Prus O. The value of the microbial flora of the nasopharynx and oropharynx and the immune response of children in the formation of variants of the clinical course and the results of infectious mononucleosis

The objective of the study: to improve early prediction of clinical variants of infectious mononucleosis in children by studying the clinical manifestations of the disease, establishing a microbial landscape of the mucous membrane of the nasopharynx and oropharynx, as well as blood interleukins and immune status.Criteria for inclusion in the study were: age from three years to nine, moderate or severe infectious mononucleosis, signed informed consent of parents or guardians to participate in the study. Exclusion criteria were: congenital or acquired immunodeficiency, the presence of autoimmune diseases, the use of immunomodulatory, steroid drugs during the last month, the presence of chronic comorbidities that could affect the results of the study. The observation groups were randomized and homogeneous in terms of age and severity of IM. Clinical material was obtained in 184 children aged 3 to 9 years. Blood was taken from 30 healthy children of the appropriate age for immunological examination with the consent of the parents. Depending on the colonization by the bacterial flora of the nasopharynx and oropharynx, observation groups were formed: the first (31 children) - Staphylococcus aureus was detected by bacteriological examination of smears from the nasal mucosa and tonsil tissues; second (33 children) - Streptococcus pyogenes in combination with Staphylococcus aureus; third group (60 children) - Streptococcus pyogenes; fourth (29 children) - E. Coli; fifth group (31 children) - Streptococcus pyogenes in combination with E. Coli. In all children of these groups, these microorganisms were determined in concentrations of 10-3 - 10-7 degrees. Practical health care provided new data on the features of the clinical course of infectious mononucleosis in children with colonization of the nasopharynx and oropharynx Streptococcus pyogenes, Staphylococcus aureus, E.coli in the acute period of the disease and in the period of convalescence (8 - 14 days after hospitalization), changes in laboratory and immune indicators of these patients in the dynamics of the disease, which expands the range of theoretical knowledge of the practitioner, promotes early diagnosis and reasonable treatment of such patients, shortens hospitalization days and improves the quality of life of children. Practical health care provides objective criteria for predicting the course of infectious mononucleosis in children. The results of the work expanded the range of knowledge of the practitioner regarding the pathogenesis of the pathological process, disorders of the cellular and humoral link of the immune response, cytokine response in infectious mononucleosis in children. Practical medicine has a model of early prediction of infectious mononucleosis in children, on the basis of which in the onset of the disease, taking into account clinical and immunological data, it is possible with high probability (80%) to predict a severe course. The latter allows you to timely determine the scope of therapeutic tactics. The identified features of the course of infectious mononucleosis in children with different bacterial colonization of the nasopharynx and oropharynx will help to improve the treatment and diagnostic process in inpatient treatment.