Medicine/ 12 infection disease

Marusyk H.P., Sorokhan V.D., Trefanenko A.G.,

Bogachyk N.A., Venglovs’ka Ya.V.

Bukovinian state medical university,Chernivtsi

CORRECTING MICROECOLOGICAL ABNORMALITIES OF THE LARGE INTESTINAL CAVITY BY MEANS OF BIFIFORM

Abstract. The use of bifiform in a course of multimodality treatment of patients with lacunar tonsillitis leads to a restoration of the specific composition of the microflora of the large intestinal cavity (LIC) and a growth of the population level of autochthonous obligatory Bifidobacteriae, Lactobacteriae, Bacteroides, nonpathogenic colon bacilli, a decrease of the number of clostridiae, protei, nonpathogenic and hemolytic E. coli and a decontamination of the LIC contents from citrobacters, seratiae. Вifiform does not exert an antagonistic effect in relation to yeast-like fungi of the Candida genus.

Key words: lacunar tonsillitis, dysbacteriosis, bifiform.

Introduction. Going out from modern positions a normal microflora is considered as both high-quality and quantitative relations of population of different microorganisms of the some opened cavities, which supports the biochemical, metabolic, immunological equilibrium of human organism, that it is necessary for the keeping of human health [1, 5, 11, 14]. The normal microflora of intestine has a lot of important functions: detoxication, synthetic, digestive, sensibilisative, and carcinogenic, is the source of endogenous infection and also is the bank of genes, often associated with the “islands” of pathogenicity and markers of resistance to medications [2, 4, 9, 12]. Formation and illness course of lacunar tonsillitis accompanied by disbacteriosis of I-III degree, which requires the conduction of medical treatment, directed on decontamination of pathogenic and conditional pathogenic microorganisms, and also on a correction both specific and populational level of microbiota of the large intestinal cavity (LIC) [6, 10, 8].

Research purpose: To learn influence of bifiform (Complex probiotics  “Ferrosan” (Denmark)) on specific composition and populational level of microflora of content of LIC of patients with lacunar tonsillitis. 47 patients with a lacunar tonsillitis were examed, which were admitted to the department of infectious diseases of Chernivtsi regional clinical hospital. Microbiological study of the LIC contents of patients with tonsillitis was carried out by the way of identification of specific composition and populational level of autochthonous obligative and facultative for this biotype and allochthonous members of stool microflora with subsequent establishment of disbacteriosis degree. Research of the LIC contents is conducted for patients before treatment and after complex therapy with probiotics. Bifiform (“Ferrosan”, Denmark) was added to the complex treatment of patients with lacunar tonsillitis beause the changes of the state of microflora of the examined patients at the time of admission was, mainly, due to the deficit of Bifidobacteriae and Enterococcuses which enter in the complement of this probiotics [3, 7, 13]. Patients with complex treatment were given 1 capsule of bifiform per os 5-10 min before eating twice a day for 7 days on the base of standard treatment which included antibacterial, desintoxicational, desensibilizational preparations. In 2-3 days after completion of treatment, the LIC contents of patients was repeatedly took away and microbiological study was conducted, directed on an exposure and authentication of clean cultures of microorganisms and set the populational level of every type of microorganisms. Except for determination of specific composition and populational microflora level of content of orhopharynx mucus membrane, a complete examination of all patients was done, as Order № 430 „About claim of protocols of grant of medicare” from 03.07.2007 says in dependence on severity of tonsillitis. The ecological state of microbiocenosis was determined by the index of constancy (C%), coefficient of the quantitative prevailing (CQP) and coefficient of significance. Statistical manipulation of digital material was conducted by the program Statistica®. Used the method of variation analysis with determination of middle arithmetic (M) and middle error (+m), the difference of averages was considered reliable at the Student criterion (P < 0,05).

Results. At the study of specific composition of aerobic, facultative anaerobic and the anaerobic autochthonous microorganisms of the LIC contents found out positive influence of probiotics on specific composition in comparing with the microflora of LIC of patients at the time of seeking medical help. During the conduction of study of intestinal microbiocenosis for patients with lacunar tonsillitis at the first day of admission, was found out that basic part of microflora of LIC is made by Bacteroids, Lactobacteriae, nonpathogenic Collibacilluses, Protei. However, frequency and index of constancy of such microorganisms, as Bifidobacteriae and Enterococcuses, is considerably below, than for healthy persons. Physiological useful Bifidobacteria fully eliminates from LIC in 12,8 % patients with lacunar tonsillitis. On this background the percent of patients in which the facultative conditional pathogenic anaerobic (Peptococcuses, Clostridiums) was sown and aerobic bacteria is increased (Staphylococcuses). In the colon of patients with tonsillitis Citrobacters, Seratiae, and also yeast-like fungi of the Candida genus were appeared. In addition, considerable part of patients had contamination of LIC by hemolytic E. coli. Thus, patients with lacunar tonsillitis have already had substantial changes of specific composition of anaerobic and aerobic obligative and facultative microflora of the LIC contents at the time of admission (2nd – 3rd day of disease). The results of microbiological research, conducted for patients with a lacunar tonsillitis after complex treatment with probiotics, demonstrate characteristic changes in specific composition of anaerobic, aerobic and facultative anaerobic autochtonous and allochthonous microflora of the LIC content, considerably differing from such indexes of patients in the first days of disease. Basis of anaerobic microflora of LIC of these patients is made by Bacteroids, Bifidobacteriae, Lactobacteria; aerobic - nonnpathogenic Collibacilluses which are constant microorganisms for this biotype (LIC). It is rare to find protei, Staphylococcuses, Eubacteriae, Peptococcuses and Enterococcuses are in this group of patients, the lowest are frequency and index of constancy of Clostridiums, Peptostreptococcuses, hemolytic Collibacilluses and yeast-like fungi of the Candida genus. Citrobacters, Seratiae are fully eliminated from LIC. Thus, the use of bifiform in the complex treatment of patients with lacunar tonsillitis results in proceeding in specific composition of autochthonous obligative bacteriae – Bifidobacteriae, Lactobacteriae, Bacteroids, nonpathogenic Collibacilluses, that will have a positive influence on illness course. Findings stipulated the necessity of determination of populational level (as the most informing index of the state of microbiocenosis) of all viable microorganisms which were found in the LIC contents of patients with lacunar tonsillitis. Populational level of anaerobic, aerobic and facultative anaerobic microorganisms of LIC of patients with lacunar tonsillitis, set in the day of admittion, characterized by comparison to analogical indexes after the conduction of complex therapy. For patients with lacunar tonsillitis in the initial period of disease looked after the expressed deficit of autochthonous physiological useful Bifidobacteriae and Lactobacteriae. The amount of anaerobic gram-negative nonsporulating Bacteroids and aerobic nonpathogenic Collibacilluses which also are belonged to the obligative bacteriae are increased at the same time. Parallell with the decline of Bifidobacteria and Lactobacterie the populational level of facultative conditional and pathogenic anaerobic and aerobic microorganisms grows in LIC of the examined patients – Clostridiums, Peptococcuses, Protei, Staphylococcuses. On a background the deficit of protective components of intestinal microbiocenosis of patients with lacunar tonsillitis in the initial period of disease there is contamination of the LIC contents by hemolytic E. coli, conditional pathogenic enterobacteriae (Citobacters, Seratiae) and by yeast-like fungi of the Candida genus, that intensively propagate itself and arrive at a high populational level in the LIC contents. Thus, for patients with lacunar tonsillitis there is a disbalance of basic groups of microorganisms of the LIC contents with the change of them high-quality and quantitative correlations. The study results allow to assert that at lacunar tonsillitis of all patients is formed intestinal disbacteriosis or disbiosis due to alimination and expressed deficit of autochthonous life-useful bacteria, namely Bifidobacteriae, Lactobacteriae and Enterococcuses and contamination of colon cavity by allochthonous pathogenic hemolytic E. coli, Enterobacteriae (Citrobacters, Seratiae) and by yeast-like fungi of the Candida genus with growth of populational level of anaerobic and aerobic conditional pathogenic facultative microorganisms (Peptococcuses, Clostridiums, Protei, Staphylococcuses) on a background of dipression of protective components of microbiocenosis of LIC. Some other, more positive picture can look after for patients after the conduction of complex treatment with probiotics. Correcting influence of bifiform on consisting of intestinal microflora of composition of complex treatment of patients with lacunar tonsillitis in growth of populational level of physiological useful Bifidobacteriae, Lactobacteriae. After the conducted treatment there was a decline of amount of Clostridiums, Protei, nonpathogenic and hemolytic E. coli and decontamination of the LIC contents with Citrobacters, Seratiae. It should be noted that bifiform treatment did not have any influence in relation to the yeast-like fungi of the Candida genus. Consequently, complex therapy which includes application of probiotics of bifiform has some advantages in achievement of normalization of microbiocenosis of LIC ofr patients with lacunar tonsillitis.

Conclusions:  1) For patients with lacunar tonsillitis at the time of admission substantial changes of specific composition and populational level of anaerobic and aerobic obligative and facultative microflora of the LIC contents develop due to elimination and expressed deficit of autochthonous life-useful bacteriae and contamination of LIC and growth of populational level of anaerobic and aerobic conditional pathogenic and pathogenic microorganisms; 2) The use of bifiform in the complex treatment of patients with lacunar tonsillitis results in proceeding in composition of autochthonous obligative bacteriae – Bifidobacteriae, Lactobacteriae, Bacteroids, Enterococcuses, nonnpathogenic Collibacilluses, growth of populational level physiological useful Bifidobacteriae, Lactobacteriae, decline of amount of Clostridiums, Protei, hemolytical E. coli and decontaminations of LIC contents with Citrobacters, Seratiae; 3) Bifiform treatment does not have any influence in relation to the yeast-like fungi of the Candida genus.

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