Showing papers by "Barbara J. Stoll published in 1989"

The Protective Effect of Human Milk against Diarrhea: A Review of Studies from Bangladesh

Abstract: Field studies conducted in Bangladesh in collaboration with laboratory studies in Goteborg Bethesda and Atlanta were directed toward identifying specific enteric infections in infants influenced by breastfeeding. The international Centre for Diarrheal Disease Research set up at the Dhaka Hospital examined 4000 children under 5 with diarrhea between March 1980 and February 1982. Breast feeding is the preferred feeding method in this population and is extended into the 2nd and 3rd years in the majority. Infants 6-11 months old were more likely to be breast fed than younger infants (88 vs. 77%) suggesting that breast feeding confers some protection against diarrhea in the 1st 6 months. The most frequently found enteric pathogens were rotavirus (35%) enterotoxigenic E. coli (ETEC) (14%) C. jejuni (14%) shigella (11%) G. lamblia (6%) V. cholerae (6%) and E. histolytica (2%). Children with shigellosis were significantly less likely to be breast-fed than those with other infections. Those already weaned were more likely to have shigellosis (15 vs. 9/%) or cholera (6 vs. 3%). In contrast breast feeding was more common in children with rotavirus. Rates of breastfeeding did not differ among children positive for ETEC or C. jejuni. Among children with shigellosis breast feeding was associated with a milder disease. In mother-child pairs who were contacts of index cases breast milk with higher IgA titers was protective against clinical cholera but not against colonization with V. cholerae 01. Acute and convalescent phase sera from women showed consistently high anti-cholera titers but breast milk did not in the 3- week period of the study. Shedding of G. lamblia appeared to be enhanced in breast feeding women.

Time to positivity for detection of bacteremia in neonates.

Abstract: The blood culture results of all samples obtained from newborns at Grady Memorial Hospital, Atlanta, Ga., during a 6-month period were analyzed to determine the time required for a blood culture to become positive, the time at which a culture could safely be considered negative, and the spectrum of isolated organisms. During the study period, 1,248 samples were submitted from all nurseries and processed by an automated detection instrument (BACTEC NR660). Of the 1,248 samples, 98 (7.8%) were positive by the end of a 7-day processing period; 29 of the 98 were classified as definite bacterial pathogens, 52 were classified as possible bacterial pathogens, 9 were classified as yeasts, and 8 were classified as contaminants. Virtually all organisms (28 of 29) categorized as definite pathogens were identified by day 2 of processing, and all were identified by day 4. All isolates of group B streptococcus, Escherichia coli, Klebsiella species, and Staphylococcus aureus were identified by day 2. Of all positive blood cultures, 79% were identified by day 2, 88% were identified by day 3, and 94% were identified by day 4. Of the 21 isolates identified after day 2, the only definite pathogen was from a sick baby in the intensive care unit. From among the 870 term low-risk newborns cultured because of maternal risk factors, only four possible pathogens were identified after day 2. The positive and negative predictive values of blood culture at days 2 and 4 were 92 and 99%, respectively.We conclude that, in our institution, (i) a 2-day processing period is sufficient to detect positive blood cultures in the asymptomatic term infant, (ii) a 4-day processing period will detect virtually all clinically important infections, and (iii) clinical yield from continuing blood culture processing beyond 4 days does not justify the time and cost involved.

Effects of undernutrition on infection with Vibrio cholerae O1 and on response to oral cholera vaccine.

Abstract: The association between undernutrition and the risk of colonization and disease with Vibrio cholerae O1, concentrations of salivary IgA and the serologic response to infection and to orally administered cholera B subunit were examined prospectively in a family study in Bangladesh. Children ages 1 to 8 years who were family contacts of patients hospitalized with culture-confirmed cholera were visited within 24 hours of the hospitalization and daily for 10 days, queried for the presence of diarrhea and cultured for V. cholerae O1. On Day 1 each child was weighed and saliva was collected to measure total IgA. On Days 1 and 21 blood was taken to assess vibriocidal and antitoxin titers, and on Days 1 and 2 B subunit or placebo was given orally as part of a trial to look for a toxin-blocking effect. Of 412 children enrolled in the study 35% (143) became infected with V. cholerae O1 and 49% (70) of these developed diarrhea. Undernutrition, defined in a child as weight less than 70% of the Harvard reference weight-for-age, was not associated with colonization, disease or the duration or severity of cholera. Moreover well-nourished children did not differ from undernourished children in their concentrations of salivary total IgA, initial serum antitoxin or vibriocidal antibodies or in their serologic response to colonization, disease or B subunit. The immune system in its response to cholera appears to be quite resistant to nutritional insults. The good antitoxin response to B subunit among undernourished children is of particular importance in considering the use of future oral cholera vaccines in areas where such undernutrition is common.