State of cavity microbiota of the colon in breastfed children with acute enterocolitis with infection of breast milk
Background. Despite the significant progress made in the field of acute enterocolitis in children, many questions of etiology, pathogenesis, microecological relations, formation of intestinal dysbacteriosis/dysbiosis and taxonomic composition and population level of major, additional and accidental microbiota of intestinal microbiocenosis and other issues of enterocolitis require study, taking into account bacteriological and immunological researches of today. This is especially related to the children one to six months of age (who are breastfed) with enterocolitis. Normally, breast milk is sterile, but during the inflammatory process in breast, it can be infected, so the disease have a threat to a child fed with this milk, and there is a threat to the life of the mother. The first reaction to such feeding will be from a side of cavity microbiota of the colon that characterizes the relevance of study of the colon microbiota in infants suffering from enterocolitis. Materials and methods. Contents of colon cavity of 53 children one to six months of age with enterocolitis (control — 35 children), who were breastfed, and, in fact, breast milk, by which the children were fed, underwent bacteriological and mycological examination. Results. To reveal the mechanisms of contamination of the colon in children one to six months of age, in patients with acute enterocolitis there has been used ecological method that revealed the specific characteristics of coexistence of taxons in ecosystem “host-microbiota” and identified the direction of disorders of colon microecology on the background of acute enterocolitis in children, who were fed by breast milk infected with bacteria of the genus Staphylococcus. The results of bacteriological studies have shown that in 49 (92.45 %) patients Staphylococcus aureus was isolated and identified, and in 4 (7.55 %) women — Staphylococcus epidermidis. Population level of the selected strains was 3.0–7.0 lg CFU/ml (M ± m = (4.37 ± 0.38) lg CFU/ml). Breastfeeding with milk infected by Staphylococcus leads to a decrease of population of Bifidobacterium by 43.03 % (3 orders), Lactobacillus — by 32.24 % (2 orders). With the decline of population of Bifidobacteria and Lactobacilli in the intestinal microbiocenosis, the colonization resistance of intestinal mucosa becomes disturbed, which promotes colonization of the intestine, especially the colon, with opportunistic Enterobacteria — hemolytic Escherichia (E.coli Hly+) in 16.48 % of children with acute enterocolitis, Proteus — in 22.53 %, Citrobacter — in 3.77 %, Peptococci — in 15.09 %, Peptostreptococci — in 55.42 % and Staphylococcus — in 91.43 % of cases. In addition, in the colon of children with acute enterocolitis breastfed with the infected milk, there is an increase of population levels of Bacteroides by 32.59 % (2 orders). Furthermore, there is a growth in population levels of Peptostreptococci in the colon by 61.50 % (3 orders), and contamination with Peptococci ((9.13 ± 0.37) lg CFU/g). Reduced concentration of Bifidobacteria and Lactobacilli among other components of ecosystem also leads to an increase of the population level of E.coli by 19.07 % (2 orders) in the colon of children with enterocolitis. In the experimental group of children, Staphylococci were isolated from all sick children in concentration (6.16 ± 0.12) lg CFU/g that is 2.92 times higher than in healthy children fed naturally with uninfected milk. Thus, the growth of the population level of Staphylococci in the colon of infants suffering from enterocolitis may be linked, according to our point of view, on the one hand, with the constant contamination of the gastrointestinal tract due to breastfeeding to milk containing ((4.37 ± 0.38) lg CFU/g) Staphylococci, and, on the other hand, to the changes of colonization resistance of the colon mucosa as a result of decline in population level of the major part of the large intestine microbiota — bacteria of the genera Bifidobacterium and Lactobacillus. The obtained data shows that the acute enterocolitis in infants, who were breastfed with Staphylococci-positive milk, develops on the background of the prevailing dysbiosis in all children. In most affected, there was the second degree dysbiosis, and in 2 patients — the third degree. Conclusions. Breastfeeding with milk infected by Staphylococcus in children aged from one to six months leads to the formation of Staphylococcal dysbacteriosis of the first (up to 43.40 %), second (up to 52.83 %) and third (3.77 % of cases) stages, and on its background — enterocolitis due to the association of pathogenic (E.coli Hly+) and opportunistic Enterobacteriaceae (E.coli, Proteus, Citrobacter), Staphylococci (in population level (6.16 ± 0.12) lg CFU/g), Bacteroides, Peptococci, Peptostreptococci and other bacteria. Enterocolitis in infants breastfed with milk infected by Staphylococci (S.aureus, S.epidermidis) is an infectious process of mixed etiology, provocative factor of which is the association of opportunistic Gram-negative Enterobacteria, Bacteroides and Gram-positive Staphylococci, Peptostreptococci and Peptococci. Dysbacteriosis in infants suffering from acute enterocolitis is characterized by a reduction of a part of Bifidobacteria and Lactobacilli in intestininal microbiota and increasing number and value in microbiocenosis (by a rate of quantitative dominance and significance) of Gram-negative opportunistic Enterobacteriaceae, Bacteroides and Gram-positive opportunistic bacteria of the genera Staphylococcus, Peptostreptococcus and Peptococcus.
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