THE VALUE OF THE MICROBIAL FLORA OF THE NASAL AND OROPHARYNGEAL MUCOSA IN THE FORMATION OF CLINICAL AND IMMUNOLOGICAL FEATURES OF INFECTIOUS MONONUCLEOSIS IN CHILDREN

Abstract

Objective. The article presents the results of studies to determine the significance of the microbial flora of the nasal mucosa and oropharynx in the formation of the clinical course and immune response in children with infectious mononucleosis (IM). Materials and methods. Under the supervision were 93 children aged three to nine years, patients with mononucleosis. In 32 children (first group), Streptococcus pyogenes at concentrations of 10-5 and higher was isolated during bacteriological examination of the mucosa of the nasopharynx and oropharynx. 30 (second group) - 10-4 degrees or less. In 31 (the third group), Staphylococcus aureus, Spirochetae buccalis, E. Coli and other bacteria, except streptococcus, were sown in smears from the mucous membrane of the nasoropharynx. The immune status of patients was assessed by indicators of levels of lymphocytes CD3+, CD4+, CD8+, CD22+ and the content of interleukins 1β, 4, TNFα. Results. The acute period of the mononucleosis in children of the first group was characterized more severe symptoms of intoxication, more severe morphological changes in the tissues of the tonsils, lymph nodes, liver and spleen. Also a significant decrease in the relative amount of CD3+, CD4+, CD8+ was observed compared with the indicators of children of the second and third groups. The increase in blood CD22+ content was more significant in children of the first group. The content of pro-inflammatory IL-1β and TNF-α in patients of all groups was significantly higher than in healthy children. The IL-4 increased in children of the second and third groups. In the period of early convalescence in children of the second and third groups, the relative content of CD3+, CD4+, CD8+ cells approached the corresponding indices of the control group. This was not observed in children of the first group. CD22+ levels in all observation groups decreased by the convalescence period, but remained high compared with the control group. In children of the studied groups, by the period of reconvalescence, a decrease in the levels of IL-1β, TNF-α is noted, more significant in children of the second and third groups. At the same time, in children of the first group, the level of pro-inflammatory interleukins by the period of reconvalescence remained at high numbers. The content of IL-4 was a significant difference in the indicators of its content in comparison with the digital characteristics of healthy ones in children of the second and third groups. Conclusion. An analysis of the results of the study found that the presence of streptococcus in its high concentration on the mucosa of the nosopharynx of children with mononucleosis already contributes to the formation of cellular immunosuppression and a pronounced reaction of pro-inflammatory interleukins at the initial stage of the disease, which, in general, leads to aggravation of the clinical manifestations of the disease and, in our opinion, may be a causative factor of a possible unfavorable course of the disease.