Úvod: Horná časť aerodigestívneho traktu je najčastejším miestom vstupu mikroorganizmov do tela a prvým miestom vzájomnej interakcie mikroorganizmu a imunitného systému človeka. Veľká časť porúch imunity sa manifestuje práve infekciami horného aerodigestívneho traktu. Tieto infekcie sa vyskytujú pomerne často aj u pacientov s neporušeným imunitným systémom, a to najmä v detskom veku. Metodika: Do prospektívnej štúdie bolo zaradených 61 detí, ktorým bola vykonaná endoskopická adenotómia v celkovej anestézii na Klinike otorinolaryngológie a chirurgie hlavy a krku, UK JLF a UNM v Martine. Autori určovali mikrobiologický nález v strednom nosovom priechode a v nosohltane, ich vzájomný vzťah, sledovali výskyt atopie a stanovovali vybrané parametre humorálnej a celulárnej imunity. Výsledky: Patogénne baktérie sme izolovali u 58 % detí v strednom nosovom priechode a u 72 % v nosohltane. Z patogénov sme najčastejšie identifikovali druhy Streptococcus pneumoniae, Staphylococcus aureus, Haemophillus influenzae a Moraxella catarrhalis, a to v strednom nosovom priechode ako aj v nosohltane. Identifikácia baktérií v nosovej dutine nekorelovala s ich nálezom v nosohltane. Atopiu sme diagnostikovali u 83 % detí. U detí s atopiou sme detegovali signifikantne nižšiu kolonizáciu saprofytmi (p=0,037) a vyššie zastúpenie patogénov (p=0,045) v strednom nosovom priechode v porovnaní s deťmi bez atopie. Závažnú poruchu imunity sme nedetegovali. Záver: Identifikácia baktérií v nosovej dutine nekoreluje s ich nálezom v nosohltane. Pri výbere cielenej ATB liečby je smerodajný výsledok steru z nosohltana a nie z nosovej dutiny. Atopia je dôležitý faktor v patogenéze adenoidných vegetácií. Imunoalergologické vyšetrenie by preto malo byť štandardnou súčasťou manažmentu a diagnostického postupu u detí s adenoidnými vegetáciami. Deti s recidivujúcimi respiračnými infekciami majú len zriedkavo závažnú vrodenú poruchu imunity.

Introduction: The upper aerodigestive tract is the most common point of entry for pathogens and serves as a first step in interaction between microorganisms and immune system. Many disorders of immune system are manifested as infection of upper aerodigestive tract. On the other hand, those infections are also common in patients with an intact immunity, especially among children. Methods: The prospective study was conducted with 61 children that were scheduled to endoscopic adenotomy for adenoid vegetation at the Department of Otorhinolaryngology, Head and Neck Surgery, Comenius University, Jessenius Faculty of Medicine, University Hospital in Martin, Slovakia. Relationship between microbiological findings in middle meatus and nasopharynx, presence of atopy, as well humoral and cellular components of immunity were evaluated. Results: Pathogenic bacteria were isolated in 58 % samples from middle nasal meatus and 72 % samples from nasopharynx. Streptococcus pneumoniae, Staphylococcus aureus, Haemophillus influenzae and Moraxella catarrhalis were the most common identified pathogens in both middle nasal metaus and nasopharynx. Identification of pathogenic bacteria in middle nasal meatus did not correlate with isolation of pathogenic bacteria in nasopharynx. Atopy was diagnosed in 83 % children with adenoid hypertrophy. Presence of atopy was associated with significantly decreased presence of saprophytes and more often colonization of pathogenic bacteria in the middle nasal meatus (P=0.37, P=0.45, respectively). Severe impairment of immunity was not detected. Conclusion: Identification of pathogenic bacteria in middle nasal meatus does not correlate with isolation of pathogenic bacteria in nasopharynx. Targeted antibiotic treatment should be chosen by a result from nasopharyngeal swab and not from the nasal cavity. Atopy is an important factor in the pathogenesis of adenoid vegetation. Therefore, immunoallergologic examination should be a standard part of the management and diagnostic procedures in children with adenoid vegetations. Children with recurrent respiratory infections are rarely caused by inborn defects of immunity.

Klinika detí a dorastu Univ Komenského JLF a UNM v Martine

Klinika ORL a chirurgie hlavy a krku Univ Komenského JLF a UNM v Martine

ORL odd FNsP FD Roosevelta Banská Bystrica

Microbial colonization of upper respiratory pathways and immunity in children with adenoid vegetation