Analysis of the effectiveness of immunotherapy for early and late neuroborreliosis in children

Abstract

Immunostimulants are drugs that increase the effectiveness of antimicrobial therapy, improve outcomes, and participate in the process of repairing damaged tissues. Objective. To evaluate the effectiveness of the inclusion of immunostimulants in the therapy of early and late neuroborreliosis (NB) in children: glucosaminylmuramyldipeptide (Licopid), recombinant interferon α-2b in combination with antioxidants vitamins E and C (Viferon®) and recombinant interleukin-2 (Roncoleukin). Patients and methods. Forty-two patients with NB aged 2–17 years were examined and received therapy. The diagnosis included clinical-epidemiological and laboratory-etiological methods (enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR)) for Borrelia burgdorferi s.l. (Bb). Electroneuromyography was performed in early NB, and magnetic resonance imaging (MRI) of the brain and spinal cord was performed in late NB. The main group included children with early NB (n = 13) who received 1 mg of Licopid orally and Viferon® rectal suppositories 150,000 or 500,000 IU (depending on age) twice a day for 10 days. In late NB, children in the main group (n =1 2) received drip intravenous injection of Roncoleukin №3 at a dosage of 0.5 mg for 3 days. The comparison groups included 9 children with early NB and 8 children with late NB who received antimicrobial and pathogenetic therapy without immunostimulants. Results. In early NB (n = 22), children with aseptic meningitis and Bannwarth syndrome were observed, and in late NB (n = 20) – children with leukoencephalitis and disseminated encephalomyelitis. The prescription of Licopid and Viferon® ensured the eradication of Bb in the cerebrospinal fluid (CSF) by PCR results and led to the complete recovery of facial and peripheral nerve function in all cases, whereas in the comparison group, in 11.1% (n = 1), Bb remained in CSF on day 15, and after 6 months, a neurological deficit was detected in 2 (40%) of 5 children with Bannwarth syndrome: in the form of facial muscle contraction (n = 1) and polyneuropathy (n = 1). In late NB, the presription of Roncoleukin reduced the duration of bed days (by an average of 13 days) and mean neurological deficit on the EDSS scale after 1, 6 and 12 months. After 1 year, ¼ of children had complete regression of foci on MRI, and 41.6% (n = 5) had regression of both foci and clinical symptoms. During the year, there were no exacerbations, and CSF PCR was negative. In the comparison group, 3 (37.5%) children had clinical and/or radiation exacerbation. Conclusion. The inclusion of immunostimulants (Licopid, Viferon®) in therapy in early NB and the drug Roncoleukin in late NB accelerates the eradication of Borrelia, reduces neurological deficit, avoids exacerbations, progression of infection and repeated courses of antibiotics. Key words: neuroborreliosis, immunotherapy, Licopid, Viferon, Roncoleukin, children