Hypoallergenic diet may control refractory epilepsy in allergic children: A quasi experimental study.

Recent data has suggested a definitive role for inflammatory processes in the pathophysiology of epilepsy. In this study we hypothesized that food allergies, as chronic inflammatory processes, underlie the pathophysiology of refractory idiopathic epilepsy and investigated whether food elimination diets may assist in managing refractory epilepsy. The study was conducted on 34 patients up to 16 years of age with refractory convulsions who attended the Allergy Outpatient Clinic, Mofid Children Hospital between 2015 and 2016 with youngest and oldest participants at ages of 3 months and 16 years old, respectively. The participants were categorized into three groups according to the results of skin prick test and serum specific IgE measurements. Elimination diets were instituted for the patients with non IgE-mediated and mixed food allergies. The study was conducted for a period of 12 weeks. The participants were assessed for at least 50% reduction in number of seizures following the intervention. There was a significant reduction in number of seizures (p < 0.001) following the intervention. Seventeen patients (50%) did not experience any seizures after 8 weeks of treatment and 12 patients (35%) had a significant (51-99%) decrease in the number of their seizures. Five patients did not show any changes in their daily seizure frequency. The obtained data suggest that food allergy may play a role in triggering refractory epilepsies and their adequate response to treatment. A trial of elimination diet showed more than 50% seizure reduction in more than 85% of the children studied. However, we believe these results are preliminary and they motivate a fully controlled study in the future.

The epidemiology of chlamydial infections in childhood: a serological investigation.

Blood samples from 382 children between the ages of one and 15 years were tested for anti-chlamydial antibody. A low prevalence of antibody against Chlamydia trachomatis was found among children under the age of seven years. Antibody against the Chlamydial agent C IOL-207 was rare before the age of five years, but was found with increasing prevalence in older children. It is suggested that the mode of transmission of the two agents is different and that C IOL-207 may be transmitted at school.

Conjunctival impression cytology.

A new technique is presented using impression of the conjunctiva with a plastic device to study the conjunctival response in various conjunctival disease states. When used with a rapid acting stain the impression technique proved to be accurate, reproducible, and nondestructive when compared to the standard spatula scraping of the conjunctiva using Giemsa stain.

Indirect micro-immunofluorescence test for detecting type-specific antibodies to herpes simplex virus.

A rapid indirect micro-immunofluorescence test capable of detecting and differentiating type-specific antibodies to herpes simplex virus is described. The test proved highly sensitive and, in 80 patients with active herpes ocular infection, antibody was detected in 94%. No anti-herpes antibody was detected in a control group of 20 patients with adenovirus infections. Testing of animal sera prepared against herpes simplex virus types 1 and 2 and of human sera from cases of ocular and genital herpes infections showed that the test can differentiate antibodies to the infecting serotypes. Specimens of whole blood, taken by fingerprick, and eye secretions, both collected on cellulose sponges, could be tested by indirect micro-immunofluorescence. Anti-herpes IgG, IgM, and IgA can also be detected.

A rapid method for staining inclusions of Chlamydia psittaci and Chlamydia trachomatis.

A new staining method was developed for the detection of inclusions of Chlamydia psittaci and Chlamydia trachomatis inclusions in cell cultures. Using a combination of methyl green and neutral red stains and washing at pH 5.0, inclusions were stained red while cell cytoplasm was pale pink and cell nuclei were pale green. The method was significantly better than Giemsa staining and comparable to immunofluorescence for detecting C psittaci inclusions. Its sensitivity for detection C trachomatis inclusions by dark field microscopy was similar to that of Giemsa staining.

Modification of the microimmunofluorescence test to provide a routine serodiagnostic test for chlamydial infection.

A modification of the microimmunofluorescence test to provide a practicable routine serodiagnostic test for detecting and characterising chlamydial infection is described which uses four antigen pools, one of which corresponds with each of the four main clinical and epidemiological types of chlamydial infection. The three subgroup A Chlamydia (Chlamydia trachomatis) pools are: pool 1, hyperendemic trachoma TRIC agent serotypes A, B, and C; pool 2, paratrachoma TRIC agent serotypes D, E, F, G, H, I, and K; pool 3, lymphogranuloma venereum (LGV) agent serotypes L1, L2, and L3. Pool 4 contained four representative isolates of subgroup B Chlamydia (Chlamydia psittaci). For routine purposes sera need be screened only against these four representative antigen pools. This will detect antibody and indicate which clinical and epidemiological type of chlamydial infection is implicated, thereby clearly distinguishing those infections that are due to C. psittaci. The pattern of the cross-reactions may indicate the individual serotype involved, and further titration requiring a maximum of four individual antigens is sufficient to determine the serotype. The slight loss in sensitivity (twofold) is more than compensated for by the reduction in cost and the tenfold increase in the total number of sera which can be examined.

Sensitivity of immunoperoxidase and immunofluorescence staining for detecting chlamydia in conjunctival scrapings and in cell culture.

The sensitivities of Giemsa, immunofluorescence, and immunoperoxidase staining for the detection of Chlamydia psittaci inclusions in conjunctival scrapings and in irradiated McCoy cell monolayers were compared. Conjunctival specimens were obtained from a cat colony in which a trachoma-like disease, feline chlamydial keratoconjunctivitis, was endemic. The two immunochemical techniques were found to be of equal sensitivity and 50% to 100% more sensitive than Giemsa stain. Permanent preparations of immunoperoxidase stained material can be made and can be read using a simple light microscope. These features make the technique more useful than immunofluorescence staining, which gives temporary preparations that must be examined with a specialised fluorescence microscope.

Comparison of the sensitivity of human embryo kidney cells, HeLa cells, and WI38 cells for the primary isolation of viruses from the eye.

A comparison has been made of the efficiency of human embryo kidney (HEK) cills, HeLa cells, and WI38 cells for the isolation of viruses from the eyes of patients suffering from acute conjunctivitis or keratoconjunctivitis. From a total of 99 specimens 21 adenoviruses (serotypes 3, 4, 7, 8, and 13) were isolated in HEK cells, eight (serotypes 3 and 8) in HeLa cells, and four (serotype 3) in WI38 cells. Of the ten herpes simplex viruses isolated nine were recovered in HEK cells, seven in WI38 cells, and none in HeLa cells. The combination of HeLa cells and WI38 cells is not considered an adequate alternative to the difficult-to-obtain HEK cells for the isolation of viruses from the eye.

Evidence of chlamydial infection in infertile women with and without fallopian tube obstruction.

This study investigates the prevalence of Chlamydia trachomatis antibodies in 164 infertile women who underwent diagnostic laparoscopy and dye insufflation as part of routine infertility investigations. C. trachomatis antibodies were found in 36 (22%) of 164 infertile women, which was significantly more than the prevalence of antibodies in a control group (22 of 200, 11%). C. trachomatis antibodies were found in 25 (35.7%) of 70 infertile women who had laparoscopically verified peripheral tubal disease. This was significantly more than the prevalence of C. trachomatis antibodies in infertile women with normal fallopian tubes (6 of 52, 11.5%). The prevalence of C. trachomatis antibodies in infertile patients with laparoscopically verified cornual disease was similar to those without cornual disease. C. trachomatis was not isolated from any of the patients studied. This study confirms that past chlamydial salpingitis is associated with the development of peripheral fallopian tube obstruction with resultant infertility.

Causes of conjunctivitis and keratoconjunctivitis in Karachi, Pakistan.

The causes of conjunctivitis and keratoconjunctivitis in 388 patients who attended eye casualty departments in Karachi, Pakistan, during a 5 month period were investigated. Most of these infections were diagnosed as adenovirus (291, 75%) or bacterial (71, 18.3%). Of the remainder, 9 cases (2.3%) were caused by herpes simplex virus and 7 (1.8%) by Chalmydia trachomatis. There was no evidence of typical active trachoma in this urban population. Bacteria or Candida albicans were also grown from 44 of the adenovirus cases (15%). Many of the bacteria grown from eyes in this study were resistant to antibiotics, probably because of inadequate and/or inappropriate self-medication with antibiotics in this community.

Acute conjunctivitis caused by an atypical chlamydial strain: Chlamydia IOL 207.

A case of acute conjunctivitis in man caused by Chlamydia IOL 207 is described. Chlamydiae were isolated from the eye, and rising titres of type-specific antibodies to C. IOL 207, in serum and tears demonstrated an aetiological role for this agent. C. IOL 207 is an atypical chlamydial strain which serological studies suggest is widespread in some communities.

Transmission of chlamydiae by the housefly.

The ability of the housefly to carry viable Chlamydia trachomatis and to transmit a chlamydial ocular infection was studied under laboratory conditions. After feeding flies (Musca domestica) on suspensions of egg yolk sac infected with C. trachomatis serotypes A or B (responsible for hyperendemic trachoma) the agents were reisolated from flies' intestines for up to 6 hours and from their legs and/or proboscises for up to 2 hours. It was found that the viability of chlamydiae is dependent on the protective effect of yolk concentration in the original inoculum. Results of experiments with guinea-pig inclusion conjunctivitis as an animal model show that under laboratory conditions flies can readily transmit this chlamydial ocular infection from one animal to another. These results suggest that under field conditions flies can play an important role in the transmission of trachoma, particularly in areas with favourable conditions such as a large reservoir of infection among children with severe trachoma, copious eye discharge caused by trachoma and associated bacterial infections, a large fly population, and close proximity of children in large family groups.

Marginal corneal abscess associated with adult chlamydial ophthalmia.

In four patients with an adult chlamydial ophthalmia small, marginal corneal abscesses were detected. These corneal abscesses were associated with unilateral papillary and follicular conjunctivitis and punctate keratitis. In these patients no bacteria was isolated from the abscesses, but Chlamydia trachomatis was isolated from materials collected from the abscesses and from the conjunctival swabbings. In addition all patients had microbiologically proved concomitant chlamydial genital infections. The clinical signs resolved after topical treatment with rifampicin or tetracycline eye ointment for six weeks or systemic treatment with tetracycline for two weeks. Because of concomitant chlamydial genital infection it is advisable to treat patients with adult chlamydial ophthalmia with systemic tetracycline and to refer these patients and their consorts for investigation and treatment of their genital infection.

A rapid and sensitive culture test for detecting herpes simplex virus from the eye.

A rapid and sensitive culture test has been developed for detecting herpes simplex virus (HSV) in ocular infections. The virus is cultured by inoculation and centrifugation of cell monolayers grown on coverslips and the inclusions detected by an indirect immunofluorescence technique. This rapid test takes only two days to complete. By comparison, in our hands the conventional culture test, which depends on the development of cytopathic effect, took between 1 and 20 days with a mean of 4.7 days. Of the 1638 ocular clinical specimens inoculated in parallel by the two methods a total of 188 were positive for HSV. The virus was detected from 184 (97.8%) specimens by the rapid test and from 144 (76.6%) by the conventional test (McNemar's test, U = 5.76, p less than 0.001).

Recurrent herpes simplex virus ocular infection: epidemiological and clinical features.

The epidemiological and clinical features of recurrent herpes simplex virus ocular infection (RHSV) were studied. Of 108 patients with primary herpes simplex virus ocular infection (PHSV) who were followed up for two to 15 years 35 (32%) suffered one or more recurrent attacks. The recurrence rate was significantly higher in patients under 20 years of age, but there was no significant difference between recurrence rates in males and females. Of 35 patients with RHSV 17 (49%) had one recurrent attack, 14 (40%) had between two and five, and four (11%) had between six and 15 attacks. The mean time interval between PHSV and the first four RHSV attacks was 10 months, and was shorter in subsequent attacks. The duration and severity of RHSV were reduced in successive recurrences. Patients with more severe conjunctivitis and lid lesions during PHSV ocular infection had a higher incidence of recurrent infection. The severity of the corneal signs in PHSV had no influence on the incidence of recurrent infection. Several clinical forms of RHSV were observed. Conjunctivitis associated with lid lesions was observed in 29 (83%) patients. In six (17%) patients the disease presented as an acute follicular conjunctivitis without characteristic lid or corneal lesions. Dendritic ulcer was found in three (9%) patients, and in one of them it was associated with a disciform keratitis. A chronic blepharoconjunctivitis developed in eight (23%) patients. The epidemiological and clinical features of RHSV were compared with those of PHSV.

Responses to tuberculin in the guinea-pig eye as a model of cell mediated immune responses in the external eye.

The clinical and histological findings in an animal model of ocular cell mediated immune responses are described. These were evoked in sensitised guinea-pigs by dropping tuberculin into the conjunctival sac or injecting it under the palpebral conjunctiva. When tuberculin was dropped into the conjunctival sac, higher doses were required to evoke a strong response than when it was injected subconjunctivally. When high doses of antigen were used for challenge, a mild response was observed in unchallenged contralateral eyes. The cellular response at low doses of tuberculin consisted predominantly of mononuclear cells. At higher doses the cellular infiltrate was more pronounced, and polymorphonuclear cells tended to predominate 24 hours after challenge, while at 48 hours mononuclear cells predominated.

Unusual features in the conjunctiva and cornea of the normal guinea-pig: clinical and histological studies.

Clinical and histological studies of the outer eyes of newborn and adult female guinea-pigs were carried out together with histological studies of fetal eyes. Fine superficial corneal vessels, extending from the limbus, were seen in most newborn and adult eyes and were also present in histological preparations of fetal eyes. These vessels were therefore considered to be features of the normal guinea-pig eye. Masses of tissue composed of lymphoid cells, which were often organised into germinal centres, were found in the fornices of newborn and adult eyes. Smaller accumulations of lymphoid cells were found in fetal eyes, and this lymphoid tissue was therefore also considered to be a normal feature of the guinea-pig eye. In adult eyes mild but short-lived oedema or hyperaemia of the palpebral conjunctiva was quite common. There were no differences in the amounts of conjunctival cellular infiltration in these eyes c found in fetal eyes, and this lymphoid tissue was therefore also considered to be a normal feature of the guinea-pig eye. In adult eyes mild but short-lived oedema or hyperaemia of the palpebral conjunctiva was quite common. There were no differences in the amounts of conjunctival cellular infiltration in these eyes c found in fetal eyes, and this lymphoid tissue was therefore also considered to be a normal feature of the guinea-pig eye. In adult eyes mild but short-lived oedema or hyperaemia of the palpebral conjunctiva was quite common. There were no differences in the amounts of conjunctival cellular infiltration in these eyes compared with normal eyes, and these inflammatory changes were therefore not considered to be significant.

Value and cost effectiveness of double culture tests for diagnosis of ocular viral and chlamydial infections.

Swabbings from the eyes of 4132 patients attending ophthalmic casualty and outpatients clinics were tested for chlamydiae, adenovirus, and herpes simplex virus. Laboratory isolation tests gave positive results for one of these three agents in 696 (16.8%) cases. When a positive isolation was obtained, only 341 (49%) agreed with the clinical diagnosis while 355 (51%) either had no definite diagnosis marked on the request card or had been clinically diagnosed incorrectly. Routine testing of ocular specimens for all likely organisms can enable the correct treatment to be started sooner than doing one test at each visit, thereby reducing the number of times the patient has to visit the clinic and the expenses involved.

Oral doxycycline in the treatment of adult chlamydial ophthalmia.

Ninety-three consecutive patients with adult chlamydial ophthalmia were treated with four different regimens of oral doxycycline. In patients treated with a single dose of 5 mg/kg of body weight (300 mg) of doxycycline the severity of clinical signs was reduced, and in half of the patients shedding of the infective agent was stopped. Treatment with a weekly dose of 300 mg of doxycycline for three weeks or a daily dose of 1.5 mg/kg of body weight (100 mg) for one week produced a clinical and microbiological cure in 100% of patients. However, in some of these patients mild to moderate papillary responses were present up to six months from completion of the treatment. The best results were obtained with a daily dose of 100 mg for two weeks, which produced rapid clinical and microbiological cure in all patients.

Epidemiological and clinical features of primary herpes simplex virus ocular infection.

The epidemiological and clinical features of primary herpes simplex virus ocular infection in 108 patients were studied. Of these, 69 (64%) were aged 15 or over and only eight (7%) were under the age of 5. Associated upper respiratory tract infection was found in 38 (35%) patients and systemic disorders such as mild malaise, fever, and aching in 34 (31%) patients. Common symptoms were redness, watering, discharge, itching, irritation, and lid swelling, whereas pain, photophobia, lid vesicles and ulcers, and blurred vision were less frequent. The major signs consisted of vesicles and ulcers on the lids, papillary responses which were more severe in the upper lid conjunctiva, follicles which were more common in the lower lid conjunctiva, fine and coarse epithelial punctate keratitis, and subepithelial punctate keratitis. Dendritic ulcers and disciform keratitis were found in 16 (15%) and two (2%) patients respectively. The clinical forms of primary herpes simplex virus ocular infection varied. Moderate or severe disease was observed in 41 (38%) and 16 (15%) patients respectively. In eight (7%) patients the disease presented as an acute follicular conjunctivitis without characteristic lid or corneal lesions. A chronic blepharoconjunctivitis which lasted for months developed in 16 (15%) patients. The epidemiological and clinical features in our patients were compared with features of the disease reported previously.