Significant changes in both anaerobic and facultative microbial flora were noted in EM patients. So, in the anaerobic group of microbes, especially lactobacilli, there was a significant decrease, their number was more than 2 times (2.37 times) lower than the control values (from 5.10±0.14 to 2.15±0.05) ( p<0.001). Significant changes were also observed in the group of facultative microorganisms.
The conducted microbiological study in patients with EM shows that in particular area of aphthae (erosion), there was an excessive growth of microbes (Table 1). It should be noted that there was a balance of lactobacilli and streptococci in healthy individuals with intact oral mucosa, and on the contrary, the microbiological picture changes towards a significant dominance of strains of pyogenic streptococcus (90.74%) CCB Log / ml 4.52 ± 0.14, fungi Candida (50.00%) CCB Log/ml 3.60±0.18), Staphylococcus aureus (29.63%) CCB Log/ml 3.70±0.14)) in patients with EM. Such phenomena naturally develop in the oral cavity a state of subcompensated dysbiosis, which is characterized by the presence of at least two pathogenic species [4,9].
Table 1 Characteristics of the oral microflora in patients with erythema multiforme exudative
No.
|
Selected groups of microbes
|
abs
|
% occurrence
|
KOE Log/ml
|
M±m
|
1
|
Str.pyogenes
|
39
|
97.5
|
4.52±0.14
|
2
|
Enterobacter
|
eleven
|
27.5 _
|
6.20±0.29
|
3
|
Staff aureus
|
17
|
42.5
|
3.70±0.14
|
4
|
Staf.epidermitis
|
21
|
52.5
|
6.10±0.05
|
5
|
Candida
|
27
|
67.5
|
3.60±0.18
|
6
|
Lactobacter
|
eleven
|
27.5
|
2.15±0.13
|
We studied the quantitative analysis of microorganisms in the oral cavity of patients with MEE in the study groups before and after treatment. So, normally, Staphylococcus aureus and hemolytic streptococcus do not occur in the oral fluid. However, in the studied groups, the average titers of this pathogen fluctuated at the level of 3.30±0.16 - 2.40±0.09 Lg.KOE / ml, and the detection titers of hemolytic streptococcus fluctuated at the level of 2.40±0.12 - 5, 15±0.17 Lg.KOE / ml (P<0.001). Representatives of conditionally pathogenic microorganisms Escherichia LP and LN were observed in titers of 1.30±0.06 - 2.50±0.10 and 3.30±0.13 - 4.10±0.14 Lg.KOE / ml, respectively. appear in the normal flora of the oral cavity. Fungi of the genus Candida were noted at the level of 2.50±0.13 - 2.60±0.10, while the normal values were 2.15±0.08Lg.KOE/ml (p<0.001).
Against the background of an increase in the level of pathogenic and conditionally pathogenic microflora in the oral cavity, a decrease in the titers of representatives of the normoflora was observed. So, the indicators of the level of epidermal 2.15±0.08Lg.KOE/ml - 3.70±0.06Lg.KOE/ml and saprophytic staphylococcus 2.60±0.11Lg.KOE/ml - 3.20± 0,11Lg.KOE/ml decreased accordingly, in the control 4.40±0.15 and 4.70±0.21Lg.KOE/ml. It should be noted that the combination in the oral fluid of pathogenic Staphylococcus aureus and hemolytic streptococcus, with fungi of the genus Candida in patients with EM is an unfavorable factor for the clinical course of the disease. The combination of these pathogenic microorganisms forms oral dysbiosis.
Clinical and microbiological manifestations of dysbiosis in 9.57–10.00% of cases corresponded to a dysbiotic shift; changes in microbiocenosis were assessed as stage I-II dysbacteriosis in 46.66-50.00% of patients and they were as stage III dysbacteriosis in 40.62–43.33%. In the studied groups, there were no patients with normocenosis, and at the same time there were no patients with severe forms of IV degree dysbiosis.
The content of the main subpopulations of lymphocytes in the peripheral blood was studied in 40 patients with EM and 10 healthy donors. The results of studying the quantitative parameters of various subpopulations of lymphocytes were shown in pic.1.
The results obtained showed that in the examined patients with clinical manifestations of exudative erythema multiforme, there was a statistically significant increase in the total population of T-lymphocytes (up to 74.4 + 3.8% with 66.5 + 3.7% in healthy donors). At the same time, a quantitative decrease in CD3-CD16+CD56+CD45+ up to 12.9+1.3% was revealed, while the control figures were 15.0+1.4%. The results of the studies showed that in patients with active manifestations of MEE, the Tx/Tc coefficient was statistically significantly increased compared to that in healthy donors and amounted to 2.6±0.2.
This value of the immunoregulatory index (IRI) in the examined patients was achieved due to a significant increase in the level of T-helpers in the circulating blood up to 43.5+3.1% with 36.5+3.0% in healthy donors.
B-lymphocytes were assessed by surface antigens. In patients with erythema multiforme exudative, there was a significant increase in the total number of B-lymphocytes.
The results obtained indicated an increase in the content of antigen-primed B-lymphocytes in the blood of MEE patients (CD - CD 19+ CD 45+). The concentration of B-lymphocytes with surface antigen was more than 2 times higher than in healthy donors. At the same time, patients with MEE compared with healthy donors have 1.8 more B-lymphocytes with surface antigen. Plasma cell precursors (CD 38+) were also significantly elevated.
Thus, in patients with erythema multiforme exudative, all differentiated forms of T-lymphocytes are increased.