The aim of the study was to study the features of cytokine balance and their effect on clinical and laboratory parameters in infectious hemorrhagic colitis in children. Materials and methods. In the Department of intestinal infections in 2018 observed 28 children with infectious haemorrhagic colitis. The diagnosis was established taking into account clinical recommendations; the severity of the disease was determined by the Clark index; the etiology was verified according to bacteriological and molecular studies of feces, serological methods. In the acute period of the disease, the concentration of cytokines in the blood serum — TNF-a, IL-4, IL-6, IL-10 was studied by enzyme immunoassay. Mann-Whitney method, Kruskal-Wallis dispersion analysis, Pearson correlation method we used to estimate the obtained data.Results. The age structure of patients was dominated by young children (53.6%). Mild form of the disease was diagnosed in 32.1% of patients, moderate — in 67.9%. A high level of IL-4 was observed against a relatively low level of TNF-a, IL-6 and IL-10. Significantly higher concentrations of TNF-a and IL-6 were found in children with moderate form of the disease. The maximum values of IL-6 were observed in young children, IL-10 — in infants. In the moderate form of the disease, negative correlations of IL-4 with the number of leukocytes (r = –0.46; p = 0.05) and platelets (r = –0.48; p < 0.05) in the hemogram noted. Early age patients were found to have correlations of TNF-a with the relative number of rod neutrophils (r = 0.62; p < 0.01). There was a significant correlation of IL-4 with the relative number of segmental neutrophils (r = 0.49; p < 0.05). The relationship of TNF-a with the severity of the disease (r = 0.42; p < 0.05) revealed. The data on the possible suppressive effect of TNF-a and IL-10 on the synthesis of urea and the relationship of IL-6 with reactive changes in the liver obtained.Conclusion. Studies of cytokine balance in infectious hemorrhagic colitis in children showed the severity of systemic inflammatory response with the activation of Th-2 immune response. The correlation of TNF-a with the severity of the disease was established, which may have diagnostic and prognostic value.
The aim of the study was to determine the risk factors for the formation of gastroenterological pathology in convalescents of infectious hemocolites. In the Department of intestinal infections, 120 children aged over 1 month who had intestinal infections with hemocolitis syndrome were observed. The etiology of the disease was verified, clinical and laboratory signs of intoxication, dehydration, local and systemic inflammatory response were detected. Non-specific complications (respiratory diseases, urinary tract infection) were diagnosed. In the acute period of the disease, the composition of the intestinal microbiota was evaluated by PCR-RT. During 6 months, 65 convalescents were observed in the catamnesis. If there were complaints from the gastrointestinal tract, functional gastrointestinal disorders (FGID) were diagnosed. When «symptoms of anxiety» appeared, organic intestinal lesions were detected. When «symptoms of anxiety» appeared, organic intestinal lesions were detected. The results were evaluated using the student's test, the Mann-Whitney U-test, the Kruskal-Wallis test, the Pearson correlation method, and discriminant analysis. Studies have shown that there were 43 children with a favorable outcome (66.2%), 17 children with FGID (26.1%), and 5 children with organic intestinal lesions (7.7%). In patients who formed organic lesions, the bacterial etiology of hemocolitis was more often noted. Gastroenterocolitis was more often diagnosed in patients with a favorable outcome (41.9%; p > 0,05). Non-specific complications were more often observed in patients who formed FGID and organic lesions. The frequency of FGID decreased with age and was higher in girls (58.8%) than in boys (41.2%) (p > 0,05). Organic intestinal lesions were observed only in girls. In convalescents with FGID, more often (83.3%) than in convalescents with a favorable outcome (64.3%), signs of anaerobic intestinal imbalance were detected. A complex of clinical and laboratory signs of an acute period of infectious hemocolites that determine the risk of FGID formation has been established. It was shown that the risk of developing FGID is higher in young convalescents, and the risk of forming organic intestinal lesions is higher in girls of preschool and school age. Patients who showed more pronounced systemic inflammatory responses in the acute period of the disease were more likely to have a favorable outcome.
The aim of this work is to study the etiological and epidemiological features of infectious hemocolites (IG) in hospitalized children of different ages.Materials and methods of research. An analysis of the results of a survey of 3103 children admitted to hospital treatment for acute intestinal infections (AII) from January to December 2018, among which patients with IG were identified. The etiology of the disease was determined based on the results of the bacteriological method, PCR studies of faeces with Amplicens ® OKI screen-FL reagents, serological and immunological methods. Microscopic examination of faeces was performed to identify protozoa. Patients were divided into age groups: infant (n=78; 30%); early (n=74; 28,5%); preschool (n=63; 24,2%), school (n=45; 17,3%).Results. The incidence of IG in hospitalized children with AII was 8,4%. Bacterial pathogens of IG were detected in 66,5% of children, IG of unspecified etiology was diagnosed in 24,2%. Viral and bacterial infections were rarely detected (9,2%). Among intestinal viruses, rotavirus (37,5%), norovirus (29,2%) and enterovirus (20,8%) were more frequently detected in hemocolitis of combined viral and bacterial etiology. In the IG age structure, infants (30%), young children (28,5%) and pre-school children (24,2%) made up the majority. The maximum number of IG patients was detected in the summer (10,9% of all cases of AII). Salmonellosis was more often detected in autumn (31,6%), campylobacteriosis – in summer (17.9%) and autumn (24,1%), escherichiosis and shigellosis – in summer (11,5% and 6,4%, respectively). The maximum detection of IG in infants was observed in June (14,1%) and October (12,8%), in young children – in July (17,6%), in preschoolers – in June (12,7%) and November (15,9%), in schoolchildren in May (13,3% of cases) and in October (15,6%).Conclusion. The incidence of infectious hemocolites in hospitalized children with acute intestinal infections was 8,4%. The bacterial etiology of the disease was detected in 66,5% of children. The age structure of the IG was dominated by children of infant, early and preschool age. The maximum detection of patients with IG was observed in the summer.
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