Species composition and population level of the microbiota of the contents of the maxillary sinuses and oropharynx in patients with chronic purulent maxillary sinusitis with type 1 diabetes mellitus
Authors: Mazur O. 
Published: December 2021

Aim – to study the species composition and population level of the microbiota of the contents of the maxillary sinuses and oropharynx in patients with chronic purulent maxillary sinusitis (CPMS), which arose on the background of type 1 diabetes mellitus (DM).Material and methods. A microbiological examination of 97 samples of the contents of the maxillary sinus cavity was performed. The main group consisted of 50 patients with CPMS with type 1 diabetes aged 20-67 years (10 patients aged 20-31 years, 14 patients aged 31-45 years and 26 aged 45-67 years). Among patients of the main group, endocrinologists found in 39 patients the course of type 1 diabetes of moderate severity, in 11 - severe course. The control group consisted of 47 people of the same age, who during the last 6 months did not suffer from any diseases and considered themselves practically healthy.Results. The leading pathogens in CPMS in patients with type 1 (DM) are S. pneumoniae (34% of patients), H. influenzae (24%), M. catarrhalis (24%), S. aureus (10.0%), S. pyogenes (6.0%), E. coli Hly + (2.0%). It is established that the purulent-inflammatory process in the maxillary sinuses in patients with type 1 diabetes develops against the background of the formed dysbiosis of the oropharynx: 1st degree in 6.0%, 2nd degree - in 28% of patients and 3rd degree - in 66% of patients, which is characterized by a pronounced deficiency of indigenous obligate anaerobic and aerobic bacteria and contamination of the habitat with pathogenic and opportunistic pathogens and other microorganisms.Conclusions. The leading causative agents of chronic purulent maxillary sinusitis in patients with type 1 diabetes mellitus at the present stage are: S.pneumoniae (32.0%), H.influenzae (26.0%), M.catarrhalis (24.0%), S. pyogenes (10.0%), S. aureus (6.0%) and E. coli Hly + (2.0%). Patients with chronic purulent maxillary sinusitis, which developed on the background of type 1 diabetes mellitus, are eliminated from the habitat of bifidobacteria, lactococci and S. mutans, which are important for their multifunctional role in the microbiocenosis; the number of physiologically useful lactobacilli is significantly reduced by 2 orders of magnitude, salivary streptococci by 92.91%, S.viridans by 25.17%, S.sanguis by 86.17%, S.mitis by 45.33%, M.luteus-25.35%. Against this background, the number of opportunistic pathogens increases significantly by 84.59%, fusobacteria by 69.33%, pyogenic streptococcus - by 50.5%, hemophilic bacteria - by 55.71%, moraxella - by 74.01%, yeast-like fungi of the genus Candida - by 25.63%. Bacteria that contaminate the oropharynx and the contents of the cavities of the maxillary sinuses reach a high population level (from 4.33 ± 0.14 to 5.69 ± 0.09 lg KUO \ ml). In chronic purulent sinusitis in patients with type 1 diabetes mellitus in the contents of the oropharyngeal cavity are associations of autochthonous obligate and facultative opportunistic and allochthonous microorganisms, consisting of 3 types of microorganisms in 3 (6%) patients, out of 4 in 41 ( 82%) and out of 5 in 6 (12%) patients. Chronic purulent process in the maxillary sinus in patients with type 1 diabetes mellitus develops against the background of the formed dysbacteriosis / dysbiosis of the oropharynx I degree in 6.0%, II degree - in 28.0% of patients and III degree - in 66.0% of patients with chronic purulent maxillary sinusitis, characterized by elimination or severe deficiency of autochthonous obligate anaerobic and aerobic bacteria (bacteria of the genus Bifidobacterium, Lactobacillus, Streptococcus (S.salivarius, S.sanguis, S.mitis, S.mutans, L.lactis, M.luteus) biotope contamination by pathogenic and conditionally pathogenic S.pneumoniae, S.pyogenes, H.influenzae, M.catarrhalis, E.coli, E.coli Hly+, Enterobacter freundii., Klebsiella oxytoca, S.aureus and others.