is the treatment of patients with Reiter's disease (16 people). Patients were from 18 to 35 years old, men without other concomitant pathology. The effectiveness of treatment was evaluated using the terms of relief of the main clinical syndromes (general infectious intoxication syndrome, arthralgic syndrome, conjunctivitis, severity and duration of urethritis and prostatitis). The introduction of the etiotropic drug - moxifloxacin - 400 mg was carried out daily for 12 days. As criteria for the cure of patients from chlamydial infection, the following laboratory methods were used: polymerase chain reaction, direct immunofluorescence method - PIF, and also the cultural method. Dynamic clinical and laboratory monitoring of patients and patients with illness was carried out at 13, 23 and 60 days from the start of treatment of patients. In patients with Reiter's disease, the treatment of which was carried out using this method, the main clinical syndromes were stopped in a shorter time or immediately after treatment. Studies conducted in the long-term follow-up period (60 days from the start of treatment) revealed a lack of clinical signs (syndromes) of the disease. This method of treatment of genitourinary chlamydial infection helped to reduce the time (by 20 days) for the relief of the main clinical syndromes in patients with Reiter’s disease, and also showed higher clinical and bacteriological efficacy compared to treating patients with the traditional method.

Examples of treatment of patients according to the proposed method are indicated in appendices 1 and 2.

The use of the invention “A method for the treatment of genitourinary chlamydial infection” compared to the traditional method of treatment - the prototype allows to increase the effectiveness of treatment by reducing the time to stop the main clinical manifestations of the disease, to increase bacteriological efficiency due to the complete rehabilitation of the primary and secondary foci of infection both after treatment and more distant observation period. In this case, there is a decrease in the course dose of the etiotropic drug used, as well as a decrease in the possibility of side effects. The developed method of treatment significantly (by 20 days) reduces the time to stop the main clinical manifestations of the disease, which indicates high clinical efficacy compared to traditional intravenous antibiotic therapy. Due to the directed transport of the etiotropic drug in laser-activated leukocytes to the primary (urogenital tract) and secondary (extraurogenital) foci of inflammation, this method of treatment has higher bacteriological effectiveness and the absence of side effects. Complete rehabilitation of both primary and secondary foci of infection is observed immediately after the completion of the application of the developed method of therapy on the 13th day from the start of treatment. Ultimately, the proposed method of treatment allows you to fully achieve the rehabilitation of the affected organs from chlamydia and in the long-term observation period (60 days from the start of treatment). The developed method for the treatment of genitourinary chlamydial infection allows you to create effective concentrations of the etiotropic drug moxifloxacin in the primary and secondary foci of chlamydial infection, which allows you to reduce its course dose by 30%, which means to avoid the development of side effects with prolonged use. At the same time, an economic effect is achieved (the exchange rate of treatment is reduced). The effectiveness of treatment with this method allows us to recommend it for widespread use in medical practice.

ANNEX 1

Example 1. Patient I., 22 years old, sought medical help at the clinic of infectious diseases about “fever of unclear etiology”, considers himself ill for 3 years, when subfebral temperature, general weakness, malaise, periodic pain and swelling in the joints appeared , dysuric phenomena, disorders of sexual function. He was twice treated for genitourinary chlamydia (antibiotic therapy, bacteriotherapy, immunotherapy, enzyme therapy were used). However, to achieve complete sanitation of the genitourinary tract from chlamydia failed. As a result of an in-depth examination in a clinic using the molecular biological method (PCR), the direct immunofluorescence method (PIF) and the indirect immunofluorescence reaction (NRIF), the culture method C.trachomatis was found in scraping material from the urethra, prostate secretion, urinary centrifuge and ejaculate (primary foci). In addition, this pathogen (chlamydia) was found in the mucous membrane of the nasopharynx, conjunctiva, in rinses from the maxillary sinuses, in leukoconcentrate of venous blood and synovial fluid from the affected joints (secondary foci). According to the NRIF, the titers of chlamydial antibodies in blood serum were 1:32. Studies on other sexually transmitted infections, as well as pathogens of respiratory and intestinal (yersiniosis) infections were negative. Based on the results of the examination, the patient was diagnosed with Reiter’s disease. Subsequently, using the cultural method, a high sensitivity of chlamydia to the etiotropic drug moxifloxacin was established. A course of treatment was carried out using the method of drug plasma-leukocytopheresis, which includes the diagnosis, isolation of chlamydia from various foci of infection of the patient, determination of their sensitivity to various etiotropic drugs, venous blood sampling from a patient, centrifugation of blood in a refrigerator, separation of blood into plasma, erythrocyte mass and leukocyte suspension, plasma replacement with saline, the return of red blood cells in this saline to the patient drops intravenously Actually, activation of a He-Ne leukocyte suspension with a laser with λ = 0.63 μm and a radiation power of 10 MW, addition of moxifloxacin to the suspension with activated leukocytes and its intravenous drip. The course of therapy led to the relief of the syndrome of general infectious intoxication, arthralgic syndrome, conjunctivitis, the severity and duration of urethritis and prostatitis, which was simultaneously accompanied by bacteriological sanitation of the body from chlamydia. After the course of treatment - 10 days - a stable remission was achieved (observation period 1 year).

APPENDIX 2

Example 2. Patient R., 35 years old, turned for medical help to the clinic of infectious diseases with complaints of severe pain in the perineum, radiating to the testicles and suprapubic region, pain in the knee and ankle joints, painful rashes on the glans penis. Urination was somewhat more frequent. Clarification of the anamnesis made it possible to establish that the patient had previously been treated for chronic prostatitis. A week before the development of the disease, the patient was on vacation in Turkey. Denies sex there. Modern laboratory methods have revealed mixed chlamydial-ureaplasma-gardnerellosis balanitis of a genitourinary infection that proceeds as prostatitis and vesiculitis with echo-negative formations and microabscesses in the center and with enlarged replaceable vesicles, according to the results of ultrasound scanning. Chlamydia has also been found in conjunctivitis. The patient had a long, three to four courses, treatment using a number of drugs (antibacterial, immunocorrector, hepato- and angioprotectors) with physiotherapy and massage of the prostate gland. A course of therapy was carried out (12 days) using the method of treatment of drug plasma-leukocytapheresis. After treatment, the pains stopped, the mucous membrane in the area of erosion on the glans penis acquired normal color and epithelization started. Bacteriological studies of scraping materials from the urethra, conjunctiva, prostate secretion, urinary centrifugate and ejaculate on sexually transmitted pathogens after treatment were negative after 1 month.

Claims (1)

A method for the treatment of genitourinary chlamydial infection, including determining the sensitivity of chlamydia, isolated from a patient after a preliminary diagnosis, to various etiotropic drugs, characterized in that the patient is taken blood, sequentially centrifuged and separated into plasma, erythrocyte mass and leukocyte suspension, then removed blood plasma replaced with physiological saline, autoerythrocytes in physiological saline are returned to the patient intravenously, and the autoleukocyte suspension is activated They use laser radiation from a He-Ne laser with λ = 0.63 μm, then an etiotropic preparation, moxifloxacin, is added to it and administered intravenously to the patient, repeating the treatment procedure daily for 10-12 days.