RU2119799C1 - Method for treating botulism - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves introducing antibotulinus serum, antibacterial preparations, detoxication preparations and leukinferon as additional preparation. First of all, patient blood is analyzed to determine leukocytes, lymphocytes, immunity cell link markers, immunity humoral link markers, serum immunoglobulins A, M, G quantity, phagocytic activity of neutrophils. The values being below some normal value, conclusions are derived concerning drop in cell and humoral immunity, secondary bacterial complications are predicted and leukinferon is intramuscularly administered at a dose of 10 000 MU twice a day at the first, third and sixth day beginning from the moment of admission to a hospital. Later on, leukinferon is administered as aerosol also through thracheostome at a dose of 10 000 MU twice a day at the first, third, sixth, twelfth and sixteenth day. EFFECT: reduced risk of secondary complications; alleviating the course of the main disease. 2 tbl

Description

 The invention relates to medicine, namely to infectious diseases.

 It is known that in modern conditions, botulism therapy consists of two main areas. The first involves the active implementation of measures aimed at preventing the realization of the possibility of the formation of toxin in vivo, at the most rapid removal of the toxin from the patient's body and the neutralization of the toxin circulating in the blood. The second direction includes measures to eliminate pathological changes caused by botulinum toxin, primarily secondary bacterial complications (V. N. Nikiforov, V. V. Nikiforov in the book “Botulism”, -L .: Medicine, 1985, p. 116 -189).

 The widely used heterologous anti-botulinum serum (PBS), which neutralizes botulinum toxins, cannot be a panacea, since it does not have a quick effect, has a negligible effect with prophylactic administration and, being a foreign protein, can cause a whole complex of allergic reactions, up to anaphylactic shock.

 Detoxification therapy widespread in clinical practice (hemodesis, reopoliglukin, etc.), while not being a specific treatment method, cannot be considered as an effective way of treating botulism. In addition, the use of detoxification and saline solutions with forced diuresis leads to disruption of the electrolyte balance and loss of total protein.

 A known method of treating botulism, including the introduction into the patient's body of broad-spectrum antibiotics, for example, chloramphenicol, as well as cephalosporin, aminoclycosides (Morris J. G, Bicmedical aspects of botulism. New-Jork, Acaol. Press. Ino., 1981, p. 317 -326).

 However, the use of these drugs does not allow to avoid the occurrence of secondary bacterial complications of botulism.

 The disadvantages of antibiotic therapy include the ability of these drugs to change the reactivity of the patient's body and cause the emergence of resistant strains of microorganisms. In addition, the empirical use of antibiotic therapy in botulism patients can increase toxemia by increasing the breakdown of Cl. botulomer in the intestines.

 As a prototype, a method of treating botulism has been adopted, comprising administering anti-botulinum serum to a patient in a single therapeutic dose, followed by antibacterial therapy with chloramphenicol 1-3 times a day for 7-10 days.

 At the same time, detoxification therapy is carried out, including the introduction of water-salt (Trisol, Quartzol, Atssol, etc.) and colloidal solutions (polyglyukin, reopoliglyukin, hemodes, etc.). The treatment is accompanied by the introduction of blood products (native plasma, anti-staphylococcal immunoglobulin, etc.), hormonal anti-inflammatory drugs (prednisone, hydrocortidosis), a wide range of restorative therapy (Nikiforov VN, Nikiforov VV in the book “Botulism”, -L .: Medicine, 1985, pp. 116-189).

 However, the known method has several significant disadvantages. The introduction of a large number of antibiotics leads to intestinal dysbiosis, increases the patient's allergic background and leads to an increase in the number of microorganism strains resistant to their action. Moreover, in various biological secretions (sputum, urine), microbial associations are more often detected, due to a change in the reactivity of the organism as a whole.

 The use of the whole complex of therapeutic measures does not allow to avoid the occurrence of secondary bacterial complications.

 The terms of treatment in a known manner are 30 days or more. In this case, the flight rate reaches 16.67%.

 The objective of the invention is to provide a highly effective method of treating botulism, which can significantly reduce the number of secondary bacterial complications and reduce mortality.

 The essence of the invention lies in the fact that in a method of treating botulism, including the introduction of anti-botulinum serum, antibacterial drugs, detoxification agents into the patient’s body, the patient’s blood is examined in advance, in which the number of leukocytes, lymphocytes, markers of the cellular immunity link, markers of the humoral immune link, serum immunoglobulins of classes A, M, G, phagocytic activity of neutrophils and, when these values are below the norm, they judge a decrease in cellular and humor lax immunity, they predict the development of secondary bacterial complications and additionally inject 10 thousand IU of leukinferon intramuscularly into the patient’s body 2 times a day for 1, 3, 6 days from the moment of hospitalization, then once a day for 9, 12 and 16 days, and patients undergoing mechanical ventilation, leukinferon is also administered as an aerosol through a tracheostomy, 10 thousand IU once a day for 1, 3, 6 and 12 days.

Using the invention allows to obtain the following technical result:
1. Reducing the incidence of secondary bacterial complications from the bronchopulmonary system and urinary system.

 2. Relieving the severity of the course of the main process.

 3. In the presence of secondary bacterial complications in patients at the time of hospitalization, their severity during treatment is significantly reduced.

 4. Reducing the treatment of patients with immunocorrective therapy up to 20 - 25 days.

 5. Reducing the volume of injected drugs: antibiotics, detoxification solutions, blood substitutes, etc.

 6. Reduction in mortality to 4.76%.

 The technical result is achieved due to the fact that the authors first studied the state of cellular and humoral immunity in patients with botulism with varying degrees of severity of the main process. The most pronounced immune changes occur in patients with severe botulism. The results of these studies formed the basis for assessing the severity of immune disorders in order to predict the likelihood of secondary bacterial complications.

 The method is as follows.

 After establishing a clinical diagnosis, the patient is immunologically tested for blood taken from the ulnar vein in an amount of 6.0 ml. The number of leukocytes, lymphocytes, markers of the cellular immunity link is determined: general T-cell lymphocytes - CD5, T-helpers - CD4, T-suppressors - CD8, immunoregulatory index (IRI) - CD4 / SD8; markers of the humoral immunity: B-lymphocytes - 3F3, serum immunoglobulins of classes A, M, G and phagocytic activity of neutrophils (FAN). With a decrease in these indicators, the occurrence of secondary bacterial complications in patients with botulism is predicted.

 The patient is administered 1 dose of anti-botulinum serum once intravenously. The whole range of therapeutic measures is carried out, which includes intramuscular administration of chloramphenicol 1.0 3 times a day, detoxification agents (hemodesis, reopoliglyukin, trisol, etc.).

 With the development of decompensated acute respiratory failure, artificial lung ventilation (IVL) is performed.

 In addition, the patient is injected with the immunocorrecting drug leukinferon.

 Leukinferon is administered intramuscularly at 10 thousand IU 2 times a day for 1, 3, 6 days from the time of hospitalization, and then at 10 thousand IU once on 9, 12, 16 days. Along with this patient, whose condition required mechanical ventilation, leukinferon is also administered as an aerosol through a tracheostomy of 10 thousand IU once on 1, 3, 6, 12 days from the time of hospitalization.

 The method has passed clinical trials at the department of infectious diseases at the base of the hospital. S.P. Botkin on 21 patients.

 Among patients with severe botulism who received leukinferon during complex therapy, there were 9 men and 12 women.

 The average age of patients was 39.24 ± 2.00 years with fluctuations from 19 to 54 years.

As criteria for the effectiveness of the prophylactic use of leukinferon, we have taken the following:
1. Clinical - a decrease in the frequency and severity of secondary bacterial complications (pneumonia, bronchitis, pyelonephritis, etc.).

 2. Immunological - normalization or tendency to such indicators of cellular and humoral links of immunity.

 To assess the clinical effectiveness of leukinferon in the prevention of secondary bacterial complications, we compared the frequency and nature of complications in patients with severe botulism who received (main group - 21 patients) and did not receive (control group - 18 patients) leukinferon during traditional complex therapy .

 When analyzing the clinical efficacy of leukinferon, we took into account whether the patients of the main and control groups were on mechanical ventilation.

 Data on the nature and frequency of secondary bacterial complications that arose in patients of the main (receiving leukinferon) and control groups are presented in table. one.

 Speaking about immunological criteria for the effectiveness of leukinferon, it should be noted that we did not reveal any significantly significant differences in the initial indices of cellular and humoral immunity in patients of the main and control groups upon admission (Table 2).

 Data on the state of cellular and humoral immunity in patients of the main (receiving leukinferon) and control groups are presented in table. 2.

 Example. Patient M., 42 years old, and / b N 100243, was admitted to the clinic on January 22, 93 with complaints of a feeling of pressure behind the sternum and lack of air, difficulty swallowing, decreased visual acuity, dry mouth, general weakness.

From the anamnesis: was admitted on the 3rd day of illness. She became acutely ill 16 hours after eating canned home-made mushrooms. The condition at admission is serious. The skin is pale. The patient is dynamic, lethargic. Complete ptosis, severe mydriasis, ophthalmoplegia are noted. Dysphagia, dysarthria, dysphonia. NPV - 22 per min. Vital lung capacity (VC) - 16.67 cm ³ / kg body weight. In the lungs, breathing is weakened, single dry rales in the lower sections. Pulse 102 beats. in minutes, rhythmic. A / D 110/70 mm. Hg. Art. The abdomen is soft, swollen, painless. Intestinal motility is not heard.

 From the ulnar vein of the patient taken 6 ml of blood. An immunological analysis was performed (table. 3).

 The clinical diagnosis is botulism, severe course, acute decompensated respiratory failure, acute catarrhal tracheobronchitis.

 At 14.00 hours, 01/22. the patient was administered 1 - a therapeutic dose of I / O PBS once, appointed - gastric lavage (through a probe), cleansing enema. Chloramphenicol succinate 1.0 x 3 times a day intramuscularly, intravenous detoxification therapy (hemodesis, reopoliglyukin, trisol) in a volume of up to 3.0 l with forced diuresis.

 Against the background of complex therapy in order to prevent the occurrence of secondary bacterial complications, leukinferon was additionally used, which was administered as follows: 22.01., 24.01., 26.01. the drug was administered intramuscularly 2 times a day for 10 thousand IU and aerosol 1 time per day for 10 thousand IU. In the following days 29.01., 01.02.-4.02., 7.02. the drug was administered intramuscularly once a day for 10 thousand IU.

At 20.00 hours on January 22., Despite the ongoing therapy, the patient's condition deteriorated sharply - breathing became superficial, appeared cyanosis of the lips. NPV - 26-28 per min, VC - 9.09 cm ³ / kg. According to vital indications, the patient was transferred to mechanical ventilation. The patient was additionally administered leukinferon in the form of an aerosol of 10 thousand IU through a tracheostomy: 23.01., 24.01., 27.01. The condition remains serious, in the mind. The skin is of normal color, no cyanosis. The patient is in controlled breathing with the following parameters: tidal volume - 760 ml, NPV - 24 per minute, minute volume - 11 l, O ₂ - 70%. Breathing in the lungs is carried out in all departments, wheezing is not heard. Pulse 88 in min, A / D 110/70 mm Hg The abdomen is soft, swollen. Intestinal motility is not heard. On the part of the neurological status, stabilization of neurological symptoms is noted, with no tendency to progression.

 When conducting chest x-ray, ultrasound examination of the heart in a patient, pathological changes were not detected.

 01/26. The patient is on mechanical ventilation with a gradual transition to independent breathing. The condition remains serious, although positive dynamics can be traced from the neurological status.

 On a chest x-ray without pathological changes. On rehabilitation fibrobronchoscopy, catarrhal tracheobronchitis is noted.

From 01/28. - independent breathing. Neurological symptoms regress: free swallowing appeared, the severity of ophthalmoplegia, ptosis decreased. Intestinal motility recovered. An X-ray examination of the chest revealed a slight expansion of the shadows of the roots of the lungs without focal phenomena. The VC was 21.21 cm ³ / kg.

 Further neurological symptoms regressed. The patient was discharged 02/14/93 (on the 22nd day of hospitalization) in satisfactory condition. Side effects on the introduction of leukinferon were not observed.

Claims (1)

 A method for the treatment of botulism, including the introduction of anti-botulinum serum, antibacterial drugs, detoxification agents into the patient’s body, characterized in that the patient’s blood is first examined, in which the number of leukocytes, lymphocytes, cell immunity markers, humoral immunity markers, serum immunoglobulins of class A are determined, M, G, phagocytic activity of neutrophils and when the values of these indicators are below the norm, they judge a decrease in cellular and humoral immunity, p ognoziruyut development of secondary bacterial complications, and further introduced into the patient's body leukinferon intramuscularly to 10 thousand. IU 2 times a day for 1, 3 and 6 hours from the time of hospitalization, and then once a day for 9, 12 and 16 hours.

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