{"id":1254,"date":"2017-09-27T11:15:20","date_gmt":"2017-09-27T09:15:20","guid":{"rendered":"http:\/\/www.newslab.sk\/2017\/09\/27\/vyuzitie-autovakcin-v-liecbe-chronickych-a-recidivujucich-kolpitid\/"},"modified":"2017-09-27T13:13:54","modified_gmt":"2017-09-27T11:13:54","slug":"application-of-autovaccines-in-the-treatment-of-chronic-and-recurrent-colpitises","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/application-of-autovaccines-in-the-treatment-of-chronic-and-recurrent-colpitises\/","title":{"rendered":"Application of autovaccines in the treatment of chronic and recurrent colpitises"},"content":{"rendered":"
*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf \r\nattachment at the end of the paper.<\/span> \r\n<\/strong><\/pre>\n
\u00davod<\/strong><\/p>\n
Lie\u010dba mikrobi\u00e1lnymi autovakc\u00ednami sa pou\u017e\u00edva viac ako 100 rokov(1). Tento terapeutick\u00fd princ\u00edp sa uk\u00e1zal ako ve\u013emi prospe\u0161n\u00fd v obdob\u00ed, ke\u010f medic\u00edna nemala k dispoz\u00edcii \u00fa\u010dinn\u00e9 antimikrobi\u00e1lne l\u00e1tky. V dobe antibiot\u00edk sa dostala do \u00fazadia, dnes je op\u00e4\u0165 jedn\u00fdm z dostupn\u00fdch sp\u00f4sobov lie\u010dby chronick\u00fdch
\na recidivuj\u00facich infekci\u00ed po opakovanej a ne\u00faspe\u0161nej antimikrobi\u00e1lnej terapii. V \u010dase hroziaceho n\u00e1stupu postantibiotickej \u00e9ry sa \u010doraz viac stret\u00e1vame s probl\u00e9mom zlyhania antimikrobi\u00e1lnej lie\u010dby z r\u00f4znych d\u00f4vodov. Pacienti s chronick\u00fdmi infekciami s\u00fa \u010dasto opakovane prelie\u010dovan\u00ed antibiotikami bez trval\u00e9ho efektu. Hlavn\u00fdm cie\u013eom lie\u010dby autovakc\u00ednami je preru\u0161enie tohto bludn\u00e9ho kruhu, pred\u013a\u017eenie asymptomatick\u00e9ho stavu, redukcia po\u010dtu recid\u00edv infekcie a\u017e dosiahnutie trvalej bezpr\u00edznakovosti a zlep\u0161enia kvality \u017eivota. Posilnenie vroden\u00fdch imunitn\u00fdch mechanizmov pravideln\u00fdm u\u017e\u00edvan\u00edm antig\u00e9nneho komplexu mikroorganizmov vyvol\u00e1vaj\u00facich chronick\u00fa a rekurentn\u00fa infekciu je jedna z mo\u017enost\u00ed lie\u010dby t\u00fdchto infekci\u00ed. Na tento \u00fa\u010del sa pou\u017e\u00edvaj\u00fa hromadne pripravovan\u00e9 mikrobi\u00e1lne lyz\u00e1ty obsahuj\u00face imunog\u00e9nne komponenty bakt\u00e9ri\u00ed alebo kvasiniek, vyr\u00e1ban\u00e9 r\u00f4znymi v\u00fdrobcami liekov. S\u00fa v\u0161ak pr\u00edpady, ke\u010f je potrebn\u00e9 lie\u010dbu individualizova\u0165 a pripravi\u0165 mikrobi\u00e1lnu vakc\u00ednu z aktu\u00e1lnych mikrobi\u00e1lnych kme\u0148ov pacienta \u2013 autovakc\u00ednu alebo zmes, mikrobi\u00e1lnu vakc\u00ednu z kme\u0148ov, ktor\u00e9 koluj\u00fa v popul\u00e1cii \u2013 tzv. stock vakc\u00ednu. Jednou z hlavn\u00fdch indik\u00e1ci\u00ed lie\u010dby autovakc\u00ednami, resp. stock vakc\u00ednami, s\u00fa chronick\u00e9 a recidivuj\u00face infekcie urogenit\u00e1lneho syst\u00e9mu. Mechanizmus \u00fa\u010dinku autovakc\u00edn Mikrobi\u00e1lne antig\u00e9ny s\u00fa pre imunitn\u00fd syst\u00e9m \u010dloveka najprirodzenej\u0161\u00edmi antig\u00e9nnymi podnetmi(2). Je relat\u00edvne m\u00e1lo vedeck\u00fdch pr\u00e1c a \u0161t\u00fadi\u00ed zameran\u00fdch na rozpoznanie \u00fa\u010dinku autovakc\u00edn na imunitn\u00e9 mechanizmy \u010dloveka. V\u00fdsledky existuj\u00facich vedeck\u00fdch pr\u00e1c je problematick\u00e9 interpretova\u0165 a porovn\u00e1va\u0165 vzh\u013eadom na r\u00f4zny p\u00f4vod pou\u017eit\u00fdch\u00a0mikrobi\u00e1lnych kme\u0148ov, na r\u00f4zne zlo\u017eenie a d\u00e1vkovanie a odli\u0161n\u00fd sp\u00f4sob pod\u00e1vania autovakc\u00edn. Napriek tomu doteraj\u0161ie poznatky nazna\u010duj\u00fa, \u017ee autovakc\u00edny p\u00f4sobia na ne\u0161pecifick\u00fa imunitu, najm\u00e4 na \u00farovni cytok\u00ednov. V experiment\u00e1lnych podmienkach ex vivo po stimul\u00e1cii perif\u00e9rnych polymorfonukle\u00e1rnych leukocytov pacientov riedeniami autovakc\u00edny v koncentr\u00e1cii 3 x 102 \u2013 3 x 106 CFU\/ml pripraven\u00fdmi z Escherichia
\ncoli Rusch a spol. pozorovali signifikantn\u00fd pokles uvol\u0148ovania GM-CSF a IFN-\u03b3 a \u0161tatisticky v\u00fdznamn\u00e9 zv\u00fd\u0161enie tvorby IL-1\u03b2(3). Po intenz\u00edvnom pod\u00e1van\u00ed autovakc\u00edny s koncentr\u00e1ciou mikrobi\u00e1lneho antig\u00e9nneho komplexu (MAK) Escherichia coli 6 x 108 CFU\/ml 2x t\u00fd\u017edenne subkut\u00e1nne po\u010das 2 t\u00fd\u017ed\u0148ov a n\u00e1sledne 10 dn\u00ed peror\u00e1lne pacientom s chronick\u00fdmi infekciami mo\u010dov\u00fdch ciest sp\u00f4soben\u00fdmi E. coli Nolte a spol. zaznamenali pokles perif\u00e9rnych polymorfonukle\u00e1rnych leukocytov, zv\u00fd\u0161enie prolifera\u010dnej aktivity lymfocytov, zv\u00fd\u0161enie tvorby cytok\u00ednov IFN-\u03b3, TNF-\u03b1(4). Pri subkut\u00e1nnom pod\u00e1van\u00ed autovakc\u00edny s obsahom MAK Staphylococcus aureus s koncentr\u00e1ciou 1,5 x 108 CFU\/ml pacientom s chronickou infekciou ko\u017ee a horn\u00fdch d\u00fdchac\u00edch ciest sp\u00f4soben\u00fdch S. aureus, po\u013esk\u00ed vedci Szkaradkiewicz a spol. pozorovali signifikantn\u00e9 zv\u00fd\u0161enie s\u00e9rovej hladiny TNF-\u03b1, IL-1\u03b2, IFN-\u03b3 a IL-17A u 79,60 % pacientov ich s\u00faboru(5). Existuj\u00fa pr\u00e1ce dokazuj\u00face pokles z\u00e1palovej aktivity bronchi\u00e1lnej sliznice u \u013eud\u00ed s respira\u010dn\u00fdmi alergiami pri lie\u010dbe autovakc\u00ednami. Predpoklad\u00e1 sa, \u017ee lie\u010dba autovakc\u00ednami pos\u00fava imunitn\u00fd syst\u00e9m smerom k Th1 odpovedi, \u010do teoreticky m\u00f4\u017ee by\u0165 prospe\u0161n\u00e9 pre alergikov, u ktor\u00fdch prevl\u00e1da Th2 odpove\u010f, ale jednozna\u010dn\u00e9 d\u00f4kazy v zmysle \u0161tatisticky signifikantn\u00e9ho zn\u00ed\u017eenia markerov alergie (ECP, celkov\u00e9 IgE protil\u00e1tky, alerg\u00e9novo \u0161pecifick\u00e9 IgE protil\u00e1tky) zatia\u013e ch\u00fdbaj\u00fa(6). Viacer\u00ed autori poukazuj\u00fa na riziko vzniku autoimunitn\u00fdch procesov na z\u00e1klade dominancie Th1 odpovede navodenej lie\u010dbou autovakc\u00ednou(2,6). Porucha rovnov\u00e1hy Th1\/Th2 a posun reaktivity imunitn\u00e9ho syst\u00e9mu v smere Th1 m\u00f4\u017ee vyprovokova\u0165 autoimunitn\u00e9 ochorenia, z toho d\u00f4vodu je t\u00e1to lie\u010dba kontraindikovan\u00e1 u \u013eud\u00ed s dok\u00e1zan\u00fdm alebo so suspektn\u00fdm autoimunitn\u00fdm ochoren\u00edm.<\/p>\n
 <\/p>\n
Naj\u010dastej\u0161\u00ed p\u00f4vodcovia chronick\u00fdch kolpit\u00edd<\/strong><\/p>\n
Vznik chronickej bakteri\u00e1lnej alebo mykotickej infekcie je podmienen\u00fd nielen poruchou obranyschopnosti hostite\u013ea, ale aj faktormi patogenity p\u00f4vodcu infekcie, ktor\u00e9 podmie\u0148uj\u00fa jeho zotrvanie a patog\u00e9nne p\u00f4sobenie v ur\u010dit\u00fdch lokalit\u00e1ch \u013eudsk\u00e9ho organizmu. Mikroorganizmy maj\u00fa geneticky k\u00f3dovan\u00e9
\nmechanizmy, ktor\u00e9 im zabezpe\u010duj\u00fa adh\u00e9ziu na povrch ko\u017ee a slizn\u00edc, koloniz\u00e1ciu t\u00fdchto oblast\u00ed, pr\u00edstup k \u017eivin\u00e1m a \u00fanik pred obrann\u00fdmi mechanizmami hostite\u013ea. Povrchov\u00e9 \u0161trukt\u00fary mikroorganizmov s\u00fa potentn\u00fdmi stimul\u00e1tormi imunitnej odpovede. Ochorenie je v\u00fdsledkom priameho po\u0161kodenia faktormi
\nmikroorganizmu a reakcie imunitn\u00fdch mechanizmov na pr\u00edtomnos\u0165 infekcie(7). V podmienkach rutinn\u00e9ho laborat\u00f3ria je naj\u010dastej\u0161\u00edm kultiva\u010dn\u00fdm n\u00e1lezom u pacientok s chronick\u00fdmi a recidivuj\u00facimi kolpit\u00eddami kvasinka Candida albicans, z bakt\u00e9ri\u00ed sa naj\u010dastej\u0161ie vyskytuje Streptococcus agalactiae.
\nKvasinky rodu Candida s\u00fa \u010dast\u00fdmi komenz\u00e1lmi na sliznici a v pr\u00edtomnosti predisponuj\u00facich faktorov, ako je napr. dlhodob\u00e1 antimikrobi\u00e1lna lie\u010dba alebo porucha lok\u00e1lnych obrann\u00fdch mechanizmov, sa stan\u00fa patog\u00e9nnymi. Pribli\u017ene 75 % \u017eien prekon\u00e1 vulvovagin\u00e1lnu kandid\u00f3zu raz za svoj \u017eivot, u 40-50 % z nich sa infekcia objav\u00ed aj druh\u00fdkr\u00e1t. Asi 5-8 % \u017eien m\u00e1 recidivuj\u00facu vulvovagin\u00e1lnu kandid\u00f3zu minim\u00e1lne so \u0161tyrmi epiz\u00f3dami tejto infekcie za rok(8). Medzi faktory virulencie kand\u00edd patr\u00ed zmena morfol\u00f3gie z kvasinkovej formy na vl\u00e1knit\u00fa formu, expresia adhez\u00ednov a invaz\u00ednov na povrchu bunky, tigmotropizmus, tvorba biofilmov a sekr\u00e9cia hydrolytick\u00fdch enz\u00fdmov. \u010eal\u0161\u00edmi mechanizmami podporuj\u00facimi pre\u017eitie kand\u00edd je r\u00fdchla adaptabilita na zmeny okolit\u00e9ho pH, flexibilita metabolizmu, v\u00fdkonn\u00fd syst\u00e9m na z\u00edskavanie \u017eiv\u00edn a zvl\u00e1danie stresu(9). Vagin\u00e1lne epitelov\u00e9 bunky produkuj\u00fa menej cytok\u00ednov, indukuj\u00fa slab\u0161iu imunitn\u00fa odpove\u010f, s\u00fa tolerantnej\u0161ie k mikroorganizmom a \u0161kodliv\u00fdm faktorom prostredia. Toto m\u00f4\u017ee by\u0165 jeden z k\u013e\u00fa\u010dov\u00fdch faktorov pochopenia problematiky chronick\u00fdch a rekurentn\u00fdch infekci\u00ed v tejto oblasti \u013eudsk\u00e9ho tela(10).<\/p>\n
Zdrojom Streptococcus agalactiae je gastrointestin\u00e1lny syst\u00e9m, rekt\u00e1lna a vagin\u00e1lna koloniz\u00e1cia sa vyskytuje u 10 \u2013 30 % \u017eien(11). Problematika vagin\u00e1lnej koloniz\u00e1cie, resp. infekcie S. agalactiae je najviac presk\u00faman\u00e1 v popul\u00e1cii tehotn\u00fdch \u017eien, relat\u00edvne m\u00e1lo \u0161t\u00fadi\u00ed existuje na d\u00f4kaz etiologickej s\u00favislosti S. agalactiae so z\u00e1palom po\u0161vy v popul\u00e1cii negravidn\u00fdch \u017eien. Leclair a spol.(11) \u0161tudovali skupinu negravidn\u00fdch \u017eien s vyrovnanou hladinou estrog\u00e9nov vo veku nad 18 rokov, ktor\u00e9 boli bezpr\u00edznakov\u00e9 a absolvovali prevent\u00edvne gynekologick\u00e9 vy\u0161etrenie alebo mali pr\u00edznaky vaginit\u00eddy.
\nZistili, \u017ee signifikantn\u00fdm prediktorom kultiva\u010dn\u00e9ho n\u00e1lezu S. agalactiae je zv\u00fd\u0161en\u00e9 pH vag\u00edny a pr\u00edtomnos\u0165 v\u00fdtoku. Pri pH > 4,5 zaznamenali 4-n\u00e1sobne \u010dastej\u0161\u00ed kultiva\u010dn\u00fd z\u00e1chyt S. agalactiae, pri pr\u00edtomnosti patologick\u00e9ho v\u00fdtoku bol tento n\u00e1lez trojn\u00e1sobne \u010dastej\u0161\u00ed. Autori pouk\u00e1zali na
\nskuto\u010dnos\u0165, \u017ee koloniz\u00e1cia touto bakt\u00e9riou je indik\u00e1torom naru\u0161enia vagin\u00e1lneho ekosyst\u00e9mu a kauz\u00e1lna s\u00favislos\u0165 n\u00e1lezu s vaginit\u00eddou je st\u00e1le diskutabiln\u00e1. Najd\u00f4le\u017eitej\u0161\u00edm faktorom virulencie S. agalactiae je kapsul\u00e1rny polysacharid, ktor\u00fd br\u00e1ni fagocyt\u00f3ze. S\u00fa snahy vyvin\u00fa\u0165 \u00fa\u010dinn\u00fa o\u010dkovaciu l\u00e1tku, ktor\u00e1 navod\u00ed syst\u00e9mov\u00fa aj slizni\u010dn\u00fa imunitn\u00fa odpove\u010f. Shen a kol.(12) publikovali v\u00fdsledky slizni\u010dnej imuniz\u00e1cie my\u0161\u00ed konjugovanou subjednotkovou vakc\u00ednou obsahuj\u00facou kapsul\u00e1rny polysacharid III. typu S. agalactiae, konjugovan\u00fd B podjednotkou cholerov\u00e9ho tox\u00ednu. Stanovovali s\u00e9rov\u00e9 a slizni\u010dn\u00e9
\nprotil\u00e1tky v triedach IgG a IgA po peror\u00e1lnej, intranaz\u00e1lnej, vagin\u00e1lnej a rekt\u00e1lnej aplik\u00e1cii konjugovanej vakc\u00edny. Najv\u00fdznamnej\u0161ie zv\u00fd\u0161enie s\u00e9rov\u00fdch IgG protil\u00e1tok proti kapsul\u00e1rnemu polysacharidu typu III S. agalactie zaznamenali po rekt\u00e1lnej aplik\u00e1cii. Pri tejto forme aplik\u00e1cie do\u0161lo aj k zv\u00fd\u0161eniu slizni\u010dn\u00fdch IgA protil\u00e1tok v rekte, \u010drevnom trakte a vo vagin\u00e1lnom sekr\u00e9te. Autori \u0161t\u00fadie pova\u017euj\u00fa t\u00fato formu aplik\u00e1cie konjugovanej vakc\u00edny za naj\u00fa\u010dinnej\u0161iu.<\/p>\n
Cie\u013eom na\u0161ej pr\u00e1ce bolo:<\/strong>
\n\u2013 zhodnotenie priebehu a \u00faspe\u0161nosti lie\u010dby s\u00faboru pacientok s chronick\u00fdmi a recidivuj\u00facimi kolpit\u00eddami mikrobi\u00e1lnymi autovakc\u00ednami pod\u00e1van\u00fdmi na z\u00e1klade hyposenzibiliza\u010dnej d\u00e1vkovacej sch\u00e9my,
\n\u2013 sledovanie klinick\u00e9ho stavu a mikrobiologick\u00fdch kultiva\u010dn\u00fdch n\u00e1lezov s\u00faboru pacientok po\u010das 1. roka od skon\u010denia lie\u010dby a ich zhodnotenie,
\n\u2013 sledovanie klinick\u00e9ho stavu a mikrobiologick\u00fdch kultiva\u010dn\u00fdch n\u00e1lezov s\u00faboru pacientok po\u010das 2. roka od skon\u010denia lie\u010dby a ich zhodnotenie.<\/p>\n
 <\/p>\n
Materi\u00e1l a met\u00f3dy
\n<\/strong>
\nV\u00fdber a charakteristika s\u00faboru<\/strong><\/p>\n
Do s\u00faboru sme zaradili 84 pacientok, ktor\u00e9 boli lie\u010den\u00e9 peror\u00e1lnymi hyposenzibiliza\u010dn\u00fdmi autovakc\u00ednami pre chronick\u00e9 a recidivuj\u00face kolpit\u00eddy v obdob\u00ed od j\u00fana 2011 do j\u00fana 2015. V\u0161etky mali chronick\u00e9 a recidivuj\u00face z\u00e1paly po\u0161vy v trvan\u00ed 2 a\u017e 16 rokov, s recid\u00edvami 4- a\u017e 10\u00d7 za rok po opakovanej lie\u010dbe lok\u00e1lnymi a\/alebo celkov\u00fdmi antibiotikami a\/alebo antimykotikami s kr\u00e1tkotrvaj\u00facim efektom. Celkov\u00fd zdravotn\u00fd stav pacientok a ich vhodnos\u0165 na lie\u010dbu mikrobi\u00e1lnymi autovakc\u00ednami hodnotili indikuj\u00faci lek\u00e1ri na z\u00e1klade anamn\u00e9zy a laborat\u00f3rnych anal\u00fdz s prihliadnut\u00edm na indik\u00e1cie a kontraindik\u00e1cie
\nlie\u010dby autovakc\u00ednami dostupn\u00fdmi na na\u0161ej webovej str\u00e1nke http:\/\/www.hpl.sk\/ponuka-hpl\/vyroba-autovakcin (t. \u010d. inform\u00e1cie dostupn\u00e9 na www.laboratornadiagnostika. sk), resp. po telefonickej konzult\u00e1cii so zodpovedn\u00fdm pracovn\u00edkom na pr\u00edpravu mikrobi\u00e1lnych autovakc\u00edn HPL spol. s r. o.<\/p>\n
Imunologick\u00e9 vy\u0161etrenie bolo odpor\u00fa\u010dan\u00e9 v pr\u00edpadoch, ke\u010f anamnestick\u00e9 \u00fadaje pacienta sved\u010dili o nedostato\u010dnosti imunity, resp. bolo potrebn\u00e9 vyl\u00fa\u010di\u0165 autoimunitn\u00fa chorobu. Pr\u00edpravu mikrobi\u00e1lnych autovakc\u00edn indikovali u 68 (80,95 %) \u017eien gynekol\u00f3govia a u 16 (19,05 %) \u017eien lek\u00e1ri so \u0161pecializ\u00e1ciou
\nklinick\u00e1 imunol\u00f3gia a alergiol\u00f3gia. Mikrobi\u00e1lne antig\u00e9nne komplexy (MAK) na pr\u00edpravu autovakc\u00edn boli vyhotoven\u00e9 v laborat\u00f3riu klinickej mikrobiol\u00f3gie HPL, spol. s r. o., v Kom\u00e1rne a riedenia MAK (1 : 10 000, 1 : 1 000, 1 : 100, 1 : 10, 1 : 1) boli vyroben\u00e9 v spolupr\u00e1ci s partnerskou lek\u00e1r\u0148ou. Po\u010det a percentu\u00e1lne zast\u00fapenie autovakc\u00edn pod\u013ea ich zlo\u017eenia je zn\u00e1zornen\u00e9 na grafe 1. Autovakc\u00edny boli pod\u00e1van\u00e9 pacientkam pod\u013ea hyposenzibiliza\u010dnej d\u00e1vkovacej sch\u00e9my v st\u00fapaj\u00facej koncentr\u00e1cii a d\u00e1vke, po ktorej nasledovala udr\u017eiavacia lie\u010dba t\u00fd\u017edenne 10 kvapiek z riedenia MAK 1 : 1. Celkov\u00e1 d\u013a\u017eka
\nlie\u010dby bola 10 mesiacov. Jednozlo\u017ekov\u00e9 autovakc\u00edny obsahovali mikrobi\u00e1lny antig\u00e9nny komplex (MAK) Candida albicans, Streptococcus agalactiae, Escherichia coli, Enterococcus faecalis, Candida glabrata a Sacharomyces cerevisiae. Zlo\u017eenie jednozlo\u017ekov\u00fdch autovakc\u00edn uv\u00e1dzame v tabu\u013eke 1. Zlo\u017eenie dvojzlo\u017ekov\u00fdch autovakc\u00edn uv\u00e1dzame v tabu\u013eke 2.<\/p>\n
Pr\u00edprava autovakc\u00edn<\/strong>
\nMikroorganizmy na pr\u00edpravu autovakc\u00edn sme izolovali z v\u00fdterov z po\u0161vy a cervixu pacientok s chronickou alebo recidivuj\u00facou kolpit\u00eddou, u ktor\u00fdch predpokladan\u00ed p\u00f4vodcovia infekcie pretrv\u00e1vali, resp. recidivovali napriek opakovanej cielenej celkovej alebo lok\u00e1lnej lie\u010dbe antibiotikami alebo antimykotikami. Boli to preva\u017ene kvasinky a\/alebo r\u00f4zne podmienene patog\u00e9nne bakt\u00e9rie kultivovate\u013en\u00e9 na agarov\u00fdch p\u00f4dach v aer\u00f3bnych alebo mikroaerofiln\u00fdch podmienkach. S izolovan\u00fdmi kme\u0148mi sme \u010falej pracovali pod\u013ea n\u00e1\u0161ho \u0161tandardn\u00e9ho postupu v s\u00falade s modifikovanou \u0161tandardnou met\u00f3dou na pr\u00edpravu bakteri\u00e1lnych imunomodula\u010dn\u00fdch \u201estock\u201c vakc\u00edn(13). Kontamin\u00e1cii vzoriek sme predch\u00e1dzali o\u010dkovan\u00edm izolovan\u00fdch kme\u0148ov na predinkubovan\u00e9 kultiva\u010dn\u00e9 p\u00f4dy (35 \u00b0C, 24 \u2013 48 hod.), pou\u017e\u00edvan\u00edm steriln\u00fdch laborat\u00f3rnych pom\u00f4cok a pr\u00e1cou v lamin\u00e1rnom boxe triedy A. Kmene sme rozmno\u017eili kultiv\u00e1ciou na celof\u00e1ne(14). Celof\u00e1nov\u00fd kruh sme asepticky prilo\u017eili na povrch nechromog\u00e9nneho kultiva\u010dn\u00e9ho m\u00e9dia vhodn\u00e9ho na kultiv\u00e1ciu p\u00f4vodcu infekcie, na jej povrch sme kvapli sterilnou jednorazovou Pasteurovou pipetou asi 0,3 ml steriln\u00e9ho fyziologick\u00e9ho roztoku, v ktorom sterilnou umelohmotnou k\u013eu\u010dkou ohnutou do 90-stup\u0148ov\u00e9ho uhla sme suspendovali 3 a\u017e 5 kol\u00f3ni\u00ed mikroorganizmu a rovnomerne rozotreli na povrchu celof\u00e1nu. Kultivovali sme 24 \u2013 48 hod. v podmienkach vhodn\u00fdch na kultiv\u00e1ciu nao\u010dkovan\u00e9ho mikroorganizmu. Po kultiv\u00e1cii vyr\u00e1stol nao\u010dkovan\u00fd mikroorganizmus
\nna povrchu celof\u00e1nu v rovnomernej vrstve. Pomocou sterilnej Pasteurovej pipety sme opl\u00e1chli kult\u00faru z povrchu celof\u00e1nu 3-6 ml steriln\u00fdm fyziologick\u00fdm roztokom. Suspenziu sme pipetovali do 6-8 steriln\u00fdch sk\u00famaviek s fyziologick\u00fdm roztokom tak, aby hustota suspenzie v sk\u00famavk\u00e1ch zodpovedala hodnote 5 McFarland a objem suspenzie v jednotliv\u00fdch sk\u00famavk\u00e1ch bol 6 ml. \u010cistotu suspenzie v jednotliv\u00fdch sk\u00famavk\u00e1ch sme kontrolovali mikroskopick\u00fdm prepar\u00e1tom a vyo\u010dkovan\u00edm na vhodn\u00e9 kultiva\u010dn\u00e9 m\u00e9di\u00e1. Po kontrole \u010distoty sme inaktivovali mikrobi\u00e1lnu suspenziu 3,6-percentn\u00fdm roztokom formaldehydu. Z\u00edskali sme tak steriln\u00fd MAK, ktor\u00e9ho sterilitu sme kontrolovali vyo\u010dkovan\u00edm na vhodn\u00e9 agarov\u00e9 kultiva\u010dn\u00e9 m\u00e9dium a o\u010dkovan\u00edm do tioglykol\u00e1tov\u00e9ho tekut\u00e9ho m\u00e9dia a trypt\u00f3novo-s\u00f3jov\u00e9ho buj\u00f3nu v s\u00falade s postupom na kontrolu sterility farmaceutick\u00fdch surov\u00edn a produktov, uveden\u00fdm v aktu\u00e1lnom vydan\u00ed Eur\u00f3pskeho liekopisu (PhEur)(15). So steriln\u00fdm MAK-om sme pracovali \u010falej v priestoroch sp\u013a\u0148aj\u00facich z\u00e1sady spr\u00e1vnej v\u00fdrobnej praxe, t. j. v lamin\u00e1rnom boxe triedy A umiestnenom v miestnosti triedy \u010distoty B, vybavenom vzduchotechnikou s HEPA filtrami. Steriln\u00fd MAK sme centrifugovali 20 min\u00fat pri 3 000 ot\u00e1\u010dkach za min\u00fatu a 6 \u00b0C. Na pr\u00edpravu autovakc\u00edn sme pou\u017eili sediment po odstr\u00e1nen\u00ed supernatantu, ktor\u00fd sme zriedili do po\u017eadovanej
\nkoncentr\u00e1cie pod\u013ea typu mikroorganizmu. T\u00e1to koncentr\u00e1cia je r\u00e1dovo 108 pri jednozlo\u017ekov\u00fdch autovakc\u00ednach a 107 \u2013 108 v pr\u00edpade dvojzlo\u017ekov\u00fdch autovakc\u00edn. Z pripraven\u00fdch MAK-ov sme v spolupr\u00e1ci s lek\u00e1r\u0148ou pripravili kone\u010dn\u00fa liekov\u00fa formu autovakc\u00edny rieden\u00edm MAK v riediacom roztoku.
\nAutovakc\u00edny sme expedovali v prieh\u013eadn\u00fdch polyetyl\u00e9nov\u00fdch liekovk\u00e1ch s kvapkadlom, sterilizovan\u00fdch etyl\u00e9noxidom. Liekovky boli \u010d\u00edslovan\u00e9 a ozna\u010den\u00e9 farebn\u00fdmi \u0161t\u00edtkami, na ktor\u00fdch bolo uveden\u00e9 \u010d\u00edslo autovakc\u00edny, zlo\u017eenie a d\u00e1tum exspir\u00e1cie. Ka\u017ed\u00e9 balenie autovakc\u00edny obsahovalo nami vypracovan\u00fd
\npr\u00edbalov\u00fd let\u00e1k s uveden\u00edm zlo\u017eenia autovakc\u00edny, indik\u00e1ci\u00ed, kontraindik\u00e1ci\u00ed lie\u010dby d\u00f4le\u017eit\u00fdch inform\u00e1ci\u00ed t\u00fdkaj\u00facich sa sp\u00f4sobu jej u\u017e\u00edvania a d\u00e1vkovac\u00ed kalend\u00e1r. Hotov\u00e9 autovakc\u00edny boli kontrolovan\u00e9 na sterilitu na oddelen\u00ed farmaceutick\u00e9ho sk\u00fa\u0161ania HPL, spol. s r. o., v Kom\u00e1rne v s\u00falade s kapitolou \u010d. 2. 6. 1 PhEur(15).<\/p>\n
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Krit\u00e9ri\u00e1 a met\u00f3dy hodnotenia lie\u010dby<\/strong><\/p>\n
Pri hodnoten\u00ed \u00fa\u010dinnosti lie\u010dby autovakc\u00ednami sme sledovali klinick\u00fd stav a mikrobiologick\u00e9 kultiva\u010dn\u00e9 n\u00e1lezy pacientok. Potrebn\u00e9 inform\u00e1cie o klinickom stave a o v\u00fdsledkoch mikrobiologick\u00fdch kultiva\u010dn\u00fdch anal\u00fdz pacientov pred lie\u010dbou autovakc\u00ednami v priebehu lie\u010dby v intervaloch vyzna\u010den\u00fdch v d\u00e1vkovacom kalend\u00e1ri a po ukon\u010den\u00ed lie\u010dby v stanoven\u00fdch intervaloch (3 mesiace, 6 mesiacov, 1 rok, 2 roky) boli z\u00edskavan\u00e9 z laborat\u00f3rneho informa\u010dn\u00e9ho syst\u00e9mu a od o\u0161etruj\u00facich lek\u00e1rov formou dotazn\u00edkov alebo telefonickej konzult\u00e1cie.
\nU pacientok sme hodnotili priebeh lie\u010dby (po\u010das 10-mesa\u010dn\u00e9ho pod\u00e1vania autovakc\u00edn) a n\u00e1sledne 1. rok a 2. rok od ukon\u010denia lie\u010dby autovakc\u00ednou. Z\u00edskan\u00e9 v\u00fdsledky sme usporiadali do grafov.<\/p>\n
Ukazovate\u013eom \u00faspe\u0161nosti lie\u010dby bol po\u010det recid\u00edv po\u010daspod\u00e1vania autovakc\u00edn. Na z\u00e1klade po\u010dtu recid\u00edv po\u010das pod\u00e1vania autovakc\u00edn sme pacientky rozdelili do kateg\u00f3ri\u00ed:
\nkateg\u00f3ria 0 \u2013 bez recid\u00edvy po\u010das 10-mesa\u010dnej lie\u010dby,
\nkateg\u00f3ria I \u2013 jedna recid\u00edva po\u010das 10-mesa\u010dnej lie\u010dby,
\nkateg\u00f3ria II \u2013 dve recid\u00edvy po\u010das 10-mesa\u010dnej lie\u010dby,
\nkateg\u00f3ria III \u2013 tri recid\u00edvy po\u010das 10-mesa\u010dnej lie\u010dby,
\nkateg\u00f3ria IV \u2013 viac ako tri recid\u00edvy po\u010das 10-mesa\u010dnej lie\u010dby.<\/p>\n
Na z\u00e1klade uveden\u00fdch kateg\u00f3ri\u00ed sme rozdelili pacientky do skup\u00edn pod\u013ea \u00faspe\u0161nosti lie\u010dby (tabu\u013eka 3). V obdob\u00ed 1. a 2. roka po lie\u010dbe autovakc\u00ednami sme na\u010falej sledovali zdravotn\u00fd stav a kultiva\u010dn\u00e9 n\u00e1lezy pacientok. Stav pacientok sme hodnotili pod\u013ea krit\u00e9ri\u00ed zhrnut\u00fdch v tabu\u013eke 4.<\/p>\n
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V\u00fdsledky<\/strong>
\nHodnotenie lie\u010dby \u2013 pod\u00e1vania autovakc\u00edn u pacientok lie\u010den\u00fdch pre chronick\u00e9 a recidivuj\u00face kolpit\u00eddy Sledovan\u00edm klinick\u00e9ho stavu a mikrobiologick\u00fdch kultiva\u010dn\u00fdch n\u00e1lezov pacientok po\u010das 10-mesa\u010dn\u00e9ho pod\u00e1vania autovakc\u00edn sme zistili, \u017ee 41 (48,81 %) z nich nemalo recid\u00edvu, 21 (25 %) pacientok malo 1 recid\u00edvu, 12 (14,29 %) pacientok malo 2 recid\u00edvy, 7 (8,33 %) pacientok 3 recid\u00edvy a u 3 (3,57 %) pacientok boli viac ako 3 recid\u00edvy po\u010das sledovan\u00e9ho obdobia
\nlie\u010dby (graf 2). Na konci 10-mesa\u010dnej lie\u010dby autovakc\u00ednami sme zaznamenali 62 (73,81 %) \u00faspe\u0161ne lie\u010den\u00fdch pacientok, u ktor\u00fdch sa po\u010das lie\u010dby nevyskytla recid\u00edva alebo mali len jednu recid\u00edvu, 12 (14,29 %) \u010diasto\u010dne \u00faspe\u0161ne lie\u010den\u00fdch pacientok celkovo s dvomi recid\u00edvami a 10 (11,90 %) ne\u00faspe\u0161ne lie\u010den\u00fdch pacientok, u ktor\u00fdch sa nepodarilo dosiahnu\u0165 zn\u00ed\u017eenie po\u010dtu recid\u00edv po\u010das cel\u00e9ho obdobia lie\u010dby. U \u017eiadnej z lie\u010den\u00fdch pacientok nedo\u0161lo k zhor\u0161eniu zdravotn\u00e9ho stavu (graf 3).
\nV skupine \u00faspe\u0161ne lie\u010den\u00fdch pacientok (bez recid\u00edv alebo s jednou recid\u00edvou po\u010das lie\u010dby) boli aplikovan\u00e9 autovakc\u00edny obsahuj\u00face mikrobi\u00e1lny antig\u00e9nny komplex (MAK) Candida albicans u 28 (33,33 %) pacientok, v skupine \u010diasto\u010dne \u00faspe\u0161ne lie\u010den\u00fdch (2 recid\u00edvy po\u010das lie\u010dby) bol podiel autovakc\u00edn
\ns obsahom MAK C. albicans 8 (9,52 %) a v skupine ne\u00faspe\u0161ne lie\u010den\u00fdch pacientok tvorili autovakc\u00edny s obsahom MAK C. albicans iba 4 (4,76 %) (graf 4). Vzh\u013eadom na n\u00edzky po\u010det autovakc\u00edn s obsahom MAK in\u00fdch mikroorganizmov a autovakc\u00edn s obsahom MAK dvoch alebo troch mikroorganizmov,
\nt. \u010d. sa nemo\u017eno vyjadri\u0165 k ot\u00e1zke, \u010di a\/alebo ako ovplyvn\u00ed zlo\u017eenie autovakc\u00edn \u00faspe\u0161nos\u0165 lie\u010dby.<\/p>\n
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Hodnotenie klinick\u00e9ho stavu pacientok s\u00faboru po\u010das 1. roka po skon\u010den\u00ed lie\u010dby autovakc\u00ednami<\/strong>
\nSledovali sme po\u010det klinicky zjavn\u00fdch a kultiva\u010dne potvrden\u00fdch recid\u00edv u pacientok s\u00faboru po\u010das 1. roka po skon\u010den\u00ed lie\u010dby autovakc\u00ednami. Po\u010det recid\u00edv po\u010das 1. roka po skon\u010den\u00ed lie\u010dby autovakc\u00ednami v jednotliv\u00fdch kateg\u00f3ri\u00e1ch pacientok je zn\u00e1zornen\u00fd na grafe 5. Na konci 1. roka po skon\u010den\u00ed lie\u010dby autovakc\u00ednami sme zaznamenali 63 (75 %) pacientok s v\u00fdrazne zlep\u0161en\u00fdm stavom (bez recid\u00edvy alebo s jednou recid\u00edvou po\u010das 1. roka po skon\u010den\u00ed lie\u010dby), 9 (10,71 %) pacientok s \u010diasto\u010dne zlep\u0161en\u00fdm stavom (2 recid\u00edvy po\u010das 1. roka po skon\u010den\u00ed lie\u010dby) a 12 (14,29 %) pacientok bez zlep\u0161enia stavu (3 a viac recid\u00edv po\u010das 1. roka po skon\u010den\u00ed lie\u010dby). Zhor\u0161enie stavu v 1. roku po lie\u010dbe sme nezaznamenali u \u017eiadnej lie\u010denej pacientky (graf 6).<\/p>\n
Hodnotenie klinick\u00e9ho stavu pacientok po\u010das 2. roka po skon\u010den\u00ed lie\u010dby autovakc\u00ednami<\/strong>
\nSledovali sme po\u010det klinicky zjavn\u00fdch a kultiva\u010dne potvrden\u00fdch recid\u00edv u pacientok s\u00faboru po\u010das 2. roka po skon\u010den\u00ed lie\u010dby autovakc\u00ednami. Po\u010det recid\u00edv po\u010das 2. roka po skon\u010den\u00ed lie\u010dby autovakc\u00ednami v jednotliv\u00fdch kateg\u00f3ri\u00e1ch pacientok je zn\u00e1zornen\u00fd na grafe 7. Na konci 2. roka po skon\u010den\u00ed lie\u010dby autovakc\u00ednami sme zaznamenali 65 (77,38 %) pacientok s v\u00fdrazne zlep\u0161en\u00fdm stavom (bez recid\u00edvy alebo s jednou recid\u00edvou po\u010das 2. roka po skon\u010den\u00ed lie\u010dby), 7 (8,33 %) pacientok s \u010diasto\u010dne zlep\u0161en\u00fdm stavom (2 recid\u00edvy po\u010das 2. roka po skon\u010den\u00ed lie\u010dby) a 12 (14,29 %) pacientok bez zlep\u0161enia stavu (3 a viac recid\u00edv po\u010das 2. roka po skon\u010den\u00ed lie\u010dby). Zhor\u0161enie stavu v 2. roku po lie\u010dbe sme nezaznamenali u \u017eiadnej lie\u010denej pacientky
\n(graf 8).<\/p>\n
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Diskusia<\/strong>
\nJe relat\u00edvne m\u00e1lo publikovan\u00fdch v\u00fdsledkov lie\u010dby chronick\u00fdch a recidivuj\u00facich kolpit\u00edd autovakc\u00ednami. V\u00fdsledky lie\u010dby najv\u00e4\u010d\u0161ieho s\u00faboru pacientok zverejnila Rutov\u00e1 zo Zdravotn\u00e9ho \u00fastavu so s\u00eddlom v Ostrave(16). Vo svojej pr\u00e1ci prezentovala v\u00fdsledky lie\u010dby autovakc\u00ednami pripraven\u00fdmi na oddelen\u00ed bakteriol\u00f3gie a mykol\u00f3gie v laborat\u00f3riu na pr\u00edpravu imunomodul\u00e1torov po\u010das rokov 1985 \u2013 1995. Za toto obdobie pripravili pre pacientky s gynekologick\u00fdmi z\u00e1palmi 408 autovakc\u00edn, z nich 92 % bolo indikovan\u00fdch pre chronick\u00e9 mykotick\u00e9 kolpit\u00eddy. Z pripraven\u00fdch autovakc\u00edn bolo 90 % injek\u010dn\u00fdch. \u00daspe\u0161nos\u0165 lie\u010dby hodnotili na s\u00fabore 248 pacientok bezprostredne po skon\u010den\u00ed lie\u010dby. Zlep\u0161enie stavu dokumentovali u 74,90 %, bez zmeny stavu bolo 12,50 % a lie\u010dbu nedokon\u010dilo 12,50 % pacientok. Imunologick\u00e9 vy\u0161etrenie absolvovalo iba 15 % pacientok, z toho d\u00f4vodu vplyv lie\u010dby na
\nparametre imunitn\u00e9ho syst\u00e9mu nebol hodnoten\u00fd. Pacientky n\u00e1\u0161ho s\u00faboru boli lie\u010den\u00e9 peror\u00e1lnymi hyposenzibiliza\u010dn\u00fdmi autovakc\u00ednami, zlep\u0161enie stavu (\u00faspe\u0161n\u00e1 a \u010diasto\u010dne \u00faspe\u0161n\u00e1 lie\u010dba) na konci lie\u010dby sme zaznamenali u 74 (88,10 %) z nich. Napriek odli\u0161nostiam (napr. v sp\u00f4sobe pod\u00e1vania) sme zaznamenali v\u00fdrazne lep\u0161ie v\u00fdsledky. Autorky Viktorinov\u00e1 a Koukalov\u00e1(17) publikovali v\u00fdsledky ko\u017en\u00fdch testov 80 pacientok s chronickou vagin\u00e1lnou kandid\u00f3zou. Signifikantn\u00fa precitlivenos\u0165 v\u010dasn\u00e9ho typu v s\u00fabore chor\u00fdch pacientok dok\u00e1zali iba na antig\u00e9ny C. albicans. V s\u00fabore chor\u00fdch \u017eien bola zn\u00ed\u017een\u00e1 neskor\u00e1 odpove\u010f na v\u0161etky testovan\u00e9 antig\u00e9ny \u2013 C. albicans, C. krusei a C. glabrata. Pod\u013ea autoriek tento n\u00e1lez nepriamo poukazuje na zn\u00ed\u017een\u00fa bunkov\u00fa imunitn\u00fa odpove\u010f u \u017eien s chronickou a recidivuj\u00facou vagin\u00e1lnou kandid\u00f3zou. V publik\u00e1cii sa odvol\u00e1vaj\u00fa na v\u00fdsledky ich vlastnej \u0161t\u00fadie, v ktorej zistili, \u017ee u 68,10 % pacientok s recidivuj\u00facou vagin\u00e1lnou kandid\u00f3zou je zn\u00ed\u017een\u00e1 fagocyt\u00e1rna aktivita leukocytov a u 36,60 % zistili v\u00fdskyt zn\u00ed\u017een\u00e9ho po\u010dtu CD4+ T-lymfocytov. Po imunostimula\u010dnej lie\u010dbe vagin\u00e1lnou alebo peror\u00e1lnou vakc\u00ednou Kanvakol, obsahuj\u00facou mikrobi\u00e1lny lyz\u00e1t zlo\u017een\u00fd z kvasiniek C. albicans, C, krusei, C. glabrata a bakt\u00e9rie Propionibacterium acnes, do\u0161lo k \u00faprave t\u00fdchto parametrov, preto autori predpokladaj\u00fa v\u00fdznamn\u00fa \u00falohu CD4+ T-lymfocytov v obranyschopnosti proti mykotick\u00fdm infekci\u00e1m. Koukalov\u00e1 a spol.(18) publikovali v\u00fdsledky vakcinoterapie recidivuj\u00facich kvasinkov\u00fdch z\u00e1palov po\u0161vy pou\u017eit\u00edm vakc\u00edny Kanvakol vyvinutej na ich pracovisku. Do \u0161t\u00fadie zaradili 91 pacientok, v\u00fdsledky \u0161t\u00fadie hodnotili u 66 z nich, 41 pacientok bolo lie\u010den\u00fdch peror\u00e1lnou tabletovou formou vakc\u00edny, 11 pacientok vakc\u00ednou vo forme vagin\u00e1lnych glob\u00fal a 14 pacientok obidvomi formami s\u00fa\u010dasne. Kontroln\u00fa skupinu tvorilo 16 \u017eien lie\u010den\u00fdch antimykotikami. Terapia vagin\u00e1lnou formou vakc\u00edny bola \u00faspe\u0161n\u00e1 u 81,80 % pacientok a lie\u010dba peror\u00e1lnou formou u 80,40 % pacientok. Lie\u010dba obidvomi formami naraz bola \u00faspe\u0161n\u00e1 u 71,40 % pacientok. Ve\u013emi dobr\u00fd lie\u010debn\u00fd \u00fa\u010dinok dosiahli celkovo u 78,80 % pacientok.
\nPriazniv\u00fd \u00fa\u010dinok pretrv\u00e1val priemerne 9,9 mesiaca u 35 pacientok (53 %), u \u010fal\u0161\u00edch 17 (25,76 %) do\u0161lo k 1 recid\u00edve v obdob\u00ed 7 \u2013 18 mesiacov po skon\u010den\u00ed lie\u010dby. \u00daspe\u0161nos\u0165 lie\u010dby v na\u0161om s\u00fabore je porovnate\u013en\u00e1 s \u00faspe\u0161nos\u0165ou lie\u010dby s\u00faboru pacientok publikovan\u00fdch autorkami Koukalov\u00e1 a spol.(18). V\u00fdrazne zlep\u0161en\u00fd stav v 1. roku po skon\u010den\u00ed lie\u010dby sme zaznamenali u 63 (75 %) pacientok, v 2. roku u 65 (77,35 %) pacientok. Vzh\u013eadom na r\u00f4znorodos\u0165 a \u010dasto neporovnate\u013enos\u0165 v\u00fdsledkov publikovan\u00fdch in\u00fdmi autorsk\u00fdmi kolekt\u00edvami, na\u0161ou snahou je \u0161tandardizova\u0165 pod\u00e1vanie a sp\u00f4sob hodnotenia \u00faspe\u0161nosti lie\u010dby pacientok autovakc\u00ednami. Nami publikovan\u00e9 v\u00fdsledky s\u00fa v\u00fdsledkami lie\u010dby pacientok lie\u010den\u00fdch peror\u00e1lnymi hyposenzibiliza\u010dn\u00fdmi autovakc\u00ednami pod\u00e1van\u00fdmi pod\u013ea \u0161tandardnej d\u00e1vkovacej sch\u00e9my a pri hodnoten\u00ed lie\u010dby a n\u00e1sledn\u00e9ho obdobia po lie\u010dbe sme pou\u017eili rovnak\u00e9 hodnotiace krit\u00e9rium \u2013 po\u010det recid\u00edv infekcie. Prv\u00e9 nami publikovan\u00e9 v\u00fdsledky z roku 2016(19) boli v\u00fdsledkami lie\u010dby s\u00faboru pacientok (n = 101) lie\u010den\u00fdch autovakc\u00ednami, ktor\u00e9 boli pod\u00e1van\u00e9 pod\u013ea hyposenzibiliza\u010dnej, imuniza\u010dnej a kombinovanej sch\u00e9my. \u00daspe\u0161nos\u0165 lie\u010dby bola porovnate\u013en\u00e1, po skon\u010den\u00ed lie\u010dby sme zaznamenali \u00faspe\u0161n\u00fa lie\u010dbu u 68 (67,33 %) pacientok, \u010diasto\u010dne \u00faspe\u0161n\u00fa lie\u010dbu u 20 (19,80 %) a ne\u00faspe\u0161n\u00fa lie\u010dbu sme evidovali u 13 (12,87 %) pacientok.
\nV 1. roku po lie\u010dbe autovakc\u00ednami bolo 73 (72,28 %) pacientok vo v\u00fdrazne zlep\u0161enom stave, u \u010fal\u0161\u00edch 11 (10,89 %) pacientok bol stav \u010diasto\u010dne zlep\u0161en\u00fd a bez zlep\u0161enia stavu bolo 17 (16,83 %) pacientok.<\/p>\n
 <\/p>\n
Z\u00e1ver<\/strong>
\nNa z\u00e1klade na\u0161ich v\u00fdsledkov m\u00f4\u017eeme kon\u0161tatova\u0165, \u017ee lie\u010dba peror\u00e1lnymi hyposenzibiliza\u010dn\u00fdmi autovakc\u00ednami m\u00e1 svoje jasn\u00e9 opodstatnenie a pr\u00ednos ako doplnkov\u00e1 lie\u010dba chronick\u00fdch a recidivuj\u00facich kolpit\u00edd u \u017eien, u ktor\u00fdch opakovan\u00e1 antimikrobi\u00e1lna lie\u010dba nepriniesla zlep\u0161enie. Pos\u00fadenie potreby a vhodnosti tejto formy lie\u010dby pre konkr\u00e9tne pacientky je na odbornom lek\u00e1rovi gynekol\u00f3govi, imunol\u00f3govi, ktor\u00fd po zhodnoten\u00ed doteraj\u0161ieho priebehu lie\u010dby a celkov\u00e9ho zdravotn\u00e9ho stavu pacientky m\u00f4\u017ee indikova\u0165 t\u00fato lie\u010dbu. Netreba zab\u00fada\u0165, \u017ee aj t\u00e1to lie\u010dba m\u00e1 kontraindik\u00e1cie, neodpor\u00fa\u010dame ju tehotn\u00fdm \u017een\u00e1m, imunodeficientn\u00fdm pacientkam a pacientkam s autoimunitn\u00fdmi chorobami. Autori publik\u00e1cie srde\u010dne \u010fakuj\u00fa spolupracuj\u00facim gynekol\u00f3gom a imunol\u00f3gom za poskytnutie inform\u00e1ci\u00ed o klinickom stave a kultiva\u010dn\u00fdch n\u00e1lezoch pacientok s\u00faboru.<\/p>\n
 <\/p>\n
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\n19. Czirfuszov\u00e1 M, Autovakc\u00edny v lie\u010dbe chronick\u00fdch a recidivuj\u00facich kolpit\u00edd.
\nZdravotnictv\u00ed a soci\u00e1ln\u00ed pr\u00e1ce 2016; 11(3): s. 21 – 31 ISSN 1336-9326.<\/p>\n","protected":false},"excerpt":{"rendered":"
*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper. \u00davod Lie\u010dba mikrobi\u00e1lnymi autovakc\u00ednami sa pou\u017e\u00edva viac ako 100 rokov(1). Tento terapeutick\u00fd princ\u00edp sa uk\u00e1zal ako ve\u013emi prospe\u0161n\u00fd v obdob\u00ed, ke\u010f medic\u00edna nemala k dispoz\u00edcii \u00fa\u010dinn\u00e9 antimikrobi\u00e1lne l\u00e1tky. V dobe<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[292,287],"tags":[509,510,511,512],"class_list":["post-1254","post","type-post","status-publish","format-standard","hentry","category-microbiology","category-uncategorized","tag-autovaccine","tag-chronic-and-recurrent-colpitises","tag-hyposensitisation-treatment","tag-immunomodulation","typ_clanku-original-work"],"acf":{"abstrakt":"
Treatment with autovaccines at the time of the imminent onset of the post-antibiotic era is experiencing a renaissance. It is suitable for patients with chronic and recurrent colpitises whose repeated antimicrobial treatment or perhaps even treatment with mass-produced immunomodulators of microbial origin did not achieve the desired effect. The aim of our study was to evaluate the course of the treatment and subsequently, to follow up the clinical condition and microbiological cultivation results of patients in the 1st and 2nd year after the autovaccine treatment. In the group of women treated for 10 months for chronic and recurrent colpitises (n=84) we have successfully treated 62 (73.81 %) of patients and partially successfully further 12 (14.29 %) of patients. We have achieved a markedly improved condition in 63 (75.00 %) patients during the 1st year and in 65 (77.38 %) patients observed during the 2nd year after the end of the treatment. Partial improvement occurred in further 9 (10.71 %) patients in the 1st year and 7 (8.33 %) patients in the 2nd year after the end of the treatment. It follows from the results of our work that per oral hyposensitisation autovaccine treatment is beneficial as a complementary treatment in patients with chronic and recurrent colpitises. In more than 80% of treated patients, we achieved reduction in the number of recurrence of infection and improved quality of their life.<\/p>\n
Keywords:<\/strong> autovaccine, chronic and recurrent colpitises, hyposensitisation treatment, immunomodulation<\/p>\n","casopis":[{"ID":1223,"post_author":"7","post_date":"2017-09-26 14:15:30","post_date_gmt":"2017-09-26 12:15:30","post_content":"
    \r\n \t
  • Fertility disorders: immunological causes and possible curative impact<\/li>\r\n \t
  • The first results of galactose-deficient IgA1 measurement in diagnosis and monitoring of patients with IgA nephropathy<\/li>\r\n \t
  • Application of autovaccines in the treatment of chronic and recurrent colpitises<\/li>\r\n \t
  • Infections of the hip endoprostheses<\/li>\r\n \t
  • Non-invasive markers of liver fibrosis<\/li>\r\n<\/ul>","post_title":"Newslab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab-2017-2","to_ping":"","pinged":"","post_modified":"2017-09-26 14:19:35","post_modified_gmt":"2017-09-26 12:19:35","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.newslab.sk\/casopis\/newslab-2017-2\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"83","upload_clanok":{"ID":1252,"id":1252,"title":"NEWSLAB 2-2017_Czirfuszov\u00e1","filename":"NEWSLAB-2-2017_Czirfuszov\u00e1.pdf","filesize":606674,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2017\/09\/NEWSLAB-2-2017_Czirfuszov\u00e1.pdf","link":"https:\/\/www.newslab.sk\/en\/application-of-autovaccines-in-the-treatment-of-chronic-and-recurrent-colpitises\/newslab-2-2017_czirfuszova-2\/","alt":"","author":"7","description":"","caption":"","name":"newslab-2-2017_czirfuszova-2","status":"inherit","uploaded_to":1254,"date":"2017-09-27 10:58:14","modified":"2017-09-27 10:58:14","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1254","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=1254"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1254\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1254"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1254"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1254"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}