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The state of general and local immunity in patients with urogenital chlamydiosis
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Fattakhov Bobir Shavkatovich, Republican Specialized scientific -practical medical Centre of Dermatology and Venereology of the Health Ministry of the Republic of Uzbekistan, Tashkent
E-mail: fattahov_bob@mail.ru
The state of general and local immunity in patients with urogenital chlamydiosis
Abstract: The state of general and local immunity was studied in patients with urogenital chlamydiosis in this scientific work. It was found that patients with chlamydia the immune system disorder are observed which is reflected by the imbalance of cellular and humoral immune system as well. The most expressed changes of immunity, as on systemic and local levels are noted in patients in association with urogenital chlamydiosis and ureomycoplasmosis. Keywords: chlamydia, the immune system, the local immunity.
The general spread of urea plasma and chlamydia infection is revealed by frequent preservation of reservoir of the pathogen in the asymptomatic course of the disease [9]. However, despite the information about the urogenital infections, sexually transmitted diseases in recent years has changed and expanded. [1] As it is well known, 60% of nongonococcal inflammatory processes of the genitourinary system is settled for urogenital chlamydiosis, ureaplas-mosis and their associations. Currently, with these agents connect not only the defeat of urogenital organs, but also the eyes, joints, respiratory injuries and a number of systemic manifestations [8]. Research and clinical observations show that chlamydia may be a cause of infertility, decrease of fertility, cause the pathology of pregnancy, disease of the newborns and young children [1; 5].
However, only patients with severe clinical manifestations go to medical aid, so the number of chlamydia carriers is much more. An increasing number of patients with urogenital chlamydiosis make the disease very serious problem of modern medicine.
At present stage some features of inflammatory process course of lower part of the urogenital tract, caused by sexually transmitted infections were revealed [7].
1. The role of conditionally pathogens is increasing. It is known that normal conditionally pathogenic microorganisms may be in small amounts in human body and do not cause disease, and only under certain conditions they become true pathogens. In particular, conditional pathogens include Escherichia coli, Staphylococcus, Streptococcus, yeast-like fungi, etc.
2. Along with the increase of morbidity the development of incidence of drug resistance to most antibiotics has been marked. Large-scale and numerous studies conducted by clinicians and microbiologists have shown that drug stability is more complicated in treatment of the patients with different infectious processes, particularly with mixed etiology.
3. Currently, the prevalence of self-medication is the bane of modern medicine, as self treatment without medical supervision contributes to the stability of various microorganisms or other factor of therapeutic exposure, and sometimes deals with irreparable harm.
4. Currently, infectious diseases are rarely caused by single pathogen. Mixed infections compose about 20-30% of the infec-
tions of the lower genital tract, nearly in every third patients is revealed infectious process caused by several pathogens [2]. In such cases clinical manifestations of the disease are atypical and determined by character of interaction between different pathogens, leading to oppression or stimulation of one type of microorganism by others.
5. Another feature that reduces the body's resistance is the immunological change of reactivity. It is connected with quite number of reasons, particularly with avitaminosis, malnutrition, environmental conditions and difficult living conditions, and others.
6. In addition, the widespread phenomena such as alcoholism, smoking, drug addiction, which reduce the resistance of the body; its immune features often contribute the generalization of infectious process. In turn, immune deficiencies contribute to the development of immunopathological reactions.
Various authors have studied cellular and humoral immunity in urogenital chlamydiosis, which were characterized by variability and ambiguity [3; 6]. Certain violations of quantitative and functional characteristics of T- lymphocytes (including changes in the index CD4 +/CD8 +), increase the level of IgM and the increase in peripheral blood phagocytes specific to any infectious process have been noted in many studies on the problems of urogenital infections. In a number of cases, there were no marked differences of arithmetic values of some immunological parameters in the group of healthy and sick. Apparently, this is due to the fact that the results reflect the immune status of patients in total, without taking into account the clinical form, has significant impact on immunological parameters [9].
Furthermore, it was established that the general immunity is an extremely important in anti-infection protection and local immune mechanisms play an important role in localization of pathogenesis and inflammatory processes. In particular, the main content of the immunoglobulin classes A, M, G, is a component of the normal immune response, which play an important role in the rehabilitation of the body from pathogens and depend on functional activity of B-lymphocytes. Violation of the state of the local immune response can lead to prolonged chronic diseases mucous membranes, accompanied by a deficit of locally synthesized immunoglobulins and especially IgA.
Section 6. Medical science
In this context, the aim of our study was to investigate the parameters of general immunity and local immunity (IgA, IgM, IgG), in men with inflammatory diseases of the urogenital tract, and reproductive disorders caused by urogenital chlamydiosis.
The study included 45 patients with urogenital chlamydiosis, who were aged 20 to 40 years. The diagnosis was based on the study of discharged urethral smear microscopy and PCR techniques, as well as studies of blood serum for the presence of special IgM and IgG to urogenital chlamydiosis. In 23 patients the primary infertility has been established, and in 14 patients — secondary. Patients were divided into 2 groups.
1-20 patients with lesions of lower parts of urinary tract (uncomplicated);
2-25 patients with lesions of lower and upper genital tract in the form of total urethritis and chronic prostatitis.
Immunological parameters of patients were evaluated according to two criteria: the degree of urinary tract lesions and disease duration. Studies have shown the presence of some of the differences in population composition of lymphocytes in these groups (Table. № 1). Since the patients' group 1 in cellular immunity parameters did not differ from the control group. In group 2 showed an increase in CD8 + and CD19 + cells, inhibition of the functional activity of phagocytes. The data showed that urogenital chlamydial infection accompanied by the development of immunological changes, the nature of which may depend on the level of destruction of the genitourinary system.
Table 1. - Comparative characteristics of general immunity, depending on the localization of the process
Immunological indexes Control group Localization process
Anterior urethritis Total urethritis
Leukocytes, cells/mm 5329±88 6222± 103** 6627±315 *
Lymphocytes,% 32,59 ± 0,84 35,62 ± 0,66 31,54 ± 1,42
Lymphocytes, cells/mm 1738±56 2221 ± 60 ** 2100±145 *
CD3% 58,65 ± 0,81 53,25 ± 0,43 ** 42,82 ± 0,97 ***
CD3, cells/mm 1019±35 1183±34 803 ± 72
CD19,% 16,59 ± 0,41 21,12 ± 0,70 ** 28,54 ± 1,24 ***
CD19, cells/mm 282 ± 10 471 ± 23 *** 591 ± 37 ***
CD4,% 38,59 ± 0,38 33,3 ± 0,52 *** 27,91 ± 0,79 ***
CD4, cells/mm 671 ± 23 733 ± 22 585 ± 42
CD8,% 18,70 ± 0,47 21,41 ± 0,62 * 23,36 ± 1,05 *
CD8, cells/mm 324 ± 13 477 ± 20 *** 451 ± 43 ***
IRI 2,08 ± 0,05 1,58 ± 0,05 ** 1,14 ± 0,09 ***
Table 2. - Comparative characteristics of general immunity, depending on the limitations of process
Immunological indexes Control group Process term
1year 3 years
Leukocytes, cells/mm 5329 ± 88 5222 ± 103 ** 6627±315 *
Lymphocytes% 32,59 ± 0,84 35,62 ± 0,66 31,54 ± 1,42
Lymphocytes, cells/mm 1738±56 2221 ± 60 ** 2100±145 *
CD3% 58,65 ± 0,81 54,25 ± 0,43 ** 36,82 ± 0,97 ***
CD3, cells/mm 1019±35 1163±34 773 ± 72
CD19,% 16,59 ± 0,41 21,12 ± 0,70 ** 38,54 ± 1,24 ***
CD19, cells/mm 282 ± 10 471 ± 23 *** 631 ± 37 ***
CD4,% 38,59 ± 0,38 32,03 ± 0,52 *** 23,91 ± 0,79 ***
CD4, cells/mm 671 ± 23 714 ± 22 545 ± 42
CD8,% 18,70 ± 0,47 21,41 ± 0,62 * 33,36 ± 1,05 *
CD8, cells/mm 324 ± 13 477 ± 20 *** 482 ± 43 ***
IRI 2,08 ± 0,05 1,58 ± 0,05 ** 1,14 ± 0,09 ***
In blood of the control group the content of surface markers CD3-cell differentiation in average was equal to 58, 65 ± 0, 81%, and their absolute number was 1019 ± 35 cells/mm.
Studying the composition of the subpopulation of T-cells showed that the relative abundance of CD4-and CD8-cells in the average was equal to 38.59% and ± 0,38 18,70 ± 0.47%, respectively, and their absolute number in 1 ml of blood in an average was 671 ± 23 cells and 324 ± 13 cells, respectively. IRI in healthy subjects averaged 2,08 ± 0,05.
Investigation of humoral immunity showed that in blood of
control group containing an average of 0.41% ± 16.59 CD19-cells and the absolute number average was equal to 282 ± 10 cells/mm.
Along with this, it is interesting to study the extent of the violation of immunological parameters in the lesion since found that the IGO has a significant lymphoid infiltration of mucous and sub-mucos allayers. Quantitative determination of major classes of immunoglobulins A, M, G performed by enzyme immunoassay gel using monospecific antiserum. Indicators of local humoral immunity were evaluated depending on the prevalence and age of inflammation in the genitourinary organs.
Table 3. - Comparative characteristics of local humoral immunity, depending on limitations of the process
Index Control group under 1 year 1-5 years
Ig A, mg/% 87 ± 9,4 76 ± 7,2 57 ± 6,1
IgMmg/% 53 ± 6,2 52 ± 6,1 35 ± 8,1
Ig G, mg/% 1021±82 1010 ± 7,7 1234 ± 85
Pulmonary ventilation disturbances in patients with pancreatogenic toxemia (literary review)
Study of immunoglobulin concentrations depending on duration of the disease revealed that IgA and IgG levels were significantly reduced compared to the control group. And it was established that the long duration of the inflammatory process leads to significant decline in the local humoral immunity. This may indicate marked in-
In study oflocal immunity, depending on the localization of inflammation of urogenital organs showed not authentic increase level of IgA and IgG in patients with anterior urethritis with more pronounced rise of IgA. Indicators of IgG were significantly higher than the control numbers ofpatients with complicated forms of urogenital chlamydiosis, respectively, the ratio of IgG/IgA increased. This may indicate that the strain oflocal humoral immunity and the ability ofmicroorganism has to fight with the existing infectious process.
Thus, the results justifies that the state ofthe local humoral immunity in men with inflammatory diseases of the genitourinary sys-
hibition of the ability of immune cells lining the urethra to the local synthesis of immunoglobulins and absence of an adequate level of compensatory immunodiffusion degree of peripheral blood flow associated with the development of the state of secondary immunodeficiency due to the long-term persistent infection.
tem caused by urogenital chlamydiosis and reproductive disorders are accompanied by changes in the concentration of immunoglobulins in different directions, the degree of impairment depends on the duration of the disease and the prevalence of inflammation in the urogenital tract. According to indicators of the local immune response, one can judge about the state of the general immune response, as there is a close relationship between them.
These data must be considered in the development of immunotherapy which is aimed to the activation of humoral immunity and leucocytes that they have phagocytic activity.
Table 4. - Comparative characteristics of local humoral immunity, depending on localization of process
Index Control group Anterior urethritis Total urethritis
Ig A, mg/% 87 ± 9,4 119 ± 4,4 74 ± 9,7
IgMmg/% 53 ± 6,2 55 ± 5,6 38 ± 7,9
Ig G, mg/% 1021±82 1105 ±91 1322±78
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Khadjibaev Abdukhakim Muminovich, Phd, ScD, Professor Republic Research Center of Emergency Medicine, Tashkent,
Uzbekistan, Director General E-mail: uzbek_ems@uzsci.net Alidjanov Fotih Bakievich, PhD, ScD, Professor 2-Tashkent Institute for Post-graduate Education of Doctors, Uzbekistan
Rizaev Kamal Saidakbarovich, PhD Republic Research Center of Emergency Medicine, Tashkent, Uzbekistan, Deputy Director General E-mail: rizaev@rambler.ru Makhamadaminov A. G., PhD 2-Tashkent Institute for Post-graduate Education of Doctors, Uzbekistan
Pulmonary ventilation disturbances in patients with pancreatogenic toxemia (literary review)
Abstract: Steady increasing of acute pancreatitis (AP), especially its destructive forms, significant difficulties at its recognition and a big percentage of diagnostic mistakes, disputability in treatment tactics issues, high mortality determine the necessity
