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

Comparative analysis of the characteristics of rotaviral infection in vaccinated and non-vaccinated infants: prospective, descriptive study

Departamentul de pediatrie, Universitatea de Stat de Medicină şi Farmacie ”Nicolae Testemiţanu”, Chişinău, Republica Moldova, Spitalul Clinic Municipal de Copii nr. 1, Chişinău, Republica Moldova, Universitatea de Stat de Medicină şi Farmacie ”Nicolae Testemiţanu”, Chişinău, Republica Moldova, Agenţia Naţională de Sănătate Publică, Chişinău, Republica MoldovaRezumat. Introducere. Boala diareică acută este una dintre cele mai actuale probleme de sănătate ale sugarului. Infecţia rotavirală este cauza cea mai frecventă de deshidratare la sugar şi la copilul mic. Implementarea supravegherii santinelă a infecţiei rotavirale la sugari din anul 2008 în Republica Moldova a demonstrat rata înaltă a acestei infecţii (40,0%), fiind un argument în recomandarea imunizării antirotavirale la copii în cadrul Programului Naţional de Imunizări. Material şi metode. În studiu au fost incluşi copii sugari cu boală diareică acută, înrolaţi în supravegherea santinelă în perioada 2012-2016 şi care au fost trataţi în Secţia de boli diareice acute a Spitalului Clinic Municipal de Copii nr. 1. Au fost examinaţi 193 de pacienţi cu boală diareică acută, conform unui caz-cadru standard. Materialul biologic s-a examinat prin metoda reacţiei serologice ELISA, iar evidenţierea genotipurilor a fost efectuată prin reacţia de amplificare genică PCR. Rezultate. Din cei 193 de sugari cu infecţie rotavirală, 121 nu au fost vaccinaţi contra infecţiei respective, iar 72 – au fost imunizaţi. În funcţie de genotipurile întâlnite până şi după vaccinare, s-a constatat că până la vaccinare au predominat genotipurile G9P[8], G3P[8], G4P[8]. În schimb, postvaccinal au prevalat genotipurile G2P[4], G4P[8], incidenţa infecţiei rotavirale fiind în scădere, iar evoluţia bolii – mult mai uşoară. Concluzii. Acest articol reflectă evoluţia proprietăţilor genotipice a rotavirusurilor şi a particularităţilor clinico-paraclinice ale infecţiei rotavirale la sugari, cu o importanţă majoră în contextul implementării imunizării antirotavirale la copii în cadrul Programului Naţional de Imunizări din Republica Moldova.Abstract. Introduction. Acute diarrheal disease is one of the most current health problems of the baby. Rotaviral infection is the most common cause of dehydration in infants and young children. The implementation of the sentinel surveillance of rotaviral infection in infants from 2008 in the Republic of Moldova demonstrated the high rate of this infection (40.0%), being an argument in recommending the antirotaviral immunization in children within the National Immunization Program. Material and methods. The study enrolled children with acute diarrheal disease, included in the sentinel supervision (2012-2016) and treated in the Unit of acute diarrheal diseases of Clinical Children’s Hospital no. 1. Were assessed 193 patients with acute diarrheal disease, according with a standard clinical approach. The biological material was examined by serological enzyme-linked immunosorbent assay (ELISA) and genotyping revealed by polymerase chain reaction (PCR). Results. The rotaviral infection was confirmed in 193 infants, of which 121 children were not vaccinated against rotaviral infection, and 72 were immunized. Depending on the genotypes encountered before and after vaccination, it was found that G9P[8], G3P[8], G4P[8] was detected before vaccination, but post-vaccine prevailed G2P[4], G4P[8], also the incidence of rotaviral infection is decreasing, and the evolution of the disease is much easier. Conclusions. This article reflects the evolution of the genotypic properties of rotaviruses and the clinical-paraclinical particularities of rotaviral infection in infants, with a major importance in the context of the implementation of antirotaviral immunization in children within the National Immunization Program in the Republic of Moldova

Evaluarea comparativă a manifestărilor clinico-paracliniceale infecției rotavirale versus varietatea genotipică la sugari

Nicolae Testemitanu State University of Medicine and Pharmacy, Republic of Moldova, Municipal Children’s Clinical Hospital no.1, Chisinau, Republic of Moldova, National Agency for Public Health, Republic of MoldovaIntroduction. RVI (rotavirus infection) is the most common cause of dehydration in infants and young children. The implementation of the sentinel surveillance of RVI in infants from 2008 in the Republic of Moldova demonstrated the high rate of this infection (40.0%), being an argument in recommending the antirotaviral immunization in children within the National Immunization Program. Material and methods. The study enrolled 193 children with acute diarrheal disease, included in the sentinel supervision (2012-2016) and treated in the Unit for Acute Diarrheal Diseases at Children’s Clinical Hospital no. 1. The biological material was examined by serological enzyme-linked immunosorbent assay (ELISA) and genotyping, revealed by polymerase chain reaction (PCR). Results. The rotavirus infection was confirmed in 193 infants, of which 121 children were not vaccinated against RVI, and 72 were immunized. Depending on the genotypes encountered before and after vaccination, it was found that G9P [8], G3P [8], G4P [8] were detected before vaccination, although postvaccine prevailed G2P [4], G4P [8]. In addition, the incidence of RVI is decreasing and the disease evolution is much better. Conclusions. This article reflects the evolution of the genotypic properties of rotaviruses and the clinical-paraclinical particularities of RVI in infants, highlighting the importance of the implementation of antiretroviral immunization in children within the National Immunization Program in the Republic of Moldova.Introducere. IRV (infecţie rotavirală) este cauza cea mai frecventă de deshidratare la sugar şi la copilul mic. Implementarea în Republica Moldova în anul 2008 anul 2008 a supravegherii santinelă a IRV la sugari a relevat o rata înaltă a infecţiei (40,0%), acest fapt servind ca argumentîn recomandarea imunizării antirotavirale a copiilor în cadrul Programului Naţional de Imunizări. Material şi metode. În studiu au fost incluşi 193 de copii sugaricu boală diareică acută, aflați sub supravegherea santinelă în perioada 2012-2016 şi trataţi în Secţia de boli diareice acute a Spitalului Clinic Municipal de Copii nr. 1. Materialul biologic s-a examinat prin metoda reacţiei serologice ELISA, iar evidenţierea genotipurilor a fost efectuată prin reacţia de amplificare genică PCR. Rezultate. Dintre cei 193 de sugari cu infecţie rotavirală, 121 nu au fost vaccinaţi contra IRV, iar 72 – au fost imunizaţi. În funcţie de genotipurile întâlnite până şi după vaccinare, s-a constatat că până la vaccinare au predominat genotipurile G9P [8], G3P [8], G4P [8]. În schimb, postvaccinal au prevalat genotipurile G2P [4], G4P [8], incidenţa IRV fiind în scădere, iar evoluţia bolii – mult mai uşoară. Concluzii. Acest articol reflectă evoluţia proprietăţilor genotipice ale rotavirusurilor şi a particularităţilor clinico-paraclinice ale IRV la sugari, cu oimportanţă majoră în contextual procesului de implementare a imunizării antirotavirale a copiilor în cadrul Programului Naţional de Imunizări din Republica Moldova