Problem OSL (groats) is known for a long time as in domestic [115, 44, 11], and in the foreign literature [194, 220, 186]. In 50th years many authors began to consider, that OSL (croup) arises in the acute period of a respiratory mono-virus infection and is one of symptoms of implications of disease [52, 144, 145, 182, 184].krome that, the great value was given to age of the child, the small sizes of a larynx, softness of a cartilaginous skeleton.

The less child, the more relative area occupied with a quaggy connecting tissue in podskladochnom space that enlarges volume of an edema of a mucous larynx [29, 5, 226]. The differentiation of the nervous apparatus of that 1 and 2 reflexogenic zones on all their extent are merged is insufficient also and 3 reflexogenic zone which receptors plentifully branch on all mucous podskladochnogo spaces that promotes occurrence of a long laryngospasm and a stenosis of a larynx [28] is not issued

However, last years in the literature there were reports, that detection of respiratory viruses in the top respiratory tracts as at children with clinical implications of respiratory disease, and at practically healthy is natural [7, 14, 23, 91, 37] Besides, according to a number of authors Hall C.B.et al. (1986r.), La Via W.V. (1992r.), Henrickson K.J. (1998r.) a respiratorno-virus infection (RS, a parainfluenza of 3rd and 1st types, a flu And and In, the adenovirus) besides the independent importance in disease development especially at children of early age is an obligatory prelude of a bacteriemic inflammation.

Now genetics have allocated more than 1000 phenotypes of microbic DNA. It is proved, that a human body occupy more than 500 kinds of microbes. According to literature Wilian ^: Wilkins (1984r.), McNeil M. M (1990г.), Manual of Clinical МісгоЬіо1оду (1991г.), С1іп. МісгоЬіо1. (1995г.) H ^ є гR. (1997г.), Andersson MA (1997г.), Goldstein E. J. C. (2000г.), Goldstein E. J. With (2000г.), Antimicr. Agents. Chemoter. (2003г.) in a role of majorants of microbic association at inflammations act anaeroby. On a share anaerobov (Clostridium, Eubacterium, Propionibacterium (Str.)) it is necessary 80 - 95 %. On a share of aerobes 20 % from them are necessary only: aerobic aktinomitsety (aktinobakterii) make 17 % and only 3 % make staphilococcuses supervised in bacteriological laboratories, enterobakterii (E. coli, protej, klebsiela, etc.), Pseudomonas (a pyocyanic rod), Stenotrophomonas, Acinetobacter, etc.

Serious forms OSL (groats) are bound to bacteriemic flora, in particular with a hemophilic rod (tip). Associations of originators have paramount value at OSL at children who are in units of resuscitation and an intensive care (ORIT), and cause development of serious forms of disease and lethal outcomes (Savenkova M. S, 2008). In the literature there is a description of the casuistic observation OSL caused Pasterella haemolitica which has been allocated from a trachea at 9th monthly girl [210]

Besides, long presence of a pathogenic microflora at respiratory tracts causes function disturbance mukotsiliarnogo the apparatus, damage of not immune and immune mechanisms of protection bronholegochnoj systems that is one of essential mechanisms of a long current of inflammatory process [151, 207, 48] Long persistentsija the is conditional-pathogenic flora, caused

disbioticheskimi processes in an organism, it is capable to lead to a bacteriemic sensibilization of an organism, formation of a respiratory allergy.

Frequency of revealing of a sensibilization to bacteriemic allergens at children with diseases of a respiratory tract, fluctuates from 20 % to 40 %.takzhe through the changed mucosas of the top respiratory tracts and an intestine there is an absorption of bacteriemic endotoxins to blood that conducts to falling of immunologic resistance and an allergization [6, 15, 19, 24, 171, 156]

Applied for today in clinical practice methods of definition of the microecological status of a human body, and also diagnostics of infections have certain restrictions and disadvantages. For example, nedoyostatkom classical bacteriological research, besides dearness and duration (7-10 days), the impossibility to estimate a role of not cultivated microorganisms, first of all anaerobov in infectious-inflammatory process is essential. Therefore kulturalnyj diagnostics method has got rid today of itself! Why? Yes because:

1. There is no screening, the doctor should define - what group of microbes to define and what method: crops on mushrooms, on aerobes, anaeroby, on metabolites

2. And if chlamydias, viruses, a tuberculosis - to address in specialised laboratory

3. The probability of revealing real patogena is small for the reason, that it try to tap in sterile medium - urine, blood, liquor, pus, an exsudate - liquids which have the developed antigenic system. In them there should not be teleorgánic microorganisms

4. Tissues of a brain, kidneys, an intestine, joints, etc. can be received only at an operative measure

5. At testing of resistance of the clinical strain in vitro there is a number of difficulties:

1. The allocated strain seldom is the true or unique agent of an inflammation

2. Sensitivity to antibiotics in vivo, as is known, is far from sensitivity in cup Petri. More precisely - microbic community in Biomembranula condition at quorum-sensingignoriruet any strongest antibiotics [177, 189]

The obvious demand follows from all aforesaid in a reliable quantitative quick test of diagnostics of contagiums.

Unique not kulturalnym a method of definition of quantity of microorganisms 60 dominant sorts and kinds, and also their degrees of a deviation from norm - an infection or deficiency of colonisation of an organ within 3 hours is a method of a gas chromatography of mass spectrometry (GH MS)-detecting of microorganisms on the structural, genetically determined fat acids (ZHK) is immediate in object of research. The given method has started to be developed since 1963. For today method GH MS is used all over the world, in our country very much ogranichenno, basically at serious patients with a various pathology as is expensive and therefore not accessible to the general practice. [33, 141, 146, 23]

Award in 2002 of the Nobel Prize to founders of methods of an electrospray and MLDI to John Fennui Koichi Tanake became a recognition of importance of mass spectrometry for development of a modern science.

How the method of mass spectrometry of microbic markers (MSMM) in medical practice works?

As material for research MSMM any serve biological жидкости:кровь, the saliva, urine, liquor etc. By present time structure of fat acids of the majority of microorganisms is studied, shown its reproducibility, proved them is and vidospetsifichnost. The method of detecting of microorganisms on Zhk-markers is similar to the genetic analysis (PTSR, definition of sequence of nucleotides 16sPJ ІК and so forth) As the structure of fat acids is determined in DNA and is reproduced by replikatsii a site genoma transport RNK and subsequent synthesis ZHK in mitochondrions on matrix RNK. In other words, profile ZHK as is conservative, as well as DNA structure. IssleYOdovanija in the field of bacteriemic paleontology have confirmed a constancy of structure ZHK of separate microorganisms and a pool of their fat acids, as a whole, from depth of times in 2,5 mlrd years. At drawing up of the program of the analysis, algorithm of identification and quantitative calculation of effective number of cells of components of a mikst-infection data on a chemical compound of individual and collective markers more than 500 strains of conditionally pathogenic and pathogenic microorganisms (Osipov G. A, 2003.mitruka B.M are used., 1980).

Basic indicator of efficiency of spent therapy is lethality reduction. The lethality at a croup of not diphtheritic aetiology before introduction in practice sulfanilamidnyh preparations and antibiotics according to J.Brenemann (1938г) made to 88 %, H.Z.Leicher (1929г) - 80 %. After introduction in practice of Sulfanilamidums by data
F.Escher (1944г) - 25-27 %; A.Windorfer (1949г) - 4,6 %, and after introduction of antibiotics (1959-1960гг) - 2 %, D.B.Hawkins (1963г) - 1 %

As a whole with 1949г. The lethality at a croup has decreased in 19 times. Now within last decade lethal outcomes at an acute stenosing laryngitis (croup) at children it did not become perceptible. It is bound first of all by that now razrabotaty and various schemes of treatment of immediately stenosis the larynxes rendering expressed clinical effect in the form of cupping of an edema are widely applied in pediatrics that quite often is the indication for the further treatment of the child domiciliary for the purpose of avoidance of a superbecoming infected and-or an aggravation of symptoms for the account kontaminatsii with "hospital" flora [30, 191]

However, in therapy OSL (groats) paramount value has also causal treatment appointment, in particular antiviral and-or antibacterial, immediately acute respiratory infection referred on treatment.

According to N.A.Geppe (2005г), G.A.Samsyginoj

(1997г.), V.F.Uchajkina (2008г.), F.S.Harlamovoj (2011г.),

R.I.Haitova (2011г.), O.V.Kladovoj (2011г.) the reasons of development ORZ are virusno-bacteriemic associations, bacteria, mushrooms, the elementary. The Virusno-bacteriemic and bacteriemic nature of respiratory diseases is more characteristic for newborn, thoracal children and children of early age. Acute bacteriemic diseases of respiratory tracts can arise as an independent pathology. However in 60 % of cases they are complication of virus infections Virusno-bacteriemic lesions are bound to activization microbic autoflory in connection with disturbance of barrier function of a respiratory tract and depression of protective properties of an organism, and also a superbecoming infected bacteriemic agents. Joining of a bacteriemic infection leads to increase of gravity of disease and there can be the basic

The failure reason.

At the same time there are also initially bacteriemic infections of respiratory tracts. The most frequent originators are pneumococcuses (Str.pneumonie), hemolitic streptococcuses of group And (Str. pyogenes, viridans, etc.), a hemophilic rod, a pneumonia mycoplasma, moraksella katarralis. Usually in the bacteriemic nature of acute respiratory disease specifies long (more than 3 days) a febrile fever, occurrence of purulent scurf and mucopurulent or purulent separated of a nose, the expressed intoxication, and also fixing character of a respiratory infection [119, 25, 121, 60, 37]

At a choice of antibacterial therapy in practical work it is necessary to combine the decision of tactical problems which the rational choice of an antibacterial preparation with the greatest therapeutic and least toxic influence concerns, with the decision of a strategic problem which define as reduction of selection and diffusion of refractory strains of microorganisms to populations. Now at bacteriemic infections of a respiratory tract at children antibiotics of a penicillinic number (preparations of 1st choice), cephalosporins I are used, II and macroleads and other groups of preparations (reserve) are more rare than III generations (preparations of 2nd number).

Thus, stated all above suggests that OSL (croup) is not only virus aetiology of disease, and it more often a mikst-infection which at children of younger age is realised in the bacteriemic infection demanding modern methods of diagnostics and in due time and correctly begun treatment. However, absence in pediatric practice of possibilities of an estimation of a bacteriemic aetiology of the disease, the developed methods of diagnostics, treatment dictates necessity of carrying out of the further researches.

Taking into account an urgency of the given problem the purpose of our work was studying of an aetiology of an acute stenosing laryngitis (croup) by means of modern methods of diagnostics, allowing to estimate an organism condition as uniform ekosistemu, for a representation excavation about a role of a bacteriemic infection and factors of its pathogenicity on a current of disease and a substantiation of timely appointment of a causal treatment

According to an object in view work problems were:

1. To study a new direction in molecular microbic diagnostics for mikst-infection revealing, disbiozov and inflammatory processes on specific markers (to fat acids, aldehydes and sterolam) with the help hromato - mass spectrometries in blood, a saliva at children with OSL (croup).

2. To study frequency of occurrence of virusno-bacteriemic associations at OSL (groats) at children.

3. To define character of a microflora of the top respiratory tracts taking into account factors of pathogenicity of bacteriemic flora.

4. To develop diagnostic algorithm OSL (groats) of a virus and bacteriemic aetiology of disease to leading clinical signs from positions of demonstrative medicine and to solve a question on timely appointment of a causal treatment.

5. To estimate efficiency of system antibacterial therapy and the preparations strengthening a causal treatment at children with OSL (croup).

In a work basis observation over 163 patients is necessary, from them OSL (croup) became perceptible at 70 (42,9 %), from them at 15 (9,2 %) were unitary episode OSL, at 23 (14 %)-repeated, at 32 (19,6 %)-recurring. At 13 (8 %) children
OSLD it was combined from UNIFORMS. Group CHBD have made 47 (28,9 %), rare ORZ it was registered at 46 (28,2 %) children.

The expert estimation of case histories is spent spent at 640 children of younger age hospitalised concerning an acute obstructive laryngitis (croup) and relapsing croup during 1997-2010гг. In 18 infectious unit MDGKB of of Moscow.

For the decision of tasks in view in work the wide complex of methods of research has been used: anamnestic, clinical, bacteriological, virologic, mass spectrometer, tool and functional.

At inspection of a complex of clinico-anamnestic data attracts attention the allergological anamnesis of patients with OSL. Among allergic diseases in a family most often met a pollinosis - 29,5 %, allergic all-the-year-round rhinites - 22,9 %, a food allergy - 27,8 %, BA and an allergy on medicinal preparations - 21,3 %, a croup as a whole - 27,8 %. Investigating the obstetric and neonatal anamnesis, it has been taped, that the pathological current of pregnancy became perceptible at 30,6 % of mothers of the surveyed group: ORVI during pregnancy have transferred 24,8 %, the pathology of the intranatal period took place in 36,8 % of cases. Early terms of transition of the child on artificial feeding became perceptible. On early artificial feeding were 428 (61,4 %) children, duration of thoracal feeding of children with OSL basically was about 1-2 months у194 (45,3 %) the person, till 3-4 months at 166 (38,9 %), till 5-6 months at 68 (9,7 %).

At research of the family anamnesis and the anamnesis of a life of children with OSL (croup) an irrational food of mothers, application of medicines during pregnancy and feeding by a breast, smoking of both parents, adverse ecological conditions of residing took place.

In the anamnesis of all surveyed children there were indicatings on the transferred infectious diseases of the virus, bacteriemic or admixed aetiology. Frequent ORVI (more than 6 times in a year) took place at 77,8 % of patients, a repeated pneumonia at 3,8 % of children.

The accompanying pathology at the surveyed patients has been presented by group bronholegochnyh diseases: at 80 (49,1 %) the obstructive bronchitis, at 66 (40,5 %) frequent ORVI, у17 (10,4 %) a pneumonia became perceptible

Background diseases have made 12 %. Allergopatologija took place practically at each patient with OSL (croup), shown in a kind atopicheskogo a dermatitis at 114 (70 %), a pollinosis at 33 (20,2 %), a food allergy at 16 (9,8 %). Thus children with OSL (croup) have the burdened heredity on allergic diseases, a pathology pre - and the intranatal period.

At studying of accompanying allergic diseases at children with OSL (croup) it has been established, that all children at whom subsequently it was generated BA had the signs of a food allergy more often shown by dermal changes, in early age.

All observable children were Muscovites, lived in industrial regions of a city or along large highways that was an adverse ecological background.

Smokers in a family met in overwhelming majority of surveyed, frequency of passive smoking at children with OSL (croup) has made more than 80 %.

Thus, the probability of development OSL (groats) most likely depends on set of the various factors, including not only ecological aspects, but also genetic and immunologic features. At the same time till now criteria, authentic are not developed
With positions of demonstrative medicine, early diagnostics of a virus and-or bacteriemic aetiology of disease, therefore we undertake attempt, on the basis of a complex of virologic, bacteriological, mass spectrometer methods of research, to allocate group of the factors promoting more exact definition of the etiological factor in disease at children.

Bacteriological, virologic and mass spectrometer researches were spent to laboratories MDGKB (the manager. Laboratory - Ovechkina N.S.; in microbiology laboratory (the principal - prof. Moroz A.F.) NIIEM of N.F.Gamalei; in immunology laboratory (the principal - prof. Vjazov S.O.) institute of virology of D.I.Ivanovo of the Russian Academy of Medical Science; in independent laboratory "Инвитро", laboratory of the academic group of the academician of the Russian Academy of Medical Science J.F.Isakova at NTS SSH of A.N.Bakuleva (the principal - d.b.n., the professor Osipov G. A)

At inspection carrying out it has been taped what to define at each patient presence of a respiratory virus in stomatopharynx washout it is inexpedient, as it is already proved, as at healthy children it is possible to allocate by means of PTSR-DIAGNOSTICS respiratory viruses from a stomatopharynx.

At carrying out of selective virologic researches at all children it was defined any, and it is frequent and 2 respiratory viruses. Prevalence of this or that respiratory virus in sample depended on a season when research was carried out.

As a result of numerous researches of a microbiocenosis of a stomatopharynx by a bacteriological method it has been taped, that the received results directly are bound to quality of work of microbiological laboratory. So, at studying of frequency of detection of microorganisms in crops of slime from a nose and a stomatopharynx at 2761 patients, being on treatment in MDGKB for
2007г. By a bacteriological method it has been taped, that in 62,4 % of cases of observation the negative result became perceptible. A similar situation not mozhe to be only because in the existing order 535 from 22.04.1985г. Research of a biocenosis of a stomatopharynx is spent not only qualitative way, but also the quantitative maintenance of microorganisms on mucous stomatopharynxes taking into account the existing norms calculated in WHICH/TAMPON is defined. According to the methodical references stated in the order №535 MZ Russian Federation from 1985г., following specifications have been accepted: Staph. aureus-101-102; Str. haemolyticus - 103-104; Enterococcus -

101-102; E. coli - 101-102; C. albicans - 101-102; Bacillus - 102; Klebsiella 101 -

102; Streptococcus 103-104; Staph. saprophyticus 101; Candida sp. - 101.

At selective carrying out of bacteriological inspection in laboratory of microbiology NIIEiM of N.F.Gamaleja for I - V 2007г. At each patient it was sowed on 3-4-5 originators, but their bacteriemic spectrum also corresponded to "the laboratory standard».

At research of patients with OSL (croup) during 2006г. Also in laboratory of microbiology NIIEiM of N.F.Gamalei among the allocated microorganisms most often and with high degree obsemenennosti at children golden and saprophytic staphilococcuses (65 %), haemophilus spp were found out. (62,5 %), streptococcuses of various kinds (an alpha, beta and scale) (60 %), are much more rare mushrooms of sort Candida and others patogeny.

At carrying out of microbiological research of a microflora of a stomatopharynx staphilococcuses among which golden made 45 % were found out in children with ORVI among the allocated microorganisms in 25,8 %; in 24,4 % - streptococcuses among which beta and alpha hemolitic made 24,4 %; in 14 % - nejsserii among which in 43 % of cases log a caption was> 6; in 14 % - haemophilus spp.; in 6 % - mushrooms of sort Candida; in 10,1 % others were allocated patogeny.

Thus, the obtained data testify that at carrying out of a bacteriological method of research at each child the flora "traditional" for microbiological inspection is allocated, but with various level of colonisation.

At carrying out of microbiological research of a microflora of an intestine at children with OSL (croup) among the allocated microorganisms typical for a biocenosis of an intestine the flora also was allocated.

On set clinico-datas of laboratory at 21 (56,8 %) patients diagnosed disbioz an intestine of III degree, at 16 (43,2 %) - disbioz IV degrees. In obligate flora of an intestine at patients OSL (croup) with bacteriemic complications became perceptible at 34 (91,8 %) children - deficiency laktobaktery, at 21 (56,8 %) - an intestinal rod, at 18 (48,6 %) - fecal streptococcuses, at 27 (73 %) - bifidobaktery, at 15 (40,5 %) the golden staphilococcus, at 9 (24,3 %) - laktozootritsatelnaja culture enterobaktery is allocated. The facultative flora of an intestine at patients OSL (croup) with bacteriemic complications has been presented by the big colonisation both pathogenic, and is conditional-pathogenic flora. Taikm the image, at carrying out bakteriologichenskogo studying of a microbiocenosis of washouts from a stomatopharynx and intestine flora had been taped presence of the identical flora which are colonizing all mucosas GASTROINTESTINAL TRACT and being "traditional" for given method of inspection.

Considering uniformity of allocation of bacteriemic markers at surveyed children and impossibility of definition of the core or the basic originators in an aetiology of disease for the purpose of verification of possible changes of clinical semiology and the form of gravity of current infectious process we have resorted to definition of metabolites (Staphylococcal Enterotoksiny-Se) membranotoksinov (staphylolysins or hemolysins). Work it was spent to microbiology laboratories
NIIEiM of N.F.Gamalei, 2008г. D.b.n. Fluer F.S., zav.lab. D.b.n., the prof. Prokhorov V. JA.

At the moment of research there was a definition possibility only Enterotoxins And and In which were allocated in pure culture Staph.

From 10 surveyed children at 4 children has been allocated Staph. Aureus; at 2 - Staph. Epidermidis; at 2 - Staph.haemolyticus; at 1-Staph. Capitis; at 1-Staph.xylosus;. The majority (80 %) children were younger age.

In clinic of disease at these children we did not note any features.

As a result of the spent inspection in one case of observation we had no positive take. In definition of toxins on the research spent by us it is possible to explain the received negative results to that in most cases at reception of antibacterial therapy sensitive strains to an antibiotic disappeared or changed the kulturalnye properties.

Definition of other enterotoxins most likely was inexpedient, as more often (according to D.b.n. Fluer F.S., zav.lab. D.b.n., the prof. Prokhorov V. JA) is allocated SE "And" and "In".

Besides for an estimation of the form of gravity and expression of inflammatory reaction we used nuclear and leukocytic indexes of an intoxication which counted by results of the general analysis of blood. By means of simple calculation it is objectively registered both srednetjazhelaja, and dekompensirovannaja the form of gravity of disease which develops because an appreciable part of toxic products of the albuminous nature and endotoxins is fixed on microclots and units and, being switched off from the general blood flow, reduces toxicity of blood.

As a result of the spent inspection at all children the disease form became perceptible sredneyotjazhelaja. However, the average form of gravity with the moderated
Intoxication signs became perceptible only at 29,5 % of patients, in 70,5 % of cases of observation disease proceeded with the expressed signs of an intoxication.

S-jet fiber defined at 32 patients, its average value have made - 0,012 yo 0,2 g/l at norm> 70 mg/l = 0,007 g/l

Thus, the obtained data about absence SE at children with OSL (croup) against treatment by antibacterial preparations testify to inexpediency of carrying out of a similar method of diagnostics for specification of an aetiology of disease. Besides allocation SE is long enough process, that also is an obstacle for the timely equipment of an aetiology of disease. Definition SRB and JAII are exact and fast methods for acknowledgement of a bacteriemic aetiology of disease, however in clinical practice "delay" of changes from laboratory methods of research quite often becomes perceptible. Therefore now constantly there is a search of more perfect methods of diagnostics allowing quickly and is high-grade to estimate a disease aetiology. One of such methods of diagnostics is the method of a gas chromatography of mass spectrometry.

At 36 children research of a sputum and blood by means of a method of a gas chromatography of mass spectrometry is carried out. At the heart of a method of a gas chromatography of mass spectrometry high-precision definition of presence of molecular signs of microorganisms (markers) from among their cellular lipids - the higher fat acids, aldehydes, alcohols and sterolov in analyzed assay lays. Definition was made by a high-strung and selective method of a gas chromatography - masses of spectrometry (GH-MS), allowing simultaneously to measure more than hundred microbic markers immediately in an analyzed material, blood, urine, bioptatah, punctates, a sputum, both other biological liquids and tissues without preliminary crops on nutrient mediums.

As a result of the spent inspection presence of 27 microorganisms with high colonisation among which the greatest specific gravity have made Streptococcus (17 %) has been taped in a sputum; Nocardia (8,7 %); Clostridium ramosum (14 %); Staphylococcus intermedius (1,9 %); Lactobacillus (9,1 %); Candida (4,1 %); E. Moniliforme (9,7 %); Propionibacterium spp (5,7 %); Ruminicoccus (1,6 %); Peptostreptococcus anaerobius (8,4 %); Streptomyces (3,4 %). The share anaerobov has made 50 %, aerobic aktinomitsetov - 18,8 %. Others have made - 31,2 %, the originators taped kulturalnym by a method in "good" microbiological laboratories have made 15.6 % of them. As a result of the carried out research by results of mass spectrometry in blood 21 microorganism with high degree of colonisation is allocated: Streptococcus (3,7 %); Nocardia (8,6 %); Clostridium ramosum (12,2 %); Staphylococcus intermedius (6,3 %); Lactobacillus (23,1 %); Candida (4,1 %); E. Moniliforme (9,1 %); Propionibacterium spp. (6,1 %); Ruminicoccus (3,9 %); Streptomyces (1,5 %). The share anaerobov has made 46,4 %, aerobic aktinomitsetov - 21,4 %.

Others have made - 32,2 %, the originators taped kulturalnym by a method in "good" microbiological laboratories have made 17,8 % of them. At the comparative analysis it is established, that microorganisms of a saliva and blood are identical, however colonisation Streptococcus in a saliva on 13,3 % above, than in blood, and colonisation Staphylococcus intermedius on 4,4 % and Lactobacillus on 14 % above in blood that is bound to a current of an acute respiratory infection. The received results of data of mass spectrometry in a saliva and blood at patients with OSL (croup) are same on structure that testifies about uniform ekosisteme an organism, and also that for revealing of the etiological factor it is possible to be guided by indicators of any one medium, in this case a saliva and not to resort to invasive methods of inspection.

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.

For the purpose of correction of the taped disturbances in the form of presence of a probable and-or obvious clinical sign of a bacteriemic infection, sredneyotjazheloj forms of disease with the primary expressed symptom of an intoxication according to JAII, presence of authentically significant rising of level SRB, and also allocation of several bacteriemic originators with high degree of colonisation by us were applied preparations of etiotropic (antibacterial) action-roksigeksal and a preparation of the system

Enzymotherapies, (Vobenzim) influencing a homeostasis of an organism and strengthening etiotropic effect on purpose «infection excisions» from an organism and restoration of the damages put by an infection.

As a causal treatment we used the antibacterial preparation roksigeksal which is dzhenerikom roksitromitsina, representing semisynthetic 14-chlennyj a macrolead which possesses expressed immunomodulirujushchim and antiinflammatory action.

According to literature roksigeksal influences processes of immune reaction by change of synthesis by monocytes and macrophages of such important mediators of the immune answer as the factor of a necrosis of a tumour, interlejkiny, the colony stimulating factor, that as a whole renders not only bacteriostatic action, but also promotes restoration of tissues.

Under observation there were 50 patients with srednetjazhelymi forms ORVI with clinical implications of a bacteriemic infection as a stenosing laryngotracheobronchitis (25 patients), tonzillofaringita (14 children), an otitis (4 children), an obstructive bronchitis (7 children), purulent
Rhinitis (36 children), at the age from 4 months till 15 years (30 children - preschool children, 20 - schoolboys).

To a category it is frequent and it is long ill (ORZ 4-10 times a year) concerned 38 children (76 %), at 36 (72 %) patients the hypertrophy of tonsils of II degree, at 17 (34 %) - an adenoid disease, at 14 (28 %) - adenoides of II degree, at 3 (6 %) - adeno - and tonzilektomija, at 34 (68 %) - the phenomena granulematoznogo a pharyngitis, at 19 (38 %) - a chronic pharyngitis, at 4 (8 %) - a bronchial asthma, at 3 (6 %) - a vegeto-vascular dystonia, at 1 (2 %) - syndrome Alporta, at 1 (2 %) - a pseudorheumatism, at 2 (4 %) - mikoplazmennaja an infection became perceptible.

The basic group was made by 35 patients, they received roksigeksal, other 15 patients have made comparison group, of them 8 patients received ampicillin parenteralno, 5 - Cefazolinum parenteralno, 1 - augmentin inside and 1 - macrofoams inside in age dosages. The basic group was made by 35 patients, they received roksigeksal, other 15 patients have made comparison group, of them 8 patients received ampicillin parenteralno, 5 - Cefazolinum parenteralno, 1 - augmentin inside and 1 - macrofoams inside in age dosages.

Presence testified to development of a bacteriemic infection seroznoyognojnogo separated of a nose with an unpleasant smell, development of an otitis, the phenomena granuleznogo a pharyngitis with applyings of a mucopurulent secret on a back wall of a pharynx. The state of health at all children was broken: were capricious, refused meal, uneasily slept, vomiting periodically became perceptible at the expressed anxiety.

Patients showed complaints to a pharyngalgia, an ear, sensations of dryness, an alien body, discomfort, pershenija in a stomatopharynx.

S-jet fiber defined at 32 patients, its average value have made - 0,012 yo 0,2 g/l at norm> 70 mg/l = 0,007 g/l

For revealing disbioza oral cavities and estimations of sanifying efficiency of preparation roksigeksal before appointment of therapy and later 5-7 days from the treatment beginning in ispytuemoj to group and comparison group estimated structure of a microflora of a stomatopharynx.

Golden and saprophytic staphilococcuses (65 %) were found out in patients with complicated ORZ among the allocated microorganisms most often at children, Haemophilus spp. (62,5 %), streptococcuses of various kinds (an alpha, beta and scale) (60 %), are much more rare mushrooms of sort Candida and others are pathogenic.

In dynamics of observation after the termination of treatment the structure of microbic flora has essentially changed: on 20 %, Haemophilus spp.на20 %, the quantity of staphilococcuses has decreased for 10 % - E.coli, the number of mushrooms of sort Candida was enlarged by 10 % in control group, in group of streptococcuses have ceased to be allocated beta hemolitic, however total of other streptococcuses-saprophytes at children, treated roksigeksalom, was enlarged by 28 %, and in control group - on 40 %.

It is important to notice, that among treated children preparation roksigeksal has come eradikatsija 24 % of the allocated microorganisms, and in control group - 20 % in the same terms of observation that has affected on

Duration of the basic clinical symptoms and duration of disease.

Apparently from the presented data at patients, treated roksigeksalom and other antibacterial parenteral preparations of an authentic difference in duration of a fever, implication intoksikatsionnogo a syndrome (the malaise, appetite depression, delicacy, depression of physical activity), the phenomena of a laryngitis, a rhinitis did not become perceptible, however in control group took place occurrence of an allergic eruption, abdominal pains, razzhizhennogo and the speeded up chair.

At an extract full recover at treated roksigeksalom became perceptible at 13 (37,1 %) patients, improvement at 22 (62,9 %). In group of the control recover at 3 (20 %) patients, improvement - at 12 (80 %).

One of the preparations, capable to strengthen causal treatment action is Vobenzim. The basic function of system enzymotherapy (Vobenzima) is a depression of adhesive abilities of the originator and excision of cytokines from circulation therefore this therapy has received a wide circulation in pediatrics. Besides, Biomembranula, obrazuemaja bacteria is very steady against influence of any antibacterial preparations at the expense of creation of the "quorum" presented by components of an intercellular matrix, high rate of cell fission, presence of cells steady against any antibiotics, so-called "persisterov", the enzymes allocated in a matrix, and fermental preparations significantly influence on lizis this Membranula, than provide higher effect of an antibiotic.

So, According to L.P.Sizjakinoj (2002г) at patients with a bronchial asthma at application Vobenzima takes place: depression of frequency and gravity of intercurrent infections, augmentation of a specific gravity of a normal microflora, improvement of clinical indicators of a functional condition of bronchuses, an intensification of functional activity of cellular and humoral links, depression allergenindutsirovannogo the answer of lymphocytes, reduction of the Central Electoral Committee against positive changes of the basic markers of an atopy (IgE, IL-4).

According to N.S.Smirnova (2000г) at patients with atopicheskim a dermatitis at application vobenzimaotmechaetsja: Reduction of terms of the clinical

Convalescences on the average in 2 times, Augmentation of duration of clinical remission in 2-8 times, Improvement ehostruktury and functional activity of a pancreas, Improvement of a current of disease at 81.3 % of patients, Reduction of a medicamental load on children.

According to A.V.Sarychevoj (2000г) at CHBD appreciable depression of frequency ORZ at children younger (80 %) and senior (83,4 %) groups, Depression of size and density of lymph nodes, Reduction of seeding of pathogenic flora or disappearance of bacteriemic pathogenic flora at 50 % becomes perceptible.

By data multitsentrovogo retrospective research (Czechia, 1996 2002гг) At relapsing infections of respiratory tracts has место:Статистически authentic depression

Relapses on 59 %, statistically authentic depression of quantity of courses of an antibioticotherapia on 68 %.

We in research had been included 53 children with OSL (croup) with clinical signs of the bacteriemic infection, being on hospitalisation, at the age from 1 till 3 years.

Middle age of the patients included in research, has made for the basic group 2,6±0,12 years (from 1 till 6 years); for control group - 3,4±0,12 years (from 1г 2 mes till 9 years). To a sexual sign of group did not differ from each other: in the basic group of children there were 12 girls and 18 boys; in control group - 6 girls and 17 boys.

Vobenzim it was prescribed at children from 1 year till 3 years on 1 tablet to 3 kg of weight, is more senior 3th years - on 1 tablet on 6 kg of weight within 10 days.

Presence testified to development of a bacteriemic infection seroznoyognojnogo separated of a nose with an unpleasant smell (100 %), otitis development (68 %), the phenomena granuleznogo a pharyngitis with applyings of a mucopurulent secret on a back wall of a pharynx (64 %), puffiness and a hypertrophy of palatine tonsils (100 %), razryhlenie mucous and "zijanie" lacunas of tonsils, and also a bright diffuse hyperemia mucous stomatopharynxes (100 %).

All observable children concerned a category often and is long ill ORVI (to 6-9 times a year), at 36 (68 %) patients the hypertrophy of tonsils of II degree, at 21 (40 %) - an adenoid disease, at 22 (41,5 %) - adenoides of II degree, at 2 (3,8 %) - adenoektomija, at 34 (64 %) - the phenomena granulematoznogo a pharyngitis, at 19 (36 %) - a chronic pharyngitis became perceptible.

As a result of the spent treatment the patients receiving Vobenzim significant had changes on such indicators as «appetite depression», «zalozhennost a nose», «wet tussis», «the general duration of tussis», «auskultativnye changes in lungs», duration of other clinical symptoms tended to reduction

The maximum clinical effect is noted at 38 % of children for 6 days of reception of a preparation. In the same terms at 42 % of children change of density of a sputum in favour of its colliquation while in comparison group these changes were registered only at 38 % of children became perceptible.

At an expert ball estimation at patients, treated Vobenzimom in 53,3 % the clinical effect was excellent, at 46,7 % - good. In group of the control at 48 % and 52 % accordingly Changes in a microbiocenosis of an intestine at children receiving system enzimy we have not taped

As a result of the spent treatment in a nasopharynx microbiocenosis reduction of colonisation Streptococcus by 15 %, Nocardia on 7 %, Peptostreptococcus anaerobius on 4,2 % has been noted; moderate augmentation uslovnoyopatogennoj florae Clostridium ramosum on 4,3 %; Propionibacterium spp on 7,4 %.

In blood reduction Streptococcus by 1,3 %, Nocardia on 3 % and moderate augmentation Clostridium ramosum on 2,7 % became perceptible.

At the comparative analysis uniformity of a microflora of a saliva and blood takes place, thus it does not become perceptible prevalence of colonisation Streptococcus in
To saliva, in blood kolonizatsi Staphylococcus intermedius prevalence has decreased for 2 % and prevalence Lactobacillus was enlarged by 2,1 % that is bound to the period rekonvalistsentsii patients.

Level eradikatsii patogenov corresponded to reduction in 2 times of the form of gravity of disease on the Leukocytic Index of the Intoxication and 1,5 times on the Nuclear index of an intoxication

Thus, at children with OSL (croup) having signs of a probable bacteriemic infection with bacteriemic complications in the illness beginning it is possible to tell with confidence, that at them prevails bacteriemic etiolgija zaboldevanija. And even if the doctor doubts necessity of appointment А\Б it is better than them will prescribe are visible also antibiotic Appointment is justified.

Further in the absence of clinic and laboratory signs of a bacteriemic infection the antibiotic can be cancelled (not to spend so-called "course" for 7 and more days), that reduces fastness,

• Thus, all above-stated allows to develop algorithm of possible etiological decoding of an acute stenosing laryngitis (croup). At the anamnesis collecting it is necessary to pay attention to such facts as:

• Burdeness of allergic diseases

• the Pathology a pre-post perinatalnogo the period

• the Allergic anamnesis of the child

• Age of the child: till 1 year, 1-3 years, 3-6 years,> 6 years

• the Stenosis of larynx II-III of degree in a disease debut

• Frequent respiratory diseases

• It is long also flaccid ORZ

• Bacteriemic complications

• Spent therapy with presence of etiotropic treatment

• mainly virus aetiology of disease can be assumed, if at the patient the first day of disease takes place, the temperature does not exceed 38 With and 1 day remains, the stenosis of a larynx I - II degrees, quickly stopped against spent ldechenija becomes perceptible, at objective survey mucous stomatopharynxes weakly giperemirovany,

• a discharge from a nose poor, serous character, without a pathological smell,

• in OAK all indicators correspond to age norm or the moderate neutrophilia becomes perceptible.

• mainly bacteriemic aetiology of disease can be assumed, if the child is sick more than 2-3 days, the temperature> 38С during all period of disease or its rising on 2-3день, becomes perceptible a stenosis of a larynx of II degree without significant improvement more than 24 hours against spent treatment, at objective survey mucous stomatopharynxes brightly giperemirovany, are hydropic,

• a discharge from a nose of is serous-purulent character with a putrefactive smell

•, in OAK nejtrofilnyj a leukocytosis, accelerated by an ESR. In b/h SRB> 0,007g/l.

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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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  2. Conclusions
  5. Chapter 8. The CONCLUSION
  12. the CONCLUSION