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School systems are responsible for ensuring that children with special needs are safely transported on all forms of federally approved transportation provided by the school system, and a plan should be developed to provide the most current and proper support to children with special transportation requirements. This statement provides current guidelines for the protection of child passengers with specific health care needs, including those with a tracheostomy, those requiring use of car seats, or those transported in wheelchairs. Guidelines that apply to general school transportation should be followed, including the training of staff, provision of nurses or aides if needed, establishment of a written emergency evacuation plan, and a comprehensive infection control program. Research provides the basis for recommendations concerning occupant securement for children in wheelchairs and children with other special needs who are transported on a school bus. Pediatricians can help their patients by being aware of guidelines for restraint systems for children with special needs and by remaining informed of new resources. Pediatricians can also play an important role at the state and local level in the development of school bus specifications.

Knowledge of the immune response to rotavirus is crucial for vaccine development. We compared an epitope-blocking assay (EBA) that uses VP7-specific monoclonal antibodies with neutralization assays (NAs) with polyclonal antisera for detecting serum antibody responses after natural rotavirus infection in children. Twenty-six serum pairs from children living in an orphanage with and without symptoms during two rotavirus outbreaks were evaluated for VP7 type 1-, 2-, 3-, and 4-specific antibody responses. In the first outbreak, which was caused by a VP7 type 3 strain, homotypic antibody responses were detected in 11 of 11 symptomatic children by NA and in 10 of 11 symptomatic children by EBA. Heterotypic antibody responses were detected more frequently (12 of 15 children) by NA than by EBA, and the heterotypic epitope-blocking antibody responses occurred in children older than 14 months of age. Antibody responses in asymptomatic children were more commonly detected by EBA than by NA. EBA results from the sera of children in the second outbreak indicated that it was caused by VP7 type 4, whereas NA results suggested it was caused by VP7 type 3. Our results confirm that EBA is a sensitive and specific method for determining VP7 type-specific immune responses after natural rotavirus infections.

Several human milk oligosaccharides inhibit human pathogens in vitro and in animal models. In an infant, the ability of these oligosaccharides to offer protection from enteric pathogens would require that they withstand structural modification as they pass through the alimentary canal or are absorbed and excreted in urine. We investigated the fate of human milk oligosaccharides during transit through the alimentary canal by determining the degree to which breast-fed infants' urine and fecal oligosaccharides resembled those of their mothers' milk. Oligosaccharide profiles of milk from 16 breast-feeding mothers were compared with profiles of stool and urine from their infants. Results were compared with endogenous oligosaccharide profiles obtained from the urine and feces of age-, parity-, and gender-matched formula-fed infants. In all cases, oligosaccharides were extracted, purified, reduced, and separated into acidic and neutral species; the latter were perbenzoylated and subjected to reversed-phase high-performance liquid chromatography. Structures were determined by mass spectrometry after debenzoylation. Among breast-fed infants, concentrations of oligosaccharides were higher in feces than in mothers' milk, and much higher in feces than in urine. Urinary and fecal oligosaccharides from breast-fed infants resembled those in their mothers' milk. Those from formula-fed infants did not resemble human milk oligosaccharides, were found at much lower concentrations, and probably resulted from remodeling of intestinal glycoconjugates or from intestinal bacteria. Most of the human milk oligosaccharides survived transit through the gut, and some were absorbed and then excreted into the urine intact, implying that inhibition of intestinal and urinary pathogens by human milk oligosaccharides is quite likely in breast-fed infants.

Human milk contains many factors that act synergistically or with redundancy in protecting suckling infants from infectious diseases. The rigorous application of the scientific method has shown significant beneficial effects of these specific factors. The beneficial effects of biotherapeutic agents, including prebiotics and probiotics, on the alteration of intestinal microflora and modulation of the local and systemic immune response of infants have been shown. The beneficial effects of these compounds on preventing diarrhea and possibly other infectious diseases in infants serves as a model for the development and use of biotherapeutic agents to treat and prevent infectious diseases in persons of all ages.

Human caliciviruses (HuCVs) contain two genera: "Norwalk-like viruses" (NLVs) and "Sapporo-like viruses" (SLVs). The importance of the two genera as a cause of acute gastroenteritis of infants and children remains unknown. Beginning in 1989, a birth cohort of children in Mexico was enrolled and monitored for acute gastroenteritis. A subset of 115 diarrhea stool specimens from 76 children and 66 non-diarrhea stool specimens from 64 children was examined for HuCVs by RT-PCR by using a primer pair (p289/290) that detects both NLVs and SLVs. Twenty-two (19%) of the 115 diarrhea stool specimens and 5 (7%) of 66 non-diarrhea stool specimens produced RT-PCR products of expected size (319 bp for NLVs and 331 bp for SLVs). Twenty of the twenty-seven strains were cloned and sequenced. Pairwise sequence analysis showed that 9 (60%) and 6 (40%) of the 15 strains from the diarrhea stools were NLVs and SLVs, respectively. The same proportions of NLVs (60%) and SLVs (40%) were observed in the non-diarrhea stools. Strains in the NLV genus could be further divided into four clusters: Lordsdale, MxV, and HV and one potentially new cluster. Strains in the SLV genus could be divided into three clusters: Sapporo/82, Lon/92, and a potentially new cluster. Strains from the Lordsdale cluster were the most common among these children. The findings of both genera and multiple clusters of HuCVs co-circulating and the identification of new strains of HuCVs in the population justify the need for future studies of HuCVs in infants and children.

Eleven outbreaks of acute gastroenteritis, eight of which were in nursing homes or retirement facilities, were reported in virginia during the winter of 1993-1994. Serum samples (four outbreaks) and stool samples (two outbreaks) from involved people were tested for human calicivirus (HuCV) infection by enzyme immune assays (EIAs) using recombinant Norwalk virus (rNV) and Mexico virus (rMX) capsid antigens and reverse transcription-polymerase chain reaction (RT-PCR). Of the 31 pairs of acute and convalescent serum specimens tested, 24 had a fourfold or more titer increase to rMX and 4 responded to rNV. In all four outbreaks, the geometric mean titers (GMTs) against rMX were significantly higher than those against rNV in the convalescent, but not in the acute phase of illness. The antibody response to rMX among these patients was also higher than to rNV (summary mean 32-fold increase vs. 0.7-fold increase, respectively, P.001). Antigen was detected in 5 of 21 stool specimens tested by the rMX EIA, RNA in 12 of 17 stool specimens tested by RT-PCR, and small round structured virus (SRSV) particles in 12 of 21 by electron microscopy (EM); none were positive by the rNV EIA. Sequence analysis of the RT-PCR-amplified products from the viral RNA polymerase region revealed 92-93% amino acid identity with Snow Mountain agent (SMA), 86% with MX, 58-59% with NV, and 31-32% with Sapporo HuCV, suggesting that these viruses belong to the SMA HuCV genogroup.

Our understanding of the epidemiology of astrovirus-associated gastroenteritis has changed markedly with each improvement in detection method. In early surveys based on electronmicroscopy (EM), astroviruses appeared to be a rare cause of gastroenteritis, being found in fewer than 1% of children with diarrhea, usually in small outbreaks of disease and primarily during the winter season. The development and use of monoclonal antibodies and enzyme immunoassays (EIA) to detect astroviruses led to reports of a higher prevalence (2.5%-9%) of astrovirus infection among patients hospitalized with diarrhea. Astroviruses appeared second only to rotaviruses as a cause of hospitalization for childhood viral gastroenteritis. Studies based on EIA detection of astroviruses indicate that astroviruses are common causes of diarrhea in children worldwide, and that most children are infected during their first two years of life. The elderly and the immunocompromised represent high-risk groups as well. The observations that newborns monitored prospectively rarely have repeat disease and that the rate of detection decreases with increasing age suggest that immunity to astroviruses, as immunity to rotaviruses, may develop early in life. The cloning and sequencing of astroviruses have led to more sensitive assays to detect the viruses by reverse transcription, polymerase chain reaction (RT-PCR). Application of RT-PCR for detection of astroviruses in children in day-care centers showed a marked increase in the detected prevalence of astrovirus-associated diarrhea, the rate of asymptomatic infection, and the duration of shedding of virus among those infected, when compared with studies that used other methods. As with rotaviruses, neither the mode of transmission nor the reservoir of astrovirus infection has been identified. Both immune and molecular-based assays to detect astrovirus serotypes indicate that serotype 1 is most common worldwide, although the predominant serotypes may vary by region and time. In the absence of obvious strategies to prevent astrovirus-associated diarrhea, vaccines might be considered if further studies establish that the disease burden would render such a vaccine cost-effective.

To determine whether anti-Giardia lamblia secretory IgA (sIgA) antibodies in human milk protect infants from acquisition of or symptoms associated with Giardia infection.One hundred ninety-seven Mexican mother/infant pairs were followed weekly from birth for diarrheal disease and feeding status. Infant stool specimens were collected weekly and were cultured for bacterial pathogens and tested for Giardia and rotavirus by enzyme-linked immunosorbent assay. Maternal milk samples were collected weekly for 1 month postpartum and monthly thereafter. To determine the protective effect of anti-Giardia sIgA in milk against infection and against diarrhea due to Giardia, milk samples from mothers of infected infants and appropriately matched controls were assayed for anti-Giardia sIgA by enzyme-linked immunosorbent assay.Asymptomatic, infected infants ingested significantly (P = .046) higher amounts of milk anti-Giardia sIgA compared with symptomatic, infected infants. However, milk anti-Giardia sIgA concentrations did not differ between Giardia-infected and noninfected infants.The amount of anti-Giardia sIgA in human milk was associated with prevention of symptoms of diarrhea due to Giardia, but not with acquisition of the organism.

It is estimated that more than 5.3 million children attend out-of-home child day care in the United States. This includes 2.1 million children who attend approximately 63,000 licensed child day-care centers. An additional 500,000 children receive care in 105,000 regulated day-care homes. Since the total regulated child care slots available in centers and homes are only 2.6 million, some 2.7 million additional children are likely attending unregulated family day-care homes. As a result infants and preschool children are intermingled in child care facilities that often lack adequate toilet and hand-washing facilities and are frequently staffed by individuals with little or no training in the area of infection control. Placing children in out-of-home care should not compromise their health and that of the community. The risk of infection can be lessened by teaching hygiene, supervising unregulated day-care facilities and regular antibiotic use so that bacterial resistance may be prevented.

The authors review diseases that occur in day care centers and their impact on day care providers and parents. Acute infections of the gastrointestinal and respiratory tracts are the most commonly transmitted illnesses from children in day care centers to adults. The most important infections acquired by adults are those with the potential for significant clinical morbidity, such as hepatitis A, or those that generate concern, such as cytomegalovirus and parvovirus B19, because of their potential to produce congenital infections in pregnant women.

It was hypothesized that parents and child care providers are not prepared to accept children infected with human immunodeficiency virus (HIV), who are increasing in number, into the day care center setting. To determine their knowledge and attitudes toward HIV transmission, 219 parents in 4 day care centers and 176 care providers in 12 day care centers were given confidential questionnaires. More than 98% of respondents knew that sex and needle sharing can transmit HIV; 84% of parents and 77% of care providers knew that contact with blood can transmit HIV. There was, however, uncertainty about transmission via many common contacts in day care centers: human bites, urine, stool, tears, and vomit; kissing; sharing of food and eating utensils; and diaper changing areas. Only 43% of parents said they would allow their child to stay in the same room with a child who was infected with HIV. In a multiple logistic regression model, the unwillingness of parents to have their child stay in the same room with a child who was infected with HIV was significantly (P less than .0001) associated with black ethnicity, beliefs that such a child is likely to infect others (40%) and is dangerous to others (58%), and fear of their child being exposed to HIV (86%). Care providers' unwillingness to care for a child infected with HIV in the classroom (48%) was significantly (P less than .0001) associated with beliefs that such a child is likely to infect others (44%) and that common day care center contacts can transmit HIV (62%).(ABSTRACT TRUNCATED AT 250 WORDS)

Fecal coliform contamination of environmental surfaces and hands in the day-care center is common. This study evaluated the effect of two diaper types on fecal contamination. Ten rooms in four day-care centers containing 141 children were studied in a prospective, randomized, crossover study. A total of 2946 samples were cultured during the 9-week study. Fecal coliforms were isolated from 307 inanimate objects (15%), 73 toy balls (46%), and 131 hands (17%). The number of contaminated inanimate objects was significantly less in rooms where paper diapers were worn when compared with that in rooms where double cloth diapers with plastic overpants were worn and in rooms where clothes were worn over diapers. Inanimate object cultures had more contamination in rooms in which diarrhea had occurred. Containment of feces by overclothes and diaper type may be important in decreasing transmission of enteric pathogens in day-care environments.

Giardia is the most frequently identified enteric parasite in the United States, but much is not known about host-parasite interaction. Advances using immunodiagnostic techniques, endonuclease restriction analysis, surface-antigen detection methods, and measuring homologous and heterologous antibody responses are beginning to clarify the biology of Giardia.

We compared these three techniques for measuring chloramphenicol in serum or urine. Although each has its particular advantages, any of them is shown to be satisfactory and may appropriately be used by clinical laboratories, according to the facilities available.

Metronidazole is a relatively nontoxic, oral agent which may prove to be useful in the treatment of infections caused by susceptible anaerobic organisms. Use of metronidazole to treat anaerobic infections presently is investigational.

A radioimmunoassay and a radioenzymatic assay for netilmicin, a new aminoglycoside, were developed in our laboratories to assist in the study of the pharmacology of the drug and to establish values for use in its monitoring. The assays are sensitive, precise, and rapid, giving results that correlate (r = 0.90) with each other and with those of a microbiological assay in which Klebsiella pneumoniae is used as the test organism. Preliminary pharmacological studies show the drug to have a biological half-life of 135 min. which is comparable to that for other aminoglycosides.

Neither human immune globulin nor human mononuclear leukocytes (containing lymphocytes and monocytes) from herpes simplex virus (HSV) seronegative adult donors could protect infant C57BL/6 mice from a lethal HSV infection. In contrast, a combination of 5 X 10(6) leukocytes and a subneutralizing dose of antibody protected the mice. Leukocytes (5 X 10(6) or 1 X 10(7)) from neonatal humans and antibody could not mediate this protection. This is the first correlation between defective human neonatal leukocyte antibody-dependent cellular cytotoxicity (ADCC) in vitro and defective human neonate leukocyte-antibody protection against HSV infection in vivo in mice.

Enzyme-linked immunosorbent assays (ELISAs) using sera from rabbits and goats immunized with Giardia trophozoites were compared for detection of Giardia antigen in 300 stool specimens, 80 of which had positive results for Giardia by microscopic examination. The diagnostic accuracy of the two assays was similar, with sensitivities of 92% and 87% and specificities of 87% and 91% with the use of rabbit and goat antisera, respectively. Both ELISAs detected Giardia antigen in stool samples from asymptomatic as well as symptomatic excretors and from treated patients after organisms were no longer visualized by microscopic examination. The specificity of the assays was confirmed by consistently negative results on stool specimens from 10 neonates and 27 patients with enteric parasitic infections other than Giardia. Negative results also occurred when stool specimens containing 21 bacterial enteropathogens were tested. Potential confounding variables including multiple freezing and thawing episodes, prolonged storage, and stool filtration did not affect test results from clinical specimens. Antidiarrheal compounds did not interfere with assay results. Preservation of specimens in formalin did interfere with the assay, even if formalinized stool specimens were dialyzed before testing. For diagnosis of giardiasis, the ELISA is a sensitive and specific test that is not influenced by many environmental factors or by other enteropathogens. This test provides a practical and reliable method for evaluating large numbers of specimens in a variety of clinical and epidemiologic settings.

The number of day care centers and home care facilities has steadily increased in the United States. Recent interest has focused on the possible relationship between attendance at child day care facilities and the occurrence of certain infectious diseases. A variety of infectious agents have been reported as causes of illness among children and staff in day care programs. In general, however, concurrent risks for these infections among children attending and those not attending day care programs have not been established by prospective studies. A review is made of the pathogens that have been associated with infections in day care settings, patterns of occurrence of infectious diseases in day care facilities, aspects of control and prevention of these diseases, and controversies related to infectious diseases in child day care facilities. Aspects of this problem that warrant further research are outlined.

Doxorubicin (adriamycin) is an anthracycline antibiotic that is active against a variety of solid tumors and hematologic malignancies that occur in humans [13]. The therapeutic usefulness of this compound has been somewhat limited because of substantial side effects which include myelosuppression, alopecia, extravasation tissue necrosis, and most importantly, cardiotoxicity. Vitamin E has been shown to reduce the cardiac toxicity without apparently interfering with the effectiveness of adriamycin as an antitumor agent [6]. Little information is available concerning the effect of this agent on polymorphonuclear leukocytes (PMNL) and phagocytic mononuclear cell functions [8]. This study was undertaken to evaluate the effect of adriamycin on phagocytic cell function, and to ascertain whether vitamin E has protective effects.

A clinic was established at Universidad de las Americas, Cholula, Puebla, Mexico for the study of acute diarrhea rates in newly-arrived students and full-time students. Diarrhea occurred in 22 of 55 newlly-arrived U.S. summer students (40%), compared to 28 of 142 U.S. full-time students (20%), 4 of 29 Venezuelan summer and full-time students (14%) and 7 of 66 Mexican full-time students (11%) (the differences were significant, p less than 0.005). Recurrent episodes of diarrhea during the month of study occurred in 15% of U.S. summer students, 4% of U.S. full-time students, and were non-existent in students from Latin America. As well as the 61 students with diarrhea enrolled in the incidence study, all students who developed diarrhea at the univeristy were encouraged to visit the clinic. This gave a total population of 130 cases of diarrhea. The illness that developed in students form the U.S. varied widely, but it typically consisted of seven to 13 unformed stools during the first 48 hours of illness, with illness persiting three to five days. Illness tended to be more severe in the U.S. students. Fifty per cent of the U.S. students with diarrhea had "severe" illness (greater than or equal to 10 unformed stools in first 48 hours) compared to 23% of the Latin Americans. This study indicates that the agents responsible for diarrhea in Latin America are widespread and that resistance to infection develops after prolonged or repeated exposure.

Cephalexin was compared to ampicillin for the treatment of otitis media in a randomized study. Bacteriologic diagnosis was sought by needle tympanocentesis in 179 children. No overall statistically significant differences were noted between the two groups; however, 20 patients who received cephalexin had a poor response to therapy whereas only five recipients of ampicillin responded poorly. A significant difference (P less than .05) between the two regimens was noted when Hemophilus influenzae was recovered. Fifty per cent of the children with H. influenzae otitis media who were treated with cephalexin responded poorly; no patients receiving ampicillin had a poor response. Our data suggest that the use of cephalexin monohydrate is not warranted for treatment of otitis media due to H. influenzae even when the isolate proves sensitive to this drug in vitro. In selected patients with otitis media caused by Staphylococcus aureus which is resistant to penicillin, cephalexin may provide effective treatment.

We evaluated the effect of five antineoplastic drugs on the ability of human leukocytes to destroy herpes simplex virus (HSV) infected target cells in the presence of antibody (antibody-dependent cellular cytotoxicity) and in its absence (natural killer cytotoxicity). Leukocytes from healthy volunteers were separated into macrophages, polymorphonuclear leukocytes, and lymphocytes. Adriamycin, cyclophosphamide, prednisone, procarbazine, and vincristine, at various concentrations and incubation periods, were tested for their effects on the natural killer and antibody dependent cellular cytotoxicity of macrophages, lymphocytes, and polymorphonuclear lymphocytes in a 51Cr release microcytotoxicity assay against HSV-infected cells. All drugs at therapeutic concentrations inhibited natural killer and antibody dependent cellular cytotoxicity; an exception was cyclophosphamide, which did not inhibit the natural killer cytoxicity of lymphocytes. The antibody dependent cellular cytotoxicity of macrophages and polymorphonuclear leukocytes appeared to be more than that of lymphocytes. The results of short incubation (2 hours) of the drug with either effector cells or target cells, followed by drug removal, suggests that the drug effect occurred early and predominantly at the effector cell level. Antineoplastic drugs had an inhibitory effect on natural killer and antibody dependent cellular cytotoxicity against HSV-infected cells. This inhibitory action may partially explain the increased susceptibility of patients receiving chemotherapy to developing viral infections.

A radioimmunoassay and a radioenzymatic assay for netilmicin, a new aminoglycoside, were developed in our laboratories to assist in the study of the pharmacology of the drug and to establish values for use in its monitoring. The assays are sensitive, precise, and rapid, giving results that correlate (r = 0.90) with each other and with those of a microbiological assay in which Klebsiella pneumoniae is used as the test organism. Preliminary pharmacological studies show the drug to have a biological half-life of 135 min. which is comparable to that for other aminoglycosides.

Students attending a Mexican university who developed diarrhea were randomly treated with bismuth subsalicylate or a placebo. One hundred and eleven were given 30 ml each 1/2 hr until eight doses (total dose of active drug 4.2 g) were given and 58 students received twice this dose (8.2 g of active drug) over the 3 1/2-hr treatment period. The number of unformed stools was significantly decreased in both bismuth subsalicylate treatment groups compared to the placebo controls for the period 4 to 24 hr after therapy. A reduction in diarrhea was additionally noted for the duration of the 48-hr surveillance period for the students receiving the higher dose of active drug. Subjective relief within 24 hr of therapy of the symptoms of diarrhea, nausea, and abdominal pain or cramps was reported with a significantly increased frequency in the bismuth subsalicylate group. The most pronounced effect of the treatment occurred in the United States students with diarrhea who had recently arrived in Mexico. This appeared to be related to the favorable effect of bismut subsalicylate on the course of toxigenic Escherichia coli infection. Students with shigellosis did not experience a prolonged illness in either treatment group.

Antigen detection methods may facilitate diagnosis of Giardia lamblia in stool specimens. As determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis and immunoblotting, G. lamblia cysts and trophozoites share several antigens, especially in the 65-kilodalton and 30- to 34-kilodalton regions. By using blind methods, we compared results obtained by counterimmunoelectrophoresis using cyst-immune rabbit serum and by enzyme-linked immunosorbent assay (ELISA) using trophozoite-immune rabbit serum with results obtained by microscopic examination of a preserved, concentrated, and permanently stained stool specimen. Results were similar when these three methods were used to examine 118 stool specimens from clinical microbiology laboratories (53 specimens with G. lamblia) and specimens from 239 day-care-center toddlers (39 specimens with G. lamblia). Compared with microscopy, we found, for counterimmunoelectrophoresis and ELISA, respectively: sensitivity, 88 versus 94%; specificity, 97 versus 95%; positive predictive value, 86 versus 76%; negative predictive value, 98 versus 97%; and concordance, 89%. The false-positive rate by ELISA was 24% (10 of 42) in day-care-center toddlers but only 3% (1 of 32) in healthy adults (P less than 0.04) as corroborated by microscopy. This discrepancy suggests that the ELISA may be more sensitive than microscopy, which is considered the reference standard, and that results may be dependent, in part, on the epidemiology of the infection in the study subjects.

343 children with acute diarrhea were studied from january 1976 to september 1977. Rotavirus was the agent most frequently isolated (18 per cent) followed by Shigella (12 per cent) and Salmonella (10 per cent). Enterotoxigenic E. coli was identified in 8 per cent and invasive E. coli only in two cases. 80 per cent of isolated rotavirus fell in the neonate group and 25 per cent in the infant group. Diarrhea caused by rotavirus had a short duration, fever was negligible and abundant liquid stools were present without leukocytes in the fecal mucus and with a high percentage (48 per cent) of transient lactose intolerance. Polymorphonuclear leukocytes were found in fecal mucus in 75 per cent of cases caused by Shigella and only in 40 per cent of cases where the causal agent was Salmonella.

Blood was obtained on 414 occasions from 106 children with acute lymphocytic leukemia (ALL) or solid tumors. Resting and stimulated hexose monophosphate shunt (HMPS) activity and unstimulated and stimulated nitroblue tetrazolium (NBT) dye reduction were assessed on each sample. The values obtained were compared to similar determinations made on blood obtained from 178 healthy children. Resting HMPS activity of all patients with malignant diseases was significantly (p smaller than 0.01) greater, and ability to stimulate HMPSP activity significantly (p smaller than 0.01) less than that noted in healthy control patients. Unstimulated NBT dye reduction of leukocytes obtained from patients with malignant disorders was significantly (p smaller than 0.01) less than that observed in healthy control children. No significant differences were noted in HMPS activity or NBT dye reduction in patients with ALL, rhabdomyosarcoma, or other solid tumors who had bacterial infection when compared to uninfected patients, or when patients were categorized according to the type of chemotherapy provided. HMPS activity and NBT dye reduction of patients with ALL prior to treatment, in remission, and during episodes of relapse did not differ from each other. Thus, a functional impairment in leukocyte function was noted in patients with ALL even when their peripheral blood and bone marrow cells exhibited normal morphology.

Escherichia coli that produce diarrhea can be divided into three groups: 1) enteropathogenic, 2) enterotoxigenic, and 3) enteroinvasive. The mechanism of disease production by enteropathogenic E. coli is unknown, but these strains are not presently known to be inherently pathogenic, although they may be important as a cause of gastroenteritis in infants. The two known mechanisms of disease production are elaboration of enterotoxin and mucosal invasion. Heat-labile toxin-producing E. coli are the main cause of diarrhea in travelers while heat-stable toxin-producing E. coli are a cause of scours among new-born swine and cattle. Enteroinvasive E. coli have not been shown to be an important cause of diarrhea in the United States. Enteropathogenic, enterotoxigenic, and enteroinvasive E. coli that currently are associated with diarrhea worldwide may each consist of relatively few serotypes different from those associated with out-breaks of diarrhea in the past. This implies a possible new role for sero-typing of E. coli.

Stool specimens from children in daycare centers were screened for Giardia lamblia and intestinal amoebae by staining wet mounts with methylene blue and dilute Lugol's iodine. Merthiolate-iodine-formalin concentrations (MIFC) and permanent smears stained with Wheatley's trichrome method also were done. In addition, stools were preserved with polyvinyl alcohol (PVA) and 10% formalin and tested with trichrome and MIFC, respectively. The effectiveness of each method was based on a quantification scheme. Trichrome and MIFC were the best identification methods for cysts of G. lamblia. Trichrome was the superior method for identification of trophozoites. The other staining procedures were significantly less accurate. The use of preservatives did not improve recovery of G. lamblia compared with same morning processing of fresh stools. This study provides evidence that a permanent stain such as trichrome is an important tool for the diagnosis of G. lamblia and should be included in the processing of any diarrheal stool.

Blood was obtained on 36 occasions from 12 healthy adult volunteers and the polymorphonuclear leukocytes (PMNL) were separated. PMNL hexose monophosphate shunt activity of whole blood and ability of separated cells to phagocytize and kill E. coli were evaluated when the PMNL were incubated with normal pooled sera and sera containing therapeutic concentrations of either 15 cancer chemotherapeutic drugs singly and in combination or 9 antibiotics. Resting and stimulated HMPS activity was significantly (p less than 0.025 to p less than 0.001) decreased by cyclophosphamide, carmustine (BCNU), high dose prednisone (pred), vinblastine (vinbl) and vincristine (vinc) and significantly (p less than 0.025 to p less than 0.01) increased by combinations of vinc-pred, vinc-predasparaginase, 6-mercaptopurine (6MP)-methotrexate (Mtx) and 6MP-Mtx-pred when compared to controls. No significant differences in HMPS activity of PMNL were found when exposed to various antimicrobial agents singly or in combination. The killing of E. coli by PMNL was significantly (p less than 0.001) decreased when exposed to BCNU, high concentration pred or combinations of 6MP-Mtx-pred, 6MP-Mtx and vinc-vinbl-pred but not when exposed to other chemotherapeutic agents. This study shows a disparity in results obtained when evaluating PMNL function by HMPS activity and bactericidal assay. In addition, a functional impairment in PMNL exposed to various antimetabolites occurred at a time when they exhibited normal morphology.