Positive IgG Serology Research Articles

ACUTE H. PYLORI INFECTION AS A CAUSE OF ABDOMINAL PAIN IN CHILDREN

12 Non-surgical acute abdominal pain, presenting to the pediatric emergency center without an obvious etiology, is a diagnostic dilemma. OBJECTIVE: To examine the potential role of acute Hp infection as the cause of acute nonsurgical abdominal pain in children. Methods: Children ages 12 years or younger were enrolled. Entry criteria included a predominant presenting symptom of abdominal pain without diarrhea with a duration of less than 21 days with one of the following clinical features: nausea, vomiting, hematemesis, poor appetite, refusal to feed, abdominal tenderness, or halitosis. Each child underwent 13C-UBT and symptom cataloging. Symptomatic subjects also underwent anti-Hp IgG serological testing. Acute Hp was defined as a positive UBT and negative serology (FlexSure HP). RESULTS: 49 children were studied; 9 (18.3%) symptomatic children had acute Hp infections; 2 others had positive IgG serology and UBT indicating chronic infection. No symptom or combination of symptoms predicted UBT positivity. DISCUSSION: Acute Hp infection appears to constitute an important proportion (18%) of cases presenting with acute abdominal pain of undetermined etiology. Clinical signs are not helpful when predicting acute Hp infection in children. Acute Hp infection should be considered in the differential diagnosis of non-surgical abdominal pain.

Helicobacter pylori Infection in a Large Company

The Authors Reply: We appreciate Dr Ziem's interest in our health initiative to identify and treat Helicobacter pylori-related disease among BASF employees in Ludwigshafen, Germany. Dr Ziem discusses observations from her own clinical experience and proposes assessment of secretory IgA (s-IgA) in individuals with positive and negative IgG serology against H. pylori to improve our understanding of the interaction between chemical exposure and infectious illnesses. The potential role of s-IgA in the immunopathology of H. pylori infection is presently unclear.1,2 Because measurement of specific s-IgA in sputum, serum, or gastric juice samples was not included in the protocol for this health initiative, we cannot provide the assessment requested. Members of our clinic attendee recruitment subgroup are employees with potential for exposure to industrial chemicals. Within this group of employees, we observed an H. pylori infection prevalence (40%), as determined by IgG serology, that was in general agreement with that seen in an unselected German population (39%).3 The prevalence of dyspepsia (13%) also did not differ greatly from dyspepsia prevalence rates in other nonpatient populations, which have ranged from 11% to 46%.4-6 To date, we have not seen evidence of either enhanced rates of infection or an unexpected prevalence of gastrointestinal symptoms in the BASF AG workforce in Ludwigshafen. Our health initiative includes follow-up components that should enable a longitudinal assessment of the relationship between H. pylori infection and various gastrointestinal health end points, as well as an assessment of treatment success. Andreas Zober, MD, PhD Occupational Medical and Health; Protection Department; BASF AG; Ludwigshafen, Germany Dieter Schilling, MD Medical Clinic C of the Municipal; Clinic of Ludwigshafen GmbH; Ludwigshafen, Germany M. Gerald Ott, PhD Corporate Medical Department; BASF Corporation; Mt. Olive, NJ

Ten-day triple therapy with ranitidine bismuth citrate, amoxicillin, and clarithromycin in eradicating Helicobacter pylori

OBJECTIVE: Fourteen-day therapy with ranitidine bismuth citrate, amoxicillin, and clarithromycin has been shown to have a high Helicobacter pylori eradication rate (> 90%) in U.S. trials. The aim of this study was to determine the H. pylori eradication rate of a ranitidine bismuth citrate-based triple regimen of shorter duration (10 days), which has been shown to be effective in Europe. METHODS: Dyspeptic patients who had a positive baseline 13C-urea breath test and either a positive antral rapid urease test or positive IgG serology were studied. Treatment consisted of ranitidine bismuth citrate 400 mg, clarithromycin 500 mg, and amoxicillin 1 g, all given b.i.d. for 10 days. Eradication was determined >4 wk after completion of therapy by the 13C-urea breath test (enrichment <2.4%). Results are expressed for intent-to-treat (all patients randomized even if they did not take the drug) and per-protocol (major protocol violators excluded) analyses. RESULTS: Seventy-seven patients with a mean age of 48 ± 1.8 yr were studied. Forty-eight patients had eradication of H. pylori with this regimen (62%), 16 patients (21%) did not have eradication, and 13 patients (17%) did not return for breath testing. By intent-to-treat analysis the eradication rate was 62% (95% confidence intervals [CI], 51%, 73%) and by per-protocol analysis the eradication rate was 75% (95% CI, 63%, 85%). CONCLUSIONS: Ten-day, twice-daily therapy with ranitidine bismuth citrate, amoxicillin, and clarithromycin has an eradication rate that ranges from 62–75%. Fourteen-day therapy may be preferable because of higher eradication rates.

Immune response to Trypanosoma cruzi shed acute phase antigen in children from an endemic area for Chagas' disease in Bolivia.

A field study of the immune response to the shed acute phase antigen (SAPA) of Trypanosoma cruzi was carried out in the locality of Mizque, Cochabamba department, Bolivia. Schoolchildren (266), with an average of 8.6 +/- 3.6 years, were surveyed for parasitological and serological diagnosis, as well as antibodies directed against SAPA using the corresponding recombinant protein in ELISA. The antibodies against SAPA were shown in 82% of patients presenting positive serological diagnosis (IgG specific antibodies). The positive and negative predictive values were 0.88. Antibodies anti-SAPA were shown in 80.8% of the chagasic patients in the initial stage of the infection (positive IgM serology and/or positive buffy coat (BC) test) and in 81.4% of the patients in the indeterminate stage of the infection (positive IgG serology with negative BC and IgM tests). These results show that the anti-SAPA response is not only present during the initial stage of the infection (few months) but extends some years after infection.

Helicobacter pylori gastritis in dyspeptic children. A long-term follow-up after treatment with colloidal bismuth subcitrate and tinidazole.

The connection between dyspeptic symptoms and Helicobacter pylori infection was studied prospectively in 21 children treated for verified H. pylori infection with bismuth subcitrate and tinidazole. Gastroscopy with biopsy was performed before and a mean of 4 months after discontinuation of the treatment. A second post-treatment check with determination of H. pylori antibodies and serum pepsinogen 1 level was made a mean of 1.5 years after cessation of treatment. The therapy given cleared the bacteria in 67% of the patients. No significant difference in symptoms was observed between treatment successes and failures. The histopathologic diagnosis of H. pylori infection was accompanied by positive IgG serology in 15 (75%) of the 20 patients tested, and a decrease in antibody levels was observed in children with successful eradication. Serum pepsinogen 1 seemed to be even a better marker in the follow-up. The healing of acute and also to some extent of chronic gastritis took place closely after successful eradication. Our results suggest that healing of H. pylori-induced gastritis should be confirmed at reendoscopy only, independent of the symptoms.

Detection of anti-HIV-1 immunoglobulin M antibodies in patients with serologically proved HIV-1 infection.

Serum samples from 247 patients with positive HIV-1 IgG serology were investigated for specific IgM antibodies. We found that 109 also reacted positively with a least one antigen in an HIV-1 IgM Western Blot and only 31 in an HIV-1 IgM enzyme-linked immunosorbent assay (ELISA). It was shown that in some of the persons, specific IgM antibodies against the gp160/120, p66, p55, gp41, p24, and p17 antigens of the virus are synthesized at some time after infection. IgM antibodies to the endonuclease-related p31 antigen were observed in one serum only. IgM antibodies against the gp160/120, p66, gp41, and p17 antigens seemed to disappear early after infection. Those against the p55 and the p24 antigens were found in 62% and 75% of investigated cases, respectively. A direct correlation between the Western Blot patterns and the IgM ELISA results was not found.