Role of enteric adenoviruses and rotaviruses in mild and severe acute enteritis.

The role of enteric-type adenoviruses and rotaviruses in mild and severe acute gastroenteritis was investigated among children younger than 5 years of age seeking treatment at an urban hospital (UH) and at a rural health center (RHC) in India. There were 330 children at the UH and 340 at the RHC; 319 and 315 age matched nondiarrheal children served as controls for the respective groups. Rotavirus was detected in 15.2% of 330 cases and 1.9% of 319 controls at the UH (P less than 0.001) and in 16.5% of 340 cases and 2.9% of 315 controls at the RHC (P less than 0.001). RV excretion was 3- to 5-fold more common in severe compared with mild diarrhea at the UH and at the RHC (P less than 0.001). The detection rate for enteric-type adenoviruses was similar in patients and controls, respectively, at the UH (0.9%; 2.5%) and RHC (3.8%; 2.5%). At the RHC adenovirus types other than 40 and 41 were excreted by 8.8% of the patients and by only 1.0% of the controls (P less than 0.001). It is possible that the diarrheagenic role of adenoviruses may not be restricted to types 40 and 41.

Deep Candida infection in children receiving allogeneic bone marrow transplants: incidence, risk factors and diagnosis.

Fifty-eight children, who received 60 allogeneic bone marrow transplants (BMT), were studied with regard to incidence, risk factors and diagnosis of deep Candida infection (DCI). Serum samples were analysed for the presence of Candida IgA, IgM and IgG antibodies and free C. albicans glucoprotein antigen (Ag). Five children (8.7%) had a confirmed DCI and died before engraftment of the new bone marrow. When four patients with suspected deep Candida infection (SDCI) were included, the incidence was 15.6%. Four of the five children (80%) with DCI had pathological Candida IgM antibody (Ab) titers and/or free C. albicans glucoprotein Ag, 2-50 days before DCI was verified by culture, direct microscopy and/or autopsy. Risk factors, using Fisher's exact test for DCI, included not receiving bone marrow from an HLA-identical sibling donor, having a seropositive Herpes simplex virus (HSV) donor and pathological IgA and/or IgM Ab titers against Candida before BMT. In conclusion, a child with the above-mentioned risk factors, runs a risk of acquiring fatal DCI before engraftment. The institution of systemic antifungal prophylactic treatment may prevent death from DCI. After BMT, serological examinations may be of value in the early detection of DCI.

Cow's milk allergy, incidence and pathogenetic role of early exposure to cow's milk formula.

A study was performed in infants under the age of 12 months born during 1974 and admitted to St. Göran's Children's Hospital with symptoms suggestive of cow's milk allergy (CMA). The aims of the study were to determine the role of early exposure to cow's milk formulas as a predisposing factor to CMA and to estimate the incidence of CMA in infancy. Twenty-five infants fulfilled the criteria for CMA. Available records were reviewed and a careful history was obtained from the mothers on two occasions. The patient group was compared with a control group. Sixteen of the 25 infants were exposed to cow's milk protein during their first week in the nursery for newborns, 6 were exposed before the end of the fourth week of life, and 3 infants were apparently not exposed. All infants were breast fed 3 to 26 weeks before re-exposure and occurrence of symptoms. Infants with CMA were given cow's milk formulas during their first 4 weeks of life significantly more often than infants in the control group (p less than 0.01). The incidence of CMA was approximately 1 : 200. The first 4 weeks after birth seem to be a particularly vulnerable period. Hence, in order to prevent CMA, infant formula should not be given--even occasionally--during this period.

Colonization of the upper jejunum by enteropathogenic and enterotoxigenic Escherichia coli in paediatric diarrhoea.

Aspirated fluid from the upper jejunum was obtained by intubation of 27 children with diarrhoea and 7 control children without diarrhoea. The aspirated jejunal fluid was analysed for total counts of viable aerobic and anaerobic microorganisms. Gram-negative aerobic bacteria were typed biochemically and analysed for the production of heat-labile and heat-stable enterotoxin. Enteropathogenic Escherichia coli (EPEC) strains of serogroups 0111, 055 and 0127 were detected in the stools of nine patients and the respective strains concomitantly in the upper jejunum (10(3)-10(8) bact/ml) in 7 patients with diarrhoea. In 6 patients from whom isolates of enterotoxigenic E. coli (ETEC) were obtained, there were high total viable counts of non-enterotoxigenic bacteria in the upper jejunum and ETEC were recovered from this location in 3 cases. Enterotoxigenic Klebsiella was recovered from faeces but not from upper jejunum in one case. Compared to the controls, the total number of bacteria in the upper jejunum were 100-1000 times higher in patients with enteropathogenic E. coli (EPEC) or enterotoxigenic E. coli (ETEC). In another 11 cases with diarrhoea caused by Shigella, rotavirus or of unknown aetiology, the total viable counts of bacteria were similar to those of the controls. Five patients with severe EPEC diarrhoea received antibodies for 5 days. The patients improved clinically, and the EPEC strain had disappeared from the upper jejunum when they were reexamined. In conclusion, in EPEC diarrhoea a colonization of the upper jejunum by the causative organism seemed to take place, while in ETEC diarrhoea, there appeared to be a nonspecific contamination by enteric bacteria.

Susceptibility to mecillinam and other antibiotics and serogroups of enterotoxigenic Escherichia coli from children in Addis Ababa.

The in-vitro susceptibility of 64 strains of enterotoxigenic Escherichia coli (ETEC) was determined for eight antimicrobial agents. The strains were of 27 different O-serogroups of which 078 was the most common. All strains were susceptible to mecillinam, cefoxitin, gentamicin, and trimethoprim-sulphamethoxazole. Two strains were resistant to ampicillin, 15 to doxycycline, 5 to cephalothin, and 13 to chloramphenicol. No difference was found in the antibiotic susceptibility of ETEC strains producing only heat-labile enterotoxin compared with those producing both heat-labile and heat-stable enterotoxin.

Deep Candida infection in children with leukaemia: clinical presentations, diagnosis and outcome.

OBJECTIVES: To analyse the clinical features associated with deep Candida infection (DCI) and the outcome in children with leukaemia, and to evaluate various diagnostic methods. MATERIALS AND METHODS: Serum samples were analysed to determine Candida IgA, IgM and IgG antibodies and defect free C. albicans glucoprotein antigen and C. enolase antigen in eight children who had nine episodes of DCI and six with suspected DCI. RESULTS: DCI occurred shortly after the leukaemia diagnosis (median 40 days) or after the leukaemia relapse (median 30 days). Children with DCI had fever (100%), skin lesions/exanthema (45%), oral thrush (45%), oesophagitis (22%) and laryngo-tracheitis (22%). Candida endocarditis, arthritis and hepatic candidosis were diagnosed in one patient each. Two children with disseminated candidosis died in leukaemia relapse. In patients with C. albicans infections serology had a sensitivity of 83%. However, in patients with C. parapsilosis infection antibody detection was negative. As the patients were cured of their Candida infection, the IgG antibodies disappeared and the IgM and IgA antibodies fell within the normal range for age. CONCLUSION: DCI in children occurs shortly after the leukaemia diagnosis or shortly after relapse of leukaemia. The clinical features are many. Candida serology may help to diagnose or confirm DCI. The dynamics of antibody titres may help to establish the efficacy of antifungal treatment.

Enterotoxigenic Escherichia coli and other enteropathogens in paediatric diarrhoea in Addis Ababa.

This study was performed during two weeks among 86 paediatric outpatients of poor socio-economic background. A control group comprised 60 healthy children. Enterotoxigenic Escherichia coli (ETEC) was the most common diarrhoeal agent isolated (26%). Strains of ETEC producing heat-labile (LT) only or LT and heat-stable (ST) enterotoxin were isolated from 11% each and ETEC producing ST only from 4% of the patients. ETEC was also found not infrequently among controls (10%). ETEC with O-antigens 78, 6 and 8 were shown to harbour colonization factors. Enterotoxigenic bacteria were found as contaminants in 5 of 24 feeding bottles investigated. Enteropathogenic Escherichia coli (EPEC) and Shigella species were isolated from 8% each and rotavirus from 24% of the patients. Twelve patients infected with ETEC only were compared to 66 patients not infected with ETEC. Patients infected with ETEC had a relatively mild disease and it was not possible by clinical findings to distinguish those patients infected with ETEC, LT and/or ST producing, carrying or not carrying colonization factors from those infected with other agents. This study underlines the need for extended studies of the clinical significance of ETEC infection in developing countries.

Deep Candida infection in child liver transplant recipients: serological diagnosis and incidence.

Nineteen children who received 22 orthotopic liver grafts on 20 occasions were studied with regard to Candida infection. Serum samples were analysed to determine Candida, IgA, IgM and IgG antibodies and detect free C. albicans glucoprotein antigen. Five children (25%) had a confirmed deep C. albicans infection (DCI) during the first 2 weeks after transplantation. In all children with DCI, serology was positive, a median of 6 days (range 2-9 days) before Candida infection was verified by fungal culture, direct microscopy and/or autopsy. The positive predictive values for Candida IgG, IgM and IgA antibodies in children with DCI were 100%, 78% and 100%, respectively, and for free C. albicans antigen, 45%. Pathological titres of IgM and IgA antibodies against Candida before liver transplantation were present in three of four children who later developed a DCI and in no child without infection. In conclusion, regular screening by Candida serology is recommended both before and after liver transplantation.

The gastrointestinal absorption of penicillin V in children with suspected coeliac disease.

The gastrointestinal absorption of penicillin V (pc-V) was investigated in 6 children, 6-12 months old, with suspected coeliac disease. The diagnosis was set after small bowel biopsy and absorption tests of vitamin A and d-xylose. As control groups served 7 children with diarrhoea but with normal small bowel biopsy and/or absorption tests and a group of 9 children with upper respiratory tract infection of the same ages as the children in the test group. The absorption of calcium pc-V in oil suspension (Penicals) was impaired in the patients with suspected coeliac disease compared to that of the control groups. There was no significantly different absorption of pc-V between the control children with diarrhoea and those with upper respiratory tract infection. After 6-8 months of gluten free diet in the children with suspected coeliac disease their absorptive ability of oral calcium pc-V in suspension form was equal with that of a control group.

Antibody response to Candida and its use in clinical practice.

Reference values for specific IgM, IgA and IgG antibodies against three defined Candida antigens were determined in 280 healthy Swedish children aged 1 month to 15 years. The antibody response in 10 children with Candida infections was also determined. Precipitating IgG antibodies to a mannan-free Candida protein antigen were detected only in children with Candida infection. The haemagglutinating IgM antibody response in healthy children to a polysaccharide Candida antigen was weak. Adult levels of < or = 320 (95% confidence interval, CI) were not reached even in the oldest children (< or = 160). All children with Candida infections had elevated IgM titres. Adult levels of IgA antibodies to Candida mannan were reached at 10-12 years of age; at 13-15 years the titres were higher (< or = 1600) than in healthy adults (< or = 1000, 95% CI). All children with an acute Candida infection had elevated IgA titres. Our study shows that antibody testing may be used to diagnose systemic Candida infection in children and to follow the progression and resolution of systemic Candida infection with the rise and fall of antibody titres.

Seasonal fluctuations in the occurrence of enterotoxigenic bacteria and rotavirus in paediatric diarrhoea in Addis Ababa.

This study (March 1977-February 1978) was performed at the Ethio-Swedish Pediatric Clinic, Addis Ababa, to determine whether there were any seasonal fluctuations in the occurrence of diarrhoea associated with enterotoxigenic enterobacteria (ETEB), rotavirus and two parasites (Giardia lamblia and Entamoeba histolytica).A total of 1161 children (962 patients and 199 controls) were investigated. ETEB were isolated in 12.2% of the patients and 4.5% of the controls, rotavirus in 27.8% and 8%, and parasites in 6.8% and 1%, respectively. There is a statistically significant difference in the isolation rates between patients and controls (P<0.001 for rotavirus, P<0.01 for ETEB and parasites). Rotavirus was most prevalent in the 7-12 months age group and ETEB during the second year of life, while parasites showed a continuous increase with age.Two peaks in the occurrence of ETEB were found during the year, the first in August (32.6%), the second in January (19.2%). Two peaks for rotavirus though not as distinct as for ETEB, were seen in June (42.7%) and November (36.4%). The isolation rate of parasites showed no consistent pattern during the year.This study suggests a seasonal occurrence of ETEB and rotavirus but with no apparent correlation to climatological factors.