Sources of infection in childhood tuberculosis in a region of east Croatia

Possible sources of tuberculosis (TBC) infection in children have been assessed in a retrospective epidemiological study covering a north-east region of Croatia in which the incidence of childhood tuberculosis has been increasing since the war in 1991-1995. During the past decade (1993-2003), 271 children up to 18 years of age have been referred for hospital care because of known contacts with tuberculosis (142 children, group A) or because of indicative clinical signs and symptoms (129 children, group B). Possible sources of infection were identified on the basis of medical documentation and field investigations. Frequencies of source identification for different age groups were compared. In group A, the exposure took place most often within the family (parents, grandparents, siblings, 129 of 142 children, 90.87%). Relatives, neighbors, friends and schoolmates accounted for 9.2%. In group B, possible sources of infection were identified for 44 of 129 children (34.1%) and were within the family for 16 of those 44 (36.4%). Evidenced contact with tuberculosis was more usual among younger children (0-9 years of age, 65.5%) in group A than among the older ones (10-18 years of age, 34.5%). In group B, contacts with tuberculosis were equally distributed (50.0%) among younger and older children. High proportion of unrecognized contacts in children having clinical signs and symptoms indicative of tuberculosis (group B, 85 of 129, 65.9%) opens the possibility that extra-familial exposure to tuberculosis occurs more often than expected regardless of the age of children.     

Hepatitis A in Estonia (1990-1999)

During recent 10 years (1990-1999) essential changes occurred the epidemiology of viral hepatitis A (VHA) in Estonia: simultaneously with a decreased level of morbidity (morbidity rate per 100,000 of the population was 78.4 in 1990 and 7.7 in 1996, or 1,241 and 112 cases, respectively), a shift in the age structure of patients from children of preschool age to older age groups took place. Everyday contacts were the main established route of VHA transmission in recent years, but in more than 80% of cases the risk factors of the virus transmission remained obscure. During the regional outbreak of VHA in North Estonia in 1998 (937 out of 989 cases registered in the country) a rise in morbidity was observed among young people aged 15-29 years, when a wide spread of parenteral viral hepatitides B and C and drug addiction were registered in this region. During this outbreak VHA was transmitted mainly through everyday contacts. Still the considerable prevalence of injection drug users who practiced the group use of syringes and needles and took drugs from common containers, a sufficiently high level of the mixed forms of the disease (more than 18% of all registered cases of VHA), detected for the first time, make it possible to suggest that the parenteral transmission route could appear among persons belonging to the above mentioned group. Vaccination is regarded as the most effective measure for the prophylaxis of VHA.     

Haemophilus influenzae type B meningitis: a contagious disease of children.

The families of 126 consecutive patients with Haemophilus influenzae type B meningitis were surveyed for secondary invasive H influenzae disease among household contacts. A total of 120 of the families were contacted. In six cases no contact was possible and the medical record was reviewed. Some 555 household contacts were found; 31% (171) were under 5 years of age. A secondary case was defined as a household contact with H influenzae type B isolated from blood or cerebrospinal fluid more than 24 hours, but less than 30 days, after admission to hospital of the index case. Four secondary cases were identified, all in children aged under 5 years. The secondary attack rate in children under 5 years or less in the month after exposure to an index case was thus 2.3%, 800 times the endemic attack rate for H influenzae meningitis. This is a conservative estimate since five additional contact cases were documented, but not included in the secondary attack rate. Young contacts of a child with H influenzae meningitis are thus at significant risk of life-threatening secondary disease.     

Coxsackie A 13 virus in the foci of rheumatism.

Faeces and nasopharyngeal washing were examined in 12 patients and 27 contacts of these patients in family foci (primary foci) of rheumatism and in 37 patients and 32 contacts of these patients in secondary foci of rheumatism (in hospitals). Results of stimultaneous examinations of 127 children of the control groups served as the control. An analysis of the results of the investigation showed the Coxsackie A 13 virus was found considerably more frequently in both the patients (83.3%) and their contacts (148.1%) in the primary foci of rheumatism than outside these foci (11.9--15.3%). The difference is statistically significant. Wide distribution of Coxsackie A 13 virus was also observed in clinical departments in which children were hospitalized at the acute stage of rheumatism. We failed to establish marked differences in the rate of detection of other viruses in the foci of rheumatism in comparison with the control groups.     

Spread of infection with hepatitis B and C viruses in different population groups of north-western Ukraine

The detection rate of specific markers of hepatitides B and C among the child and adult population, including 487 children in 5 boarding schools, 338 oncological, hematological, urological patients and 206 medical staff members in Rovno and the Rovno region (North-Western Ukraine), was determined. In boarding-school the markers of HB (HBsAg, anti-HBs, summary anti-HBc) were detected 3.5 times more often than among the child population in general (in 28.3 and 8.0% respectively). In children staying in a boarding school for up to 1 year (126 children) these markers were determined in 23% of cases, and in those who stayed there for 3-5 years, in 58.1% of cases. Among the members of the groups where children with HBsAg were found the markers of HB occurred 3.3 more often then among the children in the groups having no HBsAg carriers (45.3 and 13.9% respectively). The detection rates of the markers of HB in children with various kinds of C.N.S. pathology (first of all, with mongolism) and without concomitant diseases were sharply different (they were found, respectively, in 52.9 and 19.6%, including HBsAg in 17.4 and 2.7%). At the same time the detection rate of anti-HCV among boarding-school children (including those with C.N.S. lesions) was no different from that among the child population in general, which was indicative of great differences in the activity of the nonartificial transmission routes HB and HC viruses. Patients with oncological, hematological and urological diseases who had great "parenteral load", as well as medical staff members, formed a high risk group for being infected with both HB and HC viruses.     

Prevalence of Candida albican serotypes in blood isolates in Chile, and first report of Candida dubliniensis candidemia

Our main goal was to determine the prevalence of C. albicans serotypes isolates from blood cultures and identify the presence of C. dubliniensis. We studied 47 strains identified as C. albicans by conventional methods, 28 were isolated from children and 19 from adult patients. The strains were re-identified by standard methods and phenotypic screening as xylose assimilation and growth at 42 degrees C. API ID 32C (bioMérieux) was employed with the C. dubliniensis suspected strains and confirmation was made by molecular fingerprinting using random amplified polymorphic DNA (RAPD). The C. albicans serotype was determined by agglutination with antiserum anti-antigen 6 from cell wall (Candida Check, Iatron Inc., Japan) and the in vitro susceptibilities were evaluated by a microdilution method. From 47 strains, 46 were confirmed as C. albicans, 31 of them (67%) were serotype A. Adult patients presented a high prevalence of serotype A (95%) and children presented a frequency of 52% of the serotype B (p<0.05). We confirmed the identification of C. dubliniensis in one strain isolated from an infant. All serotype B strains were susceptible to fluconazole, itraconazole and amphotericin B. On the other hand, 3% and 6% of serotype A strains were "susceptible dose dependent" to fluconazole and itraconazole, respectively. C. albicans serotype A was predominant in adult candidemia and its distribution was homogenous in children patients. All strains were highly susceptible to antifungals. We report here the first case of C. dubliniensis candidemia in South America.     

Sewage workers: risk of acquiring enteric virus infections including hepatitis A

To determine if sewage workers have an increased risk of acquiring viral infections, 66 workers at a small wastewater plant in north-eastern Italy and 72 control subjects recruited from blood donors were enrolled in a seroprevalence study to determine whether sewage workers are at increased risk of acquiring viral infections. In order to evaluate various risk factors, a questionnaire was filled out by each worker whereas seropositivity to Hepatitis A virus, Coxsackievirus B2 - B3 - B4 - B5, and Echovirus types 1 and 9 was determined in the laboratory. Anti-HAV antibodies were present in 37.8% of sewage workers and 36.1% of subjects in the control group. The difference was not statistically significant in the two groups, whereas a significant association was observed regarding age (P < 0.3). No association was observed with the occupational age, or with number and duration of contacts per day. The lack of evident occupational risk for hepatitis A among sewage workers may be explained by the adult age of the workers (mean age 41.3 years, range 22-58 years), and thus the antibody titre against different enteroviruses was determined. No statistically significant differences were evident with the raw values, but considering the 90 degrees percentile as a dichotomic value for the antibody levels a strong and significant association was present with Coxsackievirus B3 (O.R. 22.85, C.I. 95% 2.93-178.08) and Coxsackievirus B2 (O.R. 14.25, C.I. 95% 1.78-113.87). Analysis of the data confirms a limited risk of acquiring infection and/or disease but also the evident possibility of silent exposure to the viruses. The shift in HAV epidemiology and increased morbidity and mortality in adult age suggest that active immunization against hepatitis A should be considered.     

Childhood Tuberculosis in Household Contacts of Newly Diagnosed TB Patients

Introduction

Childhood tuberculosis (TB), although estimated to account for a major proportion of the global TB disease burden, has a lower public health priority. Reliable research and surveillance data on childhood TB is limited in most regions of the world. This study was conducted to assess the burden of childhood TB among the household contacts of new TB patients in Karachi, Pakistan.

Methods

A retrospective analysis of children (<15 years) who were household contacts of new adult TB patients presenting to Marie Adelaide Leprosy Center (MALC) clinics in Karachi during the period of 2008 to 2010 was conducted.

Results

Of the household children contacts (n = 6613) screened, 317 were suspected and 121(1.8%) diagnosed with TB. These included 89 (73.6%) with pulmonary and 32 (26.4%) with extra-pulmonary disease. Smear positivity rate in pulmonary cases was 32.6%. Mean age of children diagnosed with TB was 11.7 (±2.8) years. Within the child-contacts screened, disease was found to be significantly higher among females (2.3%) in comparison to males (1.2%) (p-value <0.01). The commonest relationship of source cases to diagnosed children was the mother (n = 51, 42.1%). The source case was a female for 66.1% (n = 76) of the children.

Conclusion

A smear positivity rate of 32.6% amongst pulmonary cases suggests their potential to spread disease and emphasizes a need to review the contribution of children in transmission of TB within communities. Greater vulnerability of the female child and considerable role of mother in disease transmission highlights a need to increase focus on females in TB control programs in Pakistan.     

Efficacy of Whooping-cough Vaccines used in the United Kingdom before 1968: Final Report to the Director of the Public Health Laboratory Service by the Public Health Laboratory Service Whooping-Cough Committee and Working Party

The efficacy of pertussis vaccines was investigated in 33 areas in the United Kingdom from November 1966 until April 1968 inclusive. Bordetella pertussis was isolated from 1,293 persons, but there were only six isolations of B. papapertussis. Among vaccinated contacts under 5 years in homes in which B. pertussis was isolated 52% developed paroxysmal cough. The corresponding attack rate among unvaccinated contacts was 69%. These findings suggest that much of the pertussis vaccine in use for five or six years before 1968 was not very effective. However, vaccine from one producer was more effective than vaccine from another. Of the cultures of B. pertussis identified 89% were serotype 1, 3 and only about 9% were serotype 1, 2, 3. Serotype 1, 2, 3 was isolated much more frequently from unvaccinated than from vaccinated children, but some cultures identified as type 1, 2, 3 were found on re-examination to contain colonies of type 1, 3. Virological investigations were made in some areas during the first year of the study. Of the wide variety of viruses identified adenovirus and parainfluenza virus were the most common groups. Virus isolation rates were similar in patients and symptomless contacts, but B. pertussis was isolated far more often from patients than from symptomless contacts. The evidence suggests that B. pertussis remained the major cause of whooping cough in the U.K.     

Nature and prevalence of risk factors associated to type B and C acute viral hepatitis cases in Bucharest, 1998-2000

The main objective of the study was to calculate and report the prevalence of probable risk factors involved in the transmission of pathogenic agents among type B and C acute viral hepatitis cases confirmed in Bucharest (1998-2000). The standardized values of the risks detected in the 45-180 days preceding the onset of illness suggest that in both types of acute viral hepatitis considered in our study transmission associated to the individuals' behaviour (19.0%-hepatitis B and 20.1%-hepatitis C) seems more frequent than "iatrogenic" transmission; in case of hepatitis B, sexual contacts with more than one partner coming first (15.7%), whilst in case of hepatitis C the use of i.v. drugs (heroine) was most frequently incriminated (12.4%). The study reviews the present knowledge of the risk factors involved in the transmission of the disease and approaches prevention strategies.     

3D7-Derived Plasmodium falciparum erythrocyte membrane protein 1 is a frequent target of naturally acquired antibodies recognizing protein domains in a particular pattern independent of malaria transmission intensity

Protection against Plasmodium falciparum malaria is largely mediated by IgG against surface Ags such as the erythrocyte membrane protein 1 family (PfEMP1) responsible for antigenic variation and sequestration of infected erythrocytes. PfEMP1 molecules can be divided into groups A, B/A, B, C, and B/C. We have previously suggested that expression of groups A and B/A PfEMP1 is associated with severe disease and that Abs to these molecules are acquired earlier in life than Abs to PfEMP1 belonging to groups B, B/C, and C PfEMP1. In this study, we compared the acquisition of IgG to 20 rPfEMP1 domains derived from 3D7 in individuals living under markedly different malaria transmission intensity and were unable to find differences in the Ab acquisition rate to PfEMP1 of different groupings (A, B, or C) or domain type (alpha, beta, gamma, delta, epsilon, or x). Abs were acquired early in life in individuals living in the high transmission village and by the age of 2-4 years most individuals had Abs against most constructs. This level of reactivity was found at the age of 10-20 years in the medium transmission village and was never reached by individuals living under low transmission. Nevertheless, the sequence by which individuals acquired Abs to particular constructs was largely the same in the three villages. This indicates that the pattern of PfEMP1 expression by parasites transmitted at the different sites was similar, suggesting that PfEMP1 expression is nonrandom and shaped by host-parasite relationship factors operating at all transmission intensities.     

Very high prevalence of infection with the human T cell leukaemia virus type 1c in remote Australian Aboriginal communities: Results of a large cross-sectional community survey

Infection with the human T cell leukaemia virus type 1 (HTLV-1) subtype C is endemic among Aboriginal people in central Australia. To provide insights into the risk factors for transmission, we conducted the first large-scale, community-based prevalence study in seven remote Aboriginal communities. Residents >2 years old were invited to participate in the study between August 2014 and June 2018. HTLV-1 infection was defined as a positive western blot (WB) test or a positive HTLV-1 PCR. 720 community residents participated in the study (children <15 years, 142; adults, 578). Prevalences for children and adults were 3.5% (5/142) and 36.8% (213/578), respectively, reaching 49.3% (106/215) for those older than 45 years. A wide range of proviral loads were measured for both asymptomatic and symptomatic participants with no difference within groups according to age or gender; however, median PVL was 1.34 log10 higher for symptomatic participants. The adult prevalence of HTLV-1 infection in central Australia is the highest reported worldwide. Sexual contact is likely to be the predominant mode of transmission.     

Trypanocide Treatment of Women Infected with Trypanosoma cruzi and Its Effect on Preventing Congenital Chagas

With the control of the vectorial and transfusional routes of infection with Trypanosoma cruzi, congenital transmission has become an important source of new cases. This study evaluated the efficacy of trypanocidal therapy to prevent congenital Chagas disease and compared the clinical and serological evolution between treated and untreated infected mothers. We conducted a multicenter, observational study on a cohort of mothers infected with T. cruzi, with and without trypanocidal treatment before pregnancy. Their children were studied to detect congenital infection. Among 354 “chronically infected mother-biological child” pairs, 132 were treated women and 222 were untreated women. Among the children born to untreated women, we detected 34 infected with T. cruzi (15.3%), whose only antecedent was maternal infection. Among the 132 children of previously treated women, no infection with T. cruzi was found (0.0%) (p<0.05). Among 117 mothers with clinical and serological follow up, 71 had been treated and 46 were untreated. The women were grouped into three groups. Group A: 25 treated before 15 years of age; Group B: 46 treated at 15 or more years of age; Group C: untreated, average age of 29.2±6.2 years at study entry. Follow-up for Groups A, B and C was 16.3±5.8, 17.5±9.2 and 18.6±8.6 years respectively. Negative seroconversion: Group A, 64.0% (16/25); Group B, 32.6% (15/46); Group C, no seronegativity was observed. Clinical electrocardiographic alterations compatible with chagasic cardiomyopathy: Group A 0.0% (0/25); B 2.2% (1/46) and C 15.2% (7/46). The trypanocidal treatment of women with chronic Chagas infection was effective in preventing the congenital transmission of Trypanosoma cruzi to their children; it had also a protective effect on the women''s clinical evolution and deparasitation could be demonstrated in many treated women after over 10 years of follow up.     

Electron microscopical study on the development of the nerve supply of the pituitary pars intermedia of the mouse

Summary The development of the nerve supply of the pituitary pars intermedia (PI) of C3H mice was studied by electron microscopy. Nerve fibres and terminal structures, most probably adrenergic, first appear in the newborn. The adult innervation pattern is achieved by the end of the first postnatal week.In the adult animal two types of nerve terminals were distinguished; type A (peptidergic or neurosecretory) and type B (adrenergic). The peptidergic fibres were scarce and exhibited no synapse-like contacts. It is suggested that they are of secondary importance in a direct nervous hypothalamic control of PI function. Type B terminals were found throughout the PI. They formed synapse-like contacts with the glandular cells, indicating that the primary innervation is exerted by adrenergic neurons.An autonomous differentiation of the glandular cells and in the adult a combined direct nervous and neurohumoral control of PI function is suggested.This investigation was supported by grant No B 2180-026 from the Swedish Natural Science Research Council. The skilful technical assistance of Mrs Ulla Wennerberg is gratefully acknowledged     

Giardiasis and other intestinal parasitic infections in a Manitoba residential school for the mentally retarded.

A case of severely symptomatic giardiasis in a school for the mentally retarded prompted an epidemiologic survey of the institution. The rate of parasitic infection in the children were just under 50%. Multiple infections were common and one child harboured five different protozoa. The yield included known pathogens (Giardia lamblia, Metorchis conjunctus and Diphyllobothrium sp.), protozoa of potential pathogenicity (Dientamoeba fragilis) and other protozoa, the significance of which has yet to be determined. The prevalence of G. lamblia in the index ward was significantly higher than in a control ward matched for age and mobility of the children. The epidemiologic data suggested person-to-person transmission of G. lamblia within the institution. Recommendations for the control of protozoal intestinal infections in custodial institutions are presented.     

牙髓拟杆菌的分离,培养,鉴定

牙髓拟杆菌是产黑色素拟杆菌群中的一个新菌种。本试验通过对牙髓腔感染标本中分离、培养、鉴定各种细菌,发现牙髓拟杆菌主要分布在牙髓腔内,其存在与根尖周炎有无症状密切相关,此菌对氧敏感,用常规鉴定及气相色谱法与其它菌无法区别,而间接免疫荧光法是确定牙髓拟杆菌菌种和直接检测牙髓腔标本中有无此菌的一个快速、可靠的方法。     

Characteristics and trends in the development of an epidemic process of Sonne and Flexner dysentery among preschool children

The results of studies indicate that the morbidity rates of dysentery among children attending preschool institutions and children brought up at home converged in recent years. This phenomenon was most pronounced among children of the kindergarten age group. At the same time dysentery caused by Sh. sonnei and Sh. flexnery produced a higher morbidity rate among children attending nursery in comparison with that among children of the same age group brought up at home. Group infections in preschool institutions were caused by Sh. sonnei in 89.1% of cases and by Sh. flexneri in 10.9% of cases. Outbreaks due to the transfer of infection through everyday contacts were observed only in dysentery caused by Sh. sonnei, constituting 71.4% of the total number of dysentery outbreaks.     

Evidence of Hepatitis A Virus Person-to-Person Transmission in Household Outbreaks

The person-to-person transmission of the hepatitis A virus primarily occurs in enclosed spaces, particularly in the presence of inadequate hygiene conditions and a high proportion of susceptible individuals. Thus, intimate family contact stands out as a risk factor for HAV infection dissemination. The present study aimed to evaluate the occurrence of household HAV transmission. Blood samples were collected from patients with hepatitis A (index cases) and their family members (contacts) that were referred to an ambulatory care clinic specializing in viral hepatitis. A total of 97 samples were collected from 30 families with a confirmed hepatitis A case (index case). Serological and molecular techniques for the diagnosis of hepatitis A were conducted on all samples. HAV infection (anti-HAV IgM + and/or HAV RNA +) was detected in 34.3% (23/67) of the contacts; 34.3% (23/67) of the contacts were immune to HAV, and 31.4% (21/67) were susceptible. In the household contacts, HAV immunity was significantly associated with older age; susceptibility to infection and HAV infection were associated with younger age. Household outbreaks were detected in 16/30 families studied. Co-circulation of subgenotypes IA and IB was found in the household outbreaks, and person-to-person transmission was evidenced in six of the household outbreaks, with 100% homology between the index case and contact strains. The results demonstrated the relevance of HAV household transmission, reaffirming the need for hepatitis A vaccine administration in susceptible contacts and effective infection control procedures to prevent the extension of household outbreaks.     

The characteristics of the serological diagnosis of meningococcal infection in children in the 1st years of life

The results of clinico-immunological examination of 181 children, aged 1 month to 6 years, with generalized forms of meningococcal infection are presented. In children under observation antimeningococcal antibodies to group-specific meningococci of the main groups A, B and C were determined over the course of the disease by passive hemagglutination (PHA) test and enzyme immunoassay (EIA). The level and frequency of seroconversion were found to depend on the patient's age and the severity of the clinical course of meningococcal infection. Antibody level was found to increase simultaneously with respect to several meningococcal polysaccharides: A, B in 18.5% and A, B, C in 3.3% of cases. In the clinical interpretation of data obtained in the PHA test and EIA not only the patient's age, the form and duration of meningococcal infection, but also serotherapy should be taken into consideration, as the latter may distort the serological results.     

Thyroid function tests in children with congenital hypothyroidism on L-thyroxine treatment

The plasma levels of thyroxine (T4), triiodothyronine (T3), free T4 (FT4), free T3 (FT3), reverse T3 (rT3) and immunoradiometrically assayed thyrotropin (IRMA TSH) have been measured in 28 L-T4-treated children with congenital hypothyroidism as well as in a control group (group C). The patients were subdivided into 2 groups according to the nonsuppressed (group A) or suppressed (group B) TSH response to TSH-releasing hormone (TRH). Basal IRMA TSH correlated with the TSH increment after TRH and it was significantly lower in group B vs. groups A and C, while no difference was present between groups A and B in regard to T4, FT4 and rT3, all higher than in group C. FT3 levels were similar in the 3 groups. In children, as in adults, basal IRMA TSH seems to be a reliable index in monitoring overtreatment.