[ERRORS IN DIAGNOSIS AND TREATMENT OF IMMUNODEPENDENT PATHOLOGY (ORIGINAL CONCEPT)].

Based on many years of experience in 2009, we developed the original concept of a mixed approach to the treatment of infectious diseases in patients. During 2.5 years(from 2013 to June 2015) to have applied for consultative-diagnostic help of 3965 patients who had not verified the primary diagnosis. The basic principle of verification of the pathology of the removal of various causes immunosuppression. Based on our extensive, research and observation was often found in patients ascaridosis (55%) and giardiasis (65%), as a possible cause of immunosuppression. In 13% of patients was found the mucosal candidiasis. Among frequently and chronically ill persons we identified the active forms of Epstein-Barr virus (quantitative polymerase chain reaction in saliva) in 40%. The criterion for assessing performance immunogram was a decrease of two sigmal deviation from the lower age limit. In the study of neutrophil myeloperoxidase content observed decline (< 60%) in 99 (9.7%) of 1015 patients, indicating a fairly common cause of long-term permit infection in the tissues and persistence C. albicans. In the study of lymphocyte subpopulations often demonstrated reduction in the number of natural killer cells (26.7% of subjects), which shows a decline of one of the most important factors of congenital immunity. Among the humoral immune disorders often noted the decrease of total IgG (2.4%) and its subclass IgG1 (22.1%), indicating a significant diagnostic value determination of IgG subclasses it even with normal serum total. Thus, approximately 76% of patients often suffer set of a decrease immunity. Patients developed with mixed infections caused by various bacterial, fungal, viral and protozoan agents and worms. Immunological study of patients should be redynamics after eliminating the causes immunosuppression and sanitation foci of infection. Only multi-level examination of the patient will determine the final diagnosis and adequate treatment.

[FREQUENCY OF IMMUNOGLOBULIN E DEFICIENCY AMONG PATIENTS WITH IMMUNODEPENDENT DISORDERS].

Isolated IgE deficiency is one of the most common primary immunodeficiency, which is still underestimated cause of health disorders of modern man. Recent genetic studies report that the cause of the IgE deficiency is immune dysregulation caused by polymorphisms of the gene, which is responsible for the synthesis of activation-induced cytidinedeaminase (AICDA). The Institute of Immunology and Allergology at Bogomolets NMU during the years 2012-2014 were examined 5298 patients with a range of different diseases, which could be suspected violations of immunity. All patients were conducted comprehensive immunological study, and 4476 of them were examined for content of total serum IgE. The criterion for the selection of patients for follow-up began serum IgE < 10 kIU/l. Serum immunoglobulin E was determined by ELISA. Serum IgE < 10 IU/ml was detected in 342 patients (7%). Average reduction in the study group made up (5.30 ± 1.31) IU/ml. Partial deficiency (5-10 kIU/l) was detected in 212 patients (4%), while the total--130 (3%). For follow-up, we are clinically selected group of patients with deficiency of IgE (n = 60) and control group (n = 30). All patients were distributed as per clinical syndromes, and the frequency of their manifestations: sinopulmonary syndrome (63%), gastrointestinal syndrome (13%), autoimmune manifestations (10%), allergic reactions (7%) and chronic fatigue syndrome (7%). The levels of serum IgG, IgA, IgM in the study group were within the age norm (IgG = 1160.00 mg/dl ± 2.88 mg/dl, IgA = 138 g/l ± 37 mg/dl, IgM = 114 mg/dl ± 30 mg/dl). However, only a small proportion of patients was observed decrease in other classes of immunoglobulins in 8 patients with IgG < 700 mg/dL in 16 patients with IgA < 90 mg/dl and 6 patients with decreased serum IgM < 90 mg/dl. These patients were examined the levels of serum IgG subclasses and sIgA levels in saliva. Significant violations by cellular immunity in determining lymphocyte subpopulations by flow cytometry using monoclonal antibodies also were found. Phagocytic indices were also no significant abnormalities. An important aspect of clinical deficiency of immunoglobulin E is its association with diseases of bacterial origin (H. influenza, M. catarrhalis, Str. pneumoniae), indicating a protective role of these antibodies in the mucosa of the respiratory tract. Thus, isolated IgE deficiency is associated with sustained decrease in serum concentrations of immunoglobulin E (< 10 kIU/l) in patients with normal immune status of other indicators that require dispensary and treatment. The results of their study indicate a high incidence of the IgE-deficiency among the population and its high incidence among the humoral defects.