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The character of dysbiotic changes in the acute period of stenosing laryngotracheitis of respiratory tract
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Samieva Gulnoza Utkurovna, The assistant of Samarkand State Medical Institute, Republic of Uzbekistan
E-mail: [email protected]
The character of dysbiotic changes in the acute period of stenosing laryngotracheitis of respiratory tract
Abstract: There is a high degree ofcontamination ofmucous URT with Staphylococcus aureus (in 20 %), a-hemolytic streptococci (20 %), complex associations (30 %) in the recurrence of SLT at an early age and in remission. Keywords: respiratory tract, acute period of stenosing laryngotracheitis.
Relevance. The mucous membranes ofthe respiratory tract carry out a barrier function is to prevent fixation and penetration extraneous substances and microorganisms in the internal environment of the human body and for this reason the study of the microbial landscape is of scientific interest [1; 3; 4; 5].
Material and methods. In 275 children aged from 6 months to 5 years with the generated recurrent of stenosing laryngotracheitis studied the microbial landscape of the mucous membranes of the upper respiratory tract (URT) by conventional methods of bacteriological examination including crops of secretions from nasal and oropharynx on nutrient medium with subsequent identification.
Results and discussion. We compared the character of dysbiotic changes of the respiratory tract in the acute period of the disease depends on the age of our patients and we have marked frequent infection of mucous membranes with Staphylococcus aureus in all age’s periods [2]. In the acute phase of the primary Stenosing laryngotracheitis in children from 6 months, up to 3 years are determined most denominated violations of microbiocenosis of mucous of respiratory tract in the nasopharynx and in the oropharynx (normal microflora composition is present in 9.5 % and 9 % of patients, respectively). We have not identified such regularities in the acute period ofRSLT. During remission at PSLT the normal microbial composition of the respiratory tract is reversed only in a half of the surveyed from 6 months. up to 3 years, at an older age structure of the normal flora in the nasopharynx in 33 % of children aged 3-6 years and 22 % at the age of 6 years and older. The normal microbial landscape of the oropharynx in children up to 3 years in remission of PSLT was determined in 50 % of cases, in the other two groups — only 25 %. In the remission of RSLT restoration of normal flora from 0 to 3 years was observed only in 16 % over 3 years — in 50 % cases the normal microflora is saved. In the acute period are marked a significant shift in the microbiocenosis of the respiratory tract in both type of SLT. Disbiotic processes characterized by settling in the mucous membranes of
URT pathogenic and conditionally pathogenic Gram-positive and Gram-negative flora with reduction of releasing of normal saprophytic microflora. Undoubted the leadership in this process in the acute period of the disease is Staphylococcus aureus. It occurs as a monoculture and as associations — in combination with other pathogenic agents. The prevalence of S. aureus of the respiratory tract in the acute period of high in both type PSLT and RSLT. In the acute period of PSLT Staphylococcus aureus was isolated from the nasal in 28 % of the surveyed children, and in 25 % from the oropharynx. In RSLT this microbe is found in 39 % of cases in the nasopharynx and in 23 % of children in the oropharynx. In associations S. aureus often sown from oropharyngeal in patients with RSLT — in 22 % of cases.
In the acute phase of the disease a-hemolytic streptococcus is determined more frequently in oropharyngeal in patients with PSLT (17 %), while in RSLT it was determined extremely rare (2 % of cases). E. coli was detected on the mucous of URT in the acute period of RSLT as in PSLT (6 and 8 %, respectively). Candida species in the oropharynx in PSLT revealed in 25 % of cases, RSLT — in 18 % from the nasopharynx also were secreted the mycelium of the fungus, as in PSLT as well as in RSLT. The complex associations of microorganisms were observed only in the nasopharynx in patients with PSLT, in RSLT they were found in the nasopharynx (15 %) and in the oropharynx (23 % of the patients). Gram-positive pathogens in the acute phase of SLT are found mainly in the form of associations, especially with Staphylococcus aureus, and do not have such a high representation in the URT, as S. aureus.
In the acute period of RSLT complex associations pathogens were more common in older children in the oropharynx (43 %). The presence of such changes of microbiocenosis characterizes the severity of dysbiotic processes and the duration of their existence. In the acute period of PSLT above regularities are not detected, although such pathogens as Candida, E. coli, Klebsiella, often are secreted in older children. Affection of mucous membranes of the respiratory tract with Staphylococcus
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Section 4. Medical science
aureus in remission is very high, both in primary and in recurrent SLT. But the process of settlement with this pathogen of the mucous in RSLT is expressed in a greater degree. In PSLT the emission level of S. aureus from the nasopharynx is 32%, in RSLT reaches almost 50 %. Alpha-hemolytic streptococcus is found in RSLT only as associations and only in the oropharynx — up to 17 % of cases, in PSLT p-hemolytic streptococcus is found in the nasopharynx as a mono-culture — to 7 % in the oropharynx in the form of associations — to 20 % in observed patients. The pneumococcus was revealed in respiratory tract in remission of PSLT in 13 %), in RSLT — only in the oropharynx in 12 % of patients. Complex associations of pathogens in remission occur in RSLT in the nasopharynx almost 2 times more often than in PSLT. Complex combinations of pathogens were revealed in the oropharynx in remission of PSLT quite often — at 33 %, in RSLT — 26 %. As in the acute period and during remission are detected phenomena of deepening of the dysbiotic processes in the nasopharynx at RSLT.
Candida species in nasopharyngeal in remission of PSTL were not discharged, in RSLT are determined in 3 % of patients. In the oropharynx the detection rate of these pathogens in the primary and recurrent SLT is about the same — 20 %. Klebsiella in the respiratory tract in remission of PSLT was not detected, in RSLT was revealed in 3 % of cases. Detection of of E.coli from the nasopharynx at the primary and recurrent SLT is approximately the same level and is 7 and 6 %. Colonization of oropharyngeal with this pathogen in RSLT increased almost in 2 times compared with PSLT — 12 and 7 % respectively. The normal flora is presented in remission, as well as in the acute phase, both in primary and in recurrent SLT predominantly with a-hemolytic streptococcus. The discharge of Staphylococcus aureus from the mucous of the respiratory tract in remission period of PSLT mentioned more frequently in children aged from 3 to 6 years.
S. aureus as a monoculture was isolated from mucosa of nasopharyngeal in 100 % of these children, and 50 % — of the oropharynx. In children of this age also noted the great
frequency of discharge of fungi Candida (75 %), pneumococcus (50 %), complex associations of micro-organisms (75 %) and the most aggressive pathogens — S. haemolyticus (25 %) and E. coli (25 %). In young children the composition of the microflora of URT in remission is mainly represented by Staphylococcus aureus and pneumococcus (14 %). At older ages, the leadership remains with Staphylococcus aureus (50 %), pneumococcus (25 %) and complex microbial associations (50 %). Discharge of Staphylococcus aureus from the mucous URT in RSLT was observed in children of all ages reaching in older children 83 % (in the nasopharynx and oropharynx). Complex combinations of pathogens and microorganisms, such as E. coli, S. haemoyiticus and Candida species are determined in remission predominantly in older children. In children older than 3 years, the main representatives of the microflora were S. aureus, pneumococcus, hemolytic Staphylococcus aureus (42,17 and 17 %, respectively). In this age group, we noted the absence release of Gram-negative bacteria — Klebsiella, E. coli, as well as a-hemolytic streptococcus. Despite the frequent administration of antibacterial drugs in children of this age, Candida species and complex associations out of the oropharynx were determined only 8% of patients.
There is a high degree of contamination of mucous URT with Staphylococcus aureus (in 20 %), a-hemolytic streptococci (20 %), complex associations (30 %) in the recurrence of SLT at an early age and in remission. It was established a considerable reduction of S. aureus discharge from the mucous of URT in compare with the acute period (from 83 to 20 %), while the proportion of a-hemolytic streptococcus in this age group (remission) increases from 0 to 20 %, also increased seeding of E. coli (0 to 10 %) and complex associations (0 to 30 %).
Conclusion: We observed worsening of disbioceno-sis process of respiratory tract in SLT characterizing by settling in the mucosa of the respiratory tract firstly with pathogenic gram-positive, then adding of gram-negative microflora, even micro-organisms, which unusual in this ecological niche.
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