Diagn Microbiol Infect Dis, 1991 Mar-Apr, 14(2), 185 - 7 Application of quadFERM+ for the identification of fastidious gram-positive and gram-negative bacilli; Yu PK et al.; The 2-hr quadFERM+ kit (qF) (Analytab Products, Plainview, NY) was compared with conventional tube tests for the identification of the HACEK bacteria (Haemophilus aphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae), other Haemophilus and Kingella spp., Capnocytophaga, Corynbacterium, and Moraxella spp . Test results were identical for 296 comparisons with 74 isolates (74%) . In the remaining 104 comparisons for 26 isolates, 50 reactions were identical, and qF produced a positive result in 46 of 54 discrepancies. Rev Chil Pediatr, 1991 Mar-Apr, 62(2), 128 - 31 {Acute epiglottitis}; Romero P et al.; Acute epiglottitis caused by Haemophilus influenzae type B (Hib) is seldom described in Chile . To reinforce the need to take this severe entity into account in the differential diagnosis of acute upper respiratory tract obstructions, the case of a 9 month old girl is described, who's symptoms were initially attributed to acute laryngitis, but showed not response to racemic epinephrine and betamethasone therapy . The correct diagnosis of acute epiglottitis was suggested five hours after admission by lateral neck's radiographs and confirmed by direct laryngoscopic examination under general anesthesia . Appropriate treatment was soon instituted including tracheal intubation respiratory support and antibiotics . An uneventful clinical course proceeded from then on . Hemophilus influenzae B was isolated from blood cultures. J Infect Dis, 1991 Mar, 163(3), 549 - 58 Interaction of nontypable Haemophilus influenzae with human respiratory mucosa in vitro; Read RC et al.; One laboratory strain (SH9) (n = 12) and five clinical isolates of unencapsulated Haemophilus influenzae replicated from 10(4) to 10(8) cfu/ml over 24 h in an organ culture of human respiratory mucosa in which only the intact mucosal surface is exposed . By transmission electron microscopy (TEM), bacteria were not seen in association with normal respiratory epithelium, even after incubation for 24 h . Histology and TEM morphometry demonstrated patchy and occasionally confluent damage to epithelia at this time, with bacteria associated only with cells that were structurally damaged . Scanning electron microscopy revealed an increased quantity of mucus in infected preparations; H . influenzae were associated with mucus by 14 h of incubation and with damaged epithelial cells by 24 h . Fimbriation of H . influenzae increased buccal cell adherence but did not facilitate association with normal respiratory epithelium and failed to increase epithelial damage or association with damaged cells . Epithelial damage may be prerequisite for association of H . influenzae with respiratory epithelium in vitro. JAMA, 1991 Feb 27, 265(8), 987 - 92 Protective efficacy of Haemophilus influenzae type b polysaccharide and conjugate vaccines in children 18 months of age and older; Greenberg DP et al.; To evaluate the protective efficacy of polyribosylribitol phosphate (PRP) and polyribosylribitol phosphate-diphtheria toxoid (PRP-D) vaccines in children 18 to 59 months of age, we conducted a case-control study in Los Angeles (Calif) County between July 1, 1988, and July 31, 1989 . Seventy-nine children with invasive Haemophilus influenzae type b disease 18 to 59 months of age were identified, and 212 controls were selected by random-digit telephone dialing methods . Cases and controls were stratified by age and month of disease onset of the case . Seventeen PRP vaccine failures and two PRP-D vaccine failures occurred more than 2 weeks after vaccination . The PRP vaccine was shown not to be effective (point estimate--47%; 95% confidence interval,--307% to 47%), but the PRP-D vaccine was 88% protective (95% confidence interval, 42% to 97%) . Adjustment of the efficacy estimates for potential confounding variables did not change the results significantly . The PRP-D vaccine provided significantly better protection than the PRP vaccine against invasive H influenzae type b disease in this population. J Pediatr, 1991 Feb, 118(2), 184 - 90 Clinical and immunologic responses to Haemophilus influenzae type b-tetanus toxoid conjugate vaccine in infants injected at 3, 5, 7, and 18 months of age; Parke JC Jr et al.; The safety and immunogenicity of Haemophilus influenzae type b-tetanus toxoid conjugate vaccine (Hib-TT) were evaluated in 77 healthy infants receiving injections at 3, 5, 7, and 18 months of age . No serious local or systemic reactions were noted . After the first injection the geometric mean Hib antibody level rose to 0.55 micrograms/ml, and each subsequent injection elicited a statistically significant rise in the geometric mean . The percentage of vaccinees with Hib antibody levels greater than 0.15 micrograms/ml serum was 75.5% after the first, 97.4% after the second, and 100% after the third Hib-TT injection . This percentage fell to 90.9% at 18 months of age but rose again to 100% after the fourth injection . Control infants (n = 10) injected with diphtheria-tetanus toxoid-pertussis vaccine only had nondetectable levels after the second injection . Hib-TT elicited increases of Hib antibody in all isotypes: IgG greater than IgM greater than IgA . Among IgG subclasses the highest increases were of IgG1 . All vaccinated subjects had greater than 0.01 U/ml of TT antibody (estimated protective level) throughout the study . We conclude that Hib-TT, injected at 3, 5, 7, and 18 months, is safe and induces protective levels of antibodies during the age of highest incidence of meningitis caused by Hib. Pediatr Infect Dis J, 1991 Feb, 10(2), 97 - 104 Efficacy in infancy of oligosaccharide conjugate Haemophilus influenzae type b (HbOC) vaccine in a United States population of 61,080 children . The Northern California Kaiser Permanente Vaccine Study Center Pediatrics Group; Black SB et al.; The efficacy of the HbOC conjugate Haemophilus influenzae type b vaccine was evaluated in a study population of 61,080 infants in the Northern California Kaiser Permanente Medical Care Program . Between February, 1988, and June, 1990, the HbOC vaccine was given as part of a three-dose series at 2, 4, and 6 months of age to 20,800 infants . The study population included children with a well-care visit at a study center during the first 6 months of life . There were 25 cases of Haemophilus influenzae type b disease in the study population: 22 in unvaccinated children and 3 in children who received only one dose of HbOC vaccine . The efficacy of the full three-dose series was evaluated by several methods: a primary analysis comparing fully vaccinated children with unvaccinated children from 7 to 18 months of age; a stratified exact analysis adjusted for age and seasonality; and a case-control analysis which further adjusted for known risk factors . The efficacy of three doses of vaccine was 100% with the lower bound of the 95% confidence interval for the three analyses at 68, 71, and 64%, respectively . There were no cases of disease resulting from two doses of HbOC vaccine yielding an estimate of 100% efficacy (95% confidence interval, 47 to 100) for two doses of HbOC vaccine . However, for children who had received only one dose of HbOC vaccine, vaccine efficacy was estimated to be 26% and the possibility that one dose of HbOC vaccine had no efficacy could not be excluded.(ABSTRACT TRUNCATED AT 250 WORDS) Pediatr Infect Dis J, 1991 Feb, 10(2), 92 - 6 Safety and immunogenicity of oligosaccharide conjugate Haemophilus influenzae type b (HbOC) vaccine in infancy . The Northern California Kaiser Permanente Vaccine Study Center Pediatrics Group; Black SB et al.; The safety and immunogenicity of the HbOC conjugate vaccine have been evaluated in a study population of 61,080 children in the Kaiser Permanente Medical Care Program of Northern California . Half of the population served as controls . The vaccine was given as part of a three-dose regimen in the first year of life with the first dose given between 6 weeks and 6 months of age, a minimum interval of 1 month between doses and with the third dose given by 1 year of age . The vaccine was highly immunogenic with 97% of infants developing 1 microgram/ml or more of anti-polyribosyl phosphate antibody as measured by Farr assay 1 month after completion of the three-dose series and with 71% maintaining this concentration until a booster dose was given at approximately 18 months of age . There were three cases of Haemophilus influenzae type b disease after the first dose of vaccine and two of these children died . However, there was no statistically significant difference between either the incidence of H . influenzae type b disease or the mortality rate in infants after one dose of HbOC vaccine when compared with H . influenzae type b disease incidence and mortality in unvaccinated children of the same age . The rate of sudden infant death syndrome following HbOC vaccine was lower than that observed within the Kaiser Permanente Medical Care Program as a whole or in the three counties in which sudden infant death syndrome surveillance was tabulated . Immediate local and systemic reactions were evaluated by telephone interviews of 6887 infants within 72 hours of vaccine.(ABSTRACT TRUNCATED AT 250 WORDS) Pediatr Infect Dis J, 1991 Feb, 10(2), 122 - 5 Imipenem/cilastatin treatment of bacterial meningitis in children; Wong VK et al.; The safety and efficacy of imipenem/cilastatin were evaluated in 21 children, ages 3 to 48 months, with bacterial meningitis . Eradication of bacteria from the cerebrospinal fluid was demonstrated within 24 hours of antibiotic therapy in all but 2 patients who had Haemophilus influenzae type b meningitis and ultimately achieved bacteriologic cure after 2 to 3 days of imipenem/cilastatin therapy . Cerebrospinal fluid penetrations of imipenem and cilastatin were determined at various times after drug administration with mean cerebrospinal fluid: serum ratios of 14 and 10% for imipenem and cilastatin, respectively . The study was terminated when 7 (33%) patients developed seizure activity after antibiotic therapy was administered . The usefulness of imipenem/cilastatin for the treatment of bacterial meningitis in children may be limited by a possible increased incidence of drug-related seizure activity. Pediatr Infect Dis J, 1991 Feb, 10(2), 113 - 7 Safety and immunogenicity of a Haemophilus influenzae type b conjugate vaccine in a high risk American Indian population; Santosham M et al.; The safety and immunogenicity of a Haemophilus influenzae type b polysaccharide conjugate vaccine linked to the outer membrane protein complex of Neisseria meningitidis (Hib-OMP) were evaluated among Apache and Navajo infants and children . One dose of the Hib-OMP was given to 42 children who were from 12 and 60 months of age . Ninety-two infants 6 to 8 weeks old were given one dose of Hib-OMP at the time of enrollment . A subsequent dose of the vaccine was given 2 months later and a third dose was offered between 12 and 15 months of age . All of the 12- to 60-month-old children achieved a protective antibody concentration (greater than 1 microgram/ml) 1 month postvaccination . Among the 6- to 8-week-old infants only 11% of the Apaches and 8% of Navajos had a protective anti-PRP antibody concentration prevaccination . One month post vaccination 68% of the Apaches and 69% of the Navajos had protective anti-PRP antibody concentrations . One month after the second immunization 67% of the Apaches and 75% of Navajos had protective anti-PRP concentrations . Among the infants that received the third (booster) immunization (N = 28) 74% had protective anti-PRP antibody titers just before the booster immunization . One month after the booster immunization all of the infants had protective concentrations of anti-PRP antibody . We conclude that the Hib-OMP is safe and highly immunogenic among Apache and Navajo infants and children. Pediatr Infect Dis J, 1991 Feb, 10(2), 108 - 12 Prospective comparison of the immune response of infants to three Haemophilus influenzae type b vaccines; Turner RB et al.; The antibody response to three Haemophilus influenzae type b vaccines was examined in 134 infants 17 to 22 months of age . Sera were collected from each subject before and 1 month after vaccination with either purified H . influenzae type b capsular polysaccharide (polyribosyl-ribitol phosphate (PRP} or one of two protein-conjugated vaccines (PRP-D or HbOC) . Comparison of the two conjugate vaccines revealed that HbOC produced an antibody response greater than or equal to 1.0 micrograms/ml in 96% compared with 72% who were vaccinated with PRP-D (P less than 0.05) . The isotype distribution of the antibodies produced by the two vaccines was similar . While all of the vaccines resulted in higher concentrations of anticapsular IgG1 than IgG2, the IgG1:IgG2 ratio was significantly higher in subjects immunized with HbOC . The IgG1:IgG2 ratio was similar in subjects immunized with PRP or PRP-D . The clinical significance of these observations remains to be determined. Pediatr Infect Dis J, 1991 Feb, 10(2), 104 - 8 Antibody response to outer membrane of noncapsulated Haemophilus influenzae isolated from the nasopharynx of children with pneumonia; Claesson BA et al.; In a prospective study aimed at determining the etiology of community-acquired pneumonia in children nasopharyngeal cultures and paired serum samples were obtained from 336 consecutive children ages 6 weeks to 15 years with pneumonia, 167 hospitalized and 169 outpatients . Results regarding Haemophilus influenzae are reported here . Blood cultures obtained from 127 of the hospitalized patients did not yield growth of H . influenzae . H . influenzae was isolated from the nasopharynx of 88 children . Seventy-three strains were noncapsulated, 2 were type b, 2 were type f and 11 were not serotyped . Paired serum samples were available from 38 children with growth of noncapsulated H . influenzae in the nasopharynx as the only potential pathogen . Sixteen of them responded with significant increases in serum antibodies against outer membrane preparations prepared from their own nasopharyngeal isolates . Thirty-eight age- and sex-matched control children with pneumonia without growth of H . influenzae in the nasopharynx served as controls . Sera from each control patient were tested for antibodies against two strains of noncapsulated H . influenzae . Of those, 4 had significant increases in antibodies against one or both outer membrane preparations . The increases in serum antibodies against the outer membrane of noncapsulated strains of H . influenzae indicate that this organism might be a cause of pneumonia in some children. Immun Infekt, 1991 Feb, 19(1), 12 - 3 {Bacterial spondylitis caused by Haemophilus aphrophilus}; Brenner KP et al.; Four weeks after a slight scratch a 43-year-old man noted a severe back pain . Physical examination gave suspicion of a bacterial spondylitis . From the biopsy of the involved vertebral body Haemophilus aphrophilus was isolated under aerobic growth conditions. Tierarztl Prax, 1991 Feb, 19(1), 14 - 20 {Gyrase inhibitors, a new class of therapeutic drugs}; Petzinger E; Fluorinated inhibitors of gyrase open a new field in chemotherapy . For veterinary purposes one drug, enrofloxacin (Baytril), has been registered hitherto in Germany . Well known disadvantages of the old gyrase blockers (e.g . nalidixic acid and others) have been their limited clinical application (compounds were useful only for therapy of infections of kidney cavities) and their deficits in antimicrobial efficacy regarding Gram-positive bacteria, pseudomonas and mycoplasmas . Fluorinated 4-quinolones, however, exhibit broad antibiotic effects in addition to their useful pharmacokinetic properties . The compounds are indicated in therapy of infections by E . coli, Salmonella, Pasteurella, Mycoplasma and Haemophilus species as well as against CRD (chronic respiratory disease) . Development of resistance is markedly slowed down compared with nalidixic acid due to a multi-step resistance . Resistance is unstable and may revert in bacteria . Nevertheless, resistant bacteria in the veterinary field are exceptions . Cross-resistance includes only compounds belonging to 4-quinolones . Adult animals show few side effects to gyrase blockers . In young animals a deficit in biotransformation and renal clearance has been observed . Most prominent are dose dependent irreparable deformations of joint cartilages which have forced to contraindicate the use of Baytril in growing dogs. Mol Microbiol, 1991 Feb, 5(2), 267 - 78 Molecular cloning, partial purification, and characterization of a haemin-binding lipoprotein from Haemophilus influenzae type b; Hanson MS et al.; A library of genomic DNA fragments from Haemophilus influenzae type b (Hib) DL42 was constructed in plasmid pBR322, transformed into Escherichia coli strain RR1, and screened for recombinant clones with haemin-binding activity by plating onto haemin-containing agar . Expression of haemin-binding activity by clones correlated with the expression of a protein with an apparent molecular weight of 51,000 (51K) that was also recognized by anti-Hib strain DL42 serum in immunoblots . One recombinant clone, designated pHM2, with the smallest DNA insert (3.62 kb) was characterized further . Ethanol inhibition of expression of pHM2 in minicells revealed that the 51K protein was the result of a processing event involving a larger precursor . E . coli RR1(pHM2) adsorbed haemin in liquid suspensions as well as from solid media . Subcloning of a 2.6 kb fragment of pHM2 into a shuttle vector permitted the construction of a recombinant Hib clone, DL42(pHM1002), which overexpressed the 51K haemin-binding protein . This 51K protein appears to be peripherally associated with the inner, and possibly outer, membranes of Hib . Affinity chromatography on haemin-agarose was utilized to purify the haemin-binding protein from both E . coli RR1(pHM2) and Hib DL42(pHM1002) to near homogeneity . The use of the antibiotic globomycin in a minicell expression system and radioimmunoprecipitation analysis of Hib proteins intrinsically radiolabelled with {3H}-palmitate indicated that the 51K haemin-binding protein is a lipoprotein. Jpn J Antibiot, 1991 Feb, 44(2), 234 - 40 {Pharmacokinetical and clinical study of cefpirome in children}; Kida K et al.; This study describes the pharmacokinetic characteristics and clinical usefulness of cefpirome (CPR) in children . Mean half-lives of 20 mg/kg and 40 mg/kg of CPR injected intravenously in one shot were 1.18 and 1.34 hours, respectively, and their mean recovery rates into urine were 69.8 and 72.2%, respectively . Minimum inhibitory concentrations of CPR against Staphylococcus aureus, Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli and Haemophilus influenzae were the same as or lower than those of ceftazidime . CPR was clinically effective in 14/15 of patients with bacterial infections; 8/9 of pneumonia, 2/2 of bronchitis, 1/1 of pharyngitis, 1/1 of tonsillitis, 1/1 of osteomyelitis, 1/1 of urinary tract infection . No clinically overt side effects of CPR were found, while an increase of eosinophils in blood was observed in 2 cases, and an increase of platelet in blood in 1 case and an elevation of serum GPT activity in 1 case were also observed . These findings indicate that CPR is useful for the treatment of bacterial infections in children. Jpn J Antibiot, 1991 Feb, 44(2), 207 - 12 {Pharmacokinetics and clinical evaluation of cefpirome in children}; Ihara T et al.; Pharmacokinetics and clinical effects of cefpirome (CPR, HR 810) in children were studied . When 20 mg/kg and 40 mg/kg doses of CPR were administered to 4 children through 30 minutes' drip infusion, half-lives were 1.23 +/- 0.23 (mean +/- S.D.) hours and 1.37 +/- 0.35 (mean +/- S.D.) hours, respectively for the 2 dose levels, and recovery rates in urine in the first 6 hours after administration were 74.8% and 56.1%, respectively . CPR was administered to 15 cases (3 tonsillitis, 3 bronchitis, 5 bronchopneumonia, 1 acute cystitis, 1 coxoiliatitis, 1 otitis media, 1 otitis externa) . The efficacy rate was 86.7% . Seven strains of bacteria were isolated and identified 4 Haemophilus influenzae, 3 Staphylococcus aureus, 1 Pseudomonas sp . from these cases . These bacteria in children were followed after administration of CPR . Six strains were eradicated and one was reduced in number . No adverse effects of CPR were observed except in 2 cases, one of which showed transient eosinophilia and the other showed a transient increase of transaminase . These results suggest that CPR may be an effective and safe drug to use on children clinically. Jpn J Antibiot, 1991 Feb, 44(2), 160 - 7 {Clinical evaluation of cefpirome in children}; Meguro H et al.; A new injectable cephem antibiotic, cefpirome (CPR), was evaluated clinically in children . CPR was effective in all the 17 evaluable cases with acute bacterial infections including 1 case of purulent meningitis due to Haemophilus influenzae type b . Diarrhea and elevation of serum GOT and GPT were associated with CPR therapy in 2 young infants, although they were mild and transient . The plasma T 1/2 beta of CPR was 1.17 +/- 0.22 hours after bolus injection and mostly excreted in 6 to 8 hours into urine of children with normal renal functions . The data indicate that CPR is safe and effective, when used in children with susceptible bacterial infections. Jpn J Antibiot, 1991 Feb, 44(2), 150 - 9 {Clinical evaluation of sultamicillin in lower respiratory tract infections}; Ishibashi T et al.; Clinical efficacy and safety of sultamicillin (SBTPC) in patients with lower respiratory tract infections, mainly pneumonia and bronchitis, have been evaluated in a multicenter trial by 19 institutions in the Kyushu area during a period of 12 months from December 1988 to November 1989 . 1 . Clinical evaluation was made in 132 patients and efficacy rates of SBTPC were 80.0% (28/35) for pneumonia, 78.5% (73/93) for bronchitis and 100% for the remaining 1 patient with other respiratory tract infections . The overall efficacy rate was 79.1% (102/129) . 2 . Clinical efficacy rate of SBTPC for respiratory tract infections in patients with underlying diseases such as chronic bronchitis, old pulmonary tuberculosis etc., was 75.0% (60/80) which was not significantly different from the efficacy rate of 85.7% (42/49) in patients without underlying diseases . 3 . Of 13 patients who failed to respond to previous antibiotic treatments, 8 (61.5%) were effectively treated with SBTPC . 4 . Clinical efficacy rates against infections caused by single species of organisms were 90.9% (10/11) for Haemophilus influenzae, 100% (8/8) for Streptococcus viridans and 100% (3/3) for Staphylococcus aureus . The overall clinical efficacy rate in all cases of monomicrobial infections was 88.6% (31/35), in polymicrobial infection 45.5% (5/11) and the overall efficacy rate in cases in which causative bacteria were identified was 78.3% (35/46) . 5 . Adverse reactions occurred in 6.8% (9/132) of the patients . The symptoms included allergic reaction in 1 patient, gastrointestinal system disorders in 7 patients and general fatigability in 1 patient . As abnormalities in laboratory test values, elevations of A1-P, GOT, and GPT were observed in 3 patients during the study, but returned to normal after discontinuation of SBTPC administration . 6 . SBTPC is a useful antibiotic in the treatment of lower respiratory tract infections under the current medical environment where resistant organisms which produce beta-lactamases have been increasing. Antimicrob Agents Chemother, 1991 Feb, 35(2), 242 - 51 Sequence and molecular characterization of the ROB-1 beta-lactamase gene from Pasteurella haemolytica; Livrelli V et al.; The ROB-1 beta-lactamase-encoding plasmids from eight Pasteurella and two Haemophilus strains were compared by restriction endonuclease and hybridization analyses . Two types of ROB-1-encoding plasmids, which differed in size, were detected . One (4.1 kb) was found only in Pasteurella strains . The other (4.4 kb) was found in both Haemophilus influenzae and in one of the eight Pasteurella strains examined . These two plasmids shared multiple homologous fragments, suggesting that one was derived from the other . The ROB-1-encoding gene from Pasteurella haemolytica LNPB 51 was cloned and sequenced . An open reading frame of 915 nucleotides was found; it encoded a 305-amino-acid protein . Analysis of this amino acid sequence confirmed that the enzyme was found; it encoded a 305-amino-acid protein . Analysis of this amino acid sequence confirmed that the enzyme is a class A beta-lactamase . It had 32 to 48% homology with other class A enzymes and exhibited several common features of the gram-positive beta-lactamases . The ROB-1 mature protein, however, contained only one cysteine residue at position 123 . These results suggest that ROB-1 is a link between beta-lactamases of gram-negative and gram-positive bacteria . An internal 230-bp DraI fragment from ROB-1 hybridized only with plasmid DNA from ROB-1-producing strains . This specific probe could be useful in epidemiological studies. Antimicrob Agents Chemother, 1991 Feb, 35(2), 220 - 3 Pharmacokinetics and antibacterial efficacy of cefpirome (HR 810) in experimental Escherichia coli and Haemophilus influenzae type b meningitis; Jafari HS et al.; Cefpirome (HR 810) is a new cephalosporin related to cefotaxime that has potent bactericidal activity against a broad spectrum of gram-negative and gram-positive organisms . The pharmacokinetics and bacteriological efficacy of cefpirome administered as a single intravenous dose were assessed in rabbits with experimental Haemophilus influenzae type b and Escherichia coli K1 meningitis . The mean penetrations into the cerebrospinal fluid (CSF) in relation to the amount of drug in serum of animals infected with H . influenzae and E . coli were 25 and 54%, respectively . The median CSF bactericidal titers were 1:128 against both organisms at 1 h of uninfected animals, the mean penetration was 4.5% . There was a significant reduction in the concentrations of bacteria in CSFs of both groups of animals treated with cefpirome compared with that in untreated groups . Mortality was also significantly lower in treated animals than it was in untreated animals . Intravenous administration of dexamethasone before the cefpirome dose did not compromise penetration, bactericidal titers, or antibacterial activity of cefpirome in CSF. J Pediatr Surg, 1991 Feb, 26(2), 207 - 9 Microbiological studies of decubitus ulcers in children; Brook I; Specimens from 58 children with decubitus ulcers were cultured for aerobic and anaerobic bacteria . Aerobic bacteria only were present in 29 (50%) ulcers, anaerobic bacteria only were recovered in 5 (9%), and mixed aerobic and anaerobic flora were present in 24 (41%) . A total of 132 isolates (79 aerobes, 53 anaerobes) were recovered, an average of 2.3 isolates per specimen (1.4 aerobes, 0.9 anaerobes) . The smallest number of isolates was recovered in ulcers of the skull (1.7 per site), and the highest number of isolates was found in ulcers of the buttocks (4.1 per site) . The predominant isolates were Staphylococcus aureus (25 isolates), Peptostreptococcus species (22), Bacteroides fragilis group (10), and Pseudomonas aeruginosa (7) . Forty-two of the organisms isolated from 38 (66%) patients produced the enzyme beta-lactamase . Most of the S aureus isolates were recovered from ulcers of the hand and the leg . Organisms that resided in the mucous membranes close to the ulcer predominated in the wounds next to these areas . Enteric gram-negative rods, group D streptococci, and B fragilis group predominated in ulcers of the buttocks . Group A streptococci, Haemophilus influenzae, Bacteroides melaninogenicus group, and Fusobacterium species were most frequently recovered in ulcers of the skull . The polymicrobial etiology of decubitus ulcers in hospitalized children and the association of bacterial flora with the anatomical site of the ulcer are demonstrated. Pathol Biol (Paris), 1991 Feb, 39(2), 140 - 6 Adhesive properties of Haemophilus influenzae to different human cells; Jallat C et al.; The adhesion of 19 nontypable strains and 3 typable (type b) Haemophilus influenzae to human cells was examined using buccal epithelial cells (BEC), the continuous HEp-2 cell line and human 0 erythrocytes . The strains were classified into three phenotypes, according to their adhesive properties . Phenotype 1 consists of strains that adhere to both buccal epithelial cells and HEp-2 cells . Phenotype 2 consists of strains that adhere to both buccal epithelial cells and erythrocytes and strains belonging to phenotype 3 adhere to none of the three cell types used . Among 22 strains studied, 18 (81.8%) belonged to phenotype 1, 2 (9.1%) to phenotype 2 and 2 (9.1%) to phenotype 3 . Fimbriae were observed for 11 (61%) among the 18 adherent strains belonging to phenotype 1 . The 7 nonpiliated strains adhered with a significant adhesion index, thus this results would indicate that a non fimbrial adhesin exists. Am J Dis Child, 1991 Feb, 145(2), 223 - 7 Antibody responses to four Haemophilus influenzae type b conjugate vaccines; Kayhty H et al.; Serum antibody responses to four Haemophilus influenzae type b capsular polysaccharide-protein conjugate vaccines (PRP-D, HbOC, C7p, and PRP-T) were studied and compared in 175 infants, 85 adults and 140 2-year-old children . Antibodies to the H influenzae type b polysaccharide vaccines were determined with a Farr-type radioimmunoassay . The infants received two doses of vaccine at the ages of 4 and 6 months . After the first dose of vaccine, the geometric mean antibody concentration measured at the age of 6 months was 0.09 to 0.10 mg/L, only marginally higher than that measured before immunization in all infants who had received PRP-D, HbOC, or C7p but increased to 0.82 mg/L in those who had received PRP-T . One month after the second dose, the geometric mean antibody concentration was increased in all vaccine groups . No significant differences were noted between recipients of HbOC, C7p, or PRP-T (geometric mean antibody concentrations, 4.32, 3.10, and 6.10 mg/L, respectively), whereas the PRP-D recipients had a significantly lower geometric mean antibody concentration (0.63 mg/L) . In contrast, PRP-D, HbOC, C7p, and PRP-T were all highly immunogenic in adults, with no differences noted among them . The 2-year-old children also responded to one dose of these vaccines with a high antibody concentration. Arch Otolaryngol Head Neck Surg, 1991 Feb, 117(2), 179 - 81 Bacteriology of the ethmoid bullae in children with chronic sinusitis; Muntz HR et al.; Cultures from 105 children with chronic sinusitis who had failed aggressive medical management were retrospectively studied . Patients with immunodeficiency and cystic fibrosis were excluded from the study . Because the most common sites of disease were the infundibula and anterior ethmoid sinuses, samples of mucosa removed from the anterior ethmoid bullae during endoscopic ethmoidectomy were routinely cultured for aerobic and anaerobic organisms . Fungal cultures were performed for 55 bullae . The principal organisms isolated were alpha-hemolytic Streptococcus, Staphylococcus aureus, Moraxella catarrhalis, Streptococcus pneumoniae, and Haemophilus influenzae non-type B . Only 12 anaerobic organisms and four fungi were isolated . Of the 204 bullae cultured, multiple organisms were found in 61 bullae and 40 showed no growth . Isolates of other less common organisms were also found . These data are analyzed on the basis of age and duration of symptoms, and antibiotic treatment is described. Infect Immun, 1991 Feb, 59(2), 600 - 8 Contribution of a 28-kilodalton membrane protein to the virulence of Haemophilus influenzae; Chanyangam M et al.; A Haemophilus influenzae b (Hib) membrane protein with a molecular mass of 28 kDa bound polyclonal antisera raised against a highly purified Hib fimbrial subunit . We cloned the gene encoding this protein and found that the gene was expressed in Escherichia coli . DNA sequence analysis identified an 843-bp open reading frame which predicted a 26.78-kDa protein with an amino-terminal signal sequence and a mature protein with 70% similarity to the 28-kDa lipoprotein of E . coli (F . Yu, S . Inouye, and M . Inouye, J . Biol . Chem . 261:2284, 1986) . Colony blot hybridization analysis with an intergenic probe of the cloned gene demonstrated that 29 of 32 H . influenzae strains hybridize with this gene . Insertion of a chloramphenicol acetyltransferase gene into the open reading frame inactivated expression of the 28-kDa protein in E . coli . Isogenic Hib strains were derived by marker exchange mutagenesis to generate mutants which no longer expressed the 28-kDa protein as recognized with Western immunoblot analysis . There was no difference in the rate of nasopharyngeal colonization of infant rats or monkeys by the isogenic mutants which lacked the 28-kDa protein compared with colonization by the wild-type strain . In contrast, the frequency of invasion and density of bacteremia in infant rats caused by the isogenic mutants were reduced relative to those caused by the wild-type Hib strain . We conclude that this 28-kDa outer membrane protein aids transepithelial invasion of type b strains but is not essential. Infect Immun, 1991 Feb, 59(2), 544 - 9 Immunogenicity of Actinobacillus pleuropneumoniae outer membrane proteins and enhancement of phagocytosis by antibodies to the proteins; Thwaits RN et al.; To determine the opsonic effect of antibodies to Actinobacillus (Haemophilus) pleuropneumoniae outer membrane proteins on phagocytosis by porcine polymorphonuclear leukocytes (PMN), we separated the integral outer membrane proteins (IOMPs) by Triton X-114 extraction . Four major IOMPs with molecular masses of 76, 50, 39, and 29 kDa were detected by sodium dodecyl sulfate-polyacrylamide gel electrophoresis . These IOMPs were found to be essentially free of endotoxin in the Limulus amebocyte lysate assay . The 76-kDa protein exhibited a more intensely stained electrophoresis band when isolated from iron-restricted cultures, and a new band at 105 kDa was present in the whole-membrane fraction but not in the integral fraction, indicating that the 105-kDa iron-repressible protein is a peripheral membrane protein . The 76-, 50-, and 39-kDa proteins were shown to be surface exposed, since antibodies to these IOMPs could be absorbed out of convalescent-phase sera by whole cells . Percentages of phagocytosis by porcine PMN of A . pleuropneumoniae opsonized with convalescent-phase sera, convalescent-phase sera absorbed with IOMPs, or convalescent-phase sera absorbed with whole cells were 46.75, 21.81, and 7.96%, respectively . These results demonstrate that antibodies to IOMPs of A . pleuropneumoniae serve as important opsonins in phagocytosis by porcine PMN. Mol Cell Probes, 1991 Feb, 5(1), 37 - 48 Development of a species-specific DNA probe for Moraxella (Branhamella) catarrhalis; Beaulieu D et al.; Moraxella (Branhamella) catarrhalis is an aerobic Gram-negative diplococcus that is now recognized as a pathogen of the respiratory tract . Rapid and direct identification of this bacterium has become important to the clinical microbiology laboratory . Recently, rapid tests for the identification of Neisseria species and M . catarrhalis have been commercialized but they are primarily for Neisseriae; in these kits, M . catarrhalis is always identified presumptively . We have developed a DNA probe of chromosomal origin that is 100% specific for M . catarrhalis . The oligonucleotide probe was derived from a cloned Ase I chromosomal DNA fragment of M . catarrhalis that did not react with Haemophilus influenzae DNA in hybridization experiments . Three of the first 17 Ase I clones were selected randomly to be tested by colony hybridization against several different species that colonize the human respiratory tract . One of these three, pLQ121, has a 550 bp fragment inserted into pBR322 and was determined to be 100% specific to M . catarrhalis . This fragment was partially sequenced and a 30-mer oligonucleotide was synthesized from the sequence data . This probe was also shown to be 100% specific to the species. J Bacteriol, 1991 Feb, 173(4), 1561 - 4 A novel approach to insertional mutagenesis of Haemophilus influenzae; Sharetzsky C et al.; Insertional mutagenesis of the Haemophilus influenzae chromosome was accomplished by a novel method employing a 2.2-kbp element, TSTE . This element, consisting of the neo gene of Tn5 flanked by Haemophilus-specific uptake sequences, was ligated to circularized chromosomal fragments before transformation into the homologous strain . Eight mutants defective in the production of haemocin were detected . This strategy provides an efficient mechanism for the insertional mutagenesis of H . influenzae. J Antimicrob Chemother, 1991 Feb, 27(2), 161 - 70 The in-vitro and disc susceptibility testing of clarithromycin and its 14-hydroxy metabolite; Logan MN et al.; The in-vitro antibacterial activity of clarithromycin, its 14-hydroxy metabolite and a combination containing clarithromycin and the 14-hydroxy metabolite in a ratio of three parts of the former to one part of the latter were compared with erythromycin by determination of MICs . Disc susceptibility testing was also performed using discs containing 6 micrograms clarithromycin, 6 micrograms clarithromycin with 2 micrograms 14-hydroxy-clarithromycin, 3 micrograms clarithromycin and 3 micrograms clarithromycin with 1 microgram 14-hydroxy-clarithromycin . This was to determine a suitable disc content and minimum zone diameter to distinguish between sensitive and resistant strains using a breakpoint of 4 mg/l clarithromycin . Clarithromycin showed similar activity to erythromycin against Streptococcus pneumoniae and Haemophilus influenzae, although the 14-hydroxy metabolite was more active against H . influenzae . The clarithromycin/14-hydroxy metabolite combination was most active against beta-haemolytic streptococci (Groups A-C) (mode MIC 0.06 mg/l) . The parent compound and the combination were similarly active against Staphylococcus aureus (MIC50 0.12 mg/l) . Branhamella catarrhalis was more susceptible to clarithromycin (MIC90 0.06) than to erythromycin (MIC90 0.25 mg/l) . Activities of all compounds against S . epidermidis and enterococci were similar but against Neisseria species erythromycin was the more active compound . The 6 micrograms clarithromycin disc strength was found to give the most consistent results for all isolates . Using a breakpoint of 4 mg/l, minimum zone diameters indicative of sensitivity were as follows: 16 mm for staphylococci, 17 mm for respiratory pathogens and 11 mm for streptococci and Neisseria spp. Jpn J Antibiot, 1991 Feb, 44(2), 223 - 33 {Pharmacokinetic and clinical studies of cefpirome in pediatric field}; Haruta T et al.; We conducted a study on the pharmacokinetics and clinical application of cefpirome (CPR) in children . 1 . A single intravenous injection of 20 mg/kg of CPR was given to a two-month-old boy, and the concentration of the drug in the blood was measured . Fifteen minutes after administration, the concentration was 53.3 micrograms/ml, and it gradually decreased thereafter, reaching a level of 5.18 micrograms/ml after 8 hours with a half-life in the plasma of 2.36 hours . 2 . A single intravenous injection of 700 mg (50 mg/kg) of CPR and that of cefotaxime (CTX) were given to a girl with suppurative meningitis (3 years old, 14 kg, causative bacteria, Haemophilus influenzae), and concentrations of the drugs in plasma and cerebrospinal fluid after 1 hour were measured . On the second day of illness, the concentration of CTX in the plasma was 39.4 micrograms/ml and the concentration of desacetyl-CTX (D-CTX) was 25.2 micrograms/ml, while concentrations in the cerebrospinal fluid were 6.22 micrograms/ml (15.8%) for CTX and 3.94 micrograms/ml (15.6%) for D-CTX . On the third day of illness, concentration of CPR in the plasma was 59.3 micrograms/ml, while its concentration in the cerebrospinal fluid was 7.44 micrograms/ml (12.5%) . 3 . CPR was intravenously administered in daily dosages of 37.7-75.0 mg/kg in 2-3 portions for periods of 4-15 days to 2 patients with septicemia (causative bacteria, Klebsiella pneumoniae in 1 case and Escherichia coli in the other), 1 patient with bronchitis (K . pneumoniae), 9 patients with pneumonia (1 case of Staphylococcus aureus, 3 cases of H . influenzae, 2 cases of Haemophilus parainfluenzae, 1 case of K . pneumoniae + Pseudomonas cepacia, 2 cases of H . influenzae + Branhamella catarrhalis), 2 patients with cellulitis (1 case of S . aureus, 1 case, causative agent unknown), 1 patient with suppurative lymphadenitis (causative agent, unknown), 1 patient with staphylococcal scalded skin syndrome, 1 patient with renal abscess (causative agent, unknown), and 1 patient with a urinary tract infection (E . coli), for a total of 18 patients, with excellent results in 9 cases and good results in 9 cases, hence an efficacy rate of 100% was obtained . 4 . As an accompanying side-effect, eruption was observed in 1 of the 18 patients, but when administration was discontinued, the symptom gradually receded, and it disappeared by the 4th day.(ABSTRACT TRUNCATED AT 400 WORDS) J Antimicrob Chemother, 1991 Feb, 27 Suppl A, 31 - 41 Individual and combined activities of clarithromycin and its 14-hydroxy metabolite in a murine model of Haemophilus influenzae infection; Vallee E et al.; Clarithromycin is metabolised in man mainly to the 14-hydroxy derivative, which is also biologically active . As this metabolite is not produced in rodents, we used a murine model of Haemophilus influenzae pulmonary infection to compare the in-vivo activity of clarithromycin and 14-hydroxy clarithromycin, alone and in combination, and erythromycin . In terms of bacterial killing, clarithromycin's 14-hydroxy metabolite was much more active than clarithromycin and erythromycin at doses of 100 mg/kg . For the combination tests, low doses of 14-hydroxy clarithromycin (12, 16 and 24 mg/kg) were ineffective alone but potentiated the bactericidal activity of clarithromycin (100 mg/kg) (P less than 0.01-0.001) . The in-vivo results can be explained by in-vitro and pharmacokinetic data: the MIC and MBC of 14-hydroxy clarithromycin are half those of clarithromycin and erythromycin, while the combination of clarithromycin and its metabolite was synergistic in terms of bacteriostatic and bactericidal activities . Potentially useful levels of 14-hydroxy clarithromycin were found after oral administration of low doses, with a prolonged half-life compared with that of the parent compound . On the basis of these results it appears that the 14-hydroxy metabolite may have an important role to play in the treatment of bronchopulmonary infections in man due to H . influenzae. J Antimicrob Chemother, 1991 Feb, 27 Suppl A, 19 - 30 The activity of clarithromycin and its 14-hydroxy metabolite against Haemophilus influenzae, determined by in-vitro and serum bactericidal tests; Dabernat H et al.; The in-vitro activity of clarithromycin and its main metabolite 14-hydroxy clarithromycin against Haemophilus influenzae was evaluated by determining minimum inhibitory and minimum bactericidal concentrations . The 14-hydroxy metabolite was more active than the parent compound against H . influenzae . The activity of the parent compound/metabolite combination was evaluated against 20 strains of H . influenzae by the chequerboard technique . The combination was synergistic against seven isolates in terms of fractional bactericidal concentration index and against five isolates in terms of fractional inhibitory concentration index; the combination demonstrated additive activity against the remaining strains . Serum bactericidal activity against H . influenzae was measured in sera from six healthy volunteers who had received 250 mg clarithromycin by mouth . The area under the serum bactericidal activity curve correlated with the area under the curves for clarithromycin and 14-hydroxy clarithromycin, and with the in-vitro susceptibility of the strains tested . Serum bactericidal activity was detected at 30 min after dosing and lasted for 5-6 h. J Antimicrob Chemother, 1991 Feb, 27 Suppl A, 11 - 7 In-vitro activity of clarithromycin combined with its 14-hydroxy metabolite A-62671 against Haemophilus influenzae; Olsson-Liljequist B et al.; Clarithromycin and its 14-hydroxy metabolite (A-62671), were tested against 20 strains of Haemophilus influenzae . Minimum inhibitory and bactericidal concentrations of the two compounds alone and in combination were determined in a microbroth system which allowed continuous turbidimetric measurement for the construction of growth curves . MICs of clarithromycin were 2-8 and 1-4 mg/l for A-62671 for the majority of strains . MBCs were identical to or one dilution higher than the respective MICs . Combinations of the two compounds were inhibitory or bactericidal at concentrations that were lower than the MICs or MBCs . On the basis of fractional inhibitory (FIC) or fractional bactericidal (FBC) concentration indices, the interactions between clarithromycin and its metabolite were defined as additive. J Antimicrob Chemother, 1991 Feb, 27 Suppl A, 109 - 16 Comparative study of clarithromycin and roxithromycin in the treatment of community-acquired pneumonia; Poirier R; The efficacy and tolerance of clarithromycin (250 mg twice daily) were compared with those of roxithromycin (150 mg twice daily) in an open, multicentre trial of 77 inpatients with community-acquired pneumonia . Sixty-five patients were clinically evaluable (34, clarithromycin; 31 roxithromycin) . Efficacy was comparable between treatment groups: 26 of 34 patients (76%) treated with clarithromycin were clinically cured, including four with atypical pneumonia . In the roxithromycin group 25 of 31 patients (81%) were clinically cured and one was improved . Cough, appearance of sputum, and fever improved in most patients in both treatment groups . Chest X-rays after treatment showed resolution or improvement in 76% of patients who received clarithromycin and 87% of those who received roxithromycin . The clinical evaluation of the response generally agreed with the bacteriological response . Among patients who were bacteriologically evaluable for four target organisms (Streptococcus pneumoniae, Haemophilus influenzae, H . parainfluenzae, and Branhamella catarrhalis) the pathogen was eradicated in four of seven (57%) in the clarithromycin-treated group and in five of six (83%) in the roxithromycin-treated group . Adverse events were reported in more patients who received roxithromycin (21.6%) than in those who received clarithromycin (12.5%) although the incidences were not statistically significantly different . The majority of adverse events were transient increases in serum alanine aminotransferase, serum aspartate aminotransferase, and alkaline phosphatase . Clarithromycin was shown to be effective and well-tolerated; the clinical efficacy and safety of clarithromycin and roxithromycin were comparable. In Vitro Cell Dev Biol, 1991 Feb, 27A(2), 113 - 20 Blood-brain barrier alterations in bacterial meningitis: development of an in vitro model and observations on the effects of lipopolysaccharide; Tunkel AR et al.; To further examine the effects of purified Haemophilus influenzae type b lipopolysaccharide (LPS) on blood-brain barrier permeability, we have developed an in vitro model of the BBB . Microvascular endothelial cells were isolated from rat cerebral cortices by enzymatic digestion, dextran centrifugation, and separation on percoll gradients . The cells were determined to be endothelial in origin by positive fluorescent staining for Factor VIII-related antigen and the ability to take up acetylated low density lipoproteins, and their cerebral origin by the formation of junctional complexes in vitro . Cells were seeded onto semipermeable polycarbonate filters and permeability assessed by measuring traversal of radioactive albumin across the monolayer . Treatment of the cells with LPS at concentrations of 1.0 microgram/ml and 0.1 microgram/ml for 4 h led to statistically significant increases in albumin permeability of 4.6% (P = 0.001) and 5.6% (P less than 0.001), respectively, without evidence of cell death as assessed by release of lactate dehydrogenase into the media . These results indicate that LPS significantly increases albumin permeability across a monolayer of cerebral microvascular endothelial cells in the absence of host inflammatory cells . Future studies on the effects of LPS on intracellular regulation will determine the mechanisms responsible for these alterations. J Gen Microbiol, 1991 Feb, 137 ( Pt 2), 277 - 85 The development of specific rRNA-derived oligonucleotide probes for Haemophilus ducreyi, the causative agent of chancroid; Rossau R et al.; Part of a ribosomal ribonucleic acid (rRNA) cistron of Haemophilus ducreyi was enzymically amplified using conserved primers within the rRNA molecules, cloned in a plasmid vector, and sequenced . From the nucleotide sequence, eight oligonucleotides complementary to different regions in the 16S and 23S rRNA molecules were selected, chemically synthesized, and used as hybridization probes . Hybridization experiments with at least 41 H . ducreyi strains and 13 or 14 non-H . ducreyi strains revealed that all eight oligonucleotide probes were highly reliable and completely specific for H . ducreyi strains . Comparisons of 16S rRNA sequences confirm that H . ducreyi is a member of the Pasteurellaceae though not closely related to other species in this family. J Clin Microbiol, 1991 Feb, 29(2), 291 - 6 Characterization of noncapsulate Haemophilus influenzae by whole-cell polypeptide profiles, restriction endonuclease analysis, and rRNA gene restriction patterns; Bruce KD et al.; Thirty-four clinical isolates of noncapsulate Haemophilus influenzae representing isolates with either related or dissimilar patterns of whole-cell polypeptide profiles on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) were further characterized by restriction enzyme analysis (REA) and rRNA gene restriction patterns . Total cellular DNA was extracted by a rapid, microcentrifuge-scale method and digested with BamHI, which gave a pattern of about 18 discrete bands . This confirmed the five closely related groupings suggested by SDS-PAGE . Isolates dissimilar by SDS-PAGE were also distinguishable by REA . However, there was no correlation between the degrees of similarity estimated from whole-cell polypeptide profiles and those obtained from REA for the dissimilar isolates . Therefore, inferences of genetic relatedness made on the basis of these data should be interpreted with caution . rRNA gene restriction patterns also confirmed the groupings suggested by the other two techniques . We conclude that the three methods were highly discriminatory and that whole-cell polypeptide patterns or REA with BamHI would be appropriate techniques for epidemiological studies of noncapsulate H . influenzae. Schweiz Med Wochenschr, 1991 Jan 26, 121(4), 105 - 9 Cystic fibrosis: infection; Hoiby N; Recurrent and chronic pulmonary infection is still the major cause of morbidity and mortality in cystic fibrosis . Although respiratory viruses are responsible for some of the acute exacerbations of the pulmonary disease, bacteria, and in some patients Aspergillus fumigatus, are the most important pathogens . Staphylococcus aureus and Haemophilus influenzae are the most prevalent pathogens in cystic fibrosis of childhood, whereas Pseudomonas aeruginosa and in some centres also Pseudomonas cepacia predominate in older children and adult patients . The chronic Pseudomonas aeruginosa infection is peculiar, since it is predominantly an endobronchial infection in small bronchioles caused by mucoid, alginate producing strains which gradually lose most of the O-antigenic determinants of the lipopolysaccharide . Although P . aeruginosa produces a number of other toxins which may play a role initially, most if not all of the pathology is caused by immune complex mediated chronic inflammation . The bacteriological results of antipseudomonas chemotherapy are disappointing, as these bacteria are virtually never permanently eliminated . The clinical results of repeated maintenance chemotherapy every 3 months are, however, good, since it is possible to preserve lung function for years and keep the patients alive . Antiinflammatory treatment with steroids for years is used in some patients with benefit. FEMS Microbiol Lett, 1991 Jan 15, 61(2-3), 283 - 7 Isolation and characterisation of Haemophilus influenzae type b mutants defective in transferrin-binding and iron assimilation; Holland J et al.; The quinone antibiotic streptonigrin was used to select mutants of Haemophilus influenzae type b defective in human transferrin binding . Compared with the parent wild-type strain (JKP1), mutant JKP5 was unable to bind transferrin whilst mutant JKP4 showed reduced binding . JKP5 appeared to lack an approximately 72 kDa transferrin-binding protein . Unlike JKP1, neither JKP4 nor JKP5 were able to acquire iron from human transferrin but their ability to use a variety of other iron and haem compounds as iron sources was unaffected . Such mutants should prove useful in further elucidating the mechanism of transferrin iron-acquisition and its contribution to the virulence of H . influenzae. Am J Epidemiol, 1991 Jan 15, 133(2), 154 - 63 Group day care and the risk of serious infectious illnesses; Berg AT et al.; Group day care attendance has been associated with an increased risk of infectious illnesses . With the exception of illnesses caused by Haemophilus influenzae type b (H . influenzae) and Neisseria Meningitidis (N . meningitidis), most studies have examined relatively mild illnesses . A matched case-control study was conducted to study the association between group day care attendance and serious infectious illnesses (requiring hospitalization) . Cases were children aged 3 months to 59 months hospitalized for an infectious illness at Yale-New Haven Hospital from June 1984 through November 1986 . Each case was matched to a control by date of birth and regular pediatrician, and their parents were interviewed . Data from 193 matched pairs were analyzed using conditional logistic regression . The matched odds ratio (OR) for the association between group day care attendance and serious infectious illness was 1.39 (95% confidence interval (CI) 0.87-2.20) . For pairs in which the case had an H . influenzae infection (n = 46), the odds ratio was 8.00 (95% CI 1.00-63.85), and for N . meningitidis (n = 9) the odds ratio was 2.00 (95% CI 0.39-10.27) . In the remaining 138 pairs, the odds ratio was 1.27 (95% CI 0.76-2.12) . In infants less than 12 months of age (n = 64) the odds ratio for group day care and illnesses (excluding H . influenzae and N . meningitidis) was 1.66 (95% CI 0.73-3.80) and it was 1.06 (95% CI 0.55-2.05) for older children (n = 74) . The data suggested an association between day care attendance and invasive bacterial infections other than H . influenza and N . meningitidis, OR = 2.00 (95% CI 0.81-4.94) but not for local bacterial infections, OR = 1.00 (95% CI 0.25-4.00) or infections of presumed viral etiology, OR = 1.00 (95% CI 0.49-2.05) . Important predictors of serious infections (excluding H . influenzae and N . meningitidis) were passive smoking (OR = 3.96, 95% CI 2.16-7.24) and sharing a bedroom (OR = 2.31, 95% CI 1.23-4.33) . These findings do not suggest that group day care attendance poses a large risk of serious infections (other than H . influenzae or N . meningitidis) to young children; however, at least one preventable factor, passive smoking, may. Antimicrob Agents Chemother, 1991 Jan, 35(1), 192 - 4 Comparison of the activity of cefixime and activities of other oral antibiotics against adult clinical isolates of Moraxella (Branhamella) catarrhalis containing BRO-1 and BRO-2 and Haemophilus influenzae; Nash DR et al.; MICs of 10 oral antibiotics were determined for 105 Moraxella catarrhalis and 96 Haemophilus influenzae isolates from adults . A two- to fourfold increase in MICs of oral cephalosporins was seen in the presence of BRO-1 but not with TEM-1 or BRO-2 . The MICs of cefixime for 90% of strains of H . influenzae (0.125 microgram/ml) and M . catarrhalis (0.25 microgram/ml) were 8- to 64-fold lower than those of other oral cephalosporins. Adv Exp Med Biol, 1991, 303, 185 - 90 Augmentation by interleukins of the antibody response to a conjugate vaccine against Haemophilus influenzae b; Bixler GS Jr et al.; Interleukins have been recognized as potential adjuvants for use during vaccination . The immunogenicity of some poorly immunogenic bacterial capsular polysaccharides have been improved by conjugation to a protein carrier . Augmentation of the immune response to these glycoconjugates, however, may be realized in the presence of interleukins . The antibody response to one such vaccine which comprises a oligosaccharide derived from the capsule of Haemophilus influenzae type b coupled to CRM197 (HbOC) can be augmented in this manner . A suboptimal dose (0.1 microgram) of HbOC and varying concentrations of IL-1 alpha or IL-1 beta (10(2) - 5 x 10(5) U) were injected intramuscularly at 0 and 2 weeks into Swiss Webster mice . Vaccines were also formulated with and without aluminum phosphate . Antibody to the oligosaccharide was determined by Farr assay . In 3/3 experiments, IL-1 alpha enhanced primary and secondary antibody responses whereas with IL-1 beta, only a slight increase in the primary antibody response was seen but enhanced secondary responses were observed . Thus, IL-1 alpha and to some extent IL-1 beta enhanced the primary and secondary antibody responses to a glycoconjugate vaccine. MMWR Recomm Rep, 1991 Jan 11, 40(RR-1), 1 - 7 Haemophilus b conjugate vaccines for prevention of Haemophilus influenzae type b disease among infants and children two months of age and older . Recommendations of the immunization practices advisory committee (ACIP). {Costs and benefits of vaccination against Haemophilus influenzae type b} Martens LL, ten Velden GH, Bol P. Abt Associates Inc., Cambridge, MA 02138-1168In the Netherlands, Haemophilus influenzae type b (Hib) causes invasive disease in hundreds of children every year; meningitis is the most frequent and most severe infection . Children from the age of 6 months can be protected against Hib-diseases by conjugated vaccines . The financial consequences of the introduction of such vaccine into the state vaccination programme are considered in a cost-effectiveness analysis . Some elements in the analysis are still uncertain, such as the price and the schedule and method of administration of the vaccine . Presumably, the costs and benefits will be in balance, if one vaccine dose will cost about 7 US $+ and if the administration can be combined with the present programme of vaccinations against diphtheria, whooping cough, poliomyelitis and tetanus. Neurol Croat, 1991, 40(1), 31 - 7 {Posttraumatic purulent meningitis in patients treated at the Clinic for Infectious Diseases at the Rijeka Clinical Center, 1980-1989}; Brncic-Dabo N; During the period from 1980 to 1989 seven patients with posttraumatic purulent meningitis (PTPM) were treated at the Clinic for Infectious Diseases of Rijeka Clinical Centre . These accounted for 11.1% of total purulent meningitis cases of the same period . Three PTPM patients had recurrent attacks of meningitis . The age range of was the PTPM patients from 5 to 49 years; men prevailed in the ratio of 6 to 1 . The etiology was confirmed in five cases (in four Streptococcus pneumoniae, in one Haemophilus influenzae) . One of these yielded Penicillin G resistant Str . pneumoniae . The average duration of antibacterial therapy was 20.5 days . Two patients acquired lasting sequelae but there were no lethal outcomes. AIDS, 1991 Jan, 5(1), 69 - 75 HIV-2 infection among prostitutes working in The Gambia: association with serological evidence of genital ulcer diseases and with generalized lymphadenopathy; Pepin J et al.; Three hundred and fifty-five prostitutes working in The Gambia were enrolled in a study of retroviral infections . Eight-seven (24.6%) were infected with HIV-2 only, two (0.6%) with HIV-1 only, four (1.1%) had sera showing double HIV-1/HIV-2 reactivity, and 37 (10.4%) were seropositive for HTLV-I . After allowing for socioeconomic and serological variables in a multivariate analysis, HIV-2 infection was associated with serological evidence of a previous episode of syphilis {a rapid plasma reagin (RPR) positive/Treponema pallidum haemagglutination assay (TPHA) positive; odds ratio (OR) = 2.18, 95% confidence interval (CI) = 1.19-3.98}, with having antibodies against Haemophilus ducreyi (OR = 2.05, 95% CI = 0.89-4.70) or against HTLV-I (OR = 2.17, 95% CI = 0.91-5.19) . HIV-2-seropositive prostitutes were three times more likely {17 out of 78 (22%) versus 15 out of 219 (7%), P less than 0.001} to have generalized lymphadenopathy than those who were seronegative . These data suggest that genital ulcer diseases may facilitate the transmission of HIV-2, and that HIV-2 rapidly induces the appearance of generalized lymphadenopathy in a substantial proportion of infected individuals. Res Vet Sci, 1991 Jan, 50(1), 81 - 5 Experimental reproduction of ovine vulvitis with bacteria of the haemophilus/histophilus group; Ball HJ et al.; Ovine vulvitis was experimentally reproduced by intravaginal inoculation of a mixture of bacterial strains of the histophilus/haemophilus group isolated from field cases . Grossly, the experimental vulvitis was identical to the field condition, and bacteria indistinguishable from the inoculated strains were reisolated. Eur J Pediatr, 1991 Jan, 150(3), 183 - 4 Haemophilus influenzae epiglottitis occurring simultaneously in two siblings; Trop M et al.; Intrafamilial spread of Haemophilus influenzae type B disease has often been described for meningitis, but rarely for epiglottitis . Here we report for the first time epiglottitis occurring simultaneously in two siblings and comment on the value of chemoprophylaxis and vaccination to prevent secondary and primary disease. Jpn J Antibiot, 1991 Jan, 44(1), 84 - 109 {Bacteriological, pharmacokinetic and clinical evaluations of cefpirome sulfate in the pediatric field . Pediatric Study Group of Cefpirome}; Fujii R et al.; A research group was organized with the purpose of making basic and clinical studies on cefpirome sulfate (HR810, CPR), a newly developed cephalosporin antibiotic, in the pediatric field . Through meetings a joint research was done involving 19 key institutions and their related facilities throughout Japan . The obtained results are summarized as follows . 1 . Antibacterial Activities Minimum inhibitory concentrations (MICs) were determined against 71 Gram-positive and 110 Gram-negative bacteria in the present clinical trials . CPR showed antibacterial activities 2-16 times higher than those of ceftazidime (CAZ) against Staphylococcus aureus and other Gram-positive bacteria including MRSA . Against Gram-negative bacteria, CPR showed a somewhat broad range of distribution in MIC against Branhamella catarrhalis, while the antibiotic inhibited the growth of all the strains of Escherichia coli and Haemophilus influenzae at concentrations no more than 0.10 and 0.20 micrograms/ml, respectively . 2 . Blood Concentrations and Urinary Excretion Rates The pharmacokinetics in pediatric patients was investigated with a dose of 20 mg/kg in most cases via one shot intravenous injection or 30- and 60-minute intravenous drip infusion . Mean blood concentrations of CPR at 15 minutes after one shot intravenous injection of 10, 20, and 40 mg/kg were 51.2, 70.5, and 123.5 micrograms/ml, with half-lives of 1.21, 1.39, and 1.53 hours, respectively . Urinary excretion rates in 6 hours were 63.6, 66.0 and 71.6%, respectively for the 3 dose levels . After 30- and 60-minute intravenous drip infusions at the same dose, the pharmacokinetic parameters observed were similar to those obtained with one shot injections . 3 . Concentration in the Cerebrospinal Fluid CPR penetrated well into the cerebrospinal fluid in patients with purulent meningitis and levels of 1.85-24.2 micrograms/ml 45-60 minutes were achieved after intravenous injection at a dose of 40-80 mg/kg, the penetration rate of CPR was at an intermediate degree compared with other cephalosporin antibiotics . 4 . Clinical Results Clinical efficacies of CPR on infectious diseases were analyzed in 454 plus 3 cases which were complicated with other infectious diseases, hence totaling 457 cases out of 499 cases originally chosen for clinical evaluation . The remaining 45 cases were excluded from the clinical evaluation . As for the clinical efficacy, CPR was found to be effective (good or excellent) in 430 (94.1%) of the 457 cases . CPR was found to be effective in 243 (95.3%) of 255 cases for which causative bacteria were identified . The efficacy rate was 92.6% (187 of 202) in those cases in which causative bacteria were not identified.(ABSTRACT TRUNCATED AT 400 WORDS) Jpn J Antibiot, 1991 Jan, 44(1), 35 - 47 {Clinical evaluation of cefixime in pediatric respiratory tract infections}; Iwai N et al.; Cefixime (CFIX) was evaluated clinically in pediatric respiratory tract infections, particularly those caused by Haemophilus influenzae: 1 . The total number of children in this study treated with CFIX was 232, out of which 215 cases were evaluated for clinical efficacy and 224 cases were investigated for safety . A daily dosage of 3-6 mg/kg/day was given divided into 2 to 3 times daily for 3-15 days . 2 . Causative organisms were identified in 146 cases, out of which 128 cases were found to be single microbial infections and 18 cases were mixed infections . In single microbial infections, clinical efficacy was 100% for those caused by H . influenzae/Haemophilus parainfluenzae, and was 95% for Streptococcus pyogenes with an overall efficacy of 96.9% . In mixed infections, the clinical efficacy was 100% for those caused by a combination of H . influenzae and Streptococcus pneumoniae, and the overall rate was 94.4% . An involvement of H . influenzae was observed in 108 cases with a clinical efficacy rate of 99.1%, and definite involvement of beta-lactamase secreting strains of H . influenzae was found in 32 cases with a clinical efficacy of 96.9% . 3 . Bacteriological effect was studied for 164 strains identified in 146 cases, and eradication rates were 89.5% for H . influenzae, 100% for H . parainfluenzae and S . pyogenes, and 71.4% for S . pneumoniae . The overall eradication rate was 91.4% . Superinfection was observed in 21 cases . MICs against 78 strains of H . influenzae were in a range of less than or equal to 0.10 microgram/ml regardless of beta-lactamase production, and far superior to cefaclor and amoxicillin . MICs against S . pyogenes and S . pneumoniae were in ranges of less than or equal to 0.10 microgram/ml and 0.39 micrograms/ml, respectively . 4 . Clinical efficacy was 93.0% in 215 cases (excellent: 136, good: 64, fairly good: 10, poor: 5) . CFIX attained a high efficacy in the range of 89.4-95.7% in acute pharyngitis, acute tonsillitis, acute bronchitis and acute pneumonia . 5 . Safety was monitored in 224 cases and there were only one case of loose stool and another of diarrhea as side effects . There were no abnormal findings in 31 cases of the laboratory test . In conclusion, it was confirmed that CFIX is excellent and safe in the treatment of the respiratory tract infections. Zhonghua Kou Qiang Yi Xue Za Zhi, 1991 Jan, 26(1), 11 - 4, 61 {Determination of DNA base composition and levels of DNA-DNA hybridization of Actinobacillus actinomycetemcomitans}; Han N; Using the strains of Actinobacillus actinomycetemcomitans (Aa) and Haemophilus aphrophilus (Haph) in experiments, the mole percent quanine plus cytosine content (mol% G + C) and level of DNA-DNA hybridization (DNA homology) were determined for the first time in oral microbiologic study in China . DNA was extracted by Marmur's method . The mol% G + C of DNA was determined by thermal denaturation method (Tm) . DNA-DNA hybridization was carried out by De Ley's optical procedure (initial renaturation rate) . The results are as follows: 1 . The mol% G + C of DNA of Aa is different from that of Haph . 2 . 2 strains of Aa had high DNA homology (73.8%) and the DNA homology between Aa and Haph was low (33.9%) . It was confirmed that Aa and Haph are different species . In order to identify the bacteria in periodontal pockets accurately, it is necessary to carry out the nucleic acid study in bacterial classification. Clin Ther, 1991 Jan-Feb, 13(1), 181 - 8 Continuous activity of significant antibiotics; Bergogne-Berezin E; Respiratory tract infections (RTIs) are the primary cause of antibiotic use in general practice . Since the first penicillin was introduced for therapeutic purposes, several classes of antibiotics have been used in the treatment of community-acquired RTIs . The phase when penicillins G and V could be active in RTIs was relatively short lived due to the early emergence of resistant organisms . Ampicillin and amoxicillin have been used successfully for more than 20 years in the treatment of RTIs . In the late 1950s and 1960s, erythromycin, tetracyclines, and co-trimoxazole were also prescribed for RTIs . In the 1970s, other molecules belonging to the cephalosporin class of antibiotics, such as cephalexin, cephaloglycin, cefadroxil, and cephradine, were introduced in general practice for the same indication . Susceptibility of the predominant respiratory pathogens to these antimicrobial agents lasted for many years . However, Haemophilus influenzae responded poorly to erythromycin, and up to 30% of pneumococcal and streptococcal strains are resistant to macrolides, tetracyclines, and co-trimoxazole . Since 1976, increasing percentages of beta-lactamase producers (up to 20% in 1989) were found among Haemophilus species, and Moraxella catarrhalis, a frequent beta-lactamase producer, is increasingly isolated as a respiratory pathogen . These problems have led to the development of additional compounds, most characterized by their stability in the presence of beta-lactamases, such as amoxicillin + clavulanic acid, or exhibiting relative resistance to enzymatic inactivation, such as cefaclor . Treatment today of most RTIs also takes into account the cost-effectiveness relationship of these antibiotics. Clin Ther, 1991 Jan-Feb, 13(1), 149 - 56; discussion 148 Respiratory tract infections: when is antibiotic therapy indicated? Lode H. Antibiotic therapy of purulent bronchitis is a matter of continuing controversy . However, recent studies on the pathogenicity of airway hyperreactivity, granulocyte-mediated bronchial obstruction, and histamine production of Haemophilus influenzae indicate an important role for viral and bacterial infections in exacerbations of chronic obstructive lung disease (COLD) . Considering the different stages of COLD in relation to lung function, bacterial pathogens, and relevant findings and symptoms of the individual patient, antibiotic treatment should be based on three different degrees of severity. Scand J Infect Dis, 1991, 23(1), 111 - 3 Serious systemic infection caused by non-encapsulated Haemophilus influenzae biotype III in an adult; Lester A et al.; Haemophilus influenzae is the aetiological agent in less than 1% of septic arthritis cases in adults and most often serotype b is involved . We report here a case of severe systemic infection due to non-encapsulated H . influenzae biotype III in a 40-year-old man, previously healthy although alcohol abuser . Cholangitis and acute alcoholic hepatitis were diagnosed simultaneously . The organism was grown from blood and from synovial fluid of the left knee, but several other joints were also affected . The close relationship between H . influenzae biotype III and H . aegyptius is mentioned in view of recent reports of fatal childhood illness caused by a special clone of H . aegyptius and the importance of reporting both serotype and biotype in severe H . influenzae induced disease is emphasized. Rev Infect Dis, 1991 Jan-Feb, 13 Suppl 2, S156 - 9 Management of children with occult bacteremia who are treated in the emergency department; Fleisher GR; Occult bacteremia, which precedes many serious infections in children, is most often due Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, or Salmonella species . Diagnosis on the basis of clinical judgment is unreliable, although the presence of certain risk factors may suggest the diagnosis . These risk factors include an age of 3 months to 3 years, a temperature of greater than or equal to 39.0 degrees C, and a white blood cell count of greater than or equal to 15,000/mm3 . Although results are delayed, a culture of blood is the only definitive test . Studies suggest that treatment with various antibiotics may be helpful, but that some drugs, particularly orally administered amoxicillin, should not be relied on to eliminate occult bacteremia or prevent its most serious sequela, meningitis. Rev Infect Dis, 1991 Jan-Feb, 13(1), 61 - 3 Haemophilus influenzae polyarthritis in an adult: an analysis of serotype b strains; Moeser PJ et al.; A 61-year-old man who presented with clinical features suggestive of septic arthritis was found to have acute septic polyarthritis due to Haemophilus influenzae (type b) . The clinical and laboratory diagnoses of the case are presented, and the isolates of H . influenzae are characterized . Four isolates recovered from different sites had identical minimal inhibitory drug concentrations, outer membrane protein patterns, and genomic DNA restriction digests . These observations indicate that the disseminated infection arose from a single source . The patient developed antibody to several outer membrane proteins, particularly the P6 protein. Chemotherapy, 1991, 37(1), 38 - 42 Antibacterial effects of meropenem and imipenem against Haemophilus influenzae; Yourassowsky E et al.; Phase contrast microscopy, killing curves and turbidimetric growth curves were used in a comparative study of the antibacterial effects of imipenem and meropenem on Haemophilus influenzae . The minimal inhibitory concentrations (MICs) and their ranges of meropenem and imipenem using five beta-lactamase-producing strains of H . influenzae were 0.03 (0.015-0.06) and 0.6 (0.5-1) micrograms/ml, respectively . Imipenem and meropenem induced spheroplast formation in cultures . Killing curves showed a bacteriostatic activity for meropenem and imipenem for MIC values, and a lag of 2 h in killing for MIC x 2 to MIC x 64 . For these concentrations the killing rates of the two antibiotics were similar . Turbidimetric growth curves showed a higher early increase in optical density for meropenem . As far as the MIC value of meropenem was 10 times lower than the MIC value of imipenem, we may conclude that meropenem was more active than imipenem on beta-lactamase-producing strains of H . influenzae. Pathol Biol (Paris), 1991 Jan, 39(1), 38 - 41 {Natural immunity to Haemophilus influenzae type b . ELISA study of the distribution of IgG, IgG1 and IgG2 in France and Africa}; Vincent-Ballereau F et al.; A Haemophilus influenzae type b capsular polysaccharide-tetanus toxoid conjugate vaccine will be released for use in infants in developing and industrialized countries in the near future . This prompted a comparative study of the natural immunity of mothers and passive immunity of their newborns in France and Africa . An ELISA method capable of discriminating immunoglobulin classes and subclasses was used . Monoclonal antibodies were used to determine titers of IgG1 and IgG2 antibodies . Because capsular polyribose ribitol phosphate does not bind readily to polystyrene, the plate was coated with streptavidine which bound to biotin linked to the antigen . Antibody titers were found to be identical in French and African study groups . Both IgG1 and IgG2 antibodies were found, often with higher titers for the latter . Both subclasses were found in cord blood of French and African children. Pediatr Infect Dis J, 1991 Jan, 10(1), 42 - 7 Etiology of acute lower respiratory tract infections in Gambian children: II . Acute lower respiratory tract infection in children ages one to nine years presenting at the hospital; Forgie IM et al.; Seventy-four children ages 1 to 9 years hospitalized because of severe pneumonia were investigated using blood cultures, lung aspirates, nasopharyngeal aspirates, serology and antigen detection procedures . A bacterial infection was identified in 57 (77%), a viral infection was seen in 25 (34%) and 18 (24%) had mixed viral-bacterial infections . The bacterial pathogens most frequently identified were Streptococcus pneumoniae and Haemophilus influenzae found in 61 and 15% of patients, respectively . The viral pathogen most frequently recovered was respiratory syncytial virus (12%) . Evidence of Chlamydia pneumoniae strain TWAR and Mycoplasma pneumoniae infection was found in 12 and 4% of cases, respectively . Overall a potential pathogen was identified in 60 (81%) children, with evidence of polymicrobial infection in 30 cases (40.5%) . The study provides information on the relative role of different infectious agents in the etiology of severe pneumonia in children in a developing country. Pediatr Pulmonol, 1991, 10(1), 11 - 7 Ultrastructural ciliary defects in children with recurrent infections of the lower respiratory tract; Barlocco EG et al.; One hundred fifty-four children with recurrent or chronic infections of the lower respiratory tract compatible with the diagnosis of primary ciliary dyskinesia (PCD) were evaluated for the presence of ultrastructural ciliary abnormalities . Studies were performed on multiple samples of respiratory mucosa obtained by nasal and bronchial brushing . Twenty-eight children showed ultrastructural ciliary defects compatible with the diagnosis of PCD: Twenty-four presented dynein arm deficiency (either as isolated defect or in association with microtubular abnormalities), two had ciliary aplasia, and two showed microtubular abnormalities . Eleven patients with PCD had situs viscerum inversus, bronchiectasis, and chronic sinusitis (Kartagener's syndrome); one child with Kartagener's syndrome had normal ciliary structure . The appearance of respiratory symptoms within the first month of life, the colonization by Haemophilus influenzae, and a history of recurrent rhinitis and otitis were characteristically present in children with PCD . The clinical status of those patients who reached adolescence was, in our experience, remarkably good . An early diagnosis with adequate prevention and therapy of respiratory infections may have an important role in minimizing irreversible lung damage. J Infect, 1991 Jan, 22(1), 59 - 69 Humoral immune response to pneumococcal antigen 23-F in an asplenic patient with recurrent fulminant pneumococcaemia; Zimmerli W et al.; Host defence mechanisms were analysed in a patient with three episodes of fulminant pneumococcaemia and one episode of bacteraemic epiglottitis with Haemophilus influenzae type b . The first episode took place 11 years after splenectomy for blunt abdominal trauma . Investigations revealed several host defence mechanisms to be impaired . In addition to the patient's asplenia, an inherited C2-deficiency was noted . Assessment of IgG subclasses repeatedly revealed markedly low IgG4 concentrations . These were not due to an increased turnover of IgG4, as could be shown following infusion of intravenous IgG . In addition, IgG2 concentrations were low in the patient who lacked G2M(23) . Opsonic mediating antibodies against type 23-F pneumococci were in the range of those of non-immune volunteers 6 months after vaccination with a 23-valent pneumococcal vaccine . These antibodies did not increase after a septic episode with 23-F capsular-type pneumococci . Neutrophil function was apparently normal. J Clin Pathol, 1991 Jan, 44(1), 83 - 4 Comparison of two commercial kits for identifying and biotyping Haemophilus parainfluenzae; Warren M et al.; The Minitek system and the more recently introduced Micro Scan HNID panels for the identification and biotyping of 98 V dependent Haemophilus isolates were compared . Identical results were obtained for 77 isolates . The discrepancy in the results of ornithine and urease was accounted for mainly by the mismatching of the identification by the two kits . When 13 isolates of H parainfluenzae with mismatched biotypes were re-examined, the results from Micro Scan correlated with 92% of those obtained by Christensen's urea broth and 100% by the ornithine test (Lab M); the corresponding figures for Minitek were 61% and 30%, respectively . Micro Scan was easy to handle on the bench and results were ready on the same day . These results suggest that further work is required to assess these two systems for the biotyping of H parainfluenzae. J Clin Pathol . 1991 Jan;44(1):77. Detection of chloramphenicol resistance in Haemophilus influenzae; Snell JJ et al.; An average of 358 (13%) of United Kingdom laboratories failed to detect resistance to chloramphenicol in strains of Haemophilus influenzae distributed by the United Kingdom National External Quality Assessment Scheme for Microbiology . Clear associations between methods used and results obtained show that error rates are minimised by the use of low content (10 micrograms) disc and a sensitive control strain of H influenzae. J Clin Microbiol, 1991 Jan, 29(1), 109 - 14 Quantitative antimicrobial susceptibility testing of Haemophilus influenzae and Streptococcus pneumoniae by using the E-test; Jorgensen JH et al.; The E-test (PDM Epsilometer; AB Biodisk, Solna, Sweden) is an antimicrobial agent gradient-coated plastic test strip which allows MIC determinations on agar media . The test is performed in a manner similar to the agar disk diffusion procedure . A collection of Haemophilus influenzae and Streptococcus pneumoniae strains possessing various resistance mechanisms was used to evaluate the E-test method . H . influenzae strains were tested with both Haemophilus test medium (HTM) and PDM ASM II chocolate agar, while the S . pneumoniae strains were tested on Mueller-Hinton sheep blood agar . E-test MICs for a total of 10 antimicrobial agents were compared with broth microdilution MICs determined according to National Committee for Clinical Laboratory Standards methods . In general, E-test MICs for both species were quickly and easily interpreted and agreed within one log2 MIC increment in 89.8% of tests with H . influenzae and in 80.4% of pneumococcal tests . The majority of disagreements between the E-test and conventional MICs occurred with trimethoprim-sulfamethoxazole because of trailing and diffuse E-test MIC endpoints with both species . Ampicillin MICs for beta-lactamase-producing H . influenzae determined by the E-test differed at times from those determined by conventional testing because of the vagaries of interpreting colonies growing within the E-test inhibition ellipses . E-test penicillin MICs for pneumococci tended to be 1 to 2 log2 dilutions lower than those determined by using Mueller-Hinton broth supplemented with lysed horse blood . Nevertheless, strains of both species with documented resistance to the study drugs were detected by E-tests, i.e., 0.7% of the tests had very major errors with H . influenzae and 0.8% had very major errors with S . pneumoniae . Thus, the E-test represents a potential alternative method for antimicrobial susceptibility testing of these two fastidious bacterial species. Arch Ophthalmol, 1991 Jan, 109(1), 63 - 6 Penetrating ocular injury from contaminated eating utensils; Feist RM et al.; Although the rate of infectious endophthalmitis following penetrating ocular injury is generally less than 10%, certain settings may carry a greater risk of infection . One such setting is penetrating injury resulting from eating utensils contaminated with oral flora . We reviewed six of these injuries . Culture-positive bacterial endophthalmitis developed in four of the six eyes; only one of the eyes retained reading visual acuity (greater than 20/50) and two eyes lost light perception . The potential for infection and limited visual outcome in this series warrants aggressive prophylaxis and treatment . The unexpected isolation of Haemophilus influenzae in two of the four infections suggests that broad-spectrum antibiotic treatment should be considered in all such injuries since less common organisms may be encountered. J Bacteriol, 1991 Jan, 173(2), 435 - 42 Primary sequence of the Escherichia coli fadL gene encoding an outer membrane protein required for long-chain fatty acid transport; Black PN; The fadL gene of Escherichia coli encodes an outer membrane protein (FadL) that plays a central role in the uptake of exogenous long-chain fatty acids . The nucleotide sequence of the fadL gene revealed a single open reading frame of 1,344 bp encoding a protein with 448 amino acid residues and a molecular weight of 48,831 . The transcriptional start, analyzed by primer extension, was shown to be 95 bp upstream from the translational start . Apparent -10 and -35 regions were found at -12 and -37 bp upstream from the transcriptional start . Three regions with hyphenated dyad symmetry (two between the transcriptional start and the translational start and one upstream from the -10 and -35 regions) were identified that may play a role in the expression of fadL . The protein product of the fadL gene contained a signal sequence and signal peptidase I cleavage site similar to that defined for other E . coli outer membrane proteins . The N-terminal sequence of mature FadL protein was determined by automated amino acid sequencing of protein purified from the outer membrane of a strain harboring fadL under the control of a T7 RNA polymerase-responsive promoter . This amino acid sequence, Ala-Gly-Phe-Gln-Leu-Asn-Glu-Phe-Ser-Ser, verified the signal peptidase I cleavage site on pre-FadL and confirmed the N-terminal amino acid sequence of FadL predicted from the DNA sequence . Mature FadL contained 421 amino acid residues, giving a molecular weight of 45,969 . The amino acid composition of FadL deduced from the DNA sequence suggested that this protein contained an abundance of hydrophobic amino acid residues and lacked cysteinyl residues . The hydrophobic amino acids within FadL were predicted to contribute to at least five regions of the protein with an overall hydrophobic character . The amino acid sequence of FadL was used to search GenBank for other proteins with amino acid sequence homology . These data demonstrated that FadL and the heat-modifiable outer membrane protein P1 of Haemophilus influenzae type b were 60.5% conserved and 42.0% identical over 438 amino acid residues. Infect Immun, 1991 Jan, 59(1), 7 - 17 Analysis of the immunoglobulin A protease gene of Streptococcus sanguis; Gilbert JV et al.; The amino acid sequence T-P-P-T-P-S-P-S is tandemly duplicated in the heavy chain of human immunoglobulin A1 (IgA1), the major antibody in secretions . The bacterial pathogen Streptococcus sanguis, a precursor to dental caries and a cause of bacterial endocarditis, yields IgA protease that cleaves only the Pro-Thr peptide bond in the left duplication, while the type 2 IgA proteases of the genital pathogen Neisseria gonorrhoeae and the respiratory pathogen Haemophilus influenzae cleave only the P-T bond in the right half . We have sequenced the entire S . sanguis iga gene cloned into Escherichia coli . A segment consisting of 20 amino acids tandemly repeated 10 times, of unknown function, occurs near the amino-terminal end of the enzyme encoded in E . coli . Identification of a predicted zinc-binding region in the S . sanguis enzyme and the demonstration that mutations in this region result in production of a catalytically inactive protein support the idea that the enzyme is a metalloprotease . The N . gonorrhoeae and H . influenzae enzymes were earlier shown to be serine-type proteases, while the Bacteroides melaninogenicus IgA protease was shown to be a cysteine-type enzyme . The streptococcal IgA protease amino acid sequence has no significant homology with either of the two previously determined IgA protease sequences, that of type 2 N . gonorrhoeae and type 1 H . influenzae . The differences in both structure and mechanism among these functionally analogous enzymes underscore their role in the infectious process and offer some prospect of therapeutic intervention. Infect Immun, 1991 Jan, 59(1), 119 - 25 Protein D, an immunoglobulin D-binding protein of Haemophilus influenzae: cloning, nucleotide sequence, and expression in Escherichia coli; Janson H et al.; The gene for protein D, a membrane-associated protein with specific affinity for human immunoglobulin D, was cloned from a nontypeable strain of Haemophilus influenzae . The gene was expressed in Escherichia coli from an endogenous promoter, and the gene product has an apparent molecular weight equal to that of H . influenzae protein D (42,000) . The complete nucleotide sequence of the gene for protein D was determined, and the deduced amino acid sequence of 364 residues includes a putative signal sequence of 18 amino acids containing a consensus sequence, Leu-Ala-Gly-Cys, for bacterial lipoproteins . The sequence of protein D shows no similarity to those of other immunoglobulin-binding proteins . Protein D is the first example of immunoglobulin receptors from gram-negative bacteria that has been cloned and sequenced. Am J Dis Child, 1991 Jan, 145(1), 70 - 4 Pneumococcal osteomyelitis and arthritis in children . A hospital series and literature review; Jacobs NM; Twenty-nine children with pneumococcal osteomyelitis and/or arthritis, 11 of whom had osteomyelitis, were treated at Cook County Hospital, Chicago, Ill, in the past 20 years . They were mostly normal children with a single focus of infection . They represented more than 5% of the hospitalized children with a systemic pneumococcal infection . Most of the pneumococcal isolates were serotyped; serotype 19, in particular, seemed to be unusually common in these children . Twenty-three of the 29 children with pneumococcal osteomyelitis and/or arthritis had been hospitalized in the past 15 years . These 23 children were compared with 161 hospitalized children who had bone and joint infections with other isolated bacteria . The children with pneumococcal osteomyelitis and/or arthritis were indistinguishable from most of the other children, except by age . All but three of the children with pneumococcal osteomyelitis and/or arthritis were between the ages of 3 and 24 months . In this age group, Pneumococcus was the common isolate from children with osteomyelitis, and second only to Haemophilus influenzae from children with bacterial arthritis . Pneumococcal osteomyelitis and/or arthritis has never been rare; the medical literature describes at least 245 other children, most of whom were younger than 2 years. Am J Dis Child, 1991 Jan, 145(1), 65 - 9 Acute osteomyelitis in children . Reassessment of etiologic agents and their clinical characteristics; Faden H et al.; One hundred thirty-five children with acute osteomyelitis were identified by chart review during a 7-year period, January 1, 1980, through December 31, 1986 . Bacteriologic causes were detected in 75 (55%) of the patients . Staphylococcus aureus, Haemophilus influenzae type b, and Pseudomonas aeruginosa were identified in 34 (25%), 16 (12%), and eight (6%) children, respectively . Staphylococcus aureus occurred in all age groups, H influenzae type b occurred only in children younger than 3 years and was the number one cause of disease in this group . Pseudomonas aeruginosa occurred exclusively in children older than 9 years . Children with H influenzae type b had clinical and laboratory findings that were almost indistinguishable from a matched group of children with osteomyelitis due to other known bacteria, although children with H influenzae type b tended to have more joint effusions (63% vs 27%), less lower extremity disease (22% vs 70%), and fewer positive cultures from bone or joint aspirates (41% vs 89%) . Unlike most pediatric cases of osteomyelitis, the ones due to P aeruginosa did not represent the hematogenous route of infection; penetrating injury to the foot was present in every case . Children with P aeruginosa infections were older than 9 years (100%), predominantly male (88%), often afebrile (83%), and never bacteremic . These data provide guidelines for the initial work-up and management of osteomyelitis in children. Pediatrics, 1991 Jan, 87(1), 48 - 53 Bacteremia with otitis media; Schutzman SA et al.; To investigate the occurrence and outcome of bacteremia associated with otitis media, charts were reviewed from patients who were 3 to 36 months of age, had temperatures greater than or equal to 39 degrees C, and were diagnosed with isolated clinical otitis media . A total of 2982 patients were identified . Blood cultures were obtained from 1666 (56%) . Of the 1666 patients, who had blood drawn for cultures, 50 (3.0%) had bacteremia . These included 39 with Streptococcus pneumoniae, 4 with Haemophilus influenzae, 2 with Neisseria meningitidis, 3 with Salmonella species, and 2 with Staphylococcus aureus . The incidence of bacteremia increased at higher temperatures, being 1.9% at temperatures less than or equal to 40 degrees C and 5.0% at temperatures greater than 40 degrees C . Younger children were more likely to have bacteremia; 3.7% less than or equal to 12 months of age, 2.4% 13 to 24 months of age, and 1.9% 25 to 36 months of age had blood culture results that were positive (not significant) . Reevaluation of the 50 bacteremic patients showed that 9 patients had continued fever, 3 patients had persistent bacteremia, pneumonia developed in 1 patient, and meningitis developed in 1 patient . It was concluded that (1) 3% of young febrile children with otitis media have bacteremia at the time of evaluation, a rate comparable to that previously reported in children with no focus of infection; (2) the incidence of bacteremia increases at higher temperatures; and (3) most febrile children with otitis media do well . The clinician must therefore weigh the potential benefit of drawing a blood culture to identify children at risk for complications against the inherent cost, inconvenience, and discomfort. Obstet Gynecol, 1991 Jan, 77(1), 92 - 6 Haemophilus influenzae: an important cause of maternal and neonatal infections; Rusin P et al.; Although Haemophilus influenzae is recognized as a major pathogen of infants, its role in maternal and neonatal infections is not as well appreciated . We analyzed the records of all mothers and neonates infected with H influenzae over a 10-year period . Twenty-eight mother/neonate sets were identified in which at least one had documented infection with H influenzae . Of the 18 mothers with documented infection, 13 had chorioamnionitis, endometritis, or both, and two of these mothers were bacteremic with H influenzae . Of the 23 infected neonates, 15 presented with early sepsis and/or pneumonia and nine had conjunctivitis . During the period of the study, only group B streptococci and Escherichia coli were more common as causes of early neonatal bacteremia . Under the conditions of this retrospective study, maternal infection predicted neonatal infection . However, prospective studies in which asymptomatic patients are cultured will be required to determine how well maternal colonization/infection with H influenzae predicts neonatal infection. Scand J Infect Dis, 1991, 23(4), 459 - 65 Double-blind comparison of cefixime and cefaclor in the treatment of acute otitis media in children; Piippo T et al.; In a double-blind study cefixime, an oral cephalosporin of the third generation, was compared to cefaclor in the treatment of acute otitis media in 397 children aged 6 months to 12 years . Clinical evaluation was carried out at the beginning, at day 10-12 and day 28-35 after the start of the treatment . Specimens for bacterial culture and sensitivity testings were taken from the nasopharynx at the initial visit . Patients were randomized either to cefixime in a dose of 8 mg/kg/day or cefaclor in a dose 40 mg/kg/day in the proportion of 2 cefixime patients to 1 cefaclor patient . Two daily doses were administered for 7 days . At day 10-12, 93.5% in the cefixime group and 90.5% in the cefaclor group (p = 0.08) were clinically cured or improved . At day 28-35 the rate of cured or improved patients had decreased, mostly due to reinfections, to 90.1% in the cefixime group and to 86.6% in the cefaclor group (p = 0.12), respectively . 375 patients (69.9%) had positive bacterial culture in the nasopharynx of at least one strain of Haemophilus influenzae, Streptococcus pneumoniae, Branhamella (Moraxella) catarrhalis or combinations of these 3.73.6% of the B . catarrhalis strains were beta-lactamase producing and 11.4% of the H . influenzae strains, respectively . All isolated bacteria were sensitive to cefixime . Adverse events were reported in 17.9% in the cefixime and 10.6% in the cefaclor group . Most reactions were of moderate or mild nature and mostly affected skin or the gastrointestinal region . No serious adverse experiences occurred . In view of the good clinical results obtained cefixime seems to be at least as effective as cefaclor in the treatment of acute otitis media in children. Acta Vet Scand, 1991, 32(1), 79 - 88 An abattoir survey of pneumonia and pleuritis in slaughter weight swine from 9 selected herds . III . Serological findings and their relationship to pathomorphological and microbiological findings; Falk K et al.; Blood samples from 777 pigs, originating from 9 different herds, were collected at slaughter and examined for antibodies to Mycoplasma hyopneumoniae and Actinobacillus (Haemophilus) pleuropneumoniae by the indirect hemagglutination assay (IHA) and the complement fixation (CF) test, respectively . Results were compared to pathological and microbiological findings . Antibodies to M . hyopneumoniae in positive titers of 1/80 or higher were found in 62% of the samples . The relationship between positive IHA titers to M . hyopneumoniae and gross findings indicative of enzootic pneumonia of pigs (EPP), histological findings indicative of EPP, the isolation of M . hyopneumoniae and the demonstration of M . hyopneumoniae by indirect immunofluorescent testing ranged from 64% to 68% . No correlation was noted between positive IHA titers and the isolation of Mycoplasma flocculare . Positive antibody titers to A . pleuropneumoniae of 1/10 or higher were detected in 5% to 85% of the samples from individual herds . Positive titers to A . pleuropneumoniae serotype 2 were found in 71% to 79% of the sampled animals from herds with high frequencies of pneumonic lesions indicative of pleuropneumonia . In herds with low frequencies of pleuropneumonia, positive titers were recorded in from 0 to 4% of the tested pigs . However, no statistical association was found between pleuropneumonia and positive titers to A . pleuropneumoniae serotype 2 in individual animals . Twenty-one per cent of samples with positive CF titers to A . pleuropneumoniae showed antibodies to more than one serotype. Acta Vet Scand, 1991, 32(1), 55 - 65 An abattoir survey of pneumonia and pleuritis in slaughter weight swine from 9 selected herds . I . Prevalence and morphological description of gross lung lesions; Lium BM et al.; The prevalence and pathomorphology of gross lung lesions were studied in 855 slaughter weight pigs from 9 selected herds in south-eastern Norway . Pneumonic or pleuritic lesions were found in 84% of the lungs, ranging from 37% in the least affected herd to 97% in the one most affected . Bronchopneumonia indicative of a primary Mycoplasma hyopneumoniae infection was found in 70% of the lungs, ranging from 9% to 82% in the individual herds . The amount of bronchopneumonic lesions in individual lungs ranged from 0 to 69%, with an average of 7.8% . Pleuropneumonia indicative of Actinobacillus (Haemophilus) pleuropneumoniae infection was found in 29% of the lungs ranging from 0 in the least affected herd to 58% in the most affected . Diffuse pleuritis was found in 41% of the lungs and the prevalence ranged from 4% to 63%. Eur J Cardiothorac Surg, 1991, 5(8), 433 - 4; discussion 435 Bronchoalveolar lavage in the prediction of post-thoracotomy chest infection; Wansbrough-Jones MH et al.; A prospective study was carried out on 75 patients undergoing pulmonary surgery to determine the relationship between perioperative lung flora and postoperative infections . Seventy-five patients having pleurectomy or pneumonectomy received cefuroxime prophylaxis; 1.5 g i.v . at induction followed by 6 further doses of 0.75 g i.v . over 48 h . Bronchoalveolar lavage samples were taken perioperatively via bronchoscopy in pleurectomy patients and from excised lung in patients undergoing lung resection . Patients were monitored for development of chest infection during the first 10 days after operation . Bacterial pathogens were cultured from 12 out of 54 lavage samples . The most common pathogen was Haemophilus influenzae and all the organisms were sensitive to cefuroxime . Eight patients (10.7%) developed postoperative chest infection . The likelihood of developing postoperative chest infection was 42% (5 out of 12 patients) in those patients whose lavage culture was positive for bacterial pathogens compared to 4.8% (2 out of 42 patients) for those whose culture was negative (chi 2 test, p less than 0.001) . These results suggest that the culturing of bacterial pathogens from lavage samples from resected lung is a significant predictor of postoperative chest infection in patients undergoing pulmonary resection. Acta Otolaryngol, 1991, 111(3), 556 - 61 Nasopharyngeal flora in otitis media with effusion . A comparative semiquantitative analysis; Hemlin C et al.; An inflammatory process in the middle ear caused by bacteria or bacterial products emanating from the nasopharynx is one etiological factor considered in the unknown pathogenesis of otitis media with effusion (OME) . The nasopharyngeal prevalence of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella (Branhamella) catarrhalis and Streptococcus pyogenes was studied in 191 children with defined OME and in 53 age-matched children without middle ear disease . Duplicate sampling and semiquantitative analysis were performed to assess even minor differences in the distribution of pathogens between the two groups of children . Pathogens were recovered in 91% of OME children . A significantly higher number of pathogen species/patient (1.66 vs . 1.15, p less than 0.01) as well as pathogen colonies/patient was found in OME children compared to control children . Chronic OME in children is associated with an increased pathogen load in the nasopharynx, suggesting a role of these pathogens in the etiology of OME. Acta Otolaryngol, 1991, 111(3), 524 - 9 Secretory antibodies specific to Streptococcus pneumoniae, Haemophilus influenzae and Branhamella catarrhalis in middle ear effusion during acute otitis media; Karjalainen H et al.; The occurrence of specific secretory antibodies against the type-specific capsular polysaccharide of Streptococcus pneumoniae (Pn) and against the whole cell antigen of Haemophilus influenzae (Hi) and Branhamella catarrhalis (Br) were measured by the ELISA method in 211 middle ear effusion (MEE) samples of 85 children with acute otitis media (AOM) during the course of the disease . Antibodies against at least one of those bacteria were detected at the initial visit in 33.6% of the ears and later in 20% . All in all, such antibodies could be found in 50% of the ears during the follow-up . Pneumococcal secretory antibodies were found in 5 out of 116 ears only, anti-Hi antibodies in 52 and anti-Br antibodies in 42 ears . The specific secretory antibodies were detected against all these bacteria regardless of the bacterial etiology of the AOM attack in question . The AOM attack was prolonged more often if such antibodies were not found in the MEE sample taken at the initial visit . The appearance of such antibodies during the disease seemed to imply termination of the AOM episode in question . The conclusions of this study are that during an AOM attack a local production of antibodies in middle ear against the three most common bacteria . Pn, Hi and/or Br, causing AOM may be induced . The appearance of such antibodies in MEE seems to be beneficial for the resolution of AOM. Scand J Infect Dis, 1991, 23(3), 347 - 54 Erythromycin and phenoxymethylpenicillin (penicillin V) in the treatment of respiratory tract infections as related to microbiological findings and serum C-reactive protein; Soderstrom M et al.; Respiratory tract pathogens (beta-haemolytic streptococci groups A, C and G, Haemophilus influenzae, Branhamella catarrhalis or pneumococci), were isolated from nasopharyngeal and/or throat swabs in 73/138 (53%) patients greater than 10 years of age with a clinical diagnosis of acute sinusitis, acute tonsillitis, purulent nasopharyngitis or acute bronchitis . Serological evidence of a viral infection (influenza A and B, parainfluenza 1, 2 and 3, respiratory syncytial virus, adenovirus) or Mycoplasma pneumoniae infection was found in 10% of the patients . The serum content of C-reactive protein (S-CRP) was increased (greater than 12 mg/l) in 26/33 (79%) patients with streptococci and in 22/59 (37%) patients without respiratory tract bacteria . In patients with a serological evidence of a virus tonsillitis, the S-CRP was also high (32-64 mg/l) . At follow-up 10-12 days after the first visit, the clinical effect of erythromycin and penicillin V was judged to be similar (90% clinical effect) . Relapse or re-infection with group A streptococci were seen in 7 patients (4 on erythromycin, 3 on penicillin) . In another 6 patients (3 on erythromycin, 3 on penicillin), antibiotic treatment was switched owing to persisting symptoms, probably due to H . Influenzae infection in 3 cases . The patients' own estimates of their symptoms suggested treatment with erythromycin to have a more rapid effect than treatment with penicillin. Int J Clin Pharmacol Res, 1991, 11(1), 1 - 6 Comparison of the serum and tissue concentrations of cefuroxime from cefuroxime axetil and phenoxymethylpenicillin in patients undergoing tonsillectomy; Jetlund O et al.; In the study described, the pharmacokinetics of two oral betalactams, cefuroxime axetil and phenoxymethylpenicillin, were compared with respect to their penetration into tonsil tissue . Seventeen patients were given cefuroxime axetil 500 mg single dose and 16 patients were given phenoxymethylpenicillin 650 mg single dose, at different time intervals before tonsillectomy . The tonsils were freeze-dried and the drug concentrations in serum and tissue determined by a high performance liquid chromatographic method . Cefuroxime axetil showed a slightly better penetration ratio (mean 35%, median 32%) than phenoxymethylpenicillin (mean 31%, median 24%) however the difference was not statistically significant . The bioavailability of cefuroxime axetil was low due to being administered in the fasting state . The relatively low penetration ratios of both drugs into samples of whole tissue can be explained by the localization of betalactam antibiotics primarily in the extracellular fluid, with low penetration into normal cells . Both drugs were found to reach concentrations in tonsil tissue above the minimum inhibitory concentration for Group A beta-haemolytic streptococci after a single oral dose . In addition to streptococci, Haemophilus influenzae and beta-lactamase producing Staphylococcus aureus were isolated in a significant number of the tonsils . These bacteria may play a pathogenic role, but this was not investigated. Rev Infect Dis, 1991 Jan-Feb, 13(1), 22 - 33 Pathogenic events during infection of the human nasopharynx with Neisseria meningitidis and Haemophilus influenzae; Stephens DS et al.; The human nasopharynx is the natural habitat and reservoir for Neisseria meningitidis and Haemophilus influenzae type b (Hib) . Meningococcal and Hib pathogenesis was studied in human nasopharyngeal tissue in organ culture . Inocula of greater than or equal to 10(6) meningococci or cfu of Hib were required for consistent production of infection in these cultures . By 24 hours meningococci and Hib grew to 10(8)-10(10) cfu/mL in culture supernatants, while 10(4)-10(7) cfu per organ culture were tissue associated . These studies further indicated that nasopharyngeal mucus contains components that specifically bind Hib; that both meningococci and Hib cause cytotoxicity, resulting in breakdown of tight junctions of epithelial cells, sloughing of ciliated cells, and ciliostasis; that pili are the most important components mediating initial attachment of meningococci to non-ciliated epithelial cells of the human nasopharynx; that Hib expresses both pilus and nonpilus adhesions that facilitate attachment to nonciliated cells; and that meningococci and Hib both invade the epithelial surface to reach the submucosa but do so by different routes . Meningococci and Hib have evolved successful, although divergent, mechanisms by which to infect the human nasopharynx. Acta Otolaryngol, 1991, 111(1), 120 - 9 Amoxycillin/clavulanate versus amoxycillin in recurrent otitis media and therapeutic failure in children; Stenstrom C et al.; A total of 102 children with recurrent otitis media or therapeutic failure after treatment with phenoxymethyl penicillin were entered into a double-blind study with parallel groups, comparing treatment with amoxycillin/clavulanate suspension (Spektramox) for 7 days with amoxycillin suspension (Imacillin) for 10 days . Bacterial and clinical investigations were performed . A total of 91 patients were evaluated for efficacy at the first follow-up visit (10-12 days after start of treatment) . Amoxycillin/clavulanate and amoxycillin showed equally high, satisfactory treatment results, i.e . more than a 90% response . Similarly, there was no statistically significant difference between the treatment groups at the second follow-up visit (about 30 days after start of treatment) . Bacteriological cultures from the nasopharynx showed equal distribution of Haemophilus influenzae, Branhamella catarrhalis and Streptococcus pneumoniae between the study groups . Elimination of the initially occurring pathogens was equal in the two study groups with the exception of B . catarrhalis which was eliminated to a significantly higher extent with amoxycillin/clavulanate . Both drugs were well tolerated . In patients with recurrent otitis media or therapeutic failure, treatment with amoxycillin/clavulanate for 7 days results in high, satisfactory clinical effects and is comparable