CHANGES IN THE MICROBIOME OF THE SKIN AND PHARYNGEAL MUCOSA IN CHILDREN AND ADOLESCENTS WITH TYPE 1 DIABETES

Abstract

Background. According to the data from a World Health Organization report for 2022, the prevalence of diabetes among children under the age of 18 has increased by 21.1% over the past 5 years. Often, these patients have a number of concomitant systemic conditions, in particular diseases caused by skin or mucosa microbiome changes (usually chronic tonsillitis and pustular skin lesions) due to dysregulation of carbohydrate metabolism and increased lipid peroxidation. Therefore, the study is relevant.
 Aim: to determine the quantitative and qualitative composition of the microbiological community of the skin and throat in children with type 1 diabetes in comparison with the control group.
 Materials and methods. 20 children of the control group (CG) and patients with type 1 diabetes mellitus (DM), on insulin therapy, aged 8-17 years, were involved in the study. The skin washes and throat swabs were delivered to the laboratory within 2 hours after collection and immediately cultured on sterile nutrient mediums: Endo, YSA, blood agar and Saburo. The nature of the growth of microorganisms on the medium was evaluated and microscopy of Gram-stained micropreparations was performed after cultivation within 1-2 days in a thermostat at a temperature of 37°C. The photos of every colony on the medium were taken with further quantitative and qualitative analysis. Statistical analysis of the obtained results was conducted. Comparisons between control and patient groups were done using the Mann-Whitney U-test. A result of p<0.05 was considered statistically sufficient.
 Results. As a result of our study, St. aureus was detected on the skin in 80.0% of patients with diabetes and in 55.0% of subjects in CG. St. epidermidis was isolated in 90.0% of patients with DM and in 70.0% of cases in CG. β-hemolytic streptococci were also more frequently observed in patients with DM (60.0% and 35.0% in CG). Nonhemolytic streptococci were revealed in 40.0% of patients with diabetes and only in 10.0% of children in CG. Candida were observed in 25.0% of the cases with DM and no one in CG. The number of colony-forming units in 1 ml (CFU/ml) of all detected microorganisms was higher in patients with diabetes (p<0.05) in general.
 In addition, the microflora of the mucous membrane of the pharynx was studied. Colonization with St. aureus was more often observed in patients with DM (65.0% and 45.0% in CG). St. epidermidis were detected in 90.0% of patients with DM and 85.0% of patients with CG. Carrier of β-hemolytic streptococci was revealed in 70.0% of patients of the experimental group and 55.0% in CG. Nonhemolytic streptococci were found in all patients from the general sample. The number of CFU/ml of all above mentioned microorganisms was higher in patients with diabetes (p<0.05).
 Conclusion. Thus, our study revealed a pattern of increasing the number of pathogenic (Staphylococcus aureus, hemolytic streptococci) and opportunistic microflora (Candida) on the skin and mucous of the pharynx in children with type 1 diabetes and on insulin therapy, in comparison to the control group. However, the trend of increasing the frequency of pathogens in the study group was not statistically confirmed. An increase in the number of microorganisms in the diabetic patients can lead to various complications: purulent-septic (furunculosis, tonsillitis) and fungal diseases caused by Candida. Therefore, such children should be advised to avoid diseases of the nasopharynx, damage to the skin and, if necessary, to use antimicrobial agents.