423 role of staff members in children’s wards.
ROTAVIRUS ASSOCIATED WITH ACUTE GASTROENTERITIS IN ADULTS to a considerable proportion of non-bacterial gastroenteritis in children being caused by a reovirus-like agent’ now generally referred to as rotavirus.2 Cnlike the Norwalk agent, another diarrhoea-associated virus,3 the rotavirus is generally considered to infect only infants and young children.4 Rotavirus infection in schoolchildren (6-12 years old) has also been noted’ but, to our knowledge, only one experimental case in an adult has hitherto been reported.6 During an outbreak of gastroenteritis (March to April, 1976) at a pxdiatric ward for non-infectious diseases some of the staff also contracted the disease. Stool samples were suspended in phosphate-buffered saline and, after brief centrifu-
SIR,—Several reports point
acute
gation, negatively stained preparations were examined by electron microscopy. Typical rota virus particles were found in one of the two nurses from whom samTests for pathogenic bacteria were nega-
several children and in
ples were obtained.
tive. A similar situation
was discovered at Rinnekoti, an institute for mentally retarded children. During an outbreak of gastroenteritis rotavirus was found in stool samples of several children. In two nurses with severe acute gastroenteritis rotavirus was present in stool samples taken between the second and fifth day from the onset of the disease. In later samples no virus was found. Immune electron microscopy4revealed the development of rotavirus coating and aggregating antibodies in serum obtained from one of these patients. The above findings suggested that adults may contract rotavirus infections, at least when exposed to rotavirus-excreting children. To find out whether rotavirus might occur more generally in connection with adult gastroenteritis, stool and serum samples were collected from cases of acute gastroenteritis at the hospital staff occupational health station of the Helsinki University Central Hospital. During a 6-week period in April and May, 1976, adequate samples were obtained from 42 patients. In 11 of these rotavirus could be visualised in the stool samples taken from one up to nine days after the onset of the dtsease. By immune electron microscopy it was found that antibodies developed in all 7 rota virus-positive patients studied. The diarrhoea in these patients was often severe, associated with relatively high fever (>39°C), and lasted for about two days. These patients were from several different clinics and wards; only 2 of them had occupational contact with children. Our results clearly indicate that rota virus can be associated with acute gastroenteritis of adults. This does not contrast with the high incidence of rota virus-specific antibodies found in adults.’9 It cannot at present be judged, however, whether the observed clinical symptoms are caused primarily by the viral multiplication in the intestines, especially since rotavirus has been found in symptom-free newborn babies.1O In our material the rota virus incidence in adult gastroenteritis was comparable to that found in 115 children examined during the same time period (26 and 40%, respectively). More extended studies are needed to establish whether rotavirus is a common causative agent of adult gastroenteritis in the community. These findings also call for attention to be paid to the possible
1 Bishop, R F, Davidson,
G.
P., Holmes,
I.
A., Ruck,
B.
J. Lancet, 1974,
i,
transmitting
Department of Virology, University of Helsinki,
rotavirus infections in
C. -H. VON BONSDORFF
00290 Helsinki 29, Finland
T HOVI
Helsinki
P. MÅKELÅ L. HOVI M. TEVALVOTO-AARNIO
University Central Hospital
Children’s
Hospital, University of Helsinki
IMMUNOSUPPRESSION BY FATTY ACIDS
SIR--Smith and his colleagues (July 31,
p.
254) emphasise
wide range of long-chain fatty acids have an immunosuppressive effect, by reference to results obtained with heptadecanoic acid. Its effect seems unlikely to be very different from that of the common hexadecanoic acid (palmitic acid). At any rate, Mertin and Hughes’ chose to study unsaturated fatty acids because they were attracted to the idea that a prostaglandin-like action might account for the immunosuppressive effects. I would like to point out that a non-specific detergent action of the long-chain fatty acids has been invoked to explain events in enzyme regulation2 and notably in the feedback control of fatty-acid synthetase.3 If the fatty acids were to enter the immunocytes one could envisage alteration of the catalytic efficiency or the synthesis-rate of a variety of enzymes. However, more attractive to me is the idea that minute concentrations of fatty acids can easily alter the membrane distribution of immunocyte receptor groups in a way comparable to the means whereby IgG has been shown on T cells.4 When, in due course, more clinical trials are mounted on the effects of the various fatty acids, attention will have to be paid to the devastating effects that they are liable to have on vascular endothelium.5 In renal transplantation a combined lipidlowering and immunosuppressive agent would be of value. Has anybody examined clofibrate or halofenate for an immunosuppressive action? that
a
33 Hawthorn
Gardens,
Kenton, Newcastle upon
Tyne NE3
3DE
E. N. WARDLE
LOW-DOSE HEPARIN IN TOTAL HIP REPLACEMENT
SIR,—Of the 84 patients in the study by Sagar et al.,’ only 41 had venograms. Since at least 22 of these venograms were done on patients in the control group, at most only 19 venograms could have been done in the 52 patients in the treated group. Our study7 clearly showed that fibrinogen scanning will not detect major thrombi in the thigh in most instances after hip surgery. Thus the true prevalence of thigh thrombi in the treated group is unknown in 33 of the 52 treated patients. This is a serious weakness of this study. We feel that, in hip patients, venography must be done routinely in all patients in order to ascertain the true prevalence of deep venous thrombosis.
149
2 Almeida,J D , Zackerman, A. J Nature, 1976, 260, 393. 3 Kapikian, A Z, Wyatt, R. G., Dolin, R., Thornhill, T. S., Kalica, Chanock, R M. J. Virol. 1972, 10, 1075.
Research Laboratories, Massachusetts General Hospital, Boston, Massachusetts 02114, U.S.A.
Orthopædic A. R.,
WILLIAM H. HARRIS
4 Kapikian, A. Z Prev. Med. 1974, 3, 535.
5 Hara, M, Mukoyama, J., Tsuruhara, T., Saito, Y., Tagaya, I. Lancet, 1976, i, 311
6 Middleton, P J , Szymanski, M T., Abbott, G. D., Bortolussi, R., Hamilton, J R ibid 1974, i, 1241. 7 Almeida, J D., Waterson, A. P Adv. Virus Res. 1967, 15, 307. 8 Middleton, P J, Petnc, M., Hewitt, C. M , Szymanski, M. T., Tam, I. S. J clin. Path 1976, 29, 191. 9 ∅rstavik,I,Figenschan, K. J., Haug, K. W., Ulstrup, J. C. Scand. J. infect. Dis. 1976, 8, 1. 10 Wkly.
Epidem Rec. 1976, 51, 131.
1. Mertin, J., Hughes, D. Int. Archs Allergy. 1975, 48, 203. 2. Taketa, K., Pogell, B. M. J. biol. Chem. 1966, 241, 720. 3. Dorsey, J. A., Porter, J. W. ibid. 1968, 243, 3512. 4. Cone, R. E., Brown, W. C. Immunochemistry, 1976, 13, 571. 5. Bloom, W. L. Metabolism, 1967, 16, 777. 6. Sagar, S., Nairn, D., Stamatakis, J. D., Maffti, F. H., Higgins, A. Thomas, D. P., Kahhar, V. V. Lancet, 1976, i, 1151. 7. Harris, W. H., and others. New Engl. J. Med. 1975, 29, 665.
F.,
ROTAVIRUS ASSOCIATED WITH ACUTE GASTROENTERITIS IN ADULTS to a considerable proportion of non-bacterial gastroenteritis in children being caused by a reovirus-like agent’ now generally referred to as rotavirus.2 Cnlike the Norwalk agent, another diarrhoea-associated virus,3 the rotavirus is generally considered to infect only infants and young children.4 Rotavirus infection in schoolchildren (6-12 years old) has also been noted’ but, to our knowledge, only one experimental case in an adult has hitherto been reported.6 During an outbreak of gastroenteritis (March to April, 1976) at a pxdiatric ward for non-infectious diseases some of the staff also contracted the disease. Stool samples were suspended in phosphate-buffered saline and, after brief centrifu-
SIR,—Several reports point
acute
gation, negatively stained preparations were examined by electron microscopy. Typical rota virus particles were found in one of the two nurses from whom samTests for pathogenic bacteria were nega-
several children and in
ples were obtained.
tive. A similar situation
was discovered at Rinnekoti, an institute for mentally retarded children. During an outbreak of gastroenteritis rotavirus was found in stool samples of several children. In two nurses with severe acute gastroenteritis rotavirus was present in stool samples taken between the second and fifth day from the onset of the disease. In later samples no virus was found. Immune electron microscopy4revealed the development of rotavirus coating and aggregating antibodies in serum obtained from one of these patients. The above findings suggested that adults may contract rotavirus infections, at least when exposed to rotavirus-excreting children. To find out whether rotavirus might occur more generally in connection with adult gastroenteritis, stool and serum samples were collected from cases of acute gastroenteritis at the hospital staff occupational health station of the Helsinki University Central Hospital. During a 6-week period in April and May, 1976, adequate samples were obtained from 42 patients. In 11 of these rotavirus could be visualised in the stool samples taken from one up to nine days after the onset of the dtsease. By immune electron microscopy it was found that antibodies developed in all 7 rota virus-positive patients studied. The diarrhoea in these patients was often severe, associated with relatively high fever (>39°C), and lasted for about two days. These patients were from several different clinics and wards; only 2 of them had occupational contact with children. Our results clearly indicate that rota virus can be associated with acute gastroenteritis of adults. This does not contrast with the high incidence of rota virus-specific antibodies found in adults.’9 It cannot at present be judged, however, whether the observed clinical symptoms are caused primarily by the viral multiplication in the intestines, especially since rotavirus has been found in symptom-free newborn babies.1O In our material the rota virus incidence in adult gastroenteritis was comparable to that found in 115 children examined during the same time period (26 and 40%, respectively). More extended studies are needed to establish whether rotavirus is a common causative agent of adult gastroenteritis in the community. These findings also call for attention to be paid to the possible
1 Bishop, R F, Davidson,
G.
P., Holmes,
I.
A., Ruck,
B.
J. Lancet, 1974,
i,
transmitting
Department of Virology, University of Helsinki,
rotavirus infections in
C. -H. VON BONSDORFF
00290 Helsinki 29, Finland
T HOVI
Helsinki
P. MÅKELÅ L. HOVI M. TEVALVOTO-AARNIO
University Central Hospital
Children’s
Hospital, University of Helsinki
IMMUNOSUPPRESSION BY FATTY ACIDS
SIR--Smith and his colleagues (July 31,
p.
254) emphasise
wide range of long-chain fatty acids have an immunosuppressive effect, by reference to results obtained with heptadecanoic acid. Its effect seems unlikely to be very different from that of the common hexadecanoic acid (palmitic acid). At any rate, Mertin and Hughes’ chose to study unsaturated fatty acids because they were attracted to the idea that a prostaglandin-like action might account for the immunosuppressive effects. I would like to point out that a non-specific detergent action of the long-chain fatty acids has been invoked to explain events in enzyme regulation2 and notably in the feedback control of fatty-acid synthetase.3 If the fatty acids were to enter the immunocytes one could envisage alteration of the catalytic efficiency or the synthesis-rate of a variety of enzymes. However, more attractive to me is the idea that minute concentrations of fatty acids can easily alter the membrane distribution of immunocyte receptor groups in a way comparable to the means whereby IgG has been shown on T cells.4 When, in due course, more clinical trials are mounted on the effects of the various fatty acids, attention will have to be paid to the devastating effects that they are liable to have on vascular endothelium.5 In renal transplantation a combined lipidlowering and immunosuppressive agent would be of value. Has anybody examined clofibrate or halofenate for an immunosuppressive action? that
a
33 Hawthorn
Gardens,
Kenton, Newcastle upon
Tyne NE3
3DE
E. N. WARDLE
LOW-DOSE HEPARIN IN TOTAL HIP REPLACEMENT
SIR,—Of the 84 patients in the study by Sagar et al.,’ only 41 had venograms. Since at least 22 of these venograms were done on patients in the control group, at most only 19 venograms could have been done in the 52 patients in the treated group. Our study7 clearly showed that fibrinogen scanning will not detect major thrombi in the thigh in most instances after hip surgery. Thus the true prevalence of thigh thrombi in the treated group is unknown in 33 of the 52 treated patients. This is a serious weakness of this study. We feel that, in hip patients, venography must be done routinely in all patients in order to ascertain the true prevalence of deep venous thrombosis.
149
2 Almeida,J D , Zackerman, A. J Nature, 1976, 260, 393. 3 Kapikian, A Z, Wyatt, R. G., Dolin, R., Thornhill, T. S., Kalica, Chanock, R M. J. Virol. 1972, 10, 1075.
Research Laboratories, Massachusetts General Hospital, Boston, Massachusetts 02114, U.S.A.
Orthopædic A. R.,
WILLIAM H. HARRIS
4 Kapikian, A. Z Prev. Med. 1974, 3, 535.
5 Hara, M, Mukoyama, J., Tsuruhara, T., Saito, Y., Tagaya, I. Lancet, 1976, i, 311
6 Middleton, P J , Szymanski, M T., Abbott, G. D., Bortolussi, R., Hamilton, J R ibid 1974, i, 1241. 7 Almeida, J D., Waterson, A. P Adv. Virus Res. 1967, 15, 307. 8 Middleton, P J, Petnc, M., Hewitt, C. M , Szymanski, M. T., Tam, I. S. J clin. Path 1976, 29, 191. 9 ∅rstavik,I,Figenschan, K. J., Haug, K. W., Ulstrup, J. C. Scand. J. infect. Dis. 1976, 8, 1. 10 Wkly.
Epidem Rec. 1976, 51, 131.
1. Mertin, J., Hughes, D. Int. Archs Allergy. 1975, 48, 203. 2. Taketa, K., Pogell, B. M. J. biol. Chem. 1966, 241, 720. 3. Dorsey, J. A., Porter, J. W. ibid. 1968, 243, 3512. 4. Cone, R. E., Brown, W. C. Immunochemistry, 1976, 13, 571. 5. Bloom, W. L. Metabolism, 1967, 16, 777. 6. Sagar, S., Nairn, D., Stamatakis, J. D., Maffti, F. H., Higgins, A. Thomas, D. P., Kahhar, V. V. Lancet, 1976, i, 1151. 7. Harris, W. H., and others. New Engl. J. Med. 1975, 29, 665.
F.,
