Infectious diseases of gastrointestinal tract in adolescents.

This article reviews the following gastrointestinal infections: esophagitis, gastritis, duodenitis including duodenal ulcers, and enteritis (gastroenteritis). The epidemiology, risk factors, microbiology and pathogenesis, diagnosis, treatment, morbidity/mortality, and prevention are discussed in relation to the most important pathogens. The symptoms and pathogenesis of esophagitis caused by Candida albicans and herpes simplex are contrasted with the symptoms of esophagitis caused by Helicobacter pylori and gastroesophageal reflux disease (GERD). The incidence of gastritis and gastric and duodenal ulcers caused by H. pylori is discussed. The treatment regimens of H. pylori infection recommended by the CDC are presented. Endoscopic findings in esophagitis, gastritis, and duodenal ulcers are presented and discussed. The difference in symptoms caused by viral agents (Norwalk virus), bacterial agents (enterotoxigenic E. coli), and parasites (Giardia lamblia and Cryptosporidium parvum) are compared and contrasted. The symptoms of infections of the terminal small bowel caused by Salmonella and Campylobacter jejuni and the symptoms of pure colonic infection, dysentery, caused by Shigella and enteroinvasive E. coli and Entamoeba histolytica are discussed. The treatment regimens for enteritis are presented.

Early severe infantile botulism.

Two neonates with a history of diarrhea, abrupt apnea, and suspected sepsis were proved to have infantile botulism. Initial symptoms in both infants suggested other diagnoses. Electrophysiologic studies were important in confirming the diagnosis. Early severe infantile botulism may be rare but should be considered in neonates who have hypotonia and respiratory arrest or a sepsis-like clinical picture.

Influence of infant diets on the ecology of the intestinal tract of human flora-associated mice.

The effect of diet on intestinal ecology was studied in germ-free mice that were inoculated orogastrically with predominant intestinal flora components isolated from the feces of breast-fed human infants. The flora components colonized the intestines of mice and persisted at fixed population levels. Groups of flora- associated mice were fed either human milk, bovine milk, whey-dominant formula, or formula modifications exclusively for 2 weeks, and then examined for changes in small intestinal and cecal flora composition, cecal pH, and resistance to intestinal colonization with Salmonella typhimurium. Dietary variations influenced the composition of the flora to a moderate degree but the differences were generally not statistically significant. However, the addition of bovine lactoferrin to the whey-dominant formula resulted in significantly greater counts of Bifidobacterium, Bacteroides, Enterococcus and total aerobes in the small intestine when compared with mice fed unsupplemented formula. Bifidobacterium was present in large numbers in both the ceca and small intestines of mice fed the lactoferrin-supplemented formula. Despite similarities in intestinal flora patterns among mice fed the various diets, human milk consumption resulted in a lower pH of cecal contents and a greater resistance to colonization by Salmonella typhimurium after orogastric challenge than the consumption of the other diets.

Variable phenotypes in a family kindred with adrenoleukodystrophy.

Adrenoleukodystrophy, an X-linked recessive disorder characterized by progressive demyelination of the central nervous system and adrenal insufficiency, usually manifests at 4-8 years of age. We report a 20-month-old male who presented with the sudden onset of status epilepticus and cortical blindness; initially, he had complete resolution of these findings, but experienced a relapse 3 months later. The initial computed tomographic scans depicted cerebral edema and possible "watershed infarcts:" however, over the next 2 weeks before discharge from the hospital, the cortical blindness and ataxia both resolved. During the next 2 months, he exhibited no symptoms: he had no seizures and his neurologic examinations were normal. Three months after the initial hospitalization, he developed what the mother believed was "a weakness on his right side." Magnetic resonance imaging confirmed severe white matter disease. Adrenoleukodystrophy was clinically suspected and an assay of plasma levels confirmed an elevation of C26 long-chain saturated fatty acid levels. After the patient's diagnosis of adrenoleukodystrophy was confirmed, long-chain fatty acid levels were obtained on his 5-year-old brother and his mother. This child had the earliest known onset of X-linked adrenoleukodystrophy.

Effect of streptomycin administration on association of enteric pathogens with cecal tissue of mice.

The effect of streptomycin on the ability of Shigella sonnei 3SR and enterotoxigenic Escherichia coli 2SR to associate with cecal tissue of mice in vivo and in vitro was examined. After orogastric challenge, both pathogens associated in significantly greater numbers (P less than or equal to 0.05) with the cecal tissue of streptomycin-treated mice than with the tissue of untreated mice. The population levels of the pathogens were also significantly greater (P less than or equal to 0.05) in the cecal contents of streptomycin-treated mice than in untreated mice. When excised cecal tissues from the two groups of mice were exposed to the pathogens in vitro, the extent of the association of the pathogens was markedly greater with tissues from streptomycin-treated mice than with tissues from untreated mice. There was also a positive correlation between the numbers of the pathogens in the suspending fluid and the extent of the tissue associations. The population size of fusiform organisms, which are the major components of the mucus layer of the ceca of mice, was reduced 100-fold by streptomycin administration. This was determined by microscopic count. Sections of cecal tissue obtained from the mice and stained with hematoxylin and eosin demonstrated that streptomycin administration greatly decreased the number of fusiform bacteria present in the mucosal microbial layer. We speculate that the partial elimination of fusiform organisms from this layer by streptomycin administration provides available association sites for pathogens so that they can successfully colonize the mouse cecum.

Mexican folk remedies and conventional medical care.

Despite reports of folk medicine use in all parts of the United States, many physicians are unaware of the extent to which patients use folk medicine and conventional medicine concurrently. A survey of Hispanic patients in West Texas showed that folk medicine was used in 50 percent of the families. Use was not influenced by educational level, employment status or primary language. Most such medicines or rituals are harmless, or possibly helpful, but there are serious exceptions.

Indications for pediatric liver transplantation.

Two hundred fifty pediatric (less than 18 years of age) patients underwent orthotopic liver transplantation because of end-stage liver disease and were given combination therapy with cyclosporine and prednisone. The most common indications for transplantation in decreasing order of frequency were biliary atresia, inborn errors of metabolism, and postnecrotic cirrhosis. The 5-year actuarial survival for the entire group was 69.2%. Age and diagnosis did not influence survival. Infections were the most common cause of death, followed by liver failure and cerebrovascular accident. The impact of retransplantation on survival depends on the indication. The survival is better when retransplantation is carried out after rejection than because of technical complications, and the latter has a better survival than does primary graft nonfunction. The difference in survival among these groups is statistically significant. The quality of life for 164 of 173 survivors is good to excellent; only nine children are currently experiencing medical problems. A persistent problem in pediatric transplantation is the scarcity of small donors.

Butane firebreathing in adolescents: a potentially dangerous practice.

Firebreathing is sometimes seen in magic acts. This is, potentially, a very dangerous practice without the proper precautions. What follows is a report of an adolescent who became a habitual butane firebreather after imitating this act. He developed hemorrhagic esophagitis and gastritis. The type of adolescent who may experiment with dangerous practices is discussed.