Jussi Eskola

Etiology of community-acquired pneumonia in 254 hospitalized children.

Background. Childhood community‐acquired pneumonia is a common illness, but there have been relatively few comprehensive studies of the viral and bacterial etiology in developed countries. The aim of the present investigation was to determine the etiology of community‐acquired pneumonia in hospitalized children by several laboratory methods. Methods. In a 3‐year prospective study a nasopharyngeal aspirate for viral studies and acute and convalescent serum samples for viral and bacterial serology were taken from 254 children with symptoms of acute infection and infiltrates compatible with pneumonia in the chest radiograph. The role of 17 microbes was investigated. Results. A potential causative agent was detected in 215 (85%) of the 254 patients. Sixty‐two percent of the patients had viral infection, 53% had bacterial infection and 30% had evidence of concomitant viral‐bacterial infection. Streptococcus pneumoniae (37%), respiratory syncytial virus (29%) and rhinovirus (24%) were the most common agents associated with community‐acquired pneumonia. Only one patient had a positive blood culture (S. pneumoniae) of 125 cultured. A dual viral infection was detected in 35 patients, and a dual bacterial infection was detected in 19 patients. Conclusions. The possible causative agent of childhood community‐acquired pneumonia can be detected in most cases. Further studies are warranted to determine what etiologic investigations would aid in the management of pneumonia. With effective immunization for S. pneumoniae and respiratory syncytial virus infections, more than one‐half of the pneumonia cases in this study could have been prevented.

Nonsuppression of cortisol in depression and immune function

Eighteen depressive patients and twenty-five healthy control subjects were studied using a comprehensive immunological test system and the dexamethasone suppression test (DST) as well as some additional neuroendocrine parameters. In addition, immune functions of six of the patients were studied serially three times at 1-2 months intervals. The OKT 4+/8+ ratio (OKT 4+ = helper/inducer phenotype; OKT 8+ = suppressor/cytotoxic phenotype) was slightly higher in those ten depressive patients showing suppression in the DST than in healthy controls, but there were no significant differences between the nonsuppressor and suppressor groups or between the nonsuppressor and suppressor groups or between nonsuppressors and control subjects. Lymphocyte transformation responses induced by phytohaemagglutinin (PHA) were similar in the nonsuppressors and suppressors, but lower in both groups than in control subjects. The number of Ig-secreting cells measured in the absence and presence of pokeweed mitogen (PWM) were similar in the nonsuppressor and suppressor groups. Four of the depressive patients tested repeatedly exhibited an abnormal response in the DST at the beginning of the study. During the follow-up period two of them recovered completely from depression as well as the patients with a normal suppression in the DST. The proportions of T and B lymphocytes and regulatory T lymphocyte subsets as well as the functions of T and B lymphocytes of the nonsuppressors and suppressors in the DST were within normal ranges before and after recovery from depression and comparable to healthy controls in repeated testing. The results indicate that in spite of the importance of cortisol in immunoregulation, the increased cortisol secretion and typical resistance to dexamethasone suppression in endogenously depressive patients is not profoundly and consistently reflected in immune functions. Neither does normalization of cortisol responses induce any major changes in immune status during a patients recovery from depression. Previous work indicates that suppressed immunity may play an important role in the increased morbidity and mortality associated with bereavement. In the light of present findings we suggest that endogenous depression differs also in this respect from grief reactions.

Myringotomy in the Treatment of Acute Otitis Media in Children

The treatment of acute otitis media was studied in 158 children. All children (mean age 4 years) received penicillin orally 80 000--100 000 IU per day for 10 days. Myringotomy was performed on 68 children at the time of the diagnosis. The other 90 children were treated with penicillin and ear drops. The bacteriological findings from the nasopharynx at the time of diagnosis were equivalent in both groups. After 2 weeks, 42% of the children without myringotomy and 71% of the children with myringotomy were cured. The children who were not cured were treated with amoxicillin for 10 days. Four weeks after diagnosis 71% and 90% of the children respectively were cured. The differences between the two groups are significant. The observations indicate that myringotomy clearly accelerates the recovery from acute otitis media.

Cell-mediated immunity in Darier's disease: effect of systemic retinoid therapy.

In five patients with Dariers disease, lymphocyte subpopulations, lymphocyte responsiveness to phytohaemagglutinin (PHA), concanavalin A (Con A), pokeweed mitogen (PWM) and purified protein derivative of tuberculin (PPD), leukocyte migration inhibitory factor (LMIF) production and suppressor cell activities were studied before and during oral etretinate treatment. Pre‐therapy investigations of cell‐mediated immunity showed no severe immunological dysfunction, although high responses to supra‐optimal Con A concentrations suggested abnormalities in immunoregulatory lymphocyte subpopulations. In addition, two patients showed enhanced LMIF production upon stimulation with Con A, PWM and PPD. Retinoid therapy decreased the number of peripheral blood total leukocytes, lymphocytes and T‐cells, normalized the LMIF production, and decreased the lymphocyte responses to mitogens. Furthermore, the dose‐response curve to Con A changed toward normal and the suppressor cell activity regulating Con A responses tended to increase.

Effect of 8-methoxypsoralen plus UVA (PUVA) on lymphocyte transformation and T cells in psoriatic patients.

The peripheral blood lympochytes of the psoriatic patients studied initially showed a normal response to phytohaemagglutinin (PHA) and to purified protein derivative of turberculin (PPD) in a microculture using whole blood, but a lower than normal response to a high concentration of concanavalin A (Con A). The initial level of E‐rosette‐forming T cells in psoriatic patients (51.3%) was significantly lower than that in healthy controls (66.7%).

Effects of indomethacin on lymphocyte proliferation, suppressor cell function, and leukocyte migration inhibitory factor (LMIF) production

The in vitro effect of indomethacin (IND) on PHA- and Con-A-induced immune responses was studied. The results showed that the enhancement of both PHA and Con A responses by IND does not significantly depend on the concentrations of mitogens or IND. A significant negative correlation was found between the initial PHA response and augmentation index, whereas there was a positive correlation between the initial Con A response and the enhancement of the Con A responses. Indomethacin significantly increased the Con-A-induced suppressor cell activity and PHA-induced leukocyte migration inhibitory factor production (LMIF), whereas the effects on the PHA-induced suppressor cell activity and Con-A-induced LMIF production were not significant. The findings indicate the indomethacin has a dual effect on PHA- and Con-A-induced immune responses probably reflecting intrinsic differences among T cells, for example, distinct lymphokines produced by different T-cell subpopulations.

Peroral Prednisolone in the Treatment of Middle-Ear Effusion in Children: A Double-Blind Study

Otitis media with effusion (OME) is one of the most important and, with respect to treatment, one of the most problematic of the common diseases of childhood. A variety of medical regimens and surgical procedures have been tried in the management of middle ear effusion. Conservative treatment has included long-term chemotherapy antihistamines, and decongestants, but definitive evidence that the clinical course of the disease is significantly shortened by any of these therapies has yet to be presented. Corticosteroid treatment has also been used both in allergic and nonallergic children. Evaluating the results of ampicillin and prednisone therapy in 160 children with OME, PERSICO et al. (1978) concluded that the steroid had a beneficial effect on Eustachian tube function. SCHWARTZ et al. (1980a) found that middle ear effusion cleared in 62S% of children with secretory otitis media as a result of treatment with 1 mg of prednisone per day. Following treatment with intranasal beclomethasone the middle ear effusion resolved in only 48% of children (SCHWARTZ et al., 1980b). A placebo-controlled trial by LINDHOLDT and KORTHOLM (1982) also failed to show a significant difference in favour of intranasal beclomethasone therapy. To obtain information on the role of prednisolone in the management of OME, we performed a clinical study in children with secretory middle ear effusion. The study was designed as a double-blind trial to compare the effects of prednisolone, sulfatrimethoprim and placebo. The outcome of therapy was assessed in a clinical follow-up of 2 months.

Serum IgA deficiency and anti-IgA antibodies in pernicious anemia

Three pernicious anemia (PA) patients with selective IgA deficiency and anti-IgA antibodies in their sera were followed for over 3 years. After instituting therapy with cyanocobalamin there was a slight increase in the anti-IgA antibodies. After 1 year the titers of anti-IgA antibodies in the sera of these patients declined significantly as compared to the values before treatment (P less than 0.02), and after 2 years one patient had no measurable anti-IgA antibodies, yet no IgA appeared in the serum of any of the three. Further, in a medium with no anti-IgA the lymphocytes of these patients were not capable of producing IgA in vitro. Thus, the reason for the IgA deficiency in PA appears to be linked to the function of B cells rather than to anti-IgA antibodies.

Effect of levamisole on the maturation of guinea pig thymocytes.

Abstract Alkaline phosphatase (AP) is a useful cell membrane marker of guinea pig thymocytes. Thymocytes with various AP activities represent different maturation stages of these cells. In this work, levamisole was found to effectively inhibit the AP activity in homogenates of thymus and thymocytes, but did not modify the AP activity of viable thymocytes. It significantly increased the number of E rosettes binding nine or more erythrocytes, but induced no change in the total number of rosette-forming thymocytes. It significantly augmented the PHA, but not the Con A, response of unfractionated thymocytes, while it had no effect on the mitogenic responses of the two subpopulations of thymocytes. The results support the concept that levamisole acts to mature a part of thymocytes as a thymomimetic compound without affecting the AP activity in the thymocyte cell membrane.

Tonsillectomy and Immune Responses

Immune response were examined in 10-year-old boys just before and one month after tonsillectomy, and in young male adults tonsillectomized 10 years earlier. All the parameters studied were found to be quite normal.