P. Larsson

Intestinal colonization with enterobacteriaceae in Pakistani and Swedish hospital-delivered infants.

ABSTRACT. Rectal cultures from Swedish and Pakistani hospital‐delivered newborn infants were analysed regarding the early aquisition of enterobacteria. Swedish infants were delivered vaginally, Pakistani infants were delivered either vaginally or by caesarean section. The Swedish infants were all breast‐fed, whereas breastfeeding was incomplete and often started late among the Pakistani infants. Both groups of Pakistani infants were more rapidly colonized with enterobacteria than were the Swedish infants. Cultures from Swedish infants seldom yielded more than one kind of enterobacteria; E. coli and Klebsiefla were most frequently isolated. E. coli dominated in both Pakistani groups, but especially caesarean section delivered infants were in addition often colonized with Proteus, Klebsiella, Enterobacter or Citrobacterspecies. Breastfeeding from the first day of life reduced colonization with Klebsiella/Enterobacter/Citrobucter.The results suggest that environmental exposure, delivery mode and early feeding habits all influence the early intestinal colonization with enterobacteria.

An outbreak of diphtheria among Swedish alcoholics

SummaryAfter 25 years without any indigenous cases of diphtheria in Sweden, an outbreak occurred in the city of Göteborg, during 1984 to 1986. A group of alcoholics constituted the reservoir ofCorynebacterium diphtheriae. The outbreak included 13 clinical cases and 65 carriers. The death-to-case ratio and the complication rate among the clinical cases was high, with three fatal cases and six patients developing reversible paralyses. The fatal cases had no history of previous immunization. The outbreak demonstrates the necessity of a good vaccination status to diphtheria, also in countries where the disease was thought to have been eradicated.ZusammenfassungNachdem in Schweden 25 Jahre lang kein eigener Fall von Diphtherie aufgetreten war, kam es in Göteborg zwischen 1984 und 1986 zu einer Epidemie. Eine Alkoholikergruppe bildete das Reservoir fürCorynebacterium diphtheriae. Insgesamt traten 13 klinische Fälle auf, bei 65 Personen wurde Trägertum nachgewiesen. Die Letalität und Komplikationsrate war bei den klinischen Fällen hoch, drei Patienten verstarben und sechs entwickelten reversible Lähmungen. Bei den Todesfällen war anamnestisch keine Impfung festzustellen. Die Bedeutung einer guten Durchimpfung gegen Diphtherie, auch in Ländern, in denen mit einer Austrottung der Erkrankung gerechnet wird, ist mit dieser Epidemie eindeutig bewiesen.

Secretory IgA antibodies to enterobacterial virulence antigens: their induction and possible relevance.

1) Milk and salivary s-IgA antibodies are via the homing of IgA producing cells from the Peyers patches closely connected with antigenic stimuli in the intestine. This explains the presence in human milk of s-IgA antibodies against E. coli O and K antigens, V. cholerae and Shigella O antigens, E. coli and V. cholerae enterotoxins. These secretory antibodies can be induced by intestinal exposure and boosted by parenteral vaccination. 2) Preliminary data suggest that the IgA response in the urinary tract and possibly in the lung may be involved in the homing mechanism as well. 3) The protective role of the milk s-IgA antibodies to enterobacterial virulence antigens is strongly suggested, as is the protection mediated by urinary antibodies against urinary tract infections.

URINARY TRACT INFECTIONS CAUSED BY PROTEUS MIRABILIS IN CHILDREN The Antibody Response to O and H Antigens and Tamm‐Horsfall Protein and Bacterial Adherence to Uro‐epithelium

ABSTRACT. Sera from seven girls with acute symptomatic pyelonephritis and nine children with acute symptomatic cystitis caused by Proteus mirabilis were analysed for antibodies against the bacterial O and H1 antigens and the Tamm‐Horsfall protein. An increase in antibody levels against O antigen and Tamm‐Horsfall protein was noted only in patients with acute pyelonephritis indicating that antibody determinations can be useful in differentiating between upper and lower urinary tract infection caused by Proteus in similarity to those caused by E. coli. In contrast no difference in adhesive ability was noted comparing Proteus strains causing acute pyelonephritis or cystitis.

The Ontogeny of the Immune Response: The Role of Maternal Factors

The newborn infant must be capable of coping with the many microorganisms to which it is exposed after birth. Most of the contact between the neonate and the microorganisms occurs on mucous membranes, which represent extensive surfaces of thin lining protecting the integrity of the host. For the understanding of the host-parasite relationship in the young infant and the ontogeny of immunity, we need to determine what factors microorganisms might use to colonize and possibly invade the mucosal membranes.

Intestinal colonization and antibody response

Rapid bacterial colonization of the gastrointestinal tract takes place immediately after birth. Only a few of theEscherichia coli strains colonizing the gut of healthy full-term neonates expressed MS pili. On the other hand, mostE. coli strains isolated carried MR pili resembling the P-fimbriae which are a known virulence factor for pyelonephritogenicE. coli. The presence of serum antibodies against pili and K antigens ofE. coli after vaccination did not influence the capacity ofE. coli to colonize and persist in the intestine of experimental animals. Unmittelbar nach der Geburt findet in kurzer Zeit eine Besiedelung des Gastrointestinaltraktes statt. Nur wenigeEscherichia coli-Stämme, die den Darm gesunder, reifer Neugeborener besiedeln, exprimieren MS Pili. Andererseits besaßen die meisten isoliertenE. coli-Stämme MR Pili, die den als Virulenzfaktor der pyelonephritogenenE. coli bekannten P-Fimbrien ähneln. Antikörper gegen Pili und K-Antigen vonE. coli, die sich nach Impfung im Serum fanden, beeinflußten nicht die Fähigkeit vonE. coli, den Darm von Laboratoriumstieren zu besiedeln und dort zu persistieren.SummaryRapid bacterial colonization of the gastrointestinal tract takes place immediately after birth. Only a few of theEscherichia coli strains colonizing the gut of healthy full-term neonates expressed MS pili. On the other hand, mostE. coli strains isolated carried MR pili resembling the P-fimbriae which are a known virulence factor for pyelonephritogenicE. coli. The presence of serum antibodies against pili and K antigens ofE. coli after vaccination did not influence the capacity ofE. coli to colonize and persist in the intestine of experimental animals.ZusammenfassungUnmittelbar nach der Geburt findet in kurzer Zeit eine Besiedelung des Gastrointestinaltraktes statt. Nur wenigeEscherichia coli-Stämme, die den Darm gesunder, reifer Neugeborener besiedeln, exprimieren MS Pili. Andererseits besaßen die meisten isoliertenE. coli-Stämme MR Pili, die den als Virulenzfaktor der pyelonephritogenenE. coli bekannten P-Fimbrien ähneln. Antikörper gegen Pili und K-Antigen vonE. coli, die sich nach Impfung im Serum fanden, beeinflußten nicht die Fähigkeit vonE. coli, den Darm von Laboratoriumstieren zu besiedeln und dort zu persistieren.

Reduced frequency of acute otitis media in breast-fed infants

The finding that breast-milk inhibits bacterial attachment in vitro(1) provided the basis for a clinical study of the protection by breast-feeding in children below one year of age. 493 infants were enrolled in the study. Breast-fed infants between 4 and 12 months had a significantly lower frequency of upper respiratory tract infections compared to the other feeding groups. In the age group 0 to 3 and 8 to 12 months of age the exclusively breast-fed children had a significantly lower frequency of acute otitis media.

Zusammenhänge zwischen immunologischen Befunden und klinischem Verlauf bei Harnwegsinfektionen

Der Harntrakt ist sehr oft Sitz bakterieller Infektionen. In vielen Fallen bleibt es bei einem einzigen Schub, aber bei anderen stellen sich Rezidive ein, und in manchen Fallen kommt es zu Vernarbungen im Nierenparenchym. Um die Pathogenese rezidivierender Infektionen und den Entstehungsmechanismus von Nierennarben verstandlicher zu machen, wurden Untersuchungen uber die Beziehungen zwischen dem Makroor- ganismus und den Erregern bei diesen Infektionen begonnen. Vielleicht konnen diese Studien dazu beitragen, eine Basis fur die Verbesserung von Diagnostik, Therapie und vielleicht Prophylaxe zu schaffen und klarere Indikationen fur eingreifende Masnahmen wie z.B. Rontgenuntersuchungen und Langzeitbehandlung zu formulieren.