1160
which data were negativeStatistical comparison with Crombie and colleagues’ study is not possible but there is little doubt that the Dundee children were also better nourished. So far three studies have described a sample sub-set with a poor diet, that responds to supplementation (ref 4, Schoenthaler et al, and this study). In other studies, reporting beneficial responses, the sample was chosen on the basis of dietary problemsor for social disadvantage such that nutritional problems might have existed.3 Thus the picture that is emerging is a subset of children, consuming a poor diet, who benefit from vitamin/mineral supplementation. We thank
localised and the timing, in May to July, need to be elucidated. Are these patterns connected with bird behaviour or with other local environmental factors? Case-control studies are underway. Department of Microbiology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
S. J.
Gateshead Health Authority
A. O. SOBO
Civic Centre, Gateshead
K. RUSSEL
Public Health Laboratory, Newcastle
N. F. LIGHTFOOT
HUDSON
Cyanamid-Benelux for its support.
Department of Psychology, University College, Swansea SA2 8PP, UK
D. BENTON
Department of Paediatrics, University Catholique de Louvain, Brussels, Belgium
J.-P. BUTS
1. Benton D, Roberts G. Effect of vitamin and mineral supplementation on intelligence of a sample of schoolchildren. Lancet 1988; i: 140-43. 2. Colgan M, Colgan L. Do nutrient supplements and dietary changes affect learning and emotional reactions of children with learning difficulties? a controlled series of 16 cases. Nutr Health 1984; 3: 69-77. 3. Boggs UR, Scheaf A, Santoro D, Ritzman R. The effects of nutrient supplements on the biological and psychological characteristics of low IQ preschool children.
J Orthomol Psychiat 1985; 14: 97-127. 4. Schoenthaler S. Malnutrition and maladaptive behavior: two correlational analyses and a double-blind placebo-controlled challenge in five states. In: Essman WB ed. Nutrients and brain function. Karger: Basel 1987. 5. Nelson M, Naismith DJ, Burley V, Gatenby S, Geddes N. Nutrient intake vitamin/mineral supplementation and intelligence in British shoolchildren. Br J Nutr (in press).
as potential source of milk-borne Campylobacter jejuni infection
Jackdaws
SIR,-Since 1981 Campylobacter jejuni has been the most commonly reported cause of acute diarrhoea in the UKl yet only rarely has the source of infection been proved. Few routes by which infection may be transferred from animals to man have been defined, yet campylobacters are widely distributed as commensals in poultry, swine, sheep, cattle, dogs, cats, and wild birds.2 During routine surveillance of campylobacter enteritis in Gateshead a cluster of 58 cases was identified over a 3-month period in a rural part of the district. Most of the cases could remember, in the week before onset of symptoms, drinking cold milk from bottles whose tops had been pecked by birds. Food histories obtained by environmental health officers showed that milk delivered to the doorstep was the only common food in all cases; the cases all lived in a housing development adjacent to open countryside and many had seen members of the crow family, notably magpies, pecking milk bottle tops; and cases within the same household had onset dates more than 7 days apart, suggesting a regular source of infection rather than an isolated incident. Environmental health officers and the local newspapers photographed jackdaws attacking milk bottles. Five pecked bottles as well as four intact ones were submitted to the Public Health Laboratory. C jejuni was isolated from two damaged bottles. No undamaged bottle showed any evidence of campylobacter. Two isolates from cases were serotyped--one was Lior non-typable/ Penner serogroup 35 and the other was Lior serogroup 1/Penner non-typable. The only isolate from milk that was available for serogrouping was Lior serogroup 20/Penner non-typable. In previous milkborne outbreaks where C jejuni has been isolated either from cases or milk filters several types have been isolated.3 Wild birds constitute an extensive reservoir of C jejuni.4 Serotypes from the two cases and the one from milk were not identical. The heterogeneity of C jejuni serotypes may be related to the wide distribution of this organism in nature. Further work is in progress to identify species of birds carrying C jejuni and to determine the mode of transmission by birds. C jejuni has been isolated from the beaks and cloacae of jackdaws (N. F. L., personal communication). Also the reasons for the outbreak being
1. Galbraith NS. Campylobacter enteritis. Br Med J 1988; 297: 1219-20. 2. Smibert RM. The genus Campylobacter. Annu Rev Microbiol 1978; 32: 673-705. 3. Robinson DA, Jones DM. Milkborne campylobacter infection. Br Med J 1981; 282: 1374-76. 4. Kapperud G, Rosef O. Avian wildlife reservoir of Campylobacter fetus subsp jejunt, Yersinia spp and Salmonella spp in Norway. Appl Environ Microbiol 1983; 45: 375-80.
hepatitis in children and hepatitis C virus testing
Autoimmune
SIR,-In children autoimmune hepatitis is a severe inflammatory disease of the liver characterised by the presence of high serum titres of non-organ specific autoantibodies. Two main subgroups of the disease have been defined, according to the presence of serum antibodies to actin cable or liver-kidney microsome (anti-LKMj).2,J The cause of this condition is unknown. However, Dr Lenzi and colleagues report (Feb 3, p 258) a high prevalence of hepatitis C virus (HCV) antibody positivity in adults with anti-LKM, - associated chronic liver disease, and suggest that HCV infection might trigger autoimmune responses. In their series,1 of 3 children was also anti-HCV positive. We have tested 55 serum samples, stored at - 20°C, from 33 French and 5 Italian children with autoimmune hepatitis. 16 children were positive for anti-LKM, 18 for anti-actin, and 4 for the newly described liver cytosol (anti-LC1) autoantibody.’’ Serum immunofluorescence autoantibody titres in all children were 100 or more before treatment in all children. None had received any transfusion of blood or blood-derived products. Thirty-six samples were obtained before treatment and nineteen during immunosuppressive therapy with prednisone and azathioprine (fifteen while the child was in clinical and biochemical remission, and four during relapse). Sera were available before and during immunosuppressive treatment in 17 children. Anti-HCV testing was done with a commercially available enzyme-linked immunosorbent assay (Ortho Diagnostic, USA). The table shows the test results. Twenty-three of the thrity-six sera (64%) obtained before treatment were anti-HCV positrive.
Only four of the nineteen sera obtained during immunosuppressive treatment were positive for anti-HCV: two had a borderline positivity and the other two were obtained during relapse. Of the 17i children studied before and during treatment, 1 was negative in both instances, 16 were positive at diagnosis, but 13 were anti-HCV negative while on immunosuppressive therapy. These results show a high frequency of positive anti-HCV tests in children with untreated autoimmune hepatitis. Anti-HCV positivity was not restricted to anti- LKM1 positive patients and was also seen in children with actin cable or LCi autoantibodies. In addition, anti-HCV tests were more often positive in children with ANTI-HCV TESTING IN CHILDREN WITH AUTOIMMUNE HEPATITIS
*2 of 3 patients In relapse † Borderlme posrtrvity
†Borderline positivity
which data were negativeStatistical comparison with Crombie and colleagues’ study is not possible but there is little doubt that the Dundee children were also better nourished. So far three studies have described a sample sub-set with a poor diet, that responds to supplementation (ref 4, Schoenthaler et al, and this study). In other studies, reporting beneficial responses, the sample was chosen on the basis of dietary problemsor for social disadvantage such that nutritional problems might have existed.3 Thus the picture that is emerging is a subset of children, consuming a poor diet, who benefit from vitamin/mineral supplementation. We thank
localised and the timing, in May to July, need to be elucidated. Are these patterns connected with bird behaviour or with other local environmental factors? Case-control studies are underway. Department of Microbiology, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
S. J.
Gateshead Health Authority
A. O. SOBO
Civic Centre, Gateshead
K. RUSSEL
Public Health Laboratory, Newcastle
N. F. LIGHTFOOT
HUDSON
Cyanamid-Benelux for its support.
Department of Psychology, University College, Swansea SA2 8PP, UK
D. BENTON
Department of Paediatrics, University Catholique de Louvain, Brussels, Belgium
J.-P. BUTS
1. Benton D, Roberts G. Effect of vitamin and mineral supplementation on intelligence of a sample of schoolchildren. Lancet 1988; i: 140-43. 2. Colgan M, Colgan L. Do nutrient supplements and dietary changes affect learning and emotional reactions of children with learning difficulties? a controlled series of 16 cases. Nutr Health 1984; 3: 69-77. 3. Boggs UR, Scheaf A, Santoro D, Ritzman R. The effects of nutrient supplements on the biological and psychological characteristics of low IQ preschool children.
J Orthomol Psychiat 1985; 14: 97-127. 4. Schoenthaler S. Malnutrition and maladaptive behavior: two correlational analyses and a double-blind placebo-controlled challenge in five states. In: Essman WB ed. Nutrients and brain function. Karger: Basel 1987. 5. Nelson M, Naismith DJ, Burley V, Gatenby S, Geddes N. Nutrient intake vitamin/mineral supplementation and intelligence in British shoolchildren. Br J Nutr (in press).
as potential source of milk-borne Campylobacter jejuni infection
Jackdaws
SIR,-Since 1981 Campylobacter jejuni has been the most commonly reported cause of acute diarrhoea in the UKl yet only rarely has the source of infection been proved. Few routes by which infection may be transferred from animals to man have been defined, yet campylobacters are widely distributed as commensals in poultry, swine, sheep, cattle, dogs, cats, and wild birds.2 During routine surveillance of campylobacter enteritis in Gateshead a cluster of 58 cases was identified over a 3-month period in a rural part of the district. Most of the cases could remember, in the week before onset of symptoms, drinking cold milk from bottles whose tops had been pecked by birds. Food histories obtained by environmental health officers showed that milk delivered to the doorstep was the only common food in all cases; the cases all lived in a housing development adjacent to open countryside and many had seen members of the crow family, notably magpies, pecking milk bottle tops; and cases within the same household had onset dates more than 7 days apart, suggesting a regular source of infection rather than an isolated incident. Environmental health officers and the local newspapers photographed jackdaws attacking milk bottles. Five pecked bottles as well as four intact ones were submitted to the Public Health Laboratory. C jejuni was isolated from two damaged bottles. No undamaged bottle showed any evidence of campylobacter. Two isolates from cases were serotyped--one was Lior non-typable/ Penner serogroup 35 and the other was Lior serogroup 1/Penner non-typable. The only isolate from milk that was available for serogrouping was Lior serogroup 20/Penner non-typable. In previous milkborne outbreaks where C jejuni has been isolated either from cases or milk filters several types have been isolated.3 Wild birds constitute an extensive reservoir of C jejuni.4 Serotypes from the two cases and the one from milk were not identical. The heterogeneity of C jejuni serotypes may be related to the wide distribution of this organism in nature. Further work is in progress to identify species of birds carrying C jejuni and to determine the mode of transmission by birds. C jejuni has been isolated from the beaks and cloacae of jackdaws (N. F. L., personal communication). Also the reasons for the outbreak being
1. Galbraith NS. Campylobacter enteritis. Br Med J 1988; 297: 1219-20. 2. Smibert RM. The genus Campylobacter. Annu Rev Microbiol 1978; 32: 673-705. 3. Robinson DA, Jones DM. Milkborne campylobacter infection. Br Med J 1981; 282: 1374-76. 4. Kapperud G, Rosef O. Avian wildlife reservoir of Campylobacter fetus subsp jejunt, Yersinia spp and Salmonella spp in Norway. Appl Environ Microbiol 1983; 45: 375-80.
hepatitis in children and hepatitis C virus testing
Autoimmune
SIR,-In children autoimmune hepatitis is a severe inflammatory disease of the liver characterised by the presence of high serum titres of non-organ specific autoantibodies. Two main subgroups of the disease have been defined, according to the presence of serum antibodies to actin cable or liver-kidney microsome (anti-LKMj).2,J The cause of this condition is unknown. However, Dr Lenzi and colleagues report (Feb 3, p 258) a high prevalence of hepatitis C virus (HCV) antibody positivity in adults with anti-LKM, - associated chronic liver disease, and suggest that HCV infection might trigger autoimmune responses. In their series,1 of 3 children was also anti-HCV positive. We have tested 55 serum samples, stored at - 20°C, from 33 French and 5 Italian children with autoimmune hepatitis. 16 children were positive for anti-LKM, 18 for anti-actin, and 4 for the newly described liver cytosol (anti-LC1) autoantibody.’’ Serum immunofluorescence autoantibody titres in all children were 100 or more before treatment in all children. None had received any transfusion of blood or blood-derived products. Thirty-six samples were obtained before treatment and nineteen during immunosuppressive therapy with prednisone and azathioprine (fifteen while the child was in clinical and biochemical remission, and four during relapse). Sera were available before and during immunosuppressive treatment in 17 children. Anti-HCV testing was done with a commercially available enzyme-linked immunosorbent assay (Ortho Diagnostic, USA). The table shows the test results. Twenty-three of the thrity-six sera (64%) obtained before treatment were anti-HCV positrive.
Only four of the nineteen sera obtained during immunosuppressive treatment were positive for anti-HCV: two had a borderline positivity and the other two were obtained during relapse. Of the 17i children studied before and during treatment, 1 was negative in both instances, 16 were positive at diagnosis, but 13 were anti-HCV negative while on immunosuppressive therapy. These results show a high frequency of positive anti-HCV tests in children with untreated autoimmune hepatitis. Anti-HCV positivity was not restricted to anti- LKM1 positive patients and was also seen in children with actin cable or LCi autoantibodies. In addition, anti-HCV tests were more often positive in children with ANTI-HCV TESTING IN CHILDREN WITH AUTOIMMUNE HEPATITIS
*2 of 3 patients In relapse † Borderlme posrtrvity
†Borderline positivity
