Pathogenic Mechanisms in Bacterial Diarrhoea

Malabsorption of apple juice and pear nectar in infants and children: clinical implications

Ingestion of fruit juices in which there is an imbalance between glucose and fructose (apple, pear nectar) and the presence of sorbitol is one of the major causes of the syndrome of chronic, nonspecific diarrhea of infancy and childhood. Stools in the condition at time of symptoms are acidic with a pH < 5.5, Clinitest positive, but free of blood and white cells. Lactose and sucrose breath hydrogen tests are normal but breath hydrogen is elevated if measured between 60-120 minutes after the offending juice is taken in sufficient quantity to elicit symptoms. Elimination of the offending juices immediately stopped the diarrhea in all of the cases. Three cases are presented documenting the variability of symptoms including one adolescent who became symptomatic while on a fruit and juice diet.

Primary adult lactose intolerance protects against development of inflammatory bowel disease

We have compared the incidence of inflammatory bowel disease (IBD) to the prevalence of lactose malabsorption (LM) in several countries. Our observations indicate that IBD is rare where LM is highly prevalent. The correlation between incidence of Crohn's disease and LM is -0.93, p less than 0.01, the correlation between incidence of ulcerative colitis and LM is -0.89, p less than 0.01. We, therefore, propose that LM results in the formation of volatile fatty acids which may inhibit multiplication of potentially pathogenic organisms.

Campylobacter jejuni enteritis in Honolulu, Hawaii

The incidence of Campylobacter jejuni in patients with acute diarrhoea was studied in Honolulu, Hawaii. C. jejuni was recovered from 8.7% of diarrhoeal stools, compared to isolation rates of 4.2% for Salmonella and 3.8% for Shigella. C. jejuni occurred mainly in the summer and autumn, and in all age and racial groups. There was a significantly higher incidence of abdominal pain, fever history, bloody stools and faecal leucocytes in patients with Campylobacter enteritis.

Colonization of the upper jejunum by enteropathogenic and enterotoxigenic Escherichia coli in paediatric diarrhoea

Aspirated fluid from the upper jejunum was obtained by intubation of 27 children with diarrhoea and 7 control children without diarrhoea. The aspirated jejunal fluid was analysed for total counts of viable aerobic and anaerobic microorganisms. Gram-negative aerobic bacteria were typed biochemically and analysed for the production of heat-labile and heat-stable enterotoxin. Enteropathogenic Escherichia coli (EPEC) strains of serogroups 0111, 055 and 0127 were detected in the stools of nine patients and the respective strains concomitantly in the upper jejunum (10(3)-10(8) bact/ml) in 7 patients with diarrhoea. In 6 patients from whom isolates of enterotoxigenic E. coli (ETEC) were obtained, there were high total viable counts of non-enterotoxigenic bacteria in the upper jejunum and ETEC were recovered from this location in 3 cases. Enterotoxigenic Klebsiella was recovered from faeces but not from upper jejunum in one case. Compared to the controls, the total number of bacteria in the upper jejunum were 100-1000 times higher in patients with enteropathogenic E. coli (EPEC) or enterotoxigenic E. coli (ETEC). In another 11 cases with diarrhoea caused by Shigella, rotavirus or of unknown aetiology, the total viable counts of bacteria were similar to those of the controls. Five patients with severe EPEC diarrhoea received antibodies for 5 days. The patients improved clinically, and the EPEC strain had disappeared from the upper jejunum when they were reexamined. In conclusion, in EPEC diarrhoea a colonization of the upper jejunum by the causative organism seemed to take place, while in ETEC diarrhoea, there appeared to be a nonspecific contamination by enteric bacteria.

Increased incidence of faecal coliforms with in vitro adhesive and invasive properties in patients with ulcerative colitis

Faecal samples were collected from 23 patients with active ulcerative colitis, 15 patients with established ulcerative colitis in remission, 20 patients with active colitis of cause other than ulcerative colitis, and 20 normal control subjects. Ten coliform colonies were randomly selected from the faecal sample cultures and serotyped before the testing of each different serotype from each sample for adhesive or invasive properties on HeLa cell monolayers. In the patients with both active ulcerative colitis and ulcerative colitis in remission and those with other types of colitis one serotype tended to dominate the faecal coliform flora. In normal controls more variety was encountered. Thirty-five per cent of the patients with active ulcerative colitis and 27% of the patients with ulcerative colitis in remission had at least one adhesive or invasive faecal coliform as compared with 5% of the patients with other types of colitis and 5% of the normal controls. These findings are significant (P < 0.05) and may have aetiological and therapeutic significance.