P. De Mol

Yersinia enterocolitica infections and pork: the missing link

To determine the risk factors for Yersinia enterocolitica (YE) infection in Belgium, which is the country with the highest incidence of this infection, 40 persons with YE infections due to serotype O:3 (n = 36) or O:9 (n = 4) were compared with matched controls. Most patients had acute gastroenteritis; 1 had a liver abscess. 20% were admitted to hospital; the mean duration of hospital stay was 9 days. YE infection was strongly associated with eating raw pork in the 2 weeks before onset (odds ratio = 12, p = 0.00002), a factor that accounted for 58% of the YE infections studied. 14 (18%) of 79 families surveyed at a well-baby clinic fed their children raw pork from a median age of 18 months. Specific control measures to reduce contamination and consumption of raw pork may reduce the incidence of YE infections.

ENTEROPATHOGENIC AGENTS IN CHILDREN WITH DIARRHOEA IN RURAL ZAIRE

A systematic study of enteropathogenic agents in the stools of children was carried out in a rural area of Kivu Province in Zaire in June, 1979. 84 inpatients and 271 outpatients with diarrhoea were investigated together with 117 inpatient and 203 outpatient controls without diarrhoea. Campylobacter jejuni was the most frequently recovered pathogen in both inpatients (24%) and outpatients (13.7%). Enterotoxigenic Escherichia coli was the next most common among children presenting as outpatients with diarrhoea (10.3%). Yersinia enterocolitica was isolated for the first time in this region. Rotaviruses were found only in outpatients with diarrhoea, and usually in children under two years of age. C. jejuni and Vibrio cholerae could also be isolated from the faeces of domestic animals living in close contact with these village families. Analysis of the clinical features did not lead to the recognition of a pattern typical of any particular pathogen. Salmonella, Shigella, and enteropathogenic E. coli did not play a significant role in the cases studied.

Seroepidemiological study on sexually transmitted diseases and hepatitis B in African promiscuous heterosexuals in relation to HTLV-III infection

A seroepidemiological study was performed on HTLV-III, T. pallidum, C. trachomatis and Hepatitis B virus (HBV), in Butare, Rwanda, among 33 female prostitutes, 25 male customers of prostitutes, and 60 male and female controls. As compared with female controls the prostitutes had a higher prevalence of antibodies to HTLV-III (29/33 versus 4/33, p<0.001), T. pallidunz (TPHA: 27/33 versus 6/33, p<0.001; RPR: 19/33 versus 2′33, p<0.001; FTA-Abs: 27/33 versus 5/33, p<0:001) and C. trachomatis (IgG IF: 31/33 versus 13/33, p<0.001). HBV serological markers were more often detected in the prostitutes than in the female controls (31/33 versus 18/33, p<0.001) although HBs antigen carriage rate was similar in both groups. As compared with male controls, the male customers of prostitutes had more frequently detectable antibodies to HTLV-III (7/25 versus 2/27, p = 0.05), and a positive RPR (10/25 versus 1/27, p<0.01). Among the 118 individuals studied, odds ratios and trend analysis disclosed a significant association between HTLV-III seropositivity and a positive TPHA, RPR, FTA-Abs, Chlamvdia IgG IF test and serological markers to HBV. No association was found between HTLV-III seropositivity and IIBs Ag carriage. This study suggests that HTLV-III has to be considered as an infectious agent transmitted among promiscuous Central African heterosexuals by sexual contact and/or parenteral contact with unsterile needles used for STD treatments.

A COMPETITIVE IMMUNOSORBENT ASSAY FOR THE DETECTION OF HEAT-STABLE ENTEROTOXIN OF ESCHERICHIA COLI

A competitive ELISA procedure for the detection of Escherichia coli heat stable enterotoxin (ST) with monoclonal antibody has been developed. This test is 10 times more sensitive than the suckling-mouse bioassay and it is specific, simple and cheap. A set of 882 strains of E. coli isolated from man were tested both by ST-ELISA and suckling-mouse bioassay, the latter serving as the reference method. Positive results in both tests were obtained with 152 strains. The remaining strains gave negative results in both tests, with the exception of two strains, known to be ST producers, that gave negative results in the suckling-mouse assay, but gave positive results by the ELISA method.

Campylobacter enteritis in Portugal: Epidemiological features and biological markers

From 1984 to 1989, stool samples from 2811 gastroenteritis cases were examined for the presence ofCampylobacter jejuni andC. Coli, Salmonella, Shigella andYersinia species. Isolation rates were:Campylobacter jejuni andC. Coli, 5.3%,Salmonella spp., 14.8%,Shigella spp., 4.6% andYersinia enterocolitica, 1.1%.Age group distribution analysis shows a higherCampylobacter isolation rate in children under one year of age. Seasonal distribution revealed a peak incidence in winter as in other Meditteranean countries.Predominant biotypes wereC. jejuni I (51%),C. jejuni II (21.5%) andC. coli I (18.8%). Antimicrobial susceptibility testing did not reveal resistance to erythromycin. Thirty of the strains harboured plasmids with 7 different profiles.

PREVALENCE OF ASYMPTOMATIC BACTERIURIA AND COMPARISON BETWEEN DIFFERENT SCREENING METHODS FOR ITS DETECTION IN INFANTS

Urine was cultured from 441 healthy children, aged 3 to 36 months, simultaneously by standard pour plating and by dip-slide. Significant bacteriuria (≥105 colony-forming units/ml in two successive specimens) was found in 13 children (2.9%): 11 boys, 2 girls. Proteus mirabilis was the most frequently isolated organism. Of the 13 infants, 2 had malformations on intravenous pyelography. All 13 had a negative antibody-coated bacteria test. Nitrite test (N-MultistixR) and microscopic examination were also performed. The results suggest that asymptomatic bacteriuria cannot be accurately predicted either by microscopic examination or by the nitrite test, and that the quantitative urine culture by dip-slide is the easiest and most reliable way of diagnosing urinary tract infections. However the criteria of Kass were found to be too strict.

Acute and recurrent salmonella infections in three children with chronic granulomatous disease

Summary Three children with chronic granulomatous disease (CGD) were infected by salmonellae and two of them had recurrences. One child received granulocyte transfusions in addition to antibiotics. Reasons are given for recommending chloramphenicol alone or in combination for acute salmonellosis in children with CGD and for using long-term amoxycillin prophylaxis thereafter.

Neonatal meningitis due to Candida albicans, associated with osteomyelitis; failure to respond to miconazole

Summary The failure of intravenous and intrathecal miconazole to sterilise the cerebrospinal fluid of an infant with Candida albicans meningitis and associated osteomyelitis is reported. The patient subsequently responded to a short course of amphotericin B. The clinical features of disseminated candidiasis are described.

Management of presumptive bacterial meningitis in childhood: A practical approach

Precise bacteriological diagnosis in acute meningitis is sometimes difficult. The present study, in which 59 of 97 children received chemotherapy for presumptive bacterial meningitis and of whom only 40 were subsequently proved to have a bacterial aetiology, reflects this. The diagnostic data from these 97 patients have therefore been reviewed in an attempt to identify factors which may assist discrimination of bacterial from non-bacterial meningitis. A decision plan for the management of suspected bacterial meningitis, based on these results, is suggested.