Pathogenetic Justification for the Prevention of Spread of the Pathological Process during Immunostimulation in Patients with Inflammatory Gynecological Diseases of Mycoplasmal Etiology

The dissertation is devoted to the pathogenesis-based justification of the prevention of spread of the pathological process during immunostimulation in patients with nonspecific inflammatory gynecological diseases of mycoplasmal etiology. The investigation revealed that immunostimulation is accompanied by activation of mycoplasmal infection and spread of the pathological process onto previously uninvolved cells, which necessitates the development of prophylactic measures. The work contains justification of the optimal timing of initiation of antibiotic therapy in the context of immunostimulation and demonstrates the expediency of prescribing antibiotics 3–4 days after the onset of immunostimulation in order to prevent damage to new cells and to improve treatment outcomes.

The prevalence of nonspecific inflammatory diseases of the urogenital tract is steadily increasing. Reports on the etiological role of conditionally pathogenic microorganisms in their development are appearing with increasing frequency (6, 10, 29, 89, 120, 124). At the same time, it must be acknowledged that, at the present time, the question of the pathogenicity of urogenital mycoplasmas has not been fully resolved. There is an opinion that the mycoplasma most frequently detected in material obtained from the urethra and the urinary tract belongs to the normal representatives of the vaginal microflora (10, 39, 42, 139, 142). However, the detection rate of M. hominis among healthy carriers amounts to 8.1–12.8%, whereas in patients with diseases of the urogenital organs it reaches up to 32.3–46.7%. It is assumed that another representative, Mycoplasma urealyticum, is more frequently detected (12, 19, 123, 149). All of this testifies to the involvement of urogenital mycoplasmas in the development of the pathological process in nonspecific inflammatory diseases of the urogenital organs (15, 54, 189, 193). The treatment of urogenital mycoplasmal infection is a complex task requiring from the physician an understanding of the features of pathogenesis and a creative approach. A specific approach to the selection of an antibiotic, its dosage, frequency, and the timing of initiation of antibacterial therapy often does not produce a positive effect and is the cause of chronic pathogenesis (Delitsky V.V. et al. 1996, Kir E.F. 19%, Douriev S et al. 19%). At the present time, an approach to the treatment of mycoplasmosis accompanied by a chronic gynecological process has been substantiated, requiring preliminary measures directed at activation of the persisting infection. As a rule, antibacterial therapy is initiated after completion of the preparatory course (Danish H, Van Y.T.H.P. 1995). However, activation of the persisting infection is accompanied by spread of the inflammatory process onto previously uninvolved tissues; accordingly, antibacterial therapy is conducted against the background of enlargement of the inflammatory focus, which constitutes a negative side effect of the preparatory course (Salutin S.L. 2001). It should be noted that the study of the pathogenetic features of the spread of infection against the background of immunostimulation and the development of prophylactic measures preventing the damage of new cells in inflammatory gynecological diseases of mycoplasmal etiology has not been given due attention, which determines the relevance and prospectiveness of the present work. The goal of this work is the pathogenesis-based justification of the prevention of spread of the pathological process during immunostimulation in patients with nonspecific inflammatory gynecological diseases of mycoplasmal etiology. The tasks: 1. To study the pathogenetic features of latent mycoplasmal infection against the background of immunostimulation in patients with inflammatory gynecological diseases. 2. To study the influence of the timing of initiation of antibiotic therapy and rectal administration of a complex immunoglobulin preparation on the spread of the pathological process during immunostimulation. 3. To conduct a comparative analysis of the results of treatment of inflammatory gynecological diseases of mycoplasmal etiology depending on the conduct of measures directed at prevention of spread of the pathological process during immunostimulation. 4. To justify the pathogenesis-based expediency of measures directed at prevention of spread of the pathological process during immunostimulation in the treatment of nonspecific inflammatory gynecological diseases of mycoplasmal etiology. Thus, the following results were obtained. It was established that during immunostimulation in women with inflammatory gynecological diseases, activation of mycoplasmal infection is observed, characterized by spread of the pathological process, which manifests as damage of cytokeratin 7 in previously uninvolved in the pathological process cells. When antibiotic therapy is prescribed 3–4 days after the onset of immunostimulation, damage of previously uninvolved in the pathological process cells does not occur, which contributes to improvement of the results and reduction of the duration of treatment of nonspecific inflammatory gynecological diseases of mycoplasmal etiology, compared with the prescription of antibiotic therapy after completion of immunostimulation. The pathogenesis-based expediency of prescribing antibiotic therapy 3–4 days after the onset of immunostimulation in the treatment of nonspecific gynecological diseases of mycoplasmal etiology has been substantiated. Positive results: 1. The pathogenetic features of activation of mycoplasmal infection against the background of immunostimulation are the appearance of clinical symptoms of exacerbation (of inflammatory gynecological diseases) and damage of mycoplasmas of previously uninvolved in the pathological process cells. 2. In nonspecific inflammatory gynecological diseases of mycoplasmal etiology, prescription of antibiotic therapy 3–4 days after the onset of immunostimulation prevents damage of previously uninvolved in the pathological process cells. 3. Prescription of antibiotic therapy 3–4 days after the onset of immunostimulation in the treatment of nonspecific inflammatory gynecological diseases of mycoplasmal etiology allows improvement of the results and reduction of the duration of treatment, which makes the initiation of antibiotic therapy at these time points pathogenesis-based expedient. Thus, the following results were obtained. The results of the investigation have been implemented at the Novgorod Regional Clinical Hospital (Veliky Novgorod), in the work of the Central Educational and Scientific Laboratory of the Institute of Medical Education of Novgorod State University (Veliky Novgorod). Based on the results of the investigation, 5 printed works have been published. The results of the work were reported at the International Conference «Modern Aspects of Epidemiology, Clinical Practice, Diagnosis, Prevention, and Treatment of Dermatoses and Sexually Transmitted Infections» (Almaty, 2003); conferences by staff of NSU (Veliky Novgorod, 2003, 2005); the International Conference of IMO KovGU (Veliky Novgorod, 2006). General volume and structure of the dissertation: The dissertation consists of 18 pages of typed text and includes an introduction, a literature review, 4 chapters of own observations, conclusion, conclusions, practical recommendations, and a list of sources used, which contains 113 sources in Russian and 100 in foreign languages. It is illustrated by 31 tables.