Prevalence of Pneumocystis Jirovecii in Frequently Ill Children on Admission to the Respiratory Department and During Sanatorium Rehabilitation

Abstract

The aim of the study was to determine the frequency of occurrence and to assess the significance of markers of pneumocystosis in frequently ill children (FIC) during inpatient treatment and during rehabilitation in a sanatorium. Materials and methods of research: 115 children with recurrent respiratory diseases were observed: 52 were treated in a hospital and 63 underwent rehabilitation in a sanatorium. Biological samples (oropharyngeal swabs, saliva, feces and blood serum) were examined for pneumocystosis. Laboratory techniques used: a polymerase chain reaction (PCR) to detect DNA pathogens, an indirect immunofluorescence reaction (NRIF) – antigens, and immunoforment analysis (IFA) – specific antibodies of immunoglobulins (Ig) of classes M (IgM) and G (IgG). The material for laboratory research was smears from the posterior pharyngeal wall (PCR, NRIF) and blood serum (IFA). Microbiological studies included seeding, isolation of cultures with quantitative counting of colony-forming units in samples of oropharyngeal swabs, feces. Determination of the functional activity of the oropharynx microbiocenosis by the concentration of short-chain fatty acids in saliva by means of GLC method. Phagocytic activity of blood neutrophils was also investigated. Results: in hospital patients, markers for pneumocystis were found in 60% of cases, including the active form (40%) and pneumocystis (13%); in the sanatorium – 33% of cases, with active infection (26%) and detection of pneumocystis (17%). Inpatients were diagnosed with clinical variants of pneumocystis infection: pneumonia, obstructive bronchitis, acute respiratory infections; schoolchildren have been diagnosed with active pneumocystis infection and carriage. Dysbiotic disorders of the loci of the oropharynx and intestines were identified in all examined subjects, inhibition of the phagocytic activity of blood neutrophils and shifts in the concentration of short-chain fatty acids have been observed. Conclusion: a high proportion of active pneumocystis infection (40% and 27% of cases) was revealed in FIC treated in the hospital and in the sanatorium, which represents a risk group for infection/reinfection with pneumocystosis in the premises.