Comparative Evaluation of the Dynamics of Parameters of Cell-Mediated Immunity under the Influence of Different Therapies for Chronic Acquired Toxoplasmosis

O.V. Bobrova, Anuar al Hatib

Abstract


The article presents a comparative evaluation of the dynamics of parameters of cell-mediated immunity in patients under the influence of different therapies for chronic acquired toxoplasmosis (CAT). Efficiency of complex treatment using antiprotozoal combined drug pyrimethamine + sulfadoxine has been studied in 1 and 5–6 months after starting treatment. After 1 month of initiation of treatment with pyrimethamine + sulfadoxine, a significant increase of CD4+ (p < 0.01), CD16+ (p < 0.05) and a decrease in the level of Toxoplasma-specific IgG antibodies (p < 0.05) were detected. After 6 months of initiation of treatment, we have revealed elevated levels of CD3+ (p < 0.05), CD4+ (p < 0.001), CD8+ (p < 0.001), CD16+ (p < 0.001), phagocytic index (p < 0.05), decreased level of circulating immune complexes (CIC) with 3.5% polyethylene glycol (PEG) (p < 0.01) and 7% PEG (p < 0.001), lymphocytotoxic autoantibodies (p < 0.01) and Toxoplasma-specific IgG antibodies (p < 0.001). These data may indicate a significant lag in homeostatic adjustment of the immune system under the influence of antiprotozoal therapy. When studying the effectiveness of combination therapy (pyrimethamine + sulfadoxine and specific immunoglobulin against T.gondii), among the immunological parameters after 1 month of starting treatment we have found a significant increase in content of CD16+ compared with baseline (p < 0.001), IgA (p < 0.001) and reduction in the level of Toxoplasma-specific IgG antibodies (p < 0.001). After 6 months of observation, we have detected an increase of CD3+ (p < 0.01), CD4+ (p < 0.001), CD8+ (p < 0.01) content in comparison with baseline, as well as lower levels of CIC with 3.5% PEG (p < 0.001) and 7% PEG (p < 0.05), lymphocytotoxic autoantibodies (p < 0.001), IgA (p < 0.05), IgM (p < 0.05), IgE (p < 0.01) and IgG antibodies to Toxoplasma (p < 0.001). Combination therapy for CAT in the acute stage of the disease has a significant impact on the normalization of all parts of immunological homeostasis. Such action was maximal in 6 months of starting treatment. When studying the effectiveness of the therapy with specific immunoglobulin against human T.gondii, when analyzing the dynamics of indicators of immunity in 1 month from the initiation of immunoglobulin therapy, we have revealed only a significant increase in CD8+ (p < 0.05) and a decrease in the ratio of CD4+/CD8+ (p < 0.05). After 6 months of starting treatment, we have established a significant increase of CD4+ (p < 0.001), CD8+ (p < 0.001), CD4+/CD8+ (p < 0.001), CD16+ (p < 0.05) levels, phagocytic index (p < 0.001) and a decrease of CIC content with 3.5% PEG (p < 0.05), lymphocytotoxic autoantibodies (p < 0.001), IgG to Toxoplasma (p < 0.001) and IgE (p < 0.05) in comparison with baseline.
Comprehensive assessment of the dynamics of immunity parameters using average values of t-test, depending on the type of therapy, showed that after 1 month from the initiation of treatment only combination therapy revealed significant (t = 3.19; p < 0.01) changes in their normalization. Application of pyrimethamine + sulfadoxine monotherapy (t = 1.25; p > 0.05) and immunoglobulin therapy (t = 1.75; p > 0.05) caused only a trend toward normalization of parameters. After 6 months of starting treatment, a pronounced dynamics was observed in patients received combination therapy (t = 5.5; p < 0.001), average — at immunoglobulin therapy (t = 3.68; p < 0.01) and a small one — in the group of patients treated with pyrimethamine + sulfadoxine (t = 2.91; p < 0.01).
Combination therapy had a highest immunological effect when treating patients in the acute stage of CAT. Treatment with T.gondii-specific immunoglobulin took an intermediate position, and therapy using pyrimethamine + sulfadoxine revealed the lowest efficiency.


Keywords


patients with chronic acquired toxoplasmosis; diagnosis; treatment; parameters of cell-mediated immunity

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DOI: https://doi.org/10.22141/2312-413x.1.06.2015.78498

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