Starkey D. Davis

Combined immunodeficiency and reticuloendotheliosis with eosinophilia.

A generalized erythematous scaly rash, alopecia, lympadenopathy, and hepatosplemonegaly developed in an infant girl during the first 6 weeks of life. Repeated bacterial and fungal infections, persistent diarrhea, and generalized wasting complicated the course of her illness, and death occurred at 5 1/2 months of age. Lymph node architecture was completely obliterated by histiocytes and eosinophils; no plasma cells or germinal centers were present. Both humoral and cellular immune systems were severely but not completely impaired. Familial reticuloendotheliosis with eosinophilia is, in some cases, associated with combined immune deficiency.

Teratogenicity of vitamin B6 deficiency: omphalocele, skeletal and neural defects, and splenic hypoplasia.

Vitamin B6 deficiency was induced in pregnant rats with a deficient diet and with 4-deoxypyridoxine, a B6 antagonist. Treated animals developed typical skin changes of B6 deficiency. Fetuses were small and appeared anemic. Major fetal malformations were omphalocele, exencephaly, cleft palate, micrognathia, digital defects, and splenic hypoplasia. This teratologic system was developed as a model for human syndromes that exhibit combined immunologic and neurologic or skeletal defects.

Dressing Changes by Specialized Personnel Reduce Infection Rates in Patients Receiving Central Venous Parenteral Nutrition

In 60 pediatric patients, 75 central venous catheters representing 1866 patient days were placed to provide parenteral nutrition. During the 21-month study period, surgical residents were responsible for dressing changes during the first 16 months and a specially trained nurse was responsible during the final 5 months. Twenty percent of the lines became infected. The infection rate was significantly higher in the lines cared for by residents, 28.8% compared to 3.3% in the lines cared for by the nurse. This occurred in spite of the lines being in place significantly longer in the nurse group (31.7 vs 20.3 patient days/line). These data indicate that a specially trained person using aseptic techniques can reduce infection rates in patients receiving central venous parenteral nutrition.

Mycobacterial cervical adenitis in children

Summary Since May 1, 1946, 24 cases of mycobacterial cervical adenitis in children under the age of 12 years were reported to the Muscogee County Tuberculosis Study. It is believed that these represent practically all the known cases in the community. On the basis of bacteriologic findings and skin sensitivity to PPD-S and other mycobacterial antigens, the cases were separated into 2 groups: one in which Myco. tuberculosis was a likely etiological agent, and the other in which the disease was probably caused by some other mycobacterium. In this series, it appeared that mostcervical adenitis, clinically compatible with a diagnosis of tuberculosis, was caused by mycobacteria other than Myco. tuberculosis . A history of exposure to tuberculosis, an insidious onset in a male Negro child, and the presence of lesions elsewhere in the body favored the diagnosis of tuberculosis. Dual skin testing, with the use of PPD-S and a PPD prepared from an atypical acid-fast bacillus causing cervical adenitis, appeared to be helpful in differentiating tuberculosis from other mycobacterial cervical adenitis. Bacteriologic examinations afforded the best opportunity to obtain an etiological diagnosis. The treatment of choice appeared to be excision of the affected node, accompanied by antituberculosis chemotherapy. Excision not only gave good therapeutic results in this series, but also yielded the best specimen for bacteriologic examination.

Experimental Keratitis Due to Pseudomonas aeruginosa: Model for Evaluation of Antimicrobial Drugs

An improved method for experimental keratitis due to Pseudomonas aeruginosa is described. Essential features of the method are use of inbred guinea pigs, intracorneal injection of bacteria, subconjunctival injection of antibiotics, “blind” evaluation of results, and statistical analysis of data. Untreated ocular infections were most severe 5 to 7 days after infection. Sterilized bacterial suspensions caused no abnormalities on day 5. Tobramycin and polymyxin B were more active than gentamicin against two strains of Pseudomonas. This model is suitable for many types of quantitative studies on experimental keratitis. Images

Defective Antibody Response to Bacteriophage ox 174 in Down Syndrome.

Antibody responses to bacteriophage OX 174 were studied in 17 institutionalized patients with trisomy 21 and in six mentally retarded control patients with normal karyotype. Primary antibody response was significantly imparired in 11 of the 17 patients. Secondary immune response was normal in one, moderately impaired in seven, and very low in nine patients. Tetiary immunization further differentiated the two groups: those with moderately impaired secondary immune responses developed normal serum titers of predominatly IgG antibody; patients with low secondary immune responses had extremely impaired tetiary immune responses consisting mainly of serum IgM antibody.

Convulsive equivalent syndrome of childhood

The convulsive equivalent syndrome is an entity of paroxysmal cerebral disorder characterized by autonomic disturbances and dysfunction in behavior and communication. This syndrome has been variously referred to by such names as abdominal epilepsy or autonomic epilepsy. Other types of seizures may coexist in certain cases. Although a close correlation between the 14 and 6 per second positive spike electroencephalographic pattern and the convulsive equivalent syndrome has been observed by Gibbs and others, the nature and significance of the 14 and 6 phenomenon remains controversial. In this study 535 cases were divided into 3 groups which have been analyzed and compared. It was found that of 349 children with convulsive equivalent epilepsy, only 55 per cent showed the 14 and 6 pattern, and of 379 children with the 14 and 6 abnormality only 50 per cent had the convulsive equivalent epilepsy.

Studies in infantile marasmus. IV. Impairment of immunologic responses in the marasmic pig.

Extract: We investigated the immunologic responses in an experimental model, the marasmic piglet. Two litters of miniature piglets of the Pitman Moore strain [46] were divided into two groups with five of the animals given normal diet and eight subjected to dietary restriction. The dietary intake of the experimental piglets was restricted to prevent further significant weight gain after the age of 35 days. The experimental animals displayed a well developed characteristic picture of severe undernutrition after 3 months of dietary restriction. Concentrations of immunoglobulins G and M (IgG and IgM) in both experimental and control pigs were similar. Antibody titers against erythrocyte A-antigen of experimental pigs were consistently lower (Table IV). Antibody responses after immunization to tetanus toxoid, sheep erythrocytes, and bacterio-phage πX 174 were remarkably similar in both groups (Tables V and VI). The experimental animals had a delay in appearance of IgG antibody after primary immunization with bacteriophage πX 174. The physiologic lymphecytosis found in the control animals was absent in the experimental group. All lymphoid organs examined in the marasmic pigs displayed marked atrophy as compared to the control animals. No tissues were identified grossly as thymus in the neck or anterior mediastinum of the experimental animals. The germinal centers of the spleen and lymph nodes were poorly formed in the experimental animals. Delayed hypersensitivity to 2,4-dinitro-fluorobenzene was demonstrated in only one of the five experimental animals while all four control animals demonstrated delayed hypersensitivity when tested at the same age. Four experimental pigs and three control pigs were immunized with BCG vaccine at 10 months of age. The mean diameter of tuberculin reaction of the experimental group was 6.5 mm; that of the controls was 27 mm when tested 4 weeks later. Both full thickness skin grafts and split thickness grafts underwent a delayed rejection in the experimental group. Lymphocyte transformation with phytohemagglutinin was studied at 6, 9, and 14 months of age in both control and experimental animals with similar results in both groups (Table VIII). Leukocytes from three experimental pigs had no increase in uptake of thymidine when tested in mixed leukocyte culture. Leukocytes from five experimental animals and three control pigs had normal leukocyte bactericidal activity against Staphylococcus aureus and Serratia marcescens. These studies provide presumptive evidence that marasmic pigs have defects in both humoral and cellular immunity. The deficiency in cellular immunity seemed greater and was manifest by thymic involution, lymphopenia, a decreased capacity to express delayed hypersensitivity, delayed homograft rejection, and absence of reactivity in the mixed leukocyte culture.Speculation: Clinical experience and recent experimental studies indicate that malnutrition decreases resistance to infection. The results presented show that cell-mediated immunity is impaired in malnutrition. Much of the immunodeficiency in malnutrition may be mediated by hyperadrenocorticism.

Relative Antagonism in vitro of Calcium in Serum to the Bactericidal Activities of Gentamicin and Tobramycin on Pseudomonas Aeruginosa

Physiologic concentrations of calcium in serum antagonize the activities in vitro of gentamicin and tobramycin on Pseudomonas aeruginosa. The relative antagonism of serum to these antibiotics in vitro was determined on 21 strains of Pseudomonas, representing three each of the seven recognized immunotypes. Serum was more antagonistic to gentamicin than to tobramycin for 14 strains. Serum had little antagonism to either antibiotic for four strains. Serum was highly antagonistic to both antibiotics for three strains. In no instance was serum more antagonistic to tobramycin than to gentamicin. These results suggest that tobramycin may be more active against most strains in vivo than gentamicin at equal concentrations. The relevance in vivo of these in vitro findings remains to be determined.

SPECIALIZED NURSES REDUCE INFECTION RATES IN CENTRAL VENOUS PARENTERAL NUTRITION (CVPN)

Although some institutions use a specially trained nurse to change CVPN dressings, the actual effect such an individual has on reducing infection rates and decreasing complications of CVPN has not been proven. During a 9 month period all children receiving CVPN were followed for both mechanical and infectious complications. For 4 months, surgical residents (group R) were responsible for the dressing changes and for the subsequent 5 months, two trained nurses were responsible for dressing changes (group N). The protocol for handling the lines was otherwise the same for the two groups. The two groups were comparable for most known confounding variables. These include primary illness, serum albumin, lymphocyte count, age, race and sex; however, lines from group N were in place longer (t=2.21,p<0.05). In group R, 49% of the lines were removed because of septic or mechanical complications. This rate compared to 20% in group N (X2=6.42,p<0.05). The infection rate alone was also higher in the R group, 31% compared to 3.3% in the N group (X2=8.7,p<0.01): relative risk (RR)=9.3. When patient days on CVPN was used as the denominator, the difference between the groups was greater, 1.42 infections/100 patient days in group R versus 0.11 in the N group (RR=12.9,p<0.01). These data indicate that the utilization of a highly trained individual using meticulous care for all dressing changes is an extremely important factor in lowering infection rates in CVPN lines.