КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯ ИЗМЕНЕНИЙ МИКРОБИОМА ПОЛОСТИ НОСА У ДЕТЕЙ СО ЗЛОКАЧЕСТВЕННЫМИ ОПУХОЛЯМИ ПАРАМЕНИНГЕАЛЬНОЙ ЛОКАЛИЗАЦИИ ВО ВРЕМЯ ХИМИОЛУЧЕВОЙ ТЕРАПИИ

Abstract

Malignant tumors of parameningeal localization are various morphological neoplasms located in the nasal cavity, nasopharynx, paranasal sinuses and middle ear. As a result of tumor growth, conditions are created for the development of chronic inflammation. Studies of the microbiome of the upper respiratory tract in children with malignant tumors were practically not conducted. Objective of the research: to identify changes in the microbiome of the nasal cavity in children with malignant tumors of parameningeal localization during chemoradiotherapy. Materials and methods: the study included 29 patients with parameningeal tumors, 2–17 years old. Among the included in the study there were 18 boys (62%) and 11 girls (37%). Morphologically, the following were verified: embryonic rhabdomyosarcoma (ERMS) – 17 (58%), alveolar rhabdomyosarcoma (arms) – 3 (10%), other sarcomas – 4 (13%), nasopharyngeal cancer – 5 (17%). All patients received induction chemotherapy. Simultaneous radiotherapy (LT) and chemotherapy (CT) – in 24 (82%) cases. After completing the chemoradiotherapy stage, consolidation therapy continued in 20 (70%) patients. Results: before the start of LT (after the induction stage of chemotherapy), a variety of microflora was observed in the nasal secretions, gram-positive and gram-negative bacteria were isolated in an equal ratio. The absence of growth of microorganisms was determined in 4 (13%) cases before the start of LT. Methicillin-resistant Staphylococcus epidermidis and Staphylococcus haemolyticus were more frequently detected after LT. Colonization of the nasal cavity of Candida albicans occurred before the start of LT in 4 (13%) and persisted after irradiation in 5 (17%) patients. In the delayed period, there was an increase in the percentage of patients who ridiculed gram-negative microorganisms – Pseudomonas aeruginosa in 4 (13%) cases. After 12 months, 3 (10%) patients showed a return of nosocomial flora (S. epidermidis MRSE and S. haemolyticus MRS), a decrease in colonization of P. aeruginosa and the preservation of C. albicans. Conclusion: at different stages of chemoradiotherapy, the nasal mucosa is colonized by various microorganisms that differ in their properties and pathogenicity. The continuation of this study will clarify the clinical significance of certain types of opportunistic microorganisms in the pathogenesis of inflammatory diseases of the upper respiratory tract in children with malignant tumors.