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studying disbioticheskih changes of a microbionomics by results of studying of genetically determined fat acids in a saliva and blood by means of a method of a gas chromatography of mass spectrometry.

By results of blood mass spectrometry disbioticheskie changes at children with OSL (croup) have been bound a lot of colonisation aktinomitsetov and anaerobov and deficiency of group enterobaktery (a drawing 20).

Drawing 20. Disbiotichesky changes of a microbionomics at children with OSL (croup).

Disbioz it is shown basically in number depression laktobatsill, bifidobaktery, propionobaktery and eubaktery - the basic inhabitants of a jejunum, and also a part aktinobaktery (rodokokki, korinebakterii, aktinomitsety), microscopical mushrooms (not kandida), enterococci, anaerobic streptococcuses and other microorganisms. A consequence of it is adequate depression of biologically active substances made by them necessary for normal functioning of cells of internal organs and a skin of patients. This circumstance reduces efficiency of the basic medical actions and extends terms of recover of children (a drawing 21).

Drawing 21. Average number of microorganisms pristenochnogo a layer of a jejunum of children before treatment by the antibiotics, reconstructed according to concentration of microbic markers in blood in comparison with norm. By yellow colour it is noted clinically significant (more than


Twice) excess of number (infection) of separate species of microorganisms.

After treatment by antibiotics there is a small superfluous growth aktinobaktery sorts Nocardia and Streptomyces, Gram-negative bacteria of groups Moraxella/Acinetobacter and Fusobacterium/Haemophyluspri deficiency laktobatsill, bifidobaktery, propionobaktery and eubaktery.

Drawing 22. Results of research of structure of microbic markers in a blood plasma of children a method of a gas chromatography - mass spectrometries. Average value to (N=22) and after (N=7) treatments by antibiotics. Data in microbic cells/ml of assay with domnozheniem on х10*5


Antibioticotherapia action was showed in essential depression of number of streptococcuses, kampilobaktera, nokardy and a cytomegalovirus. Number laktobatsill was thus enlarged on the average in one and a half time. Other components mikrobioty have not undergone quantitative changes.

At including in the therapy program vobenzima, as a result of complex treatment the aggregate number of microorganisms has grown to norm. And vobenzim equally stimulated growth of all members of community (a drawing.23).

However, at detailed analysis action vobenzima is not so unequivocal, as on the average. It individually. Changes have difficult character depending on an initial condition mikrobioty the child. For example, the big superfluous growth of many microorganisms is found initially out in several children, but at deficiency eubaktery, bifidobaktery and propionobaktery.

Fig. 23. Results of research of structure of microbic markers in a blood plasma of children a method of a gas chromatography - mass spectrometries. Average value to (N=27) and after (N=13) treatments vobenzimom + antibiotics. Data in microbic cells/ml of assay with domnozheniem on х10*5.


So, at sick K the big superfluous growth of many microorganisms is found out.

Clinically significant level staphilococcuses, streptococcuses, ruminokokki, kandida exceed, kinds Nocardia, Streptomyces, Propionibacterium jensenii, Moraxella/Acinetobacter, Pseudomonas aeruginosa, a cytomegalovirus and other microorganisms at deficiency bifidobaktery and the microscopical mushrooms producing Sitosterol and kampesterol.

Microorganisms have reacted to treatment also variously. Total number has decreased at the expense of streptococcuses (group), nokardy, rodokokkov, eubaktery and propionobaktery, butirivibrio and Propionibacterium jensenii, but the quantity of anaerobic streptococcuses (S has grown. mutans), bifidobaktery, a cytomegalovirus, Clostridium perfringens. It is possible to see normalising action In it vobenzima.

So, at patient N the aggregate number of microorganisms after treatment has not changed almost, as well as character disbioza - has remained deficiency bifidobaktery, eubaktery and propionobaktery. The medical effect was showed in depression of concentration of markers of a cytomegalovirus, propionobaktery, exogenous anaerobov Butyrivibrio/Cl. fimetarum, Peptostreptococcus anaerobius and Pseudomonas aeruginosa.Негативным it is necessary to consider as result growth of number of clostridiums of groups C. ramosum and C. perfringens.

At patient U before treatment clinically significant level staphilococcuses, streptococcuses, kandida exceed Clostridium ramosum, Peptostreptococcus anaerobius, laktobatsilly, kinds Nocardia, Streptomyces, Moraxella/Acinetobacter, Pseudomonas aeruginosa, a cytomegalovirus and other microorganisms at deficiency bifidobaktery, eubaktery and propionobaktery and the general excess mikrorganizmov. As a result of treatment vobenzimom number of a superfluous (infectious) component of the microecological status was reduced, laktobatsilly remained much. Total number has decreased. Have decreased
Cytomegalovirus, Clostridium ramosum, streptococcuses (group), nokardii, streptomitsety, butirivibrio and Peptostreptococcus anaerobius, but have grown anaerobic streptococcuses (S. mutans) and Actinomyces viscosus.

At other children - with primary big deficiency mikrobioty (intestine colonisations) changes correspond to average indicators.

Thus, aetiology OSL (groats) has the admixed character - it is found out in each child simultaneously to 20 microorganisms which number exceed norm not only a saliva, but also blood (that is norm of the general microecological status on an organism). Gram-positive bacteria, as aerobic - streptococcuses, nokardii, streptomitsety, bacilli, and anaerobic - peptostreptokokki, clostridiums, laktobatsilly, eubakterii (sort Eubacterium), anaerobic streptococcuses, bakteroidy, and also sort mushrooms kandida dominate. Gram-negative bacteria in a quantitative parity take the second place - them 10 times less.

As example OSL (relapsing croup) with presence expressed disbioticheskih changes in a stomatopharynx it is resulted following observation.

Clinical example 3

Child Misha M, 3 years, suffers frequent ORZ from 10 months against which the obstructive bronchitis (4 times) develops and OSL (time croup-3) is hospitalised in 18 unit of the Morozovsky children's city hospital with the diagnosis: OSL (croup), a stenosis of a larynx of II degree against ORVI. An obstructive bronchitis, DN II degrees.

From the life anamnesis it is known, that the child from I pregnancy proceeding against an anaemia (mum received iron preparations), from I births in time by emergency cesarean sections (because of delicacy
Patrimonial activity). Weight at a birth 3370 g, length of 52 sm, an estimation on scale Apgar of 8/9 points. It is enclosed to a breast for the first days of a life. The early neonatal period without features. It is written out from a maternity home for 7 days. Thoracal feeding till 3 months, then artificial (because of a hypogalactia at mother). Physical and psychomotor development on the first year of a life on age.

Allergoanamnez: a food allergy on peaches, apricots, vitamins "multitabs" in the form of dermal implications.

Preventive inoculations: according to a national calendar.

The transferred diseases: from 10 months become perceptible ORZ to 10 times a year, from the beginning of visiting of a kindergarten (in 2 years 5 months) - monthly. Episodes ORZ proceed in the form of a laryngotracheobronchitis of a nasopharyngitis with febrile temperature, 10-14 days last. To 2 years has transferred ORZ, complicated by a bilateral average catarral otitis. In 2 years 2 months the repeated bilateral acute average otitis, on the right purulent became perceptible. Has in total received 4 courses of antibacterial therapy, and also repeatedly - immunokorrigirujushchie preparations: anaferon, arbidol. The child nabljudaetsjasja since 2 years otorinoljaringologom concerning a hypertrophy of adenoides of II degree.

The family anamnesis: mother of 29 years suffers a bronchial asthma from children's age, the father - is practically healthy. Hereditary and chronic diseases at close relatives are not present.

The Social anamnesis: lives with mother, the grandmother, the grandfather, the uncle in three-room apartment; animals of the house are not present; visits a kindergarten from 2 years 5 months

The present disease: was ill acutely in the evening when lifting of a body temperature to 38°С became perceptible, osiplyj a voice, barking tussis. There was a complicated noisy breath at night. The first aid brigade has been caused. After introduction of a febrifugal preparation the temperature has decreased, the dyspnea was stopped, mum has refused hospitalisation. On
The next day remained dry tussis, by the evening the body temperature to 38°С again has raised, there was a complicated noisy breath. On first aid, after introduction of Prednisolonum of 15 mg intramusculary, have been hospitalised in a hospital.

At survey in unit: a body temperature 38,3°С. Frequency of breath 32 in a minute. Frequency of warm reductions of 110 blows in a minute. A moderately severe condition. Flaccid. The skin light pink, becomes perceptible a hyperemia of cheeks. Tonsillar lymph nodes, by the size to 0,5 sm, is dense-elastic, painless, mobile are palpated occipital, zadneshejnye. Nasal breath is complicated, a plentiful mucous discharge. A voice osiplyj. Tussis dry, frequent, rasping. In rest a dyspnea till 32-36 in a minute. Auskultativno in lungs rigid breath, plural mixed wet and dry rhonchuses on all fields of lungs is auscultated. Warm tones loud, a tachycardia, are not present hums. Mucous stomatopharynxes brightly giperemirovana, tonsils of II degree, quaggy, without applyings. A stomach soft, painless. The liver does not act from under edge of a costal arch. The chair, an emiction are not broken.

The general analysis of blood: Hb 129 g/l, Ayr of 5,14h1012/l, TTS 393h109/l, LTS 13,7h109/l, p.b. 1 %, s/ja 59 %, eoz. 0 %, bases. 0 %, mon. 14 %, lymphs. 26 %, СОЭ18 mm/hour. The general analysis of urine: without a pathology.

Survey otorinoljaringologa for 3rd day of illness: ORZ, a bilateral average otitis, on the right the purulent.

On the roentgenogram of organs of a thorax: In visible departments of lungs the bronho-vascular drawing is enriched. Intensifying and deformation of a pulmonary drawing on sosudisto-bronchial type with an intersticial component becomes perceptible. Roots structural. A diaphragm accurate. Sine are differentiated. Focal and infiltrativnyh shades not opredeljaesja.

The analysis of nasopharyngeal washout for definition of flora and sensitivity to and/-is not present growth.

Research of the immune status (a phagocytosis, cellular immunity, humoral immunity) - has not taped pathological changes.

At research of a saliva by means of method GH-MS the powerful becoming infected проб: has been taped. Streptococcuses dominate,

Peptostreptococcus anaerobius, nokardii, Eubacterium, Clostridium ramosum and kandida in association with aktinobakterijami Streptomyces and Gr (-) bacteria Moraxella and Fusobacterium/Haemophylus, and also other numerous microorganisms.

In a hospital to the child antibacterial therapy in the form of Cefazolinum, symptomatic therapy has been prescribed: alkaline inhalations, alkaline drops in a nose, Phencarolum, vasoconstrictive drops in a nose, Mucaltinum, Bromhexinum. During a finding in a hospital in a condition of the child remains without any dynamics within 5 days: remained
Fever to the febrile digits, the complicated breath, physical changes in lungs, have been expressed intoxication symptoms. In connection with absence of positive dynamics to the child has been prescribed tseftriakson then positive dynamics has gradually started to become perceptible, for 16th day of illness the boy has been written out with improvement.

The clinical diagnosis: the Acute stenosing laryngotracheobronchitis (relapsing croup), a stenosis of a larynx of II degree against ORVI. An obstructive bronchitis, DN II degrees. A relapsing bilateral average otitis, on the right the purulent.

The conclusion: at the child the bacteriemic aetiology of disease by results of GH-MS is proved. According to the literature at presence in assay of combination Clostridium ramosum and kandida in association with aktinobakterijami Streptomyces and Gr (-) bacteria Moraxella and Fusobacterium/Haemophylus is the indication for naznchenija an antibacterial preparation from group ftorhinolonov as the allocated flora is high-strung to the given group of preparations. To the child antibacterial preparations insensitive to allocated patogenam have been prescribed, therefore for a long time the child did not have positive dynamics during disease. Thus at inspection in microbiological laboratory MDGKB of growth in investigated assay of microorganisms it did not become perceptible.

The set example shows the proved case of a bacteriemic infection in development of disease and absence correctly chosen antbakterialnogo a preparation as research was spent later.

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Scientific source FELDFIKS LARISSA IZEVNA. ROLE of the BACTERIEMIC INFECTION AT the ACUTE STENOSING LARYNGITIS (CROUP) At CHILDREN. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

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