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Clinical, immunological characteristics and optimization of erysipelas


Author: Iarovoi Liviu
Degree:doctor of medicine
Speciality: 14.00.10 - Infections Diseases
Year:2008
Scientific adviser: Constantin Andriuţă
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 6 February, 2008
Approved by NCAA on the 17 April, 2008

Abstract

Adobe PDF document0.33 Mb / in romanian

Thesis

CZU 616.981.214.2-08..612.017

Adobe PDF document 1.24 Mb / in romanian
120 pages


Keywords

the erysipelas, ß-hemolytical streptococcus, immunological status, risk factors, clinical attributes, young age, treatment, “Regesan”, bicillin-5, timalin

Summary

It was carried out the integral and multilateral research work of the 165 patients with the erysipelas infection. All patients were epidemiologically, clinically and immunologically tested. The long-term erysipelas was observed at the patients who had more the 60 years, especially at the persons who had suffered from obesity, trombophlebitis of lower extremities, diabetes mellitus, feet mycosis or streptococcal impetigo. The most frequent complication of erysipelas infection was lymphangoitis, that excided the possibility of appearance of other pathologies. Such erysipelas complication as abscess, phlegmon, trophic ulcer and skin necrosis as a rule appeared on the lower extremities and was registered at the patients with the bullosa hemorrhagic form of the disease. Each time secondary pachydermia was reflected as a complication of erysipelas primary form with the localization on the patients’ upper extremities that suffered before of mammectomy. The rate of erysipelas complications was in the direct relation from the disease gravity and concurrent diseases such as obesity, trombophlebitis of lower extremities, diabetes mellitus, and feet mycosis. The complications of the erysipelas as usually in the form of abscess, phlegmon and skin necrosis was observed in the condition of registration in 2 times more frequent then erythematous-bullosa form of the disease in the primary erysipelas (22.9%±4.2%) then in the secondary (11.4%±4.7%).

Immunological abnormalities during as the primary erysipelas as the secondary one, were characterized as a leukocytosis of neutrophilous type in the initial period then as a lymphocytic type during the clinical decrease, deficit of T-total, T- teophelinresistent and T-teophelinsensible lymphocyte in the period of clinical increase as well as breach of TFR/TFS relation in the period of high point that was accompanied by the increase of B- lymphocytes, IgA serum and CIC level. The relatively high level of T-active lymphocytes and increase of concentration of IgC serum during the period of clinical decrease of the disease typifies for the primary form of erysipelas. The high level of IgA represents early prognostic significant factor for bullosa or hemorrhagic erysipelas elements manifestation.

Double doses of benzilpenicilina from 4 till 8 mln. UI and external application of the native preparation “Regesan”, permitted to decrease medium duration of pane, edema and bullosa elements, decrease of complications rate and increase of rate of erysipelas recovered patients. The risk of erysipelas infection decreased in 2 times at the combined bicilina-5 with the timalina.