Respiratory Tract In Children Research Articles

Molecular characteristics and biofilm formation capacity of nontypeable Haemophilus influenza strains isolated from lower respiratory tract in children

With the widespread introduction of the Hib conjugate vaccine, Nontypeable Haemophilus influenzae (NTHi) has emerged as the predominant strain globally. NTHi presents a significant challenge as a causative agent of chronic clinical infections due to its high rates of drug resistance and biofilm formation. While current research on NTHi biofilms in children has primarily focused on upper respiratory diseases, investigations into lower respiratory sources remain limited. In this study, we collected 54 clinical strains of lower respiratory tract origin from children. Molecular information and drug resistance features were obtained through whole gene sequencing and the disk diffusion method, respectively. Additionally, an in vitro biofilm model was established. All clinical strains were identified as NTHi and demonstrated the ability to form biofilms in vitro. Based on scanning electron microscopy and crystal violet staining, the strains were categorized into weak and strong biofilm-forming groups. We explored the correlation between biofilm formation ability and drug resistance patterns, as well as clinical characteristics. Stronger biofilm formation was associated with a longer cough duration and a higher proportion of abnormal lung imaging findings. Frequent intake of β-lactam antibiotics might be associated with strong biofilm formation. While a complementary relationship between biofilm-forming capacity and drug resistance may exist, further comprehensive studies are warranted. This study confirms the in vitro biofilm formation of clinical NTHi strains and establishes correlations with clinical characteristics, offering valuable insights for combating NTHi infections.

DEVELOPMENT OF ULTRASTRUCTURAL CHANGES IN DIAPHRAGM MUSCLE FIBERS DURING PARTIAL TRACHEAL STENOSIS IN YOUNG SEXUALLY IMMATURE RATS

Introduction. The study of congenital pathology of the respiratory tract in children is of great importance for theoretical and clinical pediatric otolaryngology. Currently, in the scientific literature there are single works concerning the study of the pathogenesis and clinic of laryngomalacia. First of all, this concerns the effect of acute and chronic hypoxia on the muscles of the respiratory system, in particular, the diaphragm. The aim of thіs work is to reveal the effect of hypoxia on the development of pronounced structural and functional changes in the diaphragm muscles of sexually immature animals when modeling partial tracheal occlusion. Materials and methods. Surgical partial occlusion of the trachea was performed on in sexually immature Wistar rats; we applied electron microscopy, morphometric and statistical research methods.
 Results. The obtained data demonstrated that the muscle fibers of the diaphragm are characterized by significant structural, functional and metabolic resistance to the development of acute or chronic hypoxia due to limited lung ventilation in rats. The density of muscle fibers did not change in any of the used terms of the experiment (7 and 21 days). On the 7th day of hypoxic exposure, a change in the state of the matrix of mitochondria of muscle fibers was observed, which was accompanied by partial ultrastructural rearrangements of the organization of these organelles. At the same time, no significant changes were observed during histological studies. Electrongrams demonstrated the ultrastructural damages were mainly limited to focal reduction of myofibrils and an increase in the mitochondria's diameter and found as especially pronounced on day 21 (a state of chronic hypoxia) on the muscular component of the respiratory system in rats. These changes are accompanied by the development of dystrophic disorders in the diaphragm myofibrils. On day 21 changes in the transendothelial transport of substance molecules were also detected. This was based on establishing the fact of a significant reduction in the number of pinocytosis vesicles in the cytoplasm of endothelial cells of diaphragm hemocapillaries in animals with partial tracheal occlusion. Disruption of the structural organization of actomyosin complexes was revealed in muscle fibers due to pathological changes in the mitochondria of myofibrils. It should be noted the development of destruction or complete loss of an important ultrastructural component of muscle fibers, Z-lines. These changes were completely absent on the 7th day following the influence of partial tracheal occlusion and the development of acute hypoxia. Moreover, on day 21, partial lysis of a significant amount of myofilaments of muscle fibers was observed. In addition, the development of the process of fiber swelling was detected against the background of which the above-mentioned ultrastructural destruction of the muscular component in the diaphragm was observed. These changes indicate the need for earlier treatment of laryngomalacia in children. The delay in surgical intervention leads to the development of severe or irreversible structural changes not only in the respiratory organs, but also in their muscular system.
 Conclusion. The muscular elements of the diaphragm have the pronounced and significant resistance to the state of hypoxia under conditions of limited ventilation of the respiratory tract. Ultrastructural and morphometric data, found on the 21st day after the modeling of partial tracheal stenosis, are not only of a compensatory and adaptive in nature, but also signs of pronounced disorders in the muscle fibers of the central part of the diaphragm in test animals.

Microbiota of the upper respiratory tract in children with chronic adenoiditis

Background. Routine application of the GC-MS method to assess the URT microbiota can potentially improve the efficacy and safety of treatment for chronic respiratory diseases.
 Aim. To perform a comparative analysis of the microbiota from the surface of the pharyngeal tonsil, from the deep parts of the nose, and saliva in children with chronic adenoiditis.
 Materials and methods. The study included 90 patients with chronic adenoiditis (CA) and/or pharyngeal tonsil hypertrophy (PTH). All study participants had swabs taken from the surface of the pharyngeal tonsil, from the deep parts of the nasal cavity, and saliva as a biological fluid of the oral cavity. Microorganisms were identified by specific fatty acids using GC-MS to assess the composition of the microbial community on the surface of the pharyngeal tonsil.
 Results. The study showed that the microbiota of the nasopharynx is identical in its qualitative composition to microorganisms from the deep parts of the nose. However, according to the results of the analysis of microbial markers of saliva, the oral microbiota showed significant differences in the quantitative and qualitative composition of microorganisms compared with the nasopharyngeal microbiota.
 Conclusion. The introduction of the GC-MS method for assessing the URT microbiota enables its monitoring in clinical practice for the treatment of chronic respiratory system diseases without disturbing the ecology of the mucous membranes and the whole body.

Клінічне значення деблокади носового дихання в дітей грудного і раннього віку на тлі гострих респіраторних вірусних інфекцій: переваги ізотонічного розчину морської води

Acute respiratory viral infections (ARVI) are an urgent problem in young children, which is due to their significant prevalence, they have a constant tendency to increase and occupy the first places in the structure of infectious diseases. Damage to the mucous membranes of the upper respiratory tract in children with ARVI lead to numerous problems that require adequate replacement of the main functions of the child’s body, which determined the relevance of our study. Purpose - to analyze the effectiveness of the use of isotonic dilution of sea water (Pshyk Mini medicine) for irrigation therapy in nasal congestion in infants and young children caused by acute respiratory infections. Materials and methods. A comprehensive examination of 100 infants and young children with influenza and other ARVI was conducted in the infectious diseases department of the Chernivtsi Regional Children’s Clinical Hospital. The children were randomly divided into 2 clinical groups: the Group I included 55 children (average age - 1.09±0.3 years, the proportion of boys - 58.1%), who, as part of complex standard therapy, received nasal irrigation using 2-3 drops of Pshyk mini medicine in each nostril 3 times/day. The Group II included 45 patients (average age - 1.15±0.2 years (p>0.05), the proportion of boys - 59.1% (p>0.05)), in whom isotonic sodium chloride solution was used for the purpose of the nasal sanitation. Results. The conducted studies showed that starting from the 3-4th day of hospitalization, a statistically significant decrease in catarrhal manifestations and the severity of nasal obstruction was noted in patients of the Group I who received Pshyk Mini in complex treatment. In particular, in relation to the results of the Group II, in the children of the Group I, on the 4th day of inpatient treatment, the chances of reducing the severity of catarrhal manifestations (estimated ≤2 points) increased: the absolute risk increase - 53.0%, the relative risk increase - 67.9% (95% CI: 57.8-76.9) with the minimum number of patients who need to be treated to obtain a positive result - 1.5. We also established that compared to the representatives of the Group II, children of the Group I had almost a 4-fold increase in the chances of restoring tolerance to feeding (estimation of feeding difficulties ≤2 points): attributive risk - 30.5%, relative risk - 1.6 (95% CI: 0.6-4.8), odds ratio - 3.9 (95% CI: 1.2-12.3). Conclusions. For the purpose of unblocking of nasal breathing in infants and children of early age at the background of acute respiratory viral infections, the use of an isotonic solution of sea water (Pshyk Mini medicine) has a number of significant advantages compared to the use of an isotonic solution of sodium chloride for this purpose. 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.

Socio-economic burden of respiratory syncytial viral infection of the lower respiratory tract in children aged from birth to 5 years in the Russian Federation: modeling results

Background. Respiratory syncytial virus (RSV) is a common virus causing lower respiratory tract infections (LRTI), including acute bronchiolitis and pneumonia, in children in the first 5 years of life.Objective: to estimate the annual socio-economic burden for the Russian Federation (RF) due to RSV-LRTI in children aged under 5 years.Material and methods. Based on published results of meta-analysis of epidemiological data for RSV-induced infections, the annual number of RSV-LRTI cases, the number of hospitalizations, and associated lethal outcomes were calculated in the model for groups of children aged 0 – <12 months, 12 – <24 months, and 24 – 60 months. The costs of medical care were determined according to the current tariffs of the Compulsory Health Insurance system and published Russian data on the distribution of the number of RSV-LRTI cases by severity. The damage to gross domestic product (GDP) associated with fatalities was estimated taking into account life expectancy and employment.Results. According to the estimates, 397.2 thousand children aged under 5 years in the RF fall ill with RSV-LRTI during a year, including 44.6 thousand cases requiring hospitalization, and in 268 cases, the infection becomes lethal. Medical costs for treatment exceed 2.2 billion rubles, and the damage to GDP as a result of lethal outcomes reaches almost 10 billion rubles. The main damage is related to RSV-LRTI cases in children aged under 1 year, the share of which is over 50% among those hospitalized and over 70% among those who died.Conclusion. RSV significantly affects morbidity and mortality among children aged under 5 years. According to modeling data, it causes up to 3.5% of deaths in this age group, and the associated economic losses exceed 12.2 billion rubles, which justifies the need for RSV-LRTI immunoprophylaxis.

Integrated metabolome-microbiome analysis investigates the different regulations of Pudilan Xiaoyan oral liquid in young rats with acute pharyngitis compared to adult rats

BackgroundPudilan Xiaoyan Oral Liquid (PDL) is a famous traditional Chinese prescription recorded in the Chinese Pharmacopeia, which is widely used to treat inflammatory diseases of the respiratory tract in children and adults. However, the endogenous changes in children and adults with PDL in the treatment of acute pharyngitis remain unclear. PurposeThe differential regulatory roles of PDL in endogenous metabolism and gut microbes in young and adult rats were investigated with a view to providing a preclinical data reference for PDL in medication for children. MethodsAn acute pharyngitis model was established, and serum levels of inflammatory factors and histopathology were measured. This study simulated the growth and development of children in young rats and explored the endogenous metabolic characteristics and intestinal microbial composition after the intervention of PDL by using serum metabolomic technique and 16S rRNA high-throughput sequencing technique. ResultsThe results showed that PDL had therapeutic effects on young and adult rats with acute pharyngitis. Sixteen biomarkers were identified by metabolomics in the serum of young rats and 23 in adult rats. PDL can also affect intestinal microbial diversity and community richness in young and adult rats. Alloprevotella, Allobaculum, Alistipes, Bifidobacterium, and Enterorhabdus were prominent bacteria in young rats. Bacteria from the phylum Firmicutes of the adult rats changed more significantly under the treatment of PDL. In young rats, amino acid metabolism was the primary regulatory mode of PDL, whereas, in adult rats, glycerophospholipid metabolism was studied. ConclusionThe regulation of PDL on the serum metabolite group and intestinal microflora in young rats was different from that in adult rats, indicating the necessity of an independent study on children's medication. PDL may also exert therapeutic effects on young and adult rats by regulating gut microbial homeostasis. The results support the clinical application of PDL.

Retracted: Application of 64-Slice Spiral CT Imaging Technology Based on Smart Medical Augmented Reality in the Diagnosis of Foreign Bodies in the Respiratory Tract in Children.

[This retracts the article DOI: 10.1155/2021/9962997.].

Longitudinal anellome dynamics inthe upper respiratory tract ofchildren with acute respiratory tract infections.

Anelloviruses (AVs) are ubiquitous in humans and are the most abundant components of the commensal virome. Previous studies on the diversity, transmission, and persistence of AVs mainly focused on the blood or transplanted tissues from adults; however, the profile of the anellome in the respiratory tract in children are barely known. We investigated the anellome profile and their dynamics in the upper respiratory tract from a cohort of children with acute respiratory tract infections (ARTIs). Different to that in adult, betatorquevirus is the most abundant genus, followed by alphatorquevirus. We found that the relative abundance of betatorquevirus was higher in earlier time points, and in contrast, the abundance of alphatorquevirus was higher in later time points; these results might suggest that betatorquevirus decreased with age and alphatorquevirus increased with age in childhood. No difference regarding the diversity and abundance of anellome was found between single and multiple ARTIs, consistent with the idea that AV is not associated with certain disease. Most AVs are transient, and a small proportion (8 per cent) of them were found to be possibly persistent, with persistence time ranging from 1 month to as long as 56 months. Furthermore, the individual respiratory anellome appeared to be unique and dynamic, and the replacement of existing AVs with new ones are common over different time points. These findings demonstrate that betatorquevirus may be the early colonizer in children, and the individual respiratory anellome is unique, which are featured by both chronic infections and AV community replacement.

Effect of synthetic folic acid surplus on neurological symptoms in offspring

Background. It has long been known about the need for folic acid for the vital activity of both macro-and microorganisms. It is necessary for the processes of methylation, nucleotide synthesis and also the formation of methionine and reducing the toxic effect of homocysteine. The addition of synthetic folic acid to the diet of pregnant women, as well as at the stage of pre-pregnancy preparation, significantly reduces the risks of fetal neural tube defects, heart defects, and possibly other organs and systems of the body. In addition, folic acid can help improve fertility potential. However, there is evidence of adverse effects of folic acid proficite on the health of older adults (hiding B12-deficient status) and the offspring of mothers taking high doses prescribed by medical specialists like a risks of infectious-inflammatory and allergic diseases of the upper respiratory tract in children, eczema, also disorders of psychomotor development and insulin resistance. In 1980, the direct excitatory effect of folic acid on synaptic transmission in the central nervous system was proved. This is due to the molecular structure, it contains L-glutamate.
 Therefore, the aim of the work was trying to prove the existing correlation data on probable neuropathologies, including a reduced threshold of seizures, a high risk of epilepsy in a model of offspring of Wistar rats with an increased dosage of folate throughout gestation and including at the stage of pre-gravidar preparation.
 Methods. We have determined the ability to the first convulsive act by introducing a 20% solution of caffeine at the rate of 100 mg/kg of weight intraperitoneally.
 Results. In the control group, the average clonus time was 1779.6 seconds, in the experimental group with a 1 mg/kg folic acid per diet dosage of 797.3 seconds, and in the second group with a 5 mg/kg folic acid per diet 439.7 seconds (p 0,01).
 Conclusion. The obtained results of the difference in the convulsive threshold may be due to changes in synaptic density as a result of an excess of synthetic folic acid during the formation of NT and subsequently during the differentiation of nervous tissue in the central nervous system (in particular, in the 3rd trimester with a massive appearance of glutamatergic receptors), which can affect the processes of neurogenesis and the formation of neural networks.

Порушення носового дихання в дітей: причини, наслідки, сучасні погляди на корекцію та профілактику (огляд літератури)

Purpose - to analyze data from scientific sources on the causes, consequences, and current views on the correction and prevention of nasal breathing disorders. The authors have provided and systematized information on the peculiarities of the structure and functioning of the upper respiratory tract in children of various ages. The causes and consequences of nasal breathing disorders have been established. From the standpoint of modern international recommendations, the principles of correction of nasal breathing disorders and expanded views on the possibilities of prevention of diseases of the upper respiratory tract are evaluated. Conclusions. Nasal obstruction in childhood is the most common problem that can lead to negative consequences, and the nasal mucosa in young children needs regular care and hygienic cleaning. The use of the new medical product PSHIK MINI allows for high-quality, effective and safe moisturizing and cleansing of the nasal mucosa of children as a preventive and, if necessary, therapeutic procedure. No conflict of interests was declared by the authors.

The current state of diagnostics and management of foreign bodies in the respiratory tract in children

Introduction. Foreign body aspiration (FBA) into the respiratory tract is a severe, life-threatening condition in children which requires urgent medical and diagnostic measures. Purpose. To study outcomes after FBA diagnostics and treatment in children and to develop an algorithm for diagnosing foreign bodies in the respiratory tract in this group of patients. Material and methods. Outcomes in 86 children who were hospitalized with suspected foreign bodies in their respiratory tract to the Clinic of Pediatric Surgery in Marat Ospanov West Kazakhstan Medical University, Aktobe, Republic of Kazakhstan in 2018–2022. Results. In 73 children, out of 86, FBA was confirmed. Distribution of children with FBA by age was as follows: less than one year – 5 (6.8 %) children; 1–3 years – 46 (63.1 %); 3–5 years – 7 (9.6 %), over 5 years – 15 (20.5 %). Localization of foreign bodies in the respiratory tract was as follows: larynx –6; trachea – 10, right main bronchus –26, left main bronchus – 30, both lower lobe bronchi – 1. The revealed foreign bodied were : peanuts – 24 (32.8 %) cases, sunflower seed – 13 (17.8 %), fountain pen cap – 7 (9.6 %), plastic toy part – 5 (6.8 %), fish bone – 5 (6.8 %), stationery carnation – 4 (5.5 %), bone – 4 (5.5 %), small rock – 4 (5.5 %), carrot – 3 (4.2 %), tooth – 2 (2.7 %), bead – 1 (1.4 %), food masses –1 (1.4 %). In the diagnostics of foreign bodies, anamnesis, clinical examination, radiation and endoscopic diagnostic techniques were of great importance. On analyzing the obtained clinical material, the researchers developed their own algorithm for FBA diagnosis. Foreign bodies were removed with rigid bronchoscopy in 55 children, with fibrobronchoscopy in 9 children, direct laryngoscopy – in 6 cases, at thoracotomy and bronchotomy – in 3 children. There were no complications associated with the removal of foreign bodies. Conclusions. Foreign bodies in the respiratory tract are met most often in children , aged 1–3. In doubtful cases, MSCT was used in addition to traditional diagnostic methods. It allows to exclude or identify foreign bodies invisible at X-ray images. FBA removal should be performed at the third level medical institutions.

Acute Low Respiratory Infections in Children from 2 Months to 15 Years of Age in the Pediatric Department of the Commune II Reference Health Center in Bamako (Mali)

Introduction: Acute lower respiratory infections (ALRIs) in paediatrics include a heterogeneous group of conditions affecting the lower respiratory tract in children. They constitute a real public health problem, particularly in developing countries. Patient and Method: This was a retrospective, descriptive study from 1 January to 31 December 2018, i.e. 2 years. All children aged 2 months to 15 years hospitalized for ARFU were included. Results: In our study, the prevalence of ARBI was 14.47%. The sex ratio was 1.16 in favour of boys. The under-5s were the most represented 97.5%. The peaks of hospitalizations were found in October 18.2%, November 16.5% and August 14%. According to the Expanded Programme on Immunisation, 12.5% of the children were not correctly vaccinated. The reasons for consultation of our patients were respiratory distress with 25.6% followed by cough and cold 24.5%. Fever was associated with 70.2%. The clinical forms were dominated by: pneumonia 47.9% followed by superinfected bronchiolitis 33.1% and acute bronchitis 19%. The majority were treated with the combination of Ceftriaxone and gentamycin, i.e. 62.8% as first-line treatment. The evolution was favourable in 90.9% of cases with 5% death, 2.5% discharge against medical advice and 1.6% referral to higher level. Conclusion: Low-grade ARI is a public health problem in commune II of Bamako. Raising public awareness of the early signs of low-grade ARI, strict adherence to the expanded programme of immunisation, and upgrading of community and hospital health staff will help to reduce mortality from low-grade ARI.

Longitudinal investigation of pathogenic bacterial colonization in early childhood: Emphasis on the determinants of Moraxella catarrhalis colonization.

Moraxella catarrhalis is a common, potential pathogen colonizing the respiratory tract in children. However, there is little information regarding the determinants of M. catarrhalis colonization and disease development. A population-based cohort study was conducted to collect nasopharyngeal swabs from children aged 1, 2, 4, 6, 12, 18, 24, 36, and 60 months for the detection of four common respiratory tract pathogens, including Staphylococcus aureus, M. catarrhalis, Streptococcus pneumoniae, and Haemophilus influenzae. Questionnaires on breastfeeding status were administered during each visit. A total of 921 children were enrolled between 2012 and 2018. S.aureus was the most common pathogen, although the rates declined during the initial 18 months of life; in contrast, the other three pathogens increased during the first 5 years of life. M. catarrhalis was the second most common colonizing pathogen in all age groups, with prevalence ranging from 0.8% (7/842) at one month to 20.4% (33/162) at 60 months of age. Breastfed children (odds ratio [OR]: 0.56; 95% confidence interval [CI]: 0.35-0.92; P=0.02) had a lower potential for M. catarrhalis carriage; however, infants with a longer duration of exclusive breastfeeding (OR: 1.12; 95% CI: 1.01-1.25; P=0.04), especially >12 months of age, had a higher rate of M. catarrhalis carriage. Breastfeeding should be promoted because it may be correlated with a lower risk of M. catarrhalis carriage. However, an extended period of exclusive breastfeeding may be positively associated with M. catarrhalis colonization.

Foreign bodies of the lower respiratory tract in children

Foreign bodies of the lower respiratory tract in children is one of the major life-threatening emergencies in children, having a high rate in the structure of infant mortality. This patology represents about 11% of otorhinolaryngological emergencies [2]. In the USA the statistics recorded eloquent data over a year. The intra-hospital mortality rate associated with these cases accounts for 1,8%, and anoxic brain injury is reported in 2,2% of cases. Thus, foreign body aspiration was diagnosed mainly in children aged 1-3 years, with the frequency of 56%, and the death rate of 7% [5]. Foreign bodies enter to the body by natural ways and have a diverse location, depending on their size, shape and nature. The most common location of foreign bodies is in the bronchi of the right lung, followed by the left bronchial tree and most rarely, in the trachea. Very rarely, are encountered foreign bodies with multiple locations [6]. In the etiological structure, foreign bodies of organic origin predominate - 15%, especially foreign bodies of plant origin - 75-81%, less frequently metallic foreign bodies - 10% and plastic - 5% [2,5]. Statistical age analysis of foreign body aspiration cases reported that, 21% cases are determined in children after the age of 6 months, more than half cases - in child 1-3 years and 1⁄4 cases - in children older than 3 years [1,3].

Rational choice of antibiotic therapy in children with acute respiratory infections of the upper respiratory tract

Acute respiratory infections are leading in the structure of infectious pathology in children. Despite the high importance of viruses in the etiology of acute respiratory infections, the role of bacterial pathogens remains important. Features of the current course, high frequency of complications, unreasonable prescription of antibacterial drugs and the risk of developing drug-resistant forms of microorganisms require adherence to algorithms for the timely diagnosis of bacterial infections and the rational use of antibacterial drugs. In the article, on the example of the analysis of clinical cases, the main stages of diagnosis and algorithms for choosing the initial antibiotic therapy for acute respiratory infections of the upper respiratory tract in children in an outpatient setting are considered. In the first clinical case, the principles of differential diagnosis of viral and bacterial acute otitis media, the risks of adverse outcome are considered, the main indications for prescribing systemic antibiotic therapy in preschoolers are identified. The second clinical case demonstrates the algorithms for diagnosing bacterial sinusitis, the possible masks of the disease, and the selection of a starting antibacterial drug. The example of the third clinical case shows the etiological diversity of acute tonsillopharyngitis in children, defined indications for systemic antibacterial therapy. It has been noted that only streptococcal tonsillopharyngitis is the primary indication of antibacterial prescription. The features of initial therapy and the duration of the course of antibacterial drugs in children were determined.

Микробиологическая характеристика хронического риносинусита у детей с муковисцидозом в сравнении с другими локусами респираторного тракта

One of the main factors determining the severity of the course and prognosis in cystic fibrosis (CF) is the severity of the infectious and inflammatory process and the species composition of the microflora in the lower respiratory tract (LRT). Studies show the important role of the nasal cavity and paranasal sinuses as a source and reservoir of microflora. Objective. To assess the species composition and correlation of microflora from the various parts of the upper and lower respiratory tract in children with cystic fibrosis. Patients and methods. 94 patients aged 2 to 18 years diagnosed with chronic rhinosinusitis with cystic fibrosis which had surgical intervention were included. The species composition of microflora was obtained from paranasal sinuses and nasal cavity, evaluated intraoperatively, from trachea during intubation in comparison with the actual (1-3 weeks before the intervention ) results of bacteriological test of induced sputum and / or material from the posterior pharyngeal wall, as well as the most "clinically significant" microflora in the anamnesis. Statistical analysis was carried out in order to search for correlations of the species composition of the bacterial flora between these parts of the respiratory tract. Results. The analysis showed no correlation between the microflora of different parts, except for the correlation between the most "clinically significant" microflora in anamnesis and obtained intraoperatively from paranasal sinuses in relation to two prognostically unfavorable species of bacteria: Sternotrophomonas maltophilia ( p = 0.001) and Pseudomonas aeruginosa (p = 0.047). In 13 (81.3%) of the 16 patients which had in anamnesis P. aeruginosa and was isolated from the maxillary sinus intraoperatively, its eradication was ascertained. Conclusion. The revealed positive correlation between the isolation of P. aeruginosa ever in anamnesis from low respiratory tract (LRT) and its presence in the paranasal sinuses during intraoperative sampling of the material indicates the important role of paranasal sinuses as a reservoir of pathogenic microflora and the possibility of long-term preservation of infectious agents after eradication courses of treatment and the achievement of eradication. Keywords: cystic fibrosis, children, chronic rhinosinusitis, microflora, Pseudomonas aeruginosa, paranasal sinuses

Bacterial Epidemiology and Antimicrobial Resistance Profiles of Respiratory Specimens of Children with Pneumonia in Hainan, China.

To investigate the bacterial species and antimicrobial susceptibility of respiratory specimens of children with pneumonia in Hainan, China. A total of 5017 specimens, including 4986 sputum samples, 19 bronchoalveolar lavage fluid samples and 12 tracheal tube tip samples from hospitalized children with pneumonia from April 1, 2021 to March 31, 2022 were studied. All the bacterial isolates were identified and confirmed with the VITEK 2 system. Antimicrobial susceptibility of all isolates was determined using the Kirby-Bauer method or the VITEK 2 Compact automatic system, following the breakpoints recommended by the Clinical and Laboratory Standards Institute. A total of 996 bacterial isolates were collected and classified into 24 species. The top 10 most frequent species were Haemophilus influenzae (356 isolates, 35.7%), Streptococcus pneumoniae (128, 12.9%), Moraxella catarrhalis (114, 11.5%), Escherichia coli (89, 8.9%), Staphylococcus aureus (89, 8.9%), Klebsiella pneumoniae (82, 8.2%), Acinetobacter baumannii (31, 3.1%), Pseudomonas aeruginosa (28, 2.8%), Enterobacter cloacae (18, 1.8%), and Streptococcus agalactiae (13, 1.3%). 70.5% strains had the resistant (R) and/or intermediate (I) phenotypes to at least one of the tested drugs, with a large proportion (54.6%) showing resistance to two or more commonly used antibiotics. In addition, 60.5% (69/114) of M. catarrhalis strains and 42.9% (153/356) of H. influenzae strains produced β-lactamases while 19.1% (17/89) E. coli and 6.1% (5/82) K. pneumoniae strains produced extended-spectrum β-lactamases. A diversity of pathogenic bacteria were isolated from the respiratory tract of children with pneumonia in Hainan, China. High-frequency resistance to first-line antimicrobial drugs was observed in Gram-negative and Gram-positive bacteria, including 544 isolates resistant to at least two antibiotics. Rapid identification and susceptibility testing should be implemented for children with bacterial pneumonia in Hainan before drug treatment is recommended.

Частота выделения и чувствительность изолятов Staphylococcus aureus и Pseudomonas aeruginosa из нижних дыхательных путей к антимикробным препаратам у детей с муковисцидозом

Частота выделения и чувствительность изолятов Staphylococcus aureus и Pseudomonas aeruginosa из нижних дыхательных путей к антимикробным препаратам у детей с муковисцидозом

Improving the clinical effectiveness of the treatment of acute inflammatory diseases of the upper respiratory tract in children with the use of silver-based medicines

Introduction. Acute respiratory viral infection (ARVI) is the most common reason for visits to the physician by both children and adults.The aim of the study was to analyse the features of the course of ARVIs in patients with different immune status, to evaluate the effectiveness of standard therapy for these groups of patients, as well as the use of silver-based medicines in the combination therapy of patients.Materials and methods. For the period from July to September 2022, 26 children (Group 1) without immunodeficiency conditions and 26 immunocompromised children (Group 2) were identified, all of them had symptoms of acute respiratory viral infections. In Group 1, 69.2% of children (n = 18) were classified as frequently ill children with ARVI rate of more than 8 times per year, 38.4% (n = 10) had allergic rhinitis, 7.7% (n = 2) had a concomitant bronchial asthma. In Group 2, the distribution of underlying immunocompromised disease was as follows: primary immunodeficiency – 7.7% (n = 2), Hurler syndrome after bone marrow transplantation – 11.5% (n = 3), acute lymphoblastic leukemia during specific therapy – 26.9% (n = 7), with graft versus host disease – 30.7% (n = 8) and currently in remission – 23% (n = 6). Among patients in this Group, only 7.7% of children (n = 2) had a history of allergic rhinitis.Results. The criterion for recovery in Group 1 was reversal of all clinical symptoms, in Group 2 – clinical improvement, normalization or significant decrease in C-reactive protein levels, improvement of paranasal sinuses pneumatization.Conclusion. During ARVI, post-viral rhinosinusitis often occurs, the ability of the mucosa to regenerate becomes disturbed, which makes it more vulnerable to adhesion of viruses, bacteria, and fungi. In this case, especially effective is the intranasal use of a silver-based medicine to form a protective protein film on the injured mucosa. The use of silver-based medicines in the combination therapy of patients with inflammatory pathologies of the nose, nasopharynx and paranasal sinuses can greatly increase the effectiveness of treatment, while shortening the duration of therapy and being safe.

Airways tissue expression of type I interferons and their stimulated genes is higher in children than adults

There is emerging evidence that age-dependent differences in susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) correlate with stronger innate immune response in the upper respiratory tract in children compared to adults. The efficient induction of interferon (IFN) alpha and beta (α and β) signaling, and interferon-stimulated genes (ISGs) is fundamental to the host antiviral response. In-silico transcriptomic analyses was conducted to determine the expression levels of IFN α/β pathway genes as well as 524 human ISGs in upper and lower airways of children and adults at baseline and post respiratory infections including coronavirus disease 2019 (COVID-19). To validate our in-silico analysis, we conducted qRT-PCR to measure ISGs levels in children and adult's nasal epithelial samples. At baseline, children had significantly higher levels of IFN α/β and ISGs genes compared to adults. More distinction was also seen in bronchial compared to nasal basal levels. Children nasal epithelial cells exhibited superior antiviral IFN α/β and associated ISGs response following ex-vivo poly (I:C) treatment model, and in clinical samples of SARS-CoV-2 infected patients. This was also confirmed in nasal epithelial samples using qRT-PCR validation. No gender-based difference in type I IFN levels across both age groups were observed. Understanding the biological basis for children resistance against severe COVID-19 is a challenge that has substantial clinical importance. More mechanistic studies are needed to carefully quantify how much of early IFN levels is needed to bypass the viral evasion mechanism and prevent its further replication and dissemination to lower airways and the rest of the body.