Maternal fetal immunological relationship particularly mycobacterial immunity

Thirty-nine paired maternal and cord blood from normal full term deliveries were tested for lymphocyte function by proliferative response to mitogens – Phytohemagluttin-P (PHA) and Poke weed mitogens (PWM). Monocyte function was assessed by the ability of the monocytes to release hydrogen peroxide (H 2O2 ) in response to standard stimulus (PMA). Mycobacterial immunity was assessed by lymphocyte proliferative response to purified proteins derivative (PPD) and IgM and IgG antibody response to H37Rv and 5 atypical mycobacteria. Lymphocyte functions were significantly lower in cord blood (PHA 20.6, PWM 21.2) as compared with maternal blood (PHA 65.8, PWM 37.8). The capacity of fetal monocytes to release H2O2 was comparable to maternal monocytes. The mean proliferative response of fetal lymphocytes to tubercular protein (PPD) was 0.67 as compared (P< 0.01) tO maternal lymphocytes (3.79). Nearly 86% of the cord blood did not show any response to PPD. None of the cord blood showed IgM antibody response to H37RV nor to any of the range of 5 atypical mycobacteria though maternal IgM and IgG response was present. There was only passive transfer of IgG antibody from mother to fetus. Hence, though this is a highly endemic area for atypical mycobacteria and M. tuberculosis, there was apparently 170 transplacental transfer of antigen in normal sensitized mothers

Surface markers of lymphoblasts in acute lymphoblastic leukaemia

58 children with acute lymphoblastic leukaemia (ALL) were studied for the effect of initial clinical and laboratory features and surface markers of lymphoblasts on the prognosis. 18.9% of them had T cell leukaemia while 3.4% had B-cell leukaemia. Six pre-treatment features were related to T-cell ALL, i.e. - age over 6 years, boys, presence of mediastinal enlargement, haemoglobin over 8g/dl, markedly elevated leucocyte count and CNS involvement. 90% of T-Cell ALL survived for less than 6 months. Both the cases of B-cell leukaemia died within 8 weeks. Identification of T and B cell leukaemia warrants more aggressive treatment for these patients to achieve remission and survive longer

Cell mediated immunity in post-streptococcal glomerulonephritis

Cell mediated immunity was assessed in 30 children with acute post streptococcal glomerulonephritis (APSGN) in parallel with 20 normal children and 15 children without nephritis who showed evidence of skin-sore ß-Hemolytic streptococcal infection. Delayed cutaneous hypersensitivity to 2,4, dinitrochloro benzene (DNCB) was similar in the three groups. There were no significant differences in the proportion of early and total T-rosettes. Lymphocyte transformation response to phytohemagglutinin- P (PHA), purified protein derivative (PPD) and BCG was similar in them, indirect leucocyte migration inhibition response to PPD, streptokinase streptodornase (SK-SD), and group A ß-Hemolytic T12 streptococcal antigens were not significantly different in patients when compared to normal controls and streptococcal infection controls. Cell mediated immunity was normal in APSGN in children by all the parameters studied

Humoral immunity in acute post-streptococcal glomerulonephritis

children with acute post-streptococcal glomerulonephritis in parallel with IS children with only skin streptococcal infection and 20 normal children. B-lymphocytes as assessed by EAC rosettes estimation was significantly elevated in patients. Markedly high anti-DNase B antibody titres were demonstrated in patients and to a less extent in skin infection controls, as compared to normal controls. C3 levels were decreased in all the patients and C4 levels were decreased in 76%. The levels returned to normal 2 months later. C3 and C4 levels were normal in skin infection and normal controls. Serum IgG, IgM, IgA were normal in patients and Rheumatoid factor was positive in only 24% o f patients, all of whom had a low positive titre. These studies indicate marked humoral immune response to streptococcal infection in patients with APSGN. IgG anti-IgG immune complex did not play a sign&ant role in our patients

Evaluation of PCR Using TRC4 and IS6110 Primers in Detection of Tuberculous Meningitis

We have evaluated a new set of primers (TRC4) in comparison with the IS6110 primers commonly used in PCR to detect tuberculous meningitis among children. The levels of concordance between the results of IS6110 PCR and TRC4 PCR with cerebrospinal fluid specimens from patients with clinically confirmed tuberculous meningitis were 80 and 86%, respectively. Results with the two primer sets were concordant for 55 positive and 22 negative specimens (n 5 98). We conclude that the sensitivity of PCR can be increased by using both IS6110 and TRC4 primers

A Profile of Bacteriologically Confirmed Pulmonary Tuberculosis in Children

Objective: To describe the clinical profile of children with bacteriologically confirmed tuberculosis. Study Design: A multicentric study was conducted in three hospitals in Chennai city between July 1995 and December 1997. Children aged 6 months to 12 years with signs and symptoms suggestive of tuberculosis were investigated further. Clinical examination, chest radiograph, tuberculin skin test with 1 TU PPD and, sputum or gastric lavage for mycobacterial smear and culture were done for all and, lymph node biopsy when necessary. Results: A total of 2652 children were registered and tuberculosis was bacteriologically confirmed in 201. Predominant symptoms were history of an insidious illness (49%), fever and cough (47%), loss of weight (41%) and a visible glandular swelling (49%). Respiratory signs were few and 62% were undernourished. Over half the patients with confirmed TB had normal chest X-ray. Abnormal X-ray findings included parenchymal opacities in 47% and hilar or mediastinal lymphadenopathy in 26%. The prevalence of isoniazid resistance was 12.6% and MDR TB 4%. Conclusions: Children with tuberculosis present with fever and cough of insidious onset. Lymphadenopathy is a common feature even in children with pulmonary TB. A significant proportion of children have normal chest X-rays despite positive gastric aspirate cultures. Drug resistance rates in children mirror the pattern seen in adults in this geographic area

A Comparative Study of Leptospirosis and Dengue in Thai Children

Two of the most common causes of acute febrile illnesses among children in the tropics are leptospirosis and dengue. Early in illness, these two conditions are often indistinguishable and rapid laboratory confirmation of the infecting pathogen is generally not available. An enhanced ability to distinguish leptospirosis from dengue in children would guide clinicians and public health personnel in the appropriate use of limited healthcare resources