UROEPITHELIAL DEFENSE IN CHILDREN WITH URINARY TRACT INFECTIONS (UTI)

It is well accepted that obstructive uropathy causes UTI.In patients without urological anomalies a host defense defect of the uroepithelial cells (UEC) may result in increased susceptibility to bacterial infections.Even in patients with vesicourethral reflux (VUR) and recurrent UTI the postulated defense mechanism may be impaired since a significant proportion of these patients still suffer from UTI after surgical therapy.Therefore the influence of UEC on bacterial growth was investigated in 5 groups of children: healthy donors,children with neurogenic bladder due to myelomeningocele (MMC),patients with asymptomatic bacteriuria (ABU;without obstructive uropathy) and patients with VUR after…

Pathogenic factors in recurrent urinary tract infections and renal scar formation in children

Distribution of lymphocyte surface antigens in healthy neonates.

Using flow cytometric analysis we investigated the distribution of major lymphocyte surface antigens in newborn infants. A total of 221 newborns entered the study, of whom 53 fullfilled our criteria of healthy mature neonates. Percentages of immunofluorescent-positive cells were as follows (median and range from 25th to 75th percentiles given): for CD1 3.8%; 2.3%–5.8%. CD2 60.9%; 52.4%–66.8%. CD3 57.5%; 50.5%–63.3%. TcRas 57.7%; 48.1%–60.0%. CD4 36.3%; 28.0%–42.6%. CD8 23.0%; 20.0%–27.4%. CD11a 56.3%; 46.3%–68.5%. CD19 12.1%; 8.6%–14.8%. CD20 10.9%; 8.4%–12.9%. CD25 2.6%; 2.1%–4.5%. CDw52 61.0%; 51.2%–76.1%. CD71 5.2%; 3.1%–9.3%. While the ranges for the percentage of immunofluorescent-posi…

Intrathymic tolerance induction: determination of tolerance to class II major histocompatibility complex antigens in maturing T lymphocytes by a bone marrow-derived non-lymphoid thymus cell.

Two new experimental approaches were established to analyse the influence of the thymus on tolerance induction to major histocompatibility complex (MHC) antigens: The aim of the first experiment was to perform successful transplantation of adult allogeneic thymus tissue into nude mice, an attempt that has been unsuccessful in the past. Tolerance for the MHC genotype of a prospective thymus graft recipient (A) was induced in mice of strain B by injection of (A X B) splenocytes during the neonatal period. Adult thymic tissue obtained from these allogeneic donors (B) were grafted into the nude mice of strain A. The allogeneic thymus was accepted by the nude mice and immunoreconstitution was ac…

Comparison of the antibacterial effect of uroepithelial cells from healthy donors and children with asymptomatic bacteriuria

Bacterial attachment to uroepithelial cells (UEC) and the effect of UEC on bacterial growth was investigated in 15 healthy persons and 12 patients suffering from asymptomatic bacteriuria (ABU) with recurrent urinary tract infections (UTI). Desquamated UEC and mannose-resistant Escherichia coli were co-cultivated for up to 90 min. While no difference in bacterial adherence was observed between healthy controls and patients, 33.4% of the bacteria attached to normal UEC were found to be dead under microscopic evaluation (acridine orange staining), whereas no killing effect could be observed in patients' UEC 5 min after the onset of incubation. This phenomenon was confirmed by investigating the…

Immunogenicity and safety of two doses of tetravalent measles-mumps-rubella-varicella vaccine in healthy children.

Combination vaccines against common childhood diseases are widely used, provide an improved coverage, are more convenient and are more cost-effective than multiple injections. We conducted a study to evaluate the safety and immunogenicity of a combined measles-mumps-rubella-varicella (MMRV) candidate vaccine in comparison with the separate administration of licensed measles-mumps-rubella (MMR; Priorix) and varicella (V; Varilrix) vaccines.Healthy children 12-18 months of age received 2 doses of MMRV vaccine (3 lots) 6-8 weeks apart (MMRV group) or 1 dose of MMR vaccine administered concomitantly with 1 dose of varicella vaccine, followed by a second dose of MMR at 6-8 weeks later (MMR+V gro…

Long-Term Followup Of 158 Young Adults Surgically Treated For Vesicoureteral Reflux In Childhood: The Ongoing Risk Of Urinary Tract Infections

We recorded urinary tract infections in the long term after surgical reflux correction.A total of 158 of 189 patients (160 females and 29 males) who were followed in 1985, an average of 10.8 years after reflux surgery were contacted again in 1995. At that time median patient age was 26 years (range 15.7 to 38.8) and the average period of observation was 20.3 years (range 13.4 to 26).In 82% of the patients febrile and in 18% afebrile symptomatic urinary tract infections had developed preoperatively. In the first 10-year period after operation 46% of patients continued to have symptomatic urinary tract infections compared with 52% in the second 10-year interval. In the 2 periods the incidence…

Three cases of neonatal herpes simplex virus infection presenting as fulminant hepatitis

We report three cases of neonatal herpes simplex virus (HSV) infection presenting as fulminant hepatitis. None of the patients had clear risk factors for HSV infection and they all died. Antiviral treatment for HSV is currently available but must be administered early in the course of the disease before irreversible liver tissue damage is present. Since the diagnosis may be difficult to establish, we wish to draw the attention of clinicians to the presentation of neonatal HSV infection and suggest that in such cases viral cultures, including culture of liver tissue, should be obtained early and antiviral treatment administered while awaiting the culture results.

Klinischer Verlauf und Narbenentwicklung beim operierten vesico-renalen Reflux in einer Langzeitbeobachtung

62 patients (14 boys, 48 girls) representing 85 refluxive renal units (Grade 2-4) were investigated after successful operation for the development of further urinary tract infections (UTI) and renal scars (RS). The mean follow-up was 9.3 years. With the exception of one boy, none of the male patients developed any UTI or new RS. A similar result was obtained for about 45% of the girls. These two groups of patients presented with high-grade reflux before surgery. The remaining female patients (about 55%), however, presenting with lower-grade reflux before surgical treatment, developed further UTI as well as new RS despite surgical correction of their reflux. Investigations on the capacity of…

Changes in lymphocyte subsets after cardiac surgery in children.

Children undergoing cardiopulmonary bypass (CPB) operations have an increased risk of developing severe infections. Impairment of the immune system may contribute to the development of sequelae such as capillary leaks, pulmonary dysfunction and auto-immune reactions. The objective of this study was to investigate the impact of cardiac surgery with CPB on the immune system of infants and young children. We conducted a prospective study to investigate the changes in circulating lymphocyte subpopulations in a sample of 21 consecutive infants and young children undergoing cardiac surgery for congenital heart disease. The following statistically significant (P<0.05) results were obtained: leucoc…

PRENATAL DIAGNOSIS OF X-LINKED SEVERE COMBINED IMMUNODEFICIENCY (SCID) BY FLOWCYTOMETRIC INVESTIGATION OF FETAL BLOOD

Prenatal diagnosis of SCID has until now been limited due to the inability of obtaining sufficient fetal blood volumes for immunological investigation. - We report the diagnosis of x-linked SCID at 19 weeks of gestation by using 200μl fetal blood for flowcytometrio evaluation. Amniocentesis was performed in the 17th week of pregnancy on a 36 year old woman with positive family history for X-linked SCID. chromosome analysis revealed a normal male caryotype. To confirm the suspected diagnosis of SCID a fetal blood sample was taken by puncturing the umbilical cord vein under sonographic control at 19 weeks of gestation. 300μl were used to perform chromosome analysis, the remaining 200μl were p…

Granulozytenfunktion bei Frühgeborenen ab der 34. Schwangerschaftswoche und bei reifen Neugeborenen

BACKGROUND Preterm and term neonates have an increased risk to develop severe bacterial infections. Impairment of neutrophil function may be responsible for this increased risk. Other diseases related to prematurity like retinopathia of prematurity (ROP) or broncho-pulmonary dysplasia (BPD) on the other hand may be due to poorly controlled O2-radical production. PATIENTS AND METHODS Blood samples of 112 premature (34 weeks of gestation and older) and term neonates were analysed. Blood samples of 23 healthy adults (18 to 50 years old) served as controls. O2-radical production and phagocytosis of neutrophils were determined by flow cytometry, using a commercial test system. RESULTS Under the …

Long-term follow-up of children with surgically treated vesicorenal reflux: postoperative incidence of urinary tract infections, renal scars and arterial hypertension.

With a mean follow-up of 10.8 years, 160 female and 29 male patients were investigated after successful correction of vesicoureterorenal reflux. All patients suffered from urinary tract infection (UTI) preoperatively, while postoperatively 42% of the patients developed further UTIs but with a significantly diminished rate of febrile infections. In comparison to a group of patients without postoperative UTI (n = 16), the uroepithelial cells of those patients with a high infection rate after reflux correction showed a significantly lower bacterial growth suppression (n = 37). Renal scars were found in 22% of the investigated renal units with operated ureters (n = 211). Of the preoperatively u…

Hypoparathyreoidismus und Innenohrschwerhörigkeit

Es werden 3 Kinder mit nicht-familiarem Hypoparathyreoidismus beschrieben, die durch eine hochgradige Horstorung cochlearer Genese auffielen. Wahrend bei einem der Kinder klinisch und molekulargenetisch ein Kearns-Sayre-Syndrom nachgewiesen werden konnte, bleibt die Ursache des gemeinsamen Auftretens der Storungen bei 2 Kindern ungeklart. Die Assoziation scheint haufiger als bisher angenommen: sie betrifft 3 der in der Kinderklinik Mainz betreuten 9 Kinder mit primarem Hypoparathyreoidismus. Genetisch determinierte Storungen der Haarzellmotilitat der Cochlea sowie Haarzellschadigung als Folge chronisch verringerter Kalziumkonzentrationen in der Peri- und Endolymphe werden als pathogenetisch…

Immunpathogenese der Pyelonephritis

Fast regelmasig last sich bei der Pyelonephritis eine spezifische Immunantwort gegen den verursachenden Erreger finden. Inwieweit jedoch die Immunantwort Entstehung und Verlauf der Pyelonephritis beeinflust, ist bisher ungeklart. In Analogie zu anderen Infektionen konnte angenommen werden, das eine Verschiebung der Erreger-Wirt-Beziehung zu Gunsten eines virulenten Erregers die Niereninfektion begunstigt. Bei Etablierung der Infektion reagiert der Wirt zunachst mit einem Einstrom von Granulozyten; anschliesend herrschen lymphatische Zellen vor, wobei sowohl T-Lymphozyten, die fur verzogerte Immunreaktionen verantwortlich sind, als auch B-Lymphozyten und ihre Produkte (Antikorper) lokal nach…

Progressive calcifications of lung and liver in neonatal herpes simplex virus infection

We report a female neonate who developed severe septicemia presenting with pneumonia and hepatitis due to an infection with herpes simplex virus type II. In spite of antiviral as well as intensive care therapy, three weeks after admission, extensive hepatic calcification was demonstrable on abdominal radiograph, a sign of severe cellular necrosis. In contrast the pulmonary infiltration recovered completely. The clinical follow up was completed by ultrasound and radiography. The infant died at the age of two months secondary to severe postnecrotic hepatic failure. At autopsy, histological evaluation confirmed the former diagnostic and technical findings; in addition, pulmonary calcifications…

The Interaction of Buccal Mucosal Epithelial Cells with E. coli Bacteria Enhances the Intraepithelial Calcium Flux and the Release of Prostaglandin E 2 (PgE 2 )

Mucosal epithelial cells contribute significantly to host defense mechanisms. Uroepithelial cells (UEC) from healthy donors suppress bacterial growth in vitro. Bacterial adherence to UEC has been shown to be a prerequisite. Similar results have been shown for buccal epithelial cells (BEC). The host response triggered by the host-parasite interaction seems to involve signal transduction and intracellular activation of second messengers. In this study the intraepithelial calcium flux was analyzed in individual BEC after bacterial contact. BEC were derived from scrapes of the buccal mucosa and labelled with fluo-3 (a calcium indicator). Thereafter the cells were analyzed immediately with a FAC…