ASYMPTOMATIC BACTERIURIA IN SCHOOL GIRLS

ABSTRACT: Lindberg, U., Jodal, U., Hanson, L. å. and Kaijser, B. (Department of Paediatrics and Departments of Immunology and Clinical Bacteriology, Institute of Medical Microbiology, University of Göteborg, Göteborg, Sweden). Asymptomatic bacteriuria in school girls. IV. Difficulties of level diagnosis and the possible relation to the character of infecting bacteria. Acta Paediatr Stand, 64:574, 1975.–As no method for localization of urinary tract infection has been shown to be absolutely reliable, six methods have been run parallelly in a study of 60 school girls with asymptomatic bacteriuria caused by E. coli. A poor correlation was obtained between "high infection" indicated by bladder washout test and abnormal findings of C-reactive protein, sedimentation rate, antibody litres or renal concentrating capacity, while findings of parenchymal reduction on the pyelogram and reflux on the urethrocystogram were often found within this group. The low frequency of abnormal findings of C-reactive protein, sedimentation rate and renal concentrating capacity in girls with a "high infection" may be explained by the finding that the ABU patients were infected with changed E. coli strains probably not able to cause the usual inflammatory reactions. The patients' bacteria were found to be less efficient in providing antigen for antibody determinations than were standard strains of same 0 group, indicating a difference between strains from ABU patients and standard strains. From the battery of tests used it seemed that most of the girls had a bladder infection. All tests were normal in 48% of the patients while at least three of the methods were abnormal in 12 %.     

DEXTRAN-REACTIVE ANTIBODIES IN CHILDREN Appearance during the First 4 years of Life and Relation to E. coli Infections in the Urinary Tract

ABSTRACT. The appearance of dextran-reactive antibodies (DRA) was investigated in 88 children with sampling of serum at birth ( n =87), at 3 months of age ( n =87), at 8 months ( n =88), at 2 years ( n =86) and at 4 1/2 years of age ( n =87). Serum DRA appeared at 3 months of age and a peak level exceeding the levels in adults was noted at 8 months of age. At 4 1/2 years the titres were close to those in adults. Investigation of DRA in 8 children with acute pyelonephritis and in 8 children with asymptomatic bacteriuria caused by E. coli did not indicate that the appearance of DRA was a consequence of Gram-negative infections. The practical conclusion drawn is that if therapy with i. v. dextran is considered for infants or children, they should undergo preventive therapy with hapten dextran similar to the procedure recommended for adults.     

Epidemiological Aspects of P-fimbriated Escherichia coli IV. Extraintestinal E. coli Infections before the Age of One Year and Their Relation to Fecal Colonization with P-fimbriated E. coli

ABSTRACT. In two retrospective studies we have found outbreaks of E. coli pyelonephritis and septicemia to be due to nosocomial spread and fecal colonization with virulent E. coli strains in the neonatal ward of Danderyd Hospital. The incidence of extraintestinal E. coli infections before the age of one year was therefore prospectively studied in all children born at Danderyd Hospital during two and a half years ( n =7963). The number of infections was correlated to the previous fecal colonization with P-fimbriated E. coli. During this study we found no outbreaks of E. coli infections. The incidence of E. coli pyelonephritis before the age of one year was 0.6–0.7%, which we propose to be a baseline incidence. This corresponds well with the low incidence of fecal colonization with P-fimbriated E. coli found among these children. Fecal colonization with P-fimbriated E. coli during this non-epidemic period had no predictive value for the individual child for the later development of pyelonephritis.     

The Composition of the Faecal Microflora in Breastfed and Bottle Fed Infants from Birth to Eight Weeks

ABSTRACT. Recent technical advances have improved the possibilities to classify anaerobic bacteria. The aim of the present study was to examine the validity of the time-honoured opinion that the faecal flora is dominated by bifidobacteria in breastfed infants but not in bottle fed ones. The compositon of the faecal flora of 15 breastfed and of 7 bottle fed infants was followed from birth to 8 weeks. Strictly anaerobic conditions were carefully applied. At 5 days and 3 weeks the incidence of Staph, epidermidis was significantly greater in the breastfed group compared to the bottle fed one. We were unable to confirm earlier reports of difference in the anaerobic flora between breastfed and bottle fed infants. In both feeding groups Bacteroides dominated among the anaerobic bacteria and bifidobacteria occurred in less than half of the faecal specimens. The results of the study add to other recent observations that it has been increasingly difficult to demonstrate bifidobacteria in babies delivered in large, urban hospitals. We found different frequencies of bifidobacteria in infants from different wards, suggesting the importance of environmental factors in gut colonization after delivery.     

Asymptomatic bacteriuria in schoolgirls. VI. The correlation between urinary and faecal Escherichia coli. Relation to the duration of the bacteriuria and the sampling technique.

The occurrence of the urinary strain in the anus, rectum and faeces was investigated in 27 girls with asymptomatic bacteriuria (ABU). In patients with bacteriuria of relatively short duration 46% of the faecal isolates were of the urinary strain as compared to only 18% in patients with bacteriuria of relatively long duration. In general the correlation between the urinary and faecal flora is striking at the time of establishment of ABU but diminishes with time. The diminished correlation may be due to two factors: firstly, the composition of the faecal flora changes with time. Secondly, the correlation may be obscured by complex changes in the properties of bacterial strains established in the urinary tract. Contamination by the infected urine did not seem to be a serious problem when the rectal mucosa was swabbed proximal to the anal canal.     

Inhibition of adhesion of S-fimbriated E. coli to buccal epithelial cells by human skim milk is predominantly mediated by mucins and depends on the period of lactation

Expression of S-fimbriae is frequent in Escherichia coli strains causing sepsis and meningitis in the newborn period. We analysed the ability of human skim milk to inhibit adhesion of S-fimbriated E. coli to human buccal epithelia. Adhesion was inhibited by up to 90% using colostrum (5%) and up to 50% with mature milk (5%), indicating that this anti-infective mechanism depends on the period of lactation. Elimination of up to 99% of immunoglobulins and 91% of lactoferrin by affinity chromatography had no effect on the inhibition of adhesion. After separation of high- (> 10 kD) and low-molecular-weight fractions of skim milk, only the fraction > 10 kD was found to be able to inhibit bacterial adhesion. In order to further characterize receptor molecules for bacteria, we investigated binding of isolated S-fimbriae to glycoprotein bands on Western blot strips. Fimbriae mainly bound to a high-molecular-weight band (> 200 kD). According to molecular weight and staining behaviour, this band most likely represents mucins. We conclude that carbohydrate residues on secreted mucins of human skim milk are able to inhibit bacterial adhesion to mucosal surfaces. This could provide protection against neonatal sepsis and meningitis caused by E. coli .     

Minimal effects of E. coli and Erwinia asparaginase on the coagulation system in childhood acute lymphoblastic leukemia: A randomized study

A randomized study was done in twenty newly diagnosed children with acute lymphoblastic leukemia. Ten children were treated with Escherichia coli L-asparaginase, and ten with Erwinia chrysanthemi L-asparaginase. L-asparaginase (ASP) treatment started halfway during ALL-induction treatment with vincristine, prednisone, daunorubicine and intrathecal methotrexate. The mean activated partial thromboplastin time (APTT) level in all children demonstrated a significant fall (P < 0.001) from 28.25 sec at diagnosis to 23.0 sec at the start of ASP treatment. In this same time interval, the mean fibrinogen level declined markedly from 3 g/l to 1.2 g/l (P < 0.001), probably due to prednisone therapy. The APTT stayed shortened during ASP therapy, whereas the hypofibrinogenemia recovered significantly faster in the Erwinia group (P ? 0.01). Factors (F) II, V, VII and X stayed within the normal range, while F VIII and F IX were elevated. During the entire period of induction therapy, the ATIII activity remained within the normal range in both treatment groups. The protein C values, however, demonstrated a steady decline from 140% at start of ASP treatment to a mean of 81% and 93%, respectively, at the end of the ASP therapy in the E. coli and Erwinia group. Five of the ten children treated with E. coli ASP demonstrated protein C levels below 70% at the end of ASP therapy, opposed to none of the Erwinia treated patients (P = 0.03). We suggest that the effect of ASP resulting in decreased coagulationfactor synthesis is in part counterbalanced by the effect of prednisone on the coagulation system, when ASP is administered at the end of ALL induction treatment. The overall effect of ASP either of E. coli or of Erwinia on the hemorrhagic system reveals a slight imbalance towards thrombosis, mainly because of a gradual decrease in protein C activity. This imbalance is less pronounced in the Erwinia group. © 1994 Wiley-Liss, Inc.     

The application of a serum 17OH-progesterone radioimmunoassay to the diagnosis and management of congenital adrenal hyperplasia.

Serum concentrations of 17OH-progesterone were studied serially over 24 hours in 13 treated and untreated patients with the C21 hydroxylase form of congenital adrenal hyperplasia. The results were correlated with measurements of plasma renin activity, serum electrolytes, and urinary 17-ketosteroids and pregnanetriol. In 500 healthy subjects from birth to adult life, serum 17OH-pregesterone levels ranged from 5 to 315 ng/dl. In untreated CAH, serum 17OH-progesterone was markedly elevated (2,000 to 80,000 ng/dl). Treatment with cortisol (20 to 30 mg/m2/day in 3 doses) resulted in normal serum 17OH-progesterone levels in both non-salt-losing and salt-losing patients receiving adequate mineralocorticoid. Even slightly inadequate mineralocorticoid therapy (shown by high plasma renin activity with normal serum electrolytes) was associated with elevated 17OH-progesterone (to 65,000 ng/dl) in spite of usually effective doses of cortisol. Some patients showed isolated 17OH-progesterone elevations (usually early morning), a situation which requires only revision of the cortisol dosage schedule without an increase in total dosage. The data confirm the value of 17OH-progesterone assays in both the diagnosis and management of CAH. Taken together with determinations of plasma renin activity, serum 17OH-progesterone assays can permit more exact control of CAH without excessive doses of glucocorticoid.