CC BY
8
ROLE OF MICROBIOTA IN THE ETIOLOGY OF CHRONIC RHINOSINUSITIS Madaminova N.E.1, Ulmasov B.B.2, Shaikhova Kh.E.3 Em ail: [email protected]
'Madaminova Nigora Ergashevna — Assistant; 2Ulmasov Biserbek Bakhodirovich — Assistant, DEPARTMENT OF OTORHINOLARYNGOLOGY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN;
3Shaikhova Kholida Erkinovna - Doctor of Medical Sciences, Professor, DEPARTMENT OF OTORHINOLARYNGOLOGY, TASHKENT MEDICAL ACADEMY, TASHKENT, REPUBLIC OF UZBEKISTAN
Abstract: it has now been proven that normal healthy sinuses contain various bacteria, including anaerobic microorganisms. The nasal microbiota of healthy individuals mainly consists of representatives of Actinobacteria (for example, Corynebacterium and Propionibacterium), less commonly Firmicutes (for example, Staphylococcus) andproteobacteria (for example, Enterobacter). It was revealed that the species composition of bacteria present in the sinuses in patients with ChR does not differ from that in healthy individuals; however, the spectrum of pathogens in ChR is less diverse and is characterized by a large number of either anaerobes or aerobes. Keywords: bacterial flora, anaerobic microorganisms, aspergillosis, fungal flora, subclinical forms.
РОЛЬ МИКРОБИОТЫ В ЭТИОЛОГИИ ХРОНИЧЕСКИХ РИНОСИНУСИТОВ Мадаминова Н.Э.1, Улмасов Б.Б.2, Шайхова Х.Э.3
'Мадаминова Нигора Эргашевна — ассистент; 2Улмасов Бисёрбек Баходирович — ассистент, кафедра оториноларингологии, Андижанский государственный медицинский институт, г. Андижан;
3Шайхова Холида Эркиновна — доктор медицинских наук, профессор, кафедра оториноларингологии, Ташкентская медицинская академия, г. Ташкент, Республика Узбекистан
Аннотация: в настоящее время доказано, что в норме в здоровых синусах присутствуют различные бактерии, в т. ч. анаэробные микроорганизмы. Носовая микробиота здоровых лиц в основном состоит из представителей Actinobacteria (например, Corynebacterium и Propionibacterium), реже встречаются Firmicutes (например, Staphylococcus) и протеобактерии (например, Enterobacter).
Выявлено, что у пациентов с ХР видовой состав бактерий, присутствующих в пазухах, не отличается от такового у здоровых лиц, однако спектр возбудителей при ХР отличается меньшим разнообразием и характеризуется большим количеством либо анаэробов, либо аэробов. Ключевые слова: бактериальной флоры, анаэробные микроорганизмы, аспергиллез, грибковая флора, субклинические формы.
UDC 6'6.2''/.2'6-002-036.'2-07/.084
Relevance. Thus, in a multicenter study, O.A. Ivanchenkoetal. found that aerobes were detected more often than anaerobes, both in the nasal cavity (78.7% versus 21.3%) and in the maxillary sinus (55.2% versus 44.8%). Streptococcusspp was more common in them. (28.8%) and Prevotella (17.8%), while Streptococcus pneumoniae, Haemophilusinfluenzae and Staphylococcus aureus were relatively rare (6.7%, 5.4% and 8.9%, respectively).
In another study, ChR revealed Streptococcus viridans, S. pneumoniae, Corynebacterium spp., Moraxella catarrhalis, Haemophilus parainfluenzae. The number of Propionibacterium and Porphyromonas in patients with CP was reduced. Age also influences the composition of the bacterial flora in patients with CR - in patients over 65, compared with patients under 40, Proteusspp and Pseudomonasa eruginosa are more common.
Over the past decades, significant progress has been noted in the diagnosis and treatment of respiratory diseases, in particular, various forms of sinusitis, a pathology that affects over 20% of the world's population.
The creation of new pharmacological preparations, the discovery of more advanced antibiotics made it possible to successfully fight various types of infectious pathogens. The introduction of microsurgical techniques into practice, the development of minimally invasive methods of surgical intervention, have determined a qualitatively new approach to the treatment of sinusitis.
The first descriptions of mycoses of the paranasal sinuses date back to the end of the 19th century. In 1883 P. Schubert, and then in 1889 J. Mackenzie and H. Siebermann published observations of fungal infections of the maxillary sinuses caused by fungi of the genus Aspergillus. Aspergillosis of the frontal sinus was first described in 1933 by W. Adams. All authors emphasized the exceptional rarity of such observations. The prevalence of fungal sinusitis has increased significantly over the past decade. According to J.B. Taxy (2006), in 6-12% of patients with chronic sinusitis, fungal elements are found during culture or histological examination.
Purpose of the study. Improving the efficiency of diagnostics of various forms of fungal sinusitis.
Material and research methods. In the work, a comprehensive diagnostic examination was used, including a clinical examination with an elucidation of risk factors in the anamnesis, the nature and severity of the course of the disease. Examination of the ENT organs included endoscopy of the nasal cavity and paranasal sinuses using rigid and fibroendoscopes with a diameter of 2.8 and 4.0 mm with zero, 30- and 70-degree optics.
Research results. Examination of patients with chronic rhinosinusitis revealed various forms of fungal sinusitis in 14.4%. The fungus ball was found in 25 patients (58%). Localization in the maxillary sinus was noted in 22 patients (88%), in the frontal - in one patient (4%) and in the sphenoid sinus - in two patients (8%). Superficial sinonasal mycosis was diagnosed in 6 patients (14%): 2 women and 4 men. Chronic invasive fungal sinusitis was detected in 2 female patients (4.7%). Chronic rhinosinusitis associated with fungal infection was found in 10 patients (23%): 3 men and 7 women.
From the data of the anamnesis it was found that 5 patients (11.6%) suffered from diabetes mellitus of varying severity. 2 patients (4.6%) received long-term corticosteroid therapy for bronchial asthma. 3 patients (7%) noted unfavorable working conditions associated with high humidity, the presence of mold in the room. 9 patients (20.9%) underwent more than 2 courses of antibiotic therapy. 20 patients with maxillary sinus mycetoma (46.5%) underwent complex filling of the upper row of teeth. 3 patients (3%) underwent surgical interventions in the nasal cavity several weeks ago.
Endoscopy of the nasal cavity revealed the following pathological changes: dry purulent crusts on the nasal mucosa, resembling mold plaque - 6 patients (14%), viscous mucous secretion - 14 patients (32.6%), granular inflammatory changes or small polyps in the middle nasal course - 16 patients (37%), necrotic masses in the middle nasal passage were found in 4 patients (9%), in the sphenoid sinus - in 2 (4.7%) and in the maxillary sinus - in 6 patients (14%). One of the characteristic signs of fungal infection was detected in 51% of patients. 2 or more rhinoscopic signs were found in 27%.
Microscopic examination of smears from the nasal cavity and paranasal sinuses revealed mycelium of the fungus in only 36 patients. Sowing crops was more productive. Mycetoma (fungal ball), according to a culture study, was represented by fungi of the genus Aspergillus fumigatus in 19 cases (76%), Aspergillusniger - in 3 (12%), Aspergillusflavus - in 2 (8%), Candidaaldicans - in 1 case (4%) ). In patients with superficial sinonasal mycosis during culture, fungi of the genus Candida were detected in 3 cases (50%), Aspergillus fumigatus - in 2 (33%), Penicillum - in 1 case (17%).
In chronic bacterial sinusitis in association with streptococcal and staphylococcal flora, fungi of the genus Candida were sown in 8 patients (80%), and Aspergillus fumigates (20%) were found in two patients. The fungal flora in patients with the invasive form was represented in one case by Aspergillus fumigates, in another by the genus Mucor.
The study of the immune status of patients with mycetoma and superficial mycosis of the paranasal sinuses did not reveal significant pathological changes. The most pronounced disorders of the immune status compared with the reference values were observed in cases with chronic invasive fungal sinusitis: a decrease in the absolute (0.41 ± 0.14 p <0.001) and relative (24.1% ± 0.8 p <0.01) the number of CD4 + T-lymphocytes, a decrease in the indicators of the ratio of CD4 + / CD8 +, the relative number of CD3 + T-lymphocytes (48.6% ± 1.5 p <0.01). The study of the average indices of the humoral link of immunity revealed a decrease in the indices of serum IgG (17.3 ± 1.7) and IgM (2.65 ± 0.8) with normal IgA values. There was also a significant violation of the phagocytic activity of neutrophils: a decrease in the phagocytic number (2.22 ± 0.13 P <0.05) and phagocytic index (32.3 ± 1.2 p <0.001, stimulated NBT test - 28.3 ± 1 , 8 (p <0.001) and phagocytic reserve (5.1 ± 2.8 p <0.001) .In cases of chronic rhinosinusitis associated with candidal infection, 85% of patients had T-
cell disorders: a decrease in CD3 +, CD4 +, ratios CD4 + / CD8 +, and phagocytic activity of neutrophils, which, in agreement with the clinic, indicated the development of secondary immunological deficiency.
Output. Fungal infection of the paranasal sinuses occurs in 14% of patients with chronic rhinosinusitis. In 67% of cases, fungi of the genus Aspergillus were detected, in 27.9% - fungi of the genus Candida.
Among the risk factors identified in patients with fungal sinusitis, the most significant were irrational antibiotic therapy in 20.9%, diabetes mellitus in 11.6%, iatrogenic causes in 49.5% and unfavorable environmental conditions in 7% of cases.
Comprehensive examination of patients with suspected fungal infections of the nose and paranasal sinuses using clinical, endoscopic, mycological, X-ray (CT), histological examination increases the level of diagnosis of the disease.
References / Список литературы
1. AlimovA.I. 'Practical Rhinology" (rus.). Andijan, 2008. Р. 152.
2. Alimov A.I. "Otorhinolaryngology" textbook for students, clinics of residents, masters and doctors Andijan, 2007 (Uzbek, option).
3. Ananyeva S.V. "Diseases of the ear, throat, nose". Rostov-on-Don. "Phoenix", 2003. Р. 410.
4. BogomilskiyM.R., Chistyakova V.R. "Pediatric otorhinolaryngology". Moscow, 2002. Р. 429.
5. Dadamukhamedov A.N., Mirzarasulov M.M. Bolalar otorhinolaryngology. Tashkent, 1999. 2005. 190 р.
6. Kozorez Yu.B., Kalshtein L.I. "Pediatric otorhinolaryngology". Dushanbe. 1984. Р. 320.
7. Ovchinnikova Yu.M. "Otorhinolaryngology for medical universities". Moscow, 1997. P. 296.
8. Palchun V.T., Preobrazhensky N.A. "Diseases of the ear, throat, nose". Moscow. 1980. P. 487.
