The rational treatment approach to infectious inflammatory diseases of the upper respiratory airways in children
DOI: 10.32364/2587-6821-2021-5-11-755-761
V.A. Mukhortykh
Federal Research Center for Nutrition & Biotechnology, Moscow, Russian Federation
Infectious inflammatory diseases of the upper respiratory airways are the most common among respiratory disorders. Issues in the management of infectious inflammation in upper airway mucosa are the diversity of infective agents, generation of biofilms, suppression of normal microflora, the lack of accurate and rapid laboratory tests for the analysis of the microbiota of upper airway mucosa, the risk of superinfection and complications after treatment with chemical antiseptics and antibacterial drugs. All these factors underscore the need for a more careful and rational approach to selecting therapy for the upper respiratory airways’ infectious inflammatory diseases, particularly preparations that preserve human microflora (a factor of mucosal immunity) and are characterized by a broad spectrum of activity on various pathogens. In addition, the human organism produces a variety of antimicrobial factors that relieve the burden of colonizing microbes. One of these antimicrobial factors, lysozyme, is a natural antiseptic found in high concentrations in fluids on mucosal surfaces. The results of clinical and laboratory studies have proven the effectiveness of lysozyme-containing drugs, which increases the prospects for their wider application in pediatric practice.
Keywords: lysozyme, pyridoxine, bacteria, viruses, respiratory infections, biofilms, tonsillopharyngitis, microbiome.
For citation: Mukhortykh V.A. The rational treatment approach to infectious inflammatory diseases of the upper respiratory airways in children. Russian Medical Inquiry. 2021;5(11):–761 (in Russ.). DOI: 10.32364/2587-6821-2021-5-11-755-761.
About the author:
Valeriy A. Mukhortykh — C. Sc. (Med.), junior researcher, Federal Research Center for Nutrition & Biotechnology, 21, Kashirskoe road, Moscow, 115446, Russian Federation; ORCID iD 0000-0001-8549-9493.
Contact information: Valeriy A. Mukhortykh, e-mail: valera-89@yandex.ru.
Financial Disclosure: the author has no financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 17.08.2021.
Revised 09.09.2021.
Accepted 04.10.2021.
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49. Sebaa S., Hizette N., Boucherit-Otmani Z., Courtois P. Dose-dependent effect of lysozyme upon Candida albicans biofilm. Mol Med Rep. 2017;15(3):1135–1142. DOI: 10.3892/mmr.2017.6148.
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2. Moriyama M., Hugentobler W.J., Iwasak A. Seasonality of Respiratory Viral Infections. Annu Rev Virol. 2020;7(1):83–101. DOI: 10.1146/annurev-virology-012420-022445.
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8. Savenkova M.S. Treatment of viral infections, the problem of choosing antiviral drugs. Pediatriya. 2012;91(6):70–79 (in Russ.).
9. Luss L.V. The place of immunomodulators in pediatric practice. Pediatriya. Сonsilium Medicum. 2010;(3):72–76 (in Russ.).
10. McCaig L.F., Besser R.E., Hughes J.M. Trends in antimicrobial prescribing rates for children and adolescents. JAMA. 2002;287(23):3096–3102. DOI: 10.1001/jama.287.23.3096.
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15. Feazel L.M., Robertson C.E., Ramakrishnan V.R., Frank D.N. Microbiome Complexity and Staphylococcus aureus in chronic rhinosinusitis. Laryngoscope. 2012;122:467–472. DOI: 10.1002/lary.22398.
16. Teo S.M., Mok D., Pham K., Kusel M. et al. The infant nasopharyngeal microbiome impacts severity of lower respiratory infection and risk of asthma development. Cell Host Microbe. 2015;17(5):704–715. DOI: 10.1016/j.chom.2015.03.008.
17. Rogers G.B., Shaw D., Marsh R.L. et al. Respiratory microbiota: addressing clinical questions, informing clinical practice. Thorax. 2015;70(1):74–81. DOI: 10.1136/thoraxjnl-2014-205826.
18. Wang L.-M., Qiao Х.-L., Ai L. et al. Isolation of antimicrobial resistant bacteria in upper respiratory tract infections of patients. 3 Biotech. 2016;6(2):166. DOI: 10.1007/s13205-016-0473-z.
19. Ramakrishnan V.R., Holt J., Nelson L.F. et al. Determinants of the nasal microbiome: pilot study of effects of intranasal medication use. Allergy Rhinol (Providence). 2018;9:2152656718789519. DOI: 10.1177/2152656718789519.
20. Biesbroek G., Bosch A.A., Wang X. et al. The impact of breastfeeding on nasopharyngeal microbial communities in infants. Am J Respir Crit Care Med. 2014; 190(3):298–308. DOI: 10.1164/rccm.201407-1240OC.
21. Vlastarakos P.V., Nikolopoulos T.P., Maragoudakis P. et al. Biofilms in ear, nose, and throat infections:how important are they? Laryngoscope. 2007;117(4):668–673. DOI: 10.1097/MLG.0b013e318030e422.
22. Pettigrew M.M., Gent J.F., Revai K. et al. Microbial interactions during upper respiratory tract infections. Emerg Infect Dis. 2008;14(10):1584–1591. DOI: 10.3201/eid1410.080119.
23. Wolcott R.D., Ehrlich G.D. Biofilms and Chronic Infections. JAMA. 2008;299(22):2682–2684. DOI: 10.1001/jama.299.22.2682.
24. Zuliani G., Carron M., Gurrola J. et al. Identification of adenoid biofilms in chronic rhinosinusitis. Int J Pediatr Otorhinolaryngol. 2006;70(9):1613–1617. DOI: 10.1016/j.ijporl.2006.05.002.
25. De Martino M., Ballotti S. The child with recurrent respiratory infections: normal or not? Pediatr Allergy Immunol. 2007;18:13–18. DOI: 10.1111/j.1399-3038.2007.00625.x.
26. Russell C.D., Unger S.A., Walton M., Schwarze J. The Human Immune Response to Respiratory Syncytial Virus Infection. Clin Microbiol Rev. 2017;30(2):481–502. DOI: 10.1128/CMR.00090-16.
27. Bykova V.P., Kalinin D.V. Immune barrier of mucous membranes in modern reading. Rossiyskaya rinologiya. 2009;1:40–43 (in Russ.).
28. Yarilin A.A. Immunology. M.: GEOTAR-Media; 2010; 376–380 (in Russ.).
29. Koval’chuk L.V., Gankovskaya L.V., Meshkova R.YA. Clinical immunology and allergology with the basics of general immunology. M.: GEOTAR-Media; 2011; 16–181 (in Russ.).
30. Janeway C., Travers P., Walport M., Shlomchik M. Immunobiology: The immune system in health and disease. 6th ed. New York: Garland Science; 2005.
31. Kokryakov V.N. Essays on innate immunity. SPb.: Nauka; 2006 (in Russ.).
32. Meyl D., Brostoff Dzh., Rot D., Royt. А. Immunology. M.: Logosfera; 2007;181–202 (in Russ.).
33. Karpova Ye.P., Ardatskaya M.D., Zakharova I.N. et al. Biocenosis-saving therapy of acute inflammatory diseases of the oropharynx in children. Meditsinskiy sovet. 2017:19;122–127 (in Russ.).
34. Chebotar’ I.V., Mayanskiy A.N., Konchakova.D. et al. Antibiotic resistance of biofilm bacteria. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya. 2012;14(1):51–58 (in Russ.).
35. Cole A., Liao H., Stuchlik O. et al. Cationic polypeptides are required for antibacterial activity of human airway fluid. J Immunol. 2002;169(2):6985–6991. DOI: 10.4049/jimmunol.169.12.6985.
36. Welsh I., Spitznagel J. Distribution of lysosomal enzymes, cationic proteins, and bactericidal substances in subcellular fractions of human polymorphonuclear leukocytes. Infect Immun. 1971;4(2):97–102. DOI: 10.1128/iai.4.2.97-102.1971.
37. Markart P., Korfhagen T., Weaver T., Akinbi H. Mouse lysozyme M is important in pulmonary host defense against Klebsiella pneumoniae infection. Am J Respir Crit Care Med. 2004;169(4):454–458. DOI: 10.1164/rccm.200305-669OC.
38. Cramer E., Breton-Gorius J. Ultrastructural localization of lysozyme in human neutrophils by immunogold. J Leukoc Biol. 1987;41(3):242–247. DOI: 10.1002/jlb.41.3.242.
39. Kalyuzhin O.V. Antibacterial, antifungal, antiviral and immunomodulatory effects of lysozyme: from mechanisms to pharmacological use. Effektivnaya farmakoterapiya. 2018;14:69–72 (in Russ.).
40. Ibrahim H., Matsuzaki T., Aoki T. Genetic evidence that antibacterial activity of lysozyme is independent of its catalytic function. FEBS Lett. 2001;506(1):27–32. DOI: 10.1016/s0014-5793(01)02872-1.
41. Nash J., Ballard T., Weaver T., Akinbi H. The peptidoglycan-degrading property of lysozyme is not required for bactercidal activity in vivo. J Immunol. 2006;177(1):519–526. DOI: 10.4049/jimmunol.177.1.519.
42. Ibrahim H., Thomas U., Pellegrini A. A helix-loop-helix peptide at the upper lip of the active site cleft of lysozyme confers potent antimicrobial activity with membrane permeabilization action. J Biol Chem. 2001;276(47):43767–43774. DOI: 10.1074/jbc.M106317200.
43. Wolf A.J., Arruda A., Reyes C.N. et al. Phagosomal degradation increases TLR access to bacterial ligands and enhances macrophage sensitivity to bacte-ria. J Immunol. 2011;187(11):6002–6010. DOI: 10.4049/jimmunol.1100232.
44. Muller S., Wolf A.J., Iliev I.D. et al. Poorly Cross-Linked Peptidoglycan in MRSA Due to mecA Induction Activates the Inflammasome and Exacerbates Immunopathology. Cell Host Microbe. 2015;18(5):604–612. DOI: 10.1016/j.chom.2015.10.011.
45. Rae C.S., Geissler A., Adamson P.C., Portnoy D.A. Mutations of the Listeria monocytogenes peptidoglycan N-deacetylase and O-acetylase result in enhanced lysozyme sensitivity, bacteriolysis, and hyperinduction of innate immune pathways. Infect Immun. 2011;79(9):3596–3606. DOI: 10.1128/IAI.00077-11.
46. Wang H., Zhang X., Zuo Z. et al. Rip2 Is Required for Nod2-Mediated Lysozyme Sorting in Paneth Cells. J Immunol. 2017;198(9):3729–3736. DOI: 10.4049/jimmunol.1601583.
47. Melnyk J.E., Mohanan V., Schaefer A.K. et al. Peptidoglycan Modifications Tune the Stability and Function of the Innate Immune Receptor Nod2. J Am Chem Soc. 2015;137(22):6987–6990. DOI: 10.1021/jacs.5b01607.
48. Hukic M., Seljmo D., Ramovic A. et al. The effect of lysozyme on reducing biofilms by Staphylococcus aureus, Pseudomonas aeruginosa, and Gardnerella vaginalis: an in vitro examination. Microb Drug Resist. 2018;24(4):353–358. DOI: 10.1089/mdr.2016.0303.
49. Sebaa S., Hizette N., Boucherit-Otmani Z., Courtois P. Dose-dependent effect of lysozyme upon Candida albicans biofilm. Mol Med Rep. 2017;15(3):1135–1142. DOI: 10.3892/mmr.2017.6148.
50. Shukla S.K., Rao T.S. Staphylococcus aureus biofilm removal by targeting biofilm-associated extracellular proteins. Indian J Med Res. 2017;146:S1–S8. DOI: 10.4103/ijmr.ijmr_410_15.
51. Sheffield C.L., Crippen T.L., Poole T.L., Beier R.C. Destruction of single-species biofilms of Escherichia coli or Klebsiella pneumoniae subsp. pneumoniae by dextranase, lactoferrin, and lysozyme. Int Microbiol. 2012;15(4):185–189. DOI: 10.2436/20.1501.01.171.
52. Instructions for medical use of the drug Lysobact® in tablets for resorption. (Electronic resource.) URL: https://grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=e2d4352b-c909–4d36-b3c1–60c5189d2788andt= (access date: 01.08.2021) (in Russ.).
53. Usenko D.V., Gorelov A.V., Pogorelova O.O. Clinical and laboratory efficacy of Lysobact® in children with acute respiratory diseases. Effektivnaya farmakoterapiya. Pediatriya. 2017;3(41):14–19 (in Russ.).
54. Vavilova V.P. Modern technologies in the rehabilitation program for pathology of the lympharyngeal ring in children who often suffer from respiratory diseases. Vestnik otorinolaringologii. 2003;4:37–41 (in Russ.).
55. Usenko D.V., Pogorelova O.O., Gorelov A.V. et al. New approaches to the treatment of acute respiratory infections in children with chronic ENT pathology. Farmateka. 2010;4:72–76 (in Russ.).
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