142 2017, №4 (97) Проблемы биологии и медицины
УДК: 616.233-002-036.1-073.75-072.1-078-053.81/.84
EVOLUTION OF BRONCHITIS IN YOUNG PATIENTS FROM THE POINT OF VIEW OF
INSTRUMENTAL AND BACTERIAL EXAMINATION METHODS
ORIJANA TYSH, LARYSA MATIUKHA, ANATOLY SERGIENKO*
Department of Family Medicine and Outpatient Care
Shupyk National Medical Academy
of Postgraduate Education;
*Kyiv City Clinical Hospital No. 17
ИНСТРУМЕНТАЛ ВА БАКТЕРИАЛ ТЕКШИРИШ НУҚТАИ НАЗАРИДАН ЁШЛАРДА
БРОНХИТ ЭВОЛЮЦИЯСИ
ОРИДЖАНА ТИШ, ЛАРИСА МАТИУХА, АНАТОЛИЙ СЕРГИЕНКО*
Шупика номидаги дипломдан кейинги таълим Миллий тиббиёт академияси
оилавий тиббиёт ва амбулатор даволаш бўлими;
*Киев шаҳар 17 - клиник шифохонаси
ЭВОЛЮЦИЯ БРОНХИТА У МОЛОДЫХ ПАЦИЕНТОВ С ТОЧКИ ЗРЕНИЯ МЕТОДОВ
ИНСТРУМЕНТАЛЬНОГО И БАКТЕРИАЛЬНОГО ИССЛЕДОВАНИЯ
ОРИДЖАНА ТЫШ, ЛАРИСА МАТИУХА, АНАТОЛИЙ СЕРГИЕНКО*
Отделение семейной медицины и амбулаторного лечения Национальной медицинской академии
последипломного образования имени Шупика;
*Киевская городская клиническая больница № 17
Биз 18 ёшдан 35 ёшгача бўлган 128 нафр беморни текширишдан ўтказдик. Натижаларни
таққослаш учун алоҳида гуруҳ сифатида пастки нафас йўлларининг касалликлари бўлмаган 20 нафар
кўнгиллилар (валантер) танланди. Уларда нафас йўларининг ёт жисми бор эди ва уларга
бактериологик текшириш учун бронхоальвеоляр лаваж билан бронхоскопия ўтказилди. 108 нафар
беморда рецидивланувчи бронхит (ICD-10 J.40) диагностика қилинди. Бу беморлар бронхоальвеоляр
лаважда лактобацилл бактериялар ва бифидобактериялар тўлиқ ёки нотўлиқ борлиги ёки йўқлигига
боғлиқ равишда қўшимча 3 гуруҳга бўлинди. Антибактериал терапия таъсирида ичакларда биоценоз
ўзгаришини бронхлардаги микробиоценоз ўзгариши билан таққослаш ва улар ўртасидаги боғлиқликни
аниқлаш мақсадида ахлат ҳам қўшимча бактериологик текширишдан ўтказилди. Статистик
микробиоценоз бўйича параметрлари ҳар хил бўлган (р
0,05) антибиотиклар 47,5% қабул қилган I
гуруҳдаги беморларга нисбатан антибиотиклар қабул қилган III гуруҳдаги 80% беморларда бронхиал
микробиоценоз энг юқори кўрсаткичларга эришди. 72,2% беморлага антибиотиклар қўлланилган II
гуруҳдаги беморларда лакто- ёки бифидобактериялар аниқланди. Аммо бу ўзгаришлар I гуруҳдаги
параметлар бўйича деярли фарқ қилмади (p
0,06), бу бронхиал микробиоценозда манфий ўзгаришлар
тўлиқ бўлмаганлигидан дарак беради. Олинган маълумотларга асосланган ҳолда, пастки нафас
йўлларида қўшимча касалликлари бўлмаган 100% текширилган беморларда бронхоальвеоляр лаважда
лактобацилл ва бифидобактериялар аниқланди.
Калит сўзлар:
микробиоценоз, бронхит, лактобацилл бактериялар, бифидобактериялар,
бронхоальвеоляр лаваж.
We examined 128 patients with the age from 18 to 35 years. 20 individuals without preexisting lower
respiratory tract diseases were chosen for comparison as a seperate group. They were clinically and endoscop-
ically dignosed with a foreign div of the respiratory tract and underwent bronchoscopy with bronchoalveolar
lavage for bacteriological analysis. 108 patients were diagnosed with recurrent bronchitis (ICD-10 J.40).
These patients were further divided into 3 groups. We also performed the additional bacteriologic analysis of
feces in order to determine the relationship between changes in the bronchial microbiocenosis under the influ-
ence of the antibiotic therapy in comparison with the changes in the intestinal biocenosis. 80% of patients from
the group III (no lactobacilli bacteria and bifidobacteria), who received antibiotics, demonstrated chages in
bronchial microbiocenosis, which were statistically different (р
0,05) from the parameters of the microbioce-
nosis in the group I (control), where antibiotics were administered in 47,5%. In the patients from the group II,
where antibiotic therapy was used in 72,2% of patients, either lacto- or bifidobacteria were found. However
these changes were not significantly different (p
0,06) from the parameters of the group I, which may indicate
the incompleteness of negative changes in the bronchial microbiocenosis. Based on the acquired data we found
lactobacilli bacteria and bifidobacteria in bronchoalveolar lavage in
100% of examined individuals, who had
no prior lower respiratory tract diseases.
Key words:
microbiocenosis, bronchitis, lactobacilli bacteria, bifidobacteria, bronchoalveolar lavage.
Orijana Tysh, Larysa Matiukha, Anatoly Sergienko
Биология ва тиббиёт муаммолари 2017, №4 (97) 143
Introduction.
The colonization of the human
div by microorganisms starts immediately after the
birth from the surrounding environment, which plays
a major role in the development of a healthy microbi-
ome. After the complete development the microbi-
ome becomes an independent div that provides vital
functions for its host [3,9,6]. According to the latest
knowledge, the normal human microflora is consid-
ered to be a system consisting of many microbioce-
noses. They are characterized by a specific composi-
tion of microflora species and occupy the specific
biotope in the human div.
Until recently, the whole number of microor-
ganisms living in the healthy human div, remained
unexplored. Today due to the large international re-
search trials within the Human Microbiome Project
Meta HIT project (2008-2016), it became possible to
provide a better understanding of the role of the mi-
croflora. The human div contains trillions of micro-
organisms. Their number exceeds the number of so-
matic cells in 10 times, and their total mass comprises
1-3% of the human div weight (Human Microbiome
Jumpstart Reference Strains Consortiumet al., 2010;
National Human Genome Research Institute 2012;
Meta HIT Consortium, 2016). Microorganisms colo-
nize not only all surfaces, but also tissues and organs
that were once considered sterile – breast milk, pla-
centa, bronchi (Martin R.et al., 2010; Gerritsen J.et
al, 2011; Aagaard K. et al., 2014) [7, 11].
The role of normal respiratory microflora in
maintaining the homeostasis of an organism is well
established. The divisions of the upper respiratory
tract have a high microbial burden, since their mu-
cous membrane is the first to resist the actions of var-
ious environmental factors. At the same time the mi-
croflora itself protects the div from pathogenic mi-
croorganisms, providing "colonization immunity",
that is, the resistance of the mucous membranes to
more aggressive microbial colonization prevents the
fixation of bacteria and all other pathogens to their
surface [1,3,5].
The human organism and its normal microflora
is the only interrelated, interdependent natural com-
plex, which state largely determines the state of hu-
man health. Under the influence of various adverse
factors on the human div, or its normal microflora,
changes occur in the internal environment of the or-
ganism, and the state of its normal microflora, first of
all in the intestinal microflora. In the different parts
of the gastrointestinal tract, the composition of nor-
mal microflora significantly differs. Normal micro-
flora of the oral cavity and pharynx is characterized
by a large variety of known species. It consists of
streptococci, staphylococci, lactobacilli, corinebacte-
ria and a large number of anaerobes, especially bac-
teroids [8,10].
It has been established that the human intestine
contains more than 10
14
microorganisms, that belong
to more than 1000 species and form an intestinal mi-
crobiote. The predominance of a certain type of mi-
croflora depends on genetic, geographical, ethnic and
other factors. Each person has a unique inherent mi-
croflora that is associated with the diet, family histo-
ry, the presence of diseases, the region of residence
and other factors.
There are 3 levels of natural barrier protection
that is performed by the normal intestinal microflora.
The first level (microbial-microbial), when the nor-
mal flora interferes with colonization by pathogens
and provides colonization resistance by competition
for substrates. The second level (microbial-
epithelium), when the normal microflora maintains
and enhances the barrier function of the biotope cells
by increasing mucus production, thickening of the
connections, regeneration of the epithelium. The third
level (microorganism-immune system) is associated
with the fact that a healthy intestinal microflora has
immunomodulatory function and is able to enhance
the immune response. [2,4,12].
Based on the above mentioned data, we hy-
pothesized the possible presence of lactobacteria and
bifidobacteria as the microflora, which provides "col-
onization immunity" in bronchi. Violation of this bal-
ance may occur in cases of the lower respiratory tract
diseases (recurring bronchitis, J40).
Purpose.
To study the evolution of bronchitis
using radiological methods, bronchoscopy and bacte-
riological studies in young patients with lower respir-
atory tract infection under the influence of treatment.
Materials and methods of the study.
We per-
formed a prospective study of 108 patients with the
age from 18 to 35 years, who were examined at the
Department of Family Medicine and Outpatient Care,
Shupyk National Medical Academy of Postgraduate
Education (NMAPE)
from November, 2018 to May,
2017. 61 were men (56.5 ± 4.8%), and 47 – women
(43.5 ± 4.8%). A control group included 20 individu-
als without lower respiratory diseases (men – 13 (65
± 10.7%), women – 7 (35 ± 10.7%). All patients in
the study group had recurrent bronchitis (ICD-10:
J.40 - bronchitis is not specified as acute or chronic),
with 3-4 episodes within the previous 6 months. The
duration of the disease was 0.5 to 2 years, which was
manifested by repeated cough, sometimes with spu-
tum, increase in div temperature 37.5 ºС - 39.2 ºС,
difficulty breathing. Chest X-ray was performed in all
patients for differential diagnosis. In all patients,
bronchoalveolar lavage was taken during the bron-
choscopy procedure at the endoscopic department of
the Kyiv City Clinical Hospital No. 17 and the Kyiv
Regional Clinical Hospital.
The material was taken from patients during
antibiotic therapy, which took into account a number
of antibiotics and the timing of administration. The
obtained material was placed in a sterile container
and was transported to the bacteriological laboratory
Evolution of bronchitis in young patients from the point of view of instrumental and bacterial ...
144 2017, №4 (97) Проблемы биологии и медицины
of the "Ukrainian Center for Control and Monitoring
of the Ministry of Health of Ukraine" for up to 2
hours. After the material was delivered to the labora-
tory, a microbiological study was started. Broncho-
alveolar lavage (BAL) 0.1 ml was placed on a blood
agar (BA), chocolate agar (CHOC), Endo medium,
yellow-salt agar (YSA), Enterococcus Selective Agar,
Saburo agar. In addition, the BAL was diluted from
10
-1
to 10
-8
, and 1 ml of this solution was seeded in a
medium for bifidobacteria and lactobacilli.
Cultures on blood agar, chocolate agar and En-
do medium were incubated at t
0
37
0
С during 24
hours, at yellow-salt agar - at 37
0
С during 48 hours,
on Saburo agar - at 24
0
С during 5 days, and on the
medium for bifidobacteria and lactobacilli - at 37
0
С
during 72 hours. We also made a series of dilutions of
feces from 10
-1
to 10
-8
. The resulted suspensions were
sown on nutrient medium in the following order: 0.1
ml at 10
-1
- Endo medium, Ploskirev and Selenite
broth, 10
-3
- Endo medium, yellow-salt agar, Entero-
coccus Selective Agar, Saburo agar, Simon's medi-
um, blood agar 1 ml at 10
-6
, 10
-7
, 10
-8
- medium for
bifido- and lactobacillus. Sowings from Endo medi-
um, Ploskirev, Selenite broth and bifidobacterium
and lactobacillus medium were incubated at 37
0
С
during 24 h on yellow-salt agar, Enterococcus Selec-
tive Agar, Simon medium at 37
0
С during 48 hours,
in medium for bifidobacteria and lactobacilli at 37°C
during 72 h, Saburo agar - at 24
0
С during 5 days.
Sowing from Selenite broth was placed on bismuth-
sulfite agar and incubated at 37
0
С during 48 hours.
All sowings from bronchoalveolar lavage and
feces were reviewed, colonies of every kind of spe-
cies were counted and identified by studying their
morphological, cultural, tincture and biochemical
properties. All nutrient mediums, both for primary
sowing and for the identification of microorganisms,
were developed by "Pharmactiv" Ltd. (Kyiv,
Ukraine). 20 young patients with clinical and bron-
choscopic diagnosis of foreign bodies of the respira-
tory organs, without underlying respiratory diseases,
who had not received antibiotic therapy within the
previous 12 months, were selected as a control group.
We considered these individuals having a healthy
microflora of the respiratory tract. Depending on the
presence or absence of lactobacilli bacteria and
bifidobacteria, all examined patients with recurrent
bronchitis were divided into 3 groups.
The results were processed using the Microsoft
Exel® and STATISTICA for Windows 7.0. For each
parameter, the mean (M) and its standard deviation
(SD) were calculated and the results were expressed
as M ± SD. To determine the presence of a statistical-
ly significant relationship with the risk factor, the
Pearson's chi-squared test (χ2) and the odds ratio
(OR) were used when the groups of the subjects were
compared by the frequency of the risk factor.
Results and discussion.
To achieve this goal
for differential diagnosis, the difference between the
radiographic imaging in the control group (virtually
healthy people) and in patients with recurrent bron-
chitis (3-4 episodes within the previous 6 months)
was estimated using the chest X-ray. Acute bronchitis
and recurrent bronchitis, which is not repeated once,
cannot be identified using direct radiographic signs,
because X-rays pass through the structure of the
bronchial tree. Indirect signs, such as "air bron-
chogram" may be more helpful for this purpose. This
sign depicts the indistinct contours of the lung roots
due to the tissue swelling, which makes it impossible
to confirm the progression of the disease. Examples
of the corresponding X-rays are shown in Fig.1 for
comparison. The moment of the bronchitis evolution
cannot be visualized on the X-rays. The difference
between a normal chest X-ray and an X-ray with re-
current bronchitis is absent in contrast to chronic
bronchitis, where the X-ray shows the enlarged pul-
monary texture, accompanied by the "pair strips" and
"air bronchogram" signs. At that time, during the en-
doscopic examination, the moment of bronchitis evo-
lution was evident (Fig. 2).
a) Normal
b) Recurrent bronchitis
c) Chronic bronchitis
Fig. 1.
Examples of X-rays
Orijana Tysh, Larysa Matiukha, Anatoly Sergienko
Биология ва тиббиёт муаммолари 2017, №4 (97) 145
a) Normal image
b) Recurrent bronchitis
c) Chronic bronchitis
Fig. 2.
Examples of bronchoscopic images
Here the difference between the normal picture
and recurrent bronchitis is sufficient to be visualized
and for the diagnosis. In a case of recurrent bronchi-
tis, a vascular picture is enlarged, a small amount of
mucus is present, unlike the healthy bronchial muco-
sa, and in contrast to the chronic bronchitis, mucosal
edema and the overproduction of thick bronchial se-
cret. We did not find literature data on the qualitative
or quantitative content of lactobacilli bacteria and
bifidobacteria in the bronchi of helathy indidviduals.
Therefore, we created the control group of young
people who did not have lower respiratory tract dis-
eases and did not take antibiotic therapy for any rea-
son within 1 last year, but who have been clinically
and endoscopically diagnosed with a foreign div of
the respiratory tract. We considered this group
healthy in terms of the presence of the bronchial bio-
tope which is characterized by the physiological pa-
rameters of normal flora. We have determined that
lactobacilli and bifidobacteria were found in 100% of
cases in dilutions of 10
-5
, 10
-6
, 10
-7
, 10
-8
. The fact that
normal flora is present in all examined indidviduals
from the group of comparison makes it possible to
suggest its importance in the formation of the homeo-
stasis of the organism. This group can not be regard-
ed as a control group, because the subjects did not
take antibiotics as a risk factor. In exsperts opinion,
there is no practical possibility of determining the
single standard for the composition of microbiota [7].
Therefore, we focused our attention on the generali-
zation of features for the studied groups rather than
the individual content of the biotope. Considering
this, we pointed out the fact that in groups where lac-
tobacilli or bifidobacteria were present apart or to-
gether, the diversity of the bronchial biota was wider.
In addition to lactobacilli bacteria and bifidobacteria,
one to three different bacterias, mushrooms (S. sali-
varius, S. mitis, S.virida, S. faecalis, S. pneumoniae,
S.haemolyticus, S.aureus, S. aeruginosa, Penicillium
spp, H. parainfluenzae, Escherichia coli) in various
chaotic combinations in terms of qualitative and
quantitative composition. In the absence of lactoba-
cilli bacteria and bifidobacteria, only one or two types
of bacteria (S. salivarius, S. mitis, Escherichia coli)
were present, indicating the "poverty" of the bron-
chial biota and a favorable basis for the progression
of the lower respiratory tract infection in the future,
chronicity the process. In faeces in this group lacto-
bacilli bacteria and bifidobacteria from 10
-3
до 10
-7
were found, pathogenic enterobacteria were not de-
tected. Total number of E. coli from 10
-4
до 10
-8
, E.
coli with poorly expressed enzymatic properties to
11%, hemolytic E. coli to 10
-4
, conditionally patho-
genic enterobacteria to 10
-3
,
pathogenic Staphylococ-
cus aureus
to 10
-3
, Candida mushrooms to 10
-3
. These
data reflect the higher stability of the intestinal nor-
mal flora than bronchial tubes to antibiotic therapy.
With the anamnestic and clinical data we have identi-
fied a group of patients with bronchitis, which was
repeated within the previous 6 months 3-4 times.
These patients were further divided into 3 groups,
depending on the complete or incomplete presence or
absence of lactobacilli bacteria and bifidobacteria in
the bronchoalveolar lavage. (See Fig. 3).
Fig. 3.
Evolution of bronchitis in young patients from the point of view of instrumental and bacterial ...
146 2017, №4 (97) Проблемы биологии и медицины
Table 1.
Distribution of patients depending on antibiotic therapy. Patients received semi-synthetic penicillins, cephalo-
sporins III generation, macrolides from 5 days to 19 days in different combinations
Antibiotic therapy
within the last 6
months
The first group (control)
(lactobacilli bacteria and
bifidobacteria are found)
The second group (either lac-
tobacilli bacteria or bifidobac-
teria are found)
The third group
(lactobacilli bacteria
and bifidobacteria are
not found)
abs.
%±∆%
abs.
%±∆%
abs.
%±∆%
Absent
42
52,5±5,6
5
27,8±10,6°
2
20,0± 12,6*
Present
38
47,5±5,6
13
72,2±10,6°
8
80,0± 12,6*
Notes: * - statistically significant difference between the indicator in group 3 compared with the control group
1 (р
0,05).
- not statistically significant difference between the indicators in group 2 compared with the control group 1
(р
0,06).
The highest proportion of patients was includ-
ed in the group I (control, because it was this group
was close to the indicators of the comparative healthy
group), where in bronchoalveolar lavage lactobacilli
bacteria and bifidobacteria were detected - 80 ((74,1
± 4,2)%) persons. The group II 18 ((16,6 ± 3,6)%)
was inspected, in which only lactobacilli bacteria
were detected in bronchoalveolar lavage, or
bifidobacteria. The group III - those in which in
bronchoalveolar lavage wasn’t detected no lactobacil-
li bacteria no bifidobacteria - 10 ((9,3 ± 2,8)%) of the
examined. Subsequently, the data of the groups were
analyzed depending on the presence or absence of
antibiotic therapy during the previous 6 months. The
data is given in Table 1.
According to the obtained data, the group I pa-
tients who did not use antibiotic therapy within the
previous 6 months was 42 ((52,5 ± 5,6)%) individuals
and 38 ((47,5 ± 5,6)%) individuals, where bronchos-
copy was performed after or during antibiotic thera-
py. Among the surveyed group II, it was found that
they did not use antibiotic therapy during the previ-
ous 6 months in 5 ((27.8 ± 10.6)%) patients, and 13
((72.2 ± 10.6)%) - received antibiotic therapy during
the previous 6 months. In group ІІI it was found that
they did not take antibiotic therapy 2 ((20,0 ±
12,6)%) patients and 8 ((80,0 ± 12,6)%) - patients
took it within the previous 6 months.
Based on the acquired data 80% of patients
from the group III (no lactobacilli bacteria and
bifidobacteria), who received antibiotics, demonstrat-
ed chages in bronchial microbiocenosis, which were
statistically different (р
0,05) from the parameters of
the microbiocenosis in the group I (control), where
antibiotics were administered in 47,5%. In the pa-
tients from the group II, where antibiotic therapy was
used in 72,2% of patients, either lacto- or bifidobacte-
ria were found. However these changes were not sig-
nificantly different (p
0,06) from the parameters of
the group I, which may indicate the incompleteness
of negative changes in the bronchial microbiocenosis.
These data were considered by us when calcu-
lating the odds ratio (OR) - for qualitative indicators.
Relative Risk (RR), according to our data, was
2.49 with a 95% confidence interval of 1.16 to 5.37.
The fact that the relative risk value obtained is not
equal to 1 (one) proves that this is a real property of
the population under study, and not an accidental
fluctuation due to our sample. Since 1 is not included
in the confidence interval and the relative risk value
is statistically significantly different from 1, we can
assert (with a probability of error less than 5%) that
the use of antibiotic therapy statistically significantly
increases the frequency of changes in the microflora
of the bronchial tubes in recurrent bronchitis by 2.49
times.
Comparing the groups with the frequency of
detection of risk factors by two methods, the criterion
χ2 (Pearson's chi-squared test) and the odds ratio
(OR), confirmed that with the adoption of antibiotic
therapy, there was a significant decrease in the pres-
ence of lactobacilli bacteria and bifidobacteria in
bronchoalveolar lavage. These data suggest that we
consider the prevention normal microbiocenosis of
bronchial tubes and may restore or preserve it by us-
ing probiotics in the complex treatment of recurrent
bronchitis.
Conclusions.
1. Based on the acquired data we
found lactobacilli bacteria and bifidobacteria in bron-
choalveolar lavage in
100% of examined individuals,
who had no prior lower respiratory tract diseases
. 2.
Antibiotic therapy significantly increases the fre-
quency of microflora changes in the case of recurrent
bronchitis 2,49 times. 3.
Broncial microbiocenosis is
more sensitive to antibiotic therapy than the intestinal
microbiocenosis.
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ЭВОЛЮЦИЯ БРОНХИТА У МОЛОДЫХ
ПАЦИЕНТОВ С ТОЧКИ ЗРЕНИЯ МЕТОДОВ
ИНСТРУМЕНТАЛЬНОГО И
БАКТЕРИАЛЬНОГО ИССЛЕДОВАНИЯ
ОРИДЖАНА ТЫШ, ЛАРИСА МАТИУХА,
АНАТОЛИЙ СЕРГИЕНКО*
Отделение семейной медицины и амбулаторного
лечения Национальной медицинской академии
последипломного образования имени Шупика;
*Киевская городская клиническая больница № 17
Мы исследовали 128 пациентов в возрасте
от 18 до 35 лет. Для сравнения в качестве отдель-
ной группы были выбраны 20 валантеров без
предшествующих заболеваний нижних дыхатель-
ных путей. У них было инородное тело дыхатель-
ных путей и они подверглись бронхоскопии с
бронхоальвеолярным лаважем для бактериологи-
ческого анализа. У 108 пациентов был диагности-
рован рецидивирующий бронхит (ICD-10 J.40).
Эти пациенты были дополнительно разделены на
3 группы. Мы также провели дополнительный
бактериологический анализ фекалий, чтобы опре-
делить взаимосвязь между изменениями бронхи-
ального микробиоценоза под влиянием антибак-
териальной терапии по сравнению с изменениями
в биоценозе кишечника. 80% пациентов из III
группы (без бактерий лактобацилл и бифидобак-
терий), которые получали антибиотики, проде-
монстрировали главное в бронхиальном микро-
биоценозе, которые были статистически различны
(р
0,05) по параметрам микробиоценоза в группе
I (контроль), где антибиотики вводились в 47,5%.
У пациентов из II группы, где антибиотикотера-
пия использовалась у 72,2% пациентов, были об-
наружены либо лакто-, либо бифидобактерии.
Однако эти изменения не были существенно раз-
личны (p
0,06) по параметрам I группы, что мо-
жет указывать на неполноту отрицательных изме-
нений в бронхиальном микробиоценозе. Основы-
ваясь на полученных данных, мы обнаружили
бактерии лактобацилл и бифидобактерии в брон-
хоальвеолярном лаваже у 100% обследованных
лиц, у которых не было предшествующих заболе-
ваний нижних дыхательных путей.
Ключевые слова:
микробиоценоз, бронхит,
бактерии лактобацилл, бифидобактерии, брон-
хоальвеолярный лаваж.
