VEGETATIVE REACTIVITY OF CHILDREN WITH STREPTOCOCCAL TONSILITIS ON THE BACKGROUND OF HERPES VIRAL INFECTION

Streptococcal infection in children, its complications and adverse long-term consequences remain an urgent problem in pediatrics. Scientists continue to search for factors that shape the course of the disease. One of them is the timely and adequate response of the autonomic nervous system, which provides both short-term and long-term strategic adaptation of the organism. Violations of this adaptation can lead to the presence of comorbid conditions, which are increasingly common. The share of children is growing. infected with the herpes virus group, including human herpes virus type 6 (HHV-6). The aim of the work was to study the state of vegetative reactivity (VR) of children with streptococcal tonsillitis on the background of HHV-6 infection. In 68 children aged 4 - 15 years with tonsillitis of streptococcal etiology of moderate severity, vegetative reactivity was determined by cardiointervalography (CIG) followed by analysis of heart rate variability (CP) depending on the presence or absence of concomitant HHV-6 type of infection. The studies were performed in the acute period of the disease and in the period of early convalescence. The control group consisted of 20 healthy children, similar in age and sex. Static processing of the obtained results was performed using Excel and Statistica 6.0 using parametric and non-parametric research methods. Results. In the acute period of streptococcal tonsillitis in children of both groups there was a decrease in the humoral component in the regulation of the system and the level of activity of the parasympathetic ANS, as evidenced by a decrease in Mo and ΔX, independent of background, p> 0.05. There was an activation of the influence of the sympathetic link of the VNS, increased the degree of centralization of heart rate control in all patients, and this was confirmed by an increase in AMO and IN. Prior to the convalescence period, CIG parameters were restored only in patients without concomitant VGL-6 infection, and the interrelationships of the sympathetic and parasympathetic links of the VNS were restructured with increasing role of the latter. In patients with concomitant VGL-6 infection, the values ​​of ΔX and IN differed significantly from the control group, p˂0.05. Thus, in children with streptococcal tonsillitis on the background of HHV-6 infection, there was a decrease in the level of functioning of the sympathetic VNS, but complete recovery did not occur, indicating instability of adaptation processes, depletion of the parasympathetic VNS, which hides the possibility of failure of adaptation, recurrence of the disease and / or chronicity, the development of secondary disorders of the cardiovascular system. Conclusions. The acute period of streptococcal tonsillitis is accompanied by stress of the sympathetic VNS, the severity of which does not depend on the presence of concomitant herpes virus infection. In the period of convalescence of streptococcal tonsillitis in the presence of children with HHV-6 infection there is no complete recovery of autonomic reactivity, among which the most informative are ΔX and IN.

Non-specific factors of children protection with streptococcal tonsillitis and infected with herpes virus type 6

The aim of the work was to study the characteristics of the response of non-specific protective factors in tonsillitis of streptococcal etiology in children infected and uninfected with HHV-6 infection at different periods of the disease. Materials and research methods. In 78 children aged 3–15 years, inflammation markers and phagocytic activity of peripheral blood neutrophils (PAN) were determined using the nitroblue tetrazolium reduction test. The studies were carried out in the acute period and in the period of convalescence. Mathematical and statistical processing of the data obtained was carried out using Microsoft Excel 2003 and Statistica 6.0 programs. The significance of differences between the mean values was determined using the Student's test (t). Results. It was found that infection of children with HHV-6 leads to a decrease in the functional activity of neutrophils in the onset of streptococcal tonsillitis compared with uninfected patients (p<0.05). Also, the acute period of streptococcal tonsillitis in patients with co-infection is accompanied by a violation of the functional reserve of the oxygen-dependent mechanism of bactericidal neutrophils: minimal opportunities were found in tonsillitis on the background of HHV-6 infection (p<0.05). By the period of convalescence, a decrease in the indicators of the functional activity of neutrophils, increased in the acute period, was recorded, but in children infected with HHV-6, a complete recovery of indicators to the physiological norm did not occur. One of the features of streptococcal tonsillitis in children with HHV-6 infection is an increase in serum gamma globulin level (p˂0.05), lack of significant dynamics of decrease in the ASL-O indicator. Conclusions. The presence of VHL-6t infection in a child with streptococcal tonsillitis adversely affects the state of nonspecific protective factors, in particular PAN. The obtained data must be used to optimize the management of patients at different periods of the disease, including at the stages of dispensary observation

Immune response and phagocytosis of children with streptococcal tonsillitis and infected with the herpes virus type 6.

The aim of the work is to study the indicators of cellular and humoral immune response and FAN of patients with tonsillitis in children infected with HHV-6 type. Materials and methods of research. In 72 children aged 3–15 years (mean age 8.42±1.44 years), patients with streptococcal tonsillitis of moderate severity, the levels of the main subpopulations of blood lymphocytes were determined using monoclonal antibodies by solid-phase enzyme-linked immunosorbent assay, phagocytic activity of neutrophils (FAN) using the nitrosine tetrazolium reduction test (HCT test) and serum IgA, IgM, IgG levels by radial immunodiffusion. The studies were carried out in the acute period and in the period of convalescence. Mathematical and statistical processing of the data obtained was carried out using Microsoft Excel 2003 and Statistica 6.0 programs. The significance of differences between the mean values was determined using the Student's test (t). Results. Different mechanisms of formation of pathological process at streptococcal tonsillitis at children depending on the concomitant HHV-6 type infection are revealed. In patients with mixed infection in the acute period of tonsillitis determine the signs of deficiency of the cellular immune system with the maximum deviation of CD-lymphocytes (t=3.13 vs. t=2.16 in mono-infection), the tension in the humoral link of the immune response Ig deviation (t=1.63 against t=0.91 in mono-infection) on the background of phagocytosis violation in terms of FAN deviation (t=3.22 against t=2.01 in mono-infection). By the period of convalescence, the restoration of the imbalance of specific and non-specific protection factors does not occur. Increased IgG content in the acute period is one of the features of streptococcal tonsillitis in children on the background of HHV-6t infection. Conclusions. Concomitant VGL-6 type infection in children with streptococcal tonsillitis affects the mechanisms of formation of the inflammatory process and the reactivity of patients, forming the preconditions for adverse outcomes of the disease. The obtained results can be the basis for early detection of herpes virus infection in patients with tonsillitis, will help to optimize the management of patients in different periods of the disease.

Bacterial adhesion of palatine tonsils epithelial cells in infectious mononucleosis

Aim. To evaluate the features of pharynx tonsils mucous membrane colonization by pathogenic and opportunistic microorganisms using electron microscopic examination of pharynx palatine tonsils epithelium in patients with infectious mononucleosis and acute streptococcal tonsillitis. Materials and Methods. Two patients, i.e. a patient P. (12 years old) with a confirmed diagnosis of infectious mononucleosis, and patient A. (8 years old) with acute streptococcal tonsillitis diagnosis were examined. A bacteriological examination of mucus and epithelium scraping from the surface of the pharyngeal tonsils was conducted. Tissue samples were examined in the electron microscopy laboratory of the Lviv National University. Results and Discussion. 36 tonsils epithelial tissue micro preparations of patient A. and 41 micro preparations of patient P. were studied. Streptococcus pyogenes, Str. pneumoniae, Str. viridans, Сandida albicans, as well as non-pathogenic bacteria, Diphtheroides sp., Neisseria sp., and Corynebacterium spp. were identified as result of the bacteriological examination of mucus from the surface of the pharyngeal tonsils of the patient P.. Staph. aureus, Str. Viridans, and Str. pneumoniae were identified during a bacteriological examination of the patient A. Eosinophils with a two-segmented nucleus, specific granularity, phagocytosed spherical bacteria in the cytoplasm were detected during the histological examination of the materials taken from the surface of the patient with acute tonsillitis tonsils. Research shows that bacteria accumulate not only in the structure of extracellular detritus. Numerous bacteria accumulations were found in the cytoplasm of the epithelial cells in the patient with infectious mononucleosis also. The cell's shape resembles a bunch of grapes. Conclusions. The electron microscopic examination showed differences in the coccal flora localization. The extracellular localization of bacteria in the patient with acute bacterial tonsillitis, and intraepithelial presence of the bacteria in the patient with tonsillitis during infectious mononucleosis were found.

The investigation of bacterial adhesion of palatine tonsils epithelial cells in patient with infectious mononucleosis

Aim. To evaluate the features of pharynx tonsils mucous membrane colonization by pathogenic and opportunistic microorganisms by using the pharynx palatine tonsils epithelium electron microscopic examination of the patients with infectious mononucleosis and acute streptococcal tonsillitis. Materials and methods. Two patients – patient P., 12 years old with a confirmed diagnosis of infectious mononucleosis and patient A., 8 years old with confirmed acute streptococcal tonsillitis. The patients were taken a bacteriological examination of the mucus and epithelium scraping from the surface of the pharyngeal tonsils. Tissue samples were examined in the electron microscopy laboratory of the Lviv National University. Results and discussion. 36 tonsils epithelial tissue micro preparations of patient A. and 41 micro preparations of patient P. were studied. Streptococcus pyogenes, Str. pneumoniae, Str. viridans, Сandida albicans, as well as non-pathogenic bacteria: Diphtheroides sp., Neisseria sp., Corynebacterium spp. were identified as result of the patient P. bacteriological examination of mucus from the surface of the pharyngeal tonsils. Staph. aureus, Str. viridans, Str. pneumoniae were identified during a bacteriological examination of patient A. Eosinophils with a two-segmented nucleus, specific granularity, phagocytosed spherical bacteria in the cytoplasm were detected during the histological examination of the materials taken from the surface of the patient’s tonsils with acute tonsillitis. Research showed that bacteria were accumulated not only in the structure of extracellular detritus. Numerous bacteria accumulations were also found in the cytoplasm of the epithelial cells in the patient with infectious mononucleosis. The cell's shape looked like a bunch of grapes. Conclusions. The electron microscopic examination showed differences in the coccal flora localization: the extracellular localization of bacteria in the patient with acute bacterial tonsillitis and intraepithelial presence of the bacteria in the patient with tonsillitis during infectious mononucleosis were found.

Expanding the spectrum of reactive arthritis (ReA): classic ReA and infection-related arthritis including poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA

Reactive arthritis (ReA) is a form of sterile arthritis that occurs secondary to an extra-articular infection in genetically predisposed individuals. The extra-articular infection is typically an infection of the gastrointestinal tract or genitourinary tract. Infection-related arthritis is a sterile arthritis associated with streptococcal tonsillitis, extra-articular tuberculosis, or intravesical instillation of bacillus Calmette–Guérin (iBCG) therapy for bladder cancer. These infection-related arthritis diagnoses are often grouped with ReA based on the pathogenic mechanism. However, the unique characteristics of these entities may be masked by a group classification. Therefore, we reviewed the clinical characteristics of classic ReA, poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA. Considering the diversity in triggering microbes, infection sites, and frequency of HLA-B27, these are different disorders. However, the clinical symptoms and intracellular parasitism pathogenic mechanism among classic ReA and infection-related arthritis entities are similar. Therefore, poststreptococcal ReA, Poncet’s disease, and iBCG-induced ReA could be included in the expanding spectrum of ReA, especially based on the pathogenic mechanism.

Acute Parkinsonism in Young Adult Following Streptococcal Infection

Acute parkinsonism following streptococcal infection is rarely reported. To date, there is paucity of literature of post streptococcal immune mediated acute parkinsonism and dyskinesia among adult. We report a case of 18 years old woman, who presented with acute parkinsonism after streptococcal tonsillitis. The patient who was previously well presented with a two-month history of intermittent fever, associated with sore throat and sudden onset of behaviour changes. She has been found to be quieter and respond slowly to questions and commands in the preceding one week prior to admission. Features of secondary parkinsonism was noted during examination. Her blood counts, viral screenings and anti-NMDAR were unremarkable. Her lumbar puncture revealed an opening pressure of 10 cm CSF with normal constituents. The ASO titre was raised up to 400IU/ml. Electroencephalogram (EEG) shows mild encephalopathy changes and MRI brain shows normal finding. She was initially treated initially for meningoencephalitis with intravenous acyclovir 500mg q8h and ceftriaxone 2g q12h, concomitant with intravenous methylprednisolone 1g daily for 3 days. Intravenous immunoglobulin was started on her in view of poor response to the above treatment, which later resulted in significant and rapid clinical improvement. Upon clinic review at 3 months, her tremor, bradykinesia, and rigidity resolved. Her medication was able to be weaned off and she was referred to the ENT team for further evaluation for tonsillectomy. This case illustrates the importance of recognising post-streptococcal infection as aetiology of acute parkinsonism in young adults, to avoid treatment delay. As illustrated in our case, the prognosis was excellent with prompt immunomodulatory therapy. Bangladesh Journal of Infectious Diseases 2020;7(2):110-112

Comparison of Intravenous Co-amoxiclav and Benzyl Penicillin in Children with Severe Streptococcal Tonsillitis

Background: Streptococcal tonsillitis is a common pediatric ailment which is faced by physicians on a daily basis and is associated with disastrous complications if not treated adequately. The objective of this study was to compare the efficacy, safety and cost-effectiveness of intravenous co-amoxiclav with benzyl penicillin in the treatment of severe streptococcal tonsillitis in children. Material and Methods: This Randomized Controlled Trial was carried out at CMH Mardan, Khyber Pakhtunkhwa from January 2018 to November 2019. A total of 310 children with severe tonsillitis, aged between 5 to 15 years were selected from outpatient department of Combined Military Hospital Mardan. The cases were divided into two groups. Injection co-amoxiclav was given to patients in Group A (n=155) and injection benzyl penicillin was administered to patients in Group B (n=155). Both groups were compared in terms of effectiveness of treatment, safety and cost effectiveness. All the data was assessed with help of SPSS (Statistical Package for Social Sciences) version 21. Chi square and independent T test were used with P-value < 0.05 taken as statistically significant. Results: There were 310 children with severe tonsillitis, 155 in each group. Mean age in Group A was 9.35 ± 3.17 years and in Group B, 9.96 ± 2.96 years, respectively. In Group A, 2 cases developed hypersensitivity to injection co-amoxiclav after initial test dose as compared to 3 cases in Group B. Mean duration for complete resolution of symptoms (i.e. hospital stay) was 4.13 ± 0.375 days for Group A as compared to 4.09 ± 0.377 days for Group B (P=0.458). Mean cost of antibiotic drugs for each child in Group A was Rs. 965.88 ± 298 and in Group B was Rs. 152.36 ± 53. Benzyl penicillin was found to be significantly cost effective as compared to co-amoxiclav (P=0.000). Conclusions: Both the drugs have similar efficacy and safety profile in the treatment of severe streptococcal tonsillitis in children. However, benzyl penicillin is more cost effective than co-amoxiclav in our study population.

Calprotectin, a new biomarker for diagnosis of acute respiratory infections

Respiratory tract infections require early diagnosis and adequate treatment. With the antibiotic overuse and increment in antibiotic resistance there is an increased need to accurately distinguish between bacterial and viral infections. We investigated the diagnostic performance of calprotectin in respiratory tract infections and compared it with the performance of heparin binding protein (HBP) and procalcitonin (PCT). Biomarkers were analyzed in patients with viral respiratory infections and patients with bacterial pneumonia, mycoplasma pneumonia and streptococcal tonsillitis (n = 135). Results were compared with values obtained from 144 healthy controls. All biomarkers were elevated in bacterial and viral infections compared to healthy controls. Calprotectin was significantly increased in patients with bacterial infections; bacterial pneumonia, mycoplasma pneumonia and streptococcal tonsillitis compared with viral infections. PCT was significantly elevated in patients with bacterial pneumonia compared to viral infections but not in streptococcal tonsillitis or mycoplasma caused infections. HBP was not able to distinguish between bacterial and viral causes of infections. The overall clinical performance of calprotectin in the distinction between bacterial and viral respiratory infections, including mycoplasma was greater than performance of PCT and HBP. Rapid determination of calprotectin may improve the management of respiratory tract infections and allow more precise diagnosis and selective use of antibiotics.