Elia M. Ayoub

Effect of passive maternal antibody on influenza illness in children: a prospective study of influenza A in mother-infant pairs.

To determine the effect of passive antibody on the incidence of influenza in infants, infants born to mothers with serum antibody to influenza A (immune) and those born to mothers without evidence for this serum antibody (non-immune) were followed during the influenza H1N1 epidemic of 1979. Immune mothers had higher H1-specific antibody titers before the epidemic (P less than 0.001), were less frequently culture positive, showed fewer titer rises (P less than 0.001) and were less symptomatic than were nonimmune mothers. Infants of immune mothers had higher H1-specific passive antibody titers that correlated with their mothers antibody titers. Although infants of both groups showed no difference in incidence of influenza infection, infants of immune mothers had influenza symptoms that were delayed in onset (P = 0.02) and were of shorter mean duration compared with infants of nonimmune mothers. These findings suggest that passive maternal antibody delays the onset and decreases the severity of influenza disease in young infants.

The influence of the site of infection on the immune response to group A streptococci

The immune response after streptococcal infection of the skin and of the upper respiratory tract (URT) was studied prospectively in a group of normal children, ages 3-6 yr. The children were examined and cultures for group A streptococci were obtained weekly from the throat, nose, and skin lesions (when present). Paired sera were collected at the beginning and end of the study, and the changes in antibody titers were measured for three different streptococcal antigens: streptolysin O, deoxyribonuclease B (DNAse B), and nicotinamide adenine dinucleotidase (NADase). The findings suggest that in contrast to infection of the URT antibody response to streptolysin O is relatively feeble after streptococcal infection which is limited to the skin. The response to NADase is also poor after cutaneous infection. Antibody responses to DNAse B are generally good regardless of the site of the infection. These and other studies indicate that anti-DNAse B is the antibody of choice in studying streptococcal infection of the skin and its complications.

Lack of effect of Lactobacillus on gastrointestinal bacterial colonization in premature infants.

Studies were carried out on premature infants in the neonatal intensive care unit to determine the effect of feeding of lactobacilli on colonization of the gastrointestinal tract by antibiotic-resistant gram-negative enteric organisms. Thirty premature infants were matched by birth weight and gestational age, randomized and fed double blind either lactobacilli-containing formula or non-lactobacilli-containing formula within 72 hours of delivery. The two study groups were screened weekly by culture for stool lactobacilli, for gram-negative bacteria and for antibiotic resistance of these bacteria. Lactobacilli were cultured from the stools of 13 of 15 patients receiving lactobacilli and from 3 of 15 patients not receiving lactobacilli (P < 0.001). Gram-negative enteric organisms were isolated during 40 of the 86 weeks (47%) of hospitalization for patients receiving lactobacilli and during 28 of 57 weeks (49%) for patients not receiving lactobacilli. There was no significant difference between the study groups in the number of resistant organisms or in the proportion of resistant organisms per gram-negative enteric isolates (4 of 40 vs. 0 of 28). These results suggest that facultative gram-negative enteric bacterial colonization, with either total or aminoglycoside-resistant strains, is not decreased by oral feedings of Lactobacillus acidophilus in premature infants.

Cefuroxime versus ampicillin plus chloramphenicol in childhood bacterial meningitis: A multicenter randomized controlled trial

In a multicenter randomized trial, 107 children with bacterial meningitis were initially given either cefuroxime or ampicillin plus chloramphenicol. Patients were alternately assigned to 7- or 10-day courses of the designated antimicrobial regimen. CSF isolates included Haemophilus influenzae type b (89, of which 25% were beta-lactamase positive), Streptococcus pneumoniae, and Neisseria meningitidis. Although mean CSF bactericidal titers against Haemophilus isolates were 1:6 in each treatment group, H. influenzae was cultured from CSF in four of 39 patients receiving cefuroxime, 24 to 48 hours after initiation of therapy, compared with none of 40 patients given ampicillin plus chloramphenicol (P = 0.11). Clinical cure rates were similar (95%); one death occurred in each group. One child given cefuroxime had persistent meningitis after 5 days of therapy, and mastoiditis with secondary bacteremia developed in one on day 10. Three patients had relapse or reinfection. One patient who received cefuroxime for 10 days had a relapse of epiglottitis 17 days later, and of the patients given ampicillin plus chloramphenicol, one had a relapse of meningitis 1 week after 7 days of therapy, and bacteremia developed in one 42 days after completion of 10 days of therapy. No increase in either in-hospital complications or relapses occurred with a 7-day treatment course. Proof of the equivalence of the antibiotic regimens and the efficacy of 7-day courses of treatment, as well as the consequences of delayed CSF sterilization, will require additional investigation.

Anaphylactoid purpura: Streptococcal antibody titers and β1c-globulin levels

Evidence for antecedent group A streptococcal infection was sought in 33 patients with anaphylactoid purpura. Serum levels of β 1c -globulin were determined. Histologic and immunofluorescent studies were performed on 13 kidney biopsies obtained from patients with anaphylactoid nephritis. Elevated titers for the ASO, anti-DNase B, or anti-NADase were present in about one third of the patient population. The incidence of elevated titers as well as the geometric means of the antibody titers for either the whole group of patients with anaphylactoid purpura or the group of patients with anaphylactoid nephritis were not significantly different from the matched normal control population. β 1c -globulin levels were in the normal range. Renal biopsies showed histologic changes and immunofluorescent reactions to γ-globulin, β 1c , and fibrin of varying degrees of severity and intensity. The data obtained do not support a causal relationship between group A streptococcal infection and anaphylactoid purpura.

IgG and IgM Pneumococcal Polysaccharide Antibody Responses in Infants

ABSTRACT. The ontogeny of human antibody responses to pneumococcal polysaccharide antigens was studied by determining whether the age at immunization affects the level and/or immunoglobulin isotype of antibody produced. Twenty-nine healthy infants between 2 and 18 months of age and 13 normal adults were studied. Responses were found to vary markedly with the age at the time of immunization and with the pneumococcal serotype tested. Three general patterns of isotype-specific antibody response were observed in the infants: a high response in IgG antibody occurred as early as 2 months of age following immunization with type 3 pneumococcal polysaccharide; little or no response was noted in either IgG or IgM antibody with types 6,18, and 19; and intermediate responses with IgM antibody increases greater than IgG increases were found for type 23. These data suggest that different factors control the immunologic response of infants to various pneumococcal polysaccharide serotypes following immunization at various ages.

Cellular Immune Responses to Extracellular Streptococcal Products in Rheumatic Heart Disease

The lymphocyte transformation responses to purified preparations of two extracellular products of group A streptococci (blastogen A and nuclease B), to phytohemagglutinin, and to Candida albicans antigen were measured in tonsillar and peripheral blood lymphocytes from patients with rheumatic heart disease (RHD) and suitably matched nonrheumatic (control) subjects. The mean phytohemagglutinin dose responses of tonsillar and peripheral lymphocytes from RHD patients were essentially indistinguishable from those of controls. In contrast, the responses of tonsillar and peripheral blood lymphocytes to the two extracellular products of group A streptococci were significantly lower in RHD patients than in nonrheumatic control subjects. Candida antigen produced very little stimulation of lymphocytes in any of the subjects. The geometric means of antibody levels against streptolysin O, nuclease B, and nicotinamide adenine dinucleotidase showed no consistent differences between the control group and the group of RHD subjects. Group A streptococci were isolated from the tonsils of approximately 25% of both groups of subjects. The RHD patients clearly had a depressed cellular immune response to the two purified streptococcal extracellular antigens. The equal frequency in recovery of group A streptococci from tonsils and the absence of consistent difference in titers of humoral antibodies to streptococcal extracellular antigens, particularly nuclease B, suggest that this differential response is not due to a lower level of stimulation by repeated exposure to group A streptococcal products.

Hypoimmunoglobulinemia with normal T cell function in female siblings

Abstract A distinct syndrome reported here provides evidence for an autosomal recessive counterpart to X-linked (Brutons) hypoimmunoglobulinemia. Two sisters had humoral (B cell) immunodeficiency. One suffered from recurrent infection, the second presented with non septic arthritis. Both had markedly lowered immunoglobulin levels in serum and secretions, deficient antibody production, and absent B-dependent regions in their lymph nodes. They also lacked surface immunoglobulin-bearing peripheral blood lymphocytes. T cell number and cell-mediated immunity were normal; lymphocytes with complement or Fc receptors were present.

Prevention of Rheumatic Fever

Rheumatic fever is a recurrent disease which frequently can be prevented. Infection with group A streptococci precipitates both initial and recurrent attacks; therefore, prevention of rheumatic fever and rheumatic heart disease depends upon the control of streptococcal infections. This may be accomplished by (1) prevention of streptococcal injections in rheumatic subjects, and (2) early and adequate treatment of streptococcal infections in all individuals.Bacterial endocarditis may result from dental and other surgical procedures in patients with rheumatic or congenital heart disease. When such procedures are undertaken, these patients should be protected by administration of antibiotics in therapeutic doses.

Poststreptococcal reactive arthritis.

The occurrence of an entity designated poststreptococcal reactive arthritis (PSReA) has been highlighted in recent reports. The syndrome was considered part of the spectrum of acute rheumatic fever by some, whereas others stressed the differences between the two diseases. As distinct from acute rheumatic fever, PSReA is characterized by a shorter latency period between the inciting streptococcal infection and the onset of arthritis, a higher frequency of involvement of the small joints and axial skeleton, poor response to aspirin and other nonsteroidal anti-inflammatory drugs, a protracted course of arthritis, a low incidence of carditis, and absence of other major manifestations of acute rheumatic fever. Recent studies have demonstrated an increased frequency of DRB1*01 in patients with PSReA, which contrasts with the increased frequency of DRB1*16 in rheumatic fever. Because 6% of patients with PSReA have been reported to have late onset carditis, it is judicious to recommend that patients with PSReA receive prophylactic antimicrobials for a minimum period of 5 years or until the age of 21 years, whichever is longer.