J Laryngol Otol, 1992 Dec, 106(12), 1072 - 5 Acute epiglottitis--25 years experience with nasotracheal intubation, current management policy and future trends; Andreassen UK et al.; During a 25-year period 168 adults and 111 children in Copenhagen County were treated for acute epiglottitis . Four patients, two children and two adults died, of these the two children and one adult had a cardiac arrest on arriving at the hospital . Most children were treated by nasotracheal intubation while only some adults required nasotracheal intubation in order to secure the airway . Our data indicate that intubation of adults with epiglottitis is technically more difficult than in children . The fibrelaryngoscope, a new diagnostic tool, is advocated, and was in this study used to establish the diagnosis in 12 unclear cases of acute epiglottitis . The incidence of acute epiglottitis in children was calculated at 3.2/100,000 with a minor annual variation . As vaccination against Haemophilus influenzae type b becomes more common, the incidence will probably be markedly reduced, maybe even eradicated in children, but in adults the same reduction cannot be expected as the causative agent in this group is less frequently Haemophilus influenzae type b. Antimicrob Agents Chemother, 1992 Dec, 36(12), 2804 - 7 Pharmacokinetics and tissue penetration of a single dose of ceftriaxone (1,000 milligrams intravenously) for antibiotic prophylaxis in thoracic surgery; Martin C et al.; The pharmacokinetics and tissue penetration of ceftriaxone after a single intravenous injection of 1,000 mg to 17 patients for antibiotic prophylaxis in thoracic surgery were studied . The patients were scheduled for elective noncardiac thoracic surgery . Adequate levels in serum (higher than or equal to the MIC for 90% of isolates of Staphylococcus aureus, Streptococcus spp., Escherichia coli, Haemophilus influenzae, and Klebsiella pneumoniae) were found for all patients throughout the surgical procedures . Mean maximal (5-min) and final (24-h) ceftriaxone levels in serum were 157 +/- 42 and 8.6 +/- 4.5 mg/liter, respectively . The beta-phase elimination half-life was 8.6 +/- 3 h, the plasma clearance was 18.4 +/- 6.25 ml/min, and the apparent volume of distribution at steady state was 0.21 +/- 0.07 liters/kg . At the time of the thoracotomy, the ceftriaxone concentrations were 13.5 +/- 7.8 micrograms/g in thoracic wall fat and 27 +/- 9 micrograms/g in lung tissue . At the time of closure, the ceftriaxone concentration was 15 +/- 9 micrograms/g in thoracic wall fat . During the different steps of the surgical procedures, 100% of patients had adequate levels in tissue (higher than or equal to the MIC for 90% of isolates of Streptococcus spp., E . coli, H . influenzae, and K . pneumoniae) . For S . aureus, 90 to 100% of patients had adequate tissue ceftriaxone levels. Tierarztl Prax, 1992 Dec, 20(6), 600 - 4 {Occurrence and drug resistance of bacteria pathogenic to the lungs from autopsy material of swine}; Kofer J et al.; Eight hundred and fifty-four piglets which died or were euthanized due to pneumonia or rhinitis atrophicans, were investigated during the period of 1986-1990 . Of the animals, 569 showed bronchopneumonia, 218 had pleuritis, pericarditis and peritonitis, 165 had rhinitis atrophicans, 58 pleuropneumonia, and 9 animals had fibrinous pneumonia . Pasteurella multocida, Haemophilus parasuis, Bordetella bronchiseptica, Actinobacillus pleuropneumoniae and Pasteurella haemolytica were isolated in 59.1%, 29.5%, 27.8%, 3.7%, and 2.3% cases of bronchopneumonia respectively . Samples from pigs with pleuritis or rhinitis atrophicans showed Pasteurella multocida in 63.8 and 68.5%, Bordetella bronchiseptica in 28.4 and 39.4%, streptococci in 28.9 and 3.9%, Haemophilus parasuis in 25.2% and 20.6%, Actinobacillus pleuropneumoniae in 5.1 and 5.5%, and Pasteurella haemolytica in 3.2 and 3.0%, respectively Actinobacillus pleuropneumoniae was found in 51 of 58 cases of pleuropneumonia and in 5 of 9 cases of fibrinous pneumonia; 55.6% and 44.4% respectively of those forms of pneumonia were positive for Pasteurella multocida . In the agar diffusion test, 36.8-82.6% of bacterial isolates showed resistance to streptomycin, 7.7-45.5% to sulfamethoxazole-trimethoprim, 5.7-44.6% to tetracycline, 0.2-32.8% to ampicillin, 0.0-16.3% to lincospectin, 2.0-81.2% to furazolidone, 0.4-4.5% to chloramphenicol, 1.3-78.1% to penicillin and 0-0.3% to enrofloxacin. Lymphokine Cytokine Res, 1992 Dec, 11(6), 293 - 8 Modulation of blood-brain barrier permeability by tumor necrosis factor and antibody to tumor necrosis factor in the rat; Kim KS et al.; In an attempt to understand the role of TNF in the central nervous system (CNS) pathophysiologic events associated with bacterial meningitis, we examined the effect of intravenous vs . intracisternal administration of TNF alpha on penetration of circulating 125I-labeled albumin into cerebrospinal fluid (CSF) and CSF white blood cell (WBC) counts in rats . Intracisternal administration of tumor necrosis factor alpha (TNF-alpha) resulted in dose- and time-dependent alterations of the CSF penetration and CSF WBCs, while intravenous administration of TNF-alpha did not induce any changes . These changes by intracisternal TNF were abolished by heat treatment of TNF or coadministration of MAb to TNF-alpha . Mab to TNF-alpha also significantly reduced the CSF penetration of circulating albumin in experimental hematogenous Haemophilus influenzae type b meningitis in infant rats but this salutary effect required both intravenous and intracisternal administration . However, MAb to TNF-alpha failed to affect CSF pleocytosis in experimental hematogenous meningitis . These findings suggest that some of CNS pathophysiologic changes in bacterial meningitis may be a result of the local production of TNF but other host inflammatory responses may also participate in CNS inflammation in hematogenous bacterial meningitis. West J Med, 1992 Dec, 157(6), 637 - 40 The effect of human immunodeficiency virus infection on the distribution and outcome of pneumonia in intensive care units; Tucker KJ et al.; To determine the frequency and distribution of pneumonia in an intensive care unit (ICU), we retrospectively examined the records of 1,854 consecutive ICU admissions between January 1987 and April 1990 . A total of 266 patients met criteria for pneumonia (unilateral or bilateral infiltrate by chest roentgenogram, plus 2 of the following: leukocyte count > 10 x 10(9) per liter, temperature > 38.5 degrees C, or culture of blood or sputum positive for pathogens) . Pneumocystis carinii pneumonia in patients infected with the human immunodeficiency virus was the most frequent cause (28%) precipitating an ICU admission in this series of patients . Streptococcus pneumoniae (13%), Staphylococcus aureus (8%), Haemophilus influenzae (4%), and viruses (4%) were also commonly observed . Overall mortality was 20% . An APACHE II score of greater than 24, the need for intubation, and the presence of P carinii were predictive of increased mortality . Age, sex, and length of stay did not predict final results . Patients with P carinii pneumonia who required intubation had an overall mortality of 54%, which was higher than patients without P carinii pneumonia who required intubation (P < .05) . Our experience shows the changing spectrum of pneumonia in ICUs . In contrast to reports of a decade ago in which S pneumoniae and Pseudomonas aeruginosa are cited as most common, P carinii is now most prevalent in our ICU . Although our findings reflect the increasing incidence of human immunodeficiency virus infection in San Francisco, California, they may also be pertinent to other areas in the United States where the incidence of this infection continues to increase. J Paediatr Child Health, 1992 Dec, 28(6), 459 - 64 The epidemiology of acute epiglottitis in children in Western Australia; Hanna JN et al.; A comprehensive case definition was used to study all cases of epiglottitis that occurred in children under 15 years of age in Western Australia during a 5 year period . There was microbiological evidence of Haemophilus influenzae type b infection in 71% of 103 cases of epiglottitis . Seventy-five per cent of cases occurred in children under 5 years of age . In this age group, the estimated annual incidence (13.5 episodes per 100,000) was significantly lower than that reported in Victoria (22.7 per 100,000) . The case definition of invasive H . influenzae type b disease used for surveillance purposes in Canada was more sensitive than the definitions used in the United States or England and Wales, yet even the Canadian definition could have detected only 65% of the cases of epiglottitis that occurred in Western Australia . A simple and sensitive surveillance system which could be used to monitor the impact of H . influenzae type b immunization in Western Australia is proposed. J Learn Disabil, 1992 Dec, 25(10), 630 - 8 Academic achievement following childhood brain disease: implications for the concept of learning disabilities; Taylor HG et al.; The present study examined three hypotheses regarding the consequences of early brain damage for academic achievement: First, early brain insults will have a negative impact on achievement, even in children with normal intelligence . Second, underachievement in these children will be at least partially independent of IQ (i.e., not fully accounted for by a lowering of IQ within the average range) . Third, normally intelligent children with histories of brain insult will also manifest selective cognitive dysfunctions . To test these hypotheses, we compared two groups of children who had recovered from Haemophilus influenzae type b meningitis . The "complicated" group consisted of children who, as a consequence of having sustained neurologic complications during their illness, were more likely to have had brain insults . Children in the "uncomplicated" group did not have complications with their illness and were regarded as having escaped significant central nervous system (CNS) pathology . Only children with normal hearing and a prorated Full Scale IQ of at least 80 (WISC-R) were considered . Group differences on the Wide Range Achievement Test-Revised were consistent with the first two hypotheses . Although the two groups had similar Verbal IQs, the complicated group also had a lower mean Performance IQ and performed less well on perceptually demanding neuropsychological tasks . Findings suggest that learning disabilities may have selective, brain-related cognitive antecedents; but they challenge the practice of using IQ criteria for clinical diagnosis. Ann Emerg Med, 1992 Dec, 21(12), 1413 - 7 Utility of serum interleukin-6 for diagnosis of invasive bacterial disease in children; Saladino R et al.; STUDY OBJECTIVE: To evaluate measurement of interleukin-6 as a diagnostic test for the presence and severity of invasive bacterial disease . DESIGN: Prospective measurement of interleukin-6 in children with signs of sepsis . (Controls, retrospective from serum bank.) SETTING: Emergency department of an urban children's hospital . PARTICIPANTS: Twenty children with clinical signs of sepsis and 50 other febrile infants and toddlers with negative blood cultures . RESULTS: Eleven of the 20 patients had bacteriologically documented infections: four with meningitis and two with bacteremia caused by Neisseria meningitidis, three with meningitis caused by Haemophilus influenzae type b, and one each with meningitis and bacteremia caused by Streptococcus pneumoniae . Ten of these 11 had detectable interleukin-6 . The geometric mean interleukin-6 level in these culture-positive patients was 407 pg/mL (95% confidence interval, 108 to 1,545); all three children with levels of more than 300 pg/mL developed septic shock, and one died . One of nine culture-negative patients with clinical signs of sepsis had detectable serum interleukin-6 (166 pg/mL), but none of 50 other febrile children without occult bacteremia did . The detection of interleukin-6 had a sensitivity of 91% and a specificity of 98% for invasive bacterial disease . CONCLUSION: High levels of interleukin-6 occur in children with septic shock, and the presence of interleukin-6 in serum is predictive for the isolation of bacteria from blood and/or spinal fluid. J Infect Dis, 1992 Dec, 166(6), 1340 - 5 Changes in the distribution of Haemophilus influenzae type b clones associated with widespread infant vaccination in Finland; van Alphen L et al.; Isolates from 646 consecutive Finnish Haemophilus influenzae type b (Hib) patients with systemic disease, collected before and during large-scale vaccinations with Hib conjugate vaccines, were analyzed by major outer membrane protein (OMP) subtyping, lipopolysaccharide (LPS) serotyping, and biotyping (BT) . Strains with OMP-BT-LPS combinations (clones) 1-I-1 and 1c-I-1 disappeared at the same rate as the disease they were associated with . A preferential decrease in the number of isolates of clone 1-II-1 was recorded, whereas the reduction in disease caused by strains of clone 1-II-9 occurred at a lower rate than expected . The latter clone occurred mainly in the most densely populated area of Finland . Strains belonging to all the common Hib clones were isolated from the 16 infants who acquired Hib disease despite being (partially) vaccinated . Thus, Hib clones disappeared during mass vaccination with conjugate vaccines, although at different rates. J Infect Dis, 1992 Dec, 166(6), 1335 - 9 Characterization of the serum antibody response to the capsular polysaccharide of Haemophilus influenzae type b in children with invasive infections; Trollfors B et al.; The serum antibody response to the capsular polysaccharide of Haemophilus influenzae type b (Hib) was studied in 30 children aged 1 day-5 years with invasive Hib infections . From each child, serum was obtained 0-2 days, 5-11 days, 1 month, and 6-12 months after onset of symptoms . Total antibodies were determined with RIA and isotypes with ELISA . Only 2 children had antibody levels above the estimated protective level (0.15 microgram/mL) in the first serum sample . The antibody response was age dependent with wide individual variations . Children > or = 2 years had increases in IgG, IgM, and IgA antibodies with predominance of IgG . The initial IgG response was IgG1 and IgG2 with predominance of IgG1 . In the last serum sample, IgG1 antibodies had decreased while IgG2 antibodies remained unchanged . Only 2 of 7 children < 1 year had a detectable antibody response . The correlation coefficient for total antibodies compared with the sum of IgG, IgM, and IgA was .88 (P < .0001) and for IgG compared with the sum of IgG1 and IgG2 was .97 (P < .0001). Occas Pap R Coll Gen Pract, 1992 Dec, (58), 21 - 3 Chronic obstructive airways disease; Hetzel M et al.; 1 . Chronic obstructive airways disease is a term which should be reserved for those who have objective evidence of airways obstruction and who do not improve significantly with bronchodilators or steroids . All patients should have a trial of aggressive treatment with these drugs in case they have chronic asthma . 2 . All patients should be urged strongly to give up smoking . 3 . There is no scientific evidence that slow release aminophylline or theophylline are of benefit in these patients, and they may be hazardous in those with coronary artery disease . 4 . Acute infective exacerbations may be due to haemophilus influenzae or pneumococcus; patients with fever should be given co-trimoxazole, ampicillin, co-amoxiclav or erythromycin (co-trimoxazole should generally be avoided in the elderly) . 5 . Domiciliary oxygen therapy, given for at least 12 and preferably 16 hours a day, will prolong survival in patients with Type II respiratory failure ('blue bloaters') . It may help symptoms in Type I respiratory failure ('pink puffers') . It should only be prescribed after blood gas measurements and the patient must therefore be referred. Genetics, 1992 Dec, 132(4), 893 - 8 DNA repair and the evolution of transformation in Haemophilus influenzae; Mongold JA; Under certain environmental conditions, naturally transforming bacteria are induced to pick up DNA released into the environment by other cells of the same or closely related species and, by homologous recombination, integrate that DNA into their chromosome . The selective pressures responsible for the evolution and maintenance of this form of genetic outcrossing, or sex, in bacteria are not known . A prominent hypothesis is that transformation, and sex in general, evolved as a means of obtaining DNA templates to repair damaged regions of the chromosome . Previous results obtained with Bacillus subtilis were consistent with the repair hypothesis . In an effort to explore the generality of those results, I have tested the repair hypothesis with Haemophilus influenzae, a naturally transforming, gram-negative species of bacteria . The results of UV damage-survivorship experiments with H . influenzae were also consistent with that hypothesis . However, additional experiments demonstrate that the higher survival of transformed cultures cannot be accounted for by use of the transforming DNA as templates for repair . I consider alternative hypotheses for the means by which transformation can increase cell survival following UV exposure and discuss the implications of these results with respect to the DNA repair hypothesis and the evolution of transformation. Zentralbl Bakteriol, 1992 Dec, 277(4), 538 - 46 Adjuvant properties of Propionibacterium avidum KP-40 in vaccination against endemic viral and bacterial infections . II . Swine immunized with inactivated Haemophilus pleuropneumoniae vaccine and experimentally infected with different virulent serotypes of H . pleuropneumoniae; Markowska-Daniel I et al.; Forty 3-month old swine were treated with immunomodulating Propionibacterium avidum KP-40 (PA) and/or vaccinated with a formalin-inactivated mixture of serotypes 1, 3, 5 and 9 of Haemophilus pleuropneumoniae (Pleurovac) . Three weeks after revaccination all animals were inoculated with viable single serotypes of Haemophilus pleuropneumoniae . The IgG antibodies induced by vaccination agglutinated all serotypes of Haemophilus pleuropneumoniae, except for serotype 5 . Antibody titers were not influenced by the application of PA together with the vaccine . Infection of vaccinated piglets resulted in the development of pleuropneumonia in 8 out of 10 animals, while vaccination together with application of PA lowered the morbidity rate to 1 out of 10 (p < 0.05) . The usefulness of a PA prophylaxis was also demonstrated in non-vaccinated piglets infected with Haemophilus pleuropneumoniae . Because of the considerable variability of strains and serotypes of Haemophilus pleuropneumoniae and the generally low prophylactic potency of pleuropneumonia vaccines it is concluded that long-lasting enhancement of non-specific antiinfective resistance caused by PA may lower the risk of endemic infections in vaccinated piglets. Oral Microbiol Immunol, 1992 Dec, 7(6), 376 - 7 Evaluation of the E test for antimicrobial susceptibility testing of Actinobacillus actinomycetemcomitans; Pajukanta R et al.; The E test was compared with an agar dilution method for antimicrobial susceptibility testing of Actinobacillus actinomycetemcomitans on Mueller-Hinton Haemophilus test medium . Eighty recent isolates of A . actinomycetemcomitans from 40 subjects and 3 reference strains were studied . Excellent agreement was obtained between the E test and the agar dilution test for benzylpenicillin (98.8%), ampicillin (97.5%), cefaclor (100%), cefuroxime (100%), tetracycline hydrochloride (100%) and ciprofloxacin (98.7%); 76.0% agreement was obtained for metronidazole and only 5.2% for cotrimoxazole . This study indicates that the E test is a reliable method to determine minimal inhibitory concentrations of antimicrobials against A . actinomycetemcomitans, except for metronidazole and cotrimoxazole. Acta Paediatr, 1992 Dec, 81(12), 989 - 92 Role of non-capsulated Haemophilus influenzae as a respiratory pathogen in children; Korppi M et al.; During a 12-month surveillance period from 1981-1982, non-capsulated Haemophilus influenzae was detected in nasopharyngeal aspirates from 64 (14%) of the 449 children hospitalized for middle or lower respiratory infection . An antibody response to H . influenzae was indicated in 15(23%) of the 64 patients with H . influenzae present in nasopharyngeal aspirate and in 10 (3%) of the 385 patients with a negative finding . Thus, serological evidence of H . influenzae infection was demonstrated in 25 (6%) of all the 449 children with respiratory infection . Of 13 patients with cultures positive for H . influenzae acute otitis media, an antibody response was seen in only 4 (30%) patients . H . influenzae infection was associated with infections caused by other microbes in 20 children (80%), with viral infections in 60% and with pneumococcal infections in 24% of cases . An infection focus was present in 15 (79%) of the 25 patients with H . influenzae infection; pneumonia was present in 10 cases and acute otitis media in 9 cases . Non-specific laboratory evidence of bacterial infection was seen in 11 patients (58%); C-reactive protein was increased in 7 and erythrocyte sedimentation rate in 9 patients . It is concluded that non-capsulated H . influenzae is a genuine respiratory pathogen in children . H . influenzae infections appear to be secondary to preceding viral or other bacterial infections in children who are carriers of this strain. Jpn J Antibiot, 1992 Dec, 45(12), 1700 - 35 {Pharmacokinetic and clinical studies on cefprozil granules in the pediatric field}; Motohiro T et al.; Cefprozil (CFPZ), a newly developed oral cephalosporin in a fine granular form for pediatric use, was administered to children with bacterial infections . MICs were determined for 6 drugs including CFPZ, cephalexin (CEX), cefaclor (CCL), ampicillin (ABPC), methicillin (DMPPC) and cloxacillin (MCIPC) against the following 84 strains isolated from cases to which CFPZ was administered; 55 strains of Gram-positive cocci (GPC) including 2 strains of Staphylococcus aureus, 49 strains of Streptococcus pyogenes, 4 strains of Streptococcus pneumoniae, and 29 strains of Gram-negative bacilli (GNB) including 10 strains of Haemophilus influenzae, 18 strains of Escherichia coli, and 1 strain of Proteus mirabilis . MIC determination of these strains was done with an inoculum size of 10(6) CFU/ml . In pharmacokinetic studies, serum concentrations, urinary concentrations and urinary recovery rates were investigated using bioassay and high-performance liquid chromatography (HPLC) . CFPZ was orally administered 30 minutes before meals to 9 children with ages ranging from 7 years and 1 month to 12 years and 3 months . Three groups of 3 children were tested with doses of 4.0, 7.5 and 15.0 mg/kg, respectively . In addition to the above, clinical and bacteriological studies were performed in a total of 160 cases consisting of children with ages ranging 5 months to 12 years and 5 months . A mean dose of 8.6 mg/kg in 3-4 divided doses (130 cases of t.i.d . and 30 cases of q.i.d.) was administered for an average of 7 days . The 160 cases included 34 cases of pharyngitis, 5 cases of tonsillitis, 8 cases of acute bronchitis, 8 cases of pneumonia, 52 cases of scarlet fever, 4 cases of acute purulent otitis media, 47 cases of urinary tract infection, 1 case of purulent lymphadenitis and 1 case of posthitis . Adverse reactions and abnormal clinical laboratory test results were also examined in 166 cases, including 6 cases excluded from the evaluation of clinical efficacy . The results obtained are summarized as follows: 1 . With regard to GPC, MICs of CFPZ against 2 strains of S . aureus were 0.78 or 1.56 micrograms/ml and CFPZ showed the second highest activity to MCIPC . MICs of CFPZ against 49 strains of S . pyogenes were all less than 0.025 micrograms/ml.(ABSTRACT TRUNCATED AT 400 WORDS) Jpn J Antibiot, 1992 Dec, 45(12), 1642 - 9 {Clinical studies on cefprozil granules}; Haruta T et al.; Cefprozil granule preparation was administered orally to 16 patients (ages ranging 8 months to 9 years and 6 months) with pediatric bacterial infections at daily dose levels between 29.4 and 35.7 mg/kg divided into 3 or 4 doses . The following results were obtained . 1 . Sixteen patients including 5 with pharyngitis, 3 with tonsillitis, 3 with lacunar tonsillitis, 2 with pneumonia, 2 with contagious impetigo and 1 with scarlet fever were treated . Clinical effects were excellent in 9 cases and moderate in 7, with an overall efficacy rate of 100% . 2 . Organisms suspected as pathogens included 17 strains (10 strains of haemophilus influenzae, 2 of Haemophilus parainfluenzae, 3 of Streptococcus pyogenes and 2 of Staphylococcus aureus) . Bacteriologically, eradication of pathogens were observed for 11 strains, but no changes were obtained for 5 (all Haemophilus), and unknown results were obtained for 1, thus the eradication rate was 68.8% . 3 . No side effects were observed . Abnormal laboratory test results included 2 cases of increase in platelets, and 2 of increase in eosinophils, but those were not significant . 4 . No refusal of the drug occurred due to its taste or odor. Oral Microbiol Immunol, 1992 Dec, 7(6), 372 - 5 Rapid identification of Actinobacillus actinomycetemcomitans based on analysis of 23S ribosomal RNA; Preus HR et al.; Actinobacillus actinomycetemcomitans is a key microorganism in the pathogenesis of several different forms of periodontal diseases . Identification of this bacterium from clinical specimens may often be complicated by the fact that the colony morphology on TSBV selective medium closely resembles that of Haemophilus aphrophilus and a key differentiating characteristic, catalase reaction, may be variable . Recent genetic studies have shown that the 23S ribosomal RNA molecule is split into two smaller forms in A . actinomycetemcomitans, but is intact in H . aphrophilus . Based on this finding, we describe a new, rapid method for identifying A . actinomycetemcomitans in which single colonies isolated from culture on TSBV agar in 5% CO2 in air are lysed, electrophoresed on 1.5% submarine agarose gels and visualized by staining with ethidium bromide . Using this assay, A . actinomycetemcomitans can be easily distinguished from morphologically similar colonies such as H . aphrophilus strains by differences in 23S rRNA within 2 h. J Med Microbiol, 1992 Dec, 37(6), 413 - 9 Identification of highly conserved and species-specific polypeptides of Haemophilus ducreyi; Alfa MJ et al.; Chancroid is a sexually transmitted diseased caused by Haemophilus ducreyi . The pathological manifestations of chancroid are unique among Haemophilus species and the virulence factors of H . ducreyi that account for these features have not been identified . Some of these virulence factors may be unique components of H . ducreyi, but attempts to identify H . ducreyi-specific components have been unsuccessful . Four polypeptides--A, B, C and D of 83, 77, 56 and 28 kDa, respectively--were identified with a panel of nine H . ducreyi-specific monoclonal antibodies (MAbs) . Polypeptide C was one of the five major proteins in H . ducreyi and demonstrated micro-heterogeneity in SDS-PAGE . Polypeptides A, B and D were present in only small amounts in whole-cell lysates of H . ducreyi . The relative amounts of A and B varied, suggesting that they may be precursor molecules . The unique polypeptides C and D were not exposed on the surface . Polypeptide C was highly soluble and did not appear to be membrane-bound, whereas polypeptide D appeared to partition with the cytoplasmic membrane and was soluble in Sarkosyl . All four polypeptides appeared to be unique to H . ducreyi since MAbs directed against them did not cross-react with H . influenzae, H . parainfluenzae or Neisseria gonorrhoeae . The mol . wts of all of these polypeptides were conserved throughout 35 clinical isolates collected from 15 cities in eight countries and one reference strain of H . ducreyi that were tested.(ABSTRACT TRUNCATED AT 250 WORDS) Infect Immun, 1992 Dec, 60(12), 5204 - 11 Molecular analysis of the P2 porin protein of nontypeable Haemophilus influenzae; Sikkema DJ et al.; The P2 porin protein is the most abundant outer membrane protein (OMP) of nontypeable Haemophilus influenzae (NTHI) and shows extensive antigenic heterogeneity among strains . To study the molecular basis of this heterogeneity, the DNA sequences of the genes encoding the P2 proteins of three unrelated strains of NTHI were determined, and restriction fragment length polymorphisms around the P2 genes of 35 strains were analyzed . The deduced amino acid sequences of the P2 genes from the three strains of NTHI revealed four major (12 to 35 amino acids long) and several smaller (2 to 7 amino acids) hypervariable regions in each protein . The major variations occurred in identical portions of the genes, and these regions showed a high antigenic index and surface exposure probability in computer modeling analysis . Differences in the molecular mass of the P2 protein correlate with differences in the size of the variable region in each strain . Oligonucleotide primers suitable for amplification of the P2 genes by polymerase chain reaction were developed . Restriction fragment length polymorphism analysis showed marked heterogeneity in and around the ompP2 locus of 35 NTHI strains . These results contrast with the high degree of conservation of the P2 genes in H . influenzae type b strains . We conclude that the molecular mass and antigenic heterogeneity of the P2 molecule of NTHI is due to variations in gene sequence that are clustered primarily in four large hypervariable regions of the gene. Tidsskr Nor Laegeforen, 1992 Nov 30, 112(29), 3684 - 7 {Treatment of bacterial meningitis in children}; Flaegstad T; The treatment of children with bacterial meningitis includes many aspects, such as fluid and antibacterial therapy, treatment of convulsions, and prophylactic use of dexamethasone . This report focuses in particular on the prophylactic use of dexamethasone together with cefalosporines in order to reduce inflammation and neurological sequelae in this disease . Probably this approach is now justified in the treatment of meningitis caused by Haemophilus influenzae . Modern principles for fluid therapy and treatment of increased intracranial pressure are also discussed. Jpn J Antibiot, 1992 Nov, 45(11), 1592 - 608 {Overall clinical evaluation of cefprozil against infections in pediatric fields . Pediatric Study Group for Cefprozil}; Fujii R et al.; Cefprozil (CFPZ, BMY-28100) granule preparation was studied for pharmacokinetic, bacteriological and clinical aspects in the pediatric infections . The results obtained are summarized as follows: 1 . Serum concentrations and urinary excretion . The pharmacokinetics of CFPZ in pediatrics was investigated by single oral administration of fine granules at doses of 4.0, 7.5 and 15.0 mg/kg . Peak blood levels of CFPZ were 3.06, 4.62 and 9.65 micrograms/ml, respectively, at 1.00-1.30 hours after each dose and AUCs were 7.44, 12.50 and 27.01 micrograms.hr/ml, respectively . These data showed that Cmax and AUC depended on dose levels . T 1/2 (beta) at these dose levels were 1.03, 0.94 and 1.01 hours, respectively . There were no differences related to dose . Urinary recovery rates in the first 6 hours after administration were 51.5-57.1% . The pharmacokinetics of CFPZ before or after meals were also investigated at a dose of 7.5 mg/kg . Peak blood levels were 4.88 micrograms/ml at 1.17 hours after administration in the fasting state, and 4.30 micrograms/ml at 1.54 hours after administration in the non-fasting state . Delay of Tmax and slight decrease of Cmax were observed in the non-fasting state, but T 1/2 and AUC were 0.91 hour and 12.96 micrograms.hr/ml, respectively, in the non-fasting state, and were similar to those in the fasting state, 0.93 hour and 12.82 micrograms.hr/ml, respectively . Urinary recovery rates in the first 6 hours after administration were 63.8% in the fasting state and 50.7% in the non-fasting state . 2 . Clinical results . Clinical efficacies of CFPZ granules in various infectious diseases were studied in 804 cases . Twenty nine cases, mostly viral or mycoplasmal infections, were excluded from the statistical analysis . The clinical efficacy rate in 527 cases with causative bacteria isolated was 97.2%; and in 248 cases from whom no significant isolate had been obtained was 96.0% . The clinical efficacy rate in 475 cases with monobacterial infections (proven by culture of isolates) was 97.3%, and that in 52 case with polybacterial infections was 96.2% . Haemophilus influenzae was isolated mostly from acute respiratory infections . In 88 cases from whom H . influenzae was isolated, clinical efficacy rate was 95.5% . In cases from whom H . influenzae was found concomitant by with Staphylococcus aureus, Streptococcus pyogenes or Streptococcus pneumoniae, the clinical efficacy rates were also high . The bacteriological eradication rate in cases with 582 strains was 83.3%; the eradication rate for Gram-positive organisms was 95.8%; and for Gram-negative organisms, it was 64.2%.(ABSTRACT TRUNCATED AT 400 WORDS) Jpn J Antibiot, 1992 Nov, 45(11), 1571 - 81 {Pharmacokinetic, bacteriological and clinical studies on cefprozil in pediatric patients}; Arai S et al.; Cefprozil (CFPZ, BMY-28100), a new oral cephem antibiotic, was studied for its antibacterial activities, absorption and excretion upon administration . Its clinical efficacies were also studied in pediatric patients with infections . A study on antibacterial activities of CFPZ against 11 clinical isolates including 6 species found that its activities against Staphylococcus aureus, alpha-hemolytic Streptococcus, Escherichia coli and Haemophilus influenzae were equal or superior to those of CCL . When CFPZ was given to patients orally at 15 mg/kg, maximum serum concentration was obtained between 1 to 2 hours after administration and urinary excretion rate in the first 6 hours was 33.8 +/- 17.6% . Clinical evaluation was done in a total of 25 patients with various infections . Responses were excellent in 15 cases and good in 10 cases, hence the efficacy rate was 100% . As side effect, soft stool was found in 1 case, and eosinophilia in 2 cases and elevation of GOT and GPT in 1 case were found as abnormal laboratory test results, but none of them was serious . It appears that CFPZ is an effective and safe antibiotic in the field of pediatrics. Jpn J Antibiot, 1992 Nov, 45(11), 1558 - 70 {Laboratory and clinical studies on cefprozil in the field of pediatrics}; Hayakawa F et al.; Laboratory and clinical studies on cefprozil (CFPZ, BMY-28100), a new cephem antibiotic, were carried out in the field of pediatrics . The results obtained are summarized as follows: 1 . Serum concentrations, urinary concentrations and urinary recovery rates of CFPZ were determined upon oral administration of CFPZ after meal at doses of 4 mg/kg granules in a case, 7.5 mg/kg granules in 2 cases and 15 mg/kg granules in one . Peak serum levels of CFPZ were obtained at an hour in 3 cases and at 2 hours in 1 case after administration of the drug with a range of 2.7-8.6 micrograms/ml with half-lives of 0.69-0.95 hours . Urinary recovery rates in the first 6 hours after administration ranged from 59.4-71.3% . 2 . MICs of CFPZ against 36 clinical isolates (Staphylococcus aureus 4 strains, Streptococcus pneumoniae 5, Streptococcus pyogenes 5, Escherichia coli 5, Haemophilus influenzae 12, Haemophilus parainfluenzae 4, and Branhamella catarrhalis 1) were compared with those of cefaclor (CCL) and ampicillin (ABPC) . The antibacterial activity of CFPZ was superior to those of CCL against Gram-positive cocci, and to those of ABPC against E . coli, and was equal to those of CCL and inferior to those of ABPC against H . influenzae . 3 . Thirty-seven pediatric patients with acute infectious diseases (pharyngitis/tonsillitis 17, bronchitis 7, pneumonia 3, skin and soft tissue infection 2, and urinary tract infection 8) were treated with CFPZ at daily doses of 10-47 mg/kg t.i.d . as a rule . The efficacy rates were 100% clinically and 56% bacteriologically . 4 . Side effects or abnormal laboratory test values were not observed except for an increased platelet count in 1 case and elevated GOT, GPT values in 2 cases. Jpn J Antibiot, 1992 Nov, 45(11), 1537 - 57 {Clinical study on cefprozil in pediatrics}; Iwai N et al.; Clinical efficacy and safety of cefprozil (CFPZ, BMY-28100), a newly developed oral cephalosporin, were studied in our pediatric department . Clinical effectiveness, bacteriological effectiveness and side effects were studied in 116 pediatric patients with ages ranging 4 months to 11 years . CFPZ was given 4.6-14.1 mg/kg daily in 3 times for 3-10 days . Clinical efficacies were evaluated in 112 patients, and the therapeutic effectiveness were excellent in 1 and good in 6 for 7 patients with acute pharyngitis, excellent in 24 and good in 26 for acute purulent tonsillitis, excellent in 3, good in 8 and fair in 1 for acute bronchitis, excellent in 21, good in 7, fair in 1 and poor in 1 for acute pneumonia, excellent in 1 acute purulent parotitis, excellent in 2 and good in 7 for acute UTI, good in 1 impetigo, fair in 1 periproctal abscess and good in 1 acute enteritis . The effectiveness rate was 96.4% . Bacteriologically, 4 strains of Staphylococcus aureus (beta-lactamase producing strains), 1 strain of Staphylococcus epidermidis (beta-lactamase producing strain), 2 strains of Streptococcus pneumoniae, 2 strains of Streptococcus agalactiae, 4 strains of beta-Streptococcus, 1 strain of Klebsiella pneumoniae (beta-lactamase producing strain) and 1 strain of Salmonella C2 were all disappeared, and of 22 strains of Streptococcus pyogenes, 20 strains were disappeared, 1 was decreased and 1 was unknown, of 5 strains of Escherichia coli (3 beta-lactamase producing strains), 4 were disappeared and 1 was decreased, of 29 strains of Haemophilus influenzae (14 beta-lactamase producing strains), 14 were disappeared, 11 were decreased, 3 persisted and 1 was unknown and of 2 strains of Haemophilus parainfluenzae (1 beta-lactamase producing strain), 1 was disappeared and 1 persisted . The bacteriological eradication rates for Gram-positive bacteria and Gram-negative bacteria were 97.1% and 56.8%, respectively, and the drug was especially effective against Gram-positive bacteria . No side effects nor refusal of ingestion were observed . As abnormalities in laboratory test results, 3 cases of elevation of eosinophil counts and 1 of elevation of platelet counts were observed . In conclusion, CFPZ was considered to be a safe and highly effective antibiotic in pediatric infections. Jpn J Antibiot, 1992 Nov, 45(11), 1505 - 13 {Clinical evaluation of a new oral cephem, cefprozil in children}; Meguro H et al.; Cefprozil (CFPZ, BMY-28100) was evaluated for its efficacy, safety and pharmacokinetics in children . CFPZ was effective against streptococcal pharyngitis, pneumococcal lower respiratory tract infections, staphylococcal skin infections and Escherichia coli urinary tract infections, but was less effective against lower respiratory tract infections and otitis media due to Haemophilus influenzae . No adverse reactions were encountered in 46 cases treated with CFPZ . With a premeal administration of 7.5 mg/kg, the Cmax was approximately 3.2 micrograms/ml and the T 1/2 beta was 1.4 hours . From the present study, CFPZ appears to be safe and effective against community-acquired childhood infections. Jpn J Antibiot, 1992 Nov, 45(11), 1451 - 9 {Antimicrobial activity of cefetamet against clinically isolated microbial strains collected from urban RTI patients}; Deguchi K et al.; The authors studied antimicrobial activities of cefetamet (CFMT) and other leading oral antimicrobials of beta-lactam class against clinically isolated strains from urban respiratory tract infection (RTI) patients from January to March, 1992 . 1 . CFMT showed potent antimicrobial activities against "3 primary pathogens" of RTIs i.e., Streptococcus pyogenes, Streptococcus pneumoniae, and Haemophilus influenzae, but the drug had a slightly higher MIC than those of a few oxime-type cephems already on the market . 2 . CFMT was as stable as cefixime to beta-lactamase, generated by Moraxella subgenus Branhamella catarrhalis, which reduces the antimicrobial activity of cephems . 3 . Blood concentrations of CFMT after administering cefetamet pivoxil (CFMT-PI), an oral form of the drug, exceeded the MIC80 against the "3 primary pathogens" as well as M . (B) catarrhalis and Klebsiella pneumoniae, for a duration of approximately 9 and 11 hours, respectively, after single doses of 250 and 500 mg . This suggests that CFMT could remain above the MICs for a sufficient time period with twice daily dosages of normal dose levels . 4 . It is concluded that CFMT-PI will be useful for treating urban RTIs. Sex Transm Dis, 1992 Nov-Dec, 19(6), 309 - 14 Use of an adsorption enzyme immunoassay to evaluate the Haemophilus ducreyi specific and cross-reactive humoral immune response of humans; Alfa MJ et al.; Serodiagnosis of chancroid is limited by the cross-reactivity of Haemophilus ducreyi with Haemophilus influenzae and Haemophilus parainfluenzae . This research describes an adsorption enzyme immunoassay (EIA) that assesses the humoral immune response of North Americans and Africans to H . ducreyi . Adsorption effectively removed anti-H . influenzae and anti-H . parainfluenzae antibodies, revealing that North American control sera had no residual anti-H . ducreyi reactivity . However, African control sera still had a residual anti-H . ducreyi response . Assessment of the duration of the humoral immune response in sera from African patients with chancroid showed that the humoral antibodies persisted for up to 8 months after the diagnosis . This may explain the lack of specificity of the adsorption EIA in areas where chancroid is endemic . The detection of the humoral immune response was affected by the strain of H . ducreyi used, with indigent strains being most useful . Using H . ducreyi 35000 for Canadian sera, the sensitivity of the adsorption EIA was 100% and the specificity was 88% . For African sera, H . ducreyi strain R018 was used, and the adsorption EIA had a sensitivity of 81% and a specificity of only 23% . These data reveal that the existing humoral response in a country where chancroid is endemic differs from that in a country where it is not, and that care must be used interpreting unadsorbed humoral immune responses . The adsorption EIA approach may prove useful as an epidemiologic tool for definition of existing (past and present) levels of exposure to H . ducreyi. Antimicrob Agents Chemother, 1992 Nov, 36(11), 2569 - 72 Molecular basis of the efficacy of cefaclor against Haemophilus influenzae; Picard M et al.; Cefaclor sustained its inhibitory activity against a beta-lactamase-producing strain of Haemophilus influenzae . Although a relatively high permeability coefficient was calculated for ampicillin compared with that calculated for cefaclor, the resulting periplasmic concentration of cefaclor was 5.7 times that of ampicillin . The efficacy of cefaclor may be due to its higher beta-lactamase resistance, which allows it to achieve a greater periplasmic concentration and adequate binding to crucial penicillin-binding proteins. Diagn Microbiol Infect Dis, 1992 Nov-Dec, 15(8), 693 - 701 Haemophilus test medium interpretive criteria for disk diffusion susceptibility tests with cefdinir, cefetamet, cefmetazole, cefpodoxime, cefdaloxime (RU29246, HR-916 metabolite), and trospectomycin; Jones RN et al.; The disk diffusion zones and the MICs of six newer antimicrobials with significant activity against Haemophilus influenzae were compared using the Haemophilus test medium (HTM) and National Committee for Clinical Laboratory Standards methods . The rank order of potency was cefpodoxime (MIC50, < or = 0.03 micrograms/ml) > cefetamet > cefdinir > cefdaloxime = trospectomycin > cefmetazole (MIC50, 2 micrograms/ml) . Susceptible breakpoint interpretive criteria for HTM tests were established that conformed to prior recommendations for each drug when tested against other species . Absolute agreement between methods ranged from 89% to 100% with < or = 1% false-susceptible interpretive errors . The recommended, tentative disk diffusion susceptible interpretive criteria were for 5-micrograms cefdinir disks > or = 20 mm (MIC correlate, < or = 1 micrograms/ml); for 10-micrograms cefetamet disks > or = 18 mm (MIC correlate, < or = 4 micrograms/ml); for 30-micrograms cefetamet disks > or = 21 mm (MIC correlate, < or = 4 micrograms/ml); for 30-micrograms cefmetazole disks > or = 16 mm (MIC correlate, < or = 16 micrograms/ml); for 10-micrograms cefpodoxime disks > or = 21 mm (MIC correlate, < or = 2 micrograms/ml); for 30-micrograms cefdaloxime disks > or = 23 mm (MIC correlate, < or = 2 micrograms/ml) and for 30-micrograms trospectomycin disks > or = 17 mm (MIC correlate, < or = 16 micrograms/ml) . beta-Lactamase-negative, ampicillin-resistant (BLNAR) H . influenzae isolates consistently had the highest MICs for each cephalosporin tested.(ABSTRACT TRUNCATED AT 250 WORDS) Ann Pharmacother, 1992 Nov, 26(11), 1429 - 40 Haemophilus influenzae type B conjugate vaccines; Force RW et al.; OBJECTIVE: To review the epidemiology of Haemophilus influenzae type b (Hib) disease, the first Hib vaccine and its limitations, the characteristics and clinical efficacy of the newer conjugate vaccines, and the current recommendations for administration of Hib vaccines . DATA SOURCES: Pertinent literature was identified via a MEDLINE search . Additionally, references cited in published articles were used as data sources . STUDY SELECTION: Studies describing the epidemiology of Hib disease and the efficacy and/or immunogenicity of the Hib vaccines are reviewed . DATA SYNTHESIS: Serious invasive disease secondary to Hib infection causes significant morbidity and mortality in children between the ages of three months and five years . The original Hib vaccine was found to be ineffective in stimulating an adequate immune response in children younger than two years of age . The new Hib conjugate vaccines provide superior efficacy and immunogenicity compared with the original unconjugated vaccine . They stimulate an immune response that is distinctly different from that elicited by the original vaccine . Two vaccine products are currently licensed for use in children as young as two months of age, thus conferring immunity to those children at highest risk for Hib disease . CONCLUSIONS: The new Hib conjugate vaccines provide excellent efficacy and, when used as recommended, may significantly reduce the incidence of invasive Hib disease and its sequelae. Clin Infect Dis, 1992 Nov, 15 Suppl 1, S162 - 6 Evaluation of new anti-infective drugs for the treatment of acute hematogenous osteomyelitis in children . Infectious Diseases Society of America and the Food and Drug Administration; Nelson JD et al.; Most children with acute hematogenous osteomyelitis have no preceding illness . Their early symptoms are pain and fever . A bacterial etiology is established in approximately 75% of cases by needle aspiration of the affected site or blood culture . Clinical trials should be limited to cases of bacterial origin . The antimicrobial agents studied should be active against Staphylococcus aureus and streptococci . If children < 5 years of age are included, the drug should also be active against beta-lactamase-negative and -positive strains of Haemophilus influenzae . Randomized, prospective, double-blind comparative studies are preferable to open, evaluator-blinded trials . Clinical outcome is appraised by physical signs and symptoms . A successful microbiological outcome consists of presumptive eradication . The final assessment should be made 1 year after completion of therapy. Clin Infect Dis, 1992 Nov, 15 Suppl 1, S108 - 14 Evaluation of new anti-infective drugs for the treatment of chancroid . Infectious Diseases Society of America and the Food and Drug Administration; Ronald AR et al.; Chancroid is a mucocutaneous infection caused by Haemophilus ducreyi that produces ulcerative lesions and enhances the efficiency of transmission of human immunodeficiency virus (HIV) . Confirmation of infection by culture of H . ducreyi is essential in therapeutic trials . Minimal inhibitory concentrations of antibiotics for the isolate should be determined by agar dilution . Patients should be evaluated by appropriate laboratory tests for syphilis, infection with herpes simplex virus, gonorrhea, and (in North America) infection with Chlamydia trachomatis . The clinical history of the disease should be recorded and ulcers, buboes, and lymphadenitis mass described . Whenever possible, study participants also should be tested for HIV infection . Randomized, prospective, double-blind, active-control comparative clinical trials are preferred for evaluation of the safety and efficacy of new anti-infective drugs . Otherwise-healthy men and women should be enrolled in these studies . Patients with active syphilis or genital herpes should be excluded . Microbiological and clinical outcomes are paramount. Acta Paediatr, 1992 Nov, 81(11), 941 - 3 Chloramphenicol-resistant Haemophilus influenzae meningitis in young urban Nigerian children; Johnson AW et al.; In a developing country like Nigeria, the unusual emergence of Haemophilus influenzae type b, resistant to cost-effective antimicrobials, is of serious concern . We report three cases of H . influenzae type b meningitis in young Nigerian children in whom clinical and bacteriological features of resistance to chloramphenicol were identified . One of the cases had concomitant resistance to ampicillin (multiple-drug resistance) . Significant anaemia was an associated feature in two cases, one of whom had a recent measles infection . All three cases were malnourished . The possible mechanisms of antimicrobial resistance in H . influenzae infections are highlighted while the need for periodic surveillance of antibiotic resistance profiles in resource-poor countries is emphasized . The potential value of prophylactic measures like H . influenzae type b conjugate immunization is discussed. Arch Intern Med, 1992 Nov, 152(11), 2301 - 4 Purulent otitis media in adults; Schwartz LE et al.; While the bacterial origin of otitis media has been studied extensively in children, there are few data regarding adults with this disease . We undertook this study to identify the incidence, prevalence, and bacteriologic origin of purulent otitis media in adults . This was accomplished through a review of the English-language literature on adult otitis media and a retrospective review of adult patients with this disease who were hospitalized at our institution . Results of literature review indicate that Streptococcus pneumoniae and Haemophilus influenzae are the most common causes of otitis media in ambulatory adults, but this illness is uncommon, with an incidence of only 0.25% . Hospitalized patients in whom this diagnosis was established suffered a variety of serious suppurative complications such as mastoiditis, meningitis, or brain abscess . Otalgia and fever were the most common symptoms noted in this patient population . Further studies of adult otitis media need to be performed to determine bacteriologic, symptomatic, and high-risk patient groups. Arch Intern Med, 1992 Nov, 152(11), 2277 - 82 High incidence rates of invasive pneumococcal disease in the White Mountain Apache population; Cortese MM et al.; OBJECTIVE--In this article we determine the incidence and clinical spectrum of invasive pneumococcal disease in the White Mountain Apache population, a group known to have a high incidence of invasive disease due to Haemophilus influenzae type b . DESIGN--Patients from whom cultures of normally sterile body sites yielded Streptococcus pneumoniae were identified retrospectively through review of hospital laboratory records from a 6.8-year period . Clinical data were reviewed and incidence rates were computed . SETTING--The Whiteriver Indian Health Service Hospital is located on the 1.7-million-acre White Mountain Apache Reservation in eastern Arizona . PATIENTS--Approximately 10,000 members of the White Mountain Apache Tribe reside on or near the reservation and receive health care through the Whiteriver Indian Health Service Hospital . OUTCOME MEASURES--The average annual incidence rates of invasive pneumococcal disease were calculated and clinical characteristics were reviewed . RESULTS--One hundred thirty-eight cases of invasive pneumococcal disease were identified . The average annual incidence rate was 207 per 100,000 population, and 156 per 100,000 population when adjusted for age by direct standardization to the 1988 US population . The incidence rate was highest in children between 1 and 2 years--2396 per 100,000 . The overall case-fatality rate was 5% . Pneumococcal pneumonia was the diagnosis in 79% of the patients 5 years of age or older . Alcohol abuse, identified in 66% of the cases in adults, was the most common underlying medical condition . CONCLUSION--The incidence rates in White Mountain Apaches are the highest reported for any population . A vaccine effective in children would greatly benefit this population. Proc Natl Acad Sci U S A, 1992 Nov 1, 89(21), 10252 - 6 A periplasmic protein disulfide oxidoreductase is required for transformation of Haemophilus influenzae Rd; Tomb JF; The mutated gene in JG16, a Haemophilus influenzae strain deficient in competence-induced DNA binding and uptake, was cloned and the wild-type allele was sequenced . The gene was shown by Northern analysis to be constitutively expressed on a 1.7-kilobase transcript . The gene product was identified as a 20.6-kDa protein targeted to the periplasm . The protein contains the sequence Cys-Pro-His-Cys (CPHC) and is highly similar to two other periplasmic CPHC motif-containing proteins: DsbA, an Escherichia coli protein (45% identity, 87% homology) and TcpG, a Vibrio cholerae protein (32% identity, 74% homology) . Both DsbA and TcpG promote disulfide bond formation in periplasmic proteins, are required for pilus biogenesis, and, like thioredoxin, are capable of reducing insulin in vitro . The Haemophilus protein was shown to complement an E . coli mutation in DsbA and was named Por (periplasmic oxidoreductase) . In JG16 the competence-dependent redistribution of inner membrane proteins did not occur . These findings suggest that Por is required for the correct assembly and/or folding of one or more disulfide-containing cell envelope protein involved either in competence development or in the DNA-binding and -uptake machinery. J Bacteriol, 1992 Nov, 174(22), 7245 - 52 Use of chromosomal gene fusions to investigate the role of repetitive DNA in regulation of genes involved in lipopolysaccharide biosynthesis in Haemophilus influenzae; Szabo M et al.; The lic3 locus of Haemophilus influenzae consists of four open reading frames . The derived amino acid sequences of orf2 and orf4 exhibit homology to Escherichia coli GalE and AdK, respectively . The functions of orf1 and orf3 remain unknown . orf1 contains multiple tandem repeats of the tetrameric DNA sequence CAAT near the 5' end . Two possible translational starts (ATG1 and ATG2) lie upstream . We have used lacZ fusions to investigate whether changes in the number of CAAT repeats in conjunction with differential usage of the upstream frames control the expression of lic3-orf1 . Phase-variable expression of lacZ was observed for individual colonies and could be related to variable numbers of CAAT repeats . Of the three possible upstream frames, only one, containing the more downstream of the two possible ATG start codons (ATG2), is used for strong expression of lacZ . Utilization of the more upstream ATG (ATG1) or ATG2 was observed with medium-level expression, while utilization of any of the three possible frames was observed when lacZ was expressed at low to undetectable levels, indicating that other mechanisms may affect expression . To investigate this, lacZ was fused in frame with ATG2 of lic3-orf1, with concomitant deletion of the repeats . Phase-variable expression was still observed, supporting the view that an alternative level of control operates in conjunction with the repeat mechanism. Chest, 1992 Nov, 102(5), 1562 - 5 Pneumonia due to Haemophilus influenzae among mechanically ventilated patients . Incidence, outcome, and risk factors; Rello J et al.; Incidence and potential risk factors for pneumonia due to Haemophilus influenzae in adults treated with mechanical ventilation in a medical-surgical ICU were investigated . Diagnosis was established in 91 episodes and H influenzae was isolated in 20 of them . Mean onset of ventilator-associated pneumonia (VAP) due to H influenzae was 10.8 days after intubation . Six patients with H influenzae VAP died in the ICU . Of 13 risk factors for developing VAP due to H influenzae, an absence of prior antibiotic treatment was the only variable which had statistical significance (p < 0.001) . In these mechanically ventilated patients, Haemophilus influenzae was a common causative agent for VAP, frequently associated with Gram-positive cocci . Episodes of H influenzae VAP were associated with a lower mortality compared with other etiologies . The epidemiologic and clinical findings indicate that patients without a prior antimicrobial treatment have increased susceptibility to infections of the airway by H influenzae. Clin Exp Immunol, 1992 Nov, 90(2), 223 - 7 Cellular changes in the bronchoalveolar lavage (BAL) of pigs, following immunization by the enteral or respiratory route; Delventhal S et al.; Normal young pigs were immunized by the oral or aerogenic route with the viable or inactivated lung-pathogenic bacterium Actinobacillus (Haemophilus) pleuropneumoniae . Three weeks later the cellular composition as well as the lymphocyte subset composition of the bronchoalveolar space were examined by BAL . Lymphocytes in the lavage increased significantly, including CD4+ and CD8+ T cells . After oral immunization a dramatic increase of plasma cells and lymphoid blasts was found . Among immunoglobulin-positive lymphocytes IgG+ cells showed the most pronounced increase . For most lymphocyte subsets there was no difference between viable and inactivated bacteria . Oral immunization with a lung-pathogenic bacterium results in increased numbers of lymphocytes in the bronchoalveolar space and might play a critical role in protection against lower respiratory tract infections. Arch Otolaryngol Head Neck Surg, 1992 Nov, 118(11), 1229 - 31 Bacteremia during tonsillectomy; Francois M et al.; To determine the risk of bacteremia during tonsillectomy, we cultured blood specimens that were taken from 32 children during surgery and tonsillar swabs that were obtained just before excision, and compared the results with quantitative cultures of the excised tonsillar tissue . Twenty-five children had Haemophilus influenzae within the tonsillar tissue (density range, 10(3) to 10(8) colony-forming units per gram), and seven had Streptococcus pyogenes (density, 10(3) colony-forming units per gram in one case, 10(5) colony-forming units per gram in one case, and 10(6) colony-forming units per gram in five cases) . Twelve perioperative blood cultures were positive; H influenzae was found nine times, and Micrococcus species was found one time, and alpha-hemolytic streptococci were found two times . Haemophilus influenzae was always present in the corresponding tonsillar specimens, although there was no apparent relationship between the density of colonization of the tonsillar tissue and a positive blood culture. J Infect Dis, 1992 Nov, 166(5), 1021 - 8 Immunogenicity of Haemophilus influenzae type b conjugate vaccine in allogeneic bone marrow recipients; Barra A et al.; A randomized study was conducted in 40 allogeneic marrow recipients to compare the immunogenicity of two Haemophilus influenzae type b (Hib) vaccines (either the Hib capsular polysaccharide {Hib-CPS} or tetanus toxoid-conjugated Hib-CPS {Hib-CPS-T}) . A second injection consisted of Hib-CPS-T . Before immunization, 3 patients had serum antibody levels > 1 microgram/mL . After the first injection, the response was better after Hib-CPS-T than after Hib-CPS but lower than in normal subjects; a number of patients lacked any IgG antibody response, especially after Hib-CPS . Of patients who received two injections of Hib-CPS-T, 85% achieved an antibody concentration > or = 1 microgram/mL . Hib-CPS-T induced a response in IgG2-deficient patients whereas Hib-CPS alone did not . IgG antibodies predominantly belonged to the IgG1 subclass . The antibody response was better in patients immunized late after graft . This study shows that Hib-CPS-T is more immunogenic than Hib-CPS in marrow recipients. Infect Immun, 1992 Nov, 60(11), 4838 - 47 Complement activation by polyclonal immunoglobulin G1 and G2 antibodies against Staphylococcus aureus, Haemophilus influenzae type b, and tetanus toxoid; Bredius RG et al.; To obtain information on effector functions of human immunoglobulin G2 (IgG2), we have measured the complement-activating properties of polyclonal IgG subclass antibodies against bacterial antigens . IgG1 and IgG2 were purified from serum samples from five healthy individuals, and complement activation was measured with different bacterial antigens . We used Staphylococcus aureus Wood 46 (STAW), which is a common antigen, Haemophilus influenzae type b (Hib), which is a common pathogenic microorganism in children, and formaldehyde-inactivated tetanus toxin (TT) . Bacteria were incubated with antibodies and then incubated with sera from agammaglobulinemic patients as a complement source, and C3c deposition was measured by enzyme-linked immunosorbent assay . We found that anti-STAW IgG2 activated complement to a level similar to that of anti-STAW IgG1 . Anti-Hib IgG1 complement activation was as much as seven times higher than that of anti-Hib IgG2 in four individuals . In one individual, anti-Hib IgG2 was more effective in complement activation than anti-Hib IgG1 . Anti-TT antibodies showed patterns similar to those of anti-Hib . Our results indicate that IgG2 antibodies may contribute significantly to antibacterial defense . Also, individual differences in antibody effector functions should be taken into account when evaluating the immune status of patients and during early phase 1 studies of new vaccines. J Hosp Infect, 1992 Nov, 22 Suppl A, 89 - 97 In-vitro bactericidal activity of four oral antibiotics against pathogens responsible for acute otitis media in children; Lambert-Zechovsky N et al.; This study was designed to test the in-vitro activity of four oral antibiotics against the four microorganisms most frequently isolated in acute otitis media: beta-lactamase-positive Haemophilus influenzae (N = 10), beta-lactamase-positive Moraxella catarrhalis (N = 10), penicillin-sensitive Streptococcus pneumoniae (N = 11) and methicillin-sensitive Staphylococcus aureus (N = 10), by the bactericidal curve method . Bactericidal kinetics were determined for concentrations of antibiotic equivalent to those found in the middle ear after treatment: amoxycillin-clavulanic acid (2.5 mg l-1/0.6 mg l-1 and 2.5 mg l-1/1.2 mg l-1), cefaclor (1 mg l-1), erythromycin (0.5 mg l-1) and erythromycin/sulfisoxazole (0.2/3 mg l-1) . The inoculum was of 10(6) colony-forming units (cfu) ml-1 . The bacterial counts were performed after 5 h and 24 h using a spiral inoculator system . The results showed that amoxycillin-clavulanic acid had rapid bactericidal activity (< 24 h) on the tested organisms at each of the doses used (reduction < or = 3 log10 cfu ml-1) which was not observed with the other antibiotics at either 5 or 24 h . Erythromycin alone or combined with sulfisoxazole had a bacteriostatic effect on Moraxella catarrhalis and Streptococcus pneumoniae but not on Haemophilus influenzae or Staphylococcus aureus . Cefaclor had no bactericidal action under these conditions. Indian J Pediatr, 1992 Nov-Dec, 59(6), 719 - 21 Bacterial meningitis in Saudi children; Srair HA et al.; During the four years period from 1988 to 1991, 50 pediatric patients were diagnosed to have bacterial meningitis, out of a total number of 9057 pediatric admissions at Qatif Central Hospital, Qatif, Saudi Arabia, and 82% were less than two years of age . The causative organisms were isolated in 27 (54%) patients . The bacteria grown included Haemophilus influenzae type B in 8 patients (29.6%), Neisseria meningitidis in 8 patients (29.6%), Streptococcus pneumonia in 6 (22%) patients, and other bacteria in 5 patients (18.5%) . Cerebro spinal fluid cultures from twenty three patients (46%) showed no organisms, however their clinical and C.S.F . findings were compatible with bacterial meningitis . One case of H . influenzae type B was resistant to ampicillin . Six patients died with an over all mortality of 12%, and 10 patients (20%) developed some kind of C.N.S . sequelae . Partially treated meningitis formed a large percentage of our sample. J Clin Microbiol, 1992 Nov, 30(11), 3013 - 5 Interpretive criteria and quality control parameters for testing susceptibility of Haemophilus influenzae to enoxacin, ofloxacin, and temafloxacin; Barry AL et al.; Haemophilus influenzae isolates were uniformly susceptible to enoxacin, ofloxacin, and temafloxacin . Zone diameter and MIC interpretive criteria were proposed to define susceptible populations so that mutants with diminished susceptibility might be detected when and if they appear in clinical specimens . Additional collaborative quality control studies defined MIC and zone size limits for tests with H . influenzae ATCC 49247. Kansenshogaku Zasshi, 1992 Nov, 66(11), 1502 - 12 {Identification of strains on recurrent Haemophilus influenzae infections in patients with chronic respiratory tract infections}; Takahashi A; Nontypable Haemophilus influenzae is one of the most important pathogenic bacteria in respiratory tract infections . H . influenzae is most frequently associated with recurrent infections in chronic respiratory tract infections (CRTIs) . It is known that H . influenzae often reemerges after the antibiotic treatment has been stopped . We analyzed serotype, biotype, and the OMP patterns of H . influenzae isolates from sputum of CRTIs patients to determine whether an exacerbation is caused by an identical H . influenzae strain, or by a new H . influenzae strain . One hundred eighty nine strains of H . influenzae were obtained from 124 exacerbation from 24 patients . The first and second isolates were identical in 23 out of 33 exacerbations (< or = 15-days interval between each exacerbation) and also in 22 out of 34 exacerbations (15 < days but < or = 30-days interval between each exacerbation) . This is called early recurrence . In contrast, the first and second isolates were different in 28 out of 34 exacerbations (> 30-days interval between each exacerbation) . This is called late recurrence . These results suggest that early recurrence and late recurrence of recurrent H . influenzae infections occur in a different mechanism. Drugs, 1992 Nov, 44(5), 750 - 99 Azithromycin . A review of its antimicrobial activity, pharmacokinetic properties and clinical efficacy; Peters DH et al.; Azithromycin is an acid stable orally administered macrolide antimicrobial drug, structurally related to erythromycin, with a similar spectrum of antimicrobial activity . Azithromycin is marginally less active than erythromycin in vitro against Gram-positive organisms, although this is of doubtful clinical significance as susceptibility concentrations fall within the range of achievable tissue azithromycin concentrations . In contrast, azithromycin appears to be more active than erythromycin against many Gram-negative pathogens and several other pathogens, notably Haemophilus influenzae, H . parainfluenzae, Moraxella catarrhalis, Neisseria gonorrhoeae, Urea-plasma urealyticum and Borrelia burgdorferi . Like erythromycin and other macrolides, the activity of azithromycin is unaffected by the production of beta-lactamase . However, erythromycin-resistant organisms are also resistant to azithromycin . Following oral administration, serum concentrations of azithromycin are lower than those of erythromycin, but this reflects the rapid and extensive movement of the drug from the circulation into intracellular compartments resulting in tissue concentrations exceeding those commonly seen with erythromycin . Azithromycin is subsequently slowly released, reflecting its long terminal phase elimination half-life relative to that of erythromycin . These factors allow for a single dose or single daily dose regimen in most infections, with the potential for increased compliance among outpatients where a more frequent antimicrobial regimen might traditionally be indicated . The potential disadvantage of low azithromycin serum concentrations, however, is that breakthrough bacteraemia may occur in patients who are severely ill; nevertheless, animal studies suggest that tissue concentrations of azithromycin are more important than those in serum when treating respiratory and other infections . The clinical efficacy of azithromycin has been confirmed in the treatment of infections of the lower and upper respiratory tracts (the latter including paediatric patients), skin and soft tissues (again including paediatric patients), in uncomplicated urethritis/cervicitis associated with N . gonorrhoeae, Chlamydia trachomatis or U . urealyticum and in the treatment of early Lyme disease . Azithromycin was as effective as erythromycin and other commonly used drugs including clarithromycin, beta-lactams (penicillins and cephalosporins), and quinolone and tetracycline antibiotics in some of the above infections . Some patients with acute exacerbations of chronic bronchitis due to H . influenzae may be refractory to therapy with azithromycin (as is the case with erythromycin) indicating the need for physician vigilance, although it should be noted that azithromycin is of equivalent efficacy to amoxicillin in the treatment of such patients . In the therapy of urethritis/cervicitis associated with C . trachomatis, N . gonorrhoea or U . urealyticum, a single dose azithromycin regimen offers a distinct advantage over currently available pharmacological options, while providing effective therapy.(ABSTRACT TRUNCATED AT 400 WORDS) Med J Aust, 1992 Oct 19, 157(8), 519 - 20 Outcome of paediatric bacterial meningitis 1979-1989; Thomas DG; OBJECTIVE: To determine the outcome of all cases of paediatric bacterial meningitis over the 11-year period 1979-1989 and discuss the role of adjunctive therapy with dexamethasone . DESIGN AND SETTING: The study was performed by retrospective case review at Flinders Medical Centre, a general teaching hospital . RESULTS: There were 80 episodes in 79 patients . The age range was 2 days to 15 years (mean, 1.7 years) . Haemophilus influenzae type b was the commonest organism (60 of 80 cases; 75%) . There were five deaths (6.3%) . Sensorineural hearing loss was found in six of 71 children (8.5%) and was bilateral and severe in four (5.6%) . Other problems included learning difficulties (12.7%), motor problems (7%), speech delay (7%), hyperactivity (4.2%), blindness (2.8%), obstructive hydrocephalus (2.8%) and recurrent seizures (2.8%) . CONCLUSIONS: Bacterial meningitis remains a disease with significant morbidity and mortality . Adjunctive therapy with dexamethasone should be considered, and vaccination against Haemophilus influenzae type b should be routine. Arch Ophthalmol, 1992 Oct, 110(10), 1450 - 4 Endophthalmitis caused by gram-negative organisms; Irvine WD et al.; The medical records of 52 patients (53 eyes) with culture-proven gram-negative endophthalmitis between January 1982 and December 1990 were reviewed . Pseudomonas aeruginosa (23% {12/53}) and Haemophilus influenzae (19% {10/53}) were the most frequent isolates in this series . Overall, 26 (49%) of 53 treated patients achieved 20/400 or better visual acuity . Fifty-two (98%) of the original 53 gram-negative isolates were sensitive to the aminoglycoside antibiotics . To determine their sensitivity to recently developed antibiotics, 35 of the isolates were again grown on culture media and their sensitivities to ceftazidime, ciprofloxacin, and imipenem were obtained . Only ceftazidime demonstrated in vitro efficacy for all the organisms tested. Protein Sci, 1992 Oct, 1(10), 1326 - 32 A new subfamily of bacterial ABC-type transport systems catalyzing export of drugs and carbohydrates; Reizer J et al.; Sequence comparison studies revealed that the drug resistance transporter of Streptomyces peucetius (DrrAB) and two nodulation gene products (NodIJ) of Rhizobium leguminosarum are homologous to proteins encoded by three sets of genes that comprise capsular polysaccharide export systems in gram-negative bacteria: KpsTM of Escherichia coli, BexABC of Haemophilus influenzae, and CtrDCB of Neisseria meningitidis . These five systems comprise a new subfamily within the family of ATP binding cassette (ABC)-type transporters . We have termed this subfamily the ABC-2 subfamily . For three of the systems comprising this subfamily (Drr, Nod, and Kps) only one integral membrane constituent has been identified, whereas for the other two systems (Bex and Ctr) two dis-similar integral membrane constituents have been found . This observation suggests that the transmembrane channels of ABC-2-type transporters can be formed of homo- or heterooligomers as is true of several other classes of transport systems. Eur J Clin Microbiol Infect Dis, 1992 Oct, 11(10), 930 - 4 A simple medium for the primary isolation of Haemophilus ducreyi; Dangor Y et al.; Two simple, inexpensive media containing gonococcal agar-base, supplemented with 5% Fildes' extract and either chocolated or unchocolated horse blood (GC-FHBC or GC-FHB) were compared with the standard gonococcal agar-based (GC-HgS) and Mueller-Hinton agar-based media (MH-HB) normally used for primary isolation of Haemophilus ducreyi from presumptive chancroid lesions . Overall, Haemophilus ducreyi was recovered from 162 of 178 (91%) samples from primary chancroid lesions . As a single isolation medium GC-HgS proved the most sensitive with an isolation rate of 80% followed by GC-FHB (75%), MH-HB and GC-FHC (both 71%) . Use of a combination of GC-HgS and MH-HB resulted in isolation of Haemophilus ducreyi in 160 of 178 cases (90%) . Since GC-FHB is approximately one-quarter the cost of the combination and half the cost of GC-HgS or MH-HB alone, this medium could prove suitable for diagnostic purposes in developing countries where chancroid is endemic. Thorax, 1992 Oct, 47(10), 818 - 20 Microbial flora of the trachea during intubation of patients undergoing upper abdominal surgery; Dilworth JP et al.; BACKGROUND: The presence of Haemophilus influenzae in the oropharynx is correlated with the subsequent development of chest infection . The importance of colonisation of the trachea by bacteria at the time of surgery is uncertain . This study investigated the tracheal flora at the time of intubation in 24 patients undergoing elective upper abdominal surgery . METHODS: The bacterial flora of the trachea was sampled in all 24 patients immediately after intubation and immediately before extubation . Patients were assessed postoperatively for the development of chest infection . RESULTS: Bacteria, including H influenzae in five cases, were isolated from the post-intubation brushings of the trachea of 15 patients . The pre-extubation brushings from only four patients yielded growth . Three of five patients developing a chest infection were colonised by H influenzae according to the postintubation brush, compared with two of 19 without chest infections . Before extubation two of five developing chest infections had H influenzae in the trachea but none of 19 without infection . All but one of the patients from whom H influenzae was isolated were smokers . CONCLUSIONS: These results suggest that the increased risk of postoperative chest infection in cigarette smokers may be due in part to colonisation of the trachea by H influenzae at the time of operation. Jpn J Antibiot, 1992 Oct, 45(10), 1403 - 19 {Laboratory and clinical evaluation of meropenem in pediatric field}; Iwai N et al.; We performed laboratory and clinical evaluation of meropenem (SM-7338, MEPM), a new carbapenem antibiotics, in pediatric field . Pharmacokinetics of MEPM was examined with 5 patients, at a dose of 10 mg/kg via 30 minutes drip infusion . Mean plasma concentrations at 30 minutes, 1, 1.5, 2.5, 3.5 and 5.5 hours after dose were 18.8, 6.97, 3.62, 1.14, 0.43 and 0.12 micrograms/ml, respectively, with a half life of 0.96 hour . The urine recovery rate in 6 hours was 70.4% . Clinical efficacy of MEPM was evaluated in 36 patients with various infectious diseases . MEPM was administered at doses ranging 9.5 to 30.6 mg/kg/dosage, 3 to 4 times a day, 21/3 to 10 days . Clinical effects were excellent in 24, good in 11, fair in 1, with an efficacy rate of 97.2% . Bacteriologically, all causative organisms except one each of Haemophilus influenzae and Salmonella enteritidis were eradicated, an eradication rate for Gram-positive and Gram-negative bacteria were 100% and 93.3%, respectively . No side effects were observed . Elevations of GOT and/or GPT were noted in 2 patients . From the above results, we believe that MEPM is a highly effective and safe drug for patients with various infectious diseases in pediatric fields. Ann Pediatr (Paris), 1992 Oct, 39(8), 485 - 90 {Bacterial epidemiology of acute otitis media}; Gehanno P et al.; Since the middle of the 1980's, Haemophilus influenzae is the most common bacterial species responsible for acute otitis media in France, followed by Streptococcus pneumoniae . Haemophilus influenzae has maintained its leading position since 1985, but the rate of pneumococcal acute otitis media is increasing fairly steadily . The other recent change with regard to the distribution of bacterial agents is the emergence, four years later than in North America, of Branhamella catarrhalis which currently accounts for 10% of cases of acute otitis media . Modifications in the behavior of microorganisms in relation to antimicrobials usually given to treat upper respiratory tract infections have occurred . Staphylococcus aureus and Branhamella catarrhalis have always exhibited marked resistance to ampicillin due to the production of beta-lactamases . Resistance of Haemophilus influenzae to ampicillin has been increasing gradually since 1985, again with a lag of a few years as compared with the United States; at present, this form of resistance is seen in approximately 35% of strains . More recently in France, 20% of pneumococcal strains recovered from middle ear pus have been shown to have abnormal susceptibility to penicillin . These changes in the behavior of the two main pathogens, i.e., Haemophilus influenzae and Streptococcus pneumoniae, require implementation of rigorous multiregional epidemiologic surveillance programs and may justify reappraisal of current therapeutic approaches. Vet Microbiol, 1992 Oct, 32(3-4), 319 - 25 Sequence analysis of the ROB-1 beta-lactamase gene from Actinobacillus pleuropneumoniae; Chang YF et al.; The ROB-1 beta-lactamase gene from Actinobacillus pleuropneumoniae was cloned and sequenced . The structural gene encodes a 305 amino acid polypeptide . The ROB-1 beta-lactamase gene sequence is identical to that derived from Pasteurella haemolytica and only one amino acid different from that of Haemophilus influenzae, suggesting that they are derived from the same ancestor, and transformed from one to another. Gesundheitswesen, 1992 Oct, 54(10), 528 - 34 {Vaccination against Haemophilus influenzae B and rubella}; Windorfer A; Haemophilus influenzae B was the most frequent pathogen of bacterial meningitis in childhood during the mid-eighties to the end of the eighties of the present century, taking the place of meningococci since approximately 1984 at about twice the rate of that pathogen, as shown by the records kept during 1980-1990 in Bavarian Departments of Paediatrics . In fact, in 1990 the incidence of HIB meningitides was about 2.5 times that of meningococcus meningitides (85 vs . 34, respectively) . For practically 2 years now vaccination against HIB is being publicly recommended and should be made use of as intensively as possible to prevent all HIB infections . For several years the principle of on-target rubella vaccination has been applied to schoolgirls in Lower Saxony, Bremen and Hamburg to prevent rubella embryopathy, a procedure that has proved much more successful than blank vaccination . None of the other Federal German Laender have been following this procedure to date; in consequence there of, although the strategy of on-target vaccination will be continued in Lower Saxony, greater uniformity and greater efficiency are being aimed at throughout Germany by public recommendation of rubella vaccination at an infant age. Gut, 1992 Oct, 33(10), 1331 - 7 Fasting hypochlorhydria with gram positive gastric flora is highly prevalent in healthy old people; Husebye E et al.; Fifteen healthy old people mean age 84 years (range 80-91 years), were examined to assess the effect of advanced age on the microecology of the upper gastrointestinal tract . Twelve of 15 (80%) were hypochlorhydric with pH 6.6 (0.3) (mean (SEM) and a mean bacterial count of 10(8) colony forming units (CFU) per ml (range 10(5)-10(10)) in fasting gastric aspirate . Normochlorhydric subjects had low counts (< or = 10(1) CFU/ml) . The microbial flora was dominated by viridans streptococci, coagulase negative staphylococci, and Haemophilus sp . Only one subject harboured significant concentrations of Gram negative bacilli with Escherichia coli (10(4-5) CFU/ml) and Klebsiella (10(4-5)) . Strict anaerobes were not found . The total concentration of short chain fatty acids in gastric aspirate was 10.6 (2.9) mmol/l (mean (SEM) . Absence of significant, intraluminal fermentation of xylose to CO2 was shown by the 14C-d Xylose breath test, and ambulatory manometry showed preserved fasting motility pattern of the small intestine . Serum immunoglobulins were normal . Advanced age is accompanied by fasting hypochlorhydria and colonisation with mainly Gram positive flora in the upper gut . Other factors than old age and fasting hypochlorhydria are required for colonisation with Gram negative bacilli. Antimicrob Agents Chemother, 1992 Oct, 36(10), 2147 - 55 Effect of beta-lactams on peptidoglycan metabolism of Haemophilus influenzae grown in animals; Rousseau N et al.; We have examined bacterial determinants that influence beta-lactam activity in Haemophilus influenzae cells cultivated in a system that reproduces in vivo growth conditions . Bacteria grown in diffusion chambers were recovered from the peritoneal cavities of rats, and their cell properties were compared with those of bacteria grown in broth cultures by various tests performed in vitro . The rate of peptidoglycan synthesis was measured as the incorporation of {14C}alanine into cell wall material in the presence of chloramphenicol . The total incorporation of {14C}alanine into peptidoglycan was markedly increased in cells grown in rats prior to the assay but was efficiently reduced by the beta-lactams . The extent of cross-linking was lower in the peptidoglycan of in vivo-grown bacteria, as estimated by sodium dodecyl sulfate- to trichloroacetic acid-insoluble radioactive cell wall material ratios . A whole-cell labeling assay with 125I-penicillin was used to characterize the penicillin-binding proteins (PBPs) . Four PBPs showed a striking reduction in the binding of the labeled penicillin in cells grown in rats . Such changes resembled the PBP alterations seen in beta-lactamase-negative clinical strains that were resistant to the beta-lactams . Although ampicillin and moxalactam showed delayed inhibitory activities in vitro for cells collected from rats, cells recovered from beta-lactam-treated rats showed evidence of antibiotic effectiveness (binding of the beta-lactams to PBPs in vivo and altered morphology), and the killing of cells exposed to antibiotics in broth or in peritoneal fluid was equally good . Finally, the frequencies of spontaneous resistance or tolerance to ampicillin or moxalactam were estimated, and there was no significant difference for in vitro- or in vivo-grown cells . These data demonstrated that the cultivation of H . influenzae in animals created changes in PBPs and the overall peptidoglycan metabolism . Such alterations did not impair the bactericidal activities of the beta-lactams, although they resulted in delayed bacterial inhibition, a phenomenon that may have important consequences in antibiotherapy. Eur J Pediatr, 1992 Oct, 151(10), 779 - 82 Cortical visual impairment following bacterial meningitis: magnetic resonance imaging and visual evoked potentials findings in two cases; Thun-Hohenstein L et al.; Cortical visual impairment (CVI) following bacterial meningitis is a very uncommon complication . Two children with CVI following bacterial meningitis are reported . Bacterial agents were Haemophilus influenzae type B in one and meningococci in the other child . Both children showed only insufficient recovery from CVI, mental retardation and residual neurological symptoms . Flash visual evoked potentials (VEP) showed preserved cortical response at onset of CVI . Re-evaluations several months later showed significantly reduced amplitudes, but normal latencies for P100 . Thus, flash VEP does not allow prediction of visual outcome . MRI results have not been reported before . MRI at onset of diagnosis showed occipital parenchymal irregularities with enlarged sulci and subarachnoid spaces . Follow up MRI 15 months after onset of CVI in one patient showed marked atrophy of the occipital cortex, hyperintensities of the cortical white matter and no visible optic radiation . The MRI findings indicate hypoxic-ischaemic lesions in the border zone between the distribution of the great cerebral arteries. Clin Infect Dis, 1992 Oct, 15(4), 720 - 5 A two-year prospective, nationwide study to determine the epidemiology and impact of invasive childhood Haemophilus influenzae type b infection in Israel . The Israeli Pediatric Bacteremia and Meningitis Group; Dagan R; Accurate data on invasive Haemophilus influenzae type b (Hib) disease from countries other than the United States and western Europe are limited, and none are available from the Middle East . We report the results of a nationwide prospective epidemiological study in Israel whose purpose was to provide a background for decisions regarding the need for Hib conjugate vaccinations . During the 2 study years, 344 patients less than 13 years of age with a positive blood or CSF culture for Hib were seen in 25 medical centers in which pediatric patients were hospitalized . The overall incidence of Hib disease was 34 per 100,000 persons less than 5 years old, an incidence in the range of those reported for western Europe . Twenty-two percent of patients were less than or equal to 6 months old, 69% were less than or equal to 12 months, 87% were less than or equal to 18 months, and 93% were less than or equal to 24 months . Thus, our findings represent a unique epidemiological pattern: the age distribution of our patients resembles that of immunologically compromised populations or of persons living in less-industrialized areas, but the incidence of disease is similar to that found in western Europe . In view of these data, the Israeli Ministry of Health decided to license conjugate vaccines for immunization of infants beginning at 2 months of age. Clin Infect Dis, 1992 Oct, 15(4), 716 - 9 Hepatobiliary infections caused by Haemophilus species; O'Bryan TA et al.; Haemophilus species are rarely associated with hepatobiliary infections . We report a case of hepatic abscess caused by Haemophilus paraphrophilus and review the English-language literature for reports of infections of the liver and biliary system caused by Haemophilus species . Most patients identified had predisposing conditions . The pathogenesis of hepatobiliary infections due to Haemophilus species may involve ascending spread from the gastrointestinal tract or hematogenous seeding following oropharyngeal colonization. Ann Thorac Surg, 1992 Oct, 54(4), 755 - 60 Surgical management of infective endocarditis in children; Citak M et al.; Infective endocarditis occurs infrequently in the general pediatric population, occurring mostly in patients with congenital heart disease . This study reviews our surgical experience with infective endocarditis based on a policy of aggressive intervention, conservative operative debridement, and creative reconstruction options using pericardium and prosthetic heart valves . From 1982 to 1989, 16 patients, 3 weeks to 16 years of age, underwent 19 intracardiac operations for infective endocarditis therapy at Kosair Children's Hospital . Eight (42%) were for resection of vegetations alone; an additional 11 operations (58%) involved more extensive debridements requiring either valve replacement or valvuloplasty using pericardium for exclusion of an abscess cavity, closure of a fistula, or for valve repair . Operative mortality was 25% (4 patients) and related to preoperative disease severity . There was one late death . Offending organisms included Staphylococcus species (31%), Haemophilus influenzae (13%), pneumococcus (5%), gram-negative organisms (13%), and Candida (13%); no organism grew on culture in 25% . We conclude that aggressive surgical exploration in patients with infective endocarditis is indicated and often requires resection of vegetations alone . More extensive procedures should preserve as much valvular tissue as possible . Pericardium is useful for reconstruction after debridement. Am J Dis Child, 1992 Oct, 146(10), 1160 - 5 Uses and technique of pediatric lumbar puncture; Ward E et al.; OBJECTIVES--To review diagnostic and therapeutic indications, contraindications, complications, and technique of pediatric lumbar puncture with emphasis on diagnosis of bacterial meningitis in bacteremia, cellulitis, and fever with seizures and to discuss cerebrospinal fluid findings in partially treated infection and traumatic blood-contaminated spinal tap . RESEARCH DESIGN--Literature review . CONCLUSIONS--We recommend lumbar puncture for children younger than 1 year with bacteremia, children with Haemophilus influenzae type B cellulitis, and children with fever and seizures not classified as simple . Pretreatment with antibiotics rarely changes cerebrospinal fluid characteristics such that a diagnosis of bacterial meningitis would be obscured . In a traumatic spinal tap, the equation to predict cerebrospinal fluid pleocytosis based on the peripheral blood cell count is invalid . When used together, cerebrospinal fluid glucose level, Gram's staining, and observed-to-expected ratio of white blood cells are highly reliable in diagnosing bacterial meningitis. South Med J, 1992 Oct, 85(10), 1015 - 6 Recurrent pneumococcal pneumonia in an HIV-positive patient with lymphoid interstitial pneumonitis; Harley W et al.; Lymphoid interstitial pneumonitis (LIP) is a rare complication of AIDS in adults . Patients with AIDS and LIP are at high risk for bacterial pneumonia caused by Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus . We have described an HIV-positive patient with LIP complicated by recurrent pneumonia due to Streptococcus pneumoniae; recurrence was apparently prevented by maintenance penicillin therapy. Pediatr Infect Dis J, 1992 Oct, 11(10), 855 - 9 IgG1, IgG2 and IgM responses to two Haemophilus influenzae type b conjugate vaccines in young infants; Ambrosino DM et al.; PRP-meningococcal outer membrane protein complex (PRP-OMPC) and oligosaccharide linked to variant diphtheria toxin (HbOC) Haemophilus influenzae type b (HIB) conjugate vaccines have both been licensed for United States infants at 2 months of age . Differences in serologic responses for these vaccines have been noted with PRP-OMPC producing an early response at 2 months of age and HbOC producing a higher response after a third dose at 6 months of age . To further characterize the nature of these distinct responses, we measured the IgG1, IgG2 and IgM anti-HIB concentrations by enzyme-linked immunosorbent assay after administration of both vaccines . PRP-OMPC produced an IgM and IgG1 anti-HIB response following the initial dose at 2 months of age . After two doses of HbOC an increase in IgG1 and IgM were noted and after a third dose at 6 months of age an IgG2 anti-HIB response occurred . In addition 33 study subjects were boosted with PRP-OMPC at age 18 months and compared with 34 subjects who received only a primary dose . The anti-HIB IgG1 and IgG2 concentrations following the booster dose were both significantly higher for the primed group (P = 0.0001 and P = 0.001, respectively) . Both HIB conjugate vaccines produce predominantly IgG1 anti-HIB antibody responses . The early response to PRP-OMPC vaccine at 2 months of age may result from adjuvant characteristics of the OMPC. J Med Microbiol, 1992 Oct, 37(4), 268 - 72 Association of Haemophilus ducreyi with cell-culture lines; Shah L et al.; The association of Haemophilus ducreyi with epithelial cell cultures was studied by light microscopy, electronmicroscopy and viable counts . Associated organisms were engulfed by epithelial cells and sequestered from the cell-surface environment . Large numbers of organisms within epithelial cells appeared to induce cell lysis and release of H . ducreyi . Such a mechanism occurring in vivo may assist H . ducreyi to evade the bactericidal action of polymorphonuclear leucocytes and may explain some of the tissue damage seen in genital ulcers caused by H . ducreyi. J Bacteriol, 1992 Oct, 174(20), 6455 - 9 Generation of lipooligosaccharide mutants of Haemophilus influenzae type b; McLaughlin R et al.; We previously reported the analysis of recombinant plasmids from Haemophilus influenzae type b (Hib) that lead to modifications of Escherichia coli lipopolysaccharide (LPS) (Y . Abu Kwaik, R . E . McLaughlin, M . A . Apicella, and S . M . Spinola, Mol . Microbiol . 5:2475-2480, 1991) . The modified LPS species are recognized by monoclonal antibodies (MAbs) 6E4 and 3F11 . MAb 6E4 binds to a stable 2-keto-3-deoxyoctulosonic acid epitope, while MAb 3F11 binds to a Gal beta 1-4GlcNac epitope that phase varies in Hib at a frequency of 2 to 5% . The internal EcoRI fragment containing most of the DNA required for LPS modification in E . coli was used as the target for transposon mutagenesis . Plasmids containing minitransposon m-Tn3(Cm) randomly inserted into the target fragment were transformed into the isogenic Hib strain, and transposon integration into the Hib chromosome was verified by colony hybridization . The lipooligosaccharides of 36 transformants were phenotypically and antigenically characterized by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and reactivity with a variety of MAbs that recognize both stable and phase-varying lipooligosaccharide epitopes . The majority of the mutants had altered reactivity with MAb 6E4 . With one exception, these mutants retained the ability to express phase-varying epitopes . Analysis of the transformants suggested that the 6E4 epitope was contained on an oligosaccharide chain separate from that of phase-varying epitopes and appeared to be assembled in at least three separate steps. J Bacteriol, 1992 Oct, 174(20), 6674 - 7 Site-specific integration of the Haemophilus influenzae bacteriophage HP1: location of the boundaries of the phage attachment site; Hauser MA et al.; Plasmids containing DNA segments from the attachment region of phage HP1 were constructed and tested for the ability to replace the phage attachment site substrate in site-specific recombination reactions . The distance separating the boundaries of the functional site was 418 bp . Replacements within the 11-residue segment 5'-GGCGGTTATCG at the left boundary or within the 12-residue segment 5'-GGATTTTTTGAA at the right boundary abolished substrate activity . A segment of the 418-residue sequence preserves the integrity of an operon of three Haemophilus influenzae tRNA genes after HP1 insertion within the coding sequence. Infect Immun, 1992 Oct, 60(10), 4111 - 8 Molecular analysis of the Haemophilus ducreyi groE heat shock operon; Parsons LM et al.; Chancroid is a sexually transmitted genital ulcer disease caused by Haemophilus ducreyi . Previously, we developed diagnostic DNA probes for H . ducreyi (L . M . Parsons, M . Shayegani, A . L . Waring, and L . H . Bopp, J . Clin . Microbiol . 27:1441-1445, 1989) . In the present study, DNA sequencing of one of the diagnostic probes revealed two adjacent open reading frames (ORFs) . These H . ducreyi ORFs and the encoded proteins show significant homology with the groE genes and GroES and GroEL heat shock proteins from several bacterial pathogens and with conserved eukaryotic 60-kDa heat shock proteins . The first H . ducreyi ORF (groES) is preceded by sequences similar to those of the Escherichia coli consensus heat shock promoters and is 288 nucleotides long and is capable of encoding a protein of 10.3 kDa . The second ORF (groEL) is 1,641 nucleotides long and is capable of encoding a protein of 57.8 kDa . Northern (RNA blot) analysis demonstrated the presence of a high level of groE mRNA in exponential-phase H . ducreyi grown in hemin broth at the organism's optimal growth temperature (33 degrees C), with increased levels seen following heat shock . Heat shock also increased the thermostability of the organisms, since stressed cells were more resistant to the lethal effects of rapid chilling . Electrophoretic analysis and immunoblots demonstrated that the predominant protein produced by exponential-phase H . ducreyi was a heat-inducible, immunoreactive protein of approximately 60 kDa (GroEL) . Also, H . ducreyi groE mRNA and GroEL were expressed and inducible by heat in E . coli . This is the first report describing the cloning, sequencing, and expression of H . ducreyi protein-encoding genes. Antimicrob Agents Chemother, 1992 Oct, 36(10), 2185 - 91 Comparative in vitro activities of a new quinolone, OPC-17116, possessing potent activity against gram-positive bacteria; Wakebe H et al.; The in vitro antibacterial activity of OPC-17116, a new fluoroquinolone, against a wide variety of clinical isolates was evaluated and compared with those of ciprofloxacin, ofloxacin, and norfloxacin . OPC-17116 showed potent broad-spectrum activity against gram-positive and -negative bacteria . The activity of this compound against gram-positive bacteria was higher than those of other quinolones, and its activity against gram-negative and anaerobic bacteria was roughly comparable to those of other quinolones . OPC-17116 had potent activity against important pathogens of respiratory tract infections such as Staphylococcus aureus, Streptococcus pneumoniae, Klebsiella pneumoniae, Pseudomonas aeruginosa, Haemophilus influenzae, and Branhamella catarrhalis . The MICs of this compound against 90% of these organisms, except for methicillin-resistant S . aureus, ranged from less than or equal to 0.006 to 3.13 micrograms/ml . OPC-17116 at more than one-half the MICs was bactericidal against clinical isolates of S . aureus, Escherichia coli, K . pneumoniae, and P . aeruginosa . The activity of OPC-17116 was decreased by several culture conditions such as acidic pH, high concentration of Mg2+ ions, and inoculum size of 10(7) CFU/ml . OPC-17116 inhibited the supercoiling activity of DNA gyrases from E . coli KL-16 and S . aureus SA113 (50% inhibitory concentrations, 0.19 and 23.0 micrograms/ml, respectively) . The amount of OPC-17116 accumulation was higher than that of other quinolones in S . aureus. Infect Immun, 1992 Oct, 60(10), 4024 - 31 Modification in penicillin-binding proteins during in vivo development of genetic competence of Haemophilus influenzae is associated with a rapid change in the physiological state of cells; Dargis M et al.; By using whole-cell labeling assay with 125I-penicillin V, we observed a reduction in the binding of the radiolabeled beta-lactam to four or five penicillin-binding proteins (PBPs) in Haemophilus influenzae cells cultivated under specific conditions . PBPs 3A, 3B, 4, and 6 were altered after the growth of bacteria in diffusion chambers implanted in the peritoneal cavity of rats . PBP 2 was also modified when cells were cultivated in human cerebrospinal fluids . Because this observation may have important consequences on the efficacy of beta-lactams during antibiotic therapy, we characterized the physiological state of bacteria cultivated in animals in the hope of explaining how such important changes in cell properties develop in vivo . Since the development of natural genetic competence occurs at the stationary phase of growth in H . influenzae, we used a DNA transformation assay to evaluate the physiological state of bacteria grown in diffusion chambers implanted in rats . Chromosomal DNA isolated from an antibiotic-resistant donor strain was mixed with bacteria in diffusion chambers . At different times during a 5-h incubation period, recipient bacteria were collected from the chambers, CFU were determined by plate counting, and antibiotic-resistant transformants were isolated on selective plates . Genetic competence rapidly developed in cells grown in rats, and the frequency of transformation by test DNA was elevated . Electron microscopy revealed an irregular cell shape and blebs at the surface of bacteria cultivated in animals and in cerebrospinal fluids . In an attempt to induce a similar physiological state in vitro, we supplemented broth cultures with cyclic AMP or synchronized cultures by a nutritional upshift . No changes in PBPs were observed with supplemental cyclic AMP or during a single cell cycle . Finally, a reduction in the affinity of PBPs for 125I-penicillin V identical to that observed in bacteria grown in rats was observed in cells isolated from the stationary phase of growth in vitro . These results clearly indicate that H . influenzae cells grown in animals undergo a rapid change to a physiological state similar to that found in late-stationary-phase cultures in vitro . This observation indicates that the rational design of future and improved antibiotic therapy of H . influenzae infections should consider cell properties of slow-growing or latent bacteria. Mol Microbiol, 1992 Oct, 6(20), 3051 - 63 The gal locus from Haemophilus influenzae: cloning, sequencing and the use of gal mutants to study lipopolysaccharide; Maskell DJ et al.; The gal locus from Haemophilus influenzae was cloned and sequenced . Four genes were identified by amino acid homology: galT, galK, galM and galR . The coding direction of galT, galK and galM is divergent from that of galR . There are non-coding intergenic regions between galR and galT, galT nd galK, and galK and galM . Deletion-insertion mutations constructed in galK and galE, which is in lic3, were moved into the H . influenzae chromosome generating each of the single mutants as well as the double gal mutant . Even when grown on complex media, the double mutant failed to react with an anti-lipopolysaccharide monoclonal antibody known to react with a digalactoside epitope . Both the galE single and the galE galK double mutants were serum-sensitive and relatively avirulent in infant rats, indicating a critical role for galactose metabolism, and providing evidence to support a central role for lipopolysaccharide, in H . influenzae virulence. Br Med Bull, 1992 Oct, 48(4), 912 - 30 Microbiology of lung infection in cystic fibrosis; Govan JR et al.; Bronchopulmonary infection in cystic fibrosis (CF) patients is associated with chronic progressive lung disease and episodes of acute exacerbation . Infection is predominantly caused by bacteria, although infections with viruses, mycoplasma and fungi may play undervalued roles . Bacteria commonly isolated from CF sputum include Staphylococcus aureus, Haemophilus influenzae and Pseudomonas aeruginosa . Colonisation of the airways by mucoid, alginate-producing variants of P . aeruginosa is recognised as a major cause of pulmonary deterioration . In addition, there is now considerable concern relating to the clinical consequences of colonisation and cross-infection with P . cepacia . This review discusses the microbiology of CF focussing on the pathogenesis and epidemiology of P . aeruginosa and P . cepacia. Med Clin (Barc), 1992 Sep 26, 99(9), 324 - 6 {Haemophilus influenzae pulmonary infection in patients infected with the human immunodeficiency virus}; Tudela P et al.; BACKGROUND: Haemophilus influenzae has frequently been identified as the etiologic agent in pneumonias of patients with the human immunodeficiency virus (HIV) infection . The experience of the authors is reviewed and the significance of isolating this microorganism in respiratory samples commented upon . METHODS: The clinical, radiological and microbiological data of patients with HIV infection in whom H . influenzae was identified in blood, lung tissue, or samples of the lower respiratory tract obtained by fibrobronchoscopy were retrospectively evaluated . RESULTS: Twenty cases were diagnosed with 75% presenting bilateral lung infiltration . In 70% the isolation sample was that of bronchoalveolar lavage . In 40% of the total another microorganism was identified in coinfection with H . influenzae, of which Mycobacterium tuberculosis was the most frequent . Thirty-five percent of the cases presented antecedents of one or several previous pulmonary infections . H . influenzae infection was not observed with either concomitant or previous infections in 20% of the patients . CONCLUSIONS: A high frequency of pneumonias by Haemophilus influenzae with bilateral radiologic presentation have been found . H . influenzae is frequently demonstrated as in coinfection with other agents . The role that this microorganism has in pulmonary infection of patients with HIV infection is not clearly defined. Rev Prat, 1992 Sep 15, 42(14), 1797 - 803 {Infectious risk in day-nursery children}; Collet JP et al.; High proximity in daycare centers is a well established risk factor for upper respiratory tract infections as well as Haemophilus influenza meningitis . Many studies have also reported the development of gastroenteritis as well as hepatitis A outbreaks in daycare centers; however, because of lack of controls, these studies do not provide enough information about the excess of risk attributable to daycare attendance . Main risk factors such as age, or seasons, are still very important in daycare centers and studies have also shown that a protection occurs rapidly after the beginning of attendance, may be in relation to the stimulation of the non-specific immunity . All these results do not provide enough data to implement a rational intervention project . More studies have to be carried out to assess the long term consequences (at school age for instance) of these infections . In order to make a rational decision regarding daycare attendance, it is important to have a global assessment of all the effects related to attendance (which are numerous and sometimes opposite); studies focusing on a single aspect of daycare attendance, or on its short term effect, may result in partial and misleading conclusions. J Allergy Clin Immunol, 1992 Sep, 90(3 Pt 2), 457 - 61; discussion 462 The microbial etiology and antimicrobial therapy of adults with acute community-acquired sinusitis: a fifteen-year experience at the University of Virginia and review of other selected studies; Gwaltney JM Jr et al.; Pretreatment sinus puncture was performed on 339 patients with acute community-acquired sinusitis (ACAS) between 1975 and 1990 . Bacterial species recovered in titers of greater than or equal to 10(4) colony-forming units per milliliter (CFU/ml) from 383 sinus aspirates included Streptococcus pneumoniae, 92 (41%); Haemophilus influenzae, 79 (35%); anaerobes, 17 (7%); streptococcal species, 16 (7%); Moraxella catarrhalis, 8 (4%); Staphylococcus aureus, 7 (33%); and other, 8 (4%) . Viruses (rhinovirus, parainfluenza virus, and influenza virus) and fungi (Aspergillus, zygomycoses, Phaeohyphomycis, Pseudallescheria, and Hyalohyphomycis) have also been reported to cause ACAS . Posttreatment sinus puncture was performed on 220 of the 339 patients in six studies to evaluate efficacy of selected antimicrobial agents in producing bacteriologic cure . Ampicillin, 500 mg four times daily; amoxicillin, 500 mg three times daily; trimethoprim-sulfamethoxazole, twice a day; cefaclor, 500 mg four times daily; bacampicillin, 800 mg twice a day; cyclacillin, 500 mg three times a day; cefuroxime axetil, 250 mg twice daily; amoxicillin-clavulanate, 500/125 three times daily; and loracarbef 400 mg twice daily, given in 10-day courses, produced bacteriologic cure in more than 90% of patients . Early studies were done before beta-lactamase-producing strains of H . influenzae were a frequent cause of ACAS in Charlottesville . Management of therapeutic failures is a difficult problem for which diagnostic and therapeutic sinus puncture and lavage, prolonged antimicrobial therapy, steroid therapy, and evaluation of allergy, immunodeficiency, and surgically correctable lesions of the osteomeatal complex are recommended. Mol Microbiol, 1992 Sep, 6(18), 2583 - 8 Construction of chimaeric genes for mapping a surface-exposed epitope on the pilus of non-typable Haemophilus influenzae strain M37; Palmer KL et al.; A murine monoclonal antibody (mAb), designated 3H12, reacts with a surface-exposed conformational epitope on the pilus of non-typable Haemophilus influenzae strain M37 . This antibody does not recognize the related pilus from H . influenzae type b, strain MinnA . Although mAb 3H12 does not recognize strain M37 pilin on Western blots, mAb 3H12 recognizes the recombinant M37 pilin protein expressed by Escherichia coli . In order to map the epitope recognized by mAb 3H12, we constructed a series of chimaeric genes . The chimaeric genes were expressed in E . coli and the chimaeric proteins characterized with respect to their reactivity with mAb 3H12 . Residues between 37 and 100 of the M37 pilin protein are essential for the expression of the mAb 3H12 epitope . Residues in the carboxyl half of the M37 protein enhance the reactivity of mAb 3H12 when expressed in the presence of residues 37-100 . Construction of chimaeric genes may provide a general methodology for mapping of conformational epitopes expressed by one of a related pair of proteins. Tidsskr Nor Laegeforen, 1992 Sep 10, 112(21), 2747 - 50 {Bacte