Biochemical markers of the severity and emergence of non-smooth progression of pseudotuberculosis in children

Background. Currently, pseudotuberculosis is characterized by a high incidence in children and it is the second acute intestinal infection by frequency after shigellosis. The search for relationships between early changes in cell metabolism, dysfunctions of some organs and body systems under the pathogenic effect of an infectious agent and the severity, the occurrence of a non-smooth course of pseudotuberculosis in children is relevant.

Aim. Search for biochemical markers to predict the severity and occurrence of a non-smooth variant of the course of pseudotuberculosis in children.

Material and methods. A prospective study was performed in 125 patients with pseudotuberculosis during pe­riods of the disease height, early convalescence and recovery: 17 patients with mild severity and a smooth course of the disease; 64 — with moderate severity and smooth course of the disease; 28 — with moderate severity and non-smooth course, 16 — with high severity and non-smooth course of the disease. The comparison group consisted of 45 children from the IIA health group. The distribution of the examined children by sex was equal, the age ranged from 9 to 13 years. The spectrophotometric method determined the following: in blood plasma — the content of malondialdehyde; in erythrocytes — the concentration of reduced glutathione, the activity of glutathione reductase, glutathione peroxidase, glutathione-S-transferase and catalase. The following ratios were calculated: reduced glutathione/malondialdehyde, reduced glutathione/glutathione reductase, reduced glutathione/glutathione peroxidase, reduced glutathione/glutathione S-transferase, glutathione peroxidase/catalase. Normality of the obtained data distribution was checked using the Shapiro–Wilk test, and the statistical hypotheses about the difference between the studied groups were checked using the nonparametric Mann–Whitney test at a significance level of p <0.05.

Results. In the acute period of the disease, based on the analysis, a statistically significant decrease in the ratios of reduced glutathione/malonic dialdehyde, reduced glutathione/glutathione reductase, reduced glutathione/glutathione peroxidase by 3.0, 3.5 and 3.1 times, respectively, was established (p <0.05) in patients with mild severity and smooth course; 5.3, 5.1 and 3.8 times (p <0.05) — with moderate severity and smooth course; 5.8, 4.0 and 3.0 times (p <0.05) — with moderate severity and non-smooth course; by 8.1 and 6.1 times (p <0.05) — with heavy severity and non-smooth course relative to control values. However, during the period of early convalescence of a non-smooth course, these indicators significantly decreased by 2.2, 4.4 and 1.8 times (p <0.05) in patients with moderate severity and by 3.4, 6.8 and 2.2 times ( p <0.05) — with heavy severity relative to control values.

Conclusion. Prognostically significant criteria for an increase in the severity and occurrence of a non-smooth course of pseudotuberculosis in children in the acute period of the disease are a decrease in the ratios of reduced glutathione/malonic dialdehyde less than 17.0, reduced glutathione/glutathione reductase below 38.0 and reduced glutathione/glutathione peroxidase less than 12.0.