Clinical and immunological characteristic of children with recurrent episodes of acute laryngotracheitis, acute respiratory infections, otorhinolaryngological deseases

Abstract

Introduction. Researching on pathogenesis and immunopathogenesis of acute respiratory infections in conjunction with recurrent episodes of acute laryngotracheitis and otorhinolaringological diseases (tonsillopharyngitis, rhinosinusitis, otitis) — is a high priority task for pediatrics, what is necessary to do to create an approach for preventing chronic illnesses.The aim of the present work. Researching on clinical and immunological characteristics and efficiency of treatment with prescription of bacterial lysate (OM-85) for children with recurrent episodes of acute laryngotracheitis, acute respiratory infections (ARI), otorhinolaringological diseases.Materials and methods. Fifty children 3-9 years old (32 children 3-6 years, 18 children 7-9 years old; 32 boys, 28 girls) in the initial period of monitoring, with recurrent episodes of acute laryngotracheitis (ALT), acute respiratory infections (ARI), otorhinolaryngological diseases were examined. The treatment in according with pediatric clinical practice guidelines, consultations with a pediatrician, otorhinolaryngologist, allergologist were provided to all children.Twenty five children (subgroup I b) received bacterial lysate (OM-85, 4 courses in 3 years ) in complex treatment. Subgroups I a, I b were similar in clinical symptoms, gender and age related. Follow up period continued three years. The results were evaluated a year and three years after treatment. Experimental group was composed of 30 children 3-9 years old, additionally examined. This group had such characteristics as: frequency of acute respiratory infections 3-5 times in a year, absence of chronic respiratory diseases, of recurrent episodes of acute laryngotracheitis. Immunological survey included some parameters of innate immunity, serum immunoglobulins, chemiluminescence, interferons (IFN-alfa, IFN-gamma).Results. In children with repeated episodes of ALT and ARI and otorhinolaryngological diseases the expression of TLR2 and TLR4 on CD14+ cells, receptors for IFN-γ (CD14+CD119+) is significantly higher than in children without ALT and with a frequency of ARI 3-5 times a year, which is accompanied by a decrease in the level of IFN-γ and IFN-α and is associated with the development of dysregulation of the immune system, which decreases with the administration of bacterial lysate (OM-86). Complex treatment of children within 3 years with the prescription of the drug significantly reduces the frequency of ARI — 2.6 times, tonsillopharyngitis — 1.8 times, rhinosinusitis — 2.2 times, the need for the prescription of antibiotics — 2.2 times. In the group treated by standards after 3 years, the need for antibiotics decreased by 1.6 times, the frequency of ARI exacerbations — by 1.2 times, tonsillopharyngitis — by 1.5 times, rhinosinusitis — by 1.8 times.