Analysis of early-onset bloodstream infection due to Escherichia coli infection in premature babies.

In early-onset bacteremia among preterm neonates, Escherichia coli (E. coli) is the main pathogen and can cause a high mortality rate. Thus, the predictive factors of mortality and extended-spectrum ß-lactamase (ESBL)-producing E. coli in preterm babies with E. coli early-onset bacteremia were reported.We retrospectively reviewed preterm neonates who had E. coli bacteremia occurring within 3 days after birth between 2004 and 2015. Maternal and perinatal information were collected from their medical records and analyzed by comparing the survival and nonsurvival groups, and also the ESBL-producing and non-ESBL-producing E. coli bacteremia groups. Mann-Whitney U test, Fisher exact test, and multivariate Cox proportional-hazard model were used for statistical analysis.A total of 27 preterm babies had E. coli bacteremia. The overall mortality rate was 55.56% (15 deaths). Five babies had ESBL-producing E. coli. The low systolic blood pressure of <48 mm Hg and low absolute neutrophil count of <2318 cells/mm were the most significant factors in predicting mortality. Moreover, the level of serum alanine aminotransferase was significantly lower in the ESBL-producing E. coli group than that in the non-ESBL-producing E. coli group.Therefore, the lower systolic blood pressure and absolute neutrophil count were the risk factors of mortality in preterm babies with early-onset E. coli bacteremia, and alanine aminotransferase could be a significant factor in predicting ESBL-producing E. coli.

Correlation of ovalbumin of egg white components with allergic diseases in children.

BACKGROUND: Immunoglobulin E (IgE)-mediated food allergy, such as egg white allergy, is common in young children (<3 years old), but not all young children sensitive to egg white present with allergic symptoms. This study investigated the relationship between sensitization to egg white component allergens and clinical manifestations of allergic diseases in young children. METHODS: From March to December 2010, 2256 children with physician-diagnosed allergic diseases were tested for serum levels of egg white, ovalbumin, and ovomucoid-specific IgE in the Pediatric Allergy and Asthma Center of Chang Gung Memorial Hospital. Serum was analyzed for specific IgE antibodies to egg white, ovalbumin, and ovomucoid by ImmunoCAP (Phadia, Uppsala, Sweden). Allergen-specific IgE levels ≥0.35 kUA/L were defined as positive. RESULTS: There was a significantly higher sensitization rate to egg white and its components in children aged 2-4 years old. The sensitization rate to egg white, ovalbumin, and ovomucoid in this age group was 53.5%, 48.3%, and 37.2%, respectively, and the trend of the sensitization decreased with age (p < 0.001). After adjusting for age, sensitization to egg white and ovalbumin was associated with children with dermatitis [egg white: odds ratio (OR) = 1.28, 95% confidence intervals (CI) = 1.03-1.58, p < 0.05; ovalbumin: OR = 1.30, 95% CI = 1.04-1.62, p < 0.05]. Children with ovomucoid sensitization had no statistically significant risk among different groups in the current study. CONCLUSION: Children aged 2-4 years old have higher sensitivity to egg white, ovalbumin, and ovomucoid. Children with egg white and ovalbumin sensitization have a higher risk for atopic dermatitis, and ovalbumin has a more important contribution. Furthermore, we suggested that in children with atopic dermatitis, if they are aged 2-4 years old and are having egg white and ovalbumin sensitization, avoiding eating raw or slightly heated eggs might have a beneficial effect.

Patterns of sensitization to peanut allergen components in Taiwanese Preschool children.

BACKGROUND/PURPOSE: Peanut allergy is very common in Western countries, although it is seldom encountered in Eastern countries. Peanuts are comprised of at least 11 components, but the contribution to clinical symptoms by each component in each individual is not known. This study investigated the distributions of sensitivity to peanut allergen components among Taiwanese children who were sensitized to peanuts and followed the evolution of sensitization patterns to these components. METHODS: We enrolled 29 preschool children (age=2.11±1.36 years) who were sensitized to peanuts above class 3. Serum was analyzed for specific immunoglobulin E (IgE) antibodies to recombinant Ara h 1, Ara h 2, Ara h 3, Ara h 8, and Ara h 9. Allergen component-specific IgE ≥0.35 kU(A)/L was defined as positive. Eighteen children were retested 22.64±5.1 months later. Peanut allergy symptoms were recorded from detailed questionnaires. RESULTS: The percentages of children sensitized to Ara h 1, 2, 3, 8, and 9 were, respectively, 51.8%, 65.5%, 62.1%, 13.8%, and 24.1%. Regarding changing patterns of peanut component sensitization at follow-up, children with clinical symptoms to peanuts had persistent elevations of Ara h 2-specific IgE: 12.6±1.01 up to 34.15±19.4 kU(A)/L; p=0.144. In contrast, Ara h 2 concentrations decreased significantly in children without clinical symptoms. Ara h 8 and 9 were nonspecific for children with or without symptoms. CONCLUSION: Ara h 1, Ara h 2, and Ara h 3 were major components contributing to peanut sensitization in Taiwanese children. Ara h 2 was probably the most important component that contributed to clinical symptoms and remained steady in children who had peanut allergy.

Serum heat shock protein 60 can predict remission of flare-up in juvenile idiopathic arthritis.

Heat shock protein (Hsp) 60 has been implicated in the pathogenesis of various inflammatory and autoimmune diseases. This study aimed to investigate synovial fluid and serum concentrations of Hsp60 and anti-Hsp60 and their relationship with juvenile idiopathic arthritis (JIA). Forty-eight patients with JIA, including 22 oligo-articular, 19 poly-articular, and 7 systemic diseases, and 33 normal controls were enrolled in this study. Synovial fluid and serum Hsp60 and anti-Hsp60 concentrations were measured via ELISA. Serum concentrations of Hsp60 of active and inactive oligo- and poly-articular JIA were significantly higher than those of normal controls. Serum concentration of anti-Hsp60 in active oligo-articular JIA was higher than that of normal controls (49.25 vs. 35.76 ng/mL, p = 0.059). Similarly, serum concentration of anti-Hsp60 in active poly-articular JIA was significantly higher than that of inactive samples (65.05 vs. 26.54 ng/mL, p = 0.008). In addition, serum concentration of Hsp60 correlated with the time required for remission from flare-ups in patients with JIA. Serum concentration of Hsp60 correlated well with time required for remission from flare-ups in patients with JIA, representing a potential disease marker to monitor disease activity.

What makes an autoantigen an autoantigen?

Multiple classes of proteins are modified to tailor them for specific physiological roles. The nature of these posttranslational modifications of proteins, as well as the relationships between them including those of the immune system proteins themselves, and immune system responses are reviewed. Aspects of protein posttranslational modification and their relationship to the pathogenesis of several autoimmune diseases and primary biliary cirrhosis are highlighted.

A review of the physiological and immunological functions of biliary epithelial cells: targets for primary biliary cirrhosis, primary sclerosing cholangitis and drug-induced ductopenias.

Our understanding of biliary epithelial cells (BEC) in physiobiology and immunology has steadily expanded. BEC transports IgA as well as IgM into bile, synthesizes and secretes various chemokines, cytokines, and expresses adhesion molecules involved in cell interaction and signal transduction. These then suggest a myriad of potential roles for BEC in defense from invading microorganisms as well as the pathogenesis of diverse immunologically driven diseases such as primary biliary cirrhosis (PBC), graft-versus-host disease, and primary sclerosing cholangitis (PSC). Despite the progress, there still remain many areas of BEC biology that require further investigation. Most importantly, it remains to be clarified that the extent to which the immunologic activities observed in BEC represent a BEC response to tissue injury or whether BEC themselves are the active participants in the pathogenesis of various cholestatic immunological diseases, including PBC and PSC.

Myeloperoxidase-positive inflammatory cells participate in bile duct damage in primary biliary cirrhosis through nitric oxide-mediated reactions.

Previous studies have suggested that increased nitric oxide (NO)-mediated products are found in the livers of subjects with primary biliary cirrhosis (PBC), but the mechanisms involved remain enigmatic. We took advantage of immunohistochemistry and several unique monoclonal antibodies to study inflammatory cells responsible for the generation of NO, the enzymes responsible for NO production, the expression of 3-nitrotyrosine, and the presence of CD68(+) and/or myeloperoxidase (MPO)(+) cells. We examined a total of 113 liver specimens, including 64 with PBC, 19 with primary sclerosing cholangitis (PSC), 6 with non-A, non-B hepatitis, 6 with alcoholic liver disease, 4 with cryptogenic cirrhosis, 4 with biliary atresia, and 10 normal subjects. Twenty-two percent of PBC had elevated expression of 3-nitrotyrosine in their bile duct epithelial cells (BECs) (P =.0316). Furthermore, the BECs in PBC also demonstrated apoptotic changes. MPO-positive inflammatory cells were also noted adjacent to the basement membrane. In contrast, the liver of normal subjects showed few apoptotic changes in the bile ducts, with no evidence of MPO staining in the portal area. Furthermore, sections from livers of subjects with stage I or stage II PBC demonstrated significantly increased inflammatory cell infiltration (P =.0064) and elevated 3-nitrotyrosine expression in BECs (P =.0246) compared with stage III and IV. The presence of 3-nitrotyrosine was closely associated with infiltrating CD68- and/or MPO-positive cells. There was also a stage-associated difference in the presence of bile duct infiltrating cells and 3-nitrotyrosine in PBC with an increase dominant in early stage disease. In conclusion, NO and reactive oxygen species, collectively determined as 3-nitrotyrosine, are associated with bile duct destruction in PBC and are particularly prevalent in early stage disease.