Asymptomatic environmental enteropathy among slum-dwelling infants.

OBJECTIVE: We documented asymptomatic environmental enteropathy, which may occur in low socioeconomic populations, and which is manifested by bacterial proliferation in the upper portions of the small bowel and by alterations in the digestive-absorptive capacity. DESIGN: Forty asymptomatic infants (< 1 year) of the Cidade Leonor slum in São Paulo, Brazil, were investigated for digestive-absorptive function, bacterial proliferation in the small bowel lumen, and jejunal morphology. They were compared with a control group of 8 well-nourished children from economically sound families. RESULTS: Mean value of the D-xylose absorption test in the slum infants 21.0 +/- 10.0 mg%) was significantly lower than in controls (46.0 +/- 13.8 mg%) (p < 0.001). Colonic bacterial proliferation in the small bowel was identified in 25 (62.5%) of slum-dwelling infants. Grade II villous atrophy with inflammatory infiltration in the lamina propria was the most frequent alteration found. CONCLUSION: These data show that alterations in the microecology, function and morphology of the small intestine can occur even in the absence of diarrhea. Therefore, the absence of symptoms does not necessarily imply a healthy well-being among children living in a slum.

Enteropathogens associated with acute diarrheal disease in urban infants in São Paulo, Brazil.

To determine the prevalence and epidemiology of enteropathogens in acute infantile diarrhea, 500 infants less than or equal to 12 months of age with diarrhea and 500 age-matched control subjects coming to a São Paulo emergency room were studied. Enteropathogens were identified in 55% of case infants and 10% of controls; enteropathogenic Escherichia coli (EPEC) of classic EPEC serotypes producing EPEC adherence factor (EAF) (26% of case infants), rotavirus (14%), Salmonella species (8%), enterotoxigenic E. coli (7%), and Shigella species (5%) were associated with diarrhea. Isolation of EAF+ classic EPEC decreased with increasing age of cases and peaked in spring, whereas rotavirus was least common in early infancy and peaked in fall and winter. Bloody stool had a 36% positive predictive value for Shigella infection, EAF+ classic EPEC were highly resistant to antimicrobial drugs. Among poor São Paulo infants, EAF+ classic EPEC equaled or exceeded rotavirus throughout the year as a cause of diarrhea bringing children to medical attention.

Use of ampicillin plus ranitidine for Helicobacter pylori gastritis.

1. Helicobacter pylori (formerly Campylobacter pylori) is now recognized as an etiological factor in gastritis and duodenal ulcers and probably also gastric ulcers. Eradication of the bacteria is fundamental to avoid ulcer relapse. Although bismuth salts have been shown to be effective for treatment, they are not commercially available in Brazil. 2. We report an attempt to treat patients with Helicobacter pylori-associated gastritis with ampicillin (1000 mg twice daily for one month) and compare the results with the conventional treatment used in Brazil (ranitidine, 300 mg daily for one month) and with a combination of the two drugs. We studied 44 patients with histologically confirmed gastritis and with Helicobacter pylori, who were examined at the beginning and after one month of treatment. 3. Ampicillin associated with ranitidine was better than ampicillin or ranitidine alone for the treatment of gastritis. Although ampicillin may be more efficient in patients with lower acid output we did not find a statistically significant difference between these two groups (ampicillin vs drug combination), perhaps owing to the small number of patients studied. When ampicillin was combined with ranitidine there was 25% normalization of the histological picture of the gastric mucosa. 4. We conclude that ampicillin in combination with ranitidine may be a useful treatment for Helicobacter pylori-associated gastritis.

Use of ampicilin plus ranitidine for Helicobacter pylori gastritis

Helicobacter pylori (formerly Campylobacter pylori) is now recognized as an etiological factor in gastritis and duodenal ulcers and probably also gastric ulcers. Eradication of the bacteria is fundamental to avoid ulcer relapse. Although bismuth salts have been shown to be effective for treatment, they are not commercially available in Brazil. We report an attempt to treat patients with Helicobacter pylori-associated gastritis with ampicilin (1000 mg twice daily for one month) and compare the results with the conventional treatment used in Brazil (ranitidine, 300 mg daily for one month) and with a combination of the two drugs. We studied 44 patients with histologically confirmed gastritis and with Helicobacter pylori, who were examined at the beginning and after one month of treatment. Ampicilin associated with ranitidine was better than ampicilin or ranitidine alone for the treatment of gastritis. Although ampicilin may be more efficient in patients with lower acid output we did not find a statistically significant difference between these two groups (ampicilin vs drug combination), perhaps owing to the small number of patients studied. When ampicilin was with ranitidine there was 25% normalization of the histological picture of the gastric mucosa. We conclude that ampicilin in combination with ranitidine may be a useful treatment for Helicobacter pylori-associated gastritis

Identification of a new enteroinvasive Escherichia coli strain.

We isolated an enteroinvasive Escherichia coli strain which did not react with antisera raised against all known E. coli serogroups, Shigella groups A, B, C and D or provisional Shigella serotypes. We propose the provisional designation of Escherichia coli MG for this strain, until the identification of its O antigen is established.

New invasive serotype of Escherichia coli.

A new invasive Escherichia coli strain which presented delayed or variable reactions in lactose, mucate, and acetate tests is described. It did not agglutinate with antisera for all known E. coli and Shigella groups A, B, C, D, and provisional Shigella serovar. We propose the designation of E. coli BH until the situation of its 0 antigen is settled.

[Extracranial shunts and pregnancy. Presentation of 2 cases]. / Derivaciones extracraneales y embarazo. Presentación de dos casos.

Two cases of extracranial derivations shunts with pregnancy treated at Hospital General de Zona No. 1, IMSS, Villahermosa, Tab. are presented. The world literature about this subject, was reviewed. Pregnancy evolution and resolution via, recommended anesthetic method and prophylactic antimicrobials, are considered. It was concluded that with surgery progress there are more cases of women with extracranial shunt who reach adulthood and are able to carry normal pregnancy and to deliver healthy children.

Virulence factors and biochemical characteristics of serotypes of Escherichia coli serogroup O29.

Escherichia coli strains belonging to serogroup O29 were studied. Invasiveness was the most common virulence factor described in this serogroup, but a few papers also reported production of heat-stable (ST) enterotoxin. In the present study invasive ability was found in O29:H- strains, whereas production of ST-I enterotoxin was observed only in serotype O29:H21 strains, showing that virulence was a characteristic of specific serotypes or bioserotypes within the O29 serogroup. Different serotypes were found among strains that were neither invasive nor toxigenic. Invasive strains were biochemically less active than the toxigenic ones and presented the invasiveness plasmid (pINV) of about 120 to 140 megadaltons, whereas hybridization tests showed that ST-I production was related to a plasmid of about 90 megadaltons. A diffuse adherence pattern to HeLa cells was observed in all ST-I isolates, but the role of this adherence in the pathogenicity of these strains was not determined. Thus, a unique biochemical pattern and plasmid profile may be useful characteristics to distinguish between pathogenic (toxigenic or invasive) and nonpathogenic O29 strains.

Campylobacter pylori in dyspeptic patients

The presence of Campylobacter pylori in gastric mucosa of patients with dyspeptic complaints has been described. The association of the symptoms and endoscopic and histopathologic alterations with the presence of the bacterium still remains unknown. 117 patients were studied with respect to dyspeptic symptoms, endoscopic and histopathologic examinations, microbiological analysis and urease test to detect Campylobacter pylori. Campylobacter pylori was found in 77 per cent of all patients. Of these 36.8 per cent had normal gastric mucosa and 84.7 per cent presented gastritis. There was no association between the symptoms, the endoscopic and histological findings.

DNA probes for identification of enteroinvasive Escherichia coli.

Eighty-one Escherichia coli strains belonging to all known invasive O serogroups were tested with two distinct invasiveness probes (pMR17 and pSF55). All 54 Sereny test-positive strains and 5 strains that lost Sereny positivity during storage hybridized with both probes. Probe-positive strains carried a 120- to 140-megadalton plasmid, did not produce lysine decarboxylase, and, with the exception of certain serotypes, were nonmotile. Motile strains of serotype O144:H25 were for the first time characterized as invasive by hybridization with the probes.

Comparison of DNA probes and the Sereny test for identification of invasive Shigella and Escherichia coli strains.

Forty-two Shigella and 29 Escherichia coli strains were screened for invasiveness in the Sereny test and for hybridization with two recently described DNA probes for the invasiveness plasmid. Both probes produced identical results. All Sereny-positive strains hybridized with both DNA probes. Three Sereny-negative strains also hybridized with the probes, suggesting that there are strains containing the invasiveness plasmid that are not pathogenic in animal models.

Correlation between adherence to HeLa cells and serogroups, serotypes, and bioserotypes of Escherichia coli.

Four hundred fifty Escherichia coli strains of 45 O serogroups and subgroups and 112 serotypes were studied to determine their patterns of adherence to HeLa cells. Adherence was exhibited by strains of 17 O serogroups and subgroups, but within these groups more than one adherence pattern was frequently observed. However, within each serotype, the adherence pattern was highly consistent. Localized adherence (LA) was observed much more frequently in serotypes that we considered to be enteropathogenic E. coli serotypes (93%) than in other serotypes (14%), whereas diffuse adherence (DA) occurred predominantly among nonenteropathogenic E. coli strains. Determination of biochemical characteristics showed that within O serogroups, nonmotile strains tended to have the same behavior as motile strains with the LA adherence pattern, suggesting that they were derived from these motile strains. LA and non-LA strains of the same serotype differed biochemically. LA appears to be a property of most E. coli commonly considered to be enteropathogenic and should assist attempts to determine which E. coli are enteropathogenic and to elucidate their pathogenic mechanisms.

Experimental guinea pig ocular infection by Salmonella typhimurium.

The clinical, microbiologic, and cytologic features of the guinea pig model of keratoconjunctivitis with enterobacteria, Salmonella typhimurium were elucidated. Guinea pig eyes were instilled with S. typhimurium and the eyes were studied by biomicroscopy, culture, cytology, pathology, and electron microscopy. All animals developed moderate to severe conjunctivitis that was present in 18% of the animals on day 1. It became more intense, appearing in all of the eyes on day 10 and disappeared before day 30. The cultures for S. typhimurium were almost all positive on days 1 and 2, declined steadily to 10% on day 10, and were negative after that. A coarse, epithelial punctate keratitis was present in more than 90% of the infected eyes at some time during the experiment. The keratitis had a biphasic clinical course. The first peak correlated with the maximum culture results, but during the second peak only 10% of the cultures were positive. Electron microscopy of the cornea showed the S. typhimurium at the epithelial surface within surface epithelial cells during the early phases of infection. The later phase keratitis, with negative culture results, resembles the keratitis of Reiter's syndrome.

Enterotoxin production, presence of colonization factor antigen I, and adherence to HeLa cells by Escherichia coli O128 strains belonging to different O subgroups.

Strains of three subgroups of Escherichia coli O128 were studied. Enterotoxin production was observed in 30 (91%) O128ac strains, whereas strains of subgroups O128ab and O128ad were not toxigenic. CFA/I was only found in two serotypes of subgroup O128ac, all of them producing heat-stable enterotoxin except for one which produced both toxins. None of the strains studied produced CFA/II. In a binding test with HeLa cells, localized adherence was found only in strains of subgroup O128ab; diffuse adherence occurred in strains of subgroup O128ac. As flagellar antigens were specific in subgroups ab and ac and toxin production was observed only in subgroup ac, the present results suggest that subgroup and serotype are useful markers for O128 strains that are enterotoxigenic or enteropathogenic.

The significance of hospitals as reservoirs for endemic multiresistant Salmonella typhimurium causing infection in urban Brazilian children.

To identify possible sources of multiply drug-resistant Salmonella typhimurium among children in São Paulo, Brazil, we reviewed records of 470 children who had visited eight outpatient clinics from March 1981 to May 1982 and of 28 children who had been admitted to one referral hospital between June and November of 1982, and we examined plasmid profiles of the Salmonella isolates by agarose-gel electrophoresis. S. typhimurium was identified in 37 of these children. Case-control studies showed that children with S. typhimurium infections were more likely to have been hospitalized before onset of diarrhea than were either age-matched children without diarrhea (P = .031) or age-matched children with nonbacterial diarrhea (P = .035). Four distinct plasmid profiles, each of which was temporally clustered, were identified in 20 (67%) of 30 S. typhimurium strains isolated from previously hospitalized children and in two (28%) of seven strains from children not previously hospitalized. Each of three of these four profiles was associated with a different hospital, results suggesting that multiresistant-S. typhimurium infections in São Paulo are often nosocomially acquired.

Invasibilidade e enterotoxigenicidade de Yersinia enterocolitica e das especies atipicas de Yersinia isoladas do homem e de caes no Brasil. / Invasion and enterotoxigenicity of Yersinia enterocolitica and atypical Yersinia isolated from human and dogs in Brazil

A producao de enterotoxina termoestavel (ST) e a invasibilidade foram estudadas em 58 amostras de Yersinia (54 Y. enterocolitica, 3 Y. frederiksenii, e 1 Y. intermedia), isoladas do homen e de caes na cidade do Rio de Janeiro. A invasibilidade foi pesquisada em cultura de celulas HeLa e pelo teste de Sereny, enquanto que a enterotoxina ST foi pesquisada pelo metodo do camundongo recem-nascido 98,1% das amostras de Y. enterocolitica invadiram celulas Hela, 88,9% produziram enterotoxina ST e 64,8% provocaram conjuntivite intensa no cobaio, sem causar ceratite; nao se observou diferencas entre as amostras isoladas do homen e de caes. As amostras de Y. frederiksenii e Y. frederiksenii e Y. intermedia mostraram-se nao invasoras, nos dois testes utilizados sendo que todas as amostras produziram enterotoxina ST