Recurrent Respiratory Diseases Research Articles

Multidisciplinary Approach To The Problem Of Managing Children With Frequent Respiratory Infections Of The Upper Respiratory Tract: Key Results

Background. Recurrent upper respiratory diseases in children are an urgent and common issue in pediatrics. Comorbidities often lead to prolonged, complicated, or chronic course of the inflammatory process in the upper airways.Objective. The aim of the study — scientific evidence and complex technology development for the management of children with recurrent upper respiratory diseases according to implemented multidisciplinary personalized approach, complex of modern methods for diagnosing and health monitoring to achieve long-term remission.Materials and methods. The study included 115 children aged from 2 years 6 months to 17 years 11 months with recurrent upper respiratory diseases. Examination included: nasal cavity, nasopharynx and larynx endoscopy, abdomen ultrasound with aqueous-siphon test, tympanometry, and laboratory tests (total and specific IgE levels, antistreptolysin-O, microbiological study of nasopharynx and oropharynx discharge, enzyme-linked immunosorbent assay of feces on Helicobacter pylori.Results. The study has revealed high prevalence of associated allergic pathology in children with recurrent upper respiratory diseases. Allergic rhinitis was the most common (55 (48%) children). There was also a high prevalence of gastroesophageal reflux disease (GERD) (37 (32%) children). Clinical signs of GERD were revealed in patients with chronic diseases significantly more often than in children with acute ENT pathology (27 (38%) and 10 (23%) children, respectively). It confirms the role of this comorbid condition in the development and course of chronic inflammatory process of the upper airways. Obtained data analysis has shown high prevalence of allergic and gastrointestinal pathology in children with recurrent upper respiratory diseases. Diagnostic and management algorithm for patients with recurrent upper respiratory diseases as well as practical guidelines were prepared based on the study data. This algorithm will allow to implement the personalized multidisciplinary approach for the management of prior and comorbid diseases via modern informative diagnostic methods. The complex approach to timely physical examination and pathogenetic treatment will ensure control of the patient’s condition and prevent the development of chronic ENT organ pathology in children.

Colonization resistance of buccal epitheliocytes as an indicator of mucosal immune homeostatic resources in children with recurrent respiratory diseases

Of particular interest is the study of colonization resistance of the oral cavity as a physiological phenomenon that reflects the ability of the microbiota and macroorganism in cooperation to protect the ecosystem of the oral cavity from pathogens. Purpose is to evaluate the significance of indicators of colonization resistance of buccal epithelial cells as a marker of homeostatic resources of mucosal immunity in recurrent respiratory diseases in children. Material and methods. 232 (5–16 years old) children were examined, including 56 children with acute bronchitis, 73 with recurrent bronchitis, 103 with community-acquired pneumonia. The control group included 31 apparently healthy children of the same age and sex. Used: conventional paraclinical and laboratory-instrumental methods, etiological verification of viruses and bacteria, colonization index and artificial colonization of buccal epitheliocytes, antiadhesive activity of saliva. Results. 64.38% of children with recurrent bronchitis and 72.82% of children with community-acquired pneumonia were born from an aggravated pregnancy and already at 3 months had signs of acute respiratory diseases. Viral antigens were detected in 63.36% of children. An inverse relationship was found between the indicators of artificial colonization and adhesion of Candida albicans on buccal epithelial cells — the lower the values of artificial colonization, the more often pneumonia and recurrent bronchitis were recorded. A significant decrease in saliva antiadhesion was found in recurrent bronchitis and community-acquired pneumonia, significantly different not only from the control, but also from patients with acute bronchitis. This contingent of patients finds itself in extremely unfavorable conditions due to the disruption of the adaptive reserves of the mucosal defense of the body. Conclusion. A decrease in the index of colonization, antiadhesive activity of saliva against the background of increasing parameters of artificial colonization in children with recurrent bronchitis and community-acquired pneumonia indicate deep dysbiosis. The high significance of screening approaches in assessing the homeostatic resources of mucosal protection of the oral cavity in children with bronchopulmonary pathology has been proven.

Семейный случай наследуемой хромосомной интеграции ВГЧ-6А с проведением филогенетического анализа

The paper reports a familial case of HHV-6A chromosomal integration being an important and relevant issue of genetics and medicine. The study was aimed to test the hypothesis of HHV-6A chromosomal integration and vertical transmission in patient with persistent virus detection during recurrent respiratory diseases and the asymptomatic period when there were no health complaints. Sequencing of the patient’s father genome DNA was performed, and a phylogenetic tree was constructed by aligning 270 HHV-6A/B genome assemblies from the GenBank database. As a result, a familial case of ciHHV-6A transmission was identified. It was found that the detected ciHHV-6A observed on the phylogenetic tree was closely related to other two chromosomally integrated HHV-6A sequences reported by Moscow researchers. The study confirmed HHV-6A chromosomal integration. Further precise chromosome mapping of ciHHV-6A would be useful in terms of excluding probable somatic disorders associated with the chromosome structure alteration following HHV-6, particularly HHV-6A, integration, as well as for identification of insertion sites specific for various geographic locations.

The effect of vitamin D supplementation on the frequency and course of recurrent respiratory diseases in children

Background. Recurrent and prolonged course of respiratory infections leads to the formation of chronic foci of inflammation, the persistence of viruses, impaired physical and psychomotor development, and a decrease in the child’s immunity. Given the participation of vitamin D (VD) in the regulation of the body’s immune response, the study of its role in the development and course of recurrent respiratory diseases in children remains re­levant. The purpose is to study the effect of vitamin D supplementation on the frequency and course of recurrent respiratory diseases in children. Materials and methods. We examined 52 children with recurrent respiratory infections aged 4 to 10 years. Children were examined before and after VD supplementation according to the study criteria: the average frequency of acute respiratory infection (ARI) episodes per year, the severity of the clinical manifestations of ARI episode, its average duration, the frequency of antibiotic prescriptions and outpatient visits to the doctor. Results. It was found that at the beginning of the exa­mination, the level of 25(OH)D in the blood serum ranged from 11.1 to 29.9 ng/ml, 22 (42.3 %) children had VD deficiency. An analysis of the frequency of ARI episodes per year showed that children with VD deficiency were ill more often than children with a sufficient level of VD (p < 0.001). According to the results of the study, it was found that VD supplementation contributes to a decrease in the frequency of ARI episodes from 8.7 ± 1.7 to 6.8 ± 1.2 times a year (p < 0.001), a decrease in the average number of symptoms of an episode of acute respiratory infections per year from 5.5 ± 0.5 to 4.5 ± 0.5 and their manifestations from 9.2 to 7.41 points (p < 0.001), a decrease in the duration of ARI episode from 6.0 ± 1.7 to 5.7 ± 1.5 days (p = 0.003), as well as a decrease in the number of outpatient visits from 5 to 4 (p = 0.004) and antibiotic prescriptions from 61 to 38 (p < 0.001). Conclusions. VD supplementation improves the course of respiratory diseases in children. The study was carried out in accordance with the Declaration of Helsinki principles. The study protocol was adopted by the ethics committee of the institution indicated in the work. The informed consent of the children’s parents was obtained.

Gastroesophageal reflux in children with recurrent and chronic respiratory diseases: non-acid or acid?

In some cases, gastroesophageal reflux (GER) may be accompanied by duodenogastric reflux, forming non-acid reflux, which has a certain influence on the clinical presentation and the response to anti-reflux therapy. The study aimed to determine the role of non-acid reflux in children with recurrent and chronic respiratory diseases (RCRD). All children with RCRD, for unknown reason, poorly responding to respiratory-specific therapy, hospitalized for gastroesophageal reflux disease (GERD) screening, using dual pH-multichannel intraluminal impedance (pH-MII). The study was conducted in 42 children at the age Me – 2.75; IQR 1.08-9.42. The most common type of reflux was weakly acid reflux - 62.25 [36.425-121.225], then acid - 34.05 [12.875-71.65], alkaline - 1.75 [0 - 12.375] episodes per day (p <0.05). Non-acid reflux was more common in children with only respiratory symptoms - no esophageal manifestations of GERD. All types of refluxes were more often recorded in the upright compared to the supine position. In 70% patients, cough could be associated with reflux, while in 88% children reflux was non-acid (including 69% - weakly acid, 19% - alkaline), in 38% - acid. Non-acid reflux is the main type of GER in children with RCRD refractory to standard therapy, which could be associated with cough in this patient population.

Multidisciplinary Approach to Recurrent Upper Respiratory Tract Diseases in Children. Intermediate Study Results

The issue of recurrent upper respiratory tract diseases in children is common and relevant. Commonly this pathology is associated with other diseases that lead to the prolonged, complicated, or chronic course of the inflammatory process in the upper respiratory tract. Objective. The aim of the study is to improve management principles for children with recurrent upper respiratory tract diseases according to the developed multidisciplinary and personalized approach (modern methods of diagnosis and health monitoring) for achieving long-term remission. Methods. The study included 65 children aged from 3 to 17 years 11 months with recurrent upper respiratory tract diseases. Examination: nasal, nasopharynx and larynx endoscopy, abdominal ultrasound with aqueous-siphon test, tympanometry, and laboratory tests (complete blood count, evaluation of total and specific IgE levels, antistreptolysin O, nasopharynx and oropharynx microbiological study, enzyme-linked immunosorbent fecal analysis for Helicobacter pylori). Results. 88% of examined children showed allergic pathology according to our study results. Clinical signs of gastroesophageal reflux disease (GERD) were revealed in 30% of children with chronic oropharynx inflammation. GERD signs were revealed both via abdominal ultrasound with aqueous-siphon test and via fiberoptic laryngoscopy and later confirmed by esophagogastroscopy in 8.7% of patients. Obtained data indicates high prevalence of allergic and gastroenterological pathology in children with recurrent upper respiratory tract diseases. Conclusion. Obtained results allow us to establish scientifically multidisciplinary and personalized approach for the management of children with recurrent upper respiratory tract disease. This approach shall include key diagnostic methods required for improvement of comorbid conditions revealing, and achieving and maintaining control over the disease symptoms. The study is currently ongoing.

SPECIFIC FEATURES OF THE ORAL MICROBIOME IN YOUNG CHILDREN WITH ARYNGOPHARYNGEAL REFLUX AND ITS ROLE THE DEVELOPMENT OF RECURRENT RESPIRATORY DISEASES.

The aim: To examine the composition of the oral microbiome in young children with laryngopharyngeal reflux (LPR) and its role the development of recurrent respiratory diseases. Materials and methods: There were examined 38 children with physiological gastroesophageal reflux (GER), 18 children with LPR who had a medical history of recurrent bronchitis and 17 healthy children (control group). The study included the collection of anamnesis, objective examination. The qualitative and quantitative microbial composition of the upper respiratory tract was performed obtained by oropharyngeal deep swab. Salivary pepsin level and IL-8 were determined by enzyme-linked immunosorbent assay. Results: This research showed significant alterations in the oral microbiome of patients with GER and LPR as compared to healthy control. We found that gram-negative microbiota such as Klebsiella pneumoniae, Escherichia coli, Proteus vulgaris, Proteus spp. and Candida albicans were identified in children with GER and LPR compared to the healthy control. At the same time, the amount of such a representative of the normal microbiome as Streptococcus viridans in children with LPR was sharply reduced. There were established a much higher mean salivary pepsin level of the patients with LPR than in the GER and control group. We found the association between high pepsin levels, saliva IL-8 levels and frequency of respiratory pathology in children with LPR. Conclusions: Our study confirms that increased levels of pepsin in saliva are a risk factor for recurrent respiratory diseases in children with LPR.

Клинико-микробиологическая характеристика течения респираторных инфекций у детей с различным прививочным анамнезом

Objective. To determine the clinical and microbiological features of the duration of respiratory infections in children with different vaccination history. Patients and methods. Children (106 people) with inflammatory diseases of the respiratory tract were examined, 64 of them were vaccinated in accordance, 42 people were vaccinated with deviations from the National schedule of vaccinations. The oropharyngeal discharge and saliva were examined in PCR to detect RNA and DNA of viral and bacterial pathogens. We used test systems produced by the Federal State Budgetary Institution of Rospotrebnadzor and “Vector-Best”. Results. It was found that the number of children with recurrent respiratory tract infections among vaccinated with deviations from the vaccination schedule and unvaccinated (59.5 ± 7.6%) is 2 times higher (p ≤ 0.01) than among vaccinated (28.1 ± 5.6%). No concomitant clinical syndromes were detected in 68.8 ± 5.8% of vaccinated children, which significantly (p ≤ 0.001) differed from a similar indicator (35.7 ± 7.4%) in children with impaired vaccination schedule and unvaccinated. Differences in the frequency of occurrence of pathogen genomes were found among pathogens of viral infections only with respect to representatives of the Herpesviridae, whose DNA was more often detected in children with the disrupted vaccination schedule and unvaccinated (p < 0.05). DNA of methicillin-resistant coagulase-negative Staphylococcus spp. more often (p < 0.05) was detected in children with violations of the vaccination schedule and unvaccinated (30.1 ± 7.0%), and more often in association with herpesviruses. Conclusion. The presented data indicate an important stimulating effect on the children's body of vaccines included in the National schedule of Vaccinations. This indicates the need for vaccination of children, especially with recurrent respiratory diseases and an unfavorable premorbid background. Key words: viral and bacterial pathogens, children, vaccination history, respiratory infections

Prediction of recurrent course of respiratory infections in premature infants

The problem of prevention of frequent respiratory diseases for children remains relevant. Among premature infants, the most vulnerable group are children with very low and extremely low birth weight. Therefore, the development of a clinical prognostic model for the development of respiratory recurrent infections in premature infants may be the basis for creating a preventive program of early intervention. Purpose - to determine the clinical and genetic determinants of the development of recurrent respiratory infections for children born with a body weight less than 1500 g and to develop an algorithm for early prediction of adverse effects. Materials and methods. A cohort prospective study was conducted, which involved 155 children with very low and extremely low body weight. Prediction of the development of recurrent respiratory diseases was performed using simple and step-by-step multiple logistic regression analysis. Genetic methods included polymorphism studies of the GSTP1, GSTT1, GSTM1, ACE, AGT2R1 and eNOS genes. Results. Important predictors of increased morbidity of the examined children in a simple logistic regression analysis were: body weight at 12 months <10 percentile, rickets in the first year of life and artificial feeding at discharge from the neonatal hospital. The study showed no effect of genes polymorphism of the glutathione-S-transferase family and genes of the renin-angiotensin system on the development of recurrent respiratory infections in children with born weight less than 1500 g. Conclusions. The developed model for predicting the recurrent course of respiratory infections for children born with a body weight less than 1500 g has a high specificity (95.35%) and moderate sensitivity (76.90%), which indicates the possibility of its use for a personalized approach to prevention adverse effects. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Figurate erythemas and herpetic infection in children

Herpetic infections are distinguished by a diverse clinical picture — this is primarily the so-called «recurrent respiratory diseases» or a recurrent variant of a chronic infectious process in the form of a so-called «mononucleosis-like syndrome,» characteristic of almost every «herpetic nosology,» persistent subfebrile condition, and febrile condition. Often, against the background of herpetic infections, various kinds of exanthems manifest, and this is not only a vesicular rash during infection with the herpes simplex virus. In practice, pediatricians often have to deal with other types of exanthems, one way or another associated with herpes infections. The article discusses 2 clinical observations of relatively unusual manifestations of chronic herpetic infections accompanied by erythema in patients aged 16 years. Photo documents of the dynamics of the skin process and laboratory parameters against the background of antiviral therapy are presented.

Experience in the phytotherapy use for rehabilitation of adolescents with recurrent respiratory diseases

Introduction. The state of modern Russian adolescents health is characterized by negative trends such as high level of morbidity, largely due to recurrent acute respiratory diseases (ARI). Recurrent acute respiratory infections negatively affect the health of adolescents, contributing to the development of chronic infection foci, having a negative impact on their physical development and psychoemotional status. Many approaches have been proposed for the rehabilitation of adolescents with recurrent acute respiratory infections, but in recent years phytotherapy has attracted the attention of researchers.Aim. The study is to analyze the experience of using phytotherapy in the rehabilitation of adolescents with recurrent respiratory diseases.Materials and methods. 124 adolescents aged 13–18 years with recurrent acute respiratory infections were examined. The control group consisted of 50 conditionally healthy adolescents. The artificial colonization of buccal epithelial cells, anti-adhesive activity of saliva and level of psychic adaptation were determined. In addition to the generally accepted measures, the herbal medicine was included in the rehabilitation complex for 51 adolescents. Statistical processing of the obtained data was carried out using the SPSS 12.0 program.Results. A decrease in oral mucosa adaptive stability in adolescents with recurrent respiratory diseases during the period of clinical well-being was found – such as decrease of anti-adhesive activity of saliva, increase artificial colonization of buccal epithelial cells index. The prevalence of persons with psychic desadaptation among adolescents with recurrent acute respiratory infections was revealed. The positive clinical effect of the herbal medicine in improving the health of adolescents with recurrent respiratory infections, manifested by the end of the course of therapy by an increase in the adaptive resistance of the oral mucosa in the most of patients, and at the follow-up period of 6 months – an increase in the immune resistance and psychic adaptation.Conclusions. The use of herbal medicine effectively restores the reserves of oral cavity mucosal protection, psychic adaptation and reduces the number of acute respiratory infections. The drug has good tolerability and can be recommended for use in a complex of recreational activities for adolescents with recurrent respiratory diseases.

The role of the palatine tonsils in the regulation of the state of humoral local immunity in patients with chronic inflammatory diseases of the nose and perinasal sinuses when infected with viruses of the respiratory group

Topicality: Acute respiratory diseases of the upper respiratory tract, which in the vast majority of cases are caused by viruses, especially with frequent recurrences of diseases, reduce local and system immunity, which often leads to the accumulation of bacterial infection due to the activation of endogenous microflora or exogenous infection and causes the development of viral-bacterial diseases. Recurrent respiratory diseases contribute to the formation of chronic pathology of the oro- and nasopharynx, which in turn supports the violation of the body's protective mechanisms. Previous studies have shown that the tonsils of the lymphadenoid pharyngeal ring perform the function of immunological protection, and the absence of palatine tonsils (PT) negatively affects the state of both local and system immunity. Aim: to determine the role of the palatine tonsils in the realization of local humoral reactions in patients with chronic inflammatory diseases of nose and paranasal sinuses when infected with viruses of the respiratory group. Materials and methods: Studies were conducted in 134 patients with chronic inflammatory diseases (CID) of nose and paranasal sinuses (PNS) in remission, among whom 93 had a diagnosis of chronic rhinosinusitis, 27 – chronic catarrhal rhinitis, 14 – allergic rhinitis with chronic bronchitis. The control group consisted of 47 practically healthy persons without pathology from the ENT organs. The examined persons were divided into those who had PT and those from whom they were surgically removed no earlier than five years ago. All examinees were divided into those who had anamnestic antibodies in their blood to one or more of the respiratory viruses, such as: adenovirus, respiratory syncytial virus and influenza A virus in a clinically significant titer, and those in whom antibodies were not detected. The local humoral immunity state of patients was assessed by the content of immune complexes (IC) and concentrations of secretory immunoglobulin A (sIgA), interferons alpha- (α-IFN) and gamma- (γ-IFN) in the oropharyngeal secretion (OS), which were determined by the immunoenzymatic method using sets of reagents for enzyme-linked immunosorbent assays ("Cytokin", RF) and the Stat Fax-2100 analyzer (USA). All examined patients had a healthy state of the oral cavity. Results: The presence or absence of palatine tonsils changes the levels of number of humoral factors of local immunity in oropharyngeal secretion in practically healthy donors and in patients with chronic inflammatory diseases of the nose and PNS. The production of sIgA and α-IFN in OS depends on PM, decreasing in practically healthy persons of the control group who underwent tonsillectomy. Chronic inflammatory diseases of the nose and PNS caused a decrease in the concentration of IC and α-IFN in the OS of patients of both groups- with or without PT. In patients with normal PMs who got sick with viral infections, in contrast to those with removed PMs, α-IFN level in OS increased and practically did not differ from those in healthy donors. The greatest suppression of α-IFN production was determined in patients with CID of the nose and PNS with removed PM and with the absence of clinically significant titers of antiviral antibodies. The level of γ-IFN production did not reliably change in the OS of patients with CID of nose and PNS in the remission phase both with normal PT and after tonsillectomy, but depended to a greater extent on the transferred infectious disease caused by viruses of the respiratory group. Conclusion: PTs play a significant role in the formation of a number of reactions of local immunity in the naso- and oropharynx, both in practically healthy individuals and in patients with chronic inflammatory disease of nose and paranasal sinuses. Therefore, the determination of local immunity indices in patients with chronic inflammatory diseases of the upper respiratory tract with different status of the palatine tonsils, who are in contact or had contact with respiratory viruses, provides an opportunity to identify the most vulnerable links in the system of their anti-infective protection, which should first of all be paid attention to during examination and treatment of patients with chronic inflammatory diseases of the upper respiratory tract, especially in cases of frequent recurrence of acute respiratory diseases.

КРИТЕРИИ ПРОГНОЗИРОВАНИЯ РИСКА РАЗВИТИЯ ЗАБОЛЕВАНИЙ С ЛИМФОПРОЛИФЕРАТИВНЫМ СИНДРОМОМ У ДЕТЕЙ

336 children with lymphoproliferative syndrome were examined to determine and develop criteria for predicting the risk of developing the primary form of Epstein-Barr viral infection, recurrent respiratory diseases, adenovirus infection.
 On the basis of the obtained results, criteria were developed for predicting individual risk of developing diseases with lymphoproliferative syndrome, the main parameters of which were significant risk factors revealed during the study. The method of prediction of risk and early diagnostics of diseases with lymphoproliferative syndrome convenient in use to pediatricians, infectologists and specialists of medical institutions, which allows to isolate children with high risk of developing lymphoproliferative syndrome and to diagnose in a timely manner the primary form of Epstein-Barr viral infection, recurrent respiratory diseases, adenovirus infection tonsillary form.

Candida albicans adhesion on buccal epitheliocytes as an indicator of microbiota homeostatic balance in children with chronic gastroduodenitis

Background. Recently, the incidence of mycoses in patients with a gastroenterological profile has grown due to an increase in the intensity of the impact on the human body of external factors that cause disturbances in the antimycotic defense system.
 Aim. To study the adhesion of Candida albicans on buccal epitheliocytes in children with chronic gastroduodenitis.
 Material and methods. 96 children (mean age 12.431.24 years) with recurrent respiratory diseases with morphologically proven chronic gastroduodenitis associated with Helicobacter pylori were examined. The adhesion of Candida, contamination of buccal epithelial cells with bacteria were studied. All children underwent paraclinical studies, instrumental methods of research, consultations of specialists were also prescribed. In the study of the adhesive reaction of C. albicans on buccal epitheliocytes, a Candida strain from the collection of the Federal Budgetary Institution of Science Nizhny Novgorod Research Institute of Hygiene and Occupational Pathology was used. 100 epitheliocytes were studied, the result was evaluated by the number of Candida in terms of 1 epitheliocyte. Registration of artificial colonization of buccal epithelial cells was carried out according to the method of D. Goldman and E. Goetzl (2003) modified by A.N. Mayansky. The children were divided into 2 groups: the main one the detected growth of C. albicans over 1000 CFU/g, and the comparative one the absence of excess growth of C. albicans. Statistical processing included the determination of the correlation coefficient, the arithmetic mean (M) and its standard error (m), differences in indicators according to Student's criteria (the level at p 0.05 was considered statistically significant).
 Results. Harmonious proportional development was observed in 55.21% of children, microbiota imbalance was noted: bloating and rumbling along the colon, (p=0.0087), unstable stool (p=0.0241) and constipation (p=0.6092). The spectrum of comorbid pathology revealed the presence of allergic diseases (p=0.0048), up to 10 episodes of acute respiratory viral infection (p=0.1702), more than 10 episodes of acute respiratory viral infection (p=0.0105), adenoid vegetations (p=0.531), chronic pyelonephritis in the stage of clinical and laboratory remission (p=0.0216). Assessment of the intestinal microbial landscape showed a significant decrease in the content of bifidobacteria in the main group (p=0.0482), and lactobacilli were comparable in both groups (p=0.0839). In the comparison group, in 88.63% of cases, the indices of adhesion of C. albicans on buccal epitheliocytes were 6.370.46, in the main group 11.860.74 (p=0.0362). A direct relationship between the parameters of artificial colonization of buccal epitheliocytes and the degree of microbiological changes in the intestine was found (r=0.58, p=0.0097).
 Conclusion. The study of adhesion of Candida albicans on buccal epitheliocytes in children with chronic gastroduodenitis revealed a unidirectional shift in the quantitative content of the obligate oral and intestinal microbiota, which can be used as a screening for the homeostatic balance of the microbiota.

Role of esophageal symptoms in the diagnosis of gastroesophageal reflux disease in children with recurrent and chronic respiratory diseases

Gastroesophageal reflux disease (GERD) is one of comorbid diseases, that worsen the course and outcomes of respiratory pathology. The study aimed to determine role of esophageal symptoms in the diagnosis of GERD in children with recurrent and chronic respiratory diseases (RCRD). The study included 125 children (70 boys, 55 girls), median 3,75 years (interquartile range, IQR – 1,21-9,38 years), with RCRD, refractory to standard therapy. GERD was diagnosed on the basis of clinical and complex instrumental examination, including fluoroscopy esophagus with contrast, esophagogastroduodenoscopy (EGDS), 24-hour esophageal pH-monitoring, dual pH-multichannel intraluminal impedance (pH-MII). In children with RCRD, the frequency of GERD was 86,4%. Among children without esophageal manifestations of GERD, pathological reflux was confirmed by instrumental methods in 81% of patients; in children with esophageal manifestations - 92%, with no statistically significant differences (p = 0,0637). Nonacid reflux is more common in patients without esophageal manifestations of GERD. The frequency of GERD in children with RCRD is very high. It is possible to screen GERD in children with RCRD, independent on the presence of clinical esophageal symptoms.

Delayed diagnosis of foreign body aspiration in children

AimsTo assess the diagnostic and therapeutic difficulties as well as the long-term complications of prolonged endobronchial foreign body retention. MethodBetween January 2000 and May 2021, 794 patients with suspected foreign body aspiration (FBA) were hospitalized in our department. A total of 12 patients with a delayed diagnosis of over 1 month were included. FBAs were confirmed by flexible or rigid endoscopy. A retrospective analysis of medical records was performed. ResultsSix male patients and six female patients were hospitalized due to prolonged FBA. The average age was 6.90 years (range: 1–13 years). The average duration of the foreign body retention was 2.60 years (2 months to 9 years). A choking event was found in eight cases. Coughing and wheezing were the main symptoms and signs. A misdiagnosis of asthma was made for five patients. Two atypical clinical presentations led to diagnosis of endobronchial foreign body, unilateral pleurisy, and hemoptysis. We report one case of an occult foreign body externalized spontaneously through a pneumo-pleuro-cutaneous fistula. The most common clinical and radiological findings were of pneumonia and atelectasis. Computed tomography showed localized bronchiectasis in three patients. FBAs were removed with a rigid bronchoscope in eight cases. Other extractions were carried out with a flexible endoscope. The foreign bodies were most frequently of vegetable origin, such as seeds and peanuts. A granulation tissue was observed in seven cases. Bronchial stenosis and bronchiectasis are the most common late complications. Only one patient needed a surgical intervention. ConclusionsFBA should always be considered in the differential diagnosis of chronic or recurrent respiratory diseases, even in the absence of a previous choking event. Clinical and radiological findings should be carefully evaluated for a possible FBA. Delay in diagnosis and treatment of FBA should be avoided in order to prevent complications. Open surgery may be required when lung abscess has occurred.

Клінічний образ дитини, що часто хворіє (новий погляд на походження, діагностику та лікування). Повідомлення 2. Діагноз та лікування

Мета: визначення клінічного образу дітей, що часто хворіють (ДЧХ), з урахуванням існуючих відомих даних медичної літератури та спостережень авторів, накопичених за останні 25 років клінічної практики. Матеріали та методи. Дизайн дослідження був клініко-діагностичним і включав пошук способів діагностики та лікування таких патологічних станів, які становили сучасний клінічний образ дітей, що часто хворіють. Дослідження мали проспективно-ретроспективний характер, були лонгітудинальними, з тривалим періодичним спостереженням за певною частиною одних і тих же пацієнтів упродовж 1–10 років після встановлення у них діагнозу «дитина, що часто хворіє» та проведення відповідного лікування. Щодо ефективності отриманих результатів, то дослідження мали прямий характер, тому що беззаперечно сприяли одужанню дитини з поліпшенням/нормалізацією її загального стану та якості життя. Дослідження були багатоцентровими, проведені в амбулаторних умовах на базі двох спеціалізованих у галузі хронічних інфекційних захворювань клінік із повним обсягом лабораторних досліджень та кафедри дитячих інфекційних хвороб медичного університету. Учасниками дослідження були діти від грудного віку до 14 років, батьки яких упродовж 2009–2020 років зверталися за консультацією зі скаргами на часті захворювання своїх дітей. Результати. Під наглядом авторів у 2010–2020 роках перебували 3547 дітей, що часто хворіли (6–12 епізодів на рік та нерідко навіть більше — 1–2 захворювання на місяць), а період кожного епізоду їхньої недуги тривав понад 5–7 діб. Дітей віком до 3 років було 862/3547 (24,3 %), від 3 до 7 років — 1295/3547 (36,5 %), від 7 до 14 років — 1390/3547 (39,2 %). З урахуванням клінічно домінуючих симптомів, які часто спліталися між собою в одну цілісну картину цих частих захворювань, дітей розподілили на дві великі групи спостережень. До I групи, яку умовно називали «Клінічний образ ДЧХ із гнійно-запальними захворюваннями», увійшли 1595/3547 (45 %) дітей. Інших 1952/3547 (55 %) дітей було включено до II групи з умовною назвою «Клінічний образ ДЧХ із домінуючими токсичними проявами». Також до ІІ групи дітей, що часто хворіють, увійшли діти з підвищеною температурою, не пов’язаною з гострими гнійно-запальними станами чи їх рецидивами. У цій групі під наглядом перебували 1952/3547 (55 %) дітей від грудного віку до 14 років із порушеннями температурного режиму, зокрема із затяжним субфебрилітетом — 1206/1952 (61,8 %), фебрильними атаками — 721/1952 (36,9 %) та 25/1952 (1,3 %) дітей переважно шкільного віку з фебрильною лихоманкою на рівні 38–40 °С і вище упродовж від декількох місяців до 4 років та іншими симптомами синдрому хронічної бактеріальної інтоксикації. Усі діти були обстежені бактеріологічно (бакпосіви з носа, глотки, рота тощо, а також із теплої сечі тричі, три дні поспіль), токсикологічно з використанням діагностичної системи «Токсикон»; проведено загальноклінічні обстеження, імуноферментний аналіз та полімеразну ланцюгову реакцію, визначення імунологічного статусу, за показаннями — інструментальне обстеження. Встановлено, що в усіх ДЧХ були наявні два вогнища хронічної бактеріальної інфекції: у носоглотці, що у 3467/3547, або 97,7 % дітей було пов’язано з Staphylococcus aureus, та у нирках (нефродисбактеріоз), у якому домінували ентерококи та кишкова паличка, що становили майже 2/3 (у 3312/5313, або 63 %) від усіх ізольованих штамів уринокультур та були виділені з сечі загалом у 3312/3547 (93,4 %) дітей. На підставі токсикологічного дослідження крові у переважної більшості дітей (77/96, або 80,2 %) була виявлена токсемія тяжкого ступеня, у 16/96 (16,7 %) — середньої тяжкості та у 3/96 (3,1 %) — легкого ступеня. Форма інтоксикації була здебільшого компенсованою у 87/96 (90,6 %) хворих, ще у 9/96 (9,4 %) — у стадії генералізації. При визначенні імунного статусу, який дослідили у 2160/3547 (60,1 %) ДЧХ від грудного віку до 14 років обох груп спостереження, встановлено, що показники клітинного та гуморального імунітету зазвичай були або в межах норми, або навіть частіше перевищували норму. Тільки у 67/2160 (3,1 %) дітей було виявлено незначну клітинну імунну недостатність, а у 7/2160 (0,3 %) дітей — селективну гіпогаммаглобулінемію IgA. Лікування всіх 3547 ДЧХ обох груп спостереження проводили з використанням бактеріальних автовакцин, виготовлених з ізольованих при бактеріологічному обстеженні штамів. Дітей, що пройшли лікування, наслідки якого можна вважати встановленими і не пов’язаними з супутнім прийомом антибактеріальних препаратів, було 3159/3547, або 89,1 %. Загалом 3093/3159, або 97,9 % дітей, що часто хворіли, повністю одужали упродовж 6–24 місяців від початку лікування бактеріальними автовакцинами без використання антибіотиків. Висновки. Клінічний образ дитини, що часто хворіє, наразі є збірним і складається з симптомів рекурентних респіраторних захворювань або повторних гострих респіраторних вірусних інфекцій, рецидивуючих гнійно-запальних захворювань носа, глотки, рота, вух, очей та бронхолегеневої системи, а також клінічних проявів синдрому хронічної бактеріальної інтоксикації, що розвинувся на тлі нефродисбактеріозу. Етіологічний і патогенетичний діагноз підтверджують результати бактеріологічного та токсикологічного обстеження. Стандартне лікування ДЧХ із використанням антибіотиків не є ефективним. Позитивний клінічний ефект вдається досягти у 97,9 % дітей з повним одужанням після використання бактеріальних автовакцин, виготовлених з ізольованих при бактеріологічному обстеженні штамів.

The systemic pro- and antioxidant processes in preschool children with recurrent acute respiratory diseases

Background. The imbalance of innate defense early mechanisms in children from pathogens — peroxidation and antioxidant system, can lead to a decrease in the efficiency of the entire immune system. The study of the lipid peroxidation (LPO) and antioxidant protection (AOP) status in children with recurrent acute respiratory diseases will complement the scientific data on the antimicrobial immunity formation processes. The study was aimed to increase the information value of timely detected pro- and antioxidant processes disorders in children with recurrent acute respiratory diseases by studying the primary, secondary, tertiary, and quaternary compounds of LPO and AOP in the serum. Materials and methods. Sixty children aged from 2 to 5 years were examined. Two groups were formed: group 1 — children with respiratory acute infectious more than six times per year (n = 30); group 2 — children with respiratory acute infectious six or fewer times per year (n = 30). Results. The children in group 1 more often presented with high serum levels of lipid hydroperoxides (by 80.0 %; p < 0.05), diene conjugates (by 80.0 %; p < 0.05), malonic dialdehyde (76.7 %; p < 0.05), diene ketones (76.7 %; p < 0.05), Schiff bases (76.7 %; p < 0.05). ceruloplasmin (80.0 %; p < 0.05), superoxide dismutase (80.0 %; p < 0.05), glutathione peroxidase (86.7 %; p < 0.05), catalase activity (86.7 %; p < 0.05). The values of retinol, tocopherol, ascorbic acid in children in the observation groups did not differ statistically significantly. Conclusions. The children aged from 2 to 5 years old with recurrent acute respiratory diseases have an imbalance of the LPO and AOP systems. It was characterized by a simultaneous increase in the serum content of the primary, secondary, and end-products of LPO, enzymes of anti-peroxide and anti-oxygen protection against the background of the lack of adaptive increase in the content of anti-radical compounds.

Клінічний образ дитини, що часто хворіє (новий погляд на походження, діагностику та лікування). Повідомлення 1. Походження та клініка

Мета: визначення клінічного образу дітей, що часто хворіють (ДЧХ), з урахуванням існуючих відомих даних медичної літератури та спостережень авторів, накопичених за останні 25 років клінічної практики. Матеріали та методи. Дизайн дослідження був клініко-діагностичним і включав пошук способів діагностики та лікування таких патологічних станів, які становили сучасний клінічний образ дітей, що часто хворіють. Дослідження мали проспективно-ретроспективний характер, були лонгітудинальними, з тривалим періодичним спостереженням за певною частиною одних і тих же пацієнтів упродовж 1–10 років після встановлення у них діагнозу «дитина, що часто хворіє» та проведення відповідного лікування. Щодо ефективності отриманих результатів, то дослідження мали прямий характер, тому що беззаперечно сприяли одужанню дитини з поліпшенням/нормалізацією її загального стану та якості життя. Дослідження були багатоцентровими, проведені в амбулаторних умовах на базі двох спеціалізованих у галузі хронічних інфекційних захворювань клінік із повним обсягом лабораторних досліджень та кафедри дитячих інфекційних хвороб медичного університету. Учасниками дослідження були діти від грудного віку до 14 років, батьки яких упродовж 2009–2020 років зверталися за консультацією зі скаргами на часті захворювання своїх дітей. Результати. Під наглядом авторів у 2010–2020 роках перебували 3547 дітей, що часто хворіли (6–12 епізодів на рік та нерідко навіть більше — 1–2 захворювання на місяць), а період кожного епізоду їхньої недуги тривав понад 5–7 діб. Дітей віком до 3 років було 862/3547 (24,3 %), від 3 до 7 років — 1295/3547 (36,5 %), від 7 до 14 років — 1390/3547 (39,2 %). З урахуванням клінічно домінуючих симптомів, які часто спліталися між собою в одну цілісну картину цих частих захворювань, дітей розподілили на дві великі групи спостережень. До I групи, яку умовно називали «Клінічний образ ДЧХ із гнійно-запальними захворюваннями», увійшли 1595/3547 (45 %) дітей. Інших 1952/3547 (55 %) дітей було включено до II групи з умовною назвою «Клінічний образ ДЧХ із домінуючими токсичними проявами». Також до ІІ групи дітей, що часто хворіють, увійшли діти з підвищеною температурою, не пов’язаною з гострими гнійно-запальними станами чи їх рецидивами. У цій групі під наглядом перебували 1952/3547 (55 %) дітей від грудного віку до 14 років із порушеннями температурного режиму, зокрема із затяжним субфебрилітетом — 1206/1952 (61,8 %), фебрильними атаками — 721/1952 (36,9 %) та 25/1952 (1,3 %) дітей переважно шкільного віку з фебрильною лихоманкою на рівні 38–40 °С і вище упродовж від декількох місяців до 4 років та іншими симптомами синдрому хронічної бактеріальної інтоксикації. Усі діти були обстежені бактеріологічно (бакпосіви з носа, глотки, рота тощо, а також із теплої сечі тричі, три дні поспіль), токсикологічно з використанням діагностичної системи «Токсикон»; проведено загальноклінічні обстеження, імуноферментний аналіз та полімеразну ланцюгову реакцію, визначення імунологічного статусу, за показаннями — інструментальне обстеження. Встановлено, що в усіх ДЧХ були наявні два вогнища хронічної бактеріальної інфекції: у носоглотці, що у 3467/3547, або 97,7 % дітей було пов’язано з Staphylococcus aureus, та у нирках (нефродисбактеріоз), у якому домінували ентерококи та кишкова паличка, що становили майже 2/3 (у 3312/5313, або 63 %) від усіх ізольованих штамів уринокультур та були виділені з сечі загалом у 3312/3547 (93,4 %) дітей. На підставі токсикологічного дослідження крові у переважної більшості дітей (77/96, або 80,2 %) була виявлена токсемія тяжкого ступеня, у 16/96 (16,7 %) — середньої тяжкості та у 3/96 (3,1 %) — легкого ступеня. Форма інтоксикації була здебільшого компенсованою у 87/96 (90,6 %) хворих, ще у 9/96 (9,4 %) — у стадії генералізації. При визначенні імунного статусу, який дослідили у 2160/3547 (60,1 %) ДЧХ від грудного віку до 14 років обох груп спостереження, встановлено, що показники клітинного та гуморального імунітету зазвичай були або у межах норми, або навіть частіше перевищували норму. Тільки у 67/2160 (3,1 %) дітей було виявлено незначну клітинну імунну недостатність, а у 7/2160 (0,3 %) дітей — селективну гіпогаммаглобулінемію IgA. Лікування всіх 3547 ДЧХ обох груп спостереження проводили з використанням бактеріальних автовакцин, виготовлених з ізольованих при бактеріологічному обстеженні штамів. -Дітей, що пройшли лікування, наслідки якого можна вважати встановленими і не пов’язаними із супутнім прийомом антибактеріальних препаратів, було 3159/3547 або 89,1 %. Загалом 3093/3159, або 97,9 % дітей, що часто хворіли, повністю одужали упродовж 6–24 місяців від початку лікування бактеріальними автовакцинами без використання антибіотиків. Висновки. Клінічний образ дитини, що часто хворіє, наразі є збірним і складається з симптомів рекурентних респіраторних захворювань або повторних гострих респіраторних вірусних інфекцій, рецидивуючих гнійно-запальних захворювань носа, глотки, рота, вух, очей та бронхолегеневої системи, а також клінічних проявів синдрому хронічної бактеріальної інтоксикації, що розвинувся на тлі нефродисбактеріозу. Етіологічний і патогенетичний діагноз підтверджують результати бактеріологічного та токсикологічного обстеження. Стандартне лікування ДЧХ з використанням антибіотиків не є ефективним. Позитивний клінічний ефект вдається досягнути у 97,9 % дітей з повним одужанням після використання бактеріальних автовакцин, виготовлених з ізольованих при бактеріологічному обстеженні штамів.

CHARACTERISTICS OF VIRAL ANTIGENS AND MICROBIAL SPECTRUM OF UPPER AND LOWER RESPIRATORY TRACT IN INFANTS WITH BRONCHITIS

Introduction. The difficulty in diagnosing different clinical forms of bronchitis is due to the fact that their clinical manifestations have a number of similar symptoms, despite the fact that these diseases may be as-sociated with different forms according to the classification. Diagnosis can be often complicated by the pre-disposition of very young children to recurrent respiratory diseases, which often mark the formation of a pro-longed and recurrent course of the disease caused by viral and bacterial contamination of the respiratory tract. The aim of this study is to investigate viral and microbial contamination of the respiratory tract in vari-ous clinical forms of bronchitis of infants and to clarify their etiological significance in parallel with the as-sessment of the intestinal microflora. Materials and methods. 578 children aged from 6 months to 3 years with various clinical forms of bronchitis were monitored. Virological examination was performed by the direct Coons method, which detected viral antigens in the cells of the mucous membrane of the lower nasal si-nuses. Bacteriological examination was performed by bacterial inoculation of nasopharyngeal mucus, spu-tum and feces in a nutrient medium. Results. Clinical and laboratory examination of young infants made it possible to identify the influence of detected viral antigens and pathogenic microflora in the throat, sputum and feces on the formation of various clinical forms of bronchitis and their clinical peculiarities not only in the period of exacerbation, but also in a remission period that indicates the persistence of viruses and bacteria. Conclusion. Detection of viral antigens, dysbiosis and microbial aggression of the upper and lower respira-tory tract gives grounds for substantiating the indications for staged rehabilitation therapy for infants with various clinical forms of bronchitis.