Immune responses to pneumococcal pilus RrgA and RrgB antigens and their relationship with pneumococcal carriage in humans.

OBJECTIVES: Pneumococcal pilus antigens are shown to be important in pneumococcal pathogenesis and induce protective immunity in animal studies, but data in humans are limited. We aimed to investigate serum and mucosal immune responses to pilus-1 proteins (RrgA and RrgB) and their relationship with pneumococcal carriage in humans. METHODS: Serum and salivary antibodies to RrgA and RrgB in children and adults were analysed by ELISA and immunoblotting. Induction of B cell antibody responses to RrgA and RrgB in nasopharynx-associated lymphoid tissue was studied by ELISpot assay following stimulation with pneumococcal culture supernatants containing pilus proteins. RESULTS: Significant levels of serum anti-RrgA and -RrgB antibodies were observed, and anti-RrgA antibody appeared to develop earlier in childhood. Importantly, anti-RrgA IgG titres in both serum and saliva were shown to be higher in culture-negative children than in those who were culture-positive for Streptococcus pneumoniae. Stimulation of adenotonsillar cells with pneumococcal culture supernatant induced significant RrgA- and RrgB-specific antibody secreting cells and antibody production. CONCLUSIONS: Pneumococcal pilus antigens, particularly RrgA, seem to induce significant serum and mucosal antibody responses that may contribute to natural immunity against pneumococcal carriage in children.

The sensitivity and specificity of an epiphora score at predicting a blocked sac washout following dacryocystorhinostomy.

In a prospective observational study, the sensitivity and specificity of an epiphora score, in predicting a patent sac washout following dacryocystorhinostomy are determined. Patients were examined in a joint otolaryngology/ophthalmology clinic for lacrimal syringing and nasal endoscopy. They completed a 0-10 visual analogue score to grade post operative symptoms. We conclude that due to the high specificity and low sensitivity of the score it is not a good predictor of patency following surgery and therefore no substitute for examining the patient.

Paediatric epistaxis: Alder Hey experience.

Referrals for epistaxis management constitute a significant proportion of paediatric ENT consultations. A prospective audit of all new referrals to our paediatric ENT department for epistaxis management yielded 88 patients over four months. Parents completed a questionnaire with particular reference to the duration of history and frequency of epistaxis. After assessment some patients were given topical chlorhexidine and neomycin cream (Naseptin), in addition some children also underwent chemical cautery (silver nitrate). Of the 64 children in whom out-patient nasal cautery was attempted it was tolerated by 63 (98 per cent). In response to a follow-up postal questionnaire returned by 65 per cent, most parents (74 per cent) felt that Naseptin was useful. A telephone survey of the patients' general practitioners found that 91 per cent of the children did not consult their general practitioner regarding epistaxis again. We conclude that paediatric epistaxis can be effectively managed with a single out-patient consultation.