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Б.К. КАРИМСАКОВА УРОГЕНИТАЛЬДЫ ИНФЕКЦИЯНЬЩ ЖYКТIЛIККЕ ЭСЕР1
Марат Оспанов атында^ Батыс Казак,стан мемлекетпк медицина университетi, Ак,тебе, Казахстан
Зерттеу дизайны: ретроспективтi ашык, рандомизацияланfан. ОМК, №2, №6 кдлалык, емханада зерттеу жYPгiзiлдi. Зерттеуге к^рг^зу критерийлерг 18-35 жастан жYктi эйелдер, жYктiлiктiн, мерзiмi - 12-42 апта. Зерттеуге шрпзшмейтш критерийлерi: 17 жастан темен жэне 35 жастан жоfары, жYктiлiктiн мерзiмi - 12 аптадан темен. 120 жYктi эйел алынып ем топка белiндi. Бiрiншi топ (бак,ылау) -алfашк,ы жYктiлiкпен 60 ден сау эйел. Екiншi топ -алfашк,ы жYктiлiкпен созылмалы урогенитальды инфекциясы бар 60 эйел. Барлык, эйелдерге жалпы зэр, к,ан анализi, биохимиялык,, цервикальды канал жvfынына бактериялык, жэне бактериоскопиялык, зерттеулер жYPгiзiлдi, жалпы жай вирус, ЦМВ, уреоплазмоз, микоплазмоз, хламидий ИФА эдiсiмен иммуноглобулин М жэне G мен титрi анык,талды. ¥рык, жаедайын баfалау Yшiн УДЗ, кардиотокография, допплерометрия жYргiзiлдi. Бiздiн зерттеу бойынша жYктiлiк кезiнде урогенитальды инфекция акушерлiк жэне перинатальдык, даму к,аупшщ факторы болып табылады. ЖYктiлiк кезiнде фетоплацентарлык, жеткпеушЫк пен жана туfан нэрестенiн жатыршЫк инфекциясы ен жиi кездесетiн аск,ынулары болып келедi.
Нег'зг'! свздер: жYктiлiк, урогенитальды инфекция, ЖГВ, ЦМВ, фетоплацентарлы жетспеушШк, к,¥рсак,iшiлiк инфекция.
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SUMMARY
B.K. KARIMSAKOVA INFLUENCE OF UROGENITAL INFECTION ON PREGNANCY OUTCOME
West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
Research design: retrospective study of open-label randomized. The study was conducted at the site of family medicine clinic, city polyclinics №2, №6. Criterion for inclusion in research: pregnant women aged 18-35 years. Gestational age from 12 to 42 weeks of pregnancy. Exclusion criteria included age younger than 17 years old and older than 35 years. Gestational age up to 12 weeks of pregnancy. The study included 120 pregnant women who were divided into 2 groups. The first group (control) - 60 somatically healthy pregnant primigravidas. The second group - primigravida pregnant with chronic urogenital infection. Every pregnant woman passed through the survey, which includes urinalysis, complete blood count, biochemical, bacteriological and direct microscopic smear from the cervix, the determination of immunoglobulin antibodies of M and G, and the titer of HSV, CMV, ureoplazmoz, mycoplasmosis, chlamydia serum by ELISA . Fetal status was assessed by ultrasound, CTG, Doppler. The results of our study showed that urogenital infection during pregnancy is a risk factor for obstetric and perinatal complications. The most common complication of pregnancy is the development of placental insufficiency and the birth of infants with intrauterine infection.
Key words: pregnancy, urogenital infection, HSV, CMV, fetoplacental insufficiency, intrauterine infection.
УДК: 618.3-022
I.Y. MURYZINA1, V.V. LAZURENKO1 , MD, N.M. PASIESHVILI2
TESTING AND CONTROL FOR UROGENITAL INFECTION AMONG PREGNANT WOMEN WITH SUGGESTIVE SIGNS OF INTRAUTERINE FOETAL INFECTION
'Kharkiv National Medical University, Kharkiv, Ukraine 2Kharkiv Regional Clinical Perinatal Centre, Kharkiv, Ukraine
Introduction. According to latest ^ numerous data the source of foetus ^ infections leading to inflammatory ^ response that may cause inflammatory-related impairment of foetus organism, ^ harbours in maternal body, especially in her genitalia. Infectious agents may
I.Y. Muryzina - Candidate of Medical Sciences, head of Obstetrics and Gynecology Department №1, phone: +38-095-337-42-40, e-mail: [email protected]; V.V. lazurenko - Professor of Obstetrics and Gynecology Department №1, phone:+38-050-582-33-50, e-mail: [email protected];
N.M.-Pasieshvili - Candidate of Medical Sciences, head physician, phone: 0038-057712-35-03, e-mail: [email protected].
Abstract. The article considers the issue of intrauterine foetal infection (IFI) elucidating relationship between maternal genital microbiota and foetal IFI, presenting data of own study, which comprised 1043 pregnant women with suggestive signs of IFI. They had undergone testing for urogenital infectious agent as well as afterwards their newborns and placenta with membranes tested immediately in the wake of delivery.
Key words: intrauterine foetal infection, bacterial vaginosis.
^ Cytomegalovirus more often amongst ^ them (9,1% and 8,3% respectively).
Mixed infection was recognized ^ in 254 cases (24,4%), its variants were shown in table 2. The most often ^ variants of mixed infection were different ^ combinations of Staphylococci and ^ Streptococci together with Candida (77
inoculate there as during pregnancy as ^ complications and treatment. Our study ^ — 30 3%) CMV and HPV2 — 34 (13 4%) long before particular conception being ^ aimed at determining of infectious agents ^ Enterobacteria with others - 51 (20,1%), dormant for a while [1]. Nevertheless, ^ of IFI and elucidation of their relationship ^ Ureaplasmaand Mycoplasma-22 (8 7%) probably a pregnant woman's organism ^ with persisting or dormant urogenital ^ Number of mixed fungal combination was develops some sort of local protection for ^ infection or distortion of pregnant woman ^ worth pointing out - 164 (64 6%) HPV2 foetus egg from genital infections even in ^vaginal microbiota as a source and 57 (224%) CMV— 53 (20 9%) spite of suppressed Th1 immune reactions ^ neonates complication as a consequence. ^ These data indicated high incidence due to the natural HCG (human chorionic ^ Methods. Study comprised 1043 ^ of sex-transmitted infections (STI) gonadotropin) and other pregnancy- ^ pregnant women who had developed ^ in pregnant women with presumed associated proteins activity. As a proof for ^ signs of foetomaternal infection. All of ^ ifi (CMV, HPV-2 Chlamydia _ 366 that presumption there is well-known fact ^ them underwent bacteriologic tests of ^(351%) Mycoplasma and Ureaplasma that no strong dose-response relationship ^ vaginal, cervical and urethral smears and ^ (8 6%)) vaginal dysbiosis (Candida exist between extent of infectious spread ^ then after delivery had their placenta ^ Enterobacterid Gardnerella) — 322 and manifestation in maternal and foetus with membranes tested for bacterial (30,9%). It drew attention that there bodies. For an example, even significant ^agents (polymerase cycle reaction - PCR). ^ was negligible number of cases with
spread of bacterial insemination in ^ Obtained data were compared with ^discrepancy between maternal and infant pregnant genitalia appears not obligatory ^ newborn bacteriologic tests. Diagnosis ^ results. Also when bacteriologic tests of
to affect pregnancy c^ree and on ^ of IFI had been made by virtue of ^ placenta, membrane and newborn were the contrary even negligible source of ^ultrasound evidence of foetal alterations ^ negative (mostly in the cases ofcaesarean dormant maternal genital infection may suggestive of foetal infection, positive delivery), either viral tests or STI were break out with aggressive inflammatory ^ abovementioned maternal bacteriologic ^ quite often positive that indicated complications of foetal or neonatal stages ^ tests, and finally this diagnosis was ^ transplacental transmission Bacterial of development [2]. Development of ^ confirmed by newborn positive tests or ^ foetal infections were recognized mostly foetal infection-related inflammatory ^ signs of inflammatory response. ^ in the cases of vaginal delivery. Scrutiny
response and extent of its adverse ^ Resu|ts and discussion. Considering ^ of neonatal morbidity among all women consequences depend on microorganism ^obtained results (table 1) three main ^ involved in study revealed that low Apgar
type its virulent capacity, ways of ^ causative factors of IFI were revealed: ^ score and foetal growth retardation were inoculation, term of gestation, propensity bacterial infection (69%), viral (26,6%) the most frequent complications (26,3% towards particular foetal tissues, foetal and fungal (4,4%) agents. Staphylococcus and 14,8% respectively), respiratory
susceptibility and its responsiveness, epidermidis was the most common distress - 5,4%, inborn pneumonia -features of maternal immune protection amongst bacterial agents (23,1%), 3,4%, omphalitis - 2,4%, intraventricular
[3, 4]. Array of microorganisms supposedly ^Staphylococcus haemolyticus was the ^ hemorrhage - 0 6% linked to intrauterine foetal infections ^ second most frequent (10,2%). 363 ^ Discussi0n. According to the latest (IFI) has changed throughout last decades ^ patients harboured Staphylococci(34,8%), ^ data from literature the main urogenital and that entailed alterations in clinical 42 (4,02%) - Streptococci, 63 (6,04%) - infection agents are: Staphylococci, E. pattern and extent of foetus injury. That's ^ Enterobacter what indicated imbalance ^ coi Candida Gardnerella vaginalis why it is extremely important to reveal for ^ of vaginal milieu and suppression of ^ Trichomonas hominis Ureaplasma sure all infectious agents of presumed IFI ^ her local immune protection. 275 cases ^ Chlamydia that may be linked to IFI in order to elaborate the most effective ^ of negative bacteriologic tests showed ^ There is an irrefutable trend towards approach for prevention from IFI-related ^ positive viral PCR: herpes simplex and ^ Staphylococci proportion rise in genital
Table 1. Results of tests for infection (n=1043)
Agent Foetus Pregnant women
Stafilococcus epidermidis 240 (23,1%) 256(24,6%)
Stafilococcus haemoliticus 106 (10,2%) 118(11,3%)
Stafilococcus aureus 17 (1,7%) 21(2,01%)
Esherihia coli 20 (1,9%) 35(3,4%)
Streptococcus anhaemolit. 14 (1,4%) 23(2,2%)
Streptococcus haemoliticus 5 (0,5%) -
Streptococcus viridance 3 (0,3%) -
Enterobacter aerogenus 20 (1,9%) -
Gardnerella vaginalis 18 (1,7%) 42(4,01%)
Klebsiela pneumonia 13 (1,3%) -
Protey mirabilis 6 (0,6%) -
E. fecalis 1 (0,1%) -
P.verugines 2 (0,2%) -
Citrobacter 3 (0,3%) -
Candida albicans 46 (4,4%) 68(6,5%)
Mycoplasma genitalium 28 (2,7%) 33(3,2%)
Ureaplasma urealyticum 12 (1,2%) 19 (1,8%)
Cytomegalovirus (CMV) 86 (8,3%) 62(5,9%)
Herpes simplex virus 2 (HSV-2) 94 (9,1%) 101(9,7%)
Chlamidia trachomatis 55 (5,3%) 34(3,3%)
Table 2. Types of mixed infection combination (n=254)
Combination Foetus Pregnant women
Stafilococcus epidermidis+Herpesvirus 9 (3,5%) 7(2,8%)
Stafilococcus epidermidis+Candida 26 (10,2%) 23(9,1%)
Stafilococcus haemoliticus +Candida 21 (8,3%) 18(7,1%)
Stafilococcus aureus+ Candida 18 (7,1%) 19(7,4%)
Stafilococcus haemoliticus+Chlamidia+ CMV +HSV 6 (2,4%) 4 (1,6%)
Stafilococcus haemoliticus+Chlamidia 4 (1,6%) 3(1,2%)
Streptococcus viridance+Stafilococcus epidermidis+Gardnerella 8 (3,2%) 7(2,8%)
Streptococcus viridance+Candida 12 (4,7%) 10(3,9%)
Streptococcus viridance+Candida+Klebsiela pneumoni 6 (3,4%) 4(1,6%)
Enterobacter +Candida+CMV+HPV-2 8 (3%2%) 6(2,4%)
Enterobacter aerogenus +CMV+HPV-2 6 (2,4%) 6(2,4%)
Enterobacter aerog.+Candida+Chlamidia 7 (2,8%) 5(1,9%)
Enterobacter aerogenus+Candida 15 (5,9%) 14(5,5%)
Enterobacter aerogenus+Candida+Klebsiela pneumonia 9 (3,5%) 7(2,8%)
Enterobacter aerog+Candida+Gardnerella 6 (2,4%) 5(1,9%)
Candida+Cytomegalovirus 5 (1,9%) 5(1,9%)
Herpesvirus+ Candida 4 (1,6%) 6(2,4%)
Gardnerella+Candida 10 (3,9%)
Klebsiela pnaumonia+Candida 8 (3,2%) 3(1,2%)
Mycoplasma +Ureaplasma 16 (6,3%) 18(7,1%)
Mycoplasma +Ureaplasma +HSV-2 6 (2,4%) 6(2,4%)
Mycoplasma genitalium+Candida 9 (3,5%) 10(3,9%)
Ureaplasma urealyticum+Stafilococcus epidermidis 7 (2,8%) 15(5,9%)
Cytomegalovirus+Herpesvirus 18 (7,1%) 18(7,1%)
CMV+HSV-2+Mycoplasma genitalium 6 (2,4%) 7(2,8%)
Chlamydia+CMV+Herpesvirus 4 (1,6%) 4 (1.6%)
samples of reproductive-age women as well as different types of Enterobacteria. That may constitute the premise for bacterial vaginosis (BV) and IFI.
Streptococci are revealed in 5-35% pregnant women, 20% of them develop asymptomatic colonization. Newborns mostly contract those germs while passing through maternal genital tract during vaginal delivery. True incidence of overt Streptococcus infection among newborns within first 7 days of life ranges 1,3-3 per 1000 [6]. In our study Streptococcus infection was identified in 42 cases (4,02%), namely: Streptococcus haemoliticus — 15 (1,5%), Streptococcus anhaemoliticus - 14 (1,4%), Streptococcus viridance — 13 (1,3%). Streptococci of B group (StB) break into neonate organism mostly during vaginal delivery, but in the case of premature membrane rupture germs are able to ascend into uterine cavity and foetus swallowing amniotic fluid that contains germs may become infected or it may occur while a newborn takes its first breath. There is suggestion that StB is capable to permeate through membranes, which haven't lost integrity then afflict a foetus, play role as causative factor of premature labour, stillborn etc.
Our study recognized Klebsiela pneumonia in 13 cases (1,3%). This microorganism is notoriously known for fast spread and causing high neonate mortality (45,6%) due to inborn pneumonia with fulminant course (61%). Gardnerella vaginalis was identified in placentas and membranes in 1,7%. According to the literature incidence of BV caused by anaerobic microorganisms
- Gardnerella vaginalis, Bacteroides spp.
- constitutes for 20-25%. BV is regarded as vaginal dysbiosis with shift in favour of obligate-anaerobic microorganisms at expense of natural gram-positive rods. The main underlying reason for recalcitrant BV reported to be suppression of local resistance due to activity of numerous
pregnancy-associated substances.
^ Endocervicitis, pelvic inflammatory ^ ^ diseases (PID) and STI in the past, ^
chorioamnionitis are seen as potential ^ prerequisites for BV exacerbation. Taking ^ ^ into consideration the fact that BV goes ^ ^ along with intestine dysbiosis in 2/3 ^ ^ patients, Kulakov V. et al suggest that ^ ^ BV is just a part of systemic disorders. ^ ^ BV raises the risk of IFI significantly and ^ ^ ensuing from IFI premature labour, ^
placental disorders, foetal distress, foetal ^ growth retardation and other intra- and ^ ^ postpartum complications. Furthermore, ^
BC may sustain asymptomatic vegetation ^ of facultative pathogenic anaerobic ^ ^ agents in cervical canal that may appear ^ ^ to encroach in placenta and membranes. ^ ^ Viral infection was found in 275 ^ ^ patients (26,4%) and mostly presented ^ ^ by CMV, Herpesvirus, also 254 ^
patients (24,4%) appeared to harbour ^ Mycoplasma, Ureaplasma, Chlamydia ^ ^ and their combination. Particularly ^ ^ Mycoplasma and Ureaplasma were ^
identified in 2,7% and 1,2% cases ^ respectively. These microorganisms ^ ^ considered being facultative causative ^ ^ factor of PID and urogenital pathology. ^ ^ According to the literature data incidence ^ ^ of asymptomatic Mycoplasma and ^ ^ Ureaplasma infection ranges 10-50%. ^ ^ During pregnancy Mycoplasma may ^ ^ ascend to foetus either by continuation ^ ^ or through placenta. This transmission ^
occurs supposedly in 18-55% of pregnant ^ women harbouring these microorganisms ^ ^ [7]. Transmission to foetus and adverse ^ ^ course of spreading infection may be ^ ^ facilitated by cell immunity suppression ^ ^ intrinsic to any pregnancy. Although ^ ^ asymptomatic course of Mycoplasma and ^ Ureaplasma infection is quite common, but strong evidence of their role in gestational pyelonephritis and puerperal endometritis has been obtained. Also Mycoplasma contributes to premature labour, placental dysfunction,
polyhydramnion.
Foetal and neonatal Herpesvirus infection proved to be prone to cause severe damage to the microcirculation, especially of lung and brain tissues leading to multifocal haemorrhages. HSV-2 is transmitted to newborn during vaginal delivery, that' why caesarean section ensures some sort of protection in such situation. Latest data have shown rise of HSV-2 infection ten-twentyfold [5]. In spite of literature data that incidence of Candida infection (thrush) among pregnant women ranges 3040%, our study revealed it only in 46 women (4,4%). That fact may suggest that Candida contributes to IFI in a less extent comparatively with other abovementioned agents.
IFI potential adverse impact on foetal wellbeing can be related to mono-or mixed infection. Incidence of latter one has showed incremental rise for the last decades that contributes to the patent trend towards the increase of IFI with severe foetal impairment. In our study mixed infection was identified much more often in newborns (mostly Klebsiela, Enterobacteria, Herpesvirus, CMV) than their mothers. That may be explained by foetus vulnerability and much weaker capacity comparatively with adult organism to clear itself from microorganisms and resist germ spreading. Especially foetal organism finds itself helpless against mixed infection when one microorganism provides another one with conducive for its spread condition by undermining local protective mechanisms.
Thus on the ground of obtained results we suggest that IFI and IFI-induced foetal impairments mostly ensued from maternal sites harbouring facultative pathogenic bacterial agents, STI, mixed infections and BV.
Conclusion. The main causative factors of IFI affecting a foetus are
urogenital infection persisting in pregnant woman, BV, non-specific vaginitis and endocervicitis. BV considered being as indicator of IFI-risk. Positive tests for Staphylococci, Streptococci, Gardnerella, Mycoplasma, Ureaplasma, anaerobic flora, CMV, HSV-2 as in maternal genitalia as in smears from placenta should urge newborn thorough testing for infection in order to anticipate imminent IFI-related complications, not to let infection spread and cause detrimental impact to neonate.
References:
1. Башмакова, М.А. Инфекция и бактериальная колонизация урогениталий у беременных, влияние на течение беременности, плод и новорожденного ребенка / М.А. Башмакова, Н.Г. Кошелева, Е.П. Калашникова // Акушерство и гинекология. - 2006. - № 1. - С. 15-18.
2. Кузьмин, В.Н. Роль ^ ^ неспецифических урогенитальных ^ ^ инфекций в патогенезе ^ ^ самопроизвольных преждевременных ^ ^ родов / В.Н. Кузьмин, Г.А. Мурриева // ^ ^ Лечащий врач. - 2013. - № 6 - С. 60-62. ^
3. Кулаков, В.И. Плацентарная ^ ^ недостаточность и инфекция: рук. ^ ^ для врачей / В.И. Кулаков, Н.В. ^ ^ Орджоникизде, В.Л. Тютюник. - М.: ^ ^ 2004. - 494 с. ^
4. Сидорова, И.С.
^ Внутриутробная инфекция: ведение ^ ^ беременности, родов и послеродового ^ ^ периода: учебное пособие / И.С. ^ ^ Сидорова. - М.: МЕДпресс-информ; ^ ^ 2012. - 160 с. ^
5. Anzivino E., Fioriti D., Mischitelli ^ ^ M. Herpes simplex virus infection in ^ ^ pregnancy and in neonate: status of art ^
of epidemiology, diagnosis, therapy and
prevention // Virol. J. - 2009. - № 6. - P. 40.
6. Beal S., Dancer S. Antenatal prevention of neonatal group B streptococcal infection // Gynaecol. Perinat. Pract. - 2006. - № 6. - P. 218225.
7. Cardenas I., Aldo P., Koga K. Subclinical viral infection in pregnancy lead to inflammatory process at the placenta with non-letal fetal demage // Am. J. Reprod. Immunol. - 2009. - 61. - P. 397, abstr.S312.
TYMIH
И.Ю. МУРЫЗИНА1, В.В. ЛАЗУРЕНКО1, Н.М. ПАСИЕШВИЛИ2
АНАЛЫК,-¥РЫК,ТЫК, Ж¥КПАСЫНЬЩ БЕЛГ1С1 БАР ЖУКТ1 ЭЙЕЛДЕРДЩ БАКМОНИТОРИНГ1
1Харьков улттык медицина университету Харьков, Украина 2Облыстык клиникалык, мамандандырылfан перинатальды орталь^ы, Харьков, Украина
Зерттеу максаты. Инфекциялык-аскынfан генездi урык бузылысынын этиологиялык факторларын аныктау жэне дереккез ретiнде олардын жYктi эйелдщ генитальды биоценоз бузылыстарымен, уйкыдаfы урогенитальды жукпасымен жэне нэтижесi ретiнде жан,адан туылу мерзiмiнiн аскынуымен байланысын орнату.
ЭдктерГ Аналык-урыктык жукпасынын белгiсi бар 1043 бактериялык вагиноздын бар-жоfын аныктауfа немесе урогенитальды жолда инфекциянын бар-жо^н аныктауfа жан-жакты тексерiстен еттi, будан кейш дэл осындай ПТР-тексерк шоfырына жана туылfан нэрестелер мен жолдасы да ушырады.
К,орытындысы. Кепшiлiк пациенттерде бактериялы (69%), вирусты (26,6%) жэне саныраукулакты (4,4%) табиfи (Staphylococci, Streptococci, Gardnerella vaginalis, Bacteroides,
РЕЗЮМЕ
И.Ю. МУРЫЗИНА1, В.В. ЛАЗУРЕНКО1, Н.М. ПАСИЕШВИЛИ2
БАКМОНИТОРИНГ БЕРЕМЕННЫХ С ПРИЗНАКАМИ МАТЕРИНСКО-ПЛОДОВОЙ ИНФЕКЦИИ
1Харьковский национальный медицинский университет, Харьков, Украина 2Областной клинический специализированный перинатальный центр, Харьков, Украина
Цель исследования. Выявить этиологические факторы поражения плода инфекционно-воспалительного генеза и установить их связь с нарушениями генитального биоценоза и дремлющей урогенитальной инфекцией беременной в качестве источника и осложнениями периода новорожденности как следствия.
Методы. 1043 пациенток с признаками материнско-плодовой инфекции прошли всестороннее обследование на присутствие бактериального вагиноза или инфекции в урогенитальном тракте, такому же спектру ПЦР-обследований подверглись впоследствии новорожденные и последы.
Результаты. У большинства пациенток выявлены патогенные и условно-патогенные микроорганизмы:
Klebsiela pneumonia жэне баска да анаэробтар, Mycoplasma, Ureaplasma, Chlamydia, CMV, HSV-2), комбинациялык (24,4%) патогeндi жэне шартты-патогeндi микроаfзалар аныкталды. Сонымен катар, жаца туылfан нэрестелерде аскынулар байкалды: Апгар бойынша темен баfа жэне урык дамуынын тeжeлiсi синдромы (сэйкеанше 26,3% жэне 14,8%), тыныс алу бузылысынын синдромы - 5,4%, туа бiткeн пневмония -3,4%, омфалит - 2,4%, асказаншЫк кан кету - 0,6%.
Тужырым. Урогенитальды инфекция жэне кынап биоценозынын бузылысы урыктын инфекциялык-аскь^ан бузылыстарынын нeгiзгi сeбeптiк факторлары болып табылады. Бактериялык вагиноз дэлелденген к,аут факторы болып шыfып турады. ЖYктi эйeлдiн урогенитальды жолында Staphylococci, Streptococci, Gardnerella, Mycoplasma, Ureaplasma, anaerobic flora, CMV, HSV-2 анык,талуы нэтижеанде аландатарлык, симптомдар болмаса да клиникалык, кезенге дeйiн инфекциялык-аскь^ан процeстeрдi аныктау максатында нэрeстeнi туылfан бойда жан-жакты мiндeттeлгeн тексеруден еткiзудi талап етедк
Нег'зг'! свздер: к,урсак,1шш1к урык,тык, инфекция, бактериялы вагиноз.
^ бактериальной (69%), вирусной (26,6%) и грибковой (4,4%) ^ природы (Staphylococci, Streptococci, Gardnerella vaginalis, ^ Bacteroides, Klebsiela pneumonia и другие анаэробы, Mycoplasma, Ureaplasma, Chlamydia, CMV, HSV-2), и в ^ комбинации (24,4%). Также, чаще встречались осложнения ^ у новорожденных: низкая оценка по Апгар и синдром задержки развития плода (26,3% и 14,8% соответственно), ^ синдром дыхательных расстройств - 5,4%, врождённая пневмония - 3,4%, омфалит - 2,4%, внутрижелудочковые ^ кровотечения - 0,6%.
Выводы. Основными причинными факторами ^ инфекционно-воспалительных поражений плода являются ^ урогенитальная инфекция и нарушение биоценоза ^ влагалища. Бактериальный вагиноз выступает доказанным ^ фактором риска. Обнаружение Staphylococci, Streptococci, Gardnerella, Mycoplasma, Ureaplasma, anaerobic flora, CMV, HSV-2 в урогенитальном тракте беременной женщины требует впоследствии обязательного всестороннего обследования новорожденного на инфекции сразу после родов даже при отсутствии настораживающих симптомов с целью выявления инфекционно-воспалительных процессов ^ на доклинической стадии.
^ Ключевые слова: внутриутробная плодовая ^ инфекция, бактериальный вагиноз.
УДК: 616.9 - 002.5 - 084
К.В. ПАВЛИКОВА
ПРОБЛЕМА СОПУТСТВУЮЩИХ ПАТОЛОГИИ У ВИЧ-ИНФИЦИРОВАННЫХ ПАЦИЕНТОВ В
УКРАИНЕ
Харьковская медицинская академия последипломного образования, Харьков, Украина
Врач-интерн, e-mail: [email protected]
Аннотация. Целью нашего исследования явилось изучение структуры сопутствующей инфекционной патологии у ВИЧ-инфицированных пациентов в Украине. Результаты исследования показали, что число больных с ВИЧ + гепатит С или В составляет 29,2 % (27,8 % и 1,4 % соответственно с С и В гепатитом); ВИЧ + инфекция TORCH комплекса - 23,6 % больных, ВИЧ + туберкулез - 7,0 % больных. У всех больных диагностирована терминальная стадия ВИЧ с уровнем CD4+ ниже 100 кл/мкл. В Украине смертность от ВИЧ-инфекции составляет 1,9% от всех зарегистрированных смертных случаев.
Ключевые слова: ВИЧ-инфекция/СПИД, туберкулез, гепатит В, гепатит С, инфекция TORCH комплекса.
Актуальность. Эпидемия ВИЧ/ СПИДа стала проблемой для всего человечества. Начавшись с единичных случаев, она охватила все страны, существенно влияя на их экономическое развитие. С начала эпидемии около 75 миллионов человек заразились ВИЧ-инфекцией. По своим негативным воздействиям на социальные, экономические и демографические аспекты развития общества эпидемия не имеет себе равных. Распространение ВИЧ -
