L. di Martino

Lactose malabsorption in children with symptomatic Giardia lamblia infection: feasibility of yogurt supplementation

An investigation was carried out on 61 children suffering from symptomatic giardiasis with the object of verifying the incidence and entity of lactose malabsorption. Furthermore, the possibility of a substitutive yogurt diet was verified in the lactose malabsorbers. The subjects, all children older than 1 year, were studied according to a schedule that included a lactose hydrogen breath test (BT) performed prior to therapy and a further BT 60 days following therapy. The subjects were divided in two groups: group A, 40 children, received a dose of 250 ml of cows milk; group B, 21 children, received a stress dose of 2 g/kg lactose (max 50 g). Those subjects who were lactose malabsorbers at the 60 day follow-up were also given a BT at 75 days, and in the case of persistent malabsorption, a further BT was performed after 24 h with the administration of yogurt (450 g containing 12.1 g of lactose). Furthermore, 40 subjects matched for age and sex but without any GI complaints served as controls. The results showed lactose malabsorption to be frequent in children with Giardia lamblia symptomatic infection. According to the BT with a standard lactose load, all patients were malabsorbers; when testing lactose absorption with 250 ml of cows milk, 45% of patients were found to be malabsorbers. In the latter subjects, the oral load of yogurt was uniformly well tolerated and gave rise to no H2 increment on the BT. We conclude that the occurrence of lactose malabsorption of nutritional relevance is common in children suffering or having suffered from giardiasis. Such children, however, may benefit from the administration of yogurt, whose lactose appears to be well absorbed.

Intestinal giardiasis associated with ophthalmologic changes.

Summary: In an ophthalmologic study of 90 children with symptomatic giardiasis, ocular alterations were found in 10. Eight of these subjects presented an extensive “salt and pepper” degeneration of the pigmented epithelium involving 360° of the midperiphery of both eyes. In one of the eight children, the pigmented epithelium showed atrophic areas, and in another there was a small hard exudate in the left eye. Of 2 remaining of the 10 children with ocular alterations, 1 presented with slight decoloration of the temporal half of the optic disc, and the other was affected by chorioretinitis. After single-dose antiprotozoic therapy (tinidazole 50 mg/kg), parasitologic tests were negative in all subjects and remained so throughout a 1-year follow-up. However, the characteristic epithelial lesion remained unalterated in all eight children for the entire follow-up period, as well as the optic disc decoloration in the only observed case. The child affected by chorioretinitis recovered after 3 weeks of combined treatment with bethametasone plus deflazacort. In two control groups, 1 of 200 healthy children and 1 of 200 children with gastrointestinal symptoms but without giardiasis, no case of “salt and pepper” degeneration of the pigmented epithelium or other significant ocular alterations was found.

Visceral leishmaniasis in a child with HIV-1 infection

Sir: The proportion of cells with memory phenotype in normal individuals rises progressively within the first two decades of life reflecting the exposition to antigenic stimuli [3]. In HIV-positive children, the percentage of memory CD4 cells declines with age, while memory CD8 cells progressively increase with age and the percentage remains higher then in uninfected children [2]. We have studied 14 HIV-1 infected children (4 P lb and 10 P2; 8 males and 6 females; mean age 55 months, range 9-104 months) and seven seroreverted children born to HIV-l-posit ive mothers (four males and three females; mean age 51 months, range 31-116 months) with CD4+ cell count >500/mm 3. We evaluated the proportion of cells with naive and memory phenotype within CD4+ and CD8+ lymphocyte subsets by flow cytometry (Cytoron, Ortho; Raritan, NJ), using fluoresceinconjugated monoclonal antibodies OKT4 (CD4) or OKT8 (CD8; Ortho) and phycoerythrin-conjugated 2H4 (CD45RA; Coulter Immunology, Hialeah, FL) or Leu45RO (CD45RO; Becton Dickinson, Mountain Wiew, CA) in a 2-colour analysis. As already reported by Borkowsky et al. [2], the proportion of cells with memory phenotype within the CD4+ subset increased with age in the controls (r = 0.67; P = 0.10) and declined in the HIVinfected children (r = 0.22; P = 0.44) although the difference between the two slopes was not statistically significant (P = 0.07), possibly because of the small number of patients studied. The proportion of memory CD8 ceils was significantly higher in HIV-infected children than in controls (17.5 + 9.4 vs 6.3 + 3.0; P < 0.001; Students t-test) and was inversely related to the percentage of CD4+ cells (r = 0.71; P < 0.01) (Fig. 1). It is conceivable that antigenic stimuli cause an unidirectional switch from the naive to the memory phenotype in CD8 cells of HIV-infected children, as in normal subjects. On the contrary, within the CD4 subset, the ability of low dose antigen to uniquely activate memory cells, may render these cells 7O