Jpn J Antibiot, 1993 Jul, 46(7), 577 - 88 {A clinical study on cefditoren pivoxil granules in the pediatric field}; Mori A et al.; The clinical efficacy of cefditoren pivoxil (CDTR-PI, ME 1207) was evaluated in 45 patients with various infections . CDTR-PI was administered after meals at a dose of 3 mg/kg t.i.d . to most patients . The clinical efficacy rate was 95.3% . As side effects, diarrhea occurred in 2 patients . Cefditoren showed excellent antibacterial activities against Haemophilus influenzae, Streptococcus pyogenes and Streptococcus pneumoniae, and was more effective against Staphylococcus aureus than other cephems. Antimicrob Agents Chemother, 1993 Jul, 37(7), 1552 - 5 In vitro susceptibilities of isolates of Haemophilus ducreyi from Thailand and the United States to currently recommended and newer agents for treatment of chancroid; Knapp JS et al.; We determined the in vitro susceptibilities of 54 isolates of Haemophilus ducreyi from Thailand (29 isolates) and San Francisco (25 isolates) to penicillin G, tetracycline, amoxicillin-clavulanic acid, ceftriaxone, cefixime, erythromycin, azithromycin, ciprofloxacin, ofloxacin, and trimethoprim-sulfamethoxazole . Isolates were susceptible to < or = 0.25 microgram of ceftriaxone per ml, < or less 0.5 microgram of cefixime per ml, < or = 0.125 microgram of ciprofloxacin per ml, and < or = 0.06 microgram of ofloxacin per ml . Erythromycin was active against all isolates (MIC for 90% of isolates tested, 0.25 microgram/ml), as was azithromycin (MIC, < or = micrograms/ml) . In contrast, all but one isolate were resistant to > or = 8.0 micrograms of tetracycline per ml, 11.1% of the isolates were resistant to and 40.9% of the isolates were resistant to trimethoprim-sulfamethoxazole (MIC, > or = 4/76 microgram/ml.) An Esp Pediatr, 1993 Jul, 39(1), 42 - 5 {Neonatal conjunctivitis: microbiologic study and antibiotic sensitivity}; Martinez Ruiz MT et al.; We have analyzed retrospectively fifty conjunctival samples from infants less than one month of age affected with conjunctivitis . Of these samples, 84% had a positive bacterial culture, with the microorganisms isolated, in order of frequency, being: Staphylococcus epidermidis (14%), Staphylococcus aureus (14%), Streptococcus pneumoniae (12%), Haemophilus sp, Chlamydia and alpha-hemolytic Streptococcus (8%) . All of these showed a high sensitivity to most of the drugs tested, except to penicillin and its derivatives . Cefotaxime, ceftriaxone and ciprofloxacin showed the highest in vitro activities . Of the pharmacological ophthalmic preparations commercially available in our country, sulfonamides, chloramphenicol, rifampicin, erythromycin and tobramycin are the agents more active against the bacteria described above. Pharmacotherapy, 1993 Jul-Aug, 13(4), 396 - 401 Institution-specific patterns of infection and Gram's stain as guides for empiric treatment of patients hospitalized with typical community-acquired pneumonia; Belliveau P et al.; STUDY OBJECTIVE . To determine the appropriateness of cefazolin as empiric treatment of typical, as opposed to atypical, bacterial community-acquired pneumonia at our institution . DESIGN . Combination of retrospective chart review and prospective determination of microbial susceptibilities and cefazolin-associated cost savings . SETTING . General acute-care referral hospital . PATIENTS . We evaluated the charts of patients discharged with a diagnosis of community-acquired pneumonia over a 10-year period . Gram's stains and culture results of sputum samples processed over 2 months were analyzed to determine the ability of the stains to predict positive Haemophilus influenzae cultures . The susceptibility and beta-lactamase status of clinical isolates of H . influenzae were determined . Cost savings of cefazolin as empiric treatment for community-acquired pneumonia were evaluated . MEASUREMENTS AND MAIN RESULTS . The frequency of H . influenzae pneumonia at our institution was 15% of the three major bacterial community-acquired pneumonias . Gram's stain was highly accurate in predicting the presence or absence of Haemophilus sp in sputum . Five patients had positive outcomes with cefazolin treatment despite being diagnosed with H . influenzae pneumonia . The organism isolates demonstrated intermediate sensitivity to cefazolin and 85% were beta-lactamase negative . Our program that encourages empiric use of cefazolin over cefuroxime for typical bacterial community-acquired pneumonia has allowed a modest projected annual cost savings of $24,000 . CONCLUSIONS . We concluded that when Gram's stain of sputum does not show Haemophilus sp in patients with typical bacterial community-acquired pneumonia, empiric treatment with cefazolin is appropriate and results in cost savings. Diagn Microbiol Infect Dis, 1993 Jul, 17(1), 61 - 5 In vitro susceptibility test practices with Haemophilus influenzae among College of American Pathologists survey participants in the United States; Doern GV et al.; Questionnaire results from 5233 clinical microbiology laboratories participating in the College of American Pathologists (CAP) survey program in the United States were used to establish current standards of practice with respect to in vitro susceptibility testing of Haemophilus influenzae . The results of this CAP survey indicated that the recently developed National Committee for Clinical Laboratory Standards (NCCLS) guidelines for H . influenzae susceptibility tests have been widely adopted, particularly with regard to the medium used to perform susceptibility tests . Haemophilus test medium (HTM) is now the most commonly used medium and there exists a general level of satisfaction (approximately 80%) with medium performance . Specific methodologic recommendations of the NCCLS, however, are often not being followed, for example, length and atmosphere of incubation and means of preparing inocula . beta-Lactamase assays constitute a very commonly employed means of assessing ampicillin activity . Among susceptibility test methods, disk diffusion (82.2%) is much more commonly used compared with broth microdilution (17.8%) procedures . Data are provided regarding the most commonly tested antimicrobials as well as some of the problems encounted when using current NCCLS methods for susceptibility tests with H . influenzae . Finally, the CAP survey questionnaire revealed that many laboratories have applied HTM to susceptibility tests with other fastidious bacteria such as pathogenic Neisseria sp., streptococci, and Moraxella catarrhalis. Eur J Pediatr, 1993 Jul, 152(7), 613 - 4 Guillain-Barré syndrome following immunisation with Haemophilus influenzae type b conjugate vaccine; Gervaix A et al.; The Guillain-Barre syndrome (GBS) is an immune-mediated disease often associated with viral or bacterial infections and with immunisation . IgM antibodies have been implicated as the main trigger event in GBS . So far, only four cases of GBS have been observed following immunisation with a conjugate vaccine against Haemophilus influenzae type b . We report another patient with GBS after this vaccination . We measured immunoglobulins against the H . influenzae type b polysaccharide (PRP) component of the vaccine . Surprisingly the anti-PRP IgM antibody level was markedly elevated (100 micrograms/ml) in the plasma of this patient . We speculate that an excessive anti-PRP IgM antibody response to the vaccine might be the cause of GBS. J Clin Microbiol, 1993 Jul, 31(7), 1856 - 9 Identification of Actinobacillus actinomycetemcomitans by leukotoxin gene-specific hybridization and polymerase chain reaction assays; Tonjum T et al.; Eleven strains of Actinobacillus actinomycetemcomitans isolated from cases of systemic infections, local abscesses, and periodontitis were identified by genetic assays using the leukotoxin gene as the target . We have developed a polymerase chain reaction (PCR) assay, based on the leukotoxin structural gene of this pathogen, which clearly identified all tested strains of A . actinomycetemcomitans and separated them from the closely related Haemophilus aphrophilus as well as other bacterial species . Furthermore, DNA-DNA hybridization was performed with the cloned partial leukotoxin structural gene (lktA) as a probe, which again clearly distinguished A . actinomycetemcomitans from H . aphrophilus, parts of the normal oral flora, and species harboring RTX (repeats in toxin) family-related cytotoxins . The PCR fragment amplified from the leukotoxin structural gene gave results similar to those given by the cloned leukotoxin gene when used as a probe in hybridization experiments . The hybridization and PCR assays described here are fundamental improvements for the identification of A . actinomycetemcomitans. Pediatr Infect Dis J, 1993 Jul, 12(7), 593 - 9 Vaccination with Haemophilus influenzae type b meningococcal protein conjugate vaccine reduces oropharyngeal carriage of Haemophilus influenzae type b among American Indian children; Takala AK et al.; The effect of Haemophilus influenzae type b (Hib) meningococcal protein conjugate vaccine (Hib-OMPC; Merck, Sharp & Dohme) on oropharyngeal (OP) carriage of Hib was evaluated in Navajo and Apache Indian children, who are known to be at high risk for invasive Hib disease . We obtained 1423 OP swabs at well child visits from 1321 children 3 months to 4 years of age: 293 of the swabs were obtained from children before the administration of any Hib-OMPC; 1119 were taken after the primary vaccination series; and 11 after the booster dose . Swabs were tested for the presence of Hib capsular polysaccharide antigen by enzyme-linked immunosorbent assay . Forty of 1423 swabs were positive for Hib . Among the 40 positive swabs 5 (13%) were obtained from children who had received Hib-OMPC vaccine appropriate for age at swabbing, compared with 500 of 1383 (36%) of negative swabs . Children who were OP carriers of Hib were older than noncarriers (mean age, 13 and 9 months, respectively) and a greater proportion of carriers (48%) had symptoms of respiratory infection at the time of swabbing than noncarriers (30%) . These variables were significantly related to increased risk of OP carriage of Hib when incorporated jointly in a logistic regression model: not vaccinated according to age (odds ratio 2.7, 95% confidence interval 1.00 to 7.05); increase of age in months (odds ratio 1.1, 95% confidence interval 1.02-1.10); and respiratory infection symptoms present (odds ratio 2.0, 95% confidence interval 1.06-3.77) . Thus besides preventing invasive Hib disease, appropriate vaccination with Hib-OMPC appears to reduce OP carriage of Hib. Pediatr Infect Dis J, 1993 Jul, 12(7), 589 - 93 Carriage of Haemophilus influenzae type b in children after widespread vaccination with conjugate Haemophilus influenzae type b vaccines; Mohle-Boetani JC et al.; Rates of invasive Haemophilus influenzae type b (Hib) disease in children decreased very rapidly after licensure of Hib conjugate vaccines . A role for a vaccine-related reduction in nasopharyngeal carriage of Hib has been suggested . We studied oropharyngeal carriage of Hib and vaccination rates in a population of 2- to 5-year-old children in metropolitan Atlanta . Among 584 children 75% were vaccinated with an Hib conjugate vaccine, 17% had not been vaccinated and 8% had no vaccination records available . Forty-one percent of the children were colonized with H . influenzae . One child was colonized with Hib . Hib carriage (0.17%; upper 95% confidence interval boundary, 0.97%) was substantially lower than the estimates of Hib carriage from prior studies of children who had not received Hib conjugate vaccines . Our data are consistent with a decline in Hib carriage induced by widespread use of conjugate Hib vaccines, which may have contributed to the decline of Hib disease in United States children. J Clin Invest, 1993 Jul, 92(1), 297 - 302 A structure-activity relationship for induction of meningeal inflammation by muramyl peptides; Burroughs M et al.; Components of bacterial peptidoglycans have potent biological activities, including adjuvant effects, cytotoxicity, and induction of sleep . Mixtures of peptidoglycan components also induce inflammation in the lung, subarachnoid space, and joint, but the structural requirements for activity are unknown . Using a rabbit model for meningitis, we determined the biological activities of 14 individual muramyl peptides constituting > 90% of the peptidoglycan of the gram-negative pediatric pathogen Haemophilus influenzae . Upon intracisternal inoculation, most of the muropeptides induced leukocytosis in cerebrospinal fluid (CSF), influx of protein into CSF, or brain edema, alone or in combination . The disaccharide-tetrapeptide, the major component of all gram-negative peptidoglycans, induced CSF leukocytosis and protein influx at doses as low as 0.4 microgram (0.42 nM) . Modification of the N-acetyl muramic acid or substitution of the alanine at position four in the peptide side chain decreased leukocytosis but enhanced brain edema . As the size of the muropeptide increased, the inflammatory activity decreased . Muropeptide carrying the diaminopimelyl-diaminopimelic acid cross-link specifically induced cytotoxic brain edema . These findings significantly expand the spectrum of biological activities of natural muramyl peptides and provide the basis for a structure-activity relationship for the inflammatory properties of bacterial muropeptides. Am Rev Respir Dis, 1993 Jul, 148(1), 201 - 7 Haemophilus influenzae infection of human respiratory mucosa in low concentrations of antibiotics; Tsang KW et al.; We examined the effects of 0.25 and 0.5 minimal inhibitory concentrations (MIC) of amoxicillin, loracarbef, and ciprofloxacin on the interaction of a clinical isolate of nontypable Haemophilus influenzae (NTHi) with human adenoid organ culture . Adenoid tissue was embedded in agar so that only the mucosal surface was exposed . Minimum essential medium containing NTHi with or without antibiotics was added to the organ culture and incubated with 5% CO2 at 37 degrees C for 24 h . The organ cultures (n = 6) were assessed for several parameters by light microscopy (LM) and transmission electron microscopy (TEM) . Bacterial viable counts after 24 h were not significantly different in all organ cultures . Compared with uninfected controls at 24 h, infection with NTHi caused significant (p < 0.05) damage to epithelium as assessed by LM: reduced ciliary beat frequency (CBF), disruption of epithelium integrity, and reduced number of ciliated sites . TEM showed extrusion of cells from the epithelial surface, loss of cilia from ciliated cells, cytoplasmic blebbing, and mitochondrial damage . In the presence of 0.25 and 0.5 MIC of all three antibiotics, the mucosal damage was significantly less (p < 0.05) . We conclude that in the presence of sub-MIC levels of amoxicillin, loracarbef, and ciprofloxacin, NTHi infection causes less functional (CBF) and structural damage. Avian Dis, 1993 Jul-Sep, 37(3), 673 - 9 Efficacy of norfloxacin nicotinate treatment of broiler breeders against Haemophilus paragallinarum; Lublin A et al.; The efficacy of the antimicrobial drug norfloxacin for treating infectious coryza was examined in 26-week-old male broiler breeders . Chickens were inoculated in the infraorbital sinus with the causal organism, Haemophilus paragallinarum . Four experimental groups were set up: control uninfected chickens, infected untreated chickens, and infected chickens treated for 5 days with either 20 mg norfloxacin/kg body weight or 40 mg norfloxacin/kg body weight . The first clinical signs were seen 24 hr postinfection . Of the observed clinical signs, sinus edema was ameliorated by the treatment, and the percentage of birds presenting sinus edema, sneezing, and increased lacrimation was significantly reduced after treatment . Clinical signs disappeared rapidly and were gone by the second day of treatment . The other signs disappeared gradually over 2 weeks after treatment began . There were no significant differences between the two dosage levels . H . paragallinarum was not reisolated from the infected infraorbital sinuses of birds treated with the higher dose of the drug, whereas the reisolation rate was 17% from those treated with the lower dose and 86% from the infected untreated birds. J Clin Pathol, 1993 Jul, 46(7), 680 - 1 Terminal subculture of blood cultures using a multipoint inoculator device; Thickett KJ et al.; A multipoint inoculation method was used for the terminal subculture of blood cultures . This economical yet reliable technique successfully isolated important human pathogens such as Haemophilus influenzae from macroscopically negative blood cultures. J Infect Dis, 1993 Jul, 168(1), 177 - 87 Molecular characterization of resistance plasmids in epidemiologically unrelated strains of multiresistant Haemophilus influenzae; Levy J et al.; Thirty-three epidemiologically unrelated strains of ampicillin-chloramphenicol-resistant isolates of Haemophilus influenzae (22 type b, 11 unencapsulated), isolated over 10 years in Belgium, were compared with 53 ampicillin-resistant chloramphenicol-susceptible isolates (22 type b, 31 unencapsulated) . All ampicillin-chloramphenicol-resistant and 76% of ampicillin-resistant chloramphenicol-susceptible strains were resistant to tetracycline, kanamycin, or both . Resistance to these antibiotics was specified by a 37- to 44-MDa conjugative plasmid . The genetic relatedness of these plasmids and of those in multiresistance strains from Spain was investigated . Plasmids specifying ampicillin-chloramphenicol-tetracycline-kanamycin resistance in Belgium or in Spain had highly related restriction fragment patterns . By homoduplex analysis, they had similar molecular organization and contained a structure identical to Tn10-TnCm, a transposon previously identified in chloramphenicol-tetracycline-resistant H . influenzae . Plasmids coding for different resistance phenotypes had less resemblance by restriction endonuclease analysis; however, study of heteroduplex molecules indicated they shared a high proportion of core sequences . These findings support the hypothesis of independent transposition events resulting in resistance plasmids of close molecular organization. Rev Latinoam Microbiol, 1993 Jul-Sep, 35(3), 297 - 300 {Evaluation of a selective medium with dilutions for the isolation of Actinobacillus pleuropneumoniae and Haemophilus spp . in pigs}; Rosado-Vallado M et al.; The aim of the present research was to evaluate the efficiency of a method used to enhance the isolation of Actinobacillus pleuropneumoniae and Haemophilus spp . 134 samples of pneumonic lungs of swine were directly grown in blood agar medium, 120 of these samples were simultaneously processed by a dilution method inoculating then into a selective and enriched broth (1% poly-enriched, 5% yeast extract . 5 micrograms/ml bacitracin, 1 microgram/ml lincomycin and 1 microgram/ml crystal violet) . The dilution method proved to be more efficient than the direct one. Rev Latinoam Microbiol, 1993 Jul-Sep, 35(3), 259 - 65 {Lack of foto reactivation of the Haemophilus influenzae transforming DNA mutated with near ultraviolet light (325-400nm)}; Alarcon-Hernandez E et al.; Three extracts from Saccharomyces cerevisiae were obtained by salting out with ammonium sulfate, these were I-G, EFRL-II-G and III-G . Fraction EFRL-II-G showed the highest photoreactivating activity on DNA str2000 irradiated with far UV light . However, the same fraction did not reactivate DNA str2000 previously inactivated by near UV irradiation . We think that the inactivation by near-UV was not due to photochemically-formed pyrimidine dimers . Decrease in spontaneous mutation frequency of cells transformed with DNA str2000 irradiated with near-UV light, was the same with the DNA treated with active or heat inactivated EFRL-II-G, therefore we may conclude that DNA lesions responsible for the effect are difference to pyrimidine dimers. Eur J Epidemiol, 1993 Jul, 9(4), 353 - 60 Genomic DNA fingerprints and phenotypic characteristics of serotype B Haemophilus influenzae isolates from Italy; Mencarelli M et al.; Three different restriction enzymes (PstI, EcoRI, SspI) were used to analyze the total genomic DNA fingerprints of 52 Haemophilus influenzae type b (Hib) isolates collected between 1982 and 1992 from patients and carriers in central-northern Italy . The same isolates were also characterized by biotyping and antimicrobial agent susceptibility typing . In addition, 13 Hib reference strains from Sweden and the Netherlands were subjected to DNA fingerprinting and compared to Italian isolates . Both genotypic and phenotypic analysis revealed low variability among the Italian study isolates . Most were biotype I and all study isolates but one were susceptible to ampicillin, chloramphenicol, rifampin, third-generation cephalosporins and cotrimoxazole . Among the 52 Italian isolates, 3 distinct DNA patterns were identified, and 88.5% of study strains belonged to the same DNA group . There was sharing of the predominant DNA profile among isolates cultured in different years from different geographical areas and different invasive, respiratory and surface infections . However, another DNA pattern was only found in carrier isolates and in one surface infection isolate . Comparison by DNA fingerprinting showed that the majority of Italian isolates were closely related to most of the analyzed Swedish and Dutch reference strains, previously shown by other techniques to be predominant in those areas . This finding provides additional support for the hypothesis that there may be a dominant European Hib clone . The results show that DNA fingerprinting is a reliable method for Hib characterization and may be a useful additional epidemiological tool for this microorganism. J Clin Microbiol, 1993 Jul, 31(7), 1952 - 4 N-acetyl-D-glucosamine medium improves recovery of Haemophilus influenzae from sputa of patients with cystic fibrosis; Moller LV et al.; A modified selective medium supplemented with N-acetyl-D-glucosamine (NAG), hemin, and NAD plus two cefsulodin disks, for primary isolation of nonencapsulated Haemophilus influenzae from sputum of patients with cystic fibrosis, is described . Isolation of H . influenzae from this medium, designated NAG medium, was compared with recovery by standard media and immunochemical detection of H . influenzae with monoclonal antibody 8BD9 . The H . influenzae recovery rate increased from 31% with standard media to 42% with NAG medium . H . influenzae was detected by immunoperoxidase staining in 54% of the sputum specimens . The results of this study demonstrate that NAG medium improves H . influenzae recovery, although immunoperoxidase staining is superior for detection of H . influenzae from sputum of cystic fibrosis patients. J Biol Chem, 1993 Jun 5, 268(16), 11594 - 8 Composition of the peptidoglycan of Haemophilus influenzae; Burroughs MH et al.; The composition of the peptidoglycan of Haemophilus influenzae was determined by analyzing glycopeptides generated by M1 muramidase hydrolysis using high pressure liquid chromatography, fast atom bombardment mass spectrometry, and fast atom bombardment collisionally activated dissociation tandem mass spectrometry, and amino acid analysis . The structures of 17 glycopeptides, representing 96% of the total peptidoglycan, were ascertained . Fifteen glycopeptides resembled species described for Escherichia coli peptidoglycan (Glauner, B., and Schwarz, U . (1983) The Target of Penicillin (Hackenbeck, R., ed), Walter de Gruyter, Berlin pp . 29-34) as compared with 9 in common with Bordetella pertussis (Tuomanen, E., Schwartz, J., Sande, S., Light, K., and Gage, D . (1989) J . Biol . Chem . 264, 11093-11098) . Substitutions for L-alanine in the fourth position of the stem peptide included glycine, aspartic acid, and serine . The peptidoglycan was 27% cross-linked, 2% of which formed between diaminopimelic acid residues . No species was identified containing lysyl-arginine residues characteristic of lipoprotein . The peptidoglycan of non-beta-lactamase-mediated antibiotic-resistant H . influenzae differed from that of sensitive strains by an increase in the amount of disaccharide tripeptides and a decrease in 1,6-anhydro dimers . Both changes were transformable properties that changed in a stepwise fashion in parallel with the degree of antibiotic resistance. Bol Med Hosp Infant Mex, 1993 Jun, 50(6), 415 - 21 {The impact of Haemophilus influenzae infections on Mexican children}; Villasenor-Sierra A et al.; A review of Haemophilus influenzae (Hi) infections in Mexico over the past 32 years was conducted . The proportion of Hi isolates in relation to positive cultures for distinct diseases was distributed as follows for meningitis (9-69%) and for pneumonia with empyema (6-28%) . There was no difference in the proportion of Hi isolation between under developed countries and the United States . In other diseases such as septic arthritis, epiglottitis, acute otitis media, acute maxillary sinusitis and in the nasopharyngeal carrier state, the information was too limited . The incidence of Hib invasive disease has been almost eliminated in some areas of the world related to the use of Hib conjugated vaccine . It is imperative for the practitioner to be aware of the advantages of Hib vaccine in infancy. J Clin Invest, 1993 Jun, 91(6), 2734 - 43 Restricted immunoglobulin VH usage and VDJ combinations in the human response to Haemophilus influenzae type b capsular polysaccharide . Nucleotide sequences of monospecific anti-Haemophilus antibodies and polyspecific antibodies cross-reacting with self antigens; Adderson EE et al.; To examine the human antibody repertoire generated against a biologically significant antigen we have obtained sequences of heavy chain variable region genes (IgVH) from 15 monoclonal antibodies specific for the capsular polysaccharide of Haemophilus influenzae type b (Hib PS) . All VH segments are members of the VH3 family and 9 of 15 are members of the smaller VH3b subfamily . Restriction is evident by the shared use of certain VDJ joints in independent hybridomas from different subjects . Two hybridomas generated from the same subject demonstrate identical heavy chain variable region gene sequences but differ in isotype and rearrange alternative light chain variable region genes (IgVL), suggesting that in a normal immune response, a single pre-B cell clone may use different light chain rearrangements and give rise to progeny capable of reacting with antigen . Using a polymerase chain reaction assay optimized to detect base pair differences among VH genes we demonstrate that at least a portion of expressed anti-Hib PS VH genes have undergone somatic mutation . Anti-Hib PS heavy chain genes are homologous to VH segments encoding autoantibodies and two hybridomas secrete anti-Hib PS antibody that cross-reacts with self antigens (double-stranded DNA and single-stranded DNA) . Comparison of VH regions of self-reactive and monospecific anti-Hib PS Ab demonstrates no consistent structural feature correlating with fine antigen specificity . These data demonstrate significant restriction in VH usage and VDJ recombination in the anti-Hib PS response and confirm that autoantibodies may be elicited during normal immune responses. Infect Immun, 1993 Jun, 61(6), 2653 - 61 Immunogenicity of overlapping synthetic peptides covering the entire sequence of Haemophilus influenzae type b outer membrane protein P2; Chong P et al.; Haemophilus influenzae type b is a major cause of bacterial meningitis in young children . Antibodies against the outer membrane protein P2 are protective in the infant rat model of bacteremia . To identify conserved, surface-exposed, and protective epitopes of P2, 17 overlapping peptides covering the entire sequence of the protein were synthesized . Antisera from mice, guinea pigs, and rabbits raised against chromatographically purified P2 were tested for their reactivities to the peptides by enzyme-linked immunosorbent assays (ELISA) . Three major linear immunodominant B-cell epitopes were mapped to residues 53 to 81, 241 to 265, and 314 to 341 of mature P2 . Human convalescent-phase antisera also reacted strongly with these three epitopes . Rabbit antisera against all peptide-keyhole limpet hemocyanin conjugates except two peptides containing residues 8 to 19 and 302 to 319 recognized the corresponding peptides in ELISA and reacted with P2 on immunoblots . Immunization with all unconjugated peptides, except the 19 N-terminal residues, induced very strong peptide-specific antibody responses, and these antisera reacted with P2 on immunoblots . Rabbit antisera raised against peptides corresponding to residues 1 to 14, 125 to 150, 193 to 219, and 241 to 319 also recognized P2 purified from H . influenzae nontypeable isolates . Identification of these immunodominant B-cell epitopes and conserved regions is a first step toward the rational design of a universal H . influenzae vaccine. Infect Immun, 1993 Jun, 61(6), 2558 - 62 Specific antibody to Haemophilus somnus in the bovine uterus following intramuscular immunization; Butt BM et al.; Sources of anti-Haemophilus somnus antibody in bovine uterine secretions following intramuscular immunization and subsequent intrauterine inoculation of killed H . somnus were investigated . Holstein cattle (n = 21) were immunized with a 270-kDa outer membrane protein from H . somnus (omp-270) by intramuscular injection . At estrus, the cattle were given an intrauterine inoculum of a heat-killed suspension of a homologous strain of H . somnus containing omp-270 (n = 7), a heterologous strain of H . somnus lacking omp-270 (n = 7), or phosphate-buffered saline (n = 7) . Uterine secretions were sampled by saline lavage immediately prior to inoculation and at 6, 24, 48, 72, 96, and 120 h after inoculation . Immunoglobulin G subclass I (IgG1) and IgG2 antibody specific for omp-270 were detectable in estrous uterine secretions of all systemically immunized cattle from which an adequate sample was obtained . IgM antibody specific for omp-270 was detected in serum following immunization but was not consistently detected in the uterine secretions of any animal . IgA antibody specific for omp-270 was not detectable in either serum or uterine secretions following immunization or intrauterine inoculation . Ratios of antibody to immunoglobulin and ratios of immunoglobulin to albumin in serum and uterine secretions indicated that about half the IgG1 and essentially all the IgG2 in secretions originated in the serum . Relative titers of IgG1 and IgG2 omp-270-specific antibodies in the uterine lumen and serum gave no evidence for selective transport of either subclass from serum into local secretions . Neither heterologous nor homologous intrauterine inocula detectably altered the serum contribution to antibody in uterine secretions within the sampling period . On the basis of these results, development of a systemic IgG2 antibody response may provide the basis for local immunological protection in the bovine reproductive tract. Microb Pathog, 1993 Jun, 14(6), 451 - 62 Genetic analysis of the diversity in outer membrane protein P2 of non-encapsulated Haemophilus influenzae; Duim B et al.; The molecular basis for the diversity of the major outer membrane protein (MOMP) P2 of non-encapsulated Haemophilus influenzae was analyzed by direct sequencing of fragments of the P2 genes, obtained by the polymerase chain reaction . Genetically divergent H . influenzae strains were isolated from patients with otitis media and from infected patients with chronic obstructive pulmonary disease (COPD) . The nucleotide sequences of these P2 genes were determined and compared with P2 gene sequences of three non-encapsulated strains and with the P2 gene of encapsulated H . influenzae type b . Variation in the nucleotide sequence of the P2 genes of non-encapsulated H . influenzae was localized in eight distinct regions which were interchanged with relatively conserved regions . Regions 2, 4, 5 and 8 were found to be hypervariable, since they were characterized by multiple deletions or substitutions of nucleotides . According to the proposed structure of MOMP P2 the variable regions were localized in eight loop structures exposed at the outside of the outer membrane . Loops 2, 4, 5 and 8 were hypervariable in all isolates whereas loop 6 varied only in isolates from COPD patients with persistent infections. Microb Pathog, 1993 Jun, 14(6), 417 - 31 Evidence of Haemophilus ducreyi adherence to and cytotoxin destruction of human epithelial cells; Lagergard T et al.; The adherence of ten different Haemophilus ducreyi strains to cultured human epithelial cells and the subsequent destruction of these cells was investigated in vitro using HEp-2 and HeLa cells . Bacterial adherence was measured with two assays, one employing viable bacteria and the other radiolabeled bacteria . In addition, the capacity of H . ducreyi to invade/penetrate the HEp-2 cells was examined . Differential interference contrast and transmission electron microscopy techniques were also used . In both cell lines, all ten strains of H . ducreyi manifested substantial adherence (the rates being 4-20% of the inoculum), irrespective of whether the bacteria were cultivated on solid or liquid media . Bacterial adherence reached a peak after about 2-3 h of incubation, though it was already manifest after only 15 min, a finding suggesting constitutive rather than inducible properties of H . ducreyi adhesins to be involved . The adherence capacity was diminished, but not totally abolished, when bacteria were heat-treated at 100 degrees C for 30 min, indicating the adhesins to be fairly stable . On the other hand, treatment of HEp-2 cells with methanol, glutaraldehyde and emetine dichloride significantly reduced the adherence, indicating viable eukaryotic cells with native surface structures to be involved in bacterial adherence . This capacity of H . ducreyi to adhere to HEp-2 cells was confirmed both by electron microscopy and by differential interference microscopy . Some adherent bacteria were also capable of penetrating epithelial cells, as observed with an invasion assay and confirmed by transmission electron microscopy . Further incubation of the cell monolayers with the ten strains resulted in the cell-death and total damage of monolayers for seven cytotoxin-producing strains, indicating cytotoxin action to be responsible for the destruction of the monolayer . All strains manifested capacity to survive and multiply on the cell monolayer . We propose the first step in the pathogenesis of chancroid to be the adherence of bacteria to epithelial cells, followed by the action of cytotoxin and further bacterial proliferation . This sequence of events is suggested to result in the production of genital ulcers by H . ducreyi organisms. J Antimicrob Chemother, 1993 Jun, 31 Suppl E, 39 - 50 Selection of dose regimens of azithromycin ; Foulds G et al.; The unique pharmacokinetics of azithromycin are characterized by high, sustained tissue concentrations . The concentrations of azithromycin were predicted, following various multiple dose regimens, from concentrations in tonsillar, prostatic, and uterine tissues following single oral doses . Following a five-day treatment regimen (500 mg on day 1, followed by 250 mg on days 2-5), or a three-day regimen (500 mg daily for three days), concentrations of azithromycin in tonsillar tissue, representative of respiratory tract tissues, will continuously be greater than the MICs for key target pathogens (Streptococcus pyogenes, Haemophilus influenzae, Staphylococcus aureus) in infections of the respiratory tract for up to 10 days . Since tissue concentrations above the MICs for infecting organisms were correlated with efficacy in animal models of infection, short treatment regimens consisting of once-daily oral administration of azithromycin should be effective in the treatment of a variety of infections . A single 1 g oral dose will provide concentrations in the uterus and prostate, representing urogenital tissues, above the MIC for Chlamydia trachomatis for approximately 10 days . Thus, this regimen should be effective in the treatment of chlamydial infections of the genital tract. J Antimicrob Chemother, 1993 Jun, 31 Suppl E, 163 - 9 The efficacy and tolerance of a three-day course of azithromycin in the treatment of community-acquired pneumonia; Myburgh J et al.; The clinical efficacy and tolerance of a three-day course of azithromycin was evaluated in patients with community-acquired pneumonia in an open, non-comparative pilot study . Sixty-six patients with clinical and radiological findings of pneumonia were treated with a total dose of 1.5 g azithromycin (500 mg once-daily for three days) . Of these 66 patients, 40 were evaluable clinically and microbiologically . Of the remaining 26 patients, 22 had no organisms isolated at baseline, and could only be evaluated clinically; two patients were lost to follow-up; and two patients were protocol violators . Of the 40 patients in whom aetiological agents were identified, 39 (98%) had a satisfactory clinical response (34 cured, five improved), including all eight patients diagnosed as having Legionella pneumophila pneumonia on the basis of serology . One patient with recurrent Haemophilus influenzae infection on day 8 was considered a failure . Total severity score for overall signs and symptoms was reduced significantly from a baseline level by day 2 (P = 0.0001) . Bacteriological eradication was achieved in 32 of 33 (97%) isolates including 27 of 27 Streptococcus pneumoniae, the most frequently isolated pathogen . All six patients with pneumococcal bacteraemia were cured clinically by day 14, and blood cultures were negative for four of these patients within 48 h . Treatment-related side effects were reported in 4 of 66 (6%) patients, but were all mild . Laboratory abnormalities were observed in 5 of 62 (8%) patients: elevated liver enzymes (2), elevated creatine levels (1), haematological test abnormalities (2), including one patient with severe eosinophilia.(ABSTRACT TRUNCATED AT 250 WORDS) J Antimicrob Chemother, 1993 Jun, 31 Suppl E, 147 - 52 A single-blind comparison of three-day azithromycin and ten-day co-amoxiclav treatment of acute lower respiratory tract infections; Hoepelman AI et al.; The efficacy and safety of a three-day regimen of azithromycin (500 mg od) and a ten-day regimen of co-amoxiclav (625 mg tid) were compared in a single-blind study in 99 patients with acute lower respiratory tract infections . Of these, 70 (71%) suffered an infective exacerbation of their chronic obstructive pulmonary disease . Nine patients had pneumonia and 19 purulent bronchitis . Treatment success, defined as cure or improvement, occurred in 43 of 48 (90%) patients in the azithromycin group, compared with 45 of 51 (88%) patients in the co-amoxiclav group . The most common isolated pathogens were Haemophilus influenzae (25 cases; MIC range of azithromycin (A) < or = 0.06-4 mg/L; for co-amoxiclav (CA) 0.25-4 mg/L; Streptococcus pneumoniae (10 cases; A: < or = 0.06- > 128; CA: < or = 0.06); and Moraxella catarrhalis (four cases; A: < or = 0.06; CA: < or = 0.06-0.25) . Microbiological response rates were comparable in the two groups . In 5% of patients, serological evidence for virus or atypical pathogens was found . Thirteen (26%) patients treated with co-amoxiclav had gastrointestinal complaints (seven with diarrhoea), compared with five (10%) treated with azithromycin (P = 0.09) . Additional complaints occurred in three patients treated with co-amoxiclav and in one patient treated with azithromycin . It was concluded that a three-day regimen of azithromycin was as effective, clinically and microbiologically, as a ten-day regimen of co-amoxiclav in the treatment of acute lower respiratory tract infections. Infect Immun, 1993 Jun, 61(6), 2419 - 24 Inhibition of human neutrophil migration in vitro by low-molecular-mass products of nontypeable Haemophilus influenzae; Cundell DR et al.; Nontypeable Haemophilus influenzae commonly causes infections in the lower and upper respiratory tract, although the mechanisms of its colonization and persistence in the airways are unclear . Culture filtrates from six clinical isolates of this bacterium were assessed for their abilities to influence neutrophil function in vitro . Each culture filtrate was assessed on six separate occasions with neutrophils obtained from six different donors . During the log and early stationary phases of growth (0 to 18 h), culture filtrates contained primarily neutrophil chemokinetic activity but no activity affecting neutrophil migration toward the chemotactic factors N-formyl-L-methionyl-L-leucyl-L-phenylalanine and leukotriene B4 . In contrast, filtrates obtained after 24 h of culture contained factors which inhibited neutrophil migration toward both of these chemotactic factors . This chemotaxis-inhibitory activity persisted between 24 and 72 h of bacterial culture, and it was not associated with the presence of either chemotactic or chemokinetic activity as assessed by checkerboard analysis . Gel filtration of pooled 72-h filtrates yielded three major peaks of chemotaxis-inhibitory activity . Endotoxin was present together with two other low-molecular-mass hydrophobic factors of approximately 8 and 2 kDa . These low-molecular-mass factors are chloroform insoluble and heat stable, and they are inactivated by protease, periodate, and diborane reduction . Activity was completely retained on a wheat germ agglutinin column, and it could be eluted with N-acetyl-D-glucosamine . These data suggest that inhibitory activity is associated with N-acetyl-D-glucosamine-containing glycopeptides, possibly derived from the bacterial cell wall . The production of these compounds may contribute to the persistence of this bacterium in vivo by inhibiting neutrophil chemotaxis in the microenvironment of the respiratory mucosa. Zentralbl Bakteriol, 1993 Jun, 279(1), 83 - 91 Genetic analysis of Actinobacillus pleuropneumoniae, and comparison with Haemophilus spp . Taxon "minor group" and Taxon C; Hampson DJ et al.; The genetic diversity among 52 field isolates, mainly from Australia, and 15 reference strains of Actinobacillus pleuropneumoniae was examined using multilocus enzyme electrophoresis . Thirty three electrophoretic types (ETs) were recognised, with a mean genetic diversity per locus of 0.312 . Australian strains of serovars 1, 2, 5 and 7 belonged to the same clonal lines as strains of these serovars in other countries, but distinct clones of serovars 3, 7, 11 and 12 were also identified . The type strains of serovars 1, 9 and 11 were placed in the same ET . Strains of A . pleuropneumoniae biovar 2 were closely related to biovar 1 strains . Twenty three isolates which did not react with the typing sera or could not be assigned to a single serovar were divided into seven clonal groups . Five strains of Haemophilus sp . Taxon "minor group" which were included in the study were distinct from A . pleuropneumoniae, and were diverse, being divided into at least two major genetic groupings . Two strains of Haemophilus sp . Taxon C were placed in another distinct ET. Zentralbl Bakteriol, 1993 Jun, 279(1), 27 - 34 Ecology and significance of Pasteurellaceae in man--an update; Frederiksen W; Within the last decade new knowledge has emerged concerning the significance of Pasteurellaceae in man; the classification has undergone some changes, and new taxa were described . Haemophilus influenzae serotype b was shown to have a clonal distribution that is related to demographic patterns of the human host . Brazilian purpuric fever is caused by a special clone of Haemophilus aegyptius . H . influenzae biotype IV seems to be a genital pathogen, and may deserve species rank . New Pasteurella species have been described, that occur in well known pathological foci in man, e.g . bite wounds . Toxigenic P . multocida may occur in man also; the significance of toxigenicity in man is not known . The real actinobacilli of man, A . ureae and A . hominis are still very rarely reported . In order to avoid wrong epidemiological conclusions, correct diagnosis is emphasized. Zentralbl Bakteriol, 1993 Jun, 279(1), 114 - 24 Prevalence and biochemical properties of V factor-dependent Pasteurellaceae from rodents; Nicklas W et al.; Organs of 1436 rats and 2839 mice were monitored for V-factor dependent Pasteurellaceae . Such bacteria were isolated from 21.2% of rats and from 2.4% of mice, respectively . They were most frequently cultured from the deep respiratory tract (lungs and trachea) . In addition, they were found in the nasal cavity and on mucous membranes of the genital and the intestinal tract . 35 phenotypical criteria were determined for 429 isolates . Based on these data, groups of bacteria showing similar biochemical properties were formed using exploratory statistical methods (principal qualitative analysis) . The majority of 333 isolates is represented in a rather homogenous group which has some characteristics in common with the Haemophilus parainfluenzae complex . The remaining isolates consist of several groups . It was shown by others that some of these bacteria are closely related to the yet unnamed Taxon B which forms a genus-like cluster together with Pasteurella pneumotropica type Jawetz. Mil Med, 1993 Jun, 158(6), 371 - 3 Immunization status of a military dependent population; Lopreiato JO et al.; The immunization status of active duty pediatric dependents served by the National Naval Medical Center was surveyed to estimate the degree to which this group was in compliance with immunization requirements . Four hundred sixteen patients who presented consecutively to a pediatric acute care clinic had their medical and immunization records screened . Ten percent of patients did not have complete records of immunization . Of the 375 patients remaining, 52 (13.9%) were deficient in one or more required immunizations based on their current age . The highest rates of delay were seen for the Haemophilus influenza vaccine followed by measles, mumps, rubella, and diphtheria, tetanus, and pertussis . The most common reason for missing immunizations was parental unfamiliarity with the recommended schedule . This study suggests that a significant number of dependents in our catchment area were delayed in immunization and that accurate record keeping and patient education about immunizations needs to be improved. Mol Microbiol, 1993 Jun, 8(6), 1135 - 43 The region of human transferrin involved in binding to bacterial transferrin receptors is localized in the C-lobe; Alcantara J et al.; Iron-saturated human transferrin was digested with either chymotrypsin or trypsin to produce C-lobe and N-lobe protein fragments . Individual protein fragments were purified by a combination of gel filtration and Concanavalin A affinity chromatographic procedures . The C-lobe and N-lobe fragments of human transferrin were then used in binding assays to assess their ability in binding to the bacterial transferrin receptors . Competitive binding assays demonstrated that the C-lobe fragment of human transferrin binds as well as intact human transferrin to bacterial transferrin receptors from Neisseria meningitidis, Neisseria gonorrhoeae and Haemophilus influenzae . Using isogenic mutants of N . meningitidis deficient in either of the transferrin-binding proteins (Tbps), we demonstrated that both transferrin-binding proteins were able to bind to the C-lobe fragment of human transferrin. J Antimicrob Chemother, 1993 Jun, 31(6), 949 - 61 Loracarbef versus doxycycline in the treatment of acute bacterial maxillary sinusitis . Scandinavian Study Group; Effects of recombinant GM-CSF and IgA opsonisation on neutrophil phagocytosis of latex beads coated with P6 outer membrane protein from Haemophilus influenzae; Lung Immunobiochemical Research Laboratory, General Hospital, Birmingham, UKBACKGROUND--IgA is the major antibody class in mucosal secretions, yet its biological functions remain poorly understood and its role as an opsonin for neutrophils has been the subject of controversy . It has been reported that treatment of neutrophils with granulocyte-macrophage colony stimulating factor (GM-CSF) induces the cells to phagocytose particles opsonised with IgA . A study was performed to investigate the effects of GM-CSF and IgA opsonisation on the ability of human neutrophils to recognise and phagocytose latex beads coated with the P6 outer membrane protein of Haemophilus influenzae . METHODS--Human neutrophils with and without preincubation with 100 pmol/l GM-CSF, were incubated with non-opsonised P6-coated latex beads or beads opsonised with IgA purified from the blood of a bronchiectatic patient with high titres of IgA anti-P6 . Phagocytosis was measured by counting internalised beads during microscopic examination . RESULTS--The phagocytosis of IgA opsonised beads by untreated neutrophils (mean (SE) 2.1 (0.43) beads/cell) was significantly greater than that of non-opsonised beads (mean (SE) 1.3 (0.30) beads/cell) . Treatment of neutrophils with GM-CSF resulted in increased phagocytosis of non-opsonised beads (mean (SE) 2.1 (0.39) beads/cell) but opsonisation with IgA increased this further (mean (SE) 3.4 (0.53) beads/cell) . CONCLUSIONS--Human neutrophils recognise and phagocytose non-opsonised particles coated with bacterial antigen . Antibodies of the IgA isotype opsonise for neutrophil phagocytosis of particles coated with bacterial antigen but this behaviour is enhanced, in an additive fashion, by treatment of the cells with GM-CSF . The results suggest that IgA and GM-CSF are important cofactors for neutrophil recognition and elimination of bacterial pathogens. Pediatr Infect Dis J, 1993 Jun, 12(6), 484 - 92 Comparative immunogenicity of four Haemophilus influenzae type b conjugate vaccines in Alaska Native infants; Bulkow LR et al.; We compared the immunogenicity of the four available Haemophilus influenzae type b (Hib) conjugate vaccines in Alaska Native infants . Three of the vaccines, Hib oligosaccharide-CRM197 (HbOC), polyribosylribitol phosphate-diphtheria toxoid (PRP-D) and polyribosylribitol phosphate-tetanus toxoid (PRP-T), were given at 2, 4 and 6 months of age, and the PRP Neisseria meningitidis outer membrane protein (PRP-OMP) conjugate vaccine was given at 2 and 4 months of age . Enrollment was largely sequential by vaccine availability beginning with HbOC and ending with PRP-T . A total of 225 infants completed the full vaccination series . Groups of infants receiving the different vaccines did not differ significantly by sex, ethnicity, degree Alaska Native or age at vaccination . The only vaccine that induced a response with the first 2-month dose was PRP-OMP; 91% of infants had > or = 0.15 micrograms/ml and 57% had > or = 1.0 microgram/ml of anti-PRP antibody by 4 months of age . After two doses it also remained the most immunogenic . After the full three vaccine series, trials that requires cough of 21 days is excessively restrictive. Pediatr Infect Dis J, 1993 Jun, 12(6), 478 - 84 Haemophilus influenzae type b carriage and immunity four years after receiving the Haemophilus influenzae oligosaccharide-CRM197 (HbOC) conjugate vaccine; Barbour ML et al.; Late in 1991, before the implementation of a national immunization program against Haemophilus influenzae type b (Hib) in the United Kingdom, we performed a 4-year follow-up of 120 children who in 1987 had been enrolled in an immunogenicity trial in which 60 of them (vaccinees) received an Hib conjugate vaccine (HbOC) at the same time as diphtheria-tetanus toxoid-pertussis vaccine at the ages of 3, 5 and 9 months . Sixty others (controls) received only diphtheria-tetanus toxoid-pertussis vaccine at the same ages and were not subsequently immunized against Hib . We investigated Hib pharyngeal colonization using the antiserum agar method and the concentrations of serum IgG antibody to the type b capsule by enzyme-linked immunosorbent assay . At 4 years of age the Hib colonization rates in vaccinees and controls were 8% (5 of 60) and 5% (3 of 60), respectively . The children colonized with Hib had greater serum anti-capsular IgG concentrations than did noncolonized children (P < 0.001), and colonized vaccinees tended to have higher concentrations than colonized controls (P = 0.053) . Regardless of Hib colonization status vaccinees had greater antibody concentrations than controls (P < 0.001) . Forty-nine percent of vaccinees had an antibody concentration > 1 microgram/ml . There was an inverse relationship between the Hib colony count on culture and the serum IgG concentration . These data indicate that the increase in serum antibody concentration after immunization with an Hib conjugate vaccine is sustained and that immunization primes for a booster response on exposure to Hib . There may be a relationship between previous Hib conjugate immunization and the density of Hib colonization in children. Pediatr Infect Dis J, 1993 Jun, 12(6), 466 - 73 Antimicrobial treatment of occult bacteremia: a multicenter cooperative study; Bass JW et al.; This prospective multicenter study was conducted to define more clearly clinical and laboratory criteria that predict a strong probability of occult bacteremia and to evaluate the effect of empiric broad spectrum antimicrobial treatment of these children . Children 3 to 36 months old with fever > or = 40 degrees C (104 degrees F) or, > or = 39.5 degrees C (103 degrees F) with white blood cells (WBC) > or = 15 x 10(9)/liter, and no focus of infection had blood cultures obtained and were randomized to treatment with oral amoxicillin/potassium clavulanate or intramuscular ceftriaxone . Sixty of 519 (11.6%) study patients had positive blood cultures: Streptococcus pneumoniae, 51; Haemophilus influenzae b, 6; Neisseria meningitidis, 2; and Group B Streptococcus, 1 . Subgroups of high risk were identified as fever > or = 39.5 degrees C and WBC > or = 15 x 10(9)/liter, 55 of 331 or 16.6% positive with increasing incidence of positive culture with increasing increments of degrees of leukocytosis to WBC > or = 30 x 10(9)/liter where 9 of 21 or 42.9% were positive . Subgroups of significantly lower risk were identified as fever > or = 39.5 degrees C and WBC < 15 x 10(9)/liter, 5 of 182 or 2.7% positive and those with WBC < 10 x 10(9)/liter, 0 of 99 or 0.0% positive . Children with positive cultures who received ceftriaxone were nearly all afebrile after 24 hours whereas a significant number who received amoxicillin/potassium clavulanate remained febrile . In the 459 culture-negative children more amoxicillin/potassium clavulanate-treated children developed diarrhea and had less improvement in clinical scores after 24 hours than ceftriaxone-treated children.(ABSTRACT TRUNCATED AT 250 WORDS) Aust Fam Physician, 1993 Jun, 22(6), 1015 - 7, 1020-1 Haemophilus influenzae type b . Conjugate vaccines for use in infants and children; Hanna JN et al.; Haemophilus influenzae type b (Hib) is a bacterial pathogen that causes serious, sometimes fatal, infections primarily in young children, especially in the second 6 months of life . Immunisation of children against Hib is now an important issue and four conjugate Hib vaccines have become available . The various vaccines, and their characteristics are documented in this paper. Kansenshogaku Zasshi, 1993 Jun, 67(6), 574 - 83 {Efficacy of fibronectin on opsonic activity by alveolar macrophage and experimental rat pneumonia}; Yoshida T; The opsonic activity of plasma fibronectin (FN) by rat alveolar macrophage (AM) was examined, and the in vivo effect of FN in Staphylococcus aureus (S . aureus) experimental rat pneumonia was evaluated . The chemiluminescence response of AM was enhanced by the presence of FN (300 micrograms/ml) in S . aureus and Streptococcus pneumoniae, but was not enhanced in gram-negative rods (Haemophilus influenzae, Branhamella catarrhalis, Pseudomonas aeruginosa) . FN (300 micrograms/ml) promoted the phagocytosis of S . aureus by AM, but did not promote the bactericidal activity of that by AM . In the experimental rat pneumonia with S . aureus inoculation, plasma FN concentration decreased with time, but increased by the administration of FN (1 mg) . The number of bacteria in the lung, peripheral white blood cell and BAL fluid cell also decreased by the administration of FN . Furthermore, FN was significantly improved on inflammatory findings of rat lung tissue 24 hours after inoculation with S . aureus . These results suggest that FN plays an important role as an opsonic by alveolar macrophage, and that FN has utility for clinical trials in patients with pneumonia. Arch Dis Child, 1993 Jun, 68(6), 763 - 7 Epidemiology of bacterial meningitis; Fortnum HM et al.; This 10 year retrospective study of all causes of bacterial meningitis for children resident in Nottingham District Health Authority area reports an annual incidence rate per 100,000 children aged 0-16 years of 16.0 (95% confidence interval 14.0 to 18.1) . There was a steady increase in incidence from 9.6/100,000 in 1980 to 24.3/100,000 in 1989 . This was mainly due to an increase in the incidence of meningococcal infections in the age group 1 month to 5 years . Incidence rates varied with age being: 37.2/100,000 (25.9 to 53.5) for 0-28 days of age, 115.5/100,000 (93.9 to 141.9) for 1-11 months of age, 28.5/100,000 (23.1 to 35.3) for 12-59 months of age, and 2.8/100,000 (1.9 to 4.1) for 5-16 years of age . Overall annual mortality incidence per 100,000 was 1.8 (1.2 to 2.8) . For the different age groups this was: 10.1 (4.8 to 21.1) for 0-28 days, 11.5 (6.0 to 22.2) for 1-11 months, 1.0 (0.3 to 3.1) for 12-59 months, and 0.4 (0.1 to 1.2) for 5-16 years of age . There were interactions between the type of meningitis and the year of the infection on the mortality rate . Mortality decreased in those with infections caused by bacteria other than Neisseria meningitidis and Haemophilus influenzae. Onderstepoort J Vet Res, 1993 Jun, 60(2), 147 - 52 Plasmid-encoded NAD independence in some South African isolates of Haemophilus paragallinarum; Bragg RR et al.; Atypical Haemophilus paragallinarum have been isolated from both laying hens and broilers suffering from typical symptoms of infectious coryza in South Africa . Re-inoculation of these bacteria into SPF chickens resulted in similar pathology . The bacteria could be successfully re-isolated from the experimentally infected chickens . Four of the isolates from layers and 3 of those from broilers were found to be closely related to H . paragallinarum serotype A (0083 strain) when tested by the use of a panel of locally developed monoclonal antibodies in the enzyme linked immunosorbent assay (ELISA) . A total of 15 isolates from layers and 19 from broilers were found to be more typical of previously collected South African field isolates of H . paragallinarum . A 3rd group, consisting of 5 isolates from layers and 15 from broilers, showed no reaction with the panel of monoclonal antibodies . All the isolates were regarded as atypical because they no longer required V factor (NAD) for growth, whereas strain 0083 and previously collected field isolates M 85 and SB 86 did require it . Crude plasmid extractions from an isolate serologically related to 0083 was used to convert reference strains of H . paragallinarum into NAD-independent isolates, thus indicating that NAD independence is carried on a plasmid. Clin Infect Dis, 1993 Jun, 16 Suppl 4, S292 - 8 Bacteriologic findings in peritonsillar abscesses in young adults; Jousimies-Somer H et al.; Aspirated pus samples from 124 patients with peritonsillar abscess were cultured quantitatively for aerobes and anaerobes . A total of 98% of the samples yielded bacteria . Of the 550 isolates obtained (mean, 4.4 per patient), 143 were aerobes (representing 16 species or groups) and 407 were anaerobes (representing 40 species or groups) . Aerobes were isolated from 86% of patients-alone in 20 cases and together with anaerobes in 87 . The most common aerobic isolates were Streptococcus pyogenes (isolated from 45% of patients), Streptococcus milleri group organisms (27%), Haemophilus influenzae (11%), and viridans streptococci (11%) . Anaerobes were isolated from 82% of the samples and as a sole finding from 15 abscesses . Fusobacterium necrophorum and Prevotella melaninogenica were both isolated from 38% of patients, Prevotella intermedia from 32%, Peptostreptococcus micros from 27%, Fusobacterium nucleatum from 26%, and Actinomyces odontolyticus from 23% . The rate of previous tonsillar/peritonsillar infections was lowest (25%) among patients infected with S . pyogenes and highest (52%) among those infected with F . necrophorum (P < .01) . Recurrences and/or related tonsillectomies were more common among patients infected with F . necrophorum than among those infected with S . pyogenes (57% vs . 19%; P < .0001) or with S . milleri group organisms (43% vs . 19%; P < .05) . beta-Lactamase was produced by only 38% of the 73 isolates of Prevotella species tested; however, 56% of the 36 patients studied harbored one or more such strains. Am J Epidemiol, 1993 Jun 1, 137(11), 1221 - 8 Cost-benefit analysis for the use of Haemophilus influenzae type b conjugate vaccine in Santiago, Chile; Levine OS et al.; Cost-benefit analyses can be integral to the evaluation of interventions in developing countries . The authors compare the potential benefits to the Chilean Ministry of Health, in terms of treatment costs averted, by prevention of Haemophilus influenzae type b (HIB) invasive disease, with the costs of adding HIB conjugate vaccine to the diphtheria-tetanus-pertussis (DTP) immunization routinely administered to infants . In their basecase model, over a 10-year period (1991-2000), vaccination against HIB will prevent 1,229 cases of HIB invasive disease, including 713 cases of meningitis, 107 of whom would suffer severe, long-term sequelae, and between 29 and 116 deaths . Assuming a cost of US$1 for a full three-dose regimen of vaccine, the benefit/cost ratio of 1.66, with a net discounted savings of over $403,225, illustrates that HIB vaccine can be cost-beneficial . Sensitivity analyses which alter each of the variables in the analysis indicate that if the true incidence of HIB disease is twice the published rate, then three doses of vaccine remains cost-beneficial at US#3PIP: Health practitioners reviewed the clinical records of all 6-60 month old children who were treated for meningitis caused by Haemophilus influenzae type b (HIB) in 1989-1990 at Roberto del Rio Children's Hospital in Santiago, Chile, to estimate costs for all phases of meningitis treatment (ambulatory visits, hospitalization, and follow-up) . They also estimated annual HIB incidence . They determined the cost of adding HIB conjugate vaccine to the DTP vaccine . They assumed a cost of US$1 for a full 3-dose regimen of vaccine . They then conducted a cost benefit analysis of the use of HIB conjugate vaccine to prevent invasive HIB disease in Santiago . The National Health Service had to pay an average of US$1301/case of HIB meningitis and US$887/case of HIB invasive disease other than meningitis, including pre- and post-hospitalization costs and adjustment for frequency of sequelae . Several factors indicated that the estimates were actually underestimates . For example, the researchers did not take into account herd immunity and the fact that sequelae often do not appear until the children are older . The addition of the HIB conjugate vaccine to the immunization program would prevent at least 1229-3111 cases of HIB invasive disease, disabling sequelae, and deaths during a 10-year period . Further, it would save the National Health Service more than US$403,225 . The benefit/cost ratio was 1.66 . The researchers changed each of the variables in the cost benefit analysis . These sensitivity analyses revealed that if the true incidence of HIB disease were 2 times greater than the based on reported data, the 3 doses of HIB conjugate vaccine would still have a cost benefit of US$3 . These results indicated that adding HIB conjugate vaccine would exert a considerable public health and cost benefit . Cost benefit analyses of vaccines would also prove useful to decision-makers in other developing countries . J Clin Microbiol, 1993 Jun, 31(6), 1575 - 8 Detection of 2-eicosanol by gas chromatography-mass spectrometry in sputa from patients with pulmonary mycobacterial infections; Alugupalli S et al.; A total of 96 sputum specimens from patients with suspected or known mycobacterial and nonmycobacterial pulmonary infections were analyzed by gas chromatography-mass spectrometry for the presence of 2-eicosanol . This secondary alcohol was detected in all of the 25 sputum specimens culture positive for Mycobacterium tuberculosis, in 7 of the 9 sputum specimens culture positive for M . avium complex, and in all 3 of the studied sputum specimens associated with M . malmoense . The alcohol was not detected in any of the 45 culture-negative sputum specimens or in 14 sputum specimens culture positive for Staphylococcus aureus, Pseudomonas aeruginosa, Haemophilus influenzae, and Streptococcus pneumoniae . The ratio of tuberculostearic acid to 2-eicosanol was much lower in sputum samples culture positive for mycobacteria than in the corresponding in vitro-grown cultures . The present findings indicate that 2-eicosanol may be useful as a chemical marker for rapid diagnosis of pulmonary infections caused by the M . avium complex, M . malmoense, and M . tuberculosis. Semin Respir Infect, 1993 Jun, 8(2), 104 - 15 Bacterial pneumonia in HIV-infected patients; Daley CL; Individuals infected with the human immunodeficiency virus (HIV) are more susceptible to bacterial infections because of defects in both cellular and humoral immunity . Streptococcus pneumoniae and Haemophilus influenzae are the most common causes of bacterial pneumonia in HIV-infected patients . However, more unusual bacteria can also cause pneumonia . Response to therapy is generally good for infections caused by pyogenic organisms, and complications are relatively few . Unfortunately, infections caused by Rhodococcus equi and Nocardia species are associated with significant morbidity and mortality . Moreover, the duration of therapy is long, and relapes are common . Prevention of bacterial pneumonia is an important part of the care of HIV-infected patients; the 23 valent pneumococcal vaccine is currently recommended for all HIV-infected patients . The role of other preventative measures remains unknown. Oral Microbiol Immunol, 1993 Jun, 8(3), 134 - 40 Killing of Actinobacillus actinomycetemcomitans and Haemophilus aphrophilus by human polymorphonuclear leukocytes in serum and saliva; Holm A et al.; The ability of polymorphonuclear leukocytes from human peripheral blood to kill Actinobacillus actinomycetemcomitans and Haemophilus aphrophilus was examined with fresh isolates and laboratory strains from each species (5 strains within each group) under different conditions . Bacterial cells were mixed with a polymorphonuclear leukocyte suspension in the presence of either active serum or heat-inactivated serum or active serum together with sterile-filtered saliva . Surviving bacteria were determined by counting the number of bacterial colony-forming units in the mixtures after a 60-min incubation at 37 degrees C . Mixtures without polymorphonuclear leukocytes served as controls for the evaluation of the degree of killing of the bacteria . In general, A . actinomycetemcomitans resisted phagocytic killing to a greater extent than H . aphrophilus, and the killing of the former species mainly depended on the presence of heat-labile serum components, probably complement factors . Laboratory strains of A . actinomycetemcomitans were more easily killed than fresh isolates . The presence of saliva in the reaction mixtures decreased the degree of killing . However, strain-dependent variations in the killing were found under either condition . The leukotoxic activity of A . actinomycetemcomitans strains, determined by a {51Cr}-release assay, was not correlated with the resistance of these strains to the phagocytic killing . The results point out a strain-dependent difference in the ability of A . actinomycetemcomitans to evade the inflammatory response associated with polymorphonuclear leukocytes . This difference may constitute a potential virulence factor for this periodontopathogen . Furthermore, the leukotoxicity of the strains is not the main determinant that modifies the interaction of A . actinomycetemcomitans with human neutrophils. Oral Microbiol Immunol, 1993 Jun, 8(3), 129 - 33 Multivariate chemosystematics demonstrate two groups of Actinobacillus actinomycetemcomitans strains; Brondz I et al.; Chemical analysis by us has indicated that Actinobacillus actinomycetemcomitans is not a homogeneous species . The present study used chemometric methods and a multitude of chemical characters to examine this further . Strains were characterized by cell sugar and fatty acid contents, lysis kinetics during EDTA and EDTA plus lysozyme exposure, methylene blue reduction, and API ZYM enzymatic assessment of whole cells and outer membrane vesicles/fragments . In total, 41 quantitative variables were analyzed from each of 9 strains and treated with principal component analysis and soft independent modeling of class analogy . These methods divided A . actinomycetemcomitans into 2 strain groups . One group contained ATCC 33384, ATCC 29522, FDC 2112 and FDC 2043; the other comprised ATCC 29524, ATCC 29523, FDC 2097, FDC 511 and FDC Y4 . With an F-test, the groups (classes) of A . actinomycetemcomitans strains could be distinguished at 95% confidence limits . Both groups were distinct from members of the genera Haemophilus and Pasteurella (Haemophilus aphrophilus, Haemophilus paraphrophilus, Haemophilus influenzae, Pasteurella multocida and Pasteurella haemolytica). Zhonghua Liu Xing Bing Xue Za Zhi, 1993 Jun, 14(3), 136 - 8 {A study on the carrier state of Haemophilus influenzae in pharynx in healthy children in Beijing Area}; Liu Y; One hundred and fifteen healthy children in 2 kindergartens of Beijing City were enrolled in a study for carrier state of Haemophilus influenzae (HI) in pharynx . Nontypable HI flora was found in 32.2% (37/115) in this group . There were no significant differences of carrier state in sex, age, and season in these children . Antibiotic sensitivity test showed that some HI strains isolated were resistant to ampicillin and tetracycline (5/34 vs 4/34), most strains resistant to SMZ Co (21/34). Zentralbl Bakteriol, 1993 Jun, 279(1), 60 - 74 Characterization of bovine Haemophilus somnus by biotyping, plasmid profiling, REA-patterns and ribotyping; Fussing V et al.; A total of 105 strains of H . somnus isolated from cattle in Denmark and other countries during 1982-1991 were compared with regard to biotypes (fermentation of 8 different sugars), plasmid profiles, Taq1 restriction endonuclease analysis of chromosomal DNA (REA-typing) and EcoRI-generated DNA restriction fragment length polymorphisms of rRNA genes (ribotyping) . Eighty-four strains originating from cases of pneumonia, and 21 originating from the genitals of bulls were included in this study . Biotyping yielded 21 different types . Twenty-two of the isolates contained plasmids, and these were divided into 12 distinct plasmid profiles . Analysis of chromosomal DNA restriction patterns, resulted in 33 different REA patterns and 16 different ribopatterns in the investigated strains . Biotypes, REA-types, and ribotypes generally showed good correlation, whereas plasmid profiles did not correlate with any other typing method . Seventy-eight percent of all Danish isolates from pneumonia belonged to the same REA-, and ribotype, indicating a single clone . Furthermore, a single strain from semen belonged to this type, but generally strains isolated from the genital tract showed little homology to strains isolated from cases of pneumonia with regard to REA-, and ribotypes . The typing methods applied in the present investigation appeared to be useful indicators of epidemiological relatedness between H . somnus strains from cattle, and might be used for epidemiological investigations as well as for taxonomic studies of this species. Zentralbl Bakteriol, 1993 Jun, 279(1), 51 - 9 Genetic relationship of strains of Haemophilus aphrophilus, H . paraphrophilus, and Actinobacillus actinomycetemcomitans studied by ribotyping; Sedlacek I et al.; Strains of H . aphrophilus, H . paraphrophilus, and A . actinomycetemcomitans are phenotypically very similar . Ribotyping of 24 strains of H . aphrophilus, 22 strains of H . paraphrophilus, 8 strains of A . actinomycetemcomitans, and one strain each of the species Pasteurella aerogenes, H . parahaemolyticus, and the genus Capnocytophaga was studied using a non-radioactive digoxigenin labelled probe based on E . coli 16S- and 23S-ribosomal RNA . Restriction fragments were generated using restriction enzyme EcoRI . The ribotypes were analysed by a numerical approach using UPGMA clustering . Two major clusters were seen: One contained all A . actinomycetemcomitans strains, the other all H . aprophilus and all except one H . paraphrophilus strain intermingled between each other . The H . paraphrophilus strain not found in the H . aphrophilus/H . paraphrophilus cluster, the H . parahaemolyticus, P . aerogenes, and the Capnocytophaga strains clustered separately from each other and the two major clusters . The H . paraphrophilus strain with the deviating ribotype was atypical in other respects: it neither did ferment lactose nor mannose and it was isolated from a deer in contradiction to the remaining H . paraphrophilus strains, which were human isolates . This study supports the view that H . aphrophilus and H . paraphrophilus should be regarded as one species separated from A . actinomycetemcomitans. Zentralbl Bakteriol, 1993 Jun, 279(1), 35 - 44 Phylogeny of the Pasteurellaceae as determined by comparison of 16S ribosomal ribonucleic acid sequences; Dewhirst FE et al.; Previously, virtually complete 16S ribosomal ribonucleic acid sequences were determined for 54 strains of species in the family Pasteurellaceae . The sequences for 16 additional strains have been determined, bringing the total number of strains sequenced to 70 . The additional strains include: Actinobacillus hominis, A . muris, A . salpingitis, Pasteurella bettyae, P . mairii, P . testudinis, and Bisgaard taxa 2, 3, 5, 6, 7, 8, 9, 13, and 14 (2 strains) . A phylogenetic tree was constructed based upon sequence similarity using the Neighbor-Joining method . The additional sequence information and phylogenetic analysis generally supported our previously described phylogenetic structure for the family Pasteurellaceae . Cluster 1, containing Haemophilus sensu stricto, was unchanged . P . mairii was closely related to P . aerogenes and Bisgaard taxon 6 was related to H . somnus in Cluster 2 . A . salpingitidis and Bisgaard taxa 2, 3, 7, and 13 fell in Cluster 3 which contains Pasteurella sensu stricto . A . hominis was closely related to Actinobacillus sensu stricto species in Cluster 4A . Bisgaard taxa 5, 8, 9 and P . bettyae fell in Cluster 4B . A . muris was related to P . pneumotropica in Cluster 5 . Haemophilus parainfluenzae strains branched deeply as a 6th cluster . Bisgaard taxon 14 and P . testudinis formed a 7th cluster which branched deeper than any previously described clusters in the family Pasteurellaceae . The branching was extremely complex and taxonomic division of the family into phylogenetically and phenotypically coherent genera will be difficult. Presse Med, 1993 May 29, 22(19), 899 - 902 {Infectious sinusitis in HIV infection . Clinical and therapeutic data on 20 patients}; Lacassin F et al.; To assess the clinical presentation and outcome of infectious sinusitis in HIV-infected patients, we analyzed in a retrospective study, the records of HIV-infected patients hospitalized from June 1986 to November 1989 . Twenty-eight episodes of infectious sinusitis, defined by radiological signs, were recorded in 20 HIV-infected patients . Clinical presentation suggestive of acute sinusitis was inconstant and in 6 episodes a persistent fever was the only symptom . Concomitant pneumonia was detected in 8 episodes . Bacteria were isolated in 8 episodes, and in 4 of them, Haemophilus influenzae was identified . Clinical relapses occurred in 8/20 patients, requiring a surgical drainage in 3 cases . The frequency of relapses and the possibility of chronicity justify a more prolonged and aggressive therapy in infectious sinusitis occurring in HIV-infected patients. Am Fam Physician, 1993 May 15, 47(7), 1595 - 603 Practical approach to bacterial meningitis in childhood; Pohl CA; The classic triad of headache, fever and nuchal rigidity that occurs in adults with bacterial meningitis is often absent in children . Evaluation of the cerebrospinal fluid remains the gold standard for the diagnosis of bacterial meningitis . The choice of antibiotic therapy is dependent on the most likely age-specific pathogen and the drug's bactericidal activity in cerebrospinal fluid . Routine fluid restriction is no longer recommended in the initial management of critically ill patients . Dexamethasone has become an important adjunct to antimicrobial therapy for meningitis due to Haemophilus influenzae type b . Prevention, especially administration of H . influenzae type b vaccine at an early age, is probably the most effective way to reduce the significant mortality and morbidity associated with bacterial meningitis in children. Postgrad Med, 1993 May 15, 93(7), 43 - 6, 49-52 Bacterial pneumonia . S pneumoniae and H influenzae are the villains; Wisinger D; Bacterial pneumonia isn't what it used to be . The most common causes, Streptococcus pneumoniae and Haemophilus influenzae, are developing strains that are resistant to powerful antibiotics: How do you choose a therapeutic agent? New organisms are being discovered to be culprits in this disease: How do you keep track of them? New drugs are being developed every day: How does that help if initial treatment is almost always empirical? Dr Wisinger identifies the problems and offers advice. Am J Ophthalmol, 1993 May 15, 115(5), 623 - 8 The penetration of oral ciprofloxacin into the aqueous humor, vitreous, and subretinal fluid of humans; Lesk MR et al.; We examined ciprofloxacin levels in the aqueous humor, vitreous, or subretinal fluid in 40 patients undergoing cataract extraction, vitrectomy, or scleral buckling . Ciprofloxacin, 750 mg, was administered orally an average of 17 1/2 and 5 1/2 hours preoperatively . We obtained mean ciprofloxacin levels of 0.53 microgram/ml in aqueous humor, 0.51 microgram/ml in vitreous, and 0.71 microgram/ml in subretinal fluid . These vitreous levels exceed the minimum inhibitory concentration (MIC)90 of Staphylococcus epidermidis, Propionibacterium species, Pseudomonas aeruginosa, Proteus mirabilis, and Haemophilus influenzae, as well as the MIC70 of S . aureus and Bacillus cereus . Therefore, ciprofloxacin may have a role in the management and prevention of endophthalmitis. Presse Med, 1993 May 15, 22(17), 815 - 6 {Haemophilus parainfluenzae meningitis in an 8-year-old boy}; Poupart MC et al.; Invasive infections caused by Haemophilus parainfluenzae, a saprophyte of the respiratory tract, are exceptional and should arise suspicion of abnormalities in immunocompetence . So far, about thirty cases of H . parainfluenzae meningitis affecting neonates, infants or adults have been published . A case of such meningitis in an 8-year old boy without any risk factor is reported here. J Clin Microbiol, 1993 May, 31(5), 1362 - 3 Evaluation of the RapID NH system for identification of Haemophilus somnus, Pasteurella multocida, Pasteurella haemolytica, and Actinobacillus pleuropneumoniae isolated from cattle and pigs with respiratory disease; Salmon SA et al.; Haemophilus somnus, Pasteurella haemolytica, Pasteurella multocida, and Actinobacillus pleuropneumoniae from cattle and pigs with respiratory disease were used to evaluate the RapID NH system (Innovative Diagnostics, Atlanta, Ga.) . Minor modifications of the RapID NH system to include animal source and growth requirements would permit the identification of all isolates tested. J Clin Microbiol, 1993 May, 31(5), 1246 - 50 Testing of Streptococcus pneumoniae for resistance to penicillin; Marshall KJ et al.; The increasing prevalence of penicillin-resistant Streptococcus pneumoniae requires antibiotic susceptibility tests that can be done with greater ease and reliability . We measured the MIC of penicillin for pneumococci by the tube macrodilution method with Mueller-Hinton broth (MHB), Haemophilus Test Medium (HTM), Todd-Hewitt broth with 0.5% yeast extract (THY), and MHB with 3% lysed horse blood (LHB) . Eight (19%) and 6 (14%) of 42 pneumococcal isolates failed to generate turbid growth in MHB and HTM, respectively, whereas all pneumococcal isolates did so in THY and LHB . For those strains that replicated to turbidity, the mean MICs of penicillin were lower in MHB and HTM than in THY and LHB, with differences being significant (P < 0.05) for comparisons with LHB . Four isolates appeared to be penicillin susceptible in HTM but were actually moderately resistant in THY and LHB, and two isolates appeared to be moderately resistant but were resistant . A similar failure to detect resistance was seen with MHB . S . pneumoniae ATCC 49619, a moderately penicillin-resistant strain that has been proposed for quality control testing, gave variable results in MHB or THM and appeared to be susceptible to penicillin in some assays, whereas the MICs for S . pneumoniae ATCC 49619 in THY or LHB fell within a twofold dilution range, with geometric means of 0.16 and 0.18 micrograms/ml, respectively . Pneumococcal isolates thus may appear falsely susceptible to penicillin when tested in MHB or HTM . LHB remains the standard medium; however, because THY is an easily prepared clear medium that can be used in automated systems and appears to yield results similar to those obtained with LHB, THY deserves consideration for routine use. J Med Microbiol, 1993 May, 38(5), 378 - 83 Outer-membrane protein and immunoblot analysis of Australian isolates of Haemophilus influenzae; Hansman D et al.; Strains of Haemophilus influenzae isolated from children in South Australia and the Northern Territory with systemic infections (mostly meningitis or epiglottitis) were subjected to serotyping, biotyping, outer-membrane protein (OMP) analysis and immunoblot subtyping . All 65 isolates examined were from blood or cerebrospinal fluid; 59 (91%) of the strains were identified as type b and the remainder as either type a (two strains) or non-typable (four strains) . Of the 59 type b strains, 45 (76%) belonged to a single OMP subtype (equivalent to subtype 3L in the Barenkamp scheme); the remaining type b strains belonged to five other OMP subtypes . No correlation was apparent between OMP subtype and geographical region, clinical diagnosis or antimicrobial drug susceptibility pattern . Immunoblot subtyping enabled nine (18%) of 41 strains belonging to the principal OMP subtype to be distinguished from the remainder. J Infect Dis, 1993 May, 167(5), 1210 - 2 Immunogenicity of Haemophilus influenzae type b conjugate vaccine in children with congenital asplenia; Webber SA et al.; The immunogenicity of Haemophilus influenzae type b polysaccharide-protein conjugate vaccines in congenitally asplenic children is unknown . The short-term immunogenicity of the H . influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine was therefore assessed in 10 children with congenital asplenia by measuring antipolyribosyl-ribitol phosphate antibody titers . An excellent antibody response was seen in 9 children (mean geometric titer in responders after immunization 44.7 micrograms/mL; range, 2.59-402) . The remaining child responded to a booster dose . Further studies are required to assess whether H . influenzae type b conjugate vaccines are immunogenic in infancy in the presence of congenital asplenia. J Infect Dis, 1993 May, 167(5), 1206 - 10 Humoral immune response of humans to lipooligosaccharide and outer membrane proteins of Haemophilus ducreyi; Alfa MJ et al.; The humoral immune response to purified lipooligosaccharide (LOS) and outer membrane proteins (OMP) of Haemophilus ducreyi was evaluated . Sera from chancroid-endemic (Uganda, Kenya) and -nonendemic (Canada) countries were tested by an ELISA . The response to OMPs was cross-reactive with other Haemophilus species, and elevated levels of antibody were detected in patients that did not have chancroid . The LOS component stimulated an H . ducreyi-specific immune response that was detected only in patients with chancroid . The sensitivity of the LOS ELISA was 96% (95% confidence interval, 89.9%-100%) and the specificity was 97% (95% confidence interval, 95.8%-98.2%) . Thus, the anti-H . ducreyi LOS immune response is a significant diagnostic and epidemiologic indicator. Chest, 1993 May, 103(5), 1502 - 7 Aerobic and anaerobic microbiology of empyema . A retrospective review in two military hospitals; Brook I et al.; The microbiology and clinical features of empyema were studied retrospectively in 197 patients whose specimens yielded bacterial growth after inoculation for aerobic and anaerobic bacteria . Three hundred forty-three organisms (216 aerobic or facultative and 127 anaerobic organisms) were isolated . Aerobic bacteria were isolated in 127 (64 percent) patients, anaerobic bacteria in 25 (13 percent), and mixed aerobic and anaerobic bacteria in 45 (23 percent) . The predominant aerobic or facultative organisms were Streptococcus pneumoniae (70 isolates), Staphylococcus aureus (58), Escherichia coli (17), Klebsiella pneumoniae (16), and Haemophilus influenzae (12) . The predominant anaerobes were pigmented Prevotella and Porphyromonas species (24), Bacteroides fragilis group (22), anaerobic cocci (36), and Fusobacterium species (20) . beta-Lactamase-producing organisms were recovered in 49 (38 percent) of 128 tested specimens . These included all 42 tested S aureus and 15 B fragilis group, 4 of 9 K pneumoniae, 3 of 9 H influenzae, 3 of 8 pigmented Prevotella and Porphyromonas species, and 2 of 6 E coli . Most patients from whom S pneumoniae and H influenzae were recovered had pneumonia, and most patients with S aureus had pneumonia, aspiration pneumonia, and lung abscesses . The recovery of anaerobic bacteria was mostly associated with the concomitant diagnosis of aspiration pneumonia, and lung, subdiaphragmatic, dental, and oropharyngeal abscesses . These data highlight the importance of anaerobic bacteria in selected cases of empyema. Infect Immun, 1993 May, 61(5), 2257 - 9 Antigenic analysis of the major outer membrane protein of Haemophilus somnus with monoclonal antibodies; Tagawa Y et al.; The major outer membrane protein of Haemophilus somnus possesses at least five distinct epitopes . Three surface-exposed epitopes on the major outer membrane protein include a conserved epitope with potential for development of a vaccine and a diagnostic test and two variable epitopes responsible for antigenic differences among strains; the remaining two epitopes are well preserved among strains but not exposed on the cell surface. Infect Immun, 1993 May, 61(5), 2233 - 7 Isolation, expression, and nucleotide sequencing of the pilin structural gene of the Brazilian purpuric fever clone of Haemophilus influenzae biogroup aegyptius; St Geme JW 3rd et al.; In this study we isolated the pilin gene from the Brazilian purpuric fever (BPF) clone of Haemophilus influenzae biogroup aegyptius, expressed the gene in Escherichia coli, and determined its nucleotide sequence . Comparison of the nucleotide sequence of the BPF pilin gene with the sequences of pilin genes from strains of H . influenzae sensu stricto demonstrated a high degree of identity . Consistent with this observation, hemagglutination inhibition studies performed with a series of glycoconjugates indicated that BPF pili and H . influenzae type b pili possess the same erythrocyte receptor specificity. Infect Immun, 1993 May, 61(5), 1950 - 7 Evaluation of mixtures of purified Haemophilus influenzae outer membrane proteins in protection against challenge with nontypeable H . influenzae in the chinchilla otitis media model; Green BA et al.; Nontypeable Haemophilus influenzae (NTHi) is one of the leading causative agents of bacterial otitis media, and no vaccine has been shown to be effective against it . Three outer membrane lipoproteins of NTHi have been investigated extensively and are leading candidates for inclusion in a vaccine against this organism . Hi-PAL (P6), recombinant PCP (rPCP), and e (P4) proteins are antigenically conserved among NTHi strains and elicit bactericidal and protective antibodies . A genetic fusion of the rPCP and Hi-PAL proteins has also been reported . Mixtures of these proteins were used for active immunization experiments in the chinchilla model of otitis media . Chinchillas were immunized either with a mixture of all three lipoproteins or with the mixture of rPCP-PAL hybrid plus e protein . When these animals were challenged with a NTHi strain injected directly into the middle ears, no protection from infection or disease, as measured by otoscopy, was observed in either group . However, effusion and inflammation measured by tympanometry were significantly reduced in animals immunized with the three lipoproteins . Animals that had been immunized with either whole NTHi cells or total outer membranes and then challenged with the homologous strain were significantly protected from both infection and disease, as determined by tympanometry and otoscopy . Unlike other animals antisera, chinchilla antisera against the purified proteins had no bactericidal activity against NTHi but did fix complement on the cell surface . Thus, the chinchilla immune responses to mixtures of these lipoproteins differ from the immune responses observed in other animal species . Further evaluation of these proteins for their vaccine potential remains to be done. Infect Immun, 1993 May, 61(5), 1793 - 8 Molecular cloning, nucleotide sequence, and characterization of lppB, encoding an antigenic 40-kilodalton lipoprotein of Haemophilus somnus; Theisen M et al.; Haemophilus somnus is a facultative intracellular pathogen which causes a wide range of diseases in cattle . To identify putative virulence determinants, a genomic library of H . somnus in Escherichia coli was screened for Congo red binding, a property associated with virulence in pathogenic bacteria, and subsequently with bovine hyperimmune sera raised against H . somnus HS25 . A Congo red-binding clone carrying a 1.8-kb DNA insert was found to encode a strongly seroreactive LppB protein with an apparent molecular weight of 40,000 . The nucleotide sequence of the entire DNA insert was determined . Two open reading frames coding for polypeptides with calculated molecular weights of 21,893 and 30,721 were identified . The larger open reading frame encoded LppB, while the smaller reading frame encoded a nonseroreactive protein with a relative molecular mass of approximately 18 kDa . The 16 amino-terminal amino acids of the deduced LppB polypeptide showed strong sequence homology to the signal peptide of secreted bacterial proteins, and the sequence Leu-Ala-Ala-Cys at the putative cleavage site corresponds to the consensus cleavage sequence of bacterial lipoproteins . Synthesis of the mature LppB lipoprotein in H . somnus was inhibited by globomycin, a specific inhibitor of signal peptidase II . LppB was localized to the outer membrane of H . somnus. Infect Immun, 1993 May, 61(5), 1750 - 5 Characterization of a heat-modifiable outer membrane protein of Haemophilus somnus; Tagawa Y et al.; In immunoblot analysis, a murine monoclonal antibody (MAb), 27-1, which was produced to an outer membrane protein (OMP) of Haemophilus somnus, showed that a major OMP is heat modifiable, having a molecular mass of 28 kDa when the N-lauroylsarcosine-insoluble OMP preparation was solubilized at 60 degrees C and a mass of 37 kDa when the OMP preparation was solubilized at 100 degrees C . The heat-modifiable OMP reacted intensely with convalescent sera obtained from calves with experimental H . somnus pneumonia in immunoblot analysis . Immunoelectron microscopic and antibody absorption studies revealed that the MAb 27-1 epitope was not surface exposed on the intact bacterium . However, a decrease in antibody reactivity to the heat-modifiable OMP in immunoblot analysis after absorption of convalescent serum with intact bacterial cells of H . somnus suggests that a surface-exposed portion of the heat-modifiable OMP is expressed on the intact bacterium . MAb 27-1 reacted with 45 of 45 strains of H . somnus tested in immunoblot analysis . The apparent molecular mass of the antigen varied among strains, and five reactivity patterns demonstrated by MAb 27-1 were observed . MAb 27-1 also reacted with six species in the family Pasteurellaceae, Escherichia coli, and Salmonella dublin, but not with the other eight species of gram-negative bacteria . The heat-modifiable OMP of H . somnus showed immunological cross-reactivity with the OmpA protein of E . coli K-12 and significant N-terminal amino acid sequence homology with the OmpA proteins of gram-negative bacteria . We conclude that a major, 37-kDa heat-modifiable OMP of H . somnus, which elicits an antibody response in H . somnus-infected animals, is a common antigen among H . somnus strains tested and is structurally related to the OmpA protein of E . coli. Infect Immun, 1993 May, 61(5), 1735 - 42 Haemophilus ducreyi adheres to but does not invade cultured human foreskin cells; Alfa MJ et al.; Haemophilus ducreyi is the etiologic agent of the localized genital ulcer disease known as chancroid . The pathogenesis of this organism is poorly understood . The role of attachment in the disease process has not been evaluated . In this study, 125I-H . ducreyi was used to quantitatively evaluate the interaction of virulent and avirulent H . ducreyi strains with human foreskin cells . Using this in vitro model system, we demonstrated that, at 22 and 35 degrees C, the attachment of virulent H . ducreyi 35000 to human foreskin cells was significantly more marked than that of avirulent H . ducreyi A77 . Although H . ducreyi penetrated between human foreskin cells, internalization was not a major component . Our competition assay data suggest that the attachment mechanism of H . ducreyi may be similar to that of Neisseria gonorrhoeae . We speculate that the attachment and microcolony formation of virulent H . ducreyi may provide a mechanism for bacterial localization and evasion of host defenses. Antimicrob Agents Chemother, 1993 May, 37(5), 1015 - 24 Preincubation of Haemophilus influenzae with subinhibitory concentrations of macrolides: influence on human neutrophil chemiluminescence; Bonnet M et al.; Preincubation of Haemophilus influenzae with antibiotics may influence opsonophagocytosis as studied by chemiluminescence . Two strains of H . influenzae (strain 1 {type b} and strain 2 {uncapsulated}) were pretreated with erythromycin, roxithromycin, clarithromycin, and azithromycin for 1 h in Haemophilus test medium (the last 25 min was either without serum or with 10% fresh serum or 10% decomplemented serum) . Human neutrophils were stimulated with a pretreated or control inoculum at four different bacterium/neutrophil ratios and tested for luminol chemiluminescence with an LKB luminometer . The results were normalized for bacterium/neutrophil ratio and compared by the two-sided Wilcoxon test . Pretreatment of bacteria with one-half of the MICs of erythromycin, clarithromycin, and roxithromycin produced nonsignificant (P > 0.05) increases in the chemiluminescence response (means of 23% for strain 1 and 4% for strain 2) . Pretreatment with azithromycin at one-half of the MIC produced an increase in the chemiluminescence response induced by serum-opsonized strain 1 (320% +/- 36% {mean +/- standard error of the mean}) and strain 2 (107% +/- 20%) (P < 0.05) . This increase was concentration dependent: for strain 1, 60% +/- 18% at one-fourth of the MIC to 440% +/- 41% at the MIC; for strain 2, 10% +/- 5% at one-fourth of the MIC to 300% +/- 20% at the MIC . For strain 1, the maximal increase with azithromycin pretreatment (at the MIC) required opsonization with fresh serum . Opsonization with decomplemented serum was associated with a 53% +/- 21% increase; this increase was 28% +/- 3% in the absence of serum . For strain 2, azithromycin reduced the lag phase of the chemiluminescence response induced by the absence of serum but did not alter the chemiluminescence response in the presence of decomplemented serum . A significant contribution of soluble factors in the enhanced response observed with bacteria preincubated with azithromycin was excluded . The increase of the chemiluminescence response with azithromycin pretreatment was probably due to improvement in complement-dependent opsonization for strain 1 and to improvement in both serum-independent and serum-dependent opsonization for strain 2. J Bacteriol, 1993 May, 175(9), 2702 - 12 Investigation of the structural heterogeneity of lipooligosaccharides from pathogenic Haemophilus and Neisseria species and of R-type lipopolysaccharides from Salmonella typhimurium by electrospray mass spectrometry; Gibson BW et al.; Heterogeneity in the lipooligosaccharides (LOS) of pathogenic Haemophilus and Neisseria species is evident from the multiplicity of components observed with electrophoretic analyses . Knowledge of the precise structures that make up these diverse LOS molecules is clearly the key to reaching an understanding of pathogenic processes such as phase variation and molecular mimicry . Except for a few cases, little is known about the specific structural features of LOS that underlie phase variation and molecular mimicry, partly because of the inherent difficulties in the structural elucidation of these complex glycolipids . In the lipopolysaccharides (LPS) from Salmonella typhimurium and Escherichia coli, rough, or R-type, mutants have been isolated that have provided insight into the biosynthetic pathways and associated genetics that control LPS expression . Nonetheless, recent work has shown that these R-type LPS are more complex than originally thought, and significant heterogeneity is still observed, primarily in their phosphorylation states . In order to investigate the structures of LPS and LOS in a more rapid fashion, we have determined the precise molecular weights of LOS (and LPS) preparations from various Haemophilus, Neisseria, and Salmonella species by electrospray ionization-mass spectrometry . The LOS (or LPS) were first O-deacylated under mild hydrazine conditions to remove O-linked esters primarily from the lipid A portion . Under negative-ion conditions, the O-deacylated LOS yield abundant multiply deprotonated molecular ions, (M-nH)n-, where n refers to the number of protons removed and therefore determines the absolute charge state, n = z . Mass spectra from different LOS and LPS preparations have provided detailed information concerning the structural basis for LOS (and LPS) heterogeneity and corresponding saccharide compositions . The identification of sialic acid in the LOS of Haemophilus and Neisseria species and the variable phosphorylation of the core of S . typhimurium LPS have afforded insights into the biosynthetic pathways used by these organisms . Information of this type is important for understanding the underlying genetic and environmental factors controlling LOS and LPS expression. Microb Pathog, 1993 May, 14(5), 389 - 98 The interaction of primate transferrins with receptors on bacteria pathogenic to humans; Gray-Owen SD et al.; The binding of primate transferrins by receptors in the human pathogens Neisseria meningitidis, Moraxella (Branhamella) catarrhalis, and Haemophilus influenzae was assessed and compared with the binding of anti-human transferrin monoclonal antibodies by primate transferrins . In competitive binding assays the three pathogens showed identical specificity for primate transferrins . Only human, gorilla, chimpanzee and orangutan sera were capable of blocking binding of labelled human transferrin . Direct binding assays and affinity isolation of receptor proteins confirmed that chimpanzee transferrin, but not rhesus monkey transferrin, was capable of effectively binding to the bacterial receptors . Five distinct patterns of binding were seen when five anti-human transferrin monoclonal antibodies were reacted with the primate transferrins and these patterns reflected phylogenetic relatedness of these species to humans . A monoclonal antibody which showed transferrin-binding specificity identical to that seen with the bacterial receptors was found to block binding of human transferrin by receptors in the three bacterial species. Vet Microbiol, 1993 May, 35(1-2), 91 - 100 Differences in protein expression of Haemophilus somnus grown under conditions of iron-restriction; Wedderkopp A et al.; Outer membrane protein profiles were compared in 14 H . somnus strains isolated from brain and lung lesions as well as from the genital tract of asymptomatic carriers during in vitro growth under iron-restricted conditions . Ethylenediamine-di-O-hydroxyphenyl acetic acid (EDDA) was used to obtain iron-restricted conditions in media used for this study . The outer membrane protein profiles were studied by the discontinuous sodium dodecyl sulfate-polyacrylamide gel electrophoretic system (SDS-PAGE), and the proteins were stained with silver or transferred to nitrocellulose sheets and western blots conducted . Growth under iron-restricted conditions resulted in the induction of outer membrane proteins in most H . somnus strains examined . Studies also indicated differences among H . somnus strains in the number of induced proteins and their molecular weights but the results did not indicate a specific relationship between these strain-dependent differences and tissue trophism . Western blot analysis revealed a high degree of immunological relatedness among strains of H . somnus in their iron-regulated proteins . However, hyperimmune serum used in these assays failed to recognize certain iron-regulated proteins expressed by some H . somnus strains, a finding which may have important implications for the induction of protective immunity in cattle against this bovine pathogen. Eur J Clin Microbiol Infect Dis, 1993 May, 12(5), 319 - 24 Evaluation of amoxicillin clavulanate twice daily versus thrice daily in the treatment of otitis media in children . Danish-Swedish Study Group; Jacobsson S et al.; A total of 311 children who had recurrent otitis media or who had experienced failure of initial treatment of acute otitis media with phenoxymethylpenicillin, amoxicillin, ampicillin esters or cefaclor were entered into a single-blind study in two parallel groups in order to compare the clinical efficacy and safety of amoxicillin/clavulanate suspension given b.i.d . or t.i.d . for seven days . The patients were examined prior to the start of treatment, at an early follow-up visit 9 to 12 days after the start of treatment and at a late follow-up visit about three weeks later . Specimens for bacteriological culture were taken from the nasopharynx at entry, at the early follow-up visit, and at the late follow-up visit if there were symptoms of otitis . Both treatment groups showed a similar response, 90% or more of the patients being cured or showing improvement at the time of the early follow-up visit . The initial nasopharyngeal cultures showed growth of Haemophilus influenzae in 53% of the patients, Moraxella catarrhalis in 43% and Streptococcus pneumoniae in 39% . After treatment, cultures showed elimination of the initial pathogens in 30% of patients in both groups and recolonization in 23% in both groups . Haemophilus influenzae was the bacteria most frequently found in the nasopharynx at the first follow-up visit . Adverse effects, which consisted mostly of gastrointestinal and dermatological reactions, tended to be more common in the b.i.d . group but the difference was not statistically significant. Pediatr Infect Dis J, 1993 May, 12(5), 389 - 94 Outcomes of bacterial meningitis in children: a meta-analysis; Baraff LJ et al.; We abstracted the results of all English language reports of the outcomes of bacterial meningitis published after 1955 . We used hierarchical Bayesian meta-analysis to determine the overall and organism-specific frequencies of death and persistent neurologic sequelae in children 2 months to 19 years of age . A total of 4920 children with acute bacterial meningitis were included in 45 reports that met the inclusion criteria . Children described in the 19 reports of prospectively enrolled cohorts from developed countries had lower mortality (4.8% vs . 8.1%) and were more likely to have no sequelae (82.5% vs . 73.9%) . In these 19 studies 1602 children were evaluated for at least 1 sequela after hospital discharge . The mean probabilities of these sequelae were: deafness, 10.5%; bilateral severe or profound deafness, 5.1%; mental retardation, 4.2%; spasticity and/or paresis, 3.5%; seizure disorder, 4.2%; and no detectable sequelae, 83.6% . Mean probabilities of outcomes varied significantly by etiologic bacteria, e.g . mortality: Haemophilus influenzae, 3.8%; Neisseria meningitis, 7.5%; Streptococcus pneumoniae, 15.3%. Pediatr Infect Dis J, 1993 May, 12(5), 362 - 7 Comparison of the epidemiology and cost of Haemophilus influenzae type b disease in five western countries; Clements DA et al.; To determine and compare the cost of Haemophilus influenzae type b (Hib) disease in Australia, Finland, Israel, Switzerland and the United Kingdom a collaborative study was undertaken . The incidence of Hib disease varies in these 5 countries from 34 to 58.5 cases per 100,000 children less than 5 years of age . Although the incidence of meningitis in this age group is similar (between 18 and 26/100,000) in these countries, the incidence of epiglottitis varies from 0 to 22.7/100,000 . The cost of hospitalization and the frequency of sequelae are similar for 4 of the 5 countries; however, the break even cost of a vaccination program to prevent 90% of Hib disease is estimated to vary from $22 to $84 per child (US$) . Because of a lower incidence of Hib disease and lower cost for hospitalization, these costs are considerably less than those for the United States ($301.64 using similar calculations). Int J STD AIDS, 1993 May-Jun, 4(3), 171 - 3 The suppressive effect of serum samples from patients with chancroid on human mononuclear cells correlates with the clinical picture and is interleukin-2-dependent; Korting HC et al.; Plasma samples from patients with chancroid diagnosed both on clinical and microbiological grounds were assessed for their ability to inhibit mitogen-induced proliferation of human lymphocytes from healthy donors . All serum samples analysed suppressed phytohaemagglutinin A (PHA) blastogenic response . A significant difference in the observed extent was seen when serum samples from patients with and without associated lymphadenopathy were compared (P < 0.05) . Using an interleukin-2 (IL-2)-dependent cell line it could be demonstrated that the addition of patients' plasma to cultured cells markedly depressed mitogen-induced IL-2 synthesis . Results presented suggest that cell-mediated mechanisms play a role in the pathogenesis of infection due to Haemophilus ducreyi. Enferm Infecc Microbiol Clin, 1993 May, 11(5), 260 - 2 {Roxithromycin in the treatment of community-acquired pneumonia}; Antela A et al.; BACKGROUND: The aim of the present study was to prospectively evaluate the efficacy and tolerance of roxithromycin in the empiric treatment of extra-hospitalary pneumonias in immunocompetent adult patients . METHODS: Over a 12 month period 101 patients with extra-hospitalary pneumonia who attended the Emergency Department were studied . Of these, 53 were treated as out patients (5 with amoxicillin-clavulanic, 25 with erythromycin and 23 with roxithromycin at daily doses of 300 mg for 10 days) . The treatment was randomly chosen, with no patient selection, thus making heterogeneous groups and, therefore, the study could not be comparative . RESULTS: In patients receiving roxithromycin, an etiologic diagnosis was achieved in 15 cases (65.3%), with Mycoplasma pneumoniae, being the most frequent pathogen (10 cases), followed by Streptococcus pneumoniae (3), Chlamydia pneumoniae (1) and Haemophilus influenzae (1) . The mean duration of fever was 1.9 days, 6.7 days for respiratory manifestations and resolution of the radiographic infiltrate 11.6 days . The evolution was good in all the patients with no secondary effects or relapse occurring in any patient . CONCLUSION: Roxithromycin is an effective, safe and comfortable antibiotic in the treatment of infections of the lower respiratory tract acquired in the community. Ann Clin Lab Sci, 1993 May-Jun, 23(3), 203 - 6 Haemophilus parainfluenzae endocarditis in a patient with mitral valve prolapse; Greene JN et al.; Haemophilus parainfluenzae is a frequent cause of "culture-negative" endocarditis (i.e., endocarditis owing to a fastidious organism which may require longer incubation periods and/or enrichment media for detection compared to traditional pathogens) . More cases will probably be identified with improvements in growth and isolation techniques . A case of H . parainfluenzae endocarditis is presented in a patient with mitral valve prolapse, which illustrates the difficulty in diagnosing endocarditis when initial blood cultures are negative . Particularly, it emphasizes the difficulty in selecting appropriate antibiotic therapy since beta-lactamase producing organisms are being isolated with increased frequency . This report is unique in that it documents successful treatment with a cephalosporin and what is, to our knowledge, the third reported case of a beta-lactamase producing H . parainfluenzae causing endocarditis . The authors believe that beta-lactamase stable second or third generation cephalosporins should constitute initial treatment of H . parainfluenzae endocarditis until sensitivity studies become available, since beta-lactamase production by this organism would nullify the effect of the previous agent of choice, ampicillin. Pharmacotherapy, 1993 May-Jun, 13(3), 189 - 201 The role of fluoroquinolones in sexually transmitted diseases; Tartaglione TA et al.; The management of sexually transmitted diseases (STDs) has reached a new level in the era of antibiotic resistance and human immunodeficiency virus infection . To date, no single antimicrobial is capable of eradicating the commonly encountered STD pathogens including Neisseria gonorrhoeae, Chlamydia trachomatis, and Treponema pallidum . Among the marketed fluoroquinolones, ciprofloxacin, ofloxacin,