RU2601408C1 - Method of treating patients with facial pain with postherpetic ganglionitis of a head - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine and is aimed at treating patients with facial pain with postherpetic ganglionitis of a head. Content of specific G antibodies to the herpes simplex virus (HSV) type 1 and cytomegalovirus, content of alpha and gamma interferons, serum and spontaneous interferon in blood, in the oral fluid: concentration of A secretory immunoglobulin, alpha interferon and lactoferrin level. Index of microorganisms adsorption reaction is calculated (MAR). If the values of serum and spontaneous interferon do not exceed 2 units/ml, content of specific G antibodies to HSV type 1 is from 1:2973.75 and higher, to cytomegalovirus - from 1:2916.91 and higher, of alpha interferon - from 194.78 unit/ml and lower, of gamma interferon - from 16.87 unit/ml and lower, and in the oral fluid: concentration of secretory immunoglobulin - from 225.11 mg/ml and lower, concentration of alpha interferon - from 8.6 pg/ml and lower, lactoferrin level - from 9613.3 ng/ml and lower, MAR index - from 6.5 and higher, the acyclic nucleosides group drug is prescribed in complex, anti-inflammatory agents, anti-histamine drugs, immunomodulators.

EFFECT: using the invention provides increase in treatment efficacy due to comprehensive application of drug therapy preparations.

1 cl, 1 ex

Description

The invention relates to medicine, namely to dentistry and to maxillofacial surgery, and can be used to treat a chronic, often recurring infection of the herpes virus etiology of autonomic parasympathetic nodes of the head.

Facial pain is an important medical problem, primarily due to chronic relapsing and, in some cases, quite resistant to many methods of treatment of pain.

The study of the problem of facial pain in the modern scientific literature is not widely represented. As practice shows, more often than others, dentists, neurologists, otorhinolaryngologists, ophthalmologists, and neurosurgeons encounter specific cases associated with facial pain (Ahadov T.A. Manifestations of neurostomatological symptoms // Journal of Neurovol. And Psychiatrist. - 1996. - Issue 1 . - 70-74).

One of the most common causes of facial pain is a lesion of the autonomic parasympathetic nerve nodes of the head of viral etiology, in particular herpes virus etiology (Zhuravlev V.P., Nikolaeva A.A.) Dentistry problems "Damage to the autonomic parasympathetic nodes of the head in the structure of neurostomatological reception", 2013, No. 3, pp. 36-39). With facial pain, herpesvirus infection does not manifest itself in any way (there are no rashes on the skin), which often provokes unjustified interference in the dentition and inadequate therapy of the patient. However, earlier, the authors of the claimed invention found that with the defeat of the autonomic parasympathetic nodes of the head of herpes virus etiology in patients, the immune status significantly decreases (patent RU 2538083, patent RU No. 2529795).

A known method of treating lesions of autonomic parasympathetic nodes of the head of herpes virus etiology (DP Samokhvalov "Diagnosis and treatment of viral ganglionitis of the pterygo-palatine node" // Diss. For the scientific scientist. Candidate of Medical Sciences. Ekaterinburg, 2009). In accordance with the method, the patient is prescribed medication: a drug from the group of acyclic nucleosides - valaciclovir 500 mg 2 times a day for 5 days, tavegil 1 tablet 1 time per day for 5 days - at night, polyoxidonium in rectal suppositories - 12 mg once a day for the first 3 days, and then with an interval of 48 hours - the remaining 9 suppositories, a non-steroidal anti-inflammatory drug - ketorol, once at a dose of 10 mg or repeatedly, depending on the severity and severity of the pain syndrome, 10 mg up to 2 times a day, not more than 5 days.

The disadvantage of this method is that before the appointment of drug therapy does not determine the immune status of the patient. As shown above, with facial pain, herpesvirus infection does not manifest itself in any way. Since in the known method, drug therapy is prescribed without first determining the immune status of the patient, which does not allow us to clearly state that the disease is caused by herpes virus infection, this can lead to unreasonable use of the prescribed drugs in the course of drug therapy, which reduces the effectiveness of the treatment.

Closest to the proposed is a method of treating patients with facial pain with postherpetic ganglionitis of the head, including determining the patient’s immune status, for which the content of specific class G antibodies to herpes simplex virus type 1 and cytomegalovirus is determined, the content of interferons alpha and gamma, serum and spontaneous interferon, and according to the results of the study - the appointment of drug therapy, namely: the complex administration of the drug from the group of acyclic nucleosides, not steroidal, anti-inflammatory, antihistamines, immunomodulators. The method closest to the proposed one is described in Example 1 of a method for treating a lesion of vegetative parasympathetic nodes of the head of herpes virus etiology (patent RU 2538083).

The disadvantage of this method, which is closest to the proposed one, is that the numerical criteria used to evaluate the results of studies of the immunological parameters of the patient do not have a clear link to the patient’s disease, namely, the defeat of the autonomic parasympathetic nodes of the head of herpes virus etiology, which reduces the reliability of the results of determining the immune the patient’s status and the likelihood of unreasonable drug intake is preserved, which reduces the effectiveness of treatment.

The present invention solves the problem of creating a method for treating patients with facial pain with postherpetic ganglionitis of the head, the implementation of which allows to achieve a technical result, which consists in increasing the effectiveness of treatment by increasing the likelihood of a reasonable intake of drug therapy.

The essence of the claimed invention lies in the fact that in the method of treating patients with facial pain with postherpetic ganglionitis of the head, according to which the patient’s immune status is preliminarily determined and the results of studies prescribe a complex administration of the drug from the group of acyclic nucleosides, non-steroidal anti-inflammatory, antihistamine drugs, immunomodulators, in order to determine the immune status, the correspondence of the content of specific class G antibodies to simple g virus is determined type 1 sow and cytomegalovirus, determine the content of alpha and gamma interferons in the blood, determine the parameters of serum and spontaneous interferon, and the indicators of serum and spontaneous interferon do not exceed 2 units / ml, the new thing is that, in addition, they perform an immunological study of the oral fluid in the process of which the concentration of secretory immunoglobulin A, interferon alpha, the level of lactoferrin in the oral fluid is determined and the non-specific resistance of the mucous membrane is assessed oral mouth, for which they calculate the rate of adsorption of microorganisms and, if the serum and spontaneous interferon do not exceed 2 units / ml, the content of specific class G antibodies to herpes simplex virus 1 tin is from 1: 2973.75 and higher, to cytomegalovirus - from 1: 2916.91 and above, interferon alpha content from 194.78 units / ml and below, gamma interferon content from 16.87 units / ml and below, in the oral fluid: the value of the concentration of secretory immunoglobulin is from 225.11 mg / ml and below, the concentration of interferon alpha is from 8.6 pg / l and lower, the level of lactoferrin is from 9613.3 ng / ml and lower, if, as a result of evaluating the nonspecific resistance of the oral mucosa, the rate of adsorption of microorganisms is from 6.5 and higher, then a complex administration of the drug from the group of acyclic nucleosides is prescribed, non-steroidal anti-inflammatory drugs, antihistamine, immunomodulators.

In addition, to assess the nonspecific resistance of the oral mucosa, the number of bacteria adsorbed on each buccal epithelium cell is counted, for this, after a patient rinses the oral cavity with water using a spatula, take a scraping from the inside of the cheek, prepare a smear on a sterile fat-free glass slide, dry the smear, fix and stained according to Romanovsky in the modification of Philipson, then the preparation is microscopic with an immersion system (x 900), the number of cells containing less than 10 is counted Actor, carry them to the category of "a", the number of cells containing 10 to 30 belong to the category of bacteria b, the number of cells containing greater than 30 bacteria, classified as to then calculate the adsorption rate of microorganisms (PAM) formula

,

,

where n is the total number of cells [Belenchuk T.A. Determination of nonspecific resistance of an organism by the degree of activity of the adsorption reaction of microorganisms (RAM) by epithelial cells of the oral mucosa / T.A. Belenchuk // Methods of diagnosis, treatment and prevention of major dental diseases. - K., 1990. - S. 51-52].

The technical result is achieved as follows. A method for treating patients with facial pain with postherpetic ganglionitis of the head is claimed, according to which the patient’s immune status is preliminarily determined and the complex preparation of the drug from the group of acyclic nucleosides, non-steroidal anti-inflammatory, antihistamines, immunomodulators are determined according to the results of studies, and the compliance with the immune status is determined the content of specific class G antibodies to herpes simplex virus type 1 and to cytomegalovirus, determined with the maintenance in blood of interferons alpha and gamma, the indicators of serum and spontaneous interferon are determined, and the indicators of serum and spontaneous interferon do not exceed 2 units / ml.

It was noted above that with facial pain, the herpes virus infection does not manifest itself in any way (there are no rashes on the skin), which often provokes unjustified interference in the dentition and inadequate therapy of the patient. However, previously, the authors of the claimed invention found that with the defeat of the autonomic parasympathetic nodes of the head of herpes virus etiology, the immune status significantly decreases in patients (RU 2538083, RU 2529795).

Previously, the inventors found (RU 2538083) that the presence of herpesvirus infection in the autonomic parasympathetic nodes of the head is accompanied by insufficiency of both cellular and humoral immunity, which is due to a decrease in cell life, as well as a decrease in the content of immunocompetent cells. As a result, the totality of the identified immunological changes contributes to the persistence of herpes viruses in the body and the relapse of the disease.

Previously, the inventors have established the relationship of the immunological parameters of the patient’s blood with the inflammatory process in the autonomic parasympathetic nodes of the head caused by an infection of herpes virus etiology.

Previously, the inventors established the relationship between the inflammatory process in the autonomic parasympathetic nodes of the head caused by an infection of herpes virus etiology and the content of specific class G antibodies to herpes simplex virus type 1 and cytomegalovirus, as well as the content of interferon alpha and the content of interferon gamma in the patient’s blood (RU 2538083, RU 2529974, RU 2529795).

From the above it follows that in the treatment of patients with facial pain with postherpetic ganglionitis of the head, it is first necessary to restore the patient's immune status, violated by the herpes virus. Moreover, the inventors first proposed the preliminary use of the results of determining the immune status of the patient as a determining factor, which determines the appointment of adequate drug therapy in the treatment of patients with facial pain with postherpetic ganglionitis of the head.

In the claimed method, before prescribing a complex treatment, the patient’s immune status is determined, for which the correspondence of the content of specific class G antibodies to herpes simplex virus type 1 and cytomegalovirus is determined, the content of interferons alpha and gamma is determined, and indicators of serum and spontaneous interferon are determined. Moreover, as a criterion for assessing the state of immunity, the previously obtained numerical values are used, which reliably correspond to the defeat of the autonomic parasympathetic nodes of the head of the herpes virus viral etiology, namely: indicators of serum and spontaneous interferon do not exceed 2 units / ml, the content of specific class G antibodies to the simple virus herpes type 1 is from 1: 2973.75 and above, to cytomegalovirus - from 1: 2916.91 and above, the content of interferon alpha is from 194.78 units / ml and below, the content of interferon gamma is from 16 , 87 units / ml and below (RU 2529795, RU 2538083).

In addition, to determine the immune status of the patient, an immunological study of the oral fluid is performed. It is known that oral fluid is a complex filtrate of blood plasma, which reflects the state of dynamic constancy of the internal environment of the body. Oral fluid is one of ten body fluids, it is one of the objects of non-invasive laboratory research. The formation of secretory immunity of the oral mucosa is ensured by the functions of a number of cellular systems, the formation of individual cellular elements, the synthesis of enzymes, mediators of intercellular interaction, substances with the ability to suspend reproduction or destroy pathogens, as well as synthesize interferon, lactoferin and specific immunoglobulins. The knowledge of secretory immunity is of paramount importance for substantiating the principles of diagnosis and treatment of this category of patients (Bazarny V.V., Beresneva N.S., Lomova O.L., 2011; Volkova M.N., Yanchenko V.V., 2011 )

In the claimed method of treatment in the oral fluid during the implementation of immunological studies determine the concentration of secretory immunoglobulin A, interferon alpha, the level of lactoferrin.

In this case, as a criterion for assessing the concentration of secretory immunoglobulin A and interferon alpha, numerical values obtained by the authors that reliably correspond to the defeat of the autonomic parasympathetic nodes of the herpes virus head etiology (RU 2529794) are used, namely: the concentration of secretory immunoglobulin in the oral fluid is from 225.11 mg / ml and below, the concentration of interferon alpha is from 8.6 pg / ml and below.

The inventors for the first time to determine the immune status of a patient with facial pain with postherpetic ganglionitis of the head used the level of lactoferrin in the patient's oral fluid.

The inventors for the first time found that lactoferrin levels ranging from 9613.3 ng / ml and lower reliably correspond to the defeat of the autonomic parasympathetic nodes of the head of herpes virus viral etiology, accompanied by facial pain, which made it possible to use this indicator to determine the patient's immune status.

Lactoferrin is one of the components of the full protection of the oral cavity. Lactoferrin is an iron-containing glycoprotein from the transferrin family. This protein has a wide variety of functions. The most important of them is participation in the formation of secretory immunity of the mucous membranes. Lactoferrin has a powerful bactericidal and bacteriostatic effect on a number of microorganisms, acting as a metal hellator and binding iron, necessary for the multiplication of bacteria (INTERNET. WIKIPEDIA). Lactoferrin also affects the phagocytic activity of neutrophils and the complement system. Thus, human lactoferrin is a first-line immune defense factor.

For the first time, the authors of the invention used to assess the nonspecific resistance of the oral mucosa to determine the patient’s immune status, namely, the value of the indicator of adsorption of microorganisms on the oral mucosa.

It has now been established that on the surface of the mucous membrane of the gastrointestinal tract and respiratory tract there are structures that prevent the penetration of pathogens into the human body. Moreover, the protective mechanisms of the oral cavity are divided into two groups: non-specific resistance to the action of all microorganisms (foreign agents) and specific (immune) developed in response to the introduction of certain types of microorganisms.

Resistance - a combination of genetically determined nonspecific protective factors that cause resistance to infections (www.studfiles.ru/preview/544122).

Among the non-specific protection factors, the mechanical, chemical, and physiological mechanisms of action of the factors of non-specific protection of a macroorganism are distinguished. In the oral cavity, mechanical protection performs the barrier function of an intact mucous membrane by washing off microorganisms with saliva, cleansing the mucous membrane during food, and adhering to cells of desquamated epithelium. In addition, saliva also acts bactericidal due to the presence of biologically active substances in it.

The number of microbes in the oral cavity of a person is variable and can vary significantly, depending on salivation, the nature of food intake, the hygienic content of the oral cavity, and the presence of somatic diseases ("Protective mechanisms of the oral cavity" www.stomfak.ru/terapvticheskav-stomatolodva/zachimve- mechanismv-polosti-rta.html).

The inventors for the first time found that the value of the adsorption index of microorganisms from 6.5 and higher, obtained by evaluating the nonspecific resistance of the oral mucosa, reliably corresponds to the presence of lesions of the autonomic parasympathetic nodes of the head of herpes virus etiology, accompanied by facial pain, which allowed the use of this indicator to determine the immune status of the patient.

The purpose of the complex administration of the drug from the group of acyclic nucleosides, preparations of non-steroidal anti-inflammatory, antihistamine, immunomodulators is explained as follows.

As shown above, the main cause of damage to the autonomic parasympathetic nodes is the herpes virus. This necessitates the use in the treatment of drugs from the group of acyclic nucleosides, which are antiviral drugs.

As shown above, the inventors found that the presence of herpes virus infection in the autonomic parasympathetic nodes of the head is accompanied by insufficiency of both cellular and humoral immunity, which is due to a decrease in cell life, as well as a decrease in the content of immunocompetent cells. The totality of the identified immunological changes can contribute to the persistence of herpes viruses in the body and the relapse of the disease (RU 2538083). This served as the basis for the inclusion of immunocorrective drugs in the treatment complex.

Nonsteroidal anti-inflammatory drugs are one of the leading and essential components in the medical treatment of facial pain (Voznesensky A.G. Clinical pharmacology of non-steroidal anti-inflammatory drugs. - Aviailable from: www.volsadmm.ru/vorma/archiv. - 2010).

In the claimed method of treating patients with facial pain with postherpetic ganglionitis of the head, a modified method of T. Belenchuk was used to evaluate the non-specific resistance of the oral mucosa (1987), which consists in counting the number of bacteria adsorbed on each cell of the buccal epithelium. For this, after a patient rinses the oral cavity with water using a spatula with rounded edges, a scraping is taken from the inner surface of the cheek, a smear is prepared on a sterile fat-free glass slide. The smear was dried. And then fixed and stained according to Romanovsky in the modification of Philipson.

However, a quantitative assessment of nonspecific resistance of the oral mucosa was proposed by the inventors for the first time. Namely: the preparation is microscopic with an immersion system (× 900), the number of cells containing less than 10 bacteria is counted, they are assigned to category “a”, the number of cells containing 10 to 30 bacteria are assigned to category b, the number of cells containing bacteria more than 30, belong to category C, then calculate the rate of adsorption of microorganisms (RAM) formula

where n is the total number of cells.

The principle proposed by the authors for calculating the adsorption rate of microorganisms is similar to the principle of semi-quantitative assessment adopted in cytochemical studies, which increases the reliability of the final result and, therefore, increases the reliability of determining the immune status of the patient, confirms the correctness of the prescribed course of drug therapy, which increases the effectiveness of the treatment by the claimed method.

From the above it follows that the authors of the claimed invention for the first time proposed to use the determination of the patient’s immune status as a factor that reliably confirms the manifestation of the herpes virus in the treatment of patients with facial pain with postherpetic ganglionitis of the head to confirm the adequacy of drug therapy, before its appointment. In order to determine the patient’s immune status, the indicators of the content of specific class G antibodies to herpes simplex virus type 1 and cytomegalovirus are used, the content of alpha and gamma interferons in the blood is determined, and the serum and spontaneous interferon are measured by immunological examination of the oral fluid, during which oral fluid, the concentration of secretory immunoglobulin A, interferon alpha, the level of lactoferrin and evaluate non-specific resistance ty of the oral mucosa. Moreover, to quantify the components used to assess the patient’s immune status, use quantitative values that reliably correspond to the disease of patients with facial pain with postherpetic ganglionitis of the head. As a result, the reliability of the results of determining the immune status of the patient is increased, the effectiveness of treatment is increased by increasing the likelihood of reasonable drug therapy.

Thus, from the foregoing, it follows that the proposed method for the treatment of patients with facial pain with postherpetic ganglionitis of the head during the implementation allows to achieve a technical result, which consists in increasing the effectiveness of treatment by increasing the likelihood of a reasonable intake of medication.

The claimed method for the treatment of patients with facial pain with postherpetic ganglionitis of the head is as follows. The patient’s immune status is preliminarily determined and, according to the results of studies, a complex administration of the drug from the group of acyclic nucleosides, non-steroidal, anti-inflammatory, antihistamine drugs, immunomodulators is prescribed.

To determine the immune status, the correspondence of the content of specific class G antibodies to herpes simplex virus type 1 to cytomegalovirus is determined, the content of alpha and gamma interferons in the blood is determined, the parameters of serum and spontaneous interferon are determined, in addition, an immunological study of the oral fluid is performed, during which in the oral fluid, the concentration of secretory immunoglobulin A, interferon alpha, the level of lactoferrin and assess non-specific resistance if mucous membrane of the oral cavity, for which the rate of adsorption of microorganisms is calculated. If the indicators of serum and spontaneous interferon do not exceed 2 units / ml, the content of specific class G antibodies to herpes simplex virus type 1 is from 1: 2973.75 and above, to cytomegalovirus - from 1: 2916.91 and above, the content of interferon alpha is from 194.78 units / ml and below, the content of interferon gamma - from 16.87 units / ml and below, in the oral fluid: the concentration of secretory immunoglobulin is from 225.11 mg / ml and below, the concentration of interferon alpha is from 8, 6 pg / ml and below, the level of lactoferrin is in from 9613.3 ng / ml and below, if as a result e assess nonspecific resistance oral mucosa indicator microorganisms adsorption is between 6.5 and higher, designate the complex reception from the group consisting of acyclic nucleosides drug, nonsteroidal anti-inflammatory drugs, anti-histamine, immunomodulators.

To assess the nonspecific resistance of the oral mucosa, the number of bacteria adsorbed on each buccal epithelial cell is counted, for this, after a patient rinses the oral cavity with water using a spatula, take a scraping from the inner surface of the cheek, prepare a smear on a sterile fat-free glass slide, dry the smear, fix and stain To Romanovsky in the modification of Philipson, then the preparation is microscopic with an immersion system (× 900), the number of cells containing less than 10 bacteria is counted from osyat them to category "a", the number of cells containing 10 to 30 belong to the category of bacteria b, the number of cells containing greater than 30 bacteria, classified as to then calculate the adsorption rate of microorganisms (PAM) formula

where n is the total number of cells.

Specific class G antibodies to herpes simplex virus type 1 (HSV1) and cytomegalovirus (CMV) anti-HSVIgGI were determined in patients; anti-HSVIgGII; anti-HSVIgMI, II; anti-CMVIgG; anti-CMVIgM.

For this, we used a combination of methods of solid-phase heterogeneous enzyme-linked immunosorbent assay (ELISA) and immunochemiluminescence. The studies were performed on automatic analyzers ARCHITECT 2000 (Abbott) and Modular Analytics Ε170 (Roche).

The determination of HSV-1 DNA and CMV was performed using the polymerase chain reaction method. The study was carried out using DNA-Technology diagnostic kits (Russia) and the DT-322 amplifier (DNA-Technology, Russia).

In order to study the state of secretory immunity, all examined received spontaneous oral fluid. Collection of mixed saliva (unstimulated) at rest was performed in the morning on an empty stomach or not earlier than 3 hours after a meal. Patients in a sitting position were asked to lower their heads down, not to swallow saliva, and not to move their tongues and lips during the entire period of saliva collection. Saliva was accumulated in the oral cavity for two minutes, then patients were asked to spit all the contents into a special tube (SalivaCapsSet, manufacturer IBLInternational GMBH) using a polypropylene straw.

Oral fluid samples were frozen prior to testing. Before the study, the samples were thawed, mixed well and centrifuged.

To assess the secretory immunity of the oral cavity, the level of secretory IgA (g / l), lactoferrin (ng / ml), IFN-α (pg / ml) were studied by solid-phase heterogeneous ELISA using the Vector-Best test systems (Russia) and registration Multiscan Ascent Photometer Results.

Comprehensive administration of the drug from the group of acyclic nucleosides, non-steroidal, anti-inflammatory, antihistamines, immunomodulators was prescribed in accordance with the prototype treatment method (RU 2538083). Famacyclovir 500 mg 3 times a day for 10 days is administered as drugs from the acyclic nucleoside group, ketorol is administered 1 tablet 2 times a day after meals for 7 days as a non-steroidal anti-inflammatory drug, tavegil 1 tablet 1 time per day at night for 10 days, neuromultivitis 1 tablet 2 times a day for 30 days, in addition, viferon in the form of rectal suppositories 1 suppository (500,000) 1 time per day for 10 days is additionally administered, and the patient takes the above drugs at the same time, at after the end of the course of taking viferon, cycloferon is prescribed in 150 mg tablets, the schedule for which is: 1st day - 1 tablet 2 times a day; 2nd day - 1 tablet once a day; 4th, 6th, 8th, 11th, 14th, 17th, 20th, 23rd days - 1 tablet 1 time per day, after receiving which the immunorm is prescribed 1 tablet 3 times a day for 30 days.

In the claimed method, non-steroidal anti-inflammatory drugs are used depending on the condition of the patient, on the degree of pain tolerated by him. It can be: Ketorol, Voltaren Acti, Phaspeak, Nimesil, Arcoxia.

Example 1. Patient B., 45 years old.

Complaints: Constant aching pain in the upper and lower teeth on the right, buccal region on the right, swelling of the right half of the face.

Medical history. Considers herself a patient for about 5 years, associates with hypothermia and a cold catarrh. Repeatedly examined and treated by a neurologist and dentist. During the treatment period, the dentist 7 teeth were treated for complicated caries, 4 teeth were removed. Received physiotherapy, procaine blockade in the projection of the second and third branches of the trigeminal nerve, but without a positive effect. Focal changes in neurological status were not detected.

St. localis The configuration of the face is changed due to a slight swelling of the right buccal and zygomatic region. There is hyperemia in the region of the right cheek, periodically rhinorrhea on the right. There are no violations of sensitivity on the face. The opening of the mouth is free, painless, there is no deviation and S-shaped movements of the lower jaw. Palpation of the right KNU and submandibular parasympathetic node is sharply painful. Percussion of the teeth of the upper and lower jaw is painless.

Preliminary diagnosis: Polyganglionitis on the right. The patient is directed to computed tomography of the paranasal sinuses.

Re-examination after additional examination:

Computed tomography of the paranasal sinuses revealed no pathologies. There is no ENT pathology.

In accordance with the claimed method of treating patients with facial pain with postherpetic ganglionitis of the head, a determination of the immune status of the patient was performed. Results of initial analyzes:

indicators of serum and spontaneous interferon do not exceed 2 units / ml;

the content of specific class G antibodies to herpes simplex virus type 1 1: 6400;

the content of specific bodies to cytomegalovirus 1: 12800;

the content of interferon alpha 80 u / ml (blood);

the content of interferon gamma 16 units / ml (blood);

the concentration of secretory immunoglobulin in saliva is 188 mg / ml;

the concentration of interferon alpha in saliva is 7.5 pg / ml;

the level of lactoferrin in saliva is 9,300 ng / ml; RAM 8.

The content of IgG for HSV 1 and CMV, the most important immunoglobulin that determines the completeness and effectiveness of the immune response, in this patient was increased

When examining the initial indicators of IFN status in this patient, significant violations were identified. The indicators of serum and spontaneous interferon do not exceed 2 units / ml. The production of antiviral interferon alpha is reduced by 8 times, regulatory IFN gamma is reduced by 8.2 times.

Final diagnosis: Polyganglionitis on the right of herpes virus etiology; immune status corresponds to postherpetic ganglionitis of the head with facial pain.

Recommended by

1) Treatment:

famacyclovir 500 mg 3 times a day for 10 days, as a non-steroidal anti-inflammatory drug, ketorol is administered 1 tablet 2 times a day after meals for 7 days, tavegil 1 tablet 1 time per day at night for 10 days, neuromultivitis 1 tablet 2 times a day for 30 days, in addition, viferon in the form of rectal suppositories is additionally administered 1 suppository (500,000) 1 time per day for 10 days, moreover, the patient takes the above drugs at the same time, after the end of the course viferon prescribed cycloferon in abletkah 150 mg, which is a graph of reception: Day 1 - 1 tablet 2 times a day; 2nd day - 1 tablet once a day; 4, 6, 8, 11, 14, 17, 20, 23rd days - 1 tablet 1 time per day, after receiving which immunorm is prescribed 1 tablet 3 times a day for 30 days;

- immunorm (1 tablet 3 times a day for 30 days).

2) After treatment, a follow-up examination and examination after an additional examination was done.

Admission after treatment: No complaints.

Results of secondary analyzes:

indicators of serum and spontaneous interferon do not exceed 2 units / ml;

the content of specific class G antibodies to herpes simplex virus type 1 1: 1600;

the content of specific bodies to cytomegalovirus 1: 3200;

the content of interferon alpha is 320 u / ml; (blood);

the content of interferon gamma 128 u / ml; (blood);

the concentration of secretory immunoglobulin in saliva is 350 mg / ml;

the concentration of interferon alpha is 9.6 pm / ml (in saliva);

the level of lactoferrin is 9,300 ng / ml;

microorganism adsorption rate is 4 units.

Stlocalis: face configuration is not changed. Skin physiological color. No discharge from the nose. There are no violations of sensitivity on the face. The opening of the mouth is free, painless, there is no deviation and S-shaped movements of the lower jaw. Palpation of autonomic parasympathetic nodes is painless. Percussion of the teeth of the upper and lower jaw is painless.

The content of IgG to HSV 1 and CMV decreased significantly after treatment (Ig G to CMV 1: 3200, Ig G to HSV 1: 1600).

The content of interferons alpha and gamma in blood and saliva increased. Close to normal.

The level of lactoferrin and the rate of adsorption of organisms decreased to normal.

Dynamic observation recommended.

Claims (1)

A method of treating patients with facial pain with postherpetic ganglionitis of the head, according to which the patient’s immune status is preliminarily determined and, according to the results of the studies, complex administration of the drug from the group of acyclic nucleosides, non-steroidal anti-inflammatory, antihistamines, immunomodulators are prescribed, while determining the immune status determines the content specific class G antibodies to herpes simplex virus type 1 and cytomegalovirus, determine the content in interferon alpha and gamma, determine the indicators of serum and spontaneous interferon, and the indicators of serum and spontaneous interferon do not exceed 2 units / ml, characterized in that, in addition, they perform an immunological study of the oral fluid, during which the secretory concentration is determined in the oral fluid immunoglobulin A, interferon alpha, the level of lactoferrin and evaluate the nonspecific resistance of the oral mucosa, for which the adsorption reaction rate is calculated organisms and, if the serum and spontaneous interferon rates do not exceed 2 units / ml, the content of specific class G antibodies to herpes simplex virus type 1 is from 1: 2973.75 and above, to cytomegalovirus - from 1: 2916.91 and above, the content of interferon alpha is from 194.78 units / ml and below, the content of interferon gamma is from 16.87 units / ml and below in the oral fluid: the concentration of secretory immunoglobulin is from 225.11 mg / ml and below, the concentration interferon alfa is from 8.6 pg / ml and lower, the level of lactoferrin is from 9613.3 ng / ml and n even if, as a result of evaluating the nonspecific resistance of the oral mucosa, the adsorption reaction rate of microorganisms is from 6.5 and higher, then a complex administration of the drug from the group of acyclic nucleosides, non-steroidal anti-inflammatory, antihistamine, and immunomodulators are prescribed.