[Microecological aspects of small intestinal bacterial overgrowth syndrome].

Small intestinal bacterial overgrowth syndrome (SIBOS) means chronic recurrent diarrhea with malabsorption, intoxication and increased risk of endogenous infection. This syndrome are accompanied by increase of overall bacterial burden in biotope >10(5) CFU/ml in adults and >10(4) CFU/ml in children, emergence of different species of enterobacteria, bacteroides, clostridia and fusobacteria et al. in small intestine. Such characteristics of the syndrome allow to consider it as syndrome of disturbances of intestinal microflora (dysbacteriosis). Microecological changes are accompanied by B12 vitamin deficiency anemia, hypovitaminosis, protein deficiency, translocation of bacteria and their toxins from intestine in blood, emergence of endotoxinemia and possible generalization of infection. SIBOS is diagnosed by concentration of hydrogen in expiratory flow (lactulosa load test) or by bacteriological study of aspirate from proximal part of small intestine. Complex treatment includes containing lacto- and bifidobacteria probiotics and, in more severe cases, antimicrobial agents (vancomycine, metronidazole, aminoglycosides, amoxicillin clavulanate, tetracycline, and cephalosporines of 2nd generation) with following correction of disturbed microbiocenosis by different probiotics.

[Bacterial overgrowth syndrome in the small intestine: pathogenesis, clinical significance and therapy tactics].

The redundant bacterial growth syndrome in the small intestine is associated with the increased total semination of over 10(5) CFU/ml presented by enterobacteria, bacteroids, clostridia, fusobacteria, etc. It is developed at the dysfunction of the gastrointestinal tract, insufficient bacteria inhibition at the time when they come from the large intestine (atony, stasis, bypasses) and is accompanied by the enhanced intestinal barrier permeability along with chronic diarrhea and intoxication. Intestinal absorption disorders cause B12-deficiency anemia, hypovitaminosis and protein deficiency. The redundant growth is diagnosed based on the hydrogen concentration in the expired air or bacterial inoculation of the small intestine aspirate. Tetracycline, Vancomycin, Metronidazole and aminoglycoside are used for the therapy; Amoxicillin/clavunate and cephalosporins of the second generation are also applied with success. Decontamination of the small intestine is more successful when probiotics are prescribed (both after antibiotics and independently), which suppress the opportunistic flora, protect the mucous coat, improve digestion and arrest diarrhea. Probifor or Bifidumbacterin forte in the complex with probiotics comprising lactobacteria can also have a therapeutic effect.

[The microecological disorders in clinical pathology and their correction by bifidum-containing probiotics]. / Mikroékologicheskie narusheniia pri klinicheskoi patologii i ikh korrektsiia bifidosoderzhashchimi probiotikami.

On the basis of independent research and published data surveyed in the paper is the prevalence and nature of disorders of the intestinal microflora observed in adults and children with different pathologies, i.e. chronic diseases of the gastrointestinal tract, acute intestinal infections, acute respiratory viral infections, pneumonias, as well as certain nephrological, gynecological, and surgical diseases etc. The deficit of Bifidobacteria was found to be the most frequent chain in intestinal microflora pathologies. The significance of Bifido-containing drugs as well as current research of Russian scientists, including new probiotics with Bifidobacteria immobilized in coal, is elucidated. The advantages of intestinal dysbacteriosis correction by sorbated Bifido-containing probiotics, like bifidumbacterin forte and probifor, are demonstrated, versus bifidumbacterin, in different pathologies; their related clinical-and-morphological effect is defined. Prospects for designing the combined and polyvalent drugs with immobilized Bifidobacteria are described.

[Associated infections in acute bronchopulmonary infections in children]. / Assotsiativnaia infektsiia pri ostrykh bronkholegochnykh zabolevaniiakh u detei.

A total of 189 children with bacterial complications of the acute respiratory viral infection (ARVI)--primarily with pneumonia and bronchitis--were dynamically examined for typical and atypical pneumotropic causative agents of the infection process (Mycoplasma pneumoniae, Chlamydia spp., Streptococcus pneumoniae, Haemophilus influenzae, Pneumocystis carini, and Citomegalovirus). A high frequency rate of the associative infection involving mycoplasmas and pneumocysts was registered (45-50%); it was lower in the cases involving Chlamydias, hemophilic bacteria, pneumococcus, and cytomegalovirus--up to 25-30%. No sharp difference was found between the indices of an infection degree and those of an active clinical infectious process involving the same pneumotropic agent: the biggest difference was observed in Chlamydia infections (9.4%) and the lowest one--in mycoplasma infections (3%). A dynamic comparison of different classes of immunoglobulins revealed that, in acute bronchitis and pneumonias, the Chlamydia and cytomegalovirus infections are, primarily, of the persistent nature; the hemophilic and pneumocystic infections are of a mixed nature; and the pneumococcus one is of the acute nature. The Mycoplasma infection, which is more often encountered in pre-school children, is of the primary type with a trend towards a prolonged clinical course. All pneumonias had a typical clinical course; the clinical picture was compared in 128 patients with the etiological factor (including a description of characteristic symptoms).

[Impaired interferon status in children with acute respiratory infection and its correction with bifidumbacterin-forte]. / Narusheniia interferonovogo statusa u detei s ostroi respiratornoi infektsiei i ego korrektsiia bifidumbakterinom-forte.

The state of interferon status was studied in 46 hospitalized children: 33 patients with complicated forms of acute respiratory virus infection (ARVI), such as pneumonia, bronchitis, etc., and 13 patients with vegetovascular dystonia (used as a comparison group). The study revealed that in patients with acute infections of the upper and lower respiratory tract considerable changes in their interferon system were registered. Children with ARVI were treated with Bifidumbacterin forte, a probiotic preparation, in large doses. Bifidumbacterin forte was found to produce a regulatory effect on the interferon system by enhancing the induction of alpha- and gamma-interferon and decreasing the production of serum interferon. The experience of using Bifidumbacterin forte in large doses proved that the preparation was well tolerated and could be used for the correction of interferon status.

[Intestinal dysbacteriosis in antibacterial therapy and perspectives in treatment by antibiotic-resistant probiotics]. / Disbakterioz kishechnika pri antibakterial'noi terapii i perspektivy lecheniia antibiotikorezistentnymi preparatami.

Effect of different antibiotics and standard antibacterial therapy regimes on intestine microflora was investigated. Lincozamides demonstrated the most negative effect. Early addition of probiotics to the treatment with antibacterials had positive effect. Susceptibility of 21 strains of normal microflora to 25 antibiotics was tested. Resistance to antibiotics of lactobacilli varied significantly (more among strains and less among species). It was shown that L. acidophilus (probiotic "Acilact") was resistant to metronidazole only. High resistance to antibiotics was shown for L. plantarum 8RA3, L. fermentum 90T4C (components of probiotic "Lactobacterin"), L. fermentum BL96, L. acidophilus BL and L. acidophilus (component of "Linex"). Susceptibility of microorganisms in complex formulation "Linex" to the modern antibiotics was low. It is concluded that the use of stable antibiotic-resistant strains of normal microflora is favorable as addition to antibiotic therapy.

[Spectrum of pneumotropic pathogens in pediatric patients with acute bronchitis and pneumonia]. / Spektr pnevmotropnykh vozbuditelei pri ostrykh bronkhitakh i pnevmonii detei.

One hundred eighty nine children with acute bronchopulmonary infectious pathological processes were examined bacteriologically and serologically for typical pneumotropic pathogens, 47 of them being as well examined for atypical organisms. Microbial associations mainly with Mycoplasma and Pneumocystis and to a lesser extent with Chlamydia were isolated from the majority of the children. Reactivation of the cytomegalovirus infection was observed in 25 per cent of the children. Pneumonia and bronchitis due to Mycoplasma pneumoniae either as a monoagent or in associations were mainly stated in children over 7 years of age. No significant changes between the indices of the infection due to a definite organism and the active progression of the infectious process of the same etiology were revealed, though in the cases of chlamydiosis the changes reached almost 10 per cent. In cases of acute bronchitis and pneumonia the chlamydial or cytomegalovirus infection could be assumed to be of the persisting nature, mainly acute in cases of pneumococcal infection, mixed in cases of hemophilic or pneumocystic infection, primary contamination with a tendency to prolonged in cases of mycoplasmic infection. The findings of the examination and the clinical and anamnestic data showed that the clinical picture of acute pneumonia had specific features associated with the supposed etiological agents, still it could change under the action of associations of pneumotropic pathogens.

[The results and characteristics of the mupirocin (Bactroban) sanative treatment of intranasal Staphylococcus carriers in a large hospital]. / Rezul'taty i osobennosti sanatsii mupirotsinom (baktroban) intranazal'nykh nositelei stafilokokka v usloviiakh krupnogo statsionara.

The action of mupirocin as a nasal ointment (Bactroban) was studied on intranasal carriers of the hospital staphylococcal strains. The study included 37 medical workers from different and mainly problem units of the large general hospital. The tolerability of the ointment was good. After the Bactroban use no complications of the patients were recorded. The efficacy of Bacroban by the microbiological criteria in total amounted to 100 per cent. The eradication of methicillin resistant Staphylococcus aureus (MRSA) was observed in 93 per cent of the cases. A decrease of the level of the nasal passages dissemination by MRSA and methicillin resistant coagulase-negative staphylococci (MRSC) up to such low titers as 100 and 90 per cent was stated. No difference in the action of Bactroban on MRSA, MSSA and MRSC was noted. The bacteriological monitoring for 3 to 4 months revealed a change of the staphylococcal strains in 94 per cent of the cases, recolonization by the same staphylococcal strain in 19 per cent, recolonization by some another staphylococcal strains in 33 per cent and no recolonization in 14 per cent. A stable decrease of staphylococcal strains was possible with simultaneous Bactroban sanitation of all the bacterial carriers of the hospital or its isolated unit.

[The antibacterial resistance of the strains making up the components of probiotic preparations]. / Antibakterial'naia rezistentnost' shtammov, vkhodiashchikh v sostav preparatov probiotikov.

The spectrum of the antibiotic resistance of 21 strains of normal microflora, mainly forming constituents of widely used probiotics to 25 antibacterial preparations. Lactobacillus spp. were prevalent in the strains under test. The spectrum of the antibiotic resistance of lactobacilli varied, the gradation of resistance being more pronounced with respect to strains and not species. Both highly sensitive and highly resistant Lactobacillus strains were found: L. acidophilus (a component of biopreparation "Linex"), L. plantarum 8RA3, L. fermentum 90T4C (probiotic "Lactobacterin"), L. fermentum BL96. Bacteria used as the components of combined preparation "Linex" exhibited the highest resistance to a number of modern antibiotics. Strains of bifidobacteria were found to be highly sensitive to antibiotics.

[Persistence of pneumotrophic infective agents in acute bronchopulmonary diseases in children]. / Persistentsiia pnevmotropnykh vozbuditelei pri ostrykh bronkholegochnykh zabolevaniiakh u detei.

175 children with acute bronchopulmonary pathology were examined for the presence of the pneumotropic infective agents by serological and bacteriological methods. In most children microbial associations with the prevalence of mycoplasmas, pneumocycts and, to a lesser extent, chlamydiae were detected. The considerable activation of cytomegalovirus (CMV) infection in children with pneumonia and bronchitis was noted. Taking into account the results of the examination and the clinico-anamnestic data, the character of infections could be established: chlamydial and CMV infections were mainly persisting; pneumococcal infection was mainly acute, hemophilic and pneumocyst infections were mixed. The clinical picture of acute pneumonia cases had characteristic features determined by the supposed etiological agent, but this picture could change under the influence of pneumotropic infective agents.

[Disruption of microbiocenosis of the large intestine and the immune and interferon status in children with bacterial complications of acute viral infections of the respiratory tract and their correction by high doses of bifidumbacterin forte]. / Narusheniia mikrobiotsenoza tolstoi kishki, immunnogo i interferonovogo statusa u detei s bakterial'nymi oslozhneniiami ORVI i rezul'taty ikh korrektsii bol'shimi dozami bifidumbakterina forte.

One hundred and twenty-nine children with acute viral and bacterial infection of the respiratory tract were examined and disturbance of the large intestine microflora was detected. It was characterized by significant reduction of lactobacilli, moderate growth of opportunistic bacteria and higher contents of Candida. Changes in T- and especially B-cellular immunity were observed in 35 per cent of the patients. In patients with decreased avidity of the immunoglobulins G in the peripheral blood the changes were observed in 82-100 per cent of the cases. In the majority of the patients the capacity for interferon genesis was suppressed. A shorten course (5 days) of the bifidumbacterin forte therapy in a dose of not less than 10(9) CFU/ml. normalized the intestinal microflora, improved the indices of the B- and T-cellular immunity (including the subpopulation of the T-helper cells but not the T-suppressor cells), stimulated NK and improved the ability to induce alfa- and gamma-interferons of the peripheral blood leukocytes. The experience with using high doses of bifidumbacterin forte was evident of its good tolerance and possible value in increasing the patient resistance to infection.

[The pathogenicity enzymes of clinical strains of Klebsiella pneumoniae]. / Fermenty patogennosti klinicheskikh shtammov Klebsiella pneumoniae.

In 108 K. pneumoniae clinical strains isolated in pneumonia (32 strains), inflammatory processes of the urinary tracts (36 strains) and toxicoseptic states (40 strains) caseinolytic, gelatinase, phosphatase, lecithinase activities and the capacity for producing DNAase and RNAase were studied. The presence of caseinolytic activity was found in 38 cultures (35.1%), gelatinase activity in 37 cultures (34.2%) and lecithinase activity in 13 cultures (12.0%). The production of RNAase was noted in 74 strains (68.5%), DNAase in 56 strains (51.8%) and acidic phosphatase in 33 strains (30.5%). The role of the above-mentioned enzymes in the development of purulent inflammatory processes, as well as the importance of further studies, including those aimed at establishing the nature of the genetic control of the already known properties of the pathogen, are discussed.

[Combined antibacterial and probiotic therapy of Helicobacter-associated diseases in children]. / Sochetannaia antibakterial'naia i probioticheskaia terapiia khelikobakterassotsiirovannykh zabolevanii u detei.

On the basis of microbiological monitoring and clinico-morphological criteria, the use of probiotics containing lacto- and bifidobacteria, simultaneously with "triple" antibacterial therapy (antibiotics of choice, metronidazole and bismuth salts), has been found to produce curative effect in the treatment of Helicobacter-associated gastroduodenal pathology in children. The influence of "triple" antibacterial therapy on the microecology of the gastrointestinal tract and the state of the immunobiological status of patients was studied. The combined scheme for correcting damaged microbiocenosis with probiotics in accordance with the concept of microecological adequacy is proposed. The scheme includes modern antibacterial therapy in combination with the probiotic preparations of lactobacteria. The prescription of bifidobacteria-containing probiotics is recommended at early stages from the beginning of etiotropic therapy. The effectiveness of the therapy may be dynamically evaluated, starting from week 5 after the end of the complex therapy, in EIA with the use of specific anti-Helicobacter antibodies.

[Bacterial endotoxinemia in children with intestinal dysbacteriosis]. / Bakterial'naia éndotoksinemiia u detei s disbiozom kishechnika.

34 children with gastrointestinal diseases of infectious, allergic and mixed etiology were examined. The state of normal microflora in the large intestine as indicated by fecal bacterial charts and the level of secretory immunoglobulin A (sIgA) in the contents of the intestine as indicated by the results of radial immunodiffusion were studied. In addition, the content of endotoxin in the children's plasma was determined with the use of the Limulus (LAL) test. The presence of endotoxin in the plasma of children with intestinal dysbiosis was determined in 71.1% of cases. The frequency of the detection of antigenemia was found to be related to the severity of manifestations of dysbiotic changes in the intestine and to the level of sIgA in fecal supernatants. The inclusion of the probiotic preparation Bifidumbacterin forte containing live bifidobacteria adsorbed on activated charcoal into the complex therapy of digestive tract diseases ensured a decrease in the detection rate of endotoxinemia, which correlated with the tendency towards the normalization of defective intestinal microflora.

[The characteristics of the caseinolytic activity of the contents of the large intestine in dysbiotic states]. / Osobennosti kazeinoliticheskoi aktivnosti soderzhimogo tolstoi kishki pri disbioticheskikh sostoianiiakh.

In the course of the study of the biochemical rapid method for the evaluation of microecological changes in the intestine by means of the test for the caseinolytic activity of fecal supernatants, the simultaneous presence of several enzymes in the samples under test was shown. Different degrees of the thermal inactivation of the active principle, linked with the expression of the positive caseinolytic sample, were established. The manifestations of caseinolytic activity, differing in their thermal stability, were found to have the proteolysis zone of equal size. The study showed the stability of this sign and its preservation during 1.5-2 years of storage of fecal supernatants in a refrigerator. Some details of making tests according to this method and the conditions ensuring the standard reproducibility of results were ascertained.

[The antagonistic action of lactobacilli on Helicobacter pylori]. / Izuchenie antagonisticheskogo deistviia laktobatsill na Helicobacter pylori.

The antagonistic activity of 9 strains of the genus Lactobacillus with respect to 25 H. pylori clinical cultures was studied with the use of the original method of ring blocks. The presence of high antagonistic activity of strains L. casei 925, L. plantarum 8 RA-3, L. fermentum BL-96 and L. 90265 was established. The newly developed method of the determination of antagonistic activity with respect to H. pylori, taking into account the biological features of this organism, was found to be convenient for work, precise and giving reproducible results.

[The probiotic correction of microecological and immune disorders in gastroduodenal pathology in children]. / Korrektsiia probiotikami mikroékologicheskikh i immunnykh narushenii pri gastroduodenal'noi patologii u detei.

The state of microbiocenosis was studied and the level of immunoglobulins was determined in the gastric juice and feces of children with chronic diseases of the digestive system. In 20% of patients an increase in the contamination of the gastric biotope with opportunistic microflora was established. The isolation rate of Helicobacter pylori was 56%. The detection of H. pylori was found to be accompanied by the aggravation of the form and course of gastritis. In cases of Helicobacter-associated pathology the deficiency of Lactobacillus sp. in the stomach was established, which was accompanied by their deficiency and absence in feces. The study also revealed a decrease in the population level of Bifidobacterium sp. with a simultaneous increase in the population of opportunistic enterobacteria and changes in the state of local immunity: the decreased level of SIgA in most samples and the decreased level of IgG in the presence of H. pylori. The correction of microecological and immune disturbances with probiotic preparations, containing bifidobacteria (bifidumbacterin-forte) and lactobacilli, yielded good results.

[The proteolytic activity of the contents of the normal large intestine and in microecological disorders]. / Proteoliticheskaia aktivnost' soderzhimogo tolstoi kishki v norme i pri mikroékologicheskikh narusheniiakh.

The proteolytic (caseinolytic) activity of fecal supernatants obtained from 52 practically healthy children and 220 children with the etiologically undetermined (unclear) diagnosis of gastrointestinal tract dysfunction has been studied. As revealed in this study, in cases of bacteriologically confirmed microecological disturbances in the intestine, accompanied by the activation of opportunistic microflora, the caseinolytic activity of fecal supernatants increases. The determination of the level of the caseinolytic activity of fecal supernatants on solid culture media as a rapid method, specially intended for the diagnosis of dysbiotic states of the gastrointestinal tract, is proposed.