Steroid-refractory inflammatory bowel disease is a risk factor for CMV infection.

OBJECTIVE: Patients with inflammatory bowel disease (IBD) show increased the prevalence of cytomegalovirus (CMV) infection due to the severity of the disease and the immunosuppressive treatments they receive. The aim of this study was to determine the prevalence of CMV infection in IBD patients and identify the risk factors for CMV infection with different demographic characteristics in IBD patients. PATIENTS AND METHODS: We enrolled 85 patients diagnosed with IBD (43 with ulcerative colitis (UC) and 42 with Crohn's disease (CD)) in this prospective study. The clinical disease activities of UC and CD were assessed using Truelove-Witts and Crohn's disease activity index (CDAI). CMV infection was assessed by detection of DNA using real-time polymerase chain reaction (PCR) in blood samples and quantitative PCR in colonic biopsy specimens and by detection of inclusion bodies using hematoxylin-eosin staining. RESULTS: Thirteen patients with IBD exhibited concomitant CMV infection. CMV infection was not detected in any of the patients in remission. Viral loads measured in the colonic mucosa of infected patients ranged from 800-7000 genome copies/mL total extracted DNA. The mean serum CMV DNA level was 1694 ± 910 copies/mL (range: 800-3800). The rate of steroid resistance in CMV-positive cases was significantly higher than that in CMV-negative cases (p = 0.001). CD with acute exacerbation was a risk factor for CMV disease (p = 0.04). All of the CMV-positive patients received immunosuppressive treatments. CONCLUSIONS: CMV infection should be suspected in steroid-resistant UC and CD. Antiviral treatment improved the clinical outcome in steroid-resistant IBD cases with serum CMV DNA levels above 1000 copies/mL.

Age-specific seroepidemiology of hepatitis A, B, and E infections among children in Istanbul, Turkey.

This study was performed for evaluation of seroprevalence of hepatitis A, B, and E among children in Istanbul, Turkey. The study group included 909 children who were 6 months-15 years of age. The children were separated to three age groups: Group 1 (6 months-4.9 years; n = 321), Group 2 (5.0-9.9 years; n = 318), and Group 3 (10.0-15.0 years; n = 270). Group I was divided to two subgroups for evaluation of the maternal antibody sera (6 months-2 years and over 2 years). Serum IgG anti-HAV, anti-HBc, and anti-HEV were tested by commercial ELISA kits. The data were studied by multivariant analysis. In all subjects, seroprevalence of hepatitis A, B, and E were determined as 29, 15.9, and 2.1% respectively. The prevalence of hepatitis A increased with age (p < 0.05; Group 1 15.1% and Group 3 49.6%). Anti-HBc IgG level did not significantly change with age (Group 1 18.6% and Group 3 15.4%; p > 0.05). The seroprevalence of hepatitis E virus infection was higher in Group 1 (3.7%) than Group 3 (0.3%; p < 0.05). In Group 1 first subgroup, between 6 month and 2 year, antibody levels were 12.2, 17.3, and 4.8% respectively, for anti-HAV IgG, anti-HBc IgG and anti-HEV IgG. Hepatitis A and B infection is a community health problem, but hepatitis E infection is low in children in Istanbul, Turkey. The high positive rate in Group I for IgG anti-HEV may be due to maternal antibodies.

Immunization of renal transplant recipients with pneumococcal polysaccharide vaccine.

BACKGROUND: Streptococcus pneumoniae, a common pathogen leading to pneumonia, is a cause of morbidity and mortality in immunosuppressed patients. Vaccination against this agent can be recommended for immunosuppressed patients, including those with chronic renal failure, nephrotic syndrome and renal transplant recipients; however, a diminished immune response and loss of protective antibodies have been observed. PATIENTS AND METHODS: In our prospective study, the efficacy and side effects of polyvalent pneumococcal vaccination were investigated in renal transplant recipients. A total of 21 patients (6 female, 15 male) with well-functioning renal allografts, who had transplant surgery at least 2 months before, were included in the study. The patients were stratified according to the immunosuppressive protocol and 8 received double, while 13 received triple, immunosuppressive agents. After obtaining basal serum samples, all cases were vaccinated with the 0.5 mL intramuscular administration of polyvalent polysaccharide pneumococcal vaccine (Pneumo 23 Pasteur Merieux, lot No: K 1131). RESULTS: Following a mean of 6 wk in all patients and also a mean of 12 wk in 12 patients, serum samples were again obtained to measure pneumococcal antibodies. Antibody titers following 6 and 12 wk of vaccination were significantly higher, as compared with basal values in all patients, except one. These titers did not show any statistically significant difference between double and triple therapies. There was no significant difference between the 12th and 6th wk postvaccination antibody titers. No systemic or local adverse effects were observed. CONCLUSION: Pneumococcal vaccination is safe and effective in patients with well-functioning renal allografts, at least in the short term. This vaccination policy may be useful for preventing invasive pneumococcal disease in immunosuppressed patients.

Immune response to Haemophilus influenzae type B vaccination in renal transplant recipients with well-functioning allografts.

BACKGROUND: Haemophilus influenzae infection is a mild and self-limited disease in the healthy population. However, it may show an aggressive course in the immunocompromised state which underlines the importance of vaccination against this agent. On the other hand, posttranplant immunosuppression may impair immune responses and thus the efficacy of the vaccination. METHODS: Forty-three renal transplant recipients with well-functioning allografts were immunized with H. influenzae type b vaccine in order to investigate the immune response. The patients received a double or a triple immunosuppressive protocol. Seven healthy members of the dialysis unit served as controls. After obtaining basal serum samples, the patients and the control subjects were immunized with H. influenzae type b conjugate vaccine. After 6 and 12 weeks, serum samples obtained again to determine H. influenzae type b antibody titers. RESULTS: The antibody titers 6 and 12 weeks after vaccination were significantly higher as compared with the basal values, similar to those of the control subjects. These titers did not show statistically significant differences between the double and triple immunosuppressive therapy groups. After 12 weeks of vaccination, the antibody titers did not show a statistically significant difference as compared with those obtained after 6 weeks. CONCLUSION: H. influenzae type b vaccination is safe and effective in patients with well-functioning renal allografts and should be recommended to renal transplant recipients who may have the risk of invasive disease on the basis of the immunosuppressive state.

Lumbar spinal stenosis: clinical/radiologic therapeutic evaluation in 145 patients. Conservative treatment or surgical intervention?

In this prospective study, 145 patients with lumbar spinal stenosis were evaluated for clinical signs and radiologic findings and conservative treatment results. Clinical parameters such as pain on motion, lumbar range of motion, straight leg raising test, deep tendon reflexes, dermatomal sensations, motor functions and neurogenic claudication distances were assessed at admission and were compared after a conservative treatment program was completed. A conservative treatment program consisted of physical therapy (infrared heating, ultrasonic diathermy and active lumbar exercises) and salmon calcitonin. Pain on motion (100%), restriction of extension (77%), limited straight leg raising test (23%), neurogenic claudication (100%), dermatomal sensory impairment (47%), motor deficit (29%), and reflex deficit (40%) were observed in the patients. All aforementioned disturbances except reflex deficits improved by the conservative treatment and results were statistically significant. The authors conclude that this conservative treatment should be the treatment of choice in elderly patients and in those patients without clinical surgical indications.

Computed tomographic investigation of the effect of traction on lumbar disc herniations.

The aim of this study was to evaluate the effect of static horizontal traction on disc herniations by computed tomographic investigation. Changes occurring under the effect of a traction load of 45 kg have been evaluated in 30 patients with lumbar disc herniation. The herniated nuclear material (HNM) has retracted in 11 (78.5%) of median, six (66.6%) of posterolateral, and four (57.1%) of lateral herniations. Clinical response of these cases to conservative treatment varied with the amount and location of HNM, the retraction of HNM, and calcification of protruded disc. Static lumbar traction showed variable effects on lumbar disc herniations, especially in relation with the amount and location of HNM.