Медицина/ 2.Хирургия

Rotar D.V., Tokar P.U.

Department of Microbiology and Virology

Bukovynian State Medical University

Bacterial contamination of lung tissue and pleural cavity at acute destructive pancreatitis

Despite the progress achieved in intensive care and surgical treatment, mortality in complicated acute destructive pancreatitis (ADP) remains relatively high, requiring further development of diagnostics methods, prevention and treatment of complications of ADP. Considering results of microbiological study set in our works, which show the translocation of pathogenic Enterobacteria conventionally, Staphylococci and Bacteroides to mesenterial lymphatic system, and therefore to the thoracic lymphatic duct, and thence into the superior vena cave with the need of study of contamination of lung tissue in the process of formation and development of acute destructive pancreatitis.

Study date results of study of species composition of lung tissue of microflora in different periods of ADP show that in 24 hours at the modeling of ADP testfy thecontamination lung tissue by conditionally pathogenic enterobacteria (E.coli, K.pneumoniae) and epidermal Staphylococcus in 5 of 7 animals, as well as in 48 hours enterotoxigenic Escherichia and Staphylococcus aureus. In 72 hours pathogens were isolated only in 3 of 7 animals, and in 96 hours - in one. Later lung tissue was sterile.

These researches of population level of microflora that persists in the lung tissue of experimental animals with ADP demonstrates that its concentration is minimal and does not reach the critical level at any time of observation. Such a low population level in the lungs microflora is connected with the high efficiency actions of the factors and mechanisms of antiinfectious protection, that meet microbes during a translocation into this biotope. In the area of alveoli and the smallest bronchies the leading role belongs to alveolar macrophages and other phagocytic cells. During phagocytosis there occurs decay of microorganisms in phagolysosomes, and the remains of microorganisms are transported by alveolar and migrating macrophages into mucociliary system, where the elimination of components of bacteria take place. In the area of the alveoli and smallest bronchi immune responses are mediated by different structural elements. The leading role in alveolies play alveolar macrophages, which come from bone marrow, but in the process of parts of inflammation conduct specific changes in organs with maintenance of functional activity (processing of microorganisms). They make up 85-95% of the cells in the distal departments of lung, 7-15% - lymphocytes, of which 70% - T-lymphocytes, in mainly activated form, 10% - B- lymphocytes and 20% O-lymphocytes. Granulocytes make up 1.2% of all cells. All this confirms the high degree of cooperation of immunocompetent cells in formation of cells in the immune response to bacteria entering the lungs. Besides, the alveolar fluid contains immunoglobulins of all classes, with the highest concentration of Ig A, and all components of the complement system too. Listed above shows power of antiinfectious protection of lung tissue. Therefore, microflora, which contaminates lungs undergoes significant inhibition that prevents the growth and reproduction of these microorganisms that can not reach the critical population level.

Thus, the formation and development of experimental ADP in 24- 96 hours is conected translocation of pathogenic conditionally Enterobacteria and Staphylococcus in lung tissue, but thanks to a well-developed factors and mechanisms of nonspecific and specific immune antiinfectious protection in the tissue of the lungs (in the area of alveoli and terminal bronchi) that inhibit the growth and reproduction of microorganisms, they do not achieve not only high,but moderate population level. In further terms the lung tissue is sterile.

Set translocation of pathogenic and conditionally pathogenic Enterobacteria, Staphylococci, bacteroides and other microorganisms into viscera ovgans, blood and peritoneal cavity stimulates us to determine the degree of contamination of the pleural cavity. Translocation into this occurs only in 24 hours, with conditionally pathogenic Enterobacteriae (E.coli, K pneumoniae) isolater in 3 from 7 animals, and in 48 hours E. coli is observed in only one study. In other periods of observation the pleural cavity was sterile. Thus, the pleural cavity in experimental ADP is contaminated by conditionally pathogenic enterobacterias in the period of 24-48 hours. The results of microbiological study of content of pleural cavity, aimed at establishing of a population level of microflora that persists in this biotope showed that conditionally pathogenic Eneterobacteria appear only in 24 and 48 hours in the low population level (minimum - 2-3 orders below the critical ).

Thus, in the process of development of experimental ADP, which is accompanied by qualitative and quantitative violation in the relationships between autochthonous obligate, facultative and allochthon representatives of intestinal microflora with of disorders profound colonization resistance of the mucous membranes of the intestine, especially deep breach of mukose microflora of distal small intestine, occurs transient (short-lived) pleural cavity contamination with pathogenic Enterobacteria conventionally (E. coli, K. pneumoniae) in the low (minimum) population level.

Literature:

1. Бодяка В.Ю. Особливості бактеріальної транслокації за внутрішньоочеревинної гіпертензії в експерименті / В.Ю. Бодяка, О.І. Іващук, В.В. Бех, О.М. Печенога, В.М. Свінціцький // Буковинський медичний вісник. – 2012. - Т.16, № 4 (64). - С. 15-21.

2. С.І. Іващук Транслокація патогенних та умовно патогенних мікроорганізмів у тканини внутрішніх органів ууу процесі формування і перебігу експериментального набрякового гострого панкреатиту / С.І. Іващук // Клінічна анатомія та оперативна хірургія. – 2014 – Т. 13, № 4 – С.23-28.

3. Ротар Д.В. Динаміка гематогенного поширення мікрофлори кишечнику при експериментальному гострому деструктивному панкреатиті / Д.В. Ротар // Буковинський медичний вісник. - 2014.- Т. 18. - № 3 (71), С. 132-137.

4. Сидорчук Л.І. Аутохтонна облігатна, факультативна анаеробна та аеробна мікробіота порожнини дисталь- ного відділу тонкої кишки спленектомірованих білих щурів / Л.І. Сидорчук // Клін. і експерим. патол. – 2011. – Т. Х, № 2 (36). – Ч. 1. – С. 91-95.