Culture diagnosis of meningococcal carriers: yield from different sites and influence of storage in transport medium.

Different specimens and techniques have been used in the diagnosis of carriers of Neisseria meningitidis, reflecting the uncertainty about the optimal diagnostic procedure. In the present investigation the culture yield of meningococci from throat specimens was compared to that from nasopharyngeal speimens in 178 persons: 44 carriers were diagnosed. All of them were detected by culture of throat specimens while 34% of them would have remained undiagnosed if only nasopharyngeal specimens had been examined. Storage of throat specimens in a transport medium for 24 hours before culture gave a negative culture for meningococci in 41% of the carriers. This loss was surprisingly high, the reasons for which are discussed.

Use of a rapid fermentation test for indentification of anaerobic bacteria.

Rapid fermentation tests of carbohydrates were performed on 84 strains of anaerobic bacteria, and the result is compared with a commercially available micromultitest, API. An overall correlation of 87% was achieved between the two systems. The rapid fermentation test is easy to perform, since it is done aerobically, and easy to read. This study shows that RFT is useful in routine diagnosis of anaerobic bacteria, if it is used in combination with other relevant biochemical tests, morphologic examination, and gas chromatography.

Inflammatory bowel disease in children and adolescents: a somatic and psychiatric investigation.

Twenty consecutive patients between 9 and 18 years of age with inflammatory bowel disease (IBD) [ulcerative colitis (UC) or Crohn's disease (CD)] were assessed for the presence of psychiatric disorder. The prevalence of psychiatric disorder using the DSM-III-R criteria (Diagnostic and Statistical Manual 3rd ed., revised), was 60% in the IBD group compared to 15% in a matched control group (p = 0.009). The psychiatric disturbances were mainly depressive or anxiety disorders. The IBD children also scored significantly higher (p = 0.0028) on the Child Behaviour Checklist (CBCL) which was completed by the mothers. This indicates more behavioural problems in the IBD group than in the control group. The present study suggests that children and adolescents with IBD comprise a population at high risk for developing a psychiatric disorder that may not be overt but nevertheless plays an important interactive role in the course of the disease.

Problems in anlysis of faecal sugar.

Significant amounts of sugar were found in 22% of 180 faecal samples from 135 children with acute or chronic diarrhoea. The methods used were the Clinitest method and paper chromatography. There was very good correlation between the results of these methods. Screening by Ph was less reliable. Various di- and monosaccharides were found. However, a disaccharide was never found without the simultaneous finding of its component monosaccharides. In vitro studies showed that the faecal flora has the ability to split disaccharides very rapidly. Within a few minutes much of the disaccharide had been split and no traces could be found after 30 minutes. Since the same process is assumed to take place in the lower gut, children with disacchardase deficency cannot be expected to excrete disaccharide alone in their faeces without the corresponding monosaccharides. The lack of a disaccharide in the faeces does not exclude the possibility of disaccharidase deficiency. Acid hydrolysis of faecal samples in cases of suspected sucrase deficiency seems not to be necessary.

Clinical and epidemiological aspects of Crohn's disease in children and adolescents.

Between 1971 and 1980 34 children (18 boys and 16 girls) were diagnosed as having Crohn's disease in Orebro county, Sweden, corresponding to a yearly incidence of 6.1 and a prevalence of 41 per 100,000 children. Classical gastrointestinal symptoms were common, but initially only five patients presented with extraintestinal symptoms and had a normal ESR. Of the patients 13 have only been treated medically and 21 have been operated on. Nine of the children have had a quiescent course, whereas 13 had a recurrent and 11 a chronic course. Most of the children have a good quality of life, which we think is the result of a carefully individualized therapy. One child died.

Epidemiology of Neisseria meningitidis; prevalence and symptoms from the upper respiratory tract in family members to patients with meningococcal disease.

The prevalence of Neisseria meningitidis during endemic conditions was studied in 2 groups of people: (1) 64 family members to patients with meningococcal disease, and (2) 64 family members to patients with meningitis due to Haemophilus influenzae or Streptococcus pneumoniae. In group 1 the carrier rate of meningococci of the same serogroup, sensitivity to sulphonamide, and serotype (group B) as the index strain was 34%. The carrier rate of meningococci group A, B, C and Y was 39% in group 1 and 1.6% in group 2. The 25 times higher carrier rate in group 1 gives some explanation of the increased risk for family members to patients with meningococcal disease. This risk was calculated to have been 3,000-4,000 times higher for the family members during one month after the diagnosis of an index case 1965-1977 in our county. The hypothesis that meningococci as a rule are introduced into a family by an adult and then spread within the family to a child finds no support in the present study. A statistically highly significant association was found between carriage of pathogenic meningococci and symptoms from the upper respiratory tract.

Severe pulmonary infection by Haemophilus aphrophilus in a non-compromised child.

A Haemophilus aphrophilus pulmonary infection with abscess formation in a previously healthy 9-year-old girl is reported. This has not been reported earlier in the literature. The clinical features were extremely severe with respiratory, circulatory and renal insufficiency. Artificial ventilation for 10 days was necessary, initially with 100% oxygen and extremely high airway pressure. The girl is now in perfect health again.

Effect of vitamin A deficiency on the adherence of fimbriated and nonfimbriated Salmonella typhimurium to isolated small intestinal enterocytes.

In vitamin A-deficient children, increased rates of bacterial infections in the intestine have been observed. The adherence of bacteria is a prerequisite for invasion. Thus, the effect of vitamin A deficiency on the adherence of fimbriated and nonfimbriated Salmonella typhimurium to isolated small intestinal enterocytes was studied. Male weanling rats matched by weight were divided into three groups: one group was fed a vitamin A-free diet for 8-12 weeks; another was given the same diet supplemented with retinol acetate; a third group matched for age served as controls. The vitamin A-deficient group showed a significantly lower growth rate and lower serum retinol levels than either the retinol acetate-supplemented or control groups. In all the groups, S. typhimurium possessing mannose-sensitive fimbriae adhered to enterocytes in significantly larger numbers than the nonfimbriated strains. The number of fimbriated S. typhimurium bound to enterocytes from the proximal small intestine was significantly higher in the vitamin A-deficient rats than in the pair-fed vitamin A-supplemented group (19.3 +/- 14.9 versus 7.8 +/- 5.0; p less than 0.05) or the control group (19.3 +/- 14.9 versus 8.7 +/- 3.5, p = 0.01). The specific activities of the enterocytes lactase, sucrase, and maltase and the protein content in the vitamin A-deficient rats were similar to those in the controls. These results demonstrate that vitamin A deficiency in rats is associated with the increased ability of S. typhimurium to adhere to proximal small intestinal enterocytes. However, the possible changes in the membrane of the enterocyte do not include decreases in brush border disaccharidases or protein content.

Behavioral medicine treatment in chronic constipation with paradoxical anal sphincter contraction.

Nine women and five children with severe chronic constipation received behavioral medicine therapy. Before treatment, all patients had a paradoxical contraction of the external anal sphincter at defecation attempts as demonstrated with electromyography and/or anorectal manometry. An electromyographic biofeedback device connected to an anal probe was used for the training that was performed on a regular toilet seat during five 1-hour sessions. Thirteen of the patients improved considerably and could learn to defecate spontaneously, and the use of laxatives ceased or diminished. Simultaneously with improvement, the paradoxical anal contraction disappeared. The results remained after 6 months, although two of the patients had received booster sessions of biofeedback training during follow-up.

Adherence of Salmonella typhimurium to small-intestinal enterocytes of the rat.

The adherence of radiolabeled Salmonella typhimurium to freshly isolated enterocytes of rats was studied. The results established that type 1 fimbriated strains adhered in significantly higher numbers than did related nonfimbriated strains. Adherence was inhibited by D-mannose and methyl alpha-D-mannoside. Results of kinetic studies indicated that adherence was biphasic; the number of bacteria that adhered per enterocyte remained constant for approximately 20 min and then increased rapidly under the assay conditions. The second phase was associated with structural damage to the enterocytes. The addition of chloramphenicol did not prevent the initial attachment of bacteria to enterocytes but did prevent the second phase. Viable and nonviable bacterial cells adhered to enterocytes, but only viable bacteria were destructive. Freshly isolated enterocytes (trypan blue impermeable) and enterocytes stored overnight (trypan blue permeable) were infected by viable S. typhimurium in a similar manner, suggesting that metabolic activity of the host cell was of less consequence than metabolic activity of the bacterial cells. A model for the role of mannose-sensitive fimbriae as a virulence factor is proposed.

Endomysium and gliadin IgA antibodies in children with coeliac disease.

The diagnostic sensitivity and specificity of IgA endomysium antibodies (EmA) and IgA gliadin antibodies (AGA) for coeliac disease (CD) were studied in Swedish children. Indirect immunofluorescence was used for demonstration of EmA and the diffusion-in-gel enzyme-linked immunosorbent assay method for AGA. Serum samples were collected and analysed from 77 consecutive children undergoing small-intestinal biopsy on recognized clinical indications. The diagnostic sensitivity for CD was 98.1% for EmA and 86.5% for AGA. The specificity of the two tests was 92.7% for EmA and 92.7% for AGA in paediatric patients. In addition, 115 sera from control children showed 2.6% positive for EmA and 0.9% positive for AGA.

Concanavalin A promotes adherence of Salmonella typhimurium to small intestinal mucosa of rats.

A number of dietary lectins have been shown to resist proteolytic digestion. These lectins interact with the small intestinal mucosa causing structural and functional changes. Concomitant to these changes, bacterial overgrowth was reported and a possible interaction between lectins and bacteria in the small intestine was postulated. The aim of this study was to investigate the effect of various lectins on adherence of Salmonella typhimurium to both isolated small intestinal enterocytes and ligated intestinal loops. Isolated intestinal cells or ligated intestinal loops were incubated with [3H] adenine-S. typhimurium in the presence or absence of concanavalin A, phytohemagglutinin, peanut agglutinin, and wheat germ agglutinin. Only concanavalin A promoted the adherence of various strains of nonfimbriated S. typhimurium to isolated viable intestinal cells. Other lectins showed no effect on the adherence. In situ studies showed that bacterial binding was increased in concanavalin A-treated intestinal loops, supporting the significance of the experiments in vitro. These data suggest that lectins may act by promoting bacterial adherence to the small intestine, thereby facilitating colonization and infection, and leading to bacterial overgrowth.

The effect of postnatal development on the adherence of nonfimbriated and fimbriated Salmonella typhimurium to isolated small intestinal enterocytes.

The adherence of radiolabeled fimbriated (S 7471 OF) and nonfimbriated (S 7471 N) Salmonella typhimurium to small intestinal rat enterocytes was examined during postnatal development. The fimbriated strain invariably adhered in higher numbers than the nonfimbriated strain during all periods of development. The capability of enterocytes to bind Salmonella increased significantly during postnatal development and reached adult levels at weaning time (21 days of age). Bacterial adherence to enterocytes was similar if the cells were isolated from the proximal or the distal small intestine. Early weaning of pups did not affect the capability of enterocytes to bind Salmonella. Pretreatment of isolated enterocytes from adult animals with rat's milk before exposure to Salmonella had no effect on the level of bacteria that adhered per enterocyte. Conversely, pretreatment of Salmonella with rats' milk before binding to enterocytes from adult animals also did not alter the level of bacteria adhered per enterocyte. These results suggest an age-dependent, postnatal development of available receptors for S. typhimurium on rat enterocytes. The acquisition of these receptors is not affected by mother's milk and is unaltered by early weaning.