The most important determinants of the gut microbiotic composition in infants were the mode of delivery, type of infant feeding, gestational age, infant hospitalization, and antibiotic use by the infant. Term infants who were born vaginally at home and were breastfed exclusively seemed to have the most "beneficial" gut microbiota (highest numbers of bifidobacteria and lowest numbers of C difficile and E coli).
Background and aims: Perturbations in intestinal microbiota composition due to lifestyle changes may be involved in the development of atopic diseases. We examined gut microbiota composition in early infancy and the subsequent development of atopic manifestations and sensitisation. Methods: The faeces of 957 infants aged 1 month and participating in the KOALA Birth Cohort Study were analysed using quantitative real-time PCR. Information on atopic symptoms (eczema, wheeze) and potential confounders was acquired through repeated questionnaires. Total and specific IgE were measured in venous blood samples collected during home visits when the infant was 2 years old. During these home visits a clinical diagnosis of atopic dermatitis was made according to the UK-Working Party criteria. Results: The presence of Escherichia coli was associated with a higher risk of developing eczema (OR adj = 1.87; 95% CI 1.15 to 3.04), this risk being increased with increasing numbers of E coli (p for
BackgroundInterpretation of serological assays in Lyme borreliosis requires an understanding of the clinical indications and the limitations of the currently available tests. We therefore systematically reviewed the accuracy of serological tests for the diagnosis of Lyme borreliosis in Europe.MethodsWe searched EMBASE en MEDLINE and contacted experts. Studies evaluating the diagnostic accuracy of serological assays for Lyme borreliosis in Europe were eligible. Study selection and data-extraction were done by two authors independently. We assessed study quality using the QUADAS-2 checklist. We used a hierarchical summary ROC meta-regression method for the meta-analyses. Potential sources of heterogeneity were test-type, commercial or in-house, Ig-type, antigen type and study quality. These were added as covariates to the model, to assess their effect on test accuracy.ResultsSeventy-eight studies evaluating an Enzyme-Linked ImmunoSorbent assay (ELISA) or an immunoblot assay against a reference standard of clinical criteria were included. None of the studies had low risk of bias for all QUADAS-2 domains. Sensitivity was highly heterogeneous, with summary estimates: erythema migrans 50 % (95 % CI 40 % to 61 %); neuroborreliosis 77 % (95 % CI 67 % to 85 %); acrodermatitis chronica atrophicans 97 % (95 % CI 94 % to 99 %); unspecified Lyme borreliosis 73 % (95 % CI 53 % to 87 %). Specificity was around 95 % in studies with healthy controls, but around 80 % in cross-sectional studies. Two-tiered algorithms or antibody indices did not outperform single test approaches.ConclusionsThe observed heterogeneity and risk of bias complicate the extrapolation of our results to clinical practice. The usefulness of the serological tests for Lyme disease depends on the pre-test probability and subsequent predictive values in the setting where the tests are being used. Future diagnostic accuracy studies should be prospectively planned cross-sectional studies, done in settings where the test will be used in practice.
keywords Schistosoma mansoni, praziquantel, resistance correspondence Y.S. Liang, Jiangsu Institute of Parasitic Diseases, Meiyuan, Wuxi, Jiangsu 214064, P. R.China.The tolerance of Schistosoma mansoni to praziquantel has been reported in some endemic regions (Fallon et al. 1995;Stelma et al. 1995;Ismail et al. 1996;Guisse et al. 1997). To establish the reasons for clinical failures of praziquantel, a simple, quick and economic assay is required to detect resistance. Ideally this will involve the use of eggs or miracidia since these are the stages of the parasite life cycle which can easily be obtained from the faecal material of infected humans. As praziquantel causes changes in the shape of miracidia (Coles 1979), this was used as the basis for designing a test for resistance.In 24-well flat bottom microplates we observed the effect of praziquantel on miracidia hatched from eggs obtained from the faeces of mice infected with six isolates of S. mansoni. Two isolates were praziquantel-susceptible (one from Puerto Rico and one a mixture of isolates from Puerto Rico, Brazil, Egypt and Kenya), and four isolates were praziquantelinsusceptible, including a laboratory-selected praziquantelresistant population (Fallon & Doenhoff 1994) and three Senegalese isolates. The cessation of swimming of miracidia was observed in different concentrations of praziquantel at various times and then the morphological changes were checked by adding a drop of Lugol's iodine.When the miracidia of both the susceptible and insusceptible isolates were exposed to 10 -3 and 10 -4 M praziquantel, they immediately contracted in the middle part of their bodies, giving the shapes of an unequal dumbbell or calabash, with the greater mass at the anterior end. In 5 ϫ 10 -6 M praziquantel 100% of miracidia from the susceptible isolates immediately changed shape, whereas only 11-15% of those from the insusceptible isolates did. Thus by addition of Lugol's iodine immediately after administering praziquantel, an objective measure of susceptibility could be obtained. After 1 minute in 10 Ϫ6 M praziquantel 52% to 100% of susceptible miracidia had changed shape, and after 5 min 100% had done so compared with 3% to 15% and 9% to 18% of the insusceptible miracidia. Susceptibility could also be detected by determining whether miracidia had stopped swimming but this was less easy to read as a test than change in shape.By exposing freshly hatched miracidia to 10 Ϫ6 M praziquantel and observing change in shape over one minute it should be possible to determine whether failed therapy is due to the presence of praziquantel-tolerant worms. It is planned to investigate this in field trials in China. The work was supported by the UNDP/World Bank/WHO Special Programmme for Research and Training in Tropical Diseases. ReferencesColes GC (1979) The effect of praziquantel on Schistoma mansoni. Journal of Helminthology 53, 31-33. Fallon PG, Sturrock RF, Niang AC, Doenhoff MJ (1995) Short report: diminished susceptibility to praziquantel in a Senegal isolate of Schistosoma ...
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