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The influence of concurrent metazoan infection on the colonization and immune response to E. coli
910
Abstracts
feedings have been used (Cheek and Staub J. PEDIATI1. 82: 955, 1973; Rhea and associates, J. PEDIATR.82: 951, 1973). We compared nasogastric feeding (N/G) and nasojejunal feeding (N/J) in a controlled study of 21 infants ( 1500 grams and/or ( 32 weeks' gestation. The N/G and N/J groups were comparable in the number in each group (9), in gestational age, birth weight, head circumference, and clinical condition. The N/J fed infants had significantly less weight loss (p ~ 0.01-0.001). Cumulative weight gain for the first three weeks of life averaged more in the N/J infants every day and was significantly greater (p = 0.05-0.001) from Day 3 through Day 15. The initial rate of weight gain was greater in the N/J infants during the first 10 days; thereafter the two groups were similar. Birth weight was regained in 6.5 days (ave.) in N/J infants and 14.5 days (ave.) in N/G infants. Calorie per kilogram per day and cubic centimeter per kilogram per day intake were significantly greater (p = 0.05-0.001) during the first four days in N/J infants. Serum Na, K, CI, Ca, PO4, and osmolarity remained within normal limits for both groups. Occult blood in the stool was seen with the same frequency in both groups. Nasal cultures were comparable in the two groups. Three additional infants who were N/G failures while on the respirator all had marked increases in weight gain, calorie per kilogram per day, and cubic centimeter per kilogram per day (p.o. intake) when switched to N/J feedings. It is concluded that N/J feeding in the ( 1,500 gram neonate compares favorably to N/G feedings and is a safe, effective means of early nutritional intake, with advantages most pronounced during the first two weeks of life. COMMENT: Dr. Klineberg asked if the infants were fed by continuous drip or fed discontinuously. Dr. Wells indicated that infants who received nasogastric feedings were fed every 2 to 3 hours; those who received nasojejunal feedings were fed continuously. Dr. Lonsdale asked whether there was a difference in apnea between the two groups. The authors replied that there was not and also indicated that both groups contained one or two small-for-gestational-age babies. There was no evidence of erosion due to the tubes upon examination of the gastrointestinal mucosa. Dr. Oliver asked whether the incidence of necrotizing enterocolitis was increased; Dr. Wells replied that it had increased recently in the nursery but that this was not necessarily related to feeding methods since this disorder appears to be increasing in incidence throughout the United States.
6. The influence of concurrent metazoan infection on the colonization and immune response to E. coli D. M. Swida,* R. H. Cypess,* J. F. Kenny, and R. B. Yee,* Pittsburgh, Pa. In certain socioeconomic environments the weanling host is repeatedly infected with both metazoan and bacterial pathogens. Little specific information is available on the interaction of these agents. To examine this relationship, a laboratory model was developed using N. dubius, a natural parasite of the upper intestine of the mouse, and enteropathogenic E. coil 0127. Weanling mice, infected with N. dubius, were orally inoculated with E. col# and the distribution of both agents was studied in three
The Journal of Pediatrics June 1974
120 mm. segments of intestine. In parasitized animals numbers of E. coliwere 102 to 103 times greater in the lumen and wall of all portions of the intestine, with increases most marked in the upper two segments. Although no bacteria were found in the liver of nonparasitized mice, 103 E. eoli per gram of tissue were cultured from parasitized animals. The altered distribution of E. coli was reflected by a greatly increased specific immune response. The mean number of anti-E, coli plaque-forming cells in the spleen of N. dubius-infected mice was 53,501 vs. 1,497 for nonparasitized controls (p (0.001). These findings suggest that certain gastrointestinal parasites alter the growth and distribution ofenteropathogenic E. coli, promoting colonization of the upper intestine where these organisms exert their pathogenicity. Extraintestinal dissemination o f organisms may also increase morbidity in these infections. COMMENT: This study was directed toward developing a greater understanding of the synergistic effect of dual infection upon the mammalian host. Studies of this type may have important implications for human disease states. Additional studies of dual infection should be pursued.
7. Infantile cirrhosis associated with heterozygous alpha-l-antitrypsin deficiency R. Langsdorf* and D. Lonsdale, Cleveland, Ohio A 16-week-old Caucasian female infant was referred to Cleveland Clinic for evaluation of prolonged jaundice. Extensive biochemical and radiographic studies revealed the presence of a normal bile duct system but failed to establish the exact etiology. Liver biopsy revealed early cirrhotic changes and bile stasis, consistent with a form of neonatal hepatitis. In addition there was a large amount of PAS-positive, diastase resistant material within the liver cells. Serum alpha-l-antitrypsin (alpha-l-A.T.) concentration was in the heterozygous range (720 /zg per milliliter) and the histologic appearance of the liver suggested the need for further study of the alpha-l-A.T, system. Trypsin inhibitory capacity was 1.35 mg. trypsin inhibited per milliliter serum (normal: 0.95 to 1.2 mg. per milliliter) and the concentration of serum alpha-l-A.T, by partigen plate was normal (242 rag. per 100 ml.). Dr. Harvey L. Sharp performed Pi phenotyping and showed that the infant and both parents were Pi type MS, heterozygous for the alpha-l-A.T, allele. Electron microscopy and alpha-l-A.T, immunofluorescence of liver tissue is currently under study. Family history revealed that 4 paternal uncles had pulmonary emphysema with an unusually early onset; further studies of family members are being performed. This child is believed to be the first reported case of infantile liver disease associated with partial alpha-l-A.T, deficiency in serum. COMMENT: The possible diagnoses of rubella and of cytomegalic inclusion disease were sought by appropriate serologic determinations and cultures; all titers and cultures were negative. In response to a series of questions by Dr. Krivit, the authors indicated that they had not performed studies to determine if antiplasmin or antiprotease were present in leukocytes from the patient. PAS-positive staining of hepatocytes was noted. The biopsies in this patient were carried out first and only subsequently was the patient found to be heterozygous for alpha-l-antitrypsin.
Abstracts
feedings have been used (Cheek and Staub J. PEDIATI1. 82: 955, 1973; Rhea and associates, J. PEDIATR.82: 951, 1973). We compared nasogastric feeding (N/G) and nasojejunal feeding (N/J) in a controlled study of 21 infants ( 1500 grams and/or ( 32 weeks' gestation. The N/G and N/J groups were comparable in the number in each group (9), in gestational age, birth weight, head circumference, and clinical condition. The N/J fed infants had significantly less weight loss (p ~ 0.01-0.001). Cumulative weight gain for the first three weeks of life averaged more in the N/J infants every day and was significantly greater (p = 0.05-0.001) from Day 3 through Day 15. The initial rate of weight gain was greater in the N/J infants during the first 10 days; thereafter the two groups were similar. Birth weight was regained in 6.5 days (ave.) in N/J infants and 14.5 days (ave.) in N/G infants. Calorie per kilogram per day and cubic centimeter per kilogram per day intake were significantly greater (p = 0.05-0.001) during the first four days in N/J infants. Serum Na, K, CI, Ca, PO4, and osmolarity remained within normal limits for both groups. Occult blood in the stool was seen with the same frequency in both groups. Nasal cultures were comparable in the two groups. Three additional infants who were N/G failures while on the respirator all had marked increases in weight gain, calorie per kilogram per day, and cubic centimeter per kilogram per day (p.o. intake) when switched to N/J feedings. It is concluded that N/J feeding in the ( 1,500 gram neonate compares favorably to N/G feedings and is a safe, effective means of early nutritional intake, with advantages most pronounced during the first two weeks of life. COMMENT: Dr. Klineberg asked if the infants were fed by continuous drip or fed discontinuously. Dr. Wells indicated that infants who received nasogastric feedings were fed every 2 to 3 hours; those who received nasojejunal feedings were fed continuously. Dr. Lonsdale asked whether there was a difference in apnea between the two groups. The authors replied that there was not and also indicated that both groups contained one or two small-for-gestational-age babies. There was no evidence of erosion due to the tubes upon examination of the gastrointestinal mucosa. Dr. Oliver asked whether the incidence of necrotizing enterocolitis was increased; Dr. Wells replied that it had increased recently in the nursery but that this was not necessarily related to feeding methods since this disorder appears to be increasing in incidence throughout the United States.
6. The influence of concurrent metazoan infection on the colonization and immune response to E. coli D. M. Swida,* R. H. Cypess,* J. F. Kenny, and R. B. Yee,* Pittsburgh, Pa. In certain socioeconomic environments the weanling host is repeatedly infected with both metazoan and bacterial pathogens. Little specific information is available on the interaction of these agents. To examine this relationship, a laboratory model was developed using N. dubius, a natural parasite of the upper intestine of the mouse, and enteropathogenic E. coil 0127. Weanling mice, infected with N. dubius, were orally inoculated with E. col# and the distribution of both agents was studied in three
The Journal of Pediatrics June 1974
120 mm. segments of intestine. In parasitized animals numbers of E. coliwere 102 to 103 times greater in the lumen and wall of all portions of the intestine, with increases most marked in the upper two segments. Although no bacteria were found in the liver of nonparasitized mice, 103 E. eoli per gram of tissue were cultured from parasitized animals. The altered distribution of E. coli was reflected by a greatly increased specific immune response. The mean number of anti-E, coli plaque-forming cells in the spleen of N. dubius-infected mice was 53,501 vs. 1,497 for nonparasitized controls (p (0.001). These findings suggest that certain gastrointestinal parasites alter the growth and distribution ofenteropathogenic E. coli, promoting colonization of the upper intestine where these organisms exert their pathogenicity. Extraintestinal dissemination o f organisms may also increase morbidity in these infections. COMMENT: This study was directed toward developing a greater understanding of the synergistic effect of dual infection upon the mammalian host. Studies of this type may have important implications for human disease states. Additional studies of dual infection should be pursued.
7. Infantile cirrhosis associated with heterozygous alpha-l-antitrypsin deficiency R. Langsdorf* and D. Lonsdale, Cleveland, Ohio A 16-week-old Caucasian female infant was referred to Cleveland Clinic for evaluation of prolonged jaundice. Extensive biochemical and radiographic studies revealed the presence of a normal bile duct system but failed to establish the exact etiology. Liver biopsy revealed early cirrhotic changes and bile stasis, consistent with a form of neonatal hepatitis. In addition there was a large amount of PAS-positive, diastase resistant material within the liver cells. Serum alpha-l-antitrypsin (alpha-l-A.T.) concentration was in the heterozygous range (720 /zg per milliliter) and the histologic appearance of the liver suggested the need for further study of the alpha-l-A.T, system. Trypsin inhibitory capacity was 1.35 mg. trypsin inhibited per milliliter serum (normal: 0.95 to 1.2 mg. per milliliter) and the concentration of serum alpha-l-A.T, by partigen plate was normal (242 rag. per 100 ml.). Dr. Harvey L. Sharp performed Pi phenotyping and showed that the infant and both parents were Pi type MS, heterozygous for the alpha-l-A.T, allele. Electron microscopy and alpha-l-A.T, immunofluorescence of liver tissue is currently under study. Family history revealed that 4 paternal uncles had pulmonary emphysema with an unusually early onset; further studies of family members are being performed. This child is believed to be the first reported case of infantile liver disease associated with partial alpha-l-A.T, deficiency in serum. COMMENT: The possible diagnoses of rubella and of cytomegalic inclusion disease were sought by appropriate serologic determinations and cultures; all titers and cultures were negative. In response to a series of questions by Dr. Krivit, the authors indicated that they had not performed studies to determine if antiplasmin or antiprotease were present in leukocytes from the patient. PAS-positive staining of hepatocytes was noted. The biopsies in this patient were carried out first and only subsequently was the patient found to be heterozygous for alpha-l-antitrypsin.