State of local immunity in patients with furunculosis
Authors: Popov M.M. , Samusenko D.S. , Ohnivenko O.V. 
Published: January 2025

Background. The etiopathogenetic factor of the occurrence and development of furunculosis is a microbial factor, a violation of general and local immunity.

Furunculosis can occur in an acute or chronic form, accompanied by deterioration of well-being, fever, headache. Until now, the immunological processes that accompany the occurrence and course of furunculosis have not been definitively determined. In a number of cases, ineffective treatment is connected not so much with the tactics of managing patients, but with the determination of individual links of the immunopathogenesis of furunculosis. Understanding immune processes as the basis of pathogenesis is crucial in predicting the course of the disease, in treatment, prevention of complications, and relapses.Purpose – is to study the state of local immunity in patients with general furunculosis complicated by nasal furuncle as a leading factor in the occurrence of rhinogenic intracranial inflammatory processes. Materials and Methods. The examination group consisted of patients who were being treated at the «MKL № 30» medical center in the city of Kharkiv, with a diagnosis of general furunculosis (МКХ-10: L02), complicated by a furuncle of the nose (МКХ-10: J34.0).3 categories of patients were included in the research group: 1st group – patients with furunculosis of the nasal cavity (30 people); Group 2 – patients with general furunculosis (30 people), group 3 – patients with general furunculosis complicated by nasal furuncle (30 people). The age of the examined patients was 22–45 years. The control group consisted of 30 healthy people of the appropriate age. The state of local immunity was determined by the level of lysozyme, defensins, sIgA, mIgA and IgG in oropharyngeal secretions. The cytological composition of the nasal mucosa was also studied.The content of lysozyme was determined in the morning on an empty stomach by the diffusion method in agar according to the recommendations of E.F. Chernushenko and L.S. Kogosova. The level of α-defensins (HNP-human neutrophiles peptides) was determined with the help of «Bender medsystems» reagents in UVA. The level of sIgA, mIgA and IgG in oral secretions was measured spectrophotometrically in the presence of PEG-6000. Statistical processing of data was carried out using the software package «Statistica 10.0 for Windows». Results. Analysis of the cellular composition of the nasal mucosa shows that among the cells in the scrapings of patients of group 1 and group 3, destroyed epithelial cells predominate, the percentage of which is 61.4 ± 5.6% and 66.5 ± 6.3% of the total number of cells in the preparation, respectively.In patients of group 2, epitheliocytes are mainly represented by intact units, their percentage was 66.5 ± 0.6%, and destroyed cells – 20.7 ± 0.2%. In contrast to patients of group 2, in patients of groups 1 and 3, a large percentage of neutrophilic leukocytes was observed in nasal scrapings (23.4% and 23.5%, respectively), among which a significant number was represented by destroyed cells (19.1 ± 1.7% and 21.4 ± 2.1%, respectively) from the total number of cells.The total percentage of monocytes, lymphocytes, and eosinophilic leukocytes in scrapings from the nasal mucosa in patients of groups 1, 2, and 3 did not exceed 7.1%. When comparing the indicators of the cellular composition of the nasal mucosa of patients of groups 1 and 3 with the indicators of healthy individuals, probable differences were observed among intact and destroyed epithelial and neutrophilic leukocytes.Probable differences between the 2nd group of patients and the control were affected only by an increase in the number of destroyed neutrophilic leukocytes, monocytes, and lymphocytes on the nasal mucosa of patients with furunculosis.The analysis of local immunity shows that the main indicators (lysozyme, defensins, sIgA) in patients of groups 1 and 3 were probably lower than those of the control group, and in patients of group 2 they tend to decrease. The greatest decrease in the level of lysozyme, defensins and sIgA was observed in patients of group 3. Thus, the level of lysozyme in patients of group 3 was lower by 31.6%, defensins by 30.1%, and sIgA by 33.4%. 26.7%, 23.0% and 29.2% of patients in group 1, respectively. A slight increase in the level of mIgA and IgG in patients of groups 1 and 3 in the oropharyngeal secretion compared to healthy individuals is probably associated with inflammatory processes in the nasopharynx and increased transduction of immunoglobulins through the vascular wall.A decrease in local immunity creates conditions for increased colonization of the nasal mucosa, which in turn contributes to the development and maintenance of the inflammatory process, and subsequently to the generalization of the infection and the occurrence of rhinogenic complications. A high concentration of microbes due to the production of exotoxins can suppress local immunity and thus affect the course of the inflammatory process in the nose.

Thus, the microbial community and microorganisms are in a close relationship, the nature of which depends on the development and course of any infectious and inflammatory processes. It should be noted that in determining the effective treatment tactics for patients with furunculosis, the above-mentioned processes are of leading importance.

Conclusions. In patients with nasal furunculosis and general furunculosis complicated by a furuncle of the nose, local immunity is significantly suppressed, which creates conditions for the development and progression of inflammation of the nose and the occurrence of rhinogenic complications.Indicators of local immunity can serve as prognostic criteria for the course of the inflammatory process in the nose and correction of the therapy.