IMMUNOPATHOGENESIS OF OROPHARYNGEAL CANDIDIASIS IN PATIENTS WITH HEMOBLASTOSIS
A series of observations, studies of the state and features of local immunity in patients with hemoblastoses, in particular, complicated by oropharyngeal candidiasis, was carried out. As a result of a prospective, dynamic, observational study of 525 patients with hemoblastosis for 5 years, the frequency of complications, the significance of contamination with Candida spp. according to the type of the main disease, chemotherapy and the use of antibiotic therapy were established. Inflammatory response cytokines were studied in 137 of them, including 51 patients with an established diagnosis of oropharyngeal candidiasis in the oral fluid. It was found that high contamination of Candida spp. (more than 500 MG/ml) in the oral cavity of patients with hemoblastosis coincided with increased local synthesis of IL-6, IL-8, MCP-1, β-defensin 2 (DEFb2), secretory leukocyte protease inhibitor (SLPI) and a decrease in IL-17. This change in cytokine levels found in the oral fluid of patients with hemoblastosis indicates the possibility of excessive compensatory attraction and activation of cells of early and initiative inflammation, in particular, neutrophils and epithelial cells. In different types of hemoblastosis, the local synthesis of IFN-y, the main organizer of high-quality protection against fungi, was reduced, which indicates the inadequacy of this protection. In patients with the development of oropharyngeal candidiasis, a decrease in the level of IL-17 corresponded to a lower ability of mucosal cells to synthesize MCP-1, a chemoattractant, primarily for macrophage cells, which further contributed to the attraction of neutrophils and the damaging effect of their enzymes on oral tissue in some patients, led to an increase in the pathogenic properties of fungi and the development of candidiasis.