Violation of the vaginal microflora. How to properly collect material for research? Restoration of vaginal biocenosis

Violation of the qualitative and quantitative composition of the intestinal microflora, in which opportunistic microorganisms begin to predominate in it. Dysbacteriosis in young children is manifested by regurgitation, low rates of weight gain, and stool disturbances; in older children – belching, loss of appetite, unstable stool, intestinal colic. Confirmation of dysbacteriosis in children is carried out using bacteriological examination of stool and coprogram analysis. Treatment of dysbiosis in children includes diet, phage therapy or antibacterial therapy, taking probiotics and prebiotics, immunoregulators, and vitamins.

Classification

Depending on the predominant opportunistic flora, Proteus, staphylococcal, candidiasis, and associated forms of intestinal dysbiosis in children are distinguished; By clinical course– latent, local and generalized variants.

The severity of dysbacteriosis in children is determined by the species and quantitative composition of the microflora:

• I degree- anaerobic microflora predominates; the number of bifidobacteria is at least 107-108; opportunistic pathogens no more than two types, 102-104 CFU per 1 g of feces.
• II degree- equal amount of anaerobic and aerobic flora; opportunistic microorganisms 106-107 CFU per 1 g of feces; ordinary Escherichia coli is replaced by hemolyzing and lactose-negative ones.
• III degree– aerobic flora predominates, up to the complete suppression of bifidobacteria and lactobacilli; the number of opportunistic microorganisms is significantly increased.
• IV degree– associated dysbacteriosis in children; absolute predominance of opportunistic microflora resistant to antibiotics.

According to clinical and bacteriological criteria, compensated, subcompensated and decompensated dysbacteriosis in children is distinguished.

Compensated dysbacteriosis in children occurs in a latent form and corresponds to degrees I-II of severity. Clinically, the child remains healthy, develops normally and gains weight; Appetite and stool are normal.

Subcompensated dysbiosis in children corresponds to the local variant, II-III degrees gravity. Moderate clinical symptoms are noted: lethargy, poor appetite, poor weight gain, dyspeptic disorders.

Decompensated dysbacteriosis in children can have a local or generalized course, III-IV severity. Significantly worsening general state child due to vomiting, frequent loose stools, intoxication. Against this background, acute intestinal infections, enterocolitis, bacteremia and sepsis.

The clinical picture of dysbiosis in children may be dominated by one or more characteristic syndromes: diarrheal, dyskinetic, digestive and absorption disorders (maldigestion and malabsorption), intoxication, asthenoneurotic, dermointestinal.

Symptoms of dysbiosis in children

In newborns and infants Dysbacteriosis is accompanied by regurgitation, vomiting, flatulence, rumbling and spasms along the intestines. The child does not gain enough weight, behaves restlessly, and sleeps poorly. The stool of a child with dysbacteriosis is usually liquid or mushy, copious, foamy with an admixture of lumps or mucus, unusual color(white, greenish), with a putrid or sour odor.

With malabsorption syndrome, diarrhea, steatorrhea, malnutrition, and polyhypovitaminosis develop. Endogenous intoxication due to dysbacteriosis in children is accompanied by polydeficiency anemia, delayed physical development, and decreased appetite. The processes of fermentation and putrefaction in the intestines cause autoallergization and the development of dermointestinal syndrome (urticaria, atopic dermatitis). Manifestations of asthenoneurotic syndrome include irritability, weakness, and sleep disturbance.

At an older age, dysbiosis in children can occur with constipation, diarrhea, or their alternation; intestinal colic, belching, unpleasant smell from the mouth, a feeling of fullness in the stomach after eating. Secondary extraintestinal manifestations of dysbacteriosis in children associated with hypovitaminosis, metabolic disorders, decreased immunity can be seizures in the corners of the mouth, stomatitis, furunculosis, acne, brittle hair and nails, etc.

Generalized dysbacteriosis usually develops in children with an immunodeficiency state and occurs as candidiasis with symptoms of thrush, glossitis, cheilitis, damage to smooth skin, vulvitis or balanoposthitis, visceral candidiasis.

Diagnostics

Establishing a diagnosis of dysbacteriosis is preceded by an examination of the child by a pediatrician and pediatric gastroenterologist, laboratory tests and additional instrumental studies. Using a physical examination of children, the condition of the skin and mucous membranes is assessed; Palpation of the abdomen reveals pain along the intestine.

Laboratory diagnosis usually includes bacteriological or biochemical research stool for dysbacteriosis. Microbiological criteria for dysbiosis in children are a decrease in the number of bifidobacteria and lactobacilli, a decrease or increase in the number of normal Escherichia coli, as well as the appearance of their modified strains, the detection of gram-negative bacilli, an increase in the number of cocci, fungi, and clostridia. Biochemical analysis is based on determining the level of metabolites of volatile fatty acids (propionic, acetic, butyric) produced by microorganisms living in the gastrointestinal tract.

To find out the cause of dysbiosis in children, ultrasound examinations of organs may be prescribed. abdominal cavity, gastroscopy, biochemical liver tests, stool analysis for Giardia and helminth eggs. The study of the coprogram allows us to identify the degree of disruption of the breakdown and absorption of food.

If dysbiosis is suspected in children, it is important to exclude nonspecific ulcerative colitis, acute intestinal infections, and malabsorption syndrome.

Treatment of dysbiosis in children

Therapy for dysbiosis in children begins with the selection of individual diet therapy. Fermented milk products are introduced into the diet of mixed-fed children. In the diet of older children, sugars, carbohydrates, and animal proteins are limited; to restore normal intestinal microflora, lactic acid products enriched with biocultures are recommended, alimentary fiber.

For intestinal dysbiosis in children, probiotics are prescribed - preparations containing monocultures or combinations of beneficial bacteria; prebiotics that promote the growth and reproduction of microbes of normal intestinal flora; symbiotics - combination drugs.

With the aim of selective decontamination intestinal dysbiosis in children, bacteriophages are used that lyse pathogenic bacteria, and if ineffective, antibiotics (macrolides, cephalosporins) are used. Treatment of candidal dysbiosis in children is carried out with antifungal drugs (nystatin, fluconazole).

In case of severe digestive disorders, enzymes are prescribed; in case of intoxication, the use of sorbents is indicated. Immunomodulatory therapy with adaptogens and vitamin therapy are recommended for frequently ill children.

Prevention

The key to the formation of normal intestinal microflora in a child is taking care of his health expectant mother: pregnancy planning, balanced diet during pregnancy, treatment of bacterial vaginosis, adherence to a daily routine and rest, exclusion of nervous shock.

The very first measures to prevent dysbacteriosis should be early latching of the baby to the breast in the delivery room and continued breastfeeding of children for at least six months, and the gradual introduction of complementary foods. It is necessary to treat chronic diseases of the digestive system and prevent intestinal infections. To prevent the development of dysbiosis, antibiotic therapy in children should be carried out under the guise of probiotics or prebiotics.

P.Ya. Grigoriev, E.P. Yakovenko

The microflora of the digestive tract is a complex ecological system, the leading role of which is to protect the body from colonization by opportunistic and pathogenic microflora. Intestinal microflora is divided into obligate (synonyms: main, resident, indigenous, autochthonous), facultative (saprophytic and opportunistic) and transient (random).

The obligate microflora includes anaerobes: bifidobacteria, propionobacteria, peptostreptococci and aerobes: lactobacilli, enterococci, Escherichia coli. Facultative microflora is represented by saprophytes (bacterioids, peptococci, staphylococci, streptococci, bacilli, yeast mushrooms) and aero- and anaerobic bacilli. Opportunistic enterobacteria include representatives of the family intestinal bacteria: Klebsiella, Proteus, Citrobacter, Enterobacter, etc. The bulk of bacteria are fixed to specific receptors of epithelial cells of the mucous membrane of the digestive tract (parietal or mucosal microflora), forming microcolonies covered with biofilm. A small part of the normal intestinal microflora is found within the intestinal lumen. In the duodenum, jejunum and initial parts of the ileum, the total number of bacteria is 10 * 3 -10 * 4 cells per 1 g. It is important to note that in this biotope there are practically no obligate anaerobic bacteria, as well as representatives of the enterobacteria family and, first of all, intestinal wand.

IN small intestine microorganisms are localized predominantly near the walls. In the distal parts of the small intestine, the concentration of microorganisms increases and amounts to 10 * 5 -10 * 9 per 1 g of intestinal contents, and obligate anaerobic bacteria (bacteroides, bifidobacteria, etc.) join the inhabitants described above. The large intestine is the main habitat of normal intestinal flora. In this biotope, bacteroids are found in the amount of 10*10–10*12, bifidobacteria – in 10*8–10*10, enterococci and clostridia – 10*7–10*8, lactobacilli – in 10*6–10*9, intestinal coli – in 10*6–10*8, streptococci and candida – in 10*4–10*5, staphylococci – in 10*2–10*4 bacterial cells per 1 g and a number of other bacteria.

Stability of the composition of intestinal microflora in healthy person supported through a number of mechanisms. The leading host factors limiting bacterial growth in the small intestine include hydrochloric acid and intestinal motility. The composition of the intestinal microflora is influenced to a certain extent by the integrity of the intestinal mucosa, the secretion of mucus, digestive enzymes, immunoglobulins (especially secretory IgA), the volume of desquamated intestinal epithelium, as well as food components. Bacterial factors that maintain their normal composition in the intestine include: competition for the use of nutrients; changes in intraluminal pH levels; production of metabolites (short-chain fatty acids, lactic acid, etc.), enzymes, antibiotics such as “colicins”; utilization of oxygen by aerobes. Normal intestinal bacteria do not penetrate into the internal environment of the body due to the existence of the barrier function of the mucous membranes of the gastrointestinal tract.

Intestinal cytoprotection includes preepithelial, epithelial and postepithelial protective mucosal barriers. The main components of preepithelial protective barrier are mucus; immunoglobulins A 1 and A 2 associated with mucus glycoproteins; glycocalyx with its normal rheological parameters, ensuring the resistance of the epithelium to bacterial and chemical agents; a number of low-molecular intestinal metabolites that provide colonization resistance of the mucous membrane against opportunistic and pathogenic microorganisms. The epithelial (internal) protective barrier includes the apical cell membranes and close intercellular connections that block the passage of macromolecules into the cell and prevent their intercellular penetration. The postepithelial barrier includes blood flow, which provides phagocytosis, humoral immune responses and other defense mechanisms, as well as the functioning of the preepithelial and epithelial barriers.

Large protective role performed by the intestinal lymphatic system, including intraepithelial T-lymphocytes, Peyer's patches and the lamina propria of the intestinal mucosa, as well as a number of regulatory substances (prostaglandins, enkephalins, growth factors, secretin, sulfidryls, etc.) that enhance protective functions of the mucous barrier. Normal intestinal microflora performs a number of important functions in the human body. It is antagonistic towards pathogenic and conditionally pathogenic microflora, which prevents the development of acute intestinal infections. Intestinal microflora synthesizes vitamins (B 1, B 2, B 6, K, folic, nicotinic acid and etc.); promotes activation of immune reactions, creating immunological resistance. Intestinal bacteria are involved in digestion processes, and primarily in the hydrolysis of fiber. Food components are broken down by a wide range of bacterial polysaccharidases, glycosidases, proteases and peptidases into glucose oligomers and amino acids. The latter, in turn, are fermented to short-chain fatty acids, lactic acid, hydrogen, carbon dioxide and other products. The end products of hydrolysis have different effects on the function of the colon: they stimulate motility and promote fluid retention in the intestinal lumen. Organic acids, being absorbed in the colon, increase the energy potential of the macroorganism. Bacterial production of D-lactate can lead to the accumulation of D-lactic acid in the blood, causing the development of a condition similar to alcohol intoxication.

Products of microbial protein hydrolysis (ammonia, amines, indole, skatole) enhance endogenous intoxication. Microflora destroys digestive enzymes, various sterols and steroids, including cholesterol, deconjugated bile acids, androgens and estrogens. Considering that the last three substances are included in the enterohepatic circulation, their destruction by microflora leads to a decrease in androgens and estrogens in the blood and an increase in cholesterol levels. The causes of disturbances in the intestinal biocenosis are varied. The main ones are diseases of the gastrointestinal tract, poor diets, acute intestinal infections, medications, including antibiotics, that disrupt the immune status of the intestine and its motility.

Term intestinal dysbiosis includes: 1) changes in the quantitative and qualitative composition of microflora in various biotopes (small and large intestine); 2) the appearance of facultative (conditionally pathogenic) strains that are not part of the resident microflora: Proteus, Morganella, Klebsiella, Enterobacter, Citrobacter, Hafnia, E. coli with enzymatic deficiency, hemolyzing properties, Pseudomonas, etc. It should be noted that intestinal dysbiosis (synonyms : excessive bacterial growth in the intestines, intestinal dysbiosis, etc.) is not independent disease, but is accompanied by the development of a number of symptoms and syndromes that contribute to the clinical picture of diseases of the digestive system and other organs.

Clinical manifestations intestinal dysbiosis include local (intestinal) symptoms and syndromes, as well as systemic disorders caused by the translocation of intestinal microflora and its toxins into the internal environment of the macroorganism, impaired absorption processes, immunological disorders, etc. The formation of intestinal manifestations of excess bacterial growth due to three mechanisms. The first of them is associated with excess production of organic acids, which increase the osmolarity of intestinal contents and reduce the intraluminal pH level, which leads to fluid retention in the intestinal lumen. Clinical symptoms: abdominal pain, flatulence, osmotic diarrhea, which decreases or stops after 24 or 48 hours of fasting, weight loss. The second factor is bacterial deconjugation bile acids, hydroxylation of fatty acids, which are associated with stimulation of intestinal secretion of water and electrolytes, chemical damage to the mucous membrane. Clinical manifestations: secretory diarrhea, which does not stop after a 24-hour fast, the presence of inflammation and erosions in the mucous membrane. Both of the above mechanisms lead to a decrease in the content and activity of intraluminal and parietal enzymes due to a drop in the intraintestinal pH level, destruction of enzymes by bacteria, a decrease in their concentration as a result of dilution of intestinal contents and structural disorders of the brush border of enterocytes. Clinically, these disorders are manifested by maldigestion and malabsorption syndromes, including disaccharidase (lactase) deficiency. The third mechanism is related to motor disorders intestines, the main of which are: hypermotor dyskinesia with the presence of diarrhea; hypomotor dyskinesia with the presence of painless constipation; hypomotor dyskinesia with episodes of intestinal pseudo-obstruction (intense abdominal pain, nausea, vomiting, flatulence); spastic dyskinesia of the colon with the development of constipation with bean-shaped feces and abdominal pain. In addition, the presence of opportunistic microflora in the small and large intestines can lead to the development of inflammatory processes.

TO risk factors development systemic lesions with dysbiosis leading to damage to the intestinal barrier and translocation of intestinal microflora, include: the presence of opportunistic microorganisms and their toxins; taking nonsteroidal anti-inflammatory drugs, glucocorticosteroids, cytostatics that disrupt the basic mechanisms of preepithelial defense and reduce the immunological link of the protective barrier; disturbance of blood flow (abdominal ischemia, portal hypertension), violation of the integrity of the epithelium of the intestinal mucosa, etc. The main target organs that are involved in pathological process during translocation of intestinal bacteria, are The lymph nodes with the development of mesadenitis; urinary system with the presence of bacteriuria, acute and chronic pyelonephritis, urolithiasis. In some patients, non-alcoholic steatosis, steatohepatitis, nonspecific reactive hepatitis, intrahepatic cholestasis, hepatocellular dysfunction, and inflammatory processes of the extrahepatic biliary tract are formed. Great importance is attached to the circulation in the blood and the accumulation of bacterial toxins in tissues with the activation of humoral immune reactions and the formation of cross-immunological reactivity with the development of polyarthralgia, less often - reactive arthritis, myalgia, allergic dermatoses, food pseudo-allergy. A certain role in the formation of the clinic of intestinal dysbiosis is given to the development of polyhypovitaminosis and disturbances in the metabolism of macro- and microelements.

The diagnosis of intestinal dysbiosis is based on the results of clinical and microbiological examination of intestinal contents. To establish the etiology of intestinal dysbiosis, it is necessary to study the gastrointestinal tract, including, in particular, endoscopic with a biopsy from the mucous membrane of the small and large intestine (if indicated), and x-ray - primarily to study the nature of motor disorders of the digestive tract. Of particular importance is the study of the coprogram after a preliminary food load, the results of which determine the type of dyspepsia, and also identify indirect signs colon dysbiosis (presence of digestible fiber, iodophilic microflora, extracellular starch). The most common bacteriological signs of colon dysbiosis are a decrease or absence of the main bacterial symbionts - bifidobacteria and lactic acid bacilli, enterococci, staphylococci, yeast-like fungi, and the appearance of opportunistic strains. One of the directions in the diagnosis of bacterial overgrowth is the study of excretion with respiration. various metabolites, which are produced with the participation of intestinal bacteria, for example, a breath test with C 14 choleglycine, D-xylose, or lactulose with the determination of hydrogen in exhaled air. In addition, chemical methods are currently being introduced into practice that make it possible to determine the types of aerobic and anaerobic bacteria and fungi in various biological environments using gas chromatography and mass spectrometry.

Principles of treatment for patients with intestinal bacterial overgrowth include:: 1) treatment of the underlying disease (etiological treatment); 2) restoration of the normal composition of intestinal bacteria. During the treatment process, it is necessary to create conditions for the growth and functioning of normal microflora. For this purpose, a number of therapeutic measures are used aimed at: 1) restoring the processes of hydrolysis and absorption of the main ingredients of food (diet food, taking enzyme preparations, etc.); 2) normalization of intestinal motor function; 3) reducing the aggressiveness of intestinal contents (binding of deconjugated bile and other organic acids, normalizing the intraintestinal pH level); 4) administration of probiotics and/or prebiotics; 5) if indicated, conducting courses of antibacterial therapy simultaneously with prebiotics or preceding the administration of probiotics. Important role in the treatment of intestinal dysbiosis belongs to dietary nutrition. The diet is prescribed taking into account the type of dyspepsia, intestinal motor disorders and the underlying disease. For fermentative dyspepsia, it is necessary to limit vegetables, fruits, plant fiber, especially legumes, and fresh milk for 7–10 days.

For putrefactive dyspepsia, during the period of exacerbation, a diet with a predominance of vegetables and fruits in culinary processing is recommended. The complex for the treatment of intestinal dysbiosis necessarily includes probiotics - biological preparations containing normal intestinal bacteria and prebiotics - food ingredients indigestible by enzymes, or waste products of normal intestinal bacteria that stimulate its growth and functional activity. Probiotics and prebiotics have a direct antagonistic effect against abnormal strains of intestinal microflora (the leading role is played by the production or content of organic acids). They compete with pathological strains of intestinal bacteria for nutrients (even short-term deprivation of only one nutrient substrate necessary for life certain type intestinal microflora, leads to suppression of its growth). These drugs are involved in stimulating the immune response. Thus, living microorganisms or their soluble antigens increase the titer of antibodies, the functional activity of macrophages and T-killers, increase the number of plasma cells producing IgA in all mucous membranes, and stimulate the production of interferons. Waste products of normal microflora, soluble bacterial components and particles with a diameter of less than 150 microns, penetrating into the lymphatic system, initiate the maturation of B lymphocytes, their transformation into plasma cells and the dispersal of the latter into all mucous membranes with an increase in IgA synthesis in them (homing effect). One of important mechanisms action is their competition for receptors for bacterial adhesion (increased colonization resistance).

A special role belongs to the metabolites of normal intestinal bacteria - lactic acid and short-chain fatty acids. Lactic acid prevents the adhesion of abnormal microflora to the intestinal epithelium and has a direct antagonistic effect against opportunistic bacteria. Short-chain fatty acids are the main source of nutrition for the intestinal epithelium, promoting its regeneration, growth and normalization of the functions of the intestinal mucosa. They improve the absorption of Na and H2O in the intestine, participate in the adaptation of the colon to its contents, which depends on the nature of nutrition and the composition of the microflora, affect the motility of the gastrointestinal tract, namely, they reduce the tone of the stomach and slow down evacuation, and prevent the reflux of colonic contents into the small intestine, into high concentrations inhibit colonic motility.

Probiotics include preparations containing: aerobic bacteria (colibacterin, lactobacterin, etc.); anaerobic flora (bifidumbacterin, probifor, etc.); and their combinations. Preparations containing bifidobacteria are preferably used for disorders of the microbial composition of the large intestine, and aerobic strains for the small intestine. At the same time, combined drugs have the advantage of restoring the microbial biocenosis of all parts of the intestine. Any probiotic is prescribed, as a rule, 2 times a day for at least 2 weeks with strict adherence to the attached instructions for its administration. It is advisable to use probiotics against the background of prebiotics. Prebiotics include lactulose, dietary fiber and Hilak-Forte. Lactulose is a synthetic non-adsorbable disaccharide that is not broken down by digestive enzymes and enters the large intestine unchanged. Being nutrient medium, it stimulates the growth of normal intestinal bacteria, and primarily bifidumbacteria. In the ileum, lactulose is broken down by normal saccharolytic microflora to form lactic and other acids. As a result, the pH in the intestinal lumen decreases, which irritates its receptors and stimulates motility. Lactulose is prescribed mainly to patients with constipation, 15–30 ml once a day for 2–4 weeks.

Hilak-forte(ratiopharm, Germany) are biologically active substances produced by normal intestinal microflora. The main components of the drug are metabolic products of the main representatives of normal microflora, short-chain fatty acids and lactic acid. Lactic acid creates unfavorable conditions for the growth of pathogenic microflora; metabolic products stimulate the reproduction of symbionts; short-chain fatty acids promote the regeneration of the mucous membrane and eliminate its inflammation and atrophy. As a result of the complex effect of the drug, the balance of intestinal microflora is restored. Against the background of the development of normal intestinal symbionts, intestinal manifestations of dysbiosis are quickly eliminated, digestion and natural synthesis of vitamins B and K are normalized, physiological functions and regenerative processes in the mucous membrane of the gastrointestinal tract, protective immunological processes in the mucous membranes and the disturbed water-electrolyte balance in the intestinal lumen are restored. Hilak forte is prescribed to patients with bacterial overgrowth syndrome with a predominance of diarrhea and normal stool 30–60 drops 3 times a day for 2–4 weeks. In some cases, before prescribing probiotics, it is necessary to take antibacterial agents(intestinal antiseptics). Indications for intestinal decontamination: the presence of bacterial overgrowth in the small intestine; identification of opportunistic microflora in intestinal content cultures; translocation of intestinal bacteria into the internal environment; lack of effect from previous probiotic therapy. The approach to prescribing antibacterial drugs is mainly empirical, and at the same time it is necessary to take into account that in case of excessive bacterial growth in the small intestine and in case of translocation of bacteria outside the intestine, absorbable drugs are priority, and in case of disturbance of the microflora of the colon, non-absorbable drugs are given priority. Several groups of drugs are used for this purpose.

Nitrofurans have a wide spectrum of action against gram (+) cocci, as well as gram (–) microorganisms, including pathogenic ones. Basically, non-absorbable nifuroxazide 200 mg 4 times a day and furazolidone 100 mg 3-4 times a day, absorbed in the gastrointestinal tract, are used. Sulfonamides, of which combined absorbable drugs containing sulfamethoxazole and trimethoprim and non-absorbable drugs are used. The former are prescribed 960 mg 2 times a day, the latter – 0.5–1.0 g 4 times a day. The drugs have an antibacterial effect against a wide range of gram (+) and gram (–) microorganisms, including pathogenic ones.

Fluoroquinolones have a wide spectrum of action against most gram (–) microorganisms, excluding anaerobes. Ciprofloxacin 250–500 mg 2 times a day and pefloxacin 400 mg 2 times a day are used.

Metronidazole– a drug with a wide spectrum of action, effective against anaerobes and, in particular, bacteroides and some other microorganisms. Besides antibacterial action, the drug has an antiprotozoal effect against Giardia, amoebae, and trichomonas. The drug is used in a dose of 250 mg 3-4 times a day, often in combination with antibacterial agents that affect aerobic strains.

Intetrix – intestinal antiseptic wide spectrum of action. It has antimicrobial, antifungal and antiprotozoal effects. Effective against most gram (+) and gram (–) pathogenic intestinal bacteria. Normal intestinal microflora is not sensitive to Intetrix. Prescribed 1–2 capsules 3–4 times a day with meals. In some cases, biological “antibacterial” drugs are used: bacteria or yeast cells that antagonize pathological intestinal flora, as well as bacteriophages. For this purpose, it is possible to prescribe bactisubtil or flanivin BS from 2 to 4 capsules per day or corresponding bacteriophages from 15 or more ml/day. Antibiotics for intestinal decontamination are rarely used, mainly for pathology of the small intestine and for translocation of intestinal bacteria with the development of inflammatory processes in other organs. These are mainly tetracycline drugs (tetracycline hydrochloride 250 mg 4 times a day and doxycycline 100 mg 2 times a day), aminoglycosides (kanamycin, neomycin, monomycin 250–500 mg 3–4 times a day), chloramphenicol (according to 500 mg 3-4 times a day). All antibacterial agents are prescribed orally. The duration of taking the drug is 5–7 days. It is possible to carry out 2 or 3 courses of antibacterial therapy followed by the administration of probiotics. At the same time, intestinal adsorbents (buffer antacids, white clay, etc.), enzymes, drugs that normalize intestinal motility, and vitamin therapy (group B) are prescribed.

Approximate treatment regimen for small intestinal bacterial overgrowth syndrome: 1) diet depending on the underlying disease and type of dyspepsia; 2) ciprofloxacin 250 mg 2 times a day – 7 days (or furazolidone 0.1 g 3 times a day or Intetrix 1 capsule 4 times a day); from the 8th day – bifiform – 1 capsule 2 times a day – 2 weeks; 3) Hilak-Forte – 40–60 drops 3 times a day before or during meals, 2–3 weeks; 4) pancreatin 1 capsule/dragée 3 times a day with food for 7–10 days (further depending on the main diagnosis); 5) treatment of the underlying disease; 6) vitamin therapy and drugs that normalize intestinal motility - according to indications. Prevention of dysbacteriosis (primary, secondary) - determined by a balanced diet, early detection and adequate treatment of human diseases in general and diseases of the gastrointestinal tract in particular.

Literature

1. Gracheva N.M., Yushchuk N.D., Chuprinina R.P., Matsulevich T.V., Pozhalostina L.V. Intestinal dysbacteriosis, causes, diagnosis, use of bacterial biological preparations. A manual for doctors and students. M. 1999. 44 p.

2. Grigoriev P.Ya., Yakovenko A.V. Clinical gastroenterology. M: Medical Information Agency, 1998, 647 p. 3. Grigoriev P.Ya., Yakovenko E.P. Disturbance of the normal composition of intestinal microflora, clinical significance and therapeutic issues. Toolkit. M. 2000. 15 p.

4. Order of the Ministry of Health of the Russian Federation dated June 9, 2003 No. 231 “On approval of the industry standard Protocol for the management of patients. Intestinal dysbiosis” // Problems of standardization in healthcare 2003. No. 9. P. 18–91.

5. Fuller R., Gibson G.R. Modification of the intestinal microflora using probiotics and prebiotics. Scand I. Gastroenterol. –1997.–Vol.32, suppl.222.–R.28–31.

6. Goldin B.R., Gorbach S.L. Probiotics for humans. In: Fuller R., Editor A. Probiotics. The scintific basis. London: Chapman and Hall. –1992.–R.355–376.

Being the main reservoir of human microflora, the colonic biocenosis performs extremely wide range functions that support normal condition not only the intestines, but also other vital important organs and systems of the macroorganism.

One of the most significant functions of the colonic indigenous microflora is its Active participation in the formation of host colonization resistance. In addition, the normal flora of the large intestine activates the immune system - stimulates the phagocytic function of macrophages, enhances the activity of natural killer cells, the synthesis of secretory immunoglobulins, interferons, and various cytokines.

The biosynthetic activity of the colonic normal flora is of great importance. As a result, its macroorganism is supplied with a wide range of vitamins, coenzymes, hormone-like substances, bacteriostatic components, essential amino acids, low molecular weight fatty acids, peptides, etc.

Intestinal microflora is actively involved in the digestive function of the body (synthesis of various enzymes that metabolize lipids, carbohydrates, nucleic acids, minerals, bile acids, cholesterol and other components).

Normal microflora affects the differentiation and regeneration of epithelial tissue, the transit of nutrients, the regulation of muscle tone and intestinal gas composition, etc.

Trophic and energetic relationships between the human body and the microbial communities inhabiting its colonic biotope are considered as the most important conditions necessary to maintain homeostasis in the microecological system of the human body.

The colonic microbiota is capable of synthesizing signaling molecules (neurotransmitters, gamma-aminobutyric acid and glutamate). These bacterial metabolites are capable of affecting colonic motility and pain sensitivity. Gamma-aminobutyric acid is an anti-stress mediator and can affect the metabolism of epithelial cells.

One of the important effects of intestinal microflora is the maintenance of physicochemical parameters in the epithelial zone (redox potential, acidity of the environment, rheological characteristics of the glycocalyx), as well as ionic homeostasis of the body.

It has been established that intestinal normal flora takes part in the antiviral defense of the host body.

Intestinal microbiota is capable of destroying mutagens and carcinogens, increasing the resistance of epithelial tissue to them, and activating medicinal compounds.

Intestinal microflora is involved in providing heat to the body. The colon is considered as a biological thermoelement that supplies nearby organs with heat.

In the colonic biocenosis of a healthy person of any age, as a rule, bacteria of the genus Bifidobacterium . These are obligate anaerobic, gram-positive, non-motile, asporogenous, saccharolytic bacteria. The main products of their carbohydrate metabolism are acetic and lactic acids with admixtures of formic and succinic acids.

Bifidoflora is capable of synthesizing:

· amino acids,

· polysaccharides,

· vitamins (B2, B1, B6, pantothenic and folic acids,

· other biologically active metabolites.

Bifidobacteria improve hydrolysis processes And suction lipids, proteins, carbohydrates, participate in mineral metabolism, prevent colonization intestines opportunistic microorganisms.

Of the 24 species that make up the genus Bifidobacterium, 5 species are considered the most physiological for the human body: B. bifidum, B. longum, B. infantis, B. breve and B. adolescentis.

Physiologically valuable components of the colon biocenosis are lactobacilli . These microorganisms are different high colonization properties, realized through the synthesis of lactic acid, hydrogen peroxide, lysozyme, antibiotic components, lactocins, suppressing the vital activity of many pathogenic and opportunistic microorganisms.

Lactobacilli active compete with potential pathogens for limited nutrient substrates And adhesion sites on the epithelium, stimulate the activity of the immune system owner. Lactobacilli are involved in digestive, biosynthetic, detoxifying and other functions of normal flora person. They play a significant role in metabolism of proteins, fats, carbohydrates, nucleic acids, bile acids, cholesterol, hormones, oxalates. Lactobacilli are also capable of degrade individual toxins, carcinogens, allergens.

Lactobacilli prevent the absorption of toxic metabolic products(Firstly ammonia and individual amines), prevent excessive development of putrefactive processes in the intestines, etc. The wider the species composition of this component of the microbiota, the wider the range physiological functions she will comply. Most often, 6 species of lactobacilli are isolated from human biotopes: L. acidophilus, L. casei, L. plantarum, L. fermentum, L. brevis and L. salivarius.

Total concentration Lactobacillus cells in a certain biotope is not a reliable indicator of the high physiological potential of a given population. It is important biological properties(antagonism towards potential pathogens and enzymatic activity).

Another of the most important components of indigenous microflora are saccharolytic apathogenic anaerobes belonging to the genus Propionibacterium . They actively participate in symbiont digestion due to the fermentation of a wide range of carbohydrates. Organic acids accumulated during this process prevent the proliferation of pathogenic and opportunistic microorganisms. Propionic acid bacteria synthesize a wide range others antibacterial components (propionines), active against enterobacteria, putrefactive bacteria, fungi, etc., have antiviral activity. They also significantly stimulate the growth of bifid flora, show antioxidant And antimutagenic properties, are record holders among prokaryotes for cobalamin synthesis.

With the development of dysbiotic disorders in children, the level of propionic acid bacteria decreases in the intestinal biocenosis. This entails inhibition of bifidobacteria and lactobacilli. Normalization of eubiosis begins with an increase in the number of propionic acid bacteria, and then the remaining anaerobic saccharolytics.

Although organism person has a mechanism for maintaining friendly, mutually beneficial relationships with opportunistic microorganisms, with the development of microecological disturbances, this form of symbiosis easily turns into mutual aggression. This applies, for example, to bacteroides and eubacteria.

For childbirth Bacteroides And Fusobacterium , most often found in human biotopes are obligate anaerobic gram negative bacteria, characterized by many useful functions for the human body. They are actively ferment many carbohydrates And peptones with the accumulation of organic acids. Bacteroides metabolize lipids And proteins, participate in chemical transformations of cholesterol, bile acids, steroid hormones, stimulate the immune system.

Despite possession of a wide range of virulence factors, pursuit bacteroids to expand their habitat beyond the boundaries of epithelial biofilms is limited by the inability to maintain viability in oxygen-containing tissues and systems. However, under pathophysiological conditions, bacteroids are able to realize their extremely high virulence potential(synthesis of endotoxin, enterotoxin, collagenase, neuraminidase, deoxyribonuclease, heparinase, fibrinolysin, leukocidin, ability to suppress phagocytosis, etc.). For dysbiosis bacteroides may cause purulent-inflammatory diseases various localizations(inflammatory processes in the oral cavity, infectious-inflammatory diseases of the genital organs, appendicitis, peritonitis, postoperative complications sepsis, endocarditis, paraproctitis, gangrene individual organs, wound infection, etc.). From 5 to 10% diarrhea caused by enterotoxigenic variants of the B. fragilis species.

Entering into a symbiotic relationship with other aggressive microflora that are more tolerant to oxygen, bacteroids are common participants of mixed infections, characterized by rapid development, severity, difficulties in diagnosis and treatment. In the formation of predisposing conditions leading to a decrease in oxygen and redox potential in tissues (vasoconstriction, trauma, necrosis), during surgical interventions, malignant neoplasms, diabetes, leukemia, massive antibiotic therapy, the use of immunosuppressants, corticosteroids, bacteroids can act as an independent etiological factor in the development of severe purulent-inflammatory diseases.

Thus, symbiotic relationship between the human body and opportunistic bacteroids are more complex and stressful than with apathogenic saprophytes (Bifidobacterium, Lactobacillus and Propionibacterium). Only thanks to the joint activity of the macroorganism and its most friendly symbionts (which is the most important link in the functioning of the body's anti-infective resistance system) the activation of bacteroids, their uncontrolled growth and the implementation of virulent properties are restrained.

In the colonic biotope of healthy people, representatives of another genus of strictly anaerobic bacteria are common - Eubacterium . Certain species of eubacteria can convert cholesterol to coprostanol, participate in deconjugation of bile acids, able synthesize vitamins, in particular cobalamin, amino acids(alanine, valine, isoleucine), break down cellulose, participate in steroid hormone metabolism. Many eubacteria metabolize carbohydrates And peptones with accumulation oil, vinegar, formic and others organic acids used by epithelial cells in metabolic processes.

At the same time, within the rather heterogeneous genus Eubacterium many pathogens are known. Representatives of 16 species of eubacteria can serve etiological factor development in the human body of various infectious processes (pleuro-pulmonary purulent complications, inflammatory diseases oral cavity, infective endocarditis, arthritis, genitourinary tract infections, sepsis, brain and rectal abscesses, postoperative complications).

In the intestines of healthy adults, strictly anaerobic gram-positive cocci of the genus are often found in high concentrations Peptostreptococcus . Peptostreptococci belong to o one of the most common pathogens anaerobic infections . They are often isolated from lesions of appendicitis, gingivitis, periodontal disease and other diseases.

One of the optional representatives of the normal flora of a healthy person includes strict anaerobes sort of Clostridium (Gram-positive, often motile, spore-bearing prokaryotes). In eubiosis they take part in deconjugation of bile acids, trophic support of colonocytes by supplying them with oil and other low molecular weight fatty acids, maintaining colonization resistance intestinal biotope due to the suppression of aggressive microorganisms, in particular pathogenic clostridia.

With eubiosis in the intestinal biocenosis saccharolytic clostridia predominate, for the development of which favorable conditions are created in the biotope due to the functioning of protective indigenous bacteria. The appearance and increase in the population of peptolytic or purinolytic clostridia indicates decrease in population level from protective functions of indigenous saccharolytic flora. Endogenous clostridia pose a particular danger as an etiological factor in the development of antibiotic-associated pseudomembranous colitis, the causative agent of which in 90–100% of cases is Clostridium dificile.

In the functioning of the biocenoses of the small and large intestine, a certain role belongs to actinomycetes . These microorganisms occupy an intermediate position between bacteria and fungi. What they have in common with mushrooms is the ability to form branching mycelium.

Actinomycetes are extremely widespread in nature and they constantly enter the human digestive tract. Some of the species exist in separate human microbiotopes. Actinomycetes are especially often isolated from the oral cavity.

Many actinomycetes are capable of B vitamin products, have antagonistic activity due to synthesis of active antibiotics.

At the same time, increase in concentration these microorganisms in human biotopes should be considered as pathological changes in the composition of the microbiota. Actinomycetes contain enough many species pathogenic to humans. In immunocompromised patients actinomycosis leads to further serious violations in the immune system, and when actinomycetes metastasize to the brain and other internal organs, the disease in most cases has death. Due to the ability of pathogenic actinomycetes to form capsules, phagocytosis at the site of actinomycosis is incomplete.

Half of the facultative anaerobes of the human microbiota are gram-negative cocci Veillonella parvula . Veillonella are capable synthesize in the process of its metabolism significant amounts of gases. When they multiply excessively in the digestive tract, this is cause of dyspeptic disorders.

Microorganisms species Escherichia coli And Enterococcus faecium . have highest value from the aerobic component of the facultative normal colonic microflora. This is the most numerous aerobic part of the normal flora (up to 0.01% of the total microbial population of the colon). Normally they contribute stimulation of the body's immunoreactivity due to constant antigenic irritation of the local immune system. In addition, E. coli can synthesize B vitamins, TO; antibacterial substances(colicins and microcins). At a decrease in the population and a weakening of the protective properties of saccharolytic anaerobes, concentration of aerobic flora cells can increase and exhibit a range of pathogenic properties(production of hemolysins, enterotoxins, suppression of phagocytosis, etc.). One of the most serious dangers exceeding the concentration of Escherichia and enterococci above the permissible level is their ability to migrate to mesenteric lymph nodes and blood. This is accompanied by infection of the liver, spleen, brain, kidneys, lungs and the development of sepsis, meningitis, pyelonephritis, peritonitis, etc. Most often, translocation of Escherichia and enterococci occurs during massive antibiotic, chemotherapy, hormonal and immunosuppressive therapy, suppressing indigenous flora and promoting selective proliferation of coli bacteria and E. faecium with high drug resistance.

For many years, infectious complications caused by both Escherichia and Enterococci with an increase in their population level in the biocenosis have been one of the most serious problems of modern medicine.

Transient (allochthonous, residual) microflora of the colonic biocenosis represented by opportunistic enterobacteria of the genera: Citrobacter, Enterobacter, Proteus, Klebsiella, Morganella, Serratia, Hafnia, Kluyvera, etc., bacteria of the genera Staphylococcus and Pseudomonas, yeast-like fungi of the genus Candida, etc. With increasing concentration, opportunistic microflora capable realize its inherent signs of virulence and be an etiological factor in the development of an endogenous infectious process various localizations

Of the yeast-like fungi of the genus Candida, the species most often found in the intestinal and other biotopes of a healthy person are C. albicans and C. tropicalis. An increase in the concentration of fungi, especially in immunocompromised individuals, may be accompanied by the development of candidiasis.

Opportunistic clones of transient microflora can represent danger to human health only against the background of microecological disturbances, especially those accompanied by immunodeficiency conditions.

Oddly enough, most girls and women remember the vaginal microflora only when it begins to be disrupted. Leading experts rightly believe that maintaining normal vaginal microflora creates serious barriers to the occurrence of various infectious and inflammatory processes in the internal genital organs. As recent statistics show, from 20 to 30% of women of reproductive age have a violation of the vaginal microflora.

Normal vaginal biocenosis

Thanks to clinical studies, scientists have found that the natural microflora of the vagina is a combination of beneficial and opportunistic microorganisms. Fine beneficial bacteria significantly exceed opportunistic species in quantity. It is reliably known that approximately 95–97% of the vaginal biocenosis consists of lactobacilli, which, by producing lactic acid, provide an acidic environment in the vagina and protect it from infection. Opportunistic microorganisms (3–5%) are represented by the following types:

• Gram-positive rods.
• Gram-positive and gram-negative cocci.
• Anaerobic rods.
• Enterobacteriaceae.

The symbiotic relationship between beneficial and opportunistic microorganisms not only does not cause any harm, but even protects the internal genital organs from infection. Most infectious agents entering the vagina are neutralized in an acidic environment. However, it is worth noting that changes in microflora can occur during the menstrual cycle. For example, at the beginning of the cycle there is some deviation in vaginal pH towards the alkaline side. There will be a characteristic decrease in the number of lactobacilli, which is accompanied by an increase in opportunistic microorganisms. But immediately after menstruation, a rapid restoration of balance is observed.

Noticing any unnatural discharge from the genitals, do not delay visiting a doctor.

Violation of vaginal biocenosis

Not so long ago, a violation of the vaginal microflora was considered clinical syndrome. However, it is now classified as a separate nosological entity, which is given the name bacterial vaginosis. In this pathological condition, there is a sharp decrease or absence of lactobacilli and an increase in the number of opportunistic microorganisms, in particular gardnerella and gram-negative anaerobic bacteria. It should be noted that neither sexually transmitted bacterial infections, nor fungi or pathogenic protozoa are the cause of bacterial vaginosis.

As a result of the development of vaginal dysbiosis, the pH of the environment in the vagina shifts to the alkaline side and becomes more than 4.5. Such changes are associated with the presence of a large number of anaerobic bacteria, which produce volatile amines that have an extremely unpleasant odor, reminiscent of rotten fish. Changes in the biocenosis and pH of the environment deprive the vagina of a biological protective barrier, creating all the conditions for the occurrence of infectious and inflammatory diseases reproductive system women.

What causes dysbiosis?

Bacterial vaginosis does not appear out of nowhere. The following may act as a provoking factor leading to disruption of the vaginal microflora:

• Hormonal imbalance. Often observed during pregnancy and breastfeeding, during abortion, menopause, irregular sex life, etc.
• Taking antibacterial agents. If you use antibiotics, they destroy not only dangerous, but also beneficial bacteria and other microorganisms. Uncontrolled long-term use antibacterial drugs.
• Constant hypothermia, physical fatigue, unbalanced psycho-emotional stress, leading to decreased immunity.
• Crash menstrual function ovaries of various types.
• Past infectious and inflammatory diseases of the reproductive system.
• Too active sex life(several sexual partners or their frequent change).
• Both insufficient and overly thorough hygiene of the intimate area.
• Use of hormonal oral contraception and/or use of intrauterine contraceptives.

Violation of the vaginal microflora is a disease that needs to be treated purposefully.

Manifestation of dysbiosis

In the vast majority of cases, bacterial vaginosis is manifested by local symptoms. In some patients, subjective sensations may be absent. Typical clinical picture of vaginal dysbiosis:

• Marked copious discharge from the internal genital organs (whitish-gray color, strong unpleasant odor). Quite often observed after intimacy or during menstruation.
• If the disturbance of the vaginal microflora is chronic, then the discharge becomes yellowish-green, more saturated and thick, and looks like a cheesy mass.
• The amount of discharge can vary from slight to very heavy.
• Women rarely complain of itching and problems with urination. If present, they usually appear periodically.
• A characteristic symptom of bacterial vaginosis is the absence of inflammation of the vagina.
• Sometimes there are abundant menstrual bleeding and a feeling of pain in the lower abdomen.

A woman who has a violation of the vaginal microflora can contribute to the development of inflammation of the head and foreskin in her sexual partner.

How to determine dysbiosis?

Basic clinical and laboratory criteria indicating bacterial vaginosis:

• Abundant cheesy discharge with a whitish-gray tint and a very unpleasant odor, evenly covering the walls of the vagina.
• The pH of the vaginal environment is more than 4.5.
• Positive amine test. By mixing samples of vaginal discharge with a solution of potassium hydroxide in equal proportions, a characteristic fishy odor appears.
• Microscopic examination identifies “key cells.” These are desquamated epithelial cells to which various opportunistic microorganisms are attached. Normally, key cells are not detected.

If at least three of the above criteria are detected, then we can safely talk about a violation of the vaginal microflora, characteristic of bacterial vaginosis. If necessary, the diagnosis is supplemented with a bacteriological research method, which makes it possible to determine the qualitative and quantitative composition of the vaginal biocenosis.

If the vaginal microflora has been disturbed for a long time, this can affect the woman’s reproductive function.

Restoration of vaginal biocenosis

To successfully eliminate bacterial vaginosis, two main tasks must be completed:

• Suppress excessive growth and the proliferation of opportunistic bacteria (especially anaerobes) through the use of antibacterial drugs.
• Restore normal vaginal biocenosis with the help of eubiotics, which will help increase the proportion of beneficial microorganisms.

Currently, antibacterial therapy to suppress opportunistic flora includes the administration of the following medications:

• Clindamycin.
• Metronidazole.
• Tinidazole.
• Ornidazole.

The therapeutic course can last for 5–7 days. If a woman is pregnant and suffers from bacterial vaginosis, then Clindamycin in the form of a cream is usually used. After finishing antibacterial treatment carry out measures to restore normal vaginal biocenosis. There are no special restrictions regarding sexual activity during therapy. To boost immunity, it is recommended to take vitamin-mineral complexes and biogenic stimulants (Actovegin, aloe extract, etc.).

With proper adherence to the regimen and compliance with all the instructions of the attending physician, the normal microflora of the vagina is restored within several weeks.

Preparations for normalization of biocenosis

How to improve vaginal microflora? Having effectively dealt with opportunistic bacteria, they move on to taking eubiotics that help restore the vaginal biocenosis. This group of drugs includes:

• Lactobacterin.
• Lactonorm.
• Bifidumbacterin.
• Acylact.
• Ecofemin.
• Gynoflor.

Lactobacterin

One of the most popular eubiotics used to correct vaginal biocenosis is Lactobacterin. Live bacteria contained in the drug ensure the normalization of microflora, maintaining the pH of the vaginal environment at a level of no more than 4.5. In the acidic environment created by lactobacilli, many pathogenic and opportunistic microorganisms cannot grow and reproduce. Allergy to the components of the drug, vulvovaginal candidiasis and childhood are considered contraindications for use.

Side effects in the form allergic reactions are observed very rarely. Due to a decrease in the therapeutic effect, the simultaneous use of Lactobacterin and antibacterial drugs is not recommended. Restorative therapy using intravaginal suppositories can last 10–14 days. If necessary, repeated courses of treatment may be prescribed after 2-3 weeks. The cost of the drug Lactobacterin ranges from 130–150 rubles.

Gynoflor

For normalization vaginal microflora Gynoflor is widely used. Unlike the previous drug, this medicine contains not only lactobacilli acidophilus, but also a small amount of estrogen (estriol). Lactobacilli successfully cope with pathogenic and opportunistic flora. Estriol ensures the restoration of the vaginal epithelium, maintaining the biocenosis and pH of the environment, without having a systemic effect on the female body. In healthy epithelium, glycogen accumulates, which is necessary for normal life lactobacilli Among the contraindications are following states and diseases:

• Allergy to the main and auxiliary components of Gynoflor.
• Neoplasms sensitive to estrogen (tumors of the breast, reproductive system, etc.).
• Any form of endometriosis.
• Bloody discharge from the genitals of unknown origin.
• Young age.

I would like to note that Gynoflor does not change the level of natural hormones in the blood. In the early stages of pregnancy (1st trimester) it is not recommended to prescribe the drug. At the same time on later Its use is permitted if there are appropriate indications and there are no contraindications. However, there is no reliable data on the effect of Gynoflor on the course of pregnancy and fetal development, since long-term clinical studies have not been conducted.

Side effects are recorded quite rarely. Some women experienced local unwanted reactions such as redness and burning sensation in the genital area. Besides, simultaneous use with antibiotics can lead to a decrease in the effectiveness of the drug. Spermicidal agents are also not recommended to be combined with Gynoflor. The course of treatment is determined solely by the attending physician, but on average it can last 1–2 weeks. During therapy, it is better for girls and women to use sanitary tampons.

In most pharmacies, the price for the domestically produced drug Gynoflor does not exceed 950 rubles per package (6 vaginal tablets). Packs of 12 tablets are also available for sale, costing about 1,300 rubles.

Solcotrichofac

In prolonged and recurrent forms of bacterial vaginosis, the immunostimulating vaccine Solcotrichofac is used to normalize the vaginal microflora. The use of this specific drug not only helps to stabilize vaginal biocinosis, but also prevents the likelihood of relapses and mixed infections in approximately 80% of women. Solcotrichofak is actively used as both a therapeutic and prophylactic agent for bacterial vaginosis.

Vaccination with this drug should only be carried out by a doctor. The course includes 3 intramuscular injections. The interval between each administration is 14 days. The exact time of vaccination is calculated in advance so that injections do not coincide with menstruation. Revaccination is carried out after 12 months. The main contraindications to the use of Solcotrichofac are:

• Allergy to vaccine components.
• Various infections in the acute stage.
• Tuberculous organ damage.
• Diseases of the blood system.
• Severe cardiovascular pathology.
• Serious kidney problems.
• Immunodeficiency states.

During pregnancy, whether to vaccinate with Solcotrichofak or not is decided by the doctor, taking into account the benefits for the woman and the possible risk for the child. There are practically no side reactions. In rare cases, headaches, chills, fever, general weakness, etc. were observed. The drug is also effective for recurrent trichomoniasis. You can purchase the Solcotrichofac vaccine in pharmacies with a prescription.

Until recently, dysbiosis was one of the most common diagnoses in domestic pediatrics and infectology. At the same time, " dysbacteriosis“as a nosological form is not presented in the ICD-X; moreover, as a diagnosis, it is not present in the practice of Western doctors.

Apparently, at present there is a discrepancy between scientific ideas about the normal intestinal biocenosis and the factors contributing to its disruption, on the one hand, and the lack of adequate clinical and microbiological diagnostics, as well as a clear clinical and microbiological interpretation of dysbiosis, on the other. In addition, which is especially important, the diagnosis of “dysbacteriosis” usually hides other diseases of the digestive system:

• intestinal infection;
• antibiotic-associated diarrhea;
• radiation sickness;
• chronic inflammatory bowel diseases;
• irritable bowel syndrome;
• malabsorption syndrome;
• gastroesophageal reflux;
• intolerance to cow's milk proteins;
• eosinophilic enteritis and other, more rare pathology.

Some clinicians try to separate the terms " dysbacteriosis" And " dysbiosis" In this case, dysbiosis is assessed as a microbiological concept, and dysbiosis is associated with clinical disorders in the form of local and then general symptoms.

Dysbacteriosis is usually called quantitative and qualitative disturbance of the composition of normal microflora. Its diagnosis is based primarily on the results of the study colon microflora, in this case, the luminal flora is studied, since it is available for analysis. Quantitative and qualitative characteristics of the microbial luminal flora (feces) form the basis for the diagnosis of “dysbacteriosis”; thus, the bacteriological diagnosis turns into a clinical one.

Examination of stool for dysbacteriosis is labor-intensive and quite expensive. Let's analyze its information content.

IN clinical practice we, as a rule, use the interpretation of a limited range of intestinal microflora (Table).

Table.
Normal indicators of the microflora of feces in children

U healthy children microflora small intestine is not numerous: in the ileum the total number of bacteria is 10 6 CFU/ml, and in the remaining parts of the small intestine - less than 10 4 CFU/ml. If streptococci and lactobacilli dominate in the duodenum and jejunum, then anaerobic flora predominates in the large intestine. The colon is most populated by microbes: their number reaches 10 11 CFU/g of feces. The surface area of ​​the intestinal mucosa in contact with microorganisms is quite large. The biomass of microbes that populate the human intestine is approximately 5% of its total weight.

The subject of research is excreta. The intestinal microflora is analyzed, which is classified as obligate (main); facultative (opportunistic and saprophytic); transient (occasional microorganisms). TO obligate microflora include:

• bifidobacteria (among their various species in breastfed children, Bifidobacterium bifidum predominates);
• lactobacilli;
• propionobacteria;
• Escherichia;
• peptostrepto- and enterococci.

Facultative, opportunistic microflora represented by bacteroids, pepto-, staphylo-, streptococci, bacilli, yeast and yeast-like fungi, as well as opportunistic enterobacteria, etc. transient microflora These include non-fermenting gram-negative bacilli: flavobacteria, acinetobacter, some pseudomonads, etc. When conducting research, clinicians and bacteriologists are mainly limited to identifying only part of the known spectrum of microorganisms in feces (Table). Wherein not subject to analysis for technical reasons no less important flora:

• eubacteria present in the feces of formula-fed children - up to 10 10 CFU/g of feces;
• peptostreptococci detected in bottle-fed children - up to 10 9 CFU/g of feces;
• clostridia - from 10 6 to 10 8 CFU/g;
• fusobacteria - 10 8 -10 9 CFU/g;
• Veillonella - 10 5 -10 6 CFU/g,
• also bacteroides, bacilli, important representatives of the genus enterococci: E. faecalis, E. faecium, etc.

Thus, information about the spectrum of colon flora when examining stool for dysbacteriosis is far from complete. It should be added that feces are analyzed, i.e. The landscape of microbes in the luminal (not parietal!) flora of the distal intestine is being studied. At the same time, the normal biocenosis is influenced by the age of the child and the nature of feeding. It is also very important material sampling technique and research quality. It is very problematic that such an analysis can provide an adequate idea of ​​the intestinal biocenosis (from both clinical and bacteriological points of view).

Depending on the nature of changes in the luminal microflora of the large intestine, 4 degrees of dysbacteriosis.

I degree characterized by a decrease in the number of bifidobacteria and/or lactobacilli by 1-2 orders of magnitude. There may be a decrease (less than 10 6 CFU/g of feces) or an increase (more than 10 8 CFU/g) in the content of E. coli with the appearance of small titers of their altered forms (over 15%).

II degree Dysbacteriosis is determined by the presence of one type of opportunistic microorganisms in a concentration not higher than 10 4 CFU/g or when associations of opportunistic bacteria are detected in small titers (10 3 -10 4 CFU/g). It is characterized by high content lactose-negative Escherichia coli (more than 10 4 CFU/g) or E. coli with altered enzymatic properties (unable to hydrolyze lactose).

III degree Dysbacteriosis is registered when opportunistic microorganisms are detected in high titers, both of one type and in associations.

The type of disorders associated with dysbacteriosis can be isolated, combined or dislocated. The latter is also estimated as IV degree dysbacteriosis, in which the likelihood of so-called decompensation is considered, i.e. the possibility of selecting certain opportunistic microbes with virulent properties that dislocate through the intestines into the blood and are an etiological factor in systemic infections (up to sepsis).

There are other classifications of dysbiosis.

However, all of them are unlikely to meet the requirements of clinicians, since they lack clinical approach to diagnosis, microbiological and clinical concepts, and behind the diagnosis of “dysbacteriosis” are other diseases: acute intestinal infection (endogenous), sepsis, systemic inflammatory response syndrome (SIRS), pseudomembranous enterocolitis, a rather rare pathology in children - bacterial overgrowth syndrome (Stagnant Loop Syndrome, Bacterial Overgrowth Syndrome) and etc.

Does it follow from this that the concept of dysbiosis should disappear from clinician practice? Apparently, this will also be wrong, since this may also lead to a lack of respect for the intestinal biocenosis. Functions of normal microflora multiple, and apparently not yet fully understood. Some of the most famous and important include:

• participation in digestion and absorption, in the formation of local immunity;
• trophic, energy functions;
• stimulation of intestinal motility;
• detoxification;
• formation of neurotransmitters, etc.

If a child immediately after birth receives irrational antibacterial therapy, colonization occurs with opportunistic hospital flora, which can subsequently cause endogenous infection. Children who are on artificial feeding, more often suffer from enteritis, which is caused by endogenous Escherichia and other opportunistic flora.

Exists an extensive list of factors, which can influence the intestinal biocenosis, and sometimes contribute to the development various diseases. These factors include: intestinal infections, antibacterial or long-term hormonal therapy, treatment with non-steroidal anti-inflammatory drugs, surgical interventions. During the neonatal period, the intestinal biocenosis can be affected by:

• complicated pregnancy and childbirth, bacterial vaginosis and mastitis in the mother;
• low Apgar score and conduction resuscitation measures The child has;
• late breastfeeding;
• the possibility of colonization of the intestines with aggressive strains of microorganisms in the maternity hospital;
• the presence of purulent infections.

Dysbacteriosis can be caused by:

• early and improper artificial feeding;
• phenomena of diathesis, rickets, anemia, malnutrition;
• any infectious and somatic pathology.

Knowing these factors, we can well prevent the development of dysbiosis through the use of rational antibacterial therapy, adequate management of childbirth, proper feeding etc.

The reason for examination for dysbacteriosis, as a rule, is dyspeptic disorders. Many of them may indeed be accompanied by changes in the normal biocenosis. However, both in clinical and microbiological manifestations, dysbiosis will always be only a consequence of the underlying disease. Therefore it is necessary diagnosis of underlying infectious or non-infectious pathology digestive organs.

It is believed that a stool test for dysbacteriosis is carried out to ascertain it (which is not always possible) and to select treatment tactics.

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You are reading the topic:
Normal biocenosis intestines, the possibilities of its diagnosis and correction

1. Normal intestinal biocenosis and the degree of dysbiosis.
2. Principles of treatment of intestinal dysbiosis.