From theory to practice: immunotherapy of purulent-inflammatory diseases and purulent-septic complications

Abstract

Lack of anti-infective protection is one of the reasons for the occurrence of purulent-inflammatory diseases of the skin, soft tissues and purulent-septic complications in the postoperative period. Immunocorrective therapy is extremely relevant in surgical practice, and it can be used both for the prevention and treatment of postoperative complications. In this regard, special attention should be paid to low molecular weight fragments of peptidoglycan of cellular bacteria – muramyl peptides.

The study included 65 patients with purulent inflammatory diseases, of which 35 men aged 23–55 years with chronic recurrent pyoderma (ostiofolliculitis, folliculitis, sycosis, furunculosis), and 30 patients aged 18 to 65 years with purulent inflammatory diseases of soft tissues, mainly abscesses and phlegmons of various localization without pronounced concomitant pathology. The examination included 26 patients with purulent-septic complications in the postoperative period. The patients included in the study were divided into 2 equal groups: 1 is the main group, in which patients received intramuscularly Polimuramil 200 mg daily for 5 days in addition to treatment; Comparison group 2, in which patients received only standard treatment. The clinical symptoms of pyoderma were assessed from day 0 to day 7, then on day 14, after 1 and 6 months of the study. Blood samples were taken from all patients for hematological and immunological studies. The timing of the appearance of granulations was monitored daily.

The inclusion of Polimuramil in the complex treatment of pyoderma accelerated the regression of the main clinical manifestations of the disease and promoted the induction of stable remission. In patients with soft tissue infections, Polimuramil increased the degree of regression of the depth and area of the wound and accelerated the appearance of granulations. The clinical efficacy of Polimuramil in patients with purulent-septic complications in the postoperative period correlated with a decrease in CRP and procalcitonin levels. The study confirms the effectiveness of Polimuramil in the treatment of purulent-inflammatory diseases and purulent-septic complications in the postoperative period and its high immunomodulatory potential (8 figs, 2 tables, bibliography: 5 refs).

Keywords

cytokines / immunomodulator / leukocytes / lymphocytes / muramilpeptides / phagocytosis / platelets / Polimuramil / purulent-inflammatory diseases / purulent-septic complications / pyoderma / regression of symptoms / soft tissue infections / wound healing

References

[1] Vinnik YS, Markelova NM, Tyuryumin VS. Modern methods of septic wounds treatment. Sibirskoe meditsinskoye obozreniye. 2013;1(79):18–24. (In Russ.)

[2] Винник Ю.С., Маркелова Н.М., Тюрюмин В.С. Современные методы лечения гнойных ран // Сибирское медицинское обозрение. 2013, № 1 (79). С. 18–24.

[3] Shablovskaya TA, Panchenkov DN. Modern approaches to the complex treatment of purulent-necrotic soft tissue diseases. Bulletin of Experimental and Clinical Surgery. 2013;6(4):498–517. (In Russ.)

[4] Шабловская Т.А., Панченков Д.Н. Современные подходы к комплексному лечению гнойно-некротических заболеваний мягких тканей // Вестник экспериментальной и клинической хирургии. 2013. Т. 6, № 4. С. 498–517.

[5] Nesterenko AN. Immune distress аs pathogenetic аnd thanatogenetic relevant syndrome in severe sepsis and septic shock: clinical and pathomorphological substantiation of early replacement immunocorrection. Emergency medicine. 2013;6(53):94–112. (In Russ.)

[6] Нестеренко А.Н. Иммунный дистресс как патогенетически и танатогенетически значимый синдром при тяжелом сепсисе и септическом шоке: клинико-патоморфологическое обоснование ранней заместительной иммунокоррекции // Медицина неотложных состояний. 2013. № 6 (53). C. 94–112.

[7] Karaulov AV, Kalyuzhin OV. Sphere of muramyl dipeptide application within the major approaches to immunotherapy/prophylaxis of infectious diseases. Fiziologiya i patologiya immunnoy sistemy. 2013;17(5):3–15. (In Russ.)

[8] Караулов А.В., Калюжин О.В. Сфера применения мурамилпептидов в рамках основных подходов к иммунотерапии/иммунопрофилактике инфекционных болезней // Физиология и патология иммунной системы. 2013. Т. 17, № 5. С. 3–15.

[9] Pashenkov MV, Budikhina AS, Golubeva NM, et al. Results of a phase II/III clinical trial of an immunomodulator polymuramyl in patients with purulent surgical infections. Immunologiya. 2012;33(4):199–203. (In Russ.)

[10] Пащенков М.В., Будихина А.С., Голубева Н.М., и др. Результаты II/III фазы клинических испытаний иммуномодулятора полимурамил при гнойной хирургической инфекции // Иммунология. 2012. Т. 33, № 4. С. 199–203.

RIGHTS & PERMISSIONS

Alekseeva N.Y., Dyumnikov D.A., Solovyev I.A., Kalyuzhin O.V.