June 25, 1999 

Preface

This document links to 5 additional pages that comprise a report for Michael and
his parents. Among my perusals of autism-spectrum medical histories and lab data
(n<15), this report is unusual because data obtained from Great Smokies
Laboratory assays provided crucial insights, and note that this is a positive
endorsement of the information categories long provided by Great Smokies
personnel. Let me explain.

In many cases, the child's medical history and lab data indicate substantial
participation by herpes class viruses, especially CMV, EBV, and/or HHV6, and
often include sufficient alterations of leukocyte subsets so as to indicate the
possibility of viral-induced hematopoietic pathology. 
     Occasionally, other factors are quite noticeable, eg, missing antibodies
against vaccinal antigens, elevated antibodies against an enterovirus such as
Coxsackie, etc. And, in a few cases, the child's non-specific indicators (eg,
decreased NK count, impaired NK function, altered CD4 and CD8 subsets, etc) show
a strong skewing even though the pathogen-specific tests did not provide
revealing clues. 

However, Michael's lab data were different. There was no apparent involvement
of CMV, EBV, or HHV6; and there was no major skewing of white blood cell
subgroups that would have indicated pathologicl bone-marrow phenomena. Instead,
the most prominent feature of Michael's lab data was the persistent presence of
intestinal colonization by Klebsiella pneumonia and hemolytic Escherichia coli,
both reported as 4+ across three different tests. Importantly, as elaborated
with citations in the various sub-webpages that comprise this report, the
combination of Kp and hEc is *likely* to lead to translocation and sequelae
therefrom.

Perusing Michael's medical history and lab data again made clear that the
diverse tests purchased by some parents of autism-spectrum children are
important and *work together*. Had Michael's parents purchased only a thorough
immune panel, Michael's intestinal colonization by highly significant bacteria
would not have been noted. Contrastingly, even though the thorough immune panel
ordered by Hugh Fudenberg in 1997 did not contain the primary clue (in this
specific case), the immune panel enabled certain processes to be eliminated and
provided data useful for measuring immune skewing that appears to reflect the
Kp and hEc colonizations and probably translocations into various peripheral
tissues. 
     Another unusual aspect of what for me was a challenging interpretation of
data was the fact that the parents had been able to compile a goodly amount of
data, without which the analysis and tentative conclusions you'll see in the
accompanying web pages could not have been derived.

Furthermore, the pathological processes and potential neurologic sequelae
documented for Michael illustrate a way that intestinal colonizations can lead
(a) to bacterial translocations, then (b) to circulating particles of bacterial
cell-wall (mannose-like) fragments, and (c) which can affect both vascular
tissue (eg, of the blood brain barrier) and astrocytes (which have mannose
receptors). Furthermore, (d) both vascular inflammation and astrocyte
hyperactivation would have negative effects on neural function, and (e) a
measureable outcome might be regional or focal CNS hypoperfusion and
hypofunction as now being documented in autism-spectrum children (Goldberg,
Mena, and Miller, 1999) -- with certain intestinal colonizations being a non-
viral cause.

This may be *one* of the etiologic sequences that can induce a child to
deteriorate into the autism-spectrum. Further discussion and citations are on
the webpages linked hereinbelow.

 Research summary Why Klebsiella pneumonia and hemolytic E. coli have come to demand much attention in this report. (Kp, hEc)

 Translocation of Kp and hEc

 Peritoneal and abdominal Kp and hEc

 Neurologic aspects of Kp and hEc

 Miscellany regarding Kp and hEc

 Analytic journey A delineation of analytic steps, from first wonderings to gradually focusing as I did upon Kp and hEc, with a listing of Mike's various lab tests over a two year period.
 

     A series of autism-spectrum research monographs is available by
     links on a web page: http://www.jorsm.com/~binstock/index.htm