EUROMEDICA  Hanover 6-7  Juni 2008	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Russian Academy of Natural Sciences, Moscow

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The Astrakhan fever rickettsiae (AFR) is an acute infectious disease of rickettsial etiology, sporadic cases of which have been registered on the territory of Astrakhanian Region since the middle of 70-s. At present we observe the growth of morbidity and expansion of its territorial borders.

The treatment of such patients must be complex. The analysis of a complex therapy showed a higher effectiveness when the treatment was started at early stages. The etiotropic therapy implies an intake of Tetracycline antibiotics in advisable doses within three days after the elevated temperature was lowered. The pathogenetic therapy is aimed at reducing intoxication and its manifestations. Desintoxication therapy is carried out intravenously by drops in volumes from 400 ml to 1,5 – 21 depending on the severity of the disease. In case of an expressed hemorrhagic syndrome and presence of thrombocytopenia the preparations, such as ascorutin, vicasol and ascorbic acid should be indicated. A symptomatic therapy is indicated to all patients to relieve pain, improve sleep, correct hemodynamics.

Doxycycline is the most recommended medication for initial treatment of AFR in medium and severe cases. Clinical experimental data of AFR pathogenetic study show the T-lymphocyte deficit, immune status depression, interferron, in conditions of hyperthermia. In this connection during the last years we observe constant optimization of standard doxicyclintherapy in patients with ARF. In clinical practice of ARF treatment the effectiveness of interferon was demonstrated in combination with doxycycline and complexly with immunotropic preparations and combination of standard treatment with inductors of interferon.

In treatment of ARF patients we used genetic engineering preparations of interferron – alpha 2 realdiron + gamma – pheron in dosage 2,5, * 10⁵ ME +0,25 * 10⁵ and 1-1,5*10⁵ ME+1,5*105 ME during 6-8 days.

The combined action of doxycycline and interferon preparations resulted in restoration of normal homeostasis. Clinically, diminishing of prolonged ARF symptoms such as weakness, myalgia, arthralgia, tachycardia, eczantema was manifested, and consequently, reduction of disease duration and a shorter hospitalization of such patients was achieved.

But more essencial positive dynamics we observed in combination of usage of doxycycline with inductors of endogenous interferon – amixin and cycloferron. Amixin was indicated according to the scheme: 1 and 2 days by 0,25 g/d in 48 hours by 0,125 g/d during the first week. Cycloferron was used by 0,3 g on 1,2,4,6,8 days once a day. In the result of indicated combined therapy there were discovered that the usage of complex therapy of ARF of interferron inductors with doxycycline may shorten the duration of clinical symptoms of this disease: fever, intoxication symptoms, may facilitate a sooner resolution of rash. Such therapy leads to normalization of indicators of humoral-cellular immunity, phagocytosis, increases the concentration of immunoglobulins.

Investigation of immune status of patients with ARF revealed an immunodeficiency condition. In this connection we decided to use the preparation which had correcting action to the immune system of human being, that was imunofan, for complex treatment of ARF. Imunofan was given according to the scheme: 1 day – 2 ml intramuscular; 2 day and other days – by 1 ml. The treatment showed a positive effect of imunofan, enabling to reduce the duration of intoxication symptoms in AFR patients. Imunofan possesses antiinflammatory, desintoxicational and immunomodulating effects. The usage of imunofan in clinic gave the possibility to prove its desintoxicational and hepatoprotective action.

In patients with severe AFR with prolong hyperthermia we observed expressed sympoms of intoxication. Such symptoms as pain in muscles and joints might persist even after temperature normalization. Almost every fifth patient due to expressed arthralgia and myalgia experienced walking difficulties – unstable walking. In this connection during the convalescence, after normalization of temperature and rash regression the patients with AFR received the treatment of LILR. The usage of lazertherapy accelerated diminishing of weakness, headache, and eczantema. Even more positive dynamics was registered in duration of myalgia and arthtralgia. On the background of using LILR the duration of these symptoms was shortened twofold.

In conclusion, the treatment of patients with AFR should be complex and be aimed at the disease agent – rickettsia and restoration of disturbed indicators of homeostasis. The use of such therapy promotes an earlier recovery and shorter hospital stay.