Pathogenetic justification for the use of immunotherapy for the treatment of recurrent co-infections of the upper respiratory tract in children with congenital cleft lip and palate
Authors:   Kuban State Medical University, Krasnodar, Russian Federation, I.V.Nesterova I.V.Nesterova ,   Peoples’ Friendship University of Russia (RUDN), Moscow, Russian Federation, M.N.Mitropanova M.N.Mitropanova ,   Kuban State Medical University, Krasnodar, Russian Federation, G.A.Chudilova G.A.Chudilova ,   Kuban State Medical University, Krasnodar, Russian Federation, S.V.Kovaleva S.V.Kovaleva ,   Kuban State Medical University, Krasnodar, Russian Federation, V.V.Malinovskaya V.V.Malinovskaya ,   N.F.Gamaleya National Research Center for Epidemiology and Microbiology, Moscow, Russian Federation, V.V.Parfenov V.V.Parfenov ,   N.F.Gamaleya National Research Center for Epidemiology and Microbiology, Moscow, Russian Federation
Published: February 2021

The synergism of the action of co-infecting microorganisms contributes to their overcoming the epithelial barrier, modification of the function of cells of the immune system (IS) and evading the immune response. In children with congenital cleft lip and palate (CCLP), despite elimination of the anatomical defect at an earlier age, the frequency of infectious and inflammatory diseases of the respiratory tract and oral cavity involving pathogen associations increases as they get older, at the same time defects in the functioning of IS are preserved. Objective. To develop immunotherapy program for children with CCLP, suffering from recurrent co-infections of the upper respiratory tract and oral cavity, based on the study of the dynamics of the microbial landscape transformation, IS dysfunction, clinical manifestations of infectious and inflammatory diseases of the upper respiratory tract and oral cavity in children with CCLP at different ages. Patients and methods. The study included 120 children from 1 to 12 years of age with CCLP at different stages of surgical treatment. The study was carried out: T and B lymphocytes, natural killer cells (FC500 "Beckman Coulter", USA), phagocytic and microbicidal functions of neutrophilic granulocytes (NG), serum IgA, IgM, IgG and sIgA levels in the oral fluid (ELISA), detection of microbial pathogens (microbiological analysis, ELISA) and viral (PCR). Results. Comprehensive examination of children with CCLP at different age periods, including characteristics of the clinical manifestations of infectious and inflammatory diseases, assessment of the microbial landscape of the oral cavity and upper respiratory tract with the identification of co-infection features, clarification of the variants of IS dysfunction, made it possible to reveal children with the most severe clinical manifestations of recurrent co-infections and to optimize treatment. Conclusion. The developed program of combined local interferon and systemic immunotherapy for immunocompromised children with CCLP contributes to the restoration of IS functions, anti-infective resistance and achievement of positive clinical effects in the form of regression of clinical signs of immunocompromise in patients with recurrent co-infections, which allows to obtain a protective effect and provide timely surgical care, to avoid complications in the postoperative period and at the stage of recovery, and by improving anti-infective immunity to enhance the quality of life of children with CCLP. Key words: children, congenital cleft lip and palate, co-infection, systemic immunity, microbiocenosis, immunotherapy