Celiac sprue: another autoimmune syndrome associated with hepatitis C.

OBJECTIVE: Celiac sprue is being diagnosed with increasing frequency by screening individuals with epidemiologically associated autoimmune syndromes. We sought to test our hypothesis that hepatitis C also may predispose to celiac sprue because it can trigger autoimmune reactions. METHODS: Two hundred fifty-nine consecutively evaluated patients with chronic hepatitis C infection, 59 with autoimmune liver disease, 137 with other hepatic diseases, 356 with various GI syndromes, and 221 normal volunteers underwent serologic screening for celiac sprue. Patients with antigliadin, antiendomysial, and antitissue transglutaminase antibodies in serum underwent duodenoscopy and biopsy. RESULTS: There was a statistically significantly higher prevalence of antigliadin antibody in all groups of patients with liver disease compared with GI controls and normal controls. However, only patients with hepatitis C (n = 3; 1.2%) or autoimmune liver disease (n = 2; 3.4%) had antiendomysial/antitissue transglutaminase antibody in serum. One of 221 normal volunteers (0.4%) was antigliadin, antiendomysial, and antitissue transglutaminase positive; this individual also was found to have hepatitis C (previously undiagnosed). Each of these six individuals had mild intestinal symptoms, duodenal histopathology consistent with celiac sprue, and the celiac-associated HLA-DQ2 allele. Five of the six followed a prescribed gluten-free diet and experienced symptomatic improvement. CONCLUSION: Celiac sprue is epidemiologically associated with chronic hepatitis C infection and with autoimmune liver disease. Because hepatitis C is much more frequently encountered than autoimmune liver disease, hepatitis C appears to be the most common hepatic disease associated with the development of celiac sprue.

High prevalence of celiac sprue-like HLA-DQ genes and enteropathy in patients with the microscopic colitis syndrome.

OBJECTIVE: Celiac sprue is associated with specific HLA-DQ genes (mainly DQ2). Because there are epidemiological and histopathological similarities between celiac sprue and microscopic colitis, we hypothesized that these syndrome may share an HLA genetic predisposition and pathogenesis. METHODS: The HLA-DQ genes of 25 patients with celiac sprue, 53 patients with the microscopic colitis syndrome, and 429 normal controls were typed and compared. Serum was analyzed for antigliadin and antiendomysial antibodies. Small intestinal biopsies were analyzed for signs of histopathology. RESULTS: HLA-DQ2 or DQ1,3 (the latter as DQ1,7,DQ1,8, or DQ1,9) were seen more frequently in both patient groups relative to controls. In patients with the microscopic colitis syndrome, serological tests for celiac sprue were weakly positive in 17%; mild inflammation of the small intestine without villous atrophy was present in 43%, and inflammation plus partial or subtotal villous atrophy was present in 27%. CONCLUSIONS: A shared set of predisposing HLA-DQ genes account for the epidemiological overlap of celiac sprue and microscopic colitis. Mild to moderate mononuclear cell inflammation of the small intestine, often accompanied by partial or subtotal villous atrophy, is frequent in patients with the microscopic colitis syndrome. Although further studies will be necessary to determine if this enteropathy is induced by dietary gluten, we speculate that the small intestinal but not colonic histopathology in patients with microscopic colitis is caused by immunological gluten sensitivity.

A new method of quantitative fecal fat microscopy and its correlation with chemically measured fecal fat output.

Fecal fat microscopy using the Sudan stain has suffered from a relative lack of specificity, and results are "qualitative." Therefore, we developed a quantitative fecal fat microscopic method with hopes of improving diagnostic accuracy. One hundred eighty patients with chronic diarrhea collected stools for 1 to 3 days, and fecal fat output was measured by a standard chemical method, and microscopy was performed by the old qualitative and new quantitative methods. There was a highly statistically significant linear correlation between quantitative fecal fat microscopy and chemically measured fecal fat output. The quantitative microscopic method had a sensitivity of 94% and a specificity of 95%; the traditional method had a sensitivity and specificity of 76% and 99%, respectively. Fecal fat Sudan microscopy performed by a dedicated approach to counting and size measurement of fat globules can yield a quantitative result that correlates well with chemically measured fecal fat output and has a high diagnostic accuracy.

Utility of a rapid fecal latex agglutination test detecting the neutrophil protein, lactoferrin, for diagnosing inflammatory causes of chronic diarrhea.

OBJECTIVE: The utility of tests for fecal neutrophils in the setting of chronic diarrhea has not been established. The purpose of this study was to determine the causes of chronic diarrhea associated with fecal neutrophils. METHODS: One fecal specimen from each of 10 normal subjects, 26 patients with known microscopic colitis, 13 with celiac sprue, eight with Crohn's disease, four with ulcerative colitis, and 103 with chronic diarrhea of unknown origin, as well as 10 fecal specimens from a patient with chronic nongranulomatous enterocolitis were analyzed blindly for the presence of a neutrophil granule protein called lactoferrin using a commercial latex agglutination kit. Diagnostic evaluation of the 103 patients with chronic diarrhea was carried out to determine the diagnostic accuracy of this test for chronic inflammatory bowel disease. RESULTS: None of the normal control subjects, three of 39 patients with microscopic colitis or celiac sprue, all 10 specimens from the patient with enterocolitis, and all 12 control patients with ulcerative colitis or Crohn's disease had a positive fecal lactoferrin test. Eleven of 103 patients with chronic diarrhea presenting without a diagnosis had a positive test, and all were diagnosed with an inflammatory condition of the colon (five-, ulcerative colitis; four-, Crohn's disease; one-, ischemic colitis; and one-, microscopic colitis). Only one patient with inflammatory bowel disease had a negative lactoferrin test. The sensitivity, specificity, and positive and negative predictive values of the fecal lactoferrin test for ulcerative or Crohn's colitis were 90%, 98%, 82%, and 99%, respectively. CONCLUSION: The major cause of fecal neutrophils in patients with chronic diarrhea is chronic inflammatory bowel disease of the colon. The latex agglutination test for fecal lactoferrin offers a highly sensitive, specific, and simple means for detection of fecal neutrophils in these patients.

Investigation and diagnosis of diarrhea caused by sodium phosphate.

Because there are no published reference values for fecal phosphate concentration or output, diagnosing surreptitious use of phosphate laxatives has been difficult. The purposes of this study were to determine normal fecal phosphate levels and to quantitate and chemically analyze diarrhea produced by sodium phosphate. Timed stool collections were obtained from 20 normal subjects during 25 study periods (normal controls), from 27 normal subjects with diarrhea induced by a variety of laxatives not containing phosphate during 234 study periods (diarrhea controls), and from 10 normal subjects during 14 periods after ingestion of 45 or 22.5 ml of a commercially available 66% sodium phosphate solution (Fleet Phospho-Soda). All stools were analyzed for soluble phosphate concentration, and daily output was calculated. The upper limits of normal for soluble fecal phosphate concentration and output, derived from the normal controls and diarrhea controls, respectively, were 33 mmol/liter and 15 mmol/day. Diarrhea produced by 45 ml of sodium phosphate was watery and voluminous, with fecal weights averaging 1078 g/day (range 601-1713 g/day). Measured fecal phosphate concentrations and outputs averaged 85 mmol/liter and 92 mmol/day, respectively, and all values were significantly elevated. Soft, less voluminous stools were produced with 22.5 ml of sodium phosphate but all had an abnormally high soluble phosphate concentration and 24-hr output. In conclusion, the upper limits of normal for soluble fecal phosphate concentration and output established in this study should be useful in the chemical diagnosis of phosphate-induced diarrhea.

A comparison of three different regimens of infectious bursal disease vaccination in chickens.

Five days old progeny chicks from breeders which have received primary and booster doses of live infectious bursal disease vaccine, demonstrated precipitating antibodies unlike progenies from single dose vaccinated breeders. All chicks from the two different groups of breeders were however seronegative at 22 days of age, despite vaccination at 7 or 14 days of age. Post vaccination seroconversion was first noticeable at 32 days in the group of chicks vaccinated at 7 days. Post challenge mortalities was significantly lower (P less than 0.05) and organ lesions very significantly minimized (P less than 0.01) in 7 day old vaccinated group than in 14 or 28 days old vaccinated chicks. These results showed that early (7 days) IBD Vaccination was superior to vaccination at 14 or 28 days, in terms of antibody response and protectivity against mortalities and bursal lesions.

The prevalence of gastro-intestinal parasites and bacteria in the game scouts at the Kainji Lake National Park of Nigeria.

The faeces of twenty scouts working at Borgu games were examined for the presence of parasites and bacteria. Cysts of Entamoeba histolytica, Giardia lamblia and Trichomonas hominis were found. Helminth ova encountered included those of Ancylostoma duodenale, Ascaris lumbricoides, Stronglyloides stercoralis and Trichuris trichiura. Escherichia coli and Shigella flexneri were isolated from one faecal sample each. In all, parasites were found in the faeces of only 9 scouts. The epidemiological significance of the infections in highlighted.

Post coital pin-worm infection.

In Ibadan, Nigeria, an Enterobius vermicularis worm was found in the urine of a soldier complaining of urethral irritation that had started 4 hours after coitus. After his first post-coital micturition, which yielded the worm, the irritation stopped. There was convincing evidence that the worm had entered the soldier's urethra from his partner's perianal region (rear-entry coital position, no ejaculation because of partner's complaint of painful coitus, the partner was a school girl of 15, enterobiasis is common in young school girls in the city, etc.).

Gastrointestinal parasites and bacteria flora of wild animals in the Borgu game reserve in Nigeria.

Faecal droppings from animals in the Borgu game reserve were examined between the months of January and March 1981. These animals included Buffalo, Hartebeest, Kob, Roan antelope, Genu cat, Mangoose, Warthog and Monkey. Haemonchus contortus was identified from the faeces of five buffalos, Oesophagostomum species was identified from one warthog while Strongyloides species was identified from two monkeys. No pathogenic bacteria was isolated in any of the faecal samples examined. The influence of weather on the infection rate is discussed.

Pathogenic microbes isolated from rabbit urine.

Asymptomatic urinary tract infections were recovered from the urine of 40 of 100 rabbits, and identical bacteria were isolated when the rabbits were retested. Urine samples which yielded significant growths of bacteria also had pus cells. Some specimens yielded more than 2 different isolates, and staphylococci were the most frequently isolated bacteria. Oxalate and uric acid crystals were seen in 6% of the samples, particularly those with significant growths of Pseudomonas aeruginosa. No ova, parasites or fungal elements were seen in 'wet-mount' preparations and no fungi were seen when urine samples were cultured. Female rabbits showed a higher number of bacterial isolates than males. Animals with significant isolates were treated with suitable antibiotics and repeat samples yielded no growth.

The parasites obtained and bacteria isolated from house rats (Rattus rattus Linnaeus, 1758) caught in human habitations in Ibadan, Nigeria.

A total of 169 house rats were killed in different households distributed within five localities of Ibadan. A wide range of parasites were encountered. The flea, Ceratophylus fasciatus was the commonest ectoparasite found. Trichostrongylus columbriformis eggs were the commonest nematode and Hymenolepis diminuta the only cestode. Escherichia coli was the commonest bacterium found. The incidence of helminthiasis, especially H. diminuta, was generally high among rats trapped in the villages and the indigenous areas of the city. One hundred and twenty eight (128) of the rats possessed Trypanosoma lewisi infection, seventy one (71) had Anaplasma marginale while fifty seven (57) had Babesia microti infection. The public health importance of some of the parasites found is discussed.

On the use of the scrotum for feeding larval ixodid ticks on hosts.

The efficacy of feeding larval stages of Amblyomma variegatum, Hyalomma rufipes and Boophilus decoloratus on the ears and scrotum of sheep is compared. The effect of age of larvae on the number that engorged on the animal was also investigated. A significantly greater number of larvae fed on scrotum than on ears. The greatest number of larvae engorged when they were fed on the scrotum or ear within 1-4 days of hatching. The older the larvae, the less the number that fed. The economic advantages of adopting the scrotal method for rearing larval tick stages as well as the implication under natural conditions of younger larvae feeding in large numbers are discussed.

The transmission of Theileria annulata to a rabbit by the larvae of the tick Hyalomma rufipes.

A New Zealand White rabbit on which larvae of Hyalomma rufipes were fed died of theileriosis due to Theileria annulata 22 days after the larvae had fed. The larvae were direct progeny of an enorged female collected from trade cattle in the veterinary control post at Ibadan. The danger attending the feeding on rabbits of first progeny of ticks collected from cattle in countries where some tick-borne diseases are endemic is highlighted. The possibility of transovarial transmission of Theileria is discussed.