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The immune response to any antigen includes the induction of effector and regulatory T lymphocytes. In tumors, an imbalance in the subpopulation of lymphocytes is noted. Ophthalmotropic pathogens of herpes virus infections play a role in the etiopathogenesis of some oncological processes in the tissues of the eye. Their “cancer modulating” role is to regulate the functions of immunocompetent cells by viruses and reprogram it in the direction of greater progression of tumor growth. The aim of our study was a comparative analysis of the content of effector subpopulations of blood lymphocytes in patients with uveal melanoma during activation and the chronic course of herpes virus infection. The study involved 141 people: with uveal melanoma 70 patients, with corneal ulcers and involvement of the uveal tract - 38 patients and 33 healthy donors. Immunophenotyping was performed by flow laser cytofluorimetry using a monoclonal antibody system to differentiate lymphocyte subpopulations. IgM and IgG antibodies to herpes virus infections were determined in an enzyme-linked immunosorbent assay (ELISA) on an automatic ELISA analyzer "Lazurite" (USA) with diagnostic kits of CJSC Vector-Best (Koltsovo). The results of the study showed that the absolute number of blood lymphocytes (CD45 +) in patients with uveal melanoma, regardless of the presence of active or chronic herpes virus infection, did not differ from the values in healthy donors. In patients with corneal ulcers involving the uveal tract, an increase was noted. A decrease in the relative and absolute content of T cells (CD3+) was revealed in patients with uveal melanoma during activation and the chronic course of herpes virus infection. An increase in the absolute content of CD3 + was noted in patients with active and chronic herpesvirus infection in patients with inflammatory lesions of the eye. There was no difference in the relative and absolute contents of the subpopulation of CD3 + CD4 + helpers / inducers upon activation of herpes virus infections in tumor. With corneal ulcers - a significant increase in the absolute content of CD3 + CD4 + helpers / inducers with active and chronic infection. In chronic herpes virus infection, an increase in the relative and absolute number of cytotoxic T-lymphocytes (CD3 + CD8 +) with uveal melanoma was revealed. With active infection, a decrease in the relative number of T-lymphocytes (CD3 + CD8 +) in the tumor was noted. With corneal ulcers involving the uveal tract, an increase in the absolute content during activation and chronic infection and a decrease in the relative content compared to the norm were determined. When analyzing the “double positive” T cells in a tumor, an increase in relative and absolute indices was observed in chronic and active infection with herpes viruses. The same trends were observed with inflammatory eye diseases. Analysis of the content of B-lymphocytes (CD19 +) in blood with melanoma showed an increase in the absolute number during activation and the chronic course of herpes virus infection. When analyzing the indicators of the absolute and relative content of B-lymphocytes (CD19 +) with inflammation of the membranes of the eyes, their increase was revealed regardless of activation or chronic infection. The relative number of natural killers (CD16 + CD56 +) of blood with uveal melanoma increased with infection activation. In inflammatory eye diseases, a decrease in the relative content of natural killers (CD16 + CD56 +) was found in chronic infection and active herpes virus infection. With melanoma, no changes in the index of the ratio CD4 + / CD8 + were detected, with ulcerative lesions of the cornea involving the uveal tract, its increase was noted in acute and chronic infections with herpes virus infections. (p <0.05). Thus, our own studies suggest a deep suppression of the immune system of the body of patients with uveal melanoma, which does not allow the activation of antiviral protection. Tumor causes multidirectional shifts in the relative and absolute content of lymphocytes during activation and chronic infection with herpes virus infections. The results obtained are important for the development of personalized approaches to the prognosis and treatment of patients with uveal melanoma.
The immune response to any antigen includes the induction of effector and regulatory T lymphocytes. In tumors, an imbalance in the subpopulation of lymphocytes is noted. Ophthalmotropic pathogens of herpes virus infections play a role in the etiopathogenesis of some oncological processes in the tissues of the eye. Their “cancer modulating” role is to regulate the functions of immunocompetent cells by viruses and reprogram it in the direction of greater progression of tumor growth. The aim of our study was a comparative analysis of the content of effector subpopulations of blood lymphocytes in patients with uveal melanoma during activation and the chronic course of herpes virus infection. The study involved 141 people: with uveal melanoma 70 patients, with corneal ulcers and involvement of the uveal tract - 38 patients and 33 healthy donors. Immunophenotyping was performed by flow laser cytofluorimetry using a monoclonal antibody system to differentiate lymphocyte subpopulations. IgM and IgG antibodies to herpes virus infections were determined in an enzyme-linked immunosorbent assay (ELISA) on an automatic ELISA analyzer "Lazurite" (USA) with diagnostic kits of CJSC Vector-Best (Koltsovo). The results of the study showed that the absolute number of blood lymphocytes (CD45 +) in patients with uveal melanoma, regardless of the presence of active or chronic herpes virus infection, did not differ from the values in healthy donors. In patients with corneal ulcers involving the uveal tract, an increase was noted. A decrease in the relative and absolute content of T cells (CD3+) was revealed in patients with uveal melanoma during activation and the chronic course of herpes virus infection. An increase in the absolute content of CD3 + was noted in patients with active and chronic herpesvirus infection in patients with inflammatory lesions of the eye. There was no difference in the relative and absolute contents of the subpopulation of CD3 + CD4 + helpers / inducers upon activation of herpes virus infections in tumor. With corneal ulcers - a significant increase in the absolute content of CD3 + CD4 + helpers / inducers with active and chronic infection. In chronic herpes virus infection, an increase in the relative and absolute number of cytotoxic T-lymphocytes (CD3 + CD8 +) with uveal melanoma was revealed. With active infection, a decrease in the relative number of T-lymphocytes (CD3 + CD8 +) in the tumor was noted. With corneal ulcers involving the uveal tract, an increase in the absolute content during activation and chronic infection and a decrease in the relative content compared to the norm were determined. When analyzing the “double positive” T cells in a tumor, an increase in relative and absolute indices was observed in chronic and active infection with herpes viruses. The same trends were observed with inflammatory eye diseases. Analysis of the content of B-lymphocytes (CD19 +) in blood with melanoma showed an increase in the absolute number during activation and the chronic course of herpes virus infection. When analyzing the indicators of the absolute and relative content of B-lymphocytes (CD19 +) with inflammation of the membranes of the eyes, their increase was revealed regardless of activation or chronic infection. The relative number of natural killers (CD16 + CD56 +) of blood with uveal melanoma increased with infection activation. In inflammatory eye diseases, a decrease in the relative content of natural killers (CD16 + CD56 +) was found in chronic infection and active herpes virus infection. With melanoma, no changes in the index of the ratio CD4 + / CD8 + were detected, with ulcerative lesions of the cornea involving the uveal tract, its increase was noted in acute and chronic infections with herpes virus infections. (p <0.05). Thus, our own studies suggest a deep suppression of the immune system of the body of patients with uveal melanoma, which does not allow the activation of antiviral protection. Tumor causes multidirectional shifts in the relative and absolute content of lymphocytes during activation and chronic infection with herpes virus infections. The results obtained are important for the development of personalized approaches to the prognosis and treatment of patients with uveal melanoma.
Aim: To analyze the pathogenesis, clinical features, and treatment algorithm of fungal corneal ulcer with endophthalmitis to increase medical alertness and reduce the unjustified use of antibacterial and corticosteroid therapy in corneal diseases of various etiologies, leading to the development of secondary ophthalmomycosis. Results: The pathogenesis was analyzed, and the characteristic clinical symptoms of severe fungal corneal ulcer and endophthalmitis caused by Candida albicans were described. Intensive, long-term, unjustified antibacterial and corticosteroid therapy caused a prolonged course of herpetic corneal ulcer, as well as the addition of a secondary bacterial infection, and led to the development of severe corneal ulcer and fungal endophthalmitis in a 13-year-old child. Conclusion: The required maximum medical alertness and early, accurate clinical differential diagnosis between bacterial and fungal corneal ulcer, as well as the rapid flow of ophthalmomycosis and false-negative results of sowing content conjunctival sac entail expansion of the range and quantity of antibacterial drugs used in the absence of positive dynamics of antibiotic therapy and an increased frequency of secondary fungal infection. The clinical symptoms of a severe fungal corneal ulcer with endophthalmitis described in this report contribute to the early diagnosis of ophthalmomycosis before the type of pathogen is identified by laboratory methods, which makes it possible to start antifungal therapy earlier and avoid corneal perforation and eye loss. In most countries, due to the lack of an ocular form of antifungal drugs, for local treatment of corneal candidiasis, a 0.2% solution of fluconazole intended for intravenous administration is installed in the eyes.
Patiens and methods. We observed 111 patients with various forms of prolonged herpetic keratitis and inflammatory ENT pathology. All patients underwent a study of biological secretions (tear, saliva, blood and urine) for the presence of DNA of herpetic viruses by PCR, systemic antiviral therapy was prescribed. All patients underwent a standard otolaryngological examination, СТ scan of the paranasal sinuses (if necessary), microbiological study of nasopharynx swabs. Local therapy of herpetic keratitis included anti-inflammatory and antibacterial components.Results and discussion. Isolated sinus infalanmmation occurred in 59 % of cases (65 patients), in 38 % of cases (42 patients) there were variants of combinations of sinus inflammation (sinusitis, sphenoethmoiditis, pansinusitis). In 24 % of those included in the study (n = 27), during examination, in addition to the presence or absence of sinusitis, chronic tonsillitis was determined. In 30 % of cases (more often than in other secrets), herpetic viruses were detected in saliva, coccal flora dominated in swabs from the nasopharynx. A marked reduction in ophthalmological symptoms correlated with start of ENT therapy.Conclusions. This clinical and laboratory study showed a close pathogenetic relationship of anterior ophthalmic herpes and concomitant inflammatory pathology of the paranasal sinuses and oropharynx. Active etiotropic therapy of sinusitis and tonsillitis promotes short-term reduction of ophthalmic symptoms.
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