Helicobacter pylori (H. pylori) urease is a key protein for persistent infection of the bacteria in the stomach. Although H. pylori generally induce anti-H. pylori-specific antibodies (Abs), these Abs do not usually work for eradication or prevention of the H. pylori infection. In our previous study, we identified a linear epitope composed of 19-mer peptides termed UB-33, CHHLDKSIKEDVQFADSRI, within the large subunit of H. pylori urease. Anti-UB-33-specific Abs neutralized the enzymatic activity of H. pylori urease in vitro. In the present study, we evaluated the effect of immunization of BALB/c mice with H. pylori UB-33 peptide. After confirming the production of anti-UB-33-specific Abs, mice were challenged orally with H. pylori Sydney Strain-1 (SS-1). Mice producing anti-UB-33-specific Abs were not infected with SS-1, and the amount of SS-1 isolate in their stomach was significantly reduced. Also, the urease-negative mutant of H. pylori, HPP1801, did not colonize in the stomach, indicating that H. pylori urease was a critical element for infection of H. pylori in the gastric mucosa. Moreover, mice producing UB-33-specific Abs apparently suppressed H. pylori infection in the stomach where anti-UB-33 Abs were secreted in the gastric juice, indicating that H. pylori colonization was inhibited in the presence of anti-UB-33 Abs. In addition, the neutralization activity of sera from mice immunized with purified urease was less potent than that in the sera from mice immunized with UB-33. Furthermore, the recognition of epitope UB-33 was mediated through Toll-like receptor 2 (TLR2) on the B-1 cells using TLR2-knockout BALB/c mice in vivo. These results indicate that liner peptide UB-33 should be used for immunization to induce neutralizing Abs instead of purified H. pylori urease to prevent H. pylori infection and their colonization in the stomach.
Malrotation is the incomplete rotation of the intestine during the fetal period. We report a case of midgut volvulus due to intestinal malrotation in a 4-year-boy. The patient was hospitalized for abdominal pain and non-biliary emesis. Biliary emesis was observed on the second day, and intestinal obstruction was suspected. Enhanced abdominal computed tomography showed that the positions of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) were reversed left and right (SMV rotation sign), with swirling of the SMV around the SMA (whirlpool sign). The diagnosis was midgut volvulus with abnormal intestinal rotation. Emergency Ladd surgery was performed on the same day. Since surgery, the patient has not re-twisted and is in good condition. The majority of such patients are diagnosed within the first year of life with symptoms of biliary emesis and bowel obstruction.Although midgut volvulus is rare in young children, it is necessary to consider the possibility.
Delayed diagnosis of bacterial meningitis has a significant impact on prognosis and should not be overlooked. Cases of recurrent bacterial meningitis in infancy may be associated with underlying diseases such as immunodeficiencies and congenital deformities, including those of the inner ear. Streptococcus pneumoniae is a highly invasive causative agent, but the number of patients with meningitis has decreased dramatically in recent years due to the widespread use of the 13-valent pneumococcal conjugate vaccine. However, cases of vaccinated patients having invasive pneumococcal infection have been reported due to serotypes changing. We report a case of recurrent bacterial meningitis in an infant. The second occurrence was associated with Mondini deformity, for which surgical treatment was planned. The third was observed while the patient was awaiting surgery, and the fourth postoperatively. This study presents the clinical course of the Mondini deformity in this patient, which was difficult to manage due to the recurrent bacterial meningitis, and draws on epidemiological data concerning invasive pneumococcal infections occurring between April 2013 and March 2021 in Kawasaki City,
Purpose The duration of antimicrobial therapy for febrile urinary tract infections (fUTI) in children have not been established. This study aimed to explore the appropriate duration of the treatment for fUTI in children. Methods We created a protocol to determine the duration of antibiotic administration based on the fever. Transvenous antibiotics were administered for 3 days after the resolution of fever, followed by oral antibiotics for 1 week. Diagnosis of fUTI was based on a fever of 37.5°C or higher and a quantitative culture of catheterized urine showed ≥5 × 104 bacteria. Acute focal bacterial nephritis (AFBN) and pyelonephritis (PN) were diagnosed based on contrast-enhanced computed tomography (eCT) findings. We retrospectively reviewed the treatment outcomes. Results Of the 78 patients treated according to our protocol, 58 were included; 49 with PN (30 men) and nine with AFBN (three men). Blood test results showed that patients with AFBN had significantly higher white blood cell and C-reactive protein levels than those with PN; however, no differences were observed in the urinary findings and causative bacteria. The time to resolution of fever and duration of intravenous antibiotic administration were significantly longer in patients with AFBN than in those with PN. However, the average duration of AFBN treatment was 14.2 days, which was shorter than the previously reported 3-week administration and no recurrence was observed in AFBN patients. Conclusions The protocol created to determine the duration of antimicrobial treatment based on fever is useful. Invasive examinations, such as eCT, are not required.
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