Commun Dis Intell, 2000 Jun, Suppl, v - 83 Vaccine preventable diseases and vaccination coverage in Australia, 1993-1998; McIntyre P et al.; BACKGROUND: Since the introduction of childhood vaccination for diphtheria in 1932 and the widespread use of vaccines to prevent tetanus, pertussis (whooping cough) and poliomyelitis in the 1950s, deaths in Australia from vaccine preventable diseases (VPDs) have declined by more than 99% . It is important, however, that the downward trend in morbidity and mortality from VPDs is maintained and carefully monitored, and that changes are interpreted in relation to vaccination coverage . AIM: This report aimed to bring together three national sources of routinely collected data on the morbidity and mortality (notifications, hospitalisations and deaths) from VPDs during the period 1993-1998 for the 8 diseases then on the routine childhood vaccination schedule, and for 4 other diseases potentially preventable by childhood vaccination . It also examined vaccination coverage for the same period . METHODS: Data sources included notifications from the National Notifiable Diseases Surveillance System (NNDSS), hospitalisation data from the Australian Institute of Health and Welfare (AIHW) National Hospital Morbidity Database, deaths from the Australian Bureau of Statistics (ABS) Causes of Death Collection and vaccination coverage according to the Australian Childhood Immunisation Register (ACIR) . All data sources were expected to have some limitations, the most important being under-reporting for notifications and vaccination encounters, and coding errors in the hospital morbidity data . RESULTS: Notifications for the 8 diseases covered by the routine schedule declined by 42%, from an average of 11,537 cases each year in 1993-1997 to 6700 in 1998, and hospitalisations fell by 12%, from an average of 1745 per year to 1536 in 1997/1998, while deaths remained unchanged at 7 each year over the period of review (Table 1) . Tetanus caused 1 or 2 of the deaths each year . However, 6 of the 7 deaths in 1997 were in infants during a major outbreak of pertussis . Pertussis caused most of the notifications, hospitalisations and deaths during the review period . While most of these were in children, 46% of the notifications and 13% of the hospitalisations occurred in persons aged 15 years or more . There were notable declines in the numbers of notifications of invasive Haemophilus influenzae type b (Hib) disease in children under 5 years of age (77%), measles (87%) and rubella (75%), and there were no notifications of diphtheria or poliomyelitis . Vaccination coverage estimated using ACIR data increased during the review period . Coverage for the first 3 doses of diphtheria, tetanus, pertussis and Hib vaccines, assessed at 1 year of age, increased from 75% to 85%, while coverage for measles-mumps-rubella (MMR) vaccine, assessed at 2 years of age, increased from 83% to 86% . It is likely that these data underestimated coverage by 5-10%, and that the increase in coverage partly reflected better reporting to the ACIR by providers. J Chemother, 1991 Jan, 3 Suppl 1, 47 - 50 In-vitro susceptibility of Haemophilus influenzae to loracarbef (LY 163892) and other oral antibiotics . Collaborative Study Group on Pediatric Infectious Disease in Lombardy; Garlaschi ML et al.; Data on susceptibility of Haemophilus influenzae are scanty in Italy . We compared the activity of loracarbef (Ly 163892), a new carbacephem, with that of 4 other agents against 265 strains of H . influenzae (46 type b, 219 nontypable) isolated from adults and children at Istituti Clinici di Perfezionamento of Milano, between 1/1/84 and 1/1/89, and also from 7 children at pediatric departments in Lombardy during 1988 . In adults 72 strains were all isolated from sputum of patients with pneumonia or chronic bronchitis; in children 199 strains were isolated from conjunctiva (53% of the patients had also a concomitant respiratory infection), 24 from middle ear, 18 from sputum and 32 from blood or cerebrospinal fluid . Minimal inhibiting concentrations (MIC) were determined by the broth microdilution technique . The incidence of resistance of H . influenzae to ampicillin was 3.8%; the lowest percentage of resistance was found for loracarbef (0%) and the highest for erythromycin (94% for strains isolated from children and 97% for strains isolated from adults). Wiad Lek, 2002, 55(1-2), 11 - 8 {Incidence of selected bacterial pathogens of the respiratory tract in patients with bronchial asthma}; Ekiel A et al.; Chronic bacterial infections intensify the reactivity of bronchi and aggravate the course and the control of asthma . They cause the disorders of both function and the structure of respiratory epithelium . Not only structural elements of bacteria but also their toxins intensify the release of mediators of the inflammatory reaction (leucotriens, histamine, IL1, IL4, IL6, IL8, TNF alpha) . The aim of our research is to determine the prevalence of microorganisms, which can have an influence on the course of asthma . Moraxella catarrhalis has been the most frequent isolated pathogen (23.7%) in patients with bronchial asthma . We have received only individual isolations of Streptococcus pneumoniae and Haemophilus influenzae strains . Bacterial flora of the upper respiratory tract in patients with bronchial asthma has been more diverse in comparison with microflora of airways in healthy subjects . The significant percentage of Candida isolation in asthmatics (over 30% in bronchial tree secretion) poses the high risk of incidence of mycotic complications of inhaled steroids . In patients with asthma bronchial tree secretion is more valuable diagnostic material than pharyngeal swab. Zh Mikrobiol Epidemiol Immunobiol, 2002 Mar-Apr, (2), 75 - 7 {Dynamics of growth of Haemophilus influenzae serotype B and synthesis of capsular polysaccharide in the process of cultivation in a synthetic nutrient medium}; Orlova OE; The dynamics of H . influenzae, serotype b, growth and synthesis of their capsular polysaccharide in the synthetic nutrient medium, proposed by Herriot for noncapsular strains, was studied using 6 strains . The growth rate of H . influenzae, serotype b, and the amount of capsular polysaccharide, synthesized in the above mentioned medium, practically were not different from those in heart-brain broth (Difco) . The possibility of minimizing the composition of Herriot's medium without any adverse effect on the amount of synthesized capsular polysaccharide was shown . As the result of these studies, the expediency of the cultivation of H . influenzae, serotype b, in the synthetic medium, intended for obtaining the preparations of capsular polysaccharide, was proved. Zh Mikrobiol Epidemiol Immunobiol, 2002 Mar-Apr, (2), 37 - 41 {Antibodies to iron-regulated proteins of meningococci in blood sera of healthy persons of different age groups}; Gamzulina LN et al.; One hundred and twenty individual sera obtained from healthy persons of different age groups were studied for the presence of antibodies to meningococcal iron-regulated proteins (IRP) . The study revealed that occurrence of such antibodies in sera under study was IRP nature- and age-dependent . Antibodies to two IRP were found to occur most frequently: 85 kD (TbpB) and 72 kD (FrpB) . Antibodies to the former IRP were detected in more than 50% and antibodies to the latter IRP, in more than 90% of sera . This was probably due to the presence of epitopes common with those in protein antigens of some other microorganisms, such as Moraxella catarrhalis and Haemophilus influenzae . The occurrence of antibodies to periplasmatic IRP with 34 kD (FbpA) in blood sera varied within the range of 5 to 30% . At the same time the occurrence of antibodies to this protein in the sera under study was age-depended: children until five years exhibited the minimal occurrence (about 5%), while in adults it reached 30%. An Esp Pediatr, 2002 Jun, 56(6), 510 - 5 {Results of a computerized vaccination database}; Garcia Ramos R et al.; OBJECTIVE: To analyze vaccine coverage in children from Picassent in Valencia (Spain) and to evaluate the effectiveness of a new computerized vaccine registration program . MATERIAL AND METHODS: A computer equipped with our self-made Babyvac-2000 program, based on Microsoft Access was used . The 2,514 entries on children in our database were examined . The results were compared with those in other population groups . RESULTS: Uptake was high: 100 % in 12 of the 15 age groups (according to year of birth) . Coverage was as follows: diptheria-tetanus-pertussis (DTP)-oral polio vaccine was 100 % for 9 groups; the first dose of the triple virus vaccine was 100 % in 7 groups; full vaccination was between 96.2 % and 100 % for all age groups; vaccination at 6 years was between 91.6 % and 98.7 %, the second dose of the triple virus vaccine was between 72.2 % and 96.3 %; vaccination at 14 years was between 82.9 % and 87.7 %; hepatitis B vaccination in young children (from 1994 to 2000) was 100 % in 5 groups and was between 90 % and 98 % in teenagers; the Haemophilus influenzae type b vaccination rate was 100 % for children born between 1998 and 2001 and was between 74.3 % and 93.5 % for those born between 1994 and 1997; meningococcal group C conjugated vaccination was between 86.8 % and 100 % for children born between 1994 and 2001 . CONCLUSIONS: This computer program considerably increases uptake and vaccine coverage among children. J Chemother, 1991 Jan, 3 Suppl 1, 155 - 7 Global perspective on antimicrobial resistance in Haemophilus influenzae; Jorgensen JH; The prevalence of plasmid mediated beta-lactamase production among clinical isolates of Haemophilus influenzae has increased steadily since first recognized in 1973, nationwide surveillance studies were conducted in the USA in 1983-1984, 1986, and again in 1987-1988 . The 1986 study indicated that the overall rate of beta-lactamase production was 20.0% (31.7% among the serotype b isolates) . The second USA study also documented strains with resistance to chloramphenicol, tetracycline, trimethoprim-sulfamethoxazole, rifampin, erythromycin and certain older cephalosporins . Surveillance studies performed at about the same time in canada, Europe and the United Kingdom, and several Asian countries also documented high rates of beta-lactamase production and other resistance mechanisms among H . influenzae clinical isolates . Resistance to chloramphenicol and tetracycline was documented frequently in European and Asian isolates . Perhaps of greatest concern has been the isolation of H . influenzae (both serotype b and unencapsulated strains) in the USA, Europe, and Asia which possess multiple antimicrobial resistance mechanisms. J Chemother, 1991 Jan, 3 Suppl 1, 15 - 8 Significance of Haemophilus spp . and Branhamella catarrhalis in upper respiratory tract infections; Russo G et al.; Haemophilus influenzae and Branhamella catarrhalis can be considered inhabitants of the upper respiratory tract in humans . Although the pathogenetic role of H . influenzae cannot be discussed, the Authors report the mechanisms of pathogenicity of this microorganism; furthermore, they discuss the direct or indirect pathogenicity of B . catarrhalis in respiratory tract diseases and the ability of both microorganisms to produce beta-lactamases . H . influenzae and B . catarrhalis, together with S . pneumoniae, are the most common bacteria responsible for upper respiratory tract infections, namely otitis and sinusitis . The activity of these bacteria in the onset of otitis and sinusitis is reported. Med J Aust, 2002 Apr 15, 176(8), 389 - 96 4: Acute community-acquired meningitis and encephalitis; Beaman MH et al.; Acute meningitis and encephalitis are medical emergencies that require prompt assessment (usually by cerebral imaging and lumbar puncture) and treatment; specialist consultation is recommended . In acute meningitis, early administration of antibiotics can be life-saving (usually high-dose penicillin and/or a third-generation cephalosporin); antibiotics may be needed before referral to hospital . Emergence of penicillin and cephalosporin resistance in Streptococcus pneumoniae has necessitated more complex antibiotic regimens that include vancomycin or rifampicin for empirical treatment of meningitis . Adjunctive dexamethasone therapy may be of benefit in children with Haemophilus influenzae meningitis; there is no controlled evidence of its benefit in adults, but it could be considered in those with raised intracranial pressure . In possible encephalitis, empirical therapy with intravenous aciclovir should be given to cover herpes simplex virus (HSV) until the cause is established; HSV encephalitis may be fatal and leaves up to 50% of survivors with long-term sequelae. Indian Pediatr, 2002 May, 39(5), 427 - 36 Safety and immunogenicity of Haemophilus influenzae type B vaccine given in combination with DTwP at 6, 10 and 14 weeks of age; Cherian T et al.; OBJECTIVE: To assess the immunogenicity and reactogenicity of a tetanus conjugate Haemophilus influenzae type b vaccine (Act-Hib) when extemporaneously mixed and administered as a DTwP-Hib combination using an Indian DTwP vaccine (BE DTwP) in comparison with a licensed DTwP-Hib combination vaccine . METHODS: 378 healthy infants were enrolled and randomly allocated to receive either three doses, at 6, 10 and 14 weeks of age, of Act-Hib in combination with BE DTwP (Group A, n = 160), TetrAct-Hib (Group B, n = 160), or BE DTwP and Act-Hib as separate injections (Group C, n = 58) . Sera collected before the first dose and one month after the third dose were tested for antibodies to vaccine antigens . Safety was determined using parental diary cards . RESULTS: Anti-Hib antibody concentrations indicative of short-term protection (> 0.15 g/ml) were elicited in all but one subject in Group A (99.3%), and all subjects in Groups B and C . The concentration of 1 g/ml, considered to provide long-term protection, was achieved in 96.7%, 100% and 98.2% of the infants in Groups A, B and C, respectively . All children displayed satisfactory responses to the three DTwP component antigens, TetrAct-Hib eliciting higher titers against diphtheria and tetanus than BE DTwP . No vaccine-associated serious adverse events occurred . The BE DTwP vaccine was associated with more reports of fever than TetrAct-Hib, but most symptoms were regarded as mild and all resolved without sequelae . CONCLUSIONS: Combining Act-Hib and a local DTwP vaccine did not affect the anti-Hib response . In countries where DTwP vaccine available for use in the EPI program is manufactured by a local or other developing country manufacturer, mixing it with lyophilised Act-Hib is a reasonable option though the immunogenicity may have to be documented before routine use . However, use of TetrAct-Hib combination vaccine would be preferable in view of its lower reactogenicity and superior immunogenicity with respect to diphtheria and tetanus. J Clin Pathol, 2002 Jun, 55(6), 472 - 4 A survey of vaccine coverage and antibiotic prophylaxis in splenectomised patients in Scotland; Kyaw MH et al.; AIMS: To determine the coverage of vaccine and antibiotic prophylaxis in splenectomised patients in Scotland . METHODS: Patients who had undergone splenectomy between 1 January 1988 and 31 December 1998 were identified . A questionnaire was sent to general practitioners to validate vaccine and antibiotic status for these patients . RESULTS: A total of 974 living splenectomised patients were identified during the study period . Information on vaccine and antibiotic status was available for 708 (73%) and 770 (79%) of living patients, respectively . Coverage of pneumococcal vaccine (88%) was higher than that of Haemophilus influenza type b (Hib) conjugate vaccine (70%) or meningococcal vaccine (51%) . Only 47% of patients received all three vaccines . A higher coverage was also documented for pneumococcal vaccine (28%) than Hib (19%) and meningococcal vaccine (14%) before elective splenectomy . Only 13% received all three vaccines before splenectomy . Coverage of influenza vaccine increased significantly, from 76% in the 1997/1998 season to 96% in the 2000/2001 season . Antibiotic prophylaxis was received by 67% of all patients . The current recommendation, comprising pneumococcal and Hib vaccination and antibiotic prophylaxis, was received by only 52% of the patients . There was no association between the coverage of vaccine and socioeconomic status . CONCLUSION: Further improvement in coverage of recommended vaccines and antibiotic prophylaxis is still needed to reduce the risk of serious infection in this high risk group. Proc Natl Acad Sci U S A, 2002 May 28, 99(11), 7396 - 401 Functional interactions of HslV (ClpQ) with the ATPase HslU (ClpY); Ramachandran R et al.; HslVU is a bacterial homolog of the proteasome, where HslV is the protease that is activated by HslU, an ATPase and chaperone . Structures of singly and doubly capped HslVU particles have been reported, and different binding modes have been observed . Even among HslVU structures with I-domains distal to HslV, no consensus mode of activation has emerged . A feature in the Haemophilus influenzae HslVU structure, insertion of the C termini of HslU into pockets in HslV, was not seen in all other structures of the enzyme . Here we report site-directed mutagenesis, peptide activation, and fluorescence experiments that strongly support the functional relevance of the C terminus insertion mechanism: we find that mutations in HslV that disrupt the interaction with the C termini of HslU invariably lead to inactive enzyme . Conversely, synthetic peptides derived from the C terminus of HslU bind to HslV with 10(-5) M affinity and can functionally replace full HslU particles for both peptide and casein degradation but fail to support degradation of a folded substrate . Thus, the data can be taken as evidence for separate substrate unfoldase and protease stimulation activities in HslU . Enhanced HslV proteolysis could be due to the opening of a gated channel or allosteric activation of the active sites . To distinguish between these possibilities, we have mutated a series of residues that line the entrance channel into the HslV particle . Our mutational and fluorescence experiments demonstrate that allosteric activation of the catalytic sites is required in HslV, but they do not exclude the possibility of channel opening taking place as well . The present data support the conclusion that the H . influenzae structure with I-domains distal to HslV captures the active species and point to significant differences in the activation mechanism of HslV, ClpP, and the proteasome. Kansenshogaku Zasshi, 2002 Apr, 76(4), 280 - 4 {Mutation of penicillin-binding protein genes and antimicrobial susceptibility of Haemophilus influenzae isolated from spinal fluid or blood in children}; Sakata H; Between September 1999 and August 2001, we studied serotypes to capsular antigen, beta-lactamase production, mutation of penicillin binding protein (PBP) genes by PCR method, and antimicrobial susceptibilities of 13 strains of Haemophilus influenzae isolated from spinal fluid or blood in children . Diseases of patients were meningitis in 11, pneumonia in 1, and laryngitis in 1 . The age range of the patients was from 26 days to 5 years . The serotypes of all strains were b . Four of the 13 strains were beta-lactamase-positive . The mutation of genes of pbp3 was revealed from 4 isolates and 2 of the strains were beta-lactamase-positive . MICs of ampicillin to beta-lactamase-negative strains ranged from 0.125 to 1 microgram/ml and those to beta-lactamase-positive were more than 32 micrograms/ml . MICs of 2 strains of beta-lactamase-negative and mutation-positive were 0.5 and 1 microgram/ml . The excellent active antimicrobials in our study was cefotaxime (MIC90 0.06 microgram/ml), meropenem (MIC90 0.125 microgram/ml), ceftazidime (MIC90 0.25 microgram/ml), and cefepime (MIC90 0.25 microgram/ml). Eur J Pediatr, 2002 Jun, 161(6), 330 - 6 Epub 2002 Apr 25. Long-term follow-up of children with bacterial meningitis with emphasis on behavioural characteristics; Berg S et al.; The sequelae and behaviour in children several years after an episode of bacterial meningitis were studied . All children in Sweden aged 0-4 years with bacterial meningitis between 1987 and 1989 caused by Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitidis were identified . After exclusion of 16 children who died, 12 with severe concomitant diseases, ten with severe neurological damage obvious already at discharge from hospital and 34 with unknown address, questionnaires were sent to the parents of the remaining 463 children The nearest-age siblings were used as a comparison group . The questionnaires included questions concerning general health, schooling, motor function, speech, hearing and behaviour (inattention, hyperactivity and impulsiveness) . The children were 6-14 years old when the questionnaires were completed . Questionnaires were completed for 304 pairs of patients and siblings and for 154 patients without siblings . The majority of post-meningitic children were healthy and attended normal school but they had more hearing impairment, headaches and problems with balance than their siblings . When the distributions of answers regarding behaviour were compared, the post-meningitic children had significantly more symptoms in the fields of inattention, hyperactivity and impulsiveness than their siblings . CONCLUSION: Except for hearing impairment, severe sequelae after bacterial meningitis which are not discovered at discharge do not appear later . Children who appear well after bacterial meningitis have more non-specific symptoms like headache, and more signs and symptoms indicating inattention, hyperactivity and impulsiveness than their siblings. Ann Allergy Asthma Immunol, 2002 May, 88(5), 513 - 7 Recurrent acute epiglottitis in adults: defective antibody response; Gagnon R et al.; BACKGROUND: Recurrent acute epiglottitis is uncommon in adults . In the medical literature, very little is known about the immune status of this population . OBJECTIVE: To evaluate the immune system of a group of four adult patients with recurrent acute epiglottitis, in what represents the largest series ever reported . METHODS: The clinical course of these episodes was carefully evaluated and a basic immune deficiency work-up was carried out for each patient . RESULTS: All four patients displayed clinical and laboratory evidence of impaired humoral immunity . One patient was splenectomized . Another patient had a below normal immunoglobulin G level . At the time of their first evaluation, none of our patients had specific antibodies against Haemophilus influenzae and one had a subnormal Streptococcus pneumoniae immunoglobulin G level for a majority of serotypes . After specific vaccination, two patients had persistent abnormalities in their response to one or more polysaccharides or conjugate-polysaccharide antigens . In the other two, the transient abnormalities were corrected by immunization . CONCLUSIONS: When recurrent acute epiglottitis occurs in adults, it is important to investigate the immune system because a quantitative or a specific antibody deficiency could be found . It also follows that these patients will be successfully treated either by immunization or antibody replacement. Hindustan Antibiot Bull, 1999 Feb-Nov, 41(1-4), 41 - 4 In vitro susceptibility of new generation of antibacterial antibiotics against pathogenic bacteria; Singh V et al.; Antibiotic susceptibility of ten bacteria i.e . Neisseria catarrhalis, Salmonella typhi, S . enteritidis, Haemophilus influenzae, Bacillus subtilis, Pseudomonas fluorescence, Pseudomonas aeruginosa, Proteus vulgaris, Staphylococcus aureus and E . coli to twenty antibiotics i.e . cefpirom (30 mcg), ceftriaxone (30 mcg), erythromycin (15 mcg), doxycycline (30 mcg) lomefloxacin (10 mcg), sisomicin (30 mcg), vancomycin (30 mcg), augmentin (30 mcg), ampicillin (30 mcg), cotrimoxazole (25 mcg), cefotaxime (30 mcg), Chloramphenicol (30 mcg), cephalexin (30 mcg), tetracycline (30 mcg), ciprofloxacin (5 mcg), nitrofurantoin (300 mcg), nalidixic acid (30 mcg), pefloxacin (10 mcg), norfloxacin and ofloxacin (5 mcg) was studied to evaluate the antimicrobial efficacy of recently introduced second and third generation antibiotics . All the test strains were sensitive to pefloxacin, erythromycin, augmentin and chloramphenicol . Maximum resistance to cefpirom excluding E . coli and S . typhi and co-trimoxazole except S . typhi, Pseudomonas aeruginosa was observed, occasional resistance was seen against ceftriaxone, vancomycin and cefotaxime. Arch Dis Child, 2002 Jun, 86(6), 396 - 9 The UK Hib vaccine experience; Heath PT et al.; Haemophilus influenzae type b (Hib) is an important pathogen in children <5 years of age . The Hib conjugate vaccines were the first polysaccharide-protein conjugate vaccines to be used in routine childhood schedules . Their introduction in the UK in 1992 has resulted in the near elimination of Hib disease . The UK Hib vaccine programme has a number of unique features including an accelerated schedule, absence of a booster dose, and the inclusion of a catch up component at the beginning of the programme . Collaboration between UK paediatricians, microbiologists, and public health physicians has allowed active national surveillance of Haemophilus influenzae disease and enabled important conclusions to be drawn . These include high vaccine effectiveness, the presence of herd immunity, and the frequency of risk factors in cases of vaccine failure and in cases of invasive disease due to non-b H influenzae . Parallel studies have shown the immunogenicity, induction of immunological memory, and persistence of immunity following vaccination at the UK schedule, as well as measuring the impact of vaccination on pharyngeal Hib carriage . Cases continue to occur and complacency is ill advised, particularly as other vaccines and combinations are introduced . Surveillance of H influenzae disease in the UK remains important. Antimicrob Agents Chemother, 2002 Jun, 46(6), 1934 - 9 Sulfonamide resistance in Haemophilus influenzae mediated by acquisition of sul2 or a short insertion in chromosomal folP; Enne VI et al.; Determinants of sulfonamide resistance were investigated in clinical isolates of Haemophilus influenzae from the United Kingdom and Kenya . The mechanism of sulfonamide resistance in H . influenzae has not previously been reported . Eight isolates requiring at least 1,024 microg of sulfamethoxazole per ml for inhibition carried the sul2 gene, a common mediator of acquired sulfonamide resistance in enteric bacteria . In other isolates with similarly high levels of resistance, the chromosomal gene encoding dihydropteroate synthase, folP, was found to carry an insertion of 15 bp together with other missense mutations relative to folP of H . influenzae strain Rd RM118 (MIC, 8 microg/ml); the folP sequence was identical in all seven such isolates investigated, although they represented three different strains by restriction pattern analysis . The 15-bp insertion was absent in isolates inhibited by sulfamethoxazole at 2 to 64 microg/ml (although these exhibited considerable divergence in folP sequence) and in highly resistant isolates carrying sul2 . Transformation with a 599-bp fragment of folP containing the insertion but no other differences conferred high-level resistance on a recipient strain, confirming the role of the insertion . Other amino acid substitutions in dihydropteroate synthase may modulate the level of sulfonamide inhibition in susceptible isolates and those with more moderate levels of resistance . The two mechanisms of resistance, mediated by sul2 and modified folP, were detected in isolates from both the United Kingdom and Kenya. J Med Microbiol, 2002 Jun, 51(6), 526 - 9 Aerobic and anaerobic microbiology of suppurative sialadenitis; Brook I; Aspirates of pus from acute suppurative sialadenitis were investigated for the presence of aerobic and anaerobic bacteria . A total of 47 specimens, 32 from parotid, 9 from submandibular and 6 from sublingual glands yielded bacterial growth . Fifty five isolates, 25 aerobic and 30 anaerobic, were isolated from parotid infection: anaerobic bacteria only were detected in 13 (41%) specimens, aerobic or facultative bacteria only in 11 (34%) and mixed aerobic and anaerobic bacteria in 8 (25%) . Of a total of 17 isolates, 8 aerobic and 9 anaerobic, from submandibular gland infection: anaerobic bacteria only were detected in 3 (33%) specimens, aerobic or facultative bacteria only in 4 (44%) and mixed aerobic and anaerobic bacteria in 2 (22%) . Ten isolates, 5 aerobic and 5 anaerobic, were from sublingual gland infection: anaerobic bacteria only were detected in 2 (33%) specimens, aerobic or facultative bacteria only in 2 (33%) and mixed aerobic and anaerobic bacteria in 2 (33%) . The predominant aerobes were Staphylococcus aureus and Haemophilus influenzae while the predominant anaerobes were gram-negative bacilli (including pigmented Prevotella and Porphyromonas spp., and Fusobacterium spp.) and Peptostreptococcus spp . The study highlights the polymicrobial nature and importance of anaerobic bacteria in acute suppurative sialadenitis. Clin Ther, 2002 Apr, 24(4), 473 - 89 Cefdinir: an advanced-generation, broad-spectrum oral cephalosporin; Guay DR; BACKGROUND: Cefdinir is an advanced-generation, broad-spectrum cephalosporin antimicrobial agent that has been approved for the treatment of community-acquired pneumonia, acute bacterial exacerbations of chronic bronchitis, acute maxillary sinusitis, pharyngitis/tonsillitis, acute bacterial otitis media, and uncomplicated skin and skin-structure infections in adult and pediatric patients . OBJECTIVE: The purpose of this article was to review the in vitro antimicrobial activity, pharmacokinetics, clinical efficacy, safety, and potential role of cefdinir . METHODS: Studies were identified by a MEDLINE search (January 1983-September 2001) of the English-language medical literature, a review of identified articles and their bibliographies, and a review of data on file with the manufacturer . Clinical efficacy data were selected from all published trials mentioning cefdinir . Information concerning in vitro susceptibility, safety, chemistry, and the pharmacokinetic profile of cefdinir also was reviewed . RESULTS: Cefdinir has a broad spectrum of activity against many gram-negative and gram-positive aerobic organisms, including Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes, Haemophilus influenzae, and Moraxella catarrhalis . Cefdinir is stable to hydrolysis by 13 of the common beta-lactamases . It is rapidly absorbed from the gastrointestinal tract (mean time to peak plasma concentration, 3 hours) and is almost entirely eliminated via renal clearance of unchanged drug . The terminal disposition half-life of cefdinir is approximately 1.5 hours . Efficacy has been demonstrated in 19 clinical trials in adults and children with upper and lower respiratory tract infections (eg, pharyngitis, sinusitis, acute otitis media, acute bronchitis, acute bacterial exacerbation of chronic bronchitis, community-acquired pneumonia), and skin and skin-structure infections . The adverse-event profile is similar to that of comparator agents, although in 4 adult and adolescent studies and 1 adult study, diarrhea occurred significantly more frequently in cefdinir recipients than in recipients of penicillin V, cephalexin, cefaclor, and cefprozil . CONCLUSIONS: Cefdinir is an alternative to other antimicrobial agents and can be dosed once or twice daily for the treatment of upper and lower respiratory tract infections and skin and skin-structure infections . Similar to other oral expanded-spectrum cephalosporins, cefdinir has activity against common pathogens of the respiratory tract and skin and is stable in the presence of selected beta-lactamases . The clinical choice of an oral expanded-spectrum cephalosporin will be based on patient acceptance, frequency of administration, and cost. J Chemother, 2002 Apr, 14(2), 147 - 54 Antimicrobial resistance among respiratory pathogens collected in Thailand during 1999-2000; Critchley IA et al.; A multi-center surveillance study was conducted in Thailand during 1999-2000 to determine antimicrobial susceptibilities among the respiratory pathogens Streptococcus pneumoniae (n = 206), Haemophilus influenzae (n = 305), and Moraxella catarrhalis (n = 39) . Of the S . pneumoniae isolates collected, 33.5% were penicillin-susceptible, 27.2% intermediate and 39.3% resistant . Expectedly, resistance rates to beta-lactams were higher among penicillin-resistant (ceftriaxone, 14.8%; amoxicillin-clavulanate, 42.0%; cefuroxime, 100%) than penicillin-susceptible (ceftriaxone, 0%; amoxicillin-clavulanate, 0%; cefuroxime, 0%) isolates . Likewise, azithromycin and clarithromycin resistances were 4.3% and 5.8% among penicillin-susceptible isolates, and 77.8% and 95.1% among penicillin-resistant isolates . All S . pneumoniae remained susceptible to vancomycin and 99.5% were susceptible to levofloxacin . Multidrug resistance (resistance to >3 antimicrobial classes) was present in 25.2% of pneumococcal isolates (n = 52), with resistance to azithromycin, penicillin and trimethoprim-sulfamethoxazole the most common phenotype (40/52 isolates; 77.0%) . Among the isolates of H . influenzae, the prevalence of beta-lactamase production was 45.2% . All isolates of H . influenzae were susceptible to amoxicillin-clavulanate, azithromycin, ceftriaxone, cefuroxime and levofloxacin while 49.5% were resistant to trimethoprim-sulfamethoxazole . All 39 isolates of M . catarrhalis produced beta-lactamase . Azithromycin (MIC90, < or = 0.03 microg/ml) and levofloxacin (MIC90, 0.03 microg/ml) were the most active agents tested against M . catarrhalis . The results of this study may serve as a baseline for future studies to monitor antimicrobial susceptibilities among respiratory pathogens in Thailand. ORL J Otorhinolaryngol Relat Spec, 2002 Mar-Apr, 64(2), 80 - 5 Vaccination and otitis media; Karma P; Acute otitis media (AOM) caused by Streptococcus pneumoniae, Haemophilus influenzae or Moraxella catarrhalis may induce specific systemic and/or local immune responses, which may protect from otitis media caused by the same bacteria . However, earlier clinical trials with pneumococcal capsular polysaccharide vaccines have not been successful in preventing AOM . Recently developed pneumococcal polysaccharide-protein conjugates proved immunogenic even in infants, and a heptavalent pneumococcal CRM 197 conjugate vaccine gave a 57% reduction in the number of pneumococcal AOM episodes caused by the vaccine serotypes in infants in Finland . H . influenzae causing AOM is noncapsulated, and like M . catarrhalis, calls for another kind of vaccine development . Suitable vaccine candidates are not yet available but are under development and being tested for immunogenicity and safety . In some trials influenza vaccines have shown protection from AOM during respective viral epidemics . Passive immunoprophylaxis might be an important alternative for immunocompromised children, although this approach has not been successful so far . Mucosal immunization and the advent of DNA and gene technology will open new interesting prospects in the future . J Neuroimmunol, 2002 May, 126(1-2), 99 - 106 Protective molecular mimicry in experimental myasthenia gravis; Im SH et al.; Protein databases were searched for microbial sequences that bear amino acid similarities with identified T- or B-cell epitopes within the human alpha-subunit of acetylcholine receptor (AChR) . One peptide, derived from Haemophilus influenzae, exhibits 50% homology to an identified T-cell epitope of AChR alpha-subunit . This peptide was shown to have a protective effect in experimental autoimmune myasthenia gravis (EAMG) . Pretreatment of rats with the mimicry peptide attenuated the induction and progression of EAMG . These effects were accompanied by a reduced T-cell response to AChR, diminished IL-2, IL-12, IFN-gamma and IL-4 levels, as well as decreased humoral response to self-AChR. Int J Pediatr Otorhinolaryngol, 2002 May 31, 64(1), 35 - 40 Resistant bacteria in the adenoid tissues of children with otitis media with effusion; Karlidag T et al.; OBJECTIVE: To investigate the relationship between the resistant bacteria in the adenoid tissue and the middle ear effusion of children who underwent myringotomy and adenoidectomy with the diagnosis of otitis media with effusion (OME) . METHODS: This study was performed in the ENT Clinic, Firat University between January 2001 and June 2001 . Forty-one subjects who were enrolled in the study were diagnosed as OME, their age ranged from 1 to 11 years, and they underwent a myringotomy together with an adenoidectomy because of adenoid hyperthrophy . Bacteriological cultures were performed on the samples obtained from adenoid tissues and middle ear fluids, in the bacteria that were cultured; the resistance to oxacilline sodium and beta-lactamase were investigated . The resistance of penicillin was confirmed by MIC test . The control group composed of individuals who did not have OME but who underwent adenotonsillectomy due to adenotonsillary hyperthrophy . RESULTS: In the adenoid tissue cultures; Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis species were isolated from the 70% (29/41) of the study group and 40% (20/41) of the control group (P<0.01) . In the isolated bacteria, the resistance rates for oxacilline or beta-lactamase were found to be 48% (20/41) in the study group and 16% (4/25) in the control group (P<0.05) . We observed that bacterial growth in 29% (9/31) of the middle ear cultures of the study group and resistant bacteria were isolated in 77% (7/9) of them . The same pathogens which have grown in the middle ear cultures were also present in the adenoid tissue cultures . CONCLUSION: The isolation of resistant bacteria in most of the adenoid tissue samples of the children with OME, makes us to consider the possible role of these bacteria in the development of OME. Zhonghua Liu Xing Bing Xue Za Zhi, 2002 Apr, 23(2), 108 - 10 {Study on the status of oral pharyngeal carriage of Haemophilus influenzae in healthy preschool children in Fuzhou city}; Lai G et al.; OBJECTIVE: To study the status of oral pharyngeal carriage and characteristics of Haemophilus influenzae (Hi) in healthy preschool children in Fuzhou . METHODS: Six hundred and three healthy children in two representative kindergartens in Fuzhou were studied as research subjects, and the rates of oral pharyngeal carriage of Hi were studied in four seasons . All Hi strains were serotyped and biotyped . RESULTS: The oral pharyngeal carriage of Hi in day care nursery healthy children were 36.7% in winter, 18.0% in autumn, 12.4% in summer and 10.9% in spring respectively . Serotype Hib was preponderant in autumn (6.9%) . In winter, the carriage rates of NTHi and Hib were 17.1%, 5.4% respectively . The carriage rates of other serotypes were low . Biotype VII and VIII were preponderant in autumn, spring and summer but biotype VII and VIII were decreasing evidently in winter . CONCLUSION: There was evident seasonal difference in the rates of oral pharyngeal carriage and type of Hi in healthy preschool children . The carriage rate of Hi strains was high in autumn and winter . Results suggested that while the inoculation of Hib-binding bacterial vaccine was expanded the study on new bacterial vaccine of Hi still needs to be augmented. Dermatology, 2002, 204 Suppl 1, 32 - 6 Prevention of respiratory infections by povidone-iodine gargle; Nagatake T et al.; Bacterial attachment to host cells is the initial step in the pathogenesis of infection . Our studies and those of others also showed that there is a significant correlation between the attachment of bacteria to human pharyngeal epithelial cells and the occurrence of respiratory tract infections . We identified the receptor on human pharyngeal epithelial cells which mediate binding of Moraxella catarrhalis and Haemophilus influenzae . In an attempt to prevent occurrence of infections, the effects of povidone-iodine gargling on the incidence of respiratory infections were investigated . The subjects included a total of 23 adult patients, both males and females, with chronic respiratory diseases showing repeated infections . Patients were asked to gargle more than 4 times/day with povidone-iodine gargle over extended periods of time, i.e . from several months up to over 2 years . The incidence of episodes of acute exacerbation of chronic respiratory infections decreased significantly when compared with that before use of povidone-iodine gargle . Episodes of infections with Pseudomonas aeruginosa, Staphylococcus aureus (including MRSA) and H . influenzae were reduced by about 50% . Results of this study suggest that povidone-iodine gargle is effective in providing a significant reduction in the incidence of acute exacerbations of chronic respiratory disease . We assume that the colonized bacteria were destroyed and thus infection could not occur . Therefore, povidone-iodine gargle may be used in these patients as a preventive therapy . Further studies are needed to find out the mechanism of action of this drug for the prevention of respiratory tract infections . Infect Immun, 2002 Jun, 70(6), 3170 - 9 Molecular cloning of the fur gene from Actinobacillus actinomycetemcomitans; Haraszthy VI et al.; In several bacterial species, iron availability in host tissues is coordinated with the expression of virulence determinants through the fur gene product . Initial experiments showed that a cloned Escherichia coli fur gene probe hybridized to Southern blots of Actinobacillus actinomycetemcomitans strain JP2 (serotype b) chromosomal DNA . The A . actinomycetemcomitans fur gene was then cloned utilizing partial functional complementation of the fur mutant in E . coli strain H1780 . Analysis of the cloned DNA sequence revealed a 438-bp open reading frame with a deduced 146-amino-acid sequence exhibiting 80% identity to Haemophilus influenzae Fur and 62% identity to E . coli Fur . The pUC Aafur gene probe (generated from JP2 serotype b) hybridized to representatives from all five A . actinomycetemcomitans serotypes as well as to two strains derived from monkeys, suggesting that fur is widely distributed in A . actinomycetemcomitans . Open reading frames having >70% identity with the E . coli and H . influenzae flavodoxin and gyrase A genes, respectively, were found . Expression of the A . actinomycetemcomitans fur gene product repressed fiu expression and siderophore production in E . coli . A gel shift assay demonstrated that the expressed A . actinomycetemcomitans Fur protein bound the bacterial fur consensus sequence . Further characterization of the fur gene product in A . actinomycetemcomitans may improve our understanding of its role in the pathogenesis of periodontal disease and may lead to specific therapeutic modalities. Infect Immun, 2002 Jun, 70(6), 3068 - 72 beta-Defensin 1 contributes to pulmonary innate immunity in mice; Moser C et al.; Innate immunity serves as a first line defense in vertebrate organisms by providing an initial barrier to microorganisms and triggering antigen-specific responses . Antimicrobial peptides are thought to be effectors of innate immunity through their antibiotic activity and direct killing of microorganisms . Evidence to support this hypothesis in vertebrates is indirect, based on expression profiles and in vitro assays using purified peptides . Here we investigated the function of antimicrobial peptides in vivo using mice deficient in an antimicrobial peptide, mouse beta-defensin-1 (mBD-1) . We find that loss of mBD-1 results in delayed clearance of Haemophilus influenzae from lung . These data demonstrate directly that antimicrobial peptides of vertebrates provide an initial block to bacteria at epithelial surfaces. Infect Immun, 2002 Jun, 70(6), 2965 - 75 Haemophilus ducreyi requires the flp gene cluster for microcolony formation in vitro; Nika JR et al.; Haemophilus ducreyi, the etiologic agent of chancroid, has been shown to form microcolonies when cultured in the presence of human foreskin fibroblasts . We identified a 15-gene cluster in H . ducreyi that encoded predicted protein products with significant homology to those encoded by the tad (for tight adhesion) locus in Actinobacillus actinomycetemcomitans that is involved in the production of fimbriae by this periodontal pathogen . The first three open reading frames in this H . ducreyi gene cluster encoded predicted proteins with a high degree of identity to the Flp (fimbria-like protein) encoded by the first open reading frame of the tad locus; this 15-gene cluster in H . ducreyi was designated flp . RT-PCR analysis indicated that the H . ducreyi flp gene cluster was likely to be a polycistronic operon . Mutations within the flp gene cluster resulted in an inability to form microcolonies in the presence of human foreskin fibroblasts . In addition, the same mutants were defective in the ability to attach to both plastic and human foreskin fibroblasts in vitro . An H . ducreyi mutant with an inactivated tadA gene exhibited a small decrease in virulence in the temperature-dependent rabbit model for experimental chancroid, whereas another H . ducreyi mutant with inactivated flp-1 and flp-2 genes was as virulent as the wild-type parent strain . These results indicate that the flp gene cluster is essential for microcolony formation by H . ducreyi, whereas this phenotypic trait is not linked to the virulence potential of the pathogen, at least in this animal model of infection. Infect Immun, 2002 Jun, 70(6), 2853 - 61 The lbgAB gene cluster of Haemophilus ducreyi encodes a beta-1,4-galactosyltransferase and an alpha-1,6-DD-heptosyltransferase involved in lipooligosaccharide biosynthesis; Tullius MV et al.; All Haemophilus ducreyi strains examined contain a lipooligosaccharide (LOS) consisting of a single but variable branch oligosaccharide that emanates off the first heptose (Hep-I) of a conserved Hep(3)-phosphorylated 3-deoxy-D-manno-octulosonic acid-lipid A core . In a previous report, identification of tandem genes, lbgA and lbgB, that are involved in LOS biosynthesis was described (Stevens et al., Infect . Immun . 65:651-660, 1997) . In a separate study, the same gene cluster was identified and the lbgB (losB) gene was found to be required for transfer of the second sugar, D-glycero-D-manno-heptose (DD-Hep), of the major branch structure (Gibson et al., J . Bacteriol . 179:5062-5071, 1997) . In this study, we identified the function of the neighboring upstream gene, lbgA, and found that it is necessary for addition of the third sugar in the dominant oligosaccharide branch, a galactose-linked beta1-->4, to the DD-Hep . LOS from an lbgA mutant and an lbgAB double mutant were isolated and were characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, carbohydrate analysis, mass spectrometry, and nuclear magnetic resonance spectroscopy . The results showed that the mutant strains synthesize truncated LOS glycoforms that terminate after addition of the first glucose (lbgAB) or the disaccharide DD-Hepalpha1-->6Glcbeta1 (lbgA) that is attached to the heptose core . Both mutants show a significant reduction in the ability to adhere to human keratinocytes . Although minor differences were observed after two-dimensional gel electrophoresis of total proteins from the wild-type and mutant strains, the expression levels of the vast majority of proteins were unchanged, suggesting that the differences in adherence and invasion are due to differences in LOS . These studies add to the mounting evidence for a role of full-length LOS structures in the pathophysiology of H . ducreyi infection. Vaccine, 2002 May 22, 20(17-18), 2229 - 39 Immunogenicity of anti-Haemophilus influenzae type b CRM197 conjugate following mucosal vaccination with oligodeoxynucleotide containing immunostimulatory sequences as adjuvant; Mariotti S et al.; Most vaccines are delivered by injection . Mucosal vaccination would increase compliance and decrease the risk of spread of infectious diseases due to a reduction of mucosal colonization and of contaminated syringes . However, most vaccines are unable to induce immune responses when administered mucosally, and require the use of strong adjuvant or effective delivery systems . Synthetic oligodeoxynucleotides (ODN) containing CpG immunostimulatory sequences (ISS) have been shown to act as potent adjuvants of type-1 immune responses also when mucosally co-administered with protein or peptide vaccines . We have shown that ISS can increase the anti-polysaccharide polyribosyl ribitol phosphate (PRP) antibody titres and anti-diphtheria toxin neutralizing antibody, if used as adjuvant of anti-Haemophilus influenzae type b (Hib) PRP vaccine conjugated with cross-reacting material (CRM) of diphtheria toxin in mice . Here, we show that ISS have the potential to increase host local and systemic antibody response against both the PRP and the protein component of a conjugated vaccine when mucosally administered in mice . Mucosal administration of Hib-CRM vaccine induced anti-PRP and neutralizing anti-diphtheria toxin antibodies of all the IgG subclasses, with a predominance of type-1 immune response-associated IgG2a and IgG3 . At odds with systemic administration, the mucosal delivery of Hib-CRM induced anti-PRP and anti-diphtheria toxin mucosal IgA . These data envisage the feasibility of a mucosal vaccination with an already licensed Hib-CRM vaccine to achieve both an anti-H . influenzae and -diphtheria effective protection. Int J Antimicrob Agents, 2002 May, 19(5), 371 - 5 Haemophilus influenzae in acute exacerbations of chronic obstructive pulmonary disease; Leanord A et al.; Chronic obstructive pulmonary disease (COPD) is a common progressive respiratory disease that is associated with infective exacerbations that lead to worsening of symptoms . Many organisms are thought to trigger infective exacerbations, but Haemophilus influenzae is the most commonly isolated bacterium . The role of H . influenzae in infective exacerbations remains uncertain, mainly because the organism chronically colonises patients whose clinical condition is stable . H . influenzae may also comprise part of the normal nasopharyngeal flora in man, making the interpretation of positive cultures difficult in some cases. Int J Biochem Cell Biol, 2002 Aug, 34(8), 916 - 20 A novel glutathione transferase from Haemophilus influenzae which has high affinity towards antibiotics; Dainelli B et al.; Cytosolic glutathione transferase (GSTs) are a family of multi-functional proteins which catalyse the conjugation of glutathione (GSH) to a large variety of endogenous and exogenous electrophilic compounds . Much is known about cytosolic mammalian GSTs, however, the presence of GSTs in several aerobic and anaerobic micro-organisms has also been demonstrated . Several findings seem to suggest that bacterial GSTs are involved in processes of biodegradation of xenobiotics, including antibiotics . However, the function played by these enzymes in the bacterial cell still remains to be clarified . At present, it is ill-defined whether bacterial GST can be classified, as in the case of mammalian enzymes, into several distinct classes.Here we report the purification of a GST isoform from Haemophilus influenzae using GSH-affinity chromatography . The purified protein was characterised by immunological and kinetic properties different from other known GSTs . The dissociation constants of chloramphenicol, ampicillin, rifampicin and tetracycline to the purified enzyme were 0.62, 9.06, 4.08 and 1.77 microM, respectively, as determined by following the quenching of the protein intrinsic fluorescence . These values were much lower than those previously determined for the same drugs with other mammalian or bacterial GSTs.The present results indicate that the enzyme purified from H . influenzae is a novel GST isoform well distinguished from other known mammalian or bacterial GSTs. J Antimicrob Chemother, 2002 May, 49(5), 831 - 6 Comparison of selection for mutants with reduced susceptibility to ABT-773, erythromycin and rifampicin in respiratory tract pathogens; Nilius AM et al.; Attempts were made to select mutants on agar media containing the new ketolide ABT-773, erythromycin or rifampicin, at concentrations above the MICs, from Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes and Haemophilus influenzae, including erythromycin-resistant strains . ABT-773 did not select for mutants in four strains, whereas in eight strains the frequencies at 72 h were < or = 10(-9) . ABT-773 MICs were 0.015-4 mg/L for mutants, except those selected from inducible Erm(A) S . aureus . Mutants selected on ABT-773 or erythromycin were cross-resistant to ABT-773, erythromycin and, sometimes, clindamycin . The susceptibility profiles indicate that different mutations were selected and that ABT-773 and erythromycin may interact with the ribosome differently. Arch Otolaryngol Head Neck Surg, 2002 May, 128(5), 583 - 5 Bacteriology of acute and chronic frontal sinusitis; Brook I; Aspirates of 15 acutely and 13 chronically infected frontal sinuses were processed for aerobic and anaerobic bacteria . A total of 20 isolates (1.3 per specimen) were recovered from the 15 cases of acute frontal sinusitis, 16 aerobic and facultative isolates (1.1 per specimen) and 4 anaerobic isolates (0.3 per specimen) . Aerobic and facultative organisms alone were recovered in 13 specimens (87%), and mixed aerobic and anaerobic bacteria were recovered in 2 (13%) . The predominant aerobic and facultative organisms were Haemophilus influenzae (6), Streptococcus pneumoniae (5), and Moraxella catarrhalis (3) . A total of 32 isolates were recovered from the 13 cases (2.5 per patient) of chronic frontal sinusitis, 12 aerobic and facultative isolates (0.9 per specimen) and 20 anaerobic isolates (1.5 per specimen) . Aerobic and facultative organisms only were recovered in 3 instances (23%), anaerobes only in 7 instances (54%), and mixed aerobic and anaerobic bacteria in 3 instances (23%) . The predominant aerobic bacteria were gram-negative bacilli (H influenzae, Klebsiella pneumoniae, and Pseudomonas aeruginosa) . The predominant anaerobes included Prevotella species (8), Peptostreptococcus species (6), and Fusobacterium species (4) . These findings illustrate the microbiologic features of acute and chronic frontal sinusitis. Leuk Lymphoma, 2002 Mar, 43(3), 665 - 7 Life threatening acute epiglottitis in acute leukemia; Lee AC et al.; We report an 8-year-old boy who developed a life-threatening acute epiglottitis during induction chemotherapy for acute promyelocytic leukemia . He survived the infection with emergency tracheostomy, treatment with broad spectrum antibiotics and amphotericin, and the use of granulocyte-macrophage colony stimulating factor . No organism was identified . A literature review identified 18 cases of acute epiglottitis in cancer patients . Sixteen of them were suffering from hematologic malignancies and three patients had received bone marrow transplantation . Unlike the usual case of epiglottitis, the majority (15 out of 18) of affected patients were adults and none of the infections was associated with Haemophilus influenzae . Streptococcus pneumoniae and Candida albicans were the most frequently identified pathogens . Early recognition and aggressive supportive care are required for successful management. Microb Drug Resist, 2002 Spring, 8(1), 67 - 72 Characterization of haemophilus influenzae isolated from invasive disease in Brazil from 1990 to 1999; Zanella RC et al.; The Haemophilus influenzae serotype b (Hib) conjugate vaccine was introduced in the National Immunization Program in Brazil in the second half of 1999 . A retrospective analysis on serotypes, biotypes, and antimicrobial resistance of Hi invasive strains obtained through Hi survey was conducted to document the characteristics of this pathogenic agent during a decade prior the use of Hib vaccine . A total 3,204 strains from 1990 to 1999 were studied, being 88.2% isolated from cerebrospinal fluid, 10.7% from blood, and 1.1% from pleural fluid . The rate of 90.9% of strains was obtained from children up to 4 years old, and the age group >6 months old to 1 year was the higher risk to Hi infection . Type b was, by far, the most common type (97.8%), followed in frequency by type a (0.5%); only 1.5% was a nontypable strain . Biotypes I and II accounted for 97.8% of isolates . Resistance to ampicillin (AM) and chloramphenicol (CO) was detected at rates of 18.1% and 19.1%, respectively, whereas simultaneous resistance to AM and CO was identified in 13.9% of strains . Total concordance was found between AM resistance and beta-lactamase production . No strain showed resistance to ceftriaxone and rifampicin . In conclusion, the data generated through this laboratory-based surveillance should serve as a reference for assessing the impact of Hib vaccination and to detect changes on the pattern of Hi diseases in the country. Epidemiol Infect, 2002 Apr, 128(2), 185 - 92 Detection of delayed vaccinations: a new approach to visualize vaccine uptake; Laubereau B et al.; For the prevention of pertussis and invasive Haemophilus influenzae type b (Hib) infections, each with a peak for mortality and serious complications in the first year of life, early vaccination is important and needs adequate monitoring . In a 1999 national coverage survey the timing of uptake of these vaccines in German children was therefore assessed conventionally at defined age thresholds and with a new adaptation of the Kaplan-Meier (KM) method estimating immunization uptake over time by 1 minus the survival function s(t) . Only 6% and 9% of children were vaccinated against pertussis and Hib in accordance with the national recommended primary vaccination schedule . Coverage levels for the primary vaccination course of 50% and 90% were attained for pertussis after 6.6 and 16.3 months respectively and for Hib after 7.0 and 24.3 months . These estimates were only possible with the KM method which proved useful to monitor vaccination programmes and will allow the comparison of vaccination uptake in different populations. Can Vet J, 1999 Aug, 40(8), 560 - 7, 570 The associations of viral and mycoplasmal antibody titers with respiratory disease and weight gain in feedlot calves; Martin SW et al.; Blood samples from 32 groups of calves (n = 700) were taken on arrival and after 28-35 days at the feedlot . Eleven groups were housed in feedlots in Ontario, and 21 groups in feedlots in Alberta . Serum antibody titers to bovine viral diarrhea virus (BVDV), bovine respiratory syncytial virus (BRSV), parainfluenza virus type 3 (PIV-3), infectious bovine rhinotracheitis virus (IBRV), Mycoplasma dispar and M . bovis, plus data on bovine corona virus (BCV) from a previous study were investigated for their association with the risk of bovine respiratory disease (BRD), and with 28-day weight change, both before and after controlling for titers to Pasteurella haemolytica and Haemophilus somnus . Exposure to IBRV and M . bovis was infrequent, and although exposure to PIV-3 was more common, none of these agents had important associations with BRD . Higher titers to BVDV, BRSV, and BCV on arrival were associated with reduced risks of BRD and increased weight gains . However, there was some variation in these relationships and higher arrival titers to BVDV and BRSV in a subset of the calves were associated with increased risks of BRD . Titer increases to BVDV were associated with a higher risk of BRD and lower weight gains . Titer increases to BRSV were not usually associated with the occurrence of BRD, but titer increases to BRSV in a subset of calves that were vaccinated against BRSV, on arrival, were associated with an elevated risk of BRD . Of all the agents studied, BVDV had the most consistent associations with elevated risk of BRD and lower weight gains . Higher BRSV arrival titers were related to lower risk of BRD and higher weight gains; in some instances titer increases to BRSV were associated with higher BRD risk . Higher titers to BCV on arrival were related to reduced risks of BRD . Practical ways of adequately preventing the negative effects of these agents are still needed. Curr Microbiol, 2002 Jun, 44(6), 418 - 24 Inhibition of 50S ribosomal subunit assembly in Haemophilus influenzae cells by azithromycin and erythromycin; Champney WS et al.; Azithromycin is an important antibiotic for the treatment of several different Gram-positive and Gram-negative bacterial infections . Erythromycin and clarithromycin are less useful antibiotics against Gram-negative infections . This difference in inhibitory activity was explored by comparing the effects of azithromycin and erythromycin on cellular functions in Haemophilus influenzae cells . Effects of both antibiotics on translation, cell viability, and growth rates have been measured . An IC(50) of 0.4 microg/ml was found for the effects of azithromycin on each of these processes . For erythromycin, an IC(50) of 1.5 microg/ml was observed, indicating a fourfold lower sensitivity of the organisms to this compound . The features of a second target for macrolide antibiotic inhibition in H . influenzae cells have also been examined . Inhibition of the synthesis of the large 50S ribosomal subunit was measured . Subunit formation was prevented in a concentration dependent fashion, with azithromycin showing a ninefold greater effect on this process compared with erythromycin . Synthesis of the 30S ribosomal subunit was not effected . Pulse and chase labeling kinetics confirmed the slower synthesis rate of the 50S particle in the presence of each antibiotic . The results are discussed in terms of the stronger effect of azithromycin on ribosome biosynthesis in this organism. J Biol Chem, 2002 Jul 19, 277(29), 25937 - 46 Epub 2002 May 08. The Escherichia coli gene encoding the UDP-2,3-diacylglucosamine pyrophosphatase of lipid A biosynthesis; Babinski KJ et al.; UDP-2,3-diacylglucosamine hydrolase is believed to catalyze the fourth step of lipid A biosynthesis in Escherichia coli . This reaction involves pyrophosphate bond hydrolysis of the precursor UDP-2,3-diacylglucosamine to yield 2,3-diacylglucosamine 1-phosphate and UMP . To identify the gene encoding this hydrolase, E . coli lysates generated with individual lambda clones of the ordered Kohara library were assayed for overexpression of the enzyme . The sequence of lambda clone 157{6E7}, promoting overproduction of hydrolase activity, was examined for genes encoding hypothetical proteins of unknown function . The amino acid sequence of one such open reading frame, ybbF, is 50.5% identical to a Haemophilus influenzae hypothetical protein and is also conserved in most other Gram-negative organisms, but is absent in Gram-positives . Cell extracts prepared from cells overexpressing ybbF behind the T7lac promoter have approximately 540 times more hydrolase activity than cells with vector alone . YbbF was purified to approximately 60% homogeneity, and its catalytic properties were examined . Enzymatic activity is maximal at pH 8 and is inhibited by 0.01% (or more) Triton X-100 . The apparent K(m) for UDP-2,3-diacylglucosamine is 62 microm . YbbF requires a diacylated substrate and does not cleave CDP-diacylglycerol . (31)P NMR studies of the UMP product generated from UDP-2,3-diacylglucosamine in the presence of 40% H(2)180 show that the enzyme attacks the alpha-phosphate group of the UDP moiety . Because ybbF encodes the specific UDP-2,3-diacylglucosamine hydrolase involved in lipid A biosynthesis, it is now designated lpxH. Pharmacoepidemiol Drug Saf, 2002 Jan-Feb, 11(1), 21 - 30 Wheezing lower respiratory disease and vaccination of full-term infants; Mullooly JP et al.; PURPOSE: There have been speculations that increases in vaccinations have caused recent increases in wheezing lower respiratory disease during infancy . We assess possible associations between vaccines and incidence of wheezing in full-term infants . METHODS: We conducted a matched case-control study of full-term infants born into the Kaiser Permanente Northwest health plan during 1991-1994 and continuously enrolled for at least 12 months (n = 1366 case-control pairs) . Potential cases of wheeze were ascertained from medical care databases and verified by chart review . Vaccinations, demographic factors, and wheeze risk factors were abstracted from charts . Adjusted relative risks of first onset of wheeze during post-vaccination exposure windows were estimated by conditional logistic regression . We also conducted case-series analyses of wheeze onsets . RESULTS: We found no evidence that risk of wheeze during infancy is associated with recency of vaccination with whole-cell pertussis (DTP), hepatitis b (HBV), Haemophilus influenzae type b (HIB), oral polio (OPV), or measles, mumps and rubella (MMR) vaccines . We also found no evidence that risk of first wheeze is associated with exposure to HBV or MMR . CONCLUSIONS: Recent increases in wheezing during infancy do not appear to be related to increases in vaccinations of full-term infants. Genome Res, 2002 May, 12(5), 760 - 9 Determination of redundancy and systems properties of the metabolic network of Helicobacter pylori using genome-scale extreme pathway analysis; Price ND et al.; The capabilities of genome-scale metabolic networks can be described through the determination of a set of systemically independent and unique flux maps called extreme pathways . The first study of genome-scale extreme pathways for the simultaneous formation of all nonessential amino acids or ribonucleotides in Helicobacter pylori is presented . Three key results were obtained . First, the extreme pathways for the production of individual amino acids in H . pylori showed far fewer internal states per external state than previously found in Haemophilus influenzae, indicating a more rigid metabolic network . Second, the degree of pathway redundancy in H . pylori was essentially the same for the production of individual amino acids and linked amino acid sets, but was approximately twice that of the production of the ribonucleotides . Third, the metabolic network of H . pylori was unable to achieve extensive conversion of amino acids consumed to the set of either nonessential amino acids or ribonucleotides and thus diverted a large portion of its nitrogen to ammonia production, a potentially important result for pH regulation in its acidic habitat . Genome-scale extreme pathways elucidate emergent system-wide properties . Extreme pathway analysis is emerging as a potentially important method to analyze the link between the metabolic genotype and its phenotypes. Br Med Bull, 2002, 61, 63 - 80 Capsulate bacteria and the lung; Buttery J et al.; Capsulate bacteria cause the majority of community-acquired pneumonia presenting to hospital world-wide, at all ages . They are united by the virulence factor of their differing capsular polysaccharides, enabling them to evade phagocytosis . All cause invasive disease beyond the respiratory tract, including septicaemia and central nervous system infection . Recent advances in vaccine development have made the capsular polysaccharide an achievable target for vaccine strategies across all ages, with impacts already seen upon Streptococcus pneumoniae and Haemophilus influenzae type b pneumonia in countries able to afford these new vaccines. Int J Pediatr Otorhinolaryngol, 2002 May 15, 63(3), 219 - 22 beta-Lactamase-producing Moraxella catarrhalis may prevent the emergence of penicillin-resistant Streptococcus pneumoniae in children with recurrent acute otitis media; Joki-Erkkila VP et al.; We studied the effect of concomitant nasopharyngeal carriage of beta-lactamase producing Moraxella catarrhalis and Haemophilus influenzae on the occurrence of penicillin resistance of Streptococcus pneumoniae . We took nasopharyngeal samples from 306 children with recurrent otitis media and a history of several antibiotic treatments . We could isolate at least one of the pathogens in 89 subjects . Of these children 13% carried more than one pathogen . Of the isolated M . catarrhalis and H . influenzae strains 93% and 43% produced beta-lactamase, respectively . Of the S . pneumoniae strains 25% were non-susceptible (I/R) to penicillin . However, in patients carrying beta-lactamase-producing M . catarrhalis together with pneumococci all strains were susceptible to penicillin (P=0.0353) . This finding suggests that beta-lactamase producing M . catarrhalis may hinder the emergence of penicillin resistance of S . pneumoniae in children with recurrent acute otitis media. Acta Biochim Pol, 2001, 48(4), 969 - 83 Cloning of the Haemophilus influenzae Dam methyltransferase and analysis of its relationship to the Dam methyltransferase encoded by the HP1 phage; Bujnicki JM et al.; In this paper we report cloning and experimental characterization of the DNA adenine methyltransferase (dam) gene from Haemophilus influenzae and comparison of its product with the Dam protein from the lysogenic phage of H . influenzae, HP1 . Molecular modeling of M.HinDam and M.HP1Dam was carried out, providing a framework for a comparative analysis of these enzymes and their close homologs in the structural context . Both proteins share the common fold and essential cofactor-binding and catalytic residues despite overall divergence . However, subtle but significant differences in the cofactor-binding pocket have been identified . Moreover, while M.HinDam seems to contact its target DNA sequence using a number of loops, most of them are missing from M.HP1Dam . Analysis of both MTases suggests that their catalytic activity was derived from a common ancestor, but similar sequence specificities arose by convergence. Health Care Manag Sci, 2002 Apr, 5(2), 135 - 45 Using Monte Carlo simulation to determine combination vaccine price distributions for childhood diseases; Jacobson SH et al.; The Recommended Childhood Immunization Schedule provides guidelines that allow pediatricians to administer childhood vaccines in an efficient and effective manner . Research by vaccine manufacturers has resulted in the development of new vaccines that protect against a growing number of diseases . This has created a dilemma for how to insert such new vaccines into an already crowded immunization schedule, and prompted vaccine manufacturers to develop vaccine products that combine several individual vaccines into a single injection . Such combination vaccines permit new vaccines to be inserted into the immunization schedule without requiring children to be exposed to an unacceptable number of injections during a single clinic visit . Given this advantage, combination vaccines merit an economic premium . The purpose of this paper is to describe how Monte Carlo simulation can be used to assess and quantify this premium by studying four combination vaccines that may become available for distribution within the United States . Each combination vaccine is added to twelve licensed vaccine products for six childhood diseases (diphtheria, tetanus, pertussis, haemophilus influenzae type B, hepatitis B, and polio) . Monte Carlo simulation with an integer programming model is used to determine the (maximal) inclusion price distribution of four combination vaccines, by randomizing the cost of an injection . The results of this study suggest that combination vaccines warrant price premiums based on the cost assigned to administering an injection, and that further developments and innovations in this area by vaccine manufacturers may provide significant economic and societal benefits. Clin Microbiol Infect, 2001, 7 Suppl 6, 5 - 8 Impact of registration procedures on antibiotic policies; Schlemmer B; There is increasing concern over antibiotic resistance and its spread in common bacterial species, such as Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae and Escherichia coli . This results in increased morbidity and mortality . Over consumption of antibiotics has been reported in many settings and underlines the need for improving antibiotic policies . Crude measures of both antibiotic use and antibiotic resistance do not share a strong cause-and-effect relationship . However, this relationship is highly suggestive at a country level, at a hospital level, at a cohort level and at an individual level . In addition to overuse, antibiotic misuse has also to be considered, because of its impact on promoting antibiotic resistance, related to choice, dosage, dosing regimen or duration of therapy {1}. J Med Microbiol, 2002 May, 51(5), 399 - 404 Subtype distribution of Haemophilus influenzae isolates from north India; Sharma A et al.; A total of 120 Haemophilus influenzae isolates from blood, cerebrospinal fluid, sputum and throat swabs of patients and carriers in North India was characterised by biotyping, ribotyping and random amplification of polymorphic DNA (RAPD)-PCR . Of these, 77 isolates (64%) were serotype b; the other 43 (36%) were non-typable . Biotype I was the most predominant among the typable strains and biotype II among the non-typable strains . Ribotyping with restriction endonucleases HaeIII and EcoRI differentiated the isolates into three and six ribotypes, respectively . However, RAPD fingerprints generated by the application of arbitrary primers AP1 and AP2 provided a higher level of discrimination . RAPD typing revealed distinct polymorphism among the serologically typable isolates . This study is the first report that stratifies the subtypes of H . influenzae strains from India by molecular techniques. Pediatrics, 2002 May, 109(5), 826 - 32 Viral respiratory infection in schoolchildren: effects on middle ear pressure; Winther B et al.; OBJECTIVE: To evaluate the effect of uncomplicated viral respiratory infections (colds) on middle ear pressure in healthy school-aged children . METHODS: Children (ages 2-12) with normal tympanograms before onset of illness had bilateral tympanometry daily except weekends for 2 weeks after the onset of a cold . Nasopharyngeal secretion obtained at onset of illness was cultured for bacterial pathogens of otitis media using selective agars and tested for rhinovirus, coronavirus, respiratory syncytial virus, influenza A and B, and parainfluenza 1-3 by reverse transcriptase polymerase chain reaction technology . Tympanometry was designated as abnormal with peak pressure of < or =-100 daPa or > or =50 daPa and/or a compliance peak of < 0.2 cm(3) . RESULTS: Eighty-six colds were studied, 82 in schoolchildren (5-12 years old) and 4 in 2- to 3-year-olds . Abnormal negative middle ear pressure occurred at least once during the 2 weeks after onset in 57 (66%) of the 86 colds . Tympanometry was abnormal in the first week after onset in 50 (88%) of the 57 colds and was abnormal on a single day in 17 (30%) of the 57 . The middle ear pressure abnormalities were intermittent and shifted from one ear to the other ear from day to day . Reverse transcriptase polymerase chain reaction was positive for a respiratory virus in 56 (65%) of the 86 illnesses . Rhinovirus was found in 48% and respiratory syncytial virus in 14% . Pathogenic bacteria (Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis) were detected in nasopharyngeal secretion in 29 (34%) of the 86 colds; the bacteria were in high titer (> or =10(3) cfu/mL) in 26 of the 29 positive specimens . None developed illness that required a visit to a physician . Age, detection of a respiratory virus, and presence of bacterial pathogen in the nasopharyngeal secretion had a negligible effect on the occurrence of abnormal tympanometry . Occurrence of negative middle ear pressure in winter-spring colds was significantly greater than in fall colds for unexplained reasons . CONCLUSIONS: Transient negative middle ear pressure occurred in two thirds of uncomplicated colds in healthy children . This negative pressure, which may facilitate secondary viral or bacterial otitis media, seems to result from viral infection of the nasopharynx and distal tube causing bilateral eustachian tube dysfunction . Tympanometry provides an objective measure of the potential beneficial effects of investigational treatments on the risk of eustachian tube dysfunction/otitis media. Mol Microbiol, 2002 Jan, 43(2), 437 - 48 Genetic and functional analysis of the phosphorylcholine moiety of commensal Neisseria lipopolysaccharide; Serino L et al.; Phosphorylcholine (ChoP) is a common surface feature of many mucosal organisms, including Neisseria spp., in which it is present exclusively on pili of pathogenic Neisseria and on the lipopolysaccharide (LPS) of commensal Neisseria (Cn) . Its presence in Cn has been confirmed by nuclear magnetic resonance . It appears that choline is the main source for the production of ChoP by Cn . We have sequenced a locus, containing four genes (licA-D) with 47-73% identity to the lic1 locus of Haemophilus influenzae (Hi) and 21-40% identity to lic genes in Streptococcus pneumoniae, involved in the production and incorporation of ChoP . The arrangement of the Cn genes and the presence of CAAT repeats, responsible for phase variation of ChoP expression, resemble Hi and differ from S . pneumoniae . Cn DNA flanking the lic locus contains genes ilvE and NMA2149 with >85% identity to the pathogenic Neisseria genes . However, there are no lic genes in the corresponding location or elsewhere in pathogenic Neisseria . This suggests either the loss of the locus from pathogenic Neisseria or a horizontal transfer of genes to Cn, perhaps from H . influenzae spp . As in Hi, ChoP enhances adherence to and invasion of human epithelial cells via the receptor for platelet-activating factor . However, ChoP expression also increases susceptibility to serum killing mediated by complement and C-reactive protein . Taken together, these observations support the hypothesis that the ability of many organisms to switch off ChoP expression rapidly represents an important adaptation to different environments encountered during the colonization/infection process and that the ChoP moiety apparently synthesized by distinct means in pathogenic and commensal Neisseria represents an advantage in the colonization properties of these bacteria. Przegl Epidemiol, 2001, 55 Suppl 3, 55 - 61 {B Streptococcus and other pathogenic bacteria colonization in hospitals in the Gdańsk Metro Area}; Galinska A et al.; A survey of group B Streptococcus and other pathogenic bacteria colonization was carried out on 658 neonates in 8 neonatal wards of hospitals in the Gdansk Metro Area and the district of Gdansk . Out of pathogenic bacteria Haemophilus and enteric bacteria the most frequently were isolated . The percentage of Staphylococcus aureus was relatively low (19.4) . The group B Streptococcus frequency in throat was established as 3.8% and ranging from 1.7 to 8.8% in particular wards . In two cases group B streptococcus were not isolated . In probes taken from anus of newborn tested typical enteric flora dominated and E coli and Klebsiella sp were the most frequently encountered . Profile and frequency of bacterial colonization indicated that epidemiological situation in majority of particular wards in similar. Sex Transm Dis, 2002 May, 29(5), 253 - 9 Epidemic Lymphogranuloma venereum during epidemics of crack cocaine use and HIV infection in the Bahamas; Bauwens JE et al.; BACKGROUND: Since the early 1980s, the Bahamas has experienced sequential epidemics of freebase/crack cocaine use, genital ulcer-inguinal adenopathy disease (GUD), and heterosexual HIV infection . GOAL: To prospectively define the etiology of GUD in patients at the Princess Margaret Hospital during outbreaks of crack cocaine use, GUD, and HIV infection in the Bahamas . STUDY DESIGN: In Nassau, 47 consecutive patients with GUD underwent serologic testing for syphilis and for infections with HIV, herpes simplex virus type 2 (HSV-2), and Chlamydia trachomatis . Genital ulcer specimens were tested by culture and/or polymerase chain reaction (PCR) assay for Haemophilus ducreyi; by PCR and/or antigen assay for HSV; and by PCR for C trachomatis . Lymph node aspirates were tested by PCR for C trachomatis and H ducreyi . RESULTS: Twenty patients (43%) had HIV infection; eight had lymphogranuloma venereum (LGV), confirmed by PCR detection of C trachomatis sequences consistent with the L2 serovar; and nine others had possible LGV, on the basis of serum microimmunofluorescent C trachomatis antibody titers > or =256 . Inguinal lymphadenopathy or bubo was present in 15 of 17 patients, who thus met the laboratory criteria for definite or possible LGV, and in 7 of 30 who did not meet such laboratory criteria (P < 0.001) . Thirteen patients had confirmed genital herpes, seven had confirmed chancroid, and four had probable or possible primary syphilis . CONCLUSIONS: The epidemics in the Bahamas of crack use, heterosexual HIV infection, and GUD apparently included epidemic transmission of LGV. Clin Infect Dis, 2002 May 15, 34(10), 1301 - 9 Epub 2002 Apr 24. Effects of large dosages of amoxicillin/clavulanate or azithromycin on nasopharyngeal carriage of Streptococcus pneumoniae, Haemophilus influenzae, nonpneumococcal alpha-hemolytic streptococci, and Staphylococcus aureus in children with acute otitis media; Ghaffar F et al.; Prior use of antibiotics is associated with carriage of resistant bacteria . Colonization by Streptococcus pneumoniae, Haemophilus influenzae, nonpneumococcal alpha-hemolytic streptococci (NPAHS), and Staphylococcus aureus was evaluated in children receiving antibiotic therapy for acute otitis media and in untreated, healthy control subjects . Children were randomly assigned to receive either amoxicillin/clavulanate (90 mg/kg per day) or azithromycin . Swabs were obtained before initiating therapy and again 2 weeks and 2 months after initiating therapy . We also obtained swabs from control subjects at the time of enrollment and 2 weeks and 2 months after enrollment . The decrease in the rate of carriage of S . pneumoniae and H . influenzae at 2 weeks was significant only in the amoxicillin/clavulanate group (P<.001 and P=.005, respectively) . The rate of nasopharyngeal colonization with NPAHS among treated patients increased from 23% to 39% at 2 months (P=.01) . This increase was similar for both treatment groups . These results suggest that the competitive balance between organisms is altered by antibiotic therapy. Minerva Pediatr, 2002 Apr, 54(2), 153 - 60 {Neonatal vocal cord palsy . Clinical and therapeutical approaches}; Smilari P et al.; Between 1998 and 2000, four newborns have been observed for laryngeal stridor occurred some hours after birth . Otorhinolaryngologic examinations, as well as cardiac, neuroradiologic and serologic investigations have been performed to formulate the diagnosis and verify the etiology . The fiberoptic laryngoscopy showed a bilateral paralysis of the vocal cord in two newborns, a monolateral paralysis of the left vocal cord in another and in the last one, instead, a bilateral cordal hypomobility . The follow-up performed till the age of one year showed a complete remission of the symptomatology in two newborns, respectively in the one with monolateral paralysis and in the other affected by hypomobility of the vocal cords; of the two newborns with bilateral paralysis, instead, one is dead because of Haemophilus Influenzae epiglottitis, three weeks after discharge without physicians' consensus, while in the other patient, affected by lobar holoprosencephaly, it was necessary to perform a tracheotomy because of a severe obstructive apnea . The lobar holoprosencephaly, is a cerebral malformation characterized by the partial separation of the cerebral hemispheres, and it is described for the first time associated with bilateral vocal cords paralysis. Otol Neurotol, 2002 May, 23(3), 349 - 52 Nasopharyngeal penicillin-resistant Streptococcus pneumoniae strains among young children in Japan; Ito M et al.; OBJECTIVE: A rapid increase of penicillin resistance in Streptococcus pneumoniae has recently been reported in most areas of the world . Penicillin-resistant S . pneumoniae and other resistant bacteria are the principal causes of recurrent acute otitis media (AOM) . Penicillin-resistant S . pneumoniae was examined so that we could investigate the bacteriologic and clinical interpretations of nasopharyngeal flora from healthy children . METHODS: We obtained nasopharyngeal swab specimens from healthy children attending a day care center and from children attending a public health examination in Kanazawa, Japan . We also obtained clinical specimens from children with AOM who visited the Kanazawa University Hospital and 4 other hospitals in Ishikawa Prefecture in Japan . RESULTS: The chief bacteria from the children were S . pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis . Penicillin-resistant S . pneumoniae was identified in 75% of children attending a day care center . On the other hand, S . pneumoniae was identified in 37% of children who were not attending day care . Of the children with AOM, penicillin-resistant S . pneumoniae was identified in 77% . CONCLUSION: Our results suggest that there is a strong relationship between day care attendance and nasopharyngeal carriage of S . pneumoniae . The carriage rate of penicillin-resistant S . pneumoniae in healthy children in day care centers was very high and similar to the carriage rate of young patients with AOM in Japan. Arch Pediatr Adolesc Med, 2002 May, 156(5), 512 - 7 Risk of serious bacterial infection in children with fever without a source in the post-Haemophilus influenzae era when antibiotics are reserved for culture-proven bacteremia; Bandyopadhyay S et al.; OBJECTIVE: To determine the rate of serious bacterial infection in children aged 2 to 36 months with fever without a source in the post-Haemophilus influenzae era, when antibiotic therapy is reserved until blood culture results turn positive . DESIGN AND SETTING: Retrospective review of emergency department, urgent care center, and hospital medical records from an urban children's hospital . PARTICIPANTS: Eligible participants were identified from hospital medical record and microbiology laboratory databases . Immunocompetent individuals aged 2 to 36 months with fever without a source were eligible for enrollment . Exclusion criteria were temperature less than 39.0 degrees C, identifiable focus of infection, current or recent antibiotic use, and hospital admission . INTERVENTIONS AND OUTCOME MEASURES: Enrolled participants were assigned to group 1 (blood culture obtained) or group 2 (no blood culture) and did not receive empiric antibiotic treatment in the emergency department, in the urgent care center, or for home use . Demographic and outcome data were collected on all enrolled patients . RESULTS: During the study, 9241 febrile children were identified; 2641 (29%) met the enrollment criteria . Blood cultures (group 1) were performed on 1202 patients (46%), and 37 (3%) had culture-proven occult bacteremia (95% confidence interval, 2.2%-4.2%) . Streptococcus pneumoniae was the most prevalent organism (84%) . The mean +/- SD time for reporting a positive blood culture finding was 17.5 +/- 8.5 hours . Two patients (0.08%; 95% confidence interval, 0.009%-0.27%) developed serious bacterial infection, and both recovered completely . CONCLUSION: Reserving antibiotic therapy for culture-proven occult bacteremia was not associated with increased risk of developing serious bacterial infection compared with previously published data. Aust N Z J Ophthalmol, 1995 Nov, 23(4), 323 - 5 Haemophilus aphrophilus bleb infection after a mitomycin trabeculectomy; Macken PL et al.; BACKGROUND: Haemophilus aphrophilus is a rare cause of ocular infection . It has been reported once as a cause of late-onset endophthalmitis in a patient with an inadvertent bleb after cataract surgery . We present a case of Haemophilus aphrophilus bleb infection after a mitomycin trabeculectomy . METHODS: A 56-year-old woman presented with a bleb infection 10 weeks after a mitomycin C augmented trabeculectomy at a University tertiary referral practice of one of the authors (GET) . The causative organism was Haemophilus aphrophilus, identified by the Toronto Public Health Laboratory, Ontario, Canada . RESULTS: The bleb infection resolved following topical, subconjunctival and intravenous antibiotic therapy . A formal bleb revision was required to repair a persistent bleb leak . CONCLUSION: Patients who have had trabeculectomies augmented with mitomycin C may be predisposed to bleb infection with unusual organisms . Prompt diagnosis and treatment is necessary to control the infection . Increased awareness and communication with laboratory personnel may increase the isolation of this fastidious organism. J Infect, 2002 Jan, 44(1), 49 - 51 Pseudomonas pericarditis in an immunocompetent newborn: unusual presentation with review of the literature; El Hassan N et al.; Acute purulent pericarditis is a rare entity in the neonatal age group . The most common isolated organisms are Staphylococcus aureus, Haemophilus influenzae, and Streptococcus pneumoniae . Other organisms, like Pseudomonas aeruginosa, have been seldom implicated with only one case of Pseudomonas pericarditis reported in the neonatal period . The prognosis is often considered very poor in this age group . This article describes Pseudomonas pericarditis in a 1-week-old immunocompetent female newborn who was successfully managed with combined medical and surgical therapy . J Infect, 2002 Jan, 44(1), 22 - 5 Pattern of meningitis in Al-Ain medical district, United Arab Emirates--a decadal experience (1990-99); Mahmoud R et al.; OBJECTIVES: Haemophilus influenzae vaccine was introduced in the United Arab Emirates in 1999 . Our objective was to describe the pattern of meningitis in a health district in the decade before the introduction of the vaccine and compare it with the data from elsewhere . METHODS: For this retrospective study we included 128 meningitis cases reported from 1990 to 1999 . Information on the cases was abstracted from the case notification forms and clinical and laboratory data from the hospital case notes . RESULTS: H . influenzae was the most common cause of bacterial meningitis (n=59, 46.1%) followed by Streptococcus pneumoniae (n=20, 15.6%) . Meningitis was a disease primarily of infants and children and the median age was 15 months . One fifth of the patients (n=27) had neurological sequelae of which 33.3% had seizures and 25.9% developed deafness . 18.9% (10 out of 53) of H . influenzae isolates were resistant to ampicillin compared with 5.9% (3 out of 51) to chloramphenicol . 78.9% (15 out of 19) of S . pneumoniae isolates were susceptible to penicillin . CONCLUSIONS: The epidemiology of meningitis in our health district is similar to the epidemiology of meningitis during the pre-vaccine era in other countries . Curr Opin Infect Dis, 2002 Apr, 15(2), 157 - 62 Etiology and management of community-acquired pneumonia in Asia; Matsushima T et al.; The causative organisms of community-acquired pneumonia, especially in Japan and Korea, are essentially similar to those in Western countries . If there are any differences, these are due to the laboratory tests and criteria used to define pathogenicity . Overall, Streptococcus pneumoniae is the most frequently occurring pathogen and Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae and viruses follow . Legionella spp . look likely to be low frequency pathogens in Asian countries, but a reason for this might be limitations of the laboratory tests used . A high frequency of Gram-negative bacilli as pathogens of community-acquired pneumonia in some Asian countries may be due to different criteria used to identify disease-causing organisms . A small number of papers about antibiotic resistance have shown no large differences between Asian countries, but considerable differences to Western countries, such as frequency of macrolide-resistant S . pneumoniae . Some Asian countries have their own guidelines for community-acquired pneumonia, but these are written in their own languages. Curr Opin Infect Dis, 2002 Feb, 15(1), 43 - 7 Haemophilus ducreyi: clinical disease and pathogenesis; Al-Tawfiq JA et al.; Haemophilus ducreyi causes the sexually transmitted disease chancroid, which facilitates the transmission of HIV infection . This review focuses on recent advances in the epidemiology, diagnosis, treatment and pathogenesis of this disease. J Pak Med Assoc, 2002 Jan, 52(1), 7 - 11 Determination of antimicrobial activity of Cefaclor on common respiratory tract pathogens in Pakistan; Ahmed A et al.; OBJECTIVE: To determine the antimicrobial activity of Cefaclor against common respiratory tract pathogens isolated from patients in Pakistan . SETTING: Department of Microbiology, Liaquat National Postgraduate Medical Centre, Karachi . METHOD: A laboratory analysis was done on 466 isolates of respiratory tract pathogens collected from 13 laboratories from all over Pakistan . Antibiotic sensitivity test was done by Kirby Bauer disc diffusion method and MIC of Cefaclor was determined by 'E' test . RESULT: Of the 163 Streptococcus pneumoniae, 87 Moraxella catarrhalis and 216 Haemophilus influenzae > 95% isolates were susceptible to Cefaclor . The MIC 90 of all these pathogens were < 2 ug . CONCLUSION: Resistance of respiratory tract pathogens to the 2nd generation Cephalosporin, Cefaclor is very low . MIC 90 of Cefaclor against all three common respiratory tract pathogens is < 2 ug, which indicates that Cefaclor would be effective in more than 90% of cases infected with these bacteria. Antimicrob Agents Chemother, 2002 May, 46(5), 1602 - 3 Site-specific recombination with the chromosomal tRNA(Leu) gene by the large conjugative Haemophilus resistance plasmid; Dimopoulou ID et al.; Characterization of the sequences involved in recombination of the Haemophilus plasmid p1056 with the Haemophilus influenzae chromosome produced evidence indicating site-specific recombination with chromosomal tRNA(Leu) . attP sequences identical to those of p1056 were found in six plasmids of diverse origin, suggesting that a family of Haemophilus plasmids recombines with chromosomal tRNA(Leu). FEBS Lett, 2002 Apr 10, 516(1-3), 161 - 3 The YbgC protein encoded by the ybgC gene of the tol-pal gene cluster of Haemophilus influenzae catalyzes acyl-coenzyme A thioester hydrolysis; Zhuang Z et al.; This paper examines the catalytic function of the protein YbgC, encoded by the ybgC gene of the tol-pal gene cluster in Haemophilus influenzae . The YbgC protein, a homologue of the Pseudomonas sp . strain CBS3 4-hydroxybenzoyl-coenzyme A thioesterase, conserves the active site Asp residue associated with thioesterase activity . The H . influenzae ybgC gene was cloned and overexpressed in Escherichia coli . The recombinant protein was purified and tested for thioesterase activity towards acyl-CoA and acyl-N-acetylcysteamine thioesters . The YbgC protein catalyzes the hydrolysis of short chain aliphatic acyl-CoA thioesters, while the D18N YbgC mutant protein (prepared to serve as a control) does not. J Infect Chemother, 2002 Mar, 8(1), 50 - 8 Differentiation of beta-lactamase-negative ampicillin-resistant Haemophilus influenzae from other H . influenzae strains by a disc method; Ubukata K et al.; We established breakpoints for differentiating ampicillin (ABPC)-susceptible strains from resistant strains among Haemophilus influenzae isolates according to susceptibility to various beta-lactam antibiotics, using a disc method . Susceptibility testing of isolates for 13 beta-lactam agents was followed by analysis of the resistance genes, using a polymerase chain reaction (PCR) to identify the TEM-1 beta-lactamase gene ( bla) and the ftsI gene encoding penicillin-binding protein (PBP) 3, which affects beta-lactam minimum inhibitory concentrations (MICs) . A total of 228 H . influenzae isolates were classified into 114 beta-lactamase-negative, ABPC-susceptible (BLNAS) strains; 29 beta-lactamase-negative, ABPC-resistant (BLNAR) strains; 53 low-BLNAR strains with a low degree of ABPC resistance; 27 TEM-1-producing strains (BLPAR); and 5 strains with ftsI gene mutations in addition to TEM-1 production (BLPACR) according to the PCR results . To identify resistant strains by disc-method susceptibility testing, the zone of inhibition was measured for ABPC (10 microg/disc), cefaclor (30 microg/disc), cefpodoxime (10 microg/disc), and cefdinir (5 microg/disc) discs . Strains were identified as BLNAS without resistant genes when the diameter was > or =27 mm for the ABPC disc and > or =21 mm for the cefaclor disc . Other strains were identified as BLNAR when the diameter was < or =22 mm for the cefpodoxime disc and < or =17 mm for the cefdinir disc . Remaining strains were identified as low-BLNAR . These criteria differentiated resistance types with high accuracy . A discrepancy was noted between genetic results and disc-testing breakpoints for differentiating resistant from susceptible H . influenzae . A disc-testing breakpoint for cefditoren (5 microg/disc) was proposed, with the susceptibility statistically defined as a diameter of > or =24 mm, which corresponds to the breakpoint (1 microg/ml) of the microdilution method recommended by the Japanese Society of Chemotherapy. Eur J Clin Microbiol Infect Dis, 2002 Mar, 21(3), 196 - 203 Epub 2002 Mar 22. Comparison of porphyrin-based, growth factor-based, and biochemical-based testing methods for identification of Haemophilus influenzae; Munson E et al.; The accurate identification of Haemophilus spp . is essential for optimizing the role of the clinical microbiology laboratory in the diagnosis and management of Haemophilus infections . One laboratory-prepared medium and eight commercially available test systems were examined in parallel as a means of identifying 378 clinical isolates of Haemophilus spp . as either Haemophilus influenzae or non- Haemophilus influenzae spp . At least one discordant result was noted with 187 (49.5%) of the isolates tested . Discordant results were resolved either by majority rule for isolates with less than three discordant test results or by confirming the identity using conventional biochemical tests for isolates with three or more discordant test results ( n=20) . Among these 20 isolates, 2 were judged not to belong to the Haemophilus genus . Comparisons of three porphyrin-based methods, three growth factor-based methods (1 of which also incorporates a porphyrin testing component), and three biochemical-based methods revealed varying discrepancy rates within each testing method . In general, porphyrin-based methods, with overall discrepancy rates of 1.3% or less, outperformed other testing methods . One important exception was the performance of the porphyrin testing component of the Haemophilus Identification Test Kit (Remel, USA), which produced an overall discrepancy rate of 28.5% and a false-negative rate of 52.2% with non- Haemophilus influenzae isolates . Growth factor-based methods yielded overall discrepancy rates ranging from 1.6% ( Haemophilus Identification Agar Quad; Remel) to 10.4% (hemin and nicotinamide adenine dinucleotide disk component of the Haemophilus Identification Test Kit) . Biochemical-based assays produced overall discrepancy rates ranging from 4.5% (API NH; bioMerieux Vitek, USA) to 10.1% ( Neisseria Haemophilus Identification Card; bioMerieux Vitek) . Collectively, these results suggest that porphyrin-based testing methods represent the most reliable means for identifying Haemophilus spp. Int J Pediatr Otorhinolaryngol, 2002 Apr 25, 63(2), 99 - 110 Histopathologic differences due to bacterial species in acute otitis media; Caye-Thomasen P et al.; OBJECTIVE: To compare selected features of histopathology in acute otitis media caused by various bacteria and examine potential differences due to bacterial species, as well as possible correlation to experimental and human clinical findings . METHODS: Rat models of acute otitis media caused by Streptococcus pneumoniae (MC), non-typeable or type b Haemophilus influenzae (NTHI/HIB) or Moraxella catarrhalis (MC) were studied longitudinally up to 6 months after bacterial challenge . Findings related to dynamics of goblet cell density, modeling and remodeling of bone tissue structures and polyp, as well as fibrous adhesion formation and persistence are presented . RESULTS: Middle ear goblet cell density progressed to peak 2 weeks after bacterial inoculation, thereafter gradually normalizing . However, density and accordingly middle ear secretory capacity was still significantly increased after 6 months in all bacteria, except MC . The HI species induced the highest increase . Initial osteoresorption was followed by massive osteoneogenesis, progressing to a peak after 2-3 months, followed by some degree of normalization, concurrently classic remodeling . Primarily SP, but also the HI species induced more new bone formation than MC . Mucosal polyp and fibrous adhesion formation occurred regardless of bacterial species . Most polyps appeared in the early phases and the HI species induced formation of more polyps and adhesions than the other bacteria . CONCLUSION: Acute middle ear infection with the Haemophilus species induce the highest increase of mucosal secretory capacity, lasting for at least 6 months after the acute incident . Thus, a subsequent development of secretory otitis media seems more likely following infection with these bacteria . Equivalently, mucosal scarring observed as polyp and fibrous adhesion formation was more severe following Haemophilus infection . S . pneumoniae induced the most marked changes of bone tissue structures, seen as initial osteoresorption and subsequent osteoneogenesis . Overall, infection with M . catarrhalis induced the mildest changes. Infect Immun, 2002 May, 70(5), 2694 - 9 Genomic analysis of the F3031 Brazilian purpuric fever clone of Haemophilus influenzae biogroup aegyptius by PCR-based subtractive hybridization; Smoot LM et al.; PCR-based subtractive genome hybridization produced clones harboring inserts present in Brazilian purpuric fever (BPF) prototype strain F3031 but absent in noninvasive Haemophilus influenzae biogroup aegyptius isolate F1947 . Some of these inserts have no matches in the GenBank database, while others are similar to genes encoding either known or hypothetical proteins . One insert represents a 2.3-kb locus with similarity to a Thermotoga maritima hypothetical protein, while another is part of a 7.6-kb locus that contains predicted genes encoding hypothetical, phage-related, and carotovoricin Er-like proteins . The presence of DNA related to these loci is variable among BPF isolates and nontypeable H . influenzae strains, while neither of them was detected in strains of types a to f . The data indicate that BPF-causing strain F3031 harbors unique chromosomal regions, most of which appear to be acquired from unrelated microbial sources. Infect Immun, 2002 May, 70(5), 2665 - 9 The cytolethal distending toxin of Haemophilus ducreyi inhibits endothelial cell proliferation; Svensson LA et al.; Haemophilus ducreyi, the etiologic agent of the sexually transmitted disease chancroid, produces a cytolethal distending toxin (HdCDT) that inhibits mammalian cell proliferation . We investigated the effects of HdCDT on normal human endothelial cells and on tubule formation in an in vitro model of angiogenesis . Endothelial cells were arrested in the G2 phase of the cell cycle, and tubule formation was inhibited in a dose-dependent manner . The antiproliferative activities of HdCDT on endothelial cells might contribute to the characteristic slow healing and persistence of chancroid ulcers. Cell Microbiol, 2002 Apr, 4(4), 191 - 200 Molecular and cellular determinants of non-typeable Haemophilus influenzae adherence and invasion; St Geme JW 3rd; Non-typeable Haemophilus influenzae is a common cause of human disease and initiates infection by colonizing the upper respiratory tract . Based on information from histopathologic specimens and in vitro studies with human cells and tissues in culture, non-typeable H . influenzae is capable of efficient adherence and appreciable invasion, properties that facilitate the process of colonization . A number of adhesive factors exist, each recognizing a distinct host cell structure and influencing cellular binding specificity . In addition, at least three invasion pathways exist, including one resembling macropinocytosis, a second mediated via the PAF receptor and a third involving beta-glucan receptors . Organisms are also capable of disrupting cell-cell junctions and passing between cells to the subepithelial space. Acta Paediatr, 2002, 91(2), 136 - 40 Antimicrobial susceptibility of Haemophilus influenzae among children in Beijing, China, 1999-2000; Hu YY et al.; A study on the nasopharyngeal carriage and antimicrobial susceptibility of Haemophilus influenza among children was conducted in Beijing Children's Hospital from April to May 2000 . The study included 292 children between 1 and 60 mo of age with acute upper respiratory tract infection . Nasopharyngeal swabs from these patients were cultured, and 105 Haemophilus influenzae strains were isolated, 3 of which were type b . Antibiotic susceptibility of the strains was determined using disk diffusion and E-tests and the results compared with those of isolates from children with pneumonia in 1999 . The carriage rate of Haemophilus influenzae was 36.0% (105/292) . It was found that 4.8% and 1.0% of isolates were resistant to ampicillin and cefaclor, respectively, and 5.7%, 16.2% and 77.1% were resistant to chloramphenicol, tetracycline, and sulphamethoxazole/trimethoprim, respectively . Amoxicillin/clavulanic acid, cefuroxime, ceftriaxone, azithromycin, and clarithromycin were uniformly active to all strains . Compared with the data from 1999, there was a significant increase in resistance to tetracycline (from 12.7% in 1999 to 16.2%) and sulphamethoxazole/trimethoprim (from 40.5% in 1999 to 77.1%) . CONCLUSION: H . influenzae isolates from outpatients in Beijing Children's Hospital had low ampicillin resistance and were sensitive to amoxicillin/clavulanic acid . Sulphamethoxazole/ trimethoprim resistance rates increased rapidly compared with those in the 1999 data . Further surveillance investigations are important for the choice of empiric therapy of acute respiratory tract infection. J Microbiol Immunol Infect, 2002 Mar, 35(1), 65 - 7 Haemophilus parainfluenzae and Fusobacterium necrophorum liver abscess: a case report; Hwang JJ et al.; Liver abscess is a potentially life-threatening disease . The clinical features of pyogenic liver abscess are variable and probably correlate with a variety of pathogenic microorganisms and underlying diseases that may be involved . The most common pathogen of liver abscess in Taiwan is Klebsiella pneumoniae . Diabetes mellitus and hepatobiliary calculus are major diseases associated with liver abscess . Haemophilus parainfluenzae is a commensal of the upper respiratory tract, but is an uncommon isolate in liver abscess . We describe a 44-year-old man with liver abscess caused by mixed H . parainfluenzae and Fusobacterium necrophorum infection . He received percutaneous liver abscess drainage and intravenous antibiotic therapy for 3 weeks and fully recovered . No recurrence occurred during the follow-up period of 4 months. J Microbiol Immunol Infect, 2002 Mar, 35(1), 61 - 4 Haemophilus influenzae type b meningitis with subdural effusion: a case report; Chan PC et al.; Haemophilus influenzae type b causes invasive infection in children under 2 years of age . The disease may be complicated with hearing impairment, lowered learning ability, and other neurologic sequelae . The incidence of invasive H . influenzae type b has declined dramatically after the introduction of routine administration of protein-conjugated H . influenzae type b vaccine in the United States and some other countries . Because of its low incidence in Taiwan, many clinicians are not familiar with the initial symptoms and management of H . influenzae type b . This case report describes a 7-month-old H . influenzae type b meningitis patient who had initial presentations of prolonged intermittent fever and vague neurologic signs . Left peripheral facial palsy with hearing loss in left ear and bilateral frontal subdural effusion developed during the first 5 days of cefotaxime therapy . Betamethasone was then given for 4 days to relieve the severe inflammation . Drug-induced fever was observed after 11 days of antibiotic use and subsided with prednisolone treatment . Left ear hearing impairment persisted during the follow-up period, but the children did not experience other significant development delay. Southeast Asian J Trop Med Public Health, 2001 Sep, 32(3), 513 - 9 Etiology of acute lower respiratory tract infection in children at Srinagarind Hospital, Khon Kaen, Thailand; Ekalaksananan T et al.; We investigated the etiology of acute lower respiratory infection (ALRI) in children under 5 admitted to Srinagarind Hospital . The causative bacteria and viruses were determined by hemoculture and viral isolation from blood and nasopharyngeal aspirate samples . Antigens of respiratory syncytial virus (RSV) and Chlamydia trachomatis were detected using EIA . The 74 children less than 5 years of age with ALRI enrolled in our study were diagnosed with pneumonia (75.7%), croup (16.2%), and bronchiolitis (8.1%), respectively . Examination of blood or nasopharyngeal aspirate revealed viral or bacterial infections in 26 and 22 cases, respectively, whereas 5 of the children aged under 1 year (10%) were diagnosed with pneumonia caused by Chlamydia trachomatis . RSV was the most common virus detected (24.3%) and was associated with pneumonia and bronchiolitis, while the parainfluenza virus was the primary cause of croup . In cases of pneumonia, bacterial infections were identified in almost all of the cases: and Streptococcus pneumoniae and Haemophilus influenzae were the most commonly isolated (at 8.9% each) . Mixed infections were detected in 8 cases (10.8%) . The incidence of RSV infection peaked during the especially warm and cool seasons, whereas the bacterial infections were primarily associated with the relatively cool season . Our study indicates that a combined pneumococcal and Hib vaccine and a RSV vaccine would reduce the high rate of pneumonia in children under 5 years of age in Northeast Thailand. Biochemistry, 2002 Apr 16, 41(15), 4827 - 36 The 1.25 A resolution structure of the diheme NapB subunit of soluble nitrate reductase reveals a novel cytochrome c fold with a stacked heme arrangement; Brige A et al.; The diheme cytochrome NapB constitutes the small subunit of a periplasmic nitrate reductase found in a wide variety of bacterial species, including pathogens . The NapB protein is essential in transferring electrons to the large catalytic subunit NapA, which subsequently reduces nitrate to nitrite . Here we present the crystal structure of a proteolyzed form of recombinant NapB from Haemophilus influenzae, which was determined by the multiple-wavelen