Иммунологические механизмы у часто болеющих детей

Departamentul Pediatrie, USMF Nicolae TestemițanuThe purpose of this article is highlighting the pathogenic mechanisms in respiratory recurrences in children in the context of the morpho-functional peculiarities of this system in children, in acute viral infections - key factors in triggering acute respiratory relapses. As a result of frequent respiratory infections there are hypersensitivity, new allergic states, exacerbation of chronic disease and the formation of new ones at various sites. Respiratory recurrences manifestation requires differentiation from primary immunodeficiency in children. Defense system in children aged up to 5 years, unlike adults, is immature and is manifested by transient immunocompetence: quantitative and functional deficit of T-cell, cytokine synthesis deficit, immunoglobulin A, M, and G transient deficit, granulocyte, and mononuclear chemo taxis deficit. However, at those frequently ill ,certain changes intercellular interaction of immune system maintain, increase the level of cytokines IL-2, IL-4 and IL-6, IL-8 accompanied by the decrease in cell cytotoxicity, immunoglobulin disorder, increase expressing cells receptors, with the interferon genesis depletion and maintaining a latent inflammation in the absence of clinical signs. The increased incidence of respiratory morbidity in children, in most cases, is generated by reducing the body’s immune response capacity against the background of unfavorable antenatal and postnatal factors Целью данной статьи стало определение значимости патогенетических механизмов у часто болеющих детей острыми респираторными заболеваниями, в контексте возрастных морфофункциональных особенностей защитной системы у детей при острых вирусных инфекциях – решающие факторы в провоцировании острых респираторных рецидивов. В результате частых респираторных инфекций формируется гиперчувствительность, новые аллергические состояния, обострения хронического заболевания и формирование новых с различными локализациями. Проявление респираторных рецидивов требует дифференцировки от первичного иммунодефицита у детей. Защитная система у ребенка до 5 лет, в отличии от взрослого, недоразвитa и проявляется транзиторными изменениями: количественный и функциональный дефицит Т-клеток, дефицит синтеза цитокинов, транзиторный дефицит иммуноглобулинов А,M, иG, гранулоцитарный дефицит и мононуклеарный хемотаксис. Но у часто болеющих детей поддерживаются четкие нарушения межклеточного взаимоотношения иммунной системы, рост уровня цитокинов IL-2, IL-4иIL-6, IL-8, сопровождающийся уменьшением клеточной цитотоксичности, дисглобулинемии, рост уровня клеток представляющих рецепторы, истощение резервов интерфероногенеза и поддержание латентного воспаления при отсутствии клинических симптомов. Повышенная респираторная заболеваемость у детей, чаще всего, основана на снижении способности иммунного ответа организма на фоне неблагоприятных анте- и постнатальных факторов

Immunological indicators in children with ARF co-associated with herpes infection

MD, Department of Pediatrics, MPSU “Nicolae Testimitanu”The objective of the study: Assessing immunological indices in children with acute respiratory infections, serious development, co-associated with herpes infection. Materials and Methods: In the study group were included 100 children with acute respiratory infections, serious development, hospitalized in SCMC PMSI no.1, years 2010-2012. By age patients were divided into 3 groups: 1- children aged of 0-12 months (18,8%), 2- 12-24 months (62,9%),3 - 24-36 months (18,3%). Diagnosis of herpes infection was noted by PCR and enzyme immunoassay. Humoral immunity assessed using the method Mancini, cell immunity with specific monoclonal. All patients included in the study, it was considered positive family epidemiological history at herpes infections. Analysis of the results was performed by the method of medical statistics. Conclusions: 1. Existence of herpetic infections from parents involves a high risk of infection in children. 2. ARF arising on the background of herpes infections is manifested with serious evolution, thanks to immunocompetent cells misbalance, which is manifested by heterogeneous functions and may induce imunopathologies. 3. Reaches a disorder of lymphocyte cytotoxic function TCD4 helper and TCD8 suppressors

Malnutriția gravă și manifestări asociate comune la sugar și copilul mic

Background. Malnutrition is a chronic nutrition disorder caused by insufficient energy and protein intake. Objective of the study. Identify the most common manifestation of malnutrition in infants and small children aged 1 to 40 months. Material and Method. The prospective study involved 30 children aged between 1 to 40 months admitted to the Institute of Mother and Child, Clinic „Em.Coțaga” pediatric department, metabolic diseases and malnutrition. Results. This study demonstrate that 11 infants from 19 resive artificial feeding with formula: NAN, Hipp, Nestogen, Similac at al. Common manifestation in malnutrition was pneumonia, diarrhea, dehydration, gastro-esophageal reflux,malabsorption, celiac disease. The 11 children agged 12 to 40 months related serious central nervous problems – delay of neuro-motor and verbal development, microcephaly, hydrocephaly, epilepsy, cerebral palsy. Laboratory data: metabolic acidosis, iron deficiency anemia, elevate CRP and liver enzimes. Conclusion. The most common manifestation in severe malnutrition in infants are results of errors in early transfer of infants to an artificial or mixt feeding, due to afection of digestive and respiratory system. In children aged 12 to 40 months more common are severe neurological disorders. Introducere. Malnutriția este o tulburare cronică de nutriție, cauzată de insuficiența aportului energetic și proteic, caracteristică copiilor de vârstă fragedă. (1,3). Termenul de malnutriție protein-calorică, adoptat de OMS, definește starea de stagnare în creștere a sugarului și copilului mic sub percentila 25. Scopul lucrării. Identificarea manifestărilor clinice și paraclinice, asociate la sugar și copilul mic cu malnutriție gravă. Material și Metode. Studiu efectuat se bazează pe o analiză prospectivă a datelor clinice și paraclinice la 30 de copii în vârstă de 1-40 luni, spitalizați cu malnutriție, forma gravă, care sau aflat la tratament în Clinica „Em. Coțaga ”, în perioada anilor 2017-2020. Diagnosticul a fost determinat în baza datelor de anamneză, criteriilor de dezvoltare fizică, corespunzător vârstei, cu monitorizarea curbei ponderale. Rezultate. Majoritatea copiilor, incluși în studiu, au fost sugari cu vârsta 1-12 luni (19) și 11 copii cu vârsta 12 luni – 40 luni. Datele anamnezei au relatat că doar 3 sugari din 19 au fost alimentați la sân în primele 6 luni de viață, 6 sugari la alimentație mixtă din a doua lună de viață, iar 21 copii cu vârsta cuprinsă între 1- 40 luni au fost alimentați cu diferite formule lactate: Pre – NAN, Hipp, Similac, Belact, Nestogen. În unele cazuri copiii erau transferați la 2-3 formule pe perioada unei luni. Toți sugarii cu malnutriție au fost spitalizați în stare generală gravă, în Secția terapie intensivă, cu deshidratare, hipovolemie, tulburări electrolitice, doi dintre ei în șoc hipovolemic. Concluzii. Malnutriția gravă la sugari este rezultatul alimentației artificiale precoce, cu aport deficitar de proteine și calorii, diversificarea alimentației neadecvate vârstei copilului, asocierea infecțiilor sistemului digestiv și respirator. La copiii cu vârsta cuprinsă între 12 și 40 luni tulburările neurologice severe sunt mai frecvente

Humoral immunity in community-acquired pneumonia associated with manifestations of bronchial obstruction in children

Departamentul pediatrie, USMF „Nicolae Testemiţanu”The aim of the study was to evaluate the humoral immune status in children with bronchial obstruction syndrome associated with pneumonia. The main group consisted of 200 children with pneumonia and wheezing, the control group included 40 children considered healthy. The increase in IgM concentration in children with pneumonia and wheezing than those considered healthy, causes an immune reation more expressed to them, but not efficient enough for qualitative solving infectious process. In these children with bronchial obstruction the syndrome associated with pneumonia was confirmed by infectious mechanisms involving severe allergic marked by immunopathological mechanisms, exaggerated hyperimmunoglobulinemia E of immunocomplex type. Scopul studiului a fost de a evalua statusul imun umoral la copiii cu pneumonie asociată sindromului bronhoobstructiv. Lotul de bază alcătuit din 200 copii cu pneumonie şi wheezing, lotul de control a inclus 40 de copii consideraţi sănătoşi. Majorarea concentratiei IgM la copiii cu pneumonie şi cu wheezing faţă de cei consideraţi sănătoşi, determină la ei o reacţie imună mai exprimată, dar nu suficient de eficientă pentru o solutionare calitativă a procesului infecţios. La aceşti copii cu pneumonie asociată sindromului bronhoobstructiv a fost confirmată implicarea mecanismelor infecţios-alergice severe marcate prin hiperimunoglobulinemie E şi mecanisme imunopatologice exagerate de tip imunocomplex

The impact of malnutrition on immunity in respiratory infections

Department of Pediatry, Nicolae Testemitanu State University of Medicine and Pharmacy Chisinau, the Republic of Moldova, National Public Health Agency, Congresul consacrat aniversării a 75-a de la fondarea Universității de Stat de Medicină și Farmacie „Nicolae Testemițanu” din Republica Moldova, Ziua internațională a științei pentru pace și dezvoltareIntroduction: Pneumonia is known as one of the leading cause of death in children. Malnutrition in children under 5 years old increases the risk of death, amplifying the severity, frequency, and complications of pneumonia with an unfavorable prognosis. Malnutrition is a global health problem with different implications. The malnutrition causes are: poverty, world conflicts, lack of education, natural desaster and poor access to health care. Fig.1. The mechanism of this vicious circle is the disorder of immunity, thus affecting the immune responses of the host including cell-mediated immunity. Purpose: to establish the link between immune status, pneumonia, and malnutrition with outlining predictive markers of worsening. Material and methods: The PubMed database were used for a systematic research using the articles from 2009-2019 only. This including research studies about parameters of the immune status in children with pneumonia and malnutrition between the ages of 1-60 months old. Results: Stimulating an immune response through respiratory infection rises the demand for anabolic energy metabolic derivative, which leads to a metabolic disorder. More than that, a respiratory infection itself can cause a critical loss of protein and energy stores. During an immune response, energy expenditure increases at the same time as the infected host experiences a decrease in nutrients intake. Furthermore, the negative nitrogen balance seems to correlate with body weight loss. Thus, malnutrition can be a consequence of repeated respiratory infections. Experimental clinical trials reports immune distress as an immediate consequence of malnutrition of thymus and bone marrow atrophy. The consequences are devastating because these organs are producing T and B cells, thus clearly affecting hematopoiesis, causing anemia, leukopenia, also decreases the ratio of CD4/CD8/CD25/CD71/CD3 lymphocytes in the spleen, and increases the number of immature lymphocytes in the peripheral blood. There is a decrease in leptin levels and an increase in secretory Ig A for patients with malnutrition in respiratory infections. There are a multitude of immune parameters which are affected in malnutrition or remain within the normal limits – Fig.2. Morphological changes of thymic epithelial cells associated with decreased production of thymic hormone, have also been described in malnutrition – Fig.3. Conclusions: Certainly, the need for the future studies is required. Those described may be used as markers of worsening in malnourished children with pneumonia, which lead to immune imbalance. It is necessary to assess the link between the imbalanced immune system and the worsening of pneumonia in malnourished children, as well as the rate of morbidity and predictive markers for worsening pneumonia in this children

Грипп, острые респираторные вирусные инфекции (ОРВИ) и тяжёлые острые респираторные инфекции (ТОРИ) в Республике Молдова в 2013- 2014 сезоне: меры контроля и ответа

Centrul Național de Sănătate Publică, Chișinău, Conferința științifico-practică cu participare internațională Centrul de Sănătate Publică din municipiul Chișinău – 70 de ani la straja sănătăţii 23 octombrie 2014This paper contains the results of influenza, ARVI and SARI epidemiological and virological weekly monitoring in 20132014 epidemic season. It was established that influenza had regional and local geographical spread, low intensity of epidemic process, and low impact on public health. Influenza affected mostly children and has been caused mainly by influenza virus A(H3N2). Influenza morbidity in 2013-2014 season decreased 4.76 times than in 2012-2013 season. During November 2013 – January 2014 against influenza were vaccinated 160 000 people from high risk groups, thus contributing to significantly reduce of influenza morbidity in the nominated season. AVRI morbidity level deceased 1.1 times compared to the previous season. SARI morbidity 2013-2014 season increased 1.15 times than in 2012-2013 seasonПредставлены результаты еженедельного клиникоэпидемиологического и вирусологического надзора за гриппом, ОРВИ и ТОРИ в эпидемическом сезоне 201320144 гг. Установлено, что грипп имел региональное и локальное распространение с низкой интенсивностью эпидемического процесса и низким воздействием на общественное здоровье. Грипп регистрировался в основном у детей и вызван преимущественно вирусом гриппа A(H3N2). Уровень заболеваемости гриппом в 2013-2014 сезоне снизился в 4,76 раза по сравнению с предыдущим сезоном. В период с ноября 2013 г. по январь 2014 г. против гриппа было вакцинировано 160 000 лиц из группы повышенного риска заражения, что способствовало значительному снижению уровня заболеваемости гриппом в 2013-2014 сезоне. Уровень заболеваемости ОРВИ в эпидемическом сезоне 2013-2014 гг. снизился в 1,1 раза по сравнению с предыдущим сезоном. Уровень заболеваемости ТОРИ в 2013-2014 сезоне вырос в 1,15 раза по сравнению с предыдущим сезоном

Меры контроля и ответа в системе эпидемиологического и вирусологического надзора за гриппом, острыми респираторными вирусными инфекциями (ОРВИ) и тяжёлыми острыми респираторными инфекциями (ТОРИ) в Республике Молдова

Centrul Naţional de Sanătate PublicăThis paper contains the results of influenza, ARI and SARI epidemiological and virological weekly monitoring in 2014-2015 epidemic season. It was established that influenza activity was widespread, medium intensity of epidemic process, and moderate impact on public health. Influenza affected mostly people aged 15 – ≥ 65 years, causing 21 deaths and attesting the co-dominant circulation of type B and A(H1N1) pdm influenza viruses, influenza A(H3N2) virus and the presence of co-infections with influenza A(H1N1) pdm + B. Influenza morbidity in 2014-2015 season increased 3.8 times than in 2013-2014 season. During the November 2014 – January 2015 was achieved influenza vaccination campaign using 150 000 doses for immunization of persons from high risk groups. ARI morbidity level increased 1.2 times compared to the previous season. SARI morbidity in 2014-2015 season increased 1.1 times than in 2013-2014 season.Представлены результаты еженедельного эпидемиологического и вирусологического надзора за гриппом, ОРВИ и ТОРИ в эпидемическом сезоне 2014-2015 гг. Установлено, что грипп имел широкое распространение со средней интенсивностью эпидемического процесса и умеренным воздействием на систему здравоохранения. Грипп регистрировался в основном у людей в возрасте 15 – ≥ 65 лет, в том числе 21 случай со смертельным исходом. Была выявлена кодоминирующая циркуляция вирусов гриппа В и А(H1N1) pdm, вируса гриппа A(H3N2) и наличие сопутствующих инфекций с вирусами гриппа А(H1N1) pdm + В. Уровень заболеваемости гриппом в 2014-2015 сезоне повысился в 3,8 раза по сравнению с предыдущим сезоном. В период с ноября 2014 г. по январь 2015 г. была проведена кампания по вакцинации против гриппа с использованием 150 000 доз для иммунизации лиц из группы повышенного риска заражения. Уровень заболеваемости ОРВИ в эпидемическом сезоне 2014-2015 гг. повысился в 1,2 раза, а уровень заболеваемости ТОРИ – в 1,1 раза по сравнению с предыдущим сезоном (2013-2014 гг.)