CHANGES IN SELECTED CLINICAL AND LABORATORY PARAMETERS IN VARIOUS FORMS OF CHRONIC RHINOSINUSITIS ASSOCIATED WITH CHRONIC SECONDARY IMMUNE DYSFUNCTION AND CONCOMITANT DISEASES

Abstract

Chronic secondary immunodeficiency (SID) is a disorder of the immune system that affects individuals across age groups. The development of SID is associated with infectious diseases; adverse climatic and environmental conditions (including radiation exposure and related factors); allergic diseases and bronchial asthma; endocrine disorders such as hypothyroidism and diabetes mellitus; as well as various other concomitant pathologies. SID leads to impairment of the barrier and eliminatory functions of the mucous membrane of the nasal cavity and paranasal sinuses, prolonged persistence of infectious agents, and the development of chronic inflammatory processes characterized by a recurrent clinical course.

The present study aimed to investigate and analyze alterations in selected clinical and laboratory parameters across various forms of chronic rhinosinusitis that develop in the setting of chronic secondary immune dysfunction and associated comorbidities.

A total of 157 individuals aged between 15 and 72 years were enrolled in the study, including 78 men and 59 women, among whom 20 subjects were considered practically healthy controls. The remaining 137 patients presented with various forms of chronic rhinosinusitis associated with SID, including bacterial rhinosinusitis (37 cases), rhinosinusitis caused by mixed microflora (62 cases), and invasive fungal rhinosinusitis (33 cases). Mycetoma was identified in 6 cases. In addition, allergic rhinosinusitis was diagnosed in 34 patients, while polypoid rhinosinusitis was observed in 18 cases. Associated comorbid conditions included allergy and bronchial asthma (34 cases), AIDS (27 cases), fungal infections (25 cases), hypothyroidism (23 cases), and diabetes mellitus (28 cases).

A detailed medical history was obtained from all study participants. Comprehensive otorhinolaryngological evaluation was performed using both routine and advanced diagnostic approaches, including fiber-optic endoscopic examination, modern radiological imaging techniques, and microbiological investigation of nasal and paranasal sinus swab specimens. Histopathological and immunohistochemical analyses were conducted on biopsy and postoperative tissue materials. Immunophenotyping of venous blood samples was performed using flow cytometry based on the application of monoclonal antibodies directed against CD markers. Enzyme-linked immunosorbent assay (ELISA) was used to determine serum levels of immunoglobulin classes IgA, IgM, IgG, and IgE, as well as circulating immune complexes (CICs).

Radiological investigations demonstrated that, in the setting of secondary immune dysfunction, the maxillary sinuses were the most frequently affected paranasal sinuses (58 cases), It should be emphasized that inflammatory processes in these patients were predominantly bilateral (45 cases; P > 0.05). The microbiological spectrum of chronic rhinosinusitis associated with SID and concomitant diseases was highly diverse. Against the background of chronic concomitant diseases, SID exerts a significant influence on the microbiological landscape of rhinosinusitis, predisposing patients to infections caused by more complex and multicomponent pathogenic microorganisms. Immune system dysfunction, becoming allergic, hormonal problems, and fungal infections all play a major role in making inflammatory conditions long-term.

Based on the aforementioned findings, it should be emphasized that understanding the immunological characteristics of patients with chronic rhinosinusitis associated with chronic secondary immune dysfunction constitutes an essential prerequisite for conducting differentiated immunological investigations and implementing individualized therapeutic approaches. Such strategies would facilitate the timely identification of pathological processes, the establishment of appropriate and effective treatment protocols, and their subsequent application in clinical medical practice.