Comparison of four second generation kits for detection of IgG antibodies against Helicobacter pylori in adults

Four serological kits for detection of IgG antibodies against H. pylori were tested on 132 adult patients with dyspeptic symptoms. Presence of H. pylori infection was established when either culture or microscopy of gastric biopsies were positive. The prevalence of H. pylori infection was 55% in the test population. With Anti-H. pylori MTP-assay (Roche), Pylori stat test kit (Whittaker), HM-CAP (Enteric Products Inc.) and Pyloriset EIA-G (Orion) the sensitivities were 97%, 95%, 81% and 68% respectively, the specificities were 53%, 56%, 71% and 69% respectively, the positive predictive values 72%, 74%, 79% and 74% respectively and the negative predictive values were 94%, 92%, 79% and 64% respectively.

Survival and ultrastructural changes of Helicobacter pylori after phagocytosis by human polymorphonuclear leukocytes and monocytes

Few studies have been carried out on the phagocytosis and killing of Helicobacter pylori by both polymorphonuclear leukocytes (PMNs) and monocytes. In this study, H. pylori was incubated for up to 60 min either alone or with phagocytes in the presence or absence of human serum. Both non-immune serum and immune serum were used. Reduction in the number of H. pylori, which corresponds to the killing of H. pylori, was analysed by a colony count and ultrastructural changes were studied by electron microscopy. No reduction in the number of H. pylori was found when the bacteria were incubated alone or with phagocytes in the absence of serum. It is remarkable that unopsonized H. pylori was phagocytosed. When immune serum was added to the suspensions of bacteria and phagocytes, the killing rate of H. pylori was found to depend on the ratio of H. pylori to phagocytes. Thus an excess of monocytes reduced the number of H. pylori, whereas an excess of PMNs resulted in complete killing of H. pylori. On incubation with PMNs and serum, ultrastructural changes were observed in the majority of the bacteria whether they were phagocytosed or not. Controls without serum did not show any changes in the morphology of H. pylori, indicating that components in the serum play an important role in the phagocytosis and killing of H. pylori. In contrast, several of the phagocytosed bacteria were found to be unaffected after incubation with monocytes and serum. Such preparations often contained large aggregates of platelets surrounding unaffected H. pylori. In the gastric mucosa, H. pylori is often found in excess as compared to the phagocytes. If these results can be compared to the situation in vivo, the phagocytes seem to be ineffective in the killing of H. pylori, and other immune mechanisms may therefore be of importance for the elimination of H. pylori from the gastric epithelium. The possible intracellular survival of H. pylori should be taken into account when treatment regimes for H. pylori infections are chosen.

Activation of human phagocyte oxidative metabolism by Helicobacter pylori

A characteristic feature of chronic antral gastritis is the abundant inflammatory response in close association with Helicobacter pylori, but the immunopathological mechanisms of tissue damage are unknown. Because reactive oxygen radicals have been implicated in the tissue damage of other chronic inflammatory disorders, we investigated the potential ability of H. pylori sonicate to influence the oxidative burst responsiveness of human polymorphonuclear leukocytes and monocytes. For both cell types, a dose-dependent stimulation in a chemiluminescence system was observed. Furthermore, preincubation in sonicate caused a marked priming of the cells to subsequent stimulation with the oligopeptide N-f-methionyl-leucyl-phenylalanine and phorbol-myristate-acetate. The sonicate activity was nondialysable, completely destroyed by proteinase and resistant to heat treatment. However, dialysis of boiled sonicate significantly reduced the activity, suggesting the breakdown of a larger molecule(s) to smaller fragments still biologically active. Preliminary experiments suggest that the activity is 25-35 kilodaltons. The demonstration of a protein with stimulatory activity for production of reactive oxygen radicals by human phagocytes may contribute to the understanding of the immunopathology associated with H. pylori infection.

Prevalence of antibodies against heat-stable antigens from Helicobacter pylori in patients with dyspeptic symptoms and normal persons

Heat-stable antigens from Helicobacter pylori were investigated for the detection of serum IgG, IgA and IgM antibodies against H. pylori by an ELISA technique. Antibody titers against H. pylori were measured in 167 dyspeptic patients, of whom 96 were H. pylori positive confirmed by culture or microscopy, and in 482 controls (0-98 years). Increased IgG antibody titers were found significantly more often in dyspeptic patients with active chronic gastritis than in patients with normal morphology, as well as in H. pylori-positive patients as compared to H. pylori-negative patients, independent of the endoscopic findings. The heat-stable antigens were compared with acid glycine-extracted antigens and a high degree of concordance was found in the results obtained with the two antigen preparations. The differences in the IgA antibody titers against H. pylori between H. pylori-positive and H. pylori-negative dyspeptic patients were significant and may be useful to confirm a borderline IgG result. No differences were found in IgM antibody titer between H. pylori-positive and -negative patients. The greatest age-dependent increase in IgG and IgA antibody titers was found in children, and if a lower cut-off level is used for children than for adults, as has been proposed, the proportion of people with increased antibody titers against H. pylori would be almost constant from the age of between five and 10 years until the time between 61 and 80 years. Comparison of H. pylori IgG antibodies with IgG antibodies against Campylobacter jejuni and total antibodies against cytomegalovirus (CMV) showed a greater similarity between H. pylori and C. jejuni (R = 0.51) than between H. pylori and CMV (R = 0.22). This may possibly be caused by cross-reactions between H. pylori and C. jejuni. The H. pylori heat-stabile antigen seems not to be very different from other crude H. pylori antigens like acid glycine-extracted antigens, but purification and characterization of the antigens are needed to improve antibody assays.

IgG subclass antibodies against Helicobacter pylori heat-stable antigens in normal persons and in dyspeptic patients

Measurement of serum IgG antibodies against Helicobacter pylori seems to be useful in the diagnosis of H. pylori infections. IgG subclass antibodies against H. pylori have, however, not been investigated thoroughly. In this study IgG1, IgG2, IgG3 and IgG4 antibody levels against H. pylori were measured using an ELISA technique in 187 normal adult persons and in 174 patients with dyspeptic symptoms, of whom 99 patients were H. pylori positive. None of the IgG subclass antibody levels were better than the total IgG level for the diagnosis of H. pylori infection. The discrimination between H. pylori-positive and H. pylori-negative patients was better with IgG1, IgG2 and IgG4 antibody levels than with IgG3 antibody level. IgG2 was the IgG subclass antibody that mainly contributed to the age-dependent increase in the IgG antibody level. This sustains the suspicion that cross-reactions between lipopolysaccharide (LPS) from H. pylori and LPS from other Gram-negative bacteria may occur.

Immunoglobulin G antibodies to Helicobacter pylori in patients with dyspeptic symptoms investigated by the western immunoblot technique

Helicobacter pylori is a gram-negative, curved, rod-shaped bacterium known to cause gastritis and to be an important factor in the pathogenesis of peptic ulcers. Serological testing has recently been proposed as an aid in diagnosis of H. pylori infections. In this study, we used the Western immunoblot technique to evaluate the possibility of using one or more of the antigens from H. pylori for this purpose. Thirteen major bands and about 30 minor bands could be identified by Western blotting when sera from 53 consecutive dyspeptic patients, 27 healthy children, and 25 blood donors were evaluated. Antibodies against most of the major bands were found significantly more frequently in patients with H. pylori infections than in patients without such infections. However, antibodies against a single polypeptide were not produced by all patients with H. pylori infection. Polypeptides with molecular masses of 120, 50, and between 19 and 36 kDa seem to be the most specific polypeptides for the diagnosis of H. pylori infections. This study showed only minor differences in antigenic composition between different clinical isolates of H. pylori, and serological cross-reactions with other bacteria were limited. Major serological cross-reactions were found only with Campylobacter jejuni and with bacterial lipopolysaccharide. However, one band at 60 kDa reacted with antiserum to the Legionella micdadei common antigen, which may indicate a cross-reaction with common antigen from several other bacteria. This study demonstrates that a number of bands may be useful as antigens in serological tests after isolation and purification.

Chemotactic activity of Helicobacter pylori sonicate for human polymorphonuclear leucocytes and monocytes

The immunopathology of Helicobacter pylori associated active chronic gastritis, which is characterised by predominance of polymorphonuclear leucocyte infiltration, is largely unknown. To evaluate the role of bacterial components as inflammatory mediators ultracentrifuged sonicated preparations were made of clinical isolates of Helicobacter pylori. The crude sonicates were shown to exhibit chemotactic activity for human polymorphonuclear leucocytes and blood monocytes in a concentration dependent fashion. The potency was comparable with previously described bacterial derived cytotaxins. The cytotaxin(s) was non-dialysable and completely destroyed by proteinase. Heat treatment did not decrease the chemotactic activity, but in sonicate subjected to 100 degrees C for 15 minutes all activity disappeared after dialysis suggesting the breakdown of a larger protein to small fragments that are still biological active. By ammonium sulphate precipitation at increasing concentrations the cytotaxin(s) was selectively found in 10% ammonium sulphate saturation, and by further molecular gel separation the chemotactic activity was found in the molecular size range from 25 to 35 kDa. The demonstration of a polymorphonuclear leucocyte and monocyte cytotaxin from Helicobacter pylori sonicate may help in understanding the mucosal immune response in gastric inflammatory diseases.

Effect of selected neuroleptic agents and stereo-isomeric analogues on virus and eukaryotic cells

Chlorpromazine, cis(Z)-chlorprothixene (Truxal), and the non-neuroleptic trans(E)-chlorprothixene and trans(E)-flupenthixol were studied in vitro for possible antiviral effect on Herpes simplex virus 2 and for toxic effect on human diploid fibroblasts. Based on an enzyme-linked immunosorbent assay (ELISA) antiviral activity was demonstrated for all the compounds in the concentration range 0.39 micrograms/ml-25 micrograms/ml. A cell-toxic effect was shown in the higher concentration range for all the compounds except cis(Z)-chlorprothixene. A cell-stimulatory effect was also detected at the lower concentration range (about 3.13 micrograms/ml) for all compounds. Thus both cell stimulation and antiviral effect can be found for the same agent within the same concentration range. The results point to the possibility of creating different antiviral drugs--which would also include a cell-stimulatory activity--among psychopharmacological drugs and their stereoisomeric analogues.

The Helicobacter (Campylobacter) pylori-colonized duodenal mucosa and gastric metaplasia

Biopsies were obtained from non-ulcerated sites of the duodenum from 100 dyspeptic patients. Helicobacter (Campylobacter) pylori was cultivated from 19 of these biopsies. Active chronic duodenitis (ACD) was found in 17 biopsies and more than 5% gastric metaplasia in 20 biopsies. H. pylori as well as ACD occurred with a significantly increased frequency when more than 5% gastric metaplasia was found in the duodenal biopsies. H. pylori on metaplastic tissue without ACD was, however, seen in two cases. H. pylori was cultivated from 9% and ACD was found in 5% of the biopsies with less than 5% gastric metaplasia. Gastric metaplasia in the duodenum was found significantly more frequently in patients with endoscopic duodenitis or duodenal ulceration than in patients with normal endoscopy. No association between gastric metaplasia in the duodenum and gastric pH or serum antibodies against H. pylori was seen. This study indicates that there is an established, but not exclusive, connection between gastric metaplasia and the colonization of the duodenum by H. pylori, the most important role being played by the antral gastric mucosa rather than the duodenum.

Long-term suppression of severe recurrent genital herpes simplex infections with oral acyclovir: a dose-titration study

Twenty immunocompetent patients, four females and 16 males, with severe recurrent genital herpes (median number of recurrences the previous year 16, range (8-24] entered an open continuous long-term suppressive treatment with oral acyclovir (ACV) for 12 months. The study included a dose-titration schedule: (ACV, 200 mg x 4/1-3 months, ACV, 400 mg x 2/4-6 months, ACV, 200 mg x 2/7-9 months, and ACV, 400 mg x 1/10-12 months). Patients with recurrences on steps two and three received an alternative dose of ACV, 200 mg x 3. Otherwise patients entered the previous dose-step. Five (20%) of patients were completely free of symptoms (recurrences and abortive lesions) during the four dose-reduction periods. A further nine patients (50%) could be dose-reduced to 200 mg x 3 without symptoms. Isolates from three patients showed a decrease in virus sensitivity after ceasing treatment. In conclusion, 14/20 of treated patients could be dose reduced to 200 mg x 2-3 without selection of HSV strains showing clinically important decreases in sensitivity towards ACV.

Possible evidence of invasiveness of Helicobacter (Campylobacter) pylori

Gastric/duodenal biopsy material from 52 patients was examined immunohistochemically for Helicobacter (Campylobacter) pylori. Specimens from 34 of the patients harboured Helicobacter pylori along the mucosal surface and 13 of these featured, in addition, immunopositive material within the lamina propria. The remaining 18 biopsies were non-reactive. This observation suggests that Helicobacter pylori can penetrate the epithelium and its basement membrane, resulting in the production of specific systemic antibodies.

Oral acyclovir suppressive therapy in severe recurrent genital herpes. A double-blind, placebo-controlled cross-over study

A randomised, double-blind, placebo-controlled cross-over study was conducted in 24 patients, nine females and 15 males, with a history of more than eight recurrences of genital herpes in the past year. The patients received a first treatment course with 400 mg acyclovir or matching placebo by mouth, twice daily, for 12 weeks. After cross-over patients received alternative medication for another 12 weeks. The patients were followed without treatment for a further three-month period. During acyclovir therapy, recurrences were completely prevented in 17 patients (71%) and the remaining seven patients had nine recurrences as compared to 18 recurrences while receiving placebo. The placebo treatment did not reduce the recurrence rate. No adverse effects were attributable to the acyclovir treatment period. All virus isolates tested after treatment remained sensitive to acyclovir. Acyclovir prophylaxis of recurrent genital herpes is effective and safe. A continuous suppressive therapy with acyclovir offers a basis for a normal sexual life to those patients severely incapacitated by their disease, but once medication is stopped, patients shed virus as before suppression.

Trimipramine and other antipsychotics inhibit Campylobacter pylori in vitro

A series of conventional anti-ulcer drugs, tricyclic antidepressants and neuroleptics (and some CNS non-active isomers) were tested in vitro for possible inhibition of Campylobacter pylori. These bacteria are claimed to play an etiological role in peptic ulcer disease, at least in gastritis B. While cimetidine, famotidine, ranitidine and pirenzepine were inactive, all the antipsychotic agents and their isomeric derivatives were active to various degrees with IC50 of 26-59 microM. Of special interest is trimipramine (Surmontil) that has been demonstrated to be effective against duodenal ulcers in some trials. The activity of the non-neuroleptic stereo-isomers of clopenthixol and chlorprothixene may lead to investigation in patients with peptic ulcer disease of this kind of agents. However, a firm connection between the antimicrobial activity of these compounds, their possible anti-ulcer effect and the etiological role of Campylobacter pylori in peptic ulcer disease must first be established.

Jejunal diverticulosis in a family

The presence of small intestinal diverticula was examined in a family of eight siblings. Six of the siblings had diverticula of the duodenum and/or the jejunoileal tract. Three of them had multiple jejunoileal diverticula, one had two jejunal diverticula, and two had duodenal diverticula. In addition, diseases of an immunologic nature were present in four of the siblings (rheumatoid arthritis, ulcerative colitis, myxoedema following thyroiditis, and non-viral hepatitis).

Campylobacter pylori in peptic ulcer disease. II. Endoscopic findings and cultivation of C. pylori

Specimens from 153 consecutive patients were cultivated for C. pylori, and findings were correlated to the endoscopic findings. C. pylori was cultivated more frequently from males than from females. Culture-positive males had a high frequency of prepyloric abnormalities. No correlation between age or pH in gastric juice and cultivation of C. pylori was found. C. pylori was found significantly more often in patients with peptic ulcer and/or duodenitis than in patients with normal endoscopic findings. No differences could be detected between patients with gastritis or esophagitis and patients with normal endoscopic findings. C. pylori was found most frequently in the antral part of the stomach. It was cultivated significantly more often from patients with duodenal abnormalities than from patients with normal endoscopic findings. In less than half of the culture-positive patients with duodenal abnormalities we cultivated C. pylori from duodenal specimens. This study also showed C. pylori in esophageal specimens, which has not been previously described. Our results suggest that cultivation of C. pylori from duodenal specimens or gastric fluid samples gives no additional information beyond that obtained from the cultivation of antral biopsy specimens. It is our opinion that C. pylori, at least in some cases, may be a secondary infection.

Campylobacter pylori detected by indirect immunohistochemical technique

An immunohistochemical assay for staining C. pylori is described. The method is compared with cultivation of C. pylori and observation of campylobacter-like organisms (CLOs) in hematoxyline-eosine (HE) stained sections. Eighteen biopsies from which C. pylori was cultivated but not seen in HE stained sections and three culture negative biopsies with CLOs seen in HE stained sections were selected from 331 biopsies including 113 culture positive biopsies. There were agreements between cultivation of C. pylori and CLOs seen in HE stained sections in the remaining 310 biopsies. Fourteen of the 18 and one of the three biopsies were found positive by the immunohistochemical assay. In addition 21 culture-positive control biopsies and one of 18 culture-negative control biopsies were also found positive. When the immunohistochemical assay was compared with cultivation the predictive value of positive result is 93% and of negative result 89%. By this method we were able to detect single organisms and no cross-reactions to other curved bacteria on the gastric epithelium were observed.

In vitro susceptibility of diarrhoea producing gram negative enteric bacteria to sulfasalazine, 5-aminosalicylic acid, sulfapyridine and four quinolones. Brief report

The in vitro susceptibility of diarrhoea producing Gram negative enteric bacteria to sulfasalazine, 5-aminosalicylic acid, sulfapyridine and four quinolones was investigated using an agar dilution method. All strains were resistant to 1600 micrograms/ml of sulfasalazine and 5-aminosalicylic acid. MIC range of sulfapyridine for Y. enterocolitica was 3.1-25 micrograms/ml (median:6.2) and for Salmonella 25-100 micrograms/ml (median: 100) Campylobacter jejuni/coli were less susceptible to sulfapyridine with MIC values ranging from 200 to 800 micrograms/ml. Shigella and three of five E. coli strains were resistant to 1600 micrograms/ml of sulfapyridine. Two strains of E. coli were inhibited by 25 micrograms/ml. All strains were fairly susceptible to enoxacin, ciprofloxacin, pefloxacin and ofloxacin. Cirpofloxacin was the most active drug on weight basis.

Campylobacter pylori in peptic ulcer disease. III. Symptoms and paraclinical and epidemiologic findings

Only a few publications have dealt with the subjective symptoms, the paraclinical findings, or the epidemiology in relation to cultivation of C. pylori. Seventy-two patients answered a questionnaire containing questions about symptoms, dietary habits, smoking, and animal contact. C. pylori was cultivated from the biopsy specimens of 41 of these patients, and 31 were culture-negative. In addition, leukocyte count, differential count, and blood immunoglobulins were measured. In many culture-positive patients a variation in symptoms during the year was found, and symptoms had lasted more than 5 years. This was statistically significant for non-ulcer patients. In addition, we found initial abdominal pain and present vomiting to be significant features, but they did not seem to have any clinical significance. Unlike Marshall & Warren, we did not find ructus to be related to infections with C. pylori. In all other respects we found no differences between culture-negative and culture-positive patients. It was not possible to detect any descriptive variables in patients with C. pylori infections.

Nasopharyngeal bacteriology and secretory otitis media in young children

A prevalence study was performed on the nasopharyngeal bacteriology of 112 young children, aged 4-6 years. During the preceding 2 years, 74 of these children had suffered from secretory otitis media (SOM) and 40 had had normal middle ear ventilation. At the examination, one-third of the children with SOM had improved their middle ear status (previous SOM group), whereas otomicroscopy and tympanometry remained unchanged in the healthy group. The nasopharyngeal swab sample was obtained from behind the soft palate by the oral route. The isolation rate of Streptococcus pneumoniae was significantly higher in the SOM group than in the two other groups of children (p less than 0.006). The most commonly isolated capsular types of pneumococci were 6, 19, and 23, corresponding to the types involved in acute otitis media. The isolation rate of Haemophilus influenzae was 50% and an even distribution was found among the three groups of children examined. Biotypes I, II, III and IV accounted for 75% of the isolated cases of H. influenzae. As in acute otitis media, S. pneumoniae also seemed to play an important role in the pathogenesis of tubal dysfunction and SOM, and the difference is probably caused by variations in the quantitative colonization of pneumococci in the nasopharynx.

In vitro susceptibility of Campylobacter pyloridis to cimetidine, sucralfate, bismuth and sixteen antibiotics

The in vitro susceptibility of recent Danish human clinical isolates of Campylobacter pyloridis to cimetidine, sucralfate, bismuth subsalicylate and sixteen antimicrobial agents was determined by an agar-dilution technique. Benzylpenicillin was the most active drug (MIC90 = 0.1 microgram/ml); ampicillin, erythromycin, gentamicin and ciprofloxacin were slightly less active. All strains were resistant to 100 micrograms sulfamethizole, and nalidixic acid also had little activity on weight basis. Of the three anti-peptic ulcer drugs, bismuth subsalicylate was most active (MIC90 25 micrograms/ml), but sucralfate and cimetidine also had antibacterial activity, although only little (MIC90 3200 micrograms/ml).

Campylobacter pyloridis in peptic ulcer disease. I. Gastric and duodenal infection caused by C. pyloridis: histopathologic and microbiologic findings

In this study 153 patients with dyspepsia were biopsied in the gastric antrum and duodenum. All specimens were investigated histopathologically and microbiologically for the presence of Campylobacter pyloridis, and the type of inflammation was recorded in accordance with Morson's criteria. C. pyloridis was found beneath the mucus close to the epithelial cells and mostly in connection with granulocytic infiltration (active gastritis). C. pyloridis was cultured from all of 10 patients with histologically active gastritis and active duodenitis, in 86% of 64 patients with active gastritis and morphologically normal duodenum, and in only 5% of 79 patients without morphologic gastric and duodenal changes. The close relation between active gastritis and C. pyloridis shows that C. pyloridis plays an important role in gastric inflammation, as it fulfils the criterion for a localized bacterial infection.