PubMed Health⌕ Search

Biomedical subjects

B J Stoll

Publications and source records attributed to B J Stoll.

At least 73 records · Page 4Linked to original sources
PubMed1985

Predisposition for cholera of individuals with O blood group. Possible evolutionary significance.

At the Matlab Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, the authors examined the blood groups of patients hospitalized between January and September 1979 for diarrheal disease due to a variety of bacterial and viral agents. A significant association was identified only for cholera, in which cholera patients were twice as likely to have blood group O and one-ninth as likely to have blood group AB as community controls. A follow-up study of family contacts of cholera patients, carried out between September 1980 and July 1982, indicated that blood group did not affect an individual's risk of having a culture-proven infection with V. cholerae 01 but was directly related to the severity of disease. Individuals with the most severe diarrhea compared with those with asymptomatic infection were more often of blood group O (68% versus 36%, p less than 0.01) and less often of AB (0% versus 7%, p less than 0.01). It was not possible to identify the molecular basis for this genetically related protection using biologic models of cholera that are currently available. The constant selective pressure of cholera against people of O blood group may account in part for the extremely low prevalence of O group genes and the high prevalence of B group genes found among the people living in the Gangetic Delta.

ABO Blood-Group System↗
PubMed1983

Value of stool examination in patients with diarrhoea.

Findings of stool examinations in 1593 patients with diarrhoea due to a single enteric pathogen--enterotoxigenic Escherichia coli rotavirus, Shigella, Campylobacter jejuni, Vibrio cholerae 0:1, Entamoeba histolytica, or Giardia lamblia--were reviewed to determine how well they predicted the agent associated with the diarrhoea. Specimens were examined visually for blood and mucus, tested for pH, and examined under a microscope for the presence of red and white blood cells, parasites, and stool fat. Although visible blood was more common in specimens from patients infected with Shigella (51%) and Ent histolytica (39%) than in those from patients infected with other agents (6%; p less than 0.01), patients infected with Shigella were most likely to have numerous faecal leucocytes (greater than 50/high power field: 39% v 8% of all patients and 7% of patients infected with Ent histolytica, p less than 0.01 in both cases). Patients infected with enterotoxigenic E coli, rotavirus, V cholerae 0:1, or C jejuni had loose stools with fewer red or white cells. Patients infected with rotavirus and C jejuni were more likely to have acid stools with 3 to 4+ fat, but these findings were related to young age and breast feeding. Stool examination is most useful in establishing a diagnosis of dysentery and in helping to distinguish between patients infected with Shigella and Ent histolytica; it is of limited usefulness in discriminating between pathogens causing watery diarrhoea.

Adolescent↗
PubMed1983

Protection against cholera in breast-fed children by antibodies in breast milk.

We performed a prospective study to examine whether the IgA antibodies against cholera that are present in breast milk protect breast-fed infants and children against colonization with Vibrio cholerae 01 and disease. Among families of patients with cholera, we collected breast milk from mothers who had not had diarrhea in the previous week and monitored them and their breast-fed children for cholera colonization and diarrhea for 10 days. Breast milk was assayed for IgA antibodies to cholera toxin and lipopolysaccharide. Ninety-three mother--child pairs were studied; 30 infants became colonized with V. cholerae 01 and disease developed in 19. There were no differences between the antibody levels in milk fed to children who became colonized and in milk fed to children who did not. However, among the children who became colonized, those who had diarrhea drank breast milk containing significantly lower levels of both kinds of cholera antibodies than were present in the milk consumed by children who had no symptoms. We conclude that breast-milk antibodies against cholera do not appear to protect children from colonization with V. cholerae 01 but do protect against disease in those who are colonized.

Antibodies, Bacterial↗
PubMed1983

Enteric fever in patients admitted to a diarrhoeal disease hospital in Bangladesh.

The hospital records of 62 patients with blood culture-proven enteric fever admitted to the Dacca Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, over a one-year period were reviewed. Older children and young adults had the highest age-specific rates of disease. The clinical, epidemiological and laboratory features of patients with enteric fever were compared with similar information from patients in hospital for cholera and shigellosis. Patients with enteric fever had a significantly longer prodrome of illness and were more likely to have fever than patients in the other groups. Our hospital cares primarily for patients with diarrhoeal diseases and while 94% of enteric fever patients had diarrhoea, only 5% had the recognized diarrhoeal pathogens Shigella or Vibrio cholerae identified, compared to 25% of the total hospital in-patient group, suggesting that Salmonella typhi itself may be a cause of diarrhoea. Antibiotic resistance patterns of S. typhi isolates were reviewed, and one isolate was found to be multiply antibiotic resistant. The advent of an effective oral typhoid vaccine makes further work on the epidemiology of enteric fever in endemic areas such as Bangladesh a high priority.

Adolescent↗
PubMed1983

Amoebiasis and giardiasis in Bangladesh: parasitological and serological studies.

To determine the prevalence of infections with Entamoeba histolytica and Giardia lamblia in Bangladesh, we screened stool specimens from patients with diarrhoea attending urban (N = 2,246) and a rural (N = 2,791) hospital and a group of healthy urban residents (N = 440). Sera from 200 healthy villagers were also examined for antibody to E. histolytica using the immunofluorescent antibody test. The prevalence of E. histolytica cysts or trophozoites in all groups assessed by examination of a single stool specimen ranged from 0% among infants (less than 1 year) to 34% among healthy adults 30 to 44 years old. G. lamblia was uncommon in infants and found most frequently in urban hospital patients aged five to nine (21%). 12% of one- to two-year-old children had serum antibody to E. histolytica at a titre of 1:40. By age 14 years, 80% of those tested were seropositive, and this prevalence declined thereafter with increasing age. Amoebiasis and giardiasis occur frequently in Bangladeshi populations and the morbidity and mortality associated with these infections need to be assessed.

Adolescent↗
PubMed1983

Giardia lamblia infections in a cohort of Bangladeshi mothers and infants followed for one year.

Giardia lamblia infection in an endemic area was investigated by following a cohort of 33 lactating mothers and their infants in a semiurban community of Bangladesh for one year. Eighty-two percent of mothers and 42% of infants excreted Giardia at least once during the study period. Infants became infected as early as 3 months of age, and 86% of the infected infants had diarrhea, suggesting that the first exposure to the parasite results in disease. Only one of the infected mothers had diarrhea, indicating that with repeated exposure to Giardia, mothers in an endemic area may develop partial immunity that protects against disease but not infection. An interrelationship between maternal and infant colonization was not found. Local and systemic immune responses to Giardia correlated poorly with infection, but milk antibodies were a better reflection of infection than serum antibodies were. Infection with G. lamblia was significantly lower in infants younger than 6 months (9%), an age when many are totally breast-fed. However, we were unable to establish clear-cut protection related to human milk antibodies, and suggest that the lower infection rate in younger infants results mainly from decreased exposure to Giardia cysts.

Adolescent↗
PubMed1983

Epidemiologic and clinical features of endemic Campylobacter jejuni infection in Bangladesh.

Epidemiologic and clinical features of infection with Campylobacter jejuni in Bangladesh were examined in (1) diarrheal patients infected with C jejuni, (2) healthy control subjects, and (3) village children who were cultured monthly and at each diarrheal episode during a 10-month period. C jejuni was isolated from 437 (14%) of 3,038 outpatients with diarrhea. These patients had no distinct clinical presentation and were more likely to have a mixed infection than were patients infected with other pathogens (59% vs 42%, P less than 0.01). Age-specific infection rates were greatest in infants and did not differ significantly from those in control subjects. C jejuni was isolated less frequently from village children with diarrhea than from those cultured routinely (5% vs 9%, P less than 0.05). Forty percent of 47 patients with C jejuni vs 23% of 48 control subjects (P less than 0.01) had an elevated convalescent-phase antibody titer as determined by complement fixation test. In Bangladesh, enteric infection with C jejuni is common but often asymptomatic, although pathogenicity is suggested by serologic response in some patients.

Adolescent↗
PubMed1983

Identification of enterotoxigenic Escherichia coli in patients with diarrhea in Asia with three enterotoxin gene probes.

A total of 984 enterotoxigenic Escherichia coli (ETEC) and 733 non-ETEC isolated from patients with diarrhea in Asia (one isolate per patient) were examined for homology with radiolabeled fragments of DNA encoding heat-labile toxin (LT) or heat-stable toxin of porcine (ST-P) or human (ST-H) origin. A total of 246 ETEC that produced LT and ST as determined by the Y-1 adrenal and suckling mouse assays were homologous with the LT probe. Of these 246 LTST ETEC, 156 (63%) were homologous with the ST-H, 46 (19%) were homologous with the ST-P, and 44 (18%) were homologous with both probes. A total of 401 LT ETEC were homologous with the LT probe. Of 337 ST ETEC identified by the suckling mouse assay, 244 (72%) were homologous with the ST-H, 84 (25%) were homologous with the ST-P, and 9 (3%) were homologous with both probes. None of the 733 isolates that were non-enterotoxigenic as determined by the Y-1 adrenal and suckling mouse assays was homologous with genes coding for enterotoxin. Four isolates (not included among the 984 ETEC examined) that were initially considered to produce LT because sterile culture supernatants produced rounding of Y-1 adrenal cells were not homologous with the LT probe. The sterile culture supernatants of these four isolates caused rounding after 8 h and subsequent destruction after 24 h of Y-1 adrenal tissue cultures. This effect was not inhibited by convalescent human cholera antiserum, Swiss Serum Institute cholera antitoxin, or antiserum to purified LT. These isolates were also negative in the Biken test previously used to identify LT-producing E. coli. The DNA hybridization technique with three enterotoxin gene probes was developed as a specific technique to identify ETEC in large numbers of specimens in Asia.

Animals↗
PubMed1983

Changes in serotypes of enterotoxigenic Escherichia coli in Dhaka over time: usefulness of polyvalent antisera.

The finding that enterotoxigenic (ET) Escherichia coli strains from many geographic areas belong to a limited number of serogroups led investigators to hope that polyvalent antisera could be used to screen for ET E. coli in areas of the world where more complicated tests of toxigenicity are not available. We compared the serotypes of 207 ET E. coli strains obtained from patients attending the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, in 1980 with results obtained from similar surveys conducted in 1976 and 1978. During that time the distribution of serogroups changed significantly so that only 46% of our strains had O serogroups included in the polyvalent antisera capable of detecting 66% of ET E. coli strains in 1978. O167, a serogroup which was not included previously, was the third most common serogroup in our study. These findings suggest that polyvalent antisera used to screen for ET E. coli need to be reassessed over time as well as in different geographic areas and may not be as useful for field diagnosis as was originally hoped.

Diarrhea↗
PubMed1982

Surveillance of patients attending a diarrhoeal disease hospital in Bangladesh.

In October 1979 a surveillance system was set up at the International Centre for Diarrhoeal Disease Research, Bangladesh, Hospital at Dacca to study a 4% systematic sample of the 100 000 patients with diarrhoea who come to the hospital for care each year. From December 1979 to November 1980 inclusive, 3550 patients were studied. A recognised pathogenic organism was identified for 66% of patients screened for all pathogens, one-third of whom had a mixed infection with two or more agents. Enterotoxigenic Escherichia coli was the most common enteropathogen detected in all age groups (detection rate 20%), followed by rotavirus (19%), Campylobacter jejuni (14%), and Shigella (12%). Infants and young children (up to 5 years) were most often infected with rotavirus, enterotoxigenic E coli, and C jejuni and older children (5-14 years) had more infections with enterotoxigenic E coli, Shigella, and E histolytica. Surveillance has helped to define the range of disease among patients attending the Dacca Hospital. Sixty-five per cent of patients complained of watery diarrhoea, a presentation that was significantly more common in patients with Vibrio cholerae 0:1 (91%), enterotoxigenic E coli (78%), rotavirus (77%), and C jejuni (71%) than in all patients studied. Dysentery, defined as a history of diarrhoea with blood, was the presenting complaint of 20% of all patients but 55% of those with Shigella. Only patients with V cholerae 0:1 and enterotoxigenic E coli were at increased risk for severe dehydration. In addition surveillance has been used to identify areas where patient care can be improved and to generate new ideas for research.

Adolescent↗
PubMed1982

Epidemiologic and clinical features of patients infected with Shigella who attended a diarrheal disease hospital in Bangladesh.

The epidemiologic and clinical characteristics of 412 patients infected with Shigella from a systematic sample of approximately 100,000 patients attending Dacca Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh, between December 1, 1979, and November 30, 1980, were reviewed. Shigella was isolated from 11.6% of the 3,550 patients in the sample and was the second most common isolate in patients over two years old. Two clinical presentations of shigellosis were found: (I) watery diarrhea occurring in younger children and associated with a shorter duration of illness and with more vomiting and dehydration and (2) dysentery with stool blood and abdominal pain. These different presentations may reflect two mechanisms in the pathogenesis of shigellosis or different stages of the disease. The most useful signs and symptoms for the diagnosis of shigellosis were stool with blood and abdominal pain in all patients and the absence of watery diarrhea and vomiting in patients over one year old. Simple visual inspection of stool for blood correctly identified 44% of all patients infected with Shigella.

Adolescent↗
PubMed1982

Endemic cholera in rural Bangladesh, 1966-1980.

Since 1963, the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), formerly the Cholera Research Laboratory, has maintained a field station in Matlab to treat patients from a surveillance population of 240,000 who have cholera and other diarrheal diseases. Since 1966, the authors have analyzed hospital records of 7141 surveillance-area patients culture-positive for v. cholerae 01 to relate the seasonality, age and sex distribution, and geographic trends with hypotheses concerning transmission, immunity, and risk groups. From this review, they have found that: 1) children 2-9 years old and adult women are most commonly hospitalized for cholera; 2) V. cholerae 01 emerges simultaneously throughout the area of surveillance, with the early cases being of different phage types; 3) three patients were hospitalized twice for cholera compared with 29 expected on the basis of life-table analysis (p less than 0.01), suggesting that immunity to severe disease conferred by previous illness may be stable and long-lasting; 4) no constant relationship was found between the times of onset or peaks of the yearly cholera epidemic and the times of onset or peaks of the monsoon rains or river water levels; and 5) an outbreak of multiply antibiotic-resistant V. cholerae 01 infection documented in 1979 raises questions about the dissemination of resistance plasmids, antibiotic-use patterns, and the need for other drugs in addition to tetracycline. While little progress has been made in understanding the mode of transmission of v. cholerae 01, and in identifying practices for prevention, fluid therapy in this area has decreased the case fatality rate significantly and provides guidance for similar programs elsewhere.

Adolescent↗
PubMed1982

Treated maternal gonorrhea without adverse effect on outcome of pregnancy.

Infants born to mothers with gonorrhea are at risk for neonatal gonococcal infection, primarily ophthalmitis. To determine whether gonorrhea during pregnancy may have other adverse effects, we compared the outcome of pregnancy to gonorrheal status for all women who were delivered of infants at Grady Memorial Hospital in 1976 and 1977. The incidence of positive cultures was 41.1 per thousand pregnant women. For 85% of women with positive cultures, treatment was recorded in the chart. Women with positive cultures were younger (P less than .0001) and of lower parity (P less than .001) than women was negative cultures. There were no differences, however, in selected complications of labor and delivery, in the incidence of premature or low birthweight babies, or in the neonatal death rate of babies born to mothers with positive or negative gonorrhea cultures. These results indicate that gonorrhea during pregnancy, if treated, does not adversely affect the fetus or newborn.

Adolescent↗
PubMed1980

Binding of intraluminal toxin in cholera: trial of GM1 ganglioside charcoal.

A study was undertaken to investigate whether toxin produced in the gut lumen contributes significantly to clinical illness and whether binding such toxin by GM1 ganglioside adsorbed onto charcoal could alter the clinical course of disease. 46 patients with severe cholera receiving standard intravenous therapy were randomly assigned to one of three groups: GM1 ganglioside-charcoal (16), charcoal alone (16), or water (14). The results demonstrated that patients were given sufficient GM1 ganglioside-charcoal to bind all luminal toxin produced by Vibrio cholerae in their intestines. Patients treated with GM1 ganglioside tended to have a greater reduction in purging than patients treated with either charcoal alone or water. This difference was statistically significant soon after beginning medication (8-15 h) and the reduction in fluid-loss was especially pronounced in patients with very severe initial purging who had been ill only for a short time before admission. These results suggest that toxin produced in the gut lumen increases fluid-loss early in cholera, but that later in the course of disease, toxin which is inaccessible to luminal binding agents in the major stimulus of purging.

Adolescent↗