Presence paf-acether mediator of inflammation in stools of patients with inflammatory enterocolitis

Paf-acether (platelet-activating factor, paf) is one of the most potent inflammatory mediators synthesised by and acting on most inflammatory cells. Paf causes gastric ulcerations and ischemic bowel necrosis. Recently, we described the presence of paf in stools of patients bearing ileal pouch-anal anastomosis with pouchitis. These findings prompted us to search for the presence of paf in stools of patients suffering from inflammatory bowel diseases: Crohn's disease and ulcerative colitis. The fraction corresponding to paf isolated from stools exhibited the same physicochemical and biological characteristics as synthetic paf. Reverse-phase high performance liquid chromatography revealed 80% of C16 and 20% of C18 paf. The presence of a biologically active phospholipid in human stools may bring new perspectives with respect to the study of gastrointestinal diseases as well as the use of paf antagonists in the treatment of inflammatory bowel diseases.     

Yersinia pseudotubetculosis in Italy. Attempted Recovery from 37,666 Samples

From 1981 to 1991, 37,666 human, animal, food and environmental samples were cultured for Yersinia pseudotuberculosis using direct plating methods and/or cold enhancement techniques. Despite an intensive surveillance and adequate culture methods, Y. pseudotuberculosis was isolated from stools of 0.05% (5/9,720) of patients with acute enteritis, and alimentary tracts of 0.1% (10/6,849) of apparently healthy animals. No Y. pseudotuberculosis strains were recovered from stools of 4,726 healthy controls nor from the appendices (656), mesenteric lymph nodes (84), and stools (421) of 656 patients operated for suspected appendicitis. Of the 10,842 food and 4,368 environmental samples, none yielded positive cultures for Y. pseudotuberculosis.     

Comparative Trial of Tetracycline,Chloramphenicol, and Trimethoprim Sulphamethoxazole in Eradication of Vibrio cholera El Tor

A comparison of tetracycline, chloramphenicol, and trimethoprim/sulphamethoxazole showed that all hasten the eradication of Vibrio cholerae from the stools of patients with cholera.A four-day period of tetracycline or trimethoprim/ sulphamethoxazole was adequate for eradicating V. cholerae from the stools of all patients, but three days, as suggested by the W.H.O. Expert Committee, was not. Four days of chloramphenicol therapy was sufficient for most patients, but a minority required up to seven days'' therapy.Purging produced reappearance of V. cholerae in the stools of one-eighth of the patients who had had three successive daily negative stool cultures; such patients are a potential danger to the population.     

The neutrophil chemiluminescence response to Pneumocystis carinii is stimulated by GM-CSF and gamma interferon

An enzyme-linked immunosorbent assay (ELISA) with antibodies specific to beta, epsilon and iota ib toxins of Clostridium perfringens was developed to detect beta, epsilon and iota ib toxins, respectively. The ELISA was sensitive enough to detect as little as 1.0 ng/ml of purified beta and iota ib toxins and 0.1 ng/ml of purified epsilon toxin. By means of the ELISA method, 192 isolates of C. perfringens from food samples in Japan and Thailand, and 58 isolates from patients suffering from gas gangrene or gastroenteritis were examined. One isolate from food samples in Japan, three from food samples in Thailand and five from stools of patients with gastroenteritis were C. perfringens type D. One type B and one type C were detected from the stools of patients with gastroenteritis.     

Hepatitis-E-virus-associated antigen: improved detection in stools by protein Fv removal

ELISA detection of a hepatitis-E-virus-associated antigen (HEV-AAg) in stools was reappraised for its possible interference with a new Fab-binding factor, te rmed protein Fv, released during infectious hepatitis. Transaminase alevation, HEV-AAg discharge and Fv leakage appeared simultaneously in a Cercopithecus monkey inoculated with infected stools. Labelled normal, or immune human IgG, were compared with pre- and post-inoculation simian IgG, for HEV-AAg and Fv detection. Coated normal and patient human IgM were also compared to pre- and post-inoculation simian IgM in HEV-AAg and Fv capture assays. Simian IgM and β-galactosidase-labelled simian IgG minimized Fv interference and appeared to be the best adapted system for HEV-AAg detection. Nevertheless, Fv was still the caused of false-positive interpretations in some cases; therefore adsorption with monoclonal IgM was required to ensure HEV specificity.The improved test was performed on stools from 30 Senegalese patients hospitalized for various sporadic attacks of viral hepatitis. HEV-AAg was detected in 6 out of 30 cases and no positivity was observed in patients suffering from hepatitis due to HAV, HBV, cytomegalovirus or Epstein-Barr virus.The specificity of the assay was confirmed by inhibition experiments with the sera from HEV-infected patients. Hence, this inhibition assay can also be used to detect serum antibodies to HEV-AAg.     

Prevalence of diarrhea caused by Cryptosporidium parvum in non-HIV patients in Jeollanam-do, Korea

The present study investigated the prevalence rate of Cryptosporidium parvum as a cause of diarrhea. We examined 942 stools of unidentified reasons occurring in patients in whom no immunosuppression had been detected. We examined the stools for Cryptosporidium parvum via modified acid-fast staining. The clinical records of all of the positive patients were then analyzed. Nine (1%) of the stools among the 942 diarrheal patients were positive for C. parvum. The positive rate in the males was 1.1% (6/522) and the positive rate of the females was 0.7% (3/420). Age distribution revealed that the highest positive rates were in patients in their sixties, with a positive rate of 2.5% (4/158). In the clinical tests, levels of c-reactive protein, erythrocyte sedimentation rates, and neutrophil proportions were normally increased in the peripheral blood, whereas the lymphocyte proportion exhibited a tendency towards decrease. The pathological findings were compatible with an inflammatory reaction in the host.     

Fecal lactoferrin and Clostridium spp. in stools of autistic children

Stools from autistic and healthy children were studied for fecal lactoferrin, Clostridium difficile toxins, Clostridium perfringens enterotoxin and cultured for Clostridium spp. Elevated level of FLA was demonstrated in 24.4% stools, all from boys (31.25%). No toxins were detected. Clostridium spp. was isolated with similar frequency from all samples. C. perfringens were isolated significantly often from the autistic stools, intermediate sensitive strains to penicillin 19%, to clindamycin 11.3%, and to metronidazole 7.5% were detected. Further studies on fecal microflora and inflammatory mediators, with larger groups of patients, are required in order to explain their role in neurological deficits.     

免疫胶体金试剂的制备及应用胶体金免疫电镜技术检测戊型肝炎病毒

报道了用胶体金免疫电镜技术检测戊型肝炎病毒（ＨＥＶ）的方法。实验采用１０ｎｍ胶体金标记纯化兔抗鼠ＩｇＧ制备了免疫胶体金探针试剂。用本法从戊型肝炎患者粪便提取物中检出ＨＥＶ呈球形,直径３２±５ｎｍ。此方法具有快速、灵敏、直观等特点,在ＨＥＶ生物学性质研究中,有一定的应用价值。     

Campylobacter colitis.

Eleven consecutive patients with diarrhoea from whose stools campylobacter were isolated were investigated by sigmoidoscopy and rectal biopsy. Eight had definite proctitis, and in seven biopsy specimens were abnormal with histological changes ranging from non-specific colitis to gross colitis with goblet-cell depletion and crypt-abscess formation. Nine of the patients passed blood in their stools, and in all but one abdominal pain was a feature of the illness. Severe campylobacter colitis may be clinically, sigmoidoscopically, and histologically difficult to differentiate from ulcerative colitis and is a differential diagnosis in acute colitis.     

Clinical trial of berberine in acute watery diarrhoea.

Four hundred adults presenting with acute watery diarrhoea were entered into a randomised, placebo controlled, double blind clinical trial of berberine, tetracycline, and tetracycline and berberine to study the antisecretory and vibriostatic effects of berberine. Of 185 patients with cholera, those given tetracycline or tetracycline and berberine had considerably reduced volume and frequency of diarrhoeal stools, duration of diarrhoea, and volumes of required intravenous and oral rehydration fluid. Berberine did not produce an antisecretory effect. Analysis by factorial design equations, however, showed a reduction in diarrhoeal stools by one litre and a reduction in cyclic adenosine monophosphate concentrations in stools by 77% in the groups given berberine. Considerably fewer patients given tetracycline or tetracycline and berberine excreted vibrios in stools after 24 hours than those given berberine alone. Neither tetracycline nor berberine had any benefit over placebo in 215 patients with non-cholera diarrhoea.     

Value of stool examination in patients with diarrhoea.

Findings of stool examinations in 1593 patients with diarrhoea due to a single enteric pathogen--enterotoxigenic Escherichia coli rotavirus, Shigella, Campylobacter jejuni, Vibrio cholerae 0:1, Entamoeba histolytica, or Giardia lamblia--were reviewed to determine how well they predicted the agent associated with the diarrhoea. Specimens were examined visually for blood and mucus, tested for pH, and examined under a microscope for the presence of red and white blood cells, parasites, and stool fat. Although visible blood was more common in specimens from patients infected with Shigella (51%) and Ent histolytica (39%) than in those from patients infected with other agents (6%; p less than 0.01), patients infected with Shigella were most likely to have numerous faecal leucocytes (greater than 50/high power field: 39% v 8% of all patients and 7% of patients infected with Ent histolytica, p less than 0.01 in both cases). Patients infected with enterotoxigenic E coli, rotavirus, V cholerae 0:1, or C jejuni had loose stools with fewer red or white cells. Patients infected with rotavirus and C jejuni were more likely to have acid stools with 3 to 4+ fat, but these findings were related to young age and breast feeding. Stool examination is most useful in establishing a diagnosis of dysentery and in helping to distinguish between patients infected with Shigella and Ent histolytica; it is of limited usefulness in discriminating between pathogens causing watery diarrhoea.     

A mixed epidemic of poliomyelitis and Bornholm's disease (pleurodynia)

Summary During a mixed epidemic of poliomyelitis and Bornholm's disease in the summer of 1951, evidence was obtained of the involvement of at least 6 different immunological types of Coxsackie virus, among which the Albany A₂ type dominated. Poliomyelitis virus was isolated from the stools of 6 out of 20 patients suffering from paralytic poliomyelitis; Coxsackie virus from 1, and both poliomyelitis and Coxsackie virus from 2 out of these 20 patients. During the whole year, Coxsackie virus was recovered from the stools of patients suffering from paralytic poliomyelitis, aseptic meningitis, pleurodynia and summer grippe in approximately equal percentages (11 to 14%), but during the epidemic months from July to October, 25% of the patients with poliomyelitis, and 16% of the patients with pleurodynia gave positive results for Coxsackie virus. The sparing or the enhancing effect of Coxsackie virus infection on the development of paralysis in patients with dual infections is discussed. Aided by a grant from the National Health Research Council T.N.O.     

Intestinal microbiota in exclusively breast-fed infants with blood-streaked stools

Intestinal microbiota in exclusively breast-fed infants with blood-streaked stools and in healthy exclusively breast-fed babies was compared. Total anaerobes, bifidobacteria, lactobacilli, coliform bacteria, enterococci and clostridia were quantified by cultivation methods in feces of 17 full-term exclusively breastfed patients (aged 16.3 ± 7.4 weeks) with blood-streaked stools and in the control group of 22 healthy fullterm exclusively breast-fed infants (13.7 ± 6.4 weeks). Specific fluorescence in situ hybridization kits for Bifidobacterium spp. were used for the quantitative detection of bifidobacteria in samples. Control samples had significantly (p < 0.05) higher counts of total anaerobes. Bifidobacteria were not detected in patients’ samples in 65 % and in controls in 36 % (p < 0.01). Bifidobacteria counts were also significantly higher in the control group (p < 0.01). Furthermore, clostridia strains were detected only in feces from bifidobacteria-negative infants reaching counts >8 log CFU/g. Lactobacilli were not detected in 65 % patients and in 45 % control samples. However, this difference was not significant as well as the difference in lactobacilli counts. Eosinophilia was observed in 35 % of patients, low IgA concentration in 71 % and also low IgG concentration in 71 %. pANCA positivity was found in 53 % of patients. In conclusion a significant low proportion of bifidobacterial microbiota in patients with blood-streaked stools was shown in comparison with controls.     

The occurrence of severe infections with Rhabditis axei in AIDS patients in Iran

During an investigation on strongyloidiasis in AIDS patients from Iran, direct smears of stools revealed many eggs and larvae of Rhabditis axei, which were subcultured to confirm identification.     

Prevalence of intestinal parasites among individuals with allergic skin diseases

The prevalence of intestinal protozoans and helminths in stool samples of individuals with allergic cutaneous symptoms was evaluated to study a possible link between parasites and allergy. Altogether, 218 patients who had chronic urticaria, atopic dermatitis, or pruritus of unknown origin were included in the study. Standard laboratory tests for the detection of allergic etiology were performed for all patients. The presence of intestinal parasites was investigated using microscopy, immunofluorescence, and immunoenzymatic assays. Overall, protozoans and helminths were recovered from the stools of 48 subjects (P = 0.004), 18 of whom were affected with intestinal symptoms (P = 0.023). The presence of Giardia lamblia in the stools was significantly associated with allergic cutaneous manifestations (P = 0.030). In addition, patients with allergy were significantly more likely to have > or = 5 Blastocystis hominis organisms per field (P = 0.046). There was a set of patients with allergic cutaneous diseases in whom the presence of intestinal parasites may not be incidental.     

Microscopic Examination of Stools After Partial Gastrectomy

The present study was undertaken to determine the frequency with which undigested meat fibres in the stool could be found after partial gastrectomy. A sample of stool was examined in 61 patients who had undergone a partial gastrectomy and in 92 control patients. The age ranges and average ages of both groups were similar. The stools of 77 of the 92 control patients contained well-digested meat fibres, 14 showed partially digested fibres, and one patient had completely undigested meat fibres. In the postgastrectomy group, 44 of 61 patients had well-digested meat fibres and 17 showed partially digested fibres in their stools. None showed undigested fibres. The present study demonstrated that the finding of undigested meat fibres is as infrequent in postgastrectomy patients as in control patients. If undigested meat fibres are found in the stools of postgastrectomy patients, it is suggestive of pancreatic exocrine insufficiency.     

Clostridium difficile-associated diarrhea from a general hospital in Argentina

Clostridium difficile is responsible for 15-25% of all cases of antibiotic associated diarrhea. The incidence of infection with this organism is increasing in hospitals worldwide, consequent to the widespread use of broad-spectrum antibiotics. Although the clinical and financial impact of nosocomial C. difficile infection is believed to be significant, only limited information is available on the importance of C. difficile as a cause of diarrhea in Argentina. The aim of the study was to evaluate the impact and diagnosis methods of CDAD from symptomatic patients in a general hospital from Argentina. Consecutive diarrheal stool samples from symptomatic patients from a General Hospital in Argentina were screened for toxigenic C. difficile between April 2000 and April 2001. Toxins were detected in stools by the Premier Cytoclone A+B EIA. Each specimen was examined for toxigenic C. difficile strains by culture. From 104 specimens, 40 (38.5%) [32 of 87 patients (36.8%)] were positive and 64 (61.5%) [55 of 87 patients (63.2%)] were negative by stool toxin assay and/or toxigenic culture. In 11 of 40 positives samples C. difficile toxins were detected only by toxigenic culture. Five (15.6%) patients presented with symptomatic recurrences. Toxin-negative strains were not isolated. This data indicates that the high prevalence of toxigenic strains of C. difficile is of concern in routine diagnostic testing for C. difficile toxins in our study population. Detection of toxins in stools by EIA, coupled with testing strains for toxigenicity only in those cases in which direct toxin assay produces negative results, may be a satisfactory strategy. CDAD is an emerging nosocomial problem in our hospital. It will be necessary to evaluate the epidemiology and measures to control nosocomial spread.     

Intestinal microbiota and secretory immunoglobulin A in feces of exclusively breast-fed infants with blood-streaked stools

Episodes of blood‐streaked stools are not uncommon in exclusively breast‐fed infants under 6 months of age. Such bleeding is thought to be associated with food protein‐induced proctocolitis, however the pathomechanism remains unclear. The aim of this study was to investigate intestinal microbiota and secretory immunoglobulin A in the feces of exclusively breast‐fed infants with blood‐streaked stools. Fecal specimens from 15 full‐term infants with blood‐streaked stools and 15 breast‐fed healthy infants were studied and the results compared. All infants had been delivered vaginally and exclusively breast‐fed. The fecal microbiota were investigated by phylogenetic analysis combined with culture methods for some bacterial species, and feces were assessed for the presence of fecal secretory immunoglobulin A by enzyme‐linked immunosorbent assay. Phylogenetic cluster analysis revealed four major clusters of fecal bacteria, cluster A being found only in healthy infants. The Bacteroides fragilis group was observed more frequently in controls than in patients (P < 0.05). In the controls, the predominant species belonging to the Enterobacteriaceae group was Escherichia coli, whereas in the patients it was Klebsiella (P < 0.05). Concentrations of secretory immunoglobulin A were high in one third of the healthy controls. In conclusion, the pathomechanism of rectal bleeding in exclusively breast‐fed infants may be related to differences in the composition of their intestinal flora.     

Application of a colorimetric DNA-DNA hybridization method for identification ofAeromonas genomic species,isolated from diarrheal stools

The colorimetric DNA-DNA hybridization method for the identification of 18 strains ofAeromonas spp. isolated from human stools was used. Bacterial isolates were also examined by phenotypic characteristics. On the basis of biochemical tests 13 strains were included in phenogroupA. caviœ and 5 strains inA. sobria. Identification to the species level was obtained by colorimetric hybridization method. DNA-DNA similarity values showed that isolates ofA. caviœ group belong to hybridization group (HG) 4 whereas isolates ofA. sobria belong to HG 8/10. DNA relatedness results obtained by the colorimetric method showed good agreement with values detected by the spectrophotometric method. The background in the colorimetric method is lower than in the spectrophotometric one. Results of this study indicate the usefulness of the colorimetric DNA-DNA hybridization in microplates method for the identification ofAeromonas genomic species, isolated from human diarrheal stools.     

Evaluation of Trimethoprim-sulphamethoxazole Compound in Treatment of Salmonella Infections

Fifty patients suffering from infections caused by various salmonella species were treated with trimethoprim-sulphamethoxazole compound. Twenty-three had enteric fever and two were biliary carriers of Salmonella typhi. The other 25 suffered from infections caused by salmonella species other than S. typhi or S. paratyphi B. Twenty-one of the patients with enteric fever responded clinically to the drug, one failed treatment, and one died. Two patients suffering from typhoid fever relapsed and three temporarily excreted S. typhi in stools following treatment. One of the typhoid carriers was successfully treated. All patients with infections caused by salmonella species other than S. typhi or S. paratyphi B responded to treatment but 17 continued to excrete the organism in their stools after the course of trimethoprim-sulphamethoxazole compound. Four patients developed rashes during therapy and two became anaemic.