J Antimicrob Chemother, 1990 Sep, 26(3), 371 - 80 Effect of low concentrations of clavulanic acid on the in-vitro activity of amoxycillin against beta-lactamase-producing Branhamella catarrhalis and Haemophilus influenzae; Cooper CE et al.; Concentrations of amoxycillin/clavulanic acid achievable in the respiratory tract following oral dosage were assessed for in-vitro activity against beta-lactamase-producing strains of Branhamella catarrhalis and Haemophilus influenzae . In agar-dilution studies, 8 mg amoxycillin/l was required to inhibit 45 strains of beta-lactamase-producing B . catarrhalis, whereas all the strains were inhibited by 0.5 mg amoxycillin/l in the presence of 0.01 mg clavulanic acid/l . Similarly, 0.1 mg amoxycillin plus 0.05 mg clavulanic acid/l were bactericidal against beta-lactamase-producing strain of B . catarrhalis and prevented regrowth within 24 h . In tests against 43 beta-lactamase-producing strains of H . influenzae, concentrations of up to 128 mg amoxycillin/l were required for inhibition, whereas 32 strains (75%) were fully sensitive to amoxycillin (MIC 0.5 mg/l) in the presence of 0.12 mg clavulanic acid/l . These concentrations of amoxycillin/clavulanic acid were also bactericidal for a beta-lactamase-producing strain of H . influenzae . The study therefore showed that amoxycillin/clavulanic acid, at concentrations similar to those likely to be achieved in the respiratory tract following oral dosage, was bactericidal in vitro for beta-lactamase-producing isolates of B.catarrhalis and H . influenzae. J Infect Dis, 1990 Sep, 162(3), 659 - 63 Biochemical characterization and worldwide distribution of serologically distinct lipopolysaccharides of Haemophilus influenzae type b; van Alphen L et al.; The sugar composition and the electrophoretic mobility in SDS-polyacrylamide gel electrophoresis of the various lipopolysaccharides (LPS) from clinical isolates of Haemophilus influenzae type b (Hib) were determined to correlate epidemiologic data with compositional data . Rabbit sera specific in Ouchterlony immunodiffusion for 10 different LPS (LPS 1-10) reacted with 647 or 690 Hib strains isolated from patients with invasive disease in various continents . Serotype 1 was predominant and was found in 550 isolates (80%) . None of the Hib isolates reacted with antisera specific for LPS of two nonencapsulated isolates (LPS 5 and 6) . Sugar analysis by gas-liquid chromatography of trimethylsilylated methyl glycosides revealed that the LPS of the 10 serotypes contained glucose, galactose, L-glycero-D-mannoheptose, and glucosamine in various proportions . LPS 1, 2, 8, and 9 contained the highest amounts of glucose and galactose relative to L-glycero-D-mannoheptose, which is considered present in constant amounts in H . influenzae LPS . LPS 1, 2, and 9 were most frequently found in invasive disease isolates. Infect Immun, 1990 Sep, 58(9), 2972 - 6 N-linked oligosaccharides of human transferrin are not required for binding to bacterial transferrin receptors; Padda JS et al.; Derivatives of human transferrin (hTf) with removed or modified N-linked oligosaccharides were compared with native hTf with respect to their binding to bacterial hTf receptors from Neisseria meningitidis, N . gonorrhoeae, and Haemophilus influenzae . Partially and fully deglycosylated hTf were prepared by enzymatic deglycosylation with glycopeptidase F and isolated by concanavalin A-Sepharose affinity chromatography . Oligosaccharide-modified hTf was prepared via mild periodate oxidation . Competition and direct binding experiments with the hTf derivatives demonstrated that the hTf oligosaccharides are not essential for binding to the bacterial hTf receptors. Kitasato Arch Exp Med, 1990 Sep, 63(2-3), 131 - 6 Drug resistance plasmids of Actinobacillus (Haemophilus) pleuropneumoniae serotype 2 strains isolated from swine; Kawahara K et al.; Drug resistance plasmids were detected in two drug resistant strains of Actinobacillus (Haemophilus) pleuropneumoniae serotype 2 isolated in Japan . One strain, Hpn25, was resistant to ampicillin, kanamycin, streptomycin and sulfonamides, and harbored two plasmids with a molecular size of 3.7 and 4.1 kilobases (kb) . The other strain, Hpn18, which was resistant to streptomycin, tetracycline, and chloramphenicol, harbored three plasmids with a molecular size of 2.2, 12, and 35 kb . The resistance of Hpn 25 to streptomycin and sulfonamides is mediated by a 4.1 kb plasmid and that of Hpn 18 to streptomycin and chloramphenicol by one or more of the 2.2, 12, and 35 kb plasmids. Hua Xi Yi Ke Da Xue Xue Bao, 1990 Sep, 21(4), 375 - 8 {Identification and typing of Actinobacillus actinomycetemcomitans by restriction endonuclease analysis}; Han A et al.; The aim of the present study was to investigate the potential of restriction endonuclease analysis (REA) for the identifying and typing of Actinobacillus actinomycetemcomitans (Aa) . Bacterial chromosomal DNA was extracted and digested with BamHI, HindIII, Sal I and Xho I respectively and separated by agarose gel electrophoresis . DNA fragment patterns of Aa and Haemophilus aphrophilus differed strikingly from each ether . The patterns of Aa FDC Y4 and Aa ATCC 29523, belonging to two different serotypes, also differed notably . Among the 4 enzymes used, Sal I and Xho I gave the most satisfactory results . The results of our work suggested that REA could be used to identify and type Aa . REA is stable, sensitive, accurate and reproducible . The method might be valuable in molecular epidemiologic studies on periodontopathic organisms. Ugeskr Laeger, 1990 Aug 20, 152(34), 2420 - 2 {Purulent arthritis}; Riegels-Nielsen P et al.; At all ages, Staphylococcus aureus is the most common microorganism responsible for septic arthritis, but in children below five years of age Haemophilus influenzae is frequently found . In about 1/3 of the cases cultures are negative, primarily because of initiation of antibiotic therapy prior to sampling . A distended joint should be treated as infection until otherwise proved . Today repeated aspirations of the infected joint are recommended as initial treatment, if possible with additional joint lavage, together with systemic antibiotic therapy . In case with no clinical response within 2-4 days, surgical debridement of the joint with synovectomy is of utmost importance . Exercises without weight-bearing are initiated at an early stage and weight-bearing avoided for six weeks. J Immunol Methods, 1990 Aug 7, 131(2), 195 - 202 Solid phase disruption of fluid phase equilibrium in affinity assays with ELISA; Hetherington S; Quantitation of antibody affinity for antigen can provide important information in assessment of the human immune response . Enzyme-linked immunosorbent assay (ELISA) methods are sufficiently sensitive to permit affinity measurements of low affinity, low titer antibody . The major assumption in using this method, that the solid phase does not influence the equilibrium of the fluid phase antibody-antigen interaction, is not strictly true . Hence, conditions must be chosen to minimize such interference, which can result in spuriously low values of affinity . The degree of solid phase interference was therefore quantitated for an ELISA that measures the affinity between antibody directed against the capsular polysaccharide of Haemophilus influenzae type b, using a monovalent 3-unit oligosaccharide prepared from polysaccharide . The solid phase antigen density had the greatest effect upon disruption of the fluid phase . The concentration of antibody chosen had a measurable but modest effect on the outcome of ELISA, whereas the time of incubation of the antibody and oligosaccharide had no demonstrable effect . By choosing the conditions of the assay carefully, it was possible to minimize interference from the solid phase, so that the measured affinity of anticapsular polysaccharide antibody for monovalent antigen was similar to that obtained with the more traditional precipitation method. Lancet, 1990 Aug 4, 336(8710), 269 - 70 Effect of breast-feeding on antibody response to conjugate vaccine; Pabst HF et al.; Infants were immunised at the ages of 2, 4, and 6 months with conjugate Haemophilus influenzae type b vaccine, and their responses to the vaccine were evaluated by feeding method (breast or formula) . There were no significant differences between the groups in antibody levels at early ages . However the antibody levels were significantly higher in the breast-fed (57 infants) than the formula-fed group (24 infants) at 7 months (mean {SD} 29.8 {32.0} vs 17.5 {14.8} micrograms/ml) and at 12 months (55 vs 26 infants; 4.8 {4.4} vs 3.0 {2.3} micrograms/ml) . These findings are strong evidence that breast-feeding enhances the active immune response in the first year of life, and therefore the feeding method must be taken into account in the evaluation of vaccine studies in infants. Zentralbl Veterinarmed B, 1990 Aug, 37(6), 430 - 5 {Examination of cattle with respiratory diseases for Mycoplasma and bacterial bronchopneumonia agents}; Binder A et al.; A total of 247 mycoplasma strains was isolated from 435 lungs, tracheobronchial secretions and nasal swabs originating from cattle with symptoms of bronchopneumonia . Mycoplasma (M.) bovis was found 89 times (36%) and was the most common mycoplasma species in the lungs . M . bovirhinis, M . bovigenitalium, M . spec . and Acholeplasma (A.) laidlawii were isolated 158 times (64%) . Among these mycoplasmas M . bovirhinis was the most widespread species (114 isolations) . In 55 cases (62%) M . bovis was associated with Pasteurella or Actinomyces (A.) pyogenes . The other mycoplasma species were found in 67 cases (42%) together with these bacteria . Without mycoplasmas Pasteurella and A . pyogenes occurred in 33 of the probes investigated (21%) . Beside mycoplasmas Haemophilus (H.) somnus was isolated from 16 of 162 tracheobronchial secretions investigated . The results confirm earlier suppositions that in most of the cases bronchopneumonia of cattle is a multifactorial event, frequently associated with mycoplasmas--especially M . bovis. Wis Med J, 1990 Aug, 89(8), 461 - 3 Haemophilus influenzae B meningitis in a patient with a ventriculoperitoneal shunt and meningomyelocele; Brandstetter Y et al.; A child with an implanted ventriculoperitoneal (VP) shunt and meningomyelocele had an infection of his cerebrospinal fluid (CSF) . The organism cultured from the VP shunt apparatus and the meningomyelocele repair site was Haemophilus influenzae B (HIB), a very unusual pathogen in this setting . The patient was treated with the appropriate antibiotics, administered intravenously in accordance with accepted practice and available literature, with no improvement . The site of the persistent infection was finally determined to be within the meningomyelocele repair tissue . The patient's clinical status improved dramatically following the removal and replacement of the total shunt apparatus . The three-part apparatus tip was cultured according to the standard laboratory practice, but did not yield any organism . We conclude that the management of HIB meningitis in the presence of a VP shunt should include prompt removal of the apparatus . Recovery of the organism may be enhanced by separating the apparatus components and culture of the connections, instead of merely the indwelling tip. J Pediatr Gastroenterol Nutr, 1990 Aug, 11(2), 201 - 4 Immunogenicity of Haemophilus influenzae type B vaccines in children with hepatoportoenterostomies; Rosenthal P et al.; To assess the immunogenicity of HIB vaccines in patients in whom hepatoportoenterostomies were performed for biliary atresia, eight such children received Haemophilus influenzae type b-polyribosylribitol phosphate (HIB-PRP) vaccine and had pre- and postvaccination total serum anti-PRP antibody concentrations determined by radioimmunoassay . Preimmunization anti-PRP antibody levels ranged from less than 0.125 to 0.40 microgram/ml {geometric mean antibody titer (GMT) 0.106 microgram/ml}, while postvaccination levels ranged from 0.161 to 1.192 micrograms/ml (GMT = 0.489 microgram/ml) . Five children who did not achieve postimmunization anti-PRP antibody levels greater than 1.0 microgram/ml received 15 micrograms of either PRP coupled to diphtheria toxoid (PRP-D) or PRP coupled to an outer membrane protein complex of Neisseria meningitidis group B (PRP-NOMP) conjugate vaccine . Anti-PRP antibody levels 1 month after immunization with HIB conjugate vaccines ranged from 1.51 to 10.35 micrograms/ml (GMT = 3.386 micrograms/ml) . Patients with extrahepatic biliary atresia and hepatoportoenterostomies who previously received the HIB-PRP vaccine should be revaccinated with PRP protein conjugate vaccines to ensure adequate protection against H . influenzae type b disease. Biochim Biophys Acta, 1990 Aug 1, 1040(1), 84 - 8 Nonpolar interactions in the maleimide inactivation of Haemophilus influenzae D-lactate dehydrogenase; Denicola-Seoane A et al.; A series of N-alkylmaleimides varying in chain length from N-ethyl up to and including N-heptyl, was shown to effectively inactivate Haemophilus influenzae D-lactate dehydrogenase at pH 7.0 and 25 degrees C in processes proposed to involve covalent modification of cysteine residues . The inactivation proceeded through an initial reversible binding of maleimides facilitated by nonpolar interactions with a hydrophobic region of the enzyme . Subsequent irreversible inactivation of the enzyme indicated the modification of a fast-reacting group leading to approx . 80% loss of enzyme activity followed by a second slower-reacting modification process . At saturating concentrations of maleimides, the second inactivation process exhibited a common pseudo-first-order rate constant of 0.6 min-1 . The initial reversible binding of N-alkylmaleimides resulted in inhibition of the enzyme that was competitive with respect to NADH . Positive chain length effects were observed in the second-order rate constants for inactivation and in the 6-fold better binding of N-heptylmaleimide as compared to that for N-ethylmaleimide . It is suggested that the nonpolar interactions stabilizing the 1,4-dihydronicotinamide moiety of the reduced coenzyme also facilitate the initial binding of N-alkylmaleimides. J Exp Med, 1990 Aug 1, 172(2), 497 - 507 Tumor necrosis factor alpha/cachectin and interleukin 1 beta initiate meningeal inflammation; Ramilo O et al.; Although previous studies using human cytokines in rabbits and rats have provided evidence of the participation of tumor necrosis factor alpha (TNF-alpha) and interleukin 1 beta (IL-1 beta) in the meningeal inflammatory cascade, the results obtained by several groups of investigators have been discordant or, at times, contradictory . In the present study, homologous cytokines were applied to the rabbit meningitis model . Intracisternal administration of 10(2)-10(5) IU of purified rabbit TNF-alpha (RaTNF-alpha) produced significant cerebrospinal fluid (CSF) inflammation . A similar response was observed after intracisternal inoculation of 5-200 ng of rabbit recombinant IL-1 beta (rrIL-1 beta) . Preincubation of these two mediators with their specific antibodies resulted in an almost complete suppression of the CSF inflammatory response . In animals with Haemophilus influenzae type b lipooligosaccharide-induced meningitis, intracisternal administration of anti-rrIL-1 beta, anti-RaTNF-alpha, or both resulted in a significant modulation of meningeal inflammation . Simultaneous administration of 10(3) IU of RaTNF-alpha and 5 ng of rrIL-1 beta resulted in a synergistic inflammatory response manifested by a more rapid and significantly increased influx of white blood cells into the CSF compared with results after each cytokine given alone . These data provide evidence for a seminal role of TNF-alpha and IL-1 beta in the initial events of meningeal inflammation. Pediatrics, 1990 Aug, 86(2), 163 - 70 Subdural effusion and its relationship with neurologic sequelae of bacterial meningitis in infancy: a prospective study; Snedeker JD et al.; One hundred thirteen infants, aged 1 to 18 months, were screened systematically and serially using transillumination for the presence of subdural effusion during acute bacterial meningitis due to Haemophilus influenzae type b, Streptococcus pneumoniae, or Neisseria meningitidis . Effusion developed in 44 (39%) of the patients during the course of treatment . Young age, rapid onset of illness, low peripheral white blood cell count, and high cerebrospinal fluid levels of protein and bacterial antigen were associated with a higher likelihood of developing effusion . Although patients with effusion were more likely to have neurologic abnormalities both at the time of admission and at completion of therapy, and were more likely to have seizures during the course of treatment, there was no greater incidence of seizures, hearing loss, neurologic deficits, or developmental delay on longterm follow-up (median follow-up interval 5.5 years) in patients with effusion . Specific invasive therapy is not indicated in infants with meningitis and subdural effusion who are otherwise improving. Jpn J Antibiot, 1990 Aug, 43(8), 1436 - 41 {A clinical evaluation of cefdinir in pediatric infections}; Katsushima N et al.; Cefdinir (CFDN), a new oral cephalosporin, was administered to 10 patients with various infections and the following results were obtained . 1 . Clinical responses in 10 patients (1 patient with rhinitis, 2 with sinusitis, 1 with pharyngitis, 1 with tonsillitis, 4 with scarlet fever and 1 with abscess) were excellent in 6 and good in 4 with an efficacy rate of 100% . 2 . Eleven species of bacteria were isolated (3 of Staphylococcus aureus, 6 of Streptococcus pyogenes and 2 of Haemophilus influenzae) and all of them were eradicated by the treatment with CFDN . 3 . No side effects or abnormal laboratory test values were noted . None of the patients refused to take the drug. Nippon Hifuka Gakkai Zasshi, 1990 Aug, 100(9), 929 - 34 {The role of bacteria on facial rosacea-like dermatitis in adult type atopic dermatitis}; Noguchi T et al.; To investigate the role of bacteria on facial rosacea-like dermatitis lesion in adult type atopic dermatitis, we measured the numbers of bacteria on the skin, nasal and pharyngeal surface of each individual, and then examined its sensitivity to antibiotics . The numbers of bacteria on the surface of skin increased according to the severity of skin eruption . Staphylococcus aureus was detected from the skin and nasal surface more than pharyngeal surface . Bacteria on the pharyngeal surface were both staphylococcus aureus and haemophilus parainfluenzae . Therefore, it is suggested that bacterial flora on the pharynx is different from those of the skin and nose . The treatment with antibiotics was effective for exudative lesions, whereas lichenified lesion did not respond to antibiotic therapy . These results suggest that bacteria on the skin surface are one of precipitating factors of the rosacea-like dermatitis of atopic dermatitis. Arch Fr Pediatr, 1990 Aug-Sep, 47(7), 491 - 5 {Therapeutic management of purulent meningitis in children . Report of 101 cases}; Slide precipitation: a simple method to type Actinobacillus (Haemophilus) pleuropneumoniae; Regional Veterinary Investigation Centre, Torhout, BelgiumSoluble thermostable antigens prepared from Actinobacillus pleuropneumoniae, as commonly applied in the ring precipitation test, were used in rapid slide tests . This method was easier to perform than the ring precipitation test and showed the same specificity . This specificity was higher than that obtained in slide agglutination tests using whole bacterial cells. Pediatr Infect Dis J, 1990 Aug, 9(8), 555 - 61 Safety evaluation of PRP-D Haemophilus influenzae type b conjugate vaccine in children immunized at 18 months of age and older: follow-up study of 30,000 children; Vadheim CM et al.; We evaluated the safety of the PRP-D conjugate Hib vaccine (ProHIBit, Connaught) in 29,309 children vaccinated at 18-60 months of age in the Southern California Kaiser Permanente medical clinics during the period April 1, 1988, to July 31, 1989 . Surveillance for potential reactions involved postcard questionnaires, telephone surveys, reports of Kaiser staff and review of hospitalizations and covered two periods following immunization: (1) the first 48 hours and (2) days 2 through 30 . Surveillance for invasive Hib disease involved the above methods in addition to systematic reviews of laboratory and hospital records through January 31, 1990 . Rates of local and systemic reactions within 48 hours of vaccination with PRP-D alone were low (less than or equal to 2% for fever greater than 102 degrees F, local redness or swelling) and similar to those previously reported after vaccination with PRP . Hospitalization and seizures (0.15% and 0.09% of vaccinated children, respectively) occurring within 1 month of immunization appeared to be unrelated to vaccination . One 29-month-old child had onset of a fatal episode of Hib sepsis/meningitis within 48 hours of vaccination . Also, a 30-month-old child developed Hib meningitis 10 months after PRP-D vaccination . We conclude that PRP-D is safe when given alone or in combination with other childhood vaccines between 18 and 60 months of age. Antimicrob Agents Chemother, 1990 Aug, 34(8), 1480 - 4 Problems with current recommendations for susceptibility testing of Haemophilus influenzae; Mendelman PM et al.; We compared results of MIC and disk susceptibility tests on Haemophilus test medium (HTM) and those on comparative media . Ampicillin MICs were determined with seven ampicillin-resistant, non-beta-lactamase-producing (AmprNBLP) isolates by using HTM and supplemented brain heart infusion (sBHI) agar . Ampicillin and amoxicillin-clavulanate disk tests with 16 AmprNBLP strains, 18 ampicillin-susceptible (Amps) isolates, and 17 ampicillin-resistant, beta-lactamase-producing (AmprBLP) strains were performed by using five media: laboratory-prepared HTM (PHTM), commercial HTM (CHTM), sBHI, enriched chocolate agar, and Mueller-Hinton chocolate agar . We observed that five of seven and three of seven AmprNBLP strains were misclassified as susceptible with PHTM (MIC, less than 2 micrograms/ml) with inocula of 10(3) and 10(5) CFU, respectively, but were resistant with sBHI (MIC, greater than or equal to 2 micrograms/ml) . Whereas Mueller-Hinton chocolate agar and enriched chocolate agar plates supported the growth of all 51 strains by the disk tests, 37% (19 of 51) and 8% (4 of 51) of strains did not grow on PHTM and CHTM, respectively . Lack of growth on PHTM was observed for all three phenotypes; 7 of 18 Amps, 4 of 17 AmprBLP, and 8 of 16 AmprNBLP strains did not grow . The four strains that did not grow on CHTM were all AmprNBLP isolates . Zone sizes were significantly larger on PHTM than on the other media . Of the strains that were evaluable by the new National Committee for Clinical Laboratory Standards guidelines with either PHTM or CHTM, all Amps strains were classified as susceptible . Among the AmprBLP strains, CHTM correctly identified all as resistant, whereas PHTM detected two isolates to be intermediate . Among the AmprNBLP strains, CHTM and PHTM misclassified four (33%) and five (62%) isolates, respectively, as susceptible; an additional isolate was identified as intermediate on both media . We conclude that there is strain-dependent growth on HTM, that adoption of this medium for routine Haemophilus susceptibility testing is problematic due to this growth variability, and that detection of AmprNBLP isolates would be unreliable. Q J Med, 1990 Aug, 76(280), 799 - 816 Double-blind randomized study of prolonged higher-dose oral amoxycillin in purulent bronchiectasis; Currie DC et al.; Thirty-eight patients with bronchiectasis and daily expectoration of purulent sputum despite conventional antibiotic courses were randomly allocated to receive a sachet of amoxycillin (3 g) or matched placebo twice daily for 32 weeks in a double-blind study . Nine patients (four amoxycillin, five placebo) were withdrawn from the study treatment; the response of the two patients (both on amoxycillin) withdrawn within the first six weeks was not assessed . The pretreatment characteristics of the two groups were similar . Independent assessment of overall response based on patients' diary cards showed that a higher proportion improved in the amoxycillin group (11 of 17) than in the placebo group (four of 19; p = 0.02) . Patients in the amoxycillin group spent significantly less time confined to bed and away from work during treatment . The frequency of exacerbations during the study treatment phase was similar in the two groups but they were less severe than before study treatment in the amoxycillin group . There was a greater reduction in purulent sputum volume between exacerbations during the study treatment in the amoxycillin group to 20 per cent of pretreatment volume than in the placebo group (88 per cent of pretreatment volume, p = 0.008), although the concentrations of Haemophilus spp . in sputum between exacerbations was similar in the two groups . Adverse effects experienced were minor except in one patient (amoxycillin) withdrawn after developing a rash and in six patients (three amoxycillin, three placebo) who had diarrhoea lasting more than one week necessitating withdrawal of two patients (one amoxycillin, one placebo) from study treatment . Sputum and stool cultures collected regularly during the study showed no important changes in the bacterial flora in either group . Prolonged higher-dose antibiotic therapy in these patients with severe purulent bronchiectasis significantly reduced the host (patient) inflammatory response to colonizing microorganisms and reduced morbidity. Br J Clin Pract, 1990 Aug, 44(8), 329 - 31 Haemophilus aphrophilus endocarditis; Webb CH et al.; We report a case of Haemophilus aphrophilus endocarditis involving mitral and tricupsid valves in a boy with congenital heart disease . He had received dental treatment without antibiotic cover . Prolonged high-dose ampicillin with gentamicin was necessary for cure . Short courses of ampicillin alone may not successfully treat H . aphrophilus. APMIS, 1990 Aug, 98(8), 753 - 7 In vitro activity of 9 antimicrobial agents against 177 strains of Haemophilus influenzae isolated from hospitalized patients; Teigen K et al.; In vitro activity of 4 commonly used and 5 new antibiotics was examined against 177 strains of Haemophilus influenzae . All strains were collected from various sites in patients with clinical infections . The study confirms that several newer antibiotics are useful alternatives to older drugs, as measured by in vitro activity . Ciprofloxacin and ofloxacin were the most active agents, (MIC90 0.012 micrograms/ml and 0.05 micrograms/ml respectively), followed by aztreonam (MIC90 0.1 micrograms/ml) and cefuroxime (MIC90 0.8 micrograms/ml) . A new macrolide, azithromycin (CP 62,993), was more active than erythromycin, MIC90 1.6 micrograms/ml vs 6.4 micrograms/ml . Beta-lactamase production was detected in 4.5% (8/177) of the strains . In vitro activity was the same against strains collected in 1985 and 1988 . No increase in beta-lactamase production was recorded. J Clin Microbiol, 1990 Aug, 28(8), 1862 - 3 Comparison of the RIM-H rapid identification kit with conventional tests for the identification of Haemophilus spp; Palladino S et al.; A commercially available system, the RIM-H system (Austin Biological Laboratories, Austin, Tex.), was evaluated for its ability to rapidly and accurately identify various Haemophilus spp . A total of 110 clinical isolates were tested by both the RIM and conventional identification procedures . The RIM agreed with the standard identification for 100% of the Haemophilus influenzae (76 of 76) and 92.0% of the Haemophilus parainfluenzae (23 of 25) isolates tested . The identifications of Haemophilus parahaemolyticus, Haemophilus aphrophilus, and Haemophilus haemolyticus also correlated with those obtained by conventional methods . The RIM was found to be rapid and easy to use and was considered a suitable alternative to conventional identification procedures. Antimicrob Agents Chemother, 1990 Aug, 34(8), 1473 - 9 In vitro evaluation of nicotinamide riboside analogs against Haemophilus influenzae; Godek CP et al.; Exogenous NAD, nicotinamide mononucleotide, or nicotinamide riboside is required for the growth of Haemophilus influenzae . These compounds have been defined as the V-factor growth requirement . We have previously shown that the internalization of nicotinamide riboside is energy dependent and carrier mediated with saturation kinetics . Thionicotinamide riboside, 3-pyridinealdehyde riboside, 3-acetylpyridine riboside, and 3-aminopyridine riboside were prepared from their corresponding NAD analogs . These compounds and several other nicotinamide riboside analogs were evaluated for their ability to support the growth of H . influenzae and for their ability to block the uptake of {carbonyl-14C}nicotinamide riboside by H . influenzae . 3-Aminopyridine riboside blocked the uptake of {carbonyl-14C}nicotinamide riboside and inhibited the growth of H . influenzae when NAD, nicotinamide mononucleotide, or nicotinamide riboside served as the V factor . The antibacterial activity of 3-aminopyridine riboside was found to be specific for H . influenzae but had no effect on the growth of Staphylococcus aureus or Escherichia coli . In additional experiments by reversed-phase high-performance liquid chromatography, it was determined that whole cells of H . influenzae degrade 3-aminopyridine adenine dinucleotide to 3-aminopyridine riboside, which is then internalized . Inside the cell, 3-aminopyridine riboside has the ability to interfere with the growth of H . influenzae by an undetermined mechanism. J Antimicrob Chemother, 1990 Aug, 26(2), 237 - 46 Temafloxacin in acute purulent exacerbations of chronic bronchitis; Davies BI et al.; Temafloxacin hydrochloride, a new fluoroquinolone, was given orally in doses of 300 or 600 mg twice daily for ten days to 36 patients, all hospitalized because of severe acute purulent exacerbations of chronic bronchitis . Sputum cultures before, during and after treatment showed that the infection was eliminated in 12/18 evaluable patients given 300 mg and in 13/16 receiving the 600 mg doses . Haemophilus influenzae, Branhamella catarrhalis and Streptococcus pneumoniae were effectively eliminated, but only half the Pseudomonas aeruginosa infections were eradicated . MICs for most pathogens were 1 mg/l or less (including the majority of the pneumococci) but the MICs for Ps . aeruginosa ranged from 0.5 to greater than 16 mg/l, those for 10 of the 22 strains being greater than 2 mg/l . Pharmacokinetic studies on serum and sputum specimens showed serum Cmax values of 3.5 and 6.0 mg/l, the sputum Cmax being 2.35 and 4.17 mg/l after the different doses . No interaction with concomitant theophylline could be found . Two patients complained of moderate nausea or water-brash . Temafloxacin can be considered safe and effective at these dosages, but for Ps . aeruginosa infections higher dosages need to be investigated. J Antimicrob Chemother, 1990 Aug, 26(2), 209 - 13 Ceftibuten--in-vitro activity against respiratory pathogens, beta-lactamase stability and mechanism of action; Wise R et al.; The in-vitro activity of ceftibuten against respiratory pathogenic bacteria was studied and compared with that of other oral beta-lactam agents . Ceftibuten displayed high activity against Haemophilus influenzae and Branhamella catarrhalis . There was reduced activity against Streptococcus pneumoniae (MIC90 16 mg/l) . The protein binding of ceftibuten was 77% and the primary target site PBP 3 . A high degree of stability to beta-lactamase hydrolysis was observed. Ir J Med Sci, 1990 Aug, 159(8), 231 - 2 Increased ampicillin resistance in Haemophilus influenzae in Northern Ireland hospitals; Murphy PG et al.; Twenty-nine of one hundred and ninety-three (15%) clinical isolates of Haemophilus influenzae from Northern Ireland hospitals during 1985-1986 were found to be ampicillin resistant . This is twice the national average for the same period and 65% increase since a similar report in Northern Ireland three years previously . Computerised monitoring of routine specimens has shown this resistance level to be maintained in 1989 . Susceptibility to other antimicrobials is discussed. Microb Pathog, 1990 Aug, 9(2), 81 - 93 Induction of an immune response to the porin of Haemophilus influenzae type b by monoclonal anti-idiotypic antibodies; Hamel J et al.; Monoclonal anti-idiotypes were generated against monoclonal antibody (mAb) Hb-2 which recognized a highly conserved epitope on the outer membrane porin protein from Haemophilus influenzae type b (Hib) . Four hybridomas reacting with F(ab') 2 fragments of Hb-2 were selected and characterized . Inhibition studies using syngeneic anti-anti-idiotypic antisera suggested that at least three different antigenic determinants on Hb-2 were recognized by these monoclonal anti-idiotypes . The binding of each anti-idiotype to Hb-2 was inhibited by Hb-2 whereas the reaction was not affected by any other anti-Hib mAb . Complete inhibition of the binding of anti-idiotype to the idiotype could be achieved with 10 micrograms of total outer membrane protein (OMP) from Hib suggesting that the anti-idiotypes might be directed against paratope-associated idiotypes . Outer membrane antigens not recognized by mAb Hb-2 did not inhibit the reaction . Furthermore, the pre-incubation of Hb-2 with each anti-idiotype specifically prevented the reaction of Hb-2 with its antigen . Antibodies with specificity for the porin were generated in guinea pigs immunized with anti-idiotypes AHb-22 and AHb-23 . This study indicates that these particular monoclonal anti-idiotypes may be used as an antigen substitute for the porin of Hib in a xenogeneic species. J Clin Microbiol, 1990 Aug, 28(8), 1720 - 4 Antigenic relationships among the porin proteins of encapsulated Haemophilus influenzae clones; Martin D et al.; Monoclonal antibodies (Mabs) specific for Haemophilus influenzae were generated to identify antigenic determinants shared among encapsulated H . influenzae clones . Sixteen MAbs reacted by Western immunoblot with a protein of an approximate molecular size of 40 kilodaltons corresponding to the P2 major outer membrane protein (porin) . These MAbs also reacted with purified and recombinant H . influenzae porin . Fourteen of the MAbs recognized cell surface-exposed epitopes, and two of the MAbs, P2-16 and P2-17, identified epitopes that are not present or are not accessible on the cell surface . The reactivity spectrum of the MAb panel was studied by dot immunoassay against 32 serologically nontypeable and 119 encapsulated H . influenzae strains recovered worldwide, representing the major serotype a, b, and d clone families . MAbs P2-4 and P2-6 recognized only serotype b clones assigned to primary phylogenetic division I . These clones account for more than 99% of all invasive episodes worldwide . MAbs P2-3, P2-8, and P2-11 reacted with division I serotype b isolates and also identified all genetically allied strains expressing serotype a and d polysaccharide capsules . In contrast, none of the 16 MAbs reacted with genetically divergent serotype a or b clones assigned to primary phylogenetic division II . These results demonstrate that, in general, the patterns of P2 protein surface epitope exposure are cognate with genetic lineages of encapsulated H . influenzae strains and support the hypothesis that the population structure of encapsulated H . influenzae is predominantly clonal. Lancet, 1990 Jul 21, 336(8708), 159 - 60 Cross-infection by non-encapsulated Haemophilus influenzae; Gough J et al.; From October, 1988, to January, 1989, 18 patients admitted to an acute medical chest ward were infected with an ampicillin-resistant beta-lactamase-producing strain of Haemophilus influenzae . All 18 isolates were non-encapsulated strains of biotype III and showed identical cell envelope protein profiles, as judged by sodium dodecyl sulphate-polyacrylamide gel electrophoresis . The organism was not isolated from repeated environmental samples but there was strong circumstantial evidence that a spirometer was a common iatrogenic source of the cross-infection. Infect Immun, 1990 Jul, 58(7), 2343 - 51 Effect of mutations in lipooligosaccharide biosynthesis genes on virulence of Haemophilus influenzae type b; Cope LD et al.; Chemical mutagenesis techniques and genetic transformation methods were used to construct isogenic mutants of Haemophilus influenzae type b (Hib) defective in the ability to synthesize lipooligosaccharide (LOS) . A mutant (17B) which expressed a LOS molecule with an altered oligosaccharide was less virulent than the wild-type parent strain, as determined by measurement of the ability of these strains to produce bacteremia in infant rats after intranasal challenge . Further mutagenesis of this mutant strain yielded two new mutants with different LOS phenotypes . Mutant 7A was slightly sensitive to the bactericidal activity present in normal infant rat serum and was even less virulent than its immediate parent strain (17B) in the intranasal challenge model . However, both mutants 17B and 7A could produce bacteremia and meningitis when introduced into infant rats by the intraperitoneal route . The other LOS mutant (14A) derived from mutant 17B exhibited a level of virulence equivalent to that of the original wild-type strain . Genetic transformation of wild-type chromosomal DNA into the essentially avirulent mutant 7A and selection of transformants on the basis of their LOS antigenic characteristics resulted in the sequential restoration of full virulence to this mutant . These findings suggest that LOS is involved on at least two different levels in the ability of Hib to produce invasive disease in the infant rat model . Changes in LOS phenotype can independently affect the ability of Hib to produce bacteremia after intranasal challenge and the sensitivity of Hib to killing by normal infant rat serum . These results reinforce the significance of Hib LOS in the expression of virulence by this pathogen. Nucleic Acids Res, 1990 Jul 11, 18(13), 3903 - 11 Cloning, nucleotide sequence, and expression of the HincII restriction-modification system; Ito H et al.; Two genes, coding for the HincII from Haemophilus influenzae Rc restriction-modification system, were cloned and expressed in Escherichia coli RR1 . Their DNA sequences were determined . The HincII methylase (M.HincII) gene was 1,506 base pairs (bp) long, corresponding to a protein of 502 amino acid residues (Mr = 55,330) . The HincII endonuclease (R.HincII) gene was 774 bp long, corresponding to a protein of 258 amino acid residues (Mr = 28,490) . The amino acid residues predicted from the R.HincII and the N-terminal amino acid sequence of the enzyme found by analysis were identical . These methylase and endonuclease genes overlapped by 1 bp on the H . influenzae Rc chromosomal DNA . The clone, named E . coli RR1-Hinc, overproduced R.HincII . The R.HincII activity of this clone was 1,000-fold that from H . influenzae Rc . The amino acid sequence of M.HincII was compared with the sequences of four other adenine-specific type II methylases . Important homology was found between tne M.HincII and these other methylases. Antimicrob Agents Chemother, 1990 Jul, 34(7), 1456 - 8 Comparative in vitro activity of cefixime against Haemophilus influenzae isolates, including ampicillin-resistant, non-beta-lactamase-producing isolates, from pediatric patients; Mortensen JE et al.; The in vitro activity of cefixime was comparatively tested against 232 non-type b and 102 type b isolates of Haemophilus influenzae derived from clinical specimens of pediatric patients, including 10 non-type b strains that did not produce beta-lactamase and demonstrated resistance to ampicillin . Cefixime was active against the ampicillin-susceptible and ampicillin-resistant, beta-lactamase-producing isolates; however, its activity against some non-beta-lactamase-producing, ampicillin-resistant isolates appeared to be limited. Antimicrob Agents Chemother, 1990 Jul, 34(7), 1366 - 70 In vitro activity of E-1040, a 3-substituted cephalosporin, against pathogens from cystic fibrosis sputum; Stutman HR et al.; On the basis of preliminary in vitro data, we evaluated E-1040, a new cephalosporin, against 188 cystic fibrosis (CF) sputum isolates obtained from 26 CF centers in the United States . These isolates included mucoid and nonmucoid Pseudomonas aeruginosa, Pseudomonas cepacia, Staphylococcus aureus, Haemophilus influenzae, and Escherichia coli . In addition to MICs measured under standard conditions, selected isolates were tested at various pH values, inoculum sizes, and diluent (CF serum and sputum) conditions . E-1040 activities (MICs for 50 and 90% of the strains) against the isolates were as follows: P . aeruginosa (mucoid and nonmucoid), 1 and 4 micrograms/ml; P . cepacia, 4 and 16 micrograms/ml; S . aureus, 8 and 8 micrograms/ml; H . influenzae, 1 and 4 micrograms/ml; and E . coli, less than or equal to 0.12 and less than or equal to 0.12 microgram/ml . E-1040 activity against mucoid P . aeruginosa was 4-fold greater than that of aztreonam, 16-fold greater than that of ceftazidime, and 32-fold greater than that of piperacillin . E-1040 was similar to other broad-spectrum cephalosporins against S . aureus, H . influenzae, and E . coli . Bactericidal activity was less than or equal to 1 dilution of MIC for 88% of the strains, although kinetic studies with mucoid strains of P . aeruginosa demonstrated effective killing only at eight times the MIC . Variations in pH from 5 to 8, in inoculum size from 10(3) to 10(7) CFU/ml, and in diluent (CF serum or CF sputum) did not affect E-1040 activity. Anaesthesia, 1990 Jul, 45(7), 561 - 2 Respiratory tract infection and anaesthesia . Haemophilus influenzae pneumonia that developed under anaesthesia; Campbell NN; A 2-year-old boy with symptoms of a minor upper respiratory tract infection developed Haemophilus influenzae pneumonia that presented as hypoxaemia under anaesthesia for minor emergency surgery . The patient required 72 hours of mechanical ventilation in an intensive care unit after the anaesthetic and thereafter made an uneventful recovery . The value of pre-operative chest radiology and the possible contributory effect of anaesthesia are discussed. Rev Infect Dis, 1990 Jul-Aug, 12(4), 708 - 15 Life-threatening Haemophilus influenzae infections in Scandinavia: a five-country analysis of the incidence and the main clinical and bacteriologic characteristics; Peltola H et al.; The five countries of Scandinavia (Denmark, Finland, Iceland, Norway, and Sweden) comprise 22.6 million inhabitants and rather homogeneous socioeconomic conditions . A survey of systemic Haemophilus influenzae diseases over the last decades revealed that the reported incidence of H . influenzae disease is increasing . In recent years, the overall incidence has been 3.5 cases per 100,000 people each year (800 cases annually); in children less than 5 years of age, the annual incidence has been 49 cases per 100,000 . Meningitis represents only 52% of all systemic H . influenzae diseases, but lack of reliable data may obscure the importance of other entities . Few strains (less than 5%) are beta-lactamase-positive, and the case fatality rate is 3% . Analysis of seasonal variation shows peaks in June and September-October . If the efficacy of the H . influenzae conjugate vaccines were as high as that of a conjugate vaccine used in Finland during 1986-1987 (approximately 85% efficacy), then at least an 80% reduction in life-threatening H . influenzae infections would be achieved annually by routine immunization before or at the age of 6 months. Res Vet Sci, 1990 Jul, 49(1), 8 - 13 Use of monoclonal antibodies for classifying Actinobacillus (Haemophilus) pleuropneumoniae; Lida J et al.; The serological typing (by enzyme-linked immunosorbent assay) of 119 isolates of Actinobacillus (Haemophilus) pleuropneumoniae (representing in varying numbers the 12 serovars of this taxon) by monoclonal antibodies derived from the reference strains of serovars 1 to 5 in general correlated reasonably with the serotype previously established for these strains by conventional procedures employing polyclonal antisera . However, where there were reasonable numbers of isolates representing a given serovar to provide a decision, there was no instance where the correlation between the monoclonal and the polyclonal antibody was in complete accord . In addition, some of the differences between monoclonal and polyclonal antibody binding with some isolates suggest that the distribution of the serotype-specific antigens within the taxon may be even more complex than has previously been supposed. Pediatr Infect Dis J, 1990 Jul, 9(7), 488 - 94 A population-based retrospective assessment of the disease burden resulting from invasive Haemophilus influenzae in infants and young children in Santiago, Chile; Ferreccio C et al.; Clinical discharge and laboratory records were reviewed in the seven government hospitals that provide care for 93% of the pediatric population of Santiago, Chile, to detect cases of meningitis and other invasive (bacteremia-associated) infections caused by Haemophilus influenzae . infections that occurred in children less than five years of age from January, 1985, through December, 1987, were recorded and matched with census data to calculate incidence rates . The incidence of meningitis and non-meningitis syndromes peaked in the 6- to 11-month age group and tapered sharply after 12 months of age . The city-wide incidence (ca . 21.6 cases/10(5) children less than 5 years of age) is one-third to one-half that reported for the general pediatric population in the United States . However, there is much evidence for under-reporting in Santiago . In Area Norte, served by Roberto del Rio Children's Hospital where H . influenzae has been a subject of research by pediatricians for years, the incidence of invasive H . influenzae infections (42.5/105) is approximately two-fold higher than the rest of Santiago . The cumulative proportions of episodes of H . influenzae disease occurring in successively older age groups closely parallel the pattern seen in the general United States pediatric population . Although only ca . 20% of all episodes occur during the first 6 months of life, nearly 80% of episodes are seen by 18 months of age . Based on the observed incidence rates, the apparent underreporting and the high city-wide case fatality of Hib meningitis (16%), invasive H . influenzae infections represent an important public health problem in Santiago, Chile. J Infect Dis, 1990 Jul, 162(1), 248 - 50 C4B deficiency: a risk factor for bacteremia with encapsulated organisms; Bishof NA et al.; The fourth component of complement (C4) is crucial to the activation of the classical complement pathway, a key defense against invading microorganisms . The two isotypes of C4, C4A and C4B, have very different in vitro activities . An increased incidence of total C4B deficiency was found in white patients with Streptococcus pneumoniae, Haemophilus influenzae, or Neisseria meningitidis infection (14% of bacteremic children vs . 2% of race-matched controls, P = .02) . In black patients, however, there was no difference in incidence of C4B deficiency between bacteremic patients and race-matched controls (7% and 5%, respectively, P greater than .5) . These data suggest that, at least in whites, total C4B deficiency is a risk factor for invasive disease with these three encapsulated organisms. J Infect Dis, 1990 Jul, 162(1), 163 - 71 Bactericidal and opsonic activity of IgG1 and IgG2 anticapsular antibodies to Haemophilus influenzae type b; Amir J et al.; Complement-mediated bactericidal and opsonic activity of IgG1 and IgG2 antibodies to Haemophilus influenzae type b polysaccharide (polyribosyl ribitol phosphate {PRP}) were investigated . The antibody sources were IgG1 or IgG2 subclass polyclonal antibody fractions prepared by immunoabsorption of sera from adults immunized with PRP or PRP-diphtheria toxoid conjugate vaccine or clonally purified anti-PRP antibodies from eight adults immunized with PRP vaccine . In bactericidal assays using an inoculum of 3 x 10(3) colony-forming units (cfu)/ml, twofold lower concentrations of IgG1 compared with IgG2 antibody were required for 50% killing . With approximately 10(6) cfu/ml, IgG1 antibody killed 3 logs more of bacteria than were killed by comparable concentrations of IgG2 antibody . The IgG1 antibody also required lower concentrations of complement than did the IgG2 antibody for comparable bacteriolytic activity . Clonally purified IgG1 and IgG2 anti-PRP antibodies from most individuals showed similar relative differences in bactericidal activity . IgG1 anti-PRP antibody was also more efficient than IgG2 anti-PRP antibody in enhancing the uptake of radiolabeled type b H . influenzae by human polymorphonuclear leukocytes in the presence of complement and in protecting infant rats from developing bacteremia . However, the differences in opsonic or protective activity of the two subclasses were smaller than the differences in bactericidal activity . Thus, IgG1 anti-PRP antibody is functionally more effective than IgG2 antibody, but it is likely that both subclasses can confer protection against disease. J Infect Dis, 1990 Jul, 162(1), 139 - 47 Cerebrospinal fluid cachectin/tumor necrosis factor-alpha and platelet-activating factor concentrations and severity of bacterial meningitis in children; Arditi M et al.; In prospective studies, tumor necrosis factor (TNF alpha) was detected in cerebrospinal fluid (CSF) of 33 of 38 children with bacterial meningitis (BM) but in none of 15 with viral meningitis/encephalitis (P less than .001) . BM CSF TNF alpha (less than 35 to greater than 25,500 pg/ml) correlated with CSF bacterial density (P less than .01), CSF protein (P less than .001), endotoxin (LPS) in gram-negative disease (P less than .01), and consecutive febrile hospital days (P less than .001); initial CSF TNF alpha greater than 1000 pg/ml was associated with seizures (P less than .05) . Only 5 children with BM (13%) had detectable plasma TNF alpha activity on admission . A higher proportion who died had detectable plasma TNF alpha activity compared with survivors (3/4 vs . 2/34, P less than .005) . Platelet-activating factor (PAF) in CSF was higher in 19 children with Haemophilus influenzae meningitis than in 17 controls (P less than .01) and correlated with bacterial density (P less than .01), CSF LPS (P less than .01), CSF TNF alpha levels (P less than .01), and the Herson-Todd severity score (P less than .01) . Elevated CSF TNF alpha and PAF are often present in children with BM and are associated with seizures and severity of disease . Detectable CSF TNF alpha appears to distinguish BM from viral meningitis. Eur Respir J, 1990 Jul, 3(7), 840 - 1 Haemophilus influenzae lobar pneumonia in the father of a child with epiglottitis; Manji H et al.; We present a case of Haemophilus influenzae lobar pneumonia in the father of a child admitted with acute epiglottitis caused by the same organism . The suggestion that adult, as well as child, contacts for Haemophilus influenzae epiglottitis should be prophylactically treated is discussed. Pathology, 1990 Jul, 22(3), 162 - 4 Evaluation of a selective medium for the isolation and differentiation of Haemophilus influenzae and Haemophilus parainfluenzae from the respiratory tract of chronic bronchitics; Taylor DC et al.; Respiratory tract specimens from chronic bronchitic patients were cultured for Haemophilus species on conventional chocolate agar and a modified sucrose medium in order to determine the accuracy of the new medium in differentiating Haemophilus influenzae from Haemophilus parainfluenzae strains . Haemophilus influenzae biotypes II and III and Haemophilus parainfluenzae biotypes I and II were found to be the predominant strains isolated from the respiratory tract . The modified sucrose medium was found to be a rapid and reliable means of differentiating Haemophilus influenzae from Haemophilus parainfluenzae by sucrose fermentation, on initial isolation. Avian Dis, 1990 Jul-Sep, 34(3), 643 - 5 Serotyping of Haemophilus paragallinarum by the Page scheme: comparison of the use of agglutination and hemagglutination-inhibition tests; Blackall PJ et al.; Seventy-two isolates of Haemophilus paragallinarum were serotyped according to the Page scheme, using a new hemagglutination-inhibition (HI) test . The results were compared with the plate agglutination method conventionally used in the Page scheme . The HI test used washed cells of H . paragallinarum, glutaraldehyde-fixed chicken erythrocytes, and rabbit antisera originally produced for the agglutination method . For 49 of the isolates, there was complete correlation between the results of the HI serotyping test and the previously performed agglutination test--23 were serovar A, two were serovar B, and 24 were serovar C . The other 23 isolates were nontypable by the agglutination test, but 21 of them could be serotyped by the HI method--six as serovar A, two as serovar B, and 13 as serovar C . Nine isolates required treatment of the bacterial cells with hyaluronidase for the expression of hemagglutination (HA) activity . Two isolates did not have HA activity despite hyaluronidase treatment and so could not be serotyped by the HI test. Respir Med, 1990 Jul, 84(4), 325 - 30 Antibacterial and mutagenic activity of inhaled bronchodilators on the respiratory pathogen Haemophilus influenzae; Powell M et al.; The U.K . prevalence of non-beta-lactamase-mediated resistance to ampicillin among Haemophilus influenzae reached 4% in 1986 . The majority (70%) of isolates of this type come from sputa of patients with chronic obstructive airways disease . This study investigated whether bronchodilator drugs delivered directly to the respiratory tract have any antibacterial activity and/or play a role in promoting selection of organisms with this type of resistance . Antibacterial activity was detected in two out of six pharmaceutical preparations for nebulization examination but was entirely attributable to the preservative (benzalkonium chloride) in them . Exposure of ampicillin-susceptible H . influenzae (minimum inhibitory concentration 0.25 mg l-1) to concentrations of salbutamol, fenoterol and beclomethasone theoretically attainable in vivo resulted, after 48 h, in isolation of colonies with reduced susceptibility to ampicillin (minimum inhibitory concentration 1-4 mg l-1) but reversion to beta-lactam susceptibility occurred following serial subculture on chocolate agar . Organisms with stable reduced susceptibility to ampicillin were obtained when exposure to one of these three bronchodilators in broth was followed by serial subculture on agar containing the same preparations at equivalent concentrations and when the period of exposure to salbutamol at 100 mg l-1 in broth was extended to 5 days . The occurrence of these phenomena in vivo might be contributing to failures in treatment of exacerbations with ampicillin and to an increasing prevalence of beta-lactamase-negative, ampicillin-resistant H . influenzae. Jpn J Antibiot, 1990 Jul, 43(7), 1214 - 24 {Synergy between sulbactam and ampicillin or cefoperazone in antimicrobial activity against beta-lactamase producing microorganisms . Results with the use of microdilution broth method}; Deguchi K et al.; Antimicrobial activities of sulbactam (SBT) with ampicillin (ABPC) or with cefoperazone (CPZ), in other words, the effects of SBT, an beta-lactamase inhibitor, against beta-lactamase producing strains of clinical isolates, were studied using microdilution broth method . 1 . beta-Lactamase producing strains such as Staphylococcus aureus, Branhamella catarrhalis, Haemophilus influenzae, Escherichia coli and Klebsiella pneumoniae decompose benzylpenicillin (PCG) which is one of substrates of the acid-metry disc method and show a strong reaction, while they do not decompose cefazolin (CEZ), another substrate, showing no or weak reaction . Thus, it is suspected that beta-lactamases produced by these organisms are mainly penicillinase (PCase) . MIC-distributions of ABPC and CPZ against these clinical isolates which seemed to produce PCase shifted to lower MIC ranges with MIC's reduced to 1/4 or below when 0.025 to 0.39 microgram/ml of SBT was added . 2 . It appears that beta-lactamase produced by Proteus vulgaris may be oxyiminocephalosporinase (CXase), because P . vulgaris showed strong reaction on CEZ, but moderate reaction on PCG in the acid-metry disc method . MIC-distribution of ABPC and CPZ against P . vulgaris shifted to a lower range with MIC's of 1/4 or below when 0.20 to 0.39 microgram/ml of SBT was added . 3 . All the test strains of Pseudomonas aeruginosa showed strong reaction on CEZ but only 56% of the test strains showed reaction on PCG . It appears that the beta-lactamases which showed strong reaction on CEZ is cephalosporinase and is encoded in chromosome, while those beta-lactamase that showed strong reaction on PCG is encoded in a plasmid which was acquired secondarily by P . aeruginosa . MIC-distribution of CPZ against P . aeruginosa shifted to a lower range with MIC values of 1/2 or below with the addition of SBT at 1.56 micrograms/ml . 4 . It appears that the synergy of SBT with ABPC or with CPZ against the PCase or CXase producing strains may occur in the presence of SBT at a concentration far less than that reported previously. J Gen Microbiol, 1990 Jul, 136 ( Pt 7), 1203 - 9 Urogenital, maternal and neonatal isolates of Haemophilus influenzae: identification of unusually virulent serologically non-typable clone families and evidence for a new Haemophilus species; Quentin R et al.; A collection of 117 strains of Haemophilus influenzae, including 112 non-typable isolates recovered predominantly in the USA and France from genital, obstetric and neonatal sources, was characterized by the electrophoretic mobilities of 10 metabolic enzymes . Eighty-six distinctive multilocus chromosomal genotypes (electrophoretic types, ETs) were distinguished on the basis of allele profiles at the enzyme loci . Isolates of five allied biotype IV ETs were highly divergent from all other strains and hybridization of chromosomal DNA revealed that they undoubtedly represent a previously unrecognized species of Haemophilus . Isolates representing these ETs were recovered predominantly from obstetric infections and serious neonatal diseases and apparently possess specific tropism for the genital tract . Strains of these five ETs were present in samples from both the USA and France, but only in the USA did they cause bacteraemia and meningitis, an occurrence which probably reflects differences in patient management between the two countries . Although strains assigned to H . influenzae (sensu stricto) were strongly polymorphic in multilocus enzyme genotype, 69% of isolates recovered from patients with meningitis and/or septicaemia were assigned to only two clone families, a result suggesting that some serologically nontypable strains of H . influenzae originating from the genital tract are unusually virulent. J Antimicrob Chemother, 1990 Jul, 26(1), 71 - 9 Antibacterial activity of cefpodoxime proxetil in a pharmacokinetic in-vitro model; Wiedemann B et al.; The antibacterial activity of cefpodoxime proxetil was studied in an in-vitro model simulating doses of 100, 200 and 400 mg . Strains of Klebsiella spp . Proteus mirabilis, Escherichia coli, Streptococcus pyogenes, and Haemophilus influenzae were effectively reduced by a dose of 200 mg . While for Esch . coli no dose-activity relationship was observed--the maximal effect was achieved with a simulated dose of 100 mg--Staphylococcus aureus could be reduced effectively only by a simulated dose of 400 mg . The lower doses showed stepwise lower activities . Apart from broad spectrum beta-lactamases like SHV 2 or TEM 5 the presence of plasmid coded beta-lactamases in Esch . coli and H . influenzae did not affect the antibacterial activity of cefpodoxime proxetil . The results show that cefpodoxime was more active against Gram-negative bacteria than amoxycillin, and comparable activity to intramuscular cefotiam in the in-vitro model. Pediatr Neurol, 1990 Jul-Aug, 6(4), 260 - 4 Haemophilus influenzae meningitis with prolonged hospital course; Martin LD et al.; A retrospective evaluation of Haemophilus influenzae type b meningitis observed over a 2-year period documented 86 cases . Eight of these patients demonstrated an unusual clinical course characterized by persistent fever (duration: greater than 10 days), cerebrospinal fluid pleocytosis, profound meningeal enhancement on computed tomography, significant morbidity, and a prolonged hospital course . The mean age of these 8 patients was 6 months, in contrast to a mean age of 14 months for the entire group . Two patients had clinical evidence of relapse . Four of the 8 patients tested for latex particle agglutination in the cerebrospinal fluid remained positive after 10 days . All patients received antimicrobial therapy until they were afebrile for a minimum of 5 days . Subsequent neurologic examination revealed a persistent seizure disorder in 5 patients (62.5%), moderate-to-profound hearing loss in 2 (25%), mild ataxia in 1 (12.5%), and developmental delay with hydrocephalus which required shunting in 1 (12.5%) . One patient had no sequelae. Antimicrob Agents Chemother, 1990 Jul, 34(7), 1354 - 9 Sequence analysis and evolutionary perspectives of ROB-1 beta-lactamase; Juteau JM et al.; The nucleotide sequence of the ROB-1 beta-lactamase gene from Haemophilus influenzae plasmid RRob was determined . The structural gene encodes a polypeptide of 305 amino acids, with an estimated molecular mass of 30,424 for the mature form of the protein . The ROB-1 gene showed low homologies with other beta-lactamases at the nucleic acid level . By using two statistical computer methods, assessment of the extent of similarity between ROB-1 and other known beta-lactamase amino acid sequences suggested that ROB-1 is a class A enzyme . Alignment of class A beta-lactamases with ROB-1 identified conserved residues . The use of a mutation matrix for detecting distance relationships indicated that ROB-1 has higher values and homologies with beta-lactamases of gram-positive bacteria, giving insight into its ancestry and divergence. Rev Infect Dis, 1990 Jul-Aug, 12(4), 628 - 35 Bacteremic disease due to Haemophilus influenzae capsular type f in adults: report of five cases and review; Slater LN et al.; Five cases of bacteremic infections due to Haemophilus influenzae type f in adults are described, and previous reports of type f disease in nonpediatric patients are reviewed . Respiratory tract infections were most common in our series (two cases of pneumonia, one of epiglottitis, and one of nosocomial septicemia probably resulting from aspiration pneumonitis) . All of these patients had factors predisposing them to respiratory tract infections, e.g., neurologic disease, congestive heart failure, or cigarette smoking . A fifth patient, who was bacteremic without an apparent primary focus, had dysgammaglobulinemia . Six episodes of bacteremia occurred in five patients; 11 of 13 cultures of blood obtained before parenteral antibiotic therapy were positive . All isolates were biotype I and susceptible to ampicillin . Antibiotic therapy was curative in cases of proved respiratory tract infection but failed in the setting of nosocomial septicemia, perhaps because of delayed initiation . The brevity of antibiotic treatment of the cryptogenic bacteremia permitted infection of a prosthetic vascular graft and recurrent bacteremia . Graft removal and repeated antibiotic therapy were curative. J Clin Pathol, 1990 Jul, 43(7), 581 - 3 Evaluation of two rapid methods for identifying and biotyping Haemophilus influenzae; Murphy PG et al.; Several rapid method kits (one to four hours) have become available for the identification of Haemophilus and related genera . Two kits (the "Rapid NH" system and the "RIM Haemophilus" system), which include the identification and biotyping of H influenzae, were investigated for the rapid identification and biotyping of 193 isolates of H influenzae and the results compared with those obtained by more standard overnight methods . The kits were convenient to use and gave reliable and rapid speciation of all isolates . Both test systems were unreliable for biotyping: 42 isolates were wrongly biotyped by the RIM kit and 40 isolates wrongly biotyped by the rapid NH kit . It is concluded that the test kits may be useful for the rapid identification of H influenzae but that they are not reliable for the biotyping of this species. Am J Med Sci, 1990 Jul, 300(1), 45 - 52 Pneumococcal vaccination: work to date and future prospects; Musher DM et al.; In our opinion, the conclusion from all these studies is that pneumococcal polysaccharides in the form in which they have been administered are relatively poor immunogens when compared, for example, to certain proteins such as tetanus toxoid . Had pneumococcal vaccination been the success that might reasonably have been predicted, there would be no argument, this many years later, over its merits . Although polysaccharide vaccines appear to have been effective in mass vaccination programs and in epidemic situations where presumably healthy adults have been involved, it has been more difficult to document their efficacy in individuals who are most in need of them, namely those with aberrant or senescent immune systems . There seems to be no disagreement that antibody at some concentration (the precise level remains to be determined) will, in general, be associated with protection, although in any one individual, for a variety of reasons, infection with a vaccine serotype might still occur . Thus, the clear direction for the future should be not to argue further the merits of currently available vaccine preparations, but rather to work rapidly and efficiently to develop and test new and more effective polysaccharide antigens . Studies in the past 10 years have shown that the polyribosyl ribitolphosphate (PRP) of Haemophilus influenzae type b is a far more effective antigen when conjugated to diphtheria toxoid . For example, in a study in our laboratory, vaccination of healthy young adults with PRP-conjugated diphtheria toxoid yielded serum antibody levels 10- to 100-fold higher than after PRP alone . Responses may be even better if other proteins are used.(ABSTRACT TRUNCATED AT 250 WORDS) Bioorg Khim, 1990 Jul, 16(7), 889 - 97 {Isolation and characteristics of new restriction endonucleases from Haemophilus influenzae}; Lazariavichiute LG et al.; Various strains of Haemophilus influenzae have been examined for the presence of site-specific endonuclease activities, and eleven restriction endonucleases have been isolated from seven strains . For all the endonucleases recognition sequences were determined, for three of them cleavage sites being identified . The enzymes proved to be isoschizomers of known endonucleases, viz . Hin1 I, Hin8 I--Acy I; Hin1 II, Hin8 II--Nla III; Hin2 I, Hin5 I--Hpa II; Hin3 I--Cau II; Hin5 II--Asu I; Hin5 III--Hind III; Hin6 I, Hin7 I--Hha I . Restriction endonucleases Hin1 I, Hin1 II and Hin6 I recognize nucleotide {formula: see text} sequences 5'GRCGPYC, 5'CATG, 5'GCGC, respectively, and cleave them as indicated by arrows. Antimicrob Agents Chemother, 1990 Jul, 34(7), 1407 - 13 Enhancement of the in vitro and in vivo activities of clarithromycin against Haemophilus influenzae by 14-hydroxy-clarithromycin, its major metabolite in humans; Hardy DJ et al.; MICs of clarithromycin and its major human metabolite, 14-hydroxy-clarithromycin, for Haemophilus influenzae in combination were reduced two- to fourfold compared with the MICs of each compound alone . Serum reduced the MICs of the parent compound and metabolite two- to fourfold compared with the MICs in medium without serum . In serum spiked with clinically relevant concentrations of clarithromycin and 14-hydroxy-clarithromycin at a fixed ratio of 4:1, 15 of 16 strains (94%) were inhibited and killed by combinations containing 1.2 and 0.3 micrograms/ml, respectively . In time kill experiments, the combination of parent compound and metabolite at one-fourth and one-half of their individual MICs, respectively, reduced bacterial counts by greater than 5 log CFU . The postantibiotic effect of clarithromycin combined with 14-hydroxy-clarithromycin was twice that of clarithromycin when tested alone . When orally administered to gerbils with H . influenzae otitis media, the 14-hydroxy metabolite was significantly more active than clarithromycin in reducing bacterial counts from the middle ear . The in vivo activity of the two compounds in combination was synergistic or additive, depending on the level of H . influenzae present at the time treatment was initiated . Significant reductions in bacterial counts and increases in cure rates were observed when clarithromycin at 50 or 100 mg/kg of body weight was combined with 14-hydroxy-clarithromycin at 12 mg/kg or higher . Results from in vitro and in vivo combinations suggest that routine susceptibility tests and animal efficacy studies with clarithromycin alone may underestimate its potential efficacy against H . influenzae. Indian J Pathol Microbiol, 1990 Jul, 33(3), 239 - 43 Counter immuno electrophoresis for the early diagnosis of acute pyogenic meningitis; Dasgupta J et al.; A total of 123 cases of acute pyogenic meningitis were studied to investigate whether counter current immunoelectrophoresis (CIEP) would facilitate rapid etiological diagnosis when used with other routine methods in a clinical bacteriology laboratory . Of the 123 cases, 53 (43.08 percent) were culture positive . Streptococcus pneumoniae was the commonest etiological agent accounting for 30 (56.6 percent) of the isolates . There were four isolates of Haemophilus influenzae and one of Neisseria meningitidis . High rates of isolation were found from turbid CSF samples, those showing a high polymorphonuclear cellular reaction and from those with a high protein and a low sugar level . CIEP detected antigen in 50 percent of cases of Haemophilus influenzae and 76.7 percent of cases of Streptococcus pneumoniae. Diagn Microbiol Infect Dis, 1990 Jul-Aug, 13(4), 349 - 52 In vitro activity of BAY v 3522, a new oral cephalosporin tested against Haemophilus influenzae and Branhamella catarrhalis; Doern GV et al.; The in vitro activity of BAY v 3522, a new orally absorbed cephalosporin, was assessed against 150 clinical isolates each of Haemophilus influenzae and Branhamella catarrhalis . The MIC90S for beta-lactamase-positive and -negative strains of H . influenzae were 8 and 2 micrograms/ml, respectively . For beta-lactamase-positive and -negative strains of B . catarrhalis, the BAY v 3522 MIC90S were 4 and 0.25 micrograms/ml, respectively . In general, BAY v 3522 was less active against H . influenzae than amoxicillin/clavulanic acid and cefixime, equivalent in activity to cefuroxime, and more active than cefaclor . BAY v 3522 had activity most similar to cefuroxime and cefaclor for B . catarrhalis but was less active than amoxicillin/clavulanic acid and cefixime. Pediatrics, 1990 Jul, 86(1), 102 - 7 Serologic responses to an Haemophilus influenzae type b polysaccharide-Neisseria meningitidis outer membrane protein conjugate vaccine in very young Gambian infants; Campbell H et al.; Recent studies in the United States and Europe have shown that Haemophilus influenzae type b polysaccharide-protein conjugate vaccines can induce protective antibody levels in young infants, but it was not clear that this would be the case in African infants, to whom H influenzae vaccines must be given at a very early age to prevent disease caused by H influenzae . Therefore, antibody responses to an H influenzae type b polysaccharide-Neisseria meningitidis outer membrane protein conjugate vaccine were measured in very young Gambian infants . In the first group (n = 85), to whom the vaccine was given at the ages of 1 and 3 months, the geometric mean antibody level rose from a prevaccination level of 0.23 microgram/mL to a postvaccination level of 1.27 micrograms/mL, and in the second group (n = 56), vaccinated at the ages of 2 and 4 months, the prevaccination level of 0.16 microgram/mL rose to a postvaccination level of 1.59 micrograms/mL . These two final postvaccination levels did not differ significantly, and interpolation suggests that similar antibody levels were present in both groups of infants at the age of 3 months . This is the age by which protection would need to be achieved to protect against H influenzae meningitis in The Gambia and in other countries where the infection has similar epidemiologic characteristics . No significant side effects of vaccination were noted. Rev Argent Microbiol, 1990 Jul-Sep, 22(3), 115 - 22 {Haemophilus influenzae type B: subtyping of strains isolated from respiratory infections using the outer membrane protein profiles}; Catalano M et al.; Sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) applied to outer membrane protein (OMP), extracted by a micromethod, was employed to subtype H . influenza b type I . A total of 37 H . influenzae b strains were isolated from children under 4 years of age, either with lower acute respiratory infection (LARI), or asymptomatic carriers matched according sex, socioeconomic level and seasonality . Twenty seven out of the 37 H . influenzae b strains belonged to biotype I . On the basis of OMP profiles, these 27 were classified into 8 subtypes (Figs . 2, 3, 4 and 5) . The probability of two randomly chosen isolates having different OMP profiles was 0.733 . The subtype termed "a" showed the greatest relative frequency and was detected both in invasive strains and in those isolated from throat samples of LARI cases and healthy children . The use of 14% SDS-PAGE allowed de detection either of a 51kD or a 49kD, as well as 25-40kD proteins, in a single run (Fig . 1) . Most subtype profiles showed the 51 kD protein . Growth conditions and extraction of OMPs by our modified micromethod provide a single and inexpensive procedure within the means of the average clinical laboratory . Besides, this test is much less time-consuming than classical assays . Jointly, biotyping , serotyping and OMP profile determination, proved a useful epidemiological tool to survey H . influenzae b infection. Plucne Bolesti, 1990 Jul-Dec, 42(3-4), 188 - 90 {Use of Runac in patients with infections of the lower respiratory tract}; Popovac D et al.; Thirty patients went through the outpatient treatment . Causative agent was established in sputum, throat and nose smears of 26 patients . Streptococcus pneumoniae (56%) and Haemophilus influenze (30%) are mostly isolated . Good effects of the medicine is characteristic by quick withdrawal of the symptoms characteristic for respiratory tract infections (cough and expectoration, febrility, physical finding) as well as by debacillosis after 10 days therapy . The effective result of medicine has been particularly noticed through quick reduction until complete disappearance of expectoration after three to four days since the onset of treatment . No side effects of the medicine have been found. Int J STD AIDS, 1990 Jul, 1(4), 282 - 4 Soluble interleukin-2 receptors in serum and urine of patients with chancroid and their response to therapy; Abeck D et al.; To investigate cell-mediated immune response in chancroid, soluble interleukin-2 receptor levels in serum and urine samples of healthy individuals and patients were measured by an enzyme-linked immunosorbent assay . Increased levels both in serum and in urine were observed in cases of Haemophilus ducreyi infection . In patients showing a prolonged incubation period, urine levels exceeded serum values . Therapy led to a reduction of elevated interleukin-2 receptor levels in serum and in urine. Diagn Microbiol Infect Dis, 1990 Jul-Aug, 13(4), 341 - 4 Antimicrobial susceptibility of clinical isolates of Haemophilus influenzae to ampicillin-sulbactam; Mortensen JE et al.; A total of 1092 clinical isolates of Haemophilus influenzae (306 type b; 786 non-type-b), from five medical centers were obtained during 1987 and 1988 . Disk diffusion antimicrobial susceptibilities were obtained for all isolates, and broth microdilution susceptibilities were obtained for 502 isolates . Beta-lactamase was produced by 34.3% of type-b and 22.1% of non-type-b isolates, with some geographic variations . Using disk diffusion antimicrobial susceptibility testing, all isolates were susceptible to ampicillin-sulbactam, ceftriaxone, cefuroxime, and rifampin; two isolates were resistant to chloramphenicol . Whether tested using a fixed ratio of ampicillin to sulbactam of 2:1 or a fixed concentration of sulbactam, the ampicillin-sulbactam combination demonstrated good activity against clinical isolates of H . influenzae . Only 8 of the 1092 isolates did not produce beta-lactamase but demonstrated MICs of greater than or equal to 2 micrograms/ml for ampicillin. Infect Immun, 1990 Jul, 58(7), 2252 - 7 Conserved and nonconserved epitopes among Haemophilus influenzae type b pili; Gilsdorf JR et al.; We investigated the binding of antibodies raised against four different Haemophilus influenzae type b (Hib) plus antigen preparations to the native pili and denatured pilins of 21 Hib isolates . Antibodies against live piliated Hib M43p+, adsorbed with a nonpiliated variant to remove nonpilus antibodies, bound to 18 of the 21 piliated Hib isolates in immunodot assays but failed to recognize the denatured pilins from any of the strains in Western immunoblot assays . Similarly, antibodies against purified native pili of strain E1ap+ bound to 11 of 21 piliated strains in immunodot assays but to only 2 of 21 piliated strains in Western blot assays . The native pili of all 21 strains were recognized by one or both of the antisera . These observations suggest that the immunodominant epitopes of native Hib pili are dependent on conformation and are moderately conserved . In contrast, antibodies against denatured M43p+ pilin or against a peptide derived from amino acids 5 through 17 of M43p+ pilin failed to bind to native pili from any of the 21 piliated isolates on immunodot assay . However, both sera recognized the denatured pilins from all the piliated strains on Western blot assay . These data indicate that the immunodominant epitopes of denatured pilins are highly conserved among different strains of Hib but are unavailable on intact pili for antibody binding. Presse Med, 1990 Jun 23, 19(25), 1177 - 81 {Arterial embolism of the limbs in infectious endocarditis of the heart valves}; de Gennes C et al.; Nine cases of infective endocarditis (IE) on native valves, complicated by arterial embolism of the limbs (AEL), were collected between June 1974 and October 1988 (prevalence 4.3 percent) . Among the 11 AEL recorded, 9 involved the lower limbs and 2 the upper limbs . The diagnosis, suspected in patients with acute ischaemia (n = 6), transient (n = 1) or pseudophlebitic (n = 1) pain, or discovered by systematic pulse examination (n = 3), was confirmed by Doppler ultrasound (n = 3), angiography (n = 2) or oscillometry (n = 4) . AEL occurred 2.8 weeks on average after the onset of treatment; it appeared 6 months after the end of treatment in 1 case and preceded the diagnosis of IE by 1 to 6 weeks in 3 cases . The causative organisms isolated in 7 cases were: non-haemolytic streptococci (n = 4), Staphylococcus aureus (n = 1), Haemophilus parainfluenzae (n = 1) and enterococcus (n = 1) . Vegetations were found in 6 of the 7 patients explored by echocardiography . Two cases of embolism of the femoral artery required embolectomy . Effective heparin anticoagulation was obtained in only one patient . Six patients underwent valve replacement in the acute phase of endocarditis . After a mean follow-up period of 32 months (range 3 to 120 months), only one patient has symptoms (claudication of the left upper limb); 5 patients are asymptomatic with a reduced (n = 5) or abolished (n = 2) pulse . Three embolisms have left no sequelae . Altogether, AEL are not uncommon in infective endocarditis . They rarely influence the functional prognosis and are detected by systematic palpation of the pulses . Anticoagulation in effective doses is discussed . Attempts at removing the obstruction should be made only in cases with poorly tolerated proximal embolism . In patients with multiple or recurrent embolic accidents, valve replacement may be considered. Rev Prat, 1990 Jun 11, 40(17), 1551 - 8 {Cystic fibrosis: choices of treatment of respiratory manifestations (except Pseudomonas aeruginosa infections)}; Gilly R et al.; A knowledge of the natural history of cystic fibrosis is the basis for a treatment which, so far, has only been symptomatic . The three fundamental elements of our therapeutic possibilities are: prevention and treatment of bronchial obstruction, administration of antibiotics active against staphylococci and Haemophilus influenza (Pseudomonas aeruginosa infections will be dealt with in another article of this journal), and control of bronchial inflammatory processes . Some complications of cystic fibrosis regarded as serious are no longer beyond our resources . Many works of fundamental research are needed, concerning the local conditions that are necessary to the selective implantation and the development of Staphylococcus aureus in the lung, and the virus Staphylococcus and Staphylococcus-Pseudomonas relations . The real hope of an absolute treatment justifies the new, aggressive therapeutic approach but the precise indications of an antistaphylococcal treatment must still be evaluated carefully . Finally, the complexity of a treatment which must constantly be adjusted is one of the reasons for the existence of "specialized consultations", the organization of which is summarized. Antimicrob Agents Chemother, 1990 Jun, 34(6), 1079 - 87 Ampicillin killing curve patterns for ampicillin-susceptible nontypeable Haemophilus influenzae strains by the agar dilution plate count method; Woolfrey BF et al.; Ampicillin killing curve patterns for 20 strains of ampicillin-susceptible nontypeable Haemophilus influenzae were determined by the agar dilution plate count method . The paradoxical effect was detected in the 24-h killing curve patterns for each strain . For the biphasic effect, minimum survivor percentages (maximum killing) occurred over a narrow range of ampicillin concentrations immediately above the MIC, with survivor percentages then rising rapidly to peak at approximately 1-log10-unit increment higher . The 24-h minimum survivor percentages for the 20 strains ranged from approximately 0.01% (rapid killing) to greater than 10% (slow killing) . In comparison with the previous results for typeable strains, the present findings suggest that nontypeable stains are, on average, killed much more slowly . Based on the initial 24-h killing curve patterns for the 20 strains, 4 strains were selected as putative representatives of the range of bactericidal responses encountered . These strains were then studied to examine the reproducibility of the 24-h patterns and to determine sequential killing curves . These patterns were found to be reproducible and served to characterize the relative killing responses of the strains . In the sequential studies of three of the four strains, tiny colonies having the gross and microscopic characteristics of L-forms were found to be present on the agar dilution plate count plates prior to the application of penicillinase at 48 and 72 h . Such colonies reverted to vegetative forms within 24 to 48 h after application of penicillinase to the panels . Of particular interest was the observation that the paradoxical effect was manifested both by the L-form colonies and by the reverted vegetative colonies . The late development of L-forms was observed for both rapidly and slowly killed strains. Acta Paediatr Scand, 1990 Jun-Jul, 79(6-7), 587 - 92 Epidemiology of Haemophilus influenzae type b infections among children in Denmark in 1985 and 1986; Kristensen K et al.; A retrospective epidemiological study of invasive Haemophilus influenzae type b infections among children in Denmark 1985 and 1986 was carried out and 226 cases were identified . Of these 93% occurred in patients younger than five, corresponding to an annual incidence of 40 cases per 100,000 children aged 0-4 years, 68% occurred in patients younger than two years of age, and 6% in patients younger than six months . The annual incidences of meningitis and epiglottis were 27 and 8 cases, respectively, per 100,000 children aged 0-4 years . Of the 156 cases with meningitis four patients died and seven had severe neurological sequelae . Only 67% of the cases of meningitis had been notified. Nippon Juigaku Zasshi, 1990 Jun, 52(3), 533 - 42 Production and characterization of monoclonal antibodies against Actinobacillus (Haemophilus) pleuropneumoniae serotype 2; Nakai T et al.; Four hybridoma cell lines producing monoclonal antibodies (MAbs) against Actinobacillus (Haemophilus) pleuropneumoniae were established by fusion of mouse myeloma and spleen cells obtained from mice immunized with a serotype 2, strain SH-15 . Enzyme-linked immunosorbent assay-inhibition tests with antigens obtained from 12 serotype strains of A . pleuropneumoniae and 9 other gram-negative bacteria showed that all the MAbs bound to only serotype 2 strains of A . pleuropneumoniae . The epitopes recognized by the MAbs were located on a carbohydrate moiety of lipopolysaccharide (LPS) of the organism, which was sensitive to periodate oxidation . In immunoblotting analyses of LPS obtained from A . pleuropneumoniae serotype 2, all the four MAbs reacted specifically with the characteristic ladder bands of LPS detected by sodium dodecyl sulfate-polyacrylamide gel electrophoresis . These results suggest that O-antigen side chains of the LPS are one of the antigenic determinants responsible for the serotype-specificity of A . pleuropneumoniae. J Gen Microbiol, 1990 Jun, 136 ( Pt 6), 1031 - 5 Naturally occurring NAD-independent Haemophilus parainfluenzae; Gromkova R et al.; Four, NAD-independent, clinical isolates of Haemophilus parainfluenzae were recovered from a genital ulcer, a purulent skin lesion, a sputum specimen and a throat swab respectively . With the exception of NAD requirement, the strains exhibited the biochemical characteristics of H . parainfluenzae biotype II . The genetic relationship between these isolates and a standard strain of H . parainfluenzae was determined by testing transforming activities of two chromosomal markers, streptomycin resistance and nalidixic acid resistance . The clinical isolates were efficient donors and recipients in transformation . In addition, we demonstrated transfer of the genes conferring NAD independence to typical, NAD-requiring H . parainfluenzae and Haemophilus influenzae strains. J Chemother, 1990 Jun, 2(3), 182 - 4 Clindamycin in the treatment of an outbreak of streptococcal pharyngitis in a kibbutz due to beta-lactamase producing organisms; Raz R et al.; During the winter of 1987-88, an epidemic of streptococcal pharyngitis (SP) affected almost 25% of the 800 inhabitants of a community settlement (kibbutz), and failed to respond to treatment with penicillin and/or erythromycin, despite the fact that the streptococci were highly sensitive to penicillin (minimum inhibitory concentration: MIC less than 0.001 micrograms/ml) . We suggested that the concomitant presence of beta-lactamase producing organisms in the pharyngeal cavities of the affected individuals with SP could inactivate the antibiotics, rendering the streptococci resistant to penicillin . Throat swabs were taken and tested for aerobic and anaerobic beta-lactamase producing organisms and for beta-lactamase activity and clindamycin treatment was given to 110 patients with SP . Beta-lactamase activity was detected in 90 cases and the cultures were positive for Staphylococcus aureus (25 cases), Haemophilus sp . (22 cases) and anaerobes, which we did not identify in 68 cases . Ninety-eight patients completed the ten-day course of treatment with clindamycin and 96 were cured clinically and bacteriologically . The epidemic was controlled. Can J Vet Res, 1990 Jun, 54(3), 331 - 6 Epidemiology of Haemophilus somnus in young rams; Lees VW et al.; The prevalence of Haemophilus somnus in the prepuce of young rams was examined . Of 473 rams entering Record of Performance (ROP) stations at 50 days of age, 43 (9.1%) were positive . Average daily gain was not affected by Haemophilus status, but was influenced by breed of ram . Suffolks were predicted to gain 0.515 kg daily compared to 0.427 kg for a group combining all other breeds . Using logistic regression to identify risk factors for individual H . somnus infection, rams in 1989 were 0.382 times as likely to be infected as rams in 1988, and Suffolks were 0.314 times as likely to be infected as the other breeds group, but these factors were not significant at the flock level . Of 80 eligible flocks of origin, 22 (27.5%) were classified as infected with H . somnus, based on rams submitted to the ROP station . Infected flocks contributed 133 rams, 43 (32.3%) of which were positive . There was no association between H . somnus status and lambing percent of the percent of abortions and stillbirths, but there was a statistically significant association with the percent of ewes which failed to lamb . In the model developed, 6% of the bred ewes in noninfected flocks failed to lamb, compared to a rate of 12% in infected flocks . These results suggest H . somnus may influence ewe fertility earlier, rather than later in gestation . Purchasing replacement animals and having cattle on the farm were risk factors for Haemophilus infection in the flock . Where replacements had been purchased within the previous year, the risk of flock infection rose 8.5 times, and on farms having cattle as well as sheep, the risk rose 13.2 times.(ABSTRACT TRUNCATED AT 250 WORDS) Can J Vet Res, 1990 Jun, 54(3), 326 - 30 The protective effect of vaccination against experimental pneumonia in cattle with Haemophilus somnus outer membrane antigens and interference by lipopolysaccharide; Silva SV et al.; A semi-purified outer membrane anionic antigen (AA) fraction was isolated from Haemophilus somnus by a modified procedure of anion exchange chromatography to yield a protein fraction free of lipopolysaccharides (LPS) . The AA fraction (1 mg) was administered with or without the homologous lipopolysaccharide (10 micrograms/kg body weight) as vaccines to groups of cattle twice, three weeks apart . A control group which did not receive any antigen was included in the trial . Six weeks after the first vaccination, the animals were challenged intratracheally with a virulent pneumonic strain of H . somnus (70986) and observed for clinical signs of respiratory disease . The cattle were euthanized six days later and the lungs were evaluated for the severity of lesions macroscopically as well as histopathologically . Vaccination with AA alone provided the best protection against pneumonia as indicated by significantly lower clinical scores, less extensive gross lung lesions and mild histopathological lesions with immune cell infiltration . However, when AA was combined with LPS in the vaccination, this protective effect was negated and the animals showed more detrimental histopathological lesions than the controls. Can J Vet Res, 1990 Jun, 54(3), 320 - 5 Capsular polysaccharide antigens for detection of serotype-specific antibodies to Actinobacillus pleuropneumoniae; Bosse JT et al.; Capsular polysaccharides (CPS) of serotypes 1, 2, 5 and 7 of Actinobacillus (Haemophilus) pleuropneumoniae were obtained from 18 h culture supernatants by precipitation with hexadecyltrimethyl-ammonium bromide (Cetavlon) followed by extraction with sodium chloride and reprecipitation in ethanol . These crude extracts, and portions purified further by phenol extraction to remove contaminating proteins, were evaluated as antigens for the detection of serotype-specific antibodies to A . pleuropneumoniae in sera from immunized rabbits and swine by an enzyme-linked immunosorbent assay . The crude extracts reacted strongly with homologous antisera, but except for serotype 1 showed considerable cross-reactivity with antisera to other serotypes . Phenol extraction greatly improved the serospecificity of the antigens from serotypes 1, 7 and, to a lesser extent, 5 . The serotype 2 CPS antigen showed poor reactivity following phenol extraction, and did not appear as useful for detection of serotype-specific antibodies. Eur J Pediatr, 1990 Jun, 149(9), 613 - 4 Haemophilus influenzae osteomyelitis complicating dactylitis in homozygous sickle cell disease; Webb DK et al.; A case of Haemophilus influenzae osteomyelitis complicating dactylitis in homozygous sickle cell disease is described . It is the first description of this association to our knowledge, and resulted in permanent damage and shortening of all affected bones. Ann Thorac Surg, 1990 Jun, 49(6), 940 - 6; discussion 946-7 Role of lung decortication in symptomatic empyemas in children; Gustafson RA et al.; Despite appropriate antibiotics and pleural drainage, the condition of some children with empyema fails to improve . In a 5-year period, 10 children ranging in age from 2 to 16 years underwent lung decortication for a refractory, symptomatic empyema, which had developed 3 to 5 weeks after an initial pneumonic infiltrate . Responsible organisms included beta-hemolytic streptococci, Haemophilus influenzae, or Streptococcus pneumoniae in 6 children . Negative cultures were found in 4 children . The initial computed tomographic scan of the chest in 4 of 8 patients showed more than 75% limitation of lung expansion by the contents of the empyema cavity . In 4 other patients, an extensive pleural peel was seen on initial computed tomographic scan of the chest . Several studies also showed cystic lesions in the collapsed lung . Multiple computed tomographic scans in 3 patients confirmed the lack of clinical and chest roentgenographic improvement with conservative therapy . At decortication in each, the visceral and parietal pleural peel was completely removed, freeing the trapped lung . Two patients also had a concomitant lobectomy for a necrotic right upper lobe (1 patient) and left lower lobe (1) . Clinical improvement was marked, with return of temperature, white blood cell count, and appetite to normal . Postoperative morbidity was minimal . Analysis of these patients in whom traditional conservative therapy failed suggested that the initial management during the early exudative phase was often delayed and was not aggressive enough from the standpoint of pleural drainage.(ABSTRACT TRUNCATED AT 250 WORDS) Mutat Res, 1990 Jun, 244(2), 141 - 5 Mutagenic and lethal action of polychromatic near-ultraviolet (325-400 nm) on Haemophilus influenzae in the presence of nitrogen; Cabrera-Juarez E et al.; The lethal effect of polychromatic near-UV light (325-400 nm) on Haemophilus influenzae was 8 times higher under aerobic than anaerobic irradiation . This light increased the frequency of mutation to novobiocin resistance and ability to utilize protoporphyrin IX . The slope of mutagenic effect at low doses appeared greater for the aerobic than for the anaerobic group . We concluded that polychromatic near-UV mutation of H . influenzae under anaerobic irradiation was caused by direct oxygen-independent action on DNA. J Otolaryngol, 1990 Jun, 19(3), 179 - 81 Adult supraglottitis due to herpes simplex virus; D'Angelo AJ Jr et al.; Changes in the concepts regarding epiglottis have occurred over the last two decades . Supraglottis, once thought to occur exclusively in the pediatric population, is now recognized in adults . Supraglottis is a well-defined syndrome usually caused by a bacterial infection by Haemophilus influenzae type B . Recently, other organisms have been implicated as etiologic agents in cases of supraglottitis . Documented viral supraglottitis is very rare, and adult supraglottitis due to herpes simplex virus-I has not been reported to our knowledge. J Infect Dis, 1990 Jun, 161(6), 1210 - 5 The epidemiology of Haemophilus influenzae meningitis in children under five years of age in The Gambia, West Africa; Bijlmer HA et al.; Haemophilus influenzae meningitis was studied over a 2-year period in children less than 5 years of age in a population-based, prospective study in The Gambia, West Africa . A total of 77 cases were recorded . The incidence was 60 cases/100,000 children less than 5 years of age and 297 cases/100,000 children less than 1 year of age . The peak prevalence was at the age of 5 months; 83% of the children were less than 1 year old and 45% were less than 6 months old . Only 55% of cases recovered completely . The distance to the nearest hospital was an important predisposing factor for a fatal outcome . Two cases were secondary . Many patients were anemic and underweight . The observations show that H . influenzae meningitis in The Gambia has an incidence as high as that in the USA, but that it has 10-fold more devastating outcome . If the infection is to be prevented by vaccination in The Gambia, immunization will have to be given very early in life. Infect Immun, 1990 Jun, 58(6), 1600 - 5 Haemocin, the bacteriocin produced by Haemophilus influenzae: species distribution and role in colonization; LiPuma JJ et al.; Four hundred thirty-eight strains of Haemophilus influenzae were examined for production of and sensitivity to haemocin, a bacteriocin produced by some members of this species . Whereas 199 of 212 (94%) type b isolates produced haemocin, 131 of 134 (98%) nontypeable and 91 of 92 (99%) encapsulated non-type b isolates were sensitive to haemocin . Among strains previously genetically characterized by multilocus enzyme electrophoresis, haemocin production was detected in type b isolates belonging to 25 of 29 (86%) clonally distinct electrophoretic types . None of 60 clonally distinct nontypeable strains produced this substance, and all were sensitive to it in vitro . The genes encoding haemocin production were transformed independently of the genes necessary for capsule expression from a prototypic type b strain to a nontypeable strain . After intranasal inoculation of infant rats with an equal mixture of a non-haemocin-producing strain and its haemocin-producing transformant, organisms capable of haemocin production predominated in both nasopharyngeal and blood cultures . These data demonstrate that haemocin production is strongly associated with type b encapsulated members of this species and suggest a mechanism by which haemocin might play a role in host nasopharyngeal colonization by this pathogen. Southeast Asian J Trop Med Public Health, 1990 Jun, 21(2), 195 - 202 Haemophilus influenzae and Streptococcus pneumoniae in children with acute respiratory infection; Jayanetra P et al.; The incidence of Haemophilus influenzae and Streptococcus pneumoniae in children with acute respiratory infection (ARI) under 5 years was carried out by throat swab culture, blood culture, body fluid or tissue culture in 688 patients from a community, 744 patients from a teaching hospital in Bangkok, 766 normal children from the community and 303 children from a hospital well baby clinic . H . influenzae was found in the throats of 15-20% of patients and in the throats of 4-6% of normal children (p less than 0.001 for both hospital and community patients) . Only 12/332 strains (3.6%) of H . influenzae were type b . The rest of H . influenzae were non type b . The most common biotype of H . influenzae non type b was biotype II . S . pneumoniae was found in hospital patients in highly significant numbers compared to the controls (12% vs 4%) . No significant difference was observed in strains from the community patients. Southeast Asian J Trop Med Public Health, 1990 Jun, 21(2), 185 - 93 Drug resistance of Haemophilus ducreyi; Rutanarugsa A et al.; Chancroid, the disease caused by H . ducreyi is one of the common sexually transmitted diseases (STD) in Thailand and other tropical countries . In Thailand, the diagnosis of chancroid is still based on clinical appearance which may be confused with other STD manifested by genital ulcers . In recent years the increasing resistance strains of H . ducreyi to these antimicrobial agents has been reported so that cultivation and antimicrobial susceptibility tests of this organism have become more important . This study showed that MBV is the best medium for isolation with a success rate of 48% . All strains tested from isolates of this study were resistant to ampicillin, due to production of beta-lactamase . Approximately 99% of the strains were resistant to tetracycline 92% of strains were resistant to sulfamethoxazole and 32% were resistant to trimethoprim . All isolates were susceptible to chloramphenicol, ceftriaxone, erythromycin and the fluorinated quinolones ciprofloxacin, norfloxacin, ofloxacin and pefloxacin . Beta-lactamase enzymes produced by 37 strains of H . ducreyi were determined for their isoelectric point (pI) . All had pI of 5.4, indicative of plasmid-mediated beta-lactamase type TEM-1. Jpn J Antibiot, 1990 Jun, 43(6), 1164 - 73 {A clinical study on ceftazidime in the treatment of intractable respiratory infections}; Miyatake H et al.; Ceftazidime (CAZ) was administered to 51 patients (37 males, 14 females) with respiratory infections including severe cases, accompanied by various underlying respiratory diseases . The clinical efficacy and side effects of CAZ were investigated . The mean age and body weight of these 51 cases were 62.6 years and 48.0 kg, respectively . CAZ was administered by intravenous drip infusion (daily dose of 2-4 g) for a mean of 14.7 days to a mean total dose of 56.7 g . Clinical efficacy rates were 64% (18 of 28 cases), 80% (16 of 20 cases) and 67% (2 of 3 cases) for airway and intermediary regional infections, pneumonia (including lung abscess) and pyothorax, respectively . In the bacteriological study, efficacy rates and bacterial eradication rates were 69% and 67%, 33% and 20%, 100% and 100%, and 100% and 100% for infections caused by Pseudomonas aeruginosa (13 cases), Staphylococcus aureus (6 cases), Streptococcus pneumoniae (6 cases) and Klebsiella pneumoniae (4 cases), respectively, and bacterial eradication was achieved in both of 2 cases of Peptostreptococcus anaerobius and 2 cases of Haemophilus influenzae, and 1 case each of Peptococcus sp., Fusobacterium necrophorum and Serratia marcescens . Side effects observed were eruption in 1 case (2%) and elevated GOT, GPT and Al-P values in 1 case (2%), but these cases tended to recover after CAZ treatment was discontinued. Semin Dermatol, 1990 Jun, 9(2), 105 - 8 The epidemiology of sexually transmitted diseases in Africa and Latin America; Goeman J et al.; We review some aspects of the epidemiology of sexually transmitted diseases (STDs) in the developing countries of Africa and Latin America . Apart from their elevated prevalence, they are responsible for important morbidity in mother and child . Stillbirth, premature delivery, conjunctivitis, and respiratory tract morbidity of the neonate are frequently caused by STDs . Sequelae in adult women include pelvic inflammatory disease, ectopic pregnancy, and infertility . The emergence of antimicrobial resistance has complicated the picture in recent times . Genital ulcer disease is very common in developing countries, the most important being chancroid . Both continents are experiencing major epidemics of the acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection with different epidemiological characteristics than in the industrialized world . A link might exist between the high prevalence of STDs and the rapid heterosexual spread of HIV infectionPIP: Aspects of sexually transmitted diseases (STDS) peculiar to the developing countries in South America and sub-Saharan Africa are discussed . The most common STD infections are N . Gonorrhoeae, Chlamydia trachomatis, T . pallidum and T . vaginalis . Vertical transmission, particularly of syphilis among prostitutes, and of Chlamydia and gonorrhea after ophthalmia neonatorum, are common . Chlamydia is also a common respiratory tract infection in African neonates . Late complications of STDs, infertility and ectopic pregnancy, and particularly pelvic inflammatory disease, are responsible for a high proportion of hospitalizations . Antibiotic resistant gonorrhea strains are common, a result of poorly managed antibiotic treatment . Genital ulcer diseases (GUD), which predispose to HIV infections, are more common in Africa than in developed countries, not only herpes but chancroid, donovanosis and lymphogranuloma venereum . Chancroid, caused by Haemophilus ducreyi, causes 36-49% of ulcers in 2 reports . The L1-L3 strains of Chlamydia trachomatis cause lymphogranuloma venereum, the agent responsible for ulcers in 3.6-6.1% of 2 clinic populations . HIV infections have an equal sex ratio in Africa, with a younger age incidence in women and a high vertical transmission rate, while in Latin America, bisexual men, and increasingly, heterosexual transmission by intravenous drug users is reported . There is also an HIV-2 virus, whose virulence is in question, common in West Africa . Pathol Biol (Paris), 1990 Jun, 38(5 ( Pt 2)), 517 - 20 {Randomized study of cefatrizine versus cefaclor in conjunctivitis otitis syndrome}; Cohen R et al.; The association conjunctivitis-otitis is highly suggestive of Haemophilus influenzae infection . This conjunctivitis otitis syndrome could be a good model to assess the efficacy of different antibiotic regimen in the treatment of acute otitis media due to HI without tympanocentesis . This prospective randomized trial compared the efficacy of two orally cephalosporins which demonstrate in vitro an activity against HI . This study was conducted from 4.20.1988 to 3.15.1989 and involved 73 children with COS examined in an outpatient clinic . The mean age was 17.7 months . Before treatment culture were taken from the lower palpebral conjunctivae . 81 strains was found: HI 61 (beta-lactamase-producing 15), Streptococcus pneumoniae 16, Branhamella Catarrhalis 4 . The 73 patients were treated with 40 to 50 mg/kg/day of the test drug for ten days, 25 with Cefaclor in 3 divided dose (group 1), 24 with Cefatrizine in 3 divided dose (group 2), 24 with Cefatrizine in 2 divided dose (group 3) . The recoveries was obtained in 17/25 in the group 1, 18/24 in the group 2, 15/24 in the group 3 . There was no significant difference between the 3 groups. J Clin Microbiol, 1990 Jun, 28(6), 1185 - 7 Proposal of a new serovar and altered nomenclature for Haemophilus paragallinarum in the Kume hemagglutinin scheme; Blackall PJ et al.; By using the Kume hemagglutinin serotyping scheme, 13 Australian isolates of Haemophilus paragallinarum were shown to constitute a new serovar within the presently termed serogroup II . Because of the likelihood that new serovars will continue to be established, we propose a rationalization of the nomenclature of the Kume scheme . Under this altered scheme, the three recognized serogroups I, II, and III are renamed A, C, and B, respectively . Within each of the serogroups, the serovars are numbered sequentially, allowing new serovars to be added in numerical order . Thus, the nine currently recognized Kume serovars are termed A-1, A-2, A-3, A-4, B-1, C-1, C-2, C-3, and C-4. Clin Exp Immunol, 1990 Jun, 80(3), 304 - 13 Beneficial effects of the thymic hormone preparation thymostimulin in patients with defects in cell-mediated immunity and chronic purulent rhinosinusitis . A double-blind cross-over trial on improvements in monocyte polarization and clinical effects; Tas M et al.; Twenty patients with chronic purulent rhinosinusitis were treated with TP-1 (Serono; 1 mg/kg body weight), in a double-blind cross-over trial . TP-1 was administered by daily i.m . injections for the first 14 days followed by two injections/week for 6 further weeks . The patients were immunologically special in that they had defects in their cell-mediated immune system . Fourteen showed a decreased chemotactic responsiveness of their peripheral blood monocytes as measured in the polarization assay . This defective function can probably be ascribed to the presence in serum of low molecular weight factors (LMWFs; less than 25 kD) . As reported earlier, this factor shows a structural homology to the envelope protein of murine and feline leukaemia virus (P15E) . Thirteen patients showed a defective delayed-type hypersensitivity (DTH) skin test reactivity towards candidin and/or streptokinase-streptodornase (Sk/Sd) antigen, 14 had a defective MIF production from their peripheral blood lymphocytes towards candidin, Sk/Sd and/or Haemophilus influenzae antigen . Eighteen patients completed the TP-1 trial and showed clinical improvements: 12 out of 15 were feeling better during TP-1 therapy and the nasal mucosa showed on inspection absent mucopurulent secretion in 13 patients . Positive bacterial culture rates for the nose decreased from 14 out of 16 to five out of 15 . Placebo treatment had no significant effects . The clinical improvements were accompanied by a better performance of the cell-mediated immune system; the most significant effects were recorded in the monocyte polarization assay . The suppressive P15E-like LMWFs in serum clearly decreased during TP-1 treatment . In vitro TP-1 neutralized the immunosuppressive effect of the LMWFs . The restoring effects of TP-1 on monocyte polarization and its neutralizing activity of P15E-like LMWFs could explain the beneficial effects of thymic hormone treatment reported in adults with clinical signs of immunodeficiency in the presence of a full T cell repertoire. Am J Infect Control, 1990 Jun, 18(3), 160 - 6 Invasive Haemophilus influenzae type B infections: a continuing challenge; Janai H et al.; Invasive Haemophilus influenzae type b infections are a major cause of severe infections in children between 2 months and 5 years of age . Meningitis, arthritis, pneumonia, cellulitis, osteomyelitis, and epiglottitis affect