Nutrition and immunity: an overview

Historical accounts and recent epidemiologic studies have suggested a mutually aggravating relationship between malnutrition and infection. In protein-energy malnutrition, there is a significant impairment of several aspects of immunity, including cell-mediated immune responses, secretory immunoglobulin A antibody production, phagocyte function, complement system, antibody affinity and cytokine production. Several micronutrients play a crucial role in maintenance of optimum immune responses. On the other hand, excessive intake of nutrients also impairs immunity. Animals fed diets lacking in nucleotides have lower immune responses than controls but there is no enhancement of immunity when the diet contains large amounts of nucleotides. These observations have considerable practical importance in terms of designing feeding formulas.

Pneumocystis carinii pneumonia complicating Hodgkin's disease: a case report

A case of Hodgkin's disease who developed Pneumocystis carinii pneumonia (PCP) is described. The diagnosis of P. carinii was confirmed on post-mortem lung biopsy. The rarity of its occurrence in our country is emphasised as is the need for high degree of suspicion and early institution of treatment.

Simultaneous administration of hepatitis B vaccine with other E.P.I. vaccines

Development of recombinant DNA vaccine against hepatitis B grown on cultured yeast cell has made it possible to mount a world-wide effort to control and eradicate Hepatitis B infection. However, the currently recommended schedules (0, 1 & 2 months, and 0-1 and 6 months) do not coincide with the scheduled visits for other E.P.I. vaccines, and necessitate additional visits for Hepatitis B vaccination. This study was therefore carried out to find out if adequate seroconversion occurs to Hepatitis B vaccine when given with other EPI vaccines or not? Thirty nine infants born to Australia antigen positive mothers from among 850 screened pregnant mothers were recruited to receive Hepatitis B vaccine (Engerix B-10 micro gram each) at 0, 6 and 14 wks (group A) or at 0, 1 and 2 months (group B). Thirty-one infants were recruited in group A and 8 in group B. The cord blood was collected and the first dose of vaccine was given within 48 hours of birth. Simultaneous B.C.G. was given at the left deltoid. Other E.P.I. vaccines were given qt 6, 10 and 14 wks in group A and at 2, 3 and 4 months in group B. Repeat blood samples were collected prior to giving each dose of Hepatitis B vaccine, and 4 weeks after the last dose. All blood samples were assayed for HBsAg and HBsAb at the National Institute Of Communicable Diseases, utilizing standard ELISA kits. The seroconversion rates following one, two and three doses of Hepatitis B vaccine were 3.33%, 55.5%, 96.15% and 0%, 62.5% and 100% in group A and B respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of transfusion-mediated viral infections on the lymphocyte subset profile in multi-transfused children

A total of 74 multitransfused (MT) children of beta thalassaemia major were analysed for prevalent viral markers transmitted through transfusion. A higher incidence of serological markers for Hepatitis B virus (HBV), cytomegalovirus (CMV) could be observed in the group of MT children compared to control group. There was a significant trend (chi 2 = 33.4; P < 0.001) in the increase in prevalence of viral markers along with the increase in the number of transfusions. MT children receiving more than 50 transfusions were found to have evidence for at least one or multiple viral infections transmitted through blood. Children receiving more than 50 transfusions were characterized by marked alteration of T3, T8, and B cells while T4/T8 ratio was found to be significantly decreased (P < 0.001) only in the group of children receiving more than 100 transfusions. Relative assessment of the alteration of lymphocyte subsets in various groups of viral infection showed that cases with CMV IgM to have more marked influence on the alteration of T8 cells, T4/T8 ratio, and B cells compared to other groups of viral infections. Reassessment of the lymphocyte subset profile in MT children in the light of CMV IgM positive cases revealed that in children receiving more than 50 transfusions significant alterations of lymphocyte subjects were influenced by the presence of CMV IgM positive cases in these groups. Our study points out that the correlation between the alteration of lymphocyte subset profile and number of transfusion in MT children need to be reassessed in the light of acute CMV infection in the form of CMV IgM.

Trends in neonatal outcome with low Apgar scores

Trends in incidence and neonatal outcome following low Apgar scores (1 min Apgar score < 6) were prospectively studied during the years (1981, 1983, 1986 and 1988. The incidence of birth asphyxia was 7.6% of live births during the study period; it was 5.8% in 1981, increased to highest of 8.9% in 1986 with slight reduction to 7.2% in 1988. Birth weight distribution of asphyxiated babies and 1 min Apgar score < 3 (severe asphyxia) remained unchanged. A significant decline in neonatal mortality with asphyxia was noted from 46.0% to 28.4% during 1981 and 1988 respectively. Aetiological factors for asphyxia could be identified in nearly 90% of infants during 1988, and all but 2 of 12 factors studied registered significant differences from control non-asphyxiated group.

Acquired immunodeficiency syndrome (AIDS) in multitransfused children with thalassemia

Two hundred and three multi-transfused children with thalassemia attending the Thalassemia Clinic of the Charak Palika Hospital, New Delhi were screened for human immunodeficiency virus (HIV) antibodies by ELISA and all positive cases were confirmed by Western Blot. Of the 203 children screened, 18 (8.9%) were HIV positive, and in these children a detailed immunological work up was done and compared to 18 age-matched HIV negative thalassemics as controls. The tests included absolute lymphocyte counts (ALC), absolute and percentages of CD4+ and CD8+ cells and their ratios (CD4/CD8), immunoglobulin levels (IgG, IgM and IgA) and delayed cutaneous hypersensitivity (DCH) test by Multitest CMI in all the cases and the controls. Of the 18 HIV positive children, 6 were diagnosed to have clinical AIDS as per the WHO criteria. After immunological testing, the children were further classified according to the CDC criteria. By these criteria, 11 children were classified as P1 A (asymptomatic infection, normal immune function), 1 child as P1 B (asymptomatic infection, abnormal immune function), 2 children as P2 A (symptomatic infection with non-specific findings), 1 child as P2 C (lymphocytic interstitial pneumonitis), 1 child as P2 D1 (Pneumocystis carinii pneumonia) and 2 children as P2 D2 (symptomatic infection with infections). In this paper, the clinical features of the children with AIDS is described, and the immunologic functions of these children are compared with the HIV positive asymptomatic children and with controls. These are the first cases of AIDS in the pediatric age group from India.

Asymptomatic Salmonella senftenberg carriage in a neonatal ward

During a 23-day period in April 1991, nine infants in a neonatal ward were found to be colonized with Salmonella senftenberg. All were asymptomatic on detection and all except one (who developed septic ileus) remained asymptomatic on follow-up. The affected babies were isolated and subsequently discharged from the ward as soon as possible. These measures, along with emphasis on handwashing and intensification of cleaning and disinfection, were able to prevent spread to other babies. Despite extensive sampling of the environment, mothers and staff, the source of the organism could not be identified.

Prevalence of diphtheria and tetanus antibodies in young adults in Delhi

A total of 574 blood samples collected mainly from adult males, on a random basis, were tested for diphtheria and tetanus antibodies by Indirect Haemagglutination (IHA) test to find out the percentage of individuals with protective titres (> or = 0.015 IU/ml). A total of 502 (87.5 per cent) and 437 (76.2 per cent) of these had protective titres against diphtheria and tetanus respectively. The vaccination status of these subjects against diphtheria and tetanus was not ascertainable. The relevance of these findings is discussed.

Oral polio vaccination in infants: beneficial effect of additional dose at birth

This study was done to assess the response of newborns to trivalent oral polio vaccine and to study any efficacy of OPV if given to infants on third day of life. The study was conducted in two groups, A (87) and B (55) of infants in Delhi, India. In group A, the children received one birth dose or 'O' dose of TOPV, followed by 3 conventional doses started at 6 weeks, and in group B the children received only 3 doses of OPV. Pre and one month post immunization serum samples were tested for the presence of neutralising antibodies. In addition, in group A serum samples were collected at 6 weeks before the administration of 1st dose to see the sero response following 'O' dose of TOPV. It was found that administration of OPV on 3rd day of life leads to sero conversion in 15.3% of infants to all three polio virus types by the age of 6 weeks, and highest sero response was seen for polio virus type 1. Sero-conversion in group A was significantly more than sero-conversion in group B after the administration of last dose. Thus the study has established that immunization of newborns with TOPV is a safe and effective means for improving protection against the disease.

Hip instability in newborns in an urban community

BACKGROUND

It is important to recognize congenital dislocation of the hip early so that it can be treated effectively and secondary changes prevented. There is little data on the incidence of this condition in India and we, therefore, studied this problem in a large maternity and paediatric centre in New Delhi.

METHODS

Six thousand and twenty-nine consecutive newborns were examined for neonatal hip instability by an orthopaedic surgeon and a paediatrician. Clinical examination was supplemented by X-ray and ultrasonographic examination.

RESULTS

One hundred and forty-eight hips in one hundred and thirteen newborns (18.7 per 1000 live-births) were found to be unstable at first examination. Of these 12.1 per 1000 live-births had subluxatable hips and 0.82 per 1000 had dislocated hips. Those affected were more likely to be females, have involvement of the left hip and have had a breech presentation. One hundred and twenty-eight hips in 97 children had stabilized within 2 weeks, although no definite progress to stability was observed in subluxatable, dislocatable or dislocated hips. Two children who had other congenital abnormalities initially required operation, but the hips in all the other children stabilized within 20 weeks of birth with conservative treatment.

CONCLUSION

Neonatal hip instability is common in New Delhi and a screening programme should be initiated to detect its incidence in other parts of India.

Immunogenicity of enhanced potency inactivated polio vaccine

Fifty two children were immunized with two doses of enhanced potency inactivated polio vaccine in order to determine its efficacy. The vaccine was very efficacious with 92.3, 92.3 and 88.3% of the children seroconverting to the three poliovirus types, respectively. The vaccine was equally efficacious whether the two doses were given at 4-week or 8-week intervals or when immunization was started at 6-7 weeks of age or later. The presence of maternal antibodies did not interfere significantly with the seroresponse to two doses of IPV-E. The study recommends that two doses of IPV-E give satisfactory seroconversion rates. Immunization can be started as early as 6 weeks age and the two doses can be given at 4 weeks interval to complete primary immunization against poliomyelitis.

Incidence and significance of opportunistic fungi in leukemia patients in India

Twenty-four patients with acute leukemia were investigated for the incidence of opportunistic fungi. Culture isolations of the sputum and urine samples revealed significant levels of Candida in 14 patients; Candida albicans, C. tropicalis and C. pseudotropicalis were the predominant ones isolated. Aspergillus flavus was isolated from blood in two cases and C. albicans and a black yeast from the blood of another two. Serological studies showed fungal antibodies in seven patients; precipitins against Candida were detected in five and Aspergillus in two. Both of the Aspergillus positive cases and two patients who had rising antibodies against Candida died during the course of investigation. In this study 13 of 24 patients developed oral candidiasis.

Relative performance of Organon kit in comparison to Du Pont for confirmatory serological testing of HIV infection by western blot test in sera from blood donors

A total of 32 specimens with different categories of reactivity by Du Pont Western Blot kit comprising of specimens showing full spectrum of HIV-I antigen specific bands, 19 specimens showing total absence of bands and four specimens showing non-specific bands (without any interpretative importance) were subjected to Western Blot testing by Organon test. Of the nine specimens showing full spectrum of bands by Du Pont the correlation with Organon kit was 100 per cent based on WHO criteria. Four specimens with non-specific indeterminate band pattern by Du Pont failed to show any band in Organon kit, indicating that latter to be more specific.

Immunologic tolerance in lymphatic filariasis. Diminished parasite-specific T and B lymphocyte precursor frequency in the microfilaremic state

To explore the mechanisms of antigen-specific immune unresponsiveness seen in microfilaremic patients with bancroftian filariasis, T and B cell precursor frequency analysis was performed using PBMC from individuals with either asymptomatic microfilaremia (MF, n = 7) or chronic lymphatic obstruction (CP, n = 20). Highly purified CD3+ cells were partially reconstituted with adherent cells and their proliferative response to parasite antigens determined in cultures of T cells by limiting dilution analysis. A filter immunoplaque assay also assessed the frequency of both total and parasite-specific Ig-producing B cells. While the lymphocyte proliferation to mitogens and to a nonparasite antigen (Streptolysin-O, [SLO]) were similar in all groups of patients, the frequency of parasite-specific CD3+ T cells was significantly lower (geometric mean [GM], 1/3,757) in MF patients when compared to that in CP patients (GM 1/1,513; P less than 0.001). Similarly, the proportion of lymphocytes producing parasite-specific IgE or IgG was significantly lower in MF patients (IgE mean, 0.2%; IgG mean, 0.33%) compared with CP patients (IgE mean, 3.2%; IgG mean, 1.76%; P less than 0.05 for both comparisons). These observations imply that low numbers of parasite-specific T and B lymphocytes may be partially responsible for the severely diminished capacity of lymphocytes from patients with MF to produce parasite-specific antibody and to proliferate to parasite antigen in vitro. Such differences in parasite-specific lymphocyte responses suggest that tolerance by clonal anergy may be a critical mechanism for maintaining the microfilaremic state.

Lower respiratory tract infection in hospitalized children due to respiratory syncytial (RS) virus during a suspected epidemic period of RS virus in Delhi

A study of 131 children below 5 years of age seeking hospitalization due to lower respiratory tract infections (LRTI), comprising 56 cases of bronchiolitis, 61 cases of bronchopneumonia, and 14 cases of other lower respiratory tract diseases showed significant occurrence of bronchiolitis in younger age groups (chi 2 = 79.21; P less than 0.001). Employing two rapid techniques, viz. immunofluorescent antibody technique (IFAT) and enzyme immunoassay (EIA) along with tissue culture, Respiratory Syncytial (RS) virus could be detected in higher percentage of bronchiolitis cases (54 per cent by both culture and IFAT, 70 per cent by EIA) compared to bronchopneumonia (36 per cent by both culture and IFAT, 49 per cent by EIA) and other LRTI cases (14 per cent each by culture, IFAT and EIA). The detection rate of RS virus was higher in the age group 0-6 months compared to the remaining age groups combined (7-60 months) in bronchiolitis cases irrespective of the technique employed while no such difference could be noted in bronchopneumonia. Eighteen (90 per cent) out of 20 specimens positive for RS virus by EIA, but negative by culture were found to be true positives as revealed by blocking test. In comparison to culture, sensitivities of IFAT, EIA, and EIA (by blocking test) were found to be 89, 94, and 94 per cent, respectively, while specificities of these techniques were found to be 92, 74, and 76 per cent, respectively. Higher detection rate of RS virus in the present study compared to earlier ones from India is attributed to application of EIA as well as selection of LRTI cases during a period of suspected epidemic of RS virus.

Significance of cord problems at birth

Cord problems at birth were prospectively studied in 12,000 singleton deliveries, of which 258 (2.15%) babies had cord abnormalities. Nearly 32% of these cases had fetal distress and 20.5% had 1 minute Apgar score less than 6. Of the various cord problems nuchal cord was noted in 79.1%, cord prolapse in 12.4% and true knots in 3.9% cases. Perinatal mortality rate with cord problems was 85.27/1000 births. Neonatal problems noted were septicemia (4.56%), aspiration syndromes (13.48%), hypoxic ischemic encephalopathy (7.30%), neonatal convulsions (2.14%) and hyperbilirubinemia (2.14%). Although mean Hb and PCV were lower in those with cord round the neck as compared to normal controls, this difference was not significant. Seven babies had Hb less than 13 g/dl with nuchal cords. Neonates born with cord around the neck or with other cord abnormalities should be carefully followed up for morbidity.

Prolonged undiagnosed fever in northern India

A prospective study for five years along with a retrospective analysis of all patients admitted over 10 years with the diagnosis of prolonged undiagnosed fever was carried out in a referral hospital of North India to determine the specific disorders responsible for it. One hundred and fifty patients (80 prospective and 70 retrospective) were included in the study. Infections, especially tuberculosis, was the most dominant cause (50%), followed by lymphoreticular and haematological disorders (21.32%), collagen vascular disorders and neoplasms (8.67%) each. Miscellaneous causes were responsible in 6.67% and in 4.67% the cause of fever remained undiagnosed.