Laringomikozy. Diagnosis and treatment

Recently, cases of chronic inflammatory diseases of the larynx, which are difficult to treat.

A careful clinical and laboratory study of this category of patients were identified namely mycotic laryngeal lesion, and most (90% of cases) on a background of chronic hyperplastic laryngitis, which in late diagnosis and, therefore, untimely and improper tactics of treatment leads to severe changes and complications of the larynx and other organs and body systems. In connection with this fungal throat today are the actual problem and require a doctor's careful approach to the patient, a detailed survey and correct the differential treatment strategies. The main causative agents of fungal infections throat yeast are fungi of the genus Candida (90-95%), combine 20 types [1]. Patients laringomikozami usually produce eight different types of agents, among which there are two more: C. albicans, C. tropicalis, at least in the case of 5-7% are observed laryngeal mycoses caused by fungi Aspergillius, Penicillium, Mucor, Altenaria and et al [2]. As a rule, chronic inflammation develops as a result of disorders of the immune system of the body and this contributes to a number of factors: chronic diseases of the nose, throat, mycotic lesion overlying respiratory tract, namely, oropharyngeal candidiasis, systemic diseases of the blood, gastrointestinal tract (dysbiosis), malignant neoplasm, the unsustainable long-term antibiotic, corticosteroid, radiation therapy, the impact of adverse occupational factors. Development of fungal infections also helps to work in conditions of high humidity, high temperatures and dust, alcohol abuse, smoking. Mycotic lesion of larynx is as acute and chronic lesions of the larynx in acute process is noted, usually common with the defeat of the oral cavity and pharynx, chronic - the process is localized within the larynx. The clinical picture and symptoms of mycosis larynx are extremely diverse and are determined by a kind of fungus, the state of immune reactivity, the presence of other pathological processes of the larynx (HGL, foci of dyskeratosis, tumors, etc.). The most common symptoms of the disease (depending on the location and extent of the process) are mild pain hoarseness, cough, foreign body sensation, sore, burning and itching can be. Characteristically, the latter symptom is not observed in other pathological processes in the larynx. Characteristic radiographic signs for laryngeal mycoses are not available. X-ray picture at the same time similar to that in chronic hyperplastic laryngitis. Immune status of the body is starting points of the pathogenesis of chronic hyperplastic laryngitis, against which progress and relapse different forms laringomikozov [3]. Know that the issues of diagnosis and treatment of patients with laryngeal mycosis present considerable difficulties, since it does not always appear laringomikozy specific clinical features [4]. Thus, a more profound study of various forms of targeted fungal laryngeal determine the relevance of the search of rational methods of diagnosis and comprehensive treatment of various forms and methods laringomikozov prevention. This was possible due to the use of immunological methods for diagnosis, which is valuable not only in the initial stage of diagnosis, but in the future, in determining the effectiveness of treatment. At present there is sufficient experience of immunomodulators in the treatment of many diseases that can not be said about the treatment of fungal infections VDP, including the larynx. The lack of a differential approach to initial treatment of this category of patients without immunological status and the subsequent immune correction process leads to a prolonged, persistent, often recurrent course laringomikoza, resistance to conventional therapy, the development of dyskeratosis, malignant, and some other complications.

The purpose of the

Conduct a comprehensive therapy for patients with various forms of laringomikozov with immunnokorrigiruyuschego drug - Polyoxidonium based on the identification of clinical and immunological characteristics of a given pathology.

Materials and methods

In the ENT clinic of Gomel State Medical University, examined and treated 47 patients (39 (83%) males and 8 (17%) women) with various forms of laringomikoza. The median age was 45 ╠ 7, disease duration from 1 year to 20 years. All the patients underwent a comprehensive survey: general clinical, otorhinolaryngologic, microbiological, bacteriological, immunological, fibrolaringoskopicheskoe, histology, and by indications видеоларингостробоскопическое. Immunologic study included consultation with a doctor, immunologist, the definition of slgA in saliva, the number of leukocytes, T-and B-lymphocytes, Thelpery / Tsupressory, CDS, CD4, CD8, phagocytic index, phagocytic number, IgA / M / G, CEC. Mycological research: identification of species and genus of fungi, susceptibility to antimycotic drugs. Study group comprised 27 patients (23 men and 4 women) who underwent combined treatment: antibacterial, antimycotic, antihistamines, mucolytic agents in combination with polyoxy-doniem (NGOs PetrovaksFarm, RF, Reg. Bpm. № 750 305 MOH). The spectrum of clinical applications polyoxidonium very wide. Polioksidoniy - physiologically active compound with a mol. mass of about 100 kDa with a strong immunomoduliruyuscheey activity. In chemical structure to Polyoxidonium is a copolymer of M-oxide-1 ,4-ethylene-piperazine and (1M-carboxyethyl) -1,4-etilenpi-peraziniya bromide. Poly-oksidony has immunomodulatory, oxidant, detoxifying and antioxidant properties dantnymi. The control group included 20 people (16 men and 4 women) who received integrated treatment without polyoxidonium. All patients in terms of combined treatment was carried out taking into account the antimycotic therapy and bacteriology антимикотикочувствительности scheme: fluconazole (difloks) 100 mg 1 time a day for 14 days or itraconazole (Mikotroks) 100-200 1 mg once daily for 14 days, hyposensitization therapy, mucolytics (gelomirtol, Ambroxol), antibiotic therapy (if indicated). The main group used Polyoxidonium according to the scheme to 6 mg / m number 5 in a day, then 1 time a week № 2-3, in combination with endolaringealnymi instillation of 3 mg of 1 -2 times a day for 10 days along with rosehip oil , menthol. Also conducted inhalation through the mouth with amphotericin B number 10 on a daily basis. According to the testimony (in the presence of neoplasms, hyperplastic restricted areas, foci of dyskeratosis) surgical treatment of 7 patients under endotracheal anesthesia with direct mikrolaringoskopii.

Results

The research resulted in: fungi of the genus Candida - were detected in 42 (89%) patients, 5 (11%) - filamentous Mycobiota, of whom 28 (59%) - fungal-bacterial association. In terms of immunological studies, most patients noted a moderate decrease in IgA / M / G, reducing the relative amount of POP + T-lymphocytes, the relative and absolute number of CD4 +, ratio of CD4 + / CD8, a significant increase in CEC (120-140 units).. The results of immunological examination of oral fluid showed that the examined patients, there are significant changes in local immunity (decreased levels of slgA - 27,5 ╠ 3,2 mg / ml). Evaluation of the treatment was performed on a set of attributes: the normalization of laryngoscope pictures, voice function and subjective sensations of patients with three-point system - the "good", "satisfactory", "unsatisfactory." In analyzing the results of treatment of patients with laringomikozami marked "good" performance in the majority of the main group - 16 (59%), which was manifested and expressed in a significant improvement of the objective and subjective indicators of the larynx, "satisfactory" - in 10 (39%) that appeared in the positive dynamics of subjective and objective indicators, but not so clearly. In 1 (2%) patients with an objective assessment of laryngoscope pictures showed no significant clinical effect after the first treatment, although patients reported subjective improvement, which was the indication for surgical treatment and repeated course of conservative therapy after 2 months. In the second control group, no patient was found significant improvements, and 15 (75%) patients reported a positive trend, but not so clearly expressed. In 5 (25%) were received significant clinical effect. Relapse in the main group of patients within 6 months were not recorded, within 12 months, 3 patients had no recurrence. In 4 patients of the control group showed worsening after 2 months, 6 months - laringomikoza exacerbation was diagnosed in 6 patients.

Immunological parameters after treatment in patients with polyoxidonium showed a positive dynamics of the main indicators of immune status, in contrast to the control group of patients receiving conventional treatment. Portability of a product is good, side effects, allergic reactions have been identified.

Conclusions:

1. In patients with various forms of laringomikozov showed signs of failure in the general and local immunological status, which causes protracted process, frequent relapses.

2. Comprehensive survey of patients with laringomikozami, chronic throat is recommended to complement the assessment of immune status of the patient with an analysis of the parameters of the general and local immunity, which would make a significant contribution to the diagnosis, prognosis of the disease, monitoring treatment effectiveness

)) с учетом антимикотикочувствительности, позволило повысить клинический эффект пациентам с ларингомикозами, что проявилось в стабилизации патологического процесса и более длительной ремиссии заболевания. 3. Inclusion in the general scheme of treatment of immunomodulatory drug Polyoxidonium with conducting a comprehensive antimycotic therapy (fluconazole (difloks), itraconazole (mikotroks)) subject to антимикотикочувствительности, possible to increase the clinical benefit to patients with laringomikozami, which was manifested in the stabilization of the pathological process and a more prolonged remission of the disease .

References:

1. Sergeev, AJ Fungal infections: a guide for physicians / AU Sergeev, YV Sergeev - Moscow: OOO "Binompress", 2004. - 440C.

2. Kunelskaya, VJ Mycoses in otorhinolaryngology / VJ Kunelskaya / / Consillium Medicum. - 2001.-T.Z. - № 8.

3. Kryukov, AI Mycoses in otorhinolaryngology / AI Hooks / / Consillium Medicum. Otorhinolaryngology. - 2004-T.6. - № 4. - S. 47-48.

4. Zabolotny, DI, Role of fungi in the pathology of the upper respiratory tract and ear / DI Zabolotny, IS Zaritsky, OG Volskaya / / Zh. ushn. and gorl.bol. - 2002. - № 5. - S. 2-15.