Pediatr Infect Dis J, 1991 Oct, 10(10), 764 - 71 The clinical and immunologic response of Chilean infants to Haemophilus influenzae type b polysaccharide-tetanus protein conjugate vaccine coadministered in the same syringe with diphtheria-tetanus toxoids-pertussis vaccine at two, four and six months of age; Ferreccio C et al.; The safety and immunogenicity of a vaccine against Haemophilus influenzae type b consisting of purified polyribosylribitolphosphate conjugated to tetanus toxoid (PRP-T) was evaluated in 278 Chilean infants who were randomly assigned to one of three treatment groups: Group A, PRP-T mixed with diphtheria-tetanus toxoids-pertussis (DTP) vaccine in a single syringe and given as a single inoculation in one arm and placebo in the other arm; Group B, PRP-T given in one arm and DTP in the other arm; Group C, DTP given in one arm and placebo in the other . Infants were immunized at 2, 4 and 6 months of age and examined daily for 4 days after each immunization; serum PRP antibodies were measured at baseline and 2 months after each dose . The only adverse systemic reaction attributable to PRP-T beyond that caused by DTP alone was a 7 to 20% increase in febrile responses in the first 24 hours after the first and second doses of vaccine; the fevers were largely low grade and not accompanied by increased irritability, diminished activity or loss of appetite, compared with the group who received DTP without PRP-T . After the first dose 72% of infants who received PRP-T combined with DTP and 67% who received it in a separate arm attained antibody concentrations greater than or equal to 0.15 micrograms/ml . After two doses of PRP-T, 93 and 95%, respectively, had concentrations greater than or equal to 0.15 microgram/ml and after three doses 100% of infants who received PRP-T had such titers.(ABSTRACT TRUNCATED AT 250 WORDS) Pediatr Infect Dis J, 1991 Oct, 10(10), 758 - 63 Safety and immunogenicity of Haemophilus type b-tetanus protein conjugate vaccine, mixed in the same syringe with diphtheria-tetanus-pertussis vaccine in young infants; Watemberg N et al.; As new vaccines are developed there is increasing interest in reducing the number of injections given to children by combining vaccines in one syringe . We studied the safety and immunogenicity of Haemophilus influenzae type b-tetanus protein conjugate vaccine (PRP-T) administered at ages 2, 4 and 6 months mixed in the same syringe with DTP vaccine and its effects on the seroresponse to DTP vaccine . A group of 112 healthy 2-month-old infants received DTP-PRP-T or DTP-placebo mixed immediately before immunization in the same syringe . The addition of PRP-T to DTP did not increase the rate of local or systemic reactions . After the first, second and third dose, the PRP-T recipients showed a geometric anti-PRP antibody mean of 0.13, 2.31 and 6.40 micrograms/ml vs . 0.07, 0.05 and 0.05 micrograms/ml among the DTP-placebo recipients, respectively . Of the PRP-T recipients, 94 and 98% attained antibody concentration of greater than or equal to 0.15 micrograms/ml protein after the second and third dose, respectively, and 65 and 94% attained a concentration of greater than or equal to 1.0 micrograms/ml after the second and third dose, respectively . At the age of 1 year 94 and 52% of the DTP-PRP-T recipients vs . 12% and 0% of the placebo recipients still maintained titers of greater than or equal to 0.15 and greater than or equal to 1.0 micrograms/ml, respectively . The administration of DTP in the same syringe with PRP-T did not affect significantly the antibody response to diphtheria and tetanus toxoid and to pertussis agglutinins . It is concluded that PRP-T vaccine could be administered in the same syringe as DTP. J Trop Med Hyg, 1991 Oct, 94(5), 295 - 303 A five-year prospective study of septicaemia in hospitalized children in Hong Kong; Cheng AF et al.; In a 5-year prospective study in a Hong Kong teaching hospital there were 344 clinically significant episodes of paediatric septicaemia . Many of the microbiological and clinical features were similar to those reported in Japanese and Western studies but there were some important differences . Half of the episodes (or 70% if neonatal infections are excluded) were community-acquired . The commonest organisms found were Salmonella spp (15% of all and 27% of community-acquired infections); this was related to the high local incidence of salmonellosis and typhoid fever . Salmonella typhi, which was responsible for one-third of the salmonella septicaemias, was usually seen in school-age children, while non-typhoid salmonellae were common in infants . Methicillin-resistant Staphylococcus aureus, which are now endemic in Hong Kong hospitals, was a common cause of hospital-acquired septicaemia . Pneumococcal septicaemia accounted for 22% of episodes in infants and pre-school children, but Haemophilus influenzae was uncommon (2% of all episodes) and there was no case of meningococcal septicaemia . The rarity of invasive infection with H . influenzae and Neisseria meningitidis in Hong Kong children is unexplained. J Clin Microbiol, 1991 Oct, 29(10), 2333 - 4 Novel plasmid combinations in Haemophilus ducreyi isolates from Thailand; Sarafian SK et al.; Thirty isolates of Haemophilus ducreyi collected in Thailand in 1984 were characterized by plasmid content . Three novel plasmids with estimated molecular masses of 1.8, 2.6, and 2.8 MDa were observed in 29 isolates, in addition to the 3.2-, 5.7-, and 7.0-MDa beta-lactamase and 4.4-MDa sulfonamide resistance plasmids . At least three of the seven plasmids were observed in each of the 29 isolates . The number and diversity of plasmids observed in these isolates of H . ducreyi distinguish them from strains previously described. J Clin Microbiol, 1991 Oct, 29(10), 2193 - 6 Direct identification of bacterial isolates in blood cultures by using a DNA probe; Davis TE et al.; This study involved the rapid, direct identification of Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Haemophilus influenzae, Enterococcus sp., and Streptococcus agalactiae from positive blood culture bottles (BACTEC, Johnston Laboratories, Inc.) by using the AccuProbe (Gen-Probe, San Diego, Calif.) culture confirmation test . This method uses a chemiluminescent DNA probe that detects the rRNA of the target organisms . The manufacturer's instructions were modified to use a pellet of bacteria made directly from positive blood culture broth rather than a colony from an agar plate . Two separate procedures of selective centrifugation were employed in order to obtain the pellet . The first utilized a routine clinical centrifuge and a large volume of broth (10 to 12 ml) from the blood culture bottle . The second method used a microcentrifuge and less volume (1 to 1.5 ml) . A total of 196 clinical specimens taken directly from positive blood culture broths were correctly identified by AccuProbe from pellets made by using the clinical centrifuge technique, while 166 clinical specimens used as negative controls failed to show hybridization . The microcentrifuge technique for obtaining pellets was performed on 105 patient specimens, and all were correctly identified . When combined with the microcentrifuge technique for pellet preparation, the AccuProbe test has several advantages: (i) direct identification of bacteria from blood culture broths, (ii) rapid turn-around time (30 min), (iii) simplicity of the procedure, and (iv) relative low cost. Mayo Clin Proc, 1991 Oct, 66(10), 1074 - 81 Imipenem; Hellinger WC et al.; Imipenem is the first of a new class of beta-lactam antibiotics, the carbapenems, to be released for clinical use . It has the broadest antibacterial activity of all antibiotics available for systemic use in humans . It is active against streptococci, methicillin-sensitive staphylococci, Neisseria, Haemophilus, anaerobes, and the common aerobic gram-negative nosocomial pathogens including Pseudomonas . Resistance to imipenem may emerge during treatment of P . aeruginosa infections, as has occurred with other beta-lactam agents; P . maltophilia and P . cepacia are typically resistant to it . Like the penicillins, imipenem has inhibitory activity against enterococci . Daily doses may range from 500 mg to 1 g, every 6 to 8 hours, in patients with normal renal function . The principal toxic effects have been nausea and vomiting, which occur during intravenous infusion, and seizures, which develop in 1 to 3% of treated patients and are likely to occur in the setting of renal insufficiency and underlying disease of the central nervous system . Imipenem should be considered for treatment of mixed bacterial infections and treatment of resistant aerobic gram-negative bacteria that are not susceptible to other beta-lactam agents . In addition to provoking unnecessary toxicity, indiscriminate use of this agent will promote dissemination of resistance against it. J Bacteriol, 1991 Oct, 173(20), 6632 - 4 Lethal and mutagenic action of hydrogen peroxide on Haemophilus influenzae; Sanchez-Rincon DA et al.; The lethal and mutagenic effects of H2O2 on wild-type Haemophilus influenzae Rd and on uvr1, uvr2, rec1, and rec2 mutant strains were studied . The first two mutants are sensitive to UV, and the second two are defective in recombination . Rd, urv1, and rec1 strains were more sensitive to the killing effect of H2O2 treatment than were uvr2 and rec2 strains . There were peaks of mutagenesis at two H2O2 concentrations over a range of 30 to 275 mM . Our results suggest a specific repair of H2O2 damage that is independent of the Uvr2 and Rec2 gene products . Sensitivity to the killing effect of H2O2 and to the lethal action of near-UV light were similar for Rd and uvr1 strains . This finding suggests that the mechanisms of killing by and repair of H2O2 damage may have some overlap with those of near-UV radiation. Avian Dis, 1991 Oct-Dec, 35(4), 965 - 8 Immunogenicity of Haemophilus paragallinarum serovar B strains; Yamaguchi T et al.; Immunogenicity of three Haemophilus paragallinarum serovar B strains was investigated in cross-protection tests using monovalent vaccines prepared from the B strains, as well as one strain each of serovars A and C . A bivalent vaccine composed of the serovar A and C strains also was used . In the studies with the monovalent vaccines, the immunogenicity of serovar B strains was different from that of serovar A and C strains, although only partial serovar B-specific protection with the three strains was observed . Chickens vaccinated with the bivalent vaccine protected against challenge with one serovar B strain, as well as serovar A and C strains, but not against the other two serovar B strains. J Vet Med Sci, 1991 Oct, 53(5), 917 - 20 Expression of hemagglutinin of Haemophilus paragallinarum serotype A in Escherichia coli; Takagi M et al.; The genomic DNA of Haemophilus paragallinarum (Hpg) serotype A strain 221 was cloned into vector plasmid pBR322 . The recombinant plasmids were introduced into Escherichia coli (E . coli) strain C600 . Subsequently, a total of 277 transformants were obtained . One, designated strain no . 6, expressed hemagglutination activity against chicken erythrocytes . Strain no . 6 contained the recombinant plasmid pNV102, and DNA of about 2.57 kb was inserted into pNV102 . When strain no . 6 was cured of pNV102, the strain lost hemagglutination activity . When the cured strain was retransformed with pNV102, hemagglutination activity was restored . E . coli strain no . 6 reacted with monoclonal antibody specific to the hemagglutinin of Hpg serotype A in a dot-blotting analysis . Chickens immunized with the inactivated strain no . 6 produced the hemagglutination inhibition (HI) antibody, and chickens possessing the HI antibody showed protection against challenge exposure by Hpg strain 221. Postgrad Med, 1991 Oct, 90(5), 135 - 6, 139-40 Current status of pediatric vaccines; Feldman WE; Pediatric immunization schedules have become more complex, especially with the approval of two new vaccines for Haemophilus influenzae type b and changes in recommendations for measles vaccine . In addition, vaccines for other infections (eg, rotavirus, varicella, and respiratory syncytial virus) are in development and likely will become available in the future . These recent advances raise hope that the list of diseases eradicated through vaccination will be expanded. Rev Saude Publica, 1991 Oct, 25(5), 375 - 80 {Epidemiological study of Brazilian purpuric fever . Epidemic in a locality of São Paulo state (Brazil), 1986}; Kerr-Pontes LR et al.; A case control model was used in the study of an outbreak of Brazilian purpuric fever BPF which occurred in Serrana, S . Paulo State, Brazil, in 1986 . Three hypotheses were raised: 1--purulent conjunctivitis is associated with BPF; 2--a cluster effect occurs in BPF; 3--respiratory symptoms may be a variation of the clinical picture of the disease . Numerical values were attributed to different findings, as follows: fever = 5; diarrhea and/or vomiting = 1; haemorrhagic findings = 3; thrombocytopenia and/or leukopenia = 3; Haemophilus aegyptius positive hemoculture and/or Haemophilus aegyptius positive cerebrospinal fluid culture and/or H . a . oropharynx culture = 7; Waterhouse Friedrichsen syndrome = 7 . Those cases for which the sum total of points reached or exceeded 13 were considered as confirmed and those obtaining between 8 and 12 were considered as suspect . Children with a score below 5 were taken as control cases . Cases and controls were matched according to sex, age and socioeconomic level . The total groups studied included 14 confirmed cases, 38 suspect cases and 78 controls . It was concluded that purpuric fever is strongly associated with previous and/or present purulent conjunctivities; a cluster effect seems to occur; respiratory symptoms such as coughing and/or coryza were not associated with BPF. Dan Med Bull, 1991 Oct, 38(5), 407 - 10 Intracranial abscesses in Odense Hospital . Survey of bacteriology, epidemiology, and treatment with antibiotics, 1963-1989; Duel P et al.; Fifty-nine patients were operated or punctured in 60 incidents of brain abscess from 1963-1989, twice as many in men as in women . The number of cases tripled in 1980 to an incidence of 3.6 per million inhabitants per year, supposedly due to the advent of computerized tomography . Simultaneously, the aetiology changed from staphylococci and Gram negative rods to dominance of streptococci and Haemophilus aphrophilus . Apart from temporal abscesses, there was no correlation between localisation in the brain and the bacterial species isolated . Ninety-five per cent of the specimens from untreated patients gave growth, but so did specimens from six of 18 patients treated with relevant antibiotics up to 11 days before puncture . Therefore, we recommend removal of pus by excision or puncture. Mikrobiyol Bul, 1991 Oct, 25(4), 305 - 12 {Haemophilus influenzae strains isolated from various clinical specimens and their antibiotic susceptibilities}; Durmaz G et al.; In this study, a bacteriological examination was performed in the specimens of nose, ear and conjunctiva taken from 135 patients aged between 0-6 years old and 335 patients aged more than six years old for the isolation of H . influenzae . Ten H . influenzae strains were isolated, six of them were type b . Seven isolates were from 0-6 years old group (5.2%) . All strains were susceptible to chloramphenicol, three strains were resistant to ampicillin with Kirby-Bauer disc diffusion method. Mol Cell Probes, 1991 Oct, 5(5), 375 - 9 Capsular typing of Haemophilus influenzae with a DNA probe; Kroll JS et al.; We describe the use of a DNA probe for genotyping clinical isolates of Haemophilus influenzae . The probe, containing capsulation genes, differentiates between the six Haemophilus serotypes in a Southern blotting procedure . It also hybridizes with a distinctive pattern to DNA from capsule-deficient mutants of serotype b strains, while failing to hybridize to DNA from typical clinical isolates of non-serotypable H . influenzae . The probe can thus resolve issues of serotyping uncertainty such as arise, for example, when capsulate strains are found to have lost reactivity with serotyping reagents after storage or transmission from one laboratory to another . The probe has proved useful in the evaluation of Haemophilus infections in infants following administration of H . influenzae type b vaccine . In an illustrative example, the probe was used to resolve serotyping ambiguity in a case of Haemophilus bacteraemia in a vaccine recipient, providing compelling evidence that the organism responsible was neither type b nor derived from a type b strain . The widespread introduction of vaccines against H . influenzae type b disease will increase the importance of the precise identification of strains infecting immunized children . This need can only be met by the development of 'gold standards' such as capsulation gene probes. Avian Dis, 1991 Oct-Dec, 35(4), 955 - 9 Evaluation of a panel of monoclonal antibodies in the subtyping of Haemophilus paragallinarum; Blackall PJ et al.; A panel of four monoclonal antibodies (MAbs) was evaluated, using a hemagglutination-inhibition test, for its ability to subtype 76 isolates of Haemophilus paragallinarum . The results of the MAb reactions were compared with the results of both the Page and Kume serotyping schemes (the serovars of the Page scheme correspond to the serogroups of the Kume scheme) . One MAb (E5C12D10) was raised against a Page serovar A strain and the remaining MAbs (F2E6, D6D8D5, and B3E6F9) against a Page serovar C strain . Six different reaction patterns were found among the 76 isolates of H . paragallinarum . There was total correlation between the MAb reaction pattern and the Page scheme, and thus the Kume scheme, to the serogroup level . All 19 Page serovar A (= Kume serogroup A) strains reacted only with MAb E5C12D10, whereas all five Page serovar B (= Kume serogroup B) strains failed to react with any of the MAbs . All 52 remaining strains were Page serovar C (= Kume serogroup C), and all failed to react with MAb E5C12D10 but showed varying reaction patterns with the three other MAbs . Although the MAbs recognized four subdivisions within Kume serogroup C, these subdivisions differed from the four Kume C serovars . This panel of MAbs can be used to assign isolates of H . paragallinarum to either Page serovars or Kume serogroups . Although the subdivisions recognized by the MAbs within the Page serovar C strains do not correspond to the Kume serovars, they may be useful in epidemiological applications. J Trop Pediatr, 1991 Oct, 37(5), 232 - 4 Acute purulent pericarditis in Omani children; Ballal N et al.; A total of eight children admitted to the Royal Hospital, Muscat with purulent pericardial effusions were analysed . Six of the cases were in children less than 2 years of age . Five of the eight children had positive blood cultures: Haemophilus influenzae was cultured from two patients, Streptococcus pneumoniae from one patient, E . coli from one patient and Streptococcus viridans from the remaining child . In three children both blood and pericardial cultures were sterile; two of these children had received prior antibiotics . In our experience early diagnosis by cross-sectional echocardiography followed by adequate surgical drainage and parenteral administration of broad spectrum antibiotics helped prevent the high morbidity and mortality usually reported in this condition in developing countries. J Gen Microbiol, 1991 Oct, 137 ( Pt 10), 2415 - 21 Plasmid-mediated NAD independence in Haemophilus parainfluenzae; Windsor HM et al.; The location of the genes coding for NAD independence in four unusual clinical isolates of Haemophilus parainfluenzae was determined by transferring these genes to plasmid-free Haemophilus influenzae Rd by transformation and analysing transformants for the presence of plasmids by agarose gel electrophoresis . All NAD-independent transformants were found to carry a single plasmid species . The plasmids, originally harboured by the four H . parainfluenzae isolates recovered from unrelated sources, were of the same size (5.25 kb) . Spontaneous reversion to NAD dependence occurred with a low frequency (0.1 to 0.2% of the progeny of a single clone) in both H . parainfluenzae and H . influenzae Rd . The revertants had lost this small plasmid . Mitomycin C exhibited a plasmid 'curing' effect with a frequency of 'curing' of between 1 and 6% of the surviving clones . It was concluded that the genes conferring NAD independence were located on the small 5.25 kb plasmid. Jpn J Antibiot, 1991 Oct, 44(10), 1158 - 67 {Pharmacokinetic, bacteriological and clinical studies on cefdinir fine granules in the field of pediatrics}; Haruta T et al.; The Pharmacokinetics and clinical effectiveness of cefdinir (CFDN, FK482) were examined in pediatric patients . The results are summarized as follows . 1 . Plasma concentrations and urinary excretions of CFDN after administration of 5% fine granules were investigated on 4 children at a dose level of 6 mg/kg . Average plasma concentrations peaked at 4 hours after administration at 0.99 micrograms/ml with a half-life of 2.12 hours . The first 24-hour urinary recovery rates of CFDN in 3 children averaged 22.0% . 2 . CFDN was given to 24 children (11 with pharyngitis, 3 with tonsillitis, 8 with scarlet fever, 1 with urinary tract infection and 1 with enteritis due to Salmonella); 15 were treated with 5% fine granules and 9 with 10% fine granules at daily doses of about 10 mg/kg in 2 to 3 divided portions . Clinical effects were excellent in 16, good in 7 and not evaluable in 1, with an overall efficacy rate of 100% . 3 . Identified causative organisms were 12 strains of Streptococcus pyogenes, 4 of Haemophilus influenzae, 5 of Haemophilus parainfluenzae, 1 of Escherichia coli, and 1 of Salmonella . Bacteriological effects were rated as "eradicated" for 19 strains, "unchanged" for 4 with an eradication rate of 82.6% . 4 . No side effects were observed . As for abnormal laboratory test results, a transient decrease of white blood cells was observed in 1 patient . 5 . The CFDN fine granule preparations were preferably accepted by the children . 6 . The fine granular preparations of CFDN, a new oral antibiotic, were useful for the treatment of bacterial infections in pediatrics. Jpn J Antibiot, 1991 Oct, 44(10), 1119 - 33 {Pharmacokinetic, bacteriological and clinical evaluations of cefdinir 10% fine granules in pediatrics}; Iwai N et al.; Pharmacokinetic, bacteriological, and clinical studies on cefdinir (CFDN, FK482) (10% fine granules), a new oral cephem, were performed in pediatrics . 1 . Bioequivalencies of plasma concentrations and urinary excretions of CFDN 5% and 10% fine granules were investigated on 3 pediatric patients with ages between 5 to 13 years administered with a drug in fasting state at a dose level of 3 mg/kg using a cross over method . Average plasma concentrations in a group of patients administered with 5% fine granules peaked at 3 hours after administration with a level of 1.05 +/- 0.29 micrograms/ml (mean +/- S.E.) and decreased to 0.12 +/- 0.05 micrograms/ml at 8 hours with a half-life of 1.48 +/- 0.09 hours . In the group administered with 10% fine granules, average plasma concentrations peaked at 2 hours after administration with a level of 1.32 +/- 0.12 micrograms/ml, and decreased to 0.20 +/- 0.11 microgram/ml at 8 hours with a half-life of 1.68 +/- 0.28 hours . The first 8-hour urinary recovery rates of CFDN in the 5% and 10% fine granules groups averaged 19.64 +/- 5.69% and 23.37 +/- 2.36%, respectively . Both average and individual plasma concentrations and urinary recovery rates in the patients of the 10% fine granules group were somewhat higher than those of the 5% fine granules group, but no significant differences were observed between the 2 groups including areas under concentrations . 2 . CFDN 10% fine granule preparation was administered to 33 pediatric patients with ages between 1 to 13 years with various infections, and its clinical effects, bacteriological effects and safety were assessed . In 31 of the 33 patients (2 patients were excluded since they were with non-bacterial infections) clinical effects were excellent in all of 9 patients with scarlet fever (3), acute pharyngitis (3) or impetigo (3), excellent in 12 and good in 3 of 15 patients with acute purulent tonsillitis, and excellent in 4 and good in 3 of 7 patients with acute pneumonia . The overall efficacy rate was 100% . Bacteriological effects against causative organisms were evaluated . All the identified Staphylococcus aureus (4 strains) and Streptococcus agalactiae (1) were eradicated . Of 10 strains of Streptococcus pyogenes, 9 strains were eradicated and the other one was reduced . Of 7 strains of Haemophilus influenzae 4 were eradicated, 1 persisted and the fate of the remaining 2 were unknown . The overall eradication rate was 90.0% . Microbial substitutions were observed in 5 patients . The new, replacing bacteria were all Haemophilus spp.(ABSTRACT TRUNCATED AT 400 WORDS) Jpn J Antibiot, 1991 Oct, 44(10), 1096 - 118 {Clinical evaluation of cefdinir 5% fine granules in pediatrics}; Iwai N et al.; Clinical evaluation in pediatrics on cefdinir (CFDN, FK482) (5% fine granules), a new oral cephem, was performed . 1 . CFDN was administered to 112 pediatric patients with ages between 1 month to 13 years with various infections . Dose levels used were 3.0-8.9 mg/kg (mean 5.1 mg/kg) t.i.d . for 3-14 days (mean 6.7 days) . The studied patients included 2 patients with scarlet fever, 6 with acute pharyngitis, 6 with acute rhinopharyngitis, 52 with acute purulent tonsillitis, 8 with acute bronchitis, 24 with acute pneumonia, 7 with acute urinary tract infections, 1 with acute vaginitis, and 6 with impetigo . Total doses ranged from 0.6 to 4.05 g . One hundred eleven of the 112 patients were evaluated for clinical efficacy and all the patients were evaluated for safety . 2 . Clinical effects were excellent in 51 cases, good in 57, and fair in 3 with an extremely high efficacy rate of 97.3% . Efficacy rates were 100% in scarlet fever, acute pharyngitis, acute purulent tonsillitis, acute bronchitis, acute vaginitis and impetigo, and 83.3%, 95.7%, 85.7% in acute rhinopharyngitis, acute pneumonia, and acute urinary tract infections, respectively . Good clinical effects were observed regardless of diseases . 3 . Causative organisms were identified in 79 cases, of which 71 were found to be monobacterial infections and 8 were found to be multi-bacterial infections . In mono-bacterial infections, clinical efficacies were 100% for those caused by Staphylococcus aureus/Streptococcus pyogenes/Streptococcus pneumoniae/beta-Streptococcus except those in A and B groups with an overall efficacy of 100% against Gram-positive cocci (GPC) and they were 89.5%, 100%, 100% for those caused by Haemophilus influenzae, Haemophilus parainfluenzae, and Escherichia coli, respectively, with an overall efficacy of 90.3% in Gram-negative rods (GNR) . In multi-bacterial infections also, a clinical efficacy of 100% was obtained . 4 . Bacteriological effects were studied for 89 strains in the 79 cases . The eradication rate for a few strains of S . pneumoniae was low, 25%, but it was 100% for S . aureus, with the same results for S . pyogenes, and beta-Streptococcus . The eradication rate on GPC was high 94.1% . Among GNR, 66.7% of E . coli, 50.0% of H . influenzae, and 71.4% of H . parainfluenzae was eradicated . The overall eradication rate for GNR was 55.3%, lower than that for GPC . Microbial substitutions were observed in 13 cases, with Haemophilus sp . replacing other bacteria . 5 . Diarrhea and soft stools were noted in 4 and 2 patients, respectively . The severity of these side effects, however, was slight and it was possible to continue the CFDN treatment.(ABSTRACT TRUNCATED AT 400 WORDS) J Antimicrob Chemother, 1991 Oct, 28(4), 569 - 75 A randomized trial of cefepime (BMY-28142) and ceftazidime for the treatment of pneumonia; Edelstein H et al.; Cefepime is a new cephalosporin with a broad antimicrobial spectrum that includes Staphylococcus aureus and Pseudomonas aeruginosa . To study the efficacy and safety of cefepime for treatment of pneumonia, 65 patients were randomized to therapy with either cefepime or ceftazidime at a two to one ratio . Of the 57 evaluable patients, 89% of the cefepime patients and 84% of the ceftazidime patients were cured clinically or improved . Haemophilus spp., Streptococcus pneumoniae, and Neisseria spp . were common pathogens . Bacteriological cure was achieved in 31 (91%) of cefepime patients and 17 (100%) ceftazidime patients . Adverse clinical and laboratory reactions possibly due to study drug occurred in 9 (21%) cefepime patients and in 1 (5%) ceftazidime patient . Most reactions were mild and resolved with discontinuation of study drug . In this study, cefepime appeared as effective as ceftazidime for the treatment of pneumonia. J Antimicrob Chemother, 1991 Oct, 28(4), 533 - 6 Killing kinetics of cefuroxime axetil against Haemophilus influenzae in an in-vitro model simulating serum concentration profiles after oral administration; Bingen E et al.; We have used a dynamic in-vitro model to determine the killing kinetics of two formulations of cefuroxime axetil against 18 clinical strains of Haemophilus influenzae . The concentration of cefuroxime axetil was adjusted dynamically to simulate the mean serum profile in healthy volunteers following the administration of a single 250 mg dose in oral suspension or tablet form . Bacterial numbers were reduced by 3 log10 cfu/mL during the eight-hour experimental period with both dosage form simulations . Our results suggest that cefuroxime axetil, 250 mg in oral suspension or tablet form, may protect against the dissemination of H . influenzae during episodes of bacteraemia. Antimicrob Agents Chemother, 1991 Oct, 35(10), 2042 - 5 Pharmacokinetics of cefuroxime axetil suspension in infants and children; Powell DA et al.; The pharmacokinetics of cefuroxime axetil suspension in 28 infants and children, ranging in age from 3 months to 12 years (mean, 23 months), were studied . Mean maximum serum cefuroxime concentrations of 3.3, 5.1, and 7.0 micrograms/ml were achieved 3.6, 2.7, and 3.1 h after the administration of doses of 10, 15, and 20 mg, respectively, of cefuroxime axetil suspension per kg of body weight together with milk or milk formula . These concentrations exceed the MICs for common respiratory tract pathogens, including beta-lactamase-producing strains of Haemophilus influenzae and Moraxella (Branhamella) catarrhalis . Following a 10- or 15-mg/kg dose, serum cefuroxime concentrations are similar to those achieved in adults following the administration of a 250-mg cefuroxime axetil tablet . There were linear relationships between dose and both maximum serum cefuroxime concentration and area under the serum drug concentration-verus-time curve . The mean half-life of cefuroxime in serum was independent of dose and ranged from 1.4 to 1.9 h . No cefuroxime axetil (intact ester) was detected in the blood . The intact ester in the urine of four children was measured; however, the amount recovered represented less than 0.1% of the administered dose. Antimicrob Agents Chemother, 1991 Oct, 35(10), 1960 - 4 In vitro activity of orally administered antimicrobial agents against Haemophilus influenzae recovered from children monitored longitudinally in a group day-care center; George MJ et al.; To determine whether the prevalence of resistance to commonly used oral antimicrobial agents varied over time, we compared the in vitro susceptibilities of 217 strains of Haemophilus influenzae recovered from nasopharyngeal secretions of children in a day-care center studied longitudinally between 1979 and 1987 . The overall rate of beta-lactamase production in these strains was 18%, with rates of 57% in type b isolates (n = 21) and 14% in non-type b isolates (n = 196) . The percentages of isolates for which MICs were less than or equal to 1.0 micrograms/ml for amoxicillin alone, amoxicillin in combination with clavulanic acid, and cefuroxime alone were 82, 92, and 93%, respectively . The percentage of strains for which cefaclor MICs were less than or equal to 1.0 micrograms/ml was only 0.5% . Isolates for which chloramphenicol MICs were greater than 2.0 micrograms/ml or for which trimethoprim-sulfamethoxazole MICs were greater than 0.5/9.5 micrograms/ml were uncommon: 1 and less than 1%, respectively . High concentrations of erythromycin alone and in combination with sulfisoxazole were required to inhibit the majority of test strains; there was no evidence of erythromycin-sulfisoxazole synergy . In vitro susceptibility to commonly used oral antimicrobial agents remained at a constant level when H . influenzae isolates collected from children in a day-care center during 1979 through 1983 were compared with strains collected during 1984 through 1987. J Laryngol Otol, 1991 Oct, 105(10), 858 - 9 Bilateral thoracic empyema complicating adult epiglottitis; Hussan WU et al.; Haemophilus influenzae is a common cause of epiglottitis and meningitis in children and exacerbation of chronic bronchitis in adults . However, the ability of this organism to cause serious infections in adults is less well recognized . We report a case of a 34-year-old previously healthy female who presented with epiglottitis and later developed bilateral empyema; both blood and pleural fluid grew Haemophilus influenzae. Ann Pediatr (Paris), 1991 Oct, 38(8), 549 - 55 {Antibiotic treatment of acute otitis media}; Baron S et al.; The strategy of antimicrobial therapy in acute otitis media rests on bacteriologic and pharmacokinetic data . Pneumococci and Haemophilus are still the two most prevalent pathogens in acute otitis media and raise problems regarding susceptibility: 25% of Haemophilus beta-strains produce beta-lactamases and 6 to 12% of pneumococci are intermediate or resistant to penicillin . Pharmacologic features required of antimicrobials used in acute otitis media include good penetration in the ear and sustained supra-MIC levels in middle ear fluid . Kinetics of drugs in the ear are still often incompletely understood . The last selection criterion is analysis of comparative trials . Available data do not point to superiority of any drug over the others . Amoxicillin should no longer be given as first-line therapy . Amoxicillin combined with clavulanic acid (Augmentin) is effective on the entire spectrum of causative organisms . Higher levels of amoxicillin may be needed (concomitant use of amoxicillin and (Augmentin) . First-generation cephalosporins are effective but may prove unsuccessful in patients with large inocula . Pediazole is clinically effective although penetration of erythromycin in the ear is delayed . The new oral third generation cephalosporins are effective in infections due to beta-lactamase-producing Haemophilus strains . A bacteriologic study should be performed routinely whenever otitis media occurs in an infant under three months of age. Ann Pediatr (Paris), 1991 Oct, 38(8), 531 - 6 {Treatment of bacterial meningitis in children}; Taillebois L et al.; The initial treatment of infantile and childhood bacterial meningitis is now well standardized, but three current aspects are discussed in this paper . Although classically, ampicillin can still be given as the initial treatment of bacterial meningitis in children, current epidemiologic data demonstrate the emergence of resistant strains of Haemophilus and Pneumococcus, and consequently use of a third-generation cephalosporin should be preferred . Concerning duration of treatment, 4 to 5 days seem adequate for meningococci and 7 days for Haemophilus influenzae and pneumococci . Lastly, the usefulness of adjunctive antiinflammatory treatment is considered . The purpose of this treatment is to lower the risk of cerebral complications and neurosensory impairment . Current data suggest that use of corticosteroids as early as possible may be helpful . Improved understanding of the pathophysiology of pediatric bacterial meningitis has led to other forms of treatment being proposed, but their value remains to be proven. Ann Pediatr (Paris), 1991 Oct, 38(8), 523 - 8 {Antibiotic treatment of cystic fibrosis}; de Montalembert M et al.; Lower respiratory tract superinfection is nearly constant in cystic fibrosis and has a significant impact on mortality . The three organisms which most often colonize the bronchial tree are Staphylococcus aureus, Haemophilus influenzae and Pseudomonas aeruginosa . The latter organism is found in 70% to 90% of older cystic fibrosis patients . P . aeruginosa infections are remarkably persistent and cause severe, extensive lung damage . Antimicrobial therapy is indicated in patients with clinical symptoms (fever, weight loss, changes in sputum and auscultation) and should be selected on the basis of cytobacteriologic studies of sputum . Oral antibiotics are usually successful in eradicating S . aureus and H . influenzae . Conversely, intravenous therapy is required in most cases of P . aeruginosa infection . Fifteen-day courses are given repeatedly, either on a routine basis every three months, or whenever new clinical symptoms develop . Antimicrobials usually fail to eradicate P . aeruginosa even when significant clinical improvement occurs . Two-drug therapy and judicious use of the various available anti-microbial agents should delay development of resistant strains, an event which is nearly inevitable as antimicrobial treatments are repeated. Vet Microbiol, 1991 Oct, 29(2), 159 - 72 Phenotypic variation in the outer membrane protein composition of Actinobacillus (Haemophilus) pleuropneumoniae: non-specific effect of exogenous pyridine nucleotide supply; O'Reilly T et al.; Actinobacillus pleuropneumoniae, grown in batch culture, was provided with pyridine nucleotides at concentrations that limited the final growth yield (pyridine nucleotide-deficient cultures) or did not determine the final extent of growth (pyridine nucleotide-sufficient cultures) . Sarkosyl-extracted outer membranes from stationary phase, pyridine nucleotide-sufficient organisms contained 23,000 Mr and 43,000 Mr polypeptides that were absent (23,000 Mr) or barely detectable (43,000 Mr) in outer membranes from stationary phase, pyridine nucleotide-deficient organisms or exponential phase organisms . When growth ceased due to exhaustion of pyridine nucleotide, the ratio of the major outer membrane polypeptides (31,000, 38,000 and 69,000 Mr) was altered, becoming more like the ratio found with exponential phase organisms . Similar results were obtained when growth ceased due to glucose exhaustion at low biomass concentrations demonstrating that diverse nutrient deprivations can induce similar changes in outer membrane protein profile . All of these polypeptides were recognized by porcine immune sera indicating their production by A . pleuropneumoniae growing in vivo. Mol Microbiol, 1991 Oct, 5(10), 2475 - 80 Analysis of Haemophilus influenzae type b lipooligosaccharide-synthesis genes that assemble or expose a 2-keto-3-deoxyoctulosonic acid epitope; Abu Kwaik Y et al.; We recently isolated a recombinant phage from a Haemophilus influenzae type b (Hib) library that assembles an oligosaccharide with an apparent molecular weight of 1400 (1.4 K) on a 4.1 K Escherichia coli lipopolysaccharide (LPS) structure, producing a 5.5 K LPS species that contains a KDO (2-keto-deoxyoctulosonic acid) epitope . Subcloning and deletional analysis of the 14 kb Haemophilus insert showed that three overlapping restriction fragments contained within a 7.2 kb Pstl-BamHl fragment sequentially modified an E . coli 4.1 K LPS structure, generating novel species of 4.5 K, 5.1 K and 5.5 K . Only the 5.5 K species contained the KDO epitope . We confirmed the relationship between the cloned genes and Hib lipooligosaccharide (LOS) biosynthesis by constructing a mutant that expressed an altered LOS . Thus, the Hib 7.2 kb Pstl-BamHl restriction fragment contained a cluster of at least three genetic loci whose products acted sequentially in LOS biosynthesis. Infect Immun, 1991 Oct, 59(10), 3366 - 71 Surface structures and adherence properties of diverse strains of Haemophilus influenzae biogroup aegyptius; St Geme JW 3rd et al.; Haemophilus influenzae biogroup aegyptius is an important cause of conjunctivitis and has recently been associated with Brazilian purpuric fever (BPF), a fulminant systemic disease of children . To gain insight into the bacterial factors involved in the pathogenesis of this disease, we investigated the surface structures and adherence properties of eight different strains of H . influenzae biogroup aegyptius, including both BPF and non-BPF isolates . All eight strains were able to express long peritrichous pili similar to those observed in H . influenzae . As in H . influenzae, piliation correlated with colony binding of human erythrocytes . However, two strains were capable of hemagglutination in the absence of pili; in these strains, hemagglutination was insensitive to protease treatment, suggesting a nonproteinaceous hemagglutinin . All strains possessed short, thin, surface fibers distinct from long pili and demonstrated efficient attachment to cultured human conjunctival cells . Attachment to conjunctival cells occurred independently of long pili or a capacity for hemagglutination. Eur J Clin Microbiol Infect Dis, 1991 Oct, 10(10), 846 - 9 Influence of the test medium on azithromycin and erythromycin regression statistics; Barry AL et al.; Azithromycin and erythromycin disk test results were compared to MIC values obtained in six different media . One hundred isolates were tested in triplicate, and geometric mean MICs were plotted against arithmetic mean zone diameters and regression statistics calculated . The test media evaluated did not markedly influence MIC values, but incubation in 5-7% CO2 resulted in a two- to four-fold decrease in the activity of both drugs . For testing Haemophilus influenzae and other species that need to be tested in 5-7% CO2, interpretive breakpoints for the macrolides and azalides should be modified to compensate for the anticipated decrease in activity. Schweiz Med Wochenschr, 1991 Sep 28, 121(39), 1399 - 407 {Beta-lactam/beta-lactamase inhibitor combinations for oral administration}; Franciolli M; Beta-lactamase inhibitors are compounds which are able to bind many beta-lactamase and to inactivate them irreversibly ("suicide inactivators") . Their intrinsic antimicrobial activity is weak . However, in combination with aminopenicillins they exhibit marked synergism both in vitro and in vivo against many beta-lactamase producing bacterial strains . At the achievable serum and tissue concentrations after oral administration, various aminopenicillin/beta-lactamase inhibitor combinations are active against many strains of beta-lactamase producing Haemophilus influenzae, Moraxella catarrhalis, Bacteroides fragilis and staphylococci . At levels achievable in the urine, they are also active against many strains of Escherichia coli, Proteus spp . and Klebsiella spp . Clinically, they have been shown to be effective in the treatment of various human infections of the urinary tract, airways, skin, soft tissues, ear and sinuses . Mild gastrointestinal disturbances are the most commonly encountered side effects . Aminopenicillin/beta-lactamase inhibitor combinations may be a suitable therapeutic option in treating mild to moderately severe infections, i.e . in an outpatient setting. Ugeskr Laeger . 1991 Sep 23;153(39):2753. {Splenectomy and Haemophilus influenzae meningitis}; Pedersen CM et al.; The case of a boy aged 13 years with Haemophilus influenzae type b meningitis is presented . Six years previously, splenectomy was performed on account of trauma . He died from the meningitis after ten days despite the recommended antibiotic treatment . Splenectomized patients should always seek medical advice at the first of any infection . If there is any doubt about the severity of infection, these patients should be admitted to hospital . Some countries recommended administration of Haemophilus influenzae type b vaccine to patients at risk. Cancer, 1991 Sep 15, 68(6 Suppl), 1415 - 21 Historic aspects of intravenous immunoglobulin therapy; Good RA et al.; The earliest preparations of immunoglobulins (Ig) decreased the susceptibility of agammaglobulinemic patients to infections caused by pneumococci, Haemophilus influenzae, meningococci, streptococci, and Pseudomonas aeruginosa . Intramuscular administration of such preparations was painful and traumatic, especially for children . Ethanol-fractionated Ig could not be administered intravenously (IV) because the IgG molecules tended to aggregate and thus were more likely to produce anaphylactoid reactions . New Ig preparations, isolated at low pH (e.g., pH 4) in the presence of traces of pepsin to inhibit reaggregation, were well tolerated when administered IV . Thus a new era of treatment and prophylaxis of disease using IV Ig (IVIG) was launched . The IVIG preparations revolutionized the management of virtually all immunodeficiency syndromes characterized by failure of antibody responses . Amelioration of antibody deficiency secondary to certain chronic diseases or surgical trauma can be achieved with these preparations . Newer uses of IVIG include treatment of some autoimmune diseases; in some conditions, the beneficial influences may be attributable to antiidiotype antibodies present in the IVIG . Another likely explanation is that IVIG inhibits damage to cells and tissues by antibody-mediated cellular cytotoxicity or blocks phagocytosis that is facilitated by Fc receptor mechanisms . The value of IVIG in preventing infection in patients undergoing bone marrow or organ transplantation and in the treatment and prophylaxis of life-threatening infections in neonates and premature infants also is reviewed. Am J Med, 1991 Sep 12, 91(3A), 31S - 35S Multicenter evaluation of azithromycin and cefaclor in acute lower respiratory tract infections; Dark D; This was a randomized, third-party-blinded, multicenter study that compared once-daily azithromycin (500 mg on day 1, followed by 250 mg on days 2-5) to cefaclor (500 mg three times daily for 10 days) in the treatment of patients with acute bronchitis or pneumonia . A total of 546 patients were entered into the study and 272 patients were evaluable for efficacy analysis . Of these, 249 (176 azithromycin, 73 cefaclor) had bronchitis and 23 (15 azithromycin, 8 cefaclor) had pneumonia . The combined clinical cure and improvement rate, as determined by the investigator, was 96% for azithromycin and 94% for cefaclor, with 88% bacteriologic eradication in both treatment groups . The elimination of Haemophilus influenzae was significantly better with azithromycin (94.5%) than with cefaclor (61.1%) (p less than 0.001; Fisher's exact two-tail test) . The two antibiotics were well tolerated during this study; the incidence of side effects reported was similar for azithromycin and cefaclor . Approximately two thirds of the side effects were mild . Only minor abnormalities in the screening laboratory tests were noted . This study shows that a 5-day course of once-daily azithromycin is as effective as a 10-day three times daily course of cefaclor in the treatment of patients with acute lower respiratory tract infections. Am J Med, 1991 Sep 12, 91(3A), 12S - 18S Clinical microbiology of azithromycin; Neu HC; Azithromycin contains an aza-methyl substitution in the 15-membered aglycone ring and as such it is the prototype antibiotic of the azalide class, similar in mechanism of activity to the macrolides . It demonstrates a broad spectrum of activity against many aerobic and anaerobic Gram-positive species, and also inhibits a number of important aerobic and anaerobic Gram-negative bacteria . Significantly, azithromycin shows good activity against Haemophilus influenzae, an organism against which older macrolide antibiotics have proved disappointing . It is highly effective in inhibiting clinically significant intracellular pathogens such as Chlamydia trachomatis and Legionella . Bactericidal activity is seen for certain streptococci and for H . influenzae . Closely linked with azithromycin's microbiologic activity are its novel pharmacokinetics . Azithromycin moves rapidly from blood to tissue compartments where it remains for prolonged periods . Although serum concentrations remain low, the levels attained in the tissues (often greater than 2 mg/kg) are higher than the minimum inhibitory concentration for many common pathogens, and delivery of drug to infection sites by phagocytic cells contributes to these concentrations . This penetration into eukaryotic and prokaryotic cells may be responsible for azithromycin's expanded spectrum of activity, particularly against intracellular organisms . The use of antibiotic blood levels as breakpoints for susceptibility would appear to be inappropriate in the case of azalides . Rather, levels of drug at the tissue site of infection should be considered as guides to predicting efficacy . The in vitro activity of azithromycin, together with its unique tissue pharmacodynamics, define an agent that should demonstrate utility in infections of the respiratory tract, skin and skin structures, and certain sexually transmitted diseases. J Infect Dis, 1991 Sep, 164(3), 555 - 63 In vivo and in vitro expression of Haemophilus influenzae type b lipooligosaccharide epitopes; Mertsola J et al.; An indirect immunofluorescence system involving monoclonal antibodies (MAbs) directed against surface epitopes of Haemophilus influenzae type b (Hib) lipooligosaccharide (LOS) was used to examine individual Hib cells in cerebrospinal fluid (CSF) from infants with Hib meningitis . In four of five CSF samples studied, 100% of the bacteria bound at least one LOS-directed MAb . When the bacteria from these CSF samples were grown in broth, most of these cells lost some or all of their ability to bind the MAb(s) that were bound by the same organisms present in human CSF . When in vitro-grown cells were used for intracisternal injection of rabbits, the populations of Hib cells observed in rabbit CSF after the development of meningitis generally resembled those of the respective broth-grown inocula in terms of their LOS antigenic characteristics . Hib cell populations recovered in infant rat CSF after intranasal challenge again had LOS antigenic characteristics similar to those of the in vitro-grown challenge inocula . These results indicate that a population of Hib cells growing in the infected human host may be quite different, with regard to its LOS antigenic characteristics, from the same Hib strain growing in vitro or in vivo in animal models. Carbohydr Res, 1991 Sep 2, 216, 187 - 96 Synthesis of an artificial antigen that corresponds to a disaccharide repeating unit of the capsular polysaccharide of Haemophilus influenzae type d . A facile synthesis of methyl 2-acetamido-2-deoxy-beta-D-mannopyranoside; Classon B et al.; The synthesis is described of p-nitrophenyl 2-acetamido-3-O-(2-acetamido-2-deoxy-beta-D-glucopyranosyl)-2-deoxy-beta -D- mannopyranosiduronic acid, corresponding to the disaccharide repeating unit of the capsular polysaccharide of Haemophilus influenzae type d, which, after conversion of the p-nitro- into a p-amino-phenyl residue, may be attached to a protein to make an artificial antigen for immunological studies . The synthesis incorporates a facile route to the 2-acetamido-2-deoxy-beta-D-mannopyranosyl unit. Infect Dis Clin North Am, 1991 Sep, 5(3), 485 - 507 Bacterial pneumonia in the HIV-infected patient; Cohn DL; The incidence of bacterial pneumonia is increased in human immunodeficiency virus (HIV) infection, and bacteremia and recurrences occur frequently . Streptococcus pneumoniae and Haemophilus influenzae are the most common pathogens, but several other organisms have now been identified as etiologies . Several abnormalities in B-cells and humoral immunity, and possibly neutropenia and white blood cell dysfunction, predispose to bacterial pneumonia . Despite the severity of pneumonia in HIV infection, most patients respond well to specific antimicrobial chemotherapy . Potential preventive measures include vaccines, immunoglobulin therapy, and antimicrobial prophylaxis. Dtsch Tierarztl Wochenschr, 1991 Sep, 98(9), 327 - 30 {Relationship between serotype, virulence and SDS-PAGE protein patterns of Haemophilus parasuis}; Rosner H et al.; 141 Haemophilus (H.) parasuis and 8 H . parasuis-like strains from different farms were serotyped according to Morozumi and Nicolet (1986 b) as well as to Bakos et al . (1952) . It was possible to classify 72.8% of the investigated strains . 7 out of 12 serotypes have been described for the first time . The high specificity in the agar gel precipitation test was not reproducible in the more sensitive dot-blot procedure . The dot-blot results point to a participation of non-immunogenic polysaccharides in the detection reaction . The serotypes SV 1, SV 5, SV Jena 6 and SV Jena 10 proved to be highly virulent in SPF pigs, SV 2 and SV 4 were of medium virulence . The other serotypes were found to be nonvirulent . Unencapsulated strains and isolates of serotype SV 5 prevailed in animals with Glasser's disease . 23 H . parasuis and 3 H . parasuis-like strains were examined in sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) . On the basis of protein profiles of whole-cell lysates, 23 of them could be assigned to 5 groups . Apart from the highly virulent strains of serovar 1, which belonged to PAGE type III, all other highly virulent strains of the serovars SV 5, SV Jena 6 and SV Jena 10 were grouped into PAGE type I . No correlation could be found between PAGE type on the one hand and virulence or origin of isolates on the other hand. Antimicrob Agents Chemother, 1991 Sep, 35(9), 1860 - 3 Pharmacokinetics of cefuroxime axetil and cefaclor: relationship of concentrations in serum to MICs for common respiratory pathogens; James NC et al.; The pharmacokinetics of single doses of cefaclor at 250 and 375 mg and cefuroxime axetil at 250 mg administered under optimal conditions (i.e., cefuroxime axetil after food and cefaclor in the fasted state) were studied in 24 healthy male volunteers . Drug concentrations in serum were related to MICs for common respiratory tract pathogens by using data generated from a recently completed national survey . The time the concentrations in serum exceeded the MICs for Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella (formerly Branhamella) catarrhalis were significantly greater (P less than 0.05) for cefuroxime axetil at 250 mg than for cefaclor at 250 or 375 mg . With the recommended dosing regimens (cefuroxime axetil at 250 mg and cefaclor at 375 mg twice daily or cefaclor at 250 mg three times daily), cefuroxime concentrations exceed the MIC for 90% of the strains tested for a greater time period than cefaclor concentrations with either regimen . The reasons for this difference are (i) the greater potency and slower clearance of cefuroxime compared with those of cefaclor and (ii) the greater sensitivity of these pathogens to cefuroxime. Salud Publica Mex, 1991 Sep-Oct, 33(5), 504 - 12 {Haemophilus influenzae b: a review on the determinants of pathogenicity and immune response to the infection}; Gomez de Leon P et al.; Haemophilus influenzae is still one of the main causes of diverse invasive diseases in children in Mexico . Epidemiologic data indicate that these processes affect primarily the central nervous system and the respiratory tract . Several factors are involved in the expression of infectious disease by this organism, among them the pathogenic determinants of the parasite and those related with resistance in the host . Occurrence of disease is usually the result of the interaction between these determinants . Knowledge of these pathogenic determinants of the parasite and of factors involved in the immune response of the host have allowed an understanding of the infectious process and have directed research in a least three areas: 1) identification of bacterial membrane fractions related with diagnosis of the disease, 2) screening for immunogenic components in the bacterias as vaccine candidates to be used in the prevention of the disease and, 3) the planning of appropriate alternatives for specific antimicrobial therapy. J Thorac Imaging, 1991 Sep, 6(4), 36 - 42 Pyogenic bacterial pneumonia in the acquired immunodeficiency syndrome; Daley CL; Individuals with human immunodeficiency virus (HIV) infection are more susceptible to bacterial infections because of defects in both cellular and humoral immunity . The most common causes of community-acquired pyogenic bacterial pneumonia in HIV-infected patients are Streptococcus pneumoniae and Haemophilus influenzae . The clinical presentation of HIV-infected patients with pyogenic pneumonia does not seem to differ significantly from that of patients without HIV infection . Response to therapy is generally good, and complications relatively few . Prevention of bacterial pneumonia is very important in the care of HIV-infected persons . The pneumococcal vaccine is currently recommended for all HIV-seropositive individuals, although its efficacy is unknown is this setting . Other forms of prevention require further investigation but may prove to be helpful. J Biol Buccale, 1991 Sep, 19(3), 221 - 8 {The distribution and prevalence of Haemophilus actinomycetemcomitans in the oral cavity}; Sixou M et al.; The prevalence and distribution of Haemophilus actinomycetemcomitans (H.a.) were studied in 3292 specimens of subgingival plaque on the four subgingival aspects of all teeth of the dental arch, 150 specimens from the mucosal surface (tongue and cheek) and 30 saliva specimens in 30 subjects . The sample population of 30 subjects was subdivided into three groups: 10 normal subjects, 10 subjects with localised juvenile periodontitis (SLJP) and 10 subjects with adult chronic periodontitis (SACP) . The prevalences of H.a . in subgingival areas of each group mentioned were 30%, 90% and 60% respectively . Scores for prevalence obtained with other types of specimens proved to be lower except for saliva specimens which appear to be a less representative marker of subgingival prevalence of H.a. . Histograms for the distribution of H.a . revealed a predominance of this microorganism on the proximal surface of molar teeth in the three groups of patients . Only the SLJP also exhibited a high prevalence on the proximal aspect of the incisor teeth . The wide distribution of H.a . in all of the clinical groups studied suggests that this bacterium is not a good marker of periodontal disease and that it is necessary to define the most characteristic phenotypes and genotypes. Immunology, 1991 Sep, 74(1), 68 - 73 A role for intestinal T lymphocytes in bronchus mucosal immunity; Wallace FJ et al.; Rats immunized by intra-Peyer's patch (IPP) injection with non-typable Haemophilus influenzae (NTHI) have been shown to clear this organism from the respiratory tract faster than non-immunized rats . We therefore performed a series of experiments in order to determine the mechanism of action of the enhanced pulmonary clearance . The experiments show that homing of intestinal T cells to the respiratory tract is an important component in the observed immunity, while specific antibody adsorbed to bacteria does not influence pulmonary bacterial clearance rate . Mucosally derived lymphocytes were collected from the thoracic duct of rats primed by IPP inoculation with NTHI, and intravenously transfused to recipient rats . These rats were shown to clear bacteria from bronchial spaces faster than non-transfused rats, or rats transfused with non-immune lymphocytes . Lymphocytes collected from the spleens of immunized rats were also capable of conferring the ability to accelerate pulmonary clearance . When thoracic duct lymphocytes (TDL) purified for T lymphocytes were transferred to recipients, the NTHI clearance rate was accelerated . In experiments to evaluate the activity of specific antibody, it was demonstrated that NTHI opsonized with antibody from bronchial washings of immunized rats was not cleared from the respiratory tract of naive rats faster than non-opsonized controls . These data indicate that immune clearance of NTHI from the respiratory tract following gut immunization is dependent upon antigen-primed lymphocytes, that primed T cells are capable of conferring this protection, and that a primary role for specific antibody in the process cannot be established. Mayo Clin Proc, 1991 Sep, 66(9), 942 - 8 Laboratory tests used to guide antimicrobial therapy; Rosenblatt JE; Laboratory tests that are usually considered helpful in guiding antimicrobial therapy include antimicrobial agent susceptibility tests, determination of bacterial production of beta-lactamase, and assay of specific antimicrobial levels in serum and other body fluids . Susceptibility tests should be performed primarily on clinically significant isolates from critical specimens (such as blood or other normally sterile body fluids or tissues) with use of standardized methods established by the National Committee for Clinical Laboratory Standards . Reporting of results should be selective so that clinicians are encouraged to use the least expensive but useful agent in a group--for example, first-generation rather than third-generation cephalosporins . Because standardized methods are not available for assays of serum inhibitory and bactericidal activity, the accuracy and clinical utility of these tests are as yet undetermined . Determination of bacterial resistance to antimicrobial agents is the most important goal of susceptibility testing . Special methods are needed to detect methicillin-resistant staphylococci, high-level aminoglycoside- and glycopeptide-resistant enterococci, and antimicrobial-resistant strains of Neisseria gonorrhoeae, Streptococcus pneumoniae, and Haemophilus influenzae . Accurate measurement of serum concentrations of antimicrobial agents is important to ensure that therapeutic levels have been obtained and to avoid excessive levels of potentially toxic agents such as aminoglycosides and glycopeptides, especially when renal function is compromised. J Laryngol Otol, 1991 Sep, 105(9), 788 - 9 Acute bacterial thyroiditis presenting as otalgia; Stevenson J; A case of acute bacterial thyroiditis due to Haemophilus influenzae infection presenting as otalgia is reported . The features of this condition and the differential diagnosis from subacute (DeQuervains) thyroiditis are discussed. J Clin Invest, 1991 Sep, 88(3), 911 - 20 Variable region diversity in human circulating antibodies specific for the capsular polysaccharide of Haemophilus influenzae type b . Preferential usage of two types of VH3 heavy chains; Silverman GJ et al.; Antibodies against capsular polysaccharides are important in the defense against many pathogenic bacteria . To determine the mechanism for the variability in responses to polysaccharides, a panel of well characterized serologic reagents that identify diagnostic primary amino acid sequences in the framework and hypervariable regions of heavy (H) and light (L) chains were created to characterize the variable region diversity in circulating human antibodies . 10 normal adult volunteers were immunized with the type b capsular polysaccharide of Haemophilus influenzae (Hib PS) . By immunoblot analyses each individual was found to use at least three different variable L (VL) families, but all had preferential usage of VH3-derived H chains . Four individuals had lesser populations of VH1-derived H chains and three had populations of VH4-derived H chains, but anti-Hib PS antibodies derived from the VH2, VH5, and VH6 families were not detected . The anti-Hib PS antibodies from all subjects were also identified by serologic markers for two specific types of VH3 H chains . These H chains are structurally related to the 20P1 and 30P1 VH genes that are preferentially rearranged in the early human repertoire . These findings document the VH restriction of physiologic responses to Hib PS immunization, and demonstrate a technique to directly assess the structural and genetic diversity of specific serum antibodies. J Immunol, 1991 Sep 1, 147(5), 1667 - 74 Restricted Ig H chain V gene usage in the human antibody response to Haemophilus influenzae type b capsular polysaccharide; Adderson EE et al.; The mechanisms that govern the content of the human antibody repertoire are poorly understood . To investigate the antibody response to a clinically relevant Ag, we have produced heterohybridomas secreting human antibodies directed against the capsular polysaccharide of Haemophilus influenzae type b (Hib PS) . Immune lymphocytes were harvested 7 days after immunization with either of two vaccine formulations, a plain polysaccharide vaccine (Hib PS) or a polysaccharide-protein conjugate of Hib PS and diphtheria toxoid (Hib PS-D) . H chain V region gene nucleic acid sequences were determined for five stable hybridomas . All use members of the VHIII gene family and are 83% to 98% homologous to two candidate germ-line sequences . A variety of D and JH segments are used . Thus the Ig H chain repertoire appears to be restricted to a limited group of VHIII family members . The previously reported expression of homologous sequences in the human fetal repertoire suggests that the inability of young children to respond to this Ag is not caused by deficiencies of these important elements early in development . The restricted use of VHIII gene segments suggests that this gene family plays a pivotal role in the immune response to this important childhood pathogen. J Med Microbiol, 1991 Sep, 35(3), 139 - 47 Rat model of chronic lung infections caused by non-typable Haemophilus influenzae; Maciver I et al.; Patients with chronic obstructive pulmonary disease (COPD) often have chronic or recurrent pulmonary infections with non-typable Haemophilus influenzae . A model of these infections exploited agar bead vehicles to protect the inoculum from rapid clearance, and a chronic lung infection of at least 42 days duration was established in rats . This infection induced increases in serum IgG titres to outer-membrane (OM) and lipo-oligosaccharide (LOS) antigens; immunoblotting demonstrated that this humoral response was directed partly against the outer-membrane proteins (OMPs) . Lung lavage fluid also contained an increased titre of IgG antibodies to OM and LOS 42 days after infection . Antibodies produced during infection with one strain of H . influenzae cross-reacted with OMPs from another, non-typable H . influenzae strain . Despite their encasement in agar beads, pulmonary H . influenzae remained susceptible to amoxycillin . This model of chronic pulmonary infections due to non-typable H . influenzae appears to resemble the situation in COPD patients and may be useful for experimental therapeutic studies. Med J Malaysia, 1991 Sep, 46(3), 274 - 82 A microbiological study of genital ulcers in Kuala Lumpur; Zainah S et al.; The microbial aetiology of genital ulcers was studied in 249 patients (241 men and 8 women) attending a Sexually Transmitted Disease Clinic in Kuala Lumpur, Malaysia . Herpes simplex virus type 2 was isolated in 48 (19.2%) patients, Haemophilus ducreyi from 22 (8.8%), Neisseria gonorrhoeae from seven (2.8%) and Chlamydia trachomatis from four (1.6%) . Syphilis was diagnosed in 18 (7.2%) patients on the basis of dark field microscopy . Two (0.8%) patients were found to have both chancroid and syphilis and one (0.5%) had both gonorrhoea and syphilis . No organism was isolated in the remaining 151 (61.5%) patients . Overall, the accuracy of clinical diagnosis was 58% for single infection, 67% for herpes, 63% for syphilis, 47% for chancroid and 0% for lymphogranuloma venereum . Therefore, our study confirms the need for laboratory tests to diagnose accurately the aetiology of genital ulcer disease. Acta Otorhinolaryngol Ital, 1991 Sep-Oct, 11(5), 497 - 504 {Chronic tonsillitis in childhood: a bacteriological study in connection with benzathine penicillin treatment and the role of bacterial flora in tonsillar hypertrophy}; Carbonaro V et al.; In this study the authors evaluated the importance of bacteriological study in the diagnostics of chronic tonsillitis in children and investigated the eventuality of modification in superficial as well as parenchymal tonsillar microflora brought about by preventive treatment with benzylpenicillin G . The study further aimed at revealing an eventual relationship between microflora and classic laboratory parameters (haemochromocytometric examination, leukocytic formula, VES, ASLO and urine analysis) as well as at evaluating the possibility of a correlation between the degree of tonsillar hypertrophy and microflora . The 100 patients studied had chronic tonsillitis, were between the ages of 4 and 12 and were all candidates for tonsillectomy . The subjects were divided into two groups of 50 patients each; one group had not had any antibiotic treatment for at least 30 days prior to the study, while the second group had undergone antibiotic treatment during the days or weeks immediately before the study and was administered benzylpenicillin G 24 hours prior to sampling . The superficial and intraparenchymal tonsillar tampon samples taken in both groups underwent bacteriological studies . The most frequently isolated bacteria was Haemophilus Influenzae (40% of the cases) . A clear-cut prevalence of this bacteria was observed in those patients treated with benzylpenicillin G as opposed to those not treated . Haemolytic Group A Streptococcus was found almost exclusively in the tonsils of those patients not treated with antibiotics (14 out of 15 cases) . Various degrees of tonsillar hypertrophy were observed although no sure correlation between the presence of the pathology and the bacteria found, either superficially or in the parenchyma, was established . Furthermore, no significant was revealed between the presence of superficial or intraparenchymal bacteria. Ann Acad Med Singapore, 1991 Sep, 20(5), 696 - 9 Acute epiglottitis; Benjamin B; Acute epiglottitis, a fulminating infection in the supraglottic tissue due to Haemophilus influenzae type B can cause relentlessly progressive airway obstruction in infants, children and sometimes in adults . Rapid infection and swelling of the epiglottis and aryepiglottic folds causes airway obstruction which can be relieved by endotracheal intubation . The systemic infection and septicaemia must be treated by the appropriate intravenous antibiotics . Acute epiglottitis must be differentiated from viral laryngotracheitis or "croup" which is very common and from pseudo-membranous bacterial tracheitis which is rare . A protocol for management of acute inflammatory airway obstruction must involve an orderly sequence of diagnostic and therapeutic measures, instituted without delay. Comput Methods Programs Biomed, 1991 Sep, 36(1), 51 - 61 RECPAM: a computer program for recursive partition and amalgamation for survival data and other situations frequently occurring in biostatistics . III . Classification according to a multivariate construct . Application to data on Haemophilus influenzae type b meningitis; Ciampi A et al.; The methodology of RECursive Partition and AMalgamation (RECPAM) previously presented in Parts I and II (A . Ciampi et al., Computer . Methods Progr . Biomed . 26 (1988) 239-256 and 30 (1989) 283-296) pursues its development with an application to predict long-term effects of a disease given a set of clinical information measured at the time of illness . This paper illustrates how RECPAM deals with a situation typical in Medical Informatics applied to data on Haemophilus influenzae type b meningitis. Pathol Biol (Paris), 1991 Sep, 39(7), 658 - 67 {Bactericide activity of cefadroxil comparated with amoxicillin-clavulanic acid, cefaclor and josamycin}; Etesse-Carsenti H et al.; Betalactamase-producing organisms are responsible for an increasing number of ENT and lower respiratory tract infections . Or cephalosporins and the combination of amoxicillin with the beta-lactamase inhibitor clavulanic acid are alternatives to ampicillin therapy . The killing activity of cefadroxil on the organisms most often responsible for ENT and respiratory infections was evaluated in vitro using a viable bacteria count method, comparatively with cefaclor, josamycin, and amoxicillin-clavulanic acid . Killing activity was found to be time-dependent for all the antimicrobial agents studied . Cefadroxil exhibited the same bactericidal effect on Streptococcus pyogenes and S . pneumoniae than the other agents . Haemophilus influenzae and an increasing number of Pneumococcus strains were resistant to josamycin which is therefore not appropriate for first-line therapy . As compared with amoxicillin and amoxicillin-clavulanic acid, cefadroxil was less active on H . influenzae and more active on Staphylococcus aureus . Production of beta-lactamase failed to influence the killing activity of cefadroxil . These bacteriologic data, together with results of pharmacologic studies (long half-life and good penetration within tissues) can explain the clinical successes obtained with cefadroxil in ENT and lower respiratory tract infections. Nihon Kyobu Shikkan Gakkai Zasshi, 1991 Sep, 29(9), 1111 - 8 {Predictive factors of etiologic agents of community-acquired pneumonia presenting at a district general hospital}; Koyama H et al.; Community-acquired pneumonia is one of the major respiratory diseases causing hospital admission in previously healthy patients . Prompt and appropriate antibiotic selection is essential for recovery . The authors tried to determine the distribution of the etiologic agents of community-acquired pneumonias and to analyze predictive factors . Out of 188 cases of community-acquired pneumonia presenting to our hospital, etiologic agents were determined in 106 cases (56%) . Twenty-nine cases were due to Streptococcus pneumoniae, 27 cases due to Mycoplasma, 17 cases due to Haemophilus influenzae and 21 cases due to Mycobacterium tuberculosis . M . tuberculosis was the cause in 11% of all cases and the importance of pulmonary tuberculosis must be emphasized as a community-acquired pneumonia . Out of 58 cases under 50 years old, Mycoplasma pneumoniae was the etiologic agent in 23 cases (40%) and S . pneumoniae in 7 cases (12%) . Out of 62 cases not less than 70 years old . M . tuberculosis was the most common etiologic agent (15 cases, 24%) . S . pneumoniae followed, being causative in 13 cases (21%) . M . tuberculosis was the cause in 10 cases out of 31 cases who did not complain of fever at presentation . In 86 cases who did not show leukocytosis on admission, 21 cases were due to Mycoplasma (24%) and 15 cases were due to M . tuberculosis (17%) . In particular 17 cases were due to Mycoplasma among 28 cases under 50 years old without leukocytosis (61%), and 11 cases were due to M . tuberculosis in the 27 cases no less than 70 years old without leukocytosis (41%).(ABSTRACT TRUNCATED AT 250 WORDS) P N G Med J, 1991 Sep, 34(3), 204 - 10 Acute respiratory infections in Australian Aboriginal children: current knowledge and future requirements; Hanna J et al.; Although inadequately documented, it is clear that acute respiratory infection (ARI) is a major cause of morbidity and hospitalization in Australian Aboriginal children . ARIs continue to cause substantial mortality in Aboriginal children, and they are likely to cause a variety of potentially serious sequelae . The literature emphasizes the importance of pneumonia as a cause of hospitalization of Aboriginal children . There is good evidence that Streptococcus pneumoniae and Haemophilus influenzae are predominant causes of severe pneumonia, but little is known about the importance of other respiratory pathogens, such as respiratory syncytial virus, as causes of ARI in Aboriginal children . Poor living conditions, low birthweight and malnutrition are likely to be important risk factors for ARI in some groups of Aboriginal children . Although broad-ranging economic and environmental changes will be required to bring about a sustained reduction in ARI in Aboriginal children, there should be an emphasis upon correct case management of ARI at the primary care level so as to reduce the need for hospitalization . Some research priorities are discussed. P N G Med J, 1991 Sep, 34(3), 185 - 98 The bacteriology of acute pneumonia and meningitis in children in Papua New Guinea: assumptions, facts and technical strategies; Gratten M et al.; Acute respiratory infections in children aged less than 5 years in the Eastern Highlands of Papua New Guinea were investigated bacteriologically for 10 years from November 1978 . Haemophilus influenzae and Streptococcus pneumoniae were responsible for 73% of all bacteria cultured from lung aspirate (83 samples), 85.5% from blood (1024 samples) and 92% from cerebrospinal fluid (155 samples) . Nonencapsulated H . influenzae was carried by up to 90% of children and was the predominant haemophilus type cultured from lung tissue . Mixed infections of the lung with two types of H . influenzae (8 cases) and both H . influenzae and S . pneumoniae (18 cases), commonly together with other organisms of questionable pathogenicity, reflected the proximity of this organ to the upper respiratory tract . Serotype b accounted for 62% and 82% of H . influenzae isolated from bacteraemic pneumonia and meningitis cases, respectively . Polymicrobic bacteraemic pneumonia occurred in 16 children . Both H . influenzae and S . pneumoniae establish dense, unregulated long-term colonization in the nasopharynx during the neonatal period . Each inhibit autochthonous microflora by mechanisms that are currently unclear . Infections with two or more types occur in 30% (S . pneumoniae) and 60% (H . influenzae) of carriage-positive children . 70-75% of H . influenzae and S . pneumoniae isolates from blood concomitantly colonize the upper respiratory tract . Intense exposure of Papua New Guinean children to penicillin at all levels of health care since the 1940s has resulted in widespread relative resistance among pneumococci to this antibiotic . Resistant strains are now found in 32 serotypes, and in children penicillin resistance is present in 75% of all carriage strains and 52% and 22% of blood and cerebrospinal fluid isolates, respectively . Penicillin-susceptible and resistant pneumococcal serotypes commonly coexist in multiply populated carriage sites . Resistance to betalactam antibiotics is rare among H . influenzae strains and resistance has not been detected in either H . influenzae or S . pneumoniae to chloramphenicol, erythromycin, tetracycline or cotrimoxazole . It should not be assumed that the technology of respiratory bacteriology as it is practised in developed countries can be transferred to the third world for utilization in paediatric aetiology and carriage studies . Respiratory bacteriology strategies as they evolved in Goroka were subject to diverse influences . The type distribution of the major causative agents defied fashionable beliefs, generated the need for more precise epidemiological differentiation and, by virtue of their carriage density, cultural properties and response to commonly used antibiotics, required the introduction or development of compatible diagnostic procedures. J Am Board Fam Pract, 1991 Sep-Oct, 4(5), 307 - 11 The epidemiology of bacterial meningitis; Walling AD et al.; BACKGROUND: The incidence by age and causative organism of bacterial meningitis are not known on a community basis . METHODS: The epidemiology of bacterial meningitis in a metropolitan county was studied by identifying all cases admitted to a hospital from 1983 through 1987 . RESULTS: The overall incidence of bacterial meningitis was 5 per 100,000 person-years, but numbers of cases ranged from 40 per 100,000 for children younger than 5 years to 1.0 per 100,000 in adults aged between 16 and 64 years . No significant excesses of cases were found in male patients or in blacks . The predominant causative organism varied with age . Overall, Haemophilus influenzae was the most common causative organism, but 32 percent of cases were due to Streptococcus pneumoniae . Case fatality rates were high for S . pneumoniae (12.5 percent) and very high for the small number of elderly patients suffering from bacterial meningitis . CONCLUSIONS: Significant declines have occurred in the last decade in the incidence of bacterial meningitis in children, particularly in those younger than 5 years, and in disease caused by H . influenzae and group B streptococcus. Infect Immun, 1991 Sep, 59(9), 3191 - 8 The e (P4) outer membrane protein of Haemophilus influenzae: biologic activity of anti-e serum and cloning and sequencing of the structural gene; Green BA et al.; Outer membrane proteins of nontypeable (NT) Haemophilus influenzae are among the major candidates for inclusion in vaccines against these organisms . This article reports the purification of the e (P4) lipoprotein of H . influenzae and the subsequent production of antiserum directed against this protein . The anti-e polyclonal serum cross-reacted with e protein in multiple clinical NT H . influenzae isolates . Monoclonal antibody analysis of e protein showed at least one surface-exposed epitope to be conserved among NT H . influenzae strains . Anti-e serum also had bactericidal activity against multiple clinical isolates of NT H . influenzae . These results are in contrast to previous reports in the literature that purified P4 protein did not elicit biologically active antibodies . Anti-e antibodies exhibited synergistic bactericidal activity directed against NT H . influenzae when mixed with antibodies directed against another Haemophilus lipoprotein, PCP . This bactericidal synergy was observed against a variety of NT clinical isolates . We also report the cloning of the Haemophilus e lipoprotein, or hel, gene encoding the e protein and its expression and processing in Escherichia coli . The nucleotide sequence of the gene and deduced amino acid sequence of the protein are given . These results demonstrate that e protein is a viable candidate to be a component of a vaccine against NT H . influenzae. Zhonghua Kou Qiang Yi Xue Za Zhi, 1991 Sep, 26(5), 259 - 62, 316 {The study of major anaerobic bacteria from subgingival plaques of juvenile periodontitis}; Wang ZL; The studies of the subgingival plaques from juvenile periodontitis (JP) have shown that JP is associated with Haemophilus actinomycetemcomitans (H . a), Capnocytophaga (Capno.) and other species . This study was designed to study these species with Chinese JP patients using selective cultivable technique . The media used include TSBV to support H . a, TBBP to support Capno . and selective media for Bacteroides gingivalis . A total of 303 subgingival samples were collected from 43 JP, 31 gingivitis and 13 normal juvenile . It was found that the recovery rates of H . a and Capnocytophaga in JP group were higher than that in two other groups . The Black-pigmented Bacteroides had a similar recovery rate in JP and gingivitis groups, but higher than that in periodontal healthy group . The bacterial counts and the correlation analysis between bacteria findings and clinical indices were consistent with the above results. J Hosp Infect, 1991 Sep, 19(1), 25 - 31 A nosocomial outbreak of amoxycillin-resistant non-typable Haemophilus influenzae in a respiratory ward; Hekker TA et al.; A nosocomial outbreak of acute bronchitis due to amoxycillin-resistant, non-typable Haemophilus influenzae occurred in a 23-bed unit, housing patients with respiratory disorders . Within a period of one month, 13 patients and two, previously healthy, members of staff were affected . The isolates were studied for strain relatedness by serotyping, biotyping and major outer membrane protein (MOMP) profiles after SDS-polyacrylamide gel electrophoresis; 13 of the isolates belonged to the same biotype and MOMP type, indicating cross-infection . Routine throat cultures of all patients and personnel were undertaken . To stop the epidemic, patients and nurses positive for amoxycillin-resistant H . influenzae were isolated or sent home and, if symptomatic, were treated with co-trimoxazole . We stress the importance of early intervention when amoxycillin-resistant H . influenzae strains occur in a ward. J Med Microbiol, 1991 Sep, 35(3), 129 - 38 Differential binding of Haemophilus influenzae to human tissues by fimbriae; Sterk LM et al.; The hypothesis was investigated that tissue tropism of Haemophilus influenzae during colonisation and infection is associated with the ability of fimbriate bacteria to bind to the organs and cell types involved . H . influenzae type b with fimbriae (strain 770235f+) bound to several cell types, including ciliated columnar epithelial cells, pneumocytes, ependymal cells, glial cells, connective tissue fibroblasts, synovial cells, antigen-presenting cells, lymphocytes, erythrocytes and endothelial cells . Binding of H . influenzae to kidney, liver and conjunctiva cells was poor . Fimbriae-specific monoclonal antibody (MAb 6HE8) inhibited this binding . Some binding to endothelial cells and macrophages was also observed with non-fimbriate strains . This binding was not inhibited by MAb 6HE8 . We conclude that in-vitro binding of fimbriate H . influenzae is mainly to those tissues and cells where H . influenzae is found during colonisation and infection . The data suggest that a shift to the non-fimbriate form is required for bacteria in the bloodstream to escape clearance mechanisms mediated by blood cells. J Clin Microbiol, 1991 Sep, 29(9), 1949 - 54 Molecular characterization of Haemophilus ducreyi by ribosomal DNA fingerprinting; Sarafian SK et al.; Intraspecies genotypic heterogeneity among Haemophilus ducreyi isolates was examined by using genomic fingerprints with rRNA from Escherichia coli as a probe . DNA from 44 isolates of H . ducreyi was digested by restriction endonuclease HincII or HindIII, separated by agarose gel electrophoresis, transferred to nylon membranes, and hybridized with 32P-labeled 16S and 23S rRNA . HincII digests yielded four hybridization patterns (ribotypes), whereas HindIII digests yielded eight ribotypes . Four HincII and five HindIII ribotypes were observed among 14 H . ducreyi isolates collected within a period of 1 month in Kenya, where chancroid is endemic . In contrast, one HincII and two HindIII ribotypes were observed among 28 isolates collected during the Orange County, Calif., chancroid epidemic that occurred in 1981 and 1982 . The plasmid content, in conjunction with ribotyping, provided additional differentiation among some isolates of H . ducreyi . This study demonstrates that ribotyping of H . ducreyi may be used to study the epidemiology of chancroid. J Int Med Res, 1991 Sep-Oct, 19(5), 373 - 83 Simplified treatment of acute lower respiratory tract infection with azithromycin: a comparison with erythromycin and amoxycillin . European Azithromycin Study Group; Daniel R; In two randomized, multicentre studies azithromycin treatment (1.5 g in five or six doses over 5 days) was compared with erythromycin treatment (14 or 20 g in 28 or 40 doses over 7 or 10 days) and amoxycillin treatment (10.5 g in 21 doses over 7 days) in patients with acute respiratory tract infection . In the two separate studies, azithromycin gave complete clinical cure in 70% and 51%, respectively, of patients compared with in 60% of erythromycin- and 45% of amoxycillin-treated patients . Eradication of the main pathogens isolated at baseline (Haemophilus influenzae, Streptococcus pneumoniae and Staphylococcus aureus) was comparable in the azithromycin, erythromycin and amoxycillin treatment groups . Efficacy was not affected by the presence or absence of underlying pulmonary disease . There were no major abnormalities in laboratory safety parameters and adverse events, principally mild/moderate gastro-intestinal symptoms occurred in 5% or 15%, respectively, of azithromycin-treated patients compared with in 18% or 17%, respectively, of those receiving erythromycin or amoxycillin . It is concluded that azithromycin was as effective and better tolerated than erythromycin or amoxycillin. J Bacteriol, 1991 Sep, 173(18), 5612 - 8 sxy-1, a Haemophilus influenzae mutation causing greatly enhanced spontaneous competence; Redfield RJ; A Haemophilus influenzae strain carrying a competence-enhancing mutation (sxy-1) was selected by transformation of a mutagenized culture in exponential growth at low cell density, where spontaneous competence is very rare . Under these conditions, sxy-1 cells spontaneously transformed 100 to 1,000 times more efficiently than wild-type cells . Moreover, sxy-1 cells responded to all known competence-inducing treatments with further increases in transformation frequency . At high cell densities, sxy-1 cells spontaneously developed the level of competence reached by wild-type cells only after maximal induction by transfer to starvation medium . The sxy-1 mutation appears to act early in the sequence of events leading to competence; it increased the competence of cells carrying the early-acting transformation-defective (Tfo-) mutation tfo-98 by as large a factor as it did the competence of wild-type cells, but it had no effect when combined with another early-acting Tfo- mutation (tfo-87) or with the late-acting Tfo- mutation rec-2. BMJ, 1991 Aug 24, 303(6800), 441 - 5 Epidemiology of Haemophilus influenzae type b invasive disease in Wales; Howard AJ et al.; OBJECTIVE--To investigate the epidemiology of invasive disease due to Haemophilus influenzae type b, the clones responsible, and the antibiotic resistance of the isolates . DESIGN--Prospective population based analysis of clinical and epidemiological data collected for Gwynedd during 1980-90 and in the whole of Wales during 1988-90 . SETTING--19 hospitals in Wales; all medical microbiology laboratories in Wales participated . PATIENTS--82 patients with confirmed invasive infections caused by H influenzae type b in Gwynedd during 1980-90 and 207 in Wales during 1988-90 . MAIN OUTCOME MEASURES--Clinical and epidemiological measures; analysis of the clonal types of the isolates based on the electrophoretic mobilities of 17 metabolic enzymes; and antibiotic resistance . RESULTS--The annual incidence of H influenzae type b infections in Gwynedd was 3.2 cases/100,000 and in Wales was 2.5 cases/100,000 . Most cases occurred in children aged under 5 years, the highest annual incidence being in those aged under 1 (84.6/100,000 and 56.9/100,000 in Wales) . The cumulative risk of acquiring H influenzae type b disease by the fifth birthday was one in 456 in Gwynedd and one in 578 in Wales . Fifteen per cent of cases in Gwynedd and 7% of those in Wales occurred in adults . Predominant clinical conditions were meningitis in children and pneumonia in adults . In Gwynedd 2/70 (3%) children and 5/12 (42%) adults died . Long term neurological sequelae occurred in 8% (4/48) of children who survived haemophilus meningitis . Children presenting with infection were usually the youngest members of their family . No secondary household cases were identified . 100 of 128 (78%) strains were of a single clone, electrophoretic type 12.5, and 4/207 (1.9%) isolates from Wales were resistant to both ampicillin and chloramphenicol . CONCLUSIONS--The annual rate of infection in children aged under 5 in four Welsh counties was 12-44% higher than that previously published for the United Kingdom . The study emphasises the potential value of a vaccine effective in early infancy and provides baseline data to assess its efficacy after its introduction . Alternatives to ampicillin and chloramphenicol should be used as first line, empirical treatment for severe infections that might be caused by H influenzae type b in Wales. Lancet, 1991 Aug 17, 338(8764), 406 - 9 Severity of childhood bacterial meningitis and duration of illness before diagnosis; Kilpi T et al.; Rapid diagnosis of childhood bacterial meningitis (BM) is generally believed to be essential to avoid poor outcome . To see whether duration of illness before admission to hospital was related to the severity of illness, data from children with BM diagnosed in 18 paediatric hospitals in Finland from 1984 to 1989 were collected prospectively . We divided 286 cases with culture-positive cerebrospinal fluid (CSF) into three groups: BM with a history of up to 24 h (short-history group, n = 141), of more than 24 h and up to 48 h (intermediate-history group, n = 75), and of more than 48 h (long-history group, n = 70) . The longer the history, the better the clinical condition of the child . If symptoms or signs of BM lasted 48 h or less, the child did significantly worse, as judged by seven variables, than if the history was longer than 48 h (level of consciousness, p less than 0.001; seizures, p less than 0.01; CSF protein concentration, p less than 0.001; positive CSF gram-stain, p less than 0.01; positive blood culture, p less than 0.05 in Haemophilus influenzae meningitis; serum C-reactive protein, p less than 0.01 between intermediate-history and long-history groups; and urine sodium concentration, p less than 0.001) . The differences were not affected by causative organism, sex, age, or preadmission oral antimicrobial agents . The findings show that if BM follows an insidious pattern of disease, diagnostic delay may be unavoidable, which may have medicolegal implications. Lancet, 1991 Aug 17, 338(8764), 395 - 8 Efficacy of Haemophilus influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine in US children aged 18-59 months . Haemophilus Influenzae Vaccine Efficacy Study Group; Wenger JD et al.; Vaccines prepared from the polyribosylribitol phosphate (PRP) capsule of Haemophilus influenzae b (Hib) have not consistently shown good efficacy in protecting children aged over 18 months from invasive Hib disease . To evaluate the efficacy of conjugate-PRP vaccines in this age-group, and to compare their effect with that of PRP vaccines, a post-marketing case-control study was conducted among 10,400,000 persons . Between Oct 1, 1988, and Feb 28, 1990, 75 patients with Hib disease and 161 control children between 18 and 60 months of age were enrolled . To minimise potentially confounding socioeconomic variables, controls were selected either from among patients' classmates at their day-care centre or from among family acquaintances . 9 of the 75 patients had received the diphtheria toxoid conjugate Hib vaccine more than 2 weeks before onset of illness . After adjusting for age and household crowding, the efficacy of PRP Hib vaccine was 64% (95% Cl = -20,89) and efficacy of the diphtheria toxoid conjugate Hib vaccine was 74% (95% Cl = 30,90) . The study shows that the protective efficacy of this conjugate vaccine is less than ideal and highlights the need for additional post-licensing studies to confirm and expand understanding of the efficacy of these new products. N Z Med J, 1991 Aug 14, 104(917), 334 - 6 Haemophilus influenzae type b cellulitis; Stanley TV et al.; Five cases of cellulitis due to H influenzae type b in children are described . Cellulitis due to H influenzae type b should be treated in hospital using parenteral antibiotics in appropriate dosage to cross the blood brain barrier; it is recommended a lumbar puncture is performed in all cases of cellulitis in under two year olds, both to exclude meningitis and to allow the giving of steroids immediately prior to starting the first dose of antibiotics . Index cases and close contacts should be offered chemoprophylaxis to prevent spread of the organism . It seems likely that a vaccine against H influenzae b, effective in under two year olds, will become available in the next few years. J Infect Dis, 1991 Aug, 164(2), 353 - 8 Detection of experimental Haemophilus influenzae type b bacteremia and endotoxemia by means of an immunolimulus assay; Mertsola J et al.; The rapid quantitation of bacteria in blood was achieved by using a novel assay method for gram-negative bacterial lipopolysaccharide (endotoxin, LPS) . The assay involves the capture of specific LPS onto microtiter plates by means of monoclonal antibodies directed against the oligosaccharide region of the LPS, followed by detection of the bound LPS by a chromogenic Limulus amebocyte lysate (LAL) system . This immunolimulus (IML) assay combines the specificity of monoclonal antibodies with the sensitivity of the LAL system to achieve the first specific, sensitive quantitation of bioactive endotoxin in plasma . In the animal model tested, Haemophilus influenzae type b (Hib) bacteremia in infant rats, there was a strong correlation between IML results and the concentration of Hib colony-forming units in blood samples (r = .845, P less than .001) . Using antibodies with appropriate specificities, this approach should be useful for rapid detection of a wide range of gram-negative bacteria and endotoxins in blood. J Bacteriol, 1991 Aug, 173(15), 4603 - 10 Identification of two genes, kpsM and kpsT, in region 3 of the polysialic acid gene cluster of Escherichia coli K1; Pavelka MS Jr et al.; The polysialic acid capsule of Escherichia coli K1, a causative agent of neonatal septicemia and meningitis, is an essential virulence determinant . The 17-kb kps gene cluster, which is divided into three functionally distinct regions, encodes proteins necessary for polymer synthesis and expression at the cell surface . The central region, 2, encodes products required for synthesis, activation, and polymerization of sialic acid, while flanking regions, 1 and 3, are thought to be involved in polymer assembly and transport . In this study, we identified two genes in region 3, kpsM and kpsT, which encode proteins with predicted sizes of 29.6 and 24.9 kDa, respectively . The hydrophobicity profile of KpsM suggests that it is an integral membrane protein, while KpsT contains a consensus ATP-binding domain . KpsM and KpsT belong to a family of prokaryotic and eukaryotic proteins involved with a variety of biological processes, including membrane transport . A previously described kpsT chromosomal mutant that accumulates intracellular polysialic acid was characterized and could be complemented in trans . Results of site-directed mutagenesis of the putative ATP-binding domain of KpsT are consistent with the view that KpsT is a nucleotide-binding protein . KpsM and KpsT have significant similarity to BexB and BexA, two proteins that are essential for polysaccharide capsule expression in Haemophilus influenzae type b . We propose that KpsM and KpsT constitute a system for transport of polysialic acid across the cytoplasmic membrane. Infect Immun, 1991 Aug, 59(8), 2658 - 63 Molecular conservation of the P6 outer membrane protein among strains of Haemophilus influenzae: analysis of antigenic determinants, gene sequences, and restriction fragment length polymorphisms; Nelson MB et al.; Infections caused by Haemophilus influenzae are a major worldwide health problem . In particular, nontypeable strains of H . influenzae are a common cause of otitis media in infants and children . A vaccine to prevent these infections would result in the prevention of substantial morbidity and cost savings . A problem in identifying an appropriate vaccine antigen has been the enormous antigenic heterogeneity among nontypeable strains of H . influenzae . The present study was undertaken to characterize the conservation of the P6 outer membrane protein (approximately 16,000 daltons) among strains of H . influenzae . A total of 20 type b strains and 20 nontypeable strains of diverse geographic and clinical origins was studied . Three approaches were taken . (i) Antigenic determinants recognized by monoclonal and polyclonal antibodies were present on P6 in all 40 strains tested . The molecular weight of P6 was identical in all strains . (ii) Comparison of the DNA sequences of the P6 genes from three epidemiologically and serologically unrelated strains demonstrated 100% homology at the amino acid level and 97 to 99% homology at the nucleotide level . (iii) Restriction fragment length polymorphism analysis demonstrated that the P6 gene and flanking sequences were highly conserved among all strains . These three independent series of experiments indicated that the P6 protein is highly conserved among strains of H . influenzae . P6 should receive serious consideration for inclusion in a vaccine to prevent infections caused by nontypeable H . influenzae. Med J Aust, 1991 Aug 5, 155(3), 160 - 4 Bacterial meningitis in children under five years of age in Western Australia; Hanna JN et al.; OBJECTIVES: To describe the epidemiology and the associated mortality and serious neurological sequelae of bacterial meningitis in children under five years of age in Western Australia, and to consider the potential impact of a Haemophilus influenzae type b vaccine on this group of children . DESIGN: A retrospective survey, using multiple sources of case ascertainment . PATIENTS: All children in Western Australia from one month to five years of age who developed bacterial meningitis, over a five-year period (from 1984 to 1988 inclusive) . MAIN OUTCOME MEASURES: Episodes of bacterial meningitis, deaths associated with bacterial meningitis, and sensorineural deafness (requiring hearing aids) and cerebral palsy following bacterial meningitis . RESULTS: Two hundred and seventy episodes of bacterial meningitis were identified; 200 occurred in non-Aboriginal children and 70 in Aboriginal children . There were 16 meningitis-associated deaths (case fatality rate, 5.9%), 7 children developed profound sensorineural deafness and a further 7 children developed cerebral palsy after bacterial meningitis . H . influenzae type b caused nearly 70% of the cases of childhood bacterial meningitis . The annual incidence rate of H . influenzae meningitis was significantly greater in Aboriginal children (150 episodes per 100,000 children under five years of age per year) than in non-Aboriginal children (27 episodes per 100,000), and the mean age of onset of H . influenzae meningitis was significantly lower in Aboriginal children (6.8 months) than in non-Aboriginal children (19.8 months) . CONCLUSIONS: Any conjugate H . influenzae type b vaccine should be effective when administered to non-Aboriginal children in the first six months of life, but only the most immunogenic vaccines (for example, the vaccine known as PRP-OMP) are likely to be effective in Aboriginal infants. Acta Paediatr Scand, 1991 Aug-Sep, 80(8-9), 795 - 7 Invasive Haemophilus influenzae infections in household contacts of patients with Haemophilus influenzae meningitis and epiglottitis; Trollfors B; In a retrospective nation-wide Swedish study of Haemophilus influenzae meningitis and epiglottitis, a total of 500 cases of culture-verified meningitis and 841 cases of epiglottitis fulfilling strict clinical criteria were found during a three-year period . Eight families with two cases of these infections occurring with an interval of less than 60 days were identified . Four of the secondary cases occurred in siblings and four in mothers of the index case . Two of the secondary cases were twins to the index case . This shows that the risk of developing invasive H . influenzae infections is considerably increased in both siblings and parents of patients with invasive infection . Rifampicin prophylaxis, which is recommended in the United States for family contacts, would, however, prevent less than 1% of all invasive infections with H . influenzae. Aust N Z J Med, 1991 Aug, 21(4), 427 - 32 A controlled trial of a killed Haemophilus influenzae vaccine for prevention of acute exacerbations of chronic bronchitis; Tandon MK et al.; Sixty-four patients with chronic bronchitis with a history of recurrent respiratory tract infections were admitted to a double-blind randomised controlled study in which the efficacy of an oral vaccine containing killed Haemophilus influenzae in preventing acute exacerbations of chronic bronchitis was compared with placebo . Patients given vaccine developed fewer acute infective episodes . Although the numbers of patients who required antibiotic therapy in the two groups were not significantly different, the number of antibiotic prescriptions given to the vaccinated group of patients was significantly less than that required by the control group . A reduction in colonisation with Haemophilus influenzae occurred in the active group, which was maximal 14 weeks after the onset of the study. Jpn J Antibiot, 1991 Aug, 44(8), 813 - 9 {Bacteriological study on fosfomycin against organisms clinically isolated from paranasal sinusitis}; Deguchi K et al.; Multi-center bacteriological and clinical studies on fosfomycin (FOM) nasal solution were performed in subjects with paranasal sinusitis from January, 1988 to May, 1990 . In these studies, we were exclusively responsible for bacterial isolation from clinical sources, bacterial identification and the determination of drug susceptibility . Before local administration of FOM nasal solution, many strains of various bacterial species were isolated from sources totalling 396 cases involved in phase II clinical studies, dose-finding and open clinical studies . From antibacterial activities of FOM against those isolates, we obtained the following conclusions . 1 . Among the 447 isolates, Streptococcus spp . occupied 25.7%, Staphylococcus spp . 21.7% and anaerobic Gram-positive cocci (GPC) 13.6%, showing high detection frequency of aerobic and anaerobic GPC . Next to these, Haemophilus influenzae, Pseudomonas aeruginosa, Klebsiella spp . and Branhamella catarrhalis also were often obtained . 2 . After exclusion of possibly contaminating strains which might have entered into cultures at samplings or transfers, the MIC50 and the MIC80 of FOM against the remaining 354 isolates were determined to be 12.5 and 25 micrograms/ml, respectively, indicating that local use of FOM would be fully effective to eradicate most of the bacteria . 3 . FOM nasal solution showed sufficient eradication efficacy against most clinical isolates of possible causative organisms of paranasal sinusitis, and appeared to be useful as a topical preparation for the treatment of this disease. J Pediatr, 1991 Aug, 119(2), 211 - 7 Early bacteriologic, immunologic, and clinical courses of young infants with cystic fibrosis identified by neonatal screening; Abman SH et al.; To understand better the events associated with the initiation of lung disease in young children with cystic fibrosis (CF), we prospectively performed a longitudinal study examining the early bacteriologic, immunologic, and clinical courses of 42 children with CF diagnosed after identification by neonatal screening . Serial evaluations included history and physical examination, chest radiographs, throat cultures for bacteria, and determinations of serum immunoglobulin levels and circulating immune complexes . At a mean follow-up age of 27 months, 19% of the children had serial throat cultures positive for Pseudomonas aeruginosa; the first positive culture was found at a mean age of 21 months . In three infants the initial P . aeruginosa isolates were mucoid . As determined by typing with a DNA probe, serial P . aeruginosa isolates from each patient were identical over time but were genetically distinct from isolates recovered from other patients . Of 11 infants with P . aeruginosa, nine (82%) had previous isolates of Staphylococcus aureus or Haemophilus influenzae; all had received prior antibiotic therapy . In comparison with other infants with CF, children with P . aeruginosa grown on serial throat cultures more frequently had daily cough (p less than 0.01), lower chest radiograph scores (p less than 0.05), and elevated levels of circulating immune complexes (p less than 0.01) . None of the study infants had persistent hypogammaglobulinemia or hypergammaglobulinemia . We conclude that (1) S . aureus and H . influenzae remain the isolates most frequently recovered from infants with CF; (2) initial recovery of P . aeruginosa by throat culture is often preceded by the onset of chronic respiratory signs; (3) elevations of circulating immune complexes can occur early, often after the initial recovery of P . aeruginosa; and (4) early P . aeruginosa isolates are genetically distinct, demonstrating the lack of cross-colonization in this newborn population. Pediatr Infect Dis J, 1991 Aug, 10(8), 578 - 84 Haemophilus influenzae causing conjunctivitis in day-care children; Trottier S et al.; The role of Haemophilus influenzae in acute purulent conjunctivitis was studied during an outbreak among children in day care . Five day-care centers contributed 20 cases and 35 controls . All the children were subjected to culture of the nasopharynx and the eyes . H . influenzae was carried in the nasopharynx of 53% of the children (range between day care centers, 20 to 91%) . Of the 20 children with acute conjunctivitis 8 had eye cultures positive for H . influenzae, 2 had Moraxella and the remaining were culture-negative . Ten colonies of H . influenzae were isolated from each positive culture and identified by capsular type, biotype and multi-locus enzyme electrophoresis . All but one of the isolates were nonencapsulated . They belonged to 4 biotypes and 8 electrophoretic types . The same strain was recovered from the eyes and nasopharynx of the symptomatic children, suggesting that the H . influenzae in the eyes originated from the nasopharynx . There was no evidence for spread of the same H . influenzae strains between day-care centers . Even within each center the Haemophilus strains recovered from the eyes varied among the symptomatic children . The in vitro capacity to attach to oropharyngeal epithelial cells was not increased among the H . influenzae recovered from the eyes . The results question if the majority of conjunctivitis cases were caused by H . influenzae and suggested that eyes were colonized with the nasopharyngeal carrier strain rather than infected by an isolate with special virulence for the eye. Pediatr Infect Dis J, 1991 Aug, 10(8), 560 - 4 Persistence of serum antibodies elicited by Haemophilus influenzae type b-tetanus toxoid conjugate vaccine in infants vaccinated at 3, 5 and 12 months of age; Claesson BA et al.; Eighty-five children received three injections of a vaccine consisting of Haemophilus influenzae type b (Hib) capsular polysaccharide (CPS) conjugated to tetanus toxoid (TT) (Hib-TT) at 3, 5 and 12 months of age according to the vaccination schedule for Swedish children . Diphtheria-tetanus toxoid vaccine was concurrently injected at another site . Two dosages, 7.5 and 15