The use of bacterial lysates in the complex treatment of patients with chronic decompensated tonsillitis

Анотація

Introduction. Chronic tonsillitis (CT) occupies a leading place in the structure of general Oto-rhino-laryngology (ORL) pathology which is characterized by a tendency to an increase in the number of patients with recurrent course, the development of complications and the diversity of etiopathogenetic mechanisms of onset. It has been established that the most acceptable tactic for the prevention of exacerbations of chronic tonsillitis is the use of various groups of drugs that enhance the humoral immunity of the mucous membranes. The drug Ismigen is an immunostimulant based on a bacterial lysate, which increases the body's resistance to infections due to an increase in serum and secretory antibodies, activation of cellular and humoral factors of nonspecific immunity.The aim of the study was to evaluate the effectiveness of the use of Ismigen in the complex treatment of patients with chronic decompensated tonsillitis by studying the dynamics of microbiological indicators.Materials and methods. To achieve this goal, 31 patients with chronic decompensated tonsillitis (CDT) were examined. Patients were divided into 2 groups depending on the proposed treatment regimen:Group A: patients with chronic decompensated tonsillitis who underwent laser tonsillotomy - 15 patients;Group B: patients with chronic decompensated tonsillitis who underwent laser tonsillotomy with further immunostimulation with the drug Ismigen - 16 patients.The control group (CG) consisted of 17 practically healthy individual.Patient in group B had sublingual Ismigen postoperatively: once daily for a period for a period of 10 days. Microbiological examination of the material from the mucous membranes of the tonsils or oropharynx was carried out in dynamics before the treatment, 7 days after the treatment and 1-2 months after the end of the course of treatment. A comprehensive assessment of the status of the oropharynx microbiocenosis was carried out in accordance with the criteria described earlier. According to these criteria, the status of the microbiocenosis of the oropharynx was divided into: eubiosis, dysbiosis of the 1^st degree, dysbiosis of the 2^nd degree and dysbiosis of the 3^rd degree.Results and discussion. Before treatment, in the decompensated state of CT (59.7±2.8)% of the examined subjects was accompanied by dysbiotic manifestations and were classified to grade 3: 60.0% of patients in group A and in 62.5% of patients in group B. In no case pathology of the tonsils did not reveal the microbiological picture of eubiosis.Carrying out various types of therapeutic measures for patients with CDT positively affected the microbiocenosis status of the studied biotope in comparison with the initial data.Comparison of the results of microbiological examination of patients in groups A and B showed the advantages of using immunocorrection after laser tonsillotomy. Thus, in 81.3% of the examined group B microbiocenoses of the mucous membranes of preserved tonsils are represented by eubiosis, compared with 26.7% in group A (p<0.01). The rest of the patients (18.7%) of group B showed dysbiotic phenomena of 1^st degree, against 53.3% of persons in group A (p<0.05).The study of the species composition of the oropharynx microbiota of patients with CDT before treatment and its comparison with bacterial antigens that are part of the preparation of Ismigen showed that practically every patient had persistent one or two respiratory pathogens, which are eliminated by bacterial lysates of Ismigen. Immediately after the treatment, there were no significant differences in the incidence of the above-mentioned bacteria between groups of patients. Respiratory pathogens were detected in 5 patients of group A and 3 patients of group B. The density of seeding of the biotope decreased significantly compared to baseline values and averaged lg (4.1±0.2) CFU/g (p <0.01).1-2 months after the treatment in none of the patients who received the preparation of «Ismigen», the indicated bacteria were detected in the microbiocenosis of the mucous tonsils, against 66.7% of the group A patients who did not undergo sublingual immunization (p<0.01) . «Sanitizing», with respect to the microbial factor of CT, the effectiveness of performed tonsillotomy in a third of patients of group A was lost.The aforementioned respiratory pathogens are most often encountered in chronic inflammatory processes in the upper respiratory tract. Long-term persistence of microorganisms is accompanied by aggravation of immunological disorders and an increased risk of recurrence of the disease [14]. Our studies confirmed the above for patients in Group A, who underwent adequate pathogenetic organ-sparing treatment of the tonsils, but without subsequent immunocorrection.

Conclusions.1. Ismigen, administered to patients with chronic decompensated tonsillitis as part of complex treatment provided a more pronounced antimicrobial effect and promoted restoration of the normocoenosis of the oropharynx.2. Laser tonsillotomy performed with further immunomodulation with the help of immunostimulant on the basis of bacterial lysates Ismigen, allows to achieve the indices of microbial communities of the mucous membranes of preserved tonsils, which did not differ statistically from the microbiota of the control group of practically healthy persons: in 81.3% of patients, eubiosis and in 18.7% of the dysbiosis of the 1st degree. In persons without pathology of the tonsils, these indicators were 88.2% and 11.8%, respectively.3. Ismigen has a selective antimicrobial effect against the most common respiratory pathogens, which is objectively manifested by the restoration of the eubiotic colonization profile of the oropharynx in patients with CDT 1-2 months after treatment.