Impactul malnutriției asupra imunității în infecțiile respiratorii

Background. Pneumonia is one of the leading cause of death in children.Malnutrition increases the risk of death, amplifying the severity, frequency, complications of pneumonia. The mechanism of this vicious circle is the disorder of immunity, affecting the immune responses of the host and cell-mediated immunity Objective of the study. To establish the link between immune status, pneumonia, and malnutrition with outlining predictive markers of worsening. Material and Method. The PubMed database were used for a systematic research using the articles from 2014-2019 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. Clinical and experimental studies reports leukopenia as well as decreased CD4/CD8, CD25, CD71, CD3 lymphocytes in the spleen and increased number of immature T-lymphocytes in the peripheral blood, as a result of immune suffering, a consequence of thymus atrophy in malnutrition. There is a decrease in leptin levels and an increase in secretory Ig A for patients with malnutrition in respiratory infections. Conclusion. Those exposed may be as markers of aggravation in the pneumonia of malnourished children, suggesting an immune imbalance.It is necessary to assess the link between immune system imbalance and worsening of pneumonia in malnourished children, the rate of morbidity and predictive circumstances. Introducere. Pneumonia este una din principalele cauze de deces la copii. Malnutriția crește riscul de deces, amplifică severitatea, frecvența, complicațiile pneumoniei cu prognostic nefavorabil. Mecanismul cercului vicios este dereglarea imunității, afectându-se răspunsul imun al gazdei și imunitatea mediată celular. Scopul lucrării. Stabilirea legăturii dintre sistemul imun, pneumonie și malnutriție cu evidențierea markerilor predictivi de agravare. Material și Metode. A fost realizată o căutare sistematică, în baza de date PubMed (a.2014-2019), cu includerea studiilor de cercetare a parametrilor statutului imun la copiii cu pneumonie și malnutriție, vârsta 1-60 luni. Rezultate. Studiile clinice și experimentale relatează suferința imună drept consecința imediată a atrofiei timusului în malnutriție - leucopenia, scăderea raportului CD4/CD8, CD25, CD71, CD3 limfocite în splină și creșterea numărului de T- limfocite imature în sângele periferic. La pacienții cu malnutriție în infecțiile respiratorii se atestă o scădere a nivelului de leptină și o creștere a Ig A secretorie. Concluzii. Se conturează necesitatea unui studiu, cele expuse pot fi ca markeri de agravare în pneumonie și malnutriție, sugerând un dezechilibru imunologic.Se necesită evaluarea legăturii dintre dezechilibrul sistemului imun, agravarea pneumoniei în malnutriție, rata morbidității și a circumstanțelor predictive

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