CC BY
5МЕДИЦИНСКИЕ НАУКИ
PRINCIPLES OF THERAPY OF CHLAMYDIAL AND MYCOPLASMA INFECTIONS AT THE PRESENT STAGE Kudratova Z.E.1, Mukhamadieva L.A.2, Mamatkulova D.^3,
Rustamova G.R.4
1Kudratova Zebo Erkinovna - Assistant, DEPARTMENT OF CLINICAL LABORATORY DIAGNOSTICS;
Mukhamadieva Lola Atamuradovna - MD, Head of the
Department;
Mamatkulova Dilrabo Hamidovna - Associate Professor, Assistant Department;
4Rustamova Gulnoza Rustamovna - Assistant Department, DEPARTMENT 3 PEDIATRICS AND MEDICAL GENETICS; SAMARKAND STATE MEDICAL INSTITUTE SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: obstructive bronchitis is an essential part of infectious and inflammatory diseases of upper and lower respiratory tracts, the incidence of which has a direct dependence on the season, region, age of the child, and also depends on epidemiological situation. Despite the significant progress in the development of methods of bronchitis treatment, clinicians often face the lack of their effectiveness. At the same time, resistance of pathogenic factors to traditional medications is increasing. This indicates the need to improve the tactics of etiotropic and pathogenetic therapy [6].
Keywords: obstructive bronchitis, bronchopulmonary diseases, immune system, chlamydial and mycoplasma infections.
UDC 616.22-002.1-231-002
Studies in recent years have provided evidence that bronchopulmonary diseases often develop against the background of impaired immune system functioning, and in some cases immunodeficiency states - primary and secondary. Consequently, immunotherapy occupies an important place in the therapeutic tactics of obstructive bronchitis [1,3,5].
23
The development, course and outcome of chlamydial and mycoplasma infections are determined primarily by the state of the macroorganism, the characteristics of its immune reactions (including those genetically determined), homeostasis indicators, the presence of concomitant pathology and many other factors, as well as the unique biological properties of the pathogen, its ability for long-term persistence [2, 5, 11].
The treatment plan for a child with chlamydia should take into account the patient's age, previous and concomitant pathology, chlamydia species, and the nosological form of the disease. Currently, macrolides in general and clarithromycin in particular are included in the recommendations for the treatment of respiratory tract infections caused by "atypical" pathogens, due, on the one hand, to the high antimicrobial activity of macrolides against chlamydia and mycoplasmas and the absence of significant problems with resistance of the above pathogens, and on the other hand - to the favorable safety profile of macrolides and the possibility of use in children from a very young age. Macrolides have the ability to accumulate in tissues and inflammation foci, and this process occurs most intensively in tonsils, lymph nodes, lungs, pleural fluid, pelvic organs, joints, which determines their choice for treatment of chlamydia [1, 9, 10].
The role of macrolides in the treatment of upper and lower respiratory tract diseases has significantly increased. The peculiarity of pharmacodynamics of some macrolides is their long-term post-antibiotic effect. The most widely used 3 groups of macrolides: Group 1 - 14-member (erythromycin, oleandomycin, clarithromycin, roxithromycin); Group 2-15-member (azithromycin); Group 3 - 16-member (jozamicin, spiramycin, midekamicin). The group of modern macrolides (azithromycin, jozamycin, roxithromycin, clarithromycin, midecamycin, spiramycin, etc.) lacks the main drawback of erythromycin - instability in the acidic environment of the stomach. It has a broad spectrum of antimicrobial action -bacteriostatic at medium doses and bactericidal at high doses of antibiotics [3,5,7,8,9].
Macrolides are effective against Gram-positive microorganisms. Also against Enterobacteriaceae, most anaerobes, spirochetes, chlamydia and mycoplasmas. Having a long period of elimination from the body, they retain antibacterial activity for 4-5 days after the end of antibiotic therapy. Since chlamydiae and mycoplasmas are obligate intracellular parasites, prone to prolonged persistence in a child with transient immunological insufficiency, a single course of antibiotics against symptomatic therapy does not often lead to eradication of chlamydial and mycoplasma infections. Therefore, the use of immunostimulants is indicated in the treatment of almost all forms of chlamydial infections in children. The effect of etiotropic therapy should be evaluated by the elimination of clinical symptoms of the disease, normalization of blood tests, elimination of the pathogen. Only the totality of clinical and laboratory data and the dynamics of specific antibody titers in subsequent follow-up examinations and observations can serve as a basis for judging the recovery of the child. The optimal period of repeated examinations after the end of treatment is 3-6 months [4,8,9,10,11].
Thus, at the present stage, children's pulmonology faces urgent tasks: improving diagnosis of acute obstructive bronchitis in children with atypical microflora, the need to clarify the leading links in the pathogenesis, optimization of evaluation criteria for the results of modern clinical, instrumental and laboratory research methods with the formation of prognostic criteria for the course of acute obstructive bronchitis with atypical microflora in children to improve the system of treatment measures with the formation of personalized.
References
1. Association between C-589T polymorphism of interleukin-4
gene promoter and asthma: a meta-analysis / Y. Li, B. Guo, L.
Zhang [et al.] // Respir. Med., 2008. Vol. 102. P. 984-92.
2. Becker T.C. Bone marrow is a preferred site for homeostatic proliferation of memory CD8 T cells / T.C. Becker, S.M. Coley, E.J. Wherry, R. Ahmed // J. Immunol., 2005. Vol. 174. P. 1269-1273.
3. Beljakov I.M. Immunnaja sistema slizistyh // Immunologija, 2012. № 4. S. 7-12 (In Russ).
4. Bianchi T. Myc. acts downstream of IL-15 in the regulation of memory- CD8 T cell homeostasis / ^ Bianchi, S. Gasser, A. Trump, R. MacDonald // Blood, 2006. № 9. 38-51.
5. Exhaled nitric oxide in the diagnosis of asthma: comparison with bronchial provocation tests / N. Berkman, A. Avital, R. Breuer [et al.] // Thorax, 2005. Vol. 60. P. 383-388.
6. Fortin M. Prevalence of multimorbidity among adults seen in family practice ^ext] / M. Fortin, G. Bravo, C. Hudon [et al.] // Annals of Family Medicine, 2005. Vol. 3. P. 223-228.
7. Gel'cer B.I., Prosekova E.V., Derkach V.V, Markelova E.V., Kostjushko A.V., Kondrashova N.M. Sistema citokinov i bolezni organov dyhanija. Vladivostok: Dal'nauka, 2005. 256 s. (In Russ).
8. Genetic polymorphisms in transforming growth factor beta-1 (TGFB1) and childhood asthma and atopy / Huiling Li, Isabelle Romieu, Hao Wu [et al.] // Am. J. Hum. Genet., 2007. Vol. 121. P. 529-38.
9. Medunicin N.V., Avdeeva Zh.I., Akol'zina S.E. Soderzhanie citokinov v immunobiologicheskih zhidkostjah // Immunologija, 2011. № 2. S. 42-45 (In Russ).
10. Molecular analysis of sequence variants in the Fcepsilon receptor I beta gene and IL-4 gene promoter in Italian atopic families / L. Rigoli, C. Di Bella, V. Procopio [et al.] // Allergy, 2004. Vol. 59. P. 213-8.
11. Nieters A. Association of polymorphisms in Th1, Th2 cytokine genes with hayfever and atopy in a subsample of EPIC-Heidelberg / A. Nieters, J. Linseisen, N. Becker // Clin. Exp. Allergy, 2004. Vol. 34. P. 346-353.
