Pancreas size and exocrine function is decreased in young children with recent-onset Type 1 diabetes.

AIMS: To measure pancreatic area and exocrine function in young children with recent-onset Type 1 diabetes to determine whether the exocrine pancreas is also affected in the pathophysiology of early childhood diabetes. METHODS: Thirty-two children (14 boys) aged 5.5 (4.5, 7.3) median (IQR) years presenting with recent-onset Type 1 diabetes and 90 controls (44 boys) of similar age had ultrasound imaging of the pancreas. Children with Type 1 diabetes were receiving insulin and were without ketosis. Transverse and longitudinal areas of the pancreas were measured by digitalized outline. Pancreatic faecal elastase-1 was analysed using an enzyme-linked immunosorbent assay kit in recent-onset Type 1 diabetes and 38 first-degree relative control children. RESULTS: Pancreatic area and exocrine function were reduced in Type 1 diabetes. Mean transverse area (SD) in Type 1 diabetes was 6.82 cm2 (1.61) vs. 8.31 cm2 (1.74) in controls, adjusted estimate (95% CI) 1.45 (-2.12, -0.79), P < 0.001; longitudinal area was 1.28 cm2 (0.44) vs. 1.55 cm2 (0.43), adjusted estimate (95% CI) -0.27 (-0.45, -0.09), P = 0.003. Faecal elastase-1 levels in Type 1 diabetes were 455 (323, 833) ug/g, median (IQR) vs. 1408 µg/g (1031, 1989) in controls, P < 0.001. CONCLUSION: Pancreatic area and accompanying subclinical exocrine function were reduced in very young children with recent-onset Type 1 diabetes. This supports changes in the exocrine pancreas in the pathophysiology of Type 1 diabetes presenting in early life.

Increasing the exclusive breastfeeding rate in a private hospital in UAE through quality improvement initiatives.

BACKGROUND: Mother's milk is the best, and ideal method for infant feeding. We found that this practice was not being followed in our hospital. A survey was conducted in the unit with regards to breastfeeding practices which revealed that most babies who were discharged from our nursery were on formula supplements. Our goal was to improve established breastfeeding rates in the unit by increasing the number of full-term healthy babies who were discharged on exclusive Breastfeeding. METHOD: A project team was formed, and data were collected through direct observations and direct interviews with postnatal mothers. Exclusive Breastfeeding at discharge was defined as a baby being fully on breastfeed with no additional formula supplements for at least 12 hours prior to discharge. The primary outcome was to increase the percentage of babies being discharged on exclusive Breastfeeding. We used the FOCUS PDCA model to measure improvements and 8 PDCA cycles of 4 weeks duration were implemented to test the changes. RESULTS: The interventions we put in place led to a considerable nine times overall improvement in the established breastfeeding rates. Among all the interventions, the most promising results were observed during the PDCA cycles involving staff education, the introduction of antenatal classes for mothers, skin to skin contact and rooming in. CONCLUSION: Breastfeeding rates in the private sector with nursery services can be improved by reinforcing breastfeeding education for mothers in addition to training the maternal care staff, empowering them to promote and assist in breastfeeding.

Level III dissection in locally advanced breast cancer following neoadjuvant chemotherapy: a retrospective study.

INTRODUCTION: Breast cancer is the most common female cancer in India, and 30-60% of patients present with locally advanced breast cancer. Level III clearance is routinely performed in India in locally advanced breast cancer following neoadjuvant chemotherapy, even in clinical complete response. We analysed our data of patients with locally advanced breast cancer post-neoadjuvant chemotherapy who have undergone level III clearance to identify any subgroup in which level III dissection can be avoided. MATERIAL AND METHODS: This is a retrospective study of female patients with locally advanced breast cancer who received neoadjuvant chemotherapy and underwent breast surgery including level III nodal clearance between June 2016 and May 2018. Data collected included age, menopausal status, TNM stage at presentation, grade, estrogen, progesterone, human epidermal growth factor receptor 2 status, response to treatment, post-chemotherapy stage and final histopathology. Uni- and multivariate analysis was undertaken. RESULTS: Data from 200 patients was analysed. The level III positivity rate was 15.5%. The clinical complete response rate was 43%, of which 41% had pathological complete response. A significant association was present between level III node positivity and pathological T stage (p=0.03). No association was seen between level III positivity and any other studied variables. In the subset of patients with cT3N1 and cT2N2, level III positivity was seen in only 3/49 (6.1%) and 1/31 (3%), respectively. CONCLUSION: Level III positivity rate is high and so cannot be avoided in locally advanced breast cancer following neoadjuvant chemotherapy. None of the preoperative factors predict for level III positivity. Level III positivity in cT3N1 and cT2N2 is low and these subgroups require further studies.

Anorectal melanoma: experience from a tertiary cancer care centre in South India.

Introduction Mucosal malignant melanoma of the anorectum is a rare and aggressive disease, in which early diagnosis is difficult. The prognosis remains extremely poor, irrespective of the treatment. We share our experience in treating this malignancy at our centre in South India. Methods This study describes a retrospective analysis of 31 cases of anorectal melanoma presented to our centre between January 2001 and December 2013. Results Twenty-two patients (71%) presented with metastasis and had a median overall survival of nine months. None of the 22 patients survived for two years. Nine patients (29%) had curative surgery, in the form of abdominoperineal resection (six patients), abdominoperineal resection with bilateral inguinal node dissection (one patient), abdominoperineal resection with liver resection (one patient) and posterior exenteration (one patient). In patients who underwent curative surgery, the median overall survival was 15 months and disease-free survival was nine months, with a two-year overall survival of 22%. Conclusions Anorectal melanoma is an aggressive disease with a poor prognosis. The majority of patients present with distant metastases. Prognosis depends on stage at presentation. Early diagnosis and surgical resection may improve the overall outcome. Newer modalities such as immunotherapy and targeted therapies such as anti-CTLA4 monoclonal antibody and anti-programmed cell death protein 1 monoclonal antibodies have radically changed the management of mucosal melanoma and may, in the future, improve the overall prognosis of anorectal melanoma.

Physicians' Opinions on Engaging Patients' Religious and Spiritual Concerns: A National Survey.

CONTEXT: There has been a sustained debate in the medical literature over whether physicians should engage with patients' religious and spiritual concerns. OBJECTIVES: This study explores what physicians believe about the relative importance and appropriateness of engaging with patients' spiritual concerns and physicians' choices of interventions. METHODS: In 2010, a questionnaire was mailed to 2016 U.S. physicians with survey items querying about the relative importance of addressing patients' spiritual concerns at the end of life and the appropriateness of interventions in addressing those concerns. The survey also contained an experimental vignette to assess physicians' willingness, if asked by patients, to participate in prayer. RESULTS: Adjusted response rate was 62% (1156/1878). The majority of physicians (65%) believe that it is essential to good practice for physicians to address patients' spiritual concerns at the end of life. Physicians who were more religious were more likely to believe that spiritual care is essential to good medical practice (odds ratio: 2.76, 95% CI 1.12-6.81) and believe that it is appropriate to always encourage patients to talk to a chaplain (odds ratio: 5.71, 95% CI: 2.28-14.3). A majority of the physicians (55%) stated that, if asked, they would join the family and patient in prayer. Physicians' willingness to join ranged from 67% when there was concordance between the physician's and the patient's religious affiliation to 51% when there was discordance. CONCLUSION: The majority of U.S. physicians endorse a limited role in the provision of spiritual care, although opinions varied based on physicians' religious characteristics.

Voltammetric studies of sparfloxacin and application to its determination in pharmaceuticals.

A detailed study of the electrochemistry of sparfloxacin at a glassy carbon electrode was carried out in the pH range 2.0-10.0 in aqueous solution using cyclic and differential pulse voltammetry. Influence of different supporting electrolytes, pH, scan rate and concentrations were studied on the voltammetric response. The studies revealed the irreversible oxidation of sparfloxacin at basic pH in a diffusion controlled manner. In addition, a differential pulse voltammetric method was proposed for the determination of the drug in different pharmaceutical formulations.

Chasing coccidia--new tools enter the race.

The 8th International Coccidiosis Conference, held on 9--13 July 2001 in Palm Cove, Australia, was a showcase of the latest studies on widely known coccidia, including Eimeria and Toxoplasma in addition to the emerging or re-emerging parasites such as Neospora, Cryptosporidium and Cyclospora. This meeting was staged in conjunction with the Annual Scientific Meeting of the Australian Society for Parasitology.

Cell: sporozoite interactions and invasion by apicomplexan parasites of the genus Eimeria.

The site specificity that avian Eimeria sporozoites and, to a more limited degree, other apicomplexan parasites exhibit for invasion in vivo suggests that specific interactions between the sporozoites and the target host cells may mediate the invasion process. Although sporozoite motility and structural and secreted antigens appear to provide the mechanisms for propelling the sporozoite into the host cell,there is a growing body of evidence that the host cell provides characteristics by which the sporozoites recognise and interact with the host cell as a prelude to invasion. Molecules on the surface of cells in the intestinal epithelium, that act as receptor or recognition sites for sporozoite invasion, may be included among these characteristics. The existence of receptor molecules for invasion by apicomplexan parasites was suggested by in vitro studies in which parasite invasion was inhibited in cultured cells that were treated with a variety of substances designed to selectively alter the host cell membrane. These substance included cationic compounds or molecules, enzymes that cleave specific linkages, protease inhibitors, monoclonal antibodies, etc. More specific evidence for the presence of receptors was provided by the binding of parasite antigens to specific host cell surface molecules. Analyses of host cells have implicated 22, 31, and 37 kDa antigens, surface membrane glycoconjugates,conserved epitopes of host cells and sporozoites, etc., but no treatment that perturbs these putative receptors has completely inhibited invasion of the cells by parasites. Regardless of the mechanism,sporozoites of the avian Eimeria also invade the same specific sites in foreign host birds that they invade in the natural host. Thus, site specificity for invasion may be a response to characteristics of the intestine that are shared by a number of hosts rather than to a unique trait of the natural host. Protective immunity elicited against avian Eimeria species is not manifested in a total blockade of parasite invasion. In fact, the effect of immunity on invasion differs according to the eliciting species and depends upon the area of the intestine that is invaded. Immunity produced against caecal species of avian Eimeria, for example Eimeria tenella and Eimeria adenoeides, inhibits subsequent invasion by homologous or heterologous challenge species, regardless of the area of the intestine that the challenge species invade. Conversely, in birds immunised with upper intestinal species, Eimeria acervulina and Eimeria meleagrimitis, invasion by challenge species is not decreased and often is significantly increased.

Dietary modulation of avian coccidiosis.

During the past several years, our laboratory has been investigating the anticoccidial activities of various natural products that have potential use as dietary supplements for coccidiosis control. Sources of fats containing high concentrations of n-3 fatty acids such as menhaden oil and flaxseed oil and flaxseed, when added to starter rations and fed to chicks from one day of age, effectively reduce lesions caused by the caecal parasite Eimeria tenella, but not lesions caused by Eimeria maxima. Our results are consistent with reports of effects of diets high in n-3 fatty acids on other protozoan parasites which suggest that the state of oxidative stress induced by these diets in the cells of both host and parasites is responsible for their parasitic actions. Artemisinin, a naturally occurring (Artemisia annua) endoperoxide and effective antimalarial significantly lowers lesions from E. tenella when given at low levels as a feed additive. The mechanism of its action is also considered to involve induction of oxidative stress. Diets supplemented with 8 p.p.m. gamma-tocopherol (abundant in flaxseeds) or with 1% of the spice tumeric, reduce mid-small intestinal lesion scores and improve weight gains during E. maxima infections. These compounds may exert their anticoccidial activity because they are effective antioxidants. Betaine, a choline analogue found in high concentrations in sugar beets, improves nutrient utilisation by animals under stress. When provided as a dietary supplement at a level of 0.15% it has enhanced the anticoccidial activity of the ionophore, salinomycin. Betaine may act as an osmoprotectant whereby it improves the integrity and function of the infected intestinal mucosa. In in vivo studies, betaine plus salinomycin significantly inhibit invasion of both E. tenella and E. acervulina. However, subsequent development of E. acervulina is inhibited more effectively with this combination treatment than development of E. tenella.

Specificity and cross-reactivity of hybridoma antibodies generated against Eimeria bovis sporozoites.

Spleens from mice immunized with Eimeria bovis sporozoites were removed and the cells fused with mouse myeloma cells to produce hybridoma cell lines (HCLs). The resulting HCLs were examined for antibody (HAB) production against E. bovis sporozoites using an indirect immunofluorescent antibody test on air-dried sporozoites. Four fusions resulted in the production of 19 HCLs that produced HABs to E. bovis sporozoites. These 19 HCLs were further tested for reactivity with cell culture-grown merozoites of E. bovis and Sarcocystis cruzi of cattle; sporozoites of Eimeria tenella from chickens, Eimeria meleagrimitis from turkeys, Eimeria papillata and Eimeria vermiformis from mice; and bradyzoites of S. cruzi from calves. Six HCLs produced HABs that reacted only with E. bovis sporozoites and were species specific/stage specific. Two HCLs produced HABs that reacted only with E. bovis sporozoites and merozoites, and were species specific/stage cross-reactive. Seven HCLs produced HABs that reacted with the sporozoites of the other Eimeria species examined and were species cross-reactive/stage specific. Four of the HCLs produced HABs that reacted with all organisms tested and were species cross-reactive/stage cross-reactive. The results of this study suggest the conservation of some antigens throughout developmental stages and genera of Eimeriorina.

Eimeria adenoeides and E. meleagrimitis: effect of poult age on susceptibility to infection and development of immunity.

Beltsville small white and Nicholas turkey poults, 1, 7, and 14 days old, were inoculated with mixed cultures of Eimeria adenoeides and E. meleagrimitis. Weight gain and feed conversion of 1-day-old poults were affected as severely as those of the older poults, and mortality was heaviest in this group, ranging from 25 to 45%. One dose of oocysts (2 x 10(4)-1.5 x 10(5], given at 1, 7, or 14 days of age, protected even the 1-day-old poults against challenge with 3 x 10(5) oocysts. Protection was comparable to that afforded by multiple immunizing doses given over 3 weeks. After challenge, little weight reduction or mortality was observed in immunized poults. Average feed conversions of the immunized challenged poults were 1.52 to 1.69 as compared with 2.98 to 5.14 for unimmunized challenged poults.

Avian Eimeria species: effect of prior or simultaneous inoculation of one species on cellular invasion by a second species in vivo and in vitro.

The effect of prior or simultaneous administration of Eimeria acervulina on cellular invasion by E. acervulina, E. tenella, or E. adenoeides was examined in vivo and/or in vitro. In chickens immunized with E. acervulina oocysts, invasion by sporozoites from a challenge inoculum of E. acervulina increased slightly over invasion in naive controls, and invasion by sporozoites of E. tenella and E. adenoeides increased by factors of 1.99 and 2.26, respectively, over that in controls. Conversely, simultaneous inoculation of E. acervulina along with E. tenella or E. adenoeides did not have a significant effect on invasion. Cultured baby hamster kidney cells that had been previously inoculated with E. acervulina sporozoites also supported significantly greater (by factors of 1.39 to 2.66) invasion by E. adenoeides sporozoites than did control cultures. The enhancement of invasion in vitro appeared to depend upon either the interval between the inoculation of cells with E. acervulina and E. adenoeides or the interval between the replating of the cells and their inoculation with E. adenoeides. There were no gross changes in the culture morphology between the E. acervulina-inoculated and noninoculated cultures. The data indicate that prior exposure to E. acervulina enhances invasion by other species of avian coccidia and, therefore, may exacerbate the infection produced by these species.

Response of unimmunized and sporozoite-immunized chickens to challenge with avian Eimeria species: effects of intraperitoneal injection of Sephadex.

Unimmunized chickens, given intraperitoneal injections of Sephadex at the same time that they were inoculated with oocysts of either Eimeria tenella or E. acervulina, had significantly lower lesion scores at 6 days postinoculation (PI) than unimmunized chickens that were injected with saline instead of Sephadex. Despite the difference in lesion scores, there was little effect on weight gain, except in one experiment, in which Sephadex-injected chickens gained significantly more weight than saline-injected chickens. In contrast, in chickens that were immunized by prolonged exposure to sporozoites of E. adenoeides, injection of Sephadex at the time of challenge with E. tenella did not reduce lesion scores or parasite development as compared with the uninjected chickens, and the weight gain of the Sephadex-injected challenged chickens fell to a level significantly lower than that of their saline-injected challenged counterparts. The data indicate that Sephadex injected at the time of oocyst inoculation 1) produces markedly different effects on lesion scores and weight gain in unimmunized and immunized chickens and 2) abrogates sporozoite-elicited immunity against E. tenella challenge.

Prior or concurrent exposure to different species of avian Eimeria: effect on sporozoite invasion and chick growth performance.

The effects of prior (immunity) or concurrent administration of Eimeria acervulina or Eimeria tenella on cellular invasion in vivo and in vitro and on growth performance in white leghorn chickens (WLC) were examined. Weight gains of WLC immunized with E. acervulina and challenged with E. tenella were significantly greater than those of nonimmunized chicks challenged with E. tenella (this occurred despite the increased invasion by E. tenella in E. acervulina-immunized chicks that was reported earlier). The weight gains and modest but consistent improvements in intestinal lesion scores, feed conversion ratios, and oocyst shedding in immunized/challenged WLC indicated that E. acervulina conferred a small measure of protection against E. tenella infection that was independent of the effect on invasion. In contrast, immunization of WLC with E. tenella significantly decreased (41%-51%) invasion by E. acervulina as compared with that in nonimmunized WLC but had little effect on chick growth performance. Concurrent inoculation of chicks with E. tenella and E. acervulina had little effect on invasion by E. tenella sporozoites or on subsequent performance of the chicks. In vitro, prior exposure of cultured cells to either of two isolates of E. tenella also caused a significant decrease in invasion by E. acervulina. No gross changes occurred in the culture morphology between the E. tenella-inoculated and noninoculated cultures. Collectively, the data indicate that prior exposure of WLC and cultured cells to single isolates of avian coccidia markedly influenced invasion by other species but had less effect on the growth performance of the birds.

Decreased osmotic fragility of red blood cells of Eimeria adenoeides-infected turkeys.

The osmotic fragility of red blood cells (RBC) from Eimeria adenoeides-infected turkey poults was compared with that of RBC from control and water-deprived poults. At different hypotonic NaCl concentrations, lysis of RBC from infected poults was 10 to 35% less on day 4 postinoculation (PI) and 50 to 65% less on day 7 PI than that of controls. Red blood cells of poults deprived of water for 3 days were also resistant to lysis; the percent lysis was roughly the same as that of RBC from infected poults at day 7 PI. Incubating control RBC in plasma from infected poults, in extracts of infected ceca, or at different pH levels did not increase their resistance to lysis, suggesting that neither a stabilizing factor in the plasma that had rapid effect on the RBC nor a transient shift in blood pH was involved. Mean RBC size differed little among infected, water-deprived, and control poults (14.0-14.2 X 8.0-8.1 X 3.8 microns). However, although 3.5% of RBC population of control and water-deprived poults were immature (mid to late polychromatic erythrocytes), only 0.4% of the RBC of infected poults were immature. The data suggest that reduced water intake as well as other factors may be involved in the decreased osmotic fragility of RBC from poults infected with E. adenoeides.

Effect of time on response to Eimeria adenoeides and Eimeria meleagrimitis infection in young turkeys.

Physiologic characteristics were measured on day 7 postinoculation (PI) in 2-week-old turkeys inoculated with 10(5) Eimeria adenoeides oocysts, in pair-fed controls, and in control turkeys fed ad libitum. Pathophysiologic responses were measured in turkeys inoculated with 7 x 10(4) E. adenoeides oocysts or 1.2 x 10(5) E. meleagrimitis oocysts and necropsied 2, 4, 6, 8, 10, 15, and 21 days PI. At day 7 PI, weight gains and heart weights (as a percentage of body weight) of E. adenoeides-infected turkeys were significantly lower and plasma glucose levels significantly higher than those of pair-fed counterparts. Plasma carotenoid and protein levels of the infected turkeys were significantly lower than those of the controls fed ad libitum and were consistently, but not always significantly, lower that those of the pair-fed controls. Significant responses were first observed in E. meleagrimitis-infected turkeys on day 4 PI and in E. adenoeides-infected birds on day 6 PI. Birds infected with both species commonly had reduced weight gains, heart weights, and plasma carotenoid levels and increased plasma aspartate aminotransferase levels. Plasma carotenoids in E. adenoeides-infected turkeys were significantly reduced on day 6 PI only, whereas plasma carotenoids in E. meleagrimitis-infected turkeys were sometimes reduced significantly as early as day 2 PI and remained significantly lower than control values through day 21 PI.

Avian eimeria: invasion in foreign host birds and generation of partial immunity against coccidiosis.

Four species of avian Eimeria invaded the intestine of foreign host birds in the same areas in which they invaded the natural host. Repeated inoculation (immunization) of chickens with the turkey coccidian, Eimeria adenoeides, partially protected the chickens against a subsequent challenge with 5.8 x 10(4) E. tenella oocysts. At 6 days post-challenge, the weight gain and feed conversion efficiency of the immunized chickens was significantly better than those of the chickens that were not immunized with E. adenoeides. Lesion scores and cellular invasion by the sporozoites were significantly lower in the immunized birds than in the unimmunized group. Electrophoresis and Western blot analysis identified changes in the serum antibody profiles of the chickens that appeared to be associated with the immunization and challenge programs. An antibody or antibodies recognizing a 60,000-molecular-weight antigen of E. tenella sporozoites disappeared when chickens immunized with E. adenoeides were challenged with E. tenella; an antibody or antibodies recognizing a 23,000-molecular-weight sporozoite antigen appeared within 6 days of challenge. Reciprocal studies, in which turkeys were immunized with E. tenella and challenged with E. adenoeides, showed little evidence of protection.

Use of hybridoma antibodies and recombinant DNA technology in protozoan vaccine development.

The use of hybridoma antibodies developed against the sporozoite stage of avian coccidia, coupled with genetic-engineering techniques, has made it possible to begin bird-immunization studies utilizing an Escherichia coli-elicited coccidial protein. The coccidia are currently controlled in the poultry industry by use of anticoccidial compounds, but it now may be possible to use the bird's own immune system for defense against the parasitic infection. Since the sporozoite stage, which initiates the infection in poultry, is quite complex and is made up of hundreds of proteins or antigens, hybridoma antibodies were produced to identify specific antigens. These antigens, once identified, were found in such minute amounts that it became necessary to utilize genetic engineering in order to produce enough protein for immunization studies. One such protein, designated 5401, has been shown to stimulate an antibody response in immunized birds and to impart partial protection against a coccidial challenge infection. The results of these studies indicate that development of a vaccine against coccidial parasites may someday be possible.

Effects of hybridoma antibodies on invasion of cultured cells by sporozoites of Eimeria.

Hybridoma antibodies (Hab) produced against sporozoites or merozoites of four species of Eimeria were tested for the ability to inhibit the invasion of cultured primary avian kidney cells by sporozoites of Eimeria. Five of 16 Hab that were tested showed inhibitory activity. All five of these Hab were produced against sporozoites and reacted with sporozoite surface antigens or surface/internal antigens. Four Hab produced against merozoites of E. acervulina cross-reacted with sporozoite surface antigens but failed to inhibit invasion. Similarly, Hab reacting with sporozoite anterior tips or refractile bodies had little effect on invasion. Collectively, the data suggest that surface antigens or surface/internal antigens that are unique to the sporozoite stage may influence or be part of the invasion process. Indirect immunofluorescent-antibody tests and ferritin (Fe) labeling combined with electron microscopy indicated differences in binding of two of the Hab to the sporozoite surface membranes. For example, after exposure to Hab 43A6 and a fluorescein-antimouse IgG conjugate, extracellular sporozoites of E. meleagrimitis fluoresced brightly but intracellular sporozoites exhibited little fluorescent label. Sporozoites labeled with Hab 43A6 plus a ferritin-antimouse IgG conjugate that were observed in the process of cell invasion had ferritin on the extracellular portion of the parasite but not on the intracellular portion. Extracellular aggregates of ferritin were observed near the site of invasion. The data suggested that antigens of the sporozoite surface that are recognized by Hab 43A6 are "scraped off" during the invasion of cells. In contrast, after exposure to Hab E5, both extracellular and intracellular sporozoites of E. tenella fluoresced. However, ferritin label was not observed on viable sporozoites, even when they were fixed immediately after the labeling procedure. The antigens recognized by Hab E5 may be associated with parasite secretory products rather than with an integral part of the sporozoite surface membrane.

A study of the dynamics of the invasion of immunized birds by Eimeria sporozoites.

The invasion of the intestinal epithelium of immunized and unimmunized turkeys and chickens by four species of Eimeria was quantitated. In unimmunized birds, E. adenoeides, E. acervulina, and E. tenella invaded primarily the areas in which first-generation schizonts subsequently developed. Eimeria meleagrimitis invaded a larger area of the intestine. Between 1 and 4 hr postinoculation, the numbers of intracellular sporozoites increased, but their location within the intestine was little changed. When birds were immunized with either of two lower intestinal species, E. adenoeides or E. tenella, and then challenged with the immunizing species, invasion was reduced by 36% to 55%. In contrast, immunizing and then challenging birds with either of two upper intestinal species, E. meleagrimitis or E. acervulina, did not reduce invasion: there were 44% more intracellular sporozoites in E. meleagrimitis-immunized turkeys and 11% more in E. acervulina-immunized chickens than in their unimmunized counterparts.